Does a Ketogenic Diet Help Diabetes or Make It Worse?

Does a Ketogenic Diet Help Diabetes or Make It Worse?
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Keto diets put to the test for diabetes reversal.

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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.

Ketogenic diets can certainly lower blood sugars, better than conventional diets—so much so, there is a keto product company that claims ketogenic diets can “reverse” diabetes. But they are confusing the symptom—high blood sugars—with the disease, which is carbohydrate intolerance. People with diabetes can’t properly handle carbohydrates, and this manifests as high blood sugars. Sure, if you stick to eating mostly fat, your blood sugars will stay low, but you may be actually making the underlying disease worse, at the same time.

We’ve known for nearly a century that if you put people on a ketogenic diet, their carbohydrate intolerance can skyrocket—within just two days. Here’s the blood sugar response of someone eating sugar after two days eating a high-carb diet. Here’s exposure to the same amount of sugar after a high-fat diet for two days. Their intolerance to carbohydrates skyrocketed on a high-fat diet.

One week on an 80 percent fat diet, and you can quintuple your blood sugar spike in reaction to the same carb load, compared to a week on a low-fat diet. Even a single day of excessive dietary fat intake can do it. If you’re going in for a diabetes test, having a fatty dinner the night before can adversely affect your results. One meal high in saturated fat can make the cause of diabetes—carbohydrate intolerance—worse within four hours.

Now, with enough weight loss by any means—whether from cholera or bariatric surgery—type 2 diabetes can be reversed. But a keto diet for diabetes may not just be papering over the cracks, but actively throwing fuel on the fire.

I’ve been trying to think of a good metaphor. It’s easy to come up with things that just treat the symptoms without helping the underlying disease, like giving someone with pneumonia aspirin for their fever, instead of antibiotics. But a keto diet for diabetes is worse than that, because it may treat the symptoms while actively worsening the disease. So maybe it’s more like curing the fever by throwing that pneumonia patient out into a snow bank. Or maybe “curing” your amputated finger by amputating your hand. No more unsightly finger stub! One of the co-founders of masteringdiabetes.org suggested it’s like a CEO that makes their bad bottom line look better by just borrowing tons of new cash. The outward numbers look better, but on the inside, the company is just digging itself into a bigger hole.

Remember “The Club”? Maybe I just watched too much late-night TV growing up, but it’s a car anti-theft device that attaches to your steering wheel and locks it in place, so the steering column can only turn a few inches. Imagine you’re in a car at the top of a hill with the steering wheel locked. Then the car starts rolling down the hill. What do you do? Oh, did I mention there’s also something stuck under your brake pedal too? The keto-diet-equivalent-response to this situation is who cares if you’re barreling down into traffic with no brakes and a locked steering wheel. Just stick to really straight deserted roads without any stop signs or traffic lights. If you do that, problem solved! Yeah, the longer you go, the more speed you’ll pick up, and so if you should hit a dietary bump in the road, or start to veer off the path, the consequences could get more and more disastrous with time. But if you stick to the keto straight and narrow, you’ll be A-OK. In contrast, the non-keto response would be to just unlock the steering wheel and dislodge whatever’s under your brake. In other words, fix the underlying problem, instead of just whistling past (and then into) the graveyard.

The reason keto proponents claim they can “reverse” diabetes is that they can successfully wean type 2 diabetics off their insulin. That’s like faith healing someone out of the need for a wheelchair by making them lie in bed the rest of their life. No need for a wheelchair if you never move. Their carbohydrate intolerance isn’t gone; their diabetes isn’t gone. It could be as bad or even worse. Type 2 diabetes is reversed when you can wean people off insulin eating a normal diet like everyone else—then and only then do you not have diabetes anymore. A true diabetes reversal diet is practically the opposite of a ketogenic diet;  diabetics off their insulin within a matter of weeks, eating more than 300 grams of carbs a day.

The irony doesn’t stop there. One of the reasons diabetics suffer such nerve and artery damage is due to an inflammatory metabolic toxin known as methylglyoxal that forms at high blood sugar levels. Methylglyoxal is the most potent creator of advanced glycation end products, so-called AGEs, which are implicated in degenerative disease from Alzheimer’s disease and cataracts to kidney disease and strokes. You get AGEs in your body from two sources: eating them preformed in your diet, or making them internally from methylglyoxal if you have high blood sugar levels. On a keto diet, one would expect high exposure to the preformed AGEs, since they’re found concentrated in animal-derived foods high in fat and protein. But we would expect less internal new formation due to presumably low levels of methylglyoxal, given lower blood sugars not eating carbs. Dartmouth researchers were surprised to find more methylglyoxal, though. A few weeks on the Atkins diet led to a significant increase in methylglyoxal levels, and those in active ketosis did even worse—doubling the level of this glycotoxin in their bloodstream. It turns out high sugars may not be the only way to create this toxin.

One of the ketones you make on a ketogenic diet is acetone (known for its starring role in nail polish remover). Acetone does more than just make keto dieters fail breathalyzer tests and develop what’s been described as “rotten apple breath.” Acetone can oxidize in the blood to acetol, which may be a precursor for methylglyoxal. That may be why keto dieters can end up with levels of this glycotoxin as high as those with out-of-control diabetes, which can cause the nerve damage and blood vessel damage you see in diabetics. That’s another way keto dieters can end up with a heart attack. So, the irony of treating diabetes with a ketogenic diet may extend beyond just making the underlying diabetes worse, but by mimicking some of the disease’s dire consequences.

Please consider volunteering to help out on the site.

Image credit: Quinn Dombrowski via flickr. 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.

Ketogenic diets can certainly lower blood sugars, better than conventional diets—so much so, there is a keto product company that claims ketogenic diets can “reverse” diabetes. But they are confusing the symptom—high blood sugars—with the disease, which is carbohydrate intolerance. People with diabetes can’t properly handle carbohydrates, and this manifests as high blood sugars. Sure, if you stick to eating mostly fat, your blood sugars will stay low, but you may be actually making the underlying disease worse, at the same time.

We’ve known for nearly a century that if you put people on a ketogenic diet, their carbohydrate intolerance can skyrocket—within just two days. Here’s the blood sugar response of someone eating sugar after two days eating a high-carb diet. Here’s exposure to the same amount of sugar after a high-fat diet for two days. Their intolerance to carbohydrates skyrocketed on a high-fat diet.

One week on an 80 percent fat diet, and you can quintuple your blood sugar spike in reaction to the same carb load, compared to a week on a low-fat diet. Even a single day of excessive dietary fat intake can do it. If you’re going in for a diabetes test, having a fatty dinner the night before can adversely affect your results. One meal high in saturated fat can make the cause of diabetes—carbohydrate intolerance—worse within four hours.

Now, with enough weight loss by any means—whether from cholera or bariatric surgery—type 2 diabetes can be reversed. But a keto diet for diabetes may not just be papering over the cracks, but actively throwing fuel on the fire.

I’ve been trying to think of a good metaphor. It’s easy to come up with things that just treat the symptoms without helping the underlying disease, like giving someone with pneumonia aspirin for their fever, instead of antibiotics. But a keto diet for diabetes is worse than that, because it may treat the symptoms while actively worsening the disease. So maybe it’s more like curing the fever by throwing that pneumonia patient out into a snow bank. Or maybe “curing” your amputated finger by amputating your hand. No more unsightly finger stub! One of the co-founders of masteringdiabetes.org suggested it’s like a CEO that makes their bad bottom line look better by just borrowing tons of new cash. The outward numbers look better, but on the inside, the company is just digging itself into a bigger hole.

Remember “The Club”? Maybe I just watched too much late-night TV growing up, but it’s a car anti-theft device that attaches to your steering wheel and locks it in place, so the steering column can only turn a few inches. Imagine you’re in a car at the top of a hill with the steering wheel locked. Then the car starts rolling down the hill. What do you do? Oh, did I mention there’s also something stuck under your brake pedal too? The keto-diet-equivalent-response to this situation is who cares if you’re barreling down into traffic with no brakes and a locked steering wheel. Just stick to really straight deserted roads without any stop signs or traffic lights. If you do that, problem solved! Yeah, the longer you go, the more speed you’ll pick up, and so if you should hit a dietary bump in the road, or start to veer off the path, the consequences could get more and more disastrous with time. But if you stick to the keto straight and narrow, you’ll be A-OK. In contrast, the non-keto response would be to just unlock the steering wheel and dislodge whatever’s under your brake. In other words, fix the underlying problem, instead of just whistling past (and then into) the graveyard.

The reason keto proponents claim they can “reverse” diabetes is that they can successfully wean type 2 diabetics off their insulin. That’s like faith healing someone out of the need for a wheelchair by making them lie in bed the rest of their life. No need for a wheelchair if you never move. Their carbohydrate intolerance isn’t gone; their diabetes isn’t gone. It could be as bad or even worse. Type 2 diabetes is reversed when you can wean people off insulin eating a normal diet like everyone else—then and only then do you not have diabetes anymore. A true diabetes reversal diet is practically the opposite of a ketogenic diet;  diabetics off their insulin within a matter of weeks, eating more than 300 grams of carbs a day.

