Ketogenic Diet (Keto) - Ineffective and Dangerous

[Midnight Strangler]

Calorie restriction works, and I think it can be done in a more healthy and fun way than a keto diet. Looking at some of the studies of "successful" keto diets, you see things like this:

outpatient protocol providing intensive nutrition and behavioral counseling, digital coaching and education platform, and physician-guided medication management

Not severe. Supportive. I did it myself, being horribly sick and dying was severe. This is a breeze!

I was speaking of the severe economic impact this would have if every overweight person got it. The resources aren't available. Of course you would expect insurance/Medicare/Medicaid to pay for it which means we would have to pay for it through higher premiums. Calorie restriction is easy if people just do it.

I've experienced very good results from lowering carbohydrates and increasing good fats. I'm maintaining weight loss (going on for 3 years now), have lots of energy, and am very rarely tempted to snack between meals because I don't get hungry. If I do feel like a snack I eat some macadamia nuts or a few olives, sometimes half an avocado, and find that satisfies me for way longer than say a rice cake or banana did in the past.

You can't separate your "good results" from calorie restriction. By itself, not snacking between meals can save a large amount of calories.

[cpapbro]

An opinion piece by an uninformed doctor who hasn't bothered to even read all the studies he cites.

[Janknitz]

You can't separate your "good results" from calorie restriction. By itself, not snacking between meals can save a large amount of calories.

This is one of my favorite canards. So what if there turns out to be de facto caloric restriction with a ketogenic diet? First, think about why calories might be reduced on a ketogenic diet if one is not actively counting calories. The answer is that there is satiety--one is not so hungry and craving as would be on a low fat, high carb, calorie restricted diet. On a keto diet, it's not necessary to eat 4-6 times a day to avoid the "hangries"--blood sugar and insulin levels are stabilized. If that causes one to consume fewer calories, I'd sure rather do it with fat than without.

Calories may or may not be lower on a keto diet, whether they are or not doesn't really matter to me. It's the metabolic effects that really make the difference. Metabolically, there is ample evidence that insulin resistance is reduced with a ketogenic diet, and that metabolic rate doesn't decrease as sharply as in a low fat, calorie restricted diet--that means weight loss is much easier to maintain.

So yes, you can dismiss it as "it all comes down to calorie restriction" in the end. Yet how many people succeed in maintaining that caloric restriction in the long term when it comes down to counting calories, restricting fat, eating low calorie carbs? The statistics are pretty clear that very few people maintain caloric restriction in the truly long term. Even when people have weight loss surgery, they manage to eventually overcome the mechanical restrictions to caloric intake, and gain the weight back in most cases. I'll put my 7 years of maintaining more than a 10% body mass weight loss against any low calorie dieter.

[CowFish]

I'll put my 7 years of maintaining more than a 10% body mass weight loss against any low calorie dieter.

You would lose. I lost about 20% on a low-calorie diet. It will soon be 7 years. CPAP has probably helped.

10% is not much to lose. I thought you were talking about a large amount.

[Julie]

Uh... it depends on 10% of what!

[Janknitz]

I used the generic "more than 10% of body weight". I lost 75 lbs and I guarantee you I did not weight 750 lbs. to start with. I lost a huge percentage of body weight. How much I did weigh and weigh now, is my business.

[jnk...]

My comments for the quoted doc . . .

blurred lines between faddist snake oil and sanctified medical therapy

Sadly, there is often no 'line' at all. Some 'sanctified medical therapies' are the worst form of snake oil: the widely-available and often-prescribed form that kills. High-carb recommendations are pure snake oil. And you are the one trying to sell it.

unnaturally high amount of fat consumed to maintain ketosis

That is very poor word choice for a doc, since it reflects a deep lack of understanding. High amounts of fat are not eaten to maintain ketosis. Fat is highly concentrated, so you get a lot of calories from a small amount. It is the lack of carbs that maintains ketosis, not high-fat. In fact, fasting can maintain ketosis just fine, Doc.

not eating . . . vegetables

Myth. Many vegetables are nutritionally dense without being high-carb. Docs that want to be taken seriously shouldn't build straw men like that when presenting their harebrained arguments.

no long-term data on the safety of the keto diet

Not a bright thing to say. There is no long-term data on the safety of any diet of any sort, ESPECIALLY high-carb. If you cannot produce long-term data on the safety and benefit of high-carb, why are you saying something that misleading, Doc? It implies a dangerous lie: that the way most people eat now, at the advice of their doctors, is working out really well for them.

diabetes and obesity are not a product of ketone deficiency

Another straw man. Are you sure you are a real doc? You sure don't sound like it. You are certainly no respected researcher with that kind of nonsense being put into print with your name attached.

