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Another doctor has recently come out against the Ketogenic diet, saying that following a ketogenic diet for a long period of time, even though he admits it can lead to weight loss in the short term, can lead to heart disease and death in the long term.

Oh boy.

Here is the link to his article, if you would like to read it in it’s entirety. Keto and Death

This blog is intended to refute his claims and show another perspective. He actually has some good diet advice which I would endorse, but his claims about the ketogenic diet being hard to follow and bad for heart health need to be challenged. Moreover, not all of his advice, I believe, is good for you.

To be upfront, I believe the Ketogenic diet is a very good diet to follow. It does not fit with every personality, but it is a good and healthy diet to follow, if one likes it. To give you some perspective about how both Sharon and I design our diet, I would classify it not so much as a ketogenic diet, but more like a “low carb/paleo diet”. It is not fully ketogenic, but it is very high fat/low carb with a lot of veggies. Oh, and we eat dairy (something the paleo community abhors). By the way, we do eat a lot of saturated fats, and we believe that saturated fats are an important macronutrient to a good diet. More on that later. 

Ok. Let’s get back to the article and my refutations. Surprisingly, he does not cite any sources for his viewpoint. He assumes that what he says is common knowledge, so he has no need to back up his points with research. Not a problem as far as I am concerned. I will do the same as I give a counter point to his stance. Having said that, I will give you some excellent resources at the end of this blog for you to do the deep research on my counterpoints if you so choose. 

The way I intend to do this blog is by putting on block quotations the points he makes about the ketogenic diet, and then I will propose my counter argument. In a way, this will give you two different perspectives that you can examine and come to your own conclusions. 

Here we go.

He starts with this:

In a review of scientific studies on ketogenic and intermittent fasting diets, researchers at National Jewish Health in Denver concluded that while these diets work to help people lose weight n the short term, which may contribute to cardiovascular health initially, the diets also promote the consumption of foods high in saturated fat, which is known to increase cardiovascular risk long term. The doctors concluded that these diets are unlikely to be as effective at preventing heart disease over a lifetime as well-established nutritional guidelines currently recommended by health experts.

 

Here he goes into how bad saturated fat is for heart disease. He says this as if it is common knowledge based on decades of research that should not be questioned. High saturated fat intake over a long period of time=heart disease and certain death.  Actually it is common knowledge. The problem is that “common knowledge” is not right. The research about saturated fats leading to heart disease has not been proven to be accurate.  Let’s go back about 50 years or so to where the whole “saturated fats are bad for you” paradigm started. It began with a very prolific scientist by the name of Ancel Keys. He had a hypothesis that saturated fats in the diet increased cholesterol in the body, which at that time was considered to lead to atherosclerosis (hardening of the arteries), and ultimately to a heart attack. To prove his hypothesis, he studied the diet and health patterns of people in several countries.  He measured the cholesterol levels (this was a new tool at the time), of people in seven different countries and concluded, that yes, higher saturated fat diets led to higher cholesterol levels, and thus a higher rate of heart disease. He was vey convincing. It ultimately lead to a big shift in dietary recommendations by the U.S government to eating a higher carbohydrate/lower fat diet that we have been on ever since. 

But here’s the problem. Yes, he did study seven different countries that supported his hypothesis, all this is true. What is not well known was that he actually studied twenty different countries. Many of those countries did not fit his hypothesis, and so he left them out. In other words, he cherry picked his data. When he presented his findings, many researchers pointed out the discrepancy and said that the data was not strong enough to support his hypothesis. When it was all said and done, his hypothesis was the one that gained traction and laid the groundwork for the governmental guidelines on nutrition. This lead to the high carb/low fat/low calorie diet, also called The Standard American Diet that we are stuck in today. 

Ever since then, there have been many studies attempting to corroborate the high fat/heart disease hypothesis, with most if not all researchers sure they would find it to be true. However, the overall conclusions do not support it and many are inconclusive. 

