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Is Keto a Fad Diet?

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Quick Summary tl;dr

Keto is not a fad. It is rebranding of evolution.

Therapeutic Carbohydrate Restriction (TCR) can have benefits without practitioners having to go all-in keto.

While diet is individual, a keto diet and other forms of Therapeutic Carbohydrate Restriction should be provided as an option for obesity and metabolic disease, especially because a vanishing small number of Americans are metabolically healthy.

There is no medicine without metabolism.

The keto diet is often brushed off as a fad diet, but nothing could be further from the truth.

The keto diet is so named because it relies on carbohydrate restriction to shift the body’s metabolism into a fat-burning mode, a state in which the liver also turns some fat into molecules called ketone bodies.

To watch Nick's quick video, click here.

Keto is Rebranding for the Oldest Human Diet

This shift to a fat — and ketone — dependent metabolism was central to our evolution as a species.

During evolution, our species underwent periods of food deprivation, and plentiful stores of carbohydrates were rarely available. But, while the body can only store about 450 Calories as freely available carbohydrate energy in the form of liver glycogen, our fat stores are nearly unlimited. Even a relatively lean person has 100,000 stored fat Calories.

Ketosis is a state in which the potential to use those fat Calories to fuel the body and, in particular, the brain is maximized. This “fad” diet gets its name from the fact that we now know about ketone bodies (a “digestible” form of fat for neurons, brain cells).

The keto diet is just a rebranding for the oldest human diet.

The keto diet is just a rebranding for the oldest human diet.

Is Keto a Fad Diet?

Therapeutic Carbohydrate Restriction

Admittedly, our goals in the 21st century are distinct from our goals thousands of years ago. Famine is less of an issue and feasting is the danger. In this new environmental context, does the keto diet have any place?

The short answer is, “Yes.” Today the most daunting ongoing medical challenges in the United States are metabolic disease, including obesity, diabetes, heart disease, metabolic syndrome, and Alzheimer’s disease. By mid-century, the number of people living with each diabetes and Alzheimer’s in the United States is projected to triple.

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The keto diet has a broad potential to aid what ails us.

The benefits for certain diseases, including obesity and diabetes, depend primarily on Therapeutic Carbohydrate Restriction (TCR). The keto diet is, by nature, a low-carb diet.

Decreasing carbohydrates in the diet prevents spikes and drops in the hormone insulin. These spikes and drops, colloquially termed “the insulin roller coaster,” drive a form hormonal hunger in which the body is tricked into desiring food (usually in the form of carbohydrates), not to fulfill a nutritional need, but to quench a craving.

This is one way in which the diet can be an excellent weight loss tool. It erases the insulin roller coaster to decrease maladaptive hunger while simultaneously adapting the body to relying on its own fat as a fuel source.

Furthermore, reducing carbohydrates and diminishing the insulin roller coaster improves insulin resistance, a fundamental pathology in type II diabetes ( Athinarayanan et al. 2019). It’s unsurprising that multi-year studies have demonstrated the keto diet is an excellent option for reversing diabetes. ( Athinarayanan et al. 2019, Unwin D. et al. 2020)

Importantly, to gain the weight loss and diabetes reversing benefits of keto, one need not necessarily go all-in.

While a proper keto diet definitionally requires ketone bodies to rise above a certain level, most laypeople don’t practice keto in this way. Therapeutic Carbohydrate Restriction is a spectrum and patients struggling with conditions that would benefit from TCR should be encouraged to find a carb-appropriate diet for their needs.

The benefits for other diseases, mental illnesses and neurological diseases including epilepsy and Parkinson's Disease, may also depend on ketone bodies themselves. These biomolecules are not only clean and efficient sources of fuel but potent signaling molecules. They bind receptor on and within cells, alter enzymatic pathways, and even change the way our genetic code is expressed. Through these signaling mechanisms, ketones alter metabolism to improve the fundamental pathologies (like oxidative stress and inflammation) that generally underly metabolic diseases. ( Norwitz et al 2019)

Carbs, especially refined carbs & snacking, stimulates the insulin roller coaster to drive hormonal hunger, not to fulfil a nutritional need, but to quench a craving.

