Ketogenic diets have some benefits over others, particularly for the obese, as they address satiety where so many of the rest usually fail; you won't be constantly famished.
Those of you who follow this site with any regularity will know that I am dismissive of dieting in general; researchers evaluating the whole gamut found that a year later only five percent had lost a significant amount of weight, and around a half had eventually added pounds.
If it is not sustainable don't even bother starting; a complete waste of time and effort. Can you give up bread for ever, do you really need to, and is there an alternative? Yes, there is.
"There is little support for the notion that diets lead to lasting weight-loss or health benefits.
We concluded most would have been better off not going on diet at all."
- Prof Traci Mann, U of Minn, Health and Eating lab
There is one interesting proviso though. Most of this work was done on caloric restriction diets. They leave us constantly famished, with hormonal signals to the brain chanting "eat, eat, eat."
Stop counting calories; it's a complete waste of time.
Is there such a thing as a diet that does not restrict calories?
Yes those that push us into ketosis by profoundly restricting all carbs, but increasing energy-dense foods; fats and protein.
Then the body burns fat and protein for energy; gout is a potential side-effect.
This is profoundly good for diabetics as blood-glucose drops, often dramatically. Medication must be reduced and so ketogenic diets should only be followed under the direction of your doctor, or you could go into a coma. Insulin is often immediately halved.
This means restricting all starches, both whole grains and refined carbohydrate; legumes and sugar too.
Fats are encouraged, particularly those of animal origin; butter, cream, and those from meat. Blood cholesterol may rise, sometimes dramatically.
Banting was first used by the celebrated medical doctor William Harvey when he treated a 'morbidly obese' London undertaker by the name of William Banting.
Carbohydrate was banned, and William Banting lost so much weight that Harvey reportedly did not recognise him when he returned for a follow-up consultation six-months later.
There are three levels of banting; less than 50g, 20g and 2g of carbohydrate per day. The latter is extremely difficult and only for epileptic children who respond to no medical treatment.
Eating less than 20g of carb is difficult for those used to enjoying bread, rice and legumes like green peas; and colas and cookies. It is for unstable diabetics who are not responding well to conventional medical treatment.
Less than 50g of starch per day is also difficult but a very effective way for the obese like William Banting to lose a lot of weight.
Banting too is a high fat meal plan; they have now acknowledged that they over-promoted cream and bacon dripping for example, looking more currently to increased protein as in the Atkins diet.
Since the proponents of the banting still gainsay legumes and whole grains, because of their carbohydrate content, both strongly associated with greater well-being, there are concerns whether this is a healthy way to lose weight.
The Paleo diet recommends that we follow meal plans using foods from the era beginning about two and a half million years ago; before grains and legumes were readily available. Rather, it makes more sense genetically that we should be following the ways of the hunter-gatherers; meat, fish and vegetables. They would also have eaten nuts and seeds if and when they were available.
Paleo is an effective way of losing weight but scientists have the same concerns about the absence of whole-grains and legumes. Too much protein is being obtained from meat.
Whilst the WHO is recommending that we limit red meat, being probably carcinogenic, Stone Age man would not have eaten that from a feedlot or sty as we have to.
It is incredibly difficult to find wholesome, pasture-fed red meat and whole grains.
"Eat less saturated fat: that has been the take-home message from the U.S. government for the past 30 years. But while Americans have dutifully reduced the percentage of daily calories from saturated fat since 1970, the obesity rate during that time has more than doubled, diabetes has tripled, and heart disease is still the country’s biggest killer."
- Scientific American
Notice the twenty-year rule; the onset of the massive diabetes spike two decades after changing to a diet high in refined carbohydrate and sugar.
1977 was when the McGovern select committee guidelines were promulgated.
The much vilified Atkins, going back some 50-years, is another of the more successful ketogenic diets. The theme tune remains essentially the same; strictly limit carbs like potatoes and bread, enjoy plenty of protein and don't be anxious about saturated animal fat.
Despite the contempt of the medical fraternity, researchers have now vindicated Dr Robert Atkins' belief that animal fat does not raise blood cholesterol; it is the glucose from starches that the liver turns into triglycerides that are public enemy number one.
Fats and protein provide the satiety, that feeling of fullness, that we all crave.
The Flexitarian diet is basically that of a vegetarian with occasional days when you might enjoy meat, fish or fowl. How often is not defined; it's up to you. Since whole grains and legumes are not restricted the carbohydrate content of meals would not be very low, and followers would probably not go into ketosis.
Nevertheless those following the Flexitarian way of eating are less likely to be enjoying refined carbohydrates, mitigating against obesity and type-2 diabetes. It is healthy and an effective way for the obese to consider. Weight loss is likely to be slow but sure, rather than dramatic.
