Jillian Micheals " Avoid the Keto Diet at all costs" - Offers little evidence and analysis

Deleted member 1635 · Jan 14, 2019

Rokuren said:
A recent literature review checked that https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786199/ one of their conclusions was

Thanks for that link. Don't have time to dive into it, but it looks like it's a review of various overfeeding studies throughout the last few decades?

Personally, I found this conclusion a lot more compelling (but I'm biased):

In conclusion, it is evident that overfeeding on carbohydrate and/or fat results in body composition alterations that are different than overfeeding on protein. It is commonly believed that 3,500 kcal is equivalent to 0.45 kg (1 pound) of fat and that changing energy balance in accordance with this will produce predictable changes in body weight. However, the overfeeding literature to date does not support this assertion. Dietary protein appears to have a protective effect against fat gain during times of energy surplus, especially when combined with resistance training. Therefore, the evidence suggests that dietary protein may be the key macronutrient in terms of promoting positive changes in body composition.

Basically saying that there is nothing to support the idea that all calories are equal in terms of weight gain.

Psychotext · Jan 14, 2019

When combined with resistance training... sort of an important part of the statement. Anyone that lifts weights could tell you the importance of protein.

Slight difference between a power lifter and a couch potato!

Rokuren · Jan 14, 2019

Yeah, eating protein can result in more gains of lean mass especially when combined with resistance training; not all shifts in body weight are fat mass related.

The main takeaway is obsess less over why way of eating x is secretly super special(it isn't) and just find a way to manage your intake; this'll vary from person to person.

Deleted member 1635 · Jan 14, 2019

Psychotext said:
When combined with resistance training... sort of an important part of the statement. Anyone that lifts weights could tell you the importance of protein.

Slight difference between a power lifter and a couch potato!

You must have missed the "especially" qualifier.

Regardless, it's either true or it's not. Some amount of resistance training would not change the laws of physics that CICO fans love to go on about. A calorie is a calorie is a calorie according to them.

Rokuren said:
Yeah, eating protein can result in more gains of lean mass especially when combined with resistance training; not all shifts in body weight are fat mass related.

The main takeaway is obsess less over why way of eating x is secretly super special(it isn't) and just find a way to manage your intake; this'll vary from person to person.

No. The entire point is that the laws of thermodynamics say absolutely nothing about what our bodies do with food. Carbohydrates are unique in that they can be used basically only for energy once consumed or they get stored as fat when there is excess. You can't use them to build muscle or repair tissue or do any other number of things that the body does with fat and protein, the only two essential macro nutrients.

Protein being used to build lean mass based on hormonal signals from resistance training should more than enough information to understand that not all calories are the same and there is no expectation that they should be.

Rokuren · Jan 14, 2019

You can continue to misinterpret CICO if you want, I'm not sure there's a real benefit to shoving your head in the sand though, I posted a good link about it. https://www.myoleanfitness.com/cico-evidence-based-truth/

Zefah said:
No. The entire point is that the laws of thermodynamics say absolutely nothing about what our bodies do with food. Carbohydrates are unique in that they can be used basically only for energy once consumed or they get stored as fat when there is excess. You can't use them to build muscle or repair tissue or do any other number of things that the body does with fat and protein, the only two essential macro nutrients.

Protein being used to build lean mass based on hormonal signals from resistance training should more than enough information to understand that not all calories are the same and there is no expectation that they should be.

The laws of thermodynamics absolutely restrict what our bodies can do with food don't be ridiculous.

And yet for all the differences in carbs vs fats decades worth of studies show carbs vs fats have no meaningful difference in terms of either weight gain or loss.

So the obsession with demonizing carbs is just weird.

edit:
Some quotes from link

From a thermodynamic point of view, a calorie is a calorie. However, calories from different food sources can provide different amounts of metabolizable energy to the body and can have different effects on our energy intake and output. This doesn't mean that the laws of thermodynamics are broken and that CICO doesn't work, since CICO takes all the above into account.

CICO is not a diet, let alone a recent diet "fad". It's simply a restatement of the energy balance equation. It always has and always will apply to everyone.

CICO is not about counting calories. You can lose or gain fat without ever counting a single calorie. Calories count but you don't have to count them.

CICO is neither "healthy" nor "unhealthy" because it's not a diet and because it simply doesn't make any specific dietary recommendations. Whether you make healthy dietary choices or not is up to you.

A calorie is a calorie from a thermodynamic point of view.

The quality of the foods where the calories are coming from matters for body composition, health, energy levels, etc. This doesn't go against CICO and the laws of thermodynamics, nor does it mean that a calorie is not a calorie.

All diets work for fat loss, provided that they allow you to eat fewer calories than you expend consistently over time.

Budi · Jan 14, 2019

So is Keto diet basically the same thing as Atkins' diet? I remember criticism for it many years ago.
Edit: Answered below.

LL_Decitrig · Jan 14, 2019

Budi said:
So is Keto diet basically the same thing as Atkins' diet? I remember criticism for it many years ago.

It's a therapeutic diet that can be used as part of the treatment of various severe medical conditions.

https://www.gosh.nhs.uk/health-professionals/clinical-guidelines/ketogenic-diet

A lot of people here are treating it like an updated version of Atkins, with the same hype.

Avitus · Jan 14, 2019

Rokuren said:
And yet for all the differences in carbs vs fats decades worth of studies show carbs vs fats have no meaningful difference in terms of either weight gain or loss.

Carbs are abundant, easier to overeat, and less satiating than either fats or protein. That's why we have an obesity crisis. Most people find that, by eliminating or reducing their carb intake, they also limit their intake of the most problematic foods found in the modern American diet. It's simplifying the CICO process while getting the benefits of keto.

