Ketogenic Diets and Chronic Disease: Benefits vs. Risks
frontiersin.org
frontiersin.org
1. People rarely compare it directly to something like a "Real Food" diet - they go from a lot of processed crap to mostly non processed stuff on the outside of the grocery store and then see huge benefits. But I suspect if they just switched to a Real Food diet in the first place they would see most of the same benefits.
2. It completely leaves out almost all legumes and many root vegetables and gourds which are both hugely beneficial and also some of the cheapest / most sustainable calories out there. There is a reason humans domesticated gourds early on - they are easy as hell to grow, tasty, healthy, balanced, and the shells often also provide other benefits.
On top of that the three above food groups are the main sources of high quality prebiotics (not probiotics) which are essential to our gut health and producing both essential fatty acids and Vitamin K2. The FDA just assumes that people meet an RDA value for EFA and K2 based on gut fermentation but this relies on people consuming quality fiber and most importantly specific prebiotics like long chain inulin and resistant starch (which are very different than simple starch and normal inulin). EFA and K2 are intricately involved in immune modulation, gut inflammation, inflammation in general, and all kinds of other processes.
I think we all know that the average person in the west is likely not eating nearly enough of these prebiotics and in addition many have other digestion issues as well. There is a reason scientists call them ESSENTIAL fatty acids and not "kinda sorta important" fatty acids.
Do you think the Inuit, or hunter-gatherers in northern Europe or Asia were getting 50% of their calories from non-animal sources? You know the answer is absolutely not.
I don't want to get into an annoying, repetitive ideological flame war here. What I can tell you is that depending on the climate and the length of the winters, as well as the soil, tribes had vastly different diet compositions. There are numerous studies on this.
Even outside the polar regions to places where fruits and vegetables where not available or were very limited people came relatively recently. For example, in Mongolia it happened about 20 thousands years ago. Moreover, human population there in any substantial numbers appeared less than 10K years after domestication of animals and access to their milk. In Mongolia people living in traditional ways drink a lot of fermented horse and camel milk getting enough calories from carbohydrates to avoid a permanent keto state.
So a permanent keto state from evolutionary perspective was never sustainable.
I have type 2 diabetes. For the first 7 years after my diagnosis I stuck to the ADA diet I was told to follow and to use insulin to manage my blood glucose. My insulin requirements increased every year…10-15%. My weight stayed the same, trying to lose was difficult to maintain for a long period, and when you have a lot of weight to lose…you need to maintain caloric restriction for a long period.
5 years ago I switched to keto. Within 4 months I was off all diabetes meds and have been off since. I have lost 170lbs. Does the diet alone give me all the nutrition I need? Nope. So I take a supplement or two to get what I need. That is better for me and my blood sugar maintenance than consuming beans and root vegetables. Keto enabled the change I needed to make, because one thing the diet does well is create satiety, which ultimately leads to caloric restriction which led to weight loss which led to the glucose control I needed to stop damaging my body.
Here is the main thing though. Eating the ADA diet and using insulin to control my blood glucose was ultimately a losing game. My life expectancy was likely lower eating that ADA diet than eating keto, thanks to all the keto created benefits. Diabetes might have killed me at 65, keto might kill me at 75. I’ll take the 10 years and whatever issues keto decides to deal to me.
This is just my individual story.
The ADA has quietly acknowledged these studies in their Standard of Care and more recently has adopted a position of endorsing low-carb, but they're still ignoring keto despite the clinical evidence.
As you said, the ADA's guidelines are focused on managing T2D as a progressive disease which inevitably leads to increased medical requirements over time. Although T2D remains incurable, there's enough clinical evidence to conclude that for many people it's treatable with nutritional ketosis.
I like to think I'm a rational person and don't subscribe to conspiracy theories in general, but something about the ADA and their relationship with pharmaceutical companies just rubs me wrong. To my knowledge, their largest financial sponsor is Eli Lilly which also happens to be one of the world's largest manufacturers of diabetes drugs, including insulin.
Well when your go to published eating strategy for 35 years is designed to maximize the amount of insulin that is to pumped into bodies…it’s hard not to notice coincidences.
Second point - you confirm OP's claim if I understood correctly - people go from one extreme (with having 170 pounds to lose that's some extreme obesity category, you get there by fucking up something properly and for long time and thats a kind language I am trying to use) to another extreme.
Extremes might be good for treating extremes, if it somehow magically clicks. For general population, some middle path is, as usually, the best choice. If there should be just 1 single rule and not a set of them, it should be: eat less. Of course there are many more good advices, but this should be first foundational step to any improvement.
