Show 1444: The Food Fight Over Fat: Keto and Carnivore Diets

For the last several decades, nutrition scientists have been debating the pros and cons of various dietary approaches. The Mediterranean diet has a lot of proponents, and we have interviewed some of them on The People’s Pharmacy. Dr. Barry Popkin and Dr. Walter Willett endorse olive oil, whole grains, fruits and vegetables with only small amounts of animal-sourced food. Listen to Show 1359: Is the Food on Your Plate Real or Fake? for more information. Dr. Will Bulsiewicz is a fiber evangelist. You can hear him on Show 1312: fiber, Phytonutrients and Healthy Soil. Plant-based diets can fall along a spectrum from mostly plants with some meat, fish and eggs to completely vegan. In contrast, there are experts who recommend a low-carb, high-fat ketogenic diet. Carnivore diets consisting of only animal products (meat, poultry, fish) are a subcategory of keto diets. That is the focus of this episode.

Carnivore Controversy:

We know that people have strong feelings about food. The DIETFITS study, one of the best randomized controlled trials comparing healthy low-carb to healthy low-fat diets found that both led to weight loss. Learn more by listening to our interview with lead investigator Dr. Christopher Gardner on Show 1126: Can You Find Your Best Diet? We have heard from fans of ultra-low-fat diets like those promoted by Pritikin or Dean Ornish, MD. We acknowledge that hearing about a carnivore diet may put their teeth on edge, at the very least. But information from knowledgeable sources about controversial topics is what we aim for, and this is indisputably controversial.

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care, treatment, or diet.

How You Can Listen:

You could listen through your local public radio station or get the live stream on Saturday, Sept. 13, 2025, at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on Sept. 15, 2025.

Ketogenic and Carnivore Diets:

Doctors have long prescribed ketogenic diets to treat children with hard-to-treat epilepsy (Epilepsy & Behavior, Sep. 8, 2025).  Studies suggest that people with migraines or depression might benefit from a ketogenic diet (Brain and Behavior, Sep. 2025; Translational Psychiatry, Sep. 10, 2025).
Most people now following carnivore diets, which are more extreme than ketogenic diets, began following this eating plan to lose weight and have more energy. Our co-host for this show, AAAS Mass Media Fellow Bianca Garcia, has done some investigation of this approach to nutrition, including a personal trial. She joined us in interviewing Dr. Eric Westman, an advocate for ketogenic and carnivore diets to help people with obesity and diabetes.

What is a ketogenic diet? It minimizes the carbohydrate available as fuel by including only low-starch vegetables such as greens. High-fat food sources make up the bulk of the energy in the diet. This forces the body to burn ketones derived from body fat instead of glucose derived from sugar or starch. In a carnivore diet, the vegetables disappear completely and the high-fat food sources are all derived from animals.

How Do Dietary Guidelines Mesh with Carnivore Diets?

We asked Dr. Westman about changing dietary guidelines, and he pointed out that most of the national dietary guidelines have limited scientific support. Of course, randomized controlled trials of people following carnivore diets are also few and far between. A survey of more than 2,000 self-selected volunteers following the diet was published in 2021 (Current Developments in Nutrition, Nov. 2, 2021). The DIETFITS trial, which compared a healthy low-fat, high-carb regimen to one high in fat and low in carbs found no significant difference in weight loss over the course of a year (JAMA, Feb. 20, 2018).

What Are the Effects of a High-Fat Diet?

In the clinical trials he conducted, Dr. Westman found that blood insulin levels were lower as people followed a ketogenic diet (Expert Review of Endocrinology & Metabolism, Sep. 2018). The body does not require insulin to utilize ketones for fuel. As a result, people with type 2 diabetes have better control of their blood glucose when following a low-carbohydrate ketogenic diet (Nutrition & Metabolism, Dec. 19, 2008).

He and his colleagues have published a case series suggesting that a ketogenic diet could help people with food addiction (Journal of Eating Disorders, Jan. 29, 2020). There are also hints that people with other psychiatric conditions might benefit from a ketogenic diet as well (Psychiatry Research, May 2024).

What Is Driving the Interest in Carnivore Diets?

Bianca Garcia and Dr. Eric Westman agree that the internet has a huge influence on people’s interest in carnivore diets. Podcasters like Joe Rogan and multiple influencers have promoted this approach, especially to younger people. This can contribute to social pressure to try it. Dr. Westman warns listeners that adopting a ketogenic or carnivore diet should be undertaken under knowledgeable guidance. A drastic dietary change can alter how medications work, so people with chronic illness really need to work closely with health care professionals. That may require searching for someone who is open to this approach with the expertise to recommend when supplements or salt might be needed and provide information on doses.

This Week’s Guest:

Eric Westman MD, MHS, is an Associate Professor of Medicine at Duke University. He is Board Certified in Obesity Medicine and Internal Medicine and founded the Duke Keto Medicine Clinic in 2006 after conducting clinical research regarding low-carbohydrate ketogenic diets. Dr. Westman is a past President and Master Fellow of the Obesity Medicine Association and Fellow of the Obesity Society. He is a board member of the Society of Metabolic Health Practitioners and the American Diabetes Society. In addition, he has written and edited numerous bestselling books and is a co-founder of Adapt Your Life Academy (www.adaptyourlifeacademy.com), which provides science-backed education on a range of subjects rooted in the therapeutic effects of dietary carbohydrate restriction… including his newest course, Carnivore Made Simple, which is open now for enrollment for a limited time.

Our Co-Host:

Bianca Garcia is a Filipina-American anthropologist, foodie, and radio person. She holds a master’s degree in Media, Medicine, and Health from Harvard Medical School, where she created an audio documentary on the carnivore diet. She was a AAAS Mass Media Fellow covering health and science at WUNC, North Carolina Public Radio when we conducted the interview; her favorite stories to cover always involve what people eat, and why.

Listen to the Podcast:

The podcast of this program will be available Monday, Sept. 15, 2025, after broadcast on Sept. 13. You can stream the show from this site and download the podcast for free, or you can find it on your favorite platform.

In the podcast for this episode, you’ll hear the real patient story of a doctor who weighed 350 pounds and suffered from POTS (postural orthostatic tachycardia syndrome). Do we have any idea of how a carnivore diet affects the gut microbiome? Dr. Westman describes his study on how a low-carb diet helps GERD (gastroesophageal reflux disease). Years ago, Joe looked for evidence on the traditional heartburn diet limiting fat, alcohol, coffee and tomatoes and couldn’t find any. What we have found is that science changes as researchers pursue further studies and that is not a reason to mistrust science even though the changing recommendations may be frustrating. Dr. Westman offers a message to everyone trying to make the right dietary choices but feeling overwhelmed by many different messages about food.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

Transcript for Show 1444:

A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. This transcript is copyrighted material. All rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission.

Joe

00:00-00:01

I’m Joe Graedon.

 

Terry

00:01-00:05

And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy.

 

Joe

00:06-00:26

You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Americans have been fighting about food for decades. What’s healthier: low‑fat or low‑carb eating patterns? This is The People’s Pharmacy with Terry and Joe Graedon.

 

Terry

00:33-00:44

We’ve talked with many experts about the value of a Mediterranean diet, rich in produce and low in red meat. Today we’re going to find out about the carnivore diet.

 

Joe

00:44-00:49

What’s the difference between a carnivore diet and a ketogenic diet?

 

Terry

00:49-00:59

Our guest is Dr. Eric Westman of Duke University. He started as a skeptic of the Atkins diet. Then he conducted research that turned him into an advocate.

 

Joe

00:59-01:15

Coming up on The People’s Pharmacy, the food fight over fat. Learning about keto and carnivore diets.

