Westman: Science Will Prove Low-Carb As Viable For Weight Loss, Health As Low-Fat

Dr. Westman became convinced low-carb works because of his patients

A couple of weeks ago, I introduced you to a researcher named Dr. Jeff Volek who shared some of the amazing research he is working on that shows the effectiveness of livin' la vida low-carb for both weight loss and improved health. Today I have another young researcher that I was privileged to interview for my blog named Dr. Eric C. Westman, Associate Professor in the Division of General Internal Medicine at Duke University Medical Center.

I recently named Dr. Westman one of my top 10 low-carb movers & shakers of 2006 and for good reason. His fingerprints are all over much of the positive research coming out about the low-carb lifestyle these days and I believe he is someone that everyone who supports the low-carb nutritional approach should get to know a little better.

Dr. Westman is just like you and I, except he is doing research that could quite literally change the way we look at diet, weight loss, and health forever. What an honor to have this brilliant scientist share just a small taste of what he is doing to educate the public with facts about what the low-carb diet can do for them. Read and learn from the best.

1. We are privileged to have with us today at the "Livin' La Vida Low-Carb" blog one of the nation's premier researchers on the low-carbohydrate diet, Dr. Eric C. Westman from the Duke University Medical Center. Welcome Dr. Westman and thank you for your contribution to the low-carb community with your studies into this incredible way of eating. How and when did you first become interested in nutritional science?

Thanks Jimmy. I am a specialist in internal medicine, but I've always been interested in lifestyle and disease prevention. When I was working at the Durham Veterans Affairs Medical Center in the mid-1990s, I had three patients who had lost weight using a low-carbohydrate diet. As their doctor, I was able to measure their blood glucose and serum lipids and, much to my surprise, they all improved.

At the urging of one of these patients I read the Dr. Atkins New Diet Revolution paperback book. Though I was skeptical, I was intrigued by the potential of how easy it would be for me to help patients lose weight if this method really worked like the book said (I had little success using traditional approaches). My research involved smoking cessation at the time, but my research staff was also curious about the low-carbohydrate diet, so I wrote Dr. Atkins a letter asking for data regarding his plan.

Some time passed, I don't remember exactly how long it was, but Dr. Atkins called me in my office one day, and after some discussion he invited me and my staff to his clinic in New York City. We observed the low-carbohydrate diet in action with Jackie Eberstein, a nurse who had worked with Dr. Atkins for 30 years or so. We were able to convince Dr. Atkins to fund us to do a formal pilot study of his approach in Durham, North Carolina. The pilot study results were favorable, so we convinced them to fund a second study, a randomized trial of a low-carbohydrate diet versus a 30 percent fat diet. We are now in the middle of our fifth study using a low-carbohydrate diet for various clinical disorders.

2. Tell my readers briefly what a day in the life of Dr. Eric Westman is all about. There seems to be this mysterious aura around exactly what researchers do with all their time in between releasing the results of their studies. What exactly do you do on a day-by-day basis?

Well, perhaps there’s a mysterious aura around what researchers do because it's not all that glamorous or exciting! What I do on a day-to-day basis depends on the day, and the time of year, but it involves reading and writing papers and grants, supervising junior investigators, giving talks locally or at national meetings, seeing patients in the clinic or research study, or teaching Duke medical students or residents. At this moment, much of my time is spent analyzing and writing a clinical trial that we just completed, and putting together two research presentations for an upcoming national meeting on Obesity.

3. One of the subjects of your research has been the effectiveness of the low-carbohydrate nutritional approach on the treatment of diabetes. Just before the summer, your research was presented at the annual meeting of the American Diabetes Association. How well do you think it was received among your peers in the scientific community and do you see any changes in philosophy about treating this ever-growing disease coming?

At the ADA meeting session there were three oral presentations regarding lifestyle treatments for type 2 diabetes: two low-carbohydrate and one low-fat vegetarian presentations. All three interventions led to improvement in weight and glycemic control in Type 2 diabetics. Unfortunately, this was one small session in a gigantic meeting mostly devoted to non-lifestyle approaches. Generally speaking, though, the scientific community will respond and change when sufficient scientific data are available. I'm committed to help collect that scientific data.

4. Dr. Richard Feinman from SUNY Downstate told me in a recent interview he did at my blog that he believes the ADA is backing into embracing the low-carb lifestyle as a viable option for helping diabetes patients contend with their disease. Do you share this same sentiment and how soon will we see doctors prescribing a low-carb diet to their patients with diabetes?

Every diabetic who monitors his or her blood glucose knows that blood glucose rises most in response to eating sugar and starch. There are many doctors though who still disregard the rise of blood sugar after meals as not being important, or not related to elevated fasting blood sugars. There is ample scientific evidence to support the statement that one can lower the blood glucose by lowering carbohydrate in the diet. In the medical community, I think there still is a "fear of the unknown"-- a fear of what the long-term consequences of a high-fat diet might be.

5. Your research over the past few years has provided a lot of evidence showing not only the effectiveness of programs such as the Atkins diet, but also the safety of being on such diets over longer periods of time. And yet the prevailing school of thought in 2006 among most people is that a low-carbohydrate approach is unhealthy, dangerous, and not for the long-term. How do those of us who have lost weight and kept it off eating this way counter such criticisms?

