8 ms·

I am 58, on a (mostly) strict ketogenic diet since 2013. It has worked wonders for me and I expect to eat this way the rest of my life. I eat a lot of meat and

by StacyC 6y ago

I am 58, on a (mostly) strict ketogenic diet since 2013. It has worked wonders for me and I expect to eat this way the rest of my life. I eat a lot of meat and eggs as I have found that combination (1) is something I enjoy very much, and (2) makes me feel the best. I didn’t have much weight to lose but I went from 175 to 160 (high school weight) and under 15% body fat. My energy level is consistently very good. Diet is a subjective thing, of course, but at a minimum getting rid of sugars and processed food might be a good starting point for anyone. Anecdote: my brother-in-law reversed his T2 diabetes and lost quite a bit of weight doing keto. His doctor had advised meds to “manage” the disease.

el_oni 6y ago
> reversed his T2 diabetes and lost quite a bit of weight doing keto. His doctor had advised meds to “manage” the disease. My assumption there is that compliance for meds is probably better than compliance for huge lifestyle changes (such as diet). And that most people that the doctor sees in your BILs situation wouldn't stick to a ketogenic diet, and would need to go onto meds at some point in the future anyway. Aside from that, im glad that it worked out for him. My anecdote about T2, is that a guy who works with my SO was told to control his diabetes with diet and is now insulin dependant, he hasnt been doing his insulin properly and has developed a swathe of health problems because of it.
- jonfw 6y ago
  You've also got to look at how doctors are being incentivized. Medicine funnels more money into the medical system- and kickbacks or 'rewards' programs from pharmaceutical companies are common. Outside of that- people like their doctors to do things. Everybody knows that they could use a better diet and more exercise- a doctor who says that and nothing else may not make people feel like they're getting their money's worth.
  - bosie 6y ago
    I am not even sure the incentives matter, compliance rates from patients are horrendous in medicine. Incentives or not, suggesting a lifestyle change (go from SAD to extreme low carb) might be the best course of action but how many patients will follow through? does medicine even know how to handle this transition? Of course they don't. Advising this lifestyle change might work for 1% but what about the other 99%?
  - 49para 6y ago
    Dr's are also incredibly uninformed about Keto, Carnivore, low carb in general. The response I've received from my Dr friends regarding nutritional intervention vs drugs, is that "diets don't work". They have no clue as to recent research being done. Changes to medical "best" practice are generational and take a long time.
    - el_oni 6y ago
      I wouldn't say that they are uninformed, just that they are informed by the literature. And unfortunately the literature surrounding diet is awash with special interest groups, small sample sizes and dodgy statistics. While clinical trials involving pharmaceuticals are often more rigorous. It's near impossible to do randomised double blind controls for diet, and energy levels and feeling great aren't as easy to measure empirically
    - AnonC 6y ago
      Of course “diets” don’t work. People consider diets as something you get on for some results or changes and then abandon them or give up later. So what actually works is making it a lifestyle change, which isn’t easy either, but is at least honest in what it means to people when they hear the word. Lifestyle changes are hard. Diets are what people usually see celebrities doing before an awards ceremony.
