And now he has experience as an associate professor of medicine at Duke, he is board certified in internal medicine and obesity medicine and is the founder of the Duke Lifestyle and Medicine Clinic. Now he is trying to bring his approach all over the country rather than just being in one setting and he's doing that through the Heal clinics.
He's a true pioneer in the field of low-carb medicine so much so that he is even proposing that maybe we need a keto specialty in medicine. And that's part of what I really enjoy about this interview; just getting a little bit of, a little picture of his experience. Because he probably has more singular experience than any provider out there.
So to hear from his clinical perspective and also how he bridges the gap between his clinical perspective, clinical understanding and knowledge and experience and research and bringing that together to further this movement of low-carb. Who is good for, what it can do, maybe where you have to be careful, some of the roadblocks... he knows all of this.
And of course, we can't get all of his pearls in a one-hour interview, but I think we get quite a few out of this interview. So I hope you enjoy this interview with Dr. Eric Westman. For the full transcripts join us at DietDoctor.com where you can also see the wealth of other information we have on the website. So thank you for joining us and enjoy interview with Dr. Eric Westman. Dr. Eric Westman, thanks so much for joining me on the Diet Doctor podcast today.
Why you started into this 20 years ago after been a physician for so long? And how you've progressed in your world of low-carb and keto in that time?
So I learned all about biostatistics and all that and realized that if something happens, you know, it's possible and if that happens twice, well it's more than possible; it might even happen more often. So I was curious about these two patients and looked into the books and all and at the time, I mean, Dr. Atkins was the only one in a clinic. So I kind of valued that when I read the book, it was all anecdotes, and not persuasive for me, but there was at least a book in a clinic that seemed to be in operation.
So one of the patients came back... I had read Dr. Atkins book. And he said, "What's your problem with it?" and I said, "What's your cholesterol?" "Your cholesterol is going to go up, because, you know, it's high-fat." And so I remember the gentleman kind of looked at me and just said, "Why don't you check it?"
And I said, "Okay, you're the one who is going to get the blood drawn, not me." It's a VA Hospital, there's no expense to anyone... Well, maybe the taxpayer... I mean it's a very low risk thing to do. It turned out the cholesterol levels were all better. Even if you sliced it the old way, the new way, it was all better. And that kind of got my attention, because everyone else said that it would be worse.
So I knew it couldn't be worse all the time. And then the second patient came through and I measured the cholesterol again kind of on purpose to see... would it happen twice? And again it was favorable, the change. So a lot of weight loss, good cholesterol. So what's the roadblock?
We did a review paper and there was no data really published in the medical literature. So it was like this vast wasteland and as a young researcher I thought, well this might be a good place to be if there is no data and it clearly works. And if we're safe, how easy would this be; I didn't even tell these people what to do.
Like many people today, for me- and this is 1998- I was worried about the safety. I mean I knew it could work in two people because they were in front of me. I didn't have any idea how effective would be in just about anyone who tries it, which is my opinion today, but back then-
So I did what any reasonable young researcher would do. I wrote Dr. Atkins a letter and now I realize no one else would ever do that. Because people tell me that was kind of a bizarre thing. No, I was just trying to get more information. You know, my dad's a doctor and I realized that you can learn things over a clinical practice in a lifetime. So he called back in kind of an awkward phone conversation.
That was something like, "What do you want?" I was like, "Dr. Atkins, thanks for calling." And he said, "Well, what do you want?" I said, "Well, I read your book, it seems to work." -Kind of laughed.
And we did the study on that... What? You put a patch on your skin and you don't smoke? So we did one of the first studies on the nicotine patch. And so I think that opened- unlike a lot of doctors who were just in their own little camp- it opened my mind to what could be done and showed me that if you want to change the world or find out something new, do a study. You know that was kind of the operating system I was working under.
So when faced with two patients... clearly worked. I was worried about safety... Why not contact the doctor? And Dr. Atkins quickly said, "It's all in my book" and I said, "It's not enough." And he had, I don't know... wisdom to say, "Why don't you come to my office?" I wouldn't have done that if I hadn't been asked. And so looking back I use that today and I tell other people that you're welcome to come to my office and see what I do.
Because I know that might be necessary to overcome all of these different barriers that go against everything I've been taught, I've heard that so many times. So you know, one thing led to another and we went to the office, it clearly worked, although when I went back to Duke some of my research colleagues said, "Well, they probably hired Broadway actors to sit in his office."