Unwarranted Fear of Cholesterol

The final defence of those who feel most comfortable sticking with the status quo nutritional advice is often that low-carb diets, which are necessarily high in fat, can increase levels of “bad” LDL cholesterol. Firstly, this happens only in a minority of individuals. And, when it does happen, the overall increase in LDL is primarily or completely driven be an increase in large healthy LDL, not small dense 'bad' LDL.

To get on my nutrition soapbox for a moment, since when was nutrition actually as simple as you are what you eat?

As another example, you might think that eating more saturated fat in place of carbohydrates would increase the saturated fat in your blood. As a matter of fact, it doesn’t. A randomized crossover controlled trial — the gold-standard for nutrition research — demonstrated that when participants ate a high-fat, low-carb diet they ended up with far less saturated fat in their blood than when they ate an isocaloric lower-fat, higher carb diet. This was despite that fact that on the low-carb diet they ate 2.5-times more saturated fat ( Parker N Hyde et al. 2019).

Even were saturated fat artery-clogging, these and other data strongly suggest it’s the butter, not the bread, that should remain on the table.

Here’s another important question. How is the status quo nutritional advice working for us?

Is Keto a Fad Diet?

Keto is Unfairly Vilified

A recent U.S. News and World Report article ranking the most popular diets ranks the keto diet in dead last, 39th, place for health. It states “enthusiasm outpaces evidence.” The insinuation that low-carb and ketogenic diets lack a strong evidence base, as compared to other diets ranked higher on the list, is — quite frankly — a lie.

The report’s rankings demonstrate a lack of understanding of metabolism and an ignorance of the evidence. For example, the Biggest Loser Diet is ranked in the middle of the list, seventeen positions above the keto diet. The former results in a slowing of metabolic rate and leaves an obesogenic fingerprint on the individual, as do most unsustainable crash diets. Maybe that’s why there are no Biggest Loser reunions? By comparison, carbohydrate restriction can protect or increase metabolic rate (Cara B Ebbeling), and is proven to be sustainable when properly formulated.

A survey of the evidence is telling. While there are dozens of randomized controlled trials supporting low-carb and ketogenic diets for weight loss, diabetes, neurological diseases, and other metabolic diseases, there are a sparse few for vegetarian or vegan diets and zero for other diets on the list, like the Noom diet or Dr. Weil’s diet. That’s not to disparage these diets. It’s simply to say that, in terms of evidence base, there is no stronger diet than a keto diet.

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Comments (23)

What are your views on supplementing with collagen for benefits of gut/skin/hair/nails if not for protein? Do you think a glass of grass-fed bone broth is as good if not better than a grass-fed collagen powder everyday? I am 28 and would like to supplement with collagen for my skin. Do you know of any good collagen brand that you can recommend?

I make my own cream cheese from A2 milk like this: Does it have as good a nutritional value as mozzarella/cheddar cheese? Are there benefits of having such cream cheese everyday?

Hi Hafeez, this question is more relevant for another post Nick wrote - check it out: A1 vs. A2 Milk: Cheese, Mutant Cows, Opioids & Constipation

I have experienced higher frequency of stools in Keto probably because I started taking more fibre. I would have bowel movements twice a day, once morning and again afternoon or evening. Even after moving away from keto, I continued having 2 bowel movements everyday. I am just wondering if two bowel movements a day could mean that there is more indigestible food in the body that it is trying to evict? Is it common for more fibre a day resulting an increase of bowel movements per day?

The simplest answer is more fiber equals more poop. So, yes, either you're going to have larger bowel movements or have more of them. Note that not all fibers are created equal. Soluble fibers are going to slow gastric transit. Thus, it is possible if you have relatively more soluble fiber things could be moving more slowly overnight leading to more bowel movements. If constipation-type symptoms are a concern, reducing soluble fiber could help. You could also try taking osmotic laxatives at night, such as 400 mg magnesium citrate, which is totally safe. However, if your change in habit isn't an issue for your daily living, then I wouldn't worry about it at all. Two movements isn't unusual.  

Thanks Nick. Constipation/Diarrhea isn't a problem for me. Would you set any limit to the fibre(soluble/insoluble) consumption per day or it doesn't matter?

I’m sorry that’s too individual a question. I don’t think anybody could answer that for you. Titrate to symptoms. Be observant. Live your n = 1 life!