This will not go over well with anyone that has a financial interest in people eating carbs, including Jillian Michaels.

Intermittent Fasting faces the same type of resistance despite the overwhelming evidence that 3 meals a day isn't required in the slightest to be healthy or happy.

Deleted member 1635 · Jan 14, 2019

Rokuren said:
You can continue to misinterpret CICO if you want, I'm not sure there's a real benefit to shoving your head in the sand though, I posted a good link about it. https://www.myoleanfitness.com/cico-evidence-based-truth/

The laws of thermodynamics absolutely restrict what our bodies can do with food don't be ridiculous.

And yet for all the differences in carbs vs fats decades worth of studies show carbs vs fats have no meaningful difference in terms of either weight gain or loss.

So the obsession with demonizing carbs is just weird.

I would love if people stopped just lazily linking big blog posts or studies without summarizing the relevant information to this discussion in this thread.

I never said the laws of thermodynamics do not apply or "restrict" anything, just that they say nothing about what our bodies do with the food we eat. It's absolutely true. What we actually do with the food we eat is determined by man things, such as hormones, state of health, etc. etc. Now, of course, the laws of thermodynamics certainly do apply when it comes to how much energy we can potentially derive from a certain piece of food.

Budi · Jan 14, 2019

LL_Decitrig said:
It's a therapeutic diet that can be used as part of the treatment of various severe medical conditions.

https://www.gosh.nhs.uk/health-professionals/clinical-guidelines/ketogenic-diet

A lot of people here are treating it like an updated version of Atkins, with the same hype.

Aah, that's interesting. Thanks for the link!

Rokuren · Jan 14, 2019

Avitus said:
Carbs are abundant, easier to overeat, and less satiating than either fats or protein. That's why we have an obesity crisis. Most people find that, by eliminating or reducing their carb intake, they also limit their intake of the most problematic foods found in the modern American diet. It's simplifying the CICO process while getting the benefits of keto.

This will not go over well with anyone that has a financial interest in people eating carbs, including Jillian Michaels.

Intermittent Fasting faces the same type of resistance.

Most overeaten foods tend to be combinations of fats, carbs, and salt. The studies that measured comparative weight loss weren't only in metabolic chambers, meaning people making their own decisions with the macro breakdowns still saw similar results. I have no issue with the keto diet nor how it's design can limit the more problematic food choices. I do take issue with the whole railing against CICO and attempting to portray carbs as some completely unnecessary thing that serve no purpose.

Zefah said:
I would love if people stopped just lazily linking big blog posts or studies without summarizing the relevant information to this discussion in this thread.

I never said the laws of thermodynamics do not apply or "restrict" anything, just that they say nothing about what our bodies do with the food we eat.

They still say everything about the what our bodies do with the food we eat. There are literal chemical equations that describe the breakdown of carbs/fat and how the component pieces are used in the various processes throughout the body.

Now to be clear the carbs that get stored as body fat have to be converted from glucose to fatty acids; are you suggesting those fatty acids are somehow different from those derived directly from fats? Are you suggesting that a mixed macro diet is somehow deficient in providing what the body needs to build muscle/repair tissue.

Zefah said:
;It's absolutely true. What we actually do with the food we eat is determined by man things, such as hormones, state of health, etc. etc. Now, of course, the laws of thermodynamics certainly do apply when it comes to how much energy we can potentially derive from a certain piece of food.

That's nice, now show that it matters. Show that differences in things like hormones outweigh the overall calorie balance, because that's the point of contention when you keep harping on about CICO.

https://www.myoleanfitness.com/gary-taubes-sugar-obesity/

Even if carbohydrate/sugar consumption fails to induce insulin resistance, it still stimulates insulin secretion (acutely). Taubes hypothesis suggests that insulin seems to influence fat loss/gain substantially. However, contrary to Taubes' hypothesis, hormones do not seem to regulate how much fat is stored, but rather where fat is distributed upon storage (e.g. visceral fat, leg fat, etc.). A 2017 literature review (71) on overfeeding concluded there are no major differences in fat storage between carbohydrate and fat overfeeding. Since high-carbohydrate overfeeding stimulates greater insulin secretion, higher insulin levels don't seem to produce more fat gain. Further, this review reported that high-protein overfeeding may reduce fat mass gains. Other research suggests that protein consumption increases lean mass when overfeeding, thus improving body composition compared to isocaloric carbohydrate or fat overfeeding. Since protein is highly insulinogenic, yet improves body composition, insulin doesn't seem to increase the magnitude of feeding-induced fat storage.

Deleted member 1635 · Jan 14, 2019

Horn said:
Instead of saying that the current science is garbage it sure would help if you provide better science to back up your claims. Oh, that's right Gary Taubes did just that when he started NuSi and how is that project coming along?

For all of you who don't know who Gary Taubes is: He basically is the God father of the low-carb movement and says basically the same things Zefah says in this thread:
- That the current nutritional science is terrible
- That the reason we have a epedemic in obesity is because of carbs and the release of insulin.

And as a result Taubes started NuSi, as he wanted to provide the world with better studies:

"The Nutrition Science Initiative (NuSI) is a nonprofit 501(c)(3) organization dedicated to reducing the individual, economic, and social costs of obesity, diabetes, and their related diseases by improving the quality of science in nutrition and obesity research."
About Nusi

So they invested alot of money and put people in something called a metabolic ward where you with greater detail can observe what happens to the body during different diets etc. It's really expensice and really accurate. *Update, the metabolic ward is only in study 1

The results

Study 1: https://www.cell.com/cell-metabolism/fulltext/S1550-4131(15)00350-2

"This study demonstrated that, calorie for calorie, restriction of dietary fat led to greater body fat loss than restriction of dietary carbohydrate in adults with obesity."

