Introducing Dr. Laura Buchanan
Dr. Eric Westman: Welcome to Matt and Laura. Thanks for being here.
You are the ones that are going to take this home, meaning the knowledge, the spreading of the information. That is if Raven-Symone doesn’t do it first. She is very vocal about her keto journey. But anyway, in the medical world, I see you two as leaders to train, to teach, to spread, and not to put too much burden upon you, but to help change the world. Thank you for what you do. Who are you? And where are you from? Where did you go to school? It is amazing that you are both doctors in training.
Dr. Laura Buchanan’s residency
Dr. Laura Buchanan: I grew up in Upstate New York, went to undergrad, and then medical school in Florida at the University of Florida. I always had a passion for sports. That passion for sports grew into both sports and then nutrition later on, really in medical school. We had a two-week intensive on nutrition that was really underwhelming, as you probably have heard from a lot of doctors who have had nutritional training in medical school. It was the same stuff – saturated fats are going to kill you, and then common deficiencies that you have got to be able to catch – vitamin C deficiency and scurvy – but not much more than that. Nothing practical about how I could help patients. Around that time, I started doing a lot of research on my own and came across Jason Fung’s The Obesity Code, the Low Carb MD podcast, found myself watching lectures from Low Carb USA, and my eyes were opened. Clearly, our guidelines, the national US dietary guidelines, have led us astray. I changed the way I was eating. I had avoided red meat for almost a decade. Going into residency, I decided, off the bat, this is how I am going to practice medicine. And I did. It was wonderful. After some initial conflict, or just more debates with my attendings or faculty about how I was practicing, they were wonderful and saw the results that people were having. They stopped giving me pushback. I was able to continue practicing low carb, and they were very supportive, and everyone was always in a very friendly environment.”
Dr. Eric Westman: In your residency training?
Dr. Laura Buchanan: Yes, during residency training. Initially, when I would try to order calcium scans or fasting insulin on patients, it was like, why do you need to get a fasting insulin on this individual? Their A1C is 5.5. How is that going to change management? Then it would be talking to them about insulin resistance, and early stages, trying to educate patients before prediabetes develops, and before diabetes complications occur. And for patients who came to me with an A1C of 10, guidelines say you should start them on insulin. Instead, why don’t we put a glucose monitor on and work on low-carb, ketogenic eating? If they wanted to avoid medicines, they jumped on board. They loved the idea of avoiding the insulin shots. Then I would see them backtrack their glucose, and their A1C would normalize or get significantly better, drop into the sixes with no medications. Once you start seeing results like that, you are not going to get pushback.
I also have to mention part of the things I actually used during residency was with my rotation when I came and worked at your clinic and shadowed and saw how you worked. I started using your handouts for my patients. It was hugely helpful. In one week at your clinic – I believe I am going to be slightly off, but it was around 1,300 pounds of weight loss among the 308 returned patients we had.
Dr. Eric Westman: Were you taking some notes?
Dr. Laura Buchanan: Yes, it’s incredible. I had not seen results like that. There were over 30 medications stopped during that one week. It was so exciting. This is medicine.
Uptake of patients in her residency
Dr. Eric Westman: A testimonial for other residents or trainees at any stage that with the right kind of teaching and monitoring, you could even influence your attendings. You always want to do that diplomatically. One reason I stayed in academia was to be able to learn from trainees who came in asking questions. You are always being asked ‘why,’ and I have always found that to be helpful to improve what I do. Remember, the handout that I got was taken and modified by Dr. Atkins, who had worked on it for 30 years. We are using a low-carb method that at the end of the day is simple. In your clinical practice would you say people are highly motivated or coming in sometimes? It is often like a bait & switch where I thought I was going to get medicine, but you are telling me about food.
What is the uptake in your experience for your patients in residency?