Diabetes and obesity are . . . the symptom of caloric excess, dietary indiscretion, and torpor.

So, where are your studies to prove that assumption, Doc? Bueller? Bueller? Bueller? Exactly! You can't argue against a diet approach by saying it has no science behind it and then turn around and say something with even less science behind it. Well, actually you can do that, because you just did. That's what your entire article was. But you can't be taken seriously by anyone while doing it. Oh, wait, I guess someone did take you seriously. One born every minute. Docs, that is.

Shivam Joshi is a nephrology fellow.

And a snake oil salesman. The worst kind. The kind that is complicit in the thousands of deaths caused by the unfounded, nonscientific belief that continuing to "prescribe" high-carb diets is somehow good for the diabetic obese. Should be a basis for a malpractice lawsuit. Fake medicine kills. Show me the science or shut up about high-carb, if that is your measuring stick for those suggesting low-carb. Either prove how wonderful the high-carb diet is working out, or don't pretend to have something useful to say about low-carb.

In my opinion. Which I hereby entitle, " High-Carb Diet (Anti-Keto) - Ineffective and Dangerous."

[ChicagoGranny]

continuing to "prescribe" high-carb diets

Are you saying many doctors or nutritionists do that? (Sorry, I wouldn't know because no one in my family is obese or diabetic.)

[jnk...]

continuing to "prescribe" high-carb diets

Are you saying many doctors or nutritionists do that? (Sorry, I wouldn't know because no one in my family is obese or diabetic.)

Nearly all. Yes. Usually in the form of a lethal pyramid and a picture of a plate loaded with poison and termed "dietary guidelines."

https://choosemyplate-prod.azureedge.ne ... MyWins.pdf

[ChicagoGranny]

a lethal pyramid

Seems appropriate. All of the pyramids I visited in Egypt are tombs.

[jnk...]

"The Dietary Guidelines for Americans recommends that carbohydrates make up 45 to 65 percent of your total daily calorie intake. So if you consume 2,000 calories a day, you would need to eat between 900 and 1,300 calories a day from carbohydrates." -- https://www.mayoclinic.org/healthy-life ... t-20045831

[ChicagoGranny]

https://choosemyplate-prod.azureedge.ne ... MyWins.pdf

Hmmm? After looking at that, it's pretty much the way we eat. No snacks, very limited desserts and portion control at all meals. Advanced age and no health problems besides OSA.

I think some dieters "treat" themselves two to four times per week, and the calories really add up.

[jnk...]

Some nondiabetic and nonoverweight people may do fine following the usual recommendations. But for those whose bodies do not react well to carbs, the recommendations can be lethal. And many docs do not differentiate with their one-plate-fits-all, imaginary-bell-curve approach to things. Problem is that nonoverweight now make up less than a third of the American population, so pretending otherwise with recommendations is now less than responsible.

[ChicagoGranny]

Well, in my lifetime, the population's physical activity level has decreased dramatically. Likewise, the calorie intake increased dramatically.

[jnk...]

Well, in my lifetime, the population's physical activity level has decreased dramatically. Likewise, the calorie intake increased dramatically.

Yes. Those are two of perhaps many thousands of possible statistical associations that are absolutely devoid of meaning without some form of linked causation. Is life more stressful and the environment more polluted now too? Probably. But I personally know many very skinny people who consistently overeat and are inactive couch potatoes. What does that prove? Nothing much. Just as is so with other, opposite, anecdotal assumptions. In fact, it's that exact sort of cultural assumption and so-called "common sense" thinking that blinds doctors and the public to the need for real studies and proven treatments. The assumption that every human reacts to amounts of foods and amounts of activity levels the exact same way, and that the reactions are historically consistent, is about as unscientific a guess as could possibly be made.

When a doc says "eat less and move more," he says it to make himself feel better, since there is no proof those words solve anyone's truly medical conditions. The Biggest Loser show publicly debunked that approach about as effectively as anything could. Their metabolisms were damaged with that approach and they were still unable to follow common dietary guidelines at normal activity levels without weight increase.

If it was anywhere near that simple of an issue, every overweight doctor would immediately lose his license to practice.

I get it that some researchers and practitioners will always become blinded by cultural "common sense" assumptions--scientists are people too. So I can excuse that to some extent. What I can't excuse is when those with some scientific authority choose to adopt, reinforce, and perpetuate those cultural "common sense" assumptions and proclaim them valid, established facts when there is no science to back them up. "Hey, everyone knows this to be true" are the seven most misleading words in the English language. When scientists adopt that mind-set, it does great disservice to the people who are trying to use actual logic to help fellow beings on the planet solve real medical issues.