It takes time for information and published trials to get digested, filtered and transmitted to the medical community. The best way to convince your doctor that what you are doing is not unhealthy is to collect and show your own health data (weight, serum glucose and lipids, and any other test that the doctor wants). I advise everyone to keep track of their own health data.

6. You have done a lot of comparison studies of the low-carb diet vs. the low-fat diet. Describe some of the most notable differences that you have found in your research between these opposite eating plans, including the effect on weight loss and lipid profiles.

The major difference between the low-carbohydrate diet and the low-fat diet was demonstrated best in the JAMA paper by Mike Dansinger at Tufts University. In that paper, they concluded that low-carbohydrate and low-fat diets lead to improvement in the cardiac risk profile, but by different methods. The low-carbohydrate diet raised HDL cholesterol and lowered triglycerides while the low-fat diet lowered LDL cholesterol. However, individuals still need to have their own health data monitored because these effects are not certain.

7. The "meat, cheese, and eggs" mentality about a low-carb diet is what most people believe eating low-carb is all about. And yet the low-carb diet you and your fellow researchers fed the people who participated in your study included lots of vegetables. Describe a typical day's low-carb menu for people who ate "low-carb" in your studies and provide the breakdown of the percentage of macronutrients consumed.

This is an interesting point: just what is a low-carbohydrate diet? In our studies, because we went to learn from Dr. Atkins, we kept the carbohydrate content very low--in some cases less than 20 g of carbohydrate for the entire six-month period of the study. Dr. Atkins told us that with proper monitoring this was safe in his experience. So when you ask about the vegetable intake in our studies—it was low—we required only two to three cupfuls of non-starchy vegetables per day, and gave people vitamin supplementation. To use the language of popular diets, we kept people in the Induction Phase of Atkins, or Phase 1 of South Beach.

You're right that for long-term low-carbohydrate lifestyle living, non-starchy vegetables should be the source for about 100 to 150g of carbohydrate per day. This recommendation, though, is based on consensus expert opinion and not randomized trial evidence. I would like to see further studies asking the question, "what is the optimal level of carbohydrate intake?"

8. In an article earlier this year at TheHeart.org, you were quoted as saying the following: "Show me a study where these recommendations [for reducing saturated-fat intake] have led to improved outcomes: there isn't one ... In the drug world, you can't rely on intermediate outcome measures anymore, so that makes me wonder about saturated fats. This is pretty controversial to say, but I think we just need better science to say that saturated fat is bad." That's a pretty passionate defense of saturated fat in a world that thinks fat is the enemy. Explain how and why people should consume saturated fat as part of a healthy lifestyle.

The recurrent scientific flaw of the major lifestyle outcomes studies over the past 50 years is that studies evaluating low-fat diets were assumed to work through the mechanism of lowering saturated fat--when this was never specifically tested. If I prescribe a low-saturated fat diet, many other changes are occurring relative to the baseline diet: a reduction in calories, and a reduction in high glycemic foods including sugars and sweets, a reduction in processed foods including trans-fats, etc. I hope that a future scientific meeting will critically evaluate the evidence that “saturated fat is bad.” I’m concerned that the evidence is just based on intermediate outcomes—and that’s not good enough.

9. Do you think we will ever see the day when the low-fat diet is no longer recommended by our government and health leaders as the only way to lose weight and get healthy? If so, then do you believe it is possible the low-carb approach could someday be suggested side-by-side with the low-fat diet to give people a variety of ways to tackle their obesity and obesity-related diseases?

Absolutely. I think that change is already occurring.

10. THANK YOU for agreeing to share some of your thoughts about livin' la vida low-carb with my blog readers today, Dr. Westman. When I met you in person for the first time in Brooklyn, New York in January, I found you to be one of the most down-to-Earth medical researchers I've ever met. While remaining a consummate professional at what you do with your research, you still have your finger on the pulse of the average Joe. How do you stay so grounded in reality when so many other researchers stay in their own theoretical world? Do you have any parting comments to encourage any of my readers who are considering going on a low-carb diet?

Now, Jimmy, you’re embarrassing me, and making me think about things I don't often think about. I guess I've always wondered why it didn't rain when the weatherman predicted rain, or why my patient didn't respond when the therapy was supposed to have a certain effect? I remember one of my medical school professors saying that we will learn from our patients—if we let them! I guess my story in regard to low-carbohydrate diets started by listening to my patients.

If you're considering going on a low-carb diet, and have medical problems, it's important to be monitored by someone who has experience with low-carbohydrate diets. There are a growing number of physicians who are comfortable with this approach now.

If you are following a low-carb diet and want to make it a long-term lifestyle, you need to know that the medical studies are just not there yet to validate long-term safety and effectiveness beyond one year. When all is said and done, I think science will be able to explain why some people should follow low-carbohydrate diets and why some people shouldn't follow low-carbohydrate diets. Until that time, you have to monitor yourself.

I've used this analogy, and it's not perfect, but it does hit upon some of the same themes: imagine you're setting sail from Spain to explore the New World when the prevailing wisdom is that the earth is flat. Everyone says you are crazy because you will most certainly fall off the end of the earth and die a horrible death. To hedge your bet, you decide to be in the crow’s nest at the top of the mast to be the first one to see the end of the world, so that you can turn the ship around and head back to safety. Now, I don’t know that the end of the low-carb diet story will end in the same way as this one, but I can say that I haven’t seen the end of the world yet!

You can e-mail Dr. Eric C. Westman at ewestman@duke.edu.