 

Terry

01:13-01:56

In The People’s Pharmacy Health headlines, COVID cases are increasing, especially on the West Coast. Oregon has seen a late summer surge in cases. California has also seen an alarming increase. Hospitalizations for COVID patients have almost doubled in recent weeks. An objective measure of viral spread comes from wastewater samples. The CDC’s wastewater surveillance system reports very high genomic sequencing levels for the SARS-CoV-2 virus. There is hope, however, that the summer surge will ease soon, though public health officials worry another COVID wave could start as early as November, just in time for holiday travel.

 

Joe

01:56-03:07

People who are trying to avoid COVID-19 might want to consider an inexpensive, low-risk strategy to stay safer. A study published last week in JAMA Internal Medicine tested the nasal spray Azelastine for prevention of SARS-CoV-2 infections. This over-the-counter antihistamine is sold under the brand names Astelin and Astepro. Beyond its anti-allergenic and anti-inflammatory properties, this medication has antiviral activity against several respiratory viruses from SARS-CoV-2 to RSV and flu. A double‑blind, placebo‑controlled trial in Germany included 450 patients who spritzed either azelastine or placebo into their noses three times daily for roughly two months. During that time, five people spritzing the antihistamine came down with COVID. In the group using the placebo spray, there were 15 positive cases. The authors concluded that their results support the potential of azelostine as a safe prophylactic approach, warranting confirmation in larger multicenter trials.

 

Terry

03:07-03:57

A different study tested the effects of inhaled nitric oxide against COVID-19. The investigators note that this gas is produced naturally in the body and is well known as a vasodilator. It also has antiviral and anti inflammatory properties. In a recent study, fifty-five patients hospitalized with COVID associated pneumonia got inhaled nitric oxide or usual care. Those who had up to six hours exposure to high dose nitric oxide were released from the hospital more quickly and needed less supplemental oxygen. According to the investigators, the inhaled nitric oxide treatment was safe and well‑tolerated. They suggest this approach might be helpful against other pulmonary infections.

 

Joe

03:58-05:11

Generalized anxiety disorder, GAD, is one of the most common psychiatric conditions in the U. S. Doctors may prescribe anti-anxiety drugs such as alprazolam or diazepam. But these benzodiazepines may not be suitable for long-term use. SSRI antidepressants are also prescribed, but they too don’t work for everyone with anxiety problems. Now, scientists report a single dose of the hallucinogen LSD can have lasting effects. Nearly 200 patients were recruited for the study. The researchers randomly assigned them to take placebo or one of four different doses of the active compound. The two lowest doses of LSD did not have an effect that was significantly greater than placebo. People receiving the two highest doses—100 or 200 micrograms—were significantly less anxious one month later. Adverse effects included hallucinations, nausea, and headache during the treatment. This helps establish the groundwork for further research on the potential benefits of one dose of LSD to treat disabling anxiety under careful medical supervision.

 

Terry

05:11-06:17

Are you a coffee lover? How do you drink your brew? Previous studies have shown that regular coffee drinkers get substantial health benefits. They tend to have a lower risk of liver cancer, diabetes, dementia, and cardiovascular disease. Few studies get into the details of coffee consumption, though. Now a cohort study of more than 42,000 American adults participating in the National Health and Nutrition Examination Survey. demonstrated that higher coffee consumption was associated with a lower likelihood of dying between 1999 and 2018. People drinking one to three cups daily got the most benefit, but they needed to drink their coffee black. Adding sugar or cream or non-dairy creamer blunted the effects. And that’s the health news from The People’s Pharmacy this week. Welcome to The People’s Pharmacy. I’m Terry Graedon.

 

Joe

06:17-06:30

And I’m Joe Graedon. You’ve heard a lot about the health benefits of the Mediterranean diet here on The People’s Pharmacy. We’ve also talked to guests like Dr. Will Bulsiewicz about the value of fiber in our diet.

 

Terry

06:30-07:02

Today we’ll be considering a different dietary approach. Is there any science to support the keto or carnivore diet? Joining us for this interview is Bianca Garcia. She holds a master’s degree in Media, Medicine, and Health from Harvard Medical School, where she created an audio documentary on the carnivore diet. She served as the AAAS Mass Media Fellow at WUNC. We invited Bianca to co-host this interview.

 

Joe

07:00-07:30

To help us better understand the carnivore diet, we turn to Dr. Eric Westman, Associate Professor of Medicine at Duke University. He founded the Duke Keto Medicine Clinic in 2006 after conducting clinical research regarding low-carbohydrate ketogenic diets. He’s written a number of popular books, such as End Your Carb Confusion and Keto Clarity, his newest course, Carnivore Made Simple, is open for enrollment.

 

Terry

07:31-07:35

Welcome to The People’s Pharmacy, Dr. Eric Westman.

 

Dr. Eric Westman

07:35-07:36

Thank you. It’s great to be here.

 

Terry

07:37-07:42

And we are… (DR. WESTMAN 07:38-07:38) Again. Yes, again for the I don’t know how many-eth time.

 

Dr. Eric Westman

07:42-07:43

I lost count.

 

Terry

07:43-08:00

Okay, me too. And we are really pleased to have with us in the studio helping us with the interview. Bianca Garcia, who is a journalist and I might say a medical anthropologist. We’re glad to have you here, Bianca.

 

Bianca Garcia

08:01-08:02

It’s my pleasure.

 

Joe

08:03-08:27

Dr. Westman, I have to tell you, when it comes to food, I get so confused It seems like the dietary guidelines have changed so much in my lifetime. How do you keep up and tell us what you think about this whole process? Because you’ve been studying food for decades.

 

Dr. Eric Westman

08:27-08:51

Well, so you have to think about uh the human body first. not the well this is my perspective. I’m an internal medicine specialist. So I got trained in an era where we were dealing with Oh, diabetes a little bit, high blood pressure a little bit. No obesity. I mean in the 80s in training, there’s really nothing there.

 

Terry

08:51-08:52

Obesity existed.

 

Dr. Eric Westman

08:53-13:16

Yeah, but not like today, right? So uh you know, my colleagues started giving pills and shots for everything. And I started to work here in Durham at the Durham Veterans Affairs Hospital. and started to learn about research and worked with the inventor of the nicotine patch for ten years, Jed Rose in Durham. So I got to learn about science and how to apply the scientific method to humans, I mean to clinical research. And so randomized trials were paramount. And really you might even say ignore everything until there’s a randomized trial. Well, that worked for a while.

I after ten years I realized I was not fixing anything. I mean and after ten years of my patients at the VA I l I loved them dearly, and they were all kind of getting worse. So two patients show up in my office right about the same time having fixed their diabetes and obesity and I asked them what they did. They said, all I did is eat steak and eggs. I’m like, what the heck? This is nineteen ninety-eight, okay? And so I’m thinking to myself, uh, well, lightning strikes And yet then another patient comes in. All I did is do the Atkins diet. I said, What’s that? And he said, Well, you know This book, it probably came out before you were born. And that wait wait a minute. Now you’re getting personal. So I I go to the bookstore and sure, there’s the Atkins diet, there’s the Ornish diet. There back then there was the Uh even “The Zone” hadn’t come out yet. So there weren’t a whole lot of books on the shelf. But there was a doctor who had a clinic that you could visit, and that was Dr. Atkins.

So I wrote him a letter, he calls back and invites me to his office with a couple of young researchers who were doing a different job at the time. And so I saw a clinic in action and after he seeing two people do the total opposite of everything that I was taught. And even then one of the patients who I was treating at the VA said, What are you worried about? And I said, Well your cholesterol. Your cholesterol will go up. Remember this is 1998 for me. And he looked at me and said, Well, why don’t you check it? And he the lab was down the hall at the VA and didn’t cost anything for me or him to do it. So in two cases, people lost weight. These were men- lost over fifty pounds and their cholesterol levels got better regardless of how you look at it total in LDL triglyceride and HDL Like, what the heck’s going on?

