HOPE…for people with obesity, diabetes, and chronic disease
Real Science, Real Food, Real Results
We offer a comprehensive medically supervised treatment regimen tailored to your specific metabolic needs and health goals, utilizing diet and lifestyle interventions to reduce or eliminate medications and provide optimal health, all while integrating with your existing health care system, doctor, and insurance.
Weight Management
70% of adults are overweight or obese. If traditional advice has left you frustrated, you’re not alone—lasting weight loss comes from addressing the hormonal roots of metabolism, not blame or shame.
Chronic Disease
89% of people die from chronic disease. Many chronic conditions, from heart disease and diabetes to fatty liver, cancer, and mental health disorders, can be improved through metabolic therapy.
Diabetes
70% Type 2 diabetes remission rate with the Living by Design Process. By addressing carbohydrate intolerance, many improve their blood sugar and reduce or eliminate medications.
Metabolic Testing
93% of adults are metabolically unhealthy. Are you one of them? Standard labs can miss the root causes. We use advanced testing to uncover metabolic, inflammatory, and nutritional imbalances.
Ketonutrition: What is it? How does it work?
At Living By Design, we utilize diet and lifestyle interventions to achieve optimal metabolic health. In doing so, we often see people improve or even reverse their medical conditions while reducing or eliminating medications. To make matters even better, we work with your existing health plan and providers to keep out-of-pocket costs as low as possible. If that sounds like something you want to accomplish, watch the video for more information.
RESULTS THAT COUNT
Real Science, Real Food, Real Results
16lbs
Average weight loss in 8 weeks
10-100lbs
Weight loss at 1 year
70%
Type 2 diabetes remission rate
88%
People treated with insulin for type 2 diabetes can discontinue insulin with improved glycemic control
95%
Resolve food addiction, cravings, or binge eating
$2,618/yr
Average cost savings from medication reduction
$19,736/yr
Average cost savings from diabetes remission
WE HELP PEOPLE WHO…
Have tried everything…
Including diets, exercise, or even bariatric surgery, only to regain the weight. It’s time to address the root cause: metabolic health.
Have a serious amount of weight to lose…
Living by Design Ketonutrition is for people who have a little or a lot of weight to lose. The key is to get metabolically healthy, and the weight loss will follow.
Struggle with food cravings and binge eating…
Amazingly, 95% of food addiction resolves in 8-12 weeks on ketonutrition. Ketonutrition can dramatically reduce cravings, and we offer specialized support for deeper food addiction patterns.
Need guidance for GLP-1 therapy…
GLP-1’s are useful agents if done right. If not, many people have intolerable side effects, muscle loss, or find them ineffective.
Can’t afford other options…
We accept most insurance plans, including Medicare and Medicaid, with out-of-pocket costs starting as low as $30.
WEIGHT MANAGEMENT
The cause of obesity is hormonal. Insulin is the key hormone that controls body composition: as insulin goes up, so does your weight. The only way to burn fat is to lower your insulin level. Period. Though exercise is important, it accounts for < 5% of weight loss; you need an insulin lowering diet—that’s where we come in. Adjusting the diet to fit your specific genetics and health care needs is what we do. For the vast majority, mastering the dietary lifestyle is all that is necessary. For others, we also use GLP-1 agents, other weight loss medications, and weight loss surgery if necessary. Regained your weight after weight loss surgery? You still have a “Rolls Royce” metabolic engine inside—you just need to learn how to fuel it properly. We can show you how. Need help managing your GLP-1? Only 20-25% of folks stay on GLP-1’s at 1 year often failing due to side effects. We use the lowest dose possible that does the job, tailor your diet to prevent the muscle loss that often occurs with GLP-1 therapy, and help people taper off.
DIABETES
Over 90% of folks with diabetes have type 2 diabetes. The cause of type 2 diabetes is insulin resistance. Type 2 diabetes has a strong genetic component and is essentially carbohydrate intolerance. If you have this genetic predisposition, then burning carbs for fuel all the time becomes damaging to your cells. Since insulin is required to get these carbs into your cells, the cells become resistant to insulin. Consequently, your pancreas has to crank out more and more insulin to lower your blood sugar levels until it can’t keep up. Once that occurs, you have diabetes. We believe that giving more insulin in the form of shots is wrong headed and simply exacerbates this problem and incurs more side effects. Better is to reduce the insulin resistance that is causing the problem in the first place! We use the ketogenic diet to do just that and select medications if necessary. With this approach, 70% of people can reverse their diabetes and come off medication – including insulin.
