[markstos]

Science doesn't support keto as an optimal diet for most cases, which I wouldn't call a weird stigma. The book How Not To Die is a good primer on nutrition, major diseases and longevity, and includes references to all the scientific studies references. Meat and dairy have causal or correlations with a lot of terminal diseases, which is bad news for the keto diet. Whole-food plant-based diets fare best in most scientific trials, which is fairly incompatible with keto.

Research into optimal diets for longevity also found whole-food, mostly plant-based was what folks that live the longest eat.

WFPB has also been used successfully in to address Alzheimer's and diabetes.

[toolz]

The author of that book seems to exaggerate quite heavily, often stating that there's only one proven diet that reverses heart disease, which I find completely overstating the evidence. I do think he's onto something, but he completely oversells how confident science is on plant based dieting.

Here's an interesting overview on the subject https://www.youtube.com/watch?v=Ypilw1KCq9Y

it would seem to me that Dr. Greger is simply wrong on this subject as the mediterranean diet would also appear to meet his criteria of "proven" diets and he claims only plant diets have been "proven"

[markstos]

The Mediterranean is a similar diet-- also emphasizes whole foods and mostly plants with less animal products. It's gets mentioned alongside WFPB as being good for longevity.

[cykros]

Incidentally, the Mediterranean diet also involves a lot of fat -- specifically, monounsaturated fats, which I've never heard anyone suggest ISN'T healthier than eating a large amount of animal fats, including the biggest keto proponents.

And keto does call for a moderate protein intake as well, as excess proteins are ultimately converted into glucose.

It seems there may be a bit of a straw man being built up here, based on the fact that it is very easy to tend toward an excessive meat/dairy based diet on keto, but nothing about it requires doing so.

Personally I know my reason for overdoing meats and dairy is that while I do a mostly keto-leaning diet, I'm also lifting weights, and have a higher than normal protein target for muscle growth. While vegan bodybuilders are a thing, looking at their food intake will let you know how difficult getting 150+g of protein a day from plant sources is -- there's a reason cows eat ALL day long.

Meat is the original processed protein source -- the machinery is just biological. Many of the same drawbacks as other processed foods, and many of the same conveniences.

[cmiller1]

> which I've never heard anyone suggest ISN'T healthier than eating a large amount of animal fats

I see you haven't run into the anti-seed oil nutjobs.

[blitzar]

I am an anti-seed oil nutjob - I use olive oil.

[throwawaycities]

Most “keto friendly foods” are part of the Mediterranean diet, the main difference is really a matter of cutting out foods that spike insulin and managing the marcos for ketosis. So the emphasis is on fats from the Mediterranean diets like fish, olive oils, meat, and nuts. It’s not like green vegetables (and other low glycemic vegetables) from the Mediterranean diet aren’t permitted.

[rmast]

There’s also research showing fruits (the whole thing with the fiber, not juice) can be eaten without causing an insulin spike — as in, X grams of natural sugar eaten in the form of an apple is not the same as getting those X grams as refined sugar such as a can of soda.

[throwawaycities]

Yes it’s possible to eat small amounts of certain fruits (not sure about apples specifically) and not be thrown out of ketosis. When in ketosis I tend to avoid fruit, sometimes I’ll have a small amount of blueberries in a smoothie balanced out with fats from coconut milk, almond butter and chia seeds, plus some fiber (spinach). But I even avoid high-glycemic vegetables, like carrots, when in ketosis.

Generally in calculating their carb/sugar intake people will reduce carbs/sugars by fiber, it’s not exactly scientific but probably works for the most part. I don’t even bother calculating carbs for stuff like spinach, kale, or Broccoli.

[david-gpu]

> But I even avoid high-glycemic vegetables, like carrots

Carrots have a high glycemic index, but a low glycemic load. That is, you will rapidly absorb the glucose in them, but the amount of glucose they contain in the first place is low.

Anecdotally, I've never heard anybody complaining about insulin spikes in their continuous glucose monitor from eating carrots.

