The Ketogenic Diet or Keto Diet craze (also referred to as a low carb high fat diet / LCHF and sometimes the Paleo diet) drives me nuts. I know the science on this very well, and have personal experience with a LCHF diet, but you cannot convince the keto crazed people otherwise. It’s like a cult!
I think the reason people like the idea of the Keto Diet is because they don’t have to address their bad eating habits, it seems like an easy fix for quick weight loss, and I believe we are genetically predisposed to go after and crave easy calories from fat. However, life has changed on planet earth, and we have plenty of science to back up the proper way of eating and how to get proper nutrition which I will discuss herein.
The longest lived people on this earth that have little obesity, heart disease, or other chronic diseases like Type 2 Diabetes are in areas called “The Blue Zones”. The Blue Zone areas of the world eat a primarily plant-based, high carb diet that includes whole grains.
I have an extensive article the Blue Zones called ‘Lessons From Centenarians‘.
I have listed the Blue Zones longevity food in my article ‘Top 12 Longevity Foods‘.
Epidemiology is the study and analysis of the health and disease conditions in defined populations using statistical analysis to draw appropriate conclusions about diet and their effects on health. These studies are considered correlation studies.
Long term epidemiological studies have shown that people who consume a low fat diet with plenty of fruits, vegetables, and whole grains are healthier. Some examples of these studies include:
- The China Study via a partnership between Cornell University, Oxford University, and the Chinese Academy of Preventative Medicine, with data collected over a span of 20 years including 6,500 adults.
Diet, lifestyle, and the etiology of coronary artery disease: the Cornell China study. https://www.ncbi.nlm.nih.gov/pubmed/9860369
- The Nurses Health Study with 121,700 participants, and Nurses Health study II with 116,430 participants both had a tremendous pooling of data from Harvard Medical School, Harvard T.H. Chan School of Public Health, and Brigham Women’s Hospital.
Key Research Findings: http://www.nurseshealthstudy.org/sites/default/files/pdfs/table%20v2.pdf
- The Adventist Health Studies involving 24,000 and then another 34,000 participants over 40 years with an additional study of 96,000 participants that is currently ongoing.
- The Busselton (Australia) Health Study is one of the longest-running epidemiological studies in the world. Since 1966, over 16,000 residents of Busselton have participated in surveys concerning such health topics on cardiovascular disease, pulmonary function, diabetes, and allergies. This has resulted in over 300 publications in the medical journals.
Scientific Publications: http://bpmri.org.au/research/research-publications/scientific-publications.html#item-3
The World Health Organization Epidemiology Research
The World Health Organization (WHO) with a Working Group of 22 scientists who gathered together at the International Agency for Research on Cancer (IARC), with the goal of considering ALL data from over 800 epidemiological studies on red and processed meat in order to determine their potential carcinogenicity. But hey, never mind that they found that processed meat and red meat causes cancer…… (I wrote about that in my article Processed Meat and Red Meat Are Carcinogenic)
Correlation Studies vs. Randomized Control Trials
One of the things I get a kick out of from the LCHF zealots is the fact that they make statements like “correlation does not imply causation”. In other words, studies like these even though we are talking about hundreds of thousands of people over many decades, don’t prove that certain patterns in diet cause anything. It seems that there will always be any justification for bad habits. Most epidemiology studies end up producing additional types of studies including the rigorous randomized control trials.
One proponent of the Keto Diet is Nina Theicholz who authored the book ‘Big Fat Surprise’. I see a ton of misinformation that she spreads, and she has stated to me personally that there are ‘no studies’ that show the benefits of a vegan diet. She stated that there are no randomized control trials (RCT’s) to prove it. So just for the sake of argument, here are TEN of them! (I have shared these with her by the way, she still ignores them and spreads blatant lies.)
