Is Weight Loss on Ketosis Sustainable?

Is Weight Loss on Ketosis Sustainable?
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Might the appetite-suppressing effects of ketosis improve dietary compliance?

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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.

The new data is said to debunk “some, if not all, of the popular claims made for extreme carbohydrate restriction.” But what about ketones suppressing your hunger? In the tightly-controlled metabolic ward study where the ketogenic diet made things worse, everyone was made to eat the same number of calories. So yes, eat the same number of calories on a keto diet, and lose less body fat, but out in the real world, maybe all those ketones would spoil your appetite enough that you’d end up eating significantly less overall. On a low-carb diet, people ended up storing 300 more calories of fat every day. But outside the laboratory, if you were in a state of ketosis, maybe you could offset that if you were able to sustainably eat significantly less.

Paradoxically, people may experience less hunger on a total fast compared to an extremely low-calorie diet. This may be thanks to ketones; in this state of ketosis, when you have high levels of ketones in your bloodstream, your hunger is dampened. How do we know it’s the ketones? Because if you inject ketones straight into people’s veins, even those who are not fasting lose their appetite, sometimes even to the point of getting nauseated and vomiting. So, ketones can explain why after a few days you might feel hungrier on a low-calorie diet than on a total zero-calorie diet (a fast).

Can we then exploit the appetite-suppressing effects of ketosis by eating a ketogenic diet? If you ate so few carbs to sustain brain function, couldn’t you trick your body into thinking you’re fasting, and get your liver to start pumping out ketones? Sure! But is it safe, and is it effective?

A meta-analysis of 48 randomized trials of various branded diets found that those advised to eat low-carb diets and those told to eat low-fat diets lost nearly identical amounts of weight after a year. Now obviously, “high attrition rates and poor [dietary] adherence” complicate comparisons of efficacy—I mean, they weren’t actually put on these diets; they were just told to eat that way. But you can see how even just moving in each respective direction can get rid of a lot of CRAP, which is Jeff Novick’s beloved acronym for Calorie-Rich And Processed foods. After all, the four largest calorie contributors in the American diet are refined grains, added fats, meat, and added sugars. Low-carb diets cut down on 1 and 4, and low-fat diets tend to cut down on 2 and 3. So they both tell people to cut down on doughnuts. Any diet that does that already has a leg up.

I figure a don’t-eat-anything-that-starts-with-the-letter-D diet could also successfully cause weight loss if it caused people to cut down on doughnuts, danishes, and Doritos—even if makes no nutritional sense to exclude something like dill.

The secret to long-term weight loss success on any diet is compliance. Diet adherence is difficult, though, because any time you try to cut calories, your body ramps up your appetite to try to compensate. This is why traditional weight-loss approaches, like portion control, tend to fail. For long-term success, measured not in weeks or months but in years and decades, this day-to-day hunger problem must be overcome. On a wholesome plant-based diet, this can be accomplished thanks in part to calorie density—you’re just eating so much food. On a ketogenic diet, it may be accomplished with ketosis.

In a systematic review and meta-analysis entitled “Do ketogenic diets really suppress appetite?” the answer, they found, was yes. Also, ketogenic diets offer the unique advantage of being able to track dietary compliance in real time with ketone test strips you can pee on to see if you’re still in ketosis. There’s no pee stick that will tell you if you’re eating enough fruits and veggies. All you have is the bathroom scale.

Keto compliance may be more in theory than practice, though. Even in studies where ketogenic diets are being used to control seizures, after a few months dietary compliance may drop to under 50 percent. This can be tragic for those with intractable epilepsy, but for everyone else, the difficulty in sticking to ketogenic diets long-term may actually be a lifesaver. I’ll talk about keto diet safety next.

Please consider volunteering to help out on the site.

Image credit: Ted Eytan 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.

The new data is said to debunk “some, if not all, of the popular claims made for extreme carbohydrate restriction.” But what about ketones suppressing your hunger? In the tightly-controlled metabolic ward study where the ketogenic diet made things worse, everyone was made to eat the same number of calories. So yes, eat the same number of calories on a keto diet, and lose less body fat, but out in the real world, maybe all those ketones would spoil your appetite enough that you’d end up eating significantly less overall. On a low-carb diet, people ended up storing 300 more calories of fat every day. But outside the laboratory, if you were in a state of ketosis, maybe you could offset that if you were able to sustainably eat significantly less.

Paradoxically, people may experience less hunger on a total fast compared to an extremely low-calorie diet. This may be thanks to ketones; in this state of ketosis, when you have high levels of ketones in your bloodstream, your hunger is dampened. How do we know it’s the ketones? Because if you inject ketones straight into people’s veins, even those who are not fasting lose their appetite, sometimes even to the point of getting nauseated and vomiting. So, ketones can explain why after a few days you might feel hungrier on a low-calorie diet than on a total zero-calorie diet (a fast).

Can we then exploit the appetite-suppressing effects of ketosis by eating a ketogenic diet? If you ate so few carbs to sustain brain function, couldn’t you trick your body into thinking you’re fasting, and get your liver to start pumping out ketones? Sure! But is it safe, and is it effective?

