Frequently Asked Questions
Once you make an appointment, you will be contacted by our office staff and asked to fill out two surveys IT IS IMPORTANT THAT YOU FILL THESE OUT BEFORE YOUR APPOINTMENT:
1. Dietary Questionnaire
2. Yale Food Addiction Scale (YFAS).
The initial consultation is done in person with a Certified Ketogenic Nutrition Specialist clinical provider. They will perform a medical assessment, review any necessary medication adjustments, order any needed lab tests, and review your metabolic assessment, including your dietary history and Yale Food Addiction Scale. You will also be seen by our specially trained and experienced health coaches, who will answer any questions and walk you through the next steps of the program. After your initial setup, you will receive electronic notifications (via the secure web portal of the electronic health record or email if this is not available), which will walk you through the readings and educational videos of the Low Carb Boot Camp. Access to the LCBC materials is via our secure web portal and is password-protected. You will follow up monthly with your provider (preferably in person, but telehealth is available for Iowa residents) and can ask questions at any time by replying to your notifications or via phone. We continue to follow you after the LCBC until you achieve a sustainable lifestyle that meets your health goals.
We strive to be transparent about our costs and seek to keep them as low as possible so that virtually everyone can afford them. The Low Carb Boot Camp costs $10/month OR $50/year (a $70 savings). Visits with a metabolic physician/clinician in the clinic (in person or telehealth) are billed to your insurance just like any doctor’s office visit. These visits may also include health coaching and dietitian services. Specialized testing, remote monitoring of continuous glucose monitors, additional tools such as a home biometric scale, ketone analyzer, 24-hour blood pressure monitor, etc., are optional but may incur further costs (most are eligible for HSA/FSA) depending on your insurance plan.
The Low Carb Boot Camp (LCBC) is an intensive 8-week course to discover the low-carb lifestyle that’s right for you to achieve your metabolic and health care goals. All the educational materials are online and can be completed at your own pace. Complementing the LCBC are meal plans and recipes, shopping lists, coaching tips, and guided instructions on time-restricted eating and intermittent fasting. Downloadable PDFs and access to the video materials are available through the web portal for $10/month OR $50/year ($70 savings) HSA/FSA eligible.
Yes, anyone can take the Low Carb Boot Camp and benefit from this education while working with their personal physician. At this time, telehealth appointments are only available to Iowa residents. Out-of-state residents and Iowa residents can both be seen in the metabolic clinic.
There are MANY indications for the Keto Diet. Some of the most common include:
Weight Loss and Diabetes (both type 1 and type 2)
Neurologic disorders, including epilepsy, migraines, dementia, Parkinson’s, neuropathy, and brain and spinal cord trauma.
GI Disorders: including Fatty liver disease, GERD (gastroesophageal reflux or “heartburn”), IBS (irritable bowel syndrome), IBD (inflammatory bowel disease), Chronic Diarrhea, and generalized gas and bloating, Increased Intestinal Permeability (“leaky gut”), Celiac Disease or gluten sensitivity.
Cardiovascular Disorders: Congestive heart failure, coronary disease, high blood pressure, dyslipidemia, and reduction in cardiovascular risk factors.
Mental Health Conditions: Anxiety and depression, bipolar disorder, and schizoaffective disorders.
Inflammatory Disorders: Arthritis of various types, including rheumatoid, psoriatic, and degenerative.
Cancer: The KD can be helpful in the treatment of various cancers, as well as a reduction in the side effects of chemo and radiation therapy.
Skin Conditions: Eczema, hidradenitis suppurativa.
Men and Women’s Health: PCOS, endometriosis, menopausal symptoms, low testosterone
Childhood Obesity: We have board-certified pediatricians who will work with families of children with obesity, diabetes, fatty liver disease, and other metabolic health issues.
The Metabolic Clinic combines the Low Carb Boot Camp (LCBC) with specially trained physician-directed management of your health care conditions. We have two stages in the process: the first is the more intensive stage, whereby we introduce TCR (therapeutic carbohydrate reduction) along with intermittent fasting utilizing the LCBC, while the second stage focuses on sustainability, showing you the delicious alternatives and workarounds to make the low-carb lifestyle doable for life. In addition, we use the most up-to-date medications, evidence-based treatments, and procedures to optimize your metabolic health. We also offer Advanced Metabolic Testing.
Currently, Dr. Riggs is the Medical Director for the MercyOne Weight Management and Metabolic Center located in Waterloo, Iowa. He and his team are available for consults, but are currently licensed for Iowa residents only at this time. To make an appointment, contact us.
Absolutely. We take great pains to make sure we communicate with your doctor every step of the way. Labs, medication changes, and results will be sent to them, and we are available for questions at any time.
Yes, but currently limited to Iowa residents.
Not necessarily. TCR (therapeutic carbohydrate reduction) is a spectrum from simply avoiding processed food and sugar to strict keto, coupled with time-restricted eating and intermittent fasting. We will help you individualize this to meet your needs.
Therapeutic Carbohydrate Reduction (TCR) describes the fact that the low-carb lifestyle encompasses a spectrum from low-carb (roughly 100g of carbs /day) to ketogenic (< 20 net carbs/day), depending on your metabolic condition and your health goals. We generally encourage everyone to start with the KD as part of the LCBC and experience all its benefits. Toward the end of the course, the diet can be dialed in to your specific health needs.
There can be. Some people experience fatigue, stomach upset, constipation, or headache, sometimes known as the “keto flu.” The symptoms are transient and easily controlled with proper fluid and electrolyte replacement.
Actually not. Technically, your liver can make all the glucose you need from either fat or protein. Some native cultures actually eat almost zero carbohydrates (e.g., the Inuit and Masai), and before exposure to the Western diet, they also had a very low incidence of obesity, diabetes, heart disease, or cancer. However, the usual well-formulated ketogenic diet does provide plenty of plant-based foods in the form of non-starchy vegetables.
Absolutely. We have many plant-based dietary regimens, and especially if you eat eggs and/or dairy, this is easily accommodated.
Yes. We practice the entire spectrum of obesity medicine, and weight loss drugs can play a significant role. But we do not see them as a panacea. We believe that everyone must master the diet and lifestyle first. If not, the medications have a much higher side effect rate and/or are ineffective. But with proper patient selection, the addition of certain weight loss drugs can have a synergistic effect. We use the lowest dose possible and do not believe that they should be used long term for the vast majority of patients.
Yes. As for medications, a small percentage of patients may be so metabolically broken that they will benefit from metabolic surgery. Again, the diet and lifestyle must be mastered before WLS is beneficial.