10 Randomized Control Trials
- A Plant-Based Dietary Intervention Improves Beta-Cell Function and Insulin Resistance in Overweight Adults: A 16-Week Randomized Clinical Trial http://www.mdpi.com/2072-6643/10/2/189
- Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. https://www.ncbi.nlm.nih.gov/pubmed/1973470
- Comparative effectiveness of plant-based diets for weight loss: a randomized controlled trial of five different diets. (VEGAN diet for the win). https://www.ncbi.nlm.nih.gov/pubmed/25592014
- A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. https://www.ncbi.nlm.nih.gov/pubmed/16873779
- The Effect of a Plant-Based Diet on Plasma Lipids in Hypercholesterolemic Adults: A Randomized Trial. http://annals.org/aim/article-abstract/718369/effect-plant-based-diet-plasma-lipids-hypercholesterolemic-adults-randomized-trial
- Whole-Foods, Plant-Based Diet Alleviates the Symptoms of Osteoarthritis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4359818/
- Gut microbiota and [the plant-based] Ma-Pi 2 macrobiotic diet in the treatment of type 2 diabetes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4398897/
- A two-year randomized weight loss trial comparing a vegan diet to a more moderate low-fat diet. https://www.ncbi.nlm.nih.gov/pubmed/17890496
- Intensive lifestyle changes may affect the progression of prostate cancer. https://www.ncbi.nlm.nih.gov/pubmed/16094059
- Effect of a 6-month vegan low-carbohydrate (‘Eco-Atkins’) diet on cardiovascular risk factors and body weight in hyperlipidaemic adults: a randomised controlled trial http://bmjopen.bmj.com/content/4/2/e003505
POST UPDATE: RCT #11
A plant-based diet in overweight individuals in a 16-week randomized clinical trial: metabolic benefits of plant protein. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221888/
Evidence that plant protein is assoc. w/improvements in body composition & reductions in weight & insulin resistance.
POST UPDATE: Yet another RCT published June 4th, 2019
Effects of red meat, white meat, and nonmeat protein sources on atherogenic lipoprotein measures in the context of low compared with high saturated fat intake: a randomized control trial. https://academic.oup.com/ajcn/advance-article-abstract/doi/10.1093/ajcn/nqz035/5494812
The Skeleton In The Keto Closet
In addition to the science that shows the massive benefits of a plant-based diet, there is an equal amount of studies that show the health risks and lack of benefits of a low carb high fat diet. But the keto cult chooses to ignore them.
Here they are (Courtesy of Dr. Joel Kahn https://medium.com/thrive-global/the-skeleton-in-the-ketogenic-diet-closet-what-virta-health-mark-sisson-joseph-mercola-and-704fad8bffd7 ):
- Noto et al. This meta-analysis of 272,216 subjects studied for diet and mortality reported that the risk of “all-cause” mortality in those responding that they followed a low-carbohydrate diet was approximately 30% higher than other subjects.
- Li et al. The Harvard School of Public Health studied over 4,000 men and women who had survived a heart attack. Those eating a lower carbohydrate diet higher in animal protein and fat was associated with a higher risk of all-cause and cardiovascular mortality. This increase was not identified in those responding they ate a plant-based low-carbohydrate diet
- Sjogren et al. In an analysis of over 900 elderly Swedish men, a Mediterranean diet pattern reduced mortality while a carbohydrate restricted diet was associated with a 20–40% increase in all-cause and cardiovascular mortality respectively.
- Fung et al. In an analysis of nearly 130,000 subjects followed by the Harvard School of Public Health, subjects following an animal food based low carbohydrate diet had increase in all-cause, cardiovascular and cancer mortality while there was a reduction in mortality in those following a plant based similar diet pattern.
- Snell-Bergeon et al. In a series of type 1 diabetics, a higher protein and fat diet was associated with more heart artery calcification, a marker of atherosclerosis, while a higher carbohydrate based diet was associated with a lower burden of artery calcification.
- Lagiou et al. In a research group of over 42,000 Swedish women, respondents with a dietary pattern of higher protein and low-carbohydrate was associated with higher all-cause and cardiovascular mortality
- Trichopolou et al. In a Greek population of nearly 23,000 subjects, those following a low-carbohydrate and higher protein diet had higher all-cause, cardiovascular and cancer mortality.