The irony doesn’t stop there. One of the reasons diabetics suffer such nerve and artery damage is due to an inflammatory metabolic toxin known as methylglyoxal that forms at high blood sugar levels. Methylglyoxal is the most potent creator of advanced glycation end products, so-called AGEs, which are implicated in degenerative disease from Alzheimer’s disease and cataracts to kidney disease and strokes. You get AGEs in your body from two sources: eating them preformed in your diet, or making them internally from methylglyoxal if you have high blood sugar levels. On a keto diet, one would expect high exposure to the preformed AGEs, since they’re found concentrated in animal-derived foods high in fat and protein. But we would expect less internal new formation due to presumably low levels of methylglyoxal, given lower blood sugars not eating carbs. Dartmouth researchers were surprised to find more methylglyoxal, though. A few weeks on the Atkins diet led to a significant increase in methylglyoxal levels, and those in active ketosis did even worse—doubling the level of this glycotoxin in their bloodstream. It turns out high sugars may not be the only way to create this toxin.

One of the ketones you make on a ketogenic diet is acetone (known for its starring role in nail polish remover). Acetone does more than just make keto dieters fail breathalyzer tests and develop what’s been described as “rotten apple breath.” Acetone can oxidize in the blood to acetol, which may be a precursor for methylglyoxal. That may be why keto dieters can end up with levels of this glycotoxin as high as those with out-of-control diabetes, which can cause the nerve damage and blood vessel damage you see in diabetics. That’s another way keto dieters can end up with a heart attack. So, the irony of treating diabetes with a ketogenic diet may extend beyond just making the underlying diabetes worse, but by mimicking some of the disease’s dire consequences.

Please consider volunteering to help out on the site.

Image credit: Quinn Dombrowski via flickr. Image has been modified.

Motion graphics by Avocado Video

142 responses to “Does a Ketogenic Diet Help Diabetes or Make It Worse?

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    1. Here’s a recipe website and youtube channel where the woman makes only WFPB recipes for her and her family: https://plantbasedcookingshow.com

      This website is all vegan but not all WFPB, but some of their recipes are. This alfredo sauce is one of my favorites and one kids would probably love: https://thevegan8.com/vegan-garlic-alfredo-sauce/

      And nutritional yeast will probably be a helpful tool. I highly recommend trying Sari brand nutritional yeast, the taste far surpasses any other I’ve tried and they test their products carefully and have transparency. I can’t do fortified nutritional yeast anymore because I notice the vitamin-y taste, it just doesn’t compare, I’ve been spoiled.

      This is a really good mac n cheese recipe promised to be loved by kids, I personally liked it a lot: https://www.veggieinspired.com/butternut-mac/

      1. Chickpea croutons might be a helpful way to incorporate beans into kids’ diets. They’re so good on their own and taste just like croutons in salads and soups. The recipe I use is from a really good website I can’t think of off the top of my head, but it’s a cup of soaked and drained chickpeas from dry, then toss with juice from half a lemon, going on memory 1 or 1 and a half tsp onion powder, 1 or 1 and a half tsp garlic powder and 1/4th tsp salt which you can omit if you’d like. Then bake until they get hard, I eye ball it so I don’t remember the exact reccomended time and the reccomended temp is 400 degrees fahrenheit or something around that, I’d have to look.

    2. I have been on Quora again trying to spread the word, acting like an expert cause I am a Gregeralyte.So I answered a question about type 1 diabetes with this video and some of my own thoughts.

      https://www.quora.com/How-does-a-paleo-diet-or-ketogenic-work-best-for-type-1-diabetes

      ANd a guy comments to me about how he had been on keto for 20 years with no ill affects. He says this:

      My experience does not bear this out. I’m 20 years keto to control Type I, HbA1c 8%, triple the risk of diabetic complications

      So as I move forward to try and learn more about type 1, I thought I would put this up in case it merits it’s own video and maybe educates someone like me.

      1. I messed up the paste from before

        My experience does not bear this out. I’m 20 years keto to control Type I, HbA1c 8%, triple the risk of diabetic complications

        1. I concur. I’m a 22 year type 1 diabetic and for past 2 years ,keto has reduced my insulin requirements by 25%.
          This hypothesis should be directed at type 2 only. This can be cured through diet. I understand the reasoning but when the pancreas has no function, controlling insulin intake is a good thing.

  1. There is a new idea to take NMN for longevity. Google it. I know generally Dr. Greger recommends whole foods, but Dr. David Sinclair wrotes about it in his new book on longevity. Does anyone have any information?

    1. Y,

      What is NMN?

      Also, I try to avoid supplements; the industry is completely unregulated. The supplements may contain more, less, or none of the compound listed on the label; they may be contaminated by other materials, including mold and heavy metals; and they may be adulterated by actual drugs, which are of course not listed in the ingredients. They are never required to show that they are either safe or effective.

      For some reason, many people think that the FDA regulates them, but that’s mostly untrue. The FDA may act, slowly and lethargically, after enough adverse events pile up — if they ever learn about them, because there’s no requirement to track them. But basically, as far as supplements are concerned, it’s Buyers Beware.

      I’ve never understood how folks leery of drugs manufactured by pharmaceutical companies (which ARE regulated by the FDA) will happily gulp down supplements prepared by who knows — Joe in his basement or garage? Best to try to avoid them both.

      1. “Dr. J”:

        You are incorrect regarding your position on supplements, and have stated some very false information. They are NOT ‘completely unregulated’, and NOT “never required to show they are safe and effective”. This PDF is a pretty good explanation of how supplements ARE regulated:

        http://images.info.newhope360.com/Web/NewHopeNaturalMedia/%7B8ed70d92-afc2-45cc-9fae-22be6b39564c%7D_NH360_Supplement_Quality_Safety_Guide.pdf

        It is true there are some questionable companies out there, and one must be diligent when researching and buying supplements, but at the same time, there are a good number of reputable companies that manufacture high-quality supplements – supplements that have saved lives; given someone a better quality of life, and/or naturally help people to live better/longer. I speak from personal experience, and I know many other people who have benefited immensely from taking supplements.

        To blatantly categorize all supplements as bad and unsafe is irresponsible wording.

        1. BChristine,

          My comments are correct.

          The fact that SOME supplements do contain what they state, are not contaminated, and are not adulterated, in no way negates my comments that the supplement industry is unregulated.

          In fact, you supported my conclusion, which is Buyers Beware, when you wrote: “one must be diligent when researching and buying supplements.” Perhaps you could provide advice as to how to diligently research and buy supplements, should one choose to do so. How do you know that you are getting what you think you are? How do you know that it’s safe and effective? How do you know that supplements have “saved lives; given someone a better quality of life, and/or naturally help people to live better/longer?” I’m not interested in testimonials, or anecdotes (“it worked for me!”) (to which I respond: maybe. How do you know?) but actual evidence, in the form of studies.

          Finally, I prefaced my comments by saying that I try to avoid supplements, and provided the reasons why. My information is not false. But yours may be. However, I shall keep an open mind, and wait for you to provide me with the evidence to support your position.

          1. As a follow-up to my comments:

            “FDA regulates dietary supplements under a different set of regulations than those covering “conventional” foods and drug products. Under the Dietary Supplement Health and Education Act of 1994 (DSHEA):

            Manufacturers and distributors of dietary supplements and dietary ingredients are prohibited from marketing products that are adulterated or misbranded. That means that these FIRMS are responsible for evaluating the safety and labeling of their products before marketing to ensure that they meet all the requirements of DSHEA and FDA regulations. [No data needs to be submitted to the FDA for evaluation; the companies determine for themselves that their products are safe and properly labeled.]

            FDA is responsible for taking action against any adulterated or misbranded dietary supplement product AFTER it reaches the market.” [So action may be taken AFTER patients are harmed]. [caps added]
            (https://www.fda.gov/food/dietary-supplements)

            Also:

            “Unlike drugs, supplements are not intended to treat, diagnose, prevent, or cure diseases. That means supplements should not make claims, such as “reduces pain” or “treats heart disease.” Claims like these can only legitimately be made for drugs, not dietary supplements.

            Dietary supplements include such ingredients as vitamins, minerals, herbs, amino acids, and enzymes. Dietary supplements are marketed in forms such as tablets, capsules, softgels, gelcaps, powders, and liquids.

            Under existing law, including the Dietary Supplement Health and Education Act passed by Congress in 1994, the FDA can take action to remove products from the market, but the agency must first establish that such products are adulterated (e.g., that the product is unsafe) or misbranded (e.g., that the labeling is false or misleading).” [Generally, patients are harmed by supplements before the FDA is alerted to the problem. And any harm can take a while to develop, similar to the harm from the ketogenic diet as described in this video, and in preceding videos, making it difficult to establish the cause of the harm. Meanwhile, it takes a while to establish adulteration or misbranding (is contamination included here?), and so more patients can be harmed.]
            (https://www.fda.gov/food/dietary-supplements/dietary-supplement-products-ingredients)

          2. Dr. J, It is my understanding that one needs to be diligent when researching anything that will go in the body, including food, hence this website. I’m especially careful when it comes to pharmaceuticals which, as you know, are highly regulated. Many of these kill thousands of patients annually even when prescribed and taken correctly. Can you make the same claim about nutritional supplements?

          3. Simply utilize a resource such as ConsumerLab.com to make sure your supplements are accurately labeled and non-toxic. They regularly test supplements for authenticity/toxicity and give them pass/fail ratings. Yes it requires a membership ($30/year I believe), but that’s pennies compared to the peace of mind you’ll get.

            Compared to generic drugs (see the new book “Bottle of Lies”) I feel safer taking certain supplements that have been tested by ConsumerLab than I do many generic meds.

