If you ask people who watch their carbohydrates how many you can eat, you'll get dozens of answers. Dr. Eric Westman and Amy Berger help you end your carb confusion.
Dr. Westman is an associate professor of medicine at Duke University. He is board-certified in obesity medicine and internal medicine and founded the Duke Keto Medicine Clinic in 2006 after eight years of clinical research regarding low carbohydrate ketogenic diets
Amy Berger is an Air Force veteran and certified nutrition specialist who specializes in helping people do keto without the crazy. She has a master's degree in human nutrition and writes about a wide range of health nutrition-related topics such as insulin, metabolism, weight loss, diabetes, thyroid function, and more.
Let's Say Hello
[00:00:50.270] – Allan Raz, how are you doing?
[00:00:54.250] – Rachel Good, Allan. How are you today?
[00:00:56.020] – Allan I'm doing well. We made it back down to Panama in one piece. Travel issues all the way along, running away from/dodging Covid, as I talked about earlier, because it just seemed like the caseloads that were really picking up. And we're seeing that now with the reporting on the news and all. But, you know, we're back here, case loads on the island and across most of Panama are reasonable. But, it just it's going to be here till it's not.
[00:01:22.900] – Rachel Right.
[00:01:23.330] – Allan We've got to take one day. And I know they're doing, you know, shutdowns again. And as we're going through this. And so I know it's really hard on folks right now. But, keep your chin up. Keep focused on New Year's coming. You can get through this where you've gotten this far. You can get through this. I just, you know, put your sights on what's important to you, your family, your health. And if it's your fitness, find ways to do it at home.
[00:01:47.750] – Rachel Mm hmm. That's right. We didn't come this far to come this far. So we can just keep it up and we'll get through the holidays and into next year. It'll be great.
[00:01:56.650] – Allan So how are things up in Michigan?
[00:01:58.630] – Rachel Cold, like, if I could, we haven't seen a ton of snow quite yet, but I know some places around us are getting it. So I'm I'm looking forward to the snow because if it's going to be cold, it might as well be pretty. And running in the snow is pretty entertaining for me as well. So I'm looking forward to that.
[00:02:18.810] – Allan Just watch for the ice. Particularly early in the season and late in the season where you get that melt and then refreeze and then snow on top. Just mind your footing.
[00:02:29.980] – Rachel That's right.
[00:02:31.900] – Allan Our guests today are actually pretty cool. I've met both of them at Ketofest and talked to both of them at Ketofest. And I've had both of them on the podcast before, Dr. Eric Westman and Amy Berger. So why don't we go give them a chat?
[00:03:28.840] – Allan Amy, Dr. Westman, welcome to 40+ Fitness.
[00:03:32.080] – Dr. Westman Thank you.
[00:03:32.920] – Amy Thanks. Thanks for having us.
[00:03:34.180] – Allan Well, Amy and I have to say welcome back because I have had you on before, so it's really good to see you two again and to be talking to you. You know, we've met at Ketofest and spent a little bit of time talking, so I'm very familiar with your work. And I was really excited to see the new book, End Your Carb Confusion: A Simple Guide to Customize Your Carb Intake for Optimal Health.
[00:03:55.000] – Allan And it's kind of a it's a keto book obviously, when we talk low carb, most people are going to get into ketosis at some level. But this is this is something I think that makes it simple. So many carbs. They want simple rules. But you actually took the process and said, hey, we're not going to give you a cookbook, we're not going to do it. We're just going to say, look, here's how you understand what carbs are doing to you.
[00:04:18.580] – Allan And here's a layout of a plan. And I think having that plan walks them through. It's like these are the foods you can eat. These are the foods you stay away from and you give the reasons why. I just think that is so very well put together. Book to end carb confusion.
[00:04:34.300] – Dr. Westman Thank you. You know, we have been working in the low carb space and yes, I'm known as the keto Guy. As a researcher, I helped to validate the low carb diets over the last twenty years. And but I also realized there are a lot of other ways to go about things. And I'm in a clinic treating people grounded. And I think that's helped me understand that there are a lot of ways, there are a lot of carbs that some people can eat.
[00:05:03.010] – Dr. Westman But in fact, I have a brother who can eat all of these carbs and he's never gained weight. So using kito diet in the clinic and the book, I would say it's keto and more. And we never say you have to do keto and we help you find out whether you do need it or not. And I have tried to bring in really the science not just from my own research, but the science on low glycemic diets, the science on just the lower carb types of diets that have come out well over the last twenty years.
[00:05:36.580] – Dr. Westman But yes, I am an author on the new Atkins for a new You and keto clarity. And but this is my first solo venture. I'm trying to bring in all of the information I've learned from other researchers as well. I look to Christopher Gardner at Stanford, David Ludwig at Harvard, and the common theme is sugar is the bad guy, not fat.
[00:06:03.490] – Dr. Westman And so knowing that I'm in a clinic still and busy, I teamed up with Amy Berger, who is a professional writer, I'm not. I'm a researcher and a scientific writer. And so Amy had a way of articulating the same ideas in a very readable format. So you're not going to be reading a lot of my words. They're also Amy's and she's been in this space for just about as long as me, not in the research world. But so I'm really trying to bring the knowledge that I've gained into a readable form.
[00:06:38.560] – Dr. Westman And this, I hope, is for the general public to read. It's not, you know, low carb. Or I'm going to lock you up in a low carb prison. It's understanding how can my brother eat one hundred and fifty carbs a day and still be healthy? You know, it's understanding that.
[00:06:57.460] – Allan Yeah. And Amy and Dr. Westman. Yes. That's the one thing I would say about this book is it didn't bury me in the science because a lot of books do. It was very clear. And I think, you know, for someone who's looking at this space and has just gotten scared or confused and again, don't they don't understand why can my significant other eat that way and not gain a pound? But I look at a donut and, you know, so it's very well done. I really appreciate it.