I believe you've got the wrong study here. It should be this one: https://www.ncbi.nlm.nih.gov/pubmed/27385608

It shows that insulin levels were brought down and energy expenditure was up on the low-carb diet compared to the non-low-carb diet, although there was not a significant difference in body fat loss during the observed period.

Horn said:
Study 2: https://jamanetwork.com/journals/jama/fullarticle/2673150

" In this 12-month weight loss diet study, there was no significant difference in weight change between a healthy low-fat diet vs a healthy low-carbohydrate diet, and neither genotype pattern nor baseline insulin secretion was associated with the dietary effects on weight loss. In the context of these 2 common weight loss diet approaches, neither of the 2 hypothesized predisposing factors was helpful in identifying which diet was better for whom."

So no, the claim that low-carb "works" (for some) because of not eating carbs (rather then being on a calori deficit) is not backed up by science.

Haven't really looked into this second study, but look at Table 2 that shows the diet composition. Upwards of 100+ grams of carbs (23 ~ 30% of calories) does not seem particularly low carb to me, although they are calling it "healthy low-carb."

99nikniht · Jan 14, 2019

Rokuren said:
That's nice, now show that it matters. Show that differences in things like hormones outweigh the overall calorie balance, because that's the point of contention when you keep harping on about CICO.

https://www.myoleanfitness.com/gary-taubes-sugar-obesity/

As someone that is studying for the MCAT exam, I just want to point out that hormones is everything when it comes to how our body processes nutrients and minerals. CICO means nothing without the proper balance of insulin and glucagon (the usage or storing of energy, glucose in this case). Why do you think diabetic people have such a hard time with modulating their metabolism? The calories we consume are raw ingredients that can be put towards different functions, without hormones, we'd just shit it all out, or it will actually kill us.

Rokuren · Jan 14, 2019

99nikniht said:
As someone that is studying for the MCAT exam, I just want to point out that hormones is everything when it comes to how our body processes nutrients and minerals. CICO means nothing without the proper balance of insulin and glucagon (the usage or storing of energy, glucose in this case). Why do you think diabetic people have such a hard time with modulating their metabolism? The calories we consume are raw ingredients that can be put towards different functions, without hormones, we'd just shit it all out, or it will actually kill us.

Yes, diabetes is an issue where the body regarding the effectiveness/production of insulin. I'm not denying that hormones control the bodies specific functions.

Just stating the idea that in a body where excess calories are absorbed the body will manage them to the extent that there isn't a meaningful difference if those excess calories come from fat or carbs. Since Zefah's position seems to be that the insulin response of carbs indicates that a low carb diet will result in less fat gain in overfeeding scenarios when that doesn't seem to bear out.

Deleted member 1635 · Jan 14, 2019

Rokuren said:
Yes, diabetes is an issue where the body regarding the effectiveness/production of insulin. I'm not denying that hormones control the bodies specific functions.

Just stating the idea that in a body where excess calories are absorbed the body will manage them to the extent that there isn't a meaningful difference if those excess calories come from fat or carbs. Since Zefah's position seems to be that the insulin response of carbs indicates that a low carb diet will result in less fat gain in overfeeding scenarios when that doesn't seem to bear out.

I would say the rapid development of type 2 diabetes in high-carb diets alone indicates that there are very meaningful differences in various diet compositions.

Rokuren · Jan 14, 2019

Zefah said:
I would say the rapid development of type 2 diabetes in high-carb diets alone indicates that there are very meaningful differences in various diet compositions.

To my knowledge type 2 diabetes is linked to obesity/physical activity/lifestyle/genetics not specifically to carbs.

Deleted member 1635 · Jan 14, 2019

Rokuren said:
To my knowledge type 2 diabetes is linked to obesity/physical activity/lifestyle/genetics not specifically to carbs.

Chronically elevated blood sugar leading to insulin resistance will cause many people to develop type 2 diabetes. Low-carb diets will help restore insulin sensitivity by reducing instances and duration of elevated blood sugar.

Rokuren · Jan 14, 2019

Zefah said:
Chronically elevated blood sugar leading to insulin resistance will cause many people to develop type 2 diabetes. Low-carb diets will help restore insulin sensitivity by reducing instances and duration of elevated blood sugar.

Uh okay. I think I'll listen to the american diabetes association and the NIH.

American Diabetes Assocation on Sugar and Diabetes

Is diabetes caused by eating sugar?

A diet high in calories from any source (including sugar) contributes to weight gain and weight gain increases your risk for type 2 diabetes. Type 1 diabetes is caused by genetics and unknown factors that trigger the onset of the disease. Type 2 diabetes is not caused by sugar, but by genetics and lifestyle factors.

NIH on Causes of Diabetes

What causes type 2 diabetes?
Type 2 diabetes—the most common form of diabetes—is caused by several factors, including lifestyle factors and genes.

Overweight, obesity, and physical inactivity
You are more likely to develop type 2 diabetes if you are not physically active and are overweight or obese. Extra weight sometimes causes insulin resistance and is common in people with type 2 diabetes. The location of body fat also makes a difference. Extra belly fat is linked to insulin resistance, type 2 diabetes, and heart and blood vessel disease. To see if your weight puts you at risk for type 2 diabetes, check out these Body Mass Index (BMI) charts.

Insulin resistance
Type 2 diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin well. As a result, your body needs more insulin to help glucose enter cells. At first, the pancreas makes more insulin to keep up with the added demand. Over time, the pancreas can't make enough insulin, and blood glucose levels rise.