So I had to learn basically for myself as an internist, as a clinical researcher, about nutrition. And when I went to the diet dietary meetings, the nutrition meeting, there was like, everything’s low fat, everything’s now plant-based. And I’m like, well, but but what about the patient sitting in front of me who’s fixed conditions that doctors can’t fix by doing the exact opposite of what they were taught. And I met uh Michelle Hurn who wrote the book, “The Dietitian’s Dilemma.” What if you have to do the exact opposite of what you were taught to fix yourself? And that’s Michelle, she is a dietitian and you know I’m on a board of a new society with her, so I’ve got to know her, uh gotten to know her pretty well. So I guess, you know, looking back, What do you eat matters?

You know, if if I could be dean of the all the schools of medicine and even DO schools, I’d say, you know: nutrition should be key to your education of what a human body needs attention to And in my last 25 years, we’ve documented over and over again, and other people have documented, there’s no nutrition training for doctors. They’re or they get taught the wrong thing. So so here I am today asked to talk about low carb and keto and LCHF and, and I gave a talk in London recently, and it was The Fad That Never Fades. The Fad That Never Fades was the title of my talk. And so the concepts of what we’re talking about has been here you know, for hundreds of thousands of years, the name has changed.

 

Terry

13:16-13:25

Okay. Bianca, how did you get interested in the carnivore diet? Because you’ve been following up on this for at least a year now.

 

Bianca Garcia

13:25-14:39

That’s right. I was pursuing my master’s of science and I was thinking about media and health together. And I was as a social media user starting to see a lot of social media content on the carnivore diet. Someone who’s looked at nutrition, who’s been interested in nutrition, I thought it was really, really strange that people were eating, as Dr. Westman said, just steak and eggs. So I wanted to look into kind of the anthropology of this. What is, what is making people eat the way that they are eating? And how do we think about this personal sort of decision as it weighs up against the weight of the medical institution, and that kind of knowledge. And so I have a yet unpublished audio documentary on the carnivore diet called Against the Grain. And in doing that research, I’ve seen Dr. Westman’s content. I’ve seen the content of many other creators. I’ve spoken to carnivores and learned about their personal experiences, and I’ve spoken to doctors who are also equally skeptical of the diet. So there is a wide range of opinions out there that I have been interested in following up on as a journalist.

 

Terry

14:40-14:52

Dr. Westman, I can imagine that you get some reactions, probably not so much from your patients, because your patients are coming to you saying, This is what I want to do, right?

 

Dr. Eric Westman

14:53-15:34

Well, not necessarily. Although although that that’s uh a good expectation that no uh, I’ve in fact this week, that’s why I’m in clinic at Duke four days a week in a private practice insurance pay system. Um no, actually some people have no idea who I am. I and there was just recently someone who uh goes to the Lincoln Community Health Center was referred to me and I had to kind of figure out how do I help this uh person from Mexico navigate the foods and when I say you can have all the chicharron you want, the eyes light up. You can have all the pork rinds you want. That’s also a telltale sign for uh someone from North Carolina typically. Uh but uh so

 

Terry

15:34-15:38

But thank you for translating Chicharron.

 

Dr. Eric Westman

15:38-15:51

Chicharron is or uh I’ve had the best chicharron, in uh in Colombia. The kind it was really pork belly. But anyway, it has no carbs and it’s kind of a secret trick if you’re trying to (TERRY) it’s very high fat. It’s very high fat.

 

Terry

15:51-15:54

Which is great on a carnivore or keto diet.

 

Dr. Eric Westman

15:54-16:37

It it may not be great on a low fat diet. I, I understand. And I think there are a lot of ways to be healthy, just to kind of declare I’m not just a carnivore keto proponent. I in fact it was recently when Lucia Aronica at Stanford asked Christopher Gardner to do a sub study of his paper. It’s called the DIETFITS study. The substudy was let’s look at people who did ultra low fat and let’s look at people who do did ultra low carb. And and so it selected out people who were actually following those, and looked at health parameters and actually the ultra-low carb diet looked very similar to the ultra-low fat diet.

 

Terry

16:37-16:38

In terms of outcomes?

 

Dr. Eric Westman

16:38-16:41

In terms of improving insulin resistance.

 

Terry

16:41-16:41

Uh-huh.

 

Dr. Eric Westman

16:41-16:45

Improving what we understand now is probably the root cause.

 

Joe

16:47-17:04

Well we just have a minute before the break, but I would love to have you explain insulin resistance because we are hearing about it so frequently now and it’s so critical. But I fear that a lot of people don’t yet understand it. So you have one minute to give us the insulin resistance overview.

 

Dr. Eric Westman

17:04-17:52

Yeah, so insulin resistance uh actually is a term, I don’t like it. It, you really should say high insulin levels. Because insulin resistance gives the connotation that there’s something wrong in the person, something wrong in the cell, and you just need a drug. But what insulin resistance functionally is, is that insulin is not working to lower the blood glucose like it used to. So what you see is an elevated blood glucose compared to before or A1C, the hemoglobin A1C, the three month average of the glucose. And but you see the insulin resistance also means your insulin level is high. So I would rather have you talk about high insulin levels and how to get those down than insulin resistance, which is this, you know, term out there you need a drug for.

 

Terry

17:52-18:08

You’re listening to Dr. Eric Westman, Associate Professor of Medicine at Duke University. He’s a board member of the Society of Metabolic Health Practitioners and the American Diabetes Society Dr. Westman is a specialist in internal and obesity medicine.

 

Joe

18:09-18:13

After the break, we’ll consider why dietary guidelines haven’t made a difference.

 

Terry

18:13-18:19

There’s not impeccable evidence to support the current guidelines, but that’s also true for the carnivore diet.

 

Joe

18:19-18:21

What does science tell us about how it works?

 

Terry

18:21-18:25

How do carnivore and keto diets differ?

 

Joe

18:24-18:29

What are the pros and cons for patients following a carnivore diet?

 

Terry

18:39-18:48

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Joe

18:48-19:12

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19:12-19:31

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Joe

19:32-19:52

Learn more at getsonu.com and sonu.com. Welcome back to The People’s Pharmacy. I’m Joe Graedon.

 

Terry

19:52-20:15

And I’m Terry Graedon. On The People’s Pharmacy, you hear a lot about the value of vegetables. We’ve interviewed nutrition experts like Dr. Walter Willett and Dr. Christopher Gardner who are enthusiastic about a plant-based dietary pattern. Today we’re considering a different approach to eating. What are the benefits of a carnivore diet?

 

Joe

20:15-20:24

What’s the difference between a ketogenic diet and a carnivore diet? What are the benefits and risks of such eating patterns?

 

Terry

20:24-20:52

Our guest is Dr. Eric Westman, Associate Professor of Medicine at Duke University. He founded the Duke Keto Medicine Clinic in 2006 after conducting clinical research regarding low carbohydrate ketogenic diets. He’s a board member of the Society of Metabolic Health Practitioners and the American Diabetes Society. His areas of expertise include obesity and metabolic disorders.

 

Joe

20:52-21:12

We’re also joined by Bianca Garcia. We invited her to co-host this interview while she served as WUNC’s AAAS Mass Media Fellow. She holds a master’s degree in media medicine and health from Harvard Medical School where she created an audio documentary on the carnivore diet.

 

Terry

21:12-21:28

Dr. Westman, we’ve uh kind of reviewed the, a little bit of history of dietary guidelines and advice. Do we have any idea why so many of these dietary guidelines don’t seem to have done the job?

 

Dr. Eric Westman

21:29-22:07

Well, you know, uh the way I look at it is the there was never any science behind these dietary guidelines. That’s pretty clear. And people have written papers on uh there have been a paper uh was a thought piece of was there any evidence when the dietary guidelines were made that that there were we should have those guidelines and basically know there wasn’t any evidence. So I think it was the government being lobbied to make the foods America makes be consumed more by Americans. Thus we don’t have coconut oil in the guideline because we really are not big producers of coconut oil.

 

Joe

22:08-22:15

True enough. But before we go any further, when we say the guidelines, uh what are we even talking about?

