[breck]

I'm 254 days into switching to a ketogenic diet (complete with at home instant ketone finger prick blood tests using the very affordable keto mojo), and can't believe I waited so long.

I was roughly surfing sugar highs for 39 years.

Would highly recommend looking into this if you are a sugar/carb addict like I was.

[medler]

My problem with keto is that most people on it eat so much saturated fat that their cholesterol goes through the roof, and that’s really bad for cardiovascular health.

(Keto communities deal with this by preaching an anti-science, cholesterol-denialist dogma, but that dogma has always been driven by wishful thinking).

[breck]

> My problem with keto is that most people on it eat so much saturated fat that their cholesterol goes through the roof

Dataset needed

[medler]

Here are a couple of studies:

https://www.med.ubc.ca/news/popular-keto-diet-may-be-linked-...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10121782/

[breck]

Ok, thanks for the links. I had time to read the first study you shared. Here is the link to the actual study: https://www.sciencedirect.com/science/article/pii/S2772963X2...

Positives:

- PDF is available!

- Nice formatting

- Very well written, very clear what they did

Negatives:

- Not an experiment. An observational study.

- If I'm reading correctly, they classified someone's diet mostly based on 1 single prior 24 hour food questionnaire. This is a bit...weak.

- The LCHF cohort has significant pre-existing conditions (which they do correct for, but their headline is about the non-corrected number)

- They define LCHF diets as being <100g of carbs a day, and define VLC diets as being <50g a day, but do NOT publish any results for the VLC cohort. Why not?

- They then do NOT publish their data!

- BUT if you dig into their supplementary tables, they DO report that VLCs have lower rates of ASCVD than LCHF.

- They have conflicts of interest: "Dr Brunham has served on advisory boards for Amgen, Novartis, HLS Therapeutics, and Ultragenyx. Dr Iatan has served on advisory boards for Novartis and HLS Therapeutics and receiving honoraria from Novartis and Sanofi. "

Anyway, I give that one a C-. Well executed, but looks like their hands are tied. I would not bet on its associations to reproduce in an experiment.

[medler]

We can pick apart studies all day long, but the link between saturated fat and cholesterol is hard to deny.

Were I you I would get my ApoB checked. If it’s low, then great! Keep doing what you’re doing! But don’t give yourself a heart attack following the latest fad diet.

[breck]

I appreciate the pointers.

I definitely do _not_ understand the first thing about cholesterol and adverse cardiovascular events.

Certainly high on my list of things to be able to model by the end of the year.

I have spent a fair amount of time in the lab (mostly dry, with a little bit of wet lab), so have good foundations, just that's an area I haven't had time to deep dive in yet.

[coldtea]

>My problem with keto is that most people on it eat so much saturated fat that their cholesterol goes through the roof

"In pricinple" or actually measured cholesterol levels? Because the latter doesn't happen.

[medler]

It doesn’t happen for everyone, but most people on a high-saturated-fat diet will see higher measured cholesterol levels. This has been established in many studies. And anecdotally, it happened to me when I was on a low-carb diet

[malux85]

Me too, about same time as you. Life-changing productivity increase and focus/deep work extension!

[chollida1]

My biggest problem with Keto is that is that one bad meal and your out.

I found it was just such a pain in the as for other as much as it was for me. Every meal at someone elses house I had to make my specific nutritional requirements available to the host, which then puts them out.

[devilbunny]

Sure, you're out of ketosis. Anyone who says you have to be in ketosis all the time for low-carb to work at weight loss is confusing medical ketogenic diets (e.g., for epilepsy) with practical ones. Medical keto diets don't have leeway because they depend on the ketone bodies as an antiepileptic drug. Weight loss keto is more about taming the cravings and getting you away from junk food.

I lost my weight over a decade ago, before "keto" was a buzzword. I've become less strict, because I know that if my weight starts going up, I don't have a problem going very-low-carb to drop it again. It's still calories in, calories out, at the end of the day - but for me, it's a very sustainable diet. I like cookies, but if you offered me the choice between a sweet dessert and another steak, I would have taken the steak even when I was a junk-guzzling fatty.

I never asked anyone to do any special stuff for me after the first few weeks. Someone serves you pasta alfredo? Eat it; one meal isn't the end of the world. Unless your social schedule is very different from most, you're not going to eat at someone else's house more than once a week, and restaurants (at least in the US) can be counted on to have a chicken Caesar salad if nothing else.

[ralferoo]

Actually, there seems to be some benefit in having a "regular" meal every now even then, perhaps even once a week - I read once that your body can adapt too well to using Ketones and you stop losing weight at the speed you did at the start (although my caveat to that is that the first time I did keto, I lost pretty consistently a bit over 0.5kg per week for about 9 months apart from a couple of 2-3 weeks plateaus).

Every time I've come off keto, I've always had the intention of staying "lowish-carb" afterwards. It never works. Your body just gets used to whatever it has, gives you cravings before you really need more food, and so you have a bit more and a bit more, and before you know it, you're a full on sugar monster again.

I also think it's worth keeping a food journal. Not even for counting calories or grams of carbs, more that the act of writing it down makes you think "did I really eat that much today?" and gives you a prompt to be more careful.

[devilbunny]

I’m not you, so I can believe it doesn’t work for you, but I don’t have trouble with ditching carbs, probably because I’m almost never a sugar monster. Just not my thing. Lucky for me, sucks for you. Appetite is complex and while I’m not one of those people who can eat junk ravenously and be thin, I don’t have that to deal with. Best wishes.

