8 ms·

Ketogenic Diets and Chronic Disease: Benefits vs. Risks

nradov 5y ago
I'm always leery when I see a paper with a lead author from the Physicians Committee for Responsible Medicine. This is a political advocacy organization focused on pushing their policies rather than focusing on evidence based medicine. That doesn't necessarily make this study wrong but they have been known to exaggerate the evidence in favor of plant-based diets.
- JamesBarney 5y ago
  Yeah you nailed it. Quote from the paper. > 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."
  - tech_timc 5y ago
    I looked into the MIND diet after seeing it referenced in a PBS fund-raising infomercial. Basically it makes some modifications to the DASH and Mediterranean diets. I think it may have possibilities, but the critique is that the study used a relatively small, very racially homogeneous sample from retirement homes in Chicago, that they relied on self-reported food diaries, and that dropout over the course of the study was not evenly distributed between the test and control groups. Having said that, some subsequent studies have come to similar conclusions. Original paper: MIND diet slows cognitive decline with aging https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581900/ 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.
- JPKab 5y ago
  The ridiculously biased nature of the paper was readily apparent when opening it. I've followed ketogenic diets in the past, but was also a vegan for 3 years, and a vegetarian for 5. I'm super open-minded and results based when it comes to diet. 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.
  - Flankk 5y ago
    PETA is a voluntary psych ward. Most of its members have a god complex. They are on a mentally ill cruscade to make the world perfect. Reminds me of Hitler. https://petakillsanimals.com/ https://petakillsanimals.com/
- lfuller 5y ago
  The author also maintains a blog called "Veggie Quest" which promotes vegan living, hence the anti-meat slant to the paper.
- chansiky 5y ago
  Bingo. Effectively the only message I can take away here is that some organization funded "science" to prove their product is better than their competitor's. Which is not news to me... nor science for that matter.
throwawayanon47 5y ago
I can confirm that the bits of the paper about Seizure Disorders are accurate - my daughter has Dravet Syndrome and has been on the Ketogenic diet for 5 years. Its well established that Keto works well for some seizure disorders (inc Dravet) - see https://pubmed.ncbi.nlm.nih.gov/25524846/ https://pubmed.ncbi.nlm.nih.gov/25524846/ https://pubmed.ncbi.nlm.nih.gov/16146451/ https://pubmed.ncbi.nlm.nih.gov/16146451/ - it works about as well as the best AEDs (anti eplileptic drugs) but with fewer side effects. We use it alongside AEDs as well. My daughters Ketogenic diet is actually prescribed and monitored by the NHS, with various prescription foods/ingredients provided. So its very mainstream, this isn't just some random experimental thing I'm trying as a desparate parent. (Although as an aside, as a parent of a dravet kid, you do often feel desparate - its a very challenging condition) 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.
- Melatonic 5y ago
  Medical Keto seems like something that is super legit and very interesting. "Popular" keto interests me a lot less. 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.
Melatonic 5y ago
The big problem I have with the Keto diet is twofold: 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.
- dawnerd 5y ago
  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.
  - kcplate 5y ago
    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.
- 5y ago
aimatt 5y ago
Something about this article is just fishy to me. "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]"
- Johnny555 5y ago
  How many vitamins are in non-fortified grains? 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) https://draxe.com/nutrition/wheat-berries/ https://draxe.com/nutrition/wheat-berries/
  - gregwebs 5y ago
    It's hard to understand if that is a good or bad profile the way the information is displayed. If you normalize the nutrient by the calories (2000 calories / 158 calories) then it is high in all of the listed nutrients except folate. But still, this is a minority of the vitamins and minerals you need and it is very low in the rest. So it's not an impressive nutrient profile that you would see from a leafy green, an egg yolk, or liver. Here's a visualization: https://eatnutrients.com/sources/sr28/20071 https://eatnutrients.com/sources/sr28/20071 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.
ericmcer 5y ago
Having tried all these diets, a low protein and low fat vegan diet had the most dramatic weight loss without crazy cravings. Keto was good but the huge amount of protein meant I built/kept a bunch of muscle and muscle tissue taxes your system. In retrospect a high protein low fat/cal diet is a recipe for intense cravings and extremely difficult weight loss.
- toast0 5y ago
  > In retrospect a high protein low fat/cal diet is a recipe for intense cravings and extremely difficult weight loss. 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.
  - 1_player 5y ago
    > hard to follow because of the high fat 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.
- reedjosh 5y ago
  > I built/kept a bunch of muscle and muscle tissue taxes your system 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.
  - ericmcer 5y ago
    Muscle is good to a point, it is very easy in our high calorie high protein diet to put on way too much muscle. It is little better than fat, especially with the way heavy weightlifting distributes it.
InTheArena 5y ago
The problem I have with these papers is that the standard to prove that something works is high and rigorous, while the alternatives are presented with much more flimsy evidentiary standards. 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.
SamPatt 5y ago
I lost 90 lbs on a keto diet, with no ill effects that I'm aware of. 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.
reedjosh 5y ago
As I've known it it's not really a ketogenic diet if your taking in >20g carbs per day. > 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.
- 1_player 5y ago
  Plenty of studies on ketogenic diets on rats are based on adding an incredible amount of fat on top of carbohydrate heavy and call it ketogenic. /r/ketoscience has these crappy studies posted and debunked daily. Serious research on low carb is sorely lacking and plenty of interested parties really do not want for good science to be done around high fat/meat: the money's on plant based these days. I am still salty about that sorry excuse for a study the Lancet posted a few years ago and is still making headlines.
- Byteflux 5y ago
  <20g is just the threshold that's guaranteed to put most people into ketosis, but the exact number will vary by person. <50g is also a common threshold that works for many people. I'm not an expert on what qualifies as a "ketogenic diet" but personally I would say that if your diet consistently leaves you in a state of ketosis, then it's ketogenic. I would hope that any study on ketogenic eating is actually measuring blood ketones to determine this.
- gfosco 5y ago
  Later on in the paper, they rely on a bunch of trials and specify a low-carb diet as <130g per day! 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.
deleted 5y ago
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marstall 5y ago
This study says that a Keto diet cured mice of a rare genetic condition ... anyone know anything about how that works? https://pubmed.ncbi.nlm.nih.gov/27999180/ https://pubmed.ncbi.nlm.nih.gov/27999180/
sharker8 5y ago
I tried Keto and all I got out of it was weight loss in year one, followed by plateauing, and then weight gain, and then a nice update from my dentist that I had borderline high blood pressure. Since then I've gone to mostly "low fat, mostly starch, not much animal protein" and I look and feel much better.
bradley_taunt 5y ago
I’ve been in ketosis for roughly the last 4-5 years and I honestly couldn’t see myself going back to a “standard” diet. I’ve lost any real need to track macros heavily and have entered a state of “lazy keto” as some refer to it. 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.
memcg 5y ago
I have been following my version of low carb\keto for almost a year. I'm down 80 lbs from 325 lbs. 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.
toolcombinator 5y ago
I lost 75 Lbs thanks to cutting sugar and a ketonic diet. 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'm always leery when I see a paper with a lead author from the Physicians Committee for Responsible Medicine. This is a political advocacy organization focused on pushing their policies rather than focusing on evidence based medicine. That doesn't necessarily make this study wrong but they have been known to exaggerate the evidence in favor of plant-based diets.