Who is more likely to develop insulin resistance or prediabetes?
People who have genetic or lifestyle risk factors are more likely to develop insulin resistance or prediabetes. Risk factors include

overweight or obesity

age 45 or older

a parent, brother, or sister with diabetes

African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander American ethnicity

physical inactivity

health conditions such as high blood pressure and abnormal cholesterol levels

a history of gestational diabetes

a history of heart disease or stroke

polycystic ovary syndrome, also called PCOS

Deleted member 1635 · Jan 14, 2019

Go ahead if you want, but their advice is fucking terrible, much like the official dietary recommendations in the US.

Boy · Jan 15, 2019

Zefah said:
I would say the rapid development of type 2 diabetes in high-carb diets alone indicates that there are very meaningful differences in various diet compositions.

I feel like a lot of people are trying to give carbs a bad rep. There are good carbs/bad carbs, just like fats. Carbs that has decent amount of fiber and has a low GI like oats, brown rice, lentils etc will not cause an insulin spike.

Deleted member 1635 · Jan 15, 2019

Boy said:
I feel like a lot of people are trying to give carbs a bad rep. There are good carbs/bad carbs, just like fats. Carbs that has decent amount of fiber and has a low GI like oats, brown rice, lentils etc will not cause an insulin spike.

More fiber will certainly help soften the spike in blood sugar and following rise in insulin to accommodate, but they still have a high GI value compared to something like eggs, meat, or fish, which have a value of zero.

It's funny, because you see organizations touting low-GI foods to help combat diabetes, but at the same time posting information like that which Rokuren linked to, which fails to recognize the role of carbohydrate in the development of type 2 diabetes. If low GI is better, then it stands to reason that no GI is best, but that connection just is never made for whatever reason.

BLEEN · Jan 15, 2019

Zefah said:
More fiber will certainly help soften the spike in blood sugar and following rise in insulin to accommodate, but they still have a high GI value compared to something like eggs, meat, or fish, which have a value of zero.

It's funny, because you see organizations touting low-GI foods to help combat diabetes, but at the same time posting information like that which Rokuren linked to, which fails to recognize the role of carbohydrate in the development of type 2 diabetes. If low GI is better, then it stands to reason that no GI is best, but that connection just is never made for whatever reason.

Wow, I thought this was common knowledge. What am I missing?

Deleted member 1635 · Jan 15, 2019

BLEEN said:
Wow, I thought this was common knowledge. What am I missing?

My guess is entrenched interests.

Avitus · Jan 15, 2019

Rokuren said:
Uh okay. I think I'll listen to the american diabetes association and the NIH.

American Diabetes Assocation on Sugar and Diabetes

NIH on Causes of Diabetes

I mean the quotes just support what he wrote. Specifically the part about insulin resistance. No one is saying that eating a candy bar will give you diabetes, thus it is not the 'cause' of type 2 diabetes. If you consume large amounts of sugar regularly, it will put you into a group that experiences type 2 diabetes at a much higher rate than those that eat a healthier, more balanced diet. That's just common sense.

You can help reverse type 2 by fasting and/or doing keto because they both improve insulin sensitivity.

BLEEN · Jan 15, 2019

Zefah said:
My guess is entrenched interests.

Sounds about right, heh.

KingBae · Jan 15, 2019

I don't know. I've been on keto for exactly a year now. I did not spend a Dollar on any products or trainers and lost just under 100 pounds. All I did was eating lots of chicken, broccoli, salads, and cheese. I started it to handle stress and it's been a great way to put that stuff under control. I don't talk much about it or read all the noise and complaining about it. I just keep my head down and do it and it's been working for me.

SaveWeyard · Jan 15, 2019

Zefah said:
More fiber will certainly help soften the spike in blood sugar and following rise in insulin to accommodate, but they still have a high GI value compared to something like eggs, meat, or fish, which have a value of zero.

It's funny, because you see organizations touting low-GI foods to help combat diabetes, but at the same time posting information like that which Rokuren linked to, which fails to recognize the role of carbohydrate in the development of type 2 diabetes. If low GI is better, then it stands to reason that no GI is best, but that connection just is never made for whatever reason.

That connection is never made because it doesn't necessarily follow. It's certainly a testable hypothesis, and the review I posted earlier goes into this a bit:

In patients with T2D, LC diets may have specific benefits on glycemic parameters. Carbohydrates are the main source of glucose for metabolism, and reducing their intake may lead to a decrease in insulin requirements and an improvement in insulin sensitivity that results in reduction of postprandial hyperglycemia [15, 16]. However, most of these studies are limited by their small sample size, lack of control groups, or short follow-up periods [17]. While a preferred LC diet is composed of carbohydrates with low glycemic index (GI), the amount of these carbohydrates is still uncertain [18]. Diets containing similar amounts of simple sugars and different glycemic indexes did not show an association between high GI and the chance of developing insulin resistance among non-diabetic study subject [19].

There's just not enough data to conclude what the ideal amount of carbs, fats, and protein is optimal for patients with T2D. We can say low-carb diets are more effective on glycemic parameters, especially in the short term, maybe not so much in the long term, but how many carbs, fats, and proteins in low-carb is ideal? And are there other risks to low-carb diets? Another study cited in that review talks about how both low and high carb diets are associated with higher mortality in non-diabetics compared to a diet of 50-55% carbs. And the source of the proteins and fats in the low-carb diets made a difference too (higher mortality rates with animal-based compared to plant-based). You can't just assume that since low amounts of a thing are good, no amounts must be better.