[ralferoo]

Oh, sorry, I wasn't trying to give you advice as it sounded like your result was pretty stable - was just replying for others reading to let them know that sometimes a carb break in the middle of keto actually helps, and it was meant to agree with your sentiment that you don't need to worry about the odd thing here and there.

The rest was just my experience of after I'd got to my goal weight on keto, of trying to stop keto and do something midway between keto and not keto. For me, that never works - some carbs each day, leads to more carbs, leads to lots of carbs. That was never an issue while on keto - I'd just go back to my highly restrictive diet, just that I never found re-introducing carbs easy to moderate. FWIW it's worth, I'm starting keto for the 4th time now. The first 2 times were effective, until I stopped. The third time I tried to be less restrictive than the previous two times, and I didn't really achieve any weight loss.

The "you" in that paragraph about sugar monsters was actually me, but I used the "you" form because I though it could probably generalise to whoever was reading, not specifically you in particular. Sorry for the confusion.

[devilbunny]

Your comment was appropriate and well-measured. No offense taken. I wish you well.

[cm2187]

Same thing with intermittent fasting. One deviation and the appetite comes back with a vengeance and you have to restart from scratch the process of getting used to fasting (which is the hard part, the appetite is what makes the caveman go out chase the mammoth, it's a strong force).

Experimenting with Mounjaro right now + intermittent fasting. So far so good, but only one week into it. I am hoping to use it as a guardrail in case of any accidental deviation.

[ImHereToVote]

Just be hungry dude. It's not hard. I notice I'm much more productive while I'm hungry. Also food is so much better when you have been actually hungry for a while.

[coldtea]

If you've IF for a while, you hardly have to "restart from scratch".

Except if by "one deviation" you mean a month or more going without IF...

[cm2187]

I think you are refering to weight loss. I am refering to the ability to sustain IF (i.e. the stomach to get used to it without raging for food).

[coldtea]

Never found that to be much of a problem even when starting out.

You feel a little hungry. Big deal.

[KptMarchewa]

Not from scratch. It's a setback but you don't go to start line.

[cm2187]

In term of getting your appettite used to intermittent fasting? Yes pretty much you do.

[KptMarchewa]

Not really. It takes maybe 2-3 days to go back compared to 2+ weeks initially.

[coldtea]

>My biggest problem with Keto is that is that one bad meal and your out

Until you deplete the sugar stores. So like fast 24h and you're back in.

[waynenilsen]

How much protein can you eat before getting kicked out of ketosis?

[heelix]

Carbs are what kick you out of ketosis. Protein and fats won't, but they have other issues. (Fiber can be a real challenge)

[chollida1]

why would protein kick you out of ketosis, on Keto alot of people, especially athletes load up on as much protein as they can and use fat to get the rest of their calories.

[xcskier56]

My biochem is a little rusty but basically your body can create glucose (carbs) from amino acids (proteins) in a process called gluconeogenesis. Because your body will preferentially use glucose over fat and ketones for fuel, it will prioritize this pathway and turn down/off the one that produces ketones... hence dropping you out of ketosis.

[DougWebb]

Your body doesn't prefer glucose over fat. Too much glucose is toxic, so your body will focus on reducing it first. Too little is also dangerous so your body will make some from protein if necessary. But only as much as it needs.

Fat adaptation is about shifting your hormonal balance and response to retrain your body to maintain a lower level of glucose, and to retrain your cravings and hunger.

[xcskier56]

I'm not talking at the higher organism level, I'm talking at the very low-level chemistry in mitochondria. Glucose is "easier" to produce energy out of and so that happens preferentially from a chemistry perspective. Your body also needs a minimum level of glucose to survive.

When there isn't enough glycogen, the chemical balances in the mitochondria change and the liver mitochondria will produce glucose from whatever they have. This isn't a "decision" just the relative amounts of the chemicals change leading to one chemical pathway becoming more likely compared to another. This is all mediated by the random collisions of molecules in your cells. If you have a lot less of one molecule compared to another, the frequency that molecules find each other to do one thing v/s the other will change leading to different chemical pathways becoming more or less active.

There are many routes for your body to produce glucose. It is "easier" for your body to produce it from gluconegenic amino acids (not all amino acids can be used to produce glucose) than it is from fatty acids. It's the process of converting fatty acids into glucose that generates ketones. So when you have excess amino acids that can be turned into glucose, the chemistry will prefer this pathway over breaking down fat into glucose and this will lead to lower ketone production overall and kick you out of ketosis.

(I think I've gotten the gist of this right but any biochem experts feel free to correct me)

[jddj]

I can't speak to whether or not it's true, but I heard the response to this question being that this process is quite precise, and functions specifically to meet the brain's glucose needs and nothing more.

[swiftcoder]

> on Keto alot of people, especially athletes load up on as much protein as they can

This only works because athletes tend to have pretty insane protein (and calorie!) demands.

If you as a regular, non-athlete person load up on protein (while neglecting to consume sufficient fat), your body will be forced to convert the protein into glucose, and you'll fall right out of ketosis

[KptMarchewa]

First of all, it's not a binary process.

[oarfish]

As an athlete you shouldn't avoid carbs, unless you are ok with impairing your athletic performance.

[silverquiet]

I was under the impression that the body can synthesize sugars if given enough protein.

[oarfish]

I think you can make 150g or so of glucose (?) yourself, but whether thats enough might depend on what you are doing in life i think.