Eric Westman, Duke MD, on Low Carb, High Fat, New Atkins Diet

Eric Westman Duke University

Eric Westman Duke University

Interview with Dr. Eric Westman

Duke University Research Scientist and Clinician


Interview with Shelley Schlender March 2010

Listen to Eric Westman (45 minutes)

The thing that concerns people the most with a high fat diet is that it will give you a heart attack. While it’s officially recognized now as a diet that can be used for losing weight, American Heart Association, American Diabetes Association both say that, they say, just use if for losing weight. We don’t know what the long-term dangers are. What would you say to that?

I was taught the same thing. I was taught that fat in the diet is related to heart disease and stroke, and actually caused those things. I remember growing up seeing pictures of fat in the diet and fat in the artery and . . . see? It causes it. Well, the science just hasn’t shown that to be true. Study after study has shown that by eating more fat in the diet, you actually lose weight, your good cholesterol goes up. It just has not been shown to be true in randomized, controlled trials that there’s a danger. We’ve raised the level of science so we’re able to get a clearer of the relationship between diet and health – in this case cardiovascular disease and it just ain’t so! Fat in the diet is not the causal factor we were led to believe.

Is it the kind of fat that makes a difference? For instance, Olive oil is safe to use for eating, but saturated fats in butter, in pork and meat are not safe?

Even that has been turned upside down. We were taught there were these healthy natural fats, and unhealthy natural fats, when it turns out that the culprits were the man-made fats. The trans fats, the man-made fats seem to have been put out there without enough testing. Even the saturated fat that we eat, in butter, bacon, meats that have higher levels of saturated fats-they have monounsaturated fats as well– it turns with natural fats are dealt with in our body in a healthy manner. Which kind of makes sense. That man-made things, you’re not sure about until you see them for awhile. So even saturated fats are turning out to be healthy.

Now let’s look at that more closely. With man-made fats, the molecular quality of the fat is changed by how we manipulate it to be more stable and have a longer shelf life. But it’s my understanding that heating fats up makes them more like man-made fats. So cooking high heat with fat, could that also cause a problem?

I think so, but to a smaller degree. In the big picture, I would rather have people eat and cook with natural fats than to not eat them. But the advanced course, eating this way for a lifetime, you’ll want to pay attention that how to handle fats as you cook them. Absolutely. But the first message we want to get out in the new Atkins book is that natural fats are not even “not bad.” They’re healthy.

The reason we’ve started here with the fats is because this is indeed a high fat diet.

Right. The new Atkins diet is consistent with the old Atkins in that it’s higher in fat than how Americans are eating right now. It’s all relative, right? If you compare the Atkins diet to some populations on earth, it’s not high fat. On the other hand, it’s higher in fat than were taught is healthy. But it turns out to actually be healthy.

Compared to the American diet today, it’s a high fat diet. Maybe not compared to the Inuit in the Arctic or the diet of Native American buffalo hunters or to the Masai warriors in Africa. It’s not as high fat as those, although it could be, if someone wants it to be.

Right. My understanding of how things are shifting is that, we should be talking more about blood sugar and glucose, and the fat in the diet does not increase blood sugar and glucose, so fat is really kind of off, Scott-free. It’s handled very differently in the body, and we use it in a very healthy manner, and in terms of dietary problems, we should focus on the things have been introduced since the Native American and the Masai story, things that are the Westernized foods that are full of refined carbs. These are the things that raise the blood sugar. So, yes, there’s a history of populations that have eaten high fat diets including on our own soil, and they were very healthy.

Now that we’ve talked about how this is a high fat diet, let’s talk about you, in terms of you being a scientist. How did you get interested in this realm of science for health?

About 1998, I was a young internist in the Durham VA veteran’s medical center, and I was in a research-training program, clinical research, so I’m learning clinical methods and how to do statistics, and two of my patients came having lost of a lot of weight. I guess I was a unique internist in terms of being interested in prevention. I’m finding that’s often not the case. But being prevention minded, I thought this is great. I asked them how they did it.

They said they read this little book, the Atkins Book.

I said immediately, I’m going to send you to the lab because I know your cholesterol has gone up. This is how I was trained. This is where most clinicians are today, including dieticians, physicians and nutritionists. They’re going to assume the cholesterol is going up.

I had the chance to check the cholesterol, and in two cases, two in a row, their cholesterol went down. There was a weight loss and a favorable change in cholesterol. So I got curious. So I went to a bookstore and saw many books about low-carb diets. That Atkins one stood out, since it was the ones my patients had brought in. Looking at that, I learned there was actually a clinic in operation. So I contacted Dr. Atkins, and he invited me and my staff to his clinic in New York, in 1999, and the clinic worked. The diet, I saw it in action. People were losing weight, I saw their labs; I looked over the shoulder of one of the nurses, saw the charts and talked to people. I was really amazing to see it working. And yet what I had heard was that it couldn’t work and it was unhealthy.

