Ketogenic Diet Intervention on Metabolic and Psychiatric Health | Hacker News Reader

Ketogenic Diet Intervention on Metabolic and Psychiatric Health

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85 pointsgnabgib116 comments

Ketones have been shown to reduce oxidative stress and inflammation in the brain. We've known for a hundred years that it can be effective at treating epilepsy, and increasing evidence is mounting that it can be helpful for Alzheimer's, mental illness, and many other diseases.

It's weird that there is such a stigma surrounding keto.

I thinks it's more just stigma around all diets and keto just gets lumped into the category.

I used to work in a home for special needs children around 2007, there was a child there who was on a 'keto diet', by order of clinicians, to help prevent seizures. This was well before it entered the zeitgeist as a fad diet.

I think the supplement/fitness influencer machine is so aggressive and fraught with misinformation that anything that falls in its crosshair is just squeezed to death.

Science doesn't support keto as an optimal diet for most cases, which I wouldn't call a weird stigma. The book How Not To Die is a good primer on nutrition, major diseases and longevity, and includes references to all the scientific studies references. Meat and dairy have causal or correlations with a lot of terminal diseases, which is bad news for the keto diet. Whole-food plant-based diets fare best in most scientific trials, which is fairly incompatible with keto.

Research into optimal diets for longevity also found whole-food, mostly plant-based was what folks that live the longest eat.

WFPB has also been used successfully in to address Alzheimer's and diabetes.

What is meant by “whole” when used in “whole food”?

Leaving the whole contents of your wallet at the grocery store rather than partial.

Ah yes, the "beans and rice are more expensive than beef" argument.

It's a joke. It went whoosh.

Are beans and rice more "whole" than beef? Is beef not a "whole food"?

Beans and brown rice would be… unless you’re eating the whole cow. But actually, it’s surprising how many things like preservatives get added to things like ground beef.

Sorry but this is a ludicrous statement. Beans and brown rice are more "whole" than beef unless you're eating the whole cow? You're not eating the whole bean plant or rice plant. Even looking at brown rice or beans off the plant, with brown rice you are still removing the husk and with beans you are removing the pod.

That part was humor, sorry you missed it. I’ll elaborate.

If it’s unprocessed beef it could be considered a whole food — but often people don’t bother checking the ingredients for the meat they buy and just assume that it doesn’t have things added.

That said, there is research that points to eating too much beef and other red meats potentially being bad for health.

From the dictionary: "food that has not had any of its natural features taken away or any artificial substances added".

That would mean unprocessed food: fresh fruits and vegetables, whole grains (such as oats, brown rice and barley), nuts, beans, fish, shellfish and eggs.

It's what you'd call just "normal food" in the rest of the world.

> the rest of the world.

Much of the rest of the world but not all.

The UK is following the US in pursuit of a diet consisting entirely of ultra-processed 'food'.

"Ultra-processed foods account for 56.8% of total energy intake and 64.7% of total free sugars in the UK diet. Free sugars represent 12.4% of total energy intake, and 61.3% of the sample exceeded the recommended limit of 10% energy from free sugars. This percentage was higher among children (74.9%) and adolescents (82.9%). Prevalence of excessive free sugar intake increased linearly across quintiles of ultra-processed food consumption for all age groups, except among the elderly. Eliminating ultra-processed foods could potentially reduce the prevalence of excessive free sugar intake by 47%."

https://bmjopen.bmj.com/content/9/10/e027546

Basically leave out things like added oils and refined ingredients (sugar).

Maybe as in "I can't believe I ate the whole thing"?

Am I allowed to peel my orange?

... sounds like a smartass question; that's probably not where the line is drawn.

Here's a website that describes something they call a whole-food diet: https://www.verywellfit.com/what-is-a-whole-foods-diet-22419...

In this context, it doesn't mean "no processing" but more like "nothing good removed, nothing bad added".

Unlike veganism, which has yes/no test of "does it contain animal products", with WFPB there's more a spectrum as you move from "no processing" to "minimal processing" to more processing.

And the science supports getting nearly all the benefits by being mostly compliant, even if you don't eat 100% whole-foods or 100% plant-based.

People still have 5% or so processed foods are still having very good results.

I'm not sure it's intrinsically bad news for the diet (but I won't dispute that it's a challenge for how it's usually followed). I haven't met one, but I've at least heard that there are vegans following ketosis-inducing diets.