And then our first study was done. 50 people over six months... published in the American Journal of Medicine, which is a pretty reputable internal medicine journal. And that's kind of my litmus test for anything you hear today. Someone asked me what about the Dr. Smith diet and I said, "Well, show me the paper in a peer-reviewed journal. Just 50 people over six months and show me what happens."
And then that weeds out 99% of the stuff you hear today, because we want it to be evidence-based and based in solid science. And our study of the 50 people over six months was done and published in 2002. So even now that's so old that people can't put that in their PhD thesis. It's over... it's six years older-
When our research was published in 2002 there was an increase in active... we call that the low-carb craze of 2002 to 2003 in the Dr. Atkins diet in 2003. And that was what really stopped the uptick. And there was no science that came out and said it was bad. In fact all the science was looking positive and I've been told this by other people right at that moment, the South Beach diet with Dr. Agatston behind it was planned on being launched which made it a great- there was no competition then.
I mean it was low-carb, a kind of a low-carb low-fat version, but it was clearly effective at least for a while and so that helped to have the Atkins craze fade away. But the continued research marched on. The first round of research other people were doing were kind like what we did; low-carb versus low-fat.
And now there have been so many studies on it. I mean there are meta analyses of the studies and even you can get a app that shows the score is something like 30 to nothing. Low-carb wins. Not that low-fat can't work. It's just low-carb is better. But in the early days it was I think the Dr. Atkins dying, and then the- we call them evil forces in the low-carb keto world, but the other forces out there got ahold of Dr. Atkins death certificate under false pretenses and then the word got around the world in a press release that, you know, the diet doctor dies obese.
Which actually wasn't true and it didn't matter at that point. And so there was a worldwide, you know, anti-Atkins bashing which was really sad. But in those days, you know, you can talk about eating fat.
And I'm glad we're having that debate. But we're like, you know, siblings, we got to get along, don't get mad at each other; the rest of the world is looking at the sibling rivalry when we just need to have the message I think that lowering the carbs is a good thing.
And I'm glad we can do research now to answer some of these questions, but just going back to that era it was a taboo, meaning there was a social prohibition of studying a high-fat diet. And I was able to ask a couple of the world diet experts at that time and they kind of looked at me and said, "If you lower the carbs down that low, what are you going to do? Increase the fat? We couldn't.
And a taboo is kind of a social. There's no written rule that you can't study it. So the scientists who found things... the funding agencies could say, "We don't stop people from studying it." And yet nobody applies. Well, nobody applies because there was a taboo. So that was lifted about the year 2002 with Jeff Volek's group and our group at Duke publishing... like the same month the papers came out.
But when you look back from a news thing it's ancient history, but from a kind of science, you know how conservative and slow the change science in medicine especially is. It's really kind of recent when we can now go around with meta analyses and show studies of studies that actually show that it is safe and effective. But it is as strong as a drug. So once you get into a clinical situation you want to be... not cautious, but you want to be aware that this is a very powerful thing. Medicines can become too strong.
I mean I'm compelled by the hunter gatherer, the Paleo primal... It's called face validity, meaning it's kind of common sense that if humans didn't have sugar until 100 years ago, maybe we need to be a little careful with that. You know, if we didn't have grains until 10,000 years ago... I mean it seems like a long time, but from human history standpoint is not a long time... maybe we don't need to have grains, that kind of thing.
So I am also a history major... so in college... So I spent a lot of time learning how to be a detective when you read history and learn from that. And then, at least just knowing in the relatively recent history that doctors used this approach from 1860 to 1960, just about all the doctors knew about low-carb diet and they used it for diabetes and obesity and then it was forgotten. So, well... but the knowledge is still there.
And then doing 15 years of research with people not eating many carbs at all I am left with the idea why should I have anyone eat carbs if I fixed their diabetes, hypertension, they feel great by not eating carbs. Why should I have them go back to eating carbs? That's kind of where I am. So I think this is healthy eating for anyone, as long as you're not in a medical situation, a medical problem on medications.
Do you think that muddies the waters a little bit and we should be focusing more on you should dive in and go keto? Like where do you see the balance of a more reasonable diet versus a very low-carb keto diet?
If you're going to expect everyone to do that and you won't treat them if they can't, you'll only be able to help a certain segment of society. So I think the message needs to be tailored to the individual based on their knowledge of how deep they need to know about it. Can they just follow a certain set of foods without measuring macros and writing things out? Absolutely.
