The aetiology of nutribollocks: Part 1

[TheAwfulToad]

It's time for another rant, I think.

Misinformation about diet is still as abundant as it ever was, and I thought it would be fun to talk about some of the underlying causes. One big reason is the political influence of dietitians on the medical establishment. Members of latter, having detailed knowledge of physiology, really ought to be able to hand out proper advice about diet. The former, having no knowledge of anything much, cannot and should not. But they do, and they use respected media channels to do it. A case in point is Medical News Today; these guys rarely miss a chance to support the USDA plate and/or take a dig at low-carb. I was intending to write about their latest advice on diabetes, but then I came across this:

medicalnewstoday.com/articl...

Now, although there is such a thing as 'starvation ketoacidosis', it happens almost exclusively in people with comorbidities. A healthy but starving body does not experience ketoacidosis: it's physiologically impossible. Your blood pH is buffered (primarily by means of the bicarbonate buffer system), and the production of ketones and fatty acids is under closed-loop control, in much the same way as glucose (ie., via insulin signalling). This is the basic reason why Type 1 diabetics must inject a certain amount of insulin and cannot control their condition via diet alone.

True ketoacidosis is an uncontrolled cascade of ketone production (beyond what is actually required for energy), which overwhelms bicarbonate buffering. It is a life-threatening scenario and occurs if (and only if) insulin drops to an abnormally low level - or more precisely, when the pancreas fails to properly respond to circulating levels of glucose and ketones. It therefore happens almost exclusively to Type 1 diabetics, and in fact if you scroll down, other related articles correctly explain the phenomenon.

The "trusted" Pubmed source quoted points out that 'starvation ketoacidosis' (SKA) is a qualitatively different scenario to diabetic and alcoholic ketoacidosis:

"The pH may not be as low as in DKA or AKA, and the glucose levels may be relatively normal."

but I'm guessing the nutritionist who "medically reviewed" the article doesn't have adequate medical training to comprehend the difference. In fact AKA is very similar to SKA and doesn't normally involve genuine ketoacidosis; in the rare cases where death results it's usually caused by a combination of factors (chronic and acute) resulting from prolonged, relentless alcohol consumption; people in this state quite often present with a medication overdose too. Those few cases of life-threatening SKA happen for similar reasons: poor health due to prolonged malnutrition as a result of an eating disorder, not (as the article implies) a one-off "lack of glucose". Even at the point of death from starvation - which usually occurs as a result of illness, heart failure, or just running out of fuel - ketoacidosis is unlikely.

None of that prevents Medical News Today from getting in a snide remark about low-carb diets:

"However, intermittent fasting, particularly in combination with an extreme diet such as the ketogenic diet, can put a person at higher risk of developing ketoacidosis. People interested in following specialized diets, such as the keto diet, should talk with their doctor before starting the diet."

Yeah, but no. Personally I'm not a fan of either the 'ketogenic diet' or IF, but there is no evidence that either of them might be harmful in and of themselves, nor is there any theoretical basis for thinking that they might be. Your risk of ketoacidosis on keto/IF is in the ballpark of zero. All that happens in these cases is that your body adapts to the diet, and continues to maintain its optimum target range for blood pH.

I'll do the diabetes article another day.

[Hidden]

I'd say what they call an extreme diet (such as keto) is FAR more normal than the average diet nowadays. The modern diet is full of rubbish, sprays, sugar and lord knows what else. The low carb/keto way of eating I do is simply natural foods, almost nothing in a packet, and a carb level that I would have said is historically more normal for humans.

And I feel great on it.

I'm 71, but weight, size, waist all now same as when I was 30. And no diabetes and no drugs.

[TheAwfulToad Ambassador in reply to Hidden]

Indeed. I don't know how the NHS plate gets so widely accepted as "eating normally", and a lot of the junk that people genuinely think is healthy (because it's zero-fat) is ... just junk.

[freeway15 in reply to TheAwfulToad]

Is there somewhere I can watch a video or similar on the Lchf diet as to what you can actually eat. I tried the keto diet for several months and bought all the books but I got so fed up eating eggs for breakfast ! Everything in my keto books were eggs it seemed. Keto pancakes was whipped eggs with cheese.

I understand the science you sent me before and seems to make sense to me but as a parent cooking for teenage kids- they don’t want to eat keto. So I end up having to make different meals for everyone.

I have for the past two weeks been trying low calorie and walks 12,0000 - 150000 steps but the weight is not moving. Eg yesterday I weighted 68.8 did 10k steps. Had slim fast drink for breakfast. Sushi 270 cal for lunch and evening marinaded chicken in pita bread with Tom/cucumber and a natural yogurt / hummus dressing. Raspberries And a small glass of wine. Well within 1600-1800 calories. But this morning I weigh 69.1 ! How can that be. ?

I know I am highly stressed as my businesses are all in lockdown and am anxious about money - but I can’t see to lose weight no matter how hard I try. Generally speaking my diet is low carb. I do try to take on board the elements of keto like scrambled eggs with butter. I don’t eat a lot of bread or any cakes/biscuits or sweets.

I find it hard to get excited about food and last nights meal was the first one I really enjoyed in years. It was just so tasty. On keto I just got bored of steaks, bacon and eggs so I had to stop as I found it monotonous- I don’t have time for slow stews etc as I am constantly on the go !