JamesBarney 5y ago
Yeah you nailed it. Quote from the paper. > 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."
- tech_timc 5y ago
  I looked into the MIND diet after seeing it referenced in a PBS fund-raising infomercial. Basically it makes some modifications to the DASH and Mediterranean diets. I think it may have possibilities, but the critique is that the study used a relatively small, very racially homogeneous sample from retirement homes in Chicago, that they relied on self-reported food diaries, and that dropout over the course of the study was not evenly distributed between the test and control groups. Having said that, some subsequent studies have come to similar conclusions. Original paper: MIND diet slows cognitive decline with aging https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581900/ 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.
JPKab 5y ago
The ridiculously biased nature of the paper was readily apparent when opening it. I've followed ketogenic diets in the past, but was also a vegan for 3 years, and a vegetarian for 5. I'm super open-minded and results based when it comes to diet. 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.
- Flankk 5y ago
  PETA is a voluntary psych ward. Most of its members have a god complex. They are on a mentally ill cruscade to make the world perfect. Reminds me of Hitler. https://petakillsanimals.com/ https://petakillsanimals.com/
lfuller 5y ago
The author also maintains a blog called "Veggie Quest" which promotes vegan living, hence the anti-meat slant to the paper.
chansiky 5y ago
Bingo. Effectively the only message I can take away here is that some organization funded "science" to prove their product is better than their competitor's. Which is not news to me... nor science for that matter.

throwawayanon47 5y ago

I can confirm that the bits of the paper about Seizure Disorders are accurate - my daughter has Dravet Syndrome and has been on the Ketogenic diet for 5 years. Its well established that Keto works well for some seizure disorders (inc Dravet) - see https://pubmed.ncbi.nlm.nih.gov/25524846/ https://pubmed.ncbi.nlm.nih.gov/25524846/ https://pubmed.ncbi.nlm.nih.gov/16146451/ https://pubmed.ncbi.nlm.nih.gov/16146451/ - it works about as well as the best AEDs (anti eplileptic drugs) but with fewer side effects. We use it alongside AEDs as well. My daughters Ketogenic diet is actually prescribed and monitored by the NHS, with various prescription foods/ingredients provided. So its very mainstream, this isn't just some random experimental thing I'm trying as a desparate parent. (Although as an aside, as a parent of a dravet kid, you do often feel desparate - its a very challenging condition) 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.