So there are a lot of different ways to do it, a lot of different ways to teach it. And in the talks I'm giving now, I'm trying to help tease out where the information comes from. So a lot of the current day keto comes from solid research and a lot of the current day keto it's just kind of glommed on like a Christmas tree ornament on the Christmas tree. I mean show me data where you save lives by having grass fed beef. It doesn't exist.
But it helps with the sustainability and the local farmers market support and all that. So what's happened is kind of a- probably happened because of their needs to be a critical mass of people buying products, doing it for the awareness to go up and because it's so effective even if you do it in all these different ways, that's why people stay with it. So I don't know the right answer.
The research were presented to me or if I could even, you know, convince someone to fund me to do the research- that might even happen one day- then I think different questions along this line are really important. Should you really pay attention every day or every meal to what your macros are? I'm not convinced yet.
Should you really be measuring the ketones in the breath, blood, urine? I know a lot of people can do this without measuring anything at all. But if you show me the science, it says if your beta hydroxybutyrate is between one and two you have some better outcome. Even if it's, you know, feeling better, I think that's a valid outcome. Then I'll start making a policy or general clinical recommendation.
But I try to hold out, you know, like the true beginnings where I started I want the level of evidence to be high enough so that it could be doctor to doctor, hey look... you do this, you get that kind of result. And we do expect that. We don't prescribe drugs unless we have a certain level of evidence behind it. We shouldn't change in a big way our lifestyle prescriptions, unless there is solid evidence behind it.
Yes, in fact, so it depends on the context. If someone's dying... we used to have this disease meningitis or pneumonia for that matter and everyone died because there were no antibiotics. So the first dose of penicillin for someone with meningitis and they lived, you don't need a randomized trial. So that is evidence.
So the way you use the term 'evidence' is you are using the common medical understanding, which means randomized trials, publications in journals... The clinical use of low-carb keto is decades before the academic studies. So in fact last year, 2018, we published a survey of Facebook users, TypeOneGrit.
So I do value the evidence before me. In fact in the clinical epidemiology world and I trained- I say loosely trained- followed very carefully the McMaster group in Hamilton Ontario, and the N of one trial using an individual as the outcome, can give a lot of information. So that's where we are in fine-tuning the keto diet now as you do it, N of one meaning there's sample size of one... just one person.
You try something for a while, see how you do and the problem is you can't really test long-term outcomes. Like one of the sticking points today is what happens with the cholesterol. And it's going to take a decade for something to appear so don't even do it now. Well, wait a second... I think the clinical observation is evidence and you can make decisions as a clinician based on the N of one or let's call them multiple period crossover study if you want the parlance from the research world.
So that's when you're in a group of other doctors who are very skeptical. So I spoke to a chronic pain medicine group on this traveling trip I'm on now and many of them had used low-carb for chronic pain in their patients, but most had not. And so I just was very focused with what I knew, really carefully; you know, obesity, diabetes, that's the research that we've mainly done and the observations I've seen in my clinic about pain getting better especially arthritis and fibromyalgia, those things.
But actually I did a literature review and there were some pretty recent articles about the mechanisms of how keto could improve chronic pain at the neuron level. So yeah, you want to be careful to not seem like a total zealot, convert, quack, whatever, but it's true. So for me that just depends on what audience I'm speaking to.
This is the Roux-en-Y gastric bypass surgery. And the human body is so robust. The digestive juices, you know, now get together down below the stomach, below the duodenum in the jejunum. And so the timing is all messed up after a Roux-en-Y gastric bypass. And they still gain weight. So even in a much more extreme setting where the gallbladder juices and flow is all messed up there isn't any problem with absorbing.
And although they may have symptoms so- I guess I would be open to the idea and I would love to see a series of the hundreds of people who had their gallbladders out and then follow each one carefully and then we'll know the rate of occurrence of problems after gallbladder, but from my vantage point what I know so far it's not a reason not to do it.
But there are two studies I'm aware of which is not a whole lot of evidence but it's at least some and they didn't show any change in the bone mineral density over 6 to 12 months in those who did a keto diet. So there's some data on it. In the meantime you just want to measure any health issues including bone mineral density over time. And if you see a change, well, talk to your doctor about what therapy might need to be changed.
So one of the big concerns is it's not a long-term sustainable diet. How do you respond to those criticisms?
I said, "Did you go talk to Dr. Atkins?" He said, "No, I can't do that. I have to be impartial." I said, "Well I actually talked to Dr. Atkins and what he did is he kept the carbs down 20 g or less for the whole time. "That wasn't in the book." "I know... I went and talked to the doctor." So the first round of studies you just got to realize that they weren't done by the people who know how to do it.