A meta-analysis of 48 randomized trials of various branded diets found that those advised to eat low-carb diets and those told to eat low-fat diets lost nearly identical amounts of weight after a year. Now obviously, “high attrition rates and poor [dietary] adherence” complicate comparisons of efficacy—I mean, they weren’t actually put on these diets; they were just told to eat that way. But you can see how even just moving in each respective direction can get rid of a lot of CRAP, which is Jeff Novick’s beloved acronym for Calorie-Rich And Processed foods. After all, the four largest calorie contributors in the American diet are refined grains, added fats, meat, and added sugars. Low-carb diets cut down on 1 and 4, and low-fat diets tend to cut down on 2 and 3. So they both tell people to cut down on doughnuts. Any diet that does that already has a leg up.

I figure a don’t-eat-anything-that-starts-with-the-letter-D diet could also successfully cause weight loss if it caused people to cut down on doughnuts, danishes, and Doritos—even if makes no nutritional sense to exclude something like dill.

The secret to long-term weight loss success on any diet is compliance. Diet adherence is difficult, though, because any time you try to cut calories, your body ramps up your appetite to try to compensate. This is why traditional weight-loss approaches, like portion control, tend to fail. For long-term success, measured not in weeks or months but in years and decades, this day-to-day hunger problem must be overcome. On a wholesome plant-based diet, this can be accomplished thanks in part to calorie density—you’re just eating so much food. On a ketogenic diet, it may be accomplished with ketosis.

In a systematic review and meta-analysis entitled “Do ketogenic diets really suppress appetite?” the answer, they found, was yes. Also, ketogenic diets offer the unique advantage of being able to track dietary compliance in real time with ketone test strips you can pee on to see if you’re still in ketosis. There’s no pee stick that will tell you if you’re eating enough fruits and veggies. All you have is the bathroom scale.

Keto compliance may be more in theory than practice, though. Even in studies where ketogenic diets are being used to control seizures, after a few months dietary compliance may drop to under 50 percent. This can be tragic for those with intractable epilepsy, but for everyone else, the difficulty in sticking to ketogenic diets long-term may actually be a lifesaver. I’ll talk about keto diet safety next.

Please consider volunteering to help out on the site.

Image credit: Ted Eytan via flickr. Image has been modified.

Motion graphics by Avocado Video

Doctor's Note

This is in contrast to a diet that it would actually be healthful to stick to. See, for example, my video series on the CHIP program:

This was the fourth video in a seven-part series on keto diets. If you haven’t yet, be sure to watch the first three:

Stay tuned for:

My new book, How Not to Diet, is all about weight loss, and you can get a sneak-peek of it in my talk: Evidence-Based Weight Loss.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

120 responses to “Is Weight Loss on Ketosis Sustainable?

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  1. I was curious if you can do a vegan keto diet? I understand the need to eat fat but do it with out animal products. Lots of low carb veggies out there. Low but not No carbs..
    Also about loosing fat or muscle on a keto diet would a Hydrostatic underwater weighing, or hydrostatic testing be used to tell which is more productive? This method measures just fat in the body. I got curious and who is nuts over body fat…… Body builders…. What do they do to loose body fat and how do they measure it…
    https://en.wikipedia.org/wiki/Hydrostatic_weighing
    https://www.verywellfit.com/what-is-hydrostatic-underwater-weighing-3120276
    mitch

    1. Why would you even want to do a vegan keto diet? There’s no good evidence that it even results in greater fat loss and in fact slows it down. It seems, too, that body builders would be particularly concerned about the loss of muscle mass often mistaken with fat loss on the keto diet.

    2. John, you actually are being nasty in saying they can’t spell because they spelled a word wrong. Ever hear of auto-correct messing things up? Or what about just not thinking for a second and automatically typing something wrong. It doesn’t mean they can’t spell. I also doubt they thing internet posters are their friends… weird comment.

    3. John, as dislexic, your post is just plane nasty. Educate yourself before you lecture others. Do we rite 2 convay meening or skore points of people?

      1. Do we rite 2 convay meening or skore points of people?
        —————————————————————————-
        Both… and I am more judgemental of writing that has a lot of deviations from the norm. I tend to dismiss the writer as being illiterate… unless it is obviously from someone who is not a native speaker.

        If written by a non-native speaker, I may hold their writing in higher esteem since they have found a way to communicate their point in our (English) more difficult way to express that point.

    4. Keto vegan, which includes at least 30g of fiber / day AND avoids soy protein (too much soy raises IGF-1 levels similar to animal proteins), could be a solution to combine (i) ketosis with (ii) plant-based with (iii) high fiber. There is no such study out there showing that.

      1. There is no reason to avoid soy unless you have an allergy, it doesn’t raise IGF-1 levels unless consumed in mass quantity. There also may be a binding of the IGF in those raising their levels from soy due to the antioxidants in soy: https://nutritionfacts.org/video/too-much-soy-may-neutralize-plant-based-benefits/

        And so far we know that 3 servings a day of soy does not raise IGF-1–Dr. Greger recommends no more than 3-5 servings per day: https://nutritionfacts.org/video/how-much-soy-is-too-much/ I’m not sure if there’s been any updated research to find the daily upper limit.