          4. Simply use a service such as ConsumerLab.com which tests supplements for labeling accuracy and contaminants, then publishes pass/fail. Yes it’s a $30 yearly membership, but worth every penny to me.

            As far as the illusion of “FDA approved” drug safety, see the brand new bestselling book “Bottle of Lies” by investigative reporter Katherine Eban:

            https://www.amazon.com/Bottle-Lies-Inside-Story-Generic/dp/0062338781/ref=sr_1_1?keywords=bottle+of+lies&qid=1569104023&sr=8-1

            I’m far more confident taking certain consumerlab-tested supplements than I am taking a generic med made in India where the FDA has *zero* authority and has to give drug manufacturers an 8 week heads up before they do an inspection.

    2. We have a regular poster here, Lonie, who is very enthusiastic about Sinclair’s work. He may have some information for you if he hasn’t already dropped out to work on a film script, as he recently indicated he intended..

      I would only say that Sinclair is already a multimillionaire from his previous ‘astounding’ anti-aging discoveries and has set up companies to commercialise and manufacture NMN products. As he did with his previous discoveries. Unfortunately, those previous astounding anti-aging discoveries do not appear to have lived up to their promise or the hype that accompanied them. It is apparently well-known among researchers that results in animal trials (rats etc) are often not replicated in humans. That is the risk here with NMN.

      In the meantime, though, Sinclair is enthusiastically talking up the promise of his new research. I have no doubt that he will again profit handsomely from it but whether an effective anti-aging medicine/supplement will result this time is much less certain.

      1. He may have some information for you if he hasn’t already dropped out to work on a film script, as he recently indicated he intended..
        —————————————————————————————————–
        Hi Tom

        Yes, still in the incubation stage. Thought I would skim through the posts before they get too numerous and time consuming.
        __________________________________________________________________________________________
        It is apparently well-known among researchers that results in animal trials (rats etc) are often not replicated in humans. That is the risk here with NMN.
        —————————————————————————————————————————————————–
        Actually, NMN does much of what NR (nicotinamide riboside) does and it has been around for quite a few years now. And yes, I have been taking it for lo these many years. NMN however is cheaper and the version I take of that, sublingual tablet, all gets into the bloodstream while the NR veggie caps are partially destroyed in the acidic stomach.
        ———————————————————————————————————————————-
        I have no doubt that he will again profit handsomely from it but whether an effective anti-aging medicine/supplement will result this time is much less certain.
        ——————————————————————————————————
        Comrade Tom, Isn’t Cuba the last bastion of Communism? That BS about money being the root of all evil has been debunked long ago. ‘-)

        Take the time to learn Sinclair’s back story from the Joe Rogan interview. If Harvard has no problem with his research, I think it unfair to characterize the man as a greedy capitalist when he ploughs much of his own treasure back into his research. Not all people or even companies that make money are inherently bad.

        1. Never said they were Lonie. But surely it’s relevant to know that Sinclair’s active promotion of his findings may not be completely unrelated to his financial interests? I hope he is right but he is likely to make a million or two even if he isn’t. Harvard doesn’t have a problem with him, true. The Cleveland Clinic doesn’t have a problem with Hyman either. Institutions are usually happy to appoint people who will attract funding and publicity even if their approach and public statements on scietific issues are somewhat unconventional.

          As for Cuba, well, they do have a better life expectancy than the US.- at least according to this site
          https://www.worldlifeexpectancy.com/cuba-life-expectancy

          All I am saying is that a degree of caution is warranted – results in mice/rats don’t always translate to humans.

          1. All I am saying is that a degree of caution is warranted – results in mice/rats don’t always translate to humans.
            —————————————————————————————————————————————————–
            There was a Steve McQueen line in a movie called “The Reivers.” The Steve McQueen character was telling his little brother “Sometimes you have to say goodbye to the things you know and Hello to the things you don’t.”

            All I’m sayin’ is caution is a good trait to have… but sometimes you have to take a leap of faith, otherwise you may miss out on something of great benefit.

              1. Thanks Lonie.

                However, I saw this quote in Dr Greger’s latest blog post, which may be relevant

                “For animal research, it is estimated that less than 10% of non-human investigations ever succeed in being translated to human clinical use. Over-selling the results of non-human [lab animal] studies as a promised cure potentially confuses readers and might contribute to disillusionment with science.”
                ‘https://nutritionfacts.org/2019/09/19/why-a-resource-like-nutritionfacts-org-is-so-necessary/

                On a completely different topic, I wonder how many visitors to this site end up going ‘postal’ as a result of all those infernal pop-ups?

      1. The whole point of taking the NMN is raising NAD+ and there are also plant foods, which raise NAD+

        For a cup of Crimini Mushroom, you can get up to 3.3mg of NAD+

        Whole Grains – as discussed earlier, Vitamin B3 also contains RN, the precursor for NAD.
        Lentils would be another which has precursors for NAD

        Exercise boosts it.

        Basically, food sources of Niacin and Tryptophan – to have enough of the precursors.

        The thing is the vegan and near-vegan communities are the ones which have longevity, so it makes more sense to look at what they are doing to actually have longevity, rather than just take a pill.

  2. This one deserves a round of applause!

    clap clap clap clap clap clap clap
    clap clap clap clap clap clap clap
    clap clap clap clap clap clap clap

    This is so helpful to me. The acetone can oxidize in the blood to acetol, which may be a precursor for methylglyoxal.is the sentence that keto Diabetics need to hear.

    Because, yes, they are so happy at the concept of getting off of insulin that they don’t care if they have to stay on back streets as long as it works.

    We asked for this series and this video right here is the one I was waiting for the most.

    Thank you! Thank you! Thank you!

    1. Up until this video, I thought there might be a logic for going Keto for Diabetes, even if it didn’t reverse Type 2 Diabetes.

      What amazes me is that I have listened to soooooooo many videos on Keto for Diabetes from soooooo many doctors and you were the first one who said that sentence.

      Also, the fact that their fasting Blood Sugar will be higher at their doctor’s appointment takes away the other reason to do it.

    2. Indeed, direct effect of ketosis on extra intense AGE formation is/would be a strong key fact regarding long-term usage of this diet for therapy.
      The other argument regarding temporarily weakened insulin resistance sounds less compelling: its well known and logical that the body’s ability to handle unused glucose pathways. Ability could come back quickly within a week or two upon adding (increasing) carbs again, once there was substantial loss of weight and of muscle cell fat, which is supposed to cause essential loss of resistance by that Bernard theory.

      1. Yes, I have seen the claim that the ability to handle carbs is restored after a time on a keto diet. It seems to be a common belief in the keto community but I have never seen any evidence for this belief. Do you have any?

        It would still be a risky option though I suspect. That’s because keto is often marketed as the ultimate low carb diet and there is evidence that low carb diets significantly up mortality risk

        ‘Compared to participants with the highest carbohydrate consumption, those with the lowest intake had a 32% higher risk of all-cause death over an average 6.4-year follow-up. In addition, risks of death from coronary heart disease, cerebrovascular disease, and cancer were increased by 51%, 50%, and 35%, respectively.

        The results were confirmed in a meta-analysis of seven prospective cohort studies with 447,506 participants and an average follow-up 15.6 years, which found 15%, 13%, and 8% increased risks in total, cardiovascular, and cancer mortality with low (compared to high) carbohydrate diets.

        Professor Banach said: “Low carbohydrate diets might be useful in the short term to lose weight, lower blood pressure, and improve blood glucose control, but our study suggests that in the long-term they are linked with an increased risk of death from any cause, and deaths due to cardiovascular disease, cerebrovascular disease, and cancer.”
        https://www.sciencedaily.com/releases/2018/08/180828085922.htm

        1. == Regarding long-term insulin sensitivity improvement (less resistance), e.g.:

          PMID 15047685 “Compared to a low-fat weight loss diet, a short-term very low-carbohydrate diet did not lower LDL-C but did prevent the decline in HDL-C and resulted in improved insulin sensitivity in overweight and obese, but otherwise healthy women.”

          PMID 12761364 “Insulin sensitivity, measured only in subjects without diabetes, also improved more among subjects on the low-carbohydrate diet (6±9 percent vs. –3±8 percent, P=0.01). The amount of weight lost (P<0.001) and assignment to the low-carbohydrate diet (P=0.01) were independent predictors of improvement in triglyceride levels and insulin sensitivity."

          PMID 17674517 "Efficacy of low-carbohydrate diet in the treatment of obesity in adolescents.
          .. The obtained data support that this type of diet is well tolerated by children; it normalizes cholesterol, triglyceride, and beta-lipoprotein serum values; reduces indices of insulin resistance while effective weight and appetite loss."

          == Low/high-carb cohorts:
          This (comparatively short) Mazidi/Banach study, which you refer to (PMID 31004146), partly confirms the 2 long-term Harvard/Boston cohort studies shown below (*)(PMID 30122560 / Seidelmann; PMID 20820038 / Teresa T. Fung), but does not differentiate between fat from animal vs plant sources. Those studies also show associated higher risks with animal fat sources (besides higher risks in the high-carb quantiles), but diametrically show even lower (lowest) risks associated with increased low-carb score from plant fat sources.
          Though the ranges done go into extreme explicitly planned low-cart – let alone keto diets.
          When I remember right In one of the recent videos in this keto series Dr. Greger shows a short quote regarding the plant vs animal fat fork from one of those studies.