Your comment near the end feels like you're facing information that heavily conflicts with what you're used to hearing and are instinctively reaching for the middle ground fallacy. I've yet to hear about someone on the keto diet getting anywhere near dangerously low weight. Most people just complain about plateauing at a slightly higher weight than desired before they start putting any effort into eating before they feel full.
Am I? That is interesting as I know others managing their T2 this way. Actually I know more people managing their diabetes this way than any other dietary strategy (short of the tried and true eat whatever in moderation and push insulin to counteract it approach which is basically just resigning yourself to the inevitability of the disease). It could just be that it’s a new enough strategy that it hasn’t received the widespread medical adoption yet in your area. My own doctor advised against me doing it until he saw what it did for me. Then, coincidentally that is right around when the ADA added the low carb dietary strategy to their approval list and now the medical office advises the approach as one they know can create some success. I’d say anyone using diet only to control T2 is an outlier, but using keto or low carb for those folks using diet alone…it’s likely moving to becoming the majority.
As to your second point, yes extreme to extreme, gotcha and thanks for the punctuation on the point too—but that has little to do with the fact that if your body cannot effectively process excess glucose you either need more insulin to handle it, some way to make your insulin more effective, or you need a strategy that creates less glucose that your body needs to handle. Whether you are 170lbs overweight or 1lb overweight and T2 if you limit carb intake (and protein to a degree) you can solve the excess glucose problem.
I’d also argue that considering just about every foodstuff in my local supermarket has some form of keto alternative marketed alongside it and for at least the last 4 years, we have moved away from extreme and into the realm of yet another mainstream eating strategy that has been adopted by the public.
That is the dirty little secret of keto—higher fat diets tends to trigger the satiety faster and people tend to eat less calories because of it. People assume keto means things like “all you can eat bacon” and think that people on keto are packing away 10k calories a day of bacon. Try and eat a pound of bacon...bet you can’t.
My calories were cut in half when I first moved to keto, and I never ever felt hungry which is way way different than every other calorie restricted diet I ever attempted.
given your diabetes dx seems like one area to monitor.
Doc does standard blood tests on me twice yearly now (used to be quarterly). To date, no issues with my kidneys.
Keto is not really protein heavy. I ate much more protein pre keto.
Most people in the US aren't eating a "Real food" diet, which is actually where a lot of studies benefits come from because the baseline is so unhealthy - it's about what you're not/stop eating as much as it is about what you are eating.
https://www.youtube.com/watch?v=VfQtq4YTPso&ab_channel=Stanf...
> 2. It completely leaves out almost all legumes and many root vegetables and gourds which are both hugely beneficial and also some of the cheapest / most sustainable calories out there. There is a reason humans domesticated gourds early on - they are easy as hell to grow, tasty, healthy, balanced, and the shells often also provide other benefits.
Like the article says many people are on keto diet for cancer or neuro-degenerative conditions that potentially benefit from being in a state of ketosis & you can't do that even eating healthy nutrient carb sources like legumes and root vegetables.
Any references to suggest on these?
https://ift.onlinelibrary.wiley.com/doi/abs/10.1111/j.1541-4...
https://www.sciencedirect.com/science/article/abs/pii/092422...
https://www.sciencedirect.com/science/article/abs/pii/S09639...
etc. there are alot more. You can access them through sci-hub or your institution.
But I found I ate less processed food to prior to keto since my main focus was meat, eggs, and cruciferous veggies.
I am 6'0" and used to weigh 340 pounds. I now do not and hit 168 at my skinniest. I switched to Paleo because Keto did _not_ at the time feature a "real food" aspect (as in, chugging Canola oil was fine because oil is fat; this is dangerously nonsensical from a nutritional and oxidizing fat perspective).
After I went strictly Paleo, lost most of the weight, I needed to improve my fat loss a little more, and starting trading healthy carbs for healthy fats. Thus, I took up Paleo Keto, and often do days on 20-30g of carbs.
I absolutely agree with everything here because if I had done Keto first, it would have been a failure, and I could have even injured myself due to how early Keto was obsessed with macro counting, but not obsessed with where their macros came from.
The modern scientific diet movement is basically something on the Paleo Keto spectrum, the benefits of inexpensive foods with low or no processing that are full of nutrients combined with the benefits of a low carb/high fat diet with sufficient protein.