    5. “A relevant post you made but irritating because you can’t spell”
      The problem has plagued me all my life along with the fat finger syndrome and the spelling police.. I’ve gotten over it.
      Now about the vegan keto diet…….
      mitch

  2. Keti catechism Part 1

    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)

    1. Fumbles, re: “A. I am a sceptic so I ignore the evidence (except when it supports my beliefs)”

      This describes 90% of the population in many areas of belief, not just nutrition! ;-)

        1. sceptic
          /ˈskɛptɪk/

          noun

          1. a person inclined to question or doubt accepted opinions. synonyms: cynic, doubter, questioner, scoffer, pessimist, … more
          2. an ancient or modern philosopher who denies the possibility of knowledge, or even rational belief, in some sphere.

          adjective

          1. another term for sceptical

          Powered by Oxford Dictionaries

          1. skep·tic
            /ˈskeptik/
            Learn to pronounce
            noun
            noun: sceptic; plural noun: sceptics; noun: skeptic; plural noun: skeptics

            1.
            a person inclined to question or doubt accepted opinions.
            synonyms: cynic, doubter, questioner, scoffer; More
            pessimist, prophet of doom;
            rarePyrrhonist, minimifidian
            “sceptics said the marriage wouldn’t last”
            a person who doubts the truth of Christianity and other religions; an atheist.
            synonyms: agnostic; More
            atheist, nontheist, unbeliever, nonbeliever, disbeliever, doubting Thomas;
            rationalist;
            rarenullifidian
            “empowered by that Spirit, sceptics have found faith”
            antonyms: believer
            2.
            Philosophy
            an ancient or modern philosopher who denies the possibility of knowledge, or even rational belief, in some sphere.

            adjective
            adjective: sceptic; adjective: skeptic

            another term for skeptical.
            ————————————————————————————————-
            sceptic just appears too close to septic so the use of the k instead of the c is less confusing… at least, to me.

              1. and F is not from NA, as I recall. Context is important, even in spelling.
                ———————————————————————————————-
                No problem… but FAI (For Anyone’s Information) if I see the word sceptic, my thoughts will immediately go to septic tank. ‘-)

                1. I speak and write English. The English word is ‘sceptic’.

                  What you people across the pond do is entirely up to you.

                  Lonie wrote “my thoughts will immediately go to septic tank. ‘-)”

                  Interestibg, and septic tank becomes septic which is anither word for an inhabitant of the USA (septic tank is rhyming slang for Yank – even S’utherners are called Yank). That’s why it is very important to pronounce the (hard) c in sceptic.

                  As for misspellings, while some people are touch typists, I am most defintely a touch typoist.

          1. e.g., spelling may depend on where you live….
            —————————————————————-
            I agree Liisa, that’s why I consider people who write loose for lose, favour for favor, advise for advice etc… as non native speakers and overlook their misspellings. ‘-)

                1. Also they’re not misspellings.
                  ——————————————-
                  Whew! Had me worried for a moment… thought I had misspelled misspellings. ‘-)

                  (Yes, I admit it… I’m almost as anal as you about posting misspelled words. ‘-)

    2. Considering that the average American these days has the attitude of ‘no one can tell me nothing’, most people also live in self placed ignorance based solely on their own arrogance.

  3. Ketosis evolved as the body’s temporary emergency adaptation to keep us alive in times of stressful food scarcity by burning our fat reserves. Why anyone would consider emulating this stress as their long term nutritional plan by intentionally ingesting the fat of other dead animals is bizarre! I know the desire to lose weight creates desperation in people, but weight loss is supposed to be about improving health, not destroying it! I think one of my “favorite” keto mantras is… the body has absolutely no need for carbohydrates… when all athletes know to carb load for energy before an event. Where do they get this idiocy from?

    1. Not to mention the science shows that people trying to enter a state of ketosis by ingesting the fat of fellow animals are actually losing LESS fat and instead losing water and muscle mass. It’s like getting excited over the numbers on the bathroom scale going down because you cut your foot off–I’d rather keep those numbers up.

  4. Decades ago, we (women in my exercise circle of friends) read about ketosis, but we did not eat meat or high fat foods. We ate nothing, and the fat did come off relatively painlessly. After day 2, the hunger subsides.

    I have more trouble managing hunger eating plants. It isn’t difficult to eat enough calories to maintain weight, (too easy in fact!) but quelling the urge to eat constantly is a challenge for me.

    1. Barb, re your comment: “I have more trouble managing hunger eating plants. It isn’t difficult to eat enough calories to maintain weight, (too easy in fact!) but quelling the urge to eat constantly is a challenge for me.”

      I, too, have this issue to some extent. I have resorted to being a “grazer”, that is, eating many small meals throughout the day rather than 3 big meals.

      I don’t recall ever seeing Dr Greger present a video on “Grazing” vs “3 Large Meals” and which is more healthy long term.

      Maybe someday Dr Greger and his staff could find the unbiased research and do a video on this topic?

      1. If you eat Vegan than it shouldn’t matter if you eat 3 big meals or graze.Just don’t bust your gut from all the water that is in the fruits and vegetables..

          1. Julot, where’s your evidence? It’s just a claim until you provide evidence. I graze all the time and have no enamel issues, excellent gum heath, and never had a cavity since going vegan but did have an old one heal and go away. I do typically swish with water after eating which is helpful in neutralizing acid.

      2. After day 2, the hunger subsides.
        —————————————————-
        When I fast, it takes a little longer… my last 5 day fast put me in the state of hunger-free at about 4 days. I was prepared to push past my 5 day target but felt I was running out of body fat to burn and might turn to breaking down muscle, so I stopped.
        ______________________________________________________________________

        but quelling the urge to eat constantly is a challenge for me.
        ——————————————————————————–
        I’ve noticed lately after starting a whole body vibration regimen I’ve become a little less concerned about food. That is, I eat *biscuits* with my numerous cups of tea and have to make myself eat a meal sometime during a day or evening.