Dr. Laura Buchanan: Maybe 50%. It is hard to say for sure. Because of the nature of the clinic, you end up having less follow-up. There were a handful of people I could follow up monthly and they did amazing. Matt was one year behind me and he will tell his story. But I handed off quite a few of my patients to Matt who were continuing low carb, and I knew they would be in good hands.
I work with Dr. Tro Kalayjian. We have people coming to us knowing that we are recommending low-carb as our primary intervention. We still use medications and do what is right for the patient, but primarily we are trying to help people get off medications and using lifestyle changes and using low carb.
The practice Dr. Laura Buchanan is in
Dr. Eric Westman: Describe the practice that you are in right now. Is it all telemedicine?
Dr. Laura Buchanan: Yes it is exclusively telemedicine, licensed in almost all 50 states. We see people from everywhere. There are a couple of different programs. One is more of an intensive six-month where you see either myself or Dr.Tro with a health coach, and you have weekly appointments and a lot of touch points like back-and-forth visits. We are remotely monitoring with glucose CGM, so continuous glucose monitors, scales, blood pressure cuffs, and sometimes ketones depending on the individual. Then there is also virtual metabolic care. It might not be that intensive six-month program, but you are following for basically primary care but again knowing that I would be focusing not just on your cancer screenings but all your other metabolic health needs and how we can help you age well to avoid chronic conditions rather than just start treating them once they show up.
Outside insurance and the Employee Wellness Programme
Dr. Eric Westman: I saw Dr. Tro Kalayjian on doctortro.com. I saw him give a presentation about the program. It is fantastic. In fact, it is probably one of the only ones created by a doctor who had issues himself. So he understands that if you are not checking in, you might have relapsed or, the vigilance. I have not seen that so much even in my practice. If there is this chatter that people have in their heads the week before, do I go back to see them or not? Do I go back to see the doctor? They are going to be so upset because I have not been perfect. I know if you could have that sort of touch, that would be great. Is it outside insurance?”
Dr. Laura Buchanan: It is outside insurance. The other way is not really through insurance, but we work with employers. We have an employee wellness program, and I love this because then we are getting all levels of socioeconomic status. A lot of the employees we get, we tell them what we are doing, but they are not necessarily seeking us out, but they still have amazing results. We are working on publishing our one-year data for one of the companies that we are working with, and it is on about 50 patients and an average weight loss of 40 pounds while deprescribing almost 100 medications. It is fantastic.
Dr. Eric Westman: If someone is watching this and wondering how they could get involved, they could go to their employer and say, why don’t you partner up with Dr. Tro and his group? Even if you can’t afford it individually, maybe the company or any company that is self-insured ought to be on top of this because any money you save will be saved right there, you are not paying another insurer.
Cost savings of not using medicines
Dr. Laura Buchanan: Yes, and the cost savings through the medication deprescription is almost $100,000. Medications cost so much money these days, so employers take the hit on that.
CGM – Continuous Glucose Monitor
Dr. Eric Westman: What is unbelievable is that not only are you saving money, your people are getting better. This doesn’t compute. Usually it’s how much more do I have to pay to get someone better? Here, what is happening is, no, people are getting better and you are saving the system money. I have to imagine that is why most people don’t believe it, you know, they are usually, that, how much do I have to pay? No, you are going to save money.
When you came to my office you were wearing a continuous glucose monitor, and I thought that was a bit strange or maybe just way ahead of your time. Are you still wearing a continuous glucose monitor most of the time?
Dr. Laura Buchanan: I have not had one on for about a week right now.
Dr. Eric Westman: I have not had one on since you were here. When Matt came to the clinic I put one on.
Do you watch your carbs personally yourself?
Dr. Laura Buchanan: I do, yes. I always low carb, often in ketosis. I don’t check ketones as much, that is more because of the finger prick and I just stay very low carb so I don’t worry about it. I don’t have a medical condition where the higher level of ketone is necessarily extra beneficial for me.
Dr. Eric Westman: Did you not just have a baby?
