Keto diets and the health risks: Just... - Healthy Eating

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Keto diets and the health risks

andyswarbs profile image
andyswarbs

Just uploaded to youtube is a complete analysis of the Ketogenic diet, despite its popularity understanding the weaknesses of the approach.

youtube.com/watch?v=bU2ByJ-...

(My apology for the original link which didn't work. Thank you Zest & JGBH for letting me know.)

24 Replies

Sorry can't access the link..

Zest profile image
ZestStar

Hi Andy,

You're welcome, I'll hope to watch that video sometime over the weekend.

Zest :-)

The video is technically correct in terms of the biochemistry, but the argument is all over the shop:

1) Use of strawmen to debunk an argument which nobody is actually making, eg., the speaker sets up some mythical ketogenic advocate who oversimplifies the role of insulin in metabolism and diabetes, or who says that the body has no use for glucose, and then proceeds to ridicule him. I suppose there might be such people, but he never refers to any specific author. Most of the LCHF-related books that I've read do actually explain what the guy in the video explains.

2) He states that excess insulin is known to increase the risk of atherosclerosis, but then asserts that "flatlining" your insulin profile doesn't help. Well,which is it?

3) Ketogenic diets (ie., diets high in fat) unequivocally reverse insulin resistance. The speaker actually acknowledges this at the beginning. He then goes on the state that dietary fat causes insulin resistance. Um, like, whut?

4) The video appears (initially) addressed primarily at diabetics, but the speaker then goes on a long rant about people with normal insulin function (and normal insulin response).

5) If dietary fat really did present an "increased risk for many chronic diseases", it would be abundantly obvious by now. People have been doing LCHF and its variants since the 1970s; the first crowd of Atkins advocates are now pensioners. If there were an epidemic of these people dropping dead from "lifestyle diseases", you can be 100% certain TPTB would have seized on those numbers and shouted about them from the rooftops. But it just hasn't happened.

6) There are several well-studied populations (primarily the Inuit and the Masai) who eat the most extreme keto diets (high in fat) that you can imagine. There are many populations that COULD NOT eat "low fat plant-based diets" even if they wanted to - their ecosystems don't provide it. These people simply do not get the diseases this guy says that they should. So there's something a bit wrong with his "this is what the theory says". His theory doesn't agree with experiment, so it's wrong; no ifs or buts.

7) What he refers to as "insulin resistance" (in the context of a keto-adapted person eating a high-carb meal) is actually insulin hypersensitivity. Whatever: his point here is completely irrelevant because people who do keto simply lose interest in starchy foods after a while; they rarely if ever eat "a standard American diet". If they did, obviously, they would drop out of ketosis.

8) The list of "side effects" of ketosis is just made-up rubbish. It doesn't happen. "Muscle weakness" especially gets my goat - there are plenty of endurance athletes who swear by low-carb, including myself.

Certainly when you're changing from a lifetime of excessive carbs your body gets a bit confused; during that time, and that time only, most people report (say) constipation, cramps, and light-headedness. However if those things persisted nobody would ever stick with it. Things typically stabilize after a week and a majority then report improved mood, cognition, and physical performance.

Bottom line is that the guy is basically saying to diabetics: which would you rather have, a (purely hypothetical) increased risk of heart disease, or an absolutely guaranteed physical falling-to-pieces, most likely ending in blindness, amputations, obesity, and, erm, heart disease? I know which one I'd go for.

Thank you for the considered and comprehensive response. It'll have to take me a bit to digest your thoughts.

For now my research indicates you should not rely on Inuit and Masai as good examples for you to argue from.

Masia:

The original oft-cited research did not actually know what the Masai diet was, instead they deduced it from protein analysis. It is known that the Masai had access to corn as a staple.

Mann GV, Shaffer RD, Anderson RS, Sandstead HH. Cardiovascular Disease in the Masai. Journal of atherosclerosis research 1964;4:289-312. documents athersceroris in the Masia population that should cause some concern. Further this report reports over 80% of the men over age 40 had severe fibrosis in their aorta.