        I’m not suggesting this as a remedy for anything… yet. After my next labs coming up next month I’ll be able to form a better opinion of the vibrating platform’s effect on my health in general, and then will report my observations then. And even then YMMV (Your Motion May Vary ‘-)

        1. As a man, you wont run out of body fat and your body wont burn muscles and organs untill 2-5% body fat which is extremely low and is called essential body fat.

    2. Barb,

      Are you saying that you fasted?

      For how many days did you eat nothing?

      If I am remembering properly, you are eating vegetables, fruits, and only a few lentils. I am trying to remember if you are low starchy vegetables, too?

      I think I would struggle with that.

      I don’t feel hungry if I eat enough beans and lentils. Leafy greens are also surprisingly filling. I eat 2 cups of kale and some arugula and watercress in my salad every day with lots of mushrooms and I find that filling. Creamy soups with rice added in is another thing that fills me.

      I feel like, in that way, I do find starches to be a solution for hunger like Dr. McDougall has discussed.

      I haven’t been eating potatoes or rice or recipes, but I am going to be making 2 things per week. I shifted 9/1. Trying to get my body to have a sense of seasons passing. I generally have craved food in an off-season manner since I started. I think it has helped eating salad every day. The year before, I ate my fruits and vegetables all Winter long and ate hot dishes and no vegetables all Summer long.

      Hot drinks add to my feeling of fullness, though partly because I put too much plant-milk in my coffee and I have 4 cups of coffee during the work day.

      For that reason, I am thinking about going back to tea again.

    3. That is exactly what I experienced too. I can get to about 85-90% whole plant food but then I’m losing too much weight and muscle if I try to go about that.

      I like this video because it at least being fair to those people who choose that diet. It shows the common ground , that if they get rid of the processed junk they can loose weight.
      Keto is not for me. As I’m highly active. However, I suppose people could do keto with enough nuts, avocados, and olive oils, to be vegetarian, if one were wealthy enough. At $2-3 an avocado that adds up fast.

      1. At $2-3 an avocado that adds up fast.
        —————————————————
        WOW! You must live in California or NY City… Locally I quit buying avocados when they went to 88 cents apiece (from 66 cents.) But maybe you are talking about the big Haas avocados?

    4. This is where eating fat comes into play! You would be surprised at how easy it is to keep weight off and/or lose weight (without hunger) when you add high-quality fats into your diet such as olives, olive oil, avocados, avocado oil, coconut oil, ghee, and good butter. It seemed counter-intuitive, but I did it anyway, and I was flabbergasted at how quickly I lost weight.

        1. Suz,

          I gain weight if I even add a tiny bit of oil in my diet.

          Dr. Lisle explained that MOST people don’t have stretch receptors which register the calories from fat, so if there is a little oil in a sauce or in plant-milk, people often just eat more calories.

          I gained 10 pounds when I accidentally started drinking a plant-milk which had oil. I went off of it and lost that same 10 pounds back.

          Fats have more calories, so you have to eat less of everything else to make up for the calories.

          1. Ditto, and oils aren’t even food… they’re just the fat leftover after all the fiber and nutrients are removed, why not just eat the whole food!

      1. This is where eating fat comes into play! You would be surprised at how easy it is to keep weight off and/or lose weight (without hunger) when you add high-quality fats into your diet such as olives, olive oil, avocados, avocado oil, coconut oil, ghee, and good butter. It seemed counter-intuitive, but I did it anyway, and I was flabbergasted at how quickly I lost weight.
        —————————————————————————————————————
        I agree with you, but…

        https://www.eurekalert.org/pub_releases/2019-09/bu-hfi091319.php

        I think the operative word here is “cooking oils” which suggests anything including trans fats.

        1. It did the opposite for me. I tried keto and found myself binge eating like a freak and developed cellulite for the first time in my life. Most people need glucose to feel satiated because that’s what humans naturally run on. Especially in the long-term. Now, I add walnuts to my oatmeal and make dressings out of fats such as cashews and tahini. I put fatty whole food dressings on quinoa bowls, etc. I always feel satiated and never gain weight unless I skip too many workouts. Balancing macronutrients works for weight loss and overall health. Some people like cancer patients etc need extreme diets but diets that tell the average person to stay away from fruit because it will give them diabetes and make their weight go up is absolutely ludicrous.

          1. You’re supposed to eat red and black berries on Keto. Obviously you need to watch the amount… but any Keto diet that claims otherwise is bogus.
            There is a way to do it healthy, its just hard (compared to Adkins) and requires food prep.

    5. If you haven’t done so already, I recommend checking the You Tube channel, Nutmeg Notebook. Focus on the vids that discuss chopped salads and starches. The teaching comes from Chef AJ, who got it from the Pleasure Trap. Tami with Nutmeg Notebook just put it together for me. As far as satiation, for me it way off the chart. With the chopped salad it has the added benefit of including such a wide variety of veggies it’s staggering, at least in my salads. Basically the volume of the salad affect the stretch receptors, and the starch puts it over the top in satiation. Good luck.

    6. Barb, I’ve had a different experience, I naturally don’t want to eat past the point of being full and do not enjoy to do so no matter what it is I’m eating since going WFPB whereas back when I ate junk food, I could just keep eating. Now, my food tastes better but my body and brain just function better in regards to hunger. But I eat as much as I want to the point of being full and do perfectly well. If you’re calorie restricting, you might be having more difficulty because our bodies function so much better on plants and you simply don’t need to be calorie restricting when you eat this way. Just throwing in my two cents, no suggestions or disrespect to people who like to count calories. All different kinds here and it’s all good… unless you’re eating animals because of morals and ethics, plus I’m sure you have people who love you who don’t want you to die of a “bacon” induced heart attack.

