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Summary
On episode 464 of 40+ Fitness, Coach Allan sits down with Dr. Eric Westman and Amy Berger, low carb researchers and clinicians, to talk about their book End Your Carb Confusion. Dr. Westman is an associate professor of medicine at Duke University who founded the Duke Keto Medicine Clinic in 2006, and Amy Berger is an Air Force veteran and certified nutrition specialist with a master’s degree in human nutrition.
Their central idea is the carb threshold: everyone has a genetically influenced tolerance for carbohydrate, so the goal is finding your own number instead of copying someone else’s diet. The book skips the cookbook approach and instead explains what carbs do in the body and why, so readers can build their own plan.
They also push back on the idea that carbs are the enemy. The conversation covers three levels of carb intake, why sugar and insulin (not fat) are the real problem, and why some of the most common “keto mistakes” (too many nuts, too much cheese, commercialized low carb snacks) quietly stall people’s results.
Links
- https://www.adaptyourlifeacademy.com
- https://www.drwestmanonline.com
- https://www.tuitnutrition.com
- Episode 244 – An antidote for alzheimer’s with Amy Berger
Key Takeaways
- Sugar and insulin, not dietary fat, are the root cause of metabolic disease. Dr. Westman explains that eating or drinking sugar raises blood glucose, which triggers an insulin response, and it’s that glucose-insulin cycle, not fat, that drives atherosclerosis, heart disease, stroke, kidney disease, and diabetes.
- Everyone has a “carb threshold,” and it’s largely genetic. Some people can eat 100 to 150 grams of carbs a day and stay healthy while others need to stay much lower. Dr. Westman frames it as an old survival trait: good fat-storers in a famine are today’s low-threshold carb responders.
- The book measures total carbs, not net carbs. Amy and Dr. Westman consider net carbs a “distraction” and use total carb counts because they’re more precise and easier to apply consistently.
- Their plan has three rough levels: about 20, up to 50, and up to 100-150 grams of carbs a day. The cut points aren’t fixed rules; they’re starting points, with most people beginning at the lowest level because it removes guesswork and reliably produces fat burning without tracking macros.
- High blood sugar isn’t the only danger; high insulin with normal blood sugar can still cause harm. Amy explains that “sticky,” glycated blood damages the fragile blood vessels in the eyes and kidneys even when blood sugar looks normal, because insulin is working overtime to keep it that way.
- Nuts, cheese, and cream are limited on the strictest level, not because they aren’t keto, but because they’re easy to massively overeat. Amy calls it “hand-to-mouth disease”: these foods are calorie-dense and don’t reliably signal fullness, which quietly derails fat loss.
- Commercialized “keto” snacks are one of the most common reasons fat loss stalls. Many are loaded with sugar alcohols and added fat; low carb does not mean low calorie, and those calories still have to go somewhere.
- The book deliberately doesn’t demonize carbohydrates. Amy points out that billions of people around the world eat rice, beans, fruit, and potatoes and stay healthy and lean; the right carb level depends on the individual’s health situation, not a blanket rule.
- Eric and Amy’s strategies to get and stay well: Amy says to eat, socialize, and move in ways that let you keep doing what you want to do physically and mentally, without chasing a “perfect” physique at the expense of mental and emotional health. Dr. Westman frames wellness as mind, body, and spirit, starting with getting nutrition right, then building physical activity, happiness, and community connection on top of it.
“Low carb does not mean low calorie.”
Amy Berger
Another Episode You May Enjoy
Episode 518 – How to go on and off keto for health and fitness with Tara Garrison