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I'm on the ketogenic diet.

Again, I’ve been doing this for a little while to help bring a positive message of health and wellness to this site.  I’ve had several other blogs on topics such as diabetes and prescription medications, as well as links to discussions on a wide range of topics such as intermittent fasting, GMO’s, videos on Netflix such as What the Health and Forks over Knives, etc.  I’ve made book recommendations and all kinds of stuff.  This is in the same vein as all that, though those discussions went away when I switched over to this account.  At the end of my previous discussion someone asked me to do a segment on Diets and I told them I’d be happy to and this is it.  Understand I am not a dietician, I’m a physician, so I’ll do the best I can to pull it all together and give my take on it, but it’s by no means the end all tell all of information on the topic.

Before I begin, full disclosure – I’m a vegan.  I became one recently after taking care of patient after patient with severe metabolic and pathologic syndromes who were suffering from debilitating illnesses that were severely hindering their quality of life.  I didn’t want to end up like them.  In each case the general theme is that these people didn’t pay much attention to their health through the years and were paying the price now for their shortsightedness.  It’s true that anyone could at any moment have a huge fatal heart attack – the widow maker as its called – and I’m no different in my risk for that, I just wanted to make sure I had a high quality of life up to that point and wasn’t in chronic pain or having to take insulin while my feet and toes were numb all day.  Take with a grain of salt what I write here, knowing that its coming from a vegan.  I’m not trying to convince you of becoming one not am I arguing in this discussion that it’s the only way to go.  I’m going out of my way to be objective and unbiased here.

Some background before we begin.  You go to your friend’s house for dinner and you shovel down all kinds of mashed potatos, green bean casserole, porkchops etc.  Really a wide range of fruits, veggies, and meats.  Your body doesn’t see what’s put into the stomach as green beans or potatoes, all it sees is carbohydrates (which is a fancy name for sugar), fats, and proteins.  A lot of the diets out there today focus on minimizing one or more of these or maximizing one in favor of the others. 

Also before we begin, please consider a few points.  First, I’m a physician.  I like studies that are based on things I can sink my teeth into, such as placebo controlled, double blinded and randomized trials.  I like studies where there are a lot of participants.  I like research where they can point to a group of people, such as those that live in loma linda, or Sardinia, or Okinawa who did a diet as part of there culture and by living that way did well.  I like studies that you can point to the biochemical processes that support a conclusion, you can measure the input and output and there’s an obvious correlation of cause and effect.  I like things that you can make a public health policy on without doing harm to large populations of people.  Second, as a physician, there are a few things I don’t like to see.  One is anecdotal evidence.  Uncle Ed smoked until he was 99 and he didn’t get cancer, so smoking is ok.  All these books and documentaries on diet are loaded with anecdotal evidence.  Charlie had astronomical cholesterol and became a vegan.  Afterwards his cholesterol dropped and he could quit his statin medication.  No.  No no no.  Another pet peeve of mine is the moderation argument.  Its ok to eat processed meats so long as you do it in moderation.  Its ok to take cyanide, so long as you do it to moderation.  What’s really going on with this is its an acknowledgement that diet and health is a complicated thing that isn’t important enough to look into carefully and as such you should continue doing what you already do.  If that were ok then people wouldn’t be getting diabetes and atherosclerosis, they wouldn’t be obese, and we all know these things are out of control.  People who are concerned for their health should look into ways to improve themselves beyond just moderation.  I don’t like arguments that are based on emotion of subjectivity.  I love meat and therefore when I hear arguments that suggest meat is bad I tend to shut those people out and when someone says meat is good for me I hang my hat on it to justify what I already do.  Anything to the contrary the people are idiots or treehuggers, or whatever.  Right dude, come on.  Finally I don’t like the one size fits all arguments.  Veganism is great and there are a lot of benefits of being a full fledged vegan, but for someone who is in their early 80’s, who needs a little extra protein in the diet to support the immune system, then maybe its better in their case to be pescatarian vegan.  I have no qualms at all about that.

Ok on to the diets themselves.

The first one is the high fat and protein, low carb diets, such as Atkins, Paleo, carnivore, and the new one that’s really popular now the ketogenic diet.  I lump these all together because they’re all pretty similar in that you limit carbs and eat a lot of meats – I mean a lot.  People on this diet eat what they want and drop weight.  Almost all of them report feeling better while they’re doing it and having more energy.  Ok real key point here: all these diets people lose weight on them.  The weight comes flying off these people and that’s a good thing.  If your goal is weight loss then this is a perfectly acceptable way to go about it, in the short run.  Pick any of these diets, from any of the categories here, and have at it.  I became a vegan and I lost 20 pounds.  Is any of these diets better at weight loss that the others?  Not to my knowledge.  Short run Paleo?  Go for it. 

