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http://authoritynutrition.com/23-studies-on-low-carb-and-low...

The diets most keto advocates support is not high protein; rather, it is high fat, moderate protein, very low carb (< 25 net grabs daily). The science to date supports that as being a very healthy diet, especially if your fat source is not omega-6 polyunsaturated fat, but is instead dominated by monounsaturated, omega-3 polyunsaturated and yes, saturated fat.

Oh, dear.

First study:

> Dr. Hill reports having received consulting fees from HealtheTech, Johnson & Johnson, Procter & Gamble, Coca-Cola

Second study:

> This study proves a principle and does not provide clinical guidance; given the known benefits of fat restriction, future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed.

Third study:

> The study was designed to compare weight loss and cardiovascular risk in the short term; our long-term results, although appearing successful, must be considered as anecdotal, and further long-term follow-up studies must be conducted to confirm these findings.

Fourth study:

> Although advocates for very low carbohydrate diets are likely to embrace the results of this study, several points of caution need to be emphasized. First, a single study of a specific dietary regimen cannot provide a full assessment of safety and efficacy. Despite this study being the longest randomized, controlled trial of a very low carbohydrate diet reported, our results are still limited by the 6-month time frame. Whether the very low carbohydrate diet will produce sustained weight loss and continued improvement in cardiovascular risk factors over longer periods of time remains to be determined; the gradual increase in carbohydrate consumption in the final 3 months of the study suggests that some degree of recidivism is likely in persons on this diet. In addition, increased dietary fat has been linked to certain types of cancer and may have effects on cardiovascular health beyond the risk factors assessed in this study.

Fifth study:

> Financial Interest: Dr Hennekens is funded by the Agatston Research Institute, a nonprofit foundation, as Director of Research.

Sixth study:

> Participants were healthy and were followed for only 24 weeks, factors that limit generalization of our results. The low-carbohydrate diet has not been studied extensively in patients with chronic illness, and certain patients may require close medical supervision when following this diet. Furthermore, weight loss resulting from the low-carbohydrate diet may be difficult to maintain after 24 weeks.

> Potential Financial Conflicts of Interests: Grants received: E.C. Westman (Robert C. Atkins Foundation); Grants pending: E.C. Westman and W.S. Yancy Jr. (Robert C. Atkins Foundation)

Seventh study:

> This study was supported by a grant from The Dr. Robert C. Atkins Foundation, New York, NY.

Eight study:

> There were initially 20 subjects enrolled in each experimental group [...] Over the course of the study, four subjects dropped out of the LF group and five dropped out of the LC group.

Ninth study:

> 28 overweight premenopausal women consumed either a low-carb or a low-fat diet for 6 weeks. The low-fat group was calorie restricted. [calorie restriction does not work in the long term, period]

Tenth study:

> Carbohydrate restriction was an effective method of achieving short-term weight loss compared with standard advice, but this was at the expense of an increase in relative saturated fat intake. [saturated fat causes CVD and other chronic illness]

Eleventh study:

> Mood and other symptoms were evaluated by participant self-report using the Atkins Health Indicator Test [I'm sure that's not at all biased /s]

Twelfth study:

> Limitations included the lack of a valid and comparable assessment of individual adherence to the 4 different diets, the lack of data on whether participants had familiarity using any of the specific study diets prior to enrolling in the trial, and the lack of assessment of satiety.

Thirteenth study:

> Whether either of these diets would produce similar outcomes over longer periods and under ad libitum conditions or in populations that are more vulnerable to adverse effects, such as persons with specific psychological difficulties, requires further investigation.

Seriously, I had to stop at that. I'm sure the rest are also short-sighted and cannot be generalized as a healthful diet.

Care to explain why the many people who post their bloodwork every week on r/keto have lowered body weight, improved lipid panels, better fasting glucose scores? Its easy to say these are anecdotal, but when it happens weekly for years- (That of course not to say its well controlled, because of course its not, or that there may not be some sampling bias).

I gave it a try myself and judged it by all the objective and subjective measures at my disposal. It works (at least for me).

I can respect your skepticism, are the pending studies being done by http://nusi.org/ well enough designed to be considered weighty by you?

You've basically nailed it - the evidence is anecdotal and, coming from a keto echo-chamber, is obviously subject to confirmation bias. Therefore, these findings cannot be trusted as statistically significant.