- thomascgalvin 6y ago
  > My assumption there is that compliance for meds is probably better than compliance for huge lifestyle changes (such as diet). This is probably true, but I'd like to see statistics. Compliance with med schedules is pretty terrible, too; that's why all of your antibiotics have a label telling you to actually finish your course.
  - el_oni 6y ago
    According to the highlights of this 2011 study[0], compliance is around 50% for drugs. I don't know if this is higher or lower than i was expecting to be honest... [0]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/
abtom 6y ago
Weight loss comes from having a calorie deficit, not from keto. You can gain weight on keto if you eat more calories. You can achieve the same weight loss by just eating fewer total calories, without cutting carbs as well.
- jonfw 6y ago
  This is well understood by now. The issue is that most people aren't actually going to track their calories- they eat when they're hungry. If you adjust your diet- you can satiate your appetite on a lower number of calories. The idea is that meats, vegetables, and fats help you meet your nutritional goals on a fewer amount of calories when compared to carbs- because carbs are empty calories.
  - abtom 6y ago
    Agreed that satiation is a major aspect. How satiating a food is, is not simply about carbs/proteins/fats. Most carb rich foods people eat today are high in sugar and low in fiber. That causes people to overeat. You can also overeat with high fat foods because fat is much more energy dense. You can just as easy have a bad keto diet as you can have a bad high carb diet. Replacing processed carbs with processed meat will not do any good. It's a group 1 carcinogen and will also lead to high cholesterol level causing heart disease. My point is that carbs aren't the enemy. Neither is fat. Eating unprocessed/low processed food should be the goal.
    - amanaplanacanal 6y ago
      The evidence that high cholesterol “causes” heart disease isn’t very good. There appears to be an association, but that’s really all we can say.
      - jonfw 6y ago
        in my experience- the more I learn about nutrition, the more I realize that we're just talking about everybody's best guess. Hard facts are scarce in this space.
biswaroop 6y ago
Do you avoid red meat? Also, do you worry about cholesterol intake from the meat and eggs?
- StacyC 6y ago
  I eat quite a lot of red meat, ribeye when I can, ground beef. Also pork, some fish. I prefer beef with a bit of fat. I am convinced that dietary fat and cholesterol are not the problem as we have been told for decades. My blood work is excellent. In fact, my doctor is on board with what I am doing but she also doesn’t quite know what to make of it. I think she still has some cognitive dissonance with someone eating the way I do and seeing the results that, per her training, should not be happening. I also used to take 50mg of Losartan for blood pressure but I no longer need it.
  - biswaroop 6y ago
    Ah well my concern with eating red meat is related to the cancer risk and the impact on climate change. Are you worried about these issues in relation to your diet?
    - norswap 6y ago
      The health "risks" of red meat have been really overblown, see this meta-review (there are also two others by the same others, looking at slightly different questions): https://www.gwern.net/docs/longevity/2019-zeraatkar.pdf https://www.gwern.net/docs/longevity/2019-zeraatkar.pdf
      - biswaroop 6y ago
        How do you feel about the climate change impact due to red meat production? I can't really imagine any way to decrease that other than drastically decreasing red meat consumption.
        norswap 6y ago