[00:07:29.440] – Allan Let's take that conversation about sugar a little bit further, because for decades, just stay away from fat, stay away from fat, stay away from fat. And the food companies were really nice about making the food taste good by just replacing the fat with sugar. And that's been horrific on our help. Can you explain what exactly is going on in our body when we're ingesting too much sugar?
[00:07:53.590] – Dr. Westman Sure. You know, we really rediscovered or gone back to one hundred years ago when this was all well understood. It's like we came through a period of time where it all got messed up, the focus on fat and the food. And so the understanding, of course, is deeper now. But it's been known for a long time that if you eat or drink sugar, you raise the blood sugar or glucose more specifically, and then that causes an insulin response in the body.
[00:08:24.070] – Dr. Westman And it's glucose insulin response, we now understand, is the root cause for the atherosclerosis or the heart disease, the stroke, the kidney disease and diabetes. Of course, diabetes is defined as an elevated blood sugar. So patients again, I teach this in a clinic in North Carolina where I have to have a lot of different people understand what we're talking about. And they understand that if you drink sugar, like sweet tea, it raises the blood sugar. And why we've forgotten that is a whole other story.
[00:08:59.590] – Dr. Westman But we start the book by talking about how things aren't perfect now. The focus on fat does not solve our problems. And the real reason is what sugar does in the body, sugar and insulin, glucose and insulin.
[00:09:15.050] – Allan You know Amy, as I was into the book and we got into we got into the discussion of glycation, I think that's that was some of the, I guess, a wake up word for me. You know, when your blood gets sticky, bad things are going to happen.
[00:09:27.640] – Amy Yeah, that's it's kind of an oversimplification, although kind of like you said, I mean, the subtitle of our book is A Simple Guide to Customising. You know, Eric and I both are frankly stunned at how complicated a very simple way of eating has been made out to be the last few years. So we we purposely wrote this book to appeal to a very broad audience, you know, maybe to be appealing to the people on Twitter and Facebook and Reddit that eat, sleep and breathe keto and low carb all the time.
[00:10:03.430] – Amy But also, this is the book to give to your mother or your cousin, the one that has obesity or has diabetes. But they're never going to do a keto diet. They're never going to learn about Amthor and Autophagy and all this stuff. They just want to feel a little better. And anyway, with the with the glycation, you know, we we try to explain everything without the scientific jargon and the gobbledygook. It's all written in plain English.
[00:10:29.290] – Amy And we explain why glycation is basically for people that don't realize that diabetes is really a vascular disease. It's a blood vessel disease. Cardiovascular disease is the number one actual cause of death in people with Type two diabetes. And this is why people with diabetes have so many problems with the eyes and the kidneys, because these organs or these tissues have tiny tiny, very, very fragile blood vessels, and when your blood is, for lack of a better word, very sticky with sugar and viscose, think of it like instead of water flowing through your veins.
[00:11:04.350] – Amy Now you've got molasses trying to flow through your veins. Your heart's trying to pump this sticky sugar. And not only is a blood sticky, the blood vessels are mocked up and gonked up with sugar. The whole system is just more fragile. And this this is the root of many of the problems that people with diabetes have. But something that we really harp on in the book that is like a huge mission for me to help educate people about is that even when your blood sugar is normal so you don't have diabetes or prediabetes, your blood sugar can be totally normal.
[00:11:40.050] – Amy But you might have a lot of these problems because you have really high insulin. The reason your blood sugar is normal is because that insulin is keeping it in check. So whether or not your blood sugar is normal, you still might be living with this long list of issues that come from these metabolic problems driven by by consuming too much carbohydrate.
[00:12:01.590] – Allan Now, there's a phrase you used in the book, and I've used it and I've heard it before. Some of us can tolerate more carbohydrates than others. And you use the term carbohydrate threshold. Can you talk through that and why that's important for us to understand for ourselves so we can actually have a plan. Because I think so many people go in and say, well, you know, initially this was always advertised as the bacon diet because everybody was all excited they were going to get to eat bacon again.
[00:12:28.920] – Allan And then, you know, then it was the butter in your coffee diet and then it was the MCT oil and now it's exogenous ketones and it's, you know, but simplifying it. We've got to take it back down and understand this is going to be somewhat of an experiment of N = 1 where you're the subject and it's what you can eat, what you can tolerate. That's going to be the most important thing. So can you talk about that concept of carbohydrate threshold and how it affects how we would approach the adapt your life way of eating?
[00:12:58.170] – Dr. Westman This is a scientific genetic predisposition that we're talking about and we can put people in the right direction. So we have a questionnaire you complete to see if you're going to be someone who has more carbohydrate intolerance or a lower carb threshold to achieve good health or you have a higher carb threshold. And so we have a checklist of items to look at, but it's not perfect. There is some trial and error there. And we've explained that. And this is what I do in my clinic.
[00:13:30.610] – Dr. Westman I'll start people out at if they're trying to lose weight at a very low carb level and then help people to introduce carbs, if they want to find their threshold. And we are shying away from the high tech use of ketones and blood measurements and breath. And you know, the watches, the digital watches that are non-invasive and you get ketones then, I think it would be reasonable but we don't ask anyone to do high tech measurements.
[00:14:02.250] – Dr. Westman It's predicting what direction you should be in and then monitoring how you do. And so it's a genetic predisposition. I mean, it's as if what helped us survive in famines when there was no food around is now a liability so that those who are good storers of the extra energy are the ones who have the lower threshold of carbs. So you're going to hold on to it more. Of course, the more active you are, the more carbs you can have.
[00:14:31.800] – Dr. Westman That's the the family member I have who is very active, can eat more carbs and is very healthy. But the threshold is really important in terms of the metabolic health and we help people find that out. And when I kind of step back, this is one of the first books to embrace a wide range of carbohydrates in the diet, acknowledging and recommending a wide range. But it's a lot lower than has been recommended if you're doing high carb types of diets in the past. But the carb threshold is really important and we are not using high tech ways for you to figure that out.
