Introduction to Dr. Quentin Schultze
Dr. Quentin Schultze: Dr. Westman, it’s good to meet you in person. I know we communicated some through email back and forth when I was offering a few communication suggestions your way. Let me tell you a little story that I think you’ll find interesting, and then we can have a conversation about it.
I’m an academic too, with a PhD in Communication. In fact, my latest book is on the movie A Christmas Story, about the kid who wants a Red Ryder BB gun for Christmas.
Dr. Eric Westman: Of course, it’s the classic line, “You’ll shoot your eye out!”
Dr. Quentin Schultze: That’s actually the title of the book, You’ll Shoot Your Eye Out, which is the most searched term related to that. So, that’s why the leg lamp is on behind me because I’ve been doing all these media interviews for the book. “You’ll shoot your eye out, kid!” and then Santa boots him down the thing. I got interested in it because it’s an incredibly well-written story that pulls you in, and over 50 million adults see it annually in the U.S. It’s related to communication and I’ve always been interested in communication from way back.
My wife, several years ago, was suddenly diagnosed with non-alcoholic fatty liver disease. She rarely drank at all and suddenly the doctor said, “Woah! You’ve got a problem here. I’m gonna send you to a nutritionist.” My wife reported this to me out of the blue; it was a shocker for both of us because her numbers were bad enough that our doctor suddenly became very concerned about this.
My wife goes to a nutritionist within days and the nutritionist looks over her diet, does a little inventory and says, “Okay, we’ve got it. We’re gonna take care of this.” My wife is figuring pills, pills, pills; what are we taking now? The nutritionist says, “We are going to eliminate most of your sugar.” She was using “sugar”, of course, in a generic sense. She did that and within weeks, my wife’s numbers started changing. Within a couple of months, that was the end of our fatty liver problem and our personal physician was really delighted. That nutritionist was onto something and I thought, “I’ve got to figure out what’s going on here.”
I started researching this because I’m a researcher and that got me into the whole low-carb area and the leaders in low-carb and so-called keto. I looked at some of your research going way back and research from some of your colleagues at other schools. I suddenly realized that what we all were picking up in the culture, particularly through popular media about what a good diet would look like – and I don’t mean dieting just to lose weight – was not on track. I started reading and I came across your excellent book, End Your Carb Confusion, which you co-wrote with Amy Berger. It’s one of the many books that I read and I think it’s the best one from the standpoint of someone who is just getting into this, getting started. It’s very practical. Mine’s all marked up and I looked at some of the research behind what you have in there.
I’m a communication guy, my wife’s suddenly in better health, I start reducing my carb intake, I lose a fair amount of weight without even trying to lose a lot of weight. I was not obese but a strange thing happened with me. I have arthritis, back pain, and various types of joint pain, and suddenly, that started going away. My health started improving. You’ve got my wife’s story, you’ve got me as an academic looking into it as a story and so now I’ve become an evangelist for low-carb.
Most Common Low-Carb Questions
Dr. Quentin Schultze: I thought it would be great to throw at you the 10 most common questions or comments I get from people when I raise the low carb issue – or sometimes I’ll say “keto.” This comes up all the time. For example, I don’t eat desserts – at least, not sugary desserts. I’ll have some berries or something like that, but people often ask me why. When I say I’m low-carb. Just the other day, I said I don’t eat any carbs, so these are the questions that I get. Let me throw them at you and see how you can do. You’ve probably heard all of these.
Keto Is Just a Diet Fad
Dr. Quentin Schultze: Here’s the first one: everyone says that keto is just a diet fad. I often hear, “It’s another diet fad. I don’t do diet fads. I tried diet fads – forget it. Keto is just another diet fad.” What would you say in response to that?
Dr. Eric Westman: Well, it’s the only fad that’s never gone away; it always comes back. So that defies the definition of a fad.
Dr. Quentin Schultze: That’s good! The thing there is that word “keto”.