          So while PROs for animal fat sources are hard to find, plant based fat sources may be not be so bad (as some low-fat extremists like McDougall put it). Still open discussion, association vs causality, less or more speed with reversal therapies, …

          There is even a vegan low-carb controlled trial indicating LDL/TG lowering effects – though co-financed by companies:
          BMJ 2014 PMID 24500611
          "Effect of a 6-month vegan low-carbohydrate (‘Eco-Atkins’) diet on cardiovascular risk factors and body weight in hyperlipidaemic adults: a randomised controlled trial
          ..Conclusions
          A self-selected low-carbohydrate vegan diet, containing increased protein and fat from gluten and soy products, nuts and vegetable oils, had lipid lowering advantages over a high-carbohydrate, low-fat weight loss diet, thus improving heart disease risk factors."

          Keto diets with ketosis of course are a different game. I think there are are only limited (potential) areas of application. In addition to those mentioned by Greger (incl. initial temporary diabetes treatment potentially) perhaps this: temporary training for endurance sports. e.g. Tour de France winners seem to have used it for preparation to improve fat burning pathways.

          == (*)
          — 2018 PMID 30122560 – Sara B Seidelmann – Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis
          ..During a median follow-up of 25 years there were 6283 deaths in the ARIC cohort, and there were 40 181 deaths across all ..
          However, results varied by the source of macronutrients: mortality increased when carbohydrates were exchanged for animal-derived fat or protein (1·18, 1·08–1·29) and mortality decreased when the substitutions were plant-based (0·82, 0·78–0·87).
          Interpretation
          … whereas those that favoured plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain breads, were associated with lower mortality, suggesting that the source of food notably modifies the association between carbohydrate intake and mortality.

          — 2010 PMID 20820038 / Teresa T. Fung / Low-carbohydrate diets and all-cause and cause-specific mortality: Two cohort Studies
          26 years of follow-up in women and 20 years in men …
          85,168 women (aged 34-59 years at baseline) and 44,548 men (aged 40-75 years at baseline) without heart disease, cancer, or diabetes.
          … In contrast, a higher vegetable low-carbohydrate score was associated with lower all-cause (HR=0.80, 95% CI=0.75-0.85, p-trend<0.001) and cardiovascular mortality (HR=0.77, 95% CI=0.68-0.87, p-trend<0.001).
          Conclusion
          A low-carbohydrate diet based on animal sources was associated with higher all-cause mortality in both men and women, whereas a vegetable-based low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates.

          1. Thanks Robert.

            The issue of weight loss and more particularly fat loss complicates the issue of whether the ability to process carbs returns on a keto diet.

            Losing weight (fat) may do it but continuing to eat high fat diets would presumably damage our ability to process carbs again. This is because the effects of fat on diabetes risk appear to apply to both body fat (which is why obese people seem to be at greater risk of T2D) and dietary fat.

            I am cautious about the belief that the ability to process carbs will always and/or permanently return on keto diets – especially long term keto dieting. It seems highly improbable to me but I have not seen any convincing evidence one way or the other.

      2. Robert,

        I tried to find any studies on it on PubMed and didn’t find any, but I know that sometimes you have to use the exact wording of things for them to come up.

        If you have any, now’s the time to bring them in.

            1. Dr. Greger has done positive videos on eco-Atkins, but people like Dr. Barnard, Dr. Fuhrman, and Dr. McDougall have reversed Type 2 Diabetes without going low carb and the Mastering Diabetes site has thousands of people doing it high carb.

              1. One could imagine a 2-step approach for type 2 diabetes:
                1. A short (plant-based) low-carb/keto sprint diet, maybe 3 months, which also allows to get rid immediately of high blood glucose trouble, and of insulin injections (in case that was already required, which usually makes weight loss particularly difficult and which runs at frequent danger of serious hypoglycemia).
                2. Followed by a smooth careful transition to a balanced long-term safe plant diet with (low glyx) carbs – providing further weight & cell fat loss.

                1. Robert,

                  I can imagine people choosing that.

                  Though, Dr. McDougall said that with The Starch Solution, he needs to be in contact with diabetic patients’ doctors’ at the outset, because they need to start going off their medicines almost immediately. A documentary which I watched, people were off their meds by the end of the first week on a raw vegan diet. Pretty sure Dr. Barnard’s diet, which didn’t include calorie restriction, and where people ate Twizzlers they still got off their meds within a few weeks. (I know that he didn’t prefer them eating Twizzlers, but the rules were the rules and someone found out that Twizzler’s were vegan)

                  I guess I am just saying that the same 3 weeks, it would probably be over, even if they went high-carb, though the Mastering Diabetes site had statistics, which interested me.

                  They recommend the C-Peptide test and said that if the scores were:

                  Greater than 4 ng/mL that means that your pancreas is still functioning and that you would have a 95% chance of succeeding with lifestyle alone.

                  Score of 2 to 4 ng/mL they gave a 50% chance of succeeding with diet alone

                  They gave less than 2 ng/mL as a sign of more serious damage to your pancreas with a 5% chance of controlling blood glucose through lifestyle alone. That group likely will need insulin.

                  They do have people with lower than 2 C-Peptide test who have succeeded and I read one of their stories of how and the person increased fruit and vegetable intake 3 meals per day and got off dairy and even lowered nuts and did succeed to get off meds entirely and the persons C-Peptide test crept up, almost to 2, so maybe there is even the ability to heal after serious damage, but, as Tom will point out, that is anecdotal.

                  1. We shouldn’t forget that some people with LADA or Type 1.5 diabetes are misdiagnosed as having Type 2 Diabetes. That will affect results.

                2. I just don’t see why anyone would choose a high fat diet given the endothelial cell impairment and the flawed carbohydrate/insulin model when you could just do a whole food plant based diet from the outset. Keto for 3 months would dig the hole you are in even more. If you’re willing to do something as radically insane and unhealthful as a keto diet, why not do something radically healthful like a whole foods plant based diet? Avoid high-glycemic foods in the transition and make sure you’re doctor is monitoring and reducing insulin.

              2. Regarding unsaturated (plant) fat types in LC, Deb:”Dr. Greger has done positive videos on eco-Atkins, …”,
                Mr Fumblefinger. “This is because the effects of fat on diabetes risk appear to apply to both body fat (which is why obese people seem to be at greater risk of T2D) and dietary fat.”
                Robert: “There is even a vegan low-carb controlled trial indicating LDL/TG lowering effects – though co-financed by companies:
                BMJ 2014 PMID 24500611” /
                “2-step approach for type 2 diabetes:1. A short (plant-based) low-carb/keto sprint diet ….”

                Here is another low-carb vs. high-carb study on T2D, which however ensured low saturated fat in the LC diet. The fats coming from canola, almonds, nuts, … though protein was rather animal-based.
                The LC diet outperformed on all measured differences and diabetes medication score, indicating the need to differentiate :

                https://www.ncbi.nlm.nih.gov/pubmed/26224300
                Am J Clin Nutr. 2015 Oct;102(4):780-90. doi: 10.3945/ajcn.115.112581. Epub 2015 Jul 29.
                Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial.
                CONCLUSIONS: Both diets achieved substantial weight loss and reduced HbA1c and fasting glucose. The LC diet, which was high in unsaturated fat and low in saturated fat, achieved greater improvements in the lipid profile, blood glucose stability, and reductions in diabetes medication requirements, suggesting an effective strategy for the optimization of T2D management.

    3. Couldn’t agree more. Excellent research and presentation and life saving in 7 minutes. I always suspected that the ketoers were digging themselves into a hole by crippling their ability to process carbohydrates given the high levels of dietary fat and the effect it has on insulin receptors. What a disaster of a diet. Whole food plant based 100% is the way to go.

  3. Brilliant! Thank you for connecting the dots on this, Dr. Greger — especially the point about ketosis leading to the chemical reaction that causes the same problems as high blood sugar. Excellent, excellent, excellent.

      1. S

        I agree and I had read his Atkins work and wasn’t sure what he would add to it, but this one and the cancer video are both so timely and relevant. These are some of the biggest topics out there and I have watched Dr. Barnard’s video and Mic The Vegan’s Keto video and Dr. Klapper’s Keto thoughts on Plant-Based Science London and Dr. McDougall’s thoughts and I have been patiently waiting for what Dr. Greger would add and it was something he wrote a book on, so I felt like he was the one to watch and I was right. I have read so many PubMed articles and watched everything I could find from both directions and yet, I missed the Mastering Diabetes series and that one gave Dr. Greger’s name next to the Keto Diet for Diabetes and I missed it, but that audience got this particular teaching a while back and there was a little note, which was not next to anybody else’s session and it said, “brilliant” or something like that.

        Worth the wait.

  4. What are folks’ thoughts about going into ketosis regularly from daily intermittent fasting for 14-18 hours? Cause for concern? Long-term damaging to the body?

    1. John, I don’t know much about it, but I noticed some commenters under this series have been stating that it can also be difficult to build muscle during intermitten fasting. I have seen on YouTube some pretty muscular fasters though.

      I hate fasting and love muscles so if this is true, it works perfectly fine for me.

      1. John,

        They did a study on time-restricted eating versus normal eating and it did affect muscle growth. The people in the normal eating group gained 5 pounds of muscle and the time-restricted eating group didn’t gain any muscle. That tells me that there are similarities.

        I went back to the mechanism, which Dr. Greger gave and it said:

        Acetone can oxidize in the blood to acetol, which may be a precursor for methylglyoxal. That may be why keto dieters can end up with levels of this glycotoxin as high as those with out-of-control diabetes, which can cause the nerve damage and blood vessel damage you see in diabetics. That’s another way keto dieters can end up with a heart attack.