Melatonic 5y ago
Medical Keto seems like something that is super legit and very interesting. "Popular" keto interests me a lot less. 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.

Melatonic 5y ago

The big problem I have with the Keto diet is twofold: 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.

dawnerd 5y ago
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.
- kcplate 5y ago
  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.
5y ago

aimatt 5y ago

Something about this article is just fishy to me. "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]"

Johnny555 5y ago
How many vitamins are in non-fortified grains? 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) https://draxe.com/nutrition/wheat-berries/ https://draxe.com/nutrition/wheat-berries/
- gregwebs 5y ago
  It's hard to understand if that is a good or bad profile the way the information is displayed. If you normalize the nutrient by the calories (2000 calories / 158 calories) then it is high in all of the listed nutrients except folate. But still, this is a minority of the vitamins and minerals you need and it is very low in the rest. So it's not an impressive nutrient profile that you would see from a leafy green, an egg yolk, or liver. Here's a visualization: https://eatnutrients.com/sources/sr28/20071 https://eatnutrients.com/sources/sr28/20071 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.

ericmcer 5y ago

Having tried all these diets, a low protein and low fat vegan diet had the most dramatic weight loss without crazy cravings. Keto was good but the huge amount of protein meant I built/kept a bunch of muscle and muscle tissue taxes your system. In retrospect a high protein low fat/cal diet is a recipe for intense cravings and extremely difficult weight loss.

toast0 5y ago
> In retrospect a high protein low fat/cal diet is a recipe for intense cravings and extremely difficult weight loss. 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.
- 1_player 5y ago
  > hard to follow because of the high fat 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.
reedjosh 5y ago
> I built/kept a bunch of muscle and muscle tissue taxes your system 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.
- ericmcer 5y ago
  Muscle is good to a point, it is very easy in our high calorie high protein diet to put on way too much muscle. It is little better than fat, especially with the way heavy weightlifting distributes it.

InTheArena 5y ago

The problem I have with these papers is that the standard to prove that something works is high and rigorous, while the alternatives are presented with much more flimsy evidentiary standards. 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.

SamPatt 5y ago

I lost 90 lbs on a keto diet, with no ill effects that I'm aware of. 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.

reedjosh 5y ago

As I've known it it's not really a ketogenic diet if your taking in >20g carbs per day. > 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.

1_player 5y ago
Plenty of studies on ketogenic diets on rats are based on adding an incredible amount of fat on top of carbohydrate heavy and call it ketogenic. /r/ketoscience has these crappy studies posted and debunked daily. Serious research on low carb is sorely lacking and plenty of interested parties really do not want for good science to be done around high fat/meat: the money's on plant based these days. I am still salty about that sorry excuse for a study the Lancet posted a few years ago and is still making headlines.
Byteflux 5y ago
<20g is just the threshold that's guaranteed to put most people into ketosis, but the exact number will vary by person. <50g is also a common threshold that works for many people. I'm not an expert on what qualifies as a "ketogenic diet" but personally I would say that if your diet consistently leaves you in a state of ketosis, then it's ketogenic. I would hope that any study on ketogenic eating is actually measuring blood ketones to determine this.
gfosco 5y ago
Later on in the paper, they rely on a bunch of trials and specify a low-carb diet as <130g per day! 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.

deleted 5y ago

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marstall 5y ago

This study says that a Keto diet cured mice of a rare genetic condition ... anyone know anything about how that works? https://pubmed.ncbi.nlm.nih.gov/27999180/ https://pubmed.ncbi.nlm.nih.gov/27999180/

sharker8 5y ago

I tried Keto and all I got out of it was weight loss in year one, followed by plateauing, and then weight gain, and then a nice update from my dentist that I had borderline high blood pressure. Since then I've gone to mostly "low fat, mostly starch, not much animal protein" and I look and feel much better.

bradley_taunt 5y ago

I’ve been in ketosis for roughly the last 4-5 years and I honestly couldn’t see myself going back to a “standard” diet. I’ve lost any real need to track macros heavily and have entered a state of “lazy keto” as some refer to it. 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.

memcg 5y ago

I have been following my version of low carb\keto for almost a year. I'm down 80 lbs from 325 lbs. 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.

toolcombinator 5y ago

I lost 75 Lbs thanks to cutting sugar and a ketonic diet. 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.