[Preview] Results from treating patients with a low-carb dietRandall Smitham August 28, 2019 6 Comments
Here’s a patient, 73 years old, white male
with congestive heart failure, CHF,
chronic kidney disease, CKD,
diabetes mellitus, DM,
EF or ejection fraction of 25%.
He was full of fluid, edema in his legs,
he was basically on death’s door.
They put a left ventricular
assist device in him,
which is basically a pump
outside the heart with two tubes,
one that goes from the left ventricle
to the aorta.
When you listen to the heart
there is a…
[imitating buzzing sound]
And some people
don’t even have a heartbeat,
so there’s no lub-dub.
It’s just the…
[imitating buzzing sound]
But he had a lub-dub…
that kind of thing.
Pretty sick guy
and no one was going to touch him.
He can’t even get a heart transplant,
because he weighs too much.
And what happens?
He gets sent to me.
So we put him on a low-carb high-fat diet
or a keto diet,
we include the sodium restriction,
a water restriction
and a vitamin K restriction
because he is taking Warfarin or Coumadin,
which is an anticoagulant.
It’s okay, you just monitor these things
and you don’t get so afraid
that you can’t do something.
You just monitor these things
a little more.
So it’s a little more intensive.
There are home daily weights
which you already knew,
he is home monitoring his PT/INR,
which is the blood thinner.
Over one year he has lost 44 pounds,
from 313 to 269 pounds,
his exercise tolerance has improved,
his insulin requirement decreased
from 100 units a day to 45 units a day.
People asked, “What about the kidneys?”
His creatinine, measure of kidney function,
improved from 1.8 to 1.5,
the lower the better
in terms of the creatinine.
And his most recent
left ventricular ejection fraction is 40%.
He came back just a few weeks ago,
that’s the reason I brought this here…
And he said, “You know, Doc,
they’re thinking about an explant program,
“a starting one.
“And what they are going to do
is they are going to put me in the hospital
“and they are going to turn off the pump
and see how I do.
And then they might even take out
the LVAD, the heart assist device.
So we now have
about a dozen folks with LVADs,
some we’ve sent on to heart transplant,
some who are feeling so well,
about just leaving the LVAD in
and not doing the transplant,
because a transplant is no cakewalk.
I mean it’s a big deal,
you’re on anti-rejection meds
afterwards and all.
So there’s even consideration now
of the LVAD being removed.
Essentially this would have been,
if this all goes according to plan
and he does great,
that basically his heart failure which was…
he was on death’s door…
He got abridged to get on
to a low-carb diet…
He had a ventricular device,
he lost weight,
and maybe the low-carb, the ketones,
we don’t know, helped things…
And what a save!