Ketogenic diet - fad or phenom?

[chrisbainbridge]

Diabetes is a condition where a lack of insulin leads to loss of control of blood sugar and death.
It is therefore assumed that the primary object of insulin is to control Blood sugar.

HOWEVER
if we did not have problems with type 1 diabetes then insulin would probably have been seen as an evolutionary hormone designed to drive glucose into lipogenesis and into fat cells for the winter. (What it actually does).

our understanding of the function of insulin in popular science is skewed by how it was first discovered.

[hellymedic]

<Anecdata> My erstwhile insulin-dependent diabetic uncle (late onset) is off insulin and has normal blood sugars on a red meat-free, dairy-free, low-carb diet.

Good for him, I'm on average using 6-8 units a day, right at the bottom of the scale.  I think this is due to a combination of low carb diet and general fitness prolonging the honeymoon period. I suspect some residual pancreatic function.

Could well be.
Your insulin requirements sound minimal too, which can be no bad thing.

[hellymedic]

<Anecdata> My erstwhile insulin-dependent diabetic uncle (late onset) is off insulin and has normal blood sugars on a red meat-free, dairy-free, low-carb diet.

No (OK, little) meat, no dairy, low carbs. Isn't that called just not eating?  Avocado, eggs, nuts and mackerel, over and over and over again?

Uncle does seem to eat, though finding a suitable restaurant for family group with him was a challenge!
He doesn't eat chicken but does eat fish. I don't think he eats many pulses.
His weight appears 'normal' and he seems to have shed the pot belly he had for several decades.

[ElyDave]

Diabetes is a condition where a lack of insulin leads to loss of control of blood sugar and death.
It is therefore assumed that the primary object of insulin is to control Blood sugar.

HOWEVER
if we did not have problems with type 1 diabetes then insulin would probably have been seen as an evolutionary hormone designed to drive glucose into lipogenesis and into fat cells for the winter. (What it actually does).

our understanding of the function of insulin in popular science is skewed by how it was first discovered.

Remember insulin has many different functions and these have quite an influence on both symptom and management of diabetes, and can suggest different strategies for T1 and T2.  From my immediate need to learn this stuff three years ago my paraphrasing is
1) movement of glucose to muscles, when exercising, additional receptors are activated, in addition to other transport mechanisms to improve glucose transport rate.  That's why exercising T1s with an amount of circulating insulin are at risk of hypos during exercise - they can't do the same as a normal person and reduce insulin production - I have to reduce my pump rate 3-4 hours ahead of time
2) fat storage hormone, stores excess glucose as fat
3) suppresses fat utilisation (preference for use of glucose as fuel when available)

Hence, to lose fat/use fat needs minimum insulin circulating, easy enough for me if a bit of a faff and requiring planning.  For a T2, where they are insulin resistant, high circulating insulin lays down carbs as fat, prevents it being utilised and with the insulin resistance means those circulating carbs are not as easily utilised either.  Hence T2 tends to be linked to obesity, but the question of cause vs effect s being rethought in some medical circles.

Also, with that premise in mind, a high carb diet, with those insulin spikes again logically contributes to obesity.  So being able to efficiently burn fat = low insulin = low carb.

[ElyDave]

[url]http://www.theguardian.com/society/2016/may/22/official-advice-to-eat-low-fat-diet-is-wrong-says-health-charity[url/]

If you've not seen it yet

[rafletcher]

http://www.bbc.co.uk/news/health-36345768

[mrcharly-YHT]

http://www.bbc.co.uk/news/health-36345768

Other experts have also criticised the recommendation to eat more fat, saying the report cherry-picked evidence.

Naveed Sattar, a professor of metabolic medicine at the University of Glasgow, said the report was "good, bad and ugly".
He backed calls to cut snacking, but said eating more fat as a cure for obesity and type 2 diabetes was "not warranted" by the evidence and would have "adverse" consequences.
He said the authors had been selective in their choice of evidence and had ignored "an abundant literature which goes against their conclusions"

[IJL]

I can't help wondering who this diet advice is aimed at, the population of who need diet advise will completely ignore it the population who are already obsessed with diet will just become more so.  Labelling food as good or bad is largely nonsense, the drive to reduce fat just led to it being replaced with sugar.  As someone or other said (cant be bothered to google it) "everything is a poison at the right dose"

In the mean time I see patients who seem to be drinking gallons of Coconut water, apparently it's more hydrating!!!

[mrcharly-YHT]

The problem with articles like that one is that people who eat unhealthily (chips, salt and high-monosaturated cooked fat processed foods) will read it and say "see, fat's good for you", then shove more cheap fatty, sugar and salt laden crap into themselves.