[00:15:11.200] – Amy If I could just chime in quickly. I think we do have a range, but even our highest recommendation compared to a standard type Western diet is lower. But I think the reason, Dr. Westman, is an obesity medicine specialist and I think we talk a lot about weight, but in that checklist we have where people can help and determine what level they should be starting at. Weight is only a tiny piece of this. There is so many issues that you can be dealing with, even if you're at a quote unquote normal weight.
[00:15:42.390] – Amy I hate that phrase, but a normal weight if you're not carrying excess body fat. But we do start depending on your medical situation, we start most people out at the very lowest level. Because when your carb intake is that low, like Dr. Wiseman was saying you don't have to measure your ketones, you don't have to measure your blood glucose. You're going to be in ketosis. You're going to be fat burning at that level. Everybody will. And then who can also be fat burning and be healthy at a higher level is variable.
[00:16:15.650] – Amy But the reason we tend to start most people out at the lowest level is because it's the easiest way to do it. There's not a lot of guess work. You will be either ketogenic or burning fat at that point without weighing and measuring your food and calculating the macro. I mean, I love food. I love to eat. I refuse to turn my meals. I'm never going to open a spreadsheet when I sit down to the dinner table. Other people love to do that. And if you want to, great. But the plan that we've designed is designed so that you don't have to do any of that.
[00:16:48.410] – Allan Yeah, it's it's funny because some of the science that would come out in the past, they would say we're gonna have a low carb group and a high carb group and then, you know, a lot of people in keto space would argue and say, oh, well, that's that's not keto, that's not low carb. And I'm thinking, well, if they were eating two hundred and fifty grams of sugar per day before, one hundred grams of sugar actually feels pretty darn low.
[00:17:13.820] – Amy It's all relative. Yeah.
[00:17:15.360] – Allan Yeah. So and then one of the funny things would come out of a lot of those studies would be, well it's unsustainable. You know, so they're thinking, OK, no one can go down to twenty five grams and stay there for the rest of their lives. But there's people who've been doing it for decades. So yes, you can. Can you talk about the three levels of the adapt your life eating style so people can have a general idea of what each of those entails?
[00:17:40.110] – Dr. Westman Yeah, maybe I'll talk about the levels that you give, the detail on the different foods. I mean, that's that's another great thing about having a nutrition expert as a co-author on the book we make a good team. So again, it's kind of a rough these are cut points of numbers that are not written in stone. I can't imagine that there's an equation like Einstein that says this number represents this for everyone. But there's a phenomenon that we repeatedly see, and that is the lower the carbs, the more percentage of people will be in ketosis or have the metabolic effects of the ketosis.
[00:18:25.790] – Dr. Westman And so we have kind of, the other main point is we use total carbs, not net carbs, because it's more precise. It's it's more scientific. The net carb is a whole other kind of distraction. So we start at about a 20 total carb per day sort of approach. And actually, it is very sustainable, as you say, if you learn how to do it right. And then we found that in other studies have used carbs up to about 50 per day.
[00:18:53.520] – Dr. Westman And again, this is kind of a general rule of thumb. And then we have stories of people who are using these different levels in the books, in the book. And then for those who are very active, they're younger they might be cyclists doing competitive cycling. They are able to be healthy at a much higher carb level. And we again, the numbers not important is just a higher level, but with sugar being the bad guy now, not fat and the food, we have estimated that from clinical experience and studies, some people can have up to one hundred, one hundred and fifty grams of carbs per day and be healthy.
[00:19:34.580] – Dr. Westman I mean this and so this kind of explains the person that you see, how can they eat all that and why you don't see what they're doing in terms of other lifestyle things and the metabolic flexibility or the carbohydrate tolerance is the big factor now. It's not fat anymore. In fact, I would just want to comment. We don't really make any comment on fat being bad. And so you can eat bacon on this kind of diet, too, even if you're not.
[00:20:03.260] – Dr. Westman OK, so all we've got to sanitize the the idea that fat is is bad, then you're not going to read that. So we're resetting what someone should understand about food without even paying much attention to the old stuff that got us off track.
[00:20:22.430] – Amy I think something that's unique about our book, though, is that we also don't demonize carbohydrate. I mean, look look around the world, there are quite literally billions of people that eat rice they eat beans, they eat food, they eat potatoes, and they're healthy. They're lean, they live well into old age. And so for us to say that cantaloupe is poison or black beans are killing you is kind of ridiculous.
[00:20:46.880] – Amy And so but it depends on your health situation. You know, certain foods that might be perfectly suitable for one person are not suitable for the other person who has PCOS or diabetes or hypertension or whatever. But I think that's that's unique in that we acknowledge that you can actually eat carbohydrate, you know, and we also other than just recommending, OK, depending on where you're starting from, here's the carbohydrate level we recommend.
[00:21:17.300] – Amy I think, something that's also different and that hopefully people are hungry for, no pun intended, is that we explain how to gradually increase your carbohydrate intake if you choose to. Like we were saying, you can live at twenty or thirty grams of carbs for your whole life if you want to. But let's say you you do a strict ketogenic diet. You lose two hundred pounds, you reverse your type two diabetes, you reverse that, everything's great.
[00:21:45.500] – Amy Now what do you need to stay super strict keto forever or can you have that occasional sweet potato, can you have the occasional piece of fruit? And the answer is for most people probably, yes. And we we walk you through how to reintroduce that stuff slowly and systematically so that you don't regain the weight and you don't trigger a recurrence of all those health issues. But we're very clear that you don't have to increase the carbs. But if you want to, here's how to do it in a way that is most likely to work for you long term.
[00:22:18.980] – Allan Well, I practice a thing I call seasonal ketosis where I do get strict keto for a period of time, usually starting in February after my birthday. And I'll go pretty much until August in more of a strict keto way of eating. I call that my famine season and then rolls around football season and, you know, Thanksgiving, Christmas and my birthday, like I said, and then I go into my feasting season. So, you know, if I had to give it a classification, I would say I'm in level one for much of the year.
[00:22:49.250] – Allan And then when I'm ready to let loose, I'm in level three, but I'm still generally low carb at level three. But, you know, that's that's why I liked what you were offering there, because it does kind of give us that that flexibility to say if I'm meeting my goals, my health is good, I can I can let a little bit more carbs in and I can check and see how that's working for you, because you can always step back down to that level one if you need to. So, again, I really appreciated the way you put that forward.