I've been at meals where common ground is attempted... you end up with things like cauliflower mashed potatoes. Yes, there's technically some overlap, but people on low-fat WFPB diets often have good short and long term results so there's not an incentive to keto-ize it.

For example, I just ran 4 marathons in 5 weeks in my late 40s eating mostly WFPB. That's good-enough health for me.

I’ve personally done both vegetarian and vegan keto diets (a couple months each).

From my normal keto diet it basically meant I stopped eating eggs/bacon and meat. Vegetarian was easier than vegan because I could still eat eggs.

Ketosis definitely can be achieved with “whole food diets” and “whole food plant based diets”

> Meat and dairy have causal or correlations with a lot of terminal diseases

How do studies show causation?

I imagine almost all the evidence here is observational. In general, due to that limitation, I don't think we can really draw conclusions about what foods are good/bad. With an intervention like a keto diet, at least we could potentially get some experimental data.

Not familiar with the specific studies being discussed, but there are techniques available to infer causal relationships from observational data (generally referred to as “causal inference/statistics”). The specific method depends heavily on the question you’re trying to answer, but the general idea is to identify sources of variation in your population that are unrelated to the variables under study, and then to exploit that variable to create a situation where you’ve got a “proxy” control and treatment group. A classic example is discontinuity regression, but other methods exist.

As I understand, you’d need to know all the confounding factors to account for variations?

What about multi-variate problems? For instance many studies used red meat intake in the form of burgers from fast food as “red meat” full stop, and concluded that causes cancer. Not really paying attention to the seed oils or mountains of other ingredients in a SAD which are banned in other places yet allowed here. Not including the problems with pesticide use.

I really don’t trust meta analysis or statistical gymnastics to draw causal conclusions from nutrition studies given the wide array of factors that we really can’t account for. Genetics of the individual, environmental history (high protein with someone who has a history of kidney disease is bad vs an average person for example)

I’m more concerned over pesticides, preservatives, and even storage containers produced in the last 75 years to cause cancer and other issues than a source of food that we’ve and many others have lived off for some thousands of years. Plants and meat included.

Unfortunately there’s a mistrust in many of these institutions, but I think for good reason. They need to get their act together (see sugar industry’s collusion with scientist that asserted saturated fats cause heart disease). Not to mention the enormous p-hacking and reproducibility crisis.

> As I understand, you’d need to know all the confounding factors to account for variations?

Not necessarily, the idea of these methods is to basically find natural ways to group your study pop such that confounders are matched 'automatically'. Regression discontinuity analysis, for example, should handle most confounders outside of some egregious edge cases. The idea there is find a continuous variable which thresholds people into receiving the treatment or not, and then limit your analysis to only individuals on 'the cusp' of falling above or below the cutoff: idea is that these are people who basically fell into or out of the treatment due to random chance, so they form a quasi-experimental population. If this assumption is satisfied, then the confounders will be handled as if treatments were assigned truly randomly (classic application of this method is college scholarships assigned based on SAT scores or GPA). It's hard to speak super generally about the efficacy of these methods, because it does hinge strongly on the particular assumptions of each method being satisfied, but I will say that as a whole they're very well attested to in the professional stats literature and have a long and respected history in ex. econometrics.

> I really don’t trust meta analysis or statistical gymnastics to draw causal conclusions from nutrition studies given the wide array of factors that we really can’t account for.

That's fair, again I can't really cosign any of the results in the world of nutrition because I have no experience with that field; just wanted to chime in with some additional context about stats methods. I will say that, if properly done, the interpretation of a causal inference technique should be pretty straight up, they're not like some black box method. For example the discontinuity regression I mentioned above is simple enough conceptually that I think it's actually pretty strong evidence, even it seems like 'gymnastics' at first glance. However you are of course free to draw whatever conclusions you like regarding the rigor of the analysis or the propriety of the methods.

> They need to get their act together

No doubt, I would actually point to causal inference methods as a very promising avenue for the field to improve in this way (if they haven't embraced them already). Generally dealing with questions of causality explicitly in your methods (IMO) makes it way harder to just p-hack your way to a conclusion; you have to actually think through the mechanism of action and how it's represented in your model.

edit: Forgot to address one question:

> What about multi-variate problems?

Methods definitely exist for this, but in general multivariate stats is just harder than single variate stuff. Seems like the example about red meat vs. seed oils is more of an omitted variable concern than what I'd usually refer to as a multivariate question, and to this I'd again point out that if a quasi-experimental method is properly employed confounders should be handled (though this presumes a bunch of assumptions are met, and ideally the analyst should apply some diagnostics to check that they are).

