Ketogenic Diet: Burning Fat Or Burning Out?
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In Wednesday’s newsletter, we asked you for your opinion of the keto diet, and got the above-depicted, below-described set of responses:
- About 45% said “It has its benefits, but they don’t outweigh the risks”
- About 31% said “It is a good, evidence-based way to lose weight, be energized, and live healthily”
- About 24% said “It is a woeful fad diet and a fast-track to ruining one’s overall health”
So what does the science say?
First, what is the ketogenic diet?
There are two different stories here:
- Per science, it’s a medical diet designed to help treat refractory epilepsy in children.
- Per popular lore, it’s an energizing weight loss diet for Instagrammers and YouTubers.
Can it be both? The answer is: yes, but with some serious caveats, which we’ll cover over the course of today’s feature.
The ketogenic diet works by forcing the body to burn fat for energy: True or False?
True! This is why it helps for children with refractory epilepsy. By starving the body (including the brain) of glucose, the liver must convert fat into fatty acids and ketones, which latter the brain (and indeed the rest of the body) can now use for energy instead of glucose, thus avoiding one of the the main triggers of refractory epilepsy in children.
See: The Ketogenic Diet: One Decade Later | Pediatrics
Even the pediatric epilepsy studies, however, conclude it does have unwanted side effects, such as kidney stones, constipation, high cholesterol, and acidosis:
Source: Dietary Therapies for Epilepsy
The ketogenic diet is good for weight loss: True or False?
True! Insofar as it does cause weight loss, often rapidly. Of course, so do diarrhea and vomiting, but these are not usually held to be healthy methods of weight loss. As for keto, a team of researchers recently concluded:
❝As obesity rates in the populace keep rising, dietary fads such as the ketogenic diet are gaining traction.
Although they could help with weight loss, this study had a notable observation of severe hypercholesterolemia and increased risk of atherosclerotic cardiovascular disease among the ketogenic diet participants.❞
~ Dr. Shadan Khdher et al.
On which note…
The ketogenic diet is bad for the heart: True or False?
True! As Dr. Joanna Popiolek-Kalisz concluded recently:
❝In terms of cardiovascular mortality, the low-carb pattern is more beneficial than very low-carbohydrate (including the ketogenic diet). There is still scarce evidence comparing ketogenic to the Mediterranean diet.
Other safety concerns in cardiovascular patients such as adverse events related to ketosis, fat-free mass loss, or potential pharmacological interactions should be also taken into consideration in future research.❞
~ Dr. Joanna Popiolek-Kalisz
Read in full: Ketogenic diet and cardiovascular risk: state of the art review
The ketogenic diet is good for short-term weight loss, but not long-term maintenance: True or False?
True! Again, insofar as it works in the short term. It’s not the healthiest way to lose weight and we don’t recommend it, but it did does indeed precipitate short-term weight loss. Those benefits are not typically observed for longer than a short time, though, as the above-linked paper mentions:
❝The ketogenic diet does not fulfill the criteria of a healthy diet. It presents the potential for rapid short-term reduction of body mass, triglycerides level, Hb1Ac, and blood pressure.
Its efficacy for weight loss and the above-mentioned metabolic changes is not significant in long-term observations.❞
~ Ibid.
The ketogenic diet is a good, evidence-based way to lose weight, be energized, and live healthily: True or False?
False, simply, as you may have gathered from the above, but we’ve barely scratched the surface in terms of the risks.
That said, as mentioned, it will induce short-term weight loss, and as for being energized, typically there is a slump-spike-slump in energy:
- At first, the body is running out of glucose, and so naturally feels weak and tired.
- Next, the body enters ketosis, and so feels energized and enlivened ← this is the part where the popular enthusiastic reviews come from
- Then, the body starts experiencing all the longer-term problems associated with lacking carbohydrates and having an overabundance of fat, so becomes gradually more sick and tired.
Because of this, the signs of symptoms of being in ketosis (aside from: measurably increased ketones in blood, breath, and urine) are listed as:
- Bad breath
- Weight loss
- Appetite loss
- Increased focus and energy
- Increased fatigue and irritability
- Digestive issues
- Insomnia
The slump-spike-slump we mentioned is the reason for the seemingly contradictory symptoms of increased energy and increased fatigue—you get one and then the other.
Here’s a small but illustrative study, made clearer by its participants being a demographic whose energy levels are most strongly affected by dietary factors:
The ketogenic diet is a woeful fad diet and a fast-track to ruining one’s overall health: True or False?