 

Dr. Eric Westman

22:15-23:25

Well I know and you know I, fortunately, the guidelines are pretty much uninterpretable right now to the average consumer, except institutions are still somewhat beholden to them. I was just on a panel recently at a meeting where we all kind of agreed no guideline is better than a bad guideline. And I was past president I am past president of the Obesity Medicine Association. We lobbied the government at the time and I sat in the office of the woman who created the food pyramid, Susan Susan Davis. And we said, you know, people aren’t healthy. She said, well this is a guideline for healthy Americans. And we said, no, people aren’t healthy. I’m, you know, advocating for obesity treatment. So I think the first uh question is, are we giving guidelines to healthy people? Or like the studies say and you just look around at the mall, are should we give guidelines and guidance to people who need a corrective therapeutic diet generally. So I’m not a big guideline guy and and uh I work with the patient in front of me and get results. And I yeah I think the guidelines have been a bad idea. Even even the latest ones.

 

Bianca Garcia

23:26-23:49

And Dr. Westman, as you’re pointing out, there’s not a lot of evidence for the current guidelines, but from what I’ve seen, there is not a lot of published evidence about the carnivore diet either. But we can intuit from the keto diet and other similar low carbohydrate diets why it might work. So can you walk us through a little bit about the science of why the carnivore diet works?

 

Dr. Eric Westman

23:49-24:58

Absolutely. And I, I share your kind of assessment that there’s not a whole lot of published literature. If you search carnivore, you know, you’ll get a survey. There was a survey from the Harvard group, Belinda Lennerz and David Ludwig, where they surveyed self-described carnivores and what happened to their health and all that. We actually surveyed a a group who was of type one diabetics, as people affected by type one diabetes as well. It was a Facebook survey and it was the most cited publication in the journal Pediatrics at the time. So I, I don’t discount this information, but you have to keep it in, you know, it’s preliminary um information. The the grassroots change that we’ve seen over the last ten to fifteen years is that people are changing their own diet with influencers or or just word of mouth. And getting amazing changes, including keto, including carnivore, and I think the mechanism is that they both really fix insulin resistance, meaning they lower the insulin levels. And really any effective diet can do that.

 

Terry

24:58-25:10

Dr. Westman, we’ve been talking about the carnivore diet as if we all know what it is, but I don’t. So maybe you can tell us what are people eating? What is the carnivore diet?

 

Joe

25:10-25:15

And before that even, what is the keto diet? So how do they differ and what are they?

 

Dr. Eric Westman

25:16-25:30

Yeah, so uh I think there are many different versions of these things. Carnivore, I think, can be best described as just animal-based foods. So kinda like you’re used to saying plant-based, plant-based, plant-based, plant, uh oh. That’s kind of…

 

Terry

25:30-25:31

Or plant forward.

 

Dr. Eric Westman

25:33-26:09

Oh, it changed. Oh that’s one way to do things, but you know, uh people who come to me, yes, some do self-select, they want to follow what I, not everyone comes not knowing what I do. A lot of I would say two-thirds of the people come seek me out because of the teaching that I give. I I have to admit that. But so two years ago there was a textbook called “Ketogenic: The Science of Therapeutic Carbohydrate Restriction” and I use this as show and tell to people from a first visit to my office to just show that there is a body of knowledge now out there on the keto diet.

 

Joe

26:09-26:23

And keto really makes it Let me read the the subtitle of the book you’re holding up. It’s “ketogenic, the science of therapeutic carbohydrate restriction in human health.” That’s it. Tell us about it.

 

Dr. Eric Westman

26:23-29:28

Well, Dr. Will Yancey and I at Duke have been doing research since 2002 and we contributed chapters on obesity and type 2 diabetes reversal in this textbook. But it’s much more detailed. In fact, I I haven’t read every word in it yet because, you know, uh there’s a lot of information on the keto diet. Well, keto really means that you’re using ketones in your body to an extent that you didn’t before. Is there a certain level? No, no, not really. And i is there a maximal or greatest greater keto diet? I, I don’t think we know that yet. So to me, a keto diet is a very low carbohydrate diet that allows your body to access the fat stores in a flexible manner, so that you can be burning your body fat and and as a result your ketone level goes up compared to those who eat carbs. Uh and uh the idea of fat loss, weight loss has been implanted, and that’s how I learned it. The keto diet was a weight loss diet. But it does much more than that.

And now I have people coming to me whom I’ve taught a keto diet for years and and there’s a few conditions that still remain I haven’t been able to fix; I can fix almost every internal medicine problem that my colleagues use drugs for. I can fix,  uh reverse type 2 diabetes, obesity, PCOS, heartburn, migraines, all these things. But there’s a a nagging uh uh uh uh component of problems that have to do with inflammation and autoimmunity that keto doesn’t quite fix. And and I have to say that the keto, the way I teach it, it’s unlimited meat, poultry, fish, and shellfish and eggs, till you’re comfortably full. And one cup of non-starchy vegetables, and two cups of leafy greens. Now I don’t enforce those vegetables and and so what I teach is not strictly a carnivore diet. It allows for these vegetables and leafy greens.

But people are coming to me now over the last few years fixing these autoimmunity conditions by dropping those vegetables. And so I’m I’m just wondering it, you know, so what I teach is carnivore-ish. And I passively allow people eat a carnivore diet under my care. You know, I, I monitor things. And it the science I want to go in the direction They’re case series, case studies of people who fix their inflammatory bowel disease, ulcerative colitis, the rheumatoid arthritis, and and we have a case study brewing trying to get it published of of palindromic arthritis that was basically fixed by just changing the food. So, so keto means ketosis, keto means fat metabolism. Carnivore to me is a subset of a low carb keto diet so that it doesn’t seem as far afield to me as it might to someone else.

 

Bianca Garcia

29:29-29:50

Still, this is a pretty socially and scientifically divisive idea. So I wonder how your peers and your colleagues look at um this kind of keto carnivore-ish diet, especially without uh the immense evidence base that like a plant forward diet might have. Well what kinds of reactions do you get from your colleagues?

 

Dr. Eric Westman

29:51-32:32

So actually there will never be uh uh unanimity in diet. Let that be just my first statement. There were and and that’s one reason why I’ve kept keto out of the press. In fact, whenever I’d get onto the the press or something, they would try to find someone against it. Well you can always find someone against it. You can always find a plant-based is best. No, there’s no evidence that a plant-based diet is better than a carnivore, animal‑based diet. It’s all implanted in people’s minds. So, no, because that Stanford study where they finally looked at insulin resistance between these two different very extreme diets, they both worked.

And you know, I remember, gosh, how long has it been, Joe and Terry? We were talking the Duke Rice diet started all this at the Duke campus in the nineteen thirties or you know the history of (TERRY) Yeah, before our time even. Yeah, well And then, you know, the rice diet no longer exists, although there’s still people who remember that. That was would be like an Ornish/Pritikin ultra‑low‑fat kind of diet. And and I I think it works, you know, but it doesn’t mean there’s no other way to do it. So I guess um coming around, uh Bianca, that there never will be agreement among the the experts.

And so what I’ve learned is I, I, I put my head down, created a clinic. And over the last 15 years, I learned as much as I could about using a keto and carnivore diet in a clinical setting. And if other people say, well, it doesn’t work, that’s not true. The long-term effects remain unknown, but that’s true, true for any diet. So that, you know, w we get into this, you know, oh there’s no evidence. Well, there’s really precious little evidence even for the Mediterranean diet, which everyone believes is the best. So in evidence meaning randomized trials long‑term. So we’re we’re left with what is biologically sensible and and also therapeutic. I just want to loop back to this textbook. I think there’s general consensus that a keto diet can be a therapeutic tool. I mean, so even my naysaying colleagues who don’t like the idea of carnivore and keto will say, okay, well, you can reverse things and fix things, but then what? You know, you gotta get off that eventually. And I’m like, well, but if it reversed all their problems, why would you want that get them off it? You know? And because they just know that it’s bad. I mean, if it if it’s not known, it must be bad, which I learned, you know, you and I sat in a room like this. when that first Atkins paper came out and oh the controversy and now nobody really knows that name other than the the food on the shelf.