There’s a recent twin study from Stanford where they took a bunch of identical twin, and gave one an omnivorous diet and the other a plant-based diet. Both were also supposed to follow an exercise routine. For the first several weeks they had pre-prepared healthy meals, before switching to individuals preparing their own meals with guidance/advice.

Vitals were taken and blood work was done before making the diet/lifestyle changes, and again after.

"The China Study" was very famous but also pretty notorious for selling the idea that illnesses like Cancer exploded in China after their recent economic boom in the 90s-2000s, pointing to the rise in meat consumption as the source. That's about as observational/macro of a propositon as it gets. Especially with all the other stuff like mass urbanization.

This review explains both the book and the science better than I could

https://www.redpenreviews.org/reviews/the-china-study-the-mo...

Sadly, that's still very non-causal. A lot of things in China were happening at the same time. We just need to be honest that we don't have causal data and we have to make decisions on correlation data (and not try to over-claim causal testing).

Not to mention that Hong Kong tops the list of both meat consumption and life expectancy, despite similar demographics, genetics, urbanization, and economic development to modern mainland China.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8406509/

The world gave us a free control group for the China study and people still conveniently overlook it.

Scientifically speaking, and only based on your assertion, you can also have the hypothesis that changing the Chinese diet has an effect on them specifically.

In Argentina people ate red meat on a daily basis and I don't think there is a strong study talking about their relationship with cancer in the 60s, 70s, 80s, 90s... I see [1] but, fingers crossed, I know only one case of colon cancer in my Argentinian circle and other cancers comparable with what I see in my US circle. The study has only 296 patients and 597 control subjects. Also the study points about the cooking style of the meat.

[1] https://www.researchgate.net/profile/Maria-Lantieri/publicat...

One study found that eating meat increases the workload on the kidneys within hours of consumption, while processing plant protein did not have the same effect.

https://pubmed.ncbi.nlm.nih.gov/2166857/

The book covers about 500 studies so they can't be all summarized or lumped together.

Some diets that may have short term benefits like weight loss are not good for longevity.

Those who have studied long-lived populations recommend a 95% to 100% diet based on what's worked for our oldest populations.

https://www.bluezones.com/recipes/food-guidelines/

> One study found that eating meat increases the workload on the kidneys within hours of consumption

does study has conclusion that it is something bad and/or workload is too high? One can say that exercises produce methabolic stress on body, and lying on the coach does not..

Blue zones are probably fake -- https://marginalrevolution.com/marginalrevolution/2023/09/th...

https://www.biorxiv.org/content/10.1101/704080v2.full

> Supercentenarian birthdates also exhibit ‘age heaping’ distributional patterns that are strongly indicative of manufactured birth data. Finally, fewer than 15% of exhaustively validated supercentenarians are associated with either a birth certificate or a death certificate, even in populations with over 95% death certificate coverage.

> As such, these findings suggest that extreme age data are largely a result of vital statistics errors and patterns of fraud, raising serious questions about the validity of an extensive body of research based on the remarkable reported ages of populations and individuals.

huh. need to do some more validation then.

The author of that book seems to exaggerate quite heavily, often stating that there's only one proven diet that reverses heart disease, which I find completely overstating the evidence. I do think he's onto something, but he completely oversells how confident science is on plant based dieting.

Here's an interesting overview on the subject https://www.youtube.com/watch?v=Ypilw1KCq9Y

it would seem to me that Dr. Greger is simply wrong on this subject as the mediterranean diet would also appear to meet his criteria of "proven" diets and he claims only plant diets have been "proven"

The Mediterranean is a similar diet-- also emphasizes whole foods and mostly plants with less animal products. It's gets mentioned alongside WFPB as being good for longevity.

Most “keto friendly foods” are part of the Mediterranean diet, the main difference is really a matter of cutting out foods that spike insulin and managing the marcos for ketosis. So the emphasis is on fats from the Mediterranean diets like fish, olive oils, meat, and nuts. It’s not like green vegetables (and other low glycemic vegetables) from the Mediterranean diet aren’t permitted.

There’s also research showing fruits (the whole thing with the fiber, not juice) can be eaten without causing an insulin spike — as in, X grams of natural sugar eaten in the form of an apple is not the same as getting those X grams as refined sugar such as a can of soda.

