Introduction
Dr. Eric Westman: It’s my great pleasure today to have Dr. Tro Kalayjian.
Dr. Tro Kalayjian: Thanks, Eric. You know, I’ve looked up to you and called upon you as a mentor for probably a decade now. Wow, I’m getting old, which means you’re getting old.
Dr. Eric Westman: Time flies when you’re having fun! Tro, introduce yourself to someone who hasn’t heard of you yet. Let’s assume you’re one of my patients and they’re wondering why I would want to interview you.
Dr. Tro Kalayjian: If you’re one of Dr. Eric Westman’s patients, you know I am Dr. Tro Kalayjian. I was nothing but an internal medicine doc a little over 15 years ago. I was a very large, 350-pound internal medicine doctor. I was the chief resident in a Yale-affiliated internal medicine program and I was 350-pounds. Every day hurt, it hurt to walk. My joints ached, my body ached. I never felt full of energy. I was always fatigued and I was honestly, cognitively, probably like 50% of my potential. I was just not living a life that I wanted to live.
Honestly, it wasn’t even me. I was 220 lbs at the age of 13. My older brother got up to 500 lbs. All the genes you wrote about in your textbook – FTO gene, MC4R – we were homozygous for them. My younger brother got up to 400 lbs. We were just a big family, and I was a big doctor. When my wife said to me 11 years ago, “Are you going to be alive?” and I started to go back to the literature, literally reading the obesity textbook you wrote. I tried to master medicine, and then my wife played that. I scored in the 90th percentile on my board exam. I was so arrogant about it. My wife knew me, she knew I was arrogant about it. She’s like, “You’re a smart guy. Go figure out why you’re 350 lbs and miserable.”
It wasn’t for a lack of calorie information. It wasn’t for a lack of knowing what calories were. It was a hunger issue. I was always hungry, insatiably hungry. So when I went to the literature to see what diets work for hunger, what diets work period for obesity, for metabolic syndrome, it was all there – your 2004 study, your textbook, the head-to-head studies in the New England Journal and JAMA looking at Atkins versus others – it was all there.
That’s who I am. I’m somebody who lost 150 pounds over a decade ago and I’ve kept it off. I would say I’m food addicted, and I’ve had food freedom for a decade – not without its struggles. I still go up and down and I have to battle, but I’ve devoted my career basically to taking everything that you continue to work on and pushing it as far down as I can push it.
We set up the SMHP together – the Society of Metabolic Health Practitioners. We have 3,000 docs and health coaches that are looking to get certified as metabolic health docs. We’ve worked on papers together and are trying to make people like you not shake their heads when they see a carnivore or low-carb doc on social media.
Medical Training and Nutrition
Dr. Eric Westman: Well, gosh, you’ve gone so much farther. We’ve heard this story before where doctors end up being unable to get the tools to help themselves and then they have to find it out on their own. Did you get any training through internal medicine and residency? There were no GLP-1 shots back then. So looking back, how do we help other health professionals? And of course, the SMHP is training people who are not necessarily MDs. We’ve figured out a way that you don’t need to train MDs. In fact, we’re kind of overqualified. We don’t need to know how to take out an appendix to talk to someone about food.
Please reflect for a moment back on that period of time and thank goodness for your wife to explain in a way that you would understand that you had to figure this out.
Dr. Tro Kalayjian: There’s not a lot of resources out there. Ten years ago my training was your textbook, all the studies Yancy had done, you had done, Shai and Gardner’s early work – and that was it. Whatever organized education there was, it was vegan nonsense. I’ve got nothing against vegans, nothing against the diet – go eat as many plants as you want – but it was propagandized nutrition information, a sort of bastardization from observational science.
Dr. Eric Westman: Had you done a vegan or vegetarian, plant-based diet in your search?
Dr. Tro Kalayjian: Yeah. I ate brown rice. My wife would make fun of me: “You were like the whole wheat pasta and brown rice king.”
Dr. Eric Westman: I remember I gave a class for a long time and I’d say, “No rice, no white rice.” And then people would ask, “Well, how about brown rice?” No, it’s still rice. Or the classic pasta – “No pasta.” “What about whole grain pasta?” I had to laugh.