Also, given my Keto-leaning Paleo diet, I actually eat a surprisingly large number of sweet potatoes. You know why? FDA says they're basically pure carbs, but if you actually look into the science, its mostly "slow carbs", can be cooked in ways that produce ridiculous amounts of RS (and if you don't do that, still have an amazing amount of it), and are low in enough in certain fructans that people on a FODMAP diet can either eat them (as they do not personally react to them at all) or eat small amounts of them (like a half of a medium sized sweet potato) for a serving and not react.
Keto is a very wide category that really only means restricting your carbs to 30g/day or so. You can be real-food keto and real-food not-keto.
You can be keto vegan, you can be keto carnivore. Well, all carnivores are keto. In fact the studies in the last couple years, tend to all show that effectively being keto is what matters.
The jury is still out on why it works. As you said, we've been eating tubers for eons. So why suddenly in the last ~75 years or less has it become such a problem? Perservatives, glyphosate, GMOs? Everyone seems pretty clear that our food has become toxic in some way. Lots of different approaches that eliminate grains and seed oils and drastically improve your situation. We haven't figured out what exactly is doing it.
>I think we all know that the average person in the west is likely not eating nearly enough of these prebiotics and in addition many have other digestion issues as well. There is a reason scientists call them ESSENTIAL fatty acids and not "kinda sorta important" fatty acids.
The funny thing to me, we have people effectively going 'real food' afterall a carnivore is also 'real food' but vegans are doing the same thing, but different direction on 1 spectrum and seeing the benefits as well.
The huge problem... economies collapse if we fix whatever it is. If you go to your local grocery store and throw out everything that isn't 'real food'. The grocery store becomes empty. Fast food places shut down. That's a pretty significant portion of our society who no longer work or anything. What are they to do? We can't fix the problem.
> and diets focusing on whole plant foods and limiting animal foods and processed foods, such as the MIND diet, are proven to reduce AD risk
I'm excited about the potential of the MIND diet. Here is a quote from the study they linked to
> Results: In adjusted proportional hazards models, the second (hazards ratio or HR = 0.65, 95% confidence interval or CI 0.44, 0.98) and highest tertiles (HR = 0.47, 95% CI 0.26, 0.76) of MIND diet scores had lower rates of AD versus tertile 1, whereas only the third tertiles of the DASH (HR = 0.61, 95% CI 0.38, 0.97) and Mediterranean (HR = 0.46, 95% CI 0.26, 0.79) diets were associated with lower AD rates.
That's evidence that suggests, implies, and points in the direction that AD might be reduced by the mind diet. But doesn't even come close to prove it.
I assume the rest of this paper is as sloppy overstating the evidence.
I think there is a place for scientific advocacy, but own it. Don't pretend like you're an unbiased third party trying to find the truth about keto. This review would be better seen as a "Overview of potential risks of ketogenic diets, and possible alternatives."
Original paper: MIND diet slows cognitive decline with aging https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581900/
INTRODUCTION
Dementia is now the 6th leading cause of death in the U.S.1 and the prevention of cognitive decline, the hallmark feature of dementia, is a public health priority. It is estimated that delaying disease onset by just 5 years will reduce the cost and prevalence by half.2 Diet interventions have the potential to be effective preventive strategies. Two randomized trials of the cultural-based Mediterranean diet3 and of the blood pressure lowering DASH diet (Dietary Approach to Systolic Hypertension)4 observed protective effects on cognitive decline.5;6 We devised a new diet that is tailored to protection of the brain, called MIND (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay). The diet is styled after the Mediterranean and DASH diets but with modifications based on the most compelling findings in the diet-dementia field. For example, a number of prospective studies7–10 observed slower decline in cognitive abilities with high consumption of vegetables, and in the two U.S. studies, the greatest protection was from green leafy vegetables.7;8 Further, all of these studies found no association of overall fruit consumption with cognitive decline. However, animal models11 and one large prospective cohort study12 indicate that at least one particular type of fruit – berries - may protect the brain against cognitive loss. Thus, among the unique components of the MIND diet score are that it specifies consumption of green leafy vegetables and berries but does not score other types of fruit. In this study, we related the MIND diet score to cognitive decline in the Memory and Aging Project (MAP) and compared the estimated effects to those of the Mediterranean and DASH diets, dietary patterns that we previously reported were protective against cognitive decline among the MAP study participants.13 Go to: METHODS Study Population
