Keto ranks among the worst?
 

I just read an article that ranked diets, and Keto diets rank last! I was recently asked to try this diet.. but then this study came out...

"they ranked the diets poorly on long-term weight loss success, ease of use and overall impact on health"

"the experts were especially concerned about extremely high fat content -- about 70% of daily calorie intake -- as well as unusually low carbohydrate levels: only 15 to 20 net carbs a day. The 2015-20 dietary guidelines for Americans suggest that 45% to 65% of daily calories come from carbs but less than 10% from saturated fat."

"The keto diet is just not sustainable over the long term. It doesn't teach you how to acquire healthy eating habits. It's good for a quick fix, but most people I know can hardly give up pasta and bread, let alone beans and fruit."

Thoughts? I was about to try this diet.

I've known some people who had great success with keto. Others like me would struggle with it. Just like switching to vegetarianism - ie. giving up meat doesn't mean you switch to mac and cheese all the time. You have to select your foods carefully and pick the wisest choices among that which fits into the plan.

I tend to like things with carbs in them so I would be in constant turmoil thinking about all the things I could not have.

On the other hand a friend went Keto a year ago and absolutely loves it. However she admits she is not a sweets eater (candy, sweetened drinks and baked goods) and doesn't really like fruit all that much. She got used to giving up popcorn, pasta and bread products. I wouldn't say she eats fatty things - cheese would be about the most fatty thing she would incorporate into her meals. Many of the things she makes sound quite good to us so I would not say it's an imbalanced eating plan.

Some people give things a bad rap for fats but there is a difference between healthy natural fats like eggs, avocados, salmon, lard and yes, even bacon to an extent vs the kind of fats in processed foods.

To some fat is not the enemy - sugar / carbs are. Each person's body treats foods differently. Any eating plan basically comes down to portion control, choosing healthy foods from a food list and getting regular exercise.

Why not give it a try for a while and see how you feel? My only advice would be to eat natural foods and avoid processed foods as much as possible - that's where I think you get into trouble. Good luck.

In my experience, you can do keto without all the fat consumption, especially if you are doing keto to lose weight. Many people that I know that have done keto have actually seen improvement in many of their health concerns prior to starting, such as lowering blood pressure, lowering cholesterol, and decreased swelling in legs. To do this diet correctly for weight loss you need to eat plenty of protein and veggies. The idea in keto is to limit carbs because when eaten in excess, the carbs/sugar you eat turn into fat in the body. Yes, a high-fat diet does have some negative health aspects as well, especially saturated fats, which is why when I did it I focussed on meat and veggies, those will keep you full longer and can get you the calories you need for energy for the day.

"The keto diet is just not sustainable over the long term. It doesn't teach you how to acquire healthy eating habits. It's good for a quick fix, but most people I know can hardly give up pasta and bread, let alone beans and fruit." To elaborate on this: I do think it helps people acquire healthy eating habits, as a result of this diet I learned to eat more veggies with each meal, its second nature to me now. And most diets are not for the long term. I watched an interview on youtube that was very interesting on this topic. They stated that they don't think that one diet fits a person for their whole life, a person may need different diets at different parts of their life. I found this very interesting. You can look it up: if you search "Joe Rogan #994: and "Joe Rogan #996" Both are very interesting regarding the keto diet.

the experts were especially concerned about extremely high fat content

I read that article, too. However, "experts" is not a qualification. Being "concerned" is not a scientific measurement. I didn't accept their rating because I'm not convinced by 'expert opinions' without research to back it up.

I am not following keto, and I think that long-term keto would be hard to stay on.

There are studies showing that low carb is beneficial and has good results. As my doctor says (Optifast), there are essential proteins, essential fats, but no essential carbs. Although it'd be awfully hard to stay in ketosis (usually under 20g carb a day), staying under 100 is not that hard--and 50, for dieting, isn't that hard either.

A true ketogenic diet requires lots of fat consumption, because an excess of protein can actually be insulinogenic, which will 'bump you out of ketosis', to use the colloquial phrasing. If you're not eating carbs (typically under 20-50g/day) and you're not eating lots of protein (accepted ranges typically vary between 1.3-2.2g/kg of bodyweight, or 0.6-1g protein/lb if you prefer imperial), the only maconutrient left is fat. Well, ok, I guess there's alcohol too, but that's not exactly a great substitute.