Dr. Tro Kalayjian: No, that was my life. Do you teach nutrition at Duke?
Dr. Eric Westman: Only to the medical student elective in the fourth year and residents who come through. There’s no class.
Dr. Tro Kalayjian: Why don’t we reimagine medical school through a metabolic health lens?
Dr. Eric Westman: Hold on, stay tuned. I was planning on contacting you again later from a school that has enough inertia to make some changes. I have a lead – it’s not firm – but hopefully we’ll be able to help a school that would have a leadership impact.
Thinking about your background, you just thought it was in the family then?
Dr. Tro Kalayjian: It definitely was. I mean, we can throw down. Eric, we’ve had a steak together and I impressed even you.
Dr. Eric Westman: But then a lot of people are told that there’s nothing you can do about it, it’s just in your family.
Dr. Tro Kalayjian: Yeah. I struggled my whole life. I felt miserable. My family struggled. Watching my family struggle was why I went into medicine. My mom had to undergo bariatric surgery, and when you’re a doctor, you start to have the ability to understand systems thinking – what are the systems at play? How did we get here? Where did this come from?
The sad thing is most of medicine is still guideline-based and hasn’t adapted to the pace of information. Your study was published in 2004 looking at triglyceride levels for low-carb and low-fat – this is 20 years ago – and still the NLA says do a low-fat diet for high triglycerides.
Dr. Eric Westman: The pace of information exchange has changed, but so has disinformation. The brainwashing happens as well.
But let’s focus just a minute on internal medicine. You were at excellent training, and the human body – was it ever emphasized to you that what you ate mattered?
Dr. Tro Kalayjian: No. I went to a great program, an absolutely amazing program. I was taught by the top minds at Yale. They made me a great doctor – the ability to come up with a differential, to aggregate information, to think in a way that prizes patient excellence – they gave me all of that. What they didn’t give me was critical thinking and anything on nutrition.
Dr. Eric Westman: I think we need to toot our horns just a little bit. Internal medicine training is really in-depth in how diseases happen, how the body works when organs fail. We were in there. Do you remember the saying that the stethoscope was a flea collar and that internists were the last ones to jump off a dying dog because they’re fleas? That meant if an organ wasn’t working right, we had to change and adapt. I remember being in the ICU taking care of people who were really sick – multiple organ failure, sepsis, and things like that. I think the only nutrition training I got was in TPN – total parenteral nutrition – for people who can’t eat. The principle was, “If the gut works, use it.” You put in a feeding tube and use tube feeding. But intravenous understanding is still evolving. I remember a doctor-researcher nearby trying to make choline a new essential nutrient. I didn’t realize you had to lobby and get expert opinion. When I went into his office, they found that fatty liver happened with people on TPN, the total parenteral nutrition, and they were trying to figure out why this was happening. There wasn’t enough choline in the TPN. I looked on the wall and saw that choline is in eggs, choline is in all these animal products.
We think we know. We were taught a certain way but even today we don’t know everything. The reason I brought up TPN is it’s just understood that you would start and lead with dextrose. You would lead with sugar. You start by giving sugar and then you add in proteins and amino acids and fat, but what if that sugar is turning off the ketones. There actually is a keto-compatible TPN where you don’t add sugar or dextrose right away. After traveling to a couple of meetings, one in London, the Public Health Collaboration, and one in Switzerland, called Keto Live, I’m hearing stories now of doctors using TPN without sugar. It would be similar to just allowing someone to not eat at all. They would get the ketones generated. Have you ever heard of keto-compatible TPN?
Dr. Tro Kalayjian: I’ve had to work with some companies making parental nutrition and TPN. They’ve come to me with advice. I know it’s been on the horizon. I don’t know if it’s even out on the market yet or being done or tested.
Dr. Eric Westman: The box that’s already there is for children with seizure disorders to avoid a seizure by stopping the ketones. But now I’m talking about anecdotes of reversing serious conditions that no one else could reverse to the point that the people were starving with gastroparesis. There was something about allowing the ketones to be generated that reversed that problem. I wanted to show that not only with food but with intravenous feedings, we have certain ways of going about things. Do you remember the days of TPN?