What are your views on hormone, anti-biotic free chicken breast? Chicken breast is lean but it still has little fat is what I see in nutritional info. I know PUFA in it isn't good and that there are better options like red meat, fish, shrimp, eggs for getting the protein. But given its low cost, I am thinking of eating ~125g of chicken breast everyday to fill my protein needs. What is your take on it? Should we worry about consuming it(whether in keto or not) even though the fat in it is pretty less?

I think it’s neutral. It’s a source of protein but doesn’t provide the benefits of protein sources with better healthy fat profiles. The micronutrient content also isn’t as good as grass-fed beef or fish. But, cost is a factor. I certainly don’t think it harmful. You could also considered pastured eggs for protein (scrambled or hard boiled) if you want more nutrients. Best of all, organ meat is usually cheap and very rich in nutrients.

Even if one is not in keto, trying to stay insulin sensitive is the key. I try to stick to three meals a day within a 12h window and I do strength training with weights and have 32 kgs of muscle mass. I remember you writing somewhere that 1g of protein per lb of body weight is good. I would like to know if you think there could be certain limit on the amount of protein that one can typically digest in a single meal. I am asking this because I am trying to consume 150-200g of protein(mostly from wild fish, red meat, eggs) per day to increase my muscle mass to 40 kgs and hence I need to consume 50-75g of protein in a single meal. So I am wondering if I could even digest that much protein in a meal? How can one access if 75g of protein per meal is working well for them or not? May be by not feeling bloated after eating?

There are different opinions on the protein digestion question, but I don't think there is a hard upper limit. People talk about the number 30 grams per meal, but I don't think that's substantiated. That figure is drawn from looking at acute increases in muscle protein synthesis, rather than tracking actually muscle gain overtime. More importantly, people who practice TMAD, or even OMAD, can put on muscle. If one could only digest 30 grams in a meal, how would a fully grown person eating OMAD even maintain muscle? All that said, if your lean mass is <40 kg, I think 200 g of protein may be more than you need. That doesn't mean it's harmful, but more than is necessary. You definitely don't needs more than 1g/lb and slightly less should be totally sufficient. I wouldn't go below 0.7g/lb if you're looking to gain though.

I've been keto for 3 months now and am loving it but it's hard to do it when everyone else around me thinks I'm following an unhealthy diet. There's so much misinformation! It's always the same... "you need carbs" or "all that fat will give you a heart attack"... it's exhausting. Sadly most people believe that veganism is healthy even with junk food and sugar.

I've been quoted saying that Keto isn't itself hard but social pressure makes it hard. I believe that. My uninvited advice to two is two-fold. First, be a trend setter. Science always wins in the end so be that person that people look back and think, 'oh, she was in the know.' Second, and more importantly, give yourself permission to put your health first.

What do you think about seasonal eating, like our ancestors did? Can periodic fruits, like berries and other low-GI fruits, be healthy?

In one word, "yes." In two words, "yes absolutely." Nature works in cycles, at macro and micro levels. You want a balance but balance comes, not at one time, but in the aggregate overtime. The most pertinent example is the concept of anabolism (growth) vs. catabolism (breakdown & recycling). If you're shifted too anabolic for too long, you get fat. That's the issue most people have, they spend too much time in the anabolic state. Hormonally, this corresponds to high insulin. Behaviorally, this corresponds to frequency eating of carbohydrates. But either do you want to be only catabolic. Fasting is great for stimulating authophagy and adaptation and burning visceral fat, but fasting for too long leads to muscle atrophy and death. Obviously, that's not great either. So, you want a balance. Seasonal eating is, in my opinion, a good idea. It allows you to transition your metabolic state over macrocycles and remain metabolically flexible, if practiced well. The issue is, it's hard to practice well. The fruits and veg you buy in supermarkets aren't those we evolved eating. Early man was not munching on bananas like we have them now. Nevertheless, some fresh wild fruit seasonally, paired with appropriate activity, should be no problem for someone who is healthy. That's the big caveat though! If someone is metabolically unhealthy, or has a condition like type II diabetes, avoid carbs as much as possible might be the best option. Carbs, as a macro, don't cause disease, but eliminating them can help manage/treat/reverse disease.