Dr. Eric Westman: They’ve changed the name of it. It’s gone by other names – it’s been hunter-gatherer, Paleo, Primal, Atkins, Protein Power, South Beach, and now it’s keto. The name has come and gone but the concept has been there all along. It’s not a fad concept.
Dr. Quentin Schultze: That is it and that’s what I say to people now, too. I say, “Low-carb has been around for a long time. We’ve known the health benefits of this going way back to early studies with children and so forth. They’re a little surprised by that.
What Is Keto?
Dr. Quentin Schultze: People often don’t realize that keto is essentially low-carb. I’m glad you called your book, End Your Carb Confusion rather than focusing on “keto” in the title. The labels that you use for these things do come and go.
Dr. Eric Westman: If you look at internet searches you see that “keto” peaked and is now bathing a bit. I decided to change the clinic name at Duke to the Keto Medicine Clinic to emphasize that it’s a scientifically solid metabolism change. But not everyone needs to be in full ketosis; your carb intake can match your metabolism. I’m glad you liked the book. I wish it was as sticky a name as You’ll Shoot Your Eye Out.
Dr. Quentin Schultze: Titles are tough. I’ve written a lot of books; I was on the board of a big publishing company for a long time and it’s tough to know how to pigeonhole a title on something, just like the term that you used.
“I Just Watch My Calories”
Dr. Quentin Schultze: Here’s number two: “I just watch my calories.” A person who will say this to me, typically, is significantly overweight. How do you respond to that?
Dr. Eric Westman: “How’s that working for you?” or, “Are you able to accomplish what you need to do by doing that?” If you’re trying something for two weeks and it doesn’t work, move onto something else. There are enough options out there that if it’s not working for you, try something new. You might also say, “It’s not the only way to do it.”
Dr. Quentin Schultze: The whole calories-in, calories-out concept often isn’t enough.
Dr. Eric Westman: I guess the nuance behind that is that you may even be a normal weight but if the blood sugar is elevated, you may have pre-diabetes or diabetes by watching calories. There’s some prominent physicians who are doing exercise, one was swimming across the Maui Channel and back (apparently not many people can do that) and he noticed he had this big belly. He jokes that it was as big as his pregnant wife’s belly. The weight and watching calories aren’t the only thing that watching carbs can do. It can actually change your metabolism.
“I Have This Under Control”
Dr. Quentin Schultze: Here’s the one that I probably hear more than anything else right now: “I’ve got this under control; I just buy low-fat foods.” In my own research on this, it was interesting to look in the literature at some of the graphs that showed the rise of all of the low-fat, high-processed foods and the growth of the percentage of the population that’s obese.
Dr. Eric Westman: Well, that’s just correlation, not causation, although I think it is actually causation. Low-fat food can work for some people. If you don’t want to be too contrarian, you say, “That can work for some people, but I’ve lost 27 pounds and my wife fixed her fatty liver by not even using low-fat food.” You can role model how something else can help.
Dr. Quentin Schultze: Okay, so let me stop you right there because you just hit, Dr. Westman, on the most important form of communication that there is, and that is story. I mentioned that at the beginning because I’ve got this book on A Christmas Story. The movie is a story; stories are the most potent form of human communication.
When it comes to persuading people to change their attitude, to change their actions – generally, attitude change precedes action, though not always. The form of the story that’s the most potent of all forms is testimonial, a personal story. This is what happened with me.
So when I am in a conversation with someone and I say, “Well, you know what? I don’t limit my fat intake that much.” Certain fats, there are fats that are not good for you that I stay away from, but overall, I don’t worry about fats. I keep the carbs low, no problem with the fats. In fact, I love Boston-style coffee with heavy cream in it, not to add a bunch of fat, but I just like the flavor.
Protein Shakes
Dr. Quentin Schultze: Number four – I hear this a lot: “Well, I manage my health with protein shakes.” Now, protein shakes are huge out there. We buy a lot of things at Costco and Aldi. Costco for the big quantities, and Aldi right across the parking lot for the small quantities. And those protein shakes are flying through those places like you wouldn’t believe.