[slibhb]

> Meat and dairy have causal or correlations with a lot of terminal diseases

How do studies show causation?

I imagine almost all the evidence here is observational. In general, due to that limitation, I don't think we can really draw conclusions about what foods are good/bad. With an intervention like a keto diet, at least we could potentially get some experimental data.

[markstos]

One study found that eating meat increases the workload on the kidneys within hours of consumption, while processing plant protein did not have the same effect.

https://pubmed.ncbi.nlm.nih.gov/2166857/

The book covers about 500 studies so they can't be all summarized or lumped together.

Some diets that may have short term benefits like weight loss are not good for longevity.

Those who have studied long-lived populations recommend a 95% to 100% diet based on what's worked for our oldest populations.

https://www.bluezones.com/recipes/food-guidelines/

[chlodwig]

Blue zones are probably fake -- https://marginalrevolution.com/marginalrevolution/2023/09/th...

https://www.biorxiv.org/content/10.1101/704080v2.full

[red-iron-pine]

> Supercentenarian birthdates also exhibit ‘age heaping’ distributional patterns that are strongly indicative of manufactured birth data. Finally, fewer than 15% of exhaustively validated supercentenarians are associated with either a birth certificate or a death certificate, even in populations with over 95% death certificate coverage.

> As such, these findings suggest that extreme age data are largely a result of vital statistics errors and patterns of fraud, raising serious questions about the validity of an extensive body of research based on the remarkable reported ages of populations and individuals.

huh. need to do some more validation then.

[riku_iki]

> One study found that eating meat increases the workload on the kidneys within hours of consumption

does study has conclusion that it is something bad and/or workload is too high? One can say that exercises produce methabolic stress on body, and lying on the coach does not..

[tech_ken]

Not familiar with the specific studies being discussed, but there are techniques available to infer causal relationships from observational data (generally referred to as “causal inference/statistics”). The specific method depends heavily on the question you’re trying to answer, but the general idea is to identify sources of variation in your population that are unrelated to the variables under study, and then to exploit that variable to create a situation where you’ve got a “proxy” control and treatment group. A classic example is discontinuity regression, but other methods exist.

[spacephysics]

As I understand, you’d need to know all the confounding factors to account for variations?

What about multi-variate problems? For instance many studies used red meat intake in the form of burgers from fast food as “red meat” full stop, and concluded that causes cancer. Not really paying attention to the seed oils or mountains of other ingredients in a SAD which are banned in other places yet allowed here. Not including the problems with pesticide use.

I really don’t trust meta analysis or statistical gymnastics to draw causal conclusions from nutrition studies given the wide array of factors that we really can’t account for. Genetics of the individual, environmental history (high protein with someone who has a history of kidney disease is bad vs an average person for example)

I’m more concerned over pesticides, preservatives, and even storage containers produced in the last 75 years to cause cancer and other issues than a source of food that we’ve and many others have lived off for some thousands of years. Plants and meat included.

Unfortunately there’s a mistrust in many of these institutions, but I think for good reason. They need to get their act together (see sugar industry’s collusion with scientist that asserted saturated fats cause heart disease). Not to mention the enormous p-hacking and reproducibility crisis.

[rmast]

There’s a recent twin study from Stanford where they took a bunch of identical twin, and gave one an omnivorous diet and the other a plant-based diet. Both were also supposed to follow an exercise routine. For the first several weeks they had pre-prepared healthy meals, before switching to individuals preparing their own meals with guidance/advice.

Vitals were taken and blood work was done before making the diet/lifestyle changes, and again after.

[tech_ken]

> As I understand, you’d need to know all the confounding factors to account for variations?

