A day in the life of a low-carb doctor

Christopher Stadtherr

Dr. Christopher Stadtherr, MD, is a hospitalist physician who we just started working with. Here is his first post:

As a hospitalist physician, I have the privilege of caring for general medical patients who are admitted to the hospital. I am certainly an oddity among hospitalists (and all physicians, for that matter) for the amount of effort I put into educating my patients about managing their health conditions with nutrition, particularly in regards to diabetes. I believe strongly, however, that they deserve to be informed of the simple, non-pharmaceutical treatment options all the same.

After my own discovery of the virtues of a low-carbohydrate lifestyle, I now can’t help but to constantly recognize ways that a low-carbohydrate diet can benefit my patients, as the majority of modern disease appears to be tied to essentially one disease process – Insulin Resistance. Propelled by the landmark review article, Dietary carbohydrate restriction as the first approach in diabetes management, I worked to utilize the simple concept of carbohydrate restriction in managing diabetes in the hospital setting.

Here are a few highlights from a work day that demonstrate a variety of patients I might encounter in the hospital setting for whom a low-carbohydrate approach is appropriate.

Healing patients with carb restriction

On this particular day, I started by adjusting the diet orders on 6 of my 14 patients, mainly adding an order for carbohydrate restriction of 45 grams per meal, rather than the American Diabetes Association (ADA) standard of 60 grams per meal. [Though the ADA no longer endorses a specific diet plan or quantity of carbohydrates in the hospital setting, the standard diabetic diet in hospitals throughout the US has traditionally allowed up to 60 grams of carbs per meal.]

While this restriction is still not technically “low-carb” (<130 g carbs/day), it appears to substantially improve my patients’ glycemic control without too much negative impact on their satisfaction. Furthermore, from a safety standpoint, fewer carbs consumed means less insulin required to treat the resulting hyperglycemia (high glucose), which means less risk of hypoglycemia (low glucose) from insulin reactions. I am fortunate that the hospital has partnered with me to improve the care of diabetic patients, including the development of a “45 g carbs per meal” order option in the Electronic Medical Record. While that may sound like a small thing, I consider it a testament to the fact that carbohydrate restriction is starting to be recognized as an option for managing diabetes. Not only is improved control of diabetes in the hospital associated with better outcomes, but also good glycemic control decreases length of stay and costs of hospitalization.

Early in my day, I encountered a young woman recovering from a severe kidney infection. She was morbidly obese and had abnormalities in her labs that initially appeared to suggest alcoholic liver disease, also supported by the finding of a fatty liver. It soon became evident, however, that she actually had Non-Alcoholic Fatty Liver Disease (NAFLD). I explained the connection to dietary intake of carbohydrates, citing examples of high-carbohydrate foods to avoid, to which she replied, “All the good stuff!” Nevertheless, she is relieved and excited at the prospect of reversing this condition with a low-carbohydrate, high-fat (LCHF) diet.

Later in the morning, I encountered an elderly gentleman with type 2 diabetes and numerous other diagnoses that fall within the umbrella of Insulin Resistance – obesity, hypertension, dyslipidemia – as well as complications from diabetes. He actually initiated discussion about nutrition before I could, asking me about a commercial weight loss product for which he had seen advertisements. We spent the next 35 minutes discussing how a simple nutritional intervention (LCHF) could have a profoundly positive impact on his health, including reversal of his diabetes and all the other manifestations of the metabolic syndrome. He may have gotten more of a response than he bargained for, but he was extremely grateful that someone finally explained how a simple dietary intervention could free him from these chronic diseases and the medications he was using to treat them. “Where have you been all my life?!” he exclaimed.

In addition to several other patients with diabetes who, for various reasons, were not receptive to talk about nutrition, I admitted a teenager with Diabetic Ketoacidosis (DKA), a life-threatening complication of [typically] type 1 diabetes. He had had a complication with his insulin pump and just couldn’t recover from the several hours he went without any insulin. As he already had a good appetite by the time I saw him, I decided to ask him what he eats. “Everything,” he replied. When asked if he was familiar with the concept of a low-carbohydrate diet to reduce his need for insulin, he stated that he prefers to eat whatever he wants and then treat himself with insulin. His mom shook her head in frustration, and I reluctantly accepted defeat [for now] from this young man whose Hemoglobin A1c was nearly 12% and who will almost certainly be back another day with DKA again or a complication related to his uncontrolled diabetes.

Of my 15 patients that day, 7 of them had diabetes (1 of whom had type 1 diabetes) and 2 had pre-diabetes. As I cannot possibly spend 45 minutes with each of my patients (as I did with the diabetic gentleman), there is definitely an element of triaging my efforts to get the most bang for the buck. Admittedly, it would be far easier and less time-consuming for me to simply consult a dietitian or diabetes educator for these patients, but it would be a disservice not to share with them an intervention that is not only supported by a growing body of scientific evidence but is also safe, free, and potentially life-changing. By no fault of their own, dietitians do not discuss LCHF with diabetic patients, because their “script” is driven by the ADA’s outdated guidelines.