So the claim by this doctor that saturated fats lead to heart disease really does not stand up. The truth is that saturated fats are good for your health. As a matter of fact, we need them for optimal health. There are several health benefits to eating saturated fats, too many to list here, but here are some of the important ones:

  • Improved cardiovascular risk factors. Surprise! Saturated fats actually are heart healthy. Adding saturated fats to a diet reduces lipoprotein (a). Lipoprotein (a) correlates strongly with heart disease, therefor a diet with a higher intake of saturated fats are better for heart health than a high carbohydrate diet.
  • Stronger bones. Apparently saturated fats are necessary for the bones to absorb the calcium. I did not know it until I researched for this blog.  Because of this, Dr Mary Enig actually recommends that up to 50% of the fats in our diet should be saturated.
  • Improved liver health. Studies show that saturated fats protect the liver from alcohol and medications like acetaminophen and other pain medications. I do love my wine…maybe a bit too much, so this is awesome news!
  • Healthy lungs. The airspaces in the lungs need to be coated with a thin layer of surfactant to function well. The fat content for this is 100% saturated fats. I did know about this and wrote about it on my post regarding how to keep a healthy immune system during the covid scare. I recommended that people should eat more saturated fats for this very purpose because the main complications with the late stages of the virus deals with the lungs and trouble breathing. I know it is controversial, but I still stand by that recommendation.

That’s just for starters. There are many more benefits to consuming saturated fats that are just too long to put into this post. My main point is that saturated fats are not the cause of heart disease, and they are very beneficial for overall health. 

 

Here is his next point:

Keto is a very low carbohydrate dietary approach that sends the body into ketosis, a metabolic state in which it has reduced access to glucose and is instead mostly fueled by fat. While the limited study of the keto diet shows those who follow it lose weight initially, it tends not to be sustainable according to 12-month data. It is also unclear whether the weight loss is caused by achieving ketosis or simply by calorie restriction.

 

He is right in that the goal of a low carbohydrate diet is to try to get the body into a state of ketosis. This is the best way to get the body to use it’s own fat stores for fuel. But more to the point, and this is what makes a low carbohydrate diet so successful for weight loss, is that the hormone insulin both drives the body to store fat…and keeps the fat locked in. As long as insulin levels are high, the body can never use the stored fat for fuel. It will use glucose that is stored as glycogen in muscles and the liver. So what keeps insulin levels high? You guessed it.  High carbohydrate consumption. It really does not even matter the source. It is true that simple carbohydrates such as sugar, high fructose corn syrup and other foods like white bread will raise insulin levels in the body faster, but even the complex carbohydrates raise insulin levels too. It is a little slower, but insulin levels do go up (and stay up if someone snacks all day long…a la grazing). This is one of the challenges of a high carbohydrate diet, even if it is whole foods and plant based. Many people can do just fine with a higher carbohydrate diet because they are still insulin sensitive. But more and more people are becoming insulin insensitive, which is a major factor that leads to both metabolic syndrome and eventually type 2 diabetes if it is not dealt with soon enough. This is a huge problem in America. 

As to his observation that a ketogenic diet is not sustainable more than 12 months, I just have to simply disagree. My wife and I have been eating paleo/low carb for over 7 years, and it is easy to stay on. There is plenty of variety. We feel vey satisfied after every meal, and we just do not get hungry as often as we used to. Furthermore, we have many clients that are remarkably successful following the plan. It is true that some people will have a hard time sticking to it, but they will struggle with any other restrictive diet as well. 

He also says in the above statement that it is not clear whether the weight loss is caused by the body being in a state of ketosis, or that it is simply from calorie restriction. To this I would have to say, so what? If it is just from calorie restriction…and it is working, what’s the big deal? However, there really is more to the story. He is implying that it is hard to get into ketosis, and many people actually do not achieve it eating a low carbohydrate diet. If that is what he is implying, then he is right. It is hard to get into a true state of ketosis. To get there and maintain it, someone would have to eat less than 50 grams of carbohydrate a day for a couple of weeks. I admit that this is hard to do, but one does not have to be in a full state of ketosis to be create an environment for the body to use it’s own fat stores for energy. Keeping insulin levels low (even if one is not in full on ketosis) does encourage the body to use fat from the fat stores along with the glycogen stored in the muscles and liver. It is a mild form of ketosis, and the body is able to switch from glucose to fat for energy more easily this way. Once again, to keep insulin levels low, it is better to eat a low carbohydrate diet. It may not have to be extremely low carbohydrate, but a pretty low carbohydrate opens up the fat stores in the body. Mark Sisson, who is the author of The Primal Blueprint , says that a lot of people can eat around 100 to 150 grams of carbs a day and still experience a mild form of ketosis, and with it steady fat loss (for comparison, the average American diet consists of anywhere from 300 to 600 grams of carbohydrate!). Some people may need to be more restrictive depending on how much metabolic damage they incurred over a lifetime of poor dietary habits, but many people can eat some carbs and still see fat loss.

