Ketogenic diet - fad or phenom?

[ianrobo]

By nature in any proper clinical study patients are self selecting as usually they have issues be it treatment for a cancer drug, this or simple hay fever remedies.

Which is why I always remain skeptical if studies etc for that very reason even if I agree with them. 

[Ian H]

By nature in any proper clinical study patients are self selecting as usually they have issues be it treatment for a cancer drug, this or simple hay fever remedies.

Which is why I always remain skeptical if studies etc for that very reason even if I agree with them.

On what basis might you agree with one?

[ianrobo]

By nature in any proper clinical study patients are self selecting as usually they have issues be it treatment for a cancer drug, this or simple hay fever remedies.

Which is why I always remain skeptical if studies etc for that very reason even if I agree with them.

On what basis might you agree with one?

I want it to be backed up by science, so a study just tells us that there may be something to look at, is there a causation of high cholesterol/heart disease, does low carb cure T2D ?

the science then comes along and explains how this works from a metabolic pathway, now with LC I firmly believe the science is there to prove how a calorie of fat gets processed how a calorie of a carb does, for examples the Krebs cycle.

[sojournermike]

NHS approach to T2D based on Newcastle Uni research - not keto though

https://www.bbc.co.uk/news/health-46363869

[Chris S]

NHS approach to T2D based on Newcastle Uni research - not keto though

https://www.bbc.co.uk/news/health-46363869

It sounds disgusting. Surely conformance will be an issue?

Intermittent fasting would be less unpleasant!

[DuncanM]

We were discussing this in the kitchen at work yesterday because my boss is doing something similar as part of a weight loss program. He's not dramatically overweight, so he's just doing the breakfast and lunch and then eating a regular evening meal. He actually likes the shakes he's got. Another colleague said she lost several stone doing the full on 3 shakes a day and nothing else program for 3 months to lose weight for her wedding. I guess compliance depends on how much you want to lose weight.

Personally, I would find it easier to have a "meal replacement" that leaves me feeling fullish than simply fast. It's a different way of thinking about things.

[sojournermike]

NHS approach to T2D based on Newcastle Uni research - not keto though

https://www.bbc.co.uk/news/health-46363869

It sounds disgusting. Surely conformance will be an issue?

Intermittent fasting would be less unpleasant!

Well yes and no. Think about the core target population. Significantly overweight, probably eating lots of junk/preprepped food and with a serious and expensive condition. An aggressive 3 month intervention with preprepped shakes is certainly not worse than where they are. Then, if with support they can make a fresh start in how they eat and live they have a sporting chance of a much better life.

Sticking to any controlled diet is challenging and people fail. Think of all the ‘get back on the wagon’ Keto threads out there.

Mike

[sojournermike]

We were discussing this in the kitchen at work yesterday because my boss is doing something similar as part of a weight loss program. He's not dramatically overweight, so he's just doing the breakfast and lunch and then eating a regular evening meal. He actually likes the shakes he's got. Another colleague said she lost several stone doing the full on 3 shakes a day and nothing else program for 3 months to lose weight for her wedding. I guess compliance depends on how much you want to lose weight.

Personally, I would find it easier to have a "meal replacement" that leaves me feeling fullish than simply fast. It's a different way of thinking about things.

Should have added that my Mum has significantly controlled her T2D by reducing, not eliminating, her carb intake. To me she still seems to eat quite a lot! Sadly, not in time to prevent kidney damage, but better late than never. She’s also lost quite a bit of weight.

Fasting is odd. I often skip breakfast and, consequently eat within a limited window and that’s easy enough. Riding before breakfast and going straight to lunch is fine. It’s been a few years since I didn’t eat all day mind.

[ianrobo]

NHS approach to T2D based on Newcastle Uni research - not keto though

https://www.bbc.co.uk/news/health-46363869

It sounds disgusting. Surely conformance will be an issue?

Intermittent fasting would be less unpleasant!

Just awful, a starvation diet of nothing

And what are these people like in say a years time but it also proves the lie that T2D is a progressive disease and to cure it you need no medical intervention at all, that’s what many LC supporters have been saying for years

[ian]

I'm not sure what you're saying, but type 2 diabetes had long been known to respond to dietary interventions and weight loss.

[ianrobo]

I'm not sure what you're saying, but type 2 diabetes had long been known to respond to dietary interventions and weight loss.

so why is it dealt with by insulin and often called a regressive disease as if no cure ?

