[StacyC]

I am 58, on a (mostly) strict ketogenic diet since 2013. It has worked wonders for me and I expect to eat this way the rest of my life. I eat a lot of meat and eggs as I have found that combination (1) is something I enjoy very much, and (2) makes me feel the best.

I didn’t have much weight to lose but I went from 175 to 160 (high school weight) and under 15% body fat. My energy level is consistently very good.

Diet is a subjective thing, of course, but at a minimum getting rid of sugars and processed food might be a good starting point for anyone.

Anecdote: my brother-in-law reversed his T2 diabetes and lost quite a bit of weight doing keto. His doctor had advised meds to “manage” the disease.

[el_oni]

> reversed his T2 diabetes and lost quite a bit of weight doing keto. His doctor had advised meds to “manage” the disease.

My assumption there is that compliance for meds is probably better than compliance for huge lifestyle changes (such as diet). And that most people that the doctor sees in your BILs situation wouldn't stick to a ketogenic diet, and would need to go onto meds at some point in the future anyway.

Aside from that, im glad that it worked out for him. My anecdote about T2, is that a guy who works with my SO was told to control his diabetes with diet and is now insulin dependant, he hasnt been doing his insulin properly and has developed a swathe of health problems because of it.

[jonfw]

You've also got to look at how doctors are being incentivized. Medicine funnels more money into the medical system- and kickbacks or 'rewards' programs from pharmaceutical companies are common.

Outside of that- people like their doctors to do things. Everybody knows that they could use a better diet and more exercise- a doctor who says that and nothing else may not make people feel like they're getting their money's worth.

[bosie]

I am not even sure the incentives matter, compliance rates from patients are horrendous in medicine.

Incentives or not, suggesting a lifestyle change (go from SAD to extreme low carb) might be the best course of action but how many patients will follow through? does medicine even know how to handle this transition? Of course they don't. Advising this lifestyle change might work for 1% but what about the other 99%?

[49para]

Dr's are also incredibly uninformed about Keto, Carnivore, low carb in general.

The response I've received from my Dr friends regarding nutritional intervention vs drugs, is that "diets don't work".

They have no clue as to recent research being done. Changes to medical "best" practice are generational and take a long time.

[el_oni]

I wouldn't say that they are uninformed, just that they are informed by the literature. And unfortunately the literature surrounding diet is awash with special interest groups, small sample sizes and dodgy statistics. While clinical trials involving pharmaceuticals are often more rigorous. It's near impossible to do randomised double blind controls for diet, and energy levels and feeling great aren't as easy to measure empirically

[AnonC]

Of course “diets” don’t work. People consider diets as something you get on for some results or changes and then abandon them or give up later. So what actually works is making it a lifestyle change, which isn’t easy either, but is at least honest in what it means to people when they hear the word. Lifestyle changes are hard. Diets are what people usually see celebrities doing before an awards ceremony.

[thomascgalvin]

> My assumption there is that compliance for meds is probably better than compliance for huge lifestyle changes (such as diet).

This is probably true, but I'd like to see statistics. Compliance with med schedules is pretty terrible, too; that's why all of your antibiotics have a label telling you to actually finish your course.

[el_oni]

According to the highlights of this 2011 study[0], compliance is around 50% for drugs. I don't know if this is higher or lower than i was expecting to be honest...

[0]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/

[biswaroop]

Do you avoid red meat? Also, do you worry about cholesterol intake from the meat and eggs?

[StacyC]

I eat quite a lot of red meat, ribeye when I can, ground beef. Also pork, some fish. I prefer beef with a bit of fat.

I am convinced that dietary fat and cholesterol are not the problem as we have been told for decades.

My blood work is excellent. In fact, my doctor is on board with what I am doing but she also doesn’t quite know what to make of it. I think she still has some cognitive dissonance with someone eating the way I do and seeing the results that, per her training, should not be happening.

I also used to take 50mg of Losartan for blood pressure but I no longer need it.

[biswaroop]

Ah well my concern with eating red meat is related to the cancer risk and the impact on climate change. Are you worried about these issues in relation to your diet?