 

Terry

32:33-32:54

So, Dr. Westman, would you please tell us briefly what you have seen as the clinical benefits for people who are following this carnivore or even carnivore-ish diet? And then we’d also like to talk about some potential downsides.

 

Dr. Eric Westman

32:54-34:52

Absolutely. So from my bench or or clinic, um what I see for those who follow uh carnivore or keto kind of diet with instruction from someone who knows what they’re doing. Now you know, internet and carnivore internet and keto internet there are so many different places to learn, it’s very confusing. But so you want to learn from someone who knows what they’re doing and if you’re on multiple medications, you wanna be sure to be working with someone who knows how to get you off those medicines safely. And so what I see is uh the average patient coming to me is 60, 65 years old on seven to ten medications. Medications for diabetes, high blood pressure, heartburn, arthritis. Many of these people have already had hip and joint replacements, and and now they’re have they have obesity too.

And so I simply tell people that we store fat on our bodies for energy and we want to get access to that fat store. And I could use a keto, a low glycemic, a a carnivore type of diet based on this someone’s preference. And over time I can fix, reverse all of those medical conditions by changing the food. It’s so unbelievable you won’t believe me. So for the last 10 years I’ve at medical conferences I’ve said, come to my office. And partly I set up this clinic so that it could be a teaching clinic, not only for for the patients, but for doctors. So residents and students at Duke come through my office. Other doctors have come even from around the world to see it in action. And so basically it’s the all the internal just about all of the internal medicine problems that are treated with medications today can be reversed or greatly reversed just by changing the food.

 

Joe

34:53-35:43

I want to ask you a little bit about a couple of conditions that are widespread in our society, and we don’t have good treatments for. Inflammation, which I’d love to have you define what that means from a biological perspective, and also the impact on the brain, on mental clarity, because there are a lot of people in the age bracket that you’re talking about who are complaining about mental fogginess, in you know just functionality. I, I can’t remember those names anymore the way I used to. And they were also complaining about their knees and their elbows and their fingers. What impact does this approach have on those two areas?

 

Dr. Eric Westman

35:44-36:12

Yeah, so inflammation is basically your body’s ability to clot, to fight infection, to to function. And you need some inflammation. So you don’t someone came to a meeting, an expert, and said, Well I don’t eat that ’cause it causes inflammation. I don’t eat that ’cause it causes inflammation. The first question at the microphone was, Well, what do you eat? Basically you said, I fast because eating causes inflammation. And I mean that’s to the absurd degree.

 

Terry

36:14-36:15

Not a long‑term strategy.

 

Dr. Eric Westman

36:15-37:26

Yeah. So so you w n you want some inflammation, but you don’t want too much. I guess it’s like Goldilocks, you know. You want a little bit uh of inflammation but not too much. And I I think the the elephant in the room is that food causes inflammation. Of course, stress causes inflammation and and so food, the carbs are uh and refined sugar and flour are really kind of the the ones that are causing most of the inflammation today.

Uh you know, the brain function is fascinating and I think the common consensus is that insulin resistance, oh, remember that term? High insulin levels. over a period of time actually cause Alzheimer’s. Just cause. But the problem is once you get a a memory issue from Alzheimer’s, it’s too late. So it’s like the you know, the plane’s going down. So everything I’ve learned about Alzheimer’s is that you want to take action now. Like if you have a family history of it, uh a loved one where you want to address that insulin resistance and there are numerous uh dietary ways to do that.

 

Terry

37:27-37:59

You’re listening to Doctor Eric Westman, Associate Professor of Medicine at Duke University. He founded the Duke Keto Medicine Clinic in two thousand six after conducting clinical research regarding low carbohydrate ketogenic diets. His newest course, Carnivore Made Simple, is open now for enrollment by People’s Pharmacy listeners for a limited time. Bianca Garcia, a AAAS Mass Media Fellow at WUNC, joined us in co-hosting this interview.

 

Joe

38:00-38:05

After the break, we’ll find out what people are saying on the internet about the carnivore diet.

 

Terry

38:04-38:08

How long does it take for people to see weight loss from a carnivore diet?

 

Joe

38:08-38:13

What downsides might we expect from such a diet or the keto diet?

 

Terry

38:13-38:18

Bianca will share her experience trying a carnivore diet. How did that go?

 

Joe

38:18-38:23

Should we change our thinking on nutritional science?

 

Terry

38:35-38:39

You’re listening to The People’s Pharmacy with Joe and Terry Graedon.

 

Joe

38:47-38:51

Welcome back to The People’s Pharmacy. I’m Joe Graedon.

 

Terry

38:51-38:52

And I’m Terry Graedon.

 

Joe

38:52-39:06

What’s a healthy way to eat? Humans around the world have come up with different answers to this question. Most nutrition scientists agree that the standard American diet falls far short.

 

Terry

39:06-39:38

Our guest today is Dr. Eric Westman. He is Associate Professor of Medicine at Duke University, where he founded the Duke Keto Medicine Clinic almost 20 years ago. Dr. Westman is a co-founder of Adapt Your Life Academy, where his newest course is Carnivore Made Simple. It’s open for enrollment by people’s pharmacy listeners for a short time. Bianca Garcia, a AAAS mass media fellow at WUNC, joined us in co-hosting this interview.

 

Bianca Garcia

39:40-40:12

Dr. Westman, you were talking about the internet culture of this diet. And you were saying how, you know, it’s important to get instruction from people who know what they’re doing and how to get you off your meds in order for you to, you know, safely carry out this diet. But I think I want to talk a little bit about the internet culture and you know, how this diet is spreading popularly. What are you seeing out there? What do we have to be aware of as people might be encountering this diet in the wild?

 

Dr. Eric Westman

40:13-42:05

Uh yeah, great and you know I’m uh just kind of in awe of the internet compared to twenty years ago. And it’s a wonderful thing and a terrible thing all at the same time. So the big line of, of demarcation should be if you see a doctor for a a problem that you’re taking a medicine for. Be sure to do this with a doctor who knows what they’re doing, because medicines can become too strong on the first day. I’ve had people have low blood sugars from insulin and other diabetes medicines on the first day.

So if you’re consuming this information online and it’s to the general healthy person, I’m not so worried about it. But once you get into that clinical population, now, you know, I don’t know uh uh any of my patients who are on TikTok. So that that might all automatically select the ’cause the people who come to me are generally older. But that’s that’s not always the case.

So I I’m getting patients who come to me because I kind of passively endorse a carnivore diet as a subset of a keto diet. That uh I think uh you want to do things um that um and not only feel feel right isn’t the right word. It’s the thing uh changes that make you feel good. I mean that that may correct a problem that you have. And if it even if it’s excessive hunger and all you can do is think about food. Then this is something the food is really the answer and and um I’m afraid doctors don’t have that information and you know it it really is hard to police this, isn’t it? But uh to me I I try to make sure that if you’re you know older, you’re on medicines, that you have someone who knows what they’re doing help you.

 

Bianca Garcia

42:06-42:50

I also want to add though from my field work and from the interviews that I do that young people are exploring this diet. I think there’s a lot to say about the simplicity of it. People are attracted to it because unlike the Mediterranean diet, which has like very strict um ideas of what you can and can’t eat. This is just like take out everything and stick with just meat. And that’s pretty intuitive and simple. But at the same time, that can have some, let’s say bodily impact. I tried the carnivore diet for a little bit. I couldn’t stick with it. So what can we expect about people who just get on the diet? And I guess the the essence of this question is like: how long does it take for this thing to work?

 

Dr. Eric Westman

42:51-43:07

Well, I um it depends what you’re doing it for. So uh y I I have no problem compared to all the other things you can do in terms of nutrition. I think can we agree that the standard American diet just isn’t highest on the list?