Moving on:

Keto dieters often skip fruit because of its natural sugar but study after study shows that the antioxidants, as well as vitamins C, A, B, E, and K in colorful fruits and vegetables, help boost immunity, and protect against cancer and other diseases and skipping these naturally healthy plant foods increases your lifetime risk of cancer and heart disease.

 

Ok. Here he is telling a half truth. Yes, fruits and vegetables are high in anti-oxidants and various vitamins and minerals, and yes, keto dieters do avoid these foods because of the sugar content. However, he is discounting the nutritional value that meats bring to the diet. As a matter of fact, meats are very nutrient dense. They supply an abundance of all the vitamins and minerals we need except vitamin C. I admit that it is a concern to me. Vitamin C from our diet is important because we most surely need it to avoid scurvy and have a healthy immune system among other benefits, but Dr. Steve Phinney (He has researched the ketogenic diet for 25 years now) points out that the Inuit, who ate nothing but fish and meat back in the day never suffered from scurvy (They never ate vegetables of any kind. The only times they would eat vegetables was if they were on the verge of starvation). He believes that the reason they were fine with lower overall levels of vitamin C intake was because when we eat a high carbohydrate diet, it is very oxidative (cellular damaging) for the body to process it. A high fat diet, on the other hand, is not as oxidative. Fat is a clean burning fuel that does not put the same kind of stress on the body as carbohydrates do.  

I  must say my piece here though. Personally, we do not eat fruit with any frequency. Maybe once a month or so as a treat, but we do eat a lot of low carb type vegetables such as spinach, kale, tomatoes, cucumbers and so forth because we enjoy them, and they will not give us the insulin spike that fruit does, nor as high as the starchy carbs would for that matter. It adds a lot of variety to our meals, and it is an insurance policy, if you will, about making sure we do get all or the vitamins, minerals, and other nutrients we need for a healthy life. Our way of eating falls more in line with the Paleo concept that I mentioned earlier. 

Conclusion

The author of the article has a bias toward the plant based diet. The website that she writes for is all about eating a plant based diet. Many people choose to eat a vegan diet either for better health or for moral and ethical reasons against meat consumption. I respect that. I do believe, however, that it is harder to eat a fully nutritious and healthy diet without animal products, and that vegans need to be more dialed in on getting all the nutrients they need, but it can be done. After all, we really are omnivores. But to say that saturated fats are bad for us and the research unequivocally demonstrates that a high saturated fat diet will lead to heart disease is not true. Because of this misleading advice, Americans have cut back on saturated fat consumption and replaced it with a much higher percentage of carbohydrates over the last 50 years. During that same time span, there have been an obesity epidemic and an explosion in the development of metabolic syndrome and type 2 diabetes…all of them associated with a high carbohydrate diet. 

This needs to change. Saturated fats are not bad. High fat diets are good for health (the good fats: saturated fats, monounsaturated fats, saturated fats, and Omega 3. Stay away from all industrial oils such as canola oil, vegetable oils and hydrogenated oils.), and overall carbohydrate consumption, especially simple carbs need to come down.

In good health,

Gregg Hoffman

 

Here are some good resources about low carb eating:

Gary Taubes: Good Calories, Bad Calories

Gary Taubes: Why We Get  Fat: And What to Do About It

Mark Sisson: The Primal Blueprint

Stephen Phinney: The Art and Science of Low Carbohydrate Living

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