Controversial but I would severely ration insulin on the NHS for T2D, there is no medical reason for it at all.

[sojournermike]

I'm not sure what you're saying, but type 2 diabetes had long been known to respond to dietary interventions and weight loss.

so why is it dealt with by insulin and often called a regressive disease as if no cure ?

Controversial but I would severely ration insulin on the NHS for T2D, there is no medical reason for it at all.

I know several people with T2D and non are on insulin. First line medical treatment is usually met for in I think, plus advice on weight, diet and exercise. However, I suspect that many GP’s will adopt a similar view as expressed by Chris, that most individuals will not comply with the regime necessary to put T2D into remission and so simply prescribe metformin and move on to the next patient. This probably also reflects their workload. It’s a shame, but it’s understandable.

The driver for change is that the potential cost of this lifestyle epidemic could break the NHS and it’s funders. The need to avoid that and to alleviate the consequent misery is a real driver for change.

Frankly, if someone is as obese as some patients are, a ‘starvation’ diet may be just what is required the doctor ordered - for their own good.

[ian]

I'm not sure what you're saying, but type 2 diabetes had long been known to respond to dietary interventions and weight loss.

so why is it dealt with by insulin and often called a regressive disease as if no cure ?

Controversial but I would severely ration insulin on the NHS for T2D, there is no medical reason for it at all.

I think you are confusing type 1 and type 2 diabetes.

Many people, faced with a lifestyle change, will opt for a pill. As said though, that's just creating a larger (and more expensive) problem in the future.

[ianrobo]

Frankly, if someone is as obese as some patients are, a ‘starvation’ diet may be just what is required the doctor ordered - for their own good.

But does it work long term, there are plenty of stories out there about those on the biggest loser and as an example this

http://uk.businessinsider.com/new-show-biggest-loser-winners-regained-weight-big-fat-truth-2017-6?r=US&IR=T

unless you attack the causes of weight gain and over eating (whatever they are) then people will revert back

[ianrobo]

I'm not sure what you're saying, but type 2 diabetes had long been known to respond to dietary interventions and weight loss.

so why is it dealt with by insulin and often called a regressive disease as if no cure ?

Controversial but I would severely ration insulin on the NHS for T2D, there is no medical reason for it at all.

I think you are confusing type 1 and type 2 diabetes.

Many people, faced with a lifestyle change, will opt for a pill. As said though, that's just creating a larger (and more expensive) problem in the future.

nope I am not, T1 is clearly a need for insulin, on a trip in flanders I shared with an ex pro from the Type 1 team in the states and he had one of those monitors. after speaking to him at length and what he eat I saw the impact that just a pint of beer would do ...

for Type 2 he is not just lifestyle at all, thats a cop reason and again I refer you to Robert Lustig as he very well explains how calling those T2 sloth, gluttons, greedy etc is so wrong.

[ianrobo]

I'm not sure what you're saying, but type 2 diabetes had long been known to respond to dietary interventions and weight loss.

so why is it dealt with by insulin and often called a regressive disease as if no cure ?

Controversial but I would severely ration insulin on the NHS for T2D, there is no medical reason for it at all.

I think you are confusing type 1 and type 2 diabetes.

Many people, faced with a lifestyle change, will opt for a pill. As said though, that's just creating a larger (and more expensive) problem in the future.

nope I am not, T1 is clearly a need for insulin, on a trip in flanders I shared with an ex pro from the Type 1 team in the states and he had one of those monitors. after speaking to him at length and what he eat I saw the impact that just a pint of beer would do ...

for Type 2 it is not just lifestyle at all, thats a cop out reason and again I refer you to Robert Lustig as he very well explains how calling those T2 sloth, gluttons, greedy etc is so wrong.

[ian]

Honestly, we can demonize any single foodstuff (be it fat or sugar), it doesn't address the core issue: we eat too much and do too little. That's our developed world lifestyle writ large. The solution is as obvious as the problem. Yes, it's easier to blame sugar or whatever else. And I'm sure it's not entirely innocent, but it's part of the bigger problem.

But it in that it's not simple. Of course people like to eat and drink, of course people don't like to exhaust themselves, of course people don't like to be hungry. But we need significant interventions. The cost is otherwise going to be enormous both financially and in quality of life for those affected. Frankly, shit like a small tax on sugar isn't going to do it, nor is letting the food industry water down every proposal.

[chrisbainbridge]

By nature in any proper clinical study patients are self selecting as usually they have issues be it treatment for a cancer drug, this or simple hay fever remedies.