 

Terry

43:08-43:09

I think we can all agree with that.

 

Dr. Eric Westman

43:10-43:21

So what’s then next? Can everyone do a super strict eat local, go to the farmer’s market, um, never go to McDonald’s and all or Burger King or Wendy’s?

 

Terry

43:21-43:22

Not everyone.

 

Dr. Eric Westman

43:22-45:38

Not everyone. So we have to have some sort of compromise, I believe. And and that’s also my doctor perspective. I don’t just preach as an influencer, do this and you have to be perfect. There are those who do that. They preach that and and I see people coming in worried about the the carblets, the the little microcarbs and the maltodextrin in the cheese and the I mean, come on. That’s not metabolically substantially anything you should worry about. So how you get it taught matters a lot. And the carnivore diet as it’s taught today, just eat meat.

Well, I think it’s relatively healthy and and you know, if there’s if I could go back, Joe and Terry, twenty-five years ago, I would have said, show me a study that Atkins diet is bad. There never was one. And it took me just two years ago in with Jeff Volick, a researcher who’s been with me in this space for twenty-five years. For him to be on a podium and say, you know, there’s never been a study that showed that nutritional ketosis, the Atkins diet induction even, which now, you know, is carnivore, there’s never been a study to show that it’s bad. When I thought about that and look back, we had the wrong emotional reactive position of we had to try to prove that it was good, when nobody had shown that it was bad. It was prejudging. And I have that same feeling here.

Yes, it’s a feeling, and I want science. I want more science. That that’s what’s going on today. Hey, it’s just eating meat, which is a lot better than eating all that other garbage and and you know in a scientific venue, I I do say things like, you know, prove that a keto diet is bad, you know, using the method that I use. Because we don’t see that it’s bad and if you just say a keto-ish diet from nutritional epidemiology shows that it’s bad, that doesn’t count. But so anyway, I I’m I you know me, I I was taught to to protect my data, and and protect what I saw in front of me, but then I cheated. I went to doctor’s offices who they’d done it for thirty years before me.

 

Terry

45:39-46:01

Well, Doctor Westman, here at The People’s Pharmacy, we rarely hear about a medical intervention that is just all good and has no downside ever for anyone. So can you tell us about some downsides that people might want to be aware of that could happen while you’re following a carnivore diet?

 

Joe

46:01-46:22

Or a keto diet. Because what we have learned over the years. And it took us about 40 or 50 years to recognize that some people will say, oh, this drug is marvelous. I love gabapentin, It takes away my nerve pain. And other people say gabapentin ruined my life.

 

Terry

46:23-46:23

Made me crazy.

 

Joe

46:24-46:58

I had hallucinations, it was, my brain stopped working. So nothing is ever really black or white. And some people, I am sure, as we’ve interviewed in the past, I love fiber, fiber, fiber fuel diet. It’s the best diet. And then other people say, oh my gosh, I just had so much gas I couldn’t tolerate it. So give us the pros and the cons. You’ve already given mostly the pluses, but are there some people who have problems with a keto or carnivore-ish diet?

 

Dr. Eric Westman

46:58-49:20

Well, that’s a great point. And that raises the issue and and the reason why formal research is necessary. Is that I learned a long time ago that if someone is just selecting out to come see me that because they have good results. Then I have a selection bias, what happened to people who couldn’t follow it? What happened to someone who had a problem and they didn’t come? So it’s important to have a study not only to I don’t think we need studies to show efficacy. I mean, I I could show efficacy with fifty people compared to a standard American diet for diabetes. We, our study of low glycemic versus low carb diets published in 2008 only had 50 people in it. So we can show efficacy.

And it’s the safety side that you need more people involved and, you know, you get a hundred people, you get thousands of people. Then well, with a drug, then you get millions of people, then you start to really get an idea of the side effects. But so I I think the um side effects that most people have with keto or carnivore are manageable. We teach how to have keto adaptation at first where you add salt back in if you don’t have a salt sensitive condition. If someone has headache or cravings that goes away typically in a few days or a week. There might be change in bowel function where you you treat that with a little magnesium early on or some other electrolyte supplement.

What s being able to stay on the diet to me i is is not only the biologic change that occurs, it’s also how that person perceives other people think of them and if they don’t want to go to the store and just have meat in their grocery cart. I mean that that’s a different so metabolically I have yet to see someone who cannot do a keto or carnivore diet metabolically because all of those problems are kind of screened out in pediatrics. So if if you have a serious fatty acid disorder, you can’t burn fat, you don’t really get out of childhood. So as an internist, as an adult I’m comfortable having people do a keto or carnivore diet. And most of the side effects, if if this were a drug, we’d say, well, these are mild and manageable.

 

Bianca Garcia

49:21-51:07

I’ll tell you a little bit about my perspective because like I mentioned I tried and I failed the carnivore diet. And before, before I get into that experience, I think I’ll frame it by saying like I’m a generally pretty healthy person. I was trying this as like a social experiment. There was nothing really keeping me going when I hit these roadblocks. And so for a lot of people who approach the carnivore diet, they’re doing it because they need something out of their health experience that they’re looking for at in the carnivore diet. That wasn’t my that wasn’t my case. So when I got the keto flu, as it’s popularly known, I was nauseous. I had headaches. I couldn’t get up in the morning. I was like, oh my gosh, this isn’t for me.

But also, I felt the immense social pressure of the diet. I couldn’t go out and eat with my friends the way the the way I wanted to. I am a foodie and I felt a little depressed about not getting to eat the colors on my plate. Uh and also meat is kind of expensive. So, you know, I was feeling that in my wallet. These are all social things about the carnivore diet that are pitfalls of it, and I think that we need to talk about these because nutrition is inherently social. So while there could be and while there is evidence for these like immense changes to embodied health, there’s also the social health that’s important to think about.

But I do want to follow up with a question for Dr. Westman, uh, which is about the common skepticism for this diet, which is like, what do we do with this information that we’ve all heard that red meat is carcinogenic and that if we don’t eat vegetables, we’re gonna get like a vitamin C deficiency? How do I think about that?

 

Dr. Eric Westman

51:08-51:16

Well, that’s a lot to unpack. Thanks for sharing your story. I wonder if you added salt during the keto adaptation.

 

Bianca Garcia

51:16-51:26

I learned afterwards that I should have been doing that. And I was going off the internet, you know? I think that’s the other thing. Which is…

 

Dr. Eric Westman

51:26-53:09

Ignore every internet thing except mine. Isn’t that funny? So but uh the the social things are are are real and but you know I I think back in the nineteen seventies, people started jogging and it wasn’t socially acceptable. In fact, people started starting to get treadmills and jogging I mean I’ve traveled to Europe and I was jogging and the Europeans looked at me like I was a nutcase ’cause you just didn’t jog in Europe. I didn’t see a whole lot of Europeans jogging even today. But so social acceptance can change over time. And i if you’re I think that trade-off for you w r wasn’t right. You know, you weren’t getting some benefit that you were, you know, fixing your ins incessant hunger. Or or um so I’m watching some influencers and I do React videos.

One of the things that’s really important to remember if you’re exercising a lot, And if that’s part of your life. You’re at the gym and all that. That’s not where the the clinical application of keto and carnivore came from. It started with people who were unable to exercise, fixing metabolic issues. And so th there that’s a different context that you need to learn from people who’ve figured that out online.

There are I think there are some good influencers online who’ve helped a lot of people. But again the the selection bias is a problem. So that perhaps your story or your your result is some biologic factor, not just social, and and maybe that’s underrepresented in the internet, you know, the highlight reel of, oh look me, look at I all I did all this And those who are not getting results don’t say it publicly.

 

Terry

53:10-53:21

Dr. Westman, how does what we have learned now about the carnivore diet change how we think about nutritional science?