And so I kind of look at the- again is the only evidence what's in the literature? Obviously not. So we can do better than those studies if we pull out all the bells and whistles. Imagine if we could shame and guilt... and of course I never do that... but if we could, you know, instill the fear of eating carbs in someone like the fear of eating fat is instilled in someone, that would help with long-term adherence. In fact there are so many people that can't get to eat fat, because they are so afraid of it.
So I think the idea of you can stay on it is doctors wanting a reason to just think they know more than they read the papers and they couldn't do it themselves, so how could they envision someone else doing it? And so this is another reason why it's a grassroots ground-up thing, because I know people who have done this for a long time, decades, like me. And, well, "Oh, you're not normal."
No, in fact I don't do a whole lot of obsessing about things and I think it has become easier and easier now that the environment has become more supportive. Just in the last year in our area you can get riced cauliflower; the big stores are selling, and cheese crisps and all the stuff we used to have to teach people how to do. So there's definitely a change that helps with the long-term ability of people to stay on it, but there is also a role for helping people through the sticking points for a while too.
And the unintended consequence is that it raises your insulin level and it makes your body store fat and lock it up. That's where I think sugar-free things are a fairly simple coping tool even if you will because the ability to hit something with sweetness in it doesn't have the unintended consequence of the insulin rise and the weight gain.
And I know there's a lot of- it's fine-tuning it for individuals. But why not let people still use therapeutic eating? And so the mindless munching of a pork rind that has no carbs... Who knew I'd be telling people it would be okay the pork rinds and bacon? But it doesn't elicit that insulin signal inside. So yeah you can still crunch on those things and they won't matter.
So understanding that I may not have to behaviorally work someone through that. Just give them other options that also have the hand to mouth, the munchies and that whole habit that's there. But, you know, the holidays are particularly tough where the sugar comes out of everywhere. And I learned there are ways to get chocolate without a whole lot of sugar. And that I have that in my first class... I can just see the eyes light up-
You think that would greatly benefit to being able to implement keto safely and effectively. What do you see is some of the main teaching points of what that doctor would need that's different than what we're taught normally?
You can actually sit for an exam for the obesity medicine, at the American Board of Obesity Medicine now, but you don't really need to do all that and then you really need to know about all the medications, the pharmacy stuff, because you use diet instead of medications. That is if you're preventing someone from going down this path, you know.
So the most fundamental thing that we don't get in medical school is the understanding of basic nutrition... it's just gone. I mean it's been gone since I was in medical school in the early 80s and even today we can't get to- I haven't really tried all that hard, I have to admit, but you can't get a few hours on nutrition in medical school, so I teach medical students who are already in their clinicals, so are already out in the clinical rotations. The medical residents, I have them rotate through my clinic.
So what we call 'biggie epidemiology', little E - clinical epidemiology... the science of experiments in clinical practice- that's the McMaster, the Cochrane collaboration... it's as if these are different fields, are different religions. And the biggie epidemiologists, I remember Walter Willett saying on a podcast I was on with them, he said, "Well, Dr. Westman has a rather limited view of what research is."
I said, "Yeah, I wanted to really mean something." But basically he wrote the book Nutritional Epidemiology. And if you say, well, that's not enough, you are basically bashing the whole life that he had and ego and money wrapped around. So even Ancel Keys who we hold up as a terrible- the one who started all of the low-fat stuff and fat's bad is revered at the University of Minnesota because they brought so much money into the institution.
So just because there's a field, it doesn't mean that it actually is scientific. So that's a little disturbing to me that a place like Tufts would- and especially if they rolled out just one healthy way of eating. That's not scientific.
And that disturbs me about the whole vegetarian vegan idea in general that they don't allow for the idea that there may be another way to be healthy. Because I think I'm learning more with Belinda and Gary Fettke's work of unraveling where a lot of this came from was religious beginnings.
Bret: In fairness I do need to go back and double check. I remember reading an article a while ago that Tufts was doing that. I don't know if it's been implemented-
Where a lot of the initial teaching was real foods... Just eat real food. Because the keto products didn't exist. And now you've mentioned a number of these, whether it's pork rinds or Moon Cheese or some of them that keto products that are made, they've made things a lot easier.
But can they also complicate the picture in a way? Can they lead to a little bit of danger of people overdoing it? And I say this knowing you're involved in keto products. I'm curious to get your perspective on it.
We're so anti-corporate. So then I became president of the Obesity Medicine Association where we were dying for companies to start making drugs for to treat obesity, because there weren't any.