[norswap]

The health "risks" of red meat have been really overblown, see this meta-review (there are also two others by the same others, looking at slightly different questions): https://www.gwern.net/docs/longevity/2019-zeraatkar.pdf

[biswaroop]

How do you feel about the climate change impact due to red meat production? I can't really imagine any way to decrease that other than drastically decreasing red meat consumption.

[norswap]

I honestly haven't looked into it. I have heard some people say the idea that it's vastly more polluting than farming (farming what exactly?) is not entirely accurate. So there is at least some amount of controversy.

I know that in my country (Belgium), cattle is often fed the excess and/or unused part of some local productions (beetroot, hay from the farm ...). So that actually sounds useful to prevent waste.

[jacobjuul]

you don't say how much you eat, but are you testing your ketones after eating meat? Protein in moderate to high quantities (especially lean proteins) can pull you out of ketoses quite easily.

[jasonpeacock]

Dietary cholesterol != blood cholesterol.

In fact, carbs are metabolized into cholesterol, so really you need to be avoiding bread if you want to lower your cholesterol, not eggs.

[dan00]

You might be interested what Dave Feldman has to say about the subject: https://www.youtube.com/watch?v=0LuKwsz9Woc

I really like his engineering approach.

[StacyC]

Before my last blood test a few months ago I decided to try the “Feldman Protocol” as an experiment — a week before the test I ate nothing but meat and eggs, very high in protein and fat. The results were as Feldman’s work predicts.

My HDL was up (67), triglycerides down (60). When my doctor got the results she called me and the conversation went like this:

Doc: I got your bloodwork results in today.

Me: And?

Doc: I have really good news.

Me: Great!

Doc: What are you doing?

I explained a little about the Feldman Protocol and she went quiet for a while, and finally said, well, keep doing what you’re doing I guess.

[abtom]

Weight loss comes from having a calorie deficit, not from keto. You can gain weight on keto if you eat more calories. You can achieve the same weight loss by just eating fewer total calories, without cutting carbs as well.

[jonfw]

This is well understood by now. The issue is that most people aren't actually going to track their calories- they eat when they're hungry. If you adjust your diet- you can satiate your appetite on a lower number of calories.

The idea is that meats, vegetables, and fats help you meet your nutritional goals on a fewer amount of calories when compared to carbs- because carbs are empty calories.

[abtom]

Agreed that satiation is a major aspect. How satiating a food is, is not simply about carbs/proteins/fats. Most carb rich foods people eat today are high in sugar and low in fiber. That causes people to overeat. You can also overeat with high fat foods because fat is much more energy dense.

You can just as easy have a bad keto diet as you can have a bad high carb diet. Replacing processed carbs with processed meat will not do any good. It's a group 1 carcinogen and will also lead to high cholesterol level causing heart disease.

My point is that carbs aren't the enemy. Neither is fat. Eating unprocessed/low processed food should be the goal.

[amanaplanacanal]

The evidence that high cholesterol “causes” heart disease isn’t very good. There appears to be an association, but that’s really all we can say.

[jonfw]

in my experience- the more I learn about nutrition, the more I realize that we're just talking about everybody's best guess. Hard facts are scarce in this space.

[AnonC]

> The idea is that meats, vegetables, and fats help you meet your nutritional goals on a fewer amount of calories when compared to carbs- because carbs are empty calories.

A minor correction: carbs are not necessarily empty calories. If you consider only sugary soda, then yes. There’s no one verb either. There are simple carbs, complex carbs, etc. The best kind of carbs are from whole foods (not refined where fiber and other nutrients are removed).

[keymone]

When keto person says “carbs” they actually mean “simple carbs”. Fiber is absolutely ok on keto.

[dalore]

"Eat less, move more" is the advice professionals have been giving for years. This advice doesn't work though. Yes you have to do those things but telling people to do that in of itself is useless. There are strong biological/environmental factors at play working against that very advice. Having obesity isn't just some decision that people wake up and decide on.

The main advantage of the low-carb diet is that it may cause you to want to eat less. Even without counting calories, overweight people tend to eat fewer calories on low carb. Sugar and starch may increase your hunger, while avoiding them may decrease your appetite to a more manageable level. If your body wants to have an appropriate number of calories, you don’t need to bother counting them. Thus, calories count, but you don’t need to count them.