The analytic sample is drawn from the Rush Memory and Aging Project (MAP), a study of residents of more than 40 retirement communities and senior public housing units in the Chicago area. Details of the MAP study were published previously.14 Briefly, the ongoing open cohort study began in 1997 and includes annual clinical neurological examinations. At enrollment, participants are free of known dementia15;16 and agree to annual clinical evaluation and organ donation after death. We excluded persons with dementia based on accepted clinical criteria as previously described.15,16 Participants meeting criteria for mild cognitive impairment17 (n=220) were not excluded except in secondary analyses. From February 2004- 2013, the MAP study participants were invited to complete food frequency questionnaires at the time of their annual clinical evaluations. During that period, a total of 1,545 older persons had enrolled in the MAP study, 90 died and 149 withdrew before the diet study began, leaving 1306 participants eligible for these analyses. Of these, 1068 completed the dietary questionnaires of which 960 survived and had at least two cognitive assessments for the analyses of change. The analytic sample was 95% white and 98.5% non-Hispanic. The Institutional Review Board of Rush University Medical Center approved the study, and all participants gave written informed consent. Cognitive Assessments
Each participant underwent annual structured clinical evaluations including cognitive testing. Technicians, trained and certified according to standardized neuropsychological testing methods, administered 21 tests, 19 of which summarized cognition in five cognitive domains (episodic memory, working memory, semantic memory, visuospatial ability, and perceptual speed) as described previously.18 Composite scores were computed for each cognitive domain and for a global measure of all 19 tests. Raw scores for each test were standardized using the mean and standard deviation from the baseline population scores, and the standardized scores averaged. The number of annual cognitive assessments analyzed for participants ranged from 2 to 10 with 52% of sample participants having 5 or more cognitive assessments. Diet Assessment
FFQs were collected at each annual clinical evaluation. For these prospective analyses of the estimated dietary effects on cognitive change, we used the first obtained FFQ to relate dietary scores to cognitive change from that point forward. Longitudinal analyses of change in MIND diet score using all available FFQs in a linear mixed model indicated a very small but statistically significant decrease in MIND score of −0.026 (p=0.02) compared to the intercept MIND diet score of 7.37.
Diet scores were computed from responses to a modified Harvard semi-quantitative food frequency questionnaire (FFQ) that was validated for use in older Chicago community residents.19 The FFQ ascertains usual frequency of intake over the previous 12 months of 144 food items. For some food items, natural portion sizes (e.g. 1 banana) were used to determine serving sizes and calorie and nutrient levels. Serving sizes for other food items were based on sex-specific mean portion sizes reported by the oldest men and women of national surveys.
The opening paragraphs immediately launched into direct attacks on nutrient deficiencies which can be easily remedied on a CARNIVORE diet, but which don't actually exist on a standard keto diet. They essentially used a carnivore diet without organ meat supplementation as a straw man for the keto diet.
Because my father became a vegan when I was 15 after falling in love with a radical vegan animal rights activist who worked at PETA, I spent my high school years with parties of radical vegans at my house every weekend. The way they talked about nutritional science was reminiscent of how fundamentalist Christians talk about abstinence only sex education: They are far more motivated by shoving the means down your throat than they are about the actual realities of the ends. Like them, the PCRM is not a truth-seeking organization. They already KNOW the answer, and seek only to support their agenda.
Edit:
I had to add that I can't begin to describe how utterly irritating the PETA activists were. I actually had a very good friend who was no longer allowed to come over to my house. The reason, and this is fucking nuts:
I brought the friend along on a surfing trip to Cape Hatteras Island, North Carolina. We camped at Frisco, had a great time. My dad's PETA girlfriend was with us. On the way back, while driving north on Route 12 (a 2 lane road), in moderately heavy traffic, she saw a box turtle get clipped by a vehicle ahead in the oncoming lane. She immediately swerved the vehicle (a 1993 Ford Taurus station wagon) with me and my buddy inside, to block the two lane road, losing control in the process, tires squealing. We were utterly terrified. She immediately jumped out of the vehicle to go and render aid to the turtle. We narrowly avoided getting hit by multiple vehicles. Utter fucking nutcase, and most of the others were like her. If you're a person who worked at PETA in the past reading this, I'm sorry if I'm lumping you in, but those people are lunatics who love animals more than people.
Which is not news to me... nor science for that matter.
I no longer do keto and have maintained my weight.
I don't give others diet advice but I went from obese and inactive to healthy and fit, and keto was an essential part of that transition.
That kind of keto is hard work though - everything my daughter eats is measured and weighed to the gram. Its important to get the right amount of calories too - not too many and not too few - so there's a lot to measure.