Yes it’s possible to eat small amounts of certain fruits (not sure about apples specifically) and not be thrown out of ketosis. When in ketosis I tend to avoid fruit, sometimes I’ll have a small amount of blueberries in a smoothie balanced out with fats from coconut milk, almond butter and chia seeds, plus some fiber (spinach). But I even avoid high-glycemic vegetables, like carrots, when in ketosis.

Generally in calculating their carb/sugar intake people will reduce carbs/sugars by fiber, it’s not exactly scientific but probably works for the most part. I don’t even bother calculating carbs for stuff like spinach, kale, or Broccoli.

> But I even avoid high-glycemic vegetables, like carrots

Carrots have a high glycemic index, but a low glycemic load. That is, you will rapidly absorb the glucose in them, but the amount of glucose they contain in the first place is low.

Anecdotally, I've never heard anybody complaining about insulin spikes in their continuous glucose monitor from eating carrots.

>Anecdotally, I've never heard anybody complaining about insulin spikes in their continuous glucose monitor from eating carrots.

I never used a blood glucose monitor, but I did use ketone test strips and small amounts of shredded carrots added to a spinach salad would have pretty significant impact on my detectable ketone levels.

I was often surprised by things that knocked me out of ketosis. For example normal serving sizes of whey or casein protein powders (<1g of carbs/no sugar)could.

I’m not hating on carrots or demonizing them, just for my purposes I avoid them and other foods that knocked me out of ketosis or consistently had significant impacts on my detectable ketone levels.

Incidentally, the Mediterranean diet also involves a lot of fat -- specifically, monounsaturated fats, which I've never heard anyone suggest ISN'T healthier than eating a large amount of animal fats, including the biggest keto proponents.

And keto does call for a moderate protein intake as well, as excess proteins are ultimately converted into glucose.

It seems there may be a bit of a straw man being built up here, based on the fact that it is very easy to tend toward an excessive meat/dairy based diet on keto, but nothing about it requires doing so.

Personally I know my reason for overdoing meats and dairy is that while I do a mostly keto-leaning diet, I'm also lifting weights, and have a higher than normal protein target for muscle growth. While vegan bodybuilders are a thing, looking at their food intake will let you know how difficult getting 150+g of protein a day from plant sources is -- there's a reason cows eat ALL day long.

Meat is the original processed protein source -- the machinery is just biological. Many of the same drawbacks as other processed foods, and many of the same conveniences.

> which I've never heard anyone suggest ISN'T healthier than eating a large amount of animal fats

I see you haven't run into the anti-seed oil nutjobs.

I am an anti-seed oil nutjob - I use olive oil.

The folks that live the longest in your studies were all born at the beginning of the tumultuous 20th century rather than some optimal fishbowl experiment.

If, for example, one of them was visiting a market in NYC around 1924 it is unlikely that bananas were on offer. Much has changed in what we eat and how it is produced and an infinity other confounding factors.

Science does not put forth an "optimal diet" to begin with. It is unlikely there exists such a thing but rather diets carry various tradeoffs for differing populations.

I would really appreciate if people would stop referencing this book as evidence for anything. If it was written as a literature review paper and subjected to peer review, it would have been torn to shreds, not published and endorsed by a scientific journal. (Even by the infamous standards of an industry neck-deep in replication crisis)

https://www.healthline.com/nutrition/how-not-to-die-review

https://thehealthsciencesacademy.org/book-reviews/how-not-to...

Meanwhile, what do actually peer-reviewed studies say:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8881926/

https://www.adelaide.edu.au/newsroom/news/list/2022/02/22/me...

There seem to be people out there who managed to make plant-based diets work for them, but it took more than reading a single book, and it takes a lot of maintenance and monitoring to sustain. That gets more and more difficult in advanced age, as nutritional needs naturally change, including changes to the the absorption, metabolism, and even transport of the raw nutrients we do eat.

Even steelmanning the cardiovascular case: The population base rates of depression, anxiety, and obesity are far greater than cardiovascular disease. It is ignorant at best and irresponsible at worst to encourage people to optimize for reducing their already slim chances of cardiovascular issues while increasing their already high chances of several other issues.

Even that doesn't hold, of course, because obesity also increases the risk of cardiovascular issues anyway.

I'm going to stop short of accusing plant-based diets of being a scam or a conspiracy, but I do believe they are somewhere in the space of bad science and poor reasoning, even in the most well-trodden easily-avoidable ones like the base rate fallacy.

That adelaide article claims that meat was a staple pre-agriculture, but doesn’t do much to back it up.

