Keto Diet Insights
Overview of the Ketogenic (Keto) Diet and Its Adherents
Many in the keto community are very passionate and driven by a belief that they have been deceived by those that had defined official dietary guidelines over the years.
- Supporters of low-carb diets contend that rising obesity rates "show conventional wisdom about nutrition, reflected in the guidelines, doesn't work for everyone."
- "'The main point is to get away from a one-size-fits-all diet,' said Nina Teicholz, who has written about low-carb diets."
- According to Teicholz, "In nearly every way possible, Americans have followed official dietary advice during the last few decades. In the same time period we’ve had massive epidemics of obesity and type 2 diabetes."
- "A ketogenic diet is high in fat and low in carbohydrates. It’s called 'ketogenic' because people on this diet shift from using glucose (a type of sugar) as their main fuel source to ketone bodies, which are derived from fat. In other words, people on the ketogenic diet can use their bodies’ fat stores as fuel—and this is why many studies show that this diet is superior for sustainable weight loss."
- "In reality, it's refined carbohydrates that are increasing heart-related illnesses and deaths, with sugar finally being outed as more of a poison than fat ever was, despite the food industry's demonization of it back in the 1970s. Sure, there's such a thing as too much of anything, healthy or otherwise, but given that most keto followers are eating a varied and nutritionally sound diet, as mentioned above, this is a nonissue."
Overview of Benefits
Bullet points are taken from "Ketogenic Diet Myths vs. Facts" by Nina Teicholz. Links are provided to research and studies supporting all claims.
- Studies have demonstrated that the keto diet may in fact be ideal for long term weight management. One meta-analysis found that individuals following very low-carbohydrate ketogenic diets lost more weight in one year than those on low-fat diets.
- A survey published in the Journal of Insulin Resistance found that three of four respondents on a low-carb diet reported losing 10 pounds or more; one-third reported losing more than 30 pounds. Six out of 10 respondents who were on the diet two years or more reported losing 20 pounds or more and 46% said they lost 3 inches from their waists.
Prevention and Reversal of Type 2 Diabetes
- The ketogenic diet is actually the most promising diet for people with Type 2 diabetes. Some studies have shown that extreme caloric restriction can reverse diabetes, but continued starvation is largely unsustainable.
- The other nutritional remedy for T2 diabetes is carbohydrate restriction. In a large, ongoing university-based study, 60% of patients with Type 2 diabetes reversed their diagnosis of diabetes after just one year on a ketogenic diet, supplemented by support via a mobile phone app. On this protocol, 94% of participants reduced or eliminated their need for insulin medications while improving the vast majority of cardiovascular risk factors.
- No other diet has demonstrated such promising results for Type 2 diabetes.
- Moreover, upwards of 17 scientific studies support the idea that carbohydrate restriction works to manage blood sugar, or glycemia, in patients with diabetes. (Footnote 13 of this post gives links to those studies.)
- One meta-analysis incorporating data from 447 participants found that low-carbohydrate diets not only helped individuals lose weight, but also improved their cholesterol. And another meta-analysis, citing 17 clinical trials, found that low-carb diets protected against major cardiovascular risk factors. A third study including 119 participants found that low-carbohydrate dieters had lower cholesterol than low-fat dieters after one year.
- While it’s true that low-carb diets do raise the so-called bad LDL-cholesterol in some people, it’s important to note that LDL-C, when influenced by diet, has never been shown to have any effect on cardiovascular risk. Large clinical trials and observational studies show that one’s level of LDL-C and the lowering of LDL-C through diet is not reliably linked to cardiovascular outcomes.
- Moreover, the ketogenic diet also reliably raise the “good” HDL-cholesterol, while also improving most other cardiovascular markers, including blood pressure, as this study shows. Thus, the overall effect on cholesterol and other markers for heart disease is positive. In some lean hyper-responders, a keto diet will increase LDL particle number, and this effect needs further investigation.
- One study found carbs to be the “main culprit” in causing acne. And another study found that low-glycemic diets lessened acne.
- What’s more, a review conducted by Italian researchers suggested that the keto diet could target acne by reducing inflammation and levels of insulin and IGF-1 — all known causes of acne.
