Are Keto Diets Safe?

Are Keto Diets Safe?
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The effects of ketogenic diets on nutrient sufficiency, gut flora, and heart disease risk.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Given the decades of use of ketogenic diets to treat certain cases of pediatric epilepsy, a body of safety data has accumulated. Nutrient deficiencies would seem to be the obvious issue. Inadequate intake of 17 micronutrients—vitamins and minerals—has been documented in those on strict ketogenic diets.

Dieting is a particularly important time to make sure you’re meeting all your essential nutrient requirements, since you may be taking in less food. Ketogenic diets tend to be so nutritionally vacuous that one assessment estimated that to get a sufficient daily intake of all essential vitamins and minerals. you’d have to eat more than 37,000 calories a day.

That’s one of the advantages of more plant-based approaches. As the editor-in-chief of the Journal of the American Dietetic Association put it: “What could be more nutrient dense than a vegetarian diet?” Choosing a healthy diet may be easier than sticking 50 sticks of butter in your coffee.

And we’re not talking about just not reaching your daily allowances. Children have gotten scurvy on ketogenic diets, and some have even died from selenium deficiency (which can cause sudden cardiac death). The vitamin and mineral deficiencies can be solved with supplements, but what about the paucity of prebiotics, the dozens of types of fiber and resistant starches found concentrated in whole grains and beans that you’d be missing out on?

Not surprisingly, constipation is very common on keto diets, but as I reviewed before, starving our microbial self of prebiotics can have a whole array of negative consequences. Ketogenic diets have been shown to reduce the richness and diversity of our gut flora. Microbiome changes can be detected “within 24 hours” of switching to a high-fat, low-fiber diet. The lack of fiber starves our good gut bacteria, but we used to think dietary fat itself was nearly all absorbed in the small intestine. But based on studies using radioactive tracers, we now know that about 7 percent of the saturated fat in a fat-rich meal can make it down to the colon, which may result in detrimental changes in our gut microbiome, weight gain, increased leaky gut, and pro-inflammatory changes. For example, a drop in beneficial bifidobacteria and a decrease in overall short-chain fatty acid production—both of which would be expected to “increase the risk of…gastrointestinal disorders.”

Okay, but striking at the heart of the matter, what might all that saturated fat be doing to our heart? If you look at low-carbohydrate diets and all-cause mortality, those who eat lower-carb diets suffer “a significantly higher risk of all-cause mortality,” meaning they live, on average, significantly shorter lives. From a heart disease perspective, though, it matters if it’s an animal fat or plant fat. Based on the famous Harvard cohorts, eating more of an animal-based low-carb diet was associated with higher death rates from cardiovascular disease—a 50 percent higher risk of dying from a heart attack or stroke—but no such association was found for lower-carb diets based on plant sources.

And it wasn’t just from Harvard. “Low carbohydrate dietary patterns favouring animal…protein and fat, from sources such as [red meat and chicken], were associated with higher mortality; whereas those [favoring] plant protein…and fat…, [from things like] vegetables, nuts, peanut butter, and whole grain[s], were associated with lower mortality…”

Cholesterol production in the body is directly correlated to body weight.  Every pound of weight loss by nearly any means is associated with about a one-point drop in cholesterol levels in the blood. But put people on very low-carb ketogenic diets and the beneficial effect on LDL bad cholesterol is blunted or even completely neutralized. Counterbalancing changes in LDL size or HDL (what we used to think of as good cholesterol) are not considered sufficient to offset this risk. You don’t have to wait until cholesterol builds up in your arteries to have adverse effects, though. Within three hours of eating a meal high in saturated fat, you can see a significant impairment of artery function. Even with a dozen pounds of weight loss, artery function worsens on a ketogenic diet instead of getting better—which appears to be the case with low-carb diets in general.

So: bad for the gut, bad for the heart, but is it bad to the bone? We’ll find out next.

Please consider volunteering to help out on the site.

Image credit: maglara via adobe stock photos. Image has been modified.

Motion graphics by Avocado Video

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Given the decades of use of ketogenic diets to treat certain cases of pediatric epilepsy, a body of safety data has accumulated. Nutrient deficiencies would seem to be the obvious issue. Inadequate intake of 17 micronutrients—vitamins and minerals—has been documented in those on strict ketogenic diets.

Dieting is a particularly important time to make sure you’re meeting all your essential nutrient requirements, since you may be taking in less food. Ketogenic diets tend to be so nutritionally vacuous that one assessment estimated that to get a sufficient daily intake of all essential vitamins and minerals. you’d have to eat more than 37,000 calories a day.

That’s one of the advantages of more plant-based approaches. As the editor-in-chief of the Journal of the American Dietetic Association put it: “What could be more nutrient dense than a vegetarian diet?” Choosing a healthy diet may be easier than sticking 50 sticks of butter in your coffee.

And we’re not talking about just not reaching your daily allowances. Children have gotten scurvy on ketogenic diets, and some have even died from selenium deficiency (which can cause sudden cardiac death). The vitamin and mineral deficiencies can be solved with supplements, but what about the paucity of prebiotics, the dozens of types of fiber and resistant starches found concentrated in whole grains and beans that you’d be missing out on?

Not surprisingly, constipation is very common on keto diets, but as I reviewed before, starving our microbial self of prebiotics can have a whole array of negative consequences. Ketogenic diets have been shown to reduce the richness and diversity of our gut flora. Microbiome changes can be detected “within 24 hours” of switching to a high-fat, low-fiber diet. The lack of fiber starves our good gut bacteria, but we used to think dietary fat itself was nearly all absorbed in the small intestine. But based on studies using radioactive tracers, we now know that about 7 percent of the saturated fat in a fat-rich meal can make it down to the colon, which may result in detrimental changes in our gut microbiome, weight gain, increased leaky gut, and pro-inflammatory changes. For example, a drop in beneficial bifidobacteria and a decrease in overall short-chain fatty acid production—both of which would be expected to “increase the risk of…gastrointestinal disorders.”

Okay, but striking at the heart of the matter, what might all that saturated fat be doing to our heart? If you look at low-carbohydrate diets and all-cause mortality, those who eat lower-carb diets suffer “a significantly higher risk of all-cause mortality,” meaning they live, on average, significantly shorter lives. From a heart disease perspective, though, it matters if it’s an animal fat or plant fat. Based on the famous Harvard cohorts, eating more of an animal-based low-carb diet was associated with higher death rates from cardiovascular disease—a 50 percent higher risk of dying from a heart attack or stroke—but no such association was found for lower-carb diets based on plant sources.

And it wasn’t just from Harvard. “Low carbohydrate dietary patterns favouring animal…protein and fat, from sources such as [red meat and chicken], were associated with higher mortality; whereas those [favoring] plant protein…and fat…, [from things like] vegetables, nuts, peanut butter, and whole grain[s], were associated with lower mortality…”

Cholesterol production in the body is directly correlated to body weight.  Every pound of weight loss by nearly any means is associated with about a one-point drop in cholesterol levels in the blood. But put people on very low-carb ketogenic diets and the beneficial effect on LDL bad cholesterol is blunted or even completely neutralized. Counterbalancing changes in LDL size or HDL (what we used to think of as good cholesterol) are not considered sufficient to offset this risk. You don’t have to wait until cholesterol builds up in your arteries to have adverse effects, though. Within three hours of eating a meal high in saturated fat, you can see a significant impairment of artery function. Even with a dozen pounds of weight loss, artery function worsens on a ketogenic diet instead of getting better—which appears to be the case with low-carb diets in general.

So: bad for the gut, bad for the heart, but is it bad to the bone? We’ll find out next.

Please consider volunteering to help out on the site.

Image credit: maglara via adobe stock photos. Image has been modified.

Motion graphics by Avocado Video

Doctor's Note

There’s just a few videos left in my keto series. Here’s what we have so far:

And here’s what’s coming up:

The video I mentioned is Gut Dysbiosis: Starving Our Microbial Self. For more on keeping our gut bugs happy see:

What’s the best diet for our heart? Given that heart disease is the #1 killer of men and women, consider a diet centered around whole plant foods: How Not to Die from Heart Disease.

If you haven’t yet, you can subscribe to my videos for free by clicking here and to my audio podcast here (subscribe by clicking on your mobile device’s icon). 

233 responses to “Are Keto Diets Safe?

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    1. Kristen,
      I don’t know but Dr. Breseden, who works with people having cognitive issues including Alzheimer’s, recommends “mild ketosis”. Take a look at his book. Cf. the protocol at
      https://www.apoe4.info/wiki/Bredesen_Protocol

      He also has youtube presentations.

      I am continually intrigued that so many people tend to go to extremes when it is not clear to me there is any compelling reason to do so.

      1. ” am continually intrigued that so many people tend to go to extremes when it is not clear to me there is any compelling reason to do so.”

        Possibly because the classical ketogenic diet used in refractory childhood epilepsy is 75% fat (or more). Any diet with less fat is really just a low carb diet rebranded with a more modern and cooler name. Anyway, word was getting around that low carb diets seemed to be associated with higher mortality so a name change was no bad thing (for people selling low carb diets)..

        I am an admirer of Bredesen’s business acumen if nothing else.

        https://www.buzzfeednews.com/article/stephaniemlee/jordan-peterson-daughter-mikhaila-meat-carnivore-diet

          1. At least Breseden is only recommending mild ketosis.

            To counterbalance my earlier comment, I should add people interested in diet and Alzheimer’s might also check out the book by Drs. Sherzai: The Alzheimer’s Solution: A Breakthrough Program to Prevent and Reverse the Symptoms of Cognitive Decline at Every Age, which does not recommend ketosis.