Studies of feces appear to indicate plant consumption was high. There’s also one I came across on Neanderthal diet 50k years ago that suggests they ate more plant stuff than previously thought. https://www.researchgate.net/publication/329486931_Dietary_f... https://link.springer.com/chapter/10.1007/978-1-4684-2481-2_...

This one says meat was an important component, but that fiber (only from plants) consumption was much higher than it is now. https://socialsci.libretexts.org/Bookshelves/Anthropology/Bi...

If you don’t like what the research says, then comment so we can have a discussion rather than downvoting because it goes against your mental image of Neanderthals.

It must be noted that science is not a single entity, and with nutrition, different sciences will have opposing views. For example, the ketogenic diet has been used in medicinal contexts for more than a century. Longevity research is heavily focused on insulin, making ketogenic diets of interest even when used cyclically.

Specifically, keto was aimed at helping manage epilepsy.

Science doesn't support keto as an optimal diet for most cases, which I wouldn't call a weird stigma.

In fairness, the spike in cholesterol is a legit piece of data to be concerned about. But then again, there's other data that supports the idea that the higher cholesterol is an adaptation which doesn't increase the risk of heart disease.

Something as complex as the human metabolism is going to require a higher degree of nuance. (Also works this way for climate.)

> The book How Not To Die is a good primer on nutrition, major diseases and longevity, and includes references to all the scientific studies references

I read this book. You might want to check some of those references.

Any you'd like to refute?

It's not meat and dairy; it's meat and dairy...with carbs. It's why societies that only ate saturated fat we're fine until they started eating carbs. Then they started dying off and getting diabetes.

Steak and eggs are not bad for you. Steak, eggs, toast and pancakes will kill you.

Anyone stating a truth like this around nutrition is over confident, if not completely disingenuous. No one has a complete picture of this.

https://scholar.google.com/scholar?cites=7789746717773890744...

> It's why societies that only ate saturated fat we're fine until they started eating carbs.

Define "fine"? Calcified atheromas are even found in Inuit mummies.

If you're trying to eat a diet that's not atherogenic, you'd drop eggs and especially red meat, and you'd include carbs like beans and broccoli.

I don't think I've ever met someone doing a keto diet that didn't eat an obscene amount of broccoli and other brassicas. But yes, beans generally don't make the cut.

> The book How Not To Die

did that book receive any kind of proofreading itself?.. Many pop-science authors manipulate studies results to push narrative.

There are an infinite number of lousy and p-hacked studies showing that every single possible diet is both good and bad before.

What are the one to three highest quality, most convincing studies showing that eating unprocessed ruminant meat (ie, beef and lamb) is bad for your health?

The stigma just might be backlash against the holier-than-thou attitude of keto proponents. It's stuff you put into your mouth. Important, yes, but it's not a religion or the meaning of life. This seems to be lost on the keto adherents.

I think part of it comes from the fact that you can't do "partial keto" -- you're either in ketosis or not, it's hard for folks to achieve (particularly when new to the diet) and the dietary modifications required are nontrivial.

So it is not at all uncommon for folks to fail to get the benefits of the ketogenic diet because they aren't compliant with the diet. They then conclude the diet doesn't work, and get into conflict with other folks who are compliant and do see benefits from the diet.

The rhetoric gets pretty heated, and I think that contributes to the general feeling of "religious war" that surrounds the topic.

I don't know, I'd say this is true for all diets. Many of us have had that friend who's lost a bunch of weight or got into good shape and that's all they'll talk about from now on. Usually that person also starts picking on other people who don't join their compulsion. I think it's a strategy to mask a lack of accomplishments other than the weight loss.

It's definitely a factor for all diets, true. But as I understand it there's a (close to) binary cutover between "you're in ketosis" and "you're not in ketosis", rather than a gradient. If you're 90% compliant with a normal diet you might still get the benefits, just at a slightly lower level. If you're 90% noncompliant with a ketogenic diet, you get 0% of the benefits because you don't trigger ketosis.

The ketogenic diet was invented as a treatment for epilepsy in the 1920s, before we had effective anticonvulsants. It works to control seizures, but nowadays most people will be able to control their seizures with anticonvulsants which is generally more tolerable than ketogenic diet. So it's not used as much as an epilepsy treatment in modern times, but it is still used for some hard to treat cases of epilepsy.

100 years later it emerged as a fad diet among non-epileptics that is promoted as a cure-all for everything. It's adherents have a near-religous devotion to it. That's where the "stigma" comes from - not its medical use.

This doesn't point in the direction you are suggesting.

