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Short Summary
Main recommendation: On a strict "prescription strength" keto diet, avoid almond flour, coconut flour, nuts, and nut butters at first, because they can be trigger foods and add enough total carbs to slow fat burning. Dr. Eric Westman says this approach is meant to work the first time, every time, and he counts total carbs rather than net carbs.
Key Points
- Dr. Westman calls his method "prescription strength keto," contrasting it with over-the-counter or internet keto, and says in his experience it needs to work reliably for his patients.
- He traces the approach to doctors who used low-carb diets in their practices, including Dr. Atkins, Dr. Eads, Dr. Bernstein, and Dr. Rosedale, who kept total carbs very low and banned nuts, nut flours, and nut butters.
- Nuts and nut flours can be trigger foods, meaning they drive overeating; he describes eating a whole jar of chunky peanut butter.
- Almond flour recipes can quietly add carbs, and using net carbs underestimates them because fiber may still affect ketones and blood sugar, so he says to use total carbs.
- In his informal show-of-hands surveys at events, he estimates about 50 percent of people reported trouble controlling nuts, which he considers too high a failure rate for his approach.
Details Worth Noting
- Concrete instructions:
- Start with no almond flour, no coconut flour, no nuts, and no nut butters (cashew, almond, macadamia, peanut).
- Keep total carbohydrates at about 20 grams per day or less, counting total carbs rather than net carbs.
- If making almond-flour pancakes or similar foods, carefully count how much you eat, since two or three pancakes can add about 5 to 10 total grams of carbs.
- For truffles, make them with cheese and an egg instead of almond flour.
- Focus mainly on foods with no carbs so you don't have to worry about portion counting.
- Give it a day or two for hunger to fade; he says in his observation most people lose one to two pounds per week without much effort.
- Only add nuts or nut flours later if you can control them, which he says is true for roughly half of people.
- He notes that people who avoid nuts often report feeling comfortably full and fewer cravings.
- He mentions adapt keto events held on Saturdays, where he took the show-of-hands survey, used here only as context for his informal survey, not a promotional detail.
- This is his personal clinical approach and experience, not professional medical advice for any individual.
Bottom Line
Dr. Westman's advice is to leave almond flour and other nut products out of a strict keto plan at first, since they can trigger overeating and quietly add carbs, and to add them back later only if you can control them.