We asked Dr. Atkins to fund a study back at Duke University, and he did. It was a very small study, and it was positive, and we went back and said you need to fund a study that can demonstrate the first one can be replicated, and it needs to be more randomized and larger, to reduce bias in the study, and he said sure, and funded another study. At that time, Gary Foster at Penn was doing a similar study funded by the National Institutes of Health. That study, our study, and many, many others now have come out in favor of the low carb diet.

You know, the Atkins diet came out of clinical care, what he was doing in the 70s in his own clinic. The science took a long time to catch up. I think because of the fear of fat in the diet, scientists were afraid of studying this method as well.

Let’s look at this more closely. Dr. Atkins noticed that his patients got better on a higher fat, lower carbohydrate diet . . . especially if they were prone to being overweight or having diabetes. But he wasn’t looking at the statistics. He was looking at one example after another of how this worked.

That’s right.

It was more anecdotal, what he was looking at.

Well, a lot of anecdotes turn into a clinical series. But it wouldn’t be thought of as a scientific study. Except, Geology, you can’t do clinical trials of Earth, so there’s observation there. It’s not held to the same standard as medical science, though. So he was thought of as someone who just in a practice and writing books to make money, so the serious scientists just did not take him seriously.

But you, Dr. Eric Westman, you are a public health person, you are a doctor, and you are statistician.


So you were looking at this from a different angle.

Except, I wasn’t so over-trained as to not listen. Here at Duke University, it’s standard practice that the doctors in the clinical science have their own clinic. It keeps me current, and it keeps me grounded. And then I try new things that I learn from the science and it feeds back to writing new protocols. So I guess I had more than just skepticism. I had a curiosity. For me it was just like going to learn from an older doctor in academic medicine. Dr. Atkins was really quite bright. Quite smart and doing lots of things, including the diet. He just didn’t go through the clinical studies that we would expect today.

I was trained to expect that something would be tested at the level of a drug, Food and Drug Administration testing. Now there’s no requirement like that for diets, so a diet doctor or an NIH study for a diet doesn’t have to reach the same bar as a drug.

You have published in what kinds of journals? Are they sympathetic to higher fat, lower carbohydrate diets?

We have 15-20 papers published in our group locally, and there are 50 to 100 around the world, published around the world. It’s actually hard to find a journal that’s sympathetic to low carb, because that means high fat in their minds, and there’s a paradigm view at the moment that fat in the diet is bad. I remember one review from our first paper in a prominent medical journal included the statement, we’re not used to seeing studies funded by a diet book author. There’s even in the scientific peer review system a bias against studies funded like this.

Studies could be funded by a drug company and by other kinds of interests, but the idea of someone who advocates a diet would fund a study, that made people suspicious?

Apparently so. For a couple of years it was a little bit lonely being the only group studying high fat diets, and it was funded by Atkins. No there have been studies funded by all sorts of organizations. Even investigators trying to show it was bad. One in particular, The University of Cincinnati received American Heart Association funds to explicitly show the diet was bad, and they found it was good.

The markers for Heart Disease, that specific disease, that people have been told for a generation is caused by eating a high fat diet, the markers of cholesterol, the markers of inflammation, went down.

They get better.

They get better?

On the low carb, high fat diet Atkins-type diet, they get better. Over and over.

Now somebody such as Bob Eckel, the former president of the American Heart Association, he told me last year that while yes, a high fat diet, a low carb diet can help people lose weight and reduce some markers for heart disease, it doesn’t reduce them all. Yes, it does lower triglycerides, but from his perspective, it does increase LDL cholesterol that still has many heart specialists concerned.

I know Dr. Eckel and we’ve talked about this. We have this in Chapter 13 in our new book, the New Atkins. There’s a change in how we look at that cardio-risk. We talk about the Metabolic Syndrome now. Dr. Eckel’s not the only one who thinks that way. They focus on The LDL cholesterol in the blood, partly because have drugs to treat the LDL cholesterol, but we focus now on the abdominal girth, the blood pressure, the triglyceride, the HDL, all of these factors, including the blood sugar, are actually more important than the LDL cholesterol in the blood, so we’ve actually come around to understand this low carb high fat diet is a better treatment than the low fat diet for this metabolic syndrome.

Is this represented in American Heart Association public policy at this point.

I don’t know. I do recall a meeting where I presented work in Chicago in 2002 and the American Heart Association took away their strong view against fat in the diet, based on our diet that fat in the diet is okay, in context of the Atkins diet. I haven’t kept up with their recommendations. But you know, recommendations need to be updated based on new science. I’ve been on recommendation panels. To hold to a recommendation based on old data does not make scientific sense.

Well, there are a lot of places where the old data is still very firmly in place. Our school lunch programs for instance, where the pride of school lunch programs is that the kids have low fat milk. To help kids drink more of it, they flavor it with sugar, and that is something for kids to drink for their health for it’s calcium and lack of fat, and it’s flavored so that that the children will drink more of it. Does that make sense to you?

No not at all. Not from the standpoint where we’re talking about carbohydrate in the diet being the biggest source of calories. That comes from the old view of fat in the diet having 9 calories per gram and carbohydrates having only 4 calories per grams. So if we reduce the fat we’ll reduce the calories.