      1. I don’t enjoy the feeling of eating till really full either S. Some people do. I also have to be conscious of how much I eat even though I am very active if I want to maintain my weight… unfortunately, as I get older I find I require less and less food! For some people, wfpb is not an ‘all you can eat’ plan… far from it.

  5. Annoys me that “ketogenic diet” like “vegan” and “vegetarian” is under-defined. Example is photo accompanying this video, pile of shredded meat and two fat sausages. I only know a few, but those I know on a ketogenic diet eat by far biggest volume of intake is leafy greens. Of course by calories fat. Meat only relatively small amounts and they test for IGF-1,TMAO, etc on pretty regular basis. One friend has been on it 100% strictly for nearly 6 years keeping metastatic brain tumor in remission. So far so good.

    I do NOT advocate for it but find it discouraging that most of the research is on non-matching definitions of the various diets and done by vested interests. That or it is of very low quality i.e. survey based, memory base questionaires on intake

    1. Of course by calories fat. Meat only relatively small amounts and they test for IGF-1,TMAO, etc on pretty regular basis. One friend has been on it 100% strictly for nearly 6 years keeping metastatic brain tumor in remission. So far so good.
      —————————————————————————————————
      If I were diagnosed with Cancer of any kind, that would be my first action.

      1. I know there is a woman called Megan Sherow who healed her stage 3 brain cancer. As I understand it she went high fat plant raw 100% for a year and her brain cancer stopped progressing and went into remission. Then she switched to low fat plant diet 100% raw with basically lots of fruits and green vegetables and after 2 years on this diet she was found to be completely healed of her brain cancer after further testing. An amazing story.

        1. I understand that fatty diets seem to boost some cancers, however.

          If I recall correctly, breast cancer and pancreatic cancer in particular are significantly associated with high fat diets. Some old animal studies suggest that vegetable oils may promote tumoir initiation/growth (although I am not sure if those oils were hydrogenated or not. The perils of trans fats weren’t widely known until the 1990s).

          1. Aren’t these studies (mostly) based on high saturated fat diets, or possibly high fat diets from oils, fried food? I would like to see sme evidence high fat diets from nuts is detrimental.

          2. Oops, sorry, I did not pay attention to this part of what yiunsaud:”Some old animal studies suggest that vegetable oils may promote tumoir initiation/growth (although I am not sure if those oils were hydrogenated or not. The perils of trans fats weren’t widely known until the 1990s).”

            My real point is that damning ALL high fat diets in the context of WFP diets based on nuts/seeds might be very misleading. This seems very common among the low fat group.

    2. Geoffrey, you don’t find this to be the same with vegan and vegetarian research and the various definitions of what people believe it to be?

    3. Geoffrey,

      All of the people who I know who define themselves as being on the Keto diet are eating almost all meat and butter and coconut oil and MCT oil. Bacon is a big one.

      1. Yes, exactly my complaint about the research. Lumping them in with people I know who are eating 9 cups of veg/day and maybe 4 oz meat. And minimal to zero coconut anything (due mostly to the carbon footprint)

    4. Geoffrey, “vegan” isn’t under defined, it has a very clear definition. The problem (and confusion) is that veganism is not actually a diet, it’s a lifestyle that excludes the exploitation of animals and not eating them falls under that category. Too often, especially now, people use the term improperly when referring to simply eating a diet consisting of plants. Not all plant based eaters are vegan but all vegans and plant based eaters.

      1. You are, of course, right but the co-opting of the term is rampant, and I am afraid a losing battle. I often say “100 % WFP diet” for what GL meant but it’s a bit clumsy, or alternatively ‘(ethical) vegan’ for ‘vegan’ in the sense you mean.

        1. When referring only to my diet, I either say plant based or WFPB or if I’m being really specific I say I’m a vegan and eat a WFPB diet. I don’t like the term “ethical vegan” because it plays into the misuse of the term as vegan definitely is about ethics. It absolutely seems like a losing battle, but it isn’t.

          1. >>> I don’t like the term “ethical vegan Right, which is why I switched to saying ‘100% WFP diet’. I don’t like the ‘-based’ part as it allows for some animal products,

    5. “I only know a few, but those I know on a ketogenic diet eat by far biggest volume of intake is leafy greens.”

      First of all, I’ve known some people on the keto diet and their diet does NOT look like a big bowl of leafy greens, but even so, volume? Are you kidding me? Of COURSE you’d have to go calorie by calorie because yeah, the volume of a pile of fluffy, practically floating leafy greens is going to be greater than the volume of a big wad of oil or animal fat or a hunk of flesh. That’s just silly, come on.

  6. Kinda strange that over 70 plus Keto studies are ongoing when the diet is so bad, right?

    ketogenic diet” | Recruiting, Not yet recruiting, Active, not recruiting, Enrolling by invitation Studies – List Results

    https://clinicaltrials.gov/ct2/results?term=%22ketogenic+diet%22&Search=Apply&recrs=b&recrs=a&recrs=f&recrs=d&age_v=&gndr=&type=&rslt=

    Plus, how in the world could this study ever come to these results if Keto is so bad?