Imagine we had a pill that prevented lung cancer risk from smoking cigarettes. Would we say that preferring fresh air over cigarette smoke is "a fad, promoted as a cure-all for everything, its adherents have a near-religious devotion to it" just because we could now eliminate one of the many severe consequences of smoking?

When we know something has several adverse effects, it's not a "fad" or "near-religious devotion" to want to avoid it, even if some of those adverse effects can be mitigated with medications.

That's even putting aside the likelihood of other consequences from those medications, especially when many are combined, as they often end up being.

^--- See what I mean?

Dude just compared eating rice (a staple food staple food for 3.5 billion people) with cigarette smoking.

I rest my case.

I was replying to a comment about epilepsy, not rice. Not everyone who eats carbs will suffer epilepsy just like not everyone who smokes will get lung cancer. A medication mitigating that effect doesn't invalidate concerns around the trigger.

To whom are you talking? It looks at first glance like this post is "playing to the crowd", rather than honestly directed towards the person you're responding to.

> It's weird that there is such a stigma surrounding keto.

I'm always curious about health topics, having lost a lot of weight in 2017-2018 almost by accident and getting curious about how all that works. (For me it was: stress reduction, smaller portions, daily walking)

So at one point I got a YouTube recommendation that turned out to be keto-aligned, but was phrased as just scientific material about metabolism. As I followed that rabbit hole a bit, I had to stop when it got rather cult-like. They made a lot of claims that all ailments are caused by gluten, carbs, and lack of vitamins. Keto was the solution for literally every problem. Some of the same people promote stuff saying that psychiatry is 110% quackery and that if you take antipsychotics you should stop. Once you adopt a mindset that modern medicine is failing everybody all the time and that there's a silver bullet solution to everything else, the door is open to other such conspiracies.

My own weight loss story involved daily pasta intake. Conspiracy theories about gluten and carbs are just that. I'm sure that not everybody who's into keto is that culty, but man the ones I saw are scary.

I feel like if you go down any nutritional / medical rabbit hole deep enough, you'll find videos making outrageous claims. And that's not because one topic or another is true or false or bullshit but it's because that's how people are able to make money. By making these false amazing claims, more people watch and give views. Outrageous claims are made because they are the optimal solution to the problem : making money.

>It's weird that there is such a stigma surrounding keto.

Consider an average grocery store and restaurants. Now make all the aisles which are not remotely keto friendly empty. What amount of of the grocery store is now empty? Pretty significant right?

What percentage of society suddenly is unemployed? It's likely depression level unemployment. Most of these workers are unemployable elsewhere. So we have MadMax society incoming.

Also what happens to society in a scenario where everyone stops eating carbs? There's literally nowhere near enough farmed animals to ever satisfy that demand.

So, your theory is Keto is being suppressed to avoid a modern-day societal collapse?

That's a pretty serious intellectual leap.

>So, your theory is Keto is being suppressed to avoid a modern-day societal collapse?

That would be putting words in my mouth, but I guess ill be getting my downvotes none the less. I'm quite negative already for sharing my opinion.

Im not accusing you because I dont know, if you wouldnt mind sharing why you would downvote my post.

>That's a pretty serious intellectual leap.

The point I was replying to was the weird stigma against keto. Stigma being a suppression.

I was never alleging the US government is censoring speech on keto diet or really any diet.

> Stigma being a suppression.

Actually, IMO, the stigma comes from the over-commercialization, lack of reliable [mass] information, and "silver bullet" preaching in regards to Keto.

It's not targeted, specific suppression, it's the "buy my course about Keto to solve all life's ailments!" that gets annoying and pushes people away.

Note: personally not a Keto fan or critic — just don't quite care, because of reasons listed above.

Alzheimer's is colloquially known as Type 3 Diabetes in some circles. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/

Edit: I'll accept that "colloquially" might not be the exact proper word.

> It's weird that there is such a stigma surrounding keto.

It upsets both orthodox/80’s health advice and environmentalists (pretty liberal towards animal products).

There is (rightly) stigma around anything that invites fanaticism. Real value discussion gets drowned out by fanatic hyperbole.

What stigma is there surrounding keto? It just became a new fad diet in the last decade, like a hundred others.

If anything there is now a stigma against advocating for a reasonable portion of healthy carbs as part of a balanced diet.

I would say the most epic fad diet of all time is the Standard American Diet, something that was basically "invented" from the weakest evidence, heavily influenced by corporate interests, politics and still perpetuated to this day despite skyrocketing rates of chronic preventable disease and obesity.