        I looked up acetone and time-restricted eating and it goes up for 3 to 8 days. They spoke about the breath acetone being directly relational to ketosis, so if you are in ketosis the acetone goes up. I do know though that there have been benefits for women who do 13 hours of intermittent fasting with lower rates of breast cancer, so there are benefits, but you probably don’t want to live there.

          1. No problem, John :) We’re all looking forward to Dr. Greger’s upcoming videos on fasting, too… not sure when they will be but it should be soon, I think.

        1. Deb,
          I’d also like to know how long the fasting window was among the time restricted eaters. That’s a critical variable.

    2. You may hardly enter ketosis within 18h, let alone daily in & out. Takes several days depending on physical activity level. There are too many carbs (glycogen) stored in the liver and muscles.
      Intermittent fasting fans claim, that it improves autophagy and weight loss. Certainly it creates hunger and stress.
      See Dr. Greger video “Caloric Restriction vs. Plant-Based Diets”.

      1. Oh, SO much stress, Robert… at least for me. It was miserable and I hated cramming all my sustenance in me within a small window when I wasn’t even hungry, I always felt digestively overwhelmed.

    3. I fast every day for 14 hours, but not intentionally. Am usually finished eating dinner by 6-6:30 PM, and don’t have breakfast again until 8:30 a.m. or so. (Also, I never snack between my “three squares.”)

      1. I seem to remember Rhonda Fitzpatrick saying that drinking black tea/green tea/black coffee etc means you aren’t fasting because the body is still absorbing nutrients even if those drinks effectively have no calories.

        So, even if I don’t eat for 13 or 14 hours daily, which I don’t, I am still not fasting because I would consume black coffee at some point or other during that time.

        1. Do you mean if people drink the tea or black coffee during the “off hours”? Heck no, have the beverages only with the meals. Just water, otherwise.

        2. I like to keep up my antioxidant intake, so I think sipping on tea int the evening is beneficial. I am not convinced this doesn’t count as fasting, sounds thoroughly theoretical or even hypothetical, really. Does Rhonda Fitzpatrick have any human evidence on this? Seems like a miserable way to live, to me.
          And don’t you absorb nutrients from water, too? As long as it’s not stripped of minerals, I mean. Water can contain potassium, calcium, etc… Do minerals not count in this somehow? We’re never really fasting if we drink water, it sounds like.

    4. >>>daily intermittent fasting for 14-18 hours
      I’d like to see some data on this as I restrict eating to 10-12 hrs (fasting window 12-14) and have been having trouble building muscle mass. I had thought that could not be long enough to matter. But maybe that’s wrong. On the other hand I eat 5 times per day to make sure I get enough calories and nutrients to support muscle growth. Confusing.

  5. I laughed at Rotten Tomatoes critic reviews of The Game Changers.

    One of the critics said:

    This is a movie that not only ascribes to traditional gender norms, it celebrates them and wants to enshrine them. Manly men with big, hard dicks are good; girly men whose boners aren’t up to snuff are bad.

    Really? Is that what the message was?

    I thought it was about tmproved blood flow and circulation after replacing one animal product meal with a vegan meal.

    1. To make a comment like that and have it be the vegan males in the kicking the sand into the face of the girly meat-eating community with their flaccid genitalia seems like things have come around full circle.

        1. Eww, YR, I do not see the photos of animal flesh dripping with grease enticing in any other way than enticing me to eat a salad… that banana drawing looked pretty good too.

          1. Right, that’s my point. Why not show photos of those many other foods instead of just meat? Not everybody is as strong and determined as S or (I think) Dr. J.

            For some others, the “animal flesh dripping with grease” could look mighty tasty.

            1. I actually agree with you, YR.

              Links which give what else to eat could help.

              I also agree that not everybody can succeed at going hardcore WFPB vegan and what impressed me the most about Game Changers was that the emphasis was that even small changes – even one vegan meal per week – helped blood flow in measurable ways.

            2. A fair point that some may find it appetizing, YR, and one I really didn’t consider until you pointed that out, but in my case I assure you it’s not strength or determination but that I legitimately find it disgusting looking.

              I would suspect that each individually, seeing these things as the slaughtered victims they are and becoming accustomed to a plant based diet and understanding what things like the pictured meats do to the human body, would result in not finding the images appealing for many people.

    2. Deb, what that is, is rotten tomatoes pathetically trying to use identity politic bullshit to overlook the threatening conclusion evidence has to offer.

            1. You are a bit slow on the uptake today YR. The question asked by S was how many stupid or desperate people are out there. I was suggesting that the answer might depend on your poltics.

              Try and keep up dear.

              1. Uh, uh….I see no relevance to S’s remark. I stand by my query. There are a lot of “stupid and desperate” people out there who don’t vote, much less know what’s going on in the world.

                But thanks for calling me dear.

          1. LOL hilarious video.

            Well I’m an independent through and through, so politics aside, I think the very notion of using or rather abusing something such as the way rotten tomatoes has, in order to brush over what they would like to brush over is definitively a stupid and desperate act and I think that in order to be swayed by those kinds of tactics you either have to be being stupid or desperate… or a zombie.

    3. Deb, I haven’t seen the movie yet, but I’m wondering if it is X-Rated? ;-)

      I’m planning to take my grandchildren to see it when it appears in the theaters again to encourage them to become vegan, but don’t want them to be shocked!

      1. Darwin,

        No, not X-rated, nor R-rated.

        There is a scientific mini-study with males, where there is brief showing of a model of the male genitals to show how the testing device had to be worn.

        There is just a scene with that study and discussion with what one meal meat versus plant-based did to night time erections – both in number and in firmness.

        Other than that scene, it is more like watching American Ninja Warrior or the Olympics between the events.

  6. I said this under the last one but I have to say it again… brilliant video, mind-blowing information.

    So I would imagine that for anyone on a keto or Atkins diet, if and hopefully when getting off the diet, their chances of weight gain would drastically increase, am I correct in this thinking?

  7. Study: Small cuts to carb loads can improve blood sugar:

    When you are trying to cut carbohydrates to improve your health, even a little bit can count.

    That’s what Japanese researchers demonstrated in a small experiment with a group of 41 patients with type 2 diabetes who wore continuous glucose monitors. All they changed in the participants’ diets was the carb count of the bread they consumed at each meal, swapping a low-carb version for the normal, high-carb bread.

    The result? The participants’ blood sugars and lipid markers improved, as well as other markers of pancreatic function and metabolism. The researchers concluded: “These results indicate that changing only the carbohydrate content of the staple food has benefits on glucose and lipid metabolism.”

    https://www.ncbi.nlm.nih.gov/pubmed/31466840/

    1. Greg,

      Bread is a refined carb and Dr. Greger would talk about the 5 to 1 fiber ratio of the bread and that people should be trying to eat whole grain bread.

      He has also recommended brown rice versus white rice, for instance.

        1. Greg,

          I might agree that not everything is black and white, but still, we need to know the best science.

          Not everybody will be able to do it and that is when the second best and third best options might need to be what happens.

          Looking at this study, almost everybody around me who is diabetic is trying Keto and they don’t know this information and they deserve to know.

          Still, it may come down to whether Keto is better than SAD and that becomes where it genuinely does get more complicated.

          I looked at the Mastering Diabetes site and to reverse the hardest to reverse Diabetes where the people had the most damage to the Pancreas, the person started eating more fruit and vegetables all 3 meals and that would be so hard for some of the people around me.

          But I do have one friend who is a scientist, who is high fat, because of her own understanding of how nutrition passes through the blood-brain barrier better with fat, etc. She likes fruit and vegetables and eats them and could succeed at WFPB, but she likes dairy and fat and hasn’t tried lowering her fat and her lab results were the highest her doctor had ever seen. I sent her this video because she could succeed. My brother and sister-in-law, I have to be more careful and same with my other dear friends, though I did just give it to one woman whose daughter has a mystery illness. Her whole family is Keto, too, and she has been indocrinated, but she is a more mellow person and she is a medical professional and won’t get offended by science.

        2. David Davis wasn’t a former PM (Prime Minster), he’s a former Member of Parliament MP)..

          Were the benefits due to the food he ate or simly to the weight loss?

    2. Greg

      Comparing the effects of eating standard white bread with eating low carb white bread is supposed to demonstrate that carbohydrate restriction is healthy?

      I think that every WFPB dieter would point out that white bread is unhealthful, whether low or high carb. As for the long term effects of carbohydrate restriction, they don’t appear to be positive ………..

      ‘Compared to participants with the highest carbohydrate consumption, those with the lowest intake had a 32% higher risk of all-cause death over an average 6.4-year follow-up. In addition, risks of death from coronary heart disease, cerebrovascular disease, and cancer were increased by 51%, 50%, and 35%, respectively.

      The results were confirmed in a meta-analysis of seven prospective cohort studies with 447,506 participants and an average follow-up 15.6 years, which found 15%, 13%, and 8% increased risks in total, cardiovascular, and cancer mortality with low (compared to high) carbohydrate diets.

      Professor Banach said: “Low carbohydrate diets might be useful in the short term to lose weight, lower blood pressure, and improve blood glucose control, but our study suggests that in the long-term they are linked with an increased risk of death from any cause, and deaths due to cardiovascular disease, cerebrovascular disease, and cancer.”‘
      https://www.sciencedaily.com/releases/2018/08/180828085922.htm

      1. Tom,

        You are right that the effects of eating standard white bread versus eating low carb white bread doesn’t translate to carbs are bad for people.

