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Comment by virtuallynathan | Hacker News Reader

The 800 calories they are eating doesn't seem terribly healthy: "patients were asked to follow either a ‘home-made’ milk- and fruit-juice-based diet (811 kcal/day, 64 g protein, 132 g carbohydrate, 6 g fat) with a multivitamin/mineral supplement (Forceval® [Alliance]), or a micronutrient-replete commercial LELD (832 kcal/day, 87 g protein, 120 g carbohydrate, 12 g fat).

I imagine these people are probably staving... I'd rather go low-carb myself.

This is the study, DiRECT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754868/

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This diet sounds miserable. You'd be hungry all the time. I would also much rather eat low-carb (and I do, I am a T2 diabetic that eats a ketogenic diet).

Which sounds more sustainable? Drinking 800 calories of milk and juice every day, or eating real food like steak and broccoli, or chicken with brussel sprouts, or bacon and eggs?

I am losing weight and reducing my A1c eating about 1300 calories of real food each day, and it doesn't leave me hungry at all. Keto is a very sustainable way of eating (in that you can keep doing it without misery). This "diet" looks like hell.

> This diet sounds miserable. You'd be hungry all the time. I would also much rather eat low-carb (and I do, I am a T2 diabetic that eats a ketogenic diet).

Not eating anything, and only eating proteins and fats, are both difficult for me. And simply abstaining is actually easier. When I consume anything I begin craving not only carbs, but craving the stimulation of eating, period.

I think its finally uncontroversial to say that not all calories are the same. But eating is more than just the metabolic process; like smoking it's about the physical habits and stimulation. In that way eating chips is not much different than eating pork rinds, and for some people that's what matters most.

Remember the Master Cleanser and juice fast fads? People consuming nothing but raw sugar for days, weeks, and even months on-end derived similar benefits--weight loss, improved insulin sensitivity, etc. And for some people it was really easy because you could sip on your drink constantly throughout the day, which was in an important way the antithesis of abstinence. Not all calories are the same, but it's still the case that fewer calories are better. Just do whatever it takes to get you to fewer calories.

I'm not trying to equivocate diets--vitamins, minerals, and fiber still matter. But, again, calorie count is ultimately the most important metric. How you manage it is largely a matter of your personal tastes and lifestyle. Few people can manage a perfect diet, but there's a least bad diet for everyone, and they're often wildly different. And that's basically what the expert stated in the article--the powdered diet isn't for everybody, but it was important to begin offering alternatives to the "balanced diet" recommendations.

True, I don't disagree. Keto is just the easiest way I've found to eat at a caloric deficit without feeling deprived, hangry, or succumbing to cravings and eating half a cake in one sitting.

Once you get past the first couple weeks, carb cravings fade, and it's not nearly as difficult. It's just far easier for me to say no entirely to carbs than for me to eat them in moderation, much like it's a bad idea for an alcoholic to try to have "just one" beer.

A recent analysis posted here claimed that low carb, high animal protein/fat was the unhealthiest diet long term, resulting in a 4 year drop in life expectancy, compared to a 1 year drop with a high carb diet.

Low carb looks to be dangerous for your body long term if you have too much meat.

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2...

According to a recent documentary I saw on the BBC about this very diet, the point of the 800 diet is to lose weight asap and then introduce food back in gradually over 3 weeks (I think it was restoring one meal time a week, dinner, lunch, breakfast), in a controlled manner to teach you better food habits.

The documentary was focused on 4 normal people who had health problems due to weight, they all were trying this diet to see if it would help. One of them had just developed type 2. Wouldn't be surprised if that programme paved the way for this (it was on in June).

https://www.bbc.co.uk/programmes/b0b53xqs

I eat reasonable portions of meat, not excessively large ones. Most of your calories on a ketogenic diet come from fat, not protein, both dietary fat and fat your body burns off if you're also losing weight at the same time.

I would also rather live 4 less years and be healthy til the end of my lifespan, than live 4 extra years post-foot-amputation and on dialysis because of complications from diabetes. My father was also a T2 diabetic, tried to follow the ADA recommended diet, but still wound up insulin-dependent and eventually on dialysis before his death. I do not plan to follow in his footsteps.

I feel better on this way of eating than I have at any point in my life. My body has never metabolized carbs well. When I was younger, I was reactive-hypoglycemic, meaning that eating too many carbs would actually cause my body to over-respond with insulin, causing my blood sugar to plummet. I blacked out multiple times in high school from low blood sugar. Eating carbs (other than green veggies of course) is not for me.

