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People are different, and due to individual needs and desired outcomes, one size fits all dieting isn’t the best thing.

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.

Your anecdote is supported by clinical evidence. Virta Health has been conducting clinical studies over the past few years on treating T2D with nutritional ketosis with a high rate of success in putting T2D into remission leading to many patients coming off of their meds and insulin entirely.

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.

> something about the ADA and their relationship with pharmaceutical companies just rubs me wrong

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.

Well, 2 things - you are very much an outlier and general advice usually don't work in such a case. Great you found what works for you. It might not be transferable success to any other human being out there, at least not with some side effects you may not be experiencing.

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.

> you are very much an outlier What makes you think he is? Why wouldn't other insulin-resistant people benefit from a diet that's all about managing your insulin response?

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.

> you are very much an outlier

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.

> just 1 single rule and not a set of them, it should be: eat less

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.

Rather dismissive. The Keto subreddit is overflowing with success stories, to the point that they’re spammy. Keto is a resounding weight loss success.

Keto worked for the two people I know who tried it, one of whom had been trying other weight loss diets for 10 years without success

How much protein do you consume, and do your doctors do anything to monitor your kidneys?

given your diabetes dx seems like one area to monitor.

My target protein is around 125g. I’m usually within 10% +/- of that number

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.

Good for you! Glad to hear you found something that works!

Lemme throw in my experience on this:

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.

> 1. People rarely compare it directly to something like a "Real Food" diet

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.

When I go on keto I eat a TON of processed foods and take supplements. Keto diets help people, end of story. I wouldn't have been able to lose weight otherwise, I've tried. Keto for me was almost cheating. There's some pretty great products out there with a low GI or net zero carbs but they're all pretty highly processed.

It’s certainly possible to go this route and I will admit to the occasional indulgence (generally it’s them damed keto ice cream bars).

But I found I ate less processed food to prior to keto since my main focus was meat, eggs, and cruciferous veggies.

And then the whole claim that keto was a diet of ancient people before the agricalture looked more like a fantasy. Modern hunter-gatherets in Africa get at least 50% percent of their calories from starchy vegetables and honey with latter supplying at least 10% of calories. This became apparent after scientists measured it rather than guessing based on earlier observations.

Modern hunter-gatherers in AFRICA.

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.

Ancestors of Inuits came to polar regions less then 10 thousand years ago. Yet even during this short from evolutionary perspective time frame they got a mutation that inhibited ketosis.

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 don't think that has ever been a claim of the Keto Diet, I think you are confusing it with the Paleo(lithic man) diet which is similar but distinct.

This reads like a cult member wrote it. It's hard to take you seriously when you (absurdly) state that some diet makes claims.

Uh-ok not sure why the ad hominem flame-bait, just pointing out there is another popular fad diet that makes the exact claims the GP was attributing to this popular fad diet.

…uh did you respond to the wrong comment?

Keto was originally developed as an anti-epilepsy diet until it was picked up as a weight loss diet - it's not claimed to be any kind of historical diet. I believe you're thinking of the paleo ("paleolithic") diet.

The thing is that there are a lot of people out there who don’t particularly like fruits and vegetables (gourds or not), who can’t be bothered to spend hours every day on cooking “Real food” and/or who can’t afford “real food”.

> long chain inulin and resistant starch

Any references to suggest on these?

For resistant starch, you can look up the "Potato Hack" or other similar things for popular information. There have been a large number of articles you can find on Google Scholar about cooking potatoes/rice/other things and cooling them to produce RS(resistant starch).

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.

>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.

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.