    **Long-term effects of a ketogenic diet in obese patients:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/
    CONCLUSIONS:

    The present study shows the beneficial effects of a long-term ketogenic diet. It significantly reduced the body weight and body mass index of the patients. Furthermore, it decreased the level of triglycerides, LDL cholesterol and blood glucose, and increased the level of HDL cholesterol. Administering a ketogenic diet for a relatively longer period of time did not produce any significant side effects in the patients. Therefore, the present study confirms that it is safe to use a ketogenic diet for a longer period of time than previously demonstrated.

    1. From your link Greg:

      “KD is quite safe as the concentration of ketones in persons on KD is far lower than the concentration seen in diabetic ketoacidosis and is not associated with any changes in blood pH. It must be mentioned here that human nutrition begins with a KD: Colostrum is ketogenic and serves the needs of the neonate completely.[10]”
      ___________________________________________________________________________________________________________
      If Colostrum is ketogenic (and if we nursed as babies) we came into this world on a ketogenic diet.

      It would be interesting to see a study done of adults nursing as babies compared to those on formula as babies, to measure current Body Mass Index.

      1. I’d be more interested to see whether babies are actually producing ketones while nursing. In this case, there definitely is no appetite suppressant I couldn’t find that same quote in Greg’s link and wanted to see if it was referenced at all. But seriously, at some point kids start craving real food and teeth come in and mom wants baby off… psychologically, we don’t want to be “babies” any longer. Why do adults think it’s a smart idea to drink breast milk????(I’m seeing colostrum encouraged on certain nutrition websites). Leave it for the babies please.

        1. couldn’t find that same quote in Greg’s link and wanted to see if it was referenced at all.
          ————————————————————————————————————————–
          Hah! I guess I got lost in the maze… I followed a link to another article where I read that. Under Physiology of Ketogenic Diet, two paragraphs down. Sorry for the confusion.

          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664869/

    2. What bothers me is that these studies are typically done on obese or otherwise sick people. In my case, a high intact-carb WPF diet (~ 60% carb, 25% fat, 15% protein) and lots of exercise keeps me trim, my A1c at 5.0-5.1, my triglycerides in the 60-75 range and my TC 124-134, LDL 73-84). My only issue is my HDL is slightly low at 39, but Fuhrman claims that’s fine if LDL is quite low, so I am not worrying about it. My HDL was quite a bit higher when my TC what around 165-180. Given my experience, I don’t understand the rationale for extremes, unless you are trying to fix a specific problem. More/less is not necessarily better. I realize this is an anecdotal comment but when the rubber hits the road, each person has to decide what is best for their specific circumstance, and relying just on possibly flawed, statistical studies of populations or groups of sick people can be quite misguided.

      1. Gengo,

        You have been doing WFPB for a long time.

        Most of the people who are asking questions about how to eat are either overweight or have a medical issue or were frightened into it by the soy police or lectin police, etc.

        I would agree with you that if people are WFPB and have good lab results, then some of these studies would not be useful to that group.

        The people around me are switching from a SAD and that is where they reach the Keto versus WFPB junction and Keto seems to lose weight on the scale faster and people get to eat meat and don’t have to eat vegetables is why the people around me are choosing it.

        1. Good points, Deb. But I still maintain that unless a problem is extreme, extreme measures are unlikely to be the wisest path. Both standard keto and ultra low fat diets are extremes that I would not adopt. I’m with Dr. Fuhrman on this (no keto, no ultra-low fat diets necessary and both possibly harmful in the long run).

          1. “In my case, a high intact-carb WPF diet (~ 60% carb, 25% fat, 15% protein)” Gengo

            Maybe I’m wrong,but I thought that some of the longest lived people on the planet were the Okinawan’s, with a breakdown of 85% carbs, 9% protein, and 6% fat…which seems to be in line with what Dr. Esselstyn proposes.

            1. That’s true. That does show that at least for some populations, very high carb, very low fat diets can be very healthy, at least coupled with other key factors such as limited animal foods (low animal,protein and saturated fat), some fish (provides DHA and EPA), low calories, regular physical activity, whole foods, few if any pesticides/herbicides, close social relationships.

              But the Okinawans are also genetically distinct and it is possible, but I have no solid evidence making the case, that genetics is relevant ( populations do adapt genetically to their local diets). As I have remarked before, the Okinawans are a bit of a mystery to me. In contrast, there are other Blue Zone populations that have high fat diets, so fat content per se is not an invariant unlike the other attributes listed above. I am hesitant to draw general conclusions from small, genetically homogeneous populations.

              I do believe saturated fat is a bad actor and should be highly restricted. Moreover, the 7th Day Adventists that lived the longest were the nut eating vegans, according to Fuhrman (have not been able to check that but so know nuts had a positive effect across the board). Fuhrman’s concern appears to be mostly concerned with neurological health over the long term. Since I am cautious and have no specific problem that requires extreme measures, I follow his advice on that.

              Anecdotally, my experience shows that a very low fat, WFP diet is not necessary for achieving a solid drop in total cholesterol (to 124 in my case) and LDL. Also my PSA dropped 2.5 points from 10.5 to 8 on after adopting a higher fat but low saturated fat WFP diet. That indicates to me that very low fat diets might be sufficient to get desired results but are not necessary, at least for me. Hence, my view that more/less is not necessarily better.

              I think many of the arguments in favor of ultra low fat diets are either not compelling or even unsound, e.g. pointing to what chimpanzees eat and citing our genetic similarity – that’s a bogus argument that makes me chuckle since all that shows is that relatively few genes and their interactions can make huge differences.