Dr. Laura Buchanan: I did, he is 11 months old now. During the pregnancy, I was low carb, definitely in ketosis for part of it. I have been breastfeeding this whole time and the same thing, in low-carb keto. I even did carnivore for some interest because I was testing my breast milk. There is a lab that will test the macronutrients and some of the micronutrients in your milk. Interestingly, from going from moderate carb to low carb, to keto, then carnivore, the number of calories per ounce of milk increased. It was much higher than the average formula. It is about 20 calories per ounce, and mine went from about 23 to 27 to 30 calories per ounce on carnivore.
Pregnancy and not eat carbs
Dr. Eric Westman: It makes sense when you think about it. For those watching, or listening, it is okay that someone did not eat carbs during pregnancy. If this is the first time you are hearing this. I was introduced to this on my trip to Indonesia some years ago, where the doctors were telling me about keto babies. The moms who were not eating many carbs and would fast during the day, and they even said that the keto babies that they followed were developing great, even maybe better than before. They are on Facebook and I am connected to them every day, that is KetoFastosis Indonesia. Then, the Type 1 Grit pregnancy book was published. This is the experience of a lot of people with type 1 diabetes who choose to eat low carb and have babies as well.
Just watching what other people are doing, is this more common? I assume you had a good experience not eating carbs during pregnancy?
Dr. Laura Buchanan: It went very well for me. I never had any issues. In my first trimester for a few weeks, I had significant carb cravings and I did have a little bit higher carb at that time, added a little bit of sweet potato and fruit until the cravings went away. Besides that, I played tennis. I played tennis until my 38th week of pregnancy. I played competitively until my 32nd week and was feeling great. James, my 11-month-old, is thriving. He is doing really well, a very strong, energetic little guy.
Dr. Eric Westman: Was your family supportive all this time? Because now the grandparents have some vested interest.
Dr. Laura Buchanan: Yes, fortunately, all my family is either low-carb themselves or have listened to me enough about the science that they are supportive.
Monitoring ketones and certain conditions
Dr. Eric Westman: I remember hearing a professor of obstetrics in Chicago. He came to one of our obesity meetings and he said, I am measuring the baby with an ultrasound. He said I don’t care what you do with the mother. It is okay if the mother loses weight and all because I am going to be measuring the baby as long as the baby is growing. Thanks for sharing your experience. I am sure others are interested especially if you have PCOS and you got pregnant because you did low carb. A lot of my patients will ask, what should I do? Years ago I would say, you better add back some carbs and avoid that terrible thing called ketosis – sarcasm here – we all go into ketosis after two days of not eating anything. I am beginning to think this really may be the intended metabolism. Steve Phinney is the one who has talked about that for decades. Interestingly, you said that you don’t have a medical condition that measuring ketone levels would be more beneficial, that was an interesting little insert there. What conditions in your experience should people be monitoring ketones?
Dr. Laura Buchanan: Yes, there are some mental health conditions such as schizophrenia or bipolar where individuals notice that maybe their symptoms resolve entirely, but it has to be maintained at a higher level of ketones, similar to some individuals with epilepsy where they have to keep a higher ketone threshold for the benefits. More recently, this is just anecdotal, I have had some patients with lipedema who noticed improvements with higher ketone levels as well. They say the leg pain or just the pain that they can feel sometimes throughout where there is lipedema is improving, and then inflammation and even the swelling that will come along with that all improves at the higher level of ketones. I have also had, definitely, some depression, anxiety, and acne. I have had two different people in the past few weeks whose acne significantly improved. I guess it was not a specific level of ketone but just in ketosis, it was very noticeable.
Introducing Dr. Matt Calkins
Dr. Eric Westman: The skin conditions all improved, and psoriasis, even though the published literature is way behind on that.
Matt, you guys are related in some way.