So I went full-circle to, "Novo Nordisk is making anti-obesity drugs... Hurray!" Oh rats. With my Society of General Internal Medicine hat I'm anti-Pharma. So there's a balance, I don't think you can be black-and-white about this and when these other products became available- I guess I echo what you said first which is stick to real food for the most part and every now and then have a convenience thing.
But you know, you know patients, you know people, some people will go off and do the darndest things; that's why we generally recommend people come back to us or follow up to make sure they're still doing it right. But if the products- I just want also mention that the keto products have raised the visibility. I think that's an important factor that people want to be able to purchase things, you get more companies involved, different companies now are putting on conferences based on some of the money they raised and so I think in general it's a good thing.
My philosophy of my teaching has always come from total carbs not net carbs. So when you're looking at a product I teach my patients to carefully evaluate... is it low in total carbs? And if it has net carb, it has more fiber, and now the sugar alcohols might interfere with the process. And so I don't recommend those things at first and then our product, the Adapt Your Life products are truly low in total carbs.
And if it is- we have- there's a protein bar that may have 12, 11 carbs per the whole bar and we're pretty transparent about that. It may not be keto friendly, but the little keto bars, keto minis are called, have been very popular not only because they are truly low in total carbs, but there's not a lot of extra fillers and, you know, it turns out now learning about food and products that a lot of the stuff that's added to the low-carb bar are just fillers to make it look larger.
Because people aren't going to buy something so small and so there's stuff that are not really needed and they just complicate things. So again that's getting to the clean eating. The keto not only products now- there are that have food in them, but now there are keto supplements right so that was a big surprise.
So we always thought that you couldn't really drink ketones or eat them because the body would digest them and they would be so unpalatable and no one would want to do it. So what I've seen is that the exogenous ketone idea has come a long way in terms of palatability, so people are able to consume them and they do have a kind of an immediate effect that we would say is a subjective- people feel better, but where's the data and evidence, where are the studies?
So I'm in that space of waiting for companies to pony up the studies so that I can make that old litmus test of show me 50 people over six months using the product doing the diet and publish it in a peer-reviewed journal and I'll comment on it. But I've seen there's a lot of promise there because the early research on exogenous ketones it kind of defies my prediction. I thought why not just not eat carbs?
And then you don't need to add ketones because ketones come from your own body fat. It's very preliminary but still provocative that giving exogenous ketones to someone who's naturally a carb either just eating carbs still not in ketosis might have some beneficial effects and that's pretty amazing if that's true.
Bret: It's amazing but also disturbing at the same time until more evidence comes -because that's a physiological state-
And the only time I've seen something, it wasn't an exogenous ketone, it was actually probably a homemade version of apple cider vinegar or shake or something and the gentleman didn't understand that he needed to eat real food. He thought the keto diet was just having this keto product or shake that he made.
And he said, "But my hunger is gone. I don't want to eat." That's where you get into- if a company is selling their product, then they- oh, they forgot to tell them that they should eat food as well. And of course I'm sure the companies tell people that you really need to eat food too. But as you know, people will do what people do and we want to make it as safe as possible even when people do kind of stray from the general teaching.
But when it comes to health in general, there I'm not so sure about the benefits, because there is the lifestyle that allows you to get into ketosis I think that is the most beneficial intervention rather than chasing the ketone level.
But when it comes to natural foods, you know, the vegetables and the nuts and seeds, then you revert to net carbs for your calculation? So you see a difference in how you calculate the carbs based on whether it's a natural food or a synthetic product?
So back in the early 2000's and I think Mike Eades would probably have the best- Mike and Mary Dan have the best knowledge about where net carbs came from. But it was kind of a new thing, a new kid on the block.
And I know in our book, The New Atkins For A New You, Westman, Phinney, Voloek were the authors on it, we used net carbs and I think that is fine, but it's kind of like using an over-the-counter medicine, meaning that it can work for a lot of people including those who don't have insulin resistance. They could probably eat a lot more carbs anyway. They're just lucky. So I think of the net carb calculation, 20 net as sort of the over-the-counter version and that's why I felt comfortable writing a book that had net carbs as the calculation in it.
And it wasn't wrong; It's just not quite as effective. So if someone comes to my clinic they make, you know, the trek and I sit down with them and teach them, I use total carbs, whether it's real food or fake food. And I've seen, you know, dozens I think who use net carbs and it stopped working for them and all I did was change them to total carbs which meant they ate fewer vegetables and it started working.