Dr. Tro Kalayjian: That’s like a horror story – when we had to sit down and calculate and figure out what we were going to be giving to people who can’t eat. So, TPN is like, let’s say you had an issue where you could not digest or could not absorb food, or maybe the gut needed a rest, or maybe the gut was in shock, and we needed to get you nutrition, we just put it through the IV.
Of course, there would be infections that would come. I remember fungal infections would be the big one that comes from TPN. But we had to figure out how to give nutrition. It’s the part of medicine that’s probably the most arcane, like apprentice-follows-the-master type of medicine. You have to calculate what somebody needs and then give it.
Dr. Eric Westman: In my training in the ’80s and ’90s, there was a time when we let people not eat for a few days or a week. Then the pendulum swung so far that everyone who hits the door needs some kind of feeding right away so you can get them out of the hospital. But when I reflect, not feeding someone allows people to generate ketones. The unintended consequence of feeding someone immediately with sugar is that you turn off ketones, which might be helpful for heart failure, sepsis – all these different things. I’m hoping, especially at the patient level, that if you have someone who’s been on TPN for a year – unable to digest at all – you can’t be on TPN that long for the infection risk.
Dr. Tro Kalayjian: Let’s even go to regular nutrition in hospitals. If you’re on tube feeds, it’s a disaster. It’s basically corn syrup, maltodextrin, sugar, and corn oil or soybean oil, plus vitamins. This is what they’re giving to people with sepsis, in feeding tubes, in people’s noses, if you can’t eat. The diabetes formula of that just has about 20% less sugar and high-fructose corn syrup. It’s still garbage.
Here’s the worst part: those companies that make those, like Abbott Nutrition, also make the baby formula in this country – which is no different. It turns off ketones right when you go to bottle feeding.
Dr. Tro’s Podcast
Dr. Eric Westman: Switching gears a little bit – you decided to create the Low Carb MD Podcast. Tell me about that and why.
Dr. Tro Kalayjian: Eric, you’ve had Duke behind you, you’ve published studies, you were the president of OMA (Obesity Medicine Association). I’m a punk kid coming out of residency, talking smack on social media. In 2018, Medscape wrote an article about me saying, “This doctor called fruit ‘poison.’” It was a hit piece. I needed an outlet to interview people, learn, get smart people like you out to the lay public. This was before Joe Rogan and YouTube really took off. We’re still going strong – 400 episodes in, 20 million downloads. It’s great, but I’ve set my sights on other things.
I’ve published, we’ve published together, I’m adding to the literature now, not just for metabolic health. We wrote that paper against the AAP and the American Academy of Pediatrics, and the fact that they’re taking government money now and saying that kids should not do a low-carb diet or cut sugar – unless they do 23 blood tests to monitor safety.
The GLP-1 drugs? You can just start those. There’s no mention of checking labs, despite the fact that calcitonin rises in a big portion, and there are links to thyroid cancer. We’re in an era of gaslighting medicine. Back in 2018, when I was calling this stuff out, it was so controversial. I said food and the ketogenic diet improve addiction, and doctors said I should have my license pulled. Medscape wrote that I was a quack doctor saying fruit is poison. Just this past week, Medscape wrote that I’m revolutionizing obesity care. It took eight or nine years.
Dr. Eric Westman: That’s because you hung in there.
Dr. Tro Kalayjian: I’ve had people like you tell me to calm down a little.
Dr. Eric Westman: No, you have to. I remember a mentor of mine – I asked why he was so frenetic all the time. He said, “If you’re not frenetic, nothing ever gets done.”
One of your presentations was so memorable for me because it had a systems view and brought in the idea of addiction. Many doctors told me, “Eric, you weren’t overweight and obese, so you don’t know.” But I listen to a lot of people. My story is, I heard two of my patients had success, and I went down that path.
Addiction
Dr. Eric Westman: Switching now to addiction – from your own experience and now teaching other people and now to a journal article that just came out. Tell me how you communicate this.