I’ll also add a randomized control trial:
Calorie for Calorie, Dietary Fat Restriction Results in More Body Fat Loss than Carbohydrate Restriction in People with Obesity https://www.cell.com/cell-metabolism/fulltext/S1550-4131(15)00350-2
And a Cohort Analysis Study:
Analysis of 129,716 participants in two cohort studies concluded that: A low-carbohydrate diet based on animal sources was associated with higher all-cause mortality in both men and women, whereas a vegetable-based low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates.
Low-carbohydrate diets and all-cause and cause-specificmortality: Two cohort Studies https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989112/pdf/nihms-247461.pdf
>>Additional discussion at the end of the article about saturated fats.<<<<
The Carbohydrate Insulin Hypothesis Study Failure
One of the main purveyors of a LCHF Keto fad diet is Gary Taubes. Mr. Taubes contends that sugar and refined carbohydrates caused obesity. Via his Nutrition Science Initiative (NuSI) he set out to prove his carbohydrate insulin hypothesis. He spent tens of MILLIONS of dollars of donors money trying to prove his hypothesis only to have it completely debunked by the very scientists that he hired (from the National Institute of Health) to conduct the study. One of those scientists is Dr. Kevin Hall.
The first 8 week control trial showed that an isocaloric Ketogenic Diet was not accompanied by increased body fat loss! Imagine that!
Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men https://academic.oup.com/ajcn/article/104/2/324/4564649
Dr. Kevin Hall explains the science on this study in this YouTube video https://youtu.be/atfBiEsxG5o
In further waste of money in order to prove the Taubes hypothesis, the following 12-month weight loss diet study by NuSI hired scientists concluded there was “no significant difference in weight change between a healthy low-fat diet vs a healthy low-carbohydrate diet.”
Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial. https://www.ncbi.nlm.nih.gov/pubmed/29466592
You can read more about the collapse of Taubes’ NuSI in this wired article: https://www.wired.com/story/how-a-dollar40-million-nutrition-science-crusade-fell-apart/
Zealots Continue Deceiving Public
Despite the fact that their own scientific studies / experiments did not turn out how they wanted, Taubes, Teicholz, and the rest of the Keto Diet Zealots continue to push the LCHF agenda. They continue to speak at meat and dairy industry events, conferences, and colleges and earn handsome speaking fees.
They are also now touting the Netflix film called ‘The Magic Pill’ – which, in my opinion is a very dangerous film that will further confuse people’s thoughts on proper nutrition and weight loss. I’d encourage you to review this YouTube video wherein the film is thoroughly debunked.
The scariest thing of all, is that they continue to push for reform in nutrition guidelines at the USDA thorough the ‘Nutrition Coalition’. The Nutrition Coalition is a nonprofit membership organization dedicated to ‘ensuring that national nutrition policy is based on rigorous science’. That is pretty laughable considering that their scientific theories failed, yet they continue pushing the LCHF agenda.
Recently the USDA invited for public comment regarding the 2020-2025 set of nutritional guidelines for Americans. The Nutrition Coalition, Nina Teicholz, Gary Taubes, The National Dairy Council, and others in the Keto Crowd rounded up thousands of people to comment on the guidelines in order to get the USDA to increase their recommendations on Saturated Fat. A recommendation to the USDA to ease up on saturated fat requirements is a blatant disregard for rigorous science, which they claim isn’t there. I will get to that in a minute, but back to diet and recommendations on proper diet.
Are You Still A Keto Zealot? Keep Reading…..
If indeed you think that ketosis is a good way to go, may I suggest a vegan ketogenic diet? (READ: ‘Is A Vegan Keto Diet Safe?‘). There are two approaches available. One is the Eco-Atkins Diet as mentioned above. Even though the study was small covering 39 overweight hyperlipidaemic men and postmenopausal women, the results after a 6 month randomized control trial was a weight loss of 15.2 lbs / 6.9 kg, but more important were the LDL-C and triglyceride reductions. The problem with a low carb HIGH FAT animal based diet intervention is the long term effect on cardiovascular function. Below is the study done on the “Eco-Atkins Diet”:
Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial. https://www.ncbi.nlm.nih.gov/pubmed/29466592
I hope that you understand that ketosis is a state of starvation. It burns fat and has a vast array of health benefits. However, you can achieve fat burn without doing a ‘Keto Diet’. One can burn fat easily with a caloric deficit regardless of the methodology. Yet I’m not sure why someone would want to achieve ketosis regularly when other, more healthy options are available.