Not necessarily, the idea of these methods is to basically find natural ways to group your study pop such that confounders are matched 'automatically'. Regression discontinuity analysis, for example, should handle most confounders outside of some egregious edge cases. The idea there is find a continuous variable which thresholds people into receiving the treatment or not, and then limit your analysis to only individuals on 'the cusp' of falling above or below the cutoff: idea is that these are people who basically fell into or out of the treatment due to random chance, so they form a quasi-experimental population. If this assumption is satisfied, then the confounders will be handled as if treatments were assigned truly randomly (classic application of this method is college scholarships assigned based on SAT scores or GPA). It's hard to speak super generally about the efficacy of these methods, because it does hinge strongly on the particular assumptions of each method being satisfied, but I will say that as a whole they're very well attested to in the professional stats literature and have a long and respected history in ex. econometrics.

> I really don’t trust meta analysis or statistical gymnastics to draw causal conclusions from nutrition studies given the wide array of factors that we really can’t account for.

That's fair, again I can't really cosign any of the results in the world of nutrition because I have no experience with that field; just wanted to chime in with some additional context about stats methods. I will say that, if properly done, the interpretation of a causal inference technique should be pretty straight up, they're not like some black box method. For example the discontinuity regression I mentioned above is simple enough conceptually that I think it's actually pretty strong evidence, even it seems like 'gymnastics' at first glance. However you are of course free to draw whatever conclusions you like regarding the rigor of the analysis or the propriety of the methods.

> They need to get their act together

No doubt, I would actually point to causal inference methods as a very promising avenue for the field to improve in this way (if they haven't embraced them already). Generally dealing with questions of causality explicitly in your methods (IMO) makes it way harder to just p-hack your way to a conclusion; you have to actually think through the mechanism of action and how it's represented in your model.

edit: Forgot to address one question:

> What about multi-variate problems?

Methods definitely exist for this, but in general multivariate stats is just harder than single variate stuff. Seems like the example about red meat vs. seed oils is more of an omitted variable concern than what I'd usually refer to as a multivariate question, and to this I'd again point out that if a quasi-experimental method is properly employed confounders should be handled (though this presumes a bunch of assumptions are met, and ideally the analyst should apply some diagnostics to check that they are).

[dmix]

"The China Study" was very famous but also pretty notorious for selling the idea that illnesses like Cancer exploded in China after their recent economic boom in the 90s-2000s, pointing to the rise in meat consumption as the source. That's about as observational/macro of a propositon as it gets. Especially with all the other stuff like mass urbanization.

This review explains both the book and the science better than I could

https://www.redpenreviews.org/reviews/the-china-study-the-mo...

[fl0ki]

Not to mention that Hong Kong tops the list of both meat consumption and life expectancy, despite similar demographics, genetics, urbanization, and economic development to modern mainland China.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8406509/

The world gave us a free control group for the China study and people still conveniently overlook it.

[DickingAround]

Sadly, that's still very non-causal. A lot of things in China were happening at the same time. We just need to be honest that we don't have causal data and we have to make decisions on correlation data (and not try to over-claim causal testing).

[wslh]

Scientifically speaking, and only based on your assertion, you can also have the hypothesis that changing the Chinese diet has an effect on them specifically.

In Argentina people ate red meat on a daily basis and I don't think there is a strong study talking about their relationship with cancer in the 60s, 70s, 80s, 90s... I see [1] but, fingers crossed, I know only one case of colon cancer in my Argentinian circle and other cancers comparable with what I see in my US circle. The study has only 296 patients and 597 control subjects. Also the study points about the cooking style of the meat.

[1] https://www.researchgate.net/profile/Maria-Lantieri/publicat...

[stcredzero]

Science doesn't support keto as an optimal diet for most cases, which I wouldn't call a weird stigma.

In fairness, the spike in cholesterol is a legit piece of data to be concerned about. But then again, there's other data that supports the idea that the higher cholesterol is an adaptation which doesn't increase the risk of heart disease.

Something as complex as the human metabolism is going to require a higher degree of nuance. (Also works this way for climate.)

[chlodwig]

There are an infinite number of lousy and p-hacked studies showing that every single possible diet is both good and bad before.

