3 huge new studies of 0.5MM people are casting major doubts on the keto diet | Hacker News Reader

3 huge new studies of 0.5MM people are casting major doubts on the keto diet

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41 pointsnradov73 comments

Follow the science, forget the epidemiology/poorly controlled science news.

Sustainability of improved health outcomes (https://link.springer.com/article/10.1007%2Fs13300-018-0373-...)

Rapid impact on type 2 diabetes (https://diabetes.jmir.org/2017/1/e5/)

Significant impact on cardiovascular risk factors (https://cardiab.biomedcentral.com/articles/10.1186/s12933-01...)

I suspect that a lot of the successes people have with different diets are more of a result of moving from the terrible standard US diet to better foods than from the specific diet. When I look at what a lot of people eat every day almost every diet, be it vegan, keto, paleo, Mediterranean or whatever will be a huge improvement because they consume less junk food. It doesn't matter which one they pick.

That's too vague. You can't just handwave and say 'better food' and 'junk food'. For decades junk food was thought by many as food with lots of fat instead of lots of sugar.

How about "processed food" or "fresh food"?

Cooking is a form of processing food, so are you saying "cooked food" or "raw food", or what, exactly?

Home-cooked food that sacrifices taste for nutrition and leverages the virtuous halo of home cooking to the hilt in order to prevent people from acknowledging that taste was, in fact, sacrificed.

I think it's a misconception that home cooked food tastes worse. I much prefer the food we make at home and don't think we sacrifice anything.

The parent isn't arguing that it tastes worse. They are arguing that people just end up cooking unhealthy food at home.

His statement was misleading.

Home cooked food tastes great if you don't cut down on the sugar, salt, and fat -- but then it's not health food. Home cooking lets you cut down on the sugar, salt, and fat -- but then it doesn't taste great.

> Home cooking lets you cut down on the sugar, salt, and fat -- but then it doesn't taste great.

Not true.

You don't need sugar, salt, and fat for food to taste good.

You also don't need to eliminate them for food to be healthy.

> You don't need sugar, salt, and fat for food to taste good.

I'll believe it when I see (taste) it. In a context where I'm not socially forced to pretend.

Do you not eat apples? Pears? Peaches? Corn? How about steak? Do you drink milk? Eggs? Rice?

All these things taste great all by themselves. Some need the proper application of heat, some don't. Some taste great BOTH ways.

*One super helpful thing to know is how food reacts to heat. for instance... sugars carmelize, intensifying sweetness. If you've only eaten perfectly ripe peaches raw... yes, you've had one of the worlds greatest treats, but you're missing out on what a grill can do! (cut in half, lightly oil the surface, place on low grill for a long time :-) Sweet potatoes? Man... stick one of those in a 425 oven for over an hour. (place directly on rack with tin foil on rack below to collect juices) Comes out sweet as candy. No additives needed.

If it sounds like I'm obsessed with good food... I am! I guess I'm just unusually lucky to like vegetables.

Check out this guy for inspiration: kenji alt lopez https://www.seriouseats.com/the-food-lab He's no health nut. He's just serious about good food.

When I cook I use much less sugar and salt than foods bought in store or at restaurants without losing taste. Taste buds also adjust. I find a lot of the food I buy way too salty and sweet now.

You can get used to anything. Good on you for getting used to healthy food!

Don't expect to win a taste contest, though.

Oh man, I can't tell you just how much more I like home-cooked food.

Do yourself a favor and start learning how to cook. I took a week of vacation and went to a cooking boot camp. It was great.

It's certainly possible to make food badly at home, and often people do make taste sacrifices for nutrition, but it doesn't have to be that way.

Learn to cook and you have total control over the nutrition and taste of your food.

You can have BOTH!

Your accusation that I can't cook is unfounded and more than a little amusing given your stated level of training. I am not a chef, with the high level of professional attainment that entails, but I'm still orders of magnitude beyond a weeklong cooking bootcamp.

The anticorrelation between taste and nutrition is real. Not universal, but real enough that "tasty and healthy" is a pipe dream used to sell cooking books and overpriced prepared food.

Want your couscous to taste good? Add salt and fat. Want your veggies to taste good? Salt, fat, possibly a sear -- you can occasionally dodge this with an acid, but if you try to do that all the time the result is miserable (ask me how I know). Want your tomato dish to taste good? Sugar. These, of course, are absurdly broad generalizations, and any stage in this journey you are free to remove the sugar/salt/fat and cook health food, but you will tend to work a lot harder and still come up with less tasty dishes.