There are more calories in a teaspoon of fat than in a teaspoon of sugar. That does make some obvious sense.

But if you eat three teaspoons of sugar in response to not having the teaspoon of fat, you overcompensate in calories. That’s what happened in the implementation of the low fat diet message. We didn’t stop people from overeating the carbs and the sugar.

So we may have pushed more carbs, more refined carbohydrates and more sugars. Did that mess us up in some way?

I think so. The science is pretty clear that insulin in the body is a strong signal for making fat and storing fat.

Insulin, that’s a hormone?

Insulin is produced by the pancreas, in response to blood sugar going up. Blood sugar goes up because of carbohydrates in the diet. Carbs, sugars and starches . . . eating a potato is like eating three or four teaspoons of sugar, depending on how big the potato is. Insulin goes up in response to the absorption of sugar in the body, and when insulin goes up, it tells the fat, don’t break down, because we have all this new energy coming in.

It sounds like a signal that says, store fat, don’t burn it.

The insulin signal says store fat, to the liver, and make fat to the liver, then store fat in the fat cells, the adipose cells themselves, and it’s very difficult to burn your own fat, to lose fat weight, if your insulin signal is high, and the main reason for insulin going up is sugar and starch in the diet.

People could step on a scale and see their weight going up, but they’re not going to see very easily what’s happening to their insulin levels.

We don’t typically measure insulin, although some doctors do. I’m a member of the American Society of Bariatric Physicians. It’s the medical weight loss group, and many of those doctors do measure insulin the blood. It can be quite striking to see the insulin response. Many people are not aware of this.

Does that mean in a lot of people who are overweight, or even on medicines where they’re injecting insulin because their blood sugar goes high, does that the amount of insulin their body is producing is incredibly high?

Yes. That is a major issue with obesity and Type II diabetes where the insulin level is really high and so our bodies become less sensitive to it. That’s called insulin resistance, where you would think your blood sugar should go down, but our bodies don’t respond to the insulin as well as it used to. When you reduce the carbs in the diet and you lose weight, you can actually fix that insulin resistance.

A lot of doctors will tell me it’s the losing weight that makes a difference. That if you stick with an Atkins diet, some of the benefits will go away because you aren’t losing weight anymore. As long as you’re losing weight on a diet, you’re going to be better. And once you finish losing weight, the same old problems will keep coming back.

I can see why they might say that because the clinical studies don’t follow people until they’ve lost weight. But in my own clinical practice and in the practice and experience of many other people doing low carbohydrate diets, the good effects stay. And this is something where the research information is lagging behind. In my clinical practice I’ve used the low carbohydrate diet for three and a half years at Duke University. I’ve followed many people to their goal weight. The research studies didn’t follow people long anough to say that. If you’re not going to go beyond what the studies say, I can understand why people would say that. But in clinics, we see the good effects stay. That’s the weight loss, the increase in HDL, the good cholesterol, and the reduction of the triglycerides.

You’ve been tracking people with the more comprehensive blood tests, and over time, they stay healthy even after they get to their preferred weight, and they just keep eating this way.

Yes. And It’s not really remarkable to me anymore because I just think of it as just going back to the way my grandparents ate. It’s just taking all the junk food out of the diet.

When you say junk food, Dr. Eric Westman, most people would think of junky high fat foods. That’s what a lot of nutritionists would say. That, we need to pull fat out of people’s diets. They’d say, we should have people eating baked chips. Not chips that have been fried.

No, that does not make sense from an insulin resistance, diabetes, blood sugar point of view. You want to get the sugar out of the diet. When we look at a burger with a bun, the dieticians say, oh, that burger, it’s awful. All that fat.

I say, Ooo. That bun! It’s awful. I say eat that burger without the bun. And their weight goes down and their blood sugar gets better.

This is such a different way to look at things. Let’s say somebody has a bag of potato chips, and one is baked chips, and the other is fried. Could someone say, the bag with the fried has more fat, so I can eat more of that because it’s safer because it’s less, just plain starch. Is that a safe way to think through how to eat a higher fat diet?

Not really. You have to figure out how your own body works. There’s some people who can handle more sugar nad starch than other people. So my first response would be it depends on how much potato is in the potato that’s been fried a lot. If it’s just a whiff of potato it’ll probably be okay.

One thing that’s happened is that there was a selection bias for obesity clinics. Dr. Atkins saw mostly people who were insulin resistant and obese. His method works really well for that. Those people are really sensitive to carbohydrate. So even the potato chip with a lot of fat on it might be too much potato.

Not to mention that fried chips have both the worst carbohydrates and the worst fats.

We try to teach people to eat real food, the way Mother Nature intended it. The foods at the perimeter of the typical grocery store because of the processing you’re talking about. We want people in the big picture to not worry about the fat in the diet as long as they’re eating the real foods and cutting the starches down really low. And I want to also say, there are lots of ways to achieve a healthy lifestyle. Some of your listeners may be wondering if they should do this. Well, I learned a long time ago that if it ain’t broke, don’t fix it.