What are the one to three highest quality, most convincing studies showing that eating unprocessed ruminant meat (ie, beef and lamb) is bad for your health?

[dham]

It's not meat and dairy; it's meat and dairy...with carbs. It's why societies that only ate saturated fat we're fine until they started eating carbs. Then they started dying off and getting diabetes.

Steak and eggs are not bad for you. Steak, eggs, toast and pancakes will kill you.

[hombre_fatal]

> It's why societies that only ate saturated fat we're fine until they started eating carbs.

Define "fine"? Calcified atheromas are even found in Inuit mummies.

If you're trying to eat a diet that's not atherogenic, you'd drop eggs and especially red meat, and you'd include carbs like beans and broccoli.

[cykros]

I don't think I've ever met someone doing a keto diet that didn't eat an obscene amount of broccoli and other brassicas. But yes, beans generally don't make the cut.

[newzisforsukas]

Anyone stating a truth like this around nutrition is over confident, if not completely disingenuous. No one has a complete picture of this.

https://scholar.google.com/scholar?cites=7789746717773890744...

[Attummm]

It must be noted that science is not a single entity, and with nutrition, different sciences will have opposing views. For example, the ketogenic diet has been used in medicinal contexts for more than a century. Longevity research is heavily focused on insulin, making ketogenic diets of interest even when used cyclically.

[rmast]

Specifically, keto was aimed at helping manage epilepsy.

[newzisforsukas]

> The book How Not To Die is a good primer on nutrition, major diseases and longevity, and includes references to all the scientific studies references

I read this book. You might want to check some of those references.

[markstos]

Any you'd like to refute?

[verticalscaler]

The folks that live the longest in your studies were all born at the beginning of the tumultuous 20th century rather than some optimal fishbowl experiment.

If, for example, one of them was visiting a market in NYC around 1924 it is unlikely that bananas were on offer. Much has changed in what we eat and how it is produced and an infinity other confounding factors.

Science does not put forth an "optimal diet" to begin with. It is unlikely there exists such a thing but rather diets carry various tradeoffs for differing populations.

[fl0ki]

I would really appreciate if people would stop referencing this book as evidence for anything. If it was written as a literature review paper and subjected to peer review, it would have been torn to shreds, not published and endorsed by a scientific journal. (Even by the infamous standards of an industry neck-deep in replication crisis)

https://www.healthline.com/nutrition/how-not-to-die-review

https://thehealthsciencesacademy.org/book-reviews/how-not-to...

Meanwhile, what do actually peer-reviewed studies say:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8881926/

https://www.adelaide.edu.au/newsroom/news/list/2022/02/22/me...

There seem to be people out there who managed to make plant-based diets work for them, but it took more than reading a single book, and it takes a lot of maintenance and monitoring to sustain. That gets more and more difficult in advanced age, as nutritional needs naturally change, including changes to the the absorption, metabolism, and even transport of the raw nutrients we do eat.

Even steelmanning the cardiovascular case: The population base rates of depression, anxiety, and obesity are far greater than cardiovascular disease. It is ignorant at best and irresponsible at worst to encourage people to optimize for reducing their already slim chances of cardiovascular issues while increasing their already high chances of several other issues.

Even that doesn't hold, of course, because obesity also increases the risk of cardiovascular issues anyway.

I'm going to stop short of accusing plant-based diets of being a scam or a conspiracy, but I do believe they are somewhere in the space of bad science and poor reasoning, even in the most well-trodden easily-avoidable ones like the base rate fallacy.

[rmast]

That adelaide article claims that meat was a staple pre-agriculture, but doesn’t do much to back it up.

Studies of feces appear to indicate plant consumption was high. There’s also one I came across on Neanderthal diet 50k years ago that suggests they ate more plant stuff than previously thought. https://www.researchgate.net/publication/329486931_Dietary_f... https://link.springer.com/chapter/10.1007/978-1-4684-2481-2_...

This one says meat was an important component, but that fiber (only from plants) consumption was much higher than it is now. https://socialsci.libretexts.org/Bookshelves/Anthropology/Bi...