Inuit:

Bang HO, Dyerberg J, Hjoorne N. The composition of food consumed by Greenland Eskimos. Acta Med Scand 1976;200:69-73. reports the Inuit consumed 37% carbohydrate. Whilst a study in 1962 concluded they had up to 53% carbohydrate.

In 2003 a study (Mazess RB, Mather W. Bone mineral content of North Alaskan Eskimos. The American journal of clinical nutrition 1974;27:916-25.) into the Inuit concluded "Aging bone loss, which occurs in many populations, has an earlier onset and greater intensity in the Eskimos. Nutrition factors of high protein, high nitrogen, high phosphorus, and low calcium intakes may be implicated.”

Your point "5) If dietary fat really did present an "increased risk for many chronic diseases", it would be abundantly obvious by now."

I think that is exactly true. We have an obese society with an increasing propensity to chronic conditions. As is stated at the very beginning of the What the Heath film "worldwide we're looking at approximately 315 million people with diabetes. There is no question we're in the middle of a diabetes epidemic."

And where is that epidemic? It is in societies that eat a high-fat diet. The converse is not true. Societies that have a high-carb low-fat diet do not have diabetes. As for genes, when these same HCLF societies have moved towards the SAD diet they have the same medical issues as anyone else.

Two examples - the famed okinawa tribe who used to have the longest lifespans now adopting a SAD diet have now become an increasingly obese society. Secondly during the second world war Norway had all its animals confiscated by Hitler to support the german war effort. The drop in cancer during that period is extraordinary. duo.uio.no/handle/10852/10724

suramo profile image
suramoStar in reply to andyswarbs

andyswarbs

"And where is that epidemic? It is in societies that eat a high-fat diet. The converse is not true. Societies that have a high-carb low-fat diet do not have diabetes." I need to understand . Grains and carbs are used for last 10-15 million years. What about humans before that? What's their life span? Did they have high incidence of Diabetes? Sad diet has failed to help diabetics and those having metabolic syndrome.

andyswarbs profile image
andyswarbs in reply to suramo

The movement of the same families through time or place from previous high-carb diet to modern sad diets shows as soon as they adopt the modern high fat diet they become fat. This is what propelled Dr McDougall into this business with his experience of looking after, I think Philippine workers of several generations. He saw children grow up into adults and adults grow into old people. The older generation were slim, fit and healthy, but the diet changed their children, and then their grandchildren increasingly became obese along with other illnesses under discussion.

If I remember right in Ghana they did autopsies found almost no incidence of chronic illness. They were so surprised by the results they increased the scope of the project and there simply was no incidence, like less than 1%. I am trying to remember the plant doctor who relates this story. When I remember I will clarify the details.

Going back further in time as you will know plants decay very quickly, normally within a year if not weeks. Whereas bones stay around for 1000s of years, if not 10,000s of years. This has led to a common assumption that paleo man primarily ate meat, until recently when they have analysed dental records and shown they at least ate seeds and nuts aplenty. There is now increasing evidence that plants played at least as large a part of the diet as meat. Plants are for example very easy to catch, since they do not move! Lots of interesting info coming out on this...

As to lifespan it was only when clean water came that lifespans went seriously up and up, which I guess is Victoriana.

suramo profile image
suramoStar in reply to andyswarbs

andyswarbs

Sad diet high in carbs has failed to control / reverse Diabetes. "The movement of the same families through time or place from previous high-carb diet to modern sad diets shows as soon as they adopt the modern high fat diet they become fat". I have a different view. It's because they take more refined flour rather than eating coarse grains. Bakeries have the worst food. Refined flour with trans fats. Also, ready made commercially available food care more for taste than nutrition. Good fats never increase body fat. Excess carbs. ultimately gets converted into fat because of high insulin levels. Fat gets deposited into the abdomen and this abdominal fat can cause ir.

Also more cosy lifestyles of the migrants contribute to obesity.

andyswarbs profile image
andyswarbs in reply to suramo

cosy lifestyles - totally agree We live in a totally lethargic world. However there is some great research showing that obesity is not linked to lack of exercise as much as it is diet.

Lol at muscle weakness.

Presumably all the Crossfit athletes on keto are unaware of this.