Dr. Tro Kalayjian: I don’t know if you remember, but my first case series was with Shabbani Seth and you, back in 2019 or 2020. This came after the internet was asking, “Who is this guy saying that people could be addicted to food?” We published that case series because the ADA and dietitians say you can’t restrict food in eating disorders, and food addiction and binge eating are very clearly eating disorders. They don’t want you to restrict food. I don’t want to say it was silly – it’s a good thought. If you restrict somebody, you’ll cause them to compulsively eat that thing you restricted later. Fast forward – we’ve had a committee agree on the definition of ultra-processed food addiction. We now have a defined diagnosis of binge eating. It’s important to have these definitions because it governs how we cover them and communicate as doctors.
We all know food addiction when we see it. The patient comes in saying, “I’m a chocoholic,” and is eating chocolate despite having an amputation six months ago. That’s an example. The hallmarks of addiction are the three C’s: loss of control, compulsion, and continuing to use despite consequences. The problem is, it’s super complicated. The average person coming to us is probably 50 to 60 years old, predominantly female – maybe two-thirds female, one-third male. They’ve lived a life of restriction – rice cakes, watermelon diet, pea soup diet, banana diet. By the time they come to us, they’re nutritionally depleted. You were talking about choline – choline is just one. Their B12 is low, I’ve seen single-digit vitamin D’s. Food addiction is directly related to a nutritionally, mineral-, and protein-deplete society.
If you address the food, it probably does 40 to 50% of the work. Give somebody healthy food, and their relationship to food will improve. That’s one part. Then allow them not to partake in our modern food environment – that’s intermittent fasting. You can abstain from our food environment. Everybody talks about this. How many conferences have you gone to where some doctor says, “It’s our food environment,” and then the next sentence is, “How do you feel about intermittent fasting?” Oh, it’s an eating disorder. Intermittent fasting is literally saying you can abstain from our food environment. You can abstain for this certain amount of time. These modalities offer some fighting chance to food addiction.
Then there’s the emotional component and the psychological component. I’ll give you an example. I care about my car. I care about my health. My wife, the other day, saw that I had a flat tire and said, “Tro, don’t drive. I just saw that you have a flat tire. I’m worried about you. Just take a look at it before you go and just don’t drive until we get it fixed.” And Eric, I felt like, “Oh my God, this woman loves me. She’s just looking after me. She cares about me. She’s supporting me.” I felt gratitude. Just last night, my wife was like, “Why don’t you put those salted almonds down?” And I was like, “Who are you to tell me what to do?” I was angry. I felt anger, agitation, and stubbornness. If you look at my feelings – it’s the same thing. My wife cares about my car. My wife cares about me. She’s telling me, “Don’t do that thing that’s going to potentially harm you.” Not that there’s anything wrong with salted almonds, but she knows I can overdo those. Look at the emotional reactions. When I feel support and gratitude because she found a flat tire, I fix the car. When I feel anger, agitation, opposition, defiance – what do I do? I doubled down. I eat even more. “You can’t tell me what to do.”
These emotions – we don’t control them. We think we’re in control. Everybody wants to blame themselves: “I have willpower, I need to do better, I need to do this.” But you didn’t choose that emotion. You didn’t choose to feel stubborn and oppositional. You didn’t choose to get angry when somebody said, “Don’t eat that.” You didn’t choose that – you’re left to reconcile that. It’s not a choice. You have to deal with the fact that the emotions came. That’s part of food addiction. The emotions aren’t in line with what you want to do. I don’t want to have excessive nuts, but my emotions aren’t supporting it. The solution is very easy: just put the nuts down and thank your wife. The addiction gets into cycles.
Dr. Eric Westman: I remember a book with the existentialist, The Little Prince. The Little Prince goes to different planets and they lampoon different people on different planets – meaning you’re not talking about people on Earth. But he goes to the planet with the alcoholic on it and asks, “Why do you drink?” The alcoholic says, “To forget.” “To forget what?” “To forget that I drink.” So you get into a cycle: I’m angry because I’m not in control, but the anger makes me not in control.
