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.

Read in full: The Significant Impact of High-Fat, Low-Carbohydrate Ketogenic Diet on Serum Lipid Profile and Atherosclerotic Cardiovascular Disease Risk in Overweight and Obese Adults

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:

  1. At first, the body is running out of glucose, and so naturally feels weak and tired.
  2. Next, the body enters ketosis, and so feels energized and enlivened ← this is the part where the popular enthusiastic reviews come from
  3. 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 glycaemic benefits of a very-low-carbohydrate ketogenic diet in adults with Type 1 diabetes mellitus may be opposed by increased hypoglycaemia risk and dyslipidaemia

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:

The Relationship between Modern Fad Diets and Kidney Stone Disease: A Systematic Review of Literature

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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  • How To Grow In Comfort

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    How To Grow (Without Leaving Your Comfort Zone)

    “You have to get out of your comfort zone!” we are told, from cradle to grave.

    When we are young, we are advised (or sometimes more forcefully instructed!) that we have to try new things. In our middle age, we are expected to be the world’s greatest go-getters, afraid of nothing and always pushing limits. And when we are old, people bid us “don’t be such a dinosaur”.

    It is assumed, unquestioned, that growth can only occur through hardship and discomfort.

    But what if that’s a discomforting lie?

    Butler (2023) posited an idea: “We never achieve success faster and with less effort than when we are in our comfort zone”

    Her words are an obvious callback to the ideas of Csikszentmihalyi (1970) in the sense of “flow”, in the sense in which that word is used in psychology.

    Flow is: when a person is in a state of energized focus, full involvement, and enjoyment of an activity.

    As a necessary truth (i.e: a function of syllogistic logic), the conditions of “in a state of flow” and “outside of one’s comfort zone” cannot overlap.

    From there, we can further deduce (again by simple logic) that if flow can be found, and/but cannot be found outside of the comfort zone, then flow can only be found within the comfort zone.

    That is indeed comforting, but what about growth?

    Imagine you’ve never gone camping in your life, but you want to get outside of your comfort zone, and now’s the time to do it. So, you check out some maps of the Yukon, purchase some camping gear, and off you go into the wilderness. In the event that you survive to report it, you will indeed be able to say “it was not comfortable”.

    But, did growth occur? Maybe, but… it’s a folly to say “what doesn’t kill us makes us stronger” as a reason to pursue such things. Firstly, there’s a high chance it may kill us. Secondly, what doesn’t kill us often leaves us incredibly weakened and vulnerable.

    When Hannibal famously took his large army of mostly African mercenaries across the Alps during winter to march on Rome from the other side, he lost most of his men on the way, before proceeding to terrorize Northern Italy convincingly with the small remainder. But! Their hard experience hadn’t made them stronger; it had just removed the weaker soldiers, making the resultant formations harder to break.

    All this to say, please do not inflict hardship and discomfort and danger in the hopes it’ll make you stronger; it will probably do the opposite.

    But…

    If, instead of wilderness trekking in the Yukon…

    • You start off with a camper van holiday, then you’ll be taking a fair amount of your comfort with you. In effect, you will be stretching and expanding your comfort zone without leaving it.
    • Then maybe another year you might try camping in a tent on a well-catered camping site.
    • Later, you might try “roughing it” at a much less well-catered camping site.
    • And so on.

    Congratulations, you have tried new things and undergone growth, taking your comfort zone with you all the way!

    This is more than just “easing yourself into” something

    It really is about taking your comfort with you too. If you want to take up running, don’t ask “how can I run just a little bit first” or “how can I make it easier” (well, feel free to ask those things too, but) ask yourself: how can I bring my comfort with me? Comfortable shoes, perhaps, an ergonomic water bottle, shade for your head, maybe.

    ❝Any fool can rough it, but a good soldier can make himself comfortable in any circumstances❞

    ~ British Army maxim

    This goes for more than just physical stuff, too

    If you want to learn a new skill, the initial learning curve can be anxiety-inducing, especially if you are taking a course and worried about keeping up or “not being good enough”.

    So, “secretly” study in advance, at your leisure, get yourself a head start. Find a degree of comfort in what you’ve learned so far, and then bring that comfort with you into your entry-level course that is now less intimidating.