By the same measure, we could argue smoking cigarettes is a reasonable, even healthful thing to do (on a slight tangent: exactly that was suggested by doctors in the 50's and 60's) - after all, we all know heavy smokers who haven't dropped dead, but on the contrary seem alive and thriving.

I'm glad it worked for you, but have you also fairly and objectively evaluated a plant-based, high-carb, low-fat diet? I think only then can the two be compared without bias, at least as I see it.

Regarding NuSI - I could write many paragraphs about the organization. If you have some time, please do check out these critical, detailed videos: http://plantpositive.com/warning-signs-nusi-guys-1/ and let me know what you think.

DrScump 3850 days ago

"During starvation this metabolic state is a kindness of nature allowing the victim to suffer much reduced pains of hunger while dying."

I hope you have a cite for that, as it ignores the basics of natural selection.

There is no way "nature" would select for a means to reduce the discomfort of starving to death, as death would remove that being from the gene pool, leaving that mechanism out of the gene pool as well.

nitrogen 3850 days ago

What appears to work best on the scale of a clinical study may not work so well for some subsets of the population. I've yet to find any sort of plant-based meal that makes me nearly as energetic and satisfied as one that includes animal protein of some kind.

Please check my related comment below about adjusting taste preferences. While it's true a greater amount of non-animal foods are necessary on account of them being generally less calorically dense (while at the same time being more nutrient dense), you can certainly find meals to satisfy your desires with patience and resolve. Start small - replace the beef patty with a black bean patty, for instance.

Do you realize that most people that "do keto" end up eating more veggies that they did before? There are tons of keto friendly veggies.

You can eat a ketogenic diet and eat nearly unrestricted amounts (except by satiety) amounts of things like cabbage, cauliflower, radishes (great cooked btw), brussel sprouts, spinach, green onions, broccoli, kohlrabi, lettuce, avocado, sprouts, green beans, rutabaga, leeks, yellow squash, zucchini, mushrooms, herbs.

Add that with some fish, meat, nuts and/or cheese and you have a very healthy diet.

Between the satiety of fat/protein and high-fiber foods above, its very easy to hit one's caloric goals and have a minimal blood glucose level.

Thanks - I wasn't aware of such diets, and I'm glad to hear people are eating their greens regardless of which diet they follow.

However, you're incorrect to assume adding meats and dairy products - even so-called "lean" ones - which are laden with cholesterol, saturated and trans fats - is at all healthy. All credible evidence suggests quite the opposite. If you have any studies which contradict my assertion, I would love for us to examine them together.

I mean you no offense, but to me it sounds like your understanding of nutrition science is 10 years in the past.

I do want to point out naturally occurring transfat has very different properties than the artificial common forms. I have never seen a well designed study show a low-fat diet to be superior to a high-fat-moderate-protien-very-low-carb one (usually referred to as VHFLC). I'd be interested if you know of any.

It is no longer generally accepted that dietary cholesterol is dominate factor unless you have mutation such as some of the PCSK9 mutations. Your body syntheses much more cholesterol everyday than you actually eat. The latest US government dietary guidelines has drastically shifted its position on cholesterol, write-up: https://www.washingtonpost.com/news/wonk/wp/2015/02/10/feds-...

We have since learned many things such as the importance of HDL/LDL ratio as being predictive over just LDL for example.

This is a very complex topic and I would recommend this series written by a MD: http://eatingacademy.com/nutrition/the-straight-dope-on-chol...

This is a 5 part series befitting the complexity of the issue at hand.

http://nutritionfacts.org/video/bold-indeed-beef-lowers-chol...

No offense taken, I hear what you're saying quite frequently.

Regarding the 2015 DGAC - the report did no original research to exonerate cholesterol, but rather deferred to a 2014 report by the American Heart Association, which has a financial incentive to label cholesterol-laden foods as, "heart healthy". Of course the media has chosen to play them up to stir up controversy and give the illusion there is vast disagreement in nutrition science, but that's simply not the case.