Dr. Tro Kalayjian: 100%. When you eat the almonds, you feel like crap. And when you feel like crap, you eat more often.
Dr. Eric Westman: I had the benefit of starting my weight loss career at a residential fitness program here at Duke. The Durham area had three programs at the time, all with different kinds of food. The Duke Diet and Fitness Center also had rich clients come to town – they would spend a week or a month. I saw people who were in total control of their financial world and jobs, yet had a total lack of control with food. It was not just steak – it wasn’t that they lacked quality food. These people had personal chefs, and yet they couldn’t get over this addiction. Addiction is not just to food. In my mind, it’s to sugar.
Dr. Tro Kalayjian: I think sugar is the main component. Sugar and processed carbs.
Dr. Eric Westman: Pasta, rice – these all digest to sugar. Starch gets digested to that. Nuts are a little different because they’re super low in carbs. But at conferences, I’d ask people, “How many of you have trouble with nuts?” At least half the people couldn’t control nuts. So what is it about nuts?
Dr. Tro Kalayjian: Nuts and cheese are unique, but they’re problematic. Dairy in general is problematic. Food is a poly-substance addiction. There’s sugar, carbohydrate, processed fats, salt, sweeteners, additives. I just wrote a post about this. I said the absolute healthiest way for me to gain weight is to eat nuts and cheese. Nuts are a combination of carbs and fat – just enough carbs to keep you going. I think it’s also the way we eat them; they’re salted, they’re roasted.
Dr. Eric Westman: What is it about cheese?
Dr. Tro Kalayjian: Let’s go back to evolution. Quick little story: this is about a decade ago, my wife went to Costco and she got a Costco pack of peanut butter. She took everything out the car and I helped her and everything but I guess we took out this big multipack of peanut butter and we left it outside. The next day, a squirrel had chewed through the plastic of the peanut butter jar and ate the entire jar of peanut butter. Is that squirrel addicted to peanut butter? Does he feel shame and guilt? Is he doing it to self soothe? I think these are important questions that make food addiction a little unique compared to other addictions. It’s complicated. I’ve never seen a squirrel eat a couple of acorns and then just stop. They stuff their faces and they hide and sneak acorns into stashes. There’s something about nuts. I’m not sure that we know what it is but certainly what we know is the carb-fat combination, the roasting, and the salt makes these all really amazing.
With dairy, if you look at it evolutionarily, the purpose of this thing is to make another mammal eat. We’ve processed food to make it more edible and likeable. Evolution has made this thing so that a baby latches on, doesn’t stop, and goes back to it. How does it do it? There’s talk of casomorphins, maybe having some opiate-like properties. It’s carbs and fat also, so maybe that’s the issue. Is it the type of fatty acid that differentiates both of those versus meat? That’s another thought. I don’t know.
Dr. Eric Westman: I worked for years with a nicotine expert; his contribution to the field was the non-nicotine parts of smoking. It was the behaviour of smoking. It was about having a ritual of things to do. It wasn’t just nicotine. What about the behaviour of eating? Some people find the consummatory behaviour – the crunch, filling the stomach – attractive. Getting to the milk, it’s the consuming of the milk and the food. As the son of a psychiatrist, I know that there’s a lot of baggage with food. I never thought of dairy as being something that was connected to breastfeeding, for example. That’s like the child psychiatrist’s bailiwick of all the consequences of that connection.
Dr. Tro Kalayjian: You hit the nail on the head. We’re brought into this world with soothing. Baby cries, baby gets bottle. Toddler cries, toddler gets ice cream. It is the easiest way to get happy hormones in our modern world. If you look at the ways that we get pleasure or fulfillment – prayer, meditation, exercise, community, laughter with friends – all these things are gone or going. We are left to get our happy hormones from if it’s not connection, if it’s not laughter, if it’s not prayer, meditation, or exercise. If you take my eight-year-old kid and you lock him in, you prevent him from exercising, his mood goes down. If you take him away from all his friends, his mood goes down. If you take away his routine or discipline, his mood goes down. If you give him garbage food, what happens? His mood momentarily goes up and he’s desperate for that food now because he’s so low in dopamine and other hormones like serotonin.