When I go up and I look at the label, the labels on those, I say, “Uh-oh, these are not so good for you, and I would not use them because of the carbs and, in fact, even sometimes the form of those carbs that they put in there.”
Dr. Eric Westman: That’s where my response would be, “Well, that can work, but don’t have the protein shakes all day long.” I do recommend, for some people, a low-carb protein shake, as long as you make sure it’s super low in carbs. But I share the concern that if it’s the only thing you have… you know, we’re still learning nutritionally about vitamins and so on, so they can’t possibly have everything we know about nutrition in a shake. In fact, the companies that sell shakes and bars out of doctors’ offices that cost an arm and a leg, they put in all the vitamins and nutrition. I wouldn’t be so hard to push back on that one, as long as it’s low-carb, but you’re right. Real food is the best, I think, not fake foods, not shakes.
The Food Pyramid
Dr. Quentin Schultze: Here’s number five: “Doctors agree with the established science and the food pyramid.” Sometimes they’ll say to me, “This keto stuff flies in the face of the scientific evidence, and I heard that from my doctor.” You’ve probably heard this a thousand times.
Dr. Eric Westman: I’m afraid I cringe when I hear “the food pyramid.” There was no science done before the pyramid was put out, and so, actually, most doctors don’t know the science. I’m careful not to bash other doctors too much.
If you’ve been seeing a doctor you respect for a long time, just realize they don’t have much nutrition training, and they probably learned about vitamin C from the orange juice commercials as you did. So, they’re going to be learning from companies that are selling their products. The food pyramid was one big sales pitch for American foods. The food companies lobbied the U.S. government to say people need to eat this, and that’s how it happened – it wasn’t based on science.
Medical School Nutrition Education
Dr. Qeuntin Schultze: Would it be fair to say, Dr. Westman, that going through medical school today, the average student does not even have a full semester-long course on nutrition?
Dr. Eric Westman: Oh yeah, correct. I would say, not even a week.
Dr. Quentin Schultze: Wow. Interesting side note on that – I was invited by the Association of Emergency Room Physicians to speak to their convention on communicating with patients in an emergency situation, which is a whole thing in and of itself. How do you communicate with people when they’re in a deep emergency? I went back and looked at the research on it, and I discovered that there is some research on that. One of the things is that if you don’t know how to communicate with a person who’s in an emergency room, you’re much more likely to get sued because they don’t like you. But if you can communicate in a way where they trust you and they appreciate you – the same level of care, the same quality of care, but just how they perceive you – you’re much less likely to get sued. I thought, “Isn’t that interesting?”
I talked about that and how you can be personal with people and give them a sense, “I’m here with you now; we’re going to take care of this. I’m sorry this happened to you.”
Dr. Eric Westman: I didn’t learn much nutrition through school, but I did learn residency – we get immersion training, medical school, and then residency or learning from other doctors. I learned, “Sir, you’re having a heart attack, but I’m going to take care of you,” to allay the fear.
In fact, I get that feedback from people who come to me watching YouTube or even my patients saying, “You seem to calm me down; you’re so calm.” That’s just the way I’m hardwired, I’m afraid. But that reassurance that “I’m going to take care of you while you’re having this heart attack.”
The Diet
Dr. Quentin Schultze: If someone asked us about the diet, one of the things to say is, “Hey, thanks for asking about that. I’d love to talk with you about it, and I’m not putting any pressure on you to eat the way I eat necessarily but it’s a great thing to talk about; let’s have that conversation.
Dr. Eric Westman: That’s an important point. A lot of people project onto anyone doing a diet that they’re going to be proselytized – that’s the vegan thing. “How do you know someone’s vegan? Spend a minute with them; they’ll tell you.” “How do you know someone went to Harvard? Spend a minute with them; they’ll tell you.” I think that separates the low-carb world, generally speaking, that it’s a scientific thing, not a proselytization. You might care about your family and friends from a standpoint of caring not proselytization. You can teach, right?
Dr. Quentin Schultze: Yeah, exactly. And again, to be that role model.