I am never sure why keto brings out the haters so much

andyswarbs profile image
andyswarbs in reply to Rignold

I don't think he are saying everyone on keto has muscle weakness, rather that there is a higher risk. That said I would like to research the reasons why he makes these associations. A quick google comes up with livestrong.com/article/4397...

Following through I have come across observer.com/2017/08/how-to... which recommends postponing exercise until weak symptoms reduce before exercising.

Also this bodybuilding forum has posts on the subject forum.bodybuilding.com/show...

When people throw in things like "muscle weakness" it just destroys their argument, because you start thinking: well, what else is he lying about? What bothers me here is that the guy has clearly never actually DONE a low-carb diet to find out for himself. He's just repeating what other people say.

The reality is that the symptoms he mentions are actually symptoms of a low-fat, low-carb, low-salt diet. People attempt to "improve" low-carb by reducing fat and reducing salt: I recall one "low carb" experiment where they gave the subjects nothing but boiled turkey for a week (that one should have never got past the ethics committee - luckily the subjects all walked away before they became ill). By doing this, you're depriving your body of a critical energy source and a mineral that it needs more of on LCHF. This will make you feel awful.

I can actually understand his attitude: when I bought an Atkins book (many years ago, 50p, charity shop) i was facing a 14-hour flight and thought "ah, this should be good for a laugh". I was 100% sceptical (in the popular sense, not the scientific sense). However, I knew enough biochemistry and physics to realise that Atkins's argument for LCHF was basically correct and his argument against calorie balance was spot-on. I then tried it and proved to myself that he WAS correct - or at least more correct than the people advocating low-fat diets, which I'd tried and failed at for many years. If this guy thinks he a scientist, he should act like one: do the experiment. The ridiculous part is that he thinks it's necessary to destroy LCHF in order to advocate his "low-fat plant-based" diet. There's nothing wrong with his diet. I wouldn't like it, but plenty of people prefer it and do just fine on it. Humans are, up to a point, pretty adaptable.

Incidentally, modern LCHF diets contain relatively more carbs, less protein, and more fat - because people quickly discovered it's not even necessary to remain in ketosis to get the health benefits ("ketosis" is typically defined as a state where your body is running close to 100% on fat). This is probably the strongest dismissal of his entire argument.

The video is actually very confusing because it's hard to tell who he's addressing: LCHF dieters, or diabetics. They will not be eating the same things. As mentioned, dieters are not in ketosis for more than a couple of weeks. Nor are most Type 2 diabetics, because they regain (some) insulin function after a while. Only those who have severely compromised insulin control will be on VLCHF, which is a smallish minority of the (diabetic) population.

Atherosclerosis: this is not, in itself, a disease state. This was discovered only recently. EVERYONE has atherosclerosis, even children and athletes. It seems to be some sort of natural adaptation process to alleviate mechanical stress. There are two pieces of evidence for this. Firstly, the plaques form within the artery wall, not upon it (that is, it's not mechanical "furring up" with deposits). Secondly, it doesn't happen in veins, where pressure is lower, but if you transplant a vein into an artery location it quickly develops plaques. Atherosclerosis often progresses, eventually, to stenosis, but if this happens at the end of one's life, well, you've got to die of SOMETHING. The precise connection between atherosclerosis and degenerative cardiovascular diseases is still somewhat murky.

>> did not actually know what the Masai diet was

This seems disingenuous. Unlike Ancel Keys, who jetted in and out without knowing anything about the cultures he visited, Mann stayed for some time with the Masai. It was an unforgivable oversight not to document their diet carefully, but he undoubtedly knew what they ate. Documenting diets is actually very difficult because people all have their own preferences; for example, returning to the "Chinese diet", there's an enormous range of diets in China. The majority diet is more-or-less LCHF, but some Northern populations eat VLCHF at certain times of the year, and some eat high-carb, with lots of rice, noodles, and sweet tea. To study the Chinese properly, you'd have to examine those sub-populations separately.

Also worth pointing out here the difference between mortality and morbidity. The Masai were (still are, as far as I know) incredibly fit and healthy. In contrast, the recommended high-carb diet results in accelerated ageing and almost inevitable obesity (for 'normal' people), and all kinds of horrible diseases for diabetics - the latter is not even in dispute. The video acknowledges that quality-of-life for diabetics is hugely improved on LCHF, so even if his argument is true (VLCHF dieters are at risk of certain acute diseases) the likely response from most people, diabetics or otherwise, is surely going to be "so what?".