What about the long run?  Well the problem is that it might be ok to focus on fat and protein – the problem is what else comes with it when you eat meat, namely transfats and cholesterol.  Now some people claim their levels of LDL and VLDL actually drop on these diets, but that is largely a short run phenomenon which might in fact have more to do with your drop in weight than to some counter intuitive effect of participating in the diet.  It would be hard to justify this diet much beyond the short run since bombarding your arteries with fat and cholesterol, which in essence you’re doing here, is not in your best interests.  Long term exposure to fat and cholesterol leads to elevated LDL levels, the particles of which migrate into inner most layer of the wall of your blood vessels.  Once there they act as foreign pathogens that trigger inflammation and the migration of macrophages in past the epithelial cells.  These macrophages consume the misplaced LDL molecules and transition into what are called foam cells, which release inflammatory agents that cause smooth muscle cells from the middle of the vessel wall to migrate into the inner most layer, the long and short of which is atherosclerosis and vessel narrowing.  Likewise, high levels of circulating fat and LDL trigger the internalization of glucose transporter receptors on the cell membrane of muscle cells into the cytoplasm, making them less able to shuttle glucose energy into the cell (type II diabetes).  Both of these things atherosclerosis and diabetes – these are things you don’t want. 

Then there’s cancer.  Dairy in particular is high in a molecule called IGF-1.  It’s a growth factor that promotes, of all things, getting big.  Its important to have this molecule when babies are growing quickly.  They suckle milk from mom, they get a lot of growth factor, and they grow.  Its what we do.  Problem is once we’ve grown, we don’t need it anymore and instead of being beneficial, it feeds cells in our bodies that we don’t want, namely cancer.  This has been shown very clearly in the laboratory.  Researchers took tissues with known cancer cells and ran a nutrient rich solution through it that mimicked the typical western diet and the cancer cells thrived and grew.  When they removed the IGF-1 from the solution, the cells actually withered up and died.  This prompted them to do further epidemiological investigation.  What they found was a very strong association between women that consumed high amounts of dairy and breast cancer.  There’s also heme iron to consider, which has almost the exact same potential to cause cancer as IGF-1 but is responsible for high rates of colon cancer.  Both the heme iron and IGF-1 are found in dairy, but also in meats and it didn’t matter if meats were fatty or lean.  They’re in all meats.  So this argument that eating lean chicken is healthy or that pork is the other white meat is really nothing more than advertising marketers trying to confuse the public.  There’s nothing healthy about dairy or meat consumption – at all.  In fact, processed meats, such as hot dogs and pepperonis, were recently labeled as type 1 carcinogins by the USDA.  Not good.

Well why did these people feel better after doing the diet?  It actually takes quite a bit of effort to take glucose from sugar and get it into our cells.  They’re large molecules and they need to adhere to a glucose transport molecule on the outer membrane of a cell to be transported in.  People that have glucose resistance, such as diabetics, this is a very big challenge and the cells are starved for energy.  By contracst, the fats, the proteins and the ketone bodies from these diets are much smaller and enter the cell much more easily.  Suddenly these cells are getting the energy they so desperately need and you end up feeling better.  You feel better but at what cost?  You’re increasing your atherosclerosis and making insulin resistance worse.  I don’t know, whatever.

Picking this diet and pointing to how cavemen ate it is sketchy to me.  Cavemen lived to be 33 years old on average.  It’s not a good long term choice in my option.  In fact, population studies actually argue against this approach.  The chinese for example used to eat mainly rice and vegetables, little to no meat for centuries and they had virtually no cancer, diabetes, or heart disease.  Not to say they didn’t eat meat, but when they did maybe there was one small piece of it, say the size of a hamburger patty, which the whole family cut into small pieces and shared to garnish their dishes.  When compared to countries that eat a traditional western diet, their level of diet related health complications were much lower than ours.  In the 1970’s however, the Chinese underwent a cultural change and shifted to a more western diet when companies like KFC and McDonalds became popular there.  When they did, the rates of obesity, diabetes and heart disease sky rocketed, approaching when we see in the USA.  Hmm…

