Clipboard in hand, Dr. Eric Westman strides into the office to see his patients. All of them are overweight. Many of them are diabetic and have high blood pressure or other weight-related ailments.
He scans a list of foods they eat and doesn't bat an eye at their consumption of eggs, sausage and bacon, coffee with heavy cream or pork rinds. He doesn't require them to exercise. He tells one: "Fat is your friend."
With those four words, Westman, an internist who directs Duke University's Lifestyle Medicine Clinic, declares his stance in the often vitriolic low-fat vs. low-carb debate. His research helped spark the 2004 Atkins diet boom, and he is a co-author of "The New Atkins for a New You," which devotes a chapter to the past decade's research on low-carb diets.
Westman seems out of place in Durham, which has been called "the diet capital of the world." Obese people come from afar and spend up to $7,000 a month to shed pounds at The Rice Diet Program Clinic, Structure House and the Duke Diet & Fitness Center. All three clinics prescribe a low-fat, calorie-restricted diet along with exercise.
Meanwhile, Westman runs a one-man clinic out of a Duke office building. Most of his patients live nearby, and the most they have to pay to see him is a health insurance co-pay.
For the past 10 years, Westman and other low-carb researchers have been fighting an uphill battle against the medical consensus that a low-fat, high-carb diet is best.
Low-fat dieters aim to get 65 percent of their calories from carbohydrates, such as whole-grain breads, pastas, fruits and starchy vegetables. A low-fat diet helps you lose weight because you eat bulky foods with fewer calories.
A low-carb, high-fat diet favored by Westman reduces carbohydrates to 30 percent or less. Most of the calories come from fats, protein and low-carb vegetables, such as leafy greens, broccoli and zucchini. The low-carb diet helps you slim because protein and fat leave you full longer so you consume fewer calories.
"Fat is very satiating," Westman said. "Diets that restrict fat, that's a problem. Hunger is the main reason people go off a low-fat diet."
Westman and his colleagues are not saying that low carb is better than low fat. Both diets work because they restrict calories. Research shows that the best diet for someone is the easiest one - based on personal food preferences - to follow. Westman's point is that a low-carb diet is a viable option that has been wrongly maligned by the mainstream medical community.
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