True, subjectively in the first part, as it’s a little harsher than we usually go for in tone, though it has been called a fad diet in scientific literature. The latter part (ruining one’s overall health) is observably true.
One major problem is incidental-but-serious, which is that a low-carb diet is typically a de facto low-fiber diet, which is naturally bad for the gut and heart.
Other things are more specific to the keto diet, such as the problems with the kidneys:
However, kidney stones aren’t the worst of the problems:
Is Losing Weight Worth Losing Your Kidney: Keto Diet Resulting in Renal Failure
We’re running out of space and the risks associated with the keto diet are many, but for example even in the short term, it already increases osteoporosis risk:
❝Markers of bone modeling/remodeling were impaired after short-term low-carbohydrate high-fat diet, and only one marker of resorption recovered after acute carbohydrate restoration❞
~ Dr. Ida Heikura et al.
A Short-Term Ketogenic Diet Impairs Markers of Bone Health in Response to Exercise
Want a healthier diet?
We recommend the Mediterranean diet.
See also: Four Ways To Upgrade The Mediterranean
(the above is about keeping to the Mediterranean diet, while tweaking one’s choices within it for a specific extra health focus such as an anti-inflammatory upgrade, a heart-healthy upgrade, a gut-healthy upgrade, and a brain-healthy upgrade)
Enjoy!
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The Fascinating Truth About Aspartame, Cancer, & Neurotoxicity
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Is Aspartame’s Reputation Well-Deserved?
In Tuesday’s newsletter, we asked you for your health-related opinions on aspartame, and got the above-depicted, below-described, set of responses:
- About 47% said “It is an evil carcinogenic neurotoxin”
- 20% said “It is safe-ish, but has health risks that are worse than sugar”
- About 19% said “It is not healthy, but better than sugar”
- About 15% said “It’s a perfectly healthy replacement for sugar”
But what does the science say?
Aspartame is carcinogenic: True or False?
False, assuming consuming it in moderation. In excess, almost anything can cause cancer (oxygen is a fine example). But for all meaningful purposes, aspartame does not appear to be carcinogenic. For example,
❝The results of these studies showed no evidence that these sweeteners cause cancer or other harms in people.❞
~ NIH | National Cancer Institute
Source: Artificial Sweeteners and Cancer
Plenty of studies and reviews have also confirmed this; here are some examples:
- Evaluation of aspartame cancer epidemiology studies based on quality appraisal criteria
- Aspartame, low-calorie sweeteners and disease: Regulatory safety and epidemiological issues
- Aspartame: A review of genotoxicity data
Why then do so many people believe it causes cancer, despite all the evidence against it?
Well, there was a small study involving giving megadoses to rats, which did increase their cancer risk. So of course, the popular press took that and ran with it.
But those results have not been achieved outside of rats, and human studies great and small have all been overwhelmingly conclusive that moderate consumption of aspartame has no effect on cancer risk.
Aspartame is a neurotoxin: True or False?
False, again assuming moderate consumption. If you’re a rat being injected with a megadose, your experience may vary. But a human enjoying a diet soda, the aspartame isn’t the part that’s doing you harm, so far as we know.
For example, the European Food Safety Agency’s scientific review panel concluded:
❝there is still no substantive evidence that aspartame can induce such effects❞
~ Dr. Atkin et al (it was a pan-European team of 21 experts in the field)
Source: Report on the Meeting on Aspartame with National Experts
See also,
❝The data from the extensive investigations into the possibility of neurotoxic effects of aspartame, in general, do not support the hypothesis that aspartame in the human diet will affect nervous system function, learning or behavior.
The weight of existing evidence is that aspartame is safe at current levels of consumption as a nonnutritive sweetener.❞
and
❝The safety testing of aspartame has gone well beyond that required to evaluate the safety of a food additive.
When all the research on aspartame, including evaluations in both the premarketing and postmarketing periods, is examined as a whole, it is clear that aspartame is safe, and there are no unresolved questions regarding its safety under conditions of intended use.❞
Source: Regulatory Toxicology & Pharmacology | Aspartame: Review of Safety
Why then do many people believe it is a neurotoxin? This one can be traced back to a chain letter hoax from about 26 years ago; you can read it here, but please be aware it is an entirely debunked hoax:
Urban Legends | Aspartame Hoax
Take care!
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Sensitive – by Jenn Granneman and Andre Sólo
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This book is written for what is called the “Highly Sensitive Person”, which makes it sound like a very rare snowflake condition, when in fact the diagnostic criteria (discussed early in the book) yield a population bell curve of 30:40:30, whereupon 30% are in the band of “high sensitivity”, 40% “normal sensitivity” and the remainder “low sensitivity”. You may note that “high” and “low” together outnumber “normal”, but statistics is like that.