Not all patients are receptive to the message, but I’ve also learned not to make that assumption, for I have been surprised many times at the engaging discussions that have arisen from a simple inquiry about someone’s diet.

From my vantage point in the hospital, seeing diabetics with complications from decades of following the same ineffective dietary advice, I remain hopeful that the future of diabetes care can and will be transformed by grassroots efforts and an overwhelming cohort of patients who find revitalized health with a low-carb lifestyle.


Dr. Christopher Stadtherr

More

Low Carb for Beginners

Top videos with low-carb doctors

Diabetes

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Earlier

How Low Carb Can Save Tons of Money by Reducing the Need for Medications

Virta’s Preliminary 1-Year Results: Continued Reversal of Diabetes Type 2 on a Keto Diet

About Dr. Stadtherr

Dr. Christopher Stadtherr, MD, is a hospitalist physician in the Pacific Northwest and is board-certified in Family Medicine. After completing residency, he worked as a full-spectrum family medicine physician in Minnesota before transitioning to full-time hospital medicine.

He discovered the wisdom of the low-carbohydrate lifestyle after challenging the status quo of inpatient diabetes management and now employs low-carb principles to manage diabetes and other related metabolic conditions.

13 Comments

  1. Stealth
    I hope as you continue to have better outcomes that the hospital gets a clue and lets you teach other doctors AND dietitians how to do this as well. I'm tired of doctors and dietitians hiding behind "standard practices" while their patients get sicker. Some day the reckoning will come.
  2. Joann Dixon
    Dr. Stadtherr, Bravo!
    I applaud your efforts to educate those who are ready to hear about LCHF way of eating and the benefits to their health. And to get the hospital to amend their EMR for a lower carb option is phenomenal!
  3. Michelle
    I really wish the doctor and nurses that I had seen last week had known about lchf instead of looking at me like a total weirdo and making me feel stupid. They also told me to stop taking magnesium, vitamin D and mct oil!, like I was ingesting a concoction of drugs.
  4. Jack Jaffe
    I've been on a ketogenic diet for a year now and have lost ~50#. I do take dietary side trips for a meal or two, but mentally never abandon ketogenesis.
  5. Vincent Perri
    I don't have diabetes but my cholesterol was slightly high at a point. It has nothing to do with why I started a low carb ,no sugar diet!! I wanted to lose weight!! I strickly cut out refined carbs , sugar and added 16 hrs of fasting daily. 4 months later I have last 30 PDS ...... ENOUGH said!! Wanna lose weight and eat well......
  6. Natashaw
    I am so glad to hear a hospitalist backing up the LCHF diet. I am doing the Ketogenic diet and have not been able to find a doctor in my area that supports it. My doctor actually rolled her eyeballs when I brought it up, I no longer see her.
  7. Ross A Strickland
    Dr. Atkins legacy will live on! I have used his lifestyle many times to rid myself of unwanted pounds. The first time, I lost 125 pounds in 18 months and read his book cover to cover! Nothing works better IF you read the book and follow his instructions.
  8. Anna Meuleners
    Dr. Chris as your cousin I am so proud of you and everything you have accomplished by helping others.
  9. Tina
    Just read your story. I reversed my diabetes 2 with LCHF. People ask me all the time about my diet and then give me the same "deer in the headlight" look as I explain it to them. It's very disappointing when I see these same people get sicker and sicker every year. The answer is so simple. Please don't get discouraged as you spread the word. Thanks for your work!
  10. Ana
    I love the clarity of mind and better overall feeling of well being that Keto lifestyle has given me. And that I don't feel deprived or hungry . I always knew carbs were bad for me but I never realized how much a LCHF way of eating would improve my life.
  11. Linda
    Linda,
    I have a sister who has had pancreatitis. With no relief from traditional methods of treatment, she did have the Whipple surgery at Mayo clinic in Rochester. Still no relief from horible pain. Her pancreas has now been removed along with part of her spleen and gall bladder. The doctors are expecting the islets they removed from her pancreas and were placed in her liver, to produce insulin. She has been taking insulin for 6 months now. The doctors tell her to eat all she wants of anything. She continues to be in pain and now using oxy for relief.
    Would the LCHF help her??
  12. Tamarah
    Dr Stadtherr ,, you are an Angel . I wish more Dr's would practice as you do . Please don't ever stop what your doing . If you just save 1 life at a time,, you have done a fantastic job . Thanks for all you do , I wish I knew where you practiced I would move there .
    Tamarah
  13. Kathleen Rokavec, MD
    Great article and great effort! I was a hospitalist for many years and tried to do the same you are doing. Unfortunately the hospital and dietitian were not on board. It was frustrating to see what my patients were eating and then having to dose higher and higher insulin. Thank you for the continued effort!

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