    Discomfort isn’t a badge of honor (and impedes growth)

    Take that extra rest stop on the highway. Bring your favorite coffee with you. Use that walking stick, if it helps.

    Whatever it takes to bring your comfort with you, bring it.

    Trust us, you’ll get further that way.

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  • Women take more antidepressants after divorce than men but that doesn’t mean they’re more depressed

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Research out today from Finland suggests women may find it harder to adjust to later-life divorce and break-ups than men.

    The study used population data from 229,000 Finns aged 50 to 70 who had undergone divorce, relationship break-up or bereavement and tracked their use of antidepressants before and after their relationship ended.

    They found antidepressant use increased in the four years leading to the relationship dissolution in both genders, with women experiencing a more significant increase.

    But it’s too simplistic to say women experience poorer mental health or tend to be less happy after divorce than men.

    Remind me, how common is divorce?

    Just under 50,000 divorces are granted each year in Australia. This has slowly declined since the 1990s.

    More couple are choosing to co-habitate, instead of marry, and the majority of couples live together prior to marriage. Divorce statistics don’t include separations of cohabiting couples, even though they are more likely than married couples to separate.

    Those who divorce are doing so later in life, often after their children grow up. The median age of divorce increased from 45.9 in 2021 to 46.7 in 2022 for men and from 43.0 to 43.7 for women.

    The trend of late divorces also reflects people deciding to marry later in life. The median duration from marriage to divorce in 2022 was around 12.8 years and has remained fairly constant over the past decade.

    Why do couples get divorced?

    Changes in social attitudes towards marriage and relationships mean divorce is now more accepted. People are opting not to be in unhappy marriages, even if there are children involved.

    Instead, they’re turning the focus on marriage quality. This is particularly true for women who have established a career and are financially autonomous.

    Similarly, my research shows it’s particularly important for people to feel their relationship expectations can be fulfilled long term. In addition to relationship quality, participants reported needing trust, open communication, safety and acceptance from their partners.

    Grey divorce” (divorce at age 50 and older) is becoming increasingly common in Western countries, particularly among high-income populations. While factors such as an empty nest, retirement, or poor health are commonly cited predictors of later-in-life divorce, research shows older couples divorce for the same reasons as younger couples.

    What did the new study find?

    The study tracked antidepressant use in Finns aged 50 to 70 for four years before their relationship breakdown and four years after.

    They found antidepressant use increased in the four years leading to the relationship break-up in both genders. The proportion of women taking antidepressants in the lead up to divorce increased by 7%, compared with 5% for men. For de facto separation antidepressant use increased by 6% for women and 3.2% for men.

    Within a year of the break-up, antidepressant use fell back to the level it was 12 months before the break-up. It subsequently remained at that level among the men.

    But it was a different story for women. Their use tailed off only slightly immediately after the relationship breakdown but increased again from the first year onwards.

    Woman sits at the beach
    Women’s antidepressant use increased again.
    sk/Unsplash

    The researchers also looked at antidepressant use after re-partnering. There was a decline in the use of antidepressants for men and women after starting a new relationship. But this decline was short-lived for women.

    But there’s more to the story

    Although this data alone suggest women may find it harder to adjust to later-life divorce and break-ups than men, it’s important to note some nuances in the interpretation of this data.

    For instance, data suggesting women experience depression more often than men is generally based on the rate of diagnoses and antidepressant use, which does not account for undiagnosed and unmedicated people.

    Women are generally more likely to access medical services and thus receive treatment. This is also the case in Australia, where in 2020–2022, 21.6% of women saw a health professional for their mental health, compared with only 12.9% of men.

    Why women might struggle more after separating

    Nevertheless, relationship dissolution can have a significant impact on people’s mental health. This is particularly the case for women with young children and older women.

    So what factors might explain why women might experience greater difficulties after divorce later in life?

    Research investigating the financial consequences of grey divorce in men and women showed women experienced a 45% decline in their standard of living (measured by an income-to-needs ratio), whereas men’s dropped by just 21%. These declines persisted over time for men, and only reversed for women following re-partnering.

    Another qualitative study investigating the lived experiences of heterosexual couples post-grey divorce identified financial worries as a common theme between female participants.

