Should you count total or net carbohydrates? Eric Westman, MD, explains how he approaches carbohydrate targets, health markers, and low-carb replacement foods.
Dr. Westman’s approach
In 2020, Eric Westman, MD, was described as an associate professor of medicine at Duke University, board certified in obesity medicine and internal medicine, and the founder of Duke’s Keto Medicine Clinic. The contemporary account also noted his clinical research, professional roles, books, and work with Adapt Your Life.
Dr. Westman’s 2020 conversation accompanied the release of End Your Carb Confusion, written with Amy Berger. He discussed how carbohydrate targets can vary, the difference between total and net carbohydrates, and how people can monitor their response when changing their diet.
Low-carb eating does not require one identical target
The 2020 account attributed to Dr. Westman the view that not everyone needs strict ketogenic eating or deep ketosis to benefit from reducing sugar. He described starting with a defined carbohydrate limit and then personalizing it according to medical conditions, activity, goals, and individual response.
His book was described as using a checklist of medical conditions and activity levels to help readers select a starting point. Dr. Westman’s historical framework also included adding carbohydrates back in five-gram increments, remaining at each level for one or two weeks before another change. This is his framework, not a Toward Health protocol.
Total carbohydrates versus net carbohydrates
Dr. Westman said he generally recommended counting total carbohydrates rather than net carbohydrates. The 2020 account attributed this preference to his clinical observation that some patients had better results after moving from 20 grams of net carbohydrates to 20 grams of total carbohydrates.
That statement describes the guest’s reported experience. The appropriate intake for any individual can depend on medical history, medications, activity, nutrition needs, and treatment goals.
Track more than the scale
The 2020 conversation emphasized looking at how a person feels, body measurements, and health markers such as glucose, fasting insulin, and blood pressure when changing carbohydrate intake. One scale measurement is only a momentary snapshot.
The 2020 account also attributed to Dr. Westman the observation that some athletes may tolerate substantially more carbohydrate.
Low-carb replacement foods can be useful and difficult to moderate
Dr. Westman and Tro Kalayjian, DO, viewed packaged keto replacement foods as potentially useful for long-term adherence while recognizing that highly palatable foods can be easy to overconsume, according to the 2020 account.
Dr. Westman and Dr. Tro extended the same caution to foods such as nuts and dairy. Their practical point was to notice whether a replacement helps someone follow an intended plan or becomes difficult to moderate.
Key takeaways
- A low-carbohydrate approach can be personalized rather than treated as one fixed target for everyone.
- Dr. Westman described why he favored total-carbohydrate counting in his clinical work.
- The 2020 conversation emphasized wellbeing, measurements, and relevant health markers rather than only the scale.
- Packaged keto foods may be useful in some situations but can become difficult to moderate.
- Dr. Westman and Dr. Tro compared the language of smoking cessation and food addiction.
Learn more from the Adapt Your Life Academy, or explore Toward Health’s Health Coaching program.
People using glucose-lowering or blood-pressure medication should discuss substantial dietary changes with the clinician who prescribes them.