Dr. Atkins was seeing especially people who have diabetes. They were people who had that round apple shape. They did have trouble handling sugars. So for him the people who needed the more extreme kind of dietary approach, higher fat and incredibly lower carbohydrate-sometimes 20 grams of carbohydrates a day, they did better that way.

Yes, they did.

But in your observations, it sounds like you’ve decided that it’s best to know who you are, because maybe you don’t need to do a very high fat, very low carbohydrate diet.

That’s right. That’s the wonderful thing about having a clinical practice. I can help people find their own carbohydrate thresholds, their limitations.

What’s really intriguing is even people following a low fat diet and doing really well, if there’s a food preference. If you’re not satisfied with how you’re eating, most people can transition to this kind of eating and be healthy as well. Some bodies can be healthy under very different conditions. Really we’re talking about metabolism and physiology. Some bodies are adaptable enough to eat either a low fat or a high fat diet.

Is it okay to mix and match between them? Is it okay to, one day, eat a Dean Ornish, low fat diet one day and then eat a high fat, Atkins style diet the next? Can you switch between them?

No, I don’t think that’s a good way to go because the way our bodies work, it takes about five to seven days to shift over to the different metabolism. In an Atkins diet, a low carb diet, we’re helping people shift from burning mainly sugar to burning mainly fat-and ketones-ketone substitutes for sugar, basically. It takes about 5 to 7 days for our body’s enzymes and cells to shift over totally. So if you’re in a fat-burning mode and you eat some carbs, it stops the fat-burning for 3 to 5 days. So, no, you want to choose.

Like an ocean liner, choose a direction and go in that direction.

Do some people need even more than 5 to 7 days to adapt to a high fat, low carb diet?

If the metabolism is shifted so much to the carb burning, I’ll keep grams to the 20 grams intake. That’s low. If you’ve never counted carbs, a slice of bread has 15 grams of carbs in it.

This means to have a very low carb diet, you limit your “starches” to a lot of kale, dark green leafy vegetables and salad.

Yes, a wonderful array of vegetables. There’s a myth that it’s a no carb diet, but that’s not the case.

But no toast, no crackers, no jam. Forget about that if you’re going to eat a low carb diet.

That’s right, they’re just too starchy and sugary. We hand out a little carb counter book. It’s really just amazing how much carbs are in the foods we eat today. Most people come back saying, wow! Carbs are everywhere. One thing about the new Atkins is that we’re acknowledging the new science that not everybody needs to start at that very low carb level. Although if you’re really sick, you may have to stay at the lowest level of 20 grams of carbs a day. A lot of people can start at the maintenance level, which is limiting yourself to about 100 grams of carbs a day. Tweaking it a little bit, cutting out the two slices of bread and going to one. We teach people how to do that.

What kinds of conditions can respond to a very high fat, low carb diet. The one that has the least amount of carbs in it. Is it just diabetes and being overweight that can respond to this? Are there medical conditions where there’s a statistical and scientific, good track record for a high fat diet.

That reminds me of a book I was given by a patient. She was a bookstore owner and brought in this book printed in 1921 on the principals and practices of medicine. I’m a bit of a history buff, and I looked in there for the treatment for diabetes in 1921. That was the year insulin was discovered, so this book reflected the management of diabetes before insulin. And it was a high fat diet. The treatment for diabetes before we had insulin or medicines was a high fat diet. We went back and reviewed some of the charts of the doctors who wrote about it then, and indeed, the high fat diet was therapeutic for diabetes. Not only diabetes, but metabolic syndrome which is that cardio-metabolic risk, which is the heart disease risk. If you have low HDL cholesterol, the “healthy” cholesterol, eating more fat in the diet is a good thing because it tends to raise the HDL. If you have a high triglyceride, which you need to lower, eating a high fat diet is a good thing because it lowers the triglycerides.

I’m thinking of some serious health conditions where people are often told to get the fat out of the diet. Epilepsy, Alzheimer’s disease, arthritis. Those are conditions where people are often told, you need to clean up your diet. You need to eat less fat.

No, that’s not accurate. That must be a holdover from the low-fat diet fixes everything phenomenon that we’ve lived through. And hopefully, it’s run its course. The high fat diet is a treatment for epilepsy. Eric Kossoff at Johns Hopkins has found that a high fat diet is useful for treating epilepsy.

You mean that someone on epileptic medications could perhaps shift to a high fat diet and some of their symptoms might go away?

Yes, and before making that recommendation personally, we’re looking for more science on how to do it safely, but it looks like that’s the path to go, not only for epilepsy but Alzheimer’s disease, heartburn, fatty liver.

Heartburn? Most people who have heartburn are told, “You need to cut the fat out of your diet and then the heartburn will go away.” And you’re saying it’s the other way around?

