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For the Skinny on Keto and Plant-Based Diets, Ask Kim Williams, M.D.

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  • by Cathy Katin-Grazzini

Dr. Kim Williams is one busy man. Past President of the American College of Cardiology, he is Professor of Heart Research, Chief of Cardiology at Rush Medical College, and just took up the mantle as Editor-in-Chief of a new academic journal, uniquely devoted to disease prevention and reversal. When he’s not in Chicago, he is trotting the globe, addressing medical conferences. I caught up with Dr. Williams who was kind enough to share his thoughts on current dietary trends as he was rushed to the airport for his next assignment. 

Tell us about your new International Journal of Disease Reversal and Prevention1. What’s it’s mission?
A good characterization of healthcare is a picture of a doctor mopping up the floor while the sink is overflowing. This is what medicine has been about for so long. We've got some really darn good mops, particularly in cardiology with our defibrillators, diagnostic techniques, nuclear CT-echo scans, bypass surgery and the like.  We have made so many wonderful developments during my career as a cardiologist for almost 40 years, but how much have we done to turn off the faucet, that is, on prevention?

It’s time to focus not just on managing disease but reversing it when possible and preventing it in the first place. If you optimize the lifestyle of every American, we’d only need about 1/10th the number of cardiologists that we have. They’d serve people with electrical system abnormalities and structural issues like degenerative valve diseases. That's where we should be developing our new techniques -- not dealing with coronary heart disease which is totally preventable and a lifestyle choice. People often think they have a pretty healthy diet until you ask them to recount what they actually eat. Then they realize how much damaging high-fat, high-sodium, cholesterol-rich foods they actually consume.  We're not setting out to be a nutrition-only journal, but (no pun intended) it's the lowest-hanging fruit.

We're talking about decreasing hypertension, diabetes, obesity, peripheral artery disease, coronary heart disease, stroke, erectile dysfunction, sudden cardiac death, myocardial infarction with heart failure. As a list, they just seem like disorders. But we’re talking about people's brains, their lives, the enjoyment that they get out of life. This is what we're really talking about, reversing diseases that impair or curtail life.


Do you think having an international, peer-reviewed journal focused on prevention and disease reversal will instigate more research, attract more funds for studies, and ultimately change how physicians practice medicine?
We have a lot of plant-based nutrition beliefs, based on very large observational data sets that are very supportive, but large randomized, long-term, hard endpoint studies are few and far between.  We hope to be an outlet for research but also to stimulate ideas, and let people know that prevention does exist, reversal does exist, that they should be thinking about ways to contribute to the literature, and that we have a journal for them. If we do this well, more grant-funding agencies will see their way clear to help, and that will encourage folks to design and execute research projects.


January is the time for health resolutions and people seek ways to improve their fitness and lose weight. One popular approach is the ketogenic diet. Can you explain what ketosis is and what it does in the body?


Like the classic disease state of diabetic ketoacidosis, when you consume mostly fats, some protein, with very few carbohydrates, you can't metabolize sugars because you don't produce enough insulin, so you start breaking down other elements like fat and protein.  When you metabolize fat and protein, you develop acetone-like substances called ketones. People may feel terrible during ketosis but if you persist, you get used to that feeling.  You may feel a little nauseated, suppressing your appetite, you consume fewer calories, you lose weight. These carnivorous diets that avoid carbohydrates in preference of animal protein and animal fat end up in trouble though, because they increase mortality.

At an interview I gave back in June I was famously quoted, saying, “No one should do a ketogenic diet.”  Well, when that little meme went public, some people applauded, others argued, some called me a shill for the sugar industry. They clearly had not heard me lecture: I talk way more about sugar and sugar addiction than I do about ketogenic diets!

About two months later, there was a huge analysis in The Lancet Public Health2 that looked specifically at low-carbohydrate diets with data from a primary scientific article and an additional meta-analysis of the existing literature. They concluded a high-animal fat, low-carb keto diet increased mortality by about 18%.  Now, what’s interesting is that they also looked at high-carbohydrate diets and found when high carbohydrates were refined (pastries, candies, sugar), they were extremely damaging too.

It's hard to imagine there being a plant product more dangerous to the heart and cardiovascular system than animal products, but there is: sugar. Any rapidly absorbable carbohydrate with minimal fiber will cause an insulin response and accelerate plaque. At the end of the Lancet article they also addressed data on a plant-based approach to the ketogenic diet, a low-carb diet done with things like peanut butter and vegetable protein. Here they found an 18% decrease in mortality.  

Ketosis does suppress your appetite, but consuming animals are deadly for many. When you eat animal protein and fat, you get a lot of things that you do not want in your body, like animal-based heme iron, trimethylamine n-oxide, caused by gut bacteria and common to people who eat animals, cholesterol, saturated fat, IGF-1 -- all compounds that have been identified as very harmful for the human body and particularly to the cardiovascular system. With a plant-based ketogenic diet, you benefit from not overeating and you avoid ingesting those other terrible things.