Another winner, Dr. Nick! I also just watched your YouTube bio and WOW! What an amazing story. Subscribed immediately!
On the topic of this article about keto “fad,” I agree ... NOT a fad. But with respect to evolution, Dr. Saladino argues that animal-based diets are best because plants, while we always ate them, are evolutionary “back-up food.”
Do you have thoughts on that topic?

Thanks for that 😊. Yes, I'd read his book. I think it's a great book (and even better on audio). Honestly, I find it hard to refute his central claim that plant foods are back-ups foods. I also think it's arrogant to tell people who have found success on carnivore diets that they are wrong. In general, if it's working to help your conditions, then that's all the really matters. I don't care if you'r veganism appears to be keeping your cancer in remission or your carnivory is helping your OCD. If it work, your n = 1 is all that matters. But that's a tangent to your very good question and I'll try not to dodge it, but I think there's a limitation to what we know. So, here's what we don't know. We don't know what a healthy microbiome is. We observe associations with higher microbiome diversity, higher plant matter intake, and better health at the population level, but those are just correlations. Paul would probably argue that a healthy microbiome is one associated with good health, so if you're animal based and healthy, what can one say? (He might also point out that animal connective tissue can be fermented.) The counterpoint might be that, although animal foods may have been prioritized historically, that doesn't eliminate the fact that we co-evolved with microbiomes that are adapted to consuming plant material. In other words, our biology did evolve with intake of plant matter as a factor. Building on that, a concept that interests me is that of biodiversity and resilience. More diverse systems tend to be more resilient against insult. Thus, a more diverse diet leading to a more diverse biome could make someone more resistant against metabolic challenges, both exogenous and endogenous. Those are my raw thoughts at the moment. Hope that helps.

I find it very reassuring that you look at nutrition on an individual level that way. I follow a ketogenic diet because it keeps my cystic acne at bay (female, in my 20s). People (and doctors) tend to see that very critically given that I don't have any other diseases and have never been overweight, although there are diabetes cases of both types in my extended family. I get both the "but you're lean, you shouldn't diet" and the "but acne is normal" comments a lot, however given that cystic acne at that level of severity is, by definition, a chronic disease, my personal stance isn't quite as relaxed. I've tried a lot of less restrictive dietary and lifestyle measures, but keto is the only one that I've found that works (and it works like a charm), and if that doesn't go along with the current nutritional consensus, that consensus is welcome to go jump in a lake.
All modern science is predicated on statistics, and in statistics, there will always be outliers.

I agree and sympathize Thea. I too adopted a KD despite being quite lean. Some people don't comprehend that skinny doesn't mean healthy and I think there is an element of jealously or 'misery-loves company' phenomenon as well, although I could be imagining. The key point though is you can't very easily look at someone and say they're healthy. One topic I and my colleagues are very interested in, for example, is visceral fat and the invisible obesity epidemic. There are a lot of people walking around who appear thin but have a lot of pro-inflammatory visceral fat in their abdominal cavity sitting around their organs. Usually, VAT levels correlate weight BMI/weight, but not in everyone and not always. It's the VAT, more than the total fat, that impacts your health. Anyway, I'm getting on my soap box and should probably return to proper works (ironically, a review paper on precision nutrition for ApoE4s and the prevention of AD). P.S. On the topic of VAT: ... a friend Dr. Brian Lenzkes wanted me to check out this paper a few days ago so I just did a little paper walkthrough.

Magnesium is one commonly used supplement for keto-dieters. Could you tell us which magnesium form you recommend if constipation is not an issue? Is magnesium glycinate best for absorption? Could you also suggest some good brands that you are aware of?

Magnesium glycinate is good. You're smart ;). I'd go with that. Personally, I use magnesium amino acid chelate. Solaray is the brand I use. Having said that, I don't think magnesium is like fish oils where there is too much of an issue with low quality. It's a simple mineral/electrolyte.

Thanks Nick. What about cellulose capsule, silica that are use to make these capsules? I see those ingredients in Solary's magnesium glycinate. Are they ok? Also I don't do keto, do you think magnesium glycinate can still help non-keto dieters too?

I don't have an issue with those compounds. Depends on your magnesium intake, but for those who aren't keto extra magnesium may not be necessary. Once you're Keto-adapted, people also find they don't need extra electrolytes, although the support rarely hurts.