Horn · Jan 15, 2019

Zefah said:
Upwards of 100+ grams of carbs (23 ~ 30% of calories) does not seem particularly low carb to me, although they are calling it "healthy low-carb."

"The dietary interventions were described previously. Briefly, the main goals were to achieve maximal differentiation in intake of fats and carbohydrates between the 2 diet groups while otherwise maintaining equal treatment intensity and an emphasis on high-quality foods and beverages. Thus, participants were instructed to reduce intake of total fat or digestible carbohydrates to 20 g/d during the first 8 weeks. Higher priorities for reduction were given to specific foods and food groups that derived their energy content primarily from fats or carbohydrates. For example, the reduction of edible oils, fatty meats, whole-fat dairy, and nuts was prioritized for the healthy low-fat group, whereas the reduction of cereals, grains, rice, starchy vegetables, and legumes was prioritized for the healthy low-carbohydrate group.

Then individuals slowly added fats or carbohydrates back to their diets in increments of 5 to 15 g/d per week until they reached the lowest level of intake they believed could be maintained indefinitely. No explicit instructions for energy (kilocalories) restriction were given. Both diet groups were instructed to (1) maximize vegetable intake; (2) minimize intake of added sugars, refined flours, and trans fats; and (3) focus on whole foods that were minimally processed, nutrient dense, and prepared at home whenever possible. Other components of the emphasis on high-quality food for both diet groups are described elsewhere."

Zefah said:
I would say the rapid development of type 2 diabetes in high-carb diets alone indicates that there are very meaningful differences in various diet compositions.

And what does the litterature say about the subject? Please link to any systematic review which conclude that carbs "alone" without weight gain is a cause for T2D.

sca · Jan 15, 2019

aren't there studies mentioning that CICO (Calories in calories out/calorie counting) being more effective for losing weight? Unless somebody needs to be on it for medical reasons, it seems like a fad diet. I guess it makes counting calories easier, by coming up with rules to essentially limit certain foods to keep your calories low and hunger satiated. But there's too much good food, so nah

LL_Decitrig · Jan 15, 2019

And now it's time for another reminder that the keto diet is a therapeutic diet, not a lifestyle. Starving your metabolism of macronutrients without very good reasons isn't a good idea. If you're on a therapeutic diet you need careful monitoring. It's not like joining WeightWatchers or giving up sweets for Lent.

https://en.wikipedia.org/wiki/Ketogenic_diet

Vincent Grayson · Jan 15, 2019

sca said:
aren't there studies mentioning that CICO (Calories in calories out/calorie counting) being more effective for losing weight? Unless somebody needs to be on it for medical reasons, it seems like a fad diet. I guess it makes counting calories easier, by coming up with rules to essentially limit certain foods to keep your calories low and hunger satiated. But there's too much good food, so nah

CICO isn't a diet method. It's just a statement of facts - if you burn more than you consume, you lose weight.

Keto, IMO, succeeds for many (myself included) because it alters what you consume and makes it far more likely that you get full and stop eating before you've eaten more than you'll burn in a day. On an "unrestricted" diet, I (and many others, clearly) find that extremely challenging, and don't manage to stick to it.

So in a way, you're right. If you can successfully count calories and simply make sure to eat less than you burn, you'll lose weight. But that's a big 'IF' for a lot of us.

Horn · Jan 15, 2019

Vincent Grayson said:
Keto, IMO, succeeds for many (myself included) because it alters what you consume and makes it far more likely that you get full and stop eating before you've eaten more than you'll burn in a day.

I don't think anybody here has a problem with statements like "diet X works for me because of Y", but to imply that diet X is better then diet Y, in general, when no data exists to support that claim it becomes tiresome.

Vincent Grayson said:
On an "unrestricted" diet,

How many diets are unrestricted? Every single diet has rules, and all of them share one thing in common: If you follow the rules you will automatically cut down on typical junkfood and you will lose weight.

AnilP228 · Jan 15, 2019

sca said:
aren't there studies mentioning that CICO (Calories in calories out/calorie counting) being more effective for losing weight? Unless somebody needs to be on it for medical reasons, it seems like a fad diet. I guess it makes counting calories easier, by coming up with rules to essentially limit certain foods to keep your calories low and hunger satiated. But there's too much good food, so nah

Weight gain/loss is massively over simplified by CICO, which is more of a buzzword/phrase than a scientific way/methodolgy of losing weight.

Here's a great video to understanding why it's a flawed concept:

Btw your avatar rules.

Deleted member 8561 · Jan 15, 2019

KingBae said:
I don't know. I've been on keto for exactly a year now. I did not spend a Dollar on any products or trainers and lost just under 100 pounds. All I did was eating lots of chicken, broccoli, salads, and cheese. I started it to handle stress and it's been a great way to put that stuff under control. I don't talk much about it or read all the noise and complaining about it. I just keep my head down and do it and it's been working for me.

So I'm guessing this was a radical change from your normal diet?

This isn't aimed at you, but reading this thread and the comments of people on keto, I really do wonder what percent of people were actually experiencing ketosis for a majority portion of their diet, or simply removed processed carbs and started eating decent food which resulted weight loss.

AnilP228 · Jan 15, 2019

TheLostBigBoss said:
So I'm guessing this was a radical change from your normal diet?

This isn't aimed at you, but reading this thread and the comments of people on keto, I really do wonder what percent of people were actually experiencing ketosis for a majority portion of their diet, or simply removed processed carbs and started eating decent food which resulted weight loss.