Dr. Matt Calkins: Yes. If you talked to Laura you have talked to my greater half. We met before medical school started and started dating soon thereafter and then got married in our third year of medical school while we were on our psych rotation. We got married on a Saturday and then on that Monday we went into the psych rotation and the attendants said, what did you guys do this week, and we said, “We got married!” He’s like, “Oh, that’s a first!” I am the same way as Laura. I did a lot of weightlifting growing up. I played football in high school and then continued weightlifting through undergrad. I decided on medical school really late in undergrad. I was like a super senior, doing my biochem class. Then I got into the University of Florida Medical School. Went straight from undergrad to medical school. I was going into emergency medicine, which is where we ultimately matched. We met in the couples match – family medicine for Laura and emergency medicine for me.
We got interested in just the metabolic health aspect around our third to fourth year of medical school. That is close to the time you have to apply. I was already thinking, this is actually what I want to do. When you are going through medical school, you are commonly taught and it is reiterated that obesity is a chronic progressive disease, diabetes is a chronic progressive disease. At some point, they take the joy or the fun out of practicing medicine because they are so negative all the time. They follow the standard of care guidelines. In general, a person’s A1C will increase by about 1% per year. So you will have to go on a new medicine every year, and then eventually you are on insulin, and then eventually you are on dialysis or things like that – the end-stage complications of diabetes.
We started listening to low carb and went to this small low-carb conference called Low Carb Boca, where there was a well-known speaker, Dr. Eric Westman. It was enlightening. It was the first time we had actually heard that diabetes doesn’t have to be chronic and progressive. You actually look up the American Diabetes Association website, and they do say diabetes is chronic and progressive, but obviously, that is not true because there are now hundreds and thousands of patients who have put their diabetes into remission, and we have data that supports that.
I think this is the first generation of medical students where there was still a saying like, patients don’t want to do the lifestyle thing, they just want the medications. I find that is actually not true at all. Every patient I have seen does not want the medication, and I have learned more from my patients than they have learned from me in terms of figuring out how to help them through lifestyle alone. Ultimately, I matched into emergency medicine. I saw Laura bringing A1C’s down from 10% to 6% with just cutting out the carbs and no other medications. I was like, this is what I want to do.
I was so far downstream of the problem in emergency medicine, which is an amazing field – I have the utmost respect for people who do it because it is one of the toughest jobs, I think, you can do. I wanted to be a thousand yards upstream, helping people not get into the river, so they can stay out of the emergency department in general. It made it really difficult. Not to go too deep into it, but it is kind of hard to switch residencies. It’s not like switching jobs. You have to reapply and do all this other stuff. There has never been a day where I have not thought that that is the best decision, one of the best decisions, in my life. Went into Family Medicine as well, and was a year behind Laura. Got to take care of her patients for an extra year when she finished training.
I have an in-person metabolic clinic, in addition to doing some urgent care on the western side of North Carolina, with hopes to expand that in the future too.
Expand, grow and amplify the message
Dr. Eric Westman: Switching gears a little bit, how do we expand, grow, and amplify your message? It is a slow process to just have one or two people come through. And where do we go from here?
Dr. Matt Calkins: I think we are doing it. It is really about reaching a critical mass of patients, advocates, providers, physicians, registered dietitians, and mental health counselors. You learned from Atkins. Your story was amazing when we first heard it. You said, “Show me the data,” and then you created the data yourself. You went through his files, and Dr. Atkins taught you. You, through the data you published in the early 2000s and the conferences you are putting on now, are just basically the roots of a tree at this point.
I do think we have reached a critical threshold because even the co-residents now, or used to be our co-residents, and the residents that are still training, they know of low carb. They know it is safe and effective for many different chronic diseases. We have a couple that actively practice this in residency right now, whereas it never happened before. Before Laura and I were in residency, there were zero people at our particular residency. Now, including us two, there are at least four people. So, four people in the last two to three years that actively practice low-carb keto in their practice. I think people that came before us definitely paved the way. Laura paved the way for me because I never got asked about calcium scores or ordering insulins. The attendants already knew, and she already advocated for that. That is what you guys are doing and continuing to put out there, and it is just going to snowball.
