Comment by wdewind | Hacker News Reader

Comment by wdewind | Hacker News Reader

The problem with basically all of the keto science (this study included) is that it doesn't adequately differentiate between the effects of a ketogenic diet and simple caloric restriction:

> In rodents, ketogenic diets – and caloric restriction, in general – are known to reduce inflammation,

While there is some science showing differences in calorically balanced diets that vary in macronutrient composition, the truth is it is not strong, not well reproduced and there reasonable logical models that strongly bring the keto claims into question.

That doesn't mean keto is stupid or not worth studying. It's just that the interesting things about keto aren't really the metabolic changes (which are controversial, and small even if existent), but the behavioral controls. Obviously it's an oversimplification to draw a strict line between metabolism and compliance, but the point is the important difference with keto is that for some people it helps them comply to a calorically balanced diet, not that the macronutrient composition is making a difference.

Another problem is keto seems difficult to sustain over the long term. People drop off and regain all of their weight.

Depends on how you do it. If you completely limit your diet, that's not sustainable. There are alternative versions, such as the CKD. (Which means you have a regular cheat day)

> People drop off and regain all of their weight.

That's pretty much true with all diets.

Exactly.

Oh hey, I have incurable brain inflammation Let’s not do Keto because it’s unsustainable, I’ll just have oh so sustainable brain inflammation instead

This doesn't seem to be as big a problem with keto as with other forms of diet adaptation, though. (Although, I'd provide evidence for that, if I had anything but anecdotes to back it up with..)

Another anecdote here, for what it’s worth (not much)

I've tried tons of diets over the years and keto is by far the only one I've had success with maintaining long term. Even when I take a cheat day, carbs just don't taste that good any more so I end up feeling bloated and go right back on keto.

I've noticed this too, not even with full keto even. When I eat healthier things regularly (veggies and chicken instead of burgers and fries, etc), sweet or carby things taste good but they don't compel me, UNLESS I lapse for a few days. Then the carb cravings come back and I have to work and fight them for days or weeks to reset back to healthy mode.

Modified keto where a higher amount of protein is permitted is much easier to stick to (i.e. 30% protein).. to stay within 0.5-1.5 mmol/L BHB

I thought the only real limit for keto was on non fiber carbs? Is there typically a max ratio on protein too?

Gluconeogenesis can work off excess protein, too. Also, excess protein raises insulin, which is tied directly to weight gain.

Not easier to stick to economically though...

Some people find it easier to sustain a ketogenic diet when eating only from the animal kingdom: https://www.reddit.com/r/zerocarb/

Every article states this, but personally the keto diet foods are exactly what I normally crave and want to gorge on: meat, fish, nuts, avocado, butter, double cream, low carb root vegetables, cured meats, cheese, what's not to love? It doesn't take long at all to retrain your palate to understand that rich flavours come from high fat food, not sugars.

> the point is the important difference with keto is that for some people it helps them comply to a calorically balanced diet, not that the macronutrient composition is making a difference.

The whole point of Keto diets is that the macronutrient composition is what makes compliance easy. So, you can’t really extricate macronutrient composition since a diet needs to be followed in order to be effective.

Sure, mind body connection is everything, but there are many keto proponents that argue that controlling for calories, keto still produces superior outcomes. Outside of extreme cases like epilepsy, there is not really any reason to think that's true.

Keto is one of many strategies that people use to comply to consuming the right number of calories.

> but there are many keto proponents that argue that controlling for calories, keto still produces superior outcomes

The high fat, low carbs position is that excessive carbs create an endocrine disorder where the body is storing incoming calories in fatty tissue, thus making it unavailable as energy. This causes the body to respond in two ways: 1) eating more food, and 2) expending less energy. The key is that the energy balance equation has two variables, not one. There is the amount of calories that are consumed and then the amount of calories that are expended.

So, it is correct to say that a ketogenic diet, when compared to another diet consisting of the same number of calories, cannot lead to more weight loss as a result of calorie intake. But the ketogenic diet could, in theory, produce comparatively more weight loss by fixing the endocrine system disorder and allowing calories stored in fatty tissue to be used as energy. This would manifest itself as the person on the ketogenic diet being more active and feeling like they have more energy.

I'm not saying that this is, in fact, what is happening, just that it is a plausible theory. In my opinion, the theoretical underpinnings of the low carb, high fat hypothesis seem more plausible to me, but neither side can actually claim that the science supports them, because the studies that need to be done (randomized controlled trials of various types of diets), have simply never been done.

Also: people are not rodents

See rats & vitamin c for an example

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