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[00:24:31.030] – Allan Now, whenever anything gets cool, there's a profit to be made, companies are going to step in. So when fat became a problem, they start advertising low fat. When sugar became a problem, they started advertising low sugar. And when keto came along, paleo did it now, keto, they're suddenly going to be coming out with these keto friendly products and they're everywhere and they they have the right macros. So it's like, OK, this should be good. What one of the problems that we really have when you start looking at these commercialized keto products?
[00:25:03.850] – Dr. Westman Amy, you want to take this one on first?
[00:25:06.490] – Amy Well, yeah. So it's like you were saying earlier or I don't know if this is maybe before we started recording. Those things are great as a transition step. If you're not prepared to give up your cookies and your cake and your pie and your ice cream, better to have the keto version made with almond flour and arithmetical and coconut flour. And for some people, that'll work perfectly long term. For other people, because it's keto, it tends to be very high in fat, like it's made with coconut butter and oils and cream cheese.
[00:25:38.350] – Amy But it also a lot of these products contain a lot of sugar, alcohol and a lot of added fiber, not intrinsic fiber, but fiber that they add for bulk or texture. And so these products are allowed to be labeled as either keto or very low in net carbs. And the problem is that some people's bodies react to sugar alcohols, these sort of non sugar sweeteners almost as if they're sugar, not not quite as extreme as regular sugar, but they're still having a blood glucose and insulin response.
[00:26:09.100] – Amy And so not only are you having that response, but you're combining it with an item that's very, very high on fat. So these sort of, quote unquote, ice creams and keto cakes and stuff are one of the biggest reasons we see for fat loss not happening the way people want it to or for just things not progressing the way someone would want to. And I'm not opposed to these things, but you have to go by a result. If these things are a regular part of your diet and you're not happy with the results you're getting, that's one of the areas you would look to to maybe cut those things out.
[00:26:44.690] – Amy It's kind of like let me put it this way, when you were saying, like in the 80s when everything was low fat and it was loaded with sugar. Oh, I can eat the whole box because it's low in fat. People are doing that now with the heat. Oh, it's low carb. So I can eat the whole pint of ice cream. It's low carb. I can eat the whole box of cookies. Low carb does not mean low calorie.
[00:27:04.340] – Amy And I know we hate the C word in our community, but just because something's low in calories, you still have to deal with that food, just because it's low in carbs, that food, energy, those calories still have to be put somewhere.
[00:27:18.080] – Allan Yeah, and I appreciate you mentioning sugar alcohols because I've never been a huge fan of those. I think when you are you're trying to go low carb and you want to make it something that's generally sustainable. We don't allow our bodies to reset our palate. You know, we're used to eating all the sugar. And so we like things sweet. You know, ketchup has a lot of sugar in it. People don't recognize that because you barely taste that sweetness, because we've been, you know, I guess for like, we were programmed. You know, they put more sugar in and we eat more and they put more sugar and we eat more.
[00:27:49.130] – Allan Sugar alcohols, in my opinion, don't really give us that opportunity to really begin to taste the sweetness in Standard Foods. But that being said, I was I was standing in line with you, Dr. Westman, at keto Fest, and you said we need to do something, something we don't have to be perfect, but we just need to do something. And it's like, again, I take that back and say, you know, if you need a bridge, you know, these commercialized products or the sugar alcohols might be OK.
[00:28:17.150] – Allan But you need to put that in context of where you where your instate is, where you want to go. So thank you for that, because that was that was pretty profound standing at a dinner line with you, Dr. Westman.
[00:28:27.470] – Dr. Westman Well, you know, progress, not perfection, is kind of a general theme when you're helping someone that has a long journey and not only the sugar alcohols, I need them for the true carb addict to keep them away from sugar, sugar addiction being the most common carb that people are addicted to. But the other thing that I see in these products is they'll add the oils or to make the macros right. But then you well, at least when I drink them, I get stomach trouble.
[00:29:04.490] – Dr. Westman So I don't think these have been well tested. And certainly they haven't been in the clinical trials of keto so we're trying to go back to the real food idea. Don't add in these other products. And certainly if you're drinking something that gives you a stomach issue, that's not keto, that's the product.
[00:29:25.790] – Allan Yeah, well its a big thing. I tell people you know, one of the big tips for weight loss is don't drink your calories. So if you're adding fat to your coffee, you might like it that way. But in a general sense, you're adding calories to, you're drinking them. So it's not filling you up as much as you would think it would.
[00:29:43.730] – Dr. Westman There are all these new things new that have not been tested. You know, the idea of putting oils in the coffee and in medium chain triglyceride, it will raise your ketone level momentarily. But if you have then five of those over the course of the day, you're going to be stopping your endogenous fat burning. So, and you want ketones to come from your body fat if you're trying to lose weight. And so we explain that in the book that the way you look at these things is different, depending on what you're trying to accomplish.
[00:30:20.990] – Dr. Westman And I see a lot of people who really don't need the keto metabolism, but they're doing it because it's fashionable and then, you know, six months later, well, what do I do now? Well, they didn't need it in the first place or maybe one month later. And so that's how we can help you figure out with this book what carb threshold still is going to be healthy for you. So, you know, let's say you drank the keto Kool-Aid, but you really don't need it.
[00:30:48.530] – Dr. Westman We're going to help you figure that out. And on the other hand, if you're scared about keto, that's OK, we may actually end up convincing you or reassuring you that you can eat carbs, you can have fruit, you can have some bread and still be healthy. So we're trying to demystify it and also take the fear away of it. This the end of carb confusion and it might be able to end your carb fear or keto fear as well as a title.
[00:31:18.050] – Allan And one of the things you had in level one that I understood is, you know, we're going to have to if we're going to be less than 20 grams of carbs, that's pretty much going to negate fruit from that level. But what was interesting was you also negated nuts and cheese. And I was like, oh, well, you know, fat head pizza, you've got it. You know, it's just a cheese bomb. So, you know, everybody in keto eats cheese, right?