        But people who are eating the Standard American Diet probably aren’t going to jump all the way over to Whole Food Plant-Based vegan or near vegan and switching off of the white bread already was a good choice and had some benefits.

        There are people who lose hundreds of pounds doing Keto. There is a show called something like, “My 600-pound life” and the doctor on that show uses Keto with them and they get down to a normal weight and start exercising, etc. Yes, they also die of heart attacks and they would have been better off transitioning toward Whole Food Plant-Based in the first place, but I can say that the people around me who try Keto, get off of junk food and processed food and they already accomplish getting rid of sodium, sugar and refined carbs and they even start eating vegetables and berries and those all can be steps toward WFPB.

        I am not convinced that Keto is worse than SAD. Though it could be. I am just not convinced and never saw a study on it.

        1. I will say that Keto could be worse than SAD is the second thought, which also goes through my head and that is anecdotal and it is remembering my own Atkins experience and the fact that I didn’t have disease symptoms reversal until I went off dairy and all of that saturated fat.

          He is not the doctor who should be doing that show and people die.

          Yes, there are people who are 900 pounds on the show and 900-pound people die, with or without Keto.

          I guess I am officially anti-keto because of the logic of the acetone, but I see it as something, which could be a step toward WFPB.

          But that particular group dies before they try something like WFPB.

          That breaks my heart.

          I watched their fails video and many of the people do die.

          1. I mentally tried to think of a Whole Food Plant-Based doctor with a tender heart, who could care about that community and Dr. Garth Davis is the one who could have the same show and he does bariatric surgery, just like the doctor they have.

            Most of the vegan doctors don’t have a heart for them and that population would have to be a calling.

        2. Fair enough Deb but those studies described in the quoted extract from the Science Daily report were about people eating American or Western diets. The low carb eaters appeared to have higher mortality than other people. That suggests to me that keto diets might be worse than the SAD. People eating low carb diets also seem to eat alot of meat (not all of them but many). Many also say they eat more salads and fruits than average. But people eating a lot meat seem to die earlier even if they eat a lot of fruit and vegetables (FV)

          ‘Conclusion: High intakes of red meat were associated with a higher risk of all-cause and CVD mortality. The increased risks were consistently observed in participants with low, medium, and high FV consumption.’
          https://academic.oup.com/ajcn/article/104/4/1137/4557128

          Going fromm the SAD to keto may not be a benefit on average, it may even be worse.

          1. This study is based on reviewing food frequency questionnaires which are notoriously inaccurate. In addition to that fact, it only applies to Swedish men and women and can not, therefore, be applied to the general population as a whole, many of which are not Swedish. Also, it doesn’t call into account the quality of the red meat, conventionally red meat (raised with lots of growth hormones, nitrates, antibiotics, ect,) vs pastured raised meats. And lastly, not everyone eats red meat while on a keto diet. The new carnivore diet is a bit more concerning than a keto diet…

          2. Tom,

            I have been thinking about that, too.

            Watching the My 600 Pound Life fails, the people were dying of infections and heart attacks and some of them died after losing the weight. For me the “after losing the weight” category is opposite of Dr. Ornish’s results, so you might be right.

            900 pound people would have such a greater likelihood of dying of a heart attack anyway, but watching one who had the heart attack after he got down to 250, that reminded me of my friend’s father who went Keto and succeeded and died almost in the same breath.

            Yes, I interacted with him and he was so happy and so excited about how well the diet worked and, then, I got the call that he had died.

            1. Looking at the study you posted, the line which stood out was that the association between red meat and all-cause mortality was similar across levels of fruit and vegetable consumption, with high concentrations of red meat intake associated with the highest mortality

              Adding in the plant-foods didn’t help them.

              Mentally, that is the Dr. Berg thing, which I will say, his doesn’t count here because his position is also only 5% animal products.

              But, going back to the TMAO as a cause of heart issues, I wonder if they have checked SAD versus Keto for TMAO?

        3. There are people who lose hundreds of pounds doing Keto. There is a show called something like, “My 600-pound life” and the doctor on that show uses Keto with them and they get down to a normal weight and start exercising…
          —————————————————————————————————–
          Wouldn’t it be interesting if fixing the gut… irregardless of one’s diet, is all it took to cure obesity? That’s the claim in the link below.

          https://www.eurekalert.org/pub_releases/2019-09/bidm-soa091819.php

          1. Thanks, Lonie.

            I always like “cure-all” articles and videos.

            Cure-all’s are like a box of chocolates, you are pretty sure exactly what you are getting, but sometimes they surprise you.

  8. I would love Dr Gregor to comment on the pros and cons of alternative day fasting – true fasting, that is, only water on alternate days, not the reduced calorie alternate day. I know it is endorsed by many Keto followers, however I would be looking at following Dr Gregor’s diet recommendations on the feast day – fruit, veggies, flaxseed, beans etc,

    1. Sharon,

      He did a Webinar on it and those will be trickled out on the site for free, but you can buy a DVD.

      I know that he mentioned it in a blog.

      I am looking for the link for buying the DVD’s but it isn’t obvious.

  9. I’d like to know more about keeping tight junctions in your intestinal epithelium with food. I looked at this article.

    Bonggi Lee, Kyoung Mi Moon, and Choon Young Kim, “Tight Junction in the Intestinal Epithelium: Its Association with Diseases and Regulation by Phytochemicals,” Journal of Immunology Research, vol. 2018, Article ID 2645465, 11 pages, 2018. https://doi.org/10.1155/2018/2645465.

    Some questions. If the berries of the barberry shrub have berberine, how much would you have to consume to get a therapeutic effect? How long do the effects of these chemicals last? If I eat plants with these chemicals with something bad like alcohol, gluten, casein, in the same meal, will the plants protect me? Say I have a tiny amount of alcohol and gluten after an overnight dry fast, then a few hours later I have a meal. Will these plants protect me? Thanks.

    1. There are things mentioned in the study link you posted and I went to PubMed and looked it up and fiber and butyrate are listed, tumeric, foods with zinc (beans, nuts), inhibiting mTOR, which Dr. Greger has a video on.

      Most important, going organic and getting rid of pesticides and chemicals in foods.

      Zach Bush said that RoundUp messed up the tight junctions.

      Fiber can help and that already gives a wide variety of Plant foods.

      Dr Greger has a lot of videos on how to fix your gut enterotype and if you do, you will have more butyrate.

      https://nutritionfacts.org/video/bowel-wars-hydrogen-sulfide-vs-butyrate/

      1. Thanks Deb. The information about RoundUp is disturbing. Organic is like double the price of conventional. It’s hard to find local versions of some organic pulses and grains. Some of the prices are on par with meat. Quinoa is (AUD) $10-15/kg, lentils at $8-11/kg, barley at $5/kg, rolled oats at $6/kg, farro at $16/kg, beans i forget but maybe $7-10/kg. Eat what’s left and start buying organic again.

    1. Stacey,

      I am going to recommend the Mastering Diabetes site to you. It is run by someone who has Type 1 Diabetes and if you look in the success stories, a lot of people who are Type 1 had improvements.

      1. Ok I didn’t read this conversation and have no idea what anyone is talking about, but saying a study from 1927 is irrelevant due to time is like saying we know nothing about penicillin because it was discovered in 1928. The only thing that makes a study irrelevant is a flaw in the study. It’s not like,”wow blueberries improve arterial function, we should incorporate them into our diets and then totally forget about it in 50 years.”

  10. Why do African Americans get more colon cancer than native Americans?
    I’m white British, how is this relevant?

    How are any of these studies related to the ketogenic diet?

  11. Virta Health published year long study showing individuals reversed diabetes by lowering A!C, insulin, glucose and HOMA-IR. I found your comment that reversing diabetes would be true if the individual could then eat like everyone else to be problematic. Why would we want people to “eat like everyone else” which means high processed amount of carbs? Try telling Dr Terry Wahls that she hasn’t reversed her MS because she can’t eat like everyone else. The goal should be to get these folks to eat more of the right vegetables and lower their crappy carb intake.

  12. Dr. Greger, I have a question about your matcha videos. I posted under your video on matcha but it’s old and think my chances of getting a response are better here.

    I have a concern over how accurate the results are for actual matcha. I’m looking over the study ( http://www.med.kobe-u.ac.jp/journal/contents/54/E62.pdf ) and I don’t see the specific type of tea used, there is a difference between authentic matcha which is made from shade-grown tencha leaves and inauthentic matcha which is sencha powder: green tea leaves grown in sunlight. Real matcha is made of tencha green tea leaves and the shade-growing process sweetens the taste in part by producing less catechins, so is MATCHA in fact as healthy as you show in your videos? Because in this study I’m reading they simply say “ground tea leaves” and are annoyingly unspecific. Considering you recommend matcha, could you please look into this or clarify? Or anyone who has more clarification on this, it would be incredibly helpful.

    1. Emailing aiya, I got a response and they have a chart showing that even though there are less catechins in shade-grown tea leaves, there are still substantially more catechins in matcha than brewed green tea: https://www.aiya-america.com/about-matcha#foryourhealth

      I would still really like to know what exactly the study ( http://www.med.kobe-u.ac.jp/journal/contents/54/E62.pdf ) was referring to with “ground green tea leaves” e.g. did they grind up sencha tea leaves and use that powder or purchase matcha which likely would have been made traditionally with tencha leaves.