Insulin
Dr. Quentin Schultze: The insulin thing is very interesting to me. I run across this frequently with older friends who are very obese, and they’re really loading themselves up with insulin. They say to me, “Well, I just take my insulin to control my blood sugar. I don’t need to worry about this carb thing.”
Dr. Eric Westman: That’s just so enabled by the system, isn’t it? Actually, the research shows that you can reverse type 2 diabetes, even if you’re on insulin, with the right lifestyle. It was the weight loss surgeons who had, years ago, a kind of monopoly. There was a paper that said, “Who knew that diabetes was a surgical disease?” Because if you make the stomach this big, people don’t eat, they lose 100 pounds, and the diabetes goes away. In fact, they cut the insulin out on the first day after the surgery.
A low-carb diet is not surgery; it’s what I use. A very low-calorie diet can actually reverse that type 2 diabetes, and you can have a normal A1C – 5.5, 6-ish – off medications and lose weight. I’m afraid maybe the comment is, “No, actually, you don’t have to have diabetes. Did you know that?”
Dr. Quentin Schultze: That’s it, yeah. You actually might not have to have that insulin. Don’t stop taking it, but that’s good.
Dr. Eric Westman: My most appreciative patients are the ones who are off insulin. They might have been using insulin for a decade, and no one had talked to them about stopping the sugar in the drink. In the South, it’s called sweet tea. How is that as a persuasion? But that’s a little too shocking, isn’t it, to say, “Well, you might not have to have diabetes at all.”
Dr. Quentin Schultze: I don’t think that is shocking. It’s a fact. In some respects, it’s tough for you or me to say that to someone. You can say it as their doctor, helping them, but for me to have an everyday conversation with someone – even a loved one who has a lot of insulin going – for me to say, “Well, you don’t really need that; let me tell you why,” that’s a little bit of a shocker. They know what’s going to happen if they suddenly stop and don’t adjust anything else. And, of course, they should do that only under the care of a physician anyway, even with the diet changes. But we’ve propped ourselves up.
Unsolicited Advice
Dr. Eric Westman: I’ve heard that unsolicited advice is never welcome. What if you just sent a video that Dr. Westman or some other doctor did on diabetes reversal to that person? Would, “Hey, could I send you a video to take a look at?” or something, be too much?
Dr. Quentin Schultze: It’s not too much. A couple of the videos that you’ve done where you had the testimonials from people who had been in it before are golden. Of all the things that you could provide that would be persuasive, it’s those. I’ve noticed this too, when I look at some of the numbers on YouTube for the things people are watching that are diet-related. There are those that are more theoretical or more academic; some of those do well, particularly if it’s a well-known personality. But the ones with guests or a case study – when Paul Mason does presentations, he’ll frequently do one or two case studies and say, “Here’s the person before, here’s the person after, here’s how things went,” with some of the numbers. That stuff is just golden. Again, that’s the story of what happens, and that story can be your story.
I think, actually, Dr. Westman, we’re made this way; we’re built this way. The term I like to use is we’re created such that we’re attracted by stories, and they lure us in.
Dr. Eric Westman: Then the idea, “I want to be like that. I want to have that.”
Dr. Quentin Schultze: We call that identification in my field. You can identify with that, “Oh, that’s me too, and I want to be like that.”
Keto and Cholesterol
Dr. Quentin Shultze: Doesn’t a keto diet increase cholesterol levels in the blood? Now, the way people say this to me is, “Hey, I put all that fat in there, all the cholesterol, and I’m priming myself for a heart attack.” How do you respond to that?
Dr. Eric Westman: I thought that 25 years ago when I first got into this, but now I’ve learned that actually, it gets better. People say, “My cholesterol went up.” Well, was it the good one? Because actually, the good cholesterol goes up. It’s hard to get into this at a cocktail party, but we look at triglycerides and HDL. I thought that way too, but through the years, research and clinic experience showed me that’s not true.