So, if you’re one of the approximately one in three people who fall into the higher category, and/or you have a loved one who is in that category, then this book looks at the many advantages to a commonly stigmatized and (by cruel irony) criticized personality trait.
Those advantages range from personal life to work and even public life (yes, really), and can be grown, positively highlighted, used, and enjoyed.
In the category of criticism, the book does not usefully cover the benefit of psychological resilience. Resilience does not mean losing sensitivity, just, being able to also dry one’s tears and weather life’s slings and arrows when the world is harsher than one might like. But for the authors, they have stacked all their chips on “we must make the world a better place”. Which is a noble goal, if not always an immediately attainable one.
Bottom line: if you are more sensitive than average and would like to use that to benefit yourself and those around you, then this is the book for you!
Click here to check out Sensitive, and make the most of your strengths!
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The Gym For Your Mental Health
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Getting The Most Out Of Therapy
If you’ve never had therapy, what image do you have of it? Perhaps you imagine a bearded and bespectacled man in a suit, impassively making notes on a clipboard. Perhaps you imagine an empathetic woman, with tissues and camomile tea on standby.
The reality is: the experience of therapy can vary, a lot.
In its results, too! Sometimes we may try therapy and think “well that was a waste of time and money”. Sometimes we may try therapy and it’ll change our life.
So… Is there any way to make it less of a lottery?
First: knowledge is power
And while the therapist-client relationship certainly shouldn’t be a power struggle, you do want to be empowered.
So, read about different styles of therapy, and also, read some how-to guides for self-therapy. We’ve recommended some before in previous editions of 10almonds; you can check those books out here:
- How to Be Your Own Therapist: Boost your mood and reduce your anxiety in 10 minutes a day – by Owen O’Kane
- You Are the One You’ve Been Waiting For: Applying Internal Family Systems to Intimate Relationships – by Dr. Richard Schwartz
- DBT Made Simple: A Step-by-Step Guide to Dialectical Behavior Therapy – by Sheri van Dijk
- How to Do the Work: Recognize Your Patterns, Heal from Your Past, and Create Your Self – by Dr. Nicole LaPera
This will serve two purposes:
- You’ll know what to expect out of a therapist
- You can more efficiently “get to work” in therapy
It also, of course, could help you already, without even going to therapy!
Second: begin with the end in mind
A person who does not know what they want to get out of therapy, will likely not get much out of therapy. Or rather, their first task will be to figure that out. So, figure it out in advance, if you can.
Maybe you have a problem that has a specific name, for example poor self-esteem, anxiety, stress, depression, trauma, neuroticism, phobia, etc.
This isn’t Alcoholics Anonymous, and in this case you don’t want a lifetime of “Hello, my name is ______ and I have ______”, if you can help it.
So, what do you want?
- Maybe you want to be able to go to social events without feeling anxious
- Maybe you want your relationship(s) to be more secure and fulfilling
- Maybe you want to no longer have nightmares about that traumatic thing
- Maybe you want to be able to greet each day’s tasks with confidence and without overwhelm
…etc.
A good therapist will help you to set such goals (if you haven’t already), and attain them.
If you’re going the self-therapy route, then this is your job now!
It will probably start with the question: imagine that everything currently troubling you is now healed.
What would that look like, to you?
Third: get a good match for you
Unless you are going entirely the self-therapy route (which can work for some), you will want a therapist who’s a good match for you.
It may take a degree of “suck it and see” trial runs before you find the right one, but that takes time and money, so you’ll want to streamline the process as much as you can. If you do this well, you may be able to find a good therapist for you first time.
For this, personal recommendations (such as from friends) may help more than exmaining academic and institutional affiliations.
Yes, you want a well-qualified therapist who is a member in good standing of a respectable regulated body… but whether your therapist is easy for you to “get on with” will matter at least as much as whether their approach is psychodynamic, or 4th wave CBT, or IFS, or whatever seems popular in your time and place.
Bear in mind:
- Some therapists are specialized in helping with some kinds of things and not others. It will obviously help if the therapist you choose is specialized in the thing you are seeking help for.
- Some therapists may be able to relate to you better (or not), based on simple factors of who they are. To this end, while your therapist certainly doesn’t have to be a mirror image of you, factors like age, gender, race, etc can be relevant and may be worth considering, depending on what you are seeking help with, and what factors impact that thing.