It's useless info for the people who are already closely watching their health, whether they are doing low fat diets, low carb diets or whatever. Those people are already playing attention to their health and will respond sensibly to poor health.

[ian]

Same old shit really, everyone at some level knows that eating a balanced diet with plenty of fruit and veg, no processed food and doing regular exercise is the sensible thing and the one that works for both weight and general health. It doesn't need amateur physiology and biochemistry, and you don't need to remove entire food groups, buy special products, or otherwise engage in dietary weirdness. But like I've said before, we've made food odd. Eat and drink well and enjoy it.

[caerau]

Also, the government have a responsibility to at least try and keep the population healthy, that's what leads to these pointless directives and advice as drip fed 'new evidence' comes out.  I have a bit of sympathy for them because since they do have that responsibility, being seen to do nothing is not an option. So they're damned if they do and damned if they don't.  Crap articles written by journalists with little or no science training on top doesn't help either.

We can't even work out (yet) in full the metabolic flux in the very simplest of organisms so we should really admit that we haven't got much more than a clue with a much more complex set of organisms such as ourselves.  The best advice (for me) really is just to ignore the government and 'expert' directives and do what Ian says 


Recently some scientists developed a 'minimal' form of bacterial life - that is one that has only the essential primary metabolic pathways and 'nothing else' - the point of that being that we can then clone in our own chosen pathways and do stuff like use them as biological factories for making chemicals of our choice (drugs, fuels etc.) by fermentation.  Even in that organism they reported shunt metabolic pathways for getting around other pathways that had been deleted  - they hadn't predicted these and didn't really know how the bacteria did it.  And this really did have a very minimal set of genes in it.

[Andrew]

Don't  shoot the messenger.

It's not a fault of the report that many do or don't have this knowledge, nor that many will or won't ignore it. Yes, there's a great deal of contradictory information out there, and it does confuse people and lead to frustration ("they" are always banning something, you can't win, ignore it, eat what you like) but I think that's to be expected.

Diet and nutrition is one of those areas (like, dare I say it, cycle helmets) that seems to lead to quite impassioned debates. People claiming to know 'the facts' when said facts exist in quite defined contexts. I think the truth is that the truth is not known. Until it is, you're left in the position of making up your own mind on whatever basis you so choose.

I treat such reports as potentially useful in that process. No, it doesn't say anything that I wasn't already aware of but I see it as adding to the drip drip of information that is of use in a 'weight of opinion' sense.

[ElyDave]

The really interesting thing for me was the complete disregard of the evidence-based-outcomes presented by the GP on the news this morning.

To see the attitude of some of the spokespersons in response, paraphrasing "it's dangerous" shows all that is bad about many areas of scientific debate (both now and historically).  Surely science is supposed to be about the evidence and trying to understand the world around us.  That attitude therefore stinks.  I'd have much more respect for those people as medical and scientific professionals if they simple said "that's interesting, we need to more research to understand it and see if it stands up to greater scrutiny", but perhaps I have a utopian view of science rather than one that is masked by industry lobbying.

On another note Axa have said they'll be no longer investing in tobacco. I wonder if they'll switch to vaping instead?

[ian]

But all that dietary complexity is illusory. We weirded food. It started with the obsession with fat, then low calorie, now it's low carb, and who knows what's next. We dress it up with appeals to evolution, physiology, biochemistry, and metabolism. None of this is necessary. We know a diet that works, one that let's you eat cake and sausages, pasta and curry, and whatever you really want without having to worry.

[Andrew]

We know a diet that works, one that let's you eat cake and sausages, pasta and curry, and whatever you really want without having to worry.

Who do you mean by "we" and what do you mean by a diet "that works"?  Because I'm not sure I follow you.

I accept and see your point that food has become weirded but I don't see that the public at large know how to eat healthily and I'm sure that we both see everyday examples of people that are struggling (and I say that without attributing blame or scorn). When I talk of a healthy diet, I recognise peoples motivations for eating - the mental health aspect if you will. I feel it's one thing to know that eating cake all day long doesn't work but putting into practice is another matter entirely. People eat for many reasons.

[IJL]

But all that dietary complexity is illusory. We weirded food. It started with the obsession with fat, then low calorie, now it's low carb, and who knows what's next. We dress it up with appeals to evolution, physiology, biochemistry, and metabolism. None of this is necessary. We know a diet that works, one that let's you eat cake and sausages, pasta and curry, and whatever you really want without having to worry.

The irony is that the complexity arises from the desire to find simple answers and single culprits for dietary issues.  People want there to be a dietary bogeyman. 

[Andrew]

On a separate note, and perhaps one for another thread, I personally (and it's probably due my semantic bent) don't like food being described as 'good' or 'bad'. I think it introduces a level of judgement that's not needed nor helpful. I'd prefer people ate what they wanted, guilt free, and accepted whatever consequence. I think that's a more empowering position but then, as I said, people eat for many reasons. I feel it's not something you can be strictly objective about.