Dr. Quentin Schultze: One way to respond is, “You know, that makes sense. You put all that stuff in, and it’s going to clog up your arteries, but now we know that it doesn’t quite work that way.” I convinced our personal physician. I went to the Mayo site, looked at their research, and found an in-service by one of their heart folks presenting to other heart folks on this topic. It was stunning. I took the data and it was looking at some of the ratios of triglycerides, HDL, and LDL – they did some studies on this – and I sent that link to our physician. I said, “Look at this.” The next day, she sent me a note and said, “That is a fantastic presentation. In fact, she said, “I’m going to go back and review all of the patients that I have on statins in light of that.”
She’s looking at that from within the medical community, the numbers, and so on. You can’t talk in those terms with the average person. You just have to say, “Well, it’s not quite that simple. Sometimes the fat will clog you up.”
Dr. Eric Westman: The appeal to authority should be within the person’s field. Find the doctor that could be persuaded.
Dr. Quentin Schultze: And who do people look up to? You sent me a link from Twitter of a popular female singer on the diet.
Dr. Eric Westman: A testimonial from a celebrity or a movie star can be powerful. Everyone knows Rob Lowe is advertising for the Atkins company, which is still low-carb.
Disagreement About What Keto Is
Dr. Quentin Schultze: This is an interesting one because you’re involved in this too. People will say to me, “I’ve watched a bunch of those YouTube videos on keto, and they don’t agree on what keto is.” And you know what? They are right.
Dr. Eric Westman: We call that, “internet keto.” I don’t agree with most of what those people say. There’s that language thing, that name thing. Low-carb has stood the test of time, and if the low-carb is low enough, it becomes keto.
Dr. Quentin Schultze: Yes, exactly. And there are so many people out there. When I first had the situation with my wife and I started doing the research, I looked up keto and got, of course, the most popular current YouTubers. It was some of the craziest stuff. I remember watching younger women who were doing videos. They’d been on what they considered a keto diet for two weeks, and they were talking about all the benefits and how this was the future and all. And I’m thinking, “Well, okay, two weeks – they probably lost a lot of water, but I don’t think I would go on and say, ‘In two weeks, all your problems are solved.’”
Dr. Eric Westman: It seems like there’s a method of learning now. You don’t watch the video yet – you look at the top ten comments. That could actually be scammed, couldn’t it? I mean, if someone had a bot saying the top ten comments were, “What a great doctor.” That’s happened for me. I have some videos out there, and people say, “Well, those first ten comments are great,” and then they start listening.
You always want to consider why people did the keto diet. Can you identify with their reason? If someone didn’t reverse diabetes, don’t look to them for diabetes advice, even though the name’s the same.
Dr. Quentin Schultze: Good point. You have to get into it a little bit more and look at the context of what’s going on, and that’s what causes difficulties. The more of these different videos you get into, the more confused you’re going to get.
End Your Carb Confusion
Dr. Quentin Schultze: Just to plug your book again – End Your Carb Confusion. Confusion is the issue when you have different kinds of information coming from different kinds of people. Whether they say they have an MD or a PhD, or who knows what, you still have to look a little more deeply at it. And don’t look at just one video. If you’re going to go on and look at videos, look at a few of them from a particular source and then see what you think. Are they consistent? Are they selling a lot of products? Avoid those right away. You know you’re getting into issues there.
So, there is a problem with all these disagreeing voices out there. We just have to admit that. I’m glad you’re in the arena, Dr. Westman, and you’ve got a really good voice out there. When you started doing the response videos, where you would take somebody else’s video, and then respond to it up in the box, stop it here and there and talk about the study or whatever, I thought that was just terrific because you were providing that extra critique you need to make sense of this crazy marketplace.
Dr. Eric Westman: That’s my training in internal medicine, and there’s a society of general internal medicine that really is the critics of medicine. We do reviews. It makes sense; that was my personality going into it – being the referee about it.
It also makes it so I don’t have to spend hours and hours making the content, because I’m actually busy in my office in the clinic. I had to figure out a way to generate the content, yet not be responsible for making the 20-minute video. It takes a lot of time. Most people don’t understand that. But anyway, thank you.