What I would say though (and the paper to its credit seems reasonably clear on this) you need serious Keto to get those benefits - my daughters diet is ratio 3.5:1 which means for every gram of protein or carbs there are 3.5g of fat. So essentially the diet is about 77% fat overall, which is hard to do - kindof like everything has to have as much fat as pure butter. You have to be careful at that level - too many ketones and you're heading for a coma. We have a little pin-prick ketone tesing machine, an action plan for what to do if ketones go too high, how to look for the signs etc.
So lets call that 'medical keto'. There's also 'popular keto' which is what you'll get if you google 'keto cookie recipe' - reasonably high fat, reasonably low carb food that may well help people lose weight or feel a bit better or whatever but its nowhere near 3:1 ratio or 4:1 ratio. If I look up a keto recipe and they don't even give me the ratio, I know its 'popular keto'. If its 'medical keto', they'll be telling me the ratio for sure.
In summary: strict high ratio keto works for seizures in enough cases to make it competitive with meds. Its also dangerous if you dont track it carefully. Popular keto such as you see in trendy cookbooks is a different thing and may well be good for some stuff like diets or whatnot.
What is the reason it chemically or physicals works for seizure disorders?
Not to directly compare them but I feel the same way about a lot of rhetoric around CBD - there are a lot of approved and legitimate medical uses but the amount of extra stuff that people claim it does seems like total BS.
re: CBD: Interestingly, Dravet Syndrome is also shown to react fairly well to CBD. If you've heard of the 'Charlottes web' strain of cannabis and all that stuff, that was named after Charlotte Figi who had Dravet Syndrome.
CBD is used quite widely to treat Dravet - there's been a lot of research and there's now an 'official' pharmaceutical CBD called Epidolex https://www.webmd.com/drugs/2/drug-176175/epidiolex-oral/det... - approved by the FDA, NHS etc. You can get it on prescription over here.
Theres a certain 'pot cures everything' lobby that have overblown it a bit. It does seem to work but there are side effects and there are other drugs that work just as well or better (with the caveat that with epilepsy, not every patient responds the same to every drug). e.g. Fenfleuramine is another new (or technically, repurposed) drug for Dravet that seems to work better than CBD for most people. Although I have met some Dravet parents who swear by CBD and say they've done great with it. Others say that CBD on its own isn't enough, you need proper cannabis.
My years of indigestion went away (and never came back - it's been 3.5 years since this experiment) Lost 60lbs from 220 to 160. Slept like a log. Like a solid 7-9hrs a night once I was a month in.
All my markers - lipids, metabolic, blood Glucose, etc..went from shit to within norms with LDL slightly elevated.
I had more energy during the day, and way more focus (I'm adhd).
I had to quit bc even when upping my calories to 2,500-3k a day. I was still losing weight.
Also I developed Orthorexia during this process. I became obsessed with making keto versions of bread, taco shells, home made cereal, and started to spend endless amounts of time in the kitchen. When eggs, meat and big ass salads would have done just fine. Even when quitting keto.. Taking nutrition to absurd degrees was common for years. It became a total OCD.
This saddens me a lot. I'm a low carb proponent and I remember when keto was relatively new and based around real food. Meat, fat, dairy, nuts, vegetables. Then when people started losing weight the housewives got into it, and have turned keto into how to turn replace grains and sugar with fat. So no more real food, but keto pizza and muffins packed full of artificial sweeteners. /r/keto used to be cool, now it's just cheesecakes and adding butter to your coffee. I'd be surprised if people lost weight on that abomination.
Thankfully there's some more strict fringes that haven't been contaminated yet by the greater masses, and research into its benefits can continue until the soccer moms and big snack get into those as well.
"Very-low-carbohydrate diets may lack vitamins, minerals, fiber, and phytochemicals found in fruits, vegetables, and whole grains (6–8). "
How many vitamins are in non-fortified grains?
"However, findings from a recent trial by Hall et al. suggest that a low-fat vegan diet (10% energy from fat) may be more effective than a ketogenic diet in suppressing appetite (27). "
"Conflict of Interest" "[she is the author of a food and nutrition blog, Veggie Quest]"
A quarter-cup serving of wheat berries contains approximately:
158 calories
33 grams carbohydrates
7 grams protein
1 gram fat
6 grams dietary fiber
2 milligrams manganese (97 percent DV)
34 micrograms selenium (49 percent DV)
0.25 milligram thiamine (16 percent DV)
159 milligrams phosphorus (16 percent DV)
60 milligrams magnesium (15 percent DV)
2.8 milligrams niacin (14 percent DV)
0.2 milligram copper (10 percent DV)
1.7 milligrams iron (10 percent DV)
1.3 milligrams zinc (9 percent DV)
0.2 milligram vitamin B6 (8 percent DV)
21 milligrams folate (5 percent DV)
That's before getting into much more complicated issues around digestibility and nutrient binding making some nutrients unavailable. Suffice to say, wheat berries are not a food that humans ever ate when they grew grains: they always performed processing to turn wheat into bread, etc for good reason. It would make more sense to look at the nutrition of a particular whole wheat bread, etc.