CHRONIC DISEASE
The vast majority (89%) of us will die from chronic diseases like heart disease, cancer, dementia, diabetes, and obesity related complications, etc. Incredibly, this wide variety of conditions is due primarily to one thing: insulin resistance. Just by using a whole foods well formulated ketogenic diet we fix the root cause of many conditions including fatty liver disease, PCOS, high blood pressure, eczema, erectile dysfunction, arthritis, irritable bowel syndrome, inflammatory and autoimmune conditions among others. Learn how to make this lifestyle sustainable so you can enjoy a better “healthspan”!
THE LIVING BY DESIGN METABOLIC CLINIC PROCESS
STEP
1
Onboarding Assessment
Besides basic medical history, we also ask for a dietary history and assessment of food behaviors with the Yale Food Addiction Scale (YFAS).
STEP
2
Initial Consultation
The first appointment provides a comprehensive evaluation with a Certified Ketogenic Nutrition Specialist clinical provider and health coach. A certified ketogenic dietitian and food addiction specialist is also available.
STEP
3
Individualized Metabolic Assessment
A history and physical, along with body composition testing with an electrical impedance scale, insulin resistance, glycemic control (A1c), and baseline metabolic testing. DXA scan, Coronary CT, advanced lipid testing, and a host of other tests are available depending on your health care needs.
STEP
4
Initiation Of Wholistic Plan
We initiate our educational series with the Low Carb Boot Camp, which includes a manual, brief self-paced videos, additional resources, secure electronic communication, and health coaching.
STEP
5
Remote Monitoring
May include: CGM (continuous glucose monitor) and BioBeat 24-hr blood pressure monitoring to safely taper medication as indicated
STEP
6
Diagnostic Testing
Advanced individualized metabolic testing, including DXA body composition, NMR lipoprofile, Coronary Artery CT and CT angiography, Fatty liver disease assessment, GI-MAP, and tests for SIBO and leaky gut, markers for inflammation, autoimmunity, and more is available.
STEP
7
Close Follow Up
We use secure electronic communications to walk you stepwise through the Low-Carb Boot Camp educational series and follow up at least monthly with your provider. Health coaching, along with Q&A, is available via telehealth at any time.
Living By Design’s Frequently Asked Questions
How do I make an appointment?
Go to the Contact Page.
What is the Metabolic Clinic?
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 Metabolic Testing.
I’m not from Iowa; can I still participate?
Yes, anyone can take the Low Carb Boot Camp and benefit from this education while working with their personal physician. We also see out-of-state residents in the Metabolic Clinic.
What is the Low Carb Boot Camp (LCBC)?
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 1 year. Cost is $30 (HSA/FSA eligible).
Still Have A Question?
Check out our FAQ page to see what goes on at our clinic, more details of the above, and a further explanation of common questions.
By Dr. Stephen Riggs
KetoMD
The vast majority of Americans are sick and fat. Many live desperate lives of chronic illness and obesity. They are kept alive by a medical system that doesn’t want you dead, but has no incentive to make you well.
KetoMD is written for people who are sick and tired of being trapped in obesity, diabetes, heart disease, and a host of other chronic disorders. KetoMD explores the root causes of these conditions and provides specific steps that regular people can implement in their daily lives
Meet The Riggs
Dr. Riggs MD, FACP, FAAP, DABOM, CKNS, MHP received his MD in 1987 and is triple board-certified in internal medicine, pediatrics, and obesity medicine. He is also a certified ketogenic nutrition specialist and metabolic health practitioner.
Janice Riggs is a certified health coach and co-creator of the Living by Design Ketonutrition protocol. She knows her way around the kitchen and all the local resources to make ketonutrition sustainable. She and her daughter, Kirstin Newmaster, have compiled family favorites in the Keto Tried and True Cookbook.
Dr. Steve Riggs
MD, FACP, FAAP, DABOM, CKNS, MHP
Janice Riggs
Certified health coach, co-creator
Here’s What Others Are Saying
Hear from our patients who have completed the Low Carb Boot Camp as well as the professionals who sent them.