The SMHP organization and how they can help
Dr. Eric Westman: That is reassuring to hear your optimism. I used to be there. I would not be here if I was not optimistic too, but you always want to try to get it spread as fast as you can. Creating the Society for Metabolic Health Practitioners (SMHP) is one way. Creating a group of people. This group is not just for physicians. It is for any coach or professional that wants to help with metabolic health. What do you see the SMHP’s role to be? I should say that Laura, you are the secretary. I am on the board of the SMHP. How can this organization help?
Dr. Laura Buchanan: I think there are several different roles. I also want to make sure Matt has something to say because he is the head of the advocacy committee as well now, on estimation. One, we are now associated with the Low Carb USA conferences or now the Symposiums of Metabolic Health. Meeting people there and meeting and training young doctors, dietitians, and health coaches. The people going to that conference are from all different jobs or just people who are not necessarily helping others but they just want to learn. I think getting the message out through conferences, on the website itself, there is a doctor or provider search bar that you can go try to find people in your area that can help you if this is something you are interested in but your doctor isn’t open to low carb, which is a big struggle for a lot of people. That is a really helpful resource. Matt has created a PowerPoint that is now on the website where other doctors could take the PowerPoint basically as a pitch deck to their clinic and say, here is the evidence that low carb is not only safe but extremely effective, can we start implementing this in our clinic? The other really exciting thing that the SMHP has done is it now has its own official journal – the Journal of Metabolic Health. That is going to be extremely helpful for getting more research on low-carb keto out there more quickly. There unfortunately is definitely a bias against low-carb keto if you go to some of the mainstream journals. You see it time and time again. This is going to be a journal that is not going to be biased. You still have to go through the rigorous peer review process, but they won’t have anything negative against you just for writing data on low carb.
Do you want to talk about what was recently published?
Published article through the Journal of Metabolic Health
Dr. Matt Calkins: One more thing I would say is that the standard of care in medicine is more or less sometimes based on guidelines. The standard of care doesn’t have to be guideline-based though. It is just what is a reasonable thing that other physicians do in a situation. I would say now that the standard care is actually low-carb ketogenic diets because we have a preponderance of evidence. We have a lot of physicians who practice that way. They can point to these articles. We also published a guideline through the SMHP about therapeutic carbohydrate reduction. That is just one more piece of evidence that it is the standard of care.
To Laura’s point, you helped us publish. You were one of the co-authors on this paper that we published fairly quickly through the Journal of Metabolic Health, which was excellent because the turnaround time on these things does have to be fast. Otherwise, you lose the moment. There was a paper published for your listeners last year from the American Academy of Pediatrics (AAP) on low carbohydrate ketogenic diets and type 1 diabetes pediatric, meaning children less than the age of 18. Type 1 diabetes, type 2 diabetes, and the risk of type 2 diabetes, which means obesity. That is a very large swath of the pediatric population that could be helped by low-carb diets. Their essential conclusions were it is effectively unsafe to do without very close medical supervision, which, if you read the table, they recommended six different lab draws over the first year with 14 different measurements trended, including if you have been on a ketogenic diet for two years, you should get a DEXA scan as a child.
We went through all the authors, and we read through their paper and highlighted the errors in thinking. I think at least it was helpful to publish it in the Journal of Metabolic Health because we got it out there. We first made comments on the paper because the AAP, because it was published in the AAP’s journal, said if you comment, there is a chance we might publish it as an editorial. That is what we were hoping for. It was pretty much silence, nobody responded, and nobody said anything. We really had to take matters into our own hands and publish our rebuttal.
Dr. Eric Westman: Well done. Guidelines are human, they are based on people’s best decisions. If it is totally off base like that one was, to correct it is well within the scientific realm. In fact, it should be welcomed. Journals should welcome the feedback, and yet, that is not what happened, which is a sad state.