[ian]

We know a diet that works, one that let's you eat cake and sausages, pasta and curry, and whatever you really want without having to worry.

Who do you mean by "we" and what do you mean by a diet "that works"?  Because I'm not sure I follow you.

I accept and see your point that food has become weirded but I don't see that the public at large know how to eat healthily and I'm sure that we both see everyday examples of people that are struggling (and I say that without attributing blame or scorn). When I talk of a healthy diet, I recognise peoples motivations for eating - the mental health aspect if you will. I feel it's one thing to know that eating cake all day long doesn't work but putting into practice is another matter entirely. People eat for many reasons.

I think they do. In the same way that no one thinks smoking is good for them. Of course, they do it for lots of reasons, but all of us know that sitting on the sofa all evening eating pringles isn't going to have health benefits. This argument often gets reframed as blaming, which is isn't, but equally it becomes an excuse to disempower people. They can't make choice. It's not their fault. Same as driving a car everywhere, not exercising and eating comfort food is simply easier. And that's the choice that's open to us.

[L CC]

But all that dietary complexity is illusory. We weirded food. It started with the obsession with fat, then low calorie, now it's low carb, and who knows what's next. We dress it up with appeals to evolution, physiology, biochemistry, and metabolism. None of this is necessary. We know a diet that works, one that let's you eat cake and sausages, pasta and curry, and whatever you really want without having to worry.

The diet that gets a woman of 5'3" to more than 80kg while cycling 10,000 miles a year.



It's really not that straightforward, otherwise there wouldn't be an epidemic of obesity. We're not (us fatties) actually all stupid, greedy and lazy.

[hellymedic]

[slightly OT]
I LOVE sugar! I ordered a kilogram bag from Sainsbury's yesterday, the first in 2016.
50p - bloody hell! that stuff is so cheap! - No wonder we have a problem!

I appreciate this is not my only source of sugar - we eat modest quantities of bread/biscuits/tinned soup/baked beans/chutney/chocolate etc

Sugar is seriously cheap.
Too cheap.

[simonp]

Since becoming a fully grown adult I've consumed roughly 3 tonnes of carbohydrate (300g per day for 25 years). My weight has increased in that time - by 22kg. So maybe 2g of carbs per day has been stored as fat, as a long term net average.

[ian]

But all that dietary complexity is illusory. We weirded food. It started with the obsession with fat, then low calorie, now it's low carb, and who knows what's next. We dress it up with appeals to evolution, physiology, biochemistry, and metabolism. None of this is necessary. We know a diet that works, one that let's you eat cake and sausages, pasta and curry, and whatever you really want without having to worry.

The diet that gets a woman of 5'3" to more than 80kg while cycling 10,000 miles a year.



It's really not that straightforward, otherwise there wouldn't be an epidemic of obesity. We're not (us fatties) actually all stupid, greedy and lazy.

Which again I didn't say. But unless we accept we have some control over our health then it's not going to change.

[hellymedic]

My weight is roughly the same as when I became a fully-grown adult some 40 years ago.
I have little idea of how much carbohydrate, either simple or complex, I have consumed in those 15,000-odd days.
2 tons doesn't seem like much! (150g/day).

No doubt, I wolfed down much more when I had a heavy cycling habit...

[jahs]

Just a quick note on my experience of keto. Started the diet (based on Phinney and Volek) immediately after Hardboiled so that I was already in post-exercise ketosis. Felt a loss of power and a bit miserable for a couple of days then started to get energy back again. By the time of Porkers a month later I was fine - I ate "normally" on the ride (usual audax fare of fry up with toast, jacket potato etc.) and performed better than I've ever done and felt great. Did Brimstone at the weekend and managed the first 270k on no breakfast and only a packet of salted peanuts(!), bouncing controls (started 40 min late and had two punctures so had to make up time). Furthermore this has given a breakthrough in my weight - since starting audaxing three years ago I came down from around 82kg to 73kg but then stopped. However I've dropped to 69kg in less than three months on keto.

Reading Phinney and Volek's work, it makes sense - carbs cause an insulin spike which then blocks fat burning and stimulates hunger. Avoid the carbs, keep insulin low and you burn fat rapidly. After a short period of adaptation and increased dietary salt you're able to exercise at a high level, leading to incredible weight loss. Early days, but so far I would say this is *the* cure for obesity.

[LMT]

I munch through 550-600g of carbs a day, in fact looking at my macros I get 88% of my calories from carbs, 6% from protein and the remainder from fat. Yet I've lost 6kg since February, and none of it's water weight.

How weird.