[00:31:43.160] – Allan That's the big thing we take away is the bacon and the cheese, but you also say we probably should be cutting back on the nuts or eliminating the nuts and the cheese while we're in this phase one. Can you talk about that?
[00:31:55.120] – Dr. Westman Yeah, those are probably the most common reasons that the kind of casual keto you read on the Internet, learn it from a friend, why it doesn't work for people. So if you do have a carb issue a carbohydrate intolerance, insulin resistance is the same same term prediabetes, then calories will matter and trigger foods can make you eat more of them so you overcome the calorie and carb limits. So implicit in our approach and remember, this is an approach that's been used over a hundred and fifty years.
[00:32:33.390] – Dr. Westman So it's really not all that new. But a common mistake is over consuming nuts, the cheese, the cream in the coffee or tea. So we do have and explain to why those things need to be limited. Fortunately, it's not hard to limit them once your appetite is gone. So it's not as an extreme. Oh, I can't give that up because as long as we as long as we've gotten started and your appetite is down, it's easier to make those adjustments.
[00:33:02.040] – Dr. Westman But those are common mistakes that we see. I'm doing keto, but it's not working, thats too many nuts, too much cheese and cream.
[00:33:11.300] – Amy And to be clear, those foods are suitable for a ketogenic diet. It's just if your goal is fat loss, those foods are just they call a hand to mouth or hand to mouth disease. You sit down with a bag of almonds and you're supposed to have an ounce. And before you know it, the bag is gone. And and the thing is also with nuts, I personally find they don't even fill me up. I can have half a bag of nuts and still feel like I barely ate anything.
[00:33:38.010] – Amy So nuts are actually not permitted at al on the lowest level of our diet. Cheese is permitted, but the total quantity is limited. And again, it's not you know, those foods are high in fat but low in carbs, but they're just so easy to massively overdo. And that's really why they're limited. And they are reintro, nuts and seeds are reintroduced on level two. So, you know, if you're someone that is very, very sick or very, very overweight, starting out, make it your goal to get to the point where you can progress to level two and maybe reintroduce those things.
[00:34:14.220] – Amy But yeah, that's yeah, that's I mean, that's really the rationale. Just because something is low in carbs doesn't mean it's going to be the best thing for you to eat.
[00:34:25.350] – Dr. Westman My clinical experience is quite a privilege and I've been involved in research and taking care of patients. And and it's also humbling because I'll have people come back and they look me in the eye and say it's not working. So I have to figure out why and help people. Usually it's we get a lot of information at first. And there's one little thing that didn't seem that big and all that. But still, you have to understand what we're explaining and presenting is something that really works.
[00:34:57.930] – Dr. Westman And it's been hammered through years of clinical experience and people looking in the eye saying, hey, you know, fix me. So this isn't just some off the shelf kind of rearrangement of foods, which I see, again, is another theme where you could be on the bookshelf and there are 15 different books and you don't know which one to start with. We're talking about one that has been vetted through clinical and personal experience for for a long time.
[00:35:30.750] – Dr. Westman So you can have that confidence. In fact, we were discussing in writing the book. Do we include scientific references even? And finally it came down to we don't have to. We don't we don't have one scientific reference in this because it's all proven. It's all you have to have a study that shows the sun's coming up tomorrow, you know, I mean, so, again, we want to make it simple, not distractor with the glit.
[00:35:58.620] – Dr. Westman In fact, books that have hundreds of references. I think sometimes they're protesting too much. But, you know, look at all the science, but no this is practical. It really works. And it comes from our experience with real people.
[00:36:12.540] – Amy And frankly, nothing, at least in my opinion, nothing that we say in the book is all that controversial. Nothing really needs to be backed up. Oh, well, here's a study that shows this crazy thing we're saying. Nothing, we're not even demonizing some of the things that others in the larger low carbon and keto space really worry about, like artificial sweeteners, not not the sugar alcohols, but things like sucralose and aspartame and saccharin, like Splenda, Sweet'N Low, that stuff.
[00:36:42.930] – Amy Because that really doesn't have the same metabolic effect as the sugar alcohols, it's almost negligible. Those things we don't fearmonger about the what they call the seed oils. If you're on a budget and you can't spend eight dollars for a bottle of avocado oil, salad dressing, it's OK for you to get the ranch dressing with the soybean oil. You can go to the discount store and get the the ground beef for three dollars a pound. It doesn't have to be grass fed.
[00:37:08.080] – Amy All that great stuff. The food quality local farms is fabulous if you can afford it. But this plan, Dr. Weissman's patients are the entire spectrum of financial resources, of educational level of socioeconomic status. This approach has to work for every single one of them, every race, every ethnicity, whoever walks through that clinic door, this needs to work. And so we're kind of like, we take all comers, whether you're a millionaire and you have a personal chef or you're going to go to the fast food drive thru and get the boneless burger, guess what? This is going to work as long as you stay within your carb limit.
[00:37:51.060] – Allan Yeah. And so the way I looked at this, I was like, this is like if you're if you're keto curious or low carb curious. This is a this is a good book to introduce you to it because it's not super deep in science. I mean, it's backed up. I promise you. I've seen the studies that back up everything that Dr. Westman and Amy are saying in this book. So it's there. And then if you're someone who's done keto and then plateaued, I think this is going to give you a lot of answers for why what you're doing right now might not be working for you.
[00:38:22.860] – Allan And it's a lot of the things we talked about today. It's not understanding your carb threshold. It's getting into the the recipes, you know my feed and Facebook is every other every other post in my Facebook right now from keto is some kind of sweet how to make a pie, how to make a tart, how to make a cookie, how to make a cake, how to make you know. And so, yeah, if you're if you're filling up with that kind of stuff, there's probably reasons why you're getting too many calories.