What has happened "in the last 10 years" is intense pressure from food industry lobbying to dilute research, confuse the public and distract from messages warning of saturated fat and cholesterol. Please, check out these short videos to see what exactly I'm talking about:

http://nutritionfacts.org/video/how-the-egg-board-designs-mi...

http://nutritionfacts.org/video/eggs-and-cholesterol-patentl...

http://nutritionfacts.org/video/debunking-egg-industry-myths...

http://nutritionfacts.org/video/who-says-eggs-arent-healthy-...

http://nutritionfacts.org/video/the-problem-with-the-paleo-d...

http://nutritionfacts.org/2015/08/18/dietary-cholesterol-aff...

http://nutritionfacts.org/video/big-food-using-the-tobacco-i...

(I apologize if this seems biased, coming from a single source, but if you check the videos, each has links to cited studies discussed - I simply favor the format the material is presented in)

The Eating Academy articles you've linked are by Peter Attia, a co-founder of NuSI. Please do watch the earlier review of their work I suggested - http://plantpositive.com/warning-signs-nusi-guys-1/

The healthful HCLF diets you're seeking out are known as plant-based (usually vegan, but not exclusively) diets, and are always lauded as health-promoting, albeit supposedly "unpalpable".

Low-fat meaning, low in or void of saturated- and trans-fatty acids, high (10-15% of caloric intake) in essential polyunsaturated omega-3 and omega-6 fatty acids (in the right ratio, ideally 1:1, but more practically, 1:3 or 1:5). Yet, many media outlets and conflict of interest research have no shame in claiming a diet as high as 30, 40, even 50 percent fat (always from animal products) are "low". This is simply nonsense! Your body needs only a little bit of fat, for example to increase vitamin absorption at each meal, or convert it to EPA/DHA.

High-carb meaning, the majority of calories are derived from whole, unrefined, plant-based foods, such as vegetables, fruit, legumes and whole grains, especially ones low on the glycemic index (e.g. brown rice, whole grain pasta, beans, dark green leafy veg, colorful fruit variation, etc.)

Heck, I challenge you to find me a study which says a high-carb, low-fat diet as I've described is not a great recipe for human nutrition. Unfortunately, so many people find such a diet unreasonable for practical, social and other, personal reasons. Also unfortunate is the fact there's little money to be made in promoting these simple and unprocessed foods, so the academic world is not determined to research them.

Anyway, if you're interested in reading more about these sort of diets, check out the work by Colin Campbell, John McDougall, Neal Barnard, Dean Ornish, to name a few. I've fully embraced the dietary lifestyle recommended by them and others, and can only praise the mental clarity, increased energy and satiation experienced as a result. I really believe the "trick" is to cut out processed and animal product foods altogether (at least to the degree you can sustainably practice and at the pace you find to be reasonable) - they're just unnecessary! Sure, it's anecdotal evidence, but I figure it's worth sharing with you.

DrScump 3850 days ago

"However, you're incorrect to assume adding meats and dairy products - even so-called "lean" ones - which are laden with cholesterol, saturated and trans fats"

Oh, dear.

First of all, meat and dairy don't HAVE meaningful amounts of transfat. Problematic transfats are man-made.

Secondly, there is NO proven link at all between dietary cholesterol and blood cholesterol absent carbs, Essentially all blood cholesterol is manufactured by the liver.

By all means, display your "credible evidence" to the contrary.

http://health.gov/dietaryguidelines/dga2005/document/html/ch...

> meat and dairy don't HAVE meaningful amounts of transfat

In fact, they absolutely do. It's no doubt hydrogenated oils found in processed snack foods add trans fat as well, hence my emphasis on whole plant foods.

> The major dietary sources of trans fats listed in decreasing order. Processed foods and oils provide approximately 80 percent of trans fats in the diet, compared to 20 percent that occur naturally in food from animal sources

> #1 Cakes, cookies, crackers, pies, bread, etc.

> #2 Animal products

> #3 Margarine

> there is NO proven link at all between dietary cholesterol and blood cholesterol

Surely you jest?

> Serum cholesterol concentration is clearly increased by added dietary cholesterol but the magnitude of predicted change is modulated by baseline dietary cholesterol.

https://www.ncbi.nlm.nih.gov/pubmed/1534437

Or do you suppose this is all just a grand conspiracy by the fruit and vegetable industries?

>there is NO proven link at all between dietary cholesterol and blood cholesterol absent carbs

I would change "NO proven link" to "only a weakly correlated link (assuming the patient is not a member of the 8-15% of the population estimated to have a mutation related to improper cholesterol homeostasis)"