IME, everyone who has claimed to cook tasty+healthy and who I have subsequently had the chance to evaluate has sacrificed in one or the other while deluding themselves into believing they have achieved both. Not being a jerk, I smile and play along, but the facts remain.

> I'm still orders of magnitude beyond a weeklong cooking bootcamp

As am I.

Perhaps the problem is due to the assumption that cooking with salt, fat, and sugar is unheathly. Used within reason, it's not. You also don't have to add salt, fat, and sugar to everything to make it taste good. Learning to use herbs and spices helps a lot with that. It's important to start with good ingredients too.

Take your tomatoes example. Sure, if you start with standard store bought tomatoes, you'll have to fix them. But get some nice heirloom tomatoes from someones backyard, cut thick with olive oil, a little salt and pepper, and basalmic? Fantastic. And theres a reason tomato sauce recipes start with onion... sweetness. No need for sugar.

I LOVE microwaved/steamed/boiled corn on the cob with or without salt or butter.

I will admit that I have one health related problem with all this food... portion control. Cause it's all SO good.

> the problem is due to the assumption that cooking with salt, fat, and sugar is unheathly

I agree: it's not. Eating healthy is about getting enough of each micronutrient (not typically a problem) and not too much macronutrient(s).

The problem is that people use questionable proxies for this. "McDonald's is bad," "Whole Foods is good," "home cooking is angelic mana straight from the heavens!" -- when in fact Grandma's potato salad with ranch dressing, cheese, and croutons probably has a substantially worse macronutrient profile than a BigMac, the pizza at Whole Foods probably isn't significantly better for you than the pizza at Domino's, and the seared + oil drizzled + salted veggies in a restaurant probably have about the same nutritional content as the equivalent you make at home.

I also agree about tomatoes: it is in fact possible to fix them with salt and fat instead of fixing them with sugar. You can definitely get a more intense tomato taste than the store if you water them less than a commercial outfit would. I'm not nearly as crazy for this as most people seem to be, though. Good for salads, bad for sandwiches, but not to a degree that ignites my passions either way. "Heirloom" status is completely beside the point, except as advertising, for which it is solid psychological gold.

> I LOVE microwaved/steamed/boiled corn on the cob with or without salt or butter.

Yeah, because it's a sugary vegge-grain-fruit and sugar is good even without salt and butter. Of course, put some salt and butter on there and you have the holy trinity, which is downright delicious!

We seem to agree more than I initially thought. I certainly agree with this comment.

I'll admit to a lazy use of "heirloom" as a replacement for "not-ruined-for-the-sake-of-looking-good-on-a-shelf".

Maybe you are just being provocative, but do you really feel this way? I've been in world-class restaurants, and honestly the best meals I've had have been at home, with food made by family, friends, or neighbors. I can still recall a plate of food I had when I was about ten years old - steak, corn, salads, all from local farms or family gardens. One of the reasons I so seldom go to restaurants is that I find what I can make at home is superior to the average in a restaurant. Yes, there are amazing restaurants and there are certain cuisines that I go out to eat because they are laborious or I do not have the skills / equipment to make at home. Do you have something in mind that you have not been able to replicate at home, re: taste?

A better term is probably "engineered foods" for what they are talking about. Processing via cooking or baking is one thing, but the kinds of foods that are factory made for a long shelf life via tons of additives and unnecessary ingredients if they were fresh are another.

"Processed food" seems to be used as a proxy for "optimized for consumption". Food made from ingredients picked by someone else to make it tastier (by adding more sugar, salt and fat than you might expect) and carefully prepared to require almost no chewing (liquid food like juices obviously, but most processed meat products are reconstructed from ground up meat, certainly without any bones or tendons).

If you process your food yourself, you're unlikely to have the industrial equipment necessary (and you probably won't dissolve dozens of sugar cubes in a glass of water to make a drink), so food cooked from fresh ingredients is more likely to be healthy.

"and you probably won't dissolve dozens of sugar cubes in a glass of water to make a drink"

That's actually something I have been thinking about. When I read the sugar content of a lot of soda, bottled teas, milk shakes and others I wonder how they actually do manage to get that much sugar into it. When I put 13 teaspoons of sugar into a drink, it barely dissolves and is so sweet it's undrinkable.

This mixer is claimed to achieve 66% sugar content at ambient temperature by essentially grinding the sugar particles to smaller size while mixing them with water: http://www.silverson.com/images/uploads/documents/F_Soft_Dri...

Just heat up the water before adding the sugar, and stir vigorously.

High salt content and acidity to balance the sugar and keep it from dropping out of solution.