I was in disbelief as well. One of my research subjects, who’s a nurse came in and said, “My heartburn’s gone, Doc.” I said, well, great. She said, I can give myself heartburn if I eat carbs again. I said, Ah, sure. Then I looked at the literature and in the textbooks, there was nothing about nutrition having any effect. Or if anything in the textbooks mentioned nutrition and heartburn at all, it was that a low-fat diet fixes heartburn, without any real documentation of it. So I asked her to test the cause and affect of fat and carbs again, over and over, in her own body. She told the story of the spaghetti and meatball, and she always thought it was the meatball that caused the heartburn. But it wasn’t. It was the pasta. Greg Austin, a researcher at University of North Carolina at the time decided to study this. There are several research publications now that document that if someone goes on a low carb diet with severe heartburn, the heartburn, the acidity of the stomach goes down within three days. We want to see more evidence, like that evidence for a drug. We want further studies to replicate it and all, but I see this reduction of heartburn as a routine in my clinical practice now.

Maybe those people are just really popping the heartburn pills as they’re eating that food. Maybe that’s why.

Probably because of the higher carb foods, they’re popping the pills.

Can people actually reduce their heartburn medications if they’re shift to a higher fat, lower carb diet.

Yes. That’s the fun of my clinical practice now. I was trained like the average internist to prescribe pills. Now I take pills away, and heartburn pills are some of the first pills I take away when people go on a low-carb high-fat diet.

You say people have less risk for heartburn on a high-fat diet. You said Alzheimer’s disease and epilepsy symptoms might be more reduced. What else is on your list?

How about this one? Fatty liver. When a gastro-enterologist says you have fatty liver, most people think, well, I need to cut the fat out of my diet. No! No-no. It’s actually, that the carbs are turned into fat, by your liver. So you want to cut the calories down, or cut the carbs down. We were in disbelief about this, but we had a clinical anecdote in someone with fatty liver, and we followed it up with a study. And those studies document that the fat in the liver will go down as you cut back the carbs.

The reason that people had assumed that fat causes fatty liver goes back to the assumption that fat in the food, fat in the artery? No, it’s more complicated than that. Fat in the diet, fat in the liver? No. It’s more complicated than that. It’s actually the carbs in the food that turn to the fat in our body.

How about conditions such as arthritis or multiple sclerosis?

That’s a fascinating story. Arthritis is from inflammation. There’s a good theory, and certainly anecdotes, and I see in my practice that the arthritis seems to be less painful really soon after someone goes on a high fat, low-carb diet. It’s hard for me to know what’s causing that. It could just be the enthusiasm of people losing weight as well. But I’ll take it.

Now Multiple Sclerosis, Dr. Atkins wrote about MS in some of his books, and I’d like to see some science in that area.

What would be your theory if it proves to be a possibility that a high fat diet might be beneficial in reducing the autoimmune disease of MS? What might explain that scientifically?

The high fat diet compared to the low fat diets is less inflammatory, so there’s less of those things we think of going around in our body with inflammation. So any condition that has inflammation with it, even an autoimmune condition would be less inflamed. It turns out that ketones and fat when burnt in our mitochondria, the little furnaces within our cells, create fewer inflammatory molecules, so there’s a sound rationale for why you would want to shift to a fat burning body. Now whether the diet would be strong enough to cure them, I don’t know. I’d like to see more science.

Even cancer is responding in animal models to lowering the carbohydrate in the diet.

Cancer may be less likely with a high-fat diet?

That’s right, which is really exciting because the traditional thinking was that low fat diets were the way to go. But we just had a huge study, funded by the National Institutes of Health, the Women’s Health Initiative, which did not find that the low fat diet was helpful in reducing cancer. This put a lot of diet people in despair, because what they had worked on for so long, reducing fat in the diet, did not have a beneficial outcome. So the idea of reducing calories and reducing carbs as part of those calories may be beneficial to reduce cancer growth. That’s pretty exciting

Could it be more beneficial to go to the more extreme side of eating fats? For instance, eating 80% of calories as fat, where carbs are down to 20 grams and protein is maybe 15% of the diet. Could that be especially therapeutic? Or, if someone just nudges it up a little bit. For instance, if someone goes from eating 20 percent fat up to 40 percent fat, which might be more beneficial in this more extreme situation of health and disease?

Extreme is a matter of perspective. The studies of cancer in animals, with only 40 percent fat did not look very promising. The signals are that you’d need to go to a higher level of fat intake-to at least 60 percent of your daily caloric intake.

To improve cancer treatment, or reduce the risk of cancer, at least 60% fat may be better than 40%?

And that’s thinking about how the body is working as a furnace that is burning fat, in order to get the inflammatory cells and inflammatory response to be lower.

There’s something about 60% a day that tells the mitochondria in your cells, those little furnaces, okay, I’m in fat burning mode. I can stick with this way of processing energy and really doing it well.

Fats being high AND the carbs being low.

And the carbs being low.

Because insulin will turn off your fat burning, and the insulin goes up in response to the carbs in the diet. So, keep the carbs low and get the other calories mostly from protein. Protein is really what our body needs at the end of the day. In bariatric surgery, where they make your stomach really tiny, they want you to have protein shakes.

If I’m scared of fats, what if I eat 60% of my calories as protein?

If you’re just eating real food, it’s hard to push proteins that high.

