Now’s the time to get healthy, urges ICU physician
You can also hear Dr. Kyeremanteng in a provocative discussion about preventing critical illness in the Diet Doctor Podcast episode #55 with Dr. Bret Scher. MD.
While some doctors have been supporting the low-carb, ketogenic diet for years, Canadian critical care physician Dr. Kwadwo Kyeremanteng is a newcomer who’s just starting to learn everything he can.
That’s because, in March 2020, Dr. Kyeremanteng’s intensive care unit at The Ottawa Hospital was suddenly filling up with Covid-19 patients needing ventilators and life support.
Dr. Kyeremanteng was not the first ICU physician in the world to notice a disturbing trend: those with obesity, diabetes, hypertension, high blood glucose, insulin resistance and other markers of poor metabolic health have much higher risks of serious Covid-19 complications and ICU admissions.
But he was alarmed to see it so starkly in his own ICU.
“It was so clear. It was happening right before our eyes,” Dr. Kyeremanteng says. “Poor metabolic health is such a clear risk factor for severe coronavirus complications.”
What could be done about it? How could the risks be reduced? How could they prevent more people from ending up admitted to the ICU? Dr. Kyeremanteng started researching.
Surprised that metabolic issues reverse quickly
His findings surprised him. What Dr. Kyeremanteng did not know, before March 2020, was that there was a growing, respectable evidence-base that all these various metabolic conditions could rapidly improve with a low-carb ketogenic diet.
“I had no idea that you could reverse diabetes, hypertension, and poor metabolic health so quickly — in weeks — by diet alone. I had never been taught that in medical school nor had I ever seen it in practice.”
Researching the ketogenic diet “opened my eyes,” he says.
And like many doctors before him, he could not “unsee” what he had learned. The makings of a new low-carb advocate were born.
But then he became perplexed. Why weren’t leaders in mainstream medicine and public health doing more to spread this information?
“It’s insane. Just crazy to me. Along with social distancing, handwashing, and masks, why aren’t we preaching: ‘Let’s get healthy with our diets’? Here it is right before our eyes and we are not talking about it. I think we’ve GOT to talk about it!”
Dr. Kyeremanteng has decided to talk about it — on his Twitter feed, with low-carb guests on his popular podcast Solving Healthcare, in an online ketogenic diet symposium he recently planned and executed, and in the research network he founded and created called the Resource Optimization Network, or RON.
Dr. Kyeremanteng, who is also a palliative care physician, is a key driving force behind RON, which is devoted to generating evidence that supports better patient care and hospital decision-making. The goal of RON research is to present data that leads to better patient outcomes, health care sustainability, and cost-effective use of resources.
The network has an impressive publishing record. Since its founding in 2016, RON members have published more than 45 research articles in respected medical journals. Dr. Kyeremanteng is an author on every single one.
‘Penny-wise, pound-foolish’ decisions in health care
Dr. Kyeremanteng’s inspiration for starting RON came from a patient experience that he felt was fundamentally wrong and vivid proof that the health system often spends time, money, and resources on the wrong priorities.
The cost of daily physio? Perhaps a few hundred dollars. The cost of daily ICU? $7000 or more. The impact on the quality of life and health of the patient forced to return to the ICU? Devastating.
In essence, Dr. Kyeremanteng sees these ‘penny-wise, pound-foolish’ decisions over and over again in all health systems. But for that young man, it was a travesty in terms of his quality of care, his healing, and his health.
“I see it as a fundamental issue of justice. For patients, it’s just not good care. It’s not right.”
Dr. Kyeremanteng is so new to the ketogenic diet that he hasn’t yet had time to fully investigate how low-carb diets may align with RON’s mandate for optimizing care and resources. “But the wheels are turning,” he says.
He can see great potential in researching how, by focusing resources on improving health by diet, it may be possible to document the reduction in more expensive and invasive medications, hospitalizations, and end-stage treatments like foot amputations or kidney dialysis — or perhaps even Covid-19 admissions to the ICU. “We are already starting to think about how we could study the resource impact of this. There are so many potential benefits that would be great to quantify.”