[00:38:48.750] – Allan And like you said, Amy, while a lot of people in the community don't want to count calories, you don't have to. But if you're eating calorie dense food, you're eating probably eating more calories than your body really needs. And if you're not losing weight, you're definitely eating more calories than your body probably needs. And we don't like to hear that in the Keto community. But guess what? Both camps are a little bit right. And if you put them together, you have a really good plan.
[00:39:16.590] – Allan And in your book, End Your Carb Confusion, I think you do an excellent job with the experience you have putting that in there. So thank you so much again for letting me profile this book. I do have one final question for each of you. So I'll start with you, Amy. I define wellness as being the healthiest, fittest and happiest you can be. What are three strategies or tactics to get and stay well?
[00:39:39.210] – Amy Three strategies and tactics. It depends on how we define happiness, health and all that, I and you know, you sent this question ahead of time and I didn't give it that much thought. I because I guess I thought it was more defining them than how to do it.
[00:39:55.440] – Amy I mean, whatever you need to do to be able to participate in life the way you want to, whether it's having the mobility to go do the physical pursuits you want to do, or whether it's feeling well enough mentally and emotionally to interact with people the way you want to and enjoy the hobbies you want. I don't think six pack abs are not required for any of that. So don't let health and pursuit of some kind of optimal physique come at the expense of your mental and emotional health, because I see that all the time in our community.
[00:40:31.650] – Amy And it's what's the point of looking great if you're miserable all the time on the inside? So I would say eat and socialize and move in such a way that you are able to do all the things you want to do physically and and intellectually.
[00:40:49.660] – Allan Thank you, Dr. Westman, and I'll ask you the same question, I define wellness as being the healthiest, fittest and happiest you can be. What are three strategies or tactics to get and stay well?
[00:41:01.550] – Dr. Westman I love that and, you know, I've often wondered what the doctor's role is, and doctor means teacher back in the root word, and I've often thought that the health side of things that the doctor really is just an adviser, and I'm trying to get people to live as long and as happy and as healthy a life as they can help to optimize that very consistent with your definition. And going beyond our book. It's mind body, spiritual wellness. And so we talk about nutrition.
[00:41:40.940] – Dr. Westman Getting nutrition right helps you in that direction. In so many ways. It just by changing the foods, I see people rediscovering all these other aspects of their lives that were thrown off just because of the food. So we start with nutrition and then I think being physically active and happy and then emotionally, spiritually community helps with that a lot, too. So it's more complicated than we can dive into in this book, but those are the principles that we use when we approach this book.
[00:42:15.290] – Allan Thank you.
[00:42:15.980] – Amy Yeah, that's if I just just real quick, if I can kind of piggy back, because I almost forgot, in the book, we do mention that. You know, once you start to feel better physically because, you know, a lot of people have brain fog and low mood and this shift in diet has this cascading effect that once you actually start feeling better and you have more energy and you're thinking a sharper, it's easier to re-engage with those other aspects of your life with the physicality and the spirituality and all that other stuff that maybe you literally weren't able to do because you were so limited by your physical health.
[00:42:53.880] – Allan Great. So, Amy, Dr. Westman, if someone wanted to learn more about the book, End Your Carb Confusion or what you guys are doing, where would you like for me to send them?
[00:43:03.170] – Dr. Westman End Your Carb Confusion is available at any any bookstore, Amazon or Barnes & Noble or any bookseller coming out very soon or this week. And then the deep dive. I've actually started a adapt to your life academy, where if you really want to get into detail beyond the book and this is a custom made simple course that we have available now. It's called AdaptYourLifeAcadem.com. And then Drwestmanonline.com is a resource to help figure out where to go based on the things that I understand are most helpful on the Internet. End Your Carb Confusion is available now.
[00:43:50.570] – Allan Amy?
[00:43:51.590] – Amy Yeah, right now my website is, we had a little glitch, so it's www.tuitnutrition.com. But you actually have to put the w w w dot if you just put tuitnutrition.com at the moment it won't come up. And I'm also on YouTube. My YouTube channel is the same tuitnutrition and that's my handle on Twitter.
[00:44:13.520] – Amy And Dr. Westman is also on Twitter. And adapt your life, look for that on YouTube as well. They have I mean, hundreds and hundreds of hours of interviews, not just with Dr. Westman, but Ken Berry and all kinds of experts and doctors and nutritionists and trainers that have been interviewed by the company. So lots of stuff there, too.
[00:44:34.100] – Allan Great. You can go to 40plusfitnesspodcast.com/464 and I'll be sure to have links, all the links mentioned here today. Dr. Westman, Amy, thank you so much for being a part of 40+ Fitness.
[00:44:45.650] – Amy Thank you.
[00:44:48.700] – Dr. Westman Your welcome.
[00:44:51.940] – Allan Raz, welcome back.
[00:44:53.410] – Rachel Wow, that was a great interview, Allan. A lot of good stuff in there today.
[00:44:57.880] – Allan Yeah. You know, whenever I get to talking to someone about Keto, you know, sometimes it can get really technical. And I think a lot of people get scared away by something that sounds so, so strict, something so difficult. And a lot of times you're thinking about, well, how do I keep my carbs below 25 grams when I love bread and I love biscuits and I love potatoes and I love, you know, vegetables and fruit and ice cream and cakes and all the other stuff.
[00:45:24.280] – Allan I mean, you know, we're buried in carbs. You walk into a grocery store and quite literally, the entire middle of the grocery store is just a big stack of shelves of carbs in boxes, bags, cartons. It's insane. So, you know, what they've come up with, with their adapt approach. And, you know, it just makes it a little easier to understand what's in the food you're eating. Everybody wants an easy button.
[00:45:52.720] – Allan And, you know, it would be great if we could just, like, make it easy and just say it's it's this or it's that. A lot of times I run my challenges and we find that place, you know, or I have I have the lose a size challenge thing that we go through. It's eight weeks. Or I mean its in 28 days. And then I have my other weight loss program. It's eight weeks and we kind of just stage through there to find where people are comfortable.
[00:46:19.520] – Allan We push a little bit more and we push a little bit more. You know, it's it's sometimes easier to start with the hard part and then kind of ease back and find your place. But we all have our threshold. And I think that was a really important concept.