The article you're referring to was ranking diets according to a number of different factors - including compliance, long term usage, convenience, and adaptability, as well as the more mundane 'health markers'. One of the reasons a keto diet, that's specifically designed to keep you in ketosis, is that it's HIGHLY restrictive, and for the vast majority of people, not a realistic long term option. Low carb diets (<100g/day) are often what keto folks move into, once they've met their goals. Which, while still restrictive, are generally easily maintained with a few tweaks.

However, there's some intriguing research being compiled that suggests that low carb caloric deficits are actually less effective for fat loss than low fat diets, but at the end of the day it's all a wash. The best diet is the one that you'll stick with! Some people prefer low carb meal plans because they feel more full and are less likely to get hunger cravings. Other prefer low fat diets because the carb allowance is more effective for them to work harder during training and therefore burn more kcal. Personally, I think that everyone needs to test it out for themselves, and go from there!

If it were me, I'd aim for at least 1g of protein per lb of bodyweight, a minimum of 0.3g of fat per lb of bodyweight, and then toggle between filling the rest of your caloric allowance between carbs and fats, until you find the mix that works best for you. EG. ~1,800kcal TDEE, 160lb woman = |160g protein (640kcal), 50g fat (450kcal), 175g carb (700kcal)| OR |160g protein (640kcal), g 85fat (765kcal), 100g carb (400kcal)| ......OR, somewhere in between ;) (yes, I know those kcal don't add up exactly the same, but I like round numbers)

Aaaanywho, that's just my 2c!

I don't believe it. I have plenty of other articles that say your article is faulty.

I've done a combo of low carb (paleo) and very low carb (keto). I'm down 90 lbs. My blood pressure is perfect. My cholesterol ratio is perfect. My triglycerides are very low. Energy is great. I follow dietdoctor.com and idmprogram.com and there is a ton of evidence that shows that keto not only works, it's the ideal diet for the human body. It prevents and reverses type 2 diabetes, fatty liver, and insulin resistance which all go hand in hand with being overweight. Carbs are the reason we're fat. Intuitively, we all know this. Grandma was telling us 40 years ago to lay off the bread if we didn't want to get fat. We feed farm animals grains to fatten them up. We've been lied to since the 1960's about how fat is bad and carbs are good and so a lot of times when you read a study maligning paleo or keto, it's because someone is using bias confirmation (a closed mind) and cherry picks data to make the diet look unhealthy or as though it doesn't work. I encourage you to check out dietdoctor.com, idmprogram.com or marksdailyapple.com and see the hundreds of success stories on there from people who succeeded using low carb or very low carb approaches.

This is actually being hotly debated right now in the keto community. Some of the leading experts believe that protein is being maligned unfairly, and they have their patients eat protein to satiety. It's an interesting debate.

Oh cool, if you have a moment could you point me in that direction? I'm always happy to read more about nutrition, and I'd love to see more targeted studies on it. I dunno if protein being insulinogenic is really debateable (some of them are at least, eg. whey, though I know others are less so - like casein, red meat, raw eggs, etc) but it'd be great for more data on how - if at all - it affects ketogenesis and fat loss!

I've been seeing it in a few places in the paleo/keto community. Most recently, this video came out this week on DietDoctor.com. Not sure if you'll be able to view much of it without signing up, but DietDoctor.com is an amazing resource for people interested in Keto and the first month is free- you could always sign up and binge watch and then cancel haha. https://www.dietdoctor.com/fear-protein-new-fear-fat

I was listening to an interview with another well known keto doc (whose name escapes me right now) who made a similar argument. If I run across that podcast again I'll post the link for you.

I'm seeing the argument more and more. I'd say right now it's about 80/20 with the majority still saying protein needs to be limited due to the insulin response it creates, but the other side is saying that it's not true.

Thanks! I wish they'd source the specific studies they're pulling from. I suspect though, that my understanding and your understanding are actually pretty similar; mostly because the 'acceptable' ranges that I'm familiar with for protein intake during a ketogenic diet are still more than most people manage to eat without trying. So the concern about over-consumption is overstated simply because most people can't stomach more than that anyway!