  13. Thank you so much for explaining to cons of KETO. I can’t find any information on your website on how to fix carbohydrate intolerance. Please help!!!

    1. What do you mean by carbohydrate intolerance? I think he said he’d be coming out with a video on sibo in one of his more recent interviews, but I can’t be sure I’m remembering correctly.

    2. Dayna,

      If you are Type 2 Diabetic (versus Type 1 Diabetic or 1.5 Diabetic) it is just going Whole Food Plant-Based, no refined carbs (no white flour) no oil, low salt, low sugar diet.

      Getting off of oils and saturated fats and white flour are the key components.

      The books you might want to read are Dr. Neal Barnard’s Reversing Diabetes or Dr. Joel Fuhrman’s The End of Diabetes (I think is his title)

      I also recommend Cyrus Khambatta and Robby Barbaro – they have a site Mastering Diabetes and the blog section has some good recommendations including to start with a C-Peptide test to know which type of Diabetic you are.

      If you decide to go Whole Food Plant-Based, find some good videos for learning to cook without oil. YouTube is full of techniques for how to cook without oil and there are so many Plant-Based recipes.

      If you are old enough to be on Medicare, you might be able to get Dr. Ornish’s program paid for. Possibly Dr. Barnards.

      I will give you some names Dr. Barnard, Dr. Fuhrman, Dr. McDougall has his program free online, including recipes, Dr. Greger, Dr. Ornish, Dr. Esselstyn and his son, Rip Esselstyn, T. Colin Campbell, Dr Michael Klaper, Dr. Pam Popper, Dr. Doug Lisle, Dr. Michael Novack – there are small differences between them and mostly whether to eat nuts or not and whether to eat white potatoes and white rice or not.

      Eat beans and lentils with as many meals as possible – that will help keep your blood sugar in check. See Dr. Greger’s second meal effect video.

      Once you start eating things like sweet potatoes, cooking them and then cooling them and then reheating them creates something called resistant starch and things like that can help you to have fewer blood sugar spikes the first week.

      For food most of the doctors have cookbooks, but there are also YouTube channels: Chef AJ, High Carb Hannah, Mic The Vegan, Krocks in the Kitchen, Happy Healthy Vegan has a cookbook. and we just had and there are so many others, but most of the people on this list have both books and cookbooks. Forks Over Knives has even cooking lessons and recipes. Plus there are sites like Oh She Glows, Culinary Gym, The Simple Veganista, Karrisas Vegan Kitchen, (which has the prettiest purple sweet potato gnocchi I have ever seen) The Minimalist Baker and honestly there are so many more that you will get overwhelmed.

      If you don’t like reading, they have videos on YouTube explaining it and Dr. Greger has excellent videos under his topics.

      The process is just go no animal products and no oil.

    1. I just very briefly scanned over a bit of the full text ( https://www.cell.com/cell-chemical-biology/fulltext/S2451-9456(17)30270-2?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2451945617302702%3Fshowall%3Dtrue ) and what I saw was they experimented in vitro and then when moving to in vivo, they only experimented on 3 patients. That’s only a little better than having 1 test subject.

      Don’t have time to read it all right now, but I’m sure many of the scientific minds on this site will have some input.

  14. When Fasting, blood ketone levels also rise as we start to live off body fat in ketosis.

    Does this mean fasting raises Acetone levels too and hence MG’s and AGE’s or does the fasting state somehow prevent this?

    This is an important question with the increase in fasting use as a healing mechanism, especially for diabetics. Excellent video.

    1. Yes, fasting raises ketones and acetone is a ketone. It’s produced spontaneously from acetoacetate. Acetoacetate then converts to beta-hydroxybutyrate. Acetone is expelled through the breath, which is one way to measure if you are in ketosis.

      Karen

  15. Comparing metabolic changes in the “Average Joe diabetic” on a keto diet vs another person on a WFPB diet could give misleading results unless you control for changes in body fat (or more specifically, intramuscular and liver fat).

    The real question is whether a diabetic on a low calorie keto diet who loses a large amount of intramuscular and liver fat (and hence fixes the underlying cause of diabetes) would then be as metabolically healthy as a person who loses the *same* amount of fat via other dietary means (low calorie WFPB diet, etc etc). I wonder if any studies have controlled for this and/or if any studies have demonstrated that keto dieters don’t lose as much intramuscular/intrahepatic fat as non-keto-dieters?

  16. Is this physiological state that the body adapts to with a Keto diet reversible. So, will the body get back to producing more insulin if you start taking carbs after a period of following keto diet?

  17. What about Type 1 Diabetes? My friend came down with it at age 40(which is not normal) but she’s been on this Keto diet for over a year now. I’ve been worried about what this is doing to her. Can a healthy diet help diabetes type 1 sufferers?

    1. @ Sabsi W.
      | What about Type 1 Diabetes? .. Can a healthy diet help diabetes type 1 sufferers?
      @mark savell | https://www.quora.com/How-does-a-paleo-diet-or-ketogenic-work-best-for-type-1-diabetes

      With diabetes type 1 the pancreas beta cells are already rather destroyed and cannot produce significant insulin anymore.
      A “cure” for that is unlikely.  (There may be an artificial pancreas pump in future.) The Quora question focused on “how .. work best for”, how to control T1D.

      How does low-carb work best for T1D: * no / low glucose handling = no / rare / minimal insulin needed * reduced dangers of glucose circus: spices (AGE formation) and live threatening hypoglycemia * low-carb particularly from plant fat sources (MUFA & omega3-rich preferably) improves blood lipids and quite many CVD and other risk factors: PMID: 24500611 / Jenkins 2014 ; PMID 26224300 / Tay J 2015 (plant fats 1year T2D); PMID 21310828 (plant fats & proteins).

      PMID 20820038 / TT Fung 2010, PMID 30122560 / Seidelmann 2018 show associated extra risk reduction of plant based low carb vs. medium and high carb (standard) diets in big long-term cohorts.

      PMID 20194883 / Shai 2010 (Dietary intervention to reverse carotid atherosclerosis) even shows tendencial advantages of (healthy) LC vs HC diet regarding atherosclerosis.

      See also https://nutritionfacts.org/video/plant-based-atkins-diet/

      The temporarily increased insulin resistance discussed by Dr. Greger in this video is –  as already discussed here and by this answering T1D 20-year keto-diet patient ( Jonathan Christie , studied Diabetes) on Quora – not a real “pathological insulin resistance”.

      There remains the question, how relevant is this methylglyoxal (MG/MGO) issue in deep low-carb / keto diets as discussed by Dr. Greger in the video: * Its one limited study and a case report (person with special other risk): * Its not really a big elevation factor for this AGE precursor – particularly compared to glucose troubles.
      * There was no measurement of translation to the final AGEs (“may”) – and diabetic glucose circus could be actually worse: “Physiological  human  plasma  MGO  concentration  is approximately  150nM and increases ranging from two fold [16] to four fold [46] in T2DM patients’ plasma. Moreover, glycolysis-derived MGO inter-acts with cellular proteins and nucleic acids to accelerate AGE production resulting in pancreatic beta-cell  cytotoxicity.  This  exacerbates hyperglycemia  and  hence  DM  complications  [12]” (PMID 26965039) * MG may possibly be extra buffered during KT (PMID 28820963) * Is deep low-carb / keto necessary long-term? or can a low glycemic moderate low-carb diet (mostly avoiding ketosis) work as well?
      * In Vegetarians/Vegan certain factors (fructose?) actually increase actual AGEs: PMID 11876491 “Enhanced plasma AGE levels in vegetarians in comparison to omnivores are herein presented for the first time.”
      PMID 12234125 “Vegetarians have a significantly higher carboxymethyllysine content in plasma and fluorescent AGE values. … Comparison of nutrition and plasma AGEs in vegetarian and omnivorous groups shows that the higher intake of fructose in alternative nutrition of healthy subjects may cause an increase of AGE levels.

      Review  LC & T1D: PMID: 29596460 Low-carbohydrate diets for type 1 diabetes mellitus: A systematic review ”  .. Our review identified statistically significant improvements in glycaemic control in 3 of 8 studies (/n/ > 1) that reported a change in mean HbA1c with a low-carbohydrate diet [8 , 21 , 24 ]. In addition, the importance of non-significant changes in HbA1c (i.e., maintaining glucose levels) reported in the other 5 studies [10 , 20 , 22 , 23 ] is worth noting considering the natural progression for diabetes is toward poorer glycaemic control, preventing HbA1c from rising could be considered a successful outcome.
        In this review, all five studies reporting total daily insulin showed clinically significant reductions with a low-carbohydrate diet [8 , 10 , 22 , 24 , 26 ]. The excessive use of insulin that is often required to achieve glycaemic control in type 1 diabetes increases susceptibility to severe hypoglycaemia and may lead to some measure of hyperinsulinemia [29 ]. Hyperinsulinemia is associated with; excessive weight gain [30 ], development of the metabolic syndrome [31 ], inflammation and atherosclerosis [32 ], Alzheimer’s Disease [33 ] and cancer [34 ]. Findings of the present review suggest that low-carbohydrate intakes may assist in reducing or preventing hyperinsulinemia in type 1 diabetes by decreasing the absolute amount of insulin required for tight glycaemic control. ..”

    2. Hi Sabine,

      I am a volunteer for Dr. Greger. Thank you so much for bringing your question to us at NutritionFacts.org.