[rmast]

If you don’t like what the research says, then comment so we can have a discussion rather than downvoting because it goes against your mental image of Neanderthals.

[riku_iki]

> The book How Not To Die

did that book receive any kind of proofreading itself?.. Many pop-science authors manipulate studies results to push narrative.

[abathur]

I'm not sure it's intrinsically bad news for the diet (but I won't dispute that it's a challenge for how it's usually followed). I haven't met one, but I've at least heard that there are vegans following ketosis-inducing diets.

[markstos]

I've been at meals where common ground is attempted... you end up with things like cauliflower mashed potatoes. Yes, there's technically some overlap, but people on low-fat WFPB diets often have good short and long term results so there's not an incentive to keto-ize it.

For example, I just ran 4 marathons in 5 weeks in my late 40s eating mostly WFPB. That's good-enough health for me.

[throwawaycities]

I’ve personally done both vegetarian and vegan keto diets (a couple months each).

From my normal keto diet it basically meant I stopped eating eggs/bacon and meat. Vegetarian was easier than vegan because I could still eat eggs.

Ketosis definitely can be achieved with “whole food diets” and “whole food plant based diets”

[jjtheblunt]

What is meant by “whole” when used in “whole food”?

[genezeta]

From the dictionary: "food that has not had any of its natural features taken away or any artificial substances added".

That would mean unprocessed food: fresh fruits and vegetables, whole grains (such as oats, brown rice and barley), nuts, beans, fish, shellfish and eggs.

[markstos]

In this context, it doesn't mean "no processing" but more like "nothing good removed, nothing bad added".

Unlike veganism, which has yes/no test of "does it contain animal products", with WFPB there's more a spectrum as you move from "no processing" to "minimal processing" to more processing.

And the science supports getting nearly all the benefits by being mostly compliant, even if you don't eat 100% whole-foods or 100% plant-based.

People still have 5% or so processed foods are still having very good results.

[bondarchuk]

It's what you'd call just "normal food" in the rest of the world.

[kwhitefoot]

> the rest of the world.

Much of the rest of the world but not all.

The UK is following the US in pursuit of a diet consisting entirely of ultra-processed 'food'.

"Ultra-processed foods account for 56.8% of total energy intake and 64.7% of total free sugars in the UK diet. Free sugars represent 12.4% of total energy intake, and 61.3% of the sample exceeded the recommended limit of 10% energy from free sugars. This percentage was higher among children (74.9%) and adolescents (82.9%). Prevalence of excessive free sugar intake increased linearly across quintiles of ultra-processed food consumption for all age groups, except among the elderly. Eliminating ultra-processed foods could potentially reduce the prevalence of excessive free sugar intake by 47%."

https://bmjopen.bmj.com/content/9/10/e027546

[riehwvfbk]

Leaving the whole contents of your wallet at the grocery store rather than partial.

[markstos]

Ah yes, the "beans and rice are more expensive than beef" argument.

[abduhl]

Are beans and rice more "whole" than beef? Is beef not a "whole food"?

[rmast]

Beans and brown rice would be… unless you’re eating the whole cow. But actually, it’s surprising how many things like preservatives get added to things like ground beef.

[abduhl]

Sorry but this is a ludicrous statement. Beans and brown rice are more "whole" than beef unless you're eating the whole cow? You're not eating the whole bean plant or rice plant. Even looking at brown rice or beans off the plant, with brown rice you are still removing the husk and with beans you are removing the pod.

[riehwvfbk]

It's a joke. It went whoosh.

[rmast]

Basically leave out things like added oils and refined ingredients (sugar).

[klyrs]

Am I allowed to peel my orange?

... sounds like a smartass question; that's probably not where the line is drawn.

Here's a website that describes something they call a whole-food diet: https://www.verywellfit.com/what-is-a-whole-foods-diet-22419...

[bregma]

Maybe as in "I can't believe I ate the whole thing"?