            1. I like Bredesen’s list of questions more than I like his use of oil

              I like the Sherzai’s and the fact that they are working with one very-low-rate of Alzheimer’s population and one very-high-rate of Alzheimer’s population.

              The fact that groups like the Adventists and the vegan Nuns from the Nun’s study had so few cases of Alzheimer’s is comforting to me. Plus, the Finland study where lowering saturated fats lowered the rate by 90%. It seems to me that those studies point in a WFPB direction, more than a Keto direction.

              I do, however, balance that against the vegetarian and vegan group from England who had twice the rate of the meat-eaters because of Homocysteine and not getting enough Omega 3, so I highly applaud Dr. Bredesen for his very long list of questions.

              I have used it often.

              1. Deb, Me too. I read Breseden’s book and was turned off by his many supplement recommendations. He is also too confident in his theories. I am also not sure what to make of his case studies. Interesting but not conclusive.

                If it’s any comfort my homocysteine is perfectly normal, 7.4 recently ( Breseden says 6.0 is better but less than 11.0 is normal on my lab’s scale). Just have to make sure you are getting the right vits/minerals.
                I have no idea what was up with the British vegans but would not be surprised if their diet was low in folate, B12, B6 and other vitamins and minerals. Every so often I check with cronometer to see how I am doing on the vit/mineral score, but I also take Fuhrman’s multi (as does Dr. Klaper, according to one of his videos I watched). I don’t pay much attention to studies of vegans with negative results unless it is clear they were on truly healthful WFP diet covering known possible insufficiencies or deficiencies.

    2. Kristen,

      Dr. Greger has a video on controlling the APOE4 gene

      https://nutritionfacts.org/video/the-alzheimers-gene-controlling-apoe/

      “The highest frequency of ApoE4 in the world is in Nigeria, but they also have some of the lowest Alzheimer’s rates. To understand this paradox, one has to understand the role of ApoE. What does the ApoE gene do? ApoE is the principal cholesterol carrier in the brain. So, the Nigerians’ diet appeared to have trumped their genes, due to their low cholesterol levels from their low intake of animal fat, living off of mainly grains and vegetables.”

      1. Here is what the study says:

        https://www.ncbi.nlm.nih.gov/pubmed/14501024

        ApoE mediates cholesterol homeostasis in the body and is a major lipid carrier in brain. As such, its expression in the periphery and in brain changes in response to changes in cholesterol metabolism. Here, we used a transgenic mouse model of Alzheimer’s amyloidosis to examine whether the diet-induced or pharmacologically induced changes in plasma cholesterol that result in altered brain amyloidosis also affect ApoE content in liver and in brain. We found that chronic changes in total cholesterol in plasma lead to changes in ApoE mRNA levels in brain. We also found that cholesterol loading of primary glial cells increases cellular and secreted ApoE levels and that long-term treatment of astrocytes and microglia with statins leads to a decrease in the cellular and/or secreted ApoE. These observations suggest that disrupted cholesterol metabolism may increase the risk of developing AD in part due to the effect of cholesterol on brain ApoE expression.

        1. Nicely done, Deb.

          I stopped the video (the one about APOE4) at t=0:55 and read the abstract. I tried to synthesize a few points from that abstrace:

          A “hallmark” of AD is the presence of a protein in the brain called Beta Amyloid Protein
          Beta Amyloid Protein generation and clearance is regulated by cholesterol; elevated cholesterol increases Beta Amyloid Protein
          The identification of the APOE gene and its influence on cholesterol is consistent with the role for cholesterol in the development of AD (pathogenesis).

          So it appears that even though the APOE4 gene works against Nigerians in creating more lipoprotein, diet may correct sufficiently to reduce the risk.

          I’ll have to admit I’m still a little confused.

            1. I have been thinking about whether there is a mechanism for the people in the UK study to have had an increase in Hemorrhagic Stroke and low estrogen is one I came up with.

              But the UK also has such high rates of Breast Cancer and Alzheimer’s and Estrogen can be involved in those, too. Though I genuinely am confused about it because Estrogen is protective of Alzheimer’s, but that is where the oxidized cholesterol linked the topics together.

              I found a study that eating enough fruits and vegetables helped delay menopause.

              Yes, I am past that, but I just felt like I should try to understand that study better because of my own risk factors for cancer and Alzheimer’s and because I have gone vegan and probably should do the math myself to make sure I haven’t increased my risk for Hemorrhagic stroke.

              Dr. Barnard’s answer of eggs for that topic links the 3 topics, so I am trying to understand it better.

              You would think being a woman would make learning it easier, but nope.

              1. Vitamin D fortified milk delayed menopause, too.

                I was trying to figure out what the women in the UK could do if Estrogen was a factor in Alzheimer’s, Breast Cancer and Hemorrhagic stroke and I came up with eat enough fruits and vegetables and drink enough fortified plant milk to delay Menopause. Don’t eat eggs. Don’t eat sodium, which is linked to the Hemorrhagic stroke and Alzheimer’s – even though there is a study where salt is protective in the case of Breast Cancer, so I needed a specific list of foods protective against Breast Cancer, which would also be protective over the brain, and we already have soy and flaxseed and I am not sure if I forgot this about Broccoli, but Broccoli made the list.

                In one study, eating broccoli decreased levels of a type of estrogen linked to breast cancer, while increasing levels of an estrogen type that protects against breast cancer

                1. If I could figure out the types of estrogens, I could figure out if Broccoli could kill all 3 disease risks of the UK at the same time.

                  Soy, I think maybe did, too.

                  I just have to look all of them up related to types of estrogens.

                    1. Turmeric helps all 3 of them, too. That surprised me. I didn’t think it would help a Hemorrhagic stroke.

                      https://www.sciencedaily.com/releases/2008/09/080922135229.htm

                      The other thing I think I found was that I have a hypothesis that the vegans in the UK aren’t fruitarians.

                      We found that consumption of vegetables was inversely associated with the risk for cerebral infarction, and the consumption of fruits was inversely associated with the risk for intracerebral hemorrhage.

                    2. I nominate the foods which lower the risk of Hemorrhagic stroke for a topic since the vegetarian and vegan community might have fear about it, particularly in the UK.

                    3. Beans and Legumes delay menopause – so does the oily fish. If the UK women don’t eat beans and legumes or if they eat a lot of refined carbs, that could be why the fish group bested them.

                      https://www.health.harvard.edu/blog/diet-and-age-at-menopause-is-there-a-connection-2018081014468

                      Each daily serving of oily fish, beans, and other legumes that a woman ate was associated with an average 3.3-year delay in the start of menopause. And for every additional serving of refined pasta and rice a woman ate each day, menopause was on average 1.5 years earlier.

                      Researchers also found that a higher intake of two nutrients, vitamin B6 and zinc, also appeared to delay menopause — by 0.6 and 0.3 years, respectively.

      2. I would be cautious of consuming too many grains or at least be choosy. Test yourself for blood sugar levels an hour or so after consumption and you may be shocked. For example when I consume oats in the form of porridge made from water my BG gos to 116 whereas a bowl of only rice raises it to only 89. I avoid bread although for me it is not as damaging blood sugar wise as oats. My breakfats these days consist more of beans and a couple of times a week eggs

            1. Cold rice or reheated rice?

              Carbs don’t disturb my blood sugar much, but why wife is prediabetic and has a totally different response. Both oat groats and rice spike her blood sugar, but rice is worse in her case. It seems to track the intact fiber.

                1. It does appear that fiber makes a huge difference in how much insulin spikes we get. so perhaps they have already tried steel cut oats, but if not should try that. I think I’m the same video PhD. Patrick mentioned that and said one of the reason companies keep trying to to remove more and more fiber from foods is because the less fiber the higher faster the sugar the sugar impact the more addictive a food becomes. Much like cocaine.

                  End

                  1. Now that I think about it rolled oats, which are pretty heavily processed, did strongly spike my wife’s blood sugar. I am still mystified by Mark’s rice experience.

                2. Agreed. Actually early in the morning any carb strongly spikes my prediabetic wife’s blood sugar, beans included. She ‘s kept a careful record and time of day is a key variable.

                  1. Yes there is evidence that we are all more insulin resistant in the morning due to cortisol spike which may be a natural part of the waking process.
                    See book ‘breakfast the most dangerous meal of the day’

              1. Mark, I was jus listening to dr Rhonda Patrick who is an epigeneticist talk and some people have completely different insulin responses to high carb or fat, and the continuous glucose monitoring will be utilized more in the future many scientific experiments. She is awesome because she often can explain the the mechanism of something instead of just the outcome.

                End

                1. I love Dr Rhonda Patrick. She is brilliant. I have uploaded my 23/me to her gene tool and it explains why diabetes and heart disease runs through my family. Even on a WFPB diet my TC/LDL are high since menopause. My husband’s ldl 87 and eats the same diet, plus oatmeal and is fine. I love dr Greger, but wish he would take genetics into account. Poly sat (salmon and roe) are good for me. Also fasting which I do regularly is helpful. I cannot do steel cut oatmeal even with flaxseed or nuts everyday to blunt the carb spike-i would be Pre diabetic by now. Dr Peter Atia is another great person to listen to on anti aging, along w/satchin Panda and Dr Valter Longo.

                  1. Over the last 3-4 years, my 53 y.o. wife, who is very slim, athletic and generally very healthy, became pre-diabetic (A1c 6.5 but fasting glucose 82-89). She gets sharp blood glucose spikes on pretty much any kind of whole carbs, beans and most fruit including blueberries (cranberries and grapefruit are fine). She had been eating a McDougall-type, low fat, high whole-food carb diet, and it turned out that was slowly killing her with high blood sugar spikes. The problem is particularly pronounced in the mornings, which I understand is common. She switched to a more Fuhrman-type diet with much lower whole food carb, large amounts of nonstarchy veggies, and much higher fat from nuts, seeds and avocados but almost no oil (~35% of calories). This has helped her tremendously although she still has to be very careful. The problem is much more pronounced in the mornings, which I understand is common. After a higher carb meal, she controls her spikes by doing exercise after meals (high intensity intervals on an exercise bike for about 10-20 minutes, depending on the amount of starchy carb). Works like a charm (blood sugar drops to 105 or so very quickly), but you have to have the time and be very determined.