The study categorized everyone who ate below 40% of their calories into the low carb group. That's a lot of people who simply eat SAD. It would be much more interesting if they grouped the subjects into more categories. But I suspect the data for that simply isn't good enough.

Obviously that publication didn't go over well with the keto crowd, and they found a lot to pick apart (See 1 and 2). The most relevant critiques:

Methodology-wise, the prospective study seemed pretty poor

* Those people filled out questionnaires on their eating patterns on two occasions, six years apart. Their health was followed up for 25 years, allowing for factors that might alter the results, such as smoking, income and diabetes. (the assumption presumably being that they ate the same for the rest of their lives? IMO this seems to make any results pretty much worthless)

* low carb in this study is defined as "low carbohydrate consumption (<40%)" - typically LCHF is understood to be 50-100g, so typically 10-20%, and keto is even lower (5%)

* The PURE study was cited as part of the meta-analysis but another analysis in the Lancet actually came to the findings that: "Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64–0·98], ptrend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality." https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

* The "years in life expectancy" is very unusual - usually what's presented is relative risk or hazard ratio and absolute risk. This can be found in the data - from the ARIC study, the HR for high carb was 1.16 and for "low" carb was 1.37 - the annual death rate was 1.63%, so the absolute risk was a difference from 1.38% vs 1.88%. These calculations, and a full analysis of the article is available here: http://www.zoeharcombe.com/2018/08/low-carb-diets-could-shor...

* I noticed that one of the authors listed is Willett, who invented the Mediterranean diet as we know it, and Sarah Seidelmann, the lead author is an outspoken vegan advocate, so it's worth keeping bias in mind when looking at the results. Sadly, the world of nutritional science (especially the epidemiological arm seems to really be as much about personalities as science (part of Ancel Keys' legacy, I suppose)

Actually, since I'm a bit tired of listing out points here are a few other interesting rebuttals that are primarily interesting because they point to all the pitfalls of coming to conclusions from observational studies and meta-analyses (and why nutritional reporting is simply the worst):

* https://cluelessdoctors.com/2018/08/17/when-bad-science-can-...

* https://www.linkedin.com/pulse/low-carbs-mortality-john-scho...

* https://www.psychologytoday.com/us/blog/diagnosis-diet/20180...

* https://anhinternational.org/2018/08/22/scientific-attack-on...

* https://asianwithoutrice.com/making-low-carb-a-murderer-part...

1: https://www.reddit.com/r/ketoscience/comments/98kx1w/all_nit...

2: https://www.reddit.com/r/ketoscience/comments/981ync/dietary...

It's going to be extremely difficult to confirm to 800 calories consisting almost entirely of carbs - very few people are going to succeed with this.

Neither of those consist almost entirely of carbs.

Gah, you're right, I read it on mobile and missed the protein value.

Then it's not quite as bad as I thought, but fat is still much more filling than protein:

fat > protein > carbs

That is a ton of carbs and moderate protein. I'd expect to see <80g of carbs and more focus on lean meats and veggies.

I'm betting that diet was vetted by a qualified dietitian/nutrition specialist.

I've seen a qualified dietitian working for the NHS - she hadn't a clue about what kind of diet someone with blood sugar problems should eat. Unfortunately, this has been my (even more unfortunately) wide and varied experience of several NHS consultants across different specialisms - their knowledge hasn't been updated since they left medical school, and what they were taught at medical school was 20 years out of date when it was taught.

It's targeted at people with type 2 and are obese .. which is an ever increasing issue in the UK. The BBC don't like to rock the boat.

Hasn't every study prior said fasting (especially combined with low carb diet in between) is far better than low calorie, because your body makes different adjustments to lack of food rather than some food and you actually end up worse on a low calorie diet because your body isn't getting the full amount of nutrients and calories it wants/needs but doesn't make the adjustments it'll make for brief periods of lack of food.

So I guess back in the day, milk and bananas were considered an ideal food combination,

A bowl of milk with bananas and about 1/4 cup of sugar. My grandpa ate that right up until he died. Man never gained a pound.

Yeah I think I had it backwards it was nutrients that mixed perfectly, I was editing my post as you wrote that about weight gain. I thought Norman Rockwell used it to try and join the war.

Nothing wrong with that kind of diet for people without a genetic predisposition for diabetes (or lactose intolerance) and who are otherwise eating moderately.