Why wouldn't ancient people have eaten wheat berries, boiling (like in a stew) seems like the easiest way to prepare wheat or other grain like barley
You can probably boil a cup of them and eat them and be fine. But you can find the answer to the question by eating 1000 calories of wheat berries and seeing what happens. It's going to be difficult to digest since we don't have a ruminant digestive tract. Making bread helps further break down the wheat so that it is more digestible. Bread making originally used slow fermentation (instead of quick rising yeast) to maximize this process.
What a load of bollocks. What vitamins and minerals are lacking in meat? Only one, vitamin C, and there is evidence the RDA for it is much lower if you don't ingest many carbs. The Inuit didn't get scurvy. And in any case vit C heavy plants and fruit are definitely OK on a low carb diet.
And no fibre and phytochemicals (literally "plant chemicals")? It's by design. None of these things are essential, and some find improvement in their autoimmune diseases and digestion when these are reduced or removed altogether. My digestion gets better and better as I approach literally 0g of fibre, provided my carb consumption is low of course. High carb low fibre isn't fun.
In whole grains, plenty. Refined grains are fortified/enriched in an attempt to bring their nutritional value closer to the unrefined state.
Anecdote: Back when I tried a whole foods vegan diet I found that my main problem was eating enough calories. I simply had to eat a lot more food.
> Ketogenic diets can induce weight loss (20–23). In a 2020 meta-analysis of 38 studies lasting 6–12 months and including 6,499 participants, low-carbohydrate diets, defined here as <40% of energy from carbohydrate, led to a small weight loss, compared with low-fat diets, defined as <30% of energy from fat (mean difference −1.30 kg; 95% CI, −2.02 to −0.57), with considerable variability between individuals and between studies. More than half of included studies met criteria for a general ketogenic diet, as defined in Table 1, for part or all of the low-carbohydrate intervention (24).
Even `classic keto` as defined in their table allows for 10% of your calories from carbohydrates. If eating 2kcals/day, that's 50g of carbs.
In no way do the studies referred match what I've known as keto. The goal to me is accidental carbohydrates only.
Yeah, I never see a good analysis of a strict keto diet... First two weeks are incidental carbs only, as close to 0 as possible.. after that maybe 20 a day, 30 a day, for months.
I'm on day 56 right now and down 21 pounds.
I didn’t switch for any weight loss reasons (I was quite in shape before starting - and still am). I merely just wanted to try it since I had seen it mentioned. For me the biggest switch over was the mental focus and energy benefits. I don’t wake up groggy anymore. My attention to detail has significantly increased. I feel more energetic and require less sleep.
These things are all personal and _not_ something guaranteed for everyone. But if you’re interested I’d say give a solid go.
For example, the papers on cancer are dismissed, because the studies are inconclusive because they are not large enough or randomized, while the linkage with cancer creation is on the basis of "linked to" cancer.
Without that, this is just a opinion piece.
I’m down to my ideal weight, but going back on the diet after a break, because I find that it works for me.
Considering that it was physicians who started the whole fat panic of the 70ies, and have been ignoring sugar for all these years, AND considering their ties to Big Pharma, I’m going to trust my own experience.
I eat lots of eggs, meat and leafy greens. I use a breathalyzer to track ketones.
My lab results at 3 and 6 months show improvement.
Keto is supposed to be high fat, very low carb, reasonable protein. As another poster named it, medical keto, is hard to follow because of the high fat. Popular keto is still challenging.
It really isn't, it's just a matter of adapting your taste buds. If you're used to fries and muffins daily, yeah it can be hard, but as someone from Southern Europe used to snacking on salami and cheese and butter, reaching 80% calories from fat isn't hard at all, especially considering that fat is more than 2x more calorie dense per gram than protein and carbs, so you don't need that much of it. A steak with a little butter gets you there easily.
What!? In what world is muscle not a good thing. Muscle mass is even a measure of health in aging that fairly well predicts longevity.
Where did you get these ideas from?