Which is why I always remain skeptical if studies etc for that very reason even if I agree with them.

This is a complete failure to understand the nature of clinical research and randomisation.  The paper was exceptionally poor.

[ianrobo]

Yes it was which is why the only papers worth quoting are double blinded RCT ones and simply in food science they can not be done

[gonzo]

Aside, there's a chap at my work who talks about little but the Keto diet he's on. When asked why he's doing it as it's clearly not to lose weight (he's small in height and waist), he says that it's for health. We highlighted that perhaps getting more than 3 hours sleep a night (his current average) and doing some exercise (he does none and drives <1 mile to work) or perhaps cut the caffeine (around 7 or 8 cups of coffee a day) might be of more benefit. He prefers the Keto diet.

Can these things not come with "don't be that guy" warnings?

[Ian H]

Aside, there's a chap at my work who talks about little but the Keto diet he's on. When asked why he's doing it as it's clearly not to lose weight (he's small in height and waist), he says that it's for health. We highlighted that perhaps getting more than 3 hours sleep a night (his current average) and doing some exercise (he does none and drives <1 mile to work) or perhaps cut the caffeine (around 7 or 8 cups of coffee a day) might be of more benefit. He prefers the Keto diet.

Can these things not come with "don't be that guy" warnings?

Everyone likes simple, quick fixes.  Especially those that make you feel superior to others.  It can involve a tiresome amount of preaching, though.

[mattc]

Honestly, we can demonize any single foodstuff (be it fat or sugar), it doesn't address the core issue: we eat too much and do too little. That's our developed world lifestyle writ large. The solution is as obvious as the problem. Yes, it's easier to blame sugar or whatever else. And I'm sure it's not entirely innocent, but it's part of the bigger problem.

But it in that it's not simple. Of course people like to eat and drink, of course people don't like to exhaust themselves, of course people don't like to be hungry. But we need significant interventions. The cost is otherwise going to be enormous both financially and in quality of life for those affected. Frankly, shit like a small tax on sugar isn't going to do it, nor is letting the food industry water down every proposal.

[My bold]
I do agree with all the above.

But just as the NHS sometimes deliberately prescribes "odd" diets for those with specific conditions, or allergies, there are some who for various reasons just CANNOT stick to this idyllic balanced diet, in sensible qualities. Humans are all different, and some have cycologikal problems, instead of / as well as physical ailments.

FOR EXAMPLE; if their main weakness is eating sugary snacks in-between their lovely balanced meals, then cutting those out and subbing in high-fat snacks MIGHT WELL work for them.

[In my experience, a LOT of people fall into the above example category.]

[ianrobo]

My wider point is though my diet reduces any need for snacking

[ian]

Honestly, we can demonize any single foodstuff (be it fat or sugar), it doesn't address the core issue: we eat too much and do too little. That's our developed world lifestyle writ large. The solution is as obvious as the problem. Yes, it's easier to blame sugar or whatever else. And I'm sure it's not entirely innocent, but it's part of the bigger problem.

But it in that it's not simple. Of course people like to eat and drink, of course people don't like to exhaust themselves, of course people don't like to be hungry. But we need significant interventions. The cost is otherwise going to be enormous both financially and in quality of life for those affected. Frankly, shit like a small tax on sugar isn't going to do it, nor is letting the food industry water down every proposal.

[My bold]
I do agree with all the above.

But just as the NHS sometimes deliberately prescribes "odd" diets for those with specific conditions, or allergies, there are some who for various reasons just CANNOT stick to this idyllic balanced diet, in sensible qualities. Humans are all different, and some have cycologikal problems, instead of / as well as physical ailments.

FOR EXAMPLE; if their main weakness is eating sugary snacks in-between their lovely balanced meals, then cutting those out and subbing in high-fat snacks MIGHT WELL work for them.

[In my experience, a LOT of people fall into the above example category.]

Ironically, it's usually easier to stick to a balanced diet than more restrictive diets (OK, I know some people can, but extrapolating). Anyway, we know that diets per se don't work, what is required is a fundamental lifestyle change. The key thing is that people pay attention to what they are eating (I suspect that's more important than what they actually eat). Package that up with some regular exercise and you're getting somewhere.

Easy? No. Worth it? Yes.

[ianrobo]

A question Ian in your mind what is a ‘balanced diet’ some suggest as much as 60% carbs. My view would be 40/40/20 carbs/fat/protein but some class that as low carb high fat !


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