This is a really good point. I tend to cycle on/off between keto and a diet whereby I tend to cut out all processed carbs and whilst there is certainly a difference in my workouts, energy levels and blood work, I don't think it's overly noticable. I know someone who thought he was doing keto but judging by his diet, his macro's were something along the lines of 40:50:10 (fat, protein, carbs) but he also noticed a huge improvement.

Deleted member 6949 · Jan 15, 2019

I still follow the food pyramid my health teacher gave me in the 80's. Bread is life, losers.

Deleted member 1635 · Jan 15, 2019

Horn said:
And what does the litterature say about the subject? Please link to any systematic review which conclude that carbs "alone" without weight gain is a cause for T2D.

We know the mechanisms of type 2 diabetes. It's a disease in which the either cannot produce enough insulin to deal with elevated blood sugar levels or it produces what should be enough, but the body has become resistant to its effects. Either way, it's a disease of the body losing the ability to manage elevated blood sugar. We know what elevates blood sugar. It's really quite simple.

No, I don't have a link to a systematic review that concluded carbohydrate directly causes the development of type 2 diabetes, but if dramatically reducing or even ceasing carbohydrate consumption can allow someone with type 2 diabetes to deal with their condition without having to supplement insulin, then it would stand to reason that carbohydrate consumption was the culprit (or at least one of the major culprits) in their development of it.

SaveWeyard said:
There's just not enough data to conclude what the ideal amount of carbs, fats, and protein is optimal for patients with T2D. We can say low-carb diets are more effective on glycemic parameters, especially in the short term, maybe not so much in the long term, but how many carbs, fats, and proteins in low-carb is ideal? And are there other risks to low-carb diets? Another study cited in that review talks about how both low and high carb diets are associated with higher mortality in non-diabetics compared to a diet of 50-55% carbs. And the source of the proteins and fats in the low-carb diets made a difference too (higher mortality rates with animal-based compared to plant-based). You can't just assume that since low amounts of a thing are good, no amounts must be better.

You can't assume that if low amounts of a thing are good, then no amounts must be better in all cases, but in the case of type 2 diabetes, in which the body has lost its ability to deal with elevated blood sugar on its own and you are inflicting harm on yourself each time you do elevate blood sugar, it seems sensible to avoid such harm by not elevating blood sugar in the first place, and we know how to that very easily without starving ourselves.

Rokuren · Jan 15, 2019

Zefah said:
We know the mechanisms of type 2 diabetes. It's a disease in which the either cannot produce enough insulin to deal with elevated blood sugar levels or it produces what should be enough, but the body has become resistant to its effects. Either way, it's a disease of the body losing the ability to manage elevated blood sugar. We know what elevates blood sugar. It's really quite simple.

No, I don't have a link to a systematic review that concluded carbohydrate directly causes the development of type 2 diabetes, but if dramatically reducing or even ceasing carbohydrate consumption can allow someone with type 2 diabetes to deal with their condition without having to supplement insulin, then it would stand to reason that carbohydrate consumption was the culprit (or at least one of the major culprits) in their development of it.

You can't assume that if low amounts of a thing are good, then no amounts must be better in all cases, but in the case of type 2 diabetes, in which the body has lost its ability to deal with elevated blood sugar on its own and you are inflicting harm on yourself each time you do elevate blood sugar, it seems sensible to avoid such harm by not elevating blood sugar in the first place, and we know how to that very easily without starving ourselves.

Just because people with health condition x see improvement by reducing y it doesn't necessarily follow that y is inherently bad or even the cause of x.

It doesn't make for a bad starting hypothesis but there is in fact research on the subject https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923378/

The purpose of this review is to gather current information from meta-analyses on dietary and lifestyle practices concerning reduction of risk to develop type 2 diabetes. Low glycemic index dietary patterns reduce both fasting blood glucose and glycated proteins independent of carbohydrate consumption. Diets rich in whole-grain, cereal high fiber products, and non-oil-seed pulses are beneficial. Whereas, frequent meat consumption has been shown to increase risk.

Obesity is the most important factor accounting for more than half of new diabetes' cases; even modest weight loss has a favorable effect in preventing the appearance of diabetes. Also, physical exercise with or without diet contributes to a healthier lifestyle, and is important for lowering risk.

Evidence is accumulating that whole-grain products are beneficial to health, and protect against chronic diseases (mainly cancer and cardiovascular diseases). In a meta-analysis including six cohort studies with 286,125 participants and 10,944 cases, a two-serving-per-day increment in whole grain intake was associated with a 21% reduction in risk for type 2 diabetes (95% CI: 13% to 28%), after adjusting for potential confounders and body mass index [5].

Frequent meat consumption has been shown to increase the risk of developing type 2 diabetes. This is considered true for other diseases as well. In a meta-analysis of 12 cohort studies, the estimated summary relative risk of diabetes comparing high to low intake was 1.17 for total meat (95% CI: 0.92 to 1.48), 1.21 for red meat (95% CI: 1.07 to 1.38) and 1.41 for processed meat (95% CI: 1.25 to 1.60) [8].

The exact proportion of carbohydrate inclusion in diabetic adults' diets on a daily basis has been the subject of intense analysis. It has been hypothesized that a restricted-carbohydrate dietary pattern is beneficial for type 2 diabetes. A meta-analysis included 19 randomized studies with 306 patients to investigate the effects of two prescribed diets, a low-fat, high-carbohydrate (LFHC) diet (with a 24%/58% composition in fat/carbohydrate) and a high-fat, low-carbohydrate (HFLC) diet (with a 40%/40% composition in fat/carbohydrate). HbA1c and fasting blood glucose values were found to be similar in the two groups. In contrast, replacing fat with carbohydrate deteriorated insulin resistance, which in turn increased fasting insulin by 8% (p = 0.02) [18].

