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Short Summary
Main recommendation: For weight loss and diabetes treatment on a low carb or ketogenic diet, Dr. Westman says you do not need to calculate macronutrients; instead, keep carbs very low and eat from a list of low-carb, low-glycemic foods until comfortably full. Calculating macronutrients (for example, targeting about 70 percent of calories from fat) is only useful if your goal is a specific level of ketosis, such as for performance or a therapeutic purpose.
Key Points
- Appetite typically drops within a day or two on a low-carb plan, and the body begins improving blood sugar or weight without explicit macronutrient tracking.
- Dr. Westman says he's observed that overconsuming fat, such as oils, butter, or calorie-rich drinks like coffee with added fat, can stall weight loss, because calories still matter even when they are not counted.
- Dr. Westman does not ask most patients to track protein percentages, noting that the science on exact protein needs is unclear.
- Dr. Westman says that in studies he's seen, people on ketogenic diets often ate roughly 50 to 70 percent fat, but there is a wide range and patients find their own approaches.
- Ketone level is not a proven target; Dr. Westman says the research does not yet establish that higher is better, and many people judge by how they feel.
- Nuts and seeds are excluded early on for many people because they can be trigger foods, though some can include them in portioned amounts later.
Details Worth Noting
- Concrete instructions: Start with a list of very low-carb, low-glycemic foods and eat until comfortably full, without calculating macronutrients, if your goal is weight loss or diabetes treatment.
- Concrete instructions: If you want to reach ketosis and maintain it, calculate macronutrients and aim for about 70 percent of dietary calories from fat.
- Concrete instructions: To measure ketosis on your own, check blood beta-hydroxybutyrate, which the speaker says most experts consider the best gauge; breath or urine ketones are alternatives, and a meter that checks glucose and ketones can be used.
- Concrete instructions: Limit total carbohydrates, not just net carbs, because some people absorb fiber grams and sugar alcohols can affect ketosis.
- Concrete instructions: Dr. Westman says newcomers who want to get it right the first time can aim for 20 grams or less of carbs per day, which he says puts nearly everyone in ketosis; he notes older adults may need fewer carbs, while young active people may tolerate 50 to 75 grams.
- Concrete instructions: Nuts and seeds should be avoided at first; if you can have them in portions without overeating, you may add them later.
- Named resources mentioned include adaptyourlife.com for a basic video guide and healclinics.com, where a questionnaire connects people to a partner or, if they have medical problems, to a clinic for monitored medication changes.
- The speaker cautions that people with medical conditions should work with a medical professional, and that the information reflects his clinical approach rather than professional advice for any individual.
Bottom Line
Eating low-carb foods to satiety is the simplest route for weight loss and diabetes treatment, while macronutrient calculation becomes relevant mainly when deliberately targeting ketosis.