                    There is definitely a genetic component as her mother, always slim and active, had similar problems when she got older. It turned out that one of our older female friends, also slim, active and diet/lifestyle conscious, has the same problem. Might be a minority of women but perhaps it is not all that uncommon (just undetected).

            2. Littlewood, white rice is a REFINED grain, refrained grains are unhealthy. Even milled whole grains (except in the case of pasta) will raise blood sugar level. It’s best to eat whole, intact grains. Brown rice (and maybe unhealed such as red and black, even more) is actually amazing for arterial function, check out Dr. Greger’s video on it, I don’t remember the exact title so you’ll have to search for it. But it helps heart health along the same lines as oats, except uniquely, it has (going on memory) a lasting effect of a week whereas oats would have to be eaten on a daily basis.

              And eating anything will raise blood sugar, somewhat. It’s a natural part of the digestive process of food. Meanwhile, what we do know is that whole grains are correlated with better overall health and longevity–one of the healthiest things to incorporate into a diet.

              1. Oh and as for the “many Asian people have great heart disease risk figures and thrive on rice” comment, that is in one of the rice videos as well which explains that while heart disease rates were lower in Asian cultures, they drastically increased when they switched to white rice. This is going on memory, so do check out Greger’s video on rice, there’s quite a few, but they’re all worth watching.

              2. Anything that raises your blood suagr from fasting to 116 in the morning is not healthy and therefore for me Oats are not healthy compared to lower glycemic alternatives. If Oats do not do the same to you then go ahead and eat them, but have you tested yourself?.

                1. >>>Anything that raises your blood suagr from fasting to 116

                  Why do you say that?
                  116 is perfectly normal and not a high peak. My average blood sugar level is about 100 (A1c ~ 5.1) but I know many meals probably take me to 116, sometimes a but higher, but it drops quickly.

                    1. Not fasting, Mark. I said my A1c was 5.1 (sometimes 5.0), which is equivalent to a DAILY average of 100, which is quite low. My fasting is typically more like 80, perfectly fine.

                    2. I should add that I eat 3-4 cups of starchy whole grains (with kne exception) per day including 1 cup of oat groats, 1 cup of kasha, quinoa or rice (black, brown or sometimes even white), 1 cup or more of sweet potato or purple potato. But I eat all my grains cold or room temperature to increase the resistant starch. All my relevant blood markers are perfectly fine.

                    3. Mark, i was in an accident and in the hospital hadn’t eaten for almost 30 hours and they kept asking me if I was diabetic. I told them no. My fasting blood sugar was over 110. I was so hungry, and finally when I got food my blood sugar actually dropped and began to track normal. However, I do agree that insulin resistance is something we need to watch for and possibly the cause of heart disease due to increasing inflammation especially in the arteries. Although, I’m not sure I fully agree with the keto crowd that believes it has to abnormally low to be healthy. Perhaps if one has already damaged the beta cells of the pancreatitis, and is highly insulin resistant then probably. But for the normal person maybe not.

                      End

                2. Mark Littlewood, the science shows oats to be one of the healthiest foods we can eat, steel cut are the best because they’re the most intact. You’re a human and I’m a human, while there are various difference such as allergies and maybe food sensitivities, the differences are minute and wouldn’t make a healthy whole plant food unhealthy for some and healthy for others for no reason such as an allergy or a disease such as diabetes. No need to test myself when my vitals are in amazing health and I am healthier and feel better than I’ve ever been. No need to test myself for a proven healthy food. You’re coming on this science-based website trying to tell people not to eat oats because of some anecdotal claim. There’s plenty of research out there. But no one says you need to eat oats, but it is pretty ridiculous that you think advising against a food based on an anecdotal claim on the internet holds any relevance when compared to the sea of existing data. And to be totally honest, the fact that you’re still eating white rice leads me to believe you’re not really eating a WFPB diet in the first place.

                  1. And for some persecutive: Dr. Greger, one of the most well researched people on nutritional science with a background to understand the research in full, recommends we eat oats–the more intact the better as per any whole grain. He does so based on scientific evidence. You, some guy on the internet, recommend we should avoid oats and rice (even though you were referring to white rice which is a junk food) based on your claim of your personal blood sugar test. Perspective. I’m just saying.

                  2. I eat WFPB with some fish as for the white rice I normally eat brown rice but there are occasions when its white rice or nothing eg in an indian restaurant so I wanted to know how bad or not so bad white rice was, hence the experiment. As for grains I try to avoid them, certainly wheat is off my menu. I managed to download the raw China study data and did some analysis myself and have to agree with Denise Minger that wheat came up pretty bad when it came to heart disease

                    1. Well refined grains like white rice and white bread are horrible so definitely not things we should eat regularly. Eating it in a restaurant once in a while is probably fine for your overall health I would imagine not that I’m any authority on it or trying to be.

                      Regarding Denise Minger, why trust someone because they wrote a book? Anyone can write a book. Why not trust what the scientific data has to show instead? It seems foolish to throw away the actual evidence for someone’s perspective of whatever evidence or even lack thereof they’re zooming in on.

                      Studies and correlations can be very tricky things. Like someone else recently pointed out here somewhere on this site, you can literally make a study make anything look good or bad if you wanted to. You have to decipher between good science and bad and why the collective evidence is so important.

                      Whole grains are one of the healthiest things we can eat. We should all incorporate them with the exception of a specific disease or allergy. And as Dr. Greger says, more than just whole grains, he recommends whole intact grains for blood sugar.

                    2. >>white rice or nothing eg in an indian restaurant

                      I bet whole wheat roti and brown rice in my local Indian restaurant. Roti is commonly available. Ot sure about brown rice. Since roti is a flat bread, I assume it’s GI is relatively low.

                      I do not believe whole wheat per se is a factor in heart disease.

                    3. No idea. As mentioned in my other post, it’s true that there’s an association of wheat and heart disease in the China Study data as discovered and reported in 1996, but I don’t think anyone knows for sure why.

                      https://news.cornell.edu/stories/1996/03/cornell-china-study-suggests-rice-based-diet .

                      “Gates speculates that “the differing effects of wheat and rice on SHBG and insulin may be due to the difference in amylose content, a particular kind of starch.” Other researchers have found that some rice varieties have higher amylose content than wheat; some rices, on the other hand, have comparable levels.

                      “Several recent studies have shown that starches with higher amylose content slow down glucose absorption and thus reduce the insulin response of the meal,” Gates added. “Clearly, the effects of wheat or rice on insulin response must not be isolated from the important influence of other dietary and lifestyle factors such as fat and exercise. However, this study lends support to the idea that certain starches may play an important role in the development of insulin resistance and thus increase an individual’s risk for diabetes, hypertension, and coronary artery disease.”

                    4. Despite that associational study reported by the China Study researcher Gates, T. Colin Campbell, et al., I am not really concerned about intact whole wheat. No one really knows what the causal connection might be. The original researcher speculated it might be related to amylose content but also said there are many lifestyle and other factors that would need to be sorted out. I would think that if that association were significant, more would have been published about it in the peer reviewed scientific literature in the intervening 20+ years.

                      There are many crazy correlations that come up in data mining (read ‘dishing expeditions’). Indeed this is a notorious issue in the field. T.
                      Colin Campbell has emphasized, it is essential to provide plausible mechanism, not just report correlations. For laughs, take a look at these crazy correlations.

                      https://www.tylervigen.com/spurious-correlations

                      But I do stay away from bread and flour except some roti at Indian restaurants.

                    5. If ruling out some foods eg grains was to back me into such a corner that I have little choice of food then it might be wise to just eat the whole grains but I do not find this to be the case. If a food type has some bad aspects to its profile I restrict it or rule it out until someone can prove otherwise

                    6. Mark, even in group studies there are often outliers. So unless there is long term implications of not eating one particular food I can’t possibly see how that’s bad, because after all your trying to optimize your diet, not the diet of the general population.

                      End

                    7. Mark, Checking into this, I see that an article was published in 1996 based on The China Study:

                      Cornell-China study suggests rice-based diet https://news.cornell.edu/stories/1996/03/cornell-china-study-suggests-rice-based-diet

                      “A diet based on wheat foods such as pasta, bread and cereal may be contributing to this nation’s soaring rates of diabetes, obesity, high blood pressure, high cholesterol and coronary heart disease, according to a new Cornell University study.

                      On the other hand, rice-based diets, and to a lesser extent fish and green vegetables, appear to lower the level of blood values associated with the risk of these diseases. These findings, published in the January 1996 issue of the American Journal of Clinical Nutrition, come from the Cornell-China-Oxford Project on Nutrition, Health and Environment, a massive survey across the far reaches of China that investigates more diseases and dietary characteristics than any other study to date.”

                      “We found that the pattern of blood biochemistries of people in the northern part of China who eat a predominantly wheat- based diet resemble those in people with insulin resistance,” said Jeffrey Gates, who has a doctorate in health sciences and works in Cornell’s Division of Nutritional Sciences; he collaborated with T. Colin Campbell, the Cornell biochemist and director of the China project, Banoo Parpia, Cornell research associate, and Chen Junshi of the Chinese Academy of Preventive Medicine in Beijing.

                      This pattern includes higher insulin, higher triglycerides, and lower sex hormone binding globulin (a measure of insulin resistance).”