Nutrition seems to be a critical element in any prevention strategy. There is ample evidence to show that a diet with a low glycemic index and high in fiber, mainly derived from cereals, is beneficial. Concerning food groups, intake of whole grains, non-oil seed pulses, and fish can be advocated. Data collected for nuts, fruit, and vegetables, produced uncertain and inconclusive results. More research is necessary on this topic, to draw a clear picture. In contrast, there are clear results to show that meat intake should be minimized.

Finally, trans-fatty acids (TFA) are generally regarded as potentially harmful when nutritionally available in abundance, as in the diets of western industrialized countries. TFA have been analyzed for their potential to promote insulin resistance and risk to develop type 2 diabetes [23]. Although there is observational and experimental evidence from studies that high intake of TFA may increase the risk for type 2 diabetes, methodological problems and inconsistencies across the studies do not allow a definitive conclusion [23].

There's a reason the ADA and NIH descriptions for type 2 diabetes/insulin resistance are what they are and don't zero in on carbs. It's not because they're all hilariously bad at their jobs; it's because that's based on our current understanding.

Deleted member 1635 · Jan 15, 2019

Here's a study comparing a calorie-restricted (but higher carb) low-GI diet vs. a calorie-unrestricted low-carb diet (aimed towards being ketogenic) among obese type 2 diabetes patients with a focus on how each affects glycemic control, measured by hemoglobin A1c.

https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-5-36

You can take a look at it for yourself, and while there are obvious limitations to the study, it's pretty clear that the low-carb diet, despite not having caloric restrictions, came out ahead in just about every measured health parameter.

Here's a key paragraph from the discussion section:

The greater effect of the low-carbohydrate, ketogenic diet in this study appeared to be due to the lower carbohydrate intake, because statistical significance remained after adjustment for weight loss. Because "low-glycemic" diets in previous studies typically contain from 40–60% of calories from carbohydrate, it is possible that the beneficial effect of "low-glycemic" diets could be augmented by further reduction of the absolute amount of carbohydrate, or by a reduction in caloric content.

Deleted member 32822 · Jan 15, 2019

Keto should be used as a gateway diet that leads to a CICO lifestyle.

You start with Keto. It's rather simple, you get to eat fun stuff like cheese and meat, you don't have to exercise, and you quickly start to lose pounds. Just losing those initials pounds - especially for people who have struggled with their weight their entire lives - it's an incredible boost of confidence that proves, hey, there is hope for me and dieting does work.

After x weeks of Keto (whatever you determine is right for you), you should then ease back into a normal diet that focuses on a calorie deficit so that you can start enjoying life again.

Rokuren · Jan 15, 2019

Zefah said:
Here's a study comparing a calorie-restricted (but higher carb) low-GI diet vs. a calorie-unrestricted low-carb diet (aimed towards being ketogenic) among obese type 2 diabetes patients with a focus on how each affects glycemic control, measured by hemoglobin A1c.

https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-5-36

You can take a look at it for yourself, and while there are obvious limitations to the study, it's pretty clear that the low-carb diet, despite not having caloric restrictions, came out ahead in just about every measured health parameter.

Here's a key paragraph from the discussion section:

You're missing my point.

My claim wasn't that low carb diets weren't potentially beneficial for those with diabetes/insulin resistance. It was that just because reducing carbs was beneficial for a specific condition it didn't mean that carbs were potentially dangerous in general, potentially the cause of such conditions, and that the ADA/NIH correctly not discussing carbs as a primary driver of diabetes didn't make "their advice fucking terrible".

SaveWeyard · Jan 15, 2019

Zefah said:
Here's a study comparing a calorie-restricted (but higher carb) low-GI diet vs. a calorie-unrestricted low-carb diet (aimed towards being ketogenic) among obese type 2 diabetes patients with a focus on how each affects glycemic control, measured by hemoglobin A1c.

https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-5-36

You can take a look at it for yourself, and while there are obvious limitations to the study, it's pretty clear that the low-carb diet, despite not having caloric restrictions, came out ahead in just about every measured health parameter.

Here's a key paragraph from the discussion section:

None of this is really refuting what I said. It makes intuitive sense that a low-carb diet would be a better treatment for T2D than a low-glycemic diet, and you can certainly make that your hypothesis, as I said. But you still have to test it, and right now there's not enough data to make a valid conclusion on the matter, especially since "better" in this context constitutes a variety of measures. The study linked here is certainly a good first step, although it is limited in the time-span covered (24 weeks). Additionally, some of the studies covered in the review found that various long-term effects were comparable between LC or HC diets. For example, when looking at the psychological health of T2D patients:

https://www.ncbi.nlm.nih.gov/pubmed/27010424

In obese adults with T2DM, both diets achieved substantial weight loss and comparable improvements in QoL, mood state and affect. These results suggest that either an LC or HC diet within a lifestyle modification programme that includes exercise training improves psychological well-being.

This isn't to say that we should disregard keto diets as a treatment option. We absolutely need to continue to do research precisely because this isn't a settled matter.

Deleted member 1635 · Jan 15, 2019

SaveWeyard said:
This isn't to say that we should disregard keto diets as a treatment option. We absolutely need to continue to do research precisely because this isn't a settled matter.

Sure, but people battling with overweight and diabetes don't really have the luxury of time. It ultimately comes to the individual's decision and ability to find what works for them, but waiting for the science to be settled (especially when it comes to nutrition science) basically means you're going to be waiting for an extremely long time if not forever. Doing proper controlled long-term nutrition studies with human subjects is just too cost prohibitive, which is why the more observational epidemiology rules the field despite all of the shortcomings that come with it.

