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by funnymania 1980 days ago
This doesn't say much about ketogenic diets. Were these diets even high fat?
1 comments

The literal name of the study is "Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies".

It specifically found " Low-carbohydrate diets were associated with a significantly higher risk of all-cause mortality and they were not significantly associated with a risk of CVD mortality and incidence."

Perhaps you are on the "oh but the study does specifically say, "low carb, high fat" diet, so it obviously only looked at people eating low carb, low fat diets!" train? There seems to be some fantasy with the Keto crowd that these studies somehow only look at some mysterious section of the population in which eats a very low carb diet but also low fat? People don't eat a low carb diet by accident, when they do they often follow the horrible advice given by the many misguided keto diet proponents: eat low carb, high fat, medium protein.

You can find a near endless amount of longitudinal meta analysis and more focused studies that nearly universally find diets that are lowest in carbs (regardless of protein/fat ratio) produce the highest all-cause mortality.

https://www.acc.org/latest-in-cardiology/journal-scans/2019/...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555979/

https://academic.oup.com/eurheartj/article/40/34/2870/547549...

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2...

And so on...

> People don't eat a low carb diet by accident, when they do they often follow the horrible advice given by the many misguided keto diet proponents: eat low carb, high fat, medium protein.

This is not remotely my anecdotal experience. The overwhelming majority of those I know that I have dabbled with low carb ran the bunless burger, chicken wings, bacon, and steak game and I would guess that their macro intake was high protein, medium fat (if that), low carb. The textbook versions are high fat, medium protein, low carb. And seemingly pretty hard to pull off without eating a lot of stuff like salads with a cup of olive oil.

burger, bacon, steak? This is your "medium" fat diet? Ok.

Regardless the studies are quite clear. It doesn't matter the fat/protein ratio, the diets with the lowest carbs produce the highest amount of death.

This is not my diet, it is the diet I commonly observe from those going simply lo-carb or attempting "keto": hi-protein, rather than hi-fat. This directly questions the unvalidated assertion that, "People don't eat a low carb diet by accident, when they do they often follow the horrible advice given by the many misguided keto diet proponents: eat low carb, high fat, medium protein."

Hi-protein is glucogenic and thus not ketogenic, so the ratio would seem to matter. So would the resolution between an avocado and a fistful of bacon, given the safe assumption that the materials and cooking of them rate to have different impacts on human health.

This is backed by other meta-analyses such as https://www.thelancet.com/journals/lanpub/article/PIIS2468-2... :

> Both high and low percentages of carbohydrate diets were associated with increased mortality, with minimal risk observed at 50–55% carbohydrate intake. Low carbohydrate dietary patterns favouring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were associated with higher mortality, whereas those that favoured plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain breads, were associated with lower mortality, suggesting that the source of food notably modifies the association between carbohydrate intake and mortality.

Stressing that both hi carb (contra your claim) and lo carb when specifically overindexed on animal protein had higher mortality, not just lo carb.