When you argue he is "just repeating what other people say", I think that is a bit disingenuous.

He is Cyrus Khambatta and has a in PhD Nutritional Biochemistry from Berkeley, which rather smacks to my mind of someone who has done serious study in this subject area. According to his about page masteringdiabetes.org/about/ he has Type 1 Diabetes and so has a very personal interest in insulin.

I understand that people lose weight and feel healthy on a keto diet. Many people lose weight (though initially that may be simply loss of water) and definitely they thrive. To my mind, that is not the argument he is making. The argument he is making is these short term gains are offset with a range of long term health challenges.

To respond to your Masai thoughts on the suggestion that Mann obviously knew what they ate. His conclusions states he did not.

As for studying the Chinese, studying sub-cultures is exactly what the China Study did, nutritionstudies.org/the-ch...

You would think, then, he'd have some incentive to try it. There are really only two possibilities, given his statements:

1) He's never tried it (and doesn't want to) and therefore doesn't have any personal experience of the effects.

2) He has tried it, and is possibly still using it, but somebody is paying him to say something different.

Seriously, I don't have any argument with his proposed diet. If he finds it works for him and he enjoys it, fine. No doubt some other people will like it too. Plenty of populations eat as he suggests (notably Indians - but their rate of cardiovascular disease is about the same as The West). But you can't start a presentation by pointing out that LCHF offers a near-miraculous recovery to diabetics and then attempt to trash LCHF.

I note from his website that he's a mechanical engineer, so he should know a lot about control systems and dynamics. He should appreciate that if you observe a system in which the actuator is continually hitting its limit stops (in this case the 'actuator' is insulin) while the variable under control (glucose) is exceeding its target value by a large overshoot, that system is being pushed beyond its limits. He should be further aware that an adaptive control system attempting to recalibrate to that kind of input will eventually tune itself into an incorrect or unstable state. That, in my opinion, is what happens in type 2 diabetes; the control system is fine, but the loop parameters have been messed up. This would also explain why type 2 is more-or-less curable: the adaptive processes eventually push the loop back into a stable operating range when the problematic process input is removed.

Anyway, his assertions that fat causes heart disease just don't hold water, and he quite literally contradicts himself in alternate sentences. Nobody has found any evidence to support the theory he's expounding, and that's not for want of trying: there have been enormous well-funded studies attempting to prove the point, all with a null result.

The guardian has an interesting for/against article on fat causing heart disease. theguardian.com/society/201... that presents the debate.

Nutrition facts has a whole video reporting the studies designed from the outset to show fats do not cause heart attacks. nutritionfacts.org/video/th...

If I can add about atkins diet, which I have never tested. However I have a friend who loves his meat and so when he became overweight he went on atkins and became a relatively sprightly person. That was some years ago. He still eats meat and he is now heavier, chubbier etc than he was before he started atkins. Just another anecdote, of course.

So yes, you can lose weight on atkins, of that there is no doubt. But it is long term health that, surely, we are all after.

I have cycled keto several times in the last few years and, other than the initial low carb fog, have suffered no ill effects, and to be honest that was only really a significant thing the first time I did it, mainly because I did not know what to expect.

TheAwfulToad profile image
TheAwfulToad in reply to Rignold

My workout tends to focus on power rather than endurance - something that "experts" say is impossible on low-carb. I do supersets with weights (no breaks at all) for about 50 minutes, very heavy, 6-8 reps per set, plus a 3.2km run on the treadmill (just under 16 mins at the moment). If anything, I find this workout easier to handle than when I was doing high-carb workouts 20 years ago.

Do you follow Peter Attia at all? He's a cyclist and did some interesting experiments (on himself) relating to cycling endurance and peak power on low-carb.

I say nothing is impossible. I am a person who has clearly recovered - against standard medical opinion - from rheumatoid arthritis using diet. However I am an anecdote, just one person.