But if I could, would that be healthful or stressful?

I think it would be stressful. You don’t want to eat so much protein that you’re having to get rid of the excess protein through your kidneys. Now in terms of grams per day, over 150 to 200 grams of protein a day will put additional stress on the kidneys.

If you have extra protein your body is using, does it make you have stronger muscles or just turn into sugar.

Protein in the diet can be turned into glucose or sugar, which in turn, your body will store as fat. The optimal type of weight loss I’ve seen is Jeff Volek’s research, where you give adequate protein during the weight loss process, but not so much that you turn the protein into glucose which in turn raises insulin and stops the fat-burning.

In summary, you’re not saying the whole world should go to eating a high fat diet, every many woman and child. But you’d see it as a healthy option that people can make, with good information.

Right. The science supports that, loud and clear that the low carb, high fat, Atkins type diet is a viable option. It’s a healthy lifestyle, healthy way to go, we just want to be loud and clear and it’s healthy and scientific.

If you had your dream world, if someone went into a health clinic, or a public clinic, or a nutrition office, what would you like to see offered in terms of diet options.

Well, years ago, when I first was introduced to the Atkins diet, I thought, how easy was this? As a doctor I didn’t do anything! My patients just read the book. I’d like to see healthcare people saying, why don’t you do the new Atkins. Three University professors rewrote the Atkins diet to update it and give it more flexibility. If you don’t have much time, just say, go do Atkins. It’s fine, it’s healthy, it’ll help you a lot.

Another approach is just to not give the one size fits all, low fat advice. It’s time consuming to help someone change their lifestyle. The book is placed to help someone understand the Atkins approach so they can lose the weight and keep it off for a lifetime.

Would you like health professionals actually be experts in these different dietary approaches so that they don’t say something really dumb about how to implement a high fat diet.

That depends on the training. If most people had the training I had in nutrition . . . I’m a physician . . . I don’t want them to say much about nutrition at all. Because I wasn’t trained much. I probably learned from the wrong sources along the way until about ten years ago when I sought out the world’s experts on diet.

You at one point in your professional medical career, were kind of stupid?


We had a professional writer help with this book. So we’re not going to put you to sleep, like back in school. We really wanted this to useful for the everyday language. And that way, you can be an expert in the clinic by saying, go do Atkins. No diet has been subjected to this amount of scientific scrutiny before, because of the skeptisim. And it’s come out Scott-Free.

If it’s done right, especially at the 60% fat or higher, it seems to be a healthy diet.

We want people to do it right, and that’s one of the other reasons for putting out a new book, using today’s foods in today’s environment of restaurants and fast food. I hear people say Fast Food is the cause of obesity. I say, no, not really. You can eat there and just be smart about what to eat. Like the burger without the bun. Or the chicken salad. There are no evil foods. We just help you figure out how they affect your body.

  27 comments for “Eric Westman, Duke MD, on Low Carb, High Fat, New Atkins Diet

  1. September 18, 2016 at 7:58 pm

    I’m a neonatologist I don’t treat adult but treat newborns.we do feed newborn with 4gram of protein per kilogram weight and same amount of fat but the rest is sugars so almost 50% carbohydrate .
    I think some time we may have to switch to higher fat percentage .

  2. Tara
    April 9, 2016 at 3:11 pm

    Arlene, are you getting enough magnesium? It is essential, especially in the beginning stages of the diet that you get enough electrolytes. After adding a magnesium supplement to my vitamin regime I became much more regular.

    Also macronutrient portions (carbs, protein and fat) should be calculated based upon your personal needs. There are keto calculators on the web and I have found them to be accurate for my needs. They take into consideration basal metabolism, height, weight, percentage of body fat etc. I eat around 73% fat, 7% carbs and 19% protein. I am 69, disabled, so not very active, and maintain caloric intake around 1400 calories which is more than I was able to eat prior to becoming disabled and still maintain my weight. I was overweight as a child and had to diet continually throughout my life in order to maintain a healthy weight. This diet has done so much for me.

  3. Tara
    April 9, 2016 at 2:54 pm

    I have been following this diet for over a year now. I did not need to lose weight, but I had such bad heartburn I was in agony and unable to eat. I finally realized that anything with grain in it would upset my digestive system. That is when I turned to a ketogenic diet. Now I can maintain my weight easily without stress, no longer have carb cravings and I eat well. There are apps out there that can help you track your carbs and lots of great recipes and websites to support you in making these lifestyle changes. This has been life changing for me.

  4. November 9, 2014 at 7:50 am

    Hi, Diane,

    Congratulations on what you’ve been doing. Would you like to give an update?

    On some of your questions, they are medical in nature, and my suggestion is that you find someone who is a licensed health care practitioner in your area who is experienced with people doing low carb, ketogenic diets. One group of health care experts that have more experience with these kinds of programs is the profession known as naturopathic physicians, since they have a lot more training in the nutritional sciences than do most MDs. Another way to go would be to check some of the posts here of some of the experts. AND, another resource – I’m reading “Keto Clarity” right now by Jimmy Moore of Livin’LaVida and Eric Westman, MD of Duke University. It’s excellent and may answer some of your questions also.