[shlant]

> This advice doesn't work though

It does work in the vast majority of cases. "biological/environmental factors" that may make this harder are the exception, not the norm

> The main advantage of the low-carb diet is that it may cause you to want to eat less

But this isn't unique to low-carb diets. You can also swap out a portion of your food for vegetables and get similar satiety while eating less calories. Eating slower can also help you eat less. The point is, an extremely restrictive diet is not necessary to achieve the same results.

[amanaplanacanal]

The advice doesn’t work. If it worked, why do we still have an obesity epidemic? Are there still people who haven’t heard this message?

[shlant]

> If it worked, why do we still have an obesity epidemic

not everyone follows the advice? It takes a LOT of effort and discipline? Food is a powerful vice and coping mechanism. Addiction of any kind is not an easy thing to overcome especially when that addiction is so normalized.

> Are there still people who haven’t heard this message?

I think in most first-world countries no, but there is a massive difference between hearing something, understanding something and successfully implementing something

[PeterisP]

Yes, that's the whole point. Advice "Eat less, move more" does not work because people won't follow that advice, so it's ineffective advice and we need something better.

The appropriate measure for effectiveness of public health recommendations is whether the recommendations get results. It doesn't matter if simply eating less and moving more would get results, if advising people "eat less, move more" does not result in them actually eating less and moving more.

It's not useful to compare diet A with diet B, you need to compare the effect of "tell people to follow diet A" versus "tell people to follow diet B", because the likelihood of actually following the advice (influenced by ease, convenience, and compatibility with natural urges) is probably the most important part that determines what results (if any) it will achieve.

If one system or diet is much more difficult to follow than another, if "it takes a LOT of effort and discipline" then that's a serious limitation, a legitimate flaw of that system or diet. It's worthless to evaluate the effect of a process that almost nobody will do.

And this is a key argument in favor of the keto diet - that people who don't manage to achieve a calorie reduction through simply eating less or calorie counting find it easier to get a calorie reduction through this system, because it better aligns with our normal satiety mechanism.

[dalore]

Another problem with the advice of eat less move more is that you are putting blame on the person. If they only tried harder they wouldn't be fat. No matter if they have tried really hard only to get told they aren't good enough. When really the whole game is stacked against them. Companies creating highly desired, but low in nutrition and satiety food. Cereals full of sugar being marketed as heart healthy. It's all stacked against them and the message needs to change.

[ubercow13]

>It takes a LOT of effort and discipline

That's the whole point, low-carb takes less effort and discipline for the same result

[cableshaft]

It's usually a lot harder to eat too many calories on Keto, though. I know I was struggling to get enough calories for my meals from restaurants when I was eating keto. I was getting double meat and a side salad everywhere I went just to get my meal up to like 700 calories, and paying a lot more than I did off the diet.

Like at Panda Express for example, I'd have to get a 3-entree instead of a 2-entree, get greens instead of rice for 45 calories, grilled teriyaki chicken for 300 calories, mushroom chicken for 220 calories, and broccoli beef for 150 calories, for a total of 715 calories, and even that was just enough carbs it could knock me out of keto, at 36 grams of carbs, so I usually tried to do some form of exercise after that meal.

Meanwhile at Panda Express just getting chow mein, before you even start with entrees, is 510 calories, and fried rice is 520 calories. Then they'd probably get Orange Chicken, at 480 calories, and Beijing Beef at 470 calories, and the 2-entree meal is 1,460 calories, or 2x the calories that I consumed with my 3-entree. (Those 3 things are in the top 4 most popular dishes at Panda Express according to fan rankings: https://www.ranker.com/list/best-panda-express-menu-items/ra..., if they got #3, Honey Walnut Shrimp, it'd be 100 calories less)

The amount of carbs included with just about every possible meal at most places is a substantial source of calories, and you don't get a discount for telling them to leave it off (not that I expect them to do so, but a few more keto friendly options that I don't have to substitute would be nice).

[himinlomax]

Sorry, but your statement is as true as it's pointless.

Consider: healthy people who are injected a small dose of insulin experience tiredness (reduced energy use) and increased hunger.

Contrary to eating fats, eating carbs triggers the release of insulin. Young, healthy people who have a properly working endocrine system handle eating carbs fine. But for those who don't, it's a different story. Just like those test subjects, their body limits energy consumption and experiences constant hunger.

