The Duke Keto Medicine Clinic, founded in 2006 by Dr. Eric C. Westman, offers a medically supervised approach to the ketogenic diet for individuals seeking weight loss and management of various health conditions. Dr. Westman, an associate professor of medicine at Duke University Health System, combines clinical research and patient care to provide lifestyle treatments for obesity, diabetes, and related metabolic disorders. The clinic distinguishes itself by emphasizing an evidence-based strategy, contrasting with the often-misleading information found online.
About Dr. Eric Westman
Dr. Eric C. Westman is an internationally recognized expert in low-carbohydrate nutrition and ketogenic diets. He is board-certified in Obesity Medicine and Internal Medicine. He has dedicated over two decades to helping patients reverse obesity, type 2 diabetes, and other metabolic diseases through nutritional therapy. His expertise has led to co-authorship of several books, including "The New Atkins for a New You," "Cholesterol Clarity," "Keto Clarity," and "End Your Carb Confusion." Dr. Westman is also the co-founder of Adapt Your Life, an educational and product company promoting low-carbohydrate principles.
The Duke Keto Medicine Clinic Approach
The Duke Keto Medicine Clinic provides medical supervision and lifestyle counseling for individuals with chronic conditions such as obesity, diabetes, and heart disease who are interested in pursuing weight loss through the keto diet. The clinic's approach is rooted in clinical research and aims to deliver safe and effective lifestyle treatments.
What is the Keto Diet?
The ketogenic diet is a low-carbohydrate, high-fat diet that shifts the body's primary fuel source from carbohydrates to fat. When carbohydrate intake is significantly reduced, the body enters a state called nutritional ketosis, where it begins to burn fat for energy, producing molecules called ketones. Studies suggest that increased ketone levels may help suppress appetite, leading to reduced hunger and increased satiety.
What to Expect
At the Duke Keto Medicine Clinic, the initial consultation lasts approximately 45 minutes. During this visit, the doctor will conduct a physical examination, review the patient's medical history, and discuss their goals and expectations for the diet. For patients taking insulin, the doctor will explain how to adjust the dosage as the diet rapidly lowers blood sugar levels. Lab work is performed to screen for any medications or conditions that may contribute to weight gain. Patients are also informed about the potential side effects during the initial phase of keto adaptation, often referred to as the "keto flu," which may include headaches or fatigue.
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Follow-up visits are scheduled every one to two months to monitor progress, address any challenges, answer questions about energy levels, and ensure adequate nutrition. The doctor will provide ongoing education and recommend food substitutions to help patients adhere to the diet. They will also address common concerns such as constipation, muscle cramps, or hair loss if they occur.
Key Components of the Evidence-Based Keto Diet
Dr. Westman emphasizes an "evidence-based, low-carbohydrate, ketogenic diet" that differs significantly from the often-misunderstood information found online. This approach includes:
- Unlimited consumption of meats, poultry, fish, shellfish, and eggs: Patients are encouraged to eat these foods until they are "comfortably full."
- Generous intake of vegetables: The diet includes up to 2 cups of raw leafy greens and 1 cup of raw non-starchy vegetables.
- Limited amounts of high-fat foods: Cheeses, creams, oils, and olives are allowed in moderation.
- Moderate amounts of zero-carb snacks: Sugar-free Jell-O, pepperoni slices, and low-carb jerky can be included as snacks.
What to Avoid
Dr. Westman cautions against certain practices and foods that are commonly associated with the keto diet online but are not part of his evidence-based approach. These include:
- Measuring ketones: Dr. Westman does not consider ketone measurement essential for success on the keto diet.
- Relying on apps or devices to count protein: While these tools may increase ketone levels, they do not always account for calorie and fat content.
- Consuming excessive amounts of "keto-friendly" treats: Dr. Westman warns against overindulging in high-calorie, low-carb treats, such as keto-friendly cupcakes, as they can hinder weight loss.
- Intermittent fasting: While acknowledging that intermittent fasting can aid in weight loss, Dr. Westman states that there is insufficient data to recommend it as a standard practice.
- Nuts and almond flour: Due to their potential to be "trigger foods," nuts and almond flour are generally not recommended.
- Excessive consumption of vegetables: While vegetables are included in the diet, their carbohydrate content should be considered. The maximum amount of carb consumption on the keto diet often ranges from 20 g to 50 g daily.
- Over-reliance on "net carbs": Dr. Westman suggests that focusing on net carbs can hinder progress, especially for individuals with diabetes or significant weight loss goals.
- Artificial sweeteners: Dr. Westman likens artificial sweeteners to "methadone or suboxone maintenance" for sugar cravings, suggesting they may not be the best long-term solution.
Benefits of the Keto Diet
Duke research has demonstrated that the keto diet can be effective in reversing diabetes and lowering blood pressure. People who follow the keto diet with medical guidance can expect to lose about one to two pounds per week. More broadly, evidence supporting the keto diet’s benefit to patients with various forms of CVD, as well as diabetes, obesity and polycystic ovary syndrome, has grown over the past century.
Addressing Misconceptions
Dr. Westman actively addresses the many misconceptions surrounding the ketogenic diet. He emphasizes the importance of obtaining information from reliable sources and following an evidence-based approach. He cautions against relying solely on internet-based information, which can be confusing and inaccurate.
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