Dr. Quentin Schultze: That’s a whole approach right now that’s very, very popular and very effective with younger folks. They love those things, absolutely love them. In fact, there are people now who are just taking some of the really popular videos that are out there on different topics – whatever it is, not even health-related – and doing reaction videos, and they’re getting phenomenal numbers of viewers.
Breakfast
Dr. Quentin Schultze: Here’s the last one: “Why don’t I just skip breakfast?” People say this to me all the time, “I don’t need to worry about my health, what I’m eating, and so on. I just don’t eat breakfast.”
Dr. Eric Westman: In the context of a day, that would cut down a third of the calories. Then it might work if you have a lot of weight to lose. If you stored a lot of fat on your body, you have diabetes or other metabolic issues, it doesn’t work because you’re still hungry. You’re going to compensate; you’re going to eat up those other meals, and you’re not going to drop body fat.
Intermittent fasting became very popular. Dr. Jason Fung is a great communicator. I’m sure you’ve watched some of his videos, but if you listen to him, you would think you have to do intermittent fasting. That’s not true. Intermittent fasting is just one of many different ways to do it. And even then, you want to be careful of the sugar when you intermittent fast. If someone asked for advice, I’d say, “Well, dropping breakfast won’t help if you don’t drop the sugar later in the day.”
Dr. Quentin Schultze: I’ve actually seen a couple of videos lately on this, Dr. Westman, where the recommendation is, well, don’t eat between dinner and bedtime. If you just protect that time, particularly that late-night snacking stuff, – just don’t do that. And then eat breakfast, you’re fine because you’ve got, in a sense, a fast from dinner until breakfast.
Dr. Eric Westman: It usually doesn’t work because if you’re eating that same set of foods, it’s still stimulating the glucose and the insulin rise, and it locks up your fat store.
Dr. Quentin Schultze: Yeah, for the rest of what you’re eating, you got to get the carbs down. That’s the key.
Dr. Eric Westman: If you’re gonna contact or be in touch with this person every week at church or something, say, “Well, let’s talk in a couple of weeks, see how that’s going.”
Dr. Quentin Schultze: In fact, speaking of that, I’ve been, been trying to find a physician locally that knows a lot about low-carb to speak at our church.The church we were at previously, my wife, who was a nurse for many years, home of a health care agent – head of a health care agency and all – did a session at the church we were at previously on depression. It was the single most attended session that she did, health-related. She was also a parish nurse over a course of 10 years or so. I bet a third of the congregation went to that. It was terrific. I think if we could do something on diet, but again, not defining it in terms of just losing weight, but if we find the right kind of person to do it, it would be tremendously helpful. But it’s difficult. Where do you go for such a person?
This little book that I wrote on the movie A Christmas Story is about the life lessons in the movie. I knew the screenwriter; I actually taught storytelling with the screenwriter, and he taught me so much about how to tell a story well. But one of his life lessons, which he wove through many things, including that movie, was to curtail your obsessions. Don’t get obsessed. So, Ralphie gets obsessed with wanting the Red Ryder BB rifle. He’s got to have that thing. He’s going to go to Mom; she turns him down. He’s going to go to Miss Shields, the teacher; she turns him down. He goes to Santa. Santa gives him the boot down the slide. Then he gets the rifle from the one person that he doesn’t pitch, and that’s the Old Man, his father. Don’t become obsessive about things. I think we can become obsessive about even good things, and then it becomes unhealthy.
For my wife and I, this is maybe a good way to conclude this, what we have discovered is that if we just eat low-carb, but healthily – we prepare our own stuff. We don’t eat a lot of processed stuff. We can eat a lot; we can enjoy it. I cook tremendously on the grill. I did salmon last night here with asparagus and some peppers on the grill and it really helped. It knocked out my wife’s liver problem and it greatly improved my overall health, and it will for you all too.
As these questions come up, if you’re a fan of Dr. Westman – and you should be – and of the book that he did with Amy, that’s great. Learn how to communicate it, how to be an evangelist for low-carb without being an obsessive, pushy person. Let your own life be the story. I think that’s the key.
Watch the full video here.
