Dr. Thorn on His Approach to Nutrition and Weight Loss
I recently received a question from a colleague who was interested in my plan of care for a patient in regards to weight loss. I thought that my response would be of general interest so I am posting it here:
The approach that I use is a low carbohydrate/ketogenic diet. In my view, the primary benefits of this approach are that 1) it results in reliable/relatively rapid weight loss without hunger or necessity for calorie counting, 2) it minimizes carb cravings/sweet tooth and thus facilitates a transition to eating real, non-processed food, and 3) it directly addresses what is in my view the root cause of metabolic syndrome – carbohydrate intolerance and resultant insulin resistance (not fat gain – it is complicated, but I think it is more correct to view the fat gain as an effect rather than a root cause of metabolic syndrome.)
I do not believe that a very low carb/ketogenic diet is necessary long term for all people. However, this nutritional approach is an ideal starting point when you don’t know how a patient will respond. Then, once your patient has adapted to a well formulated low carbohydrate diet and is successfully losing weight without cravings or hunger, you now have some reserve to try adding back different foods and carbohydrates and gauge tolerance. For patients who are older, have cardiovascular risk factors and/or chronic diseases such as diabetes or CAD, and often are on multiple medications, having guidance from a health care provider in making nutritional and lifestyle changes is highly beneficial. While, in the long run, there are no inherent risks in following a low carbohydrate lifestyle, in the short run, there are some risks and challenges in making the transition. These risks can all be mitigated with proper guidance and care.
I highly recommend two books for interested providers and patients. First is “A Low Carbohydrate, Ketogenic Diet Manual: no Sugar, No Starch Diet,” by Eric C. Westman, M.D.. Dr. Westman is the clinical expert on the use of well formulated low carbohydrate diets for the treatment of obesity and metabolic syndrome. This pamphlet is the instructional manual for the approach that he uses. Dr. Westman’s approach served as the model for my own and I consider him a mentor.
The second book that I recommend is “The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable.” by Jeff S. Volek, Ph.D.,R.D., and Stephen D. Phinney, M.D., Ph.D.. This is an extremely readable but still scientific and detailed guide to why carbohydrate restriction is such a powerful and ben