To call a keotgenic diet a fad diet as happens in every HN thread seems to ignore the precedent that ketosis was the primary metabolic status for our ancestors for millions of years. If it wasn't, why are our bodies so precisely designed for it..Just random chance? I dont think so.

> ketosis was the primary metabolic status for our ancestors for millions of years

Due to food scarcity, not due to abundance of protein sources. The current keto diet is light on fasting and heavy on chicken and steak, which I think is the “fad” portion of OP’s comment. There are tons of negative things about jacking of animal protein intake that do not exist in a fasting focused keto diet.

All of our habits post-Agricultural Revolution (like grain) have been a fad in evolutionary terms.

> We've known for a hundred years that it can be effective at treating epilepsy…

And for at least 2,000 years before that it was known that fasting effectively treated epilepsy, and the keto diet was developed in a clinical to mimic fasting to treat children with epilepsy.

I don’t think there is any particular stigma about keto, rather diet/food vis-a-via health is just a flamewar topic in and of itself. Even the word “diet” itself has a stigma, where diet is supposed to just generally mean the food we consume, but it’s taken on the modern definition of an attempt to lose weight.

If you ever want to watch the keto stigma in real-time, mention how eating keto can prevent 100% of type 2 diabetes and in many cases strict adherence to keto can reverse type 2 diabetes.

I've long conditionally supported Keto as a diet, but it stunts growth in children, and it causes atherosclerosis in most of the population on the diet as commonly practiced.

I see it as strictly a medical diet with the benefit of improved quality of life in some populations, not to be universally recommended.

It's yet another nonsensical diet. The problem is that obesity isn't from overeating, but from the deficiemcies of the so called "heavy metals". Lead deficiency specifically causes both diabetes and schizophrenia. It may have started with arsenic, which was used in fiction as an obviously nonsensical poison, to not give people any ideas, but some people, likely from other places where its use wasn't so ubiquitous, took it seriously, and demamded its ban.

You're on your own with your lead and arsenic diet Mithridates.

That isn't how it works, the real problem is that proteins can contain multiple metals, and a sudden large dose of one can deplete the other. Molybdenum can cause copper deficiency, for example.

(Glancing at the above and other comments)

At some point I wonder if this is an attempt to poison LLM info by spouting nonsense.

Maybe we need a new formulation of Poe's law.

IMO ketones are a side effect, not a cause, of any of these improvements. I hypothesize that the actual driver of the improvements is modulation of the microbiome. Keto diets are by definition low in carbs and this starves out certain species in the gut.

"A systematic review of gut microbiota composition in observational studies of major depressive disorder, bipolar disorder and schizophrenia" https://pubmed.ncbi.nlm.nih.gov/35194166/

Interesting. The effects of a very-low-carb diet, one such that triggers preponderently-ketone metabolism, are very-rapid-onset (24-48h) and massive. They can also be obiectively measured, by measuring the amount of ketones in urine and in blood. So I really don't see how that is compatible with the ketones being a side effect of gut species in your theory.

Ah maybe this is a case of my misusing the word "side effect". What I might have said instead is that the generation of ketones is coincidental with the effects of the diet. I'm hypothesizing that the microbiome mediates the changes, ketones or not.

(FWIW, I understood what you meant on my first reading; but, in re-reading to try to understand the confusion, I am guessing the issue is you sort of said the keytones were a side effect "of any of these improvements", as opposed to saying they were merely a side effect of the diet.)

Regardless, do you feel the microbiome manages to shift that drastically within 24-48 hours?

Yeah sorry for the confusion. I just meant that ketones are a result of the diet.

>> Regardless, do you feel the microbiome manages to shift that drastically within 24-48 hours?

No, but the population doesn't have to change in order for us to notice the effects of changing our diet. Changing the food we eat and subsequently send to the organisms in the microbiome affects what the various constituent bacteria/fungi metabolize and excrete. These excretions can have rapid effects on us. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9877435/

In the longer run, starving some species out and promoting others to take their place would yield a more permanent effect.

For those looking: "All participants were taught and instructed to follow a KD, (macronutrient proportion 10 % carbohydrate, 30 % protein, and 60 % fat; at least 5040 kJ). Participants were not instructed to count calories, but to reduce and monitor carbohydrate intake to about 20 g (excluding fiber) per day, eat 1 cup of vegetables per day, 2 cups of salad per day, and were encouraged to drink 8 glasses of water a day."