This cost-benefit data is needed, he feels, for broader acceptance and uptake of the diet by health insurers, health maintenance organizations, and public health systems like the US Veterans Health Association, the UK’s National Health System, and other countries’ universal health care programs.
“For policy-makers and decision-makers, this is their most cherished variable: the cost-benefit ratio. This is how we get massive support and uptake by showing the resource allocation data of a low-carb diet.”
More energy and better mental focus from fasting
As a fit, athletic man who plays hockey regularly, Dr. Kyeremanteng does not need to do the keto diet for weight loss or improvement of his metabolic health. However, he has been regularly incorporating intermittent fasting into his days for the last three years.
“I tried it just for lifestyle, for convenience. And I thought, ‘I feel so good. I’ve had my best workouts. I was like, ‘Wow, this is an easy tool and it seems sustainable.’ I will still ingest carbs, but I am going to be strategic about it.”
In fact, in the fast-paced, life-and-death atmosphere of the ICU, he already has experienced a real advantage to being able to go longer periods of time without eating while still maintaining high levels of energy and mental focus.
“My life is not calm. As the father of three, and a critical care physician, anything that makes me feel more agile and ready to go, I’m all about that.”
Dr. Kyeremanteng knew by age 6 that he wanted to be a doctor. He was born and raised in the Canadian city of Edmonton, Alberta. His parents, both from Ghana, met as students at the University of Alberta.
As a child, he had severe asthma that led to a number of ER visits and hospitalizations.
“My pediatrician was my idol. I’d be in respiratory distress and he had this calming presence — I still remember his presence. And I remember thinking ‘this is what I am longing to do — help others.”
As a young Black man growing up in Alberta (the Texas of Canada), he was not exposed to many Black male physician role models, except for The Cosby Show. “We are not supposed to talk about Bill Cosby now, but back then, I was a big fan. I wanted to be just like Dr. Huxtable.”
He is now a frequent national commentator on both health care and racial issues, speaking about the Black male experience in Canada, for example, on TV, and in print during Black Lives Matter protests. He described being called racial slurs as he grew up and being told to “go back to Africa.” As one of only two Black medical students during medical school at the University of Alberta, he was subjected to outright racism and microaggressions.
Even now, he is one of only a few Black physicians at The Ottawa Hospital. As he told the Canadian Broadcasting Corporation (CBC): “I guarantee it’s not because we’re not as talented or don’t have the intellectual capacity. It’s [lack of] opportunity.”
Now he is active in the mentorship of Black youth, especially as a role model to help them choose careers in science and medicine. “If I can do it, they can do it. They need role models. But honestly, it shouldn’t be an anomaly in a diverse country like Canada to have a Black physician in an ICU.”
His goal with raising questions about whether a low-carb diet might reduce Covid-19 complications is to prevent ICU admissions.
“I do not want to see you in my ICU. It is the last place you want to be. We should be doing everything to try to prevent you from winding up here.”
Questioning the feeding solutions in ICUs
Dr. Kyeremanteng has been intrigued by preliminary, small studies that have investigated feeding ICU patients low-carb, high-fat, or ketogenic diets. One small randomized study in 1989 found the length of time on a ventilator dropped by almost three days.
Other small randomized studies have found improved respiratory function in the ICU for patients given an LCHF feeding solution compared to the standard solution.
Now, a new randomized clinical trial being conducted in Italy will be examining whether a ketogenic diet fed to patients hospitalized with Covid-19 can reduce complications and ICU admissions when compared to a standard hospital diet.
“There are so many opportunities, as far as I am concerned, to just start asking questions. Like why do we feed such high glucose solutions in the ICU? Why do we feed patients 24 hours around the clock when that maybe makes no sense for insulin or circadian rhythms?”
He doesn’t have the answers, yet, but now another well-placed physician is asking probing questions.
“We have to always be asking, ‘Are we doing the right thing?’”
As a front-line physician, who sees the impact of metabolic health on Covid-19 outcomes in the ICU he feels compelled to spread the word. “Poor metabolic health and worse Covid outcomes are real, it’s not just a theory.
“So this is an ideal time for people to start talking with loved ones about what we all can do to become more metabolically healthy.”
Perhaps, says Dr. Kyeremanteng, a low carb diet may be an easy, effective place to start.