25 years ago, Richard Feinman came to me and said, we need a new journal called Nutrition and Metabolism. We need to start a new one. I said, can you do that? He explained, yes, it happens all the time when peer review gets so echo-chambered and you can’t get a fair peer review of a keto diet (back then called “low carb”), this happens all the time. You just get a new set of reviewers and you follow a similar kind of rigorous standards of review. it is just you don’t have that preconceived prejudiced notion of bias.
Sadly, some articles won’t be accepted even when they have legitimate criticism. I am really glad that you are learning that at this stage. Of course, being as diplomatic as you can – my colleague Will Yancy and I are sure in Florida, the saying is, that you attract more flies with molasses than vinegar. Not that we want to attract flies, but it is better to be diplomatic about it.
I think the SMHP will have a forum for guidelines. It will have the PowerPoint downloading so that if you are a physician who wants to do a presentation at your local clinic or you are defending yourself if someone’s giving you a hard time, the SMHP will have those resources, and that really hasn’t ever been available. Thank you so much for your help there.
How about medical education in schools and residency? I think you were working on a course, which was a heroic effort. What is the status of that?
Medical education in schools and residency
Dr. Laura Buchanan: Our friend Erin, who is also a physician, went to residency with us, and was a year ahead of us. She has stayed on as faculty at Wake Forest University, and she helped us with that course as well. We did have a couple of other residents take it. She is working on creating a longitudinal nutrition course and obesity course, basically for residents. Because of having worked with her on the other course, I think she will do a phenomenal job. That will be implemented at Wake Forest University, and she will show the evidence behind low-carb keto, and I think she’s probably going to be showing some of the other evidence as well or lack of evidence for certain things that are probably talked about. So, reviewing the dietary guidelines and what evidence was there to put those forward. I am excited to see what she comes up with. She’s dedicating a lot of her time now to that course, and so we will probably be giving some of the lectures and just assisting with her on the side.
Depending on where that goes, maybe the SMHP could be involved or help with its spreading. I am not sure where that will go, but I am open.
Dr. Eric Westman: Awesome. Any sort of experiential feedback along the way is often very helpful. I have seen that some med students put CGMs on themselves for a while and wrote a paper about their experience.
So, it is not ready for anyone else to pick up in the news at the moment?
Dr. Laura Buchanan: No, not ready yet, but we are hoping we will get there. I won’t ask you on the spot here, but she was thinking of potentially you and maybe Dr. Mark Cucuzzella, and some other people giving presentations as well that could be included.
Dr. Eric Westman: Happy to do what I can. Dr. William Yancy is also rising in academia. He is acting chief of General Internal Medicine at the moment. It is always nice to have someone in that kind of position to help with the education process.
Switching gears again, what have you learned by wearing CGMs for continuous glucose monitoring over the years? If someone is watching and they don’t know what a continuous glucose monitor is, how might it be helpful? How do you see them now?
Learning through wearing a CGM – Continuous Glucose Monitor
Dr. Matt Calkins: When I explain a CGM to a patient, a continuous glucose monitor, I say it is a quarter-size device that sits on the back of your arm, most of the time, sometimes it goes on the belly, but it gives you real-time feedback about what food is doing to your body. In the old paradigm, you would make a lifestyle change here and then you would try to measure your weight daily and then try, hopefully, to figure out what that lifestyle change would do to your weight. The problem with that is there are going to be weight fluctuations because of water weight – are you overhydrated or under-hydrated – and any number of things that could possibly derail and demoralize you. When you eat a food and you check your sugar on a CGM, you will know immediately whether that food was on your low carbohydrate ketogenic eating plan. I think that is more important now, it is actually as important as it was ever because these food companies are very sneaky. They will inject or hide sugar in many different foods.