              1. The WHO recommends a minmum of 15% fat (and a maximum of 30%).

                However, if you have existing CVD then a very low fat diet might be optimal for disease reversal as Esselstyn and Ornish propose. Perhaps 15% is better for people wiithout CVD. Mind you, I suspect that most people in the West have some degree of CVD so lower might well be better for most of us.

                I am far from convinced that genetics explain away the Okinawan longevity. For one thing, mainland Japanese in that same study were only eating 9% fat if I recall. They were the longest lived nation in the world at that time.I believe.

                However, weren’t Japanese generally (including Oninawans) famously quite small = compared to fat and meat eating Westerners anyway?

                  1. >>>However, weren’t Japanese generally (including Oninawans) famously quite small = compared to fat and meat eating Westerners anyway?

                    No IGF-1 in their diet?

                    Yes. If you want to be big (and die young), eat a lot of animal foods.
                    ——————————————————————————————
                    Three important points from Mr. FF, Liisa, and gengo, IMO.

                    Dr. Longo did research on some genetically small people in South America and found that they were deficient in IGF-1 and consequently did not have heart disease or cancer as a cause of death.

                    As to gengo’s point, it is no secret that once the Chinese population began eating larger amounts of animal products they grew taller as a population (but probably also ate more of everything so that could be a confounding factor.)

                  2. Liisa,
                    Actually, IGF-1 is produced in the body from growth hormone and various amino acids in dietary protein. Animal proteins stimulate a higher level of IGF-1 production than do plant proteins. Protein in the diet is the primary component resulting in IGF-1 production. It is unhealthy to get too little and too much of the amino acids required for adequate levels of IGF-1 production. Plant proteins provide enough but not too much. I recommend you watch Dr. Greger’s videos on this topic.

                    1. Gengo, that was my point. IGF-1 stimulates growth. Okinawans likely did not have the amount of IGF-1 that most other people do, especially nowadays.

                1. >>>However, if you have existing CVD then a very low fat diet might be optimal for disease reversal as Esselstyn and Ornish propose. Perhaps 15% is better for people wiithout CVD. Mind you, I suspect that most people in the West have some degree of CVD so lower might well be better for most of us.

                  Once again, I agree with you. That’s why I mentioned somewhere “extreme cases can require extreme actions” as in the Esselstyn/Ornish examples.  The same basic point is illustrated by keto diets and epilepsy and, I think but am not sure, some other neurological disorders.  But it is also true that optimizing along one dimension could result in less than optimal results along another, as Fuhrman, in effect, has argued.

                  It seems to me quite possible that the type and origin of the fat are more important than the amount.  After all, fat as percent of calories is not an invariant among the Blue Zone regions.  The ultra-low fat Okinawan diet is often used to argue for ultra-low fat diets but it is all too common for those making that argument to simply overlook the longevity of the Sardinians and the Ikarians, who have a much higher fat diet (up to 40%, as I recall), or even the 7DAs, among whom the nut eaters fared better.   Unfortunately, there seem to be no studies teasing out these differences.

                  Of course, I don’t know the answer and admit to being a bit on the fence, but at the same time, it bugs me that what I consider as likely overgeneralization is taken to be gospel.   

                  >>>I am far from convinced that genetics explain away the Okinawan longevity. For one thing, mainland Japanese in that same study were only eating 9% fat if I recall. They were the longest lived nation in the world at that time.I believe.

                  I am not either but I don’t dismiss it out of hand.

                  >>>However, weren’t Japanese generally (including Oninawans) famously quite small = compared to fat and meat eating Westerners anyway?

                  Yes. If you want to be big (and die young), eat a lot of animal foods.

            2. >>>Dr. Esselstyn propose

              Yes, that is true, although he has recently backtracked a bit to say that IF you have no demonstrable heart disease, eating nuts within reason is fine, and that means higher fat. He has also backed off his view that very low cholesterol is necessary. Rather, it is the overall quality of one’s diet, keeping sat fat very low, that is key (what Fuhrman has been saying for years). He has been understandably very conservative because he found an approach that reverses heart disease. That does it mean such an extreme diet is optimal in general.

    3. Long-term in that study is 24 weeks. That’s not exactly long-term in my book. Heart disease can take decades. Do you know of any studies that show differences in arterial plaque over time on a Keto diet?

    4. Greg, the evidence is in and the theory was wrong, weren’t you paying attention? Not strange at all, the keto and similar diets are highly profitable. The animal agriculture industry alone would pay big money–which they have–to try to milk it (no pun intended) as much as possible.

    5. Long term study?

      It was only 24 weeks – that’s less than 6 calendar months. That’s not long term in most people’s

      A genuinely long term study is really required to get some idea of mortality and morbidity risk. After all, how long does it take to develop heart disease and cancer or at least significantly increase their risk?

      Note also that this particular study was accompanied by continuing weight loss which would compensate for and/or mask any increased risk compared to equally obese controls. Oops sorry = that study didn’t have any controls. Note also that (unspecified) polyunsaturated and monounsaturated fats were added to the diet along with a vitamin and mineral supplement.

  7. I thought Dr Greger said in a previous video that keto diets are bad, the example he used was about the man who went on one and then he had a heart attack.

    Why is there contradictory information I don’t know what’s healthy or not.

    1. @Neil. Same thought here. Dr Greger has had better days/vids. Today beginning could have been done better. Does he have a shadow writer?
      Anyway, let’s give him some slack.