> and you probably won't dissolve dozens of sugar cubes in a glass of water to make a drink)

You'd be surprised what some recipes for 'home cooked food' calls for. My SO and I have been on a global culinary 'adventure' in our kitchen for the past few months and we are constantly having to ignore when recipes call for cups (with an 's') of sugar for things like stews, breads (not cakes..), etc. While food cooked at home can be healthy, it's important to understand that not all food cooked at home is healthy.

And more to your comment: you've obviously never had homemade southern (US) sweet tea, which is basically a bucket of sugar with a bit of tea added for flavor.

If you aren’t sensitive to them alcohol sugars are a good low caloric replacement for sugar in nearly all recipes.

"Home cooked food from raw/simple ingredients?"

I'd say that works. The article states "whole foods" which I assume would mean "unprocessed foods" which would fit in line with fresh as well. The major thing I realized when I did ketogenic for a year (and lost 65lbs doing so) was that I basically could not eat to a caloric threshold. I'm a relatively active person (run 3 times a week, walk everywhere), but if you're just consuming spinach and meats you can't consume enough to cross 2500 calories a day. When I went off keto I was still tracking my diet and found a huge caloric jump when eating the same proportions of food, but not in the low carbohydrate realm. A 100g serving of zucchini noodles versus a 100g of spaghetti has a huge caloric difference.

I suspect they mean highly refined carbohydrates, such as white bread, white rices, pasta, etc. Basically where the fibrous and nutritious parts are removed.

Based on the evidence so far, the main culprit seems to be sugar and HFCS which has the same effect on the body as sugar.

I think it's a mistake to try to reduce the problem to a single factor. Sugar plays a role, portion sizes play a role and probably a lot of other things.

I think what he's getting at is more along the lines of people losing weight and being healthier on any form of diet because before going on any diet, some people are drinking soda by the gallon and eating whatever the body wants, when it wants. Doing that means that for most people, they're consuming far more than 2k calories a day, most from "craving" sources like fat, sugar, and/or other emotionally rewarding food groups.

Going on any sort of diet sort of controls all that, and makes the person more vigilant of what's going into their body. So going from consuming wildly more than 2k calories a day, they might be consuming something closer to what their body actually needs, or less even. Metabolism catches up, and if the person is dieting, then they usually tack on some extra exercise too and that further helps their overall health etc.

I also had this assumption when I was on Keto. I wasn't sure if there was some sort of "magic" happening with ketosis, but it just made sense to me that if you take the bun off your burger you're saving x hundred calories that meal, and extrapolate that to all your meals, and obv you will be eating less than you were and probably losing weight.

This, 100%. After following Keto pretty hardcore for about two years, I strayed off a bit. However, I still maintained most of the habits. During that time, if I had to eat a burger (situational), taking the bun off was never a problem, and as you said, over years of doing this, you omit a significant amount of useless calories.

This is probably why the American Dietetic Association recommends veganism and vegatarism, even for vulnerable groups (pregnant women, nursing mothers, infants, children and young people). Something that health authorities in the germanosphere specifically discourage on the risk of malnutrition. The US has 39% obese while Germany has 23%.

The obesity rate in Germany (and many other countries) has been steadily increasing. They're on the same track as the USA, just lagging several years behind.

I definitely think that the major changes come from a switch to an "unregulated" food consumption habit, to any sort of deliberate (and often better-quality) diet. I gained some weight in late high school, and a lot of weight in early college, because I basically ate whatever without thinking much about it (and in my freshman year of college I had access to an unlimited meal plan. I think I ate 4,000 calories a day easily). After freshman year, I spent that summer dieting (mostly focusing on eating salads, and otherwise eating less, and only homemade food). I got very into cooking, and just generally ate a lot of mostly healthy, and almost always homemade food. I now eat vegetarian/vegan and overall I think the main change comes from the fact that my diet is consciously chosen (or comes from habits I developed while focusing on eating healthily).

A friend of mine lost weight through budgeting.

The simple act of recording all purchases of food and especially drink was itself enough to reduce consumption - "I could buy a chocolate bar in the vending machine, but then I'd have to note it in the accounts".

A solid approach :P

I've found that being deliberate about any of the aspects tends to lead to an improvement, and oftentimes you're deliberate about all/a lot of it. A huge shift in both health & wealth comes from switching to home-cooked meals, and then paying attention to what you put in those will help you save money and eat well.

The author seems to have a weird axe to grind with the keto diet. The link that is supposed to go to the study just goes to another summary article of the study written by her.

Low carb dieting is based on some pretty solid evidence, and it's going to take more than this to convince me it's a bad idea to remove carbohydrate derived glucose. It also gives me pause when the author says things like "low carb diets cause tumors to grow". Where's the evidence?