How would a typical omnivore become a flexitarian? Simply by cutting out meat one or two days a week, and replacing it with legumes such as peas, beans and lentils.
Lectins are proteins found in legumes and whole grains especially but in all plant foods too; they link to carbohydrates and minerals lessening their absorption. For this reason they are termed anti-nutrients.
Since a lectin-free diet would dramatically lower legumes and grains, they reduce carbohydrate consumption and increase animal protein. Whilst the aim would be different it ends up being not dissimilar to the Adkins diet.
Lectin-free is effective but not considered a healthy way to lose weight since it limits vegetables, legumes and whole grains; nuts and seeds too.
Popular guru of this way of eating, Dr Steven Gundry, describes the toxic effect of lectins on our wellness, but then totally ruins his case by saying we can eat all these foods provided we purchase his supplement.
No question of it, the obesity pandemic in the US began after Ancel Keys propounded his theory that cholesterol was the cause of heart disease. Follow up studies have however found that he doctored the figures by selecting only those countries where this appeared to be the case, and striking out those that countered his thesis.
Banerjee et al have in fact proved quite the contrary; saturated fat in the diet is associated with lower overall mortality.
Following up on Keys' misplaced theory, the McGovern dietary guidelines then advised Americans to raise their carbohydrate consumption (in practice this turned out to be increased refined starch) and lower foods rich in cholesterol like eggs.
Within twenty-years Americans started becoming morbidly obese and diabetes spiked, and continues to do so.
Ketogenic diets go entirely counter to this, strictly lowering carbohydrates and again allowing foods rich in cholesterol.
"Although the subjects on the low-carb diet ate the most saturated fat, they ended up with the healthiest ratio of HDL to LDL cholesterol and lost twice as much weight as their low-fat-eating counterparts."
- New England Journal of Medicine
Lind et al found that those with the highest TG/HDL ratio were significantly more insulin resistant and had an increased risk of coronary heart disease.
Glucose absorbed from the starches we eat, and especially those that are highly refined, is processed by the liver and turned into triglycerides (TG).
Those on one of the ketogenic diets that restrict starches will lower the TG/HDL ratio lessening the risk of coronary heart disease.
Having meandered through this page you will know that Bernie (me) is dismissive of all diets; a dirty 4-letter word that never delivers on its promises. They simply don't work for the majority and leave us famished, depressed and angry.
There is no getting round it though; if you continue consuming foods high in refined carbs you will never win. You cannot drink colas and eat chocolate cake and lose weight.
Refined carbs have to go for ever, or at least be kept for high and holy days only. This is where ketogenic diets win. And don't ever start the shakes; just eat more protein.
Enjoy more protein, from meat unless you are a vegetarian, grean beans of various kinds and eggs; we make and eat hummus daily too.
A moderate increase in fat helps to dispel hunger pangs, but get as much as possible from olive oil and avocados. Despite the cholesterol we are not anxious about butter and coconut cream.
Butter is back after and should never have been sent to Coventry.
With a little imagination salads are delicious; and supply us with the many phytochemicals that are absolutely vital for our well-being.
Enjoy as many different whole fruits as you can, especially berries and lemons. Limit the load of those with a high glycemic index; like grapes for example. We have smoothies several times a week.
Absolutely eschew fruit juices like OJ from a carton. It's a very high carb junk food.
Commercial loaves all use refined flour. It takes only five-minutes to prepare the sourdough for your own artisan bread every day.
New potatoes have far less starch than those from cold-storage but are very difficult to locate. So we grow our own.
Growing butternut squash is very easy if you have a large garden; we had an astonishing harvest this year.
There were only two things that were difficult and required some real will-power. Giving up sugar for ever and finding a source of natural honey. That meant for us keeping our own bees.
And giving up all refined flour; that meant kissing commercial bread, cookies and cakes goodbye and, instead, buying a mill, grinding our own flour and baking sourdough.
For five-minutes work you can bake a loaf of the best bread in the world for less than half a dollar; rich in fibre, lignans and vitamin E. Prior to the milling of flour heart-disease was almost unknown.
Lignans help breast tumours; a must for every woman.
Various supplement are purported from "clinical trials" to be effective in reducing weight. Researchers reporting in the journal Obesity, state that there was very little high-quality evidence supporting any of these claims. The industry is valued at over 6 billion dollars in 2020 in the US alone. Only 16 studies out of hundreds demonstrated significant results.
"Changing your lifestyle is the only way to manage your weight."
- Sharon Zarabi, director at Katz Institute for Women's Well-being.
Ketogenic diets are in the main about restricting carbs.
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