                      “The Chinese women in the south, on the other hand, eat a rice-based diet and have a pattern of blood values that would be considered low risk,”
                      Gates added.”

                      “Gates added. “Clearly, the effects of wheat or rice on insulin response must not be isolated from the important influence of other dietary and lifestyle factors such as fat and exercise. However, this study lends support to the idea that certain starches may play an important role in the development of insulin resistance and thus increase an individual’s risk for diabetes, hypertension, and coronary artery disease.”___

                      It sure looks like Minger, at the very least, did not do her homework as I doubt she referenced this published article. So there is some evidence for her claims, but she is not the one who discovered this association. Having read this and a few other of her anti-Campbell blogs, she clearly wants to present herself as doing something groundbreaking, and she has done this by knocking the very study, the researchers, and their conclusions, and in this case, she seems to have simply taken their results and presented them as her own. I cannot trust any person, especially one posing as an expert, who does not do their homework and provide proper credit.

                  3. I think he was saying they are not right for him, and was surprised to see the difference in blood sugar between eating rice and oats.

                    End

                    1. Mark, One lesson my wife learned the hard way is how inadequate the fasting blood sugar test can be. She is very slim, active, healthy, and her FBS has always been less than 90. But several years ago, she started having her A1c tested and it came back 5.6, 5.7, 6.0, i.e. now prediabetic. She had been on a high intact starch, low fat, WFP diet. She learned from daily testing that any starches, even intact ones, and most whole fruit, spike her BS above 140, but then it returns to normal fairly quickly. Mornings are particularly bad. She now restricts carbs in the am, eats a diet much higher in fat from nuts/seeds and does high intensity interval training after very carby meals, which together keep her levels normal.

                      Turns out a friend has the same problem.

                      My view is at least older people should have their A1c tested regularly.

                      On the other hand, for most people, avoiding breakfast is unnecesary.

                    2. Dr. Ford Brewer believes and is pointing to evidence that about 50% of the population is insulin resistant, if not full blown diabetic. And the insulin and the blood sugar is causing the inflammation, which leads to heart disease. Could it be the possibility that both animal fat and free sugars don’t mix. Maybe the liver has a hard time doing both operations in a timely manner. That’s been my conclusion. Dr. Brewer Also points out as did DR Greger that “vegan-low-carb “ but regular low carb did show a difference in all cause mortality.

                      End

              3. Hi tested steel cut Irish oatmeal this morning and it came in at 5.9 or 106 in mgdl which is better than the 116 for supermarket oats but still above my target of keeping breakfast blood sugar below 100. Test for yourself

                1. Mark, again, understanding and recognizing thorough studies and gaps in studies is complicated stuff. Also, you can do the research and come across a slew of cited studies all cherry picked to support a pre-decided conclusion, in fact, this happens frequently. Dr. Greger goes by the collective evidence on nutritional science and the best and latest data on nutritional science. There is no evidence to suggest that wheat or other gluten-containing grains are unhealthy except for those with specific allergies, celiacs, and possibly those with a gluten sensitivity (not from celiac disease) which isn’t really understood as in we don’t even know if there’s such a thing but there might be is my understanding.

                  The fact of the matter is, the evidence is abundant and thorough and the evidence tells us that whole grains are an incredibly healthy part of a human diet. Anyone claiming otherwise is going against the collective data. If someone feels better on one whole grain and not another then obviously they should go by how they feel. I think it’s a mistake and obsessive to pay that close of attention to blood sugar tests unless you have diabetes. Blood sugar rises are a natural part of the digestion of any food, you aren’t even describing a big spike and as pointed out, blood sugar tests themselves can be tricky. In truth it’s all very simple and common sense stuff. We don’t need to test ourselves for this and that unless we have a reason to, we just need to eat whole plant foods like we have for millennia. Places who do just that have excellent health. Obsessing over every little thing because someone who wrote a book or the internet tells us to can actually be very counterproductive to health. Worrying that much–stressing that much–is very bad for our telomeres which are the lifeline of every single cell in our body.

                  1. I am not in the least bit stressed but I am a data scientist at heart and if a few simple tests can swing the pendulum then its worth it. I am a big believer in the small incremental gains philosophy of life.
                    With regard to grains they tend to compare whole grains with non whole grains and sure whole grains will demonstrate benefits but this does not mean whole grains are optimal

                    1. Mark, there is a PLETHORA of evidence that shows the inclusion of whole grains to the diet to be optimal. Dr. Greger just spoke about this in a recent interview. I believe it was in one of his more recent live Q&A’s where someone asked if they could compensate by eating other plant foods and not incorporate whole grains, Dr. Greger explained why the incorporation of whole grains makes for an optimal diet and therefore why he recommends them as part of his daily dozen.

                      You don’t have to eat grains, you don’t even have to believe they’re important or even good for you, but to come on a science-based website and make statements that go against the collective, massive data, is of no relevance and could lead to dangerous advice and unnecessary and potentially harmful confusion.

                    2. Mark Exactly, although whole grains are better than sugars or fried donuts, but what they are compared to makes a difference. I personally like who grains and if that keeps me from eating processed crap like 95% of the population I’ll take that, but that doesn’t even mean all whole grains are equal. Saying all grains are the same, would be It’s like taking 10 people who want to run a marathon and canceling the race, and giving them all the same time because it’s all positive over someone who sat on the couch. However, we know there is a lot of variation in the population of people to perform, as well as genetic variation in people. We seen as much rice. For example some types rice has more arsenic than others. But there is nothing wrong with testing to see what the outcome is for ones self. I’m at odds that someone here would tell you not to do any self-testing. Not to make your own scientific observations, but to rely on someone else’s data. It’s been seen that just changing diet actually changes genetic expression, even in the sperm cell. Meaning what the dad eats, can signal genes to be passed on to the offspring, just like the mother.

                      End

                    3. Mark,
                      If I had realized you were a data scientist I would not have made my remarks about crazy correlations, data mining, etc. as you are obviously aware of all that. But many are not, it seems.

                    4. DArmstrong, you’ve been at odds with lots of people on this site as you’ve been pretty quick to overlook the collective evidence. You advocate eating some meat despite the scientific evidence and tried to convince other people on here why they should incorporate it. First of all, I never advised anyone not to do self-testing if they decided to, I expressed myself very clearly on that, you can go read it again if you’d like. Secondly, your comments on whole grains are alarmingly misleading… the fact that whole grains have been proven to be one of the healthiest foods a human being can include in their diet is based on mountains of evidence, not faulty science comparing oat groats to doughnuts as you imply–the science is readily available all throughout this site for anyone actually interested.

                      As per “For example some types rice has more arsenic than others” …Kind of a narrow look at it when in fact the main point is that rice is very capable of picking up arsenic, therefore the levels depend on the soil it’s grown in. There are places, such as the southern states, we should avoid getting rice grown in and places that are optimal such as the location in California which produces the least or one of the least arsenic-rich rice. And yes it’s true that some types tested especially low in arsenic such as Lundberg’s long grain brown rice so like brown jasmine presumably… going on memory on that so there’s even more detail, it’s in one of Dr. Greger’s rice videos.

                      When you post claims that go against the best collective evidence on a science-based website, you should be prepared for science-based responses and not try to accuse them of ignoring one’s own whatever and going on someone else’s data… “someone else’s” being the best available collective evidence no less. Mind you, their blood sugar concern was perfectly in a normal range. People tend to get hysteric about things they don’t need to and you yourself I remember accusing people of having a debunked eating disorder on this website so that’s interesting.

                    5. Sharryn you have to be the most militant persons on this site. To lecture his guy over and over on things that he is not even saying. To misread my comments and accuse me of doing exactly what your doing is funny.

                      End

                    6. “I agree to suggest that self testing is potentially harmful really is a poor message to send out.”

                      Re-read my post, I made very clear what and why I suggested may be more harmful than beneficial and I stand by it. It is 100% true that unnecessary worry can be very harmful to our bodies at a cellular level. I recommend you research nobel prize winner Elizabeth Blackburn’s and Elissa Epel’s groundbreaking research on telomeres. You very well may be doing your body a disservice by unnecessary testing and obsessing.

                    7. I also feel compelled to add that it’s ironic the two of you should be concerned about what you misconstrued as advisement considering the whole basis of this conversation is that you were advising people against whole grains despite the scientific data and Dr. Greger and others’ evidence-based recommendations.

                    8. Sharryn What the heck are you reading. Your wack. No one said not to eat grains for shit sake. We have been discussing the difference a couple grains make in his life. His observation was unique to him but I found it interesting. I thought you and I agreed on the fact we thought his limit for blood sugar might be to low, but you bring that up again as a point of contention. He’s eating grains, I’m eating grains- go be militant somewhere else.

                      End

                    9. gengo, Mark didn’t say he was a data scientist, he said he was a data scientist at heart. I believe that was more of a metaphor.

                    10. Mark, there is SO much on whole grains on this website. Dr. Greger isn’t going by some comparison study, he’s going by multiple studies and they are not flawed as you suggest.

                      For example: “Harvard University’s preeminent twin nutrition studies—the Nurses’ Health Study and the Health Professionals Follow-Up Study—have so far accumulated nearly three million person-years of data. A 2015 analysis found that people who eat more whole grains tend to live significantly longer lives independent of other measured dietary and lifestyle factors.”

                      Let me highlight: “INDEPENDENT OF OTHER MEASURED DIETARY AND LIFESTYLE FACTORS.” Therefore controlled.

                      Do you have any idea how huge and relevant that is?

                      Eating whole grains is also shown to reduce the risk of heart disease, type 2 diabetes, obesity, and stroke. A diet rich in them can yield the same benefits as blood pressure medication.

                      Here is that full article: https://nutritionfacts.org/topics/grains/

                      It is also one of the best forms of fiber. It is difficult to get optimal insoluble fiber without incorporating whole grains.