    A female research participant (age 68) said:

    [I am most worried about] the money, [and] what I’m going to do when the little bit of money I have runs out […] I have just enough money to live. And, that’s it, [and if] anything happens I’m up a creek. And Medicare is incredibly expensive […] My biggest expense is medicine.

    Another factor was loneliness. One male research participant (age 54) described he preferred living with his ex-wife, despite not getting along with her, than being by himself:

    It was still [good] knowing that [the] person was there, and now that’s gone.

    Other major complications of later-life divorce are possible issues with inheritance rights and next-of-kin relationships for medical decision-making.

    Separation can be positive

    For some people, divorce or separation can lead to increased happiness and feeling more independent.

    And the mental health impact and emotional distress of a relationship dissolution is something that can be counterattacked with resilience. Resilience to dramatic events built from life experience means older adults often do respond better to emotional distress and might be able to adjust better to divorce than their younger counterparts.The Conversation

    Raquel Peel, Adjunct Senior Lecturer, University of Southern Queensland and Senior Lecturer, RMIT University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Healing Back Pain – by Dr. John Sarno

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Often when we review books with titles like this one, we preface it with a “what it’s not: a think-yourself-better book”.

    In this case… It is, in fact, a think-yourself-better book. However, its many essay-length rave reviews caught our attention, and upon reading, we can report: its ideas are worth reading.

    The focus of this book is on TMS, or “Tension Myoneural Syndrome”, to give it its full name. The author asserts (we cannot comment on the accuracy) that many cases of TMS are misdiagnosed as other things, from sciatica to lupus. When other treatments fail, or are simply not available (no cure for lupus yet, for example) or are unenticing (risky surgeries, for example), he offers an alternative approach.

    Dr. Sarno lays out the case for TMS being internally fixable, since our muscles and nerves are all at the command of our brain. Rather than taking a physical-first approach, he takes a psychological-first approach, before building into a more holistic model.

    The writing style is… A little dated and salesey and unnecessarily padded, to be honest, but the content makes it worthwhile.

    Bottom line: if you have back pain, then the advice of this book, priced not much more than a box of top brand painkillers, seems a very reasonable thing to try.

    Click here to check out Healing Back Pain, and see if it works for you!

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  • The Simple Six – by Clinton Dobbins

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We at 10almonds don’t believe in keeping things a mystery, so…

    “The Simple Six” are:

    1. the squat
    2. the goblet squat
    3. the hinge
    4. the kettlebell swing
    5. the push
    6. the push-up
    7. the kettle-bell press
    8. the pull
    9. the chin-up
    10. the gait, and
    11. walking.

    Ok, we’re being a little glib here because to be fair, those are chunked into six groups, but the point is: don’t let the title fool you into thinking the book could have been an article; there’s plenty of valuable content here.

    That said, it is a short book (64 pages), but with an average of 10 pages per exercise type, it’s a lot more than for example we could ever put into our newsletter.

    Bottom line: we know that 10almonds readers like simple, clear, evidence-based, to-the-point health information, and that’s what this book is, so we do recommend it.

    Click here to check out The Simple Six, and streamline your workouts!

    Don’t Forget…

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    Learn to Age Gracefully

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  • Beating Sleep Apnea

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Healthier, Natural Sleep Without Obstruction!

    Obstructive Sleep Apnea, the sleep disorder in which one periodically stops breathing (and thus wakes up) repeatedly through the night, affects about 25% of men and 10% of women:

    Prevalence of Obstructive Sleep Apnea Syndrome: A Single-Center Retrospective Study

    Why the gender split?

    There are clues that suggest it is at least partially hormonal: once women have passed menopause, the gender split becomes equal.

    Are there other risk factors?

    There are few risk other factors; some we can’t control, and some we can:

    • Being older is riskier than being younger
    • Being overweight is riskier than not being overweight
    • Smoking is (what a shock) riskier than not smoking
    • Chronic respiratory diseases increase risk, for example:
      • Asthma
      • COPD
      • Long COVID*—probably. The science is young for this one so far, so we can’t say for sure until more research has been done.
    • Some hormonal conditions increase risk, for example:

    *However, patients already undergoing Continuous Positive Airway Pressure (CPAP) treatment for obstructive sleep apnea may have an advantage when fighting a COVID infection:

    Prolonged Effects of the COVID-19 Pandemic on Sleep Medicine Services—Longitudinal Data from the Swedish Sleep Apnea Registry

    What can we do about it?