Anecdotally, I have a friend that's no longer prediabetic because he switched to a ketogenic diet, and numerous people have told me the diet has improved their overall health.

This is probably clickbait from a publisher that can't help itself... In terms of content strategy, anti-fad diet articles are a sure winner.

I shed 3 pounds a week on a keto diet without any exercise. It's simply so much harder to consume as many calories from fats and protein as it is from carbohydrates (think heavy whipping cream vs a can of soda).

Huge proponent of keto, regardless of your protein and fat sources.

As a counterpoint, Japanese people generally eat almost the inverse of the keto diet (high-carb, low-fat[1]) and have the longest life expectancy on the planet.

It's just not as simple as "this diet" vs. "that diet".

[1] https://www.huffingtonpost.com/entry/japan-healthiest-people... [2] https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...

One interesting thing to note is that much of this comes from Okinawans in particular, and there's a possible link to a purple sweet potato they consume a lot of (or at least used to). You can get them at most asian grocery stores and they're quite tasty (but not especially keto friendly).

> Nutrition experts say that besides their potential for harm, these popular diets are really hard to follow

You can probably attribute this more to the current food environment and less so the diet. If you only have access to food that agrees with your diet, it's pretty easy to follow. Restrictive food diets are difficult because all the restricted food (generally the restricted foods are ones that are full of "empty calories" or contribute to overeating) surrounds us. It's everywhere. Restaurants. Commercials. Grocery stores. Convenient stores. The break room. Your S.O.'s pantry. If you can manage to escape it, your diet is smooth sailing. Good luck over eating spinach and hard boiled eggs, your stomach will revolt.

> Good luck over eating spinach and hard boiled eggs, your stomach will revolt.

Such an image. Gave me a good laugh. :)

Pretty sure my stomach would be fine, though. Other effects would put me off the whole thing much quicker than that.

You’re not kidding. For anyone who doubts this, try cutting carbs for 3 days and you’ll realize that carbs, especially highly processed are in everything. I wanted to go on a Keto diet but find it hard not to have something in the morning. So now I am on a low carb diet (exceptions for sweet potatoes, rankon etc...) and avoid any pasta products, sugar or bread. Before I started making exceptions I was on the way to losing a lot of weight, but after introducing some healthier carb options I am sort of at a plateau.

Eating whole veggies is hard as hell for me. I typically cook and use oil sadly. My biggest concern is heart disease as that runs in the family. Sorry for random rambling!

    "Scientists and dietitians are starting to agree on a recipe for a long, healthy life."

Whenever i read/hear people say things about other peoples options in general my BS alert goes high....

The body is one of the most complex systems we know of and people keep claiming "Ah i am an expert i know how this works" it is pure insanity.

On top of that we are all individuals and we all work differently. I find it likely that we wont find a single truth about the food we eat, and what food gives best human performance.

What we will find is statistics, this food is 90% likely to be good for a human being. Or eventually some sort of functional description that allows us to figure out what food is "good" for what people. Probably based on genetics or some sort of individual testing.

Honestly I'm hoping someday soon we will get more specific research into associations with gene markers and diets. We already have fitness programs oriented towards genetics, and starting to get diets oriented that way too. I think we need a lot more research before I believe those programs, but if it takes off like Ancestry/23andMe I think the next couple decades could see a lot of genetic based nutrition plans.

Well, the first study is the low carb = 40% of your calories from carbs study: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2...

So, this is worthless.

How is that worthless?

40% would be considered high carb. Keto is generally considered to be under 20 grams of carbs per day.

In medical research 40% is usually considered medium carb or moderately low.

That doesn't really matter, though, because that particular study wasn't defining the low carb group as people who are at exactly 40%. It was 40% or lower, and included people doing much less than 40%.

The data, which looks like it ran from around 20% to over 80% seems to show that around 50% got the best results, with the results getting worse that farther you were from that on either side.

That's sufficient to cast doubt on all low carb diets, whether you use the medical research definition of low carb or the definition used by Keto, Atkins, or other very low carb diets.

Of course it is possible that the results start getting better somewhere between 20% and zero, and maybe even get so much better that they beat that local minimum at around 50%.

There is zero reason to extrapolate from 20% (apparently the lowest percent seen in the study according to the figure), to a keto diet (5-10%). You won't even be in ketosis at 20%...

They didnt have anyone on an actual low carb diet in the study, so they made up their own definition and then drew conclusions about "low carb" diets.