EG. 1,800kcal TDEE for a 160lb woman, the upper end is 160g of protein (which is the equivalent of 1c chopped chicken breast, 3 eggs, 4oz of roast beef, and a tin of tuna - EVERY DAY). Even if she's eating at a 300kcal deficit, with under 50g of carbs a day, the remainder is ~45-55g of fat after what's in the proteins (which looks like 2Tbsp of butter, 1/2c of chopped avocado, and 1/4c of almonds), which is not an outrageous amount by any means. If this same woman ate at the lower protein range, say 1.4g/kg, that's only 100g of protein a day (take out the tin of tuna and eggs), but she'd then need to eat another 27g of fat (plus 15g from removing eggs), or an extra 2Tbsp of olive oil (plus 3Tbsp of unsweetened shredded coconut instead of eggs).

Not 'lots of fat' by any means in either of those scenarios; but if she ate at maintenance, while it's only an extra 300kcal (~33g) of fat, that's an extra 2Tbsp of peanut butter and 1/4c of sunflower seeds (in addition to butter, olive oil, coconut, almonds, AND avocado). At that point, it's starting to look like closer to 'lots of fat' to me - still not crazy numbers, but higher than I'd eat in a day without thinking about it.

I suspect you're right, I have trouble actually eating enough protein, especially since I do intermittent fasting also. A lot of times I only eat meat at dinner, fast for breakfast, and have a coffee with heavy cream for lunch. I'm trying for around 125g of protein a day. That's a lot of chicken. I don't have any problem getting enough fat because I love both heavy cream and butter.

PS- I found the podcast, it was Dr. Ted Naiman who says we need more protein than most keto docs recommend. This is the link to the podcast:
https://ketogeek.com/blogs/news/epis...-dr-ted-naiman
It's at about 40 minutes in where he starts to address protein. One of the most telling comments at 45:00, where he says he tells his patients just to eat steak and eggs until they're full. Keep listening until at least 50:00. He explains why he thinks protein restriction is not helpful.
Be warned, the guy interviewing him is a little annoying. But Dr. Naiman's info is great.

I currently have many patients doing Keto and seeing much success

Keto - Powerful Exogenous Supplement
 

These strips work perfectly. I've been doing low carb/keto on and off for twenty years and have used a variety of different brands of strips. Some of those brands didn't give proper readings (e.g not registering that I'm in ketosis when I know for a fact that I am). I've been using these strips for a week now without a problem and they are giving me accurate readings. I will definitely purchase again!

I'm a keto advocate, but I live in a realistic world and am fully accepting of the fact that new research comes out every day that could prove this way of life less-than-optimal. That said, every human is different, and what may or may not work for you can depend on your ancestry, genetics, and to a greater extent, your microbiome. I am currently doing microbiome correction work and the diet while I am correcting my bacterial balances is Keto - recommended by a top health practitioner here in Australia. But, once I am finished, I have been told that re-testing will need to be done to see exactly what food types (and macros) that my "new gut" actually need to thrive....

I think what I am trying to say is that the ONLY way to truly know what works for your body is to get testing done. Because some people need more carbs (for example) and even the right types! It costs a lot, but until you do, everything is a guess and you can only apply general health advice. There's a product available in the U.S., CAN, and U.K called VIOME that sounds AMAZING. I can't wait until it comes to AUS as it sounds even more comprehensive than what I am doing. Again, this is testing to see what is happening inside, and how your body really interacts with foods.

This argument stems more from the idea that people are spoiled brats who cannot give up their comfort foods. A diet is a change in eating habits. If you revert back to the food that caused you to gain weight in the first place, obviously you will gain all the weight back. If you think of "fat" as the result of an illness which you can get better by eating one way, and will get worse (again) by eating another way, that might make you think of it differently. People who give up smoking because they develop emphasema will remain "well" if they do not smoke, and will get sick again if they start to smoke again.

It is what you make of it
 

At the end of the day i belive that all diets and these fads all work in some form. the key i believe to keep consistent with the changes you are making and also making it into a lifestyle change so you create good habits and dont gain the weight back. Stay strong mentally and trust the process:carrot:

There are a ton of scientific studies around which conclude that a ketogenic diet (and basically ANY low carb diet) works great, don't let them distract you, they probably want to sell you Red Tea or pills or something. These days one person says one thing the other tells you it's fake news.