      1. He said he was going to talk about keto’s safety in the next video. This was about efficacy for weight loss. Dr. Greger recommends a whole food plant based diet as the healthiest diet. Read his book “How Not to Die”. The processed food and animal products industry wants you to buy their products. They’re making money off of you. It’s called marketing.

    2. Neil,

      He is giving an overview of the subject because we live in a society where people are doing keto and it is one of the top diets out there.

      People who are not going to go Whole Food Plant-Based MAY benefit on Keto if they are transitioning off of a highly-processed junk-food diet.

      For instance, there is a show about 600-pound people and the doctor in that always has them go Keto and if they succeed at losing 100 pounds, that could be potentially better than going up to 650 pounds or 1000 pounds.

      People who go Keto often do it because they are junk food binge eaters and Keto takes away the sugary food binges.

      They also do it because there is a trend where people need surgery but doctors won’t allow it unless they lose 100 pounds.

      That topic came up today because a man fell off of a 15-foot ladder and broke his vertebrae and other things, but can’t have surgery unless he loses weight.

      I have seen that “need surgery” for something leaving them in crippling pain and 60-something year olds are being told, we can’t do it until you lose 100 pounds. That is harder to do when they can’t exercise because of the very back pain that they need surgery for and they are older and the women are post-menopausal and have to reverse the trend of gaining 10 pounds per year and try to lose 100+ pounds.

      Yes, Whole Food Plant-Based could help them lose weight and with the pain, but when people don’t eat vegetables or fruit, often Keto becomes the other way they can try.

    3. There is a wide range of variance between what people call a ketogenic diet. To fit under that umbrella term, all that’s needed is to be in ketosis. You can eat a lot of meat, very little, or no meat. You can eat a lot of low carb/high nutrient vegetables or you can eat no vegetables at all! Past history counts for a lot as well. I’m sure there are a few people who go on an excellent, WFPB diet and have a heart attack because it was too little too late (there’s a range even of WFPB diets). The people I know how seem to be thriving on a keto diet are treating like what it is, an extreme, medical diet. They test a wide range of labs very frequently and tweak and adjust their personal intake to keep lipids in line, inflammation down very very low, IGF-1 low, etc.

      1. Sorry if I appear to be responding (bizarrely) to Geoffrey’s post. In fact I was trying to respond to Neil and Dino48 but this ‘nesting’ of responses gets quite confusing.

    4. Neil and dino, what are you talking about? In what of this or the previous videos did he make it out like keto diets are healthy or effective? In and up to this video, it has been nothing but showing the evidence that keto diets are ineffective and even counteractive and at the end of this video he suggests that the lack of sustainability of diets like keto are likely life-saving because they’re so unhealthy which is the topic he will (and already has–I’m watching it tonight) address in his next video in this series.

    1. s,

      I think there is a video about how they smell. I can’t remember whether it was this site or another site. Technically, you are right, but people can’t generally smell themselves.

      I do know that I no longer need breath mints and that already is a good thing.

      1. That would be an interesting video, Deb! Lol. People may not be able to smell themselves as well as others as they get used to it, but I do think to some significant degree you can, thus the whole under the arm check ritual.

  8. Last night, I ended up meeting a new grocery store worker and she was just diagnosed pre-diabetic and she was so open to trying it.

    She is a sweetheart. I am looking forward to seeing what happens.

    Strangers often immediately jump in.

      1. Deb, the specialist at the obesity clinic here prescribes a wfpb diet for those who want to (eventually) qualify for the surgery. The application process (over a period of time) includes seeing a dietition and others, but right at the outset patients are required to adopt wfpb eating. And it is strict. No blending etc, all whole foods.

        As for your question way above in the thread, I was responding to Dr Greger’s mention of hunger pangs dissipating when ketones are flowing. My friends and I noticed early on that eating nothing was easier than eating something. We did this more as a lifestyle, for months/years, not for just days at a time. One friend ate one meal per day, but she did not do all that great.

        As for what I eat now, you recall correctly. Oatbran and berries in the morning, soup OR a salad for lunch and for dinner, fruit, coffee and herb tea.

  9. Any research on CT scans and thyroid disease? After browsing YT, I stumbled on a presentation from Isabelle Wentz on the Functional Forum YT channel. When my mother got the stroke she underwent CT scans. I’m speculating that the scans affected her thyroid and this made her depressed. Considering that other people would have similar experiences in healthcare after a cvd event, it could be the healthcare causing more problems.

    Can I trust b12 supplements? The OTC stuff isn’t regulated. How can I be confident I’m getting what I paid for?

    A really short video (one minute) about b12 would be good. It’s for patients to show to doctors during the session. I’ve tried informing my GP with a video but he stopped watching before he heard about b12 function testing. Consider this. The MMA and holotranscobalamin tests are probably not covered by the public purse. I reckon that doctors are reticent about ordering unconventional tests. They might consider it as quackery. They don’t want to waste the pathology lab’s time or create more paperwork.

    Thanks.

  10. I’m on Keto. I eat a metric shit ton of veggies and try not to eat saturated fat. Adkins is dangerous but I believe almost all the things you have issues with are specifically related to how you achieve Ketosis… not ketosis and being fat adaptive itself. 0.0% of processed products with a Keto label on them should be a part of the diet. There are a few doctors that explain exactly how to overcome the dangers and live healthy… and also a body builder. They all have one thing in common…no saturated fat and a ton of veggies. Where is your review of this…anti Adkins Keto?

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