                      Here is a good video on the unique arterial benefits of brown rice: https://nutritionfacts.org/video/do-the-pros-of-brown-rice-outweigh-the-cons-of-arsenic/

                      Here are some of the videos on benefits of whole grains but they are mentioned in SO many videos:

                      https://nutritionfacts.org/video/gut-microbiome-strike-it-rich-with-whole-grains/

                      https://nutritionfacts.org/video/whole-grains-may-work-as-well-as-drugs/

                      Here is a video putting wheat and gluten into perspective:

                      https://nutritionfacts.org/video/gluten-free-diets-separating-the-wheat-from-the-chat/

                      Here are some of the videos on the benefits of oats:

                      https://nutritionfacts.org/video/can-oatmeal-reverse-heart-disease/

                      https://nutritionfacts.org/video/can-oatmeal-help-fatty-liver-disease/

                    11. Lol, who is Sharryn? Close, kind of, but definitely not.

                      You seem to be getting worked up at this point. Perhaps it’s you who hasn’t read the entire conversation in full, but the whole basis was suggesting that whole grains were bad for blood sugar and that people should be weary, to paraphrase. Thus, it suggests that people treat a green light food—a whole intact grain—as a yellow or potentially red light food. Also it was suggested that wheat is bad which goes against the data. It was also stated that whole grains were not a part of an optimal diet which goes against the collective data and the careful recommendations of some of the most well-researched M.D’s on nutritional science.

                      I’m not being militant–you are always so quick with extreme accusations–I’m pointing out that what he’s suggesting goes against the best available evidence and there is mountains of it. That isn’t militancy, that’s acknowledging the science. Your accusation is ridiculous as always.

                      I don’t care if someone doesn’t like whole grains or does or thinks they’re ok but not great or thinks they’re evil and horrible for you, but I do care when people state or suggest that something healthful is or may be harmful when the evidence says otherwise. That has been my only point; that is the only thing I had to say about it.

                      I am not militant on this site, you just don’t like me, you not liking someone doesn’t make them whatever it is you feel like accusing them of being. Grow up. Also, it’s you’re not your, for future reference.

                      The evidence is available, I am done here. Say whatever will make you feel better DArmstrong even if you have to say I’m a militant villain. Have fun with that.

                    12. Mark,

                      To counter the unsubstantiated claims in that video, take a look at this science-based, 2013 article on the topic.

                      https://www.sciencedirect.com/science/article/pii/S0733521013000969

                      Does wheat make us fat and sick?

                      One general and key criticism of Davis is that he does not provide peer-reviewed scientific literature to substantiate his strongly worded anti-wheat views. On this site, people generally expect to see peer-reviewed references in support of claims.

                      Generally speaking, anti-grain, anti-wheat and anti-carb people tend to conflate intact or minimally processed grains/complex carbs, on the one hand, and heavily processed grains/flours/simple sugars, on the other. Heavily processed grains, flours and simple sugars are to be avoided, as pretty much anyone paying attention knows. Intact grains are best.

                      I recognize that none of this implies that eating wheat or even any grain at all is necessary for a healthy diet (the Okinawans ate very little grain) . But I don’t think anyone is claiming that. What they are claiming is that there is no sound, scientific reason for the majority of people to pass on intact grains or just wheat, which have a number of important beneficial characteristics.

                      What I don’t understand is why you keep assailing wheat (and other grains, I guess) without any real evidence. I am open to learn new things, but I want to see the scientific evidence.

                1. All I can say is eat some oats, whatever variety you like and test your blood sugar an hour or two later and let me know the difference between fasting and post oats

                  1. Mark, I forget did you test with whole oat groats or steel cut oats? Did you also test the delta, meaning right before and right after? If you did not, your reports are uninformative (maybe you mentioned this in past posts but I forget if you did).

                    Steel cut oats seem to me to be no better than rolled oats in terms of GI.
                    Oat groats do not spike my blood sugar so at best it’s an individual issue.

                    1. To me there is a big difference between rolled oats and steel cut. Haven’t tested blood sugar with them, but I’ve can tell in how long before I get hungry again. With steel cut its usually more than double the time. That would indicate that blood sugar is dropping much slower, because it’s the drop in blood sugar that makes hungry.

                      End

                    2. Mark, I could , if I buy a tester. But I haven’t eaten rolled oats in a couple years. Carry a good a1c, and by trying to stay @100 blood sugar seems, not-to be normal, and may be too restrictive. Also, if I’m in a normal blood sugar range when I’m tested after eating, and don’t carry to much inflammation based on all my inflammatory markers are low, and my white count is around 3, I’m doing ok and think oats are a great food.

                      End

                    3. Mark, Nothing wrong with that, if your fat and if your a couch potato. In fact, skipping a couple days of food appears to be great for our bodies, but it’s not really recommended for athletes. If you are like me and weigh 152 pounds and burn 3500-5000 calories a day it’s not necessary or recommended. For me it’s hard to eat enough calories in a day of good food , with out eating junk. However, I often only eat two formal meals because of time constraints, but thanks your concern.

                      End

                    4. Perhaps it depends on the brand (size of pieces) or how it is cooked. I used Quaker brand and noticed the pieces were very tiny. Microwaving the resulted in a mushy cereal. Could have overcooked it. Think I’ll stick with oat groats.

                    5. Steel cut are better than rolled oats but still well above 100.

                      The idea surrounding Oats being healthy seems to be based on any cholesterol lowering properties they may have but I do not support the commonly held Cholesterol hypothesis at least in terms of LDL cholesterol.
                      If anyone can prove LDL is the main focus among those lipids then go along and claim the 3k dollars from the US guy, so far in the last 3 years no one has claimed it

      3. Are you saying that low serum cholesterol levels means low levels in the brain and are you saying that low levels of cholesterol in the brain are desirable

      1. Having read some years ago that the size of the gut adjusts to the amount of food it has to process, including lots of fiber. Everytime I see someone with a waist that is disproportionate to the rest of their body I think, that person must send a lot of food through their gut.

        When I see someone with a smaller waist, like you would find back during the ’40s, ’50s, or ’60s… I figure they don’t over eat.

        Like everyone else though, I’ve held on to the belief that fiber is a very good and necessary thing for good health. But lately I’ve been reading that whole body vibration causes the contents of the gut to “mix up” and the mixing actually reduces the number of different biotics in the gut microbiome but increases one particular one called Alistipe that produces short chain fatty acids like Butyrate.

        I’ve been doing this for a few weeks now and with more experience with the regimen, I’ll offer my conclusions.

        (Not sayin’ change what is working for you… just keep WBV in the back of your mind in case it becomes more mainstream and tested to show efficacy.)

      2. Dr. Gerald Davies, mediterranean keto is a solution to what? A virtual total absence of fiber? Ok… that’s good, but how is any form of keto a solution? That’s like saying taking a multi-vitamin with meals is a solution to the total absence of nutrition in a twinkie diet. Keto does not work, it’s bad for you, it doesn’t result in fat loss, it results in less fat loss, muscle loss, and even bone loss. Why not eat your fiber and be healthy, too? Just eat the diet that works, a WFPB diet.

      3. Dr. Gerald Davies, how is a Mediterranean keto diet a solution? Yeah, adding fiber in what is a virtually fiberless diet is better, but the diet still doesn’t work, haven’t you been paying attention to the science? Skip to the last video. Keto diets do not result in better health and they do not result in fat loss. They result in poor health, less fat loss, muscle loss and even the inability to build muscle no matter how hard you train, and even bone loss.

    3. Any thoughts on the recently (Oct 2019) published report by Bradley Johnson , Dalhousie U. In Canada that claims there is no issue with meat consumption and is safe and healthy?

    1. Why is it that an influential person can write a book – which may go on to create a fad diet – which later is proven to contribute to greater sickness and disease is never held accountable? You would think they would be taken to court and sued.

      1. Because it isn’t illegal to interpret inconclusive data differently.Nutritional science is not as hard a science as we like to imagine. Reversals of findings and reversals of reversals are all too common. And you can try suing, but unless you can prove to a court that there was willful and malicious deception, you have no case.

        1. Well said, Roger.

          Another consideration is the “groupie factor.” When rank and file laypersons get “turned on” by some new research promoted by a charismatic spokesman who makes claims about fantastic health benefits, it probably becomes harder to dissuade them when other data conflicts with what they have heard. The become groupie-devotees of their health-demigods.

          I recently watched some of a Dr.Axe infomercial on PBS promoting the Keto lifestyle and ground my teeth as I watched what he was advocating. Yet the cameras had no trouble catching a multitude of happy patrons nodding their heads in agreement with Dr.Axe.

          I guess I’ve become a NF.org groupie…

          1. Yes, I have seen that Dr. Axe PBS infomercial, too.

            It was Tom who told me that he isn’t a medical doctor.

            The prefix Dr. gets confusing nowadays.

  1. Recent study on keto and longevity.

    http://www.asahi.com/ajw/articles/AJ201905180024.html
    Low carb diet over a long time may shorten life, study shows.

    As compared to a more traditional high-carb Japanese diet, which increases longevity (and healthspan).
    Japanese diet and survival time: The Ohsaki Cohort 1994 Study
    https://www.researchgate.net/publication/331095595_Japanese_diet_and_survival_time_The_Ohsaki_Cohort_1994_Study

    “Conclusions: Adherence to a Japanese diet is associated with a longer survival time.”

  2. What if a person is eating ONLY meat. A very well known person and his daughter are claiming on Youtube that they have been entirely cured from various crippling and painful conditions, have lost weight and improved their mental health at the same time. Do you have any comments to make about this please. They seem to truly believe what they are saying and I wondered whether just losing a lot of body weight quickly might make people feel better and ease whatever condition they have, at first, but then as time goes on, other problems arise due to the limited diet…but I am genuinely confused when someone I highly regard makes these claims…..