So what dietary approach do you practice?
I practice eating nothing that contains animals at all. I do on occasion eat small amounts of sugar. For a while I gave it up completely until I realized that that whole idea of insulin driving nutrients into your system that makes most people fat was actually helping me not lose too much weight!  When you are vegan, single, working 18 hours/day, and losing weight, you've got to do something!  A whole-food plant-based diet is great for weight loss, even if it’s not the goal.


Why do you think the public is so susceptible to the low-carb message? As soon as one meaty high-fat or high-protein fad is discredited, another is waiting in the wings. We've had Atkins, then paleo, now keto, and I've caught wind of a carnivore diet, comprised almost entirely of meat. What can we do to reach people's hearts as well as their minds so that we're not always reactively fighting back the next wave of unhealthy dietary choices?

We’re conditioned by our culture, personal habits, family, churches. To attack this problem, we have to start with marketing. Eating high-fat animal products that are high in cholesterol is very comparable to cigarettes, yet there are no regulations on it.  Hopefully the journal can help us get enough science out there for people to recognize the epidemiology of food, and say we're not going to allow marketing of high-fat, high-calorie foods with very little nutritional value, particularly to children, just because they taste good and look good.

Didn't it take around 7000 studies and over 25 years before the Surgeon General came out in the 1960s with his report on the risks of tobacco? Either we need a plant-based Surgeon General or a heck of a lot more studies!
Yeah, that's the analogy that I make at the end of each one of my lectures, that doctors were actually pushing cigarettes in the '50s, saying how it doesn't hurt your health and which brand they liked the most. All of that was erroneous and tragic and it really needs to not be repeated.

For years the leading cause of death of physicians in the United States has been heart disease. It's not like physicians and nutritionists who are supposed to be charged with health, understand what to do to make a patient, their family, or themselves healthy.  There's a lot of education that needs to be done and hopefully our journal will help with that too.

And on that note, Dr. Williams was off and running, boarding that flight to his next speaking engagement. If there’s one thing a plant-based diet has given him, it’s stamina!


1 For more about The International Journal for Disease Prevention and Reversal see https://ijdrp.org/

2  https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30135-X/fulltext

For the Skinny on Keto and Plant-Based Diets, Ask Kim Williams, M.D.

by Cathy Katin-Grazzini

Dr. Kim Williams is one busy man. Past President of the American College of Cardiology, he is Professor of Heart Research, Chief of Cardiology at Rush Medical College, and just took up the mantle as Editor-in-Chief of a new academic journal, uniquely devoted to disease prevention and reversal. When he’s not in Chicago, he is trotting the globe, addressing medical conferences. I caught up with Dr. Williams who was kind enough to share his thoughts on current dietary trends as he was rushed to the airport for his next assignment.

Tell us about your new International Journal of Disease Reversal and Prevention1. What’s it’s mission?

A good characterization of healthcare is a picture of a doctor mopping up the floor while the sink is overflowing. This is what medicine has been about for so long. We've got some really darn good mops, particularly in cardiology with our defibrillators, diagnostic techniques, nuclear CT-echo scans, bypass surgery and the like.  We have made so many wonderful developments during my career as a cardiologist for almost 40 years, but how much have we done to turn off the faucet, that is, on prevention?

It’s time to focus not just on managing disease but reversing it when possible and preventing it in the first place. If you optimize the lifestyle of every American, we’d only need about 1/10th the number of cardiologists that we have. They’d serve people with electrical system abnormalities and structural issues like degenerative valve diseases. That's where we should be developing our new techniques -- not dealing with coronary heart disease which is totally preventable and a lifestyle choice. People often think they have a pretty healthy diet until you ask them to recount what they actually eat. Then they realize how much damaging high-fat, high-sodium, cholesterol-rich foods they actually consume.  We're not setting out to be a nutrition-only journal, but (no pun intended) it's the lowest-hanging fruit.

We're talking about decreasing hypertension, diabetes, obesity, peripheral artery disease, coronary heart disease, stroke, erectile dysfunction, sudden cardiac death, myocardial infarction with heart failure. As a list, they just seem like disorders. But we’re talking about people's brains, their lives, the enjoyment that they get out of life. This is what we're really talking about, reversing diseases that impair or curtail life.

Do you think having an international, peer-reviewed journal focused on prevention and disease reversal will instigate more research, attract more funds for studies, and ultimately change how physicians practice medicine?

We have a lot of plant-based nutrition beliefs, based on very large observational data sets that are very supportive, but large randomized, long-term, hard endpoint studies are few and far between.  We hope to be an outlet for research but also to stimulate ideas, and let people know that prevention does exist, reversal does exist, that they should be thinking about ways to contribute to the literature, and that we have a journal for them. If we do this well, more grant-funding agencies will see their way clear to help, and that will encourage folks to design and execute research projects.

January is the time for health resolutions and people seek ways to improve their fitness and lose weight. One popular approach is the ketogenic diet. Can you explain what ketosis is and what it does in the body?