    July 30, 2014 at 4:23 pm

    When I was diagnosed with type 2 diabetes last October, I did tons of research online and discovered the beauty of eating to my glucose meter and the low carb/high fat diet. Since then, I’ve lost 64 pounds, and keep my fasting blood glucose under 90. I use an online nutrition tracker to stay focused. I eat about 5% carbs, 15% protein, and 80% fat every day. So far, my labs are great, and I feel so much better. The only problem I have now is none of my clothes fit me, and I’m on a fixed income.

  6. Gail W
    July 28, 2014 at 4:34 pm

    It is encouraging to see some support, finally, for the very things Dr. Richard K. Bernstein, himself a type 1 diabetic, has been saying – and proving – for literally decades. Similarly heartening to see confirmation regarding the ketogenic diet for epilepsy, as proven over many decades via the work begun in the 1921 by Dr. Russel Wilder of the Mayo Clinic and resurrected and sustained at Johns Hopkins by Millicent Kelly, R.D. and Dr. John Freeman. The diet of course lost popularity in the 1950s when the pharmaceutical companies moved in with drugs to treat epilepsy.

    Congratulations on your good work, and may it continue. May these movers and shakers who began that work also receive the credit for their ingenuity and perseverance. They have had to stand strong in the face of the medical industry’s opposition and sometimes frustrating unwillingness to see or challenge its own assumptions.

  7. Diane
    May 10, 2014 at 3:42 pm

    This is the first diet that I can loose weight!!! I am 66 years old and a type 2 diabetic.
    I do have a question, I do not take my Glimepiride when I am on the diet.
    The question I have is, can my blood sugar go to low especially at night, Or with not taking the meds is it not a worry? How low can it go before I go to bed. People have told me check on this. Also, I have been told that when you loose weight to fast a person start having problems with the gall bladder. Or should you go off and on to slow the weight
    lose down.
    What is you opinion on these questions? I do realize it is opinion.
    Thank you for your time on this matter. I really appreciate
    it, as this is the first time I can loose weight.

    Thank you,


  8. April 25, 2014 at 8:39 pm

    Most of these experts generally say nuts and seeds are fine, with the caveat that nuts and seeds do contain some amount of carbs, and for some people they are somewhat irritating to digestion. So it’s beneficial to educate yourself about the “serving size” of nuts or sees that you want to eat, and check the carb content. Note that some “nuts” such as cashews and peanuts, are actually beans, and those have a lot more carbs than most real nuts do. Also, seeds tend to have more carbs per gram than tree nuts do.

  9. Diana
    April 25, 2014 at 11:27 am

    Are nuts and seeds allowed on this diet.

  10. Diane meche
    April 24, 2014 at 8:38 am

    HDL cholesterol is 80
    Triglycerides are LOW
    Appetite drastically reduced!
    Losing weight
    Great diet!!!

  11. February 20, 2014 at 10:35 am

    Hi, Roseanne,

    I’m not a doctor and don’t give medical advice – you can contact Eric Westman directly through Duke University. But as a quick observation from a regular person’s view, there’s a lot of debate about the relevance of cholesterol, and some of what determines risk, according to some experts depends on whether you have big, fluffy LDL particles or small, dense ones, and how much is HDL and how much is LDL. “The Great Cholesterol Myth” is a book that talks about that controversy in pretty clear terms, for instance. But if your cholesterol levels are a concern to you personally, the Balance Point for health program has a pretty good track record, from user reports, for dropping cholesterol. Binx and Linda Selby’s new book about that is How I Grew Younger, and You can Too. Binx’s program is NOT very low carb, per se, but it can be modified to be very low carb. Some aspects of it that seem to affect cholesterol levels are high fat (70% of calories) and VERY low protein – ie, enough protein, but never too much. That’s something that Ron Rosedale recommends as well. Binx is also a big advocate of olive oil.

    Now and then, some researchers speculate that the fat coming out of someone’s fat cells as they lose weight can increase cholesterol levels, so sometimes an increase is a transient thing.

    All of the experts I’ve mentioned have interviews here on this website that you can look up, for more information. But anyway, check out some more possibilities, and good work and good luck being a fat burner!

  12. sergio saragnese
    February 13, 2014 at 3:42 am

    please help me I’m type 2 diabetes , i need to follow food diet that will help me get better. i live in south Africa port Elizabeth, my age is 58yrs old.

  13. Roseanne Folger
    February 9, 2014 at 5:50 am

    I really need answers ..I ordered your book I have been following your diet for three weeks. The first two weeks I lost 12 lbs and on my third week I went to the doctors and he did a blood test..he called to tell me my cholesterol is at 279.. Not good. If I am following this to a T.what happened. He now has me taking actor astatine to lower it..I started this plan so I could lower my cholesterol but it didn’t happen it went up. Yes I lost weight yes I’m still on this diet going on my fourth week but I am hoping I get an answer and this isn’t just me posted for nothing…

  14. January 16, 2014 at 2:54 pm

    Hi, Doris,

    You might check with Eric Westman’s clinic at Duke University for some recommendations.