[TheAwfulToad Ambassador in reply to freeway15]

I can recommend carbdodging.com or dietdoctor.com - the former for recipes, and the latter for theory (their visual guides really make it simple). There's also the two-page 'Real Food' guide from phcuk.org.

Reading between the lines, I suspect you're overthinking it all, and perhaps trying too hard.

- You should not be counting your calories. This might seem counter-intuitive, but it's critically important you just let your appetite make the decisions. As long as your body believes that it's starving, it will have no reason to discard bodyfat.

- You should be eating proper food. I just googled 'slimfast shakes' and found this ingredients list:

Fat Free Milk, Water, Sugar, Cocoa (Processed with Alkali), Canola Oil, Fructose, Maltodextrin, Milk Protein Concentrate, Cellulose Gel, Cellulose Gum, High Fructose Corn Syrup, Natural and Artificial Flavors..

So, basically, you had a McDonald's milkshake for breakfast with extra sugar ... however, I understand that eggs can get a bit much after a while! I can only suggest browsing around the internet for low-carb breakfast recipes; I can't really advise you what to eat instead of eggs because only you know what suits your personal tastes. Just bear in mind that there's no rule that you have to eat breakfast; personally, I only have coffee most days in the morning, followed by a small brunch, and then one (large) meal in the evening. That's just me; I wouldn't suggest you have to follow that pattern.

- There's no need to stay 'keto'. The aim of your keto phase is to stay religiously minimum-carb for a couple of weeks, which has the effect of "resetting" your appetite for carbs. This really is quite tough - not least because the food is a bit boring - but once you've done that, you can introduce a wider range of ingredients and should have little desire for (say) a massive plate of pasta or a baked potato. However it's critically important that you introduce carbs not via 'cheat' meals (eg., a daily slice of bread on the basis that "you've been good the rest of the day") but by introducing ingredients like tomatoes and onions which, which technically "carby", are excellent foods in other respects.

- Get more vegetables on your plate. The more variety the better. Don't think of "cutting things out" - LCHF is as much about adding more veg as removing the starch. Similarly, try not to think of meals in terms of protein and fat - certainly you need those macros, but put some veg on your plate first and then add modest amounts of richer ingredients to make a tasty meal. Steaks, bacon and eggs, with nothing else besides, is just not very nice. And that really isn't what LCHF is about anyway.

Transitioning to low-carb rather than keto should keep the kids happy. As long as you put plenty of other things on their plate, they won't miss the starches. If they whine ... well, the bottom line is that you're the parent and you pay the supermarket bills

[MTCee]

It would be interesting to know what the numbers are for people on low carb diets or IF, actually getting keto acidosis. But I suppose, even if it happens to very few people, dieticians would still point to these small numbers to validate their views.

[TheAwfulToad Ambassador in reply to MTCee]

I can't prove it, but I'm pretty confident it's precisely zero, simply because the underlying physiology suggests it can't happen. If you have a functioning pancreas, it's impossible.

If there were any at all, you can be confident there would be at least one case study being wheeled out over and over again by the dietetics establishment.

[Subtle_badger in reply to MTCee]

I just googled it. 65% of people with T2DM die of heart attacks or strokes. Focusing on the minute dangers of a diet that can reverse this devastating illness is so counter productive.

[Subtle_badger]

You want me to post a link to prove that T2DM is bad for cardiovascular health?

😂 🤣 😂 🤣 😂 🤣 😂 🤣 😂 🤣 😂 🤣 😂

[Subtle_badger]

Why do you care about the figure? If you know anything about T2DM, you know it causes kidney, eye, cv etc issues. If you don't know that, then go read about it. I shouldn't have to provide a link for something that is well known and not controversial.

But here you go. Trust me, this isn't like saturated fat or salt or anything. The link be diabetes and cv disease is not controversial.

webmd.com/diabetes/heart-bl...

[Ladylin151]

Can I have your opinion on the "dangers" of alcohol with a keto diet? Alcoholic ketoacidosis is the only kind I have seen, always in people that were a.) Uncontrolled diabetic or b.) Severely alcoholic and then chose to go without food in favor of alcohol. But I have seen too many discussions of "pure alcohol has 0 carbs" and "lower am readings" on the same page as IF and being "in ketosis". Am I thinking in extremes or do I know too many alcoholics?

[TheAwfulToad Ambassador in reply to Ladylin151]

LOL, I suspect the latter ...

It's true that pure alcohol has 0 carbs, but that doesn't imply that alcohol suddenly stops being (potentially) harmful as soon as you go low-carb.

I also think some people get a bit hung up on keeping their ketostix deep purple. That's not the aim of the game.

My take on the matter - and it's just an opinion - is that the occasional drink doesn't do you any harm and probably isn't going to interfere with your weightloss (although some people find that it does ... and some people report getting drunk faster).

Nobody gets ketoacidosis unless, as you said, they have diabetes, or have severely misused their bodies to the point where they're at death's door anyway. I would also suggest that the average alcoholic presenting with blood pH below 7.3 and elevated ketones is in a self-limiting state (given careful refeeding, their blood pH will normalize) and any risk to their life is down to whatever other damage they've done to themselves. It's not the same scenario as DKA, where the bloodstream is being flooded with various "fuels" completely open-loop.

[Ladylin151 in reply to TheAwfulToad]

I suspect you are completely correct. 😬