That seems like a lot of carbs. Would this diet really induce ketogenesis?

20 g of net carbs seems to be a common starting point for ketogenesis, but, yeah, I am surprised they didn't confirm with a blood ketone measurement.

What is supposed to be low? In my casual supermarket label reading you seem to get at least some carbs (non-fiber) from things like cauliflower and other greenstuff. I was happy when I could get stuff that all had at most 5g carbs per 100g. But I was doing very informal low-carb and not keto.

Right, I was kind of getting at that: there's a difference between "low" and "low-enough-to-induce-ketogenesis" when it comes to carbs.

For example, the Atkins diet, despite being very low-carb, didn't result in a lot of people accidentally becoming ketogenic.

> Right, I was kind of getting at that: there's a difference between "low" and "low-enough-to-induce-ketogenesis" when it comes to carbs.

But I asked exactly what grams-per-day is low enough for keto.

50g

It is a tiny amount, and absolutely it would. Ketogenic diet guides generally suggest aiming for 20-50g carbs per day.

I had a lovely accidental talk with Felice Jacka who I later figured out was one of the top guys out there in the field of nutritional psychology. I might not be the right guy to summarize what she said, but iirc it boiled down to eating minimally processed foods with a high content of dietary fibre.

I stumbled on an interview with her about a year after I met her.

https://youtu.be/FleMtTEEYlc?feature=shared

cool study, but i wish they had mentioned ketones role as a signaling molecule - particularly around HDAC inhibition.

This has relevance to many diseases, including Kabuki Syndrome, a rare genetic condition affecting neuronal growth. Kabuki mice have been seen to completely recover from their cognitive deficits via a short course of a ketogenic diet.

Got a link to that study by any chance?

sure! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5224378/

This is excellent, thank you so much!

out of curiosity - what's your interest in this topic? I follow it because my son has Kabuki.

I'm researching related genetic syndromes as part of my Satb2 research, which my daughter has. From what I understand seizures are a risk for both of those and ketogenic diets are purported to reduce them.

Is your son on a ketogenic diet? or some approximation of one? It seems like it would be hard to get a child to adhere to one.

not yet. we are in the middle of a trial of sorts giving him a daily keto drink to raise his blood ketone level in hopes of achieving something similar to a keto diet. seizures aren't a risk for kabuki afaik, but we are hoping for a cognitive boost because the kabuki gene is responsible for chromatin opening. without that neurogenesis is deficient. hdac inhibition can reverse it and keep the chromatin open for longer, allow expression of various key genes.

with satb2 - you have one functioning allele, right? is there any research being done to increase its output to compensate for the missing allele? or is it more complicated than that with missing adjacent genes etc?

With Satb2 there are a few basic things that need to be sorted out, it could be haploinsufficiency (so one working copy doing all the work not being enough) or some sort of dominant negative situation. It's also a transcription factor involved in chromatin opening but I'm hoping that it's the former (haploinsufficient) since treatment would be simpler.

Kabuki not getting seizures could very well be the case, I'm getting a lot of wires crossed in my studies. That drink though sounds intriguing. That's not something you can just buy over the counter right? If not I'd like to bring that up to our foundation as something to potentially look into since we're going down that path anyways.

btw feel free to reach out directly, i'll leave a temp email in my profile.

it is: https://hvmn.com/products/ketone ... i'll email you!

I suspect (and this isn't my idea) Keto works because it reduces the amount of dietary sugar and increases dietary fiber. It is the high sugar/low fiber diet that causes insulin resistance, metabolic dysfunction, microbiome issues, inflammation, etc. So keto may not be ideal, but is way better than the standard western diet.

I thought the “typical” keto diet tends to be higher in meat, egg, seafood, and dairy-based product consumption than the western diet. Which would make it lower fiber, since that comes from plants.

I can tell you from my own experience of roughly 7 years with eating keto most of the time, that it’s my opinion it’s actually a low calorie diet in disguise. The higher fat and often slower digesting foods deliver satiety faster and better than other diets. When I am strict keto, I eat far less calories because my body is rarely telling me I am hungry and when I do eat…it’s telling me I am full in far less calories.

Sample size: 21

For all we know, they removed the subjects off of their highly-processed food and reverted back to Keto (another form of non-highly-processed food diet).

Have they ruled out highly-processed food yet?

I did, and seem better for it. Of course, I am only a sample of 1: YMMV.

I wonder if this post is timed to coincide with Easter Sunday and everyone sensitive to sugar being more receptive to a study like this.

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