What is important is the research showing the risks/benefits, and whether those risks a) apply to you as an individual and b) they outweigh the benefits. If so then a change in thinking seems logical.

Penel profile image
PenelModerator

The list of possible serious side effects has been taken from studies on children following a ketogenic diet. They all had serious epilepsy which did not respond well to medication, most of them also had other underlying medical problems. The side effects required managing by their medical teams. These effects are not a given.

The effects of fat on insulin have also been overstated in the video. Only certain fats have been associated with inflammation and insulin resistance, whereas others have been shown to reduce inflammation.

Although human biochemistry is very complicated and our knowledge alters over time, the therapeutic effects of ketogenic diets have been well documented. This paper from the European Journal of Clinical Nutrition summarises the positive effects of the diet on obesity, type 2 diabetes and cardiac health. It also looks at the possible health benefits in other areas.

nature.com/articles/ejcn201...

andyswarbs profile image
andyswarbs in reply to Penel

Penel, many thanks for bringing us to some research on Keto diets.

Sadly this research was at least in part funded by the keto industry to prove keto worked. This is the problem with so much research. If you look at the article you will see "no conflicts of interest" cited. However if you take a look at sci-fit.net/2018/investigat... you will find they declare author Paoli has a conflict of interest and thus the research must - in my opinion - be deemed suspect.

Penel profile image
PenelModerator in reply to andyswarbs

Indeed we always need to look critically at research, as best we can.

The ketogenic diet has been used therapeutically since the 1920s. I doubt there was anything known as the “Keto industry” at that time.

Paoli has brought together research papers from different scientists, working in different fields. He acknowledges the opposing views in certain areas and the difficulty of understanding all the mechanisms underlying the science.

Paoli may have collaborated with someone who has produced commercial advice on the subject, but this review is a collection of other people’s work. There seems to be no conflict of interest to me. He is not advocating a ketogenic “life-style”, but rather the use of diet, instead of medication, as a method of controlling certain health problems.

The use of the phrase “part funded by the Keto industry to prove Keto worked” seems to suggest that you believe we are being deliberately mislead.

suramo profile image
suramoStar

andyswarbs

Just 2 issues he spoke need consideration.

1) We, as type 2 diabetics, have higher levels of insulin. Carbs have highest influence on insulin secretion and fats have negligible. So the purpose of keto / lchf diet is to bring down insulin levels. We don't get depleted of insulin. We should not forget gng. Also, the body produces enough glucose by gng to supply to the brain. There are certain areas which need only glucose. Rest of the brain can use ketones as well.

2) On one hand he says keto diet's usefulness can only be known after studying 10-100 thousand people for at least 5 years. On the other hand he enumerates all the adverse effects like cvd, cancer, illness, etc.. As if someone has done such prolonged study on thousands of people and found out the complications of keto diet.

Lchf / keto diet philosophy can be explained scientifically. People losing weight and abdominal fat is the proof that insulin is a cause for lipogenesis and obesity.

It has been 2.5 months since 30 days of Keto and I'm still recovering..

I developed heart palpitations to the point of having to wear a halter monitor. My triglicerides quadrupled and HDL to LDL ratio worsened. My insulin resistance worsened. So I agree with all the points in the video with 1 exception.

I'm not sure if ALL dietary fat and ALL LOW CARB is created equal. For some people with pancreatic insufficiency the higher fat diet which is primarily derived from plants is not such a bad idea... For me personally I find that eating 120 grams of carbs and around 100 grams of fat is ok. If I try to increase the carbs I can't seem to handle them... Maybe over time I'll be able to heal my pancreas and raise the macros to match Mediterranean diet, which is 40% carb: 40% fat: 20% protein. That diet is the most respectable and seems to work for the majority of white people (Africans and Asians might need something else).

Also low carb diet washes out salt from the body which is what probability caused serious side effects for my heart muscle. I find that I have to eat 2 grams a day otherwise I develop muscle spasms and arrhythmia. But overall I feel perfectly fine on 120 grams of carbs a day and I'm able to eat all RDA required nutrients. I also work out.

Bottom Line:

For those who are trying to avoid insulin injections a plant based diet lowER in carbohydrates may actually be the solution.

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