      Dr. Greger doesn’t have any videos on a plant-based diet and type I diabetes, probably because there is not a whole lot of evidence on the use of plant-based diets for treating it. With type I diabetes, the body no longer produces insulin, required to lower our blood sugar levels after a meal. With type II diabetes, it is (initially) the body’s inability to use insulin effectively. In other words, the body makes insulin, but it is not effective at lowering blood sugar levels. This concept, seen in individuals with type II diabetes, is called insulin resistance. This insulin resistance concept can still be applied to individuals with type I diabetes. If you have somebody with type I diabetes inject insulin, that insulin can either be used efficiently or inefficiently. If, over time, the individual with type I diabetes becomes more insulin resistant (the insulin injections don’t work as well), then the amount of insulin they would typically use after a given meal may not be enough and their blood sugar levels would remain elevated. Researchers don’t seem to be quite sure about the cause, but this may be why individuals with type I diabetes are at an increased risk of mortality (death), primarily from diabetes-related complications and cardiovascular disease.

      A ketogenic diet will keep blood sugar levels lower, thus leading to less insulin need. However, ketogenic diets may lead to a reduced tolerance for carbohydrates (aka increased insulin resistance). It also may increase the risk for cardiovascular disease by increasing cholesterol levels. We want to reduce the risk of overall mortality and improve quality of life. I am not aware of any evidence that a ketogenic diet would do this. In fact, the most recent review of all the studies put together on carbohydrate intake found that low-carbohydrate diets increased the death rate if the diet favored animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken. High-carbohydrate diets were also linked with higher death rates, but we know that most people eating high-carbohydrate diets are eating processed foods and added sugars. Overall, the treatments for type I diabetes are not as well-studied as type II diabetes, and so the number of dietary intervention studies we have are limited. A healthy diet (eating more whole, plant foods and less animals products and processed foods) would basically be beneficial for anybody, including somebody with type I diabetes, especially to reduce the risk of cardiovascular disease. However, be sure to have your friend inform their physician regarding any significant diet changes to ensure their safety.

      I hope this helps, even though there isn’t much research on the topic, unfortunately.

  18. I was almost convinced that a WFPB diet was the way to go to manage my type 2 diabetes of over 20 years. Then I found out about the “war” of vegans/vegetarians vs carnivores/keto/LCHF. Granted there are also vegans who attempt a keto diet. What made me swing over to animal-based diets was finding out that certain nutrients are only found in animals; Vitamin B12, Creatine, Carnosine, Cholecalciferol (vitamin D3), Docosahexaenoic acid (DHA), Heme iron, and Taurine.

    Watching this video by Dr. Greger, well-meaning as he is and committed in his believes, was my way of checking to see if I have made the wrong choice. I am glad to say that I have not.

    Here are some concerns, possibly naïve, that I have with the content.
    1. In the number of studies mentioned, they involved mainly healthy men. The implication is that if the results shown are negative for a healthy person, it would be worst for an unhealthy one. Common sense, right? Still, a good study should involve the target population, IMHO. Would diabetics show the same results? Findings could be different. We just don’t know.

    2. The analogies are insensitive and, more importantly, wrong. T2 diabetes is still considered chronic and progressive. Changing the diet and going into remission effectively stopping the progression is a positive result. Many diabetics, like results shown in the #VirtaHealth study, found better glucose control and other important health markers as well. Stopping the progression of diabetes effectively means stopping future complications of blindness, kidney dialysis, heart disease, limb amputations.

    3. The suggestion that going back to normal means being able to eat carbs like before is, I find, also difficult to accept now that Dr. Robert Lustig has called sugar is an addictive drug and a slow-acting toxin. (Check out The Complete Skinny on Obesity on youtube). Sugar and all carbohydrates (because they breakdown to glucose in the body) may have been the “saviour” when Ancel Keys “told” us to fear dietary (saturated) fats but studies have shown that dietary carbs, instead, raise triglycerides and high triglyceride levels have been linked to heart diseases. Further, studies have confirmed that dietary fats are not linked to heart disease. (https://chriskresser.com/new-study-puts-final-nail-in-the-saturated-fat-causes-heart-disease-coffin/)

    4. The ketogenic diet is used to treat children with epilepsy. Possibly the dangers as mentioned in the video is not as bad as it sounds. But, IMHO, something that is used with sick children must have sufficient benefits and, importantly, safe.

    5. I have no doubt that WFPB diet may be suitable for some people but I am wondering if it is so wonderful, why isn’t there an exodus in the diabetic community to “climb on board”. Even other medical professionals have given testimony to the many benefits of keto/LCHF way of eating. Perhaps I am biased as I have, like many before me, gone into remission of my type 2 diabetes by going LCHF; a simple change of diet. In doing so, my meds were removed, my health markers have improved, I’m in good spirits and for the first time since diagnosed more than 20 years ago, I feel good about growing old.
    I appreciate such claims as they allow me to reflect on my own decisions. At this time, I choose LCHF as a lifestyle choice. Maybe you should too.

    Reflect, I mean.

    1. @Jimmy ,  there is not necessarily a contradiction between LC and WFPB, particularly when not doing deep-LC / keto (long-term). Some vegan protein extract in limited amount is probably not a problem also when combined with vegetables, spices, berries etc.
      A seamless diet transition is possible for combining advantages – while observing things with your physician. Body fat loss/control and exercise is key in (pure) T2D treatment.
      Plant-based whole-food LC regularly shows good, rather opposite outcomes vs. detrimental animal-based LC outcomes in studies which do discern things.
      Extreme high-carb (Kempner, McDougall, ..) indeed seems more questionable in studies and regarding mechanisms & evolution: Starch-based evening meals from grains providing huge glucose loads were not possible up to some 10.000 years ago, when mutations provided the necessary enzymes. Not anybody may be fit for that. There is AGE formation pressure in addition to TG production during increased blood glucose and glucose turnover. At rest and during low intensity activity the body burns fat predominantly anyway. With T2D (and more or less T1D-like pancreas damage involved) it may be particularly beneficial to reduce the glycemic loads and indices long-term again.
      In case, the focus for fat should be on MUFA and omega-3:omega-6.
      See also the previous discussion about that here – also the Dr. Greger video about plant/Eco Atkins low-carb.

      The concern regarding lack of nutrients in plant-based diets is rather pointless. Any top search results and the Dr. Greger videos will tell you the basic lesson: B12, Iodine partly, women & Fe, ALAn-3 (similar for omnivores).
      Sometimes neglected:

      * Selenium supplementation is required in low selenium (soil) areas like Europe – unless one wants togamble on the strongly varying selenium content of Brazil nuts.

      * DHA supplementation need is controversial. There is no conclusive evidence, no known epidemy or so in vegans as soon as >1.5g/day intake of ALAn-3 (plant omega-3) is ensured. Dr. Greger’s logic at last was to “better err” on the side of a ‘small’ dose supplementation of 250mg/day of LCn-3 (DHA+EPA) for optimum brain health at old age. The logic however has a very small Berlin RCT study at heart (with omega-6 sunflower oil ‘placebo’ in the control group of likely ALA-deficient old women – instead of ALA-replete controls); While a Cochrane Review failed to provide the results ‘desired’ by GOEDomega3.com , by shop researchers and index deficiency creators WS Harris and C. von Schacky etc.
      On the side of harms: Cancer pops up with 800mg LCn-3 supplements in RCTs within as little as 3 to 6 years – besides bleeding, increased stroke risk, easy oxidation/autopolymerization and other side effects. 250mg in 20 years? Is it a ‘small’ dose?   “The adult brain DHA requirement is estimated to be only 2.4-3.8 mg/day in humans” and the total brain DHA is just about 5000mg. Human evolution was/is mostly away from fish consumption. Avoiding hyperphysiological DHA from fish (or from even more concentrated shots) may even be an advantage, and “This review [PMID 25920364] summarizes evidence that DHA synthesis from ALA can provide sufficient DHA for the adult brain by examining work in humans and animals involving estimates of DHA synthesis and brain DHA requirements.”
      A detailed 1 hour video by Dr. Radak about DHA and plant-based diet: https://youtu.be/NI7_QekdVoI

      The other ‘nutrients’ mentioned on your list are uncritical (or even detrimental) in whole food diets – unless you want to exercise very hard for unnaturally big muscles (Creatine supplement) or need to supplement D3 in quite the same circumstances than omnivores.

      1. gosh I feel so dumb. I can absorb some of these technical details but I just don’t know enough for it to make sense so I can talk about it. But thanks so much for the replies, it gives me something to work with. I was going to post on Dr Gregers video bout the Yale study of omnivores vs vegans. I want to try and do something like that. A quora challenge, and decide a way we can use Youtube to try planking arms, and deep knee bends. See who beats who. The keto crowd is very full of themselves and it would be a nice reference to show them. But I am just a mechanic, I work on cars. Should I even go on quora with my limited knowledge. Would this idea of replicating the Yale study have any validity or should that be something a doctor is in charge of?
        My idea so far is , Issue the challenge on quora like this. Are Keto dieters stronger than WFPB vegans and will they prove it?Then design the study. Arm planks and knee bends.Decide the best way to do this through video live streaming.Should some thought be made to cheating, like cocaine, or getting a vegan to test in their place?It would be really cool to be part of something llke that though, for me. I tell all my family and friends, ad nauseum no doubt, how be be healthier, but I don’t have anything to recover from. My total cholesterol stays good, but it wasn’t terrible as a vegetarian. So this could be a provable display for me. I could say, see?

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