What you’re describing with your father being a psychiatrist and the fact that we all go back to childhood. A lot of this stuff does go back to how our society works and what’s happened. We have a dopamine-deficient society. That’s why we crave it. We’re not getting what we need.
Dr. Eric Westman: For the older patients in our office, so many of them told me that when they were ten years old they were put on Weight Watchers. Weight Watchers did not do a great job of limiting carbs during that era. They rarely did Atkins or low-carb because it was seen as bad for you. If you’re told your whole life that you have to eat these things that don’t make you feel good and you’re struggling to find all these other ways to feel good, isn’t there hope that if we teach that it’s really too many of those carbs and we get back to the reasonable way of eating for children, this could change fairly quickly, couldn’t it?
Dr. Tro Kalayjian: I’m very pessimistic. We have an amazing job. Ten years ago I was miserable, hurting, in pain, and hungry all the time. Now, people come to me and say, “You have so much discipline – you haven’t had bread or a slice of pizza in 10 years.” When you feel pain, you don’t want to go back. When you have suffered, it’s so easy for me. I would never stab myself. That connection that food means health, once you make a patient click with that, it’s very hard to go back.
We published in Frontiers earlier this year on weight loss at one year, which was 43 lbs, which was 15.5% of their body weight, which I was very proud of. I was talking to you, I’m like, Eric, metabolic health is like a blockbuster drug. We’re sitting on a gold mine. Our practice beats Ozempic. We showed that.
Dr. Eric Westman: And that was a workplace study, where a company hires your group to go in and help, which is fantastic.
Dr. Tro Kalayjian: Correct. We added on to that. We said, well, what happens to their relationship to food? That was this study in Frontiers Psychiatry; we published their relationship to food. It did exactly what you’d imagine. This multimodal approach focused on nutrition lowers binge eating, food addiction symptoms and severity by 45%. 80% of people either modestly improve or significantly improve for binge eating and food addiction symptoms. How does that relate? Because the average person out there may not know how that relates.
A calorie-restricted diet will not help food addiction symptoms at all. Let’s say for binge eating, the starting dose of amphetamines helps binge eating by about 40%. Our intervention, the multimodal, interactive clinic with remote monitoring and what we do – texting, online visits, the app – improves binge eating more than amphetamines. Those amphetamines cost $200–$300 a month and they come with side effects: you can’t sleep, you’re hopped up. It’s not an all-or-nothing.
With GPL-1s, we’ve had so many patients for whom they’re no longer effective or they never worked, or they couldn’t tolerate them due to nausea. What do we do for them? GLP-1s lower these symptoms by about 40–60%, a little bit more than what we saw in our program. If you analyze all the data – do a systemic analysis of these interventions – we’re within striking distance, and at a fraction of the cost. And in this particular food addiction and binge eating study, five people came off GLP-1s and two people started on them. So basically, we’re net negative. It’s not like people can say, “Well, what if it’s the drugs causing the effect?” No – we stopped these drugs in more people than we started them.
It just shows what we showed back in 2020, which is: actually, real nutrition – giving people choline, one of the nutrients from the ketogenic diet, protein, all the minerals, B12 – if you give them these foods and do it in a supportive environment, their symptoms improve. And you don’t have the 40% muscle loss that you would with a GLP-1 drug.
We have now a dedicated GLP-1 off-ramp program focused on exercise and sustaining a diet. And then we have a food addiction recovery program that’s putting all these things into an organized pathway. I’m just trying to take that next step and next step. Hopefully, one day somebody will say, “Let’s give this crazy guy a couple million dollars, and Eric, and they can go do a study.”
Dr. Eric Westman: Dr. Atkins said to me, “Why would I want to do a study? I’ve been doing this for 30 years.” This was in 1998. He had a point. This already works and a study would just be helpful to convince someone else.
Toward Health
Dr. Eric Westman: How do people find your company now?