Generally agreed, but with a caveat: diabetics are at risk of ketoacidosis on low carb diets. They would need to measure their blood ketones and moderate carbohydrate intake to keep their levels down below dangerous thresholds.

Personally when I went low carb, I got blood (not urine) ketone levels up into the range that would kill a diabetic quickly, think in the 7.0 range. Even as someone well adapted I regularly hit the 3.0s when fasting.

Obligatory: I am not a doctor.

Type 1 diabetics may be at risk for ketoacidosis if they screw up their insulin, but T2 diabetics are not at any risk from just a low-carb diet. The problem is having high blood sugar and high ketones simultaneously, not just having high ketones. And the nice thing about a low-carb diet is that you're not eating carbs, so your blood sugar does not become elevated. If your pancreas can still create insulin at all, you are highly unlikely to go into ketoacidosis.

Keto is a really good diet for both weight loss and correcting insulin resistance for a T2 diabetic.

(Source, I am a T2 diabetic that eats a ketogenic diet. I am losing weight and my A1c is dropping. My doctor is pleased with my diet choices.)

Usually type 1 diabetics (autoimmune, are more at risk for DKA. Type 2 diabetics can definitely be at risk for DKA, especially if insulin-dependent. However, they are at higher risk for hyperosmolar hyperglycemic coma, which is equally frightening.

It's definitely a risk, but not as much if your body is still making insulin to help provide your cells with at least some energy.

You dont get keto acidosis by eating low carb, that is misinformation.

Source? From my read it looks like you absolutely can.

https://www.nejm.org/doi/full/10.1056/nejmc052709

That's a case study of a single patient. Main takeaway:

>Benign dietary ketosis resulting from restricting carbohydrates could, theoretically, cause ketoacidosis in persons with a predisposition to the condition.

That sounds very much like what they were saying. “Theoretically” is closer to “can” than it is to “cannot”.

Also, I said that it’s a risk to be managed. People are acting like I said that it’s a certainty and that not eating sugar constantly as a diabetic will kill you instantly or something.

I made it very clear that it’s high ketones while diabetic that causes it. If you’d like to correct that in a more constructive way, that would be helpful.

Type 1, maybe. Type 2, not at all. In fact, a ketogenic diet will reduce or eliminate the symptoms of T2.

> ketone levels up into the range that would kill a diabetic quickly

That's not how it works. DKA happens because your body is burning fat because it's starving from a lack of insulin. Ketones from healthy weight loss are not dangerous.

Cool. What about renal load?

A lot of people here are suggesting, like you, that a low-carbs diet or ketos can help your body "heal" from T2D. I just don't see why starving yourself from carbs, which is like the basis of life for your cells, is going to help. From what I gleaned here and there, T2D is more linked to fat-heavy diet, which clutters blood vessels and keeps yours cells from absorbing the insulin your body produces, thus preventing them from "disgesting" the carbs you sending to them, resulting in diabetes. Reducing all the cholesterol in your diet will help your body "cleanse" gradually from these plaques on your blood vessels.

I'm not doctor, nor a nutrionist, but this guy makes really good and sourced videos on these subjects:

On Keto: https://www.youtube.com/watch?v=MzHLAqyO7PQ

On carbs: https://www.youtube.com/watch?v=MyOACAdvAsE

I really recommend watching them. They're clearly oriented (duh), but still quite informative.

I'm sorry, my reply is a bit rushed and not that polished, but I really wanted to reply to see if anyone has something to say about this interpretation of carbs and T2D. (And it's damn late right now where I live!)

Bodies can run on ketones (byproduct of breaking down fats) or glucose. I'm not sure where you got the information that T2 is related to fat heavy diet, that is not true at all. It can be related to bring fat, for to complications with obesity. It is related to glucose spikes, which causes insulin spikes, but the T2s body is insulin resistant and so sugar and insulin stay in the blood stream and can't be utilized. High sugar in the blood is the cause of most T2 chronic issues.

Also of note, a recent study has found that ingestion of cholesterol does not correlate with how much is in your blood.

Those videos were painful to watch (what's up with his intonation, it sounds like he's introducing prizefighters) and the guy looks anorexic and anemic; not someone from whom I'd take nutritional advice.

T2 is related to glucose ingestion(sugar, carbs) NOT fat. Glucose spikes your insulin, and the continued, extreme spiking of insulin is what causes T2.

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