    Avoiding the above risk factors, where possible, is great!

    If you are already suffering from obstructive sleep apnea, then you probably already know about the possibility of a CPAP device; it’s a mask that one wears to sleep, and it does what its name says (i.e. it applies continuous positive airway pressure), which keeps the airway open.

    We haven’t tested these, but other people have, so here are some that the Sleep Foundation found to be worthy of note:

    Sleep Foundation | Best CPAP Machines of 2024

    What can we do about it that’s not CPAP?

    Wearing a mask to sleep is not everyone’s preferred way to do things. There are also a plethora of surgeries available, but we’ll not review those, as those are best discussed with your doctor if necessary.

    However, some lifestyle changes can help, including:

    • Lose weight, if overweight. In particular, having a collar size under 16” for women or under 17” for men, is sufficient to significantly reduce the risk of obstructive sleep apnea.
    • Stop smoking, if you smoke. This one, we hope, is self-explanatory.
    • Stop drinking alcohol, or at least reduce intake, if you drink. People who consume alcohol tend to have more frequent, and longer, incidents of obstructive sleep apnea. See also: How To Reduce Or Quit Drinking
    • Avoid sedatives and muscle relaxants, if it is safe for you to do so. Obviously, if you need them to treat some other condition you have, talk this through with your doctor. But basically, they can contribute to the “airway collapses on itself” by reducing the muscular tension that keeps your airway the shape it’s supposed to be.
    • Sleep on your side, not your back. This is just plain physics, and a matter of wear the obstruction falls.
    • Breathe through your nose, not through your mouth. Initially tricky to do while sleeping, but the more you practice it while awake, the more it becomes possible while asleep.
    • Consider a nasal decongestant before sleep, if congestion is a problem for you, as that can help too.

    For more of the science of these, see:

    Cultivating Lifestyle Transformations in Obstructive Sleep Apnea

    There are more medical options available not discussed here, too:

    American Sleep Apnea Association | Sleep Apnea Treatment Options

    Take care!

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  • Is Ant Oil Just “Snake Oil”?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We Tested Out “Ant Egg Oil”

    Did you know?! There’s a special protein found only in the eggs of a particular species of ant found in Turkey, that can painlessly and permanently stop (not just slow!) hair regrowth in places you’d rather not have hair.

    Neither did we, and when we heard about it, we did our usual research, and discovered a startling secret.

    …there probably isn’t.

    We decided to dig deeper, and the plot (unlike the hair in question) thickens:

    We could not find any science for or against (or even generally about) the use of ant egg oil to prevent hair regrowth. Not a peep. What we did find though was a cosmetic chemist who did an analysis of the oil as sold, and found its main ingredient appears to be furan-2-carbaldehyde, or Furfural, to its friends.

    Surprise! There’s also no science that we could find about the effect of Furfural (we love the name, though! Fur for all!) on hair, except that it’s bad for rodents (and their hair) if they eat a lot of it. So please don’t eat it. Especially if you’re a mouse.

    And yet, many ostensibly real reviews out in the wild claim it works wonders. So, we took the investigative reporting approach and tried it ourselves.

    That’s right, a plucky member of our team tried it, and she reports:

    ❝ At first glance, it seems like olive oil. There’s something else though, adding a darker colour and a slight bitterness to the smell.

    After waxing, I applied a little every few days. When the hair eventually regrew (and it did), it grew back thinner, and removing the new hairs was a strangely easy experience, like pulling hairs out of soft soap instead of out of skin. It didn’t hurt at all, either.

    I had more of the oil, so I kept going with the treatment, and twelve weeks later there are very few hairs regrowing at all; probably there will be none left soon. Whatever’s in this, be it from ant eggs or wheat bran or something else entirely, it worked for me!❞

    So in short: it remains a mystery for now! If you try it, let us know how it went for you.

    Here’s the “interesting” website that sells it, though you may find it for less on eBay or similar. (Note, we aren’t earning any commissions from these links. We just wanted to make it easier for you to dive deeper).

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    Learn to Age Gracefully

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