The next diet is the low protein, high carb, moderate healthy fat diet, also known as the south beach diet or the mediterranean diet.  This one advocates eating lots of plants and veggies, nuts, grains, lean meats, salmon and other fish, and healthy oils such as olive oil and avocado.  Again, people on this diet lost lots of weight and felt great while on it.  At least this one there’s a group or population of people who eat like this regularly in Italy and in Okinawa, and they tend to live longer and have less cancer, diabetes, and atherosclerosis than people who eat the more traditional western diet and that’s great.  So what’s wrong with this diet?  Well nothing really, so long as your carbs are coming from fruits and veggies and not from processed sugars and your fats are from healthy sources like avocados and nuts rather than fried food.  It’s important to consider what hitchhikes along with our sugars and fats when we eat them.  People from Okinawa and Southern Italy ate foods that contained sugars from fruits and veggies that were high in fiber and had low glycemic indicies.  That means that the glucose loads didn’t hit the tissues all at once and damage cells or promote insulin resistance the way sugars from sweets and junk food do.  There’s a slow release of glucose that the cells could take their time incorporating into their metabolic processes.  Slow and steady wins the race, fast and heavy binds to fat and cholesterol and promotes atherosclerosis and plaque formation in blood vessels as well as insulin resistance.  Are processed sugars bad for you?  Table sugar is sucrose, which is 50% glucose and 50% fructose.  The breakdown byproduct of glucose goes directly into the blood and is taken up by cells for energy in the krebs cycle, making ATP and other energy molecules used by muscles.  The fructose on the other hand is taken up by the liver and fat cells and promotes lipogenesis, or the storage of fats, which is good if you’re a human being hundreds of thousands of years ago and you needed to store as much energy as you could to survive the winter, but now as we’re all fighting to keep thin its not so great.  Sugars from fruits and veggies are more 60/40 in favor of glucose, which is a better mix.  So in the final analysis, there is some truth to the statement that refined sugars are not so great, but it’s the hitchhikers such as fat and cholesterol in foods that have them rather than the beneficial fiber and low glycemic kinetics of healthier foods.

Its kind of the same idea with fats.  Do your good fats come with transfats and cholesterol?  If so then you’re probably doing more harm than good by consuming them.  How do you know by reading the label if something is transfats?  Anything with the word hydrogenated in it is trans fats.  Partially hydrogenated oils, etc are trans fats.  Does it matter if the fats are saturated or polyunsaturated or monounsaturated or whatever?  They’re all good at providing energy to cells.  I haven’t seen any compelling data to suggest there is much difference when taken by themselves, but therein lies the problem.  They’re almost never by themselves – there’s cholesterol with them.  Clean sources of fats, such as avocados and nuts you’re probably ok consuming and getting energy to cells.  Lots of studies say omega 3’s are healthy.  Studies show omega 6s are bad and lead to disease.  If you’re healthy and you work out and you need fats for energy and muscle growth then you’re probably consuming healthy fats.  If you have heart disease, are pre-diabetic, or diabetic, or have atherosclerosis, then you should probably avoid as many fats and as much cholesterol as you can.  It’s as simple as that. 

But they consume fish.  Right.  So when researchers did what you call factor analysis of the diet and looked at each thing they consumed in the Mediterranean diet what they found was that the fish and meat they ate contributed nothing to the well being of the people and that people tended to be healthier with it because they ate a lot more of fruits and veggies than they would have otherwise.  The case could be made that having fish and a small amount of meat made the diet more palatable and less arduous and thus it was more likely that people would stay on it longer than if it were a pure vegan diet.  If that’s the case then amen brother.  There’s a lot of good data out there that a physician like me would feel comfortable hanging my hat on that its healthy and a smart diet to follow, realizing its not without its flaws.

Vegetarian and Vegan diets.  They require more discipline and to the average person that doesn’t want to have to search the far corners of the cafeteria for an apple or inconvenience mom when she makes a turkey for thanksgiving, it’s a slog.  You add in the concerns people have about low protein and vitamin B12 and it’s not for everybody.  It is the optimal long term diet however when you consider all the ramifications of diabetes, heart disease and cancer.  The studies have shown that the more plant based foods you put in your body the better and the less dairy and meats the better and its not even close.  And this notion that there’s a nutrition deficit is really nothing more than fallacy – in actuality your nutrition is significantly enhanced when you eat cleaner and there’s no cleaner diet out there than a vegan diet.  You need to take B-12 supplements, its as easy as that.  The food itself?  Well to be honest, food science has improved so much recently that there are vegan butters, vegan cheeses, and all sorts of other substitutes for things a lay person is accustomed to eating.  I’m not going to blather on about veganism, since I am one and it would come across as biased when I advocate for it, but I will say that it’s the only diet shown that’s actually protective for cancer, and can reverse diseases such as diabetes and heart disease, even in people who are significantly affected by these disorders, such as those who are have had strokes and heart attacks and those whose diabetes is so bad that they have to have limbs amputated. 

Anyways, I hope this was helpful and I’m happy to discuss or answer any questions that arise (to the best of my ability).  Thanks,  Ajoel.