SaveWeyard · Jan 15, 2019

Zefah said:
Sure, but people battling with overweight and diabetes don't really have the luxury of time. It ultimately comes to the individual's decision and ability to find what works for them, but waiting for the science to be settled (especially when it comes to nutrition science) basically means you're going to be waiting for an extremely long time if not forever. Doing proper controlled long-term nutrition studies with human subjects is just too cost prohibitive, which is why the more observational epidemiology rules the field despite all of the shortcomings that come with it.

It's when people go from personal anecdotes of "hey, it worked for me!" to asserting that it just logically follows that it will work for everyone and not have any associated risks that I take issue, and what I feel responsible to fight against as a scientist. It's a matter of informing people and explaining what the limitations are of what is known so that they and their healthcare providers can make an educated decision about what to do.

Calamari41 · Jan 15, 2019

Sega Dreamcast said:
Keto should be used as a gateway diet that leads to a CICO lifestyle.

You start with Keto. It's rather simple, you get to eat fun stuff like cheese and meat, you don't have to exercise, and you quickly start to lose pounds. Just losing those initials pounds - especially for people who have struggled with their weight their entire lives - it's an incredible boost of confidence that proves, hey, there is hope for me and dieting does work.

After x weeks of Keto (whatever you determine is right for you), you should then ease back into a normal diet that focuses on a calorie deficit so that you can start enjoying life again.

Keto is especially good as a gateway to this kind of diet if for no other reason than that it makes things like processed carbs and sugary snacks and desserts taste bad to you. There's no better way to avoid the temptation of a piece of cake or a heap of fries than if you're actually revolted by the idea of eating it.

I used to be a McDonald's fry fiend, but now if I nab one it is just like I'm eating a bland piece of potato, and I wonder why I even tried it.

LL_Decitrig · Jan 15, 2019

And now it's time for a vocabulary update.

Confirmation bias.

https://en.wikipedia.org/wiki/Confirmation_bias

Peer reviewed scientific studies are carefully designed to avoid the most obvious pitfalls but even then it can take decades to root out various forms of experimental bias. Anecdotal accounts make no attempt to address bias, and the most obvious types of experimental bias show up particularly severely in anecdotal accounts and self-experiments or studies where the cohort is selected after the event.

We all experience things that work for us, and it's fun to spread the good news and make the world a better place. Bacon, gluten-free, Dianetics, Gregg's vegan sausage rolls (they're delicious!), Kabbala, Pilates, macramé, craft beer, they all have their enthusiasts. Some of us even believe that arguing on the internet is a worthwhile activity.

But if somebody tries to get you to agree with them about their latest enthusiasm, ask them how they can tell whether or not they're right. Keep asking polite questions as long as they're happy to respond, and keep thinking about alternative explanations for their experiences.

sca · Jan 15, 2019

AnilP228 said:
Weight gain/loss is massively over simplified by CICO, which is more of a buzzword/phrase than a scientific way/methodolgy of losing weight.

Here's a great video to understanding why it's a flawed concept:
It's great for people that just want to lose weight without the details of macros and such. If someone was trying to do something more specific

Btw your avatar rules.

I agree, it's really simplified, but I also think that's why it works for many people. I think when a person starts to target specific goals, like gaining muscle while losing fat or losing that last few body fat %, macros come into play. Thanks for the video

and thanks <3

Horn · Jan 16, 2019

Zefah said:
Go ahead if you want, but their advice is fucking terrible, much like the official dietary recommendations in the US.

Zefah said:
then it would stand to reason that carbohydrate consumption was the culprit (or at least one of the major culprits) in their development of it.

So you are basically guessing? That's ironic considering what you said earlier about the dietary recommendations, which is based on data. Maybe not enough or conclusive data (that's another discussion) but then to speculate based on nothing is, well interesting.

Anarion07 · Jan 16, 2019

Zefah said:
Y
No. The entire point is that the laws of thermodynamics say absolutely nothing about what our bodies do with food. Carbohydrates are unique in that they can be used basically only for energy once consumed or they get stored as fat when there is excess. You can't use them to build muscle or repair tissue or do any other number of things that the body does with fat and protein, the only two essential macro nutrients.

Protein being used to build lean mass based on hormonal signals from resistance training should more than enough information to understand that not all calories are the same and there is no expectation that they should be.

I'm sorry but this is kind of wrong.
Carbs can be used to build muscle or repair tissue. Non-essential amino acids can be produced by the body itself using Glucose as a starting point.

Deleted member 1635 · Jan 16, 2019

Horn said:
So you are basically guessing? That's ironic considering what you said earlier about the dietary recommendations, which is based on data. Maybe not enough or conclusive data (that's another discussion)

...or downright fraudulent data selectively gathered and compiled to support a foregone conclusion and agenda. Here's a good article on the history of dietary recommendations and how they came about it. https://www.theguardian.com/society/2016/apr/07/the-sugar-conspiracy-robert-lustig-john-yudkin

Horn said:
but then to speculate based on nothing is, well interesting.

You can call it a guess, but it's absolutely not based on nothing. We know that carbs raise blood sugar, that chronically elevated blood sugar leads to overproduction of insulin, which leads to insulin resistance, which leads to diabetes (a disease of being unable to manage blood sugar). We also know that reducing or removing carbs improves blood markers and often allows people to completely come off insulin.

Yes, we need more thorough studies and data points to really make a strong conclusion about some of the specifics, but this isn't just guessing based off nothing.

Jillian Micheals " Avoid the Keto Diet at all costs" - Offers little evidence and analysis

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