So yeah, they don't burn enough calories and eat too much of them, but the saying so is pointless if not insulting; the question that needs addressing is why.

[abtom]

I'm not trying to say keto isn't helpful. If it works for you that's great, go for it. It may even be better than other diets in certain scenarios as you have mentioned.

However prescribing it as the default solution isn't right. If you're gaining weight the default solution is to reduce total calorie intake. Most of the benefits people see on keto can just as easily be had by simply avoiding processed junk foods. Demonizing carbs is counterproductive as it causes people to needlessly exclude nutritious foods like fruits from their diet. Yes, you will feel hungry on a low calorie diet initially. Keto will also give you the "keto flu" in the first week. Later on your body adapts to it (in both diets). The insulin release and hunger is your body's primary mechanism developed over hundreds of thousands of years. If you're advocating bypassing that in favour of something else, you better have a very good reason to do so.

[calpaterson]

I think the keto part is operative. You can lose weight on calorie restricted diets but a) to do so is pure suffering and b) the hormonal explanation of body fat accumulation (ie insulin/glucagon cycle) seems to have a lot more predictive power than the calorie accounting theory, which just seems total bunk to me.

[switch007]

Keto is the only thing that helped me lose weight through the focus on eating satiating food and not eating empty calories.

The fact you replace bland carbs and sugar with awesome-tasting things like meat, cream, cheese etc is a win and makes the diet seem quite positive.

[StacyC]

The only thing I can say about calories is that after seven years on keto and feeling great, I have never given any thought to my calorie intake.

My weight remains stable as do my energy levels, so I can only assume that (1) I am getting exactly the right amount of calories from my diet, or (2) calories are an irrelevant metric.

[s1t5]

> You can achieve the same weight loss by just eating fewer total calories, without cutting carbs as well.

Achieve weight loss - yes, achieve the same weight loss - no. If you primarily want to lose fat rather than muscle, your insulin metabolism becomes an important variable.

[abtom]

This is a popular myth. There is simply no evidence to back to this claim. On the other hand there is a lot of evidence that preserving/increasing lean mass (non fat mass) depends only on protein and not fats/carbs. Check this article which summarizes multiple studies in this area - https://www.menshealth.com/health/a25924744/keto-diet-carbs-...

[PudgePacket]

Yes yes calorie in calorie out blah blah. Most people can't maintain a caloric deficit for an extended duration. Countless studies have shown that.

The point is people who are overweight tend to lose weight when eating ad libitum on a ketogenic diet, whereas people on a standard diet generally gain weight (see western populations).

[treis]

If you cut out cookies, cake, pretzels, chips, and virtually all other junk food of course you will lose weight. IMHO, the keto folks are missing the actual cause here. You're not losing weight because you eat your burger without a bun. It's because you don't eat a pile of fries.

[tlow]

>Most people can't maintain a caloric deficit

1. Do you have an evidence or is this just an assumption based upon your perceived "feeling"? 2. Why?

[PudgePacket]

1. People on western diets. This isn't some hidden mystery.. it's in plain view. Plenty of studies done, or just ask _any_ doctor that sees patients, or any of your friends/family who have tried diets. Or search pubmed for diet adherence.

2. Because their base metabolic rate reduces over time to match their new reduced caloric intake.

[tlow]

So no evidence, you just have an unsupported opinion. Cool.

[49para]

The benefit of low carb is the reduction in your body's production of Insulin.

Insulin resistance after decades of high carb diets, regardless of the # of calories consumed, is the source of all metabolic disease.

Low carb is going to reverse this, a simple reduction in calories won't.

The low carb diet also has access to your entirety of fat stores.

Insulin resistance will result in a huge amount of insulin in your blood stream. Insulin prevents fat from being removed from your fat storage so a reduction in calories, while it does show a short term (i.e.6 week) reduction in body weight, it also reduces your BMR which is why people regain the weight lost.

Once the alpha cells in your pancrease are insulin resistant, they will be producing glucagon causing elevated blood sugar compounding the problem.

tl/dr; - Insulin resistance is the source of all metabolic disease. Reduce it via a low carb/fasting lifestyle.