I look to this diet from a very different perspective, because I'm no trying to lose weight, but since I started with a low-carb approach (first Whole30 and then keto) I feel that my long term allergies, my defective intestine problems, my stuff nose and somehow my ADHD just disappeared.

I cannot argue on the downside of this diet, but I definitely can talk about the benefits, and I'm sold.

I've had the same luck with allergies...pretty awesome!

Wait, keto can improve allergies? How long after starting does that start? I'm 2 weeks in.

I'm 515..or I was 2 weeks ago (now I'm 500).. I started a weightloss challenge at a Crossfit gym, where they basically make you pay $400 if you lose 25lbs in 6 weeks and go to all 18 classes (6 wks*3 classes), and follow nutrition guidelines (my coach was okay me modifying that to keto) you get your money back, and probably a pitch to continue crossfit, which I might fall for...I do really like the team/people there.

I do feel a LOT better, stronger, and crossfit is getting a little easier.

So far it hasn't done anything for my adhd (inattentive).. I still can't focus for shit. But would be nice if that would be improved. Can you elaborate on how long that takes to manifest? My depression has improved but I think that could be workout related endorphins.

Hey pal, probably you are in the tipping point. Everytime that I restart a cycle, I wait up to 10-15 days to start feeling the difference. Keep trying two more weeks and tell us if it changed :)

Keto is a difficult and usually expensive diet to follow properly. I followed it for about two years and lost around 80lbs within the first, all while under doctor supervision. There were certain things I had to adjust within the diet and supplement in order for my doctor to be happy with my blood work. I have no doubt that people are following the diet incorrectly and coincidentally causing harm, but hey, it's probably better than choking down a bunch of exothermic fat burners every day or having an all-fruit diet.

What do you consider expensive? I am able to follow the keto diet on around $200 a month, and that's with splurging on things here and there. I've never really understood why people say it is so much more expensive.

I think that it depends on how far you go after fat adaptation. Once that happened for me, and I got comfortable with eating straight butter when in a time crunch, things became very very cheap. Butter, sugar free bacon, eggs and spinach are basically all I buy anymore. I have found, personally, that all of my desire for variety was really desire for carbohydrate variety and now I'm totally fine with whatever keto option is cheap, fast and convenient.

you really eat straight butter? I'm 2 weeks into keto, but that doesn't sound too appetizing lol.

Oh yes, but it sounded horrible to me for many many many months. Once you're fat adapted, food is often just for energy and nothing else. It took me maybe 6 months to even consider not nasty and after a year it became a regular occurrence.

I'd much rather eat a hamburger or chicken than butter... but I also have a lot of native fat to contend with. A keto nutritionist told me just eat your protein first then any veggies you can get down.. having had VSG I can only eat maybe a 4-6oz steak or burger or chicken and maybe two pickles or stalks of asparagus before I'm full.

When I eat candy/sugar/soda I can eat a lot throughout the day, and get a lot of calories in from sugar... i still eat smaller meals, but the sugar did me in. When I'm in keto, my appetite is non-existent, like ever. I'm hardly ever hungry. I don't produce ghrellin so most hunger is mental for me anyways.

Starting the diet: I transitioned from eating simple things like cheap bread, pastas, lots of frozen crap, etc to eating lots of meats, oils, eggs, etc. When you compare the cheapest routes of a poorly balanced S.A.D. (what most generally unhealthy people are following) vs properly balanced Keto, I've found Keto to be more expensive.

After losing weight and maintaining the diet: it was more expensive to maintain a high caloric load after losing the weight. At the time I racked up about 6000 miles/yr on my road bike while at my optimal weight (no body fat to burn). Fats to supply the fuel I needed (mostly MCT's) were far more expensive than simple carbohydrates.

EDIT: I'm not complaining about the cost, I'm just comparing it to what unhealthy people are generally used to. I am currently on the Sated Keto (Ketolent) diet and it's costing around $270/mo which is perfectly acceptable.

Buying more meats/cheeses over pastas and sauces. Buying Almond flour over AP flour. Buying Avocado or coconut oil over corn oil. This list goes on and on. Yes, you can spend a low amount on this diet but you really might be limiting your meal variety.

Probably better than a diet that's 40% or greater soda + cookies + cakes + candy, which mine probably used to be before I started keto lol.

I wish this article wasn't flagged, as even if the info is biased crap it is an important topic.

The only comment I have toward the discussion is to remember that the medical field (especially in the US) has a strong religious bias to diet. There are universities, medical schools, and hospitals built by religious groups who have very strong opinions on what is a 'good' diet. Medicine is more craft than science. Medical study quality and governance board decisions should always be questioned.

The majority of the people who say they are on a keto diet aren't actually in ketosis.

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