So I would love to do a clinical trial, randomize people to total carbs or net carbs in a flexibility arm maybe. So that's where I am, where I teach people to figure out their own threshold, although most people after six months of not eating carbs, they don't really want to anymore. So I don't make people go back to eating carbs either.
I would think ketosis is where you'd want to stop. So add back carbs, you know, slowly, not 20 to 100... it's more 20-25 for a week, measure your ketones, your weight, your general hunger, things like that, and then if you can add back five again, so now you are up to 30 after two weeks, 35 three weeks, four weeks... most people won't be able to eat over 50 total carbs. But that's 80 to 100 net depending how you do it.
And even then I tried to come up with a table that showed the exact calculation between total and net. I mean you really can't do it, because the subtraction isn't perfect. So a lot of general principles - keep it low, follow the ketone level in some way as a guide.
Or what fascinated me was the cardiac surgeon sending you their severe heart failure patients to have them lose weight so they can implant an LVAD, a mechanical pump in their heart; you see a number of these patients to get them healthier for their surgeries and they are the sickest of the sick.
So I guess two questions here: one is just to hear a little bit more about that experience, because it's amazing, but two, was there anybody too sick for a keto diet or in the past six months have you taken anybody off a keto diet and why? So it's two sort of different questions there but I am curious to get your perspective on those.
So when we opened the clinical practice using a keto diet in 2006 I just opened the door and then, you know, obesity comes in... after six months or a year, you're kind of like, "This really works." That's where I'm starting to say, "If you do this, it's going to work." I can't make you do it and I can't go home with you, but like a prescription drug the evidence is that strong.
You know, it's going to work. So then other doctors got wind of... You know, there's at first, "Oh, that doesn't work." And then, "Oh, that works... Who did you see?", "Well, Dr. Westman." And then the other doctor will forget about it, time will pass, and then, "Who did you see?", "Dr. Westman", "Oh, Dr. Westman!" Maybe lightning does strike twice.
And then I got a few people sent from the cardiac surgery clinic and I remember the first gentleman, he didn't have a pulse. And the LVADs, the ventricular assist devices came out after my training. We didn't have them back in the 80s. So I wanted to outpatient medicine that really didn't know much about.
And they're keeping them in longer and longer because they can't get hearts or because people are too heavy. And so we've been able at Duke to keep lots of people on- I'm not part of that program; they just send me the patients and I send them back. But now it turns out come to find out one of the cardiothoracic surgeons had become a keto doctor... keto personally. And that's the general theme is that the doctor tries at first... "Oh, what's good for me must be good for everyone." No, don't make that mistake.
One of the areas that we're looking at and I think needs more science wrapped around it is early renal insufficiency, so kidney issues, I don't know for sure. In my area the kidney specialists just expect the kidney failure to happen. It progresses. So they're not upset if someone's on keto and they are on dialysis or pre-dialysis.
They just put the fistula in as a precaution. I think whether someone can lose weight, I think there is a subset of folks who for whatever reason they are exercising a lot at the gym. They are doing, you know, every day an hour or more of intense exercise and the ad lib. way of I just have people eat until they are full and all that, it doesn't work.
So there you just have to work with people on the calorie issue and, you know, God forbid that you wouldn't exercise... although it's interesting to watch when someone gets sick and then they can exercise; sometimes that's when the weight loss happens.
But there's something about exercise and it's in the literature, Steve Phinney gave a great talk some years ago at an obesity meetings on how some people gain weight when you restrict calories and make them exercise. And so that's just the little niche in the obesity world we know and that spills over to the keto world as well.
All right, Dr. Westman it's been a great discussion and just to get a little sliver of your experience in the 20+ years that you've been doing this has been wonderful, so thank you for sharing all that with us. If people want to learn more about you, where would you direct them to go?
Sadly the wait period is about eight months to come see me at Duke, so I'm working with two new companies, one of them is called Heal Clinics, H-E-A-L clinics.com and we're seeing people through there, not always me personally, but we're basically training people and Jackie Eberstein who worked with Dr. Atkins is on my team there, she is the director of education.
So Heal Clinics is a way to get access to the information now and then the Adapt products, adaptyourlife.com, is a lot of free information there. In fact Glenn Finkel my co-owner there has taught me a lot about using the YouTube as a quick and easy way.
So I have a lot of YouTube videos there with Adapt Your Life. And yeah of course Diet Doctor is a great resource and I'm glad a lot of the information that I've been able to generate is used at Diet Doctor.com too.
Bret: Wonderful, thank you for your work, we're looking forwards to seeing so much more from you in the future.
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