The other way to potentially do a vegan (or even non-vegan) ketogenic style diet is a fasting mimic diet (FMD). Professor Valter Longo has done some fascinating research on how to fast without completely fasting in order to go into starvation mode (that is essentially what ketosis is) which can regenerate cells. The FMD is basically a 5 day fast. Day one at 1100 calories and days 2-5 at 800 calories. If you are obese or have health issues, it is recommended by Prof. Longo that you do a 5 day fast like this once per month for 3 months in order to reset your body. This is a topic for another day.
The Real Dietary Science
Proponents of a low carb high fat diet like to blame sugar, refined carbs, and just carbs in general (even plant carbs) on the obesity epidemic. I have even seen some blame it on ‘nutritional guidelines’ (what a joke considering that each of us make our choices based on learned behavior, availability, and partially on marketing propaganda). Some vegans like to blame it on merely too much animal fat.
Here us what happened in China when the Chinese people moved away from a traditional starchy diet, and replaced it with fats:
Here is another example of correlation between plant food / carbohydrates in various countries:
This extremely balanced BMJ (formerly British Medical Journal) Commissioned paper was just published 13 June 2018, and was written by unbiased authors from 3 Continents. The authors make it clear about diet and the role of CALORIES in obesity. In short, it’s not one food that is the culprit for obesity.
Here is what the paper states:
“The energy equation – that calories consumed=calories expended +/- calories stored (as body fat or glycogen)—is always true.”
Key Points From The Paper:
- The balance between calorie intake and calorie expenditure determines body weight and body fat changes
- Different foods influence total energy consumption by modifying appetite, or by affecting energy expenditure, eg through diet induced thermogenesis
- Overweight people generally consume more food energy (calories) than thinner people to maintain their higher body weight weight
- Any diet plan that an individual is able to adhere to will cause weight loss, but different dietary patterns may influence adherence to different degrees in different subgroups
- Weight loss maintenance is a greater challenge than weight loss for many people because it requires adapting to permanently eating less energy despite living with in the same physical, social, cultural, and educational environments in which they developed obesity
Making progress on the global crisis of obesity and weight management https://www.bmj.com/content/361/bmj.k2538
Another very comprehensive review of diets was done by Dr. David Katz, Director of Yale University School of Public Health. In his peer reviewed paper that references 167 studies and is published in the Annual Review of Public Health ‘Can We Say What Diet Is Best for Health?’ he states:
“The case that we should, indeed, eat true food, mostly plants, is all but incontrovertible.”
Without going into great detail about this paper, Dr. Katz believes we should cut the refined food and eat mostly unrefined whole plant foods, and not a diet heavy in refined carbohydrates, or high in saturated fats, or high in animal proteins.
Can We Say What Diet Is Best for Health https://www.annualreviews.org/doi/full/10.1146/annurev-publhealth-032013-182351
My Personal Experience With LCHF
In my 20’s, I worked in the restaurant industry and was married to a woman that loved to bake. My weight would fluctuate up and down. In my 30’s I had a very good paying job but was always on the run, and could eat wherever I wanted. I admit that I indulged but noticed an increasing waist line and was having a difficult time keeping the excess weight off. A couple of people had mentioned the book ‘Protein Power – The High-Protein/Low-Carbohydrate Way to Lose Weight, Feel Fit, and Boost Your Health–in Just Weeks!’ by Michael R. Eades and Mary Dan Eades. I knew nothing about nutrition so I followed their advice and did loose weight quickly. Any time I needed to drop a few pounds, I would do a LCHF for a few weeks or months and take it off, but I would constantly yo-yo’d up and down in weight, and as soon as I ate a carb (refined carbohydrate mind you), the weight would go back on. Normally I was 20-40 lbs. Over weight.