Improvement in Patients with Gastroesophageal Reflux Disease (GERD)
- [P]atients with [GERD] have been shown to improve after eating very low carbohydrate diets.
- Another study found increased carb-intake worsened GERD, while a high-fat, low-carbohydrate diet reduced symptoms. And two studies have linked esophageal diseases, including Barrett’s esophagus (BE) and GERD, to sugar and carbohydrate intake.
Treat Fatty Liver Disease
- The European Association for the Study of the Liver actually cites a low-carbohydrate diet as a way to treat the disease. Studies show that cutting carbohydrates and particularly fructose, or sugar from plants, works to improve liver fat metabolism.
- What’s more, high-carbohydrate diets have been associated with worsening non-alcoholic fatty liver disease. Find evidence here, here and here.
- A survey of 1,580 low-carb consumers published in late 2017 by the Journal of Insulin Resistance found that while more than 11% of respondents reported using sleep-aids before beginning their low-carb diet, less than 5% reported using them after their diet. Moreover, nearly seven in 10 reported improved quality of sleep after dieting while only 3.4% said their sleep quality had worsened.
Prevent Gall Stones
- Multiple studies have found that diets higher in fat prevent gallstone formation. Examples are here and here. Meanwhile, diets low in fat actually increase gallbladder volume and may increase the risk of gallstone development, as do diets high in sugar and carbohydrates.
The Keto Community is led by doctors, scientists and journalists that are passionate on upending what they see as decades of governmental nutrition policy gone awry, including the demonification of dietary fat. Leader and influencers within the keto community is active on social media, podcasts, writing books and articles, and attending conferences and conventions.
- There are dozens of official conferences throughout the world where people gather to learn about keto. One of the largest is KetoCon in Austin, Texas, that features dozens of speakers, including researchers, scientists and doctors.
Leaders and Influencers in the Keto Movement
- Robert Lustig — Professor emeritus of Pediatrics, Division of Endocrinology at the University of California, San Francisco. "Dr. Lustig has fostered a global discussion of metabolic health and nutrition, exposing some of the leading myths that underlie the current pandemic of diet-related disease. He believes the food business, by pushing processed food loaded with sugar, has hacked our bodies and minds to pursue pleasure instead of happiness; fostering today’s epidemics of addiction and depression. Yet by focusing on real food, we can beat the odds against sugar, processed food, obesity, and disease."
- Tim Noakes — Professor Noakes has published over 750 scientific books and articles. He has been cited more than 19 000 times in scientific literature, has an H-index of 71 and has been rated an A1 scientist. Published woks include Lore of Running; Rugby without Risk; Challenging Beliefs; Waterlogged: The Serious Problem of Overhydration in Endurance Sports; Real Meal Revolution; Raising Superheroes; and The Banting Pocket Guide and Lore of Nutrition.
- Nina Teicholz — investigative science journalist; adjunct professor at New York University; Executive Director, The Nutrition Coalition; author of New York Times bestseller, The Big Fat Surprise.
- Gary Fettke — Dr. Fettke is a practicing Orthopedic Surgeon in Australia, with a longstanding interest in preventative aspects of health. He hosts The Obesity Code Podcast: Lessons and Stories from the Intensive Dietary Management Program.
- Jason Fung — Dr. Fung is a Canadian nephrologist. "He’s a world-leading expert on intermittent fasting and low carb, especially for treating people with type 2 diabetes. He has written three best-selling health books and he co-founded the Intensive Dietary Management program. Dr. Fung has his own websites at idm.health and thefastingmethod.com."
- Joe Rogan - Joe Rogan is a popular comedian that has used his popular podcast, The Joe Rogan Experience, to help educate his audience on the keto lifestyle by interviewing numerous luminaries on the subject.
- Vinny Guadagnino of Jersey Shore fame has been a huge advocate for the keto lifestyle, with a popular Instagram account and keto cookbook.
The ketogenic community has various levels of adherents with various levels of understanding. We drilled down to find the most knowledgeable circles that could provide an understanding that was supported by scientific principles.
Multiple studies have found that diets higher in fat prevent gallstone formation. Examples are here47 and here.48 Meanwhile, diets low in fat actually increase gallbladder volume49 and may increase the risk of gallstone development, as do diets high in sugar and carbohydrates.50