[00:46:32.440] – Rachel Yeah, that was really important because actually I've been playing around with my carb levels lately as well and trying to switch up my diet a little bit because I've been at a plateau. So I know it's time for a change. But it was really interesting to see how people just naturally have different levels of carbs that they can manage without feeling the bad side effects or that or messing around with the blood sugar levels. So that's a really interesting but hard to get to a point.
[00:47:01.720] – Allan Yeah. You know, self experimentation is one of those where you try something. You've got to give it time and see if it works, you know. So it's you know, it's one of those things where you're going to be investing time a lot of time. So in some cases a lot of time because you're going to say, OK, for four weeks, I'm going to eat this way and then I'm going to do some measurements. And when I look at what happened and see if it's working, if it's working, I stick with it.If not, maybe I ratchet it down a little bit more. Maybe I do something different. You can't add too many things in there or you don't know exactly what it is that's doing the good stuff or the bad.
[00:47:36.520] – Allan So finding that Mark, you know, and if you want to get technical with it, you know, you can do the glucose meters and the ketone meters. I'm a big fan of my keto mojo when I'm, you know, really trying to get down into ketosis, particularly in the early stages of it. So I'll do the keto mojo and I'm checking my blood sugar, I'm checking my ketones, and then I'm just finding that spot. I've been doing this now for eight years.
[00:48:00.970] – Rachel Wow.
[00:48:01.480] – Allan I kind of know, you know, OK, if I eat this way, this is what's going to happen to my body. And almost invariably it does. Now, that said, as I've gotten older. I've noticed that my carb tolerance has gone down, so, you know, if I try to eat more carbs just to find my line, my line has been slowly edging downward over time. And as a result, when I go into my feasting mode, I actually put on more weight faster than I did the first few years that I did this.
[00:48:30.730] – Allan So I have to still kind of I can't go completely crazy out there eating all the carbs, but I do have to pay a little bit of attention to what I'm doing or I can go a little overboard on it. But I think it's just knowing yourself, given that self-awareness is really, really important in the tools, any tool you want to use, they try to make it really simple.
[00:48:50.350] – Allan Try this than that and what you can and can't eat. But simple is good for most of us. It'll work just fine. But if you're somebody who needs a little bit more hard data, there are ways to do that.
[00:49:02.050] – Rachel Yeah, I've got one of those meters myself and I'll be getting that out pretty soon once I settle in and a couple of swaps that I want to make. You know, I've been eating similar foods. I eat a lot of eggs, brussel sprouts, a lot of beef, a lot of chicken. I feel like I'm in a rut with my food. So it's time to switch it up. And and once I do that, then I'll get out the meter and see how it how it feels or how it works.
[00:49:25.930] – Allan It's the worst tragedy in the world was the sacrifice of Brussels sprouts. We can't get them down here. And so we had two bags of them that we were going to bring down, I guess, technically smuggling, because you're not supposed to bring vegetables and fruits into the country. But we had them in our bags and bags were coming up overweight because the max weight the couple would carry is 50 pounds. We just could not get our weight right. We just couldn't get it to work. So we were like, OK, this has to go.
[00:49:57.070] – Allan And well, we let go of a lot of stuff before we let go of the Brussels sprouts. But that was kind of the last thing is, oh, I've got to leave the Brussels sprouts. It was either that or the beef jerky and deer jerky. And I'm like, no, the deer jerky is going. I'm sorry brussel sprouts.
[00:50:13.300] – Rachel Yeah.
[00:50:13.600] – Allan Yeah. So I had to make that sacrifice, but I hated leaving those in the hotel room when we checked out.
[00:50:19.210] – Rachel Such a bummer.
[00:50:22.600] – Allan And I didn't even get to eat that many Brussels sprouts when I was up in the States, which was another sad thing is that most restaurants aren't serving it. So unless you cook it for yourself, it's really again. I don't want to make I don't want to depress myself. I've got.
[00:50:36.580] – Rachel Well, that's right. That's right. You just got to make a list of all the things that you can eat and enjoy eating and then you won't miss so many other things.
[00:50:45.850] – Allan Yeah. And then I think the other thing that I just want to kind of emphasize from this conversation we had was, you know, when I was standing in the food line, at keto Fest with Dr. Westman, it was you know, it just kind of one of those moments when he said, you know, we just need to do something.
[00:51:03.160] – Rachel Right.
[00:51:03.850] – Allan The word keto, if that scares you, then it's not keto, its just low carb. I'm just lowering my carbs a little bit to see if that helps me on my weight loss journey, helps me feel and look healthier. You say you're lowering your carbs. And if that means that the way you're doing that is eating Atkin bars and, you know, canned tuna, then that's the way you're doing it. If it means that you're just looking for lower carb options ketchup and, you know, maybe even some of the fake pastas and making, you know, fake biscuits and things like that, that's fine. If that's what helps you get that start, you just have to take that first step.
[00:51:42.100] – Allan We're after progress, not perfection.
[00:51:44.560] – Rachel Right, right. You know, I like to tell people just just move that needle, just just move it slightly and make some simple swaps, you know? And, you know, if you do measure your carbs and you eat whatever one hundred grams of carbs a day or something slide that down to ninety, slide it down to eighty five, I mean, you don't have to make these huge cuts. Why make a huge cut that will make you want to binge later or that you can't live with that makes you unhappy just as long as you move that needle just slightly. I think it would make a big difference.
[00:52:15.520] – Allan Yeah. Sometimes it's as simple as saying instead of eating the banana and putting that in my morning smoothie, I'm not going to put the banana in there. I'm just gonna put the berries, you know, the protein powder and then put some ice and blend it all up. And that's going to be my breakfast. And I'm just not going to put the banana in there and try it, you know, so that cut 100 grams of calories, a hundred calories out of your meal at most, which is mostly sugar.