Dr. Tro Kalayjian: Toward Health is the company. If you want to help decrease health care costs and improve health care awareness and metabolic health, you just want to improve this in the workplace, contact us. We work with 10 companies now. We have a free app. We do a lot of free stuff: the Toward Health app, YouTube for free, podcast for free. Utilize our free stuff.
Dr. Eric Westman: I have to dream just a little bit. I hope that you and the company, in your approach – which is very similar to the Virta model, high-touch, connected – I hope it has that same success. Virta is targeting type 2 diabetes, I think, and now obesity with GLP-1s even, but you’ll be able to help people who don’t just have diabetes, right? You’re not targeting just that group.
Dr. Tro Kalayjian: Yeah. We are a chronic disease company. We’re basically a “get healthy, get off drugs” company. If you’re in the employee wellness world, we tackle chronic disease. We want the highest risk, sickest patients with the most spend – that’s who we want. We want to get people healthy.
If you’re out there in the real world, we get you off drugs and we get you healthy. It’s hard to do because we’re very high touch point: everybody gets a health coach, everybody gets a medical assistant, you’re getting remote monitoring, remote scales, blood pressure cuffs, and CGMs.
Dr. Eric Westman: I think it’s extremely helpful. I wish everyone could have it. The idea of a self-insured company saving money – it’s a no-brainer. When I got into that for a moment of trying to market services like this, most companies outsource their health insurance. But if it’s self-insured, then explain to personnel that means they’re going to save the money directly that you saved them. Unlike health insurance companies that are middlemen. Is that your understanding?
Dr. Tro Kalayjian: Yeah, Eric, you got it 100% right. If you’re at a company with over 100 people, it’s more than likely your company is paying for all their health care costs. When I first started doing the employee wellness cohorts and papers, this was 2021, our first group was really sick, and we showed we were able to save about $4,000 a year just in drug costs. This was while their A1Cs went down 1%, while stopping medications, while losing 30 pounds, while blood pressure came down 17 points. Virta is just doing diabetes; we’re looking at everything. If your reflux is better, let’s get you off reflux medications. If your mood is better, let’s taper the mood medications. Blood pressure is the easiest one – we saw a 17-point drop in blood pressure.
When we did our second study we took a pre-diabetic and overweight cohort instead of having diabetes. They were less sick. We still saved $2,500 a year in drug costs. So at this point, we don’t charge the company unless we produce results. We’re confident enough to do that. Self-funded companies love that because we have to get people healthy. We don’t have a choice. That’s how we get paid, so if you’re coming to see us, that’s the culture: I don’t get paid if you don’t get better. There’s no better relationship. Everybody’s interests are aligned.
The employees don’t pay anything for us. We work with 10 companies and the employees get this for free. We also have a direct consumer segment.
Dr. Eric Westman: That’s hard to beat!
Watch the full video here.
Speaker Bios
Eric Westman, MD, MHS, is an Associate Professor of Medicine at Duke University, the Medical Director of Adapt Your Life Academy and the founder of the Duke Keto Medicine Clinic in Durham, North Carolina. He is board-certified in Internal Medicine and Obesity Medicine and has a master’s degree in clinical research. As a past President of the Obesity Medicine Association and a Fellow of the Obesity Society, Dr. Westman was named “Bariatrician of the Year” for his work in advancing the field of obesity medicine. He is a best-selling author of several books relating to ketogenic diets as well as co-author on over 100 peer-reviewed publications related to ketogenic diets, type 2 diabetes, obesity, smoking cessation, and more. He is an internationally recognized expert on the therapeutic use of dietary carbohydrate restriction and has helped thousands of people in his clinic and far beyond, by way of his famous “Page 4” food list.
Dr. Tro Kalayjian, founder and Chief Medical Officer of TOWARD Health, is a board-certified physician in Internal Medicine and Obesity Medicine. He is a founding member of the Society of Metabolic Health Practitioners. After losing 150 pounds by challenging conventional medical advice, Dr. Tro is now dedicated to helping others reclaim their health, reverse chronic disease, and reduce dependence on medications. His ultimate goal is to help patients improve their health, manage disease, and reduce medication through sustainable lifestyle changes focused on nutrition, movement, and mindset.
Medical Disclaimer
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