Keto works for a reason, we get fat because of the carbs we eat, this is a scientifically proven fact, so why try something else ? Personally I have great success with keto and I'm from planet earth so I assume it works for every human being in this world. :smug:

I mean, realistically speaking, it doesn't really matter if you go low carb or low fat - it just depends on which one you can stick with!


eg.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3530364/

https://examine.com/nutrition/low-fa...r-weight-loss/


Many of the studies that show low carb to be superior to other dieting methods do not correct for increased protein intake, which is a confounding variable which directly effects diet outcome. One of the most recent studies, that used over 600 participants, concluded that there's no statistical difference between low-carb vs low-fat so long as total calories and protein are kept consistent.

Actually, no, it does matter if you go low fat if you're still eating a high carb count. While the body can, and will, utilise both fat and protein to make glycogen, it takes significantly more effort for the body to undertake those processes. During that phase, the blood sugar (glycogen) doesn't spike and trigger the insulin response which lays excess blood sugar to fat. This is why nearly everyone on a ketogenic diet will lose weight - regardless of whether they are adherents to the high fat or moderate fat values. The important thing is to keep carbs low. How low you need to go depends on your personal physiology. Some people are extremely carb sensitive (metabolic disorder) and need to keep it under 30 net carbs, and some of us can go up to 100 carbs and still lose.

As with ALL diets, the most important aspect is to ensure that you are getting sufficient vitamins, minerals and trace minerals to support your body's functions - either through food or supplementation AND to take in sufficient fluid to flush toxins out of the body.

Protein is absolutely necessary - not just for the physical strength to carry your own body weight around, but also because the heart is a muscle and if you diet without regard for "sufficient" protein to avoid muscle loss then you are asking for an early death. The accepted rule of thumb for protein is half a pound of lean protein per pound of body weight, and more if you are strength training with the aim of building muscle rather than maintaining it.

Basically, do the research yourself and don't rely on advice given by others. There is a lot of disinformation out there, both by the food industry who do not want to lose your business AND those who "play" at dieting.

The biggest problem with going low fat is that carbs do not trigger the leptin response which tells the brain that you are full. Fat will do that, and it keeps the ghrelin (hunger hormone) under control. The great benefit to low carb versus low fat is that you lose the sugar addiction pretty quickly.

So, yes, a massive difference in how the body responds between low fat and low carb. The body has minimal need of carbs for a tiny proportion of brain function. Otherwise, humans run better on ketones.

I respect that you prefer a low-carb lifestyle, but to arbitrarily state that it is the superior option for all populations is misguided, IMO.

For one thing, losing weight comes from many different things: eating below your TDEE, losing water vapour during exhalation, voiding (either #1 or #2), changes in bone density, your body changing how it holds onto water, etc. But to lose weight in the sense that I think you mean, it has everything to do with a caloric deficit. Fat vs. carb doesn't even come into the discussion.

Yes, everyone will lose more WEIGHT initially with a low carb diet, specifically due to glycogen storage & water retention. That balances out pretty quickly though, within a month or two: https://www.ncbi.nlm.nih.gov/pubmed/17415320

Those who display symptoms of insulin resistance do better with fewer carbs - no argument there. But in a healthy population, there is no statistical difference: A Low-Glycemic Load Diet Facilitates Greater Weight Loss in Overweight Adults With High Insulin Secretion but Not in Overweight Adults With Low Insulin Secretion in the CALERIE Trial | Diabetes Care . And in those whom are insulin sensitive, they could actually lose more weight on a low fat diet: https://www.ncbi.nlm.nih.gov/pubmed/15897479

Insulin and of itself isn't an issue - after all, we need insulin to preserve muscle mass too. Protein is also actually quite insulinogenic - it just doesn't raise blood sugar levels. The problems come in when there is insulin resistance in muscle cells, which most commonly correlates to high bodyfat percentages. Again, insulin doesn't cause fat gain - that's entirely dependent on if you are consuming a caloric surplus or not.