        1. Making money could relieve depression. Worked for me.
          —————————————————————————–
          ‘-) ‘-) ‘-)

    1. It is possible Jordan Peterson is mentally unwell, as well as his daughter . Have you ever listened to his ramblings ? His daughter also went through six weeks of diarrhea when started all meat diet . Not everyone will survive six weeks of diarrhea .

      1. My own diet is sorted. I’ve been vegan for about 30 years but J Peterson and his daughter, people I assume to be very smart, seem to insist their health has significantly improved on this horrible meat only thing…I have no idea if they actually make money from publicising their lifestyle in this way but certainly it seems a lot of people are copying them.

        1. In my view, I don’t care how smart you think he is in other ways, his advice is dangerous. Why would you think about taking diet advice from someone like him? Plenty of Nobel prize level scientists have had very wacky ideas outside of their areas of expertise.

        2. I suspect what Jordan Peterson is experiencing is a short term relief from symptoms that were brought on by something other than meat. What the long term prognosis is for such a diet remains to be seen but my guess is that its a whole lot better than a standard western diet although I would wager not optimal. My own preference is WFPB with some wild fish and the occasional eggs but no wheat

    2. greyjaybee, internet claims are as valuable as my claim that I am a mermaid and goddess of the seven seas (a lot of you didn’t know that about me). An all meat diet is probably even WORSE for you than the horrific keto diet which at least lets you eat spinach or something once in a while.

      What you should be questioning is the reason you regard these people at all… That is a red flag if ever there was one, to DISregard a person or persons. Listen to the science, not youtube personalities no matter how much they may have moved you at any point. And listen to something even more profound than science, watch Earthlings. Their diet is the epitome of no morals or ethics. They promote holocausts and deadly disease.

      1. I didn’t pay much attention to the name until I read Mark Littlewood plainly spell it out. That is very disappointing and surprises me. He is brilliant in what he knows, PSYCHOLOGY, but clearly very stupid in regards to nutritional science. Obviously he’s clueless in every regard to animal rights as well.

        Would you go to your family doctor for a dental cavity he was unqualified to treat? No, but it wouldn’t mean he didn’t know what he was doing for what he is qualified for.

        No on is God, they can be smart at one thing and stupid at another, just take the good and leave the bad behind and that is the smartest thing we as individuals can do and the best way to become our smartest selves.

  3. I think you should also talk about the Gout risk associated with Keto diets as well. The Keto people play this off and say it diminishes over time. I did a Keto diet for a couple of weeks (I was stuck at a certain weight and couldn’t break through), and lost about 10 pounds, 8 of which has stayed off 6 months later. However, I had gout attacks during and for several months after. It’s a well established fact/risk.

    1. My brother has had so many gout episodes slouching toward Keto.

      The thing is, none of the people I know who are doing Keto actually eat diets where they would be in ketosis and he cheats with pizza – though he mostly eats the topping, he always cheats eventually on the crust.

      Meaning, he gets no benefits for his Diabetes and if the gout ever does go away, he never reaches that point.

      The gout medicine is terrifying.

      1. I recently had a gout episode on my WFP diet, my first in 3 years on a totally WFP diet. Thought they were behind me. My doc thinks it was dehydration as I exercise a lot, even in hot weather. Nevertheless I started doing the following: drinking (decafe) coffee and taking tart cherry extract as both have an anti-gout effect. Also I’ve cut back on beans/legumes even though the purines in plants are not suppose to be a factor (quite a few people claim they are for them). But none of this compares to giving up animal proteins, except that dairy also helps prevent gout flares (I pass on that). The upper bound for normal uric acid levels is typically considered to be 7.0 mg/dl for men (my lab says 8.0). I have read articles arguing this should be dropped to 6.0. The saturation point for uric acid is 6.8 mg/dl, so above that the risk of crystallization in joints goes up, and to get rid of stored crystals requires a level below 6.0, with 5.5 a better target. Some people cannot get that low without medication, very unfortunately. But what I do not understand is that most gout sufferers are underexcreters , yet the standard medicine prescribed, allopurinol (which is scary) targets overproduction. There are medicines for underexcretion (uricosuric drugs), which seem much safer. My brother also has gout and takes a uricosuric and has never had any problems, no attacks and no noticeable side effects. Cf.

        https://www.aafp.org/afp/1999/0401/p1799.html

  4. Wow Dr G , great video!! you make a very compelling case, and this is exactly why I’ve suspected the keto diet is at best a short term bandaid to get away from overly processed carbohydrates and junk foods.
    So thankful i found this organization and this site. Cheers

  5. Should have also mentioned that Ketogenic diets beget Zombies… as evidenced by the number of *successful* ketogenic diet practitioners who have posted in the commentary sections.

    Those folk are obviously Zombies who just think their health has improved by eating good fats.

      1. Deleterious effects would likely take many years to manifest.
        —————————————————————–
        Or may never manifest. ‘-)

  6. The Dr’s video points out in a perfect storm (fat only diet) how things can fearfully go wrong. However, he leaves out the part about the accompanying parts of the diet… yes he gives supplementation a quick mention but doesn’t give protein a mention at all that I remember. I guess it was assumed to be from animal consumption along with saturated fats (he forgot to mention there are unsaturated fats?)

    But what if the protein came from Hemp?… an edible protein that contains all the essential amino acids as well as omegas 3,6, and 9 essential fatty acids.

    Instead of using cases of poorly done or managed keto diets (which are probably few and far between) as fearful dangers of keto, how about some balance by including cases of “death by carbs” as well.

      1. or a new movie by Quentin Tarantino
        ————————————————-
        heh, there would have to be blood, gore, and violence… Tarantino would find a way. ‘-)

          1. He also said he wouldn’t go digital because film is “organic.” Kodak said they would keep making film stock but in much smaller amounts.

            Soderbergh said he was through making films but then has made one with a cell phone camera, and is currently making two back-to-back using the same actresses (Meryl Streep is one.)

            As we’ve seen looking at pictures of people from the 40s, 50s, and 60s… things change. ‘-)

    1. Well-managed and medically supervised keto diets may also be dangerous

      “RESULTS: The most common early-onset complication was dehydration, especially in patients who started the KD with initial fasting. Gastrointestinal disturbances, such as nausea/vomiting, diarrhea, and constipation, also were frequently noted, sometimes associated with gastritis and fat intolerance. Other early-onset complications, in order of frequency, were hypertriglyceridemia, transient hyperuricemia, hypercholesterolemia, various infectious diseases, symptomatic hypoglycemia, hypoproteinemia, hypomagnesemia, repetitive hyponatremia, low concentrations of high-density lipoprotein, lipoid pneumonia due to aspiration, hepatitis, acute pancreatitis, and persistent metabolic acidosis. Late-onset complications also included osteopenia, renal stones, cardiomyopathy, secondary hypocarnitinemia, and iron-deficiency anemia. Most early- and late-onset complications were transient and successfully managed by careful follow-up and conservative strategies. However, 22 (17.1%) patients ceased the KD because of various kinds of serious complications, and 4 (3.1%) patients died during the KD, two of sepsis, one of cardiomyopathy, and one of lipoid pneumonia.’
      https://europepmc.org/articles/PMC1198735

      17% of patients ceased the diet because of serious complications and 3% died? Doesn’t sound like the type of diet i’d want – even under medical supervison.

      1. and patients died… of sepsis
        —————————————–
        I think you misspelled sceptics… and no telling how many patients died by being scared (w)itless by anti-sepsis sceptics.

        (One wonders if some europep countries against keto don’t sacrifice a few of the cohort in order to be able to print calumnies… probably not, but you never know ‘-)

        1. lonie

          You’ve hit the nail on the head. It’s all a giant conspiracy. That’s clear to me now.

          As he who must not be named used to tell us, all the so-called evidence is ‘fake’ and ‘bogus’.

          1. You’ve hit the nail on the head. It’s all a giant conspiracy. That’s clear to me now.
            —————————————————————————————————————-
            Welcome to the enlightened side… may the Force be with you as you are now Jedi.

        1. Deb, I have a feeling Dr G purposely changed the “for” to a “to” in that last sentence when he got to the bone part. Just to test and see if any of us would pick up on it :-)

        1. Yep, and that George T. video had one of the original Rock & Roll/Blues combo stars in it, Bo Diddley! Bo never gained the popularity like many of the other R&R stars, but he sure had a unique sound with that rectangular guitar ;-)

          And yes, pool was cool back then. One had to combine strategy with skill to be good at it.

  7. Very timely and potent information, in the wake of the keto craze.
    Autophagy is however a most useful side effect of ketosis, and likely
    the most important… Useful vid the study cited from the NIH.

    1. Yes Dr Paul, and supposedly according to Dr Longo, it only takes approx 5 days or so to reach that point. They seem to have garnered positive results using the high fat vegan approach, 5 days per month, for 3 months. My question would be, are the (vegan) fats necessary for this process? What would be the advantage over water fasting for example?

      1. Barb,

        That is a good question.

        Dr Longo’s ProLon plan is mostly soup.

        Soup, olives, a few bars.

        There weren’t oils in it that I know of.

        I bought it, but I wasn’t the one who used it.

        1. I just impulse bought a new bed because of a sale and a good salesman. Charming in a geeky, orderly, overly knowledgeable, simple man type of way.

          He doesn’t get a commission and he only sells mattresses and has been selling them for 40 years. He told me that the mattresses near the front of the store were $5000 with the base, but he said these are wrong for you. Then he did a verbal Goldilocks and the 3 bears process and said, “These are too soft for you. These are too hard for you. I am going to start you off with the best for you and we can go to the ones which are close to it but cheaper in price after that.”