Prefer keeping things to yourself?
Therapy isn’t for everyone, but having a good relationship with oneself definitely is. You might want to invest in one of the books whose reviews we linked above, and you might also get value from previous Psychology Sunday articles, which you can find in our archive (every seventh edition here has a Psychology Sunday main feature):
Click Here To Check Out The 10almonds Archive
To borrow the catchphrase of Dr. Kirk Honda (a therapist and therapy educator with decades of experience):
❝Take care of yourself, because you deserve it; you really, really do.❞
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Healing Spices – by Dr. Bharat Aggarwal & Debora Yost
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This is exactly what the subtitle promises it to be, and more. It’s actually herbs and spices, but definitely mostly spices, and includes the kinds found in even the smallest supermarket, to some you might not have heard of, and might need to order online.
We are treated to an explanation of the health-giving properties of each (and any potential contraindications), as well as the culinary properties, many tables of what goes with what and how and why, and even recipes to use them in. For the more adventurous, there’s even advice on how to grow, prepare, and store each of them.
An extra benefit is that everything is cross-linked such that you can look things up by spice or by health condition or by flavor profile, and find what you need and what’ll go with it.
The style is simple and informational, clearly laid-out in encyclopedic form.
Bottom line: this book should be in your kitchen (or related nearby kitchen-book-place).
Click here to check out Healing Spices, and advance your culinary repertoire!
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The Easiest Way To Take Up Journaling
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Dear Diary…
It’s well-established that journaling is generally good for mental health. It’s not a magical panacea, as evidenced by The Diaries of Franz Kafka for example (that man was not in good mental health). But for most of us, putting our thoughts and feelings down on paper (or the digital equivalent) is a good step for tidying our mind.
And as it can be said: mental health is also just health.
But…
What to write about?
It’s about self-expression (even if only you will read it), and…
❝Writing about traumatic, stressful or emotional events has been found to result in improvements in both physical and psychological health, in non-clinical and clinical populations.
In the expressive writing paradigm, participants are asked to write about such events for 15–20 minutes on 3–5 occasions.
Those who do so generally have significantly better physical and psychological outcomes compared with those who write about neutral topics.❞
Source: Emotional and physical health benefits of expressive writing
In other words, write about whatever moves you.
Working from prompts
If you read the advice above and thought “but I don’t know what moves me”, then fear not. It’s perfectly respectable to work from prompts, such as:
- What last made you cry?
- What last made you laugh?
- What was a recent meaningful moment with family?
- What is a serious mistake that you made and learned from?
- If you could be remembered for just one thing, what would you want it to be?
In fact, sometimes working from prompts has extra benefits, precisely because it challenges us to examine things we might not otherwise think about.
If a prompt asks “What tends to bring you most joy recently?” and the question stumps you, then a) you now are prompted to look at what you can change to find more joy b) you probably wouldn’t have thought of this question—most depressed people don’t, and if you cannot remember recent joy, then well, we’re not here to diagnose, but let’s just say that’s a symptom.
A quick aside: if you or a loved oneare prone to depressive episodes, here’s a good resource, by the way:
The Mental Health First-Aid That You’ll Hopefully Never Need
And in the event of the mental health worst case scenario:
The six prompts we gave earlier are just ideas that came to this writer’s mind, but they’re (ok, some bias here) very good ones. If you’d like more though, here’s a good resource:
550+ Journal Prompts: The Ultimate List
The Good, The Bad, and The Ugly
While it’s not good to get stuck in ruminative negative thought spirals, it is good to have a safe outlet to express one’s negative thoughts/feelings:
Remember, your journal is (or ideally, should be) a place without censure. If you fear social consequences should your journal be read, then using an app with a good security policy and encryption options can be a good idea for journaling
Finch App is a good free option if it’s not too cutesy for your taste, because in terms of security:
- It can’t leak your data because your data never leaves your phone (unless you manually back up your data and then you choose to put it somewhere unsafe)
- It has an option to require passcode/biometrics etc to open the app
As a bonus, it also has very many optional journaling prompts, and also (optional) behavioral activation prompts, amongst more other offerings that we don’t have room to list here.
Take care!
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Foods for Stronger Bones
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It’s Q&A Day!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
Q: Foods that help build stronger bones and cut inflammation? Thank you!
We’ve got you…
For stronger bones / To cut inflammation
That “stronger bones” article is about the benefits of collagen supplementation for bones, but there’s definitely more to say on the topic of stronger bones, so we’ll do a main feature on it sometime soon!
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