 

Dr. Eric Westman

53:21-54:24

Well, that’s a great question, and I’ve always been a critic of nutritional epidemiology. Where you ask people what they eat periodically, sometimes once a year, and then you follow their health outcomes without any sort of experimental manipulation. And so I’ve I’ve always been critical of that and I’m a clinical trialist and so I value the Stanford paper with a couple hundred people on the diet and they were they know they were following it and and I trust the prospective data more than the cohort studies. So that so my perspective is we have to get to biology. So I’ve started to teach, let’s look at what the body’s made of. Let’s understand that we’re mostly water, protein, and fat. In fact, there’s no carbs stored on our body. I go over this with the body composition personally with my patients now. And I explain that we store fat on our body, not carbs.

 

Joe

54:25-55:23

Dr. Westman, people learn best from stories. And I know it’s not science. But on the other hand, we we can begin to have some sense of your many decades of experience with um first the Atkins diet, then the keto diet, now the carnivore-ish diet, you’ve had, you know, probably hundreds of patients, perhaps now thousands of patients. Tell us about some that stand out in your mind where they they came in perhaps overweight, perhaps with a diabetes problem, perhaps taking, as you said many medications and not feeling well. Tell us about, without actually naming someone who could identify him or herself, how your approach has changed their lives.

 

Dr. Eric Westman

55:24-55:39

Well, that’s a great question. And I I don’t know where to begin. I mentioned the kind of garden variety reversal of diabetes, hypertension, obesity, PCOS, and GERD. And I would say those are uh papers that we have published.

 

Terry

55:40-55:51

Now, Dr. Westman, I’m gonna call you on the alphabets. You need to tell us what PCOS means. And a lot of people know what GERD means, but not everybody, so you’ll have to explain that one too, please.

 

Dr. Eric Westman

55:52-58:03

Sure. PCOS means polycystic ovarian syndrome. And then GERD is gastroesophageal reflux disorder or heartburn. Heartburn. So these are things that either my colleagues who are internists can’t fix or they give drugs for. So uh I I think the extreme cases that I’m seeing now that I’m really kind of proud of, ’cause I stick to my guns.

I I don’t I I just I’m a I’m a source where people can come and say, Hey I relapsed to sugar. And there are several patients who just when they relapse to sugar, they can gain 20 pounds in two months. And they come back and they have the safe zone almost like um I I don’t know, like be getting in a church and having sanctuary, because we know now that sugar is as addictive as any other drug. It was regarded as a drug and then in Gary Taubes’s “the case against sugar,” book he gives the history of that. So I think this um uh woman who’s stressed just stressful life and and and the sugar is just uncontrollable for that person. Um and and that’s kind of the new frontier of understanding that sugar is an addiction, uh and it’s okay not to have it.

Um but the other the medical side if I put on my internist hat, it’s the inflammatory bowel disease that goes away. It’s the again, uh my my colleagues have super strong anti-inflammatory drugs now. They can give shots that cut out any symptom from inflammatory bowel disease, Crohn’s, or ulcerative colitis. The problem is those shots are so good, you’re at risk for having cancer, because you need that anti-inflammatory response to fight cancers. And so these drugs are so strong they’re being used and then most people don’t think they need to change their diet. So I like people to understand that there’s just another way to go about things. It’s not wrong to take the drugs and eat carbs and and all, but their lifestyle is so important and so powerful when it’s done right.

 

Joe

58:04-58:24

So I’m gonna ask you in your mind to imagine John Doe or Jane Doe, a patient, a real patient, who came in struggling, came in frustrated. Their diets haven’t worked in the past, their medications are only working so well. And tell us their stories.

 

Dr. Eric Westman

58:24-58:53

Yeah, well, uh a doctor comes to mind. who uh who’s weighing three hundred and fifty pounds ish, so it doesn’t matter how tall you are, you’re gonna find you’re gonna hit the high BMI obesity category. But he he also had a really serious metabolic problem called POTS, postural orthostatic tachycardia syndrome. I’m seeing a lot more of that. And it actually he was so skeptical. I mean, come on.

 

Joe

58:53-58:55

And what’s it like to have POTS?

 

Dr. Eric Westman

58:55-59:09

Well POTS makes you uncomfortable when you stand. You might get tachycardia at a fast heartbeat, you get flushing, and then you can even pass out. So he was finding himself on the floor at home. His family would come find him.

 

Terry

59:10-59:13

And so he’s at three hundred and fifty pounds they couldn’t lift him up.

 

Dr. Eric Westman

59:13-01:00:30

Yeah. Well that that that all goes without saying. The the problems of the obesity too. I mean, so it’s like, the obesity’s kind of become, oh yeah, I can fix that, no problem. I just explain w we have fat on our body, we need your body to burn fat. It’s these other conditions. So that when he came back thinking uh or uh seeing the weight loss, that was one thing. But then when he starts saying, you know, I’m not having those spells anymore. You know, you are starting to understand the metabolic changes that are happening go beyond just the weight loss.

And this could apply to any number of things. It’s common today for people to be very skeptical and then they come back sort of the tail between their legs, you know, I didn’t think this was gonna work. Uh one gentleman in his seventies, uh and he and his wife came back and and they were like, Wow, this really does work, down, you know, twenty pounds in the first visit dur uh duration since the first visit. And so uh that kind of change can happen fast, and the idea that you could change these medical issues just by changing the food, that’s just not common knowledge. It’s not commonly known. And food really is is king

 

Terry

01:00:28-01:00:35

Do we have any idea how a carnivore diet affects the gut microbiome?

 

Dr. Eric Westman

01:00:36-01:00:37

Oh, it changes it for sure.

 

Terry

01:00:37-01:00:44

I would imagine it would because uh what what you eat does change the microbes inside you. Well what’s the impact?

 

Dr. Eric Westman

01:00:45-01:02:03

I I wrote a book with uh super smart uh writer that’s my my method is I team up with other people for books and we would go, not the microbiome again, you know, it’s another study, another distraction. So of course the microbiome changes, and it changes in a favorable way. Best way I can it can can explain it is like a a scientist who showed me at a at a world class meeting. He showed, click, here’s a slide of this jungle, like the Amazon, and here’s your microbiome. It’s beautiful, it’s of colors, and I’m like, well, there are things that can kill you there. It’s uh, you know, it’s the Amazon, little frogs and th and then he goes, Click, and here’s the microbiome on a low carb diet and it was like a desert. And I’m thinking, man, Zen meditation and and uh resort area. This is really calm. That’s what happens. Your microbiome calms down when you do a current, of course it changes. And it’s fascinating today. Well we, we study carb eaters and look at their microbiome and say, well, if we can just have that bacteria and put that in another person who doesn’t eat carbs, we’re gonna get all no, no. So the best thing for your microbiome is to cut the carbs out.

 

Joe

01:02:03-01:03:02

I’ve got a question, Dr. Westman, about GERD. I remember a paper that you wrote that was I would say semi-heretical, because at that time uh the H2 antagonist drugs were in the ascendancy, and then along came the proton pump inhibitors, which were going to be even so much better. And no more heartburn, no more GERD, we’ve got drugs. And you did a study, not a huge one, but it said a low carb diet could change everything for people suffering from GERD, from bad heartburn, esophagitis. And then we started writing about it and people started reporting, hey, you know what? It works. Even though conventional west wisdom from the medicine community was, oh, just give them a PPI.

 

Terry

01:03:02-01:03:06

Oh, and you should not be eating fat, obviously, if you have GERD, right?

 

Joe

01:03:06-01:03:06

Exactly.

 

Dr. Eric Westman

01:03:07-01:03:08

Or caffeine or chocolate.

 

Joe

01:03:08-01:03:09

Or any of that stuff.

 

Dr. Eric Westman

01:03:09-01:04:59

So that’s all the old, old stuff that doesn’t really work. (JOE) So give us an update.