[00:52:43.330] – Allan You know, you're cutting that out. And so it's it can be simple stuff like that. And I'm in no way saying don't eat bananas, that they're unhealthy. But just like Amy said, you know, we're not villainizing any food. We're just saying being aware how your body reacts to it is really what this math is all about. That's how you solve this weight loss problem, is understanding food for your body. It's unique to you. People all over the world are eating rice and beans, as Amy said, but, you know, we we need to find what food fits us best for, what our particular goals are now.
[00:53:22.120] – Allan And that can change over time. You know, someone right now that's not very active probably doesn't need a lot of carbs. But if you're doing the exercise, then your body can handle that. Insulin is just a really cool thing. We demonize that a lot of times in the keto space, but we need insulin to protect our brain, to get the blood sugar out of our our body, you know, get it out of the blood and store it.
[00:53:47.290] – Allan Now, if we're burning it, which means, let's say you went outside this morning before breakfast and you ran for two or three miles. You're going to have used up leg, muscle glycogen predominantly in your leg muscles, which are larger muscles. So they hold a good bit of glycogen and the liver and you're going to keep, and that's going to keep your blood sugar, insulin and glucagon they're going to keep your blood sugar level through that whole process at that point.
[00:54:12.730] – Allan At that point, yes. You can go ahead and have a little bit more carbs with your breakfast because you've given it somewhere to go besides body fat. A lot of people try to do it on the other side with calories. And you say, well, oh, I ran three miles, I burned 400 calories. That means I can have a Snickers bar.
[00:54:31.450] – Rachel Right! Oh, no, no. Yeah, I go for the food is fuel at that point. And as a runner right now, I'm running pretty consistently four to six miles every day or for five to six days a week. And then on the weekends I'll do a longer run, maybe 10 or 13 miles. And you can tell that on those days, like my nutritional needs on a 4 mile day, is far different from my nutritional needs on a 10 or 13 mile day.
[00:54:58.990] – Rachel And that's something else to keep in mind, too. So when you do plan out whether or not you have that banana in your smoothie, just think about what your exercise has been for that day or the next day.
[00:55:09.880] – Allan Yeah. And the plan they kind of put in here, their adapt plan, they call it. It basically is a lot easier than counting calories. I can tell you, if you're just counting carbs, that's all you're doing is one number, it's very easy to count your carbs. It's very easy to look that stuff up on the Internet if it's not on the label, which, you know, you shouldn't be eating a lot of things with labels. The actual real food doesn't have labels or they don't have to market it.
[00:55:32.320] – Allan You know, chicken doesn't need a marketing. You see the chicken, you know what the chicken tastes like, you buy the chicken and that's the way it's supposed to be. Which is kind of a little funny side story. Our dog loves chicken and rice mixed in with kibble with the dog food. We've started doing that down here. But she doesn't know what a chicken looks like. So when she sees these chickens are running around the road because they're all over the place down here, I'm thinking myself, she doesn't know that that's what she's having for dinner.
[00:56:02.440] – Allan And if she did, what would it change her behavior? Because she just ignores them. And I'm like, thats your favorite food.
[00:56:07.450] – Allan If she only knew
[00:56:08.680] – Allan That's your favorite food in the whole world and you don't even know it. We've never fed you cat, but for some reason you instinctively want to chase the cat. But there's a funny little funny little side story there. But so, yeah, you know, you don't have to think of it as keto. They say it's somewhat of a keto book. I called it somewhat of a keto book, but I don't want you to think that. I think it's just really finding that place, though. How many carbs can I tolerate based on my activity and my biology and my genetics and going from there to find an optimal way for you to eat?
[00:56:44.260] – Rachel Yeah, that sounds like a really great book.
[00:56:47.650] – Allan All right, Rachel, anything else we need to go over before we get off the call here?
[00:56:54.460] – Rachel Now, that was a really good interview. I'd like to take a look at that book as well.
[00:56:58.720] – Allan Yeah. And this would be a good book to buy now as we as we get into, because we're coming really close to, you know, the Christmas season, Hanukkah, end of the year with New Year's and all of that. And it tends to be a time when we overindulge, particularly in the sweets. So kind of having a good idea of, you know, these levels of carbs and starting to pay some attention to it. This is a good time to do it.
[00:57:23.530] – Allan So you're not putting on pounds that you been thinking about January, trying to take off.
[00:57:29.320] – Rachel Good points.
[00:57:30.020] – Allan Don't put them on there in the first place. Then you don't have to lose them again.
[00:57:33.340] – Rachel That's right. That's great.
[00:57:36.010] – Allan Have a great week, Rachel. I'll talk to you next week.
[00:57:37.330] – Rachel Thanks. You too. Take care.
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Have you ever wondered about the science behind low fat and low carb diets? Which one is better?
In a study from 2003, 40 people between the ages of 24 and 61 were evaluated during a 10-week program. This program looked at health outcomes as a result of being part of a low carb or low fat diet.
Those within the low carb diet had no more than 15% of their calories coming from carbohydrates. Those within the low fat diet had less than 18% fat in their diet. In the end, both groups improved and lost nearly the same amount of weight, with the low fat group having lost 18.2 pounds on average and the low carb group having lost an average of 18.8 pounds.
In addition, both groups lowered their triglycerides and cardiovascular risk. However, the low carb diet increased their HDL but saw no change in LDL. The low fat diet saw improved insulin sensitivity, whereas the low carb group saw no change with this. The low carb group also saw their ketones increase, while the low fat group did not experience this.
So both diets worked well in their own ways and showed weight loss. But how do you decide what will work best for you? To do this, you have to prioritize what matters most to you. If you want to impact your insulin sensitivity, perhaps the low fat diet is for you. If you want to see your ketones increase, then the low carb diet might be the right choice.
Ultimately, the right choice for you is the one that will work with your lifestyle. If the changes are not sustainable in the long-term, it won’t be the right fit. Consider what food you have access to and the nature of your everyday lifestyle. Be realistic. If you know you cannot give up bread and carbs, then perhaps the low carb diet is not for you. Choose one or the other and stick with it. The choice over a low fat or low carb diet is truly yours to make!