My personal story is, and you are not going to like this, Eric – during medical school, I would go on my vascular surgery rotation, which is a very intense rotation. I would have to get up at 4am and be at the hospital at 4:30am for rounds. These were pre-low-carb days. I was eating these “healthy” oatmeal bites, and basically, the box said all the right things: non-GMO, low-carb, in fact, high-fiber, omega-3s, all these things. If you look at the front it said that the net carbs were 2. If you look at the back, there were about 15 grams of fiber and 17 grams of total carbs in those cookies. I was like, these are great. There are eight cookies in a box, so I would eat four of those beforehand as I was driving to the hospital, still very tired, and basically the only thing I could eat before I got there.
I started to put a CGM on during that rotation, and those cookies were spiking my sugar to 180. Four cookies first thing in the morning. You quickly realize that you are getting fed this information that is not correct, and it is not good for your body long-term. If I kept eating those cookies up to today, I don’t know how long the body can sustain a reaction with sugars going as high as 180 and 190. There is a lot of chatter nowadays about what is a healthy glucose excursion, but I don’t think anybody would say that a sugar spike to 190 from four cookies is a beneficial thing.
Dr. Eric Westman: Oh, we have medicines for that! (Said sarcastically.)
Dr. Matt Calkins: I could have eventually used metformin and then all these other things. It shows you that these food companies will create metrics to make their food seem better. So the idea of net carbohydrates, one of the things that trip up my patients the most are keto breads or low-carb breads. They ultra-manufacture these foods and just push as much fiber in there, which is digestible, and it does raise sugar in these foods.
Dr. Eric Westman: But it is called non-digestible.
Dr. Matt Calkins: Yes, it is non-digestible, but it will still raise your sugar. They still see their sugars going up to 200 mg/dL (11 mmol/L).
Dr. Eric Westman: So it’s not just me that says to use total carbs, not net carbs.
Dr. Matt Calkins: Net is a marketing tool by the ultra-billion-dollar companies to sell people bad food.
Dr. Eric Westman: As Amy Berger, who helped write End Your Carb Confusion, told me years ago, and I repeat, keto, there is no “keto food.” Keto is the metabolic state achieved by lowering the carbs. I even saw a coffee bean laced with some MCT on it, and they called it keto coffee bean.
Have you become an obsessive biohacker, and you get upset when your glucose is over 100?
Dr. Matt Calkins: Personally, I don’t wear a CGM anymore because I just stare at a flat line all day. Once you know what your body is doing to your food – and I think the low carb is liberating – I enjoy eating, but it is never something that I think about. I don’t have cravings. I can eat the same thing every day. It is still incredibly satisfying to me, but that just allows me to know what food is doing to my body.
Dr. Eric Westman: Matt, how many years did you wear the CGM?
Dr. Matt Calkins: About 4 or 5 years.
Wearing of a CGM – Continuous Glucose Monitor continued
Dr. Eric Westman: I am just trying to find out, for those of you who are watching who are enamored with the CGM and maybe even using it to get off the medicine. Once you see the same thing over and over and over, it’s okay to stop using the CGM.
I joked about that and in fact, you got me to wear one. I wore one while you were in my clinic, and I ended up with a higher glucose at the end because I would test, I wonder if I could have this. I could have it when I just stayed at the keto page list. Day-to-day, did you not also learn that exercise will raise glucose, hormones, and the dawn phenomenon? There is a lot of worry that can be brought into this by measuring it.
Dr. Laura Buchanan: I think you just have to be aware of what is normal and what you might see. Don’t get worried about the glucose spike from exercise; that is totally fine. Making sure someone has the proper education so that they say don’t stop exercising because they are doing everything they can to keep it a flat line. I have not come across it causing eating disorders, which I have seen people claim on social media. We don’t claim that measuring someone’s A1C is causing an eating disorder, so it is a silly argument. As Matt said, especially when you are first starting off making those lifestyle changes, it can be incredibly helpful. Sometimes just seeing how not only what you are eating but the stress in your lifestyle. I have had a couple of patients, not common, but a few people who really respond to caffeine, significant response, raises blood glucose after caffeine, to the point where I am almost like, for you, caffeine might not be your friend.