And in already obese subjects, overeating fat is more likely to cause fat storage than overeating carbs: https://www.ncbi.nlm.nih.gov/pubmed/7598063

Ironically, there is even some postulation that too much fat itself causes insulin resistance as well: https://www.ncbi.nlm.nih.gov/pubmed/16319806 And a low carb diet doesn't necessarily improve insulin resistance: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4370345/

Those with Alzheimer's who follow a high fat diet show a slowing of cognitive decline, absolutely. But the only models that propose ketone metabolism in the brain shows protective conditions against future disease are all in rats & mice - which is to say, it hasn't been shown to have the same effect in humans. For some, a low fat diet may actually have a negative affect on moods long term - but there's no difference in cognitive function: https://jamanetwork.com/journals/jam...rticle/1108558 . Ketones have also shown mixed results in terms of improving or inhibiting athletic performance. So it comes out even: no clear evidence that suggests that humans 'run better' on ketones.

Longer term low carb diets have shown to decrease T3 levels, a symptom of developing hypothyroidism - https://www.ncbi.nlm.nih.gov/pubmed/28076316. It also results in lowered testosterone and increased cortisol - which makes you more likely to store belly fat and it's harder to build muscle: https://academic.oup.com/jcem/articl...1/4480/2598960 . There is also some new data that suggests that long term ketogenic diets can affect the rigidity/shape of arterial wall - not great: https://www.sciencedirect.com/scienc...59131113003397 Though I'll readily admit that more research needs to be done on this.

No, fat doesn't activate higher levels of leptin than carbohydrates: https://www.ncbi.nlm.nih.gov/pubmed/10567012 & https://www.ncbi.nlm.nih.gov/pubmed/12753550

Weight loss is generally similar across any caloric deficit long term:https://www.ncbi.nlm.nih.gov/pubmed/19246357 & https://jamanetwork.com/journals/jam...stract/2673150

On a side note, while RDA for protein is 0.8g/kg of bodyweight (0.36g/lb), newer studies suggest that if you are over 40 and sedentary that should be bumped to 1.2g/kg (0.55g/lb). For obese subjects trying to lose weight, even higher numbers (eg. 1.5g/kg, 0.68g/lb) are recommended. Pregnant women need at least double RDA, at 1.6-1.8g/kg (0.730.82g/lb). And non-obese subjects attempting to lose fat/weight should be aiming for 2.2-3.4g/kg (1-1.55g/lb) in order to preserve muscle mass. To gain muscle, the recommendations are similar to losing fat, with the suggestion that higher levels do not show any adverse affects on renal function or overall health - and may help prevent fat gain in a caloric surplus.

I think that if you do well with a low carb diet, that's great - keep with it! But it is not immediately the best choice for everyone under the sun. It all comes down to how you respond, and how you feel, with different macronutrient ratios. And what your Dr. says in terms of the results on long-term cardiovascular and endocrine health - on an individual basis. We could trade cherry-picked studies back and forth all day, but I imagine we can agree that the best judge of which system is best comes down to how the individual responds.

Defining, Wowza, thank-you for the smorgasbord of peer-reviewed articles! I love it when you share :)

Obviously a typo, since I'm pretty sure a 200 pound person is not supposed to eat 100 pounds of protein a day, or a week,. But now I'm curious what the accepted rule of thumb really is.

LOL, thanks. I definitely cherry picked these to make a point. ;) But I'm glad that others enjoy digging through the numbers as well.


US RDA is 0.8g/kg of bodyweight, so it works out to around 0.36g/lb of bodyweight. But older populations, especially women, do better with a higher intake, around 1.2-1.4g/kg (0.55-0.64g/lb). And higher levels still for those trying to lose fat, between 1.8-3.4g/kg (0.82-1.54g/lb) - eating more protein the leaner you are to reduce the loss of muscle in a caloric deficit. I suspect Briael meant half a gram per pound of bodyweight, but I don't want to put words in their mouth.

Defining pretty much nailed it on the head, and if you're interested in more info (and like podcasts), check this one out: https://www.gimletmedia.com/science-...ould-you-do-it

I normally do a low-carb cycle (not at keto levels, though) for about two weeks before a track meet, but ordinarily I will do a "carb pyramid". Where I have most of them in the morning and much fewer at night.