  15. Marla
    January 12, 2014 at 12:15 pm

    I am slightly confused about some of the things I read….I want to do this low-carb diet, but I’m getting mixed signals about what to eat….Too much protein will be stressfull on the kidneys???….Well, then what do I eat to make sure that I don’t take in too much protein???….Aren’t most high-fat foods, such as eggs, bacon, sausage, ground meat, pork-rinds, etc.; high in fat AND protein???….I’m not really getting it….I’m told to eat like this and then told that it can be too much….What’s too much???….Yea, I read about the certain amount of protein grams allowed a day, but the article I read in “Woman’s World” (Last Chance Diet), said I didn’t have to count calories in this diet….Just eat and lose….But, now I’m being told that I DO have to count protein grams and such….Which is it???….It sounded really simple in the article, but now I’m not so sure….And is it possible for some to pack on the pounds by eating like this???….I don’t want to GAIN weight!!!….Please clarify some things for me 🙁

  16. January 10, 2014 at 12:10 pm

    Do you know of any doctors in Georgia or Atlanta area who treat people using your program?
    Thank you.

  17. Charles
    January 9, 2014 at 9:55 pm

    I am glad to see some actual clinical research in support of the Atkins diet. Most nutritionist are still in denial! Also, most still recount the false story about Dr. Atkins dying as a result of his diet vs. a subdural hematoma.

  18. November 13, 2013 at 2:15 am

    It also helps to find a workout partner who will join
    you during your exercise sessions. The food that we consume is chemically and physiologically
    treated by our digestive system. Even worse, it erodes our
    confidence and self-respect.

  19. Mr. Edward
    August 16, 2013 at 9:13 pm

    Dr. Mary Vernon has disappeared. I would like to know if the job of insulin to stop fat burning and enhance fat storage, on the low carbs eating plan, should I still use insulin. I am insulin resistance.
    I live over seas and the doctors just do not know.I am 5’7″ and 100kgs. Now on the first month of no insulin but the reading is twice what it should be, 245.
    Please response to

  20. Faye Burke
    January 17, 2013 at 7:17 pm

    I have metabolic syndrome and have diabetes with insulin. I want to investigate for any clinical studies on the diet from Dr. Charles Mobbs which found decrease and even reversal of ESRD in mice in the lab. I have that as result of diabetes. Does Dr. Westman or the Duke researchers have anything going in this direction? This diet was a ketogenic diet with 87% fat and 8% protein. Wondering if this would work for me

  21. July 26, 2012 at 11:29 am

    Thank you so much Dr. Westman everything you have mentioned is in fact so true. I am 68 and disabled so I do not get very much exercise. No matter what diet I try except for the Atkins Diet I cannot lose a pound. I let myself get into bad eating and gained 75 pounds on two occasions. The first time I went on the Atkins Diet and lost the 75 pounds within three months. I am back on the diet again with another 70 pounds to lose. On day 15 I have lost 15 pounds. When I lose it this time I am staying on a low carb diet and I am done with being fat. No other diet worked on me at all even 800 calories a day. Thank you Eric for the great information.

    Thank you, Gary, for sharing your story. A wise observation you make here is that, even after you lose the weight you want to lose, this time, you’re planning to stay on a low carb diet. From what experts such as Dr. Westman and Dr. Steve Phinney and Dr. Ron Rosedale and Dr. Jay Wortman say, staying on a low-carb diet, long-term is a great idea. – Shelley

  22. March 23, 2011 at 7:48 am

    Hi, Arlene,

    Interesting points you raise. I can’t speak to the Reader’s Digest article on Atkins, but regarding fiber and “regularity,” Dr. Westman’s colleague and co-author, Dr. Steve Phinney, has an interesting perspective on healthy digestion depending more on healthy microbes in the digestive tract than on the amount of fiber a person eats. If you want to check out his perspective, go here. — Shelley

  23. March 20, 2011 at 3:43 pm

    I read the article in Reader’s Digest that you wrote about the Akins diet, which prompted me to buy your book and start the diet. However, something troubles me about what you wrote in the article because it is inconsistent with what is said about foods to eat on the different websites. You say you have bacon for breakfast every morning, a 3/4 pound hamburger for lunch, and a 1 lb. steak or half a chicken for dinner. The websites say not to eat bacon, hotdogs or lunch meat, and the portions recommended are much smaller than those you said you eat. Also, I see nothing in your book or on the websites about problems of irregularity while on this diet. Since we are not supposed to fruit,fruit juices and fibe cereal, how are we supposed to keep regular. I have been havinig problems with irregularity while on the diet for two weeks, even though I eat lots of salds and green vegetables. How can this be avoided.

  24. April 30, 2010 at 10:48 pm

    Low Carb diet is really the best diet if you want to reduce weight and also to maintain a healthy body.’-*

  25. April 28, 2010 at 8:39 pm

    Atkins Diet have helped me a lot to maintain a very good physique. My mom is also on an Atkins Diet. |

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