          He immediately understood me.

          Hoping it will help me sleep better.

          1. He genuinely brought me to the most comfortable mattress I have ever been on in my entire life and it was 50% off and it wasn’t the $5000 one.

            That makes me hopeful.

  8. I’m a newbie to Dr Greger’s book and web site and am very excited to have found it! An observation so far: he does not advocate for strict vegan per se, but my only conclusion so far is that there is really no alternative. I may be proven wrong as I get further into this.

    It’s a fact that humans are omnivores, not carnivores nor herbivores. This inclines me away from any “extreme” deviation from that fact including strict vegetarianism. Michael Pollan’s advice to eat real food, not too much, mostly plants serves me well. I’m wondering as I delve into Dr Greger’s work if my comfortable conclusions about nutrition are about to be turned upside down.

    1. abnoon,

      Dr. Greger promotes Whole Food Plant-Based. He also prefers the vegan form of that with supplementation of B12 and Omega 3.

      But watching his interview for “How Not to Diet” what I already know is that he isn’t in favor of trying to manipulate people into eating any particular way nor telling them what to eat.

      He gives studies and within that, he allows room for flexibility.

      He supports all of the Whole Food Plant-Based diets, including Dr. Fuhrman, whose diet is not vegan, but he believes vegan is better.

    2. abnoon,
      See Dr. Milton Mills Utube video, “Are Humans Designed to Eat Meat?” I can’t find it now; but he has a chart comparing omnivores, carnivores, herbivores, and humans. Very informative chart.

    3. Abnoon

      What people can eat and have eaten is not necessarily the same thing as what people should eat for healthy longevity.

      This is David Hume’s Is-Ought problem in another guise. In other words, we can’t conclude what ought to be from what is. Just because people can murder other people, it doesn’t mean that we ought to murder other people.

      it’s more productive to ask what does the evidence show about nutrition, diet and health?

    4. Abnoon, WFPB diets as recommended by Dr. Greger and others allow for a small amount of animal products (~5 – 10% max.), although less, including 0, is considered better, for various reasons. I happen to think the issue of fish eating is the most uncertain case as there are plenty of studies indicating fish can be health promoting, e. g. the mostly plant eating, long lived Okinawans eat small amounts of fish and even pork, and the fish eating Seventh Day Adventists did exceptionally well, even significantly better in some regards among women. Fish does supply DHA/EPA, which are vital and might not be obtained in adequate amounts through conversion from plant provided ALA. On the other hand, seafood is typically contaminated with various toxins including heavy metals like mercury and persistent organic compounds like dioxins, which is why Dr. Greger recommends taking an algae-based supplement and passing on fish. In any event, two servings of fatty fish per week should provide plenty of DHA. Is it worth the risks? Other animal foods have few if any apparent nutritional upsides but do have significant downsides, as Dr. Greger details in various videos and his book. They seem completely unnecessary, are environmentally damaging and needlessly increase one’s “cruelty footprint”, so why bother? But at very small levels of intake, studies cannot differentiate health outcomes between diets with 0% and 5% animal foods. No one can prove to you that you will be healthier under either scenario. (In my case, I choose not to eat any animal foods for ethical reasons, so the choice is simple.)

  9. Hi,

    I recently saw a video by Dr. Gundy in which he was quite critical on eating beans/legumes; especially tomatoes where he says they are full of unhealthy lecithens.

    I have become over the past 2 years a total convert to the vegetarian diet recommended by Dr. Grigor – -and make it a habit to eat an ample amount of beans/legumes daily.

    What can you provide that can “debunk” these comments by Dr. Gundy, as espoused in his book “Diet Evolution.

    Thx much – john

    1. John,

      Dr. Greger did do a video about that book and has done videos on Lectins.

      I have a friend who lost 50 pounds doing Gundry, but when she went for her lab results, her doctor said that she had the worst lab reports that he had ever seen and she was seriously symptomatic to the point where she is terrified that she has some mystery illness. She ended up with raging out-of-control diabetes, plus was losing her hair and a whole list of other things.

      The thing is, I got rid of all of my disease symptoms going WFPB and she gained so many disease symptoms going Gundry, but she lost more weight.

      1. Barb,

        I was thinking about you tonight.

        I made high carb Hannah’s broccoli and potato soup and when I eat potatoes, I get hungry.

        I end up snacking after dinner.

        I actually knew this already.

        I never feel full on potatoes unless they are part of a dish with beans.

        I tried it anyway because it was a broccoli dish, but I can’t eat dishes with that many potatoes.

        Kale fills me up. Potatoes make me hungry.

          1. That’s really interesting Deb! Now that you mention it, my salad ‘dinners’ and fruit desserts have me feeling full… I tried a chopped vegie salad tonight after someone recommended it in the forum a couple of days ago – excellent!

            I read post by Dr Mirkin recently that said carbs like potatoes can
            intensify cravings for sugar in some people, and to just beware. I generally eat a tomato and broth based veggie soup with lentils and kale in it.

          2. Deb,

            What exactly is a “high carb diet” when eating plants? Because plants are all high carbohydrate. They also contain varying amounts of protein and oils, and of course other minerals, vitamins, and phytonutrients, but they are basically built of carbohydrates. They have plant cell walls, containing cellulose — which is all carbohydrate. That’s what gives them their structure. As opposed to an internal skeleton, which amphibians, fish, reptiles, birds, and mammals have.

            I get very confused with some of the terminology people bat about. Especially about food.

            Could “high carb” mean “high starch?” Because starch is a storage form of carbohydrates, found in higher proportions in seeds, nuts, and root vegetables.

            1. I was trying to figure out what you were talking about, but I think I just did.

              High Carb Hannah is a YouTube site of a woman who lost a lot of weight on The Starch Solution.

              I made her broccoli “cheddar” soup, which has a pound of potatoes in the recipe.

              She eats it over rice, so I decided to try it the way she did.

              Two nights in a row, I honestly didn’t feel satiety even after eating a very big bowl full and both nights I was hungry and snacked a few hours after dinner, which I had not been doing at all.

              Last night, I ended up with sugar cravings, which I have not had at all. I don’t want to blame the potatoes, it just happens to be the first two nights I ate them corresponding with no satiety and sugar cravings.

              It was over Basmati rice, which I think is supposed to be lower Glucose Index than white rice and I have used the Basmati rice in the past with beans and I didn’t have this reaction.

              It could be a fluke, but I have eaten potatoes in the past and felt no satiety. Kale, I feel so much satiety that I can’t finish the 2 cups salad. Potatoes, I eat 7 cups worth and still feel hungry and try to not think about it thinking it will go away, but, both nights I ended up snacking 2 hours later and, last night, I ended up driving to the store and buying a non-dairy ice cream, which I don’t do. 180 calories per pint, but still. Two nights in a row, I ended up having the munchies 2 hours after not feeling satisfied at dinner.

              1. I was thinking about it and maybe the soup wasn’t hot enough.

                Soup is supposed to be okay even though it isn’t “whole” because it takes longer to eat.

              2. I like baked potatoes wait til they are cool back to room temp to eat. Sometimes add to my veg smoothie. I don’t remember ever getting “hungrier because of it. “ or cover wit with green salsa and acacado. . Not sure if it’s because it’s cool and therefore resistant starch or because I’m not paying attention. I be on the lookout for this.

    2. https://nutritionfacts.org/video/dr-gundrys-the-plant-paradox-is-wrong/

      in fact Gundry is dead wrong but, hey, sensational claims are what sells books – even if those claims are rubbish.

      “To identify protective dietary predictors amongst long-lived elderly people (N=785), the “Food Habits in Later
      Life” (FHILL) study was undertaken among five cohorts in Japan, Sweden, Greece and Australia. Between
      1988 and 1991, baseline data on food intakes were collected. There were 785 participants aged 70 and over
      that were followed up to seven years. Based on an alternative Cox Proportional Hazard model adjusted to age
      at enrolment (in 5-year intervals), gender and smoking, the legume food group showed 7-8% reduction in
      mortality hazard ratio for every 20g increase in daily intake with or without controlling for ethnicity (RR 0.92;
      95% CI 0.85-0.99 and RR 0.93; 95% CI 0.87-0.99, respectively). Other food groups were not found to be
      consistently significant in predicting survival amongst the FHILL cohorts.”
      http://apjcn.nhri.org.tw/server/APJCN/13/2/217.pdf

    3. Check out this repost of Fumbles earlier post:

      Legumes: the most important dietary predictor of survival in older people of different ethnicities

      http://apjcn.nhri.org.tw/server/APJCN/13/2/217.pdf

      “To identify protective dietary predictors amongst long-lived elderly people (N=785), the “Food Habits in Later Life” (FHILL) study was undertaken among five cohorts in Japan, Sweden, Greece and Australia. Between 1988 and 1991, baseline data on food intakes were collected. There were 785 participants aged 70 and over that were followed up to seven years. Based on an alternative Cox Proportional Hazard model adjusted to age at enrolment (in 5-year intervals), gender and smoking, the legume food group showed 7-8% reduction in mortality hazard ratio for every 20g increase in daily intake with or without controlling for ethnicity (RR 0.92; 95% CI 0.85-0.99 and RR 0.93; 95% CI 0.87-0.99, respectively). Other food groups were not found to be consistently significant in predicting survival amongst the FHILL cohorts.“

        1. Don’t really know but I’d guess not since I have to believe nutrients might not be as well absorbed, if you have real problems.

          I find some kinds of beans easier to digest, e.g., chickpeas and split pea soup. My view is, if anyone with problems should try all the various tricks to aid digestion. I have little trouble these days but did have quite a bit in the past.

          http://bostonfunctionalnutrition.com/beans-part-1-how-to-make-them-more-digestible/

          Still having trouble digesting beans?