I have seen first hand how one man took a “testable hypothesis” and transformed it into a thriving part of our hospital system, building a community of health for people suffering with metabolic syndrome as well as addiction to our current food environment…I continue to be amazed by the changes people are making and the freedom that they are achieving for themselves. KetoMD is the blueprint for putting it together in a way that can be implemented to create unbelievable health outcomes for our communities. —Anthony Michael, LMHC, RPT-S Food Addiction Specialist
I was privileged to practice primary care medicine with Dr. Riggs for more than 25 years. I watched him undertake an intensive study of metabolic medicine, recognizing especially the master role of insulin in a multitude of pathologic conditions and the power of ketogenic nutrition to actually reverse and even resolve them. He introduced our clinic to these principles and many people are very glad that he did (especially me!). —Mitch Bernstrom, M.D., ABFM
One of the best choices I made in my professional practice as a nutrition and diabetes educator was to read, listen, and study many of the references introduced to me by Dr. Riggs. This led me to become a certified ketogenic nutrition specialist to be able to safely guide patients on this alternative route to health. I share the same satisfaction from finally seeing patients get physically well and prosper while reducing the financial burden of medication. KetoMD is a very comprehensive reference to understand the history, recommendations, controversies, and the science to support this lifestyle. I will refer to this resource often.—Mary Steffensmeier, MA, RD, LD, CDCES, CKNS, Coordinator, Nutrition and Diabetes Education
There is no question that America is failing in the battle against obesity. Many regimens and methods for weight loss have been tried over the years with disappointing results. Dr. Riggs calls us to a different paradigm and makes a compelling case for the many benefits of adopting a ketogenic lifestyle. —Jeff Sutton MD
I have referred countless patients to Dr Riggs for help with resistant obesity and out of control diabetes, and he has helped all of those who listened get off a large list of medications and find their confidence and joy in life again”. —Lydia Mustafic, MD. Family Physician
My whole outlook on life has changed. I love life! Now I walk more than a block. I can do housework easier. I can stand on my feet longer. My A1C was 7 when I began keto and is now 5.7—prediabetic! I am off all diabetic meds and am hoping to get off more meds. In all this I can say Keto saved my life. I really can’t say enough about the Keto lifestyle! I love it! —Noreen
I’m down 42 pounds so far, not sure how many inches because I didn’t measure when I started! No more blood pressure medication. Overall, I just feel great with lots of energy. —Brenda
I learned sooo much going to Bootcamp. I’m down 19 lbs and am now off Metformin and taking less of my rheumatoid arthritis medication. Those 2 are big deals for me! —Louise
Where to begin!!! I have struggled with PCOS and weight loss for 20 years. Since starting keto I’m down 30 pounds, fitting into sizes I haven’t worn since high school! A1c and cholesterol are down! I am eating amazing food!!!!! The Energy I have and the mental clarity is something I haven’t had in years! Thanks to keto bootcamp and the health coaches I’m living a healthy happy life I didn’t think was possible! —April
From starting this Keto lifestyle I’m down just over 120 pounds. I’ve been blessed to be experiencing better mental clarity, my energy levels are up, my resting heart rate has dropped by 30 bpm on average, and I am finally able to buy clothes in the “normal” size section. My waist size went from a 52” down to a 38”. Thank you Dr Steve and Janice for helping to give me my life back! —Keith
Wow- where to start. I started off hoping for some weight loss. I did lose over 30 pounds, but what I didn’t expect was all the “extra” benefits. Mental clarity, better focus, energy and my husband says I am overall a “better human”. He tells me I am “annoyingly happy and in a good mood all the time.” Feeling like I have taken control back of food instead of having food control me has really empowered me to keep eating like I love myself. —Billie Jo
Keto Bootcamp was a life changing experience for us. In the past, cravings were a powerful force in our lives. Through Keto Bootcamp, we were provided with the tools to make more mindful health choices which resulted in each of us losing over 30 lbs and developing excellent insulin sensitivity. The class provides the science behind the benefits of adopting this lifestyle and the coaches are there to answer all questions and to offer support as you navigate these changes. We highly recommend this Bootcamp. Also, for over 20 years I was on prescription medicine for my Acid Reflux. After Keto bootcamp, and loosing 30 lbs, I am medicine and Acid Reflux free!
—Bill and Karen