Carbs vs. Keto Debate with Dr. Eric Westman and Dr. Mike Nelson

[atomicspacebunny]

I had mentioned this in one of my posts before about 20 grams of carbs per meal at 3 meals per day for 3 days being only to kick start a person into ketosis and not really intended as an extremely long-term regimen as you can see from the numbers Dr. Ruscio gives below 50- (minus) being “Metabolic no man’s land”:

That said I see many people on the forum talking about being unable to maintain the type of keto practiced on the forum; not sure if they are thinking that this is the only way to to do a ketogenic diet for weight loss vs. medical health reasons or just to be healthy? Just one of those subtle things I am noticing…

Dr. Ruscio 2 Comments Category: Diet & Lifestyle, Podcasts

Carbs vs. Keto Debate with Dr. Eric Westman and Dr. Mike Nelson:

Do you need healthy carbs to feel your best? Or, should you be ketogenic and very low carb? A case can be made for either so I decided to organize a debate between two experts to represent these respective views. This was a very fun and interesting conversation I am sure you will enjoy.

Episode Intro:

Dr. Michael Ruscio, DC: Hey everyone, welcome to Dr. Ruscio Radio . This is Dr. Ruscio. Today I’m here with Dr. Mike T. Nelson and Dr. Eric Westman. And we’re going to be talking about carbs. And two things I’m hoping to get out of this conversation. What can people doing a very low carb keto type diet do if they’re not feeling well on that diet and what I’ve termed a low carb triage list and then also have a very friendly debate over the merits and potential detriments of lower carb intake versus higher carb intake. And I’m really excited to get the ball rolling and to introduce Dr. Westman. We met at Low Carb U.S.A. and he asked some really challenging questions when we were both down there. So I said, you know what this would be a good conversation for us to have in front of an audience so that we can all learn something. So that is how Eric and I had met. But, Eric, for people who haven’t heard of you before, would you please tell us a little bit about your background?

Dr. Eric Westman: Sure. I’m a professor of medicine at Duke University. I’ve been at Duke for 28 years now. I’m a clinical researcher. My primary research is in smoking cessation for about ten years, nicotine research and now diet research for about ten years. So I’m still a professor in medicine with students and residents and have a busy clinical practice. After eight years of clinical research, we opened a lifestyle medicine clinic that basically uses a low carb, high fat or keto approach for all sorts of medical issues. So my vantage point comes from the treatment of problems, medical problems mainly in a therapeutic way using diet as – I find – the most powerful tool we have. …More

[CatGirl]

I stick to the 20 because that “no man’s land” area is kinda scary.

[CarlKeller]

After researching Keto, I decided to start at 50 total carbs per day. It was a lot less intimidating than 20 and I found the adjustment not much of a problem. On the 3rd day I noticed the transformation. It wasn’t until I joined the forum, one month in, that I switched to 20 and going from 50 to 20 wasn’t difficult.

So depending on metabolic flexibility, I believe it is possible to ease into keto. If 50 doesn’t work, a person can lower it to 40 and so forth until results are obtained.

[CatGirl]

Never going to go zero carb and “no man’s land”, if you read the interview is the point above 50 carbs a day and higher where according to Dr. Nelson:

“Where you’ve done low carb but you’ve gone low carb enough to potentially be causing some of the detrimental effects some people may experience by reducing their carbohydrate intake but not low enough to get to the beneficial realm of keto.”

[MiKetoAF]

I misunderstood. I will edit.

[atomicspacebunny]

What is so fascinating about this is when you really narrow down what is occurring is the balance between higher and lower carb is anabolism and catabolism.

The lower the carbohydrates, the more catabolism (eating itself) is occurring,

The higher the carbs, the more anabolism (creating cells) occurring.

If we are not eating fat, the body eats its own fat.

If we are not eating protein the body eats its own muscle and skin tissue.

When we are fasting everything is in catabolism mode.

When we are eating we are in anabolic mode.

[4dml]

What is so fascinating about this is when you really narrow down what is occurring is the balance between higher and lower carb is anabolism and catabolism.

The lower the carbohydrates, the more catabolism (eating itself) is occurring,

The higher the carbs, the more anabolism (creating cells) occurring.

I’m not sure those are correct statements. If it were a continuous spectrum like that, 0g carbs would be better than 20g of carb. This is clearly not the case.

Anabolic and catabolic state has more to do with hormones than macros. That’s why kids are able to be in an anabolic state even on a Twinkies diet. That’s why folks with cachexia are catabolic despite a high carb, high protein diet.

For folks with metabolic derangements, the crucial issue is not eating above your pancreas’ capability to deal with macros. The objective is to have a low basal level of insulin. If that can be done on 100g of carb, that’s fine. There’s no additional advantage to eat only 20g. To the extent that it can, the body will keep hormones within a target range, regardless of food intake. Its inability to do so is the definition of disease (ie. diabetes is when the pancreas can’t produce enough insulin to regulate BG sufficiently).

[atomicspacebunny]

I was talking more along the lines of BASIC extensive and intermittent fasting and caloric intake, reduction and restriction, I do fully understand the other things your discussing which are horses of a different color.

[atomicspacebunny]

The objective is to have a low basal level of insulin. If that can be done on 100g of carb, that’s fine. There’s no additional advantage to eat only 20g. To the extent that it can, the body will keep hormones within a target range, regardless of food intake. Its inability to do so is the definition of disease (ie. diabetes is when the pancreas can’t produce enough insulin to regulate BG sufficiently).

I’m not sure those are correct statements. If it were a continuous spectrum like that, 0g carbs would be better than 20g of carb. This is clearly not the case.

You might be right?

1. “… In order to fix our broken metabolism, we need to allow free access to the energy contained within our fat stores. We need to allow fat burning (lipolysis) to proceed normally. We need to lower insulin. The answer is low carbohydrate diets, or even better – intermittent or extended fasting. Caloric reduction wrecked our metabolism by causing it to shut down. How to fix it? Do the exact opposite of what you expect. Push your caloric intake towards zero! This is the George Costanza method. If everything you do makes things worse, do the exact opposite. It does not matter if you think it doesn’t make sense. Do it anyway and see what happens. …” - Dr. Jason Fung

2. “… The treatments that are known to lead to a cure — fasting, bariatric surgery and low carbohydrate diets all share one feature in common. They are all treatments that lower insulin. Here’s comes the sudden, horrifying realization. The treatments we have been using for type 2 diabetes were EXACTLY wrong. Too much insulin causes this disease. Giving insulin or drugs that raise insulin will not make the disease better. It will only make it worse! …” - Dr. Jason Fung