by StacyC 6y ago

el_oni 6y ago

> reversed his T2 diabetes and lost quite a bit of weight doing keto. His doctor had advised meds to “manage” the disease. My assumption there is that compliance for meds is probably better than compliance for huge lifestyle changes (such as diet). And that most people that the doctor sees in your BILs situation wouldn't stick to a ketogenic diet, and would need to go onto meds at some point in the future anyway. Aside from that, im glad that it worked out for him. My anecdote about T2, is that a guy who works with my SO was told to control his diabetes with diet and is now insulin dependant, he hasnt been doing his insulin properly and has developed a swathe of health problems because of it.

jonfw 6y ago
You've also got to look at how doctors are being incentivized. Medicine funnels more money into the medical system- and kickbacks or 'rewards' programs from pharmaceutical companies are common. Outside of that- people like their doctors to do things. Everybody knows that they could use a better diet and more exercise- a doctor who says that and nothing else may not make people feel like they're getting their money's worth.
- bosie 6y ago
  I am not even sure the incentives matter, compliance rates from patients are horrendous in medicine. Incentives or not, suggesting a lifestyle change (go from SAD to extreme low carb) might be the best course of action but how many patients will follow through? does medicine even know how to handle this transition? Of course they don't. Advising this lifestyle change might work for 1% but what about the other 99%?
- 49para 6y ago
  Dr's are also incredibly uninformed about Keto, Carnivore, low carb in general. The response I've received from my Dr friends regarding nutritional intervention vs drugs, is that "diets don't work". They have no clue as to recent research being done. Changes to medical "best" practice are generational and take a long time.
  - el_oni 6y ago
    I wouldn't say that they are uninformed, just that they are informed by the literature. And unfortunately the literature surrounding diet is awash with special interest groups, small sample sizes and dodgy statistics. While clinical trials involving pharmaceuticals are often more rigorous. It's near impossible to do randomised double blind controls for diet, and energy levels and feeling great aren't as easy to measure empirically
  - AnonC 6y ago
    Of course “diets” don’t work. People consider diets as something you get on for some results or changes and then abandon them or give up later. So what actually works is making it a lifestyle change, which isn’t easy either, but is at least honest in what it means to people when they hear the word. Lifestyle changes are hard. Diets are what people usually see celebrities doing before an awards ceremony.
thomascgalvin 6y ago
> My assumption there is that compliance for meds is probably better than compliance for huge lifestyle changes (such as diet). This is probably true, but I'd like to see statistics. Compliance with med schedules is pretty terrible, too; that's why all of your antibiotics have a label telling you to actually finish your course.
- el_oni 6y ago
  According to the highlights of this 2011 study[0], compliance is around 50% for drugs. I don't know if this is higher or lower than i was expecting to be honest... [0]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/

abtom 6y ago

Weight loss comes from having a calorie deficit, not from keto. You can gain weight on keto if you eat more calories. You can achieve the same weight loss by just eating fewer total calories, without cutting carbs as well.

jonfw 6y ago
This is well understood by now. The issue is that most people aren't actually going to track their calories- they eat when they're hungry. If you adjust your diet- you can satiate your appetite on a lower number of calories. The idea is that meats, vegetables, and fats help you meet your nutritional goals on a fewer amount of calories when compared to carbs- because carbs are empty calories.
- abtom 6y ago
  Agreed that satiation is a major aspect. How satiating a food is, is not simply about carbs/proteins/fats. Most carb rich foods people eat today are high in sugar and low in fiber. That causes people to overeat. You can also overeat with high fat foods because fat is much more energy dense. You can just as easy have a bad keto diet as you can have a bad high carb diet. Replacing processed carbs with processed meat will not do any good. It's a group 1 carcinogen and will also lead to high cholesterol level causing heart disease. My point is that carbs aren't the enemy. Neither is fat. Eating unprocessed/low processed food should be the goal.
  - amanaplanacanal 6y ago
    The evidence that high cholesterol “causes” heart disease isn’t very good. There appears to be an association, but that’s really all we can say.
    - jonfw 6y ago
      in my experience- the more I learn about nutrition, the more I realize that we're just talking about everybody's best guess. Hard facts are scarce in this space.

biswaroop 6y ago

Do you avoid red meat? Also, do you worry about cholesterol intake from the meat and eggs?

StacyC 6y ago
I eat quite a lot of red meat, ribeye when I can, ground beef. Also pork, some fish. I prefer beef with a bit of fat. I am convinced that dietary fat and cholesterol are not the problem as we have been told for decades. My blood work is excellent. In fact, my doctor is on board with what I am doing but she also doesn’t quite know what to make of it. I think she still has some cognitive dissonance with someone eating the way I do and seeing the results that, per her training, should not be happening. I also used to take 50mg of Losartan for blood pressure but I no longer need it.
- biswaroop 6y ago
  Ah well my concern with eating red meat is related to the cancer risk and the impact on climate change. Are you worried about these issues in relation to your diet?
  - norswap 6y ago
    The health "risks" of red meat have been really overblown, see this meta-review (there are also two others by the same others, looking at slightly different questions): https://www.gwern.net/docs/longevity/2019-zeraatkar.pdf https://www.gwern.net/docs/longevity/2019-zeraatkar.pdf
    - biswaroop 6y ago
      How do you feel about the climate change impact due to red meat production? I can't really imagine any way to decrease that other than drastically decreasing red meat consumption.
      - norswap 6y ago