Dr. Eric Westman: Switching to decaf coffee, for example, fixed it.
Dr. Laura Buchanan: I do like the extra accountability. I don’t like seeing a big spike. Now, it is not common again that I am going to see a big one just because I have been low carb for several years, but it is always eye-opening.
Last year, Matt decided that we should get some cookies from somewhere – I won’t say where – and my sugar stayed elevated for 13 hours. It was so eye-opening. Those cookies were not worth a 13-hour blood sugar excursion.
Dr. Eric Westman: So your pancreas was taken off guard.
Dr. Laura Buchanan: Yes.
Dr. Eric Westman: It was sleeping, then finally it’s like the security guard had to wake up. I think Benjamin Bikman has done a couple of papers where it takes a day or two for your pancreas to start “waking up,” to respond. I am so glad to hear you are measuring insulin levels among your patients, that is fantastic. Now I am thinking, Matt, you are not wearing a glucose monitor, but you are wearing a ketone monitor.
Dr. Matt Calkins: There is now a ketone monitor that we have, it is still in the box downstairs. I haven’t started using it yet.
Dr. Eric Westman: Another doctor on the internet, who shall remain nameless, has been using one for a while and really focuses, I think, too much, on the measuring of ketones. So you don’t have any information on the ketone monitor yet?
Dr. Matt Calkin: No. As you said, if you don’t eat for two days, you are in ketosis. I think the natural state anyway is even if you just eat carbs you will be in ketosis. Like, first thing in the morning, and as long as you are feeling good and at your metabolic goals, it is just to help pinpoint and figure out what additional levers you can pull if you are reaching that plateau or if you have chronic fatigue and you really want to see if you can feel even better than just low carb, do you need to target a beta-hydroxybutyrate of 3.0, stuff like that.
I think if somebody’s feeling good and they are improving and getting to their metabolic health goals I don’t want to mess up with that.
Dr. Eric Westman: Dr. Will Yancy was on Curbsiders. Are you familiar with Curbsiders?
Dr. Laura Buchanan: I am.
Getting the word out to younger doctors
Dr. Eric Westman: Dr. Yancy and I have worked together for 10 to 15 years now. Curbsiders are not going to ask me to be on for whatever reason. How do we get you into this world of doctors of your age?
Dr. Matt Calkins: Yes, I was hopeful. I will say as much, I am very optimistic. I was hopeful that we would publish this paper, the rebuttal for the AAP article, and there would at least be some communication between the AAP, like them reaching out, just starting a discourse, which did not happen. You cannot go through the academic route, there is that. The Mediterranean diet does not need advocacy. But low carb keto, if you look at some of these publications Laura alluded to earlier – I will leave that to an exercise to your listeners. I don’t want to call anybody out either on the podcast, but there are a lot of very highly influential academicians out there who publish biased things against low-carb ketogenic diets. I do think that getting our message out there through podcasts – and we have been on a variety of many excellent podcasts – but I think that is the next step, somehow breaking out of the realm of low-carb podcasts. Curbsiders is excellent. I listened to almost every single episode when I was in residency because when you are inpatient, it had amazing information for both inpatient and outpatient too.
Dr. Eric Westman: I think there is a Duke connection there, so I will see if I can make something happen. The other person who would be great, if you have not met, is Dr. Nick Norwitz. I am sure you are following Nick.
Dr. Laura Buchanan: Yes, we worked together on this last paper.
Dr. Eric Westman: Thank you for taking the time to talk to me. These are the new generation of keto-friendly doctors. It is thrilling to see you guys progress through the years. Thank you so much.
Dr. Laura Buchanan: Thank you so much for having us on.
Watch the full video here.