          Have you tried all of the above and still had tummy troubles after eating beans? Try sticking with the easiest bean varieties to digest such as: black-eyed peas, adzuki, anasazi, lentils and mung beans (general rule of thumb is the sweeter the bean, the easier to digest though sweetness is a relative thing!). The most difficult beans to digest are lima beans, navy beans and soybeans.

          1. That’s good stuff Gengo, thanks. I’m always loved beans, but it seems harder to digest than Now, then when I was younger.

            Do you think as people age they don’t produce as much stomac acid or digestive enzymes? Seems likely since everything else slows as we age. End

  10. Thanks for the comments regarding this Gundry diet.

    I changed my diet two years ago from a total carnivore to vegetarian (with some fish ).
    Blood chemistry after one year….101 LDL, 78 HDL. and still improving.
    Living in Tucson AZ I can garden year round.

    I’m 65, weigh 148 and in best health in my life……and no “early death”…..ED…..here……..ha.

    Vegetarian for life…..thank you Dr Gregor.

    1. “I changed my diet two years ago from a total carnivore to vegetarian (with some fish ))
      .- – – – – –

      Fish? So you are actually a pescaterian, yes?

      1. Yes….i suppose.
        I will eat fish…salmon in restaurants where there is no vegi choice.
        So, yes call me a pesci….but frankly, im vegi most of the time.
        “Let not your heart be troubled “….I completely embrace vegetarian diet…..even vegan diet as I do think that is the best

  11. True believers will find a million reasons to ignore this information. Here are 10 ………….

    KETO CATECHISM

    Q. What does the evidence show about keto diets?
    A. I am a sceptic so I ignore the evidence (except when it supports my beliefs)

    Q. Is long term consumption of a keto diet safe?
    A. It feels safe to me. So it must be.

    Q. Keto diets are a form of low carb diet. What about the evidence showing increased mortality on low carb diets?
    A. If I call it demonisation, it is not evidence. So I ignore it.

    Q. What about the evidence?
    A. It’s not evudence if I ignore it.

    Q. What does the evidence show about keto diets?
    A If I call it ‘vilification, it is not evidence. So I ignore it.

    Q. What does the evidence show about keto diets?
    A. if I call it dogma, it is not evidence. So I ignore it.

    Q. What does the evidence show about keto diets?
    A. if I call it ‘meat defamation’, it is not evidence. So I ignore it.

    Q. What does the evidence show about keto diets?
    A. Those studies are not about real keto diets. So I ignore it.

    Q. What does the evidence show about keto diets?
    A. Thatso-called evidence is not about’Dr’So and So’s special keto diet. So I ignore it.

    Q. What does the evidence show about keto diets?
    A. those studies weren’t long enough/short enough/didn’t include MCT oil/didn’t include positive affirmations/insert quibble of your choice here

  12. Coincidentally, Dr Mirkin’s latest newsletter (15 September 2019) contains an article on keto diets, which begins ….

    ‘The various ketogenic diets that severely restrict all carbohydrates and replace them mostly with fats are associated with increased risk for non-alcoholic fatty liver disease or NAFLD (JAMA Intern Med, published online July 15, 2019). NAFLD can lead to diabetes, heart attacks, strokes, liver cancer and other cancers (Curr Opin Clin Nutr Metab Care, Jul 1, 2012;15(4):374-380). Ketogenic diets have also been associated with kidney stones, constipation, diarrhea, fatigue, headaches, bad breath, bone fractures, and an increase in LDL cholesterol that increases risk for heart disease. Ketogenic diets increase markers of cholesterol and inflammation, although they do lower triglycerides (Obesity, June 2019;27(6):971-981).

    Any diet that restricts vegetables, fruits, whole grains and beans is unhealthful because these plant foods are rich sources of soluble fiber that is converted in your intestines to short chain fatty acids (SCFAs), which lower high cholesterol, high blood pressure, and high blood sugar. A deficiency of soluble fiber markedly increases risk for an overactive immune system (inflammation) that can damage cells throughout your body.’

  13. Just curious about studies I have read about the Inuit who survive on whale blubber and the Masai who drink about a gallon of milk a day. Both people groups have none of the diseases of our Western society.

  14. Absolute crap. Keto has all nutrients and vitamins required for health. As a bonus you lose a mountain of weight. I know because I’ve walked the keto path. Sorry, no sale..

  15. Hi Michael Reilly, thanks for your comment. Any restrictive diet for prolonged period can bring about certain deficiency in body. In this video Dr Greger analyses the research on Keto diet. One has to cautious and consult dietitian for professional advice regarding being on any particular diet. I wish you good health.

  16. I heard there was a recent study that showed vegetarians/vegans are at higher risk for stroke. What do you have to say about this study, Dr. Greger? This is very concerning! Thank you!

    1. Julie, you heard there was a study? Have you actually seen said study. Lots of people say they see studies that are not actually there or the results are not even fully understood. That’s sounds suspicious. Ask them to see the study and post it here.

      End

      1. The study is very likely the one below that was making sensational headlines recently.

        https://www.bmj.com/content/366/bmj.l5397

        “Vegetarian and pescatarian diets are linked to lower risk of ischaemic heart disease, study finds But the prospective cohort study,1 carried out by University of Oxford researchers, also found that vegetarians and vegans had a higher risk of haemorrhagic and total stroke than meat eaters, which could be due to low blood levels of total cholesterol or a low intake of certain vitamins.” ——- Here’s a review that points out significant flaws in the study.

        https://www.plantbasednews.org/opinion/-do-vegans-have-higher-risk-stroke

        I think it unwise to get worried about the results if any one study, especially one where the group of interest is so small, their diet and nutrient status not well defined, and the author had to make a lot of adjustments to squeeze out a result. Note in particular (from the review):

        “In fact, vegans made up only 2.8 percent of the total participants in the study, and only 12.1 per cent of the ‘vegetarian’ group they were lumped into. This means that the results taken from this category are not representative of vegans.”,

        and from the study publication (my *****):

        “When we assessed vegetarians and vegans separately, the point estimates [risk] for vegans were lower for ischaemic heart disease and higher for total stroke than meat-eaters, but neither estimate was ****** statistically significant *****, possibly because of the small number of cases in vegans.”

        One study, possibly poor diets, not statistically significant. Relax.

  17. Julie,

    Great question. I’ll start the response by quoting from the study authors: “Vegetarians and vegans in the EPIC-Oxford cohort have lower circulating levels of several nutrients (eg, vitamin B12, vitamin D, essential amino acids, and long chain n-3 polyunsaturated fatty acids), and differences in some of these nutritional factors could contribute to the observed associations.”

    Keep in mind that we at Nutrition Facts have consistently suggested supplementation with these essential nutrients based on the science.

    The key to any diet is to maximize your optimal intake of key nutrients and find a balance for your body.

    Dr. Alan Kadish moderator for Dr. Greger http://www.Centerofhealth.com

  18. I’ve been very impressed by Dr Gregor’s work and have been on a WFPB diet for 3-4 years now but recently came across this study ….

    Vegetarian diet and all-cause mortality: Evidence from a large population-based Australian cohort – the 45 and Up Study.
    https://www.ncbi.nlm.nih.gov/pubmed/28040519

    Its central finding is that …
    “We found no evidence that following a vegetarian diet, semi-vegetarian diet or a pesco-vegetarian diet has an independent protective effect on all-cause mortality”

    I do not have a science background but the report seems quite convincing to me. I am wondering if anyone has any thoughtful criticisms of the paper and its conclusion?

  19. Hi, KCOJ! I have read through this study, but have not examined it in detail. There are many reasons a vegetarian diet might not confer a protective effect on all-cause mortality. It looks to me like this study was focused on a food frequency questionnaire which is far from the gold standard for dietary assessment, and the questionnaire asked about how often people ate various meats, if they ate them at all, but does not appear to have asked about the frequency of eating other foods. The big question is, for people not eating meats, what were they eating instead? If they were eating eggs, cheese, or vegetarian junk foods, which are rapidly increasing in availability and popularity, then of course they would not have advantages with regard to mortality. It is widely accepted that higher consumption of fruits and vegetables is generally health-promoting, but I have encountered vegetarians who don’t eat very many fruits and vegetables. I hope that helps!

  20. Hi Christine, thanks very much for your reply.

    Upon re-reading the study I think you are exactly right. In fact the authors even make a similar comment, saying…
    “A possible reason for the lack of association on mortality is that the traditional vegetarian diet is undergoing a transition in recent years as plant foods and whole grains are being replaced by soybean substitutes, refined carbohydrates with high sugar content, and highly processed snacks and fast foods which may bring dietary risk factors more in line with the ‘normal’ diet (Clarys et al., 2014). It is recognised that the vegetarian diet patterns around the world differ greatly beyond the absence of meat. The content of the vegetarian diet between EPIC-Oxford and AHS cohorts is known to differ substantially (Orlich et al., 2013; Fraser, 2009; Appleby et al., 2016). For example, the vegetarians in AHS-2 cohort consumed more fruit and vegetables, and therefore more fibre and Vitamin C, than those in the EPIC Oxford Cohort (Orlich et al., 2013).”

    I very much appreciate you pointing this out for me

  21. Perhaps the best study comparing Vegetarians to meat consumers was the Healthy Shoppers Oxford study. In this study they attempted to get around the bias surrounding the fact that Veggies have made an effort to change their diet and are therefore more diet conscious and less likely to eat other ‘poor’ quality foods. The way they did this was to recruit both cohorts from shoppers at a health food store. The results showed that although once again plant based eaters did better on heart disease, on overall mortality there was no difference between plant and meat eaters

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