When my 40’s hit, I owned a BBQ restaurant. I’m guessing my metabolism also slowed a bit, but I always had in the back of my mind…… more meat/protein, less starch. Over the course of 6 years eating a meat heavy diet, I gained around 23 pounds per year until I weighed a whopping 348 lbs. And that was eating not many refined carbs, a salad – with meat- almost daily, a meat dish and veg in the evening, and usually a few heavy beers or some wine (that has a lot to do with my weight gain, but also a lot of saturated fat). And then I got sick! Very sick. I will spare you the details here, but I will tell you that over the course of 16 months, I lost 153 lbs and reversed a bunch of health conditions on a low fat whole food plant-based diet (read HIGH CARB low fat diet!). You can read more about that in my article ‘Easy Weight Loss On A Plant Based Diet‘.
Part of the reason I got sick is because I had the low carb high fat mentality, and ate a LOT of meat. My mission now is to help other people to get healthy, and also to spare you from that hell I went through to get back my health! So please, take my advice and throw out the low carb high fat thinking. It won’t make you healthy in the long run.
Why Ketogenic Diets KILL People
One may lose weight on a ketogenic diet. This may in the short term bring some good health benefits. As I have pointed out very clearly in this article, it is not the only way to lose weight. The risks of a ketogenic diet should be weighed against the long term health affects.
The biggest faulty information by the purveyors of the Keto Diet books and websites is that saturated fat – and thus cholesterol – doesn’t matter. It does! I can cite many sources for this, but For the purpose of keeping this article more brief than it could be, let’s talk about this study:
Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel – https://academic.oup.com/eurheartj/article/38/32/2459/3745109
This was a VERY comprehensive review of the evidence that LDL cholesterol causes heart disease. In their review of the following:
- Several large meta-analyses of prospective observational epidemiologic studies with data from 1,194,767 participants in the studies.
- Evidence from Mendelian randomization studies involving more than 300,00 participants.
- Compelling evidence from randomized clinical controlled trials including almost 170,000 individuals
Considered together, the strong and consistent evidence from the genetic studies, prospective epidemiologic cohort studies, Mendelian randomization studies, and randomized intervention trials discussed here, supported by mechanistic evidence to be presented in the second Consensus Statement on LDL causality, establishes that LDL is not merely a biomarker of increased risk but a causal factor in the pathophysiology of ASCVD.
Low-density lipoprotein (LDL) as a causal factor for atherosclerotic cardiovascular disease: key implications
- Cumulative LDL arterial burden is a central determinant for the initiation and progression of atherosclerotic cardiovascular disease.
- The lower the LDL cholesterol (LDL-C) level attained by agents that primarily target LDL receptors, the greater the clinical benefit accrued.
- Both proportional (relative) risk reduction and absolute risk reduction relate to the magnitude of LDL-C reduction.
- Lowering LDL-C in individuals at high cardiovascular risk earlier rather than later appears advisable, especially in those with familial hypercholesterolaemia.
This image is from the study:
Still don’t think dietary fat matters? Last year, the American Heart Association reviewed the scientific evidence (including recent studies) on the effects of dietary saturated fat intake – and its replacement by other types of fats, as well as carbohydrate intake – on cardiovascular disease. They looked at randomized controlled trials that lowered the intake of dietary saturated fat and replaced it with polyunsaturated fats, and they found that replacing the saturated fat with polyunsaturated fat reduced CVD by around 30%!! They state:
Replacement of saturated with unsaturated fats lowers low-density lipoprotein cholesterol, a cause of atherosclerosis, linking biological evidence with incidence of CVD in populations and in clinical trials.
Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association http://circ.ahajournals.org/content/early/2017/06/15/CIR.0000000000000510
Keep Reading About Saturated Fat and LDL……
In yet another quantitative meta-analysis of 395 dietary experiments among 129 groups of individuals, the authors of this analysis conclude that:
“Isocaloric increases (EACH bite you take) in saturated fat intake were associated with increases in total and low density lipoprotein cholesterol and smaller increases in high density lipoprotein cholesterol; increased polyunsaturated fat intake decreased total and low density lipoprotein cholesterol and increased high density lipoprotein cholesterol.”
Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies https://www.bmj.com/content/314/7074/112.full
IN OTHER WORDS: High Cholesterol from diet causes cardiovascular disease!!
Other Possible Risk Factors of a Diet High In Animal Proteins
In addition to cholesterol, eating a high protein diet will cause a microbial imbalance in your gut leaving you susceptible to all sorts of possible health conditions including Irritable Bowl Syndrome, and Autoimmune Disease. More about that in my article ‘Molecular Mimicry, How Eating Animal Products Causes Autoimmune Disease‘.
According to the World Health Organization, processed meat and red meat cause cancer! I have written about that here: Processed Meat and Red Meat Are Carcinogenic. Also mentioned above.
Cow dairy (including milk, cheese, yogurt, etc.) is another problem for ketogenic or low carb high fat diets. It contains a hormone called IGF-1 that exacerbates inflammation, a cancer promoting protein called casein, casomorpins which stimulates the same receptor in the brain as heroin and causes mood disorders and has an addictive quality, and the bovine serum albumin protein has been implicated as the cause for Type 1 Diabetes. Cow’s milk is for baby cows and has no place in human health. There is a reason that much of the world – some 70%, are lactose intolerant. I have written more about this in my post ‘Giving Up Cheese & Going Vegan‘.
Beyond cholesterol, cancer, and #DairyIsScary, the other major risk factor in a high protein animal flesh diet is called Endothelial Dysfunction. Basically, the paper thin cells in our arteries and heart become damaged from too much saturated fat and not enough nitric oxide (fruits and vegetables). You can read more about this in my article titled ‘Endothelial Dysfunction Simplified‘.
Other Possible Risk Factors From The Keto Diet
- Loss of salt (hyponatremia)
- Keto-flu (carbohydrate withdrawal symptoms include dizziness, drowsiness, muscle aches, nausea, and irritability)
- Changes in bowel habits/ constipation
- Leg cramps due to the lack of potassium and magnesium in the diet
- Bad breath
- Loss of energy and fatigue due to extreme calorie restriction
- Brain fog / slow thinking
- Racing heart rate when lying down
- Severe cravings
- Blood acidity
- Increased risk of bone fracture (Circulating ketone bodies make your blood too acidic, and your body will draw calcium from your bones as a buffer)
- Kidney stones (ketosis will raise your uric acid levels, lower your citric acid levels, and increase your oxalate levels which will cause kidney stones, especially when using animal proteins on a keto diet).
- Fatty liver (Non-alchoholic fatty liver disease NAFLD is directly related to saturated fat intake.)
The fact is, that eating a diet that is high in animal proteins has too many risk factors, especially in large quantities. We can be healthy and thrive on a plant-based or plant centered diet. Animal flesh contains a plethora of toxins and foreign proteins that the human body has little ability to process. Sometimes our immune system builds antibodies to fight those foreign proteins, in turn attacking our own cells in a process called molecular mimicry.
There are plenty of ‘proteins’ in plants – rather, the 9 essential amino acids are all available in plant matter, and you don’t need to eat animal flesh to get them. For example, a cup of beans has 41g of protein! I would encourage you to check out these VERY FIT and muscular vegans to see for your self. Silverback Gorillas are a close primate to human DNA and they eat plants and NO animal flesh. I have written about the Gorilla Diet in my article ‘Do Gorrilas Eat Meat?’
If you want good health and longevity, eat plants!
Read: Testimonies from others that have lost a tremendous amount of weight on a plant-based diet: ‘Plants Heal Humans‘.
Read: ‘Is A Vegan Keto Diet Safe?‘
If you have any questions about my content or this article, as always, please feel free to reach out to me directly via the contact page.
In Good Health,
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