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Short Summary
Main recommendation: Calories still matter if your goal is weight loss or general health, so the fat-based foods you eat or drink (such as heavy cream and oils) count toward your total intake, and the right macronutrient split depends on your specific goal rather than a fixed formula. Dr. Westman says the science on protein, macros, and low-carb diets for blood sugar control is still limited, so individual responses matter more than universal numbers.
Key Points
- Calories are handled differently depending on food type, so calorie labels alone don't tell the full story on low-carb diets.
- Eating more energy than you burn can stop weight loss or cause weight gain, even on a high-fat, low-carb diet.
- Protein can raise blood glucose; the aim for blood sugar control is adequate protein, not high protein, and fat such as oils, butter, or cream should not raise blood sugar much.
- Westman says he doesn't know the ideal protein or fat amounts for blood sugar control, and recommends individual testing with a glucometer.
- Dr. Westman says the current consensus is that triglycerides and small LDL should be as low as possible and HDL as high as possible, and he believes inflammatory markers such as CRP may be just as important or more so.
- Dr. Westman says that in his experience, low energy on a low-carb diet is more often linked to salt intake or blood pressure than to sugar.
Details Worth Noting
- Concrete instructions: If energy is low on a low-carb diet, try adding about 800 mg of salt, plus a teaspoon of bouillon, broth, soup broth, or bone broth, and see whether energy improves. In clinic, Westman checks blood pressure and, if it is on the low side, has people increase salt and water.
- Concrete instructions: If you are trying to lose weight, track total energy intake, since drinking heavy cream or oils without regard to amount can offset weight loss.
- Concrete instructions: For blood sugar control on a low-carb diet, use a glucometer to measure your own response to protein and fat rather than following a fixed number.
- The speaker explicitly frames this as an individualized area with limited science, and notes that the field is "in its toddlerhood."
- He says the mechanism debates among keto camps often matter less than the end result, which is usually similar.
- Westman does not ask clinic patients trying to lose weight to calculate their own macros, and says he doesn't know the right macro percentages, including for vegan low-carb diets.
- Westman says he has never claimed that calories don't matter, and that such claims attributed to him are inaccurate.
Bottom Line
Calories and macros matter, but the correct approach depends on whether you are losing weight, maintaining, or using low carb for blood sugar control, and there is no settled universal formula yet.