Dr. Eric Westman

Well uh looking back, the studies we did really are proof of concept studies, right? So they aren’t big randomized trials looking at different types of diets. So differ many different diets could work. But this was a interesting study by a GI fellow at UNC. So we actually had a Duke UNC collaboration at the time and he put a pH probe down the nose into the stomach of these people with refractory heartburn. and and looked just over a few days of changing the diet, the acidity changed. So you actually were changing the diet was like taking an antacid. So whoa, yeah, so that was after the clinical signal is so strong. If I put someone on twenty grams, total grams, not net of carbs a day. The heartburn goes away almost uniformly, a hundred percent. But now time passes, so so uh another study comes out where they gave a hundred grams of carbs, you know, the typical American may have two to three hundred grams. And they changed, cleaned up the food so it wasn’t junky. A hundred grams of carbs a day reduced the heartburn as well. So if we do a study that says 20 grams or less can fix, you know, 10 people, it doesn’t mean 50 grams can’t or a hundred grams can’t. And so there’s all this level of carbs that needs to be studied in my mind, or you just try it yourself, uh if you uh but the problem with that a hundred gram fixing or reversing heartburn is it didn’t work a hundred percent like the twenty gram one did. So uh yeah, that was uh a signal that, you know, I I cheated and I read that in Dr. Atkins book. Dr. Atkins health revolution, because he had seen this in his clinical practice. You know, you know.

 

Joe

01:05:00-01:05:22

You mentioned the science. Oh, we’re always looking for the science because we hear, oh Evidence-based medicine, randomized controlled trials. I searched high and low for data to support the traditional heartburn diet. Which as you say, it was uh no chocolate, no coffee, no fat.

 

Terry

01:05:23-01:05:23

No alcohol.

 

Joe

01:05:23-01:05:33

No alcohol. I mean, I I I looked for the data. Because this diet was given out by gastroenterologists all across the country for anybody who came in with heartburn. I couldn’t find it.

 

Dr. Eric Westman

01:05:34-01:06:04

Yeah, and I I think we can understand why. The mechanisms have been key for so long. So there’s the oh well caffeine loosens the lower esophageal sphincter. So it is c chocolate and and protein makes the glomerular filtration rate go up, therefore it must be bad. So if you only talk about mechanism, you can get into these strange rabbit holes. I really value whole human research where you’re not just focusing on those little things.

 

Bianca Garcia

01:06:04-01:06:52

Yeah, I think this is a really great transition into what I wanted to ask because science changes. And the carnivore diet kind of rose in popularity around COVID-19. And this was a time when scientific mistrust started to grow in the public. And we saw that as COVID guidelines changed, people were like, wait, why is science so flip-floppy? And there’s kind of a parallel here with the carnivore diet too. We’ve all been told plant-based, plant forward. Now it’s like, okay, meat forward. What do we do about this? And I think, you know, you’re you’re telling us a little bit about how science changes, but what would you say to somebody who was trying to make the right choice, but maybe feeling a little bit overwhelmed with the scientific method.

 

Dr. Eric Westman

01:06:53-01:09:27

Yeah, well, uh we do the best we can, and the basic biology to me rules. And nutrition epidemiology, even that’s the red meat causes cancer thing, it’s weak, observational, and to me that’s not something I use in my clinic. I don’t value that. That red meat does not cause cancer to the level of certainty that I need to say don’t eat red meat. And I I know I’ve been on panels with folks and there are international organizations that are based on plant-based anti-red meat principles. I understand that. But the group at McMaster, whom I visited in the late 1980s is evidence-based medicine for the world, basically. Uh and they call out that this evidence about red meat and cancer is weak. And it’s not clinically relevant. So so I don’t worry about that.

But getting back to the basic principle, don’t eat a lot of junk food. Uh ultra-processed food today unfortunately suffers from this definitional thing. And, and processed food, people come to me saying, You mean I can’t have bologna and it can’t have that I said, No, you can have bologna, but that’s processed. No, that that’s minimally processed. There’s more nitrates in beets and and broccoli than in these other you know, so I, yeah, it gets confusing, doesn’t it? So you want to eat protein, we’re made of protein. It doesn’t matter to me if it comes from an animal or a plant. We’re made of protein. Water is a given. You’re gonna have thirst. Then you can run your body on carbs or fat. It’s your choice. You can, you know, to sustain whatever kind of activity you’re trying to do. So that opens the idea that you might do a keto or carnivore diet because you’re running on fat. And that’s why we see people having such success with it. The body works just fine.

If you don’t like that way of eating and the social things today, I mean but let’s get real. Were we really designed to eat at a Thai food place and then a Mexican place and then a and then a uh you know, all these great flavors, not you know, I don’t think that’s particularly a good thing, healthy thing to do. Uh it’s very new and and uh you want to be um honest about your ability to control things. If you’re out of control with sugar, you avoid sugar. If you’re out of control with bread, you avoid bread. You know, if you’re uh so I think protein comes first. Instead of plant forward, I wish we would say protein forward.

 

Joe

01:09:28-01:09:37

Final words? (Dr. ERIC WESTMAN) To summarize about a carnivore diet?

 

Dr. Eric Westman

01:09:35-01:10:14

I think it’s a reasonable tool, and it may even be a healthy way to eat in the long run. There’s a study that just came out, meaning in the last few years. where they looked at women who had been keto‑adapted for an average of three years and all of the biochemical parameters they were able to check looked great. They fed them a UK based diet with carbs and everything went to hell in a handbasket, I know, a great scientific term. And then they went back on a keto diet, and everything looked great. The average age was 32 years old. So what’s unknown is is this a long-term thing, but it might be.

 

Terry

01:10:15-01:10:21

Dr. Eric Westman, thank you so much for talking with us in The People’s Pharmacy today.

 

Dr. Eric Westman

01:10:21-01:10:22

My pleasure.

 

Terry

01:10:23-01:10:26

And thanks to you, Bianca Garcia, for helping us with the interview.

 

Bianca Garcia

01:10:27-01:10:28

Thank you.

 

Terry

01:10:28-01:10:43

You’ve been listening to Dr. Eric Westman, Associate Professor of Medicine at Duke University. He’s a board member of the Society of Metabolic Health Practitioners and the American Diabetes Society.

 

Joe

01:10:43-01:11:00

We had help today from Bianca Garcia, a medical anthropologist, foodie, and radio person. She served as a AAAS mass media fellow covering health and science at WUNC North Carolina Public Radio.

 

Terry

01:11:01-01:11:13

Lynn Siegel produced today’s show. Daenerys Thomas and Al Wodarski engineered. Dave Graedon edits our interviews. B. J. Leiderman composed our theme music.

 

Joe

01:11:13-01:11:21

This show is a co-production of North Carolina Public Radio WUNC with The People’s Pharmacy.

 

Terry

01:11:21-01:11:40

Today’s show is number 1444. You can find it online at peoplespharmacy.com. That’s where you can share your comments about today’s interview. You can also reach us through email, radio@peoplespharmacy.com.

 

Joe

01:11:40-01:11:51

Our interviews are available through your favorite podcast provider. This week we’re celebrating 10 million downloads.

 

Terry

01:11:51-01:11:52

That’s cool.

 

Joe

01:11:52-01:12:18

Yes. You’ll find the podcast on our website on Monday morning.

 

Terry

01:12:18-01:12:42

At peoplespharmacy.com, you could sign up for our free online newsletter. That way you get the latest news about important tell stories. When you subscribe, you also get regular access to information about our weekly podcast. We’d be grateful if you’d consider writing a review of The People’s Pharmacy and posting it to the podcast platform you prefer.

 

Joe

01:12:42-01:12:45

In Durham, North Carolina, I’m Joe Graedon.

 

Terry

01:12:45-01:13:28

And I’m Terry Graedon. Thank you for listening. Please join us again next week. Thank you for listening to The People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money.

 

Joe

01:13:28-01:13:38

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01:13:38-01:13:43

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Joe

01:13:43-01:13:59

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