Like the classic disease state of diabetic ketoacidosis, when you consume mostly fats, some protein, with very few carbohydrates, you can't metabolize sugars because you don't produce enough insulin, so you start breaking down other elements like fat and protein.  When you metabolize fat and protein, you develop acetone-like substances called ketones. People may feel terrible during ketosis but if you persist, you get used to that feeling.  You may feel a little nauseated, suppressing your appetite, you consume fewer calories, you lose weight. These carnivorous diets that avoid carbohydrates in preference of animal protein and animal fat end up in trouble though, because they increase mortality.

At an interview I gave back in June I was famously quoted, saying, “No one should do a ketogenic diet.”  Well, when that little meme went public, some people applauded, others argued, some called me a shill for the sugar industry. They clearly had not heard me lecture: I talk way more about sugar and sugar addiction than I do about ketogenic diets!

About two months later, there was a huge analysis in The Lancet Public Health2 that looked specifically at low-carbohydrate diets with data from a primary scientific article and an additional meta-analysis of the existing literature. They concluded a high-animal fat, low-carb keto diet increased mortality by about 18%.  Now, what’s interesting is that they also looked at high-carbohydrate diets and found when high carbohydrates were refined (pastries, candies, sugar), they were extremely damaging too.

It's hard to imagine there being a plant product more dangerous to the heart and cardiovascular system than animal products, but there is: sugar. Any rapidly absorbable carbohydrate with minimal fiber will cause an insulin response and accelerate plaque. At the end of the Lancet article, they also addressed data on a plant-based approach to the ketogenic diet, a low-carb diet done with things like peanut butter and vegetable protein. Here they found an 18% decrease in mortality. 

Ketosis does suppress your appetite, but consuming animals are deadly for many. When you eat animal protein and fat, you get a lot of things that you do not want in your body, like animal-based heme iron, trimethylamine n-oxide, caused by gut bacteria and common to people who eat animals, cholesterol, saturated fat, IGF-1 -- all compounds that have been identified as very harmful for the human body and particularly to the cardiovascular system. With a plant-based ketogenic diet, you benefit from not overeating and you avoid ingesting those other terrible things.

So what dietary approach do you practice?

I practice eating nothing that contains animals at all. I do on occasion eat small amounts of sugar. For a while, I gave it up completely until I realized that that whole idea of insulin driving nutrients into your system that makes most people fat was actually helping me not lose too much weight!  When you are vegan, single, working 18 hours/day, and losing weight, you've got to do something!  A whole-food plant-based diet is great for weight loss, even if it’s not the goal.

Why do you think the public is so susceptible to the low-carb message? As soon as one meaty high-fat or high-protein fad is discredited, another is waiting in the wings. We've had Atkins, then paleo, now keto, and I've caught wind of a carnivore diet, comprised almost entirely of meat. What can we do to reach people's hearts as well as their minds so that we're not always reactively fighting back the next wave of unhealthy dietary choices?

We’re conditioned by our culture, personal habits, family, churches. To attack this problem, we have to start with marketing. Eating high-fat animal products that are high in cholesterol is very comparable to cigarettes, yet there are no regulations on it.  Hopefully the journal can help us get enough science out there for people to recognize the epidemiology of food, and say we're not going to allow marketing of high-fat, high-calorie foods with very little nutritional value, particularly to children, just because they taste good and look good.

Didn't it take around 7000 studies and over 25 years before the Surgeon General came out in the 1960s with his report on the risks of tobacco? Either we need a plant-based Surgeon General or a heck of a lot more studies!

Yeah, that's the analogy that I make at the end of each one of my lectures, that doctors were actually pushing cigarettes in the '50s, saying how it doesn't hurt your health and which brand they liked the most. All of that was erroneous and tragic and it really needs to not be repeated.

For years the leading cause of death of physicians in the United States has been heart disease. It's not like physicians and nutritionists who are supposed to be charged with health, understand what to do to make a patient, their family, or themselves healthy.  There's a lot of education that needs to be done and hopefully our journal will help with that too.

And on that note, Dr. Williams was off and running, boarding that flight to his next speaking engagement. If there’s one thing a plant-based diet has given him, it’s stamina!

1 For more about The International Journal for Disease Prevention and Reversal see https://ijdrp.org/

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30135-X/fulltext

Kim Allan Williams, MD, MACC, FAHA, MASNC, FESC

Dr. Williams is Chief of the Division of Cardiology at Rush University and specializes in cardiology, prevention and cardiac imaging. He has served on numerous national committees and boards including serving as the President of the American College of Cardiology, President of the American Society of Nuclear Cardiology, and Chairman of the Board of Directors of the Association of Black Cardiologists. He is also the founder of the Urban Cardiology Initiative in Detroit, Michigan to reduce ethnic heart care disparities, and continues community-based efforts in Chicago at Rush. A native of Chicago’s South Side, Dr. Williams has over 30 years of experience as an educator, researcher, and physician.

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