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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  • Farmed Fish vs Wild Caught

    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.

    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    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 😎

    ❝Is it good to eat farm raised fish?❞

    We’ll answer this as a purely health-related question (and thus not considering economy, ecology, ethics, or taste).

    It’s certainly not as good as wild-caught fish, for several reasons, some more serious than others:

    Farmed fish can have quite a different nutritional profile to wild-caught fish, and also contain more contaminants, including heavy metals.

    For example, farmed fish tend to have much higher fat content for the same amount of protein, but lower levels of minerals and other nutrients. Here are two side-by-side:

    Wild-caught salmon | Farmed salmon

    See also:

    Quantitative analysis of the benefits and risks of consuming farmed and wild salmon

    Additionally, because fish in fish farms tend to be very susceptible to diseases (because of the artificially cramped and overcrowded environment), fish farms tend to make heavy use of antibiotics, which can cause all sorts of problems down the line:

    Extended antibiotic treatment in salmon farms select multiresistant gut bacteria with a high prevalence of antibiotic resistance genes

    So definitely, “let the buyer beware”!

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  • How gender-affirming care improves trans mental health

    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.

    In recent years, a growing number of states have passed laws restricting or banning gender-affirming care for transgender people, particularly minors. As conversations about gender-affirming care increase, so do false narratives about it, with some opponents falsely suggesting that it’s harmful to mental health.

    Despite widespread attacks against gender-affirming care, research clearly shows that it improves mental health outcomes for transgender people.

    Read on to learn more about what gender-affirming care is, how it benefits mental well-being, and how you can access it.

    What is gender-affirming care?

    Gender-affirming care describes a range of medical interventions that help align people’s bodies with their gender identities. While anyone can seek gender-affirming care in the form of laser hair removal, breast augmentation, erectile dysfunction medication, or hormone therapy, among other treatments, most conversations about gender-affirming care center around transgender people, whose gender identity or gender expression does not conform to their sex assigned at birth.

    Gender-affirming care for trans people varies based on age. For example, some trans adults seek hormone replacement therapy (HRT) or gender-affirming surgeries that help their bodies match their internal sense of gender.

    Trans kids entering adolescence might be prescribed puberty blockers, which temporarily delay the production of hormones that initiate puberty, to give them more time to figure out their gender identities before deciding on next steps. This is the same medication given to cisgender kids—whose gender identities match the sex they were assigned at birth—experiencing early puberty.

    What is gender dysphoria?

    Gender dysphoria describes a feeling of unease that some trans people experience when their perceived gender doesn’t match their gender identity. This can lead to a range of mental health conditions that affect their quality of life

    Some trans people may manage gender dysphoria by wearing gender-affirming clothing, opting for a gender-affirming hairstyle, or asking others to refer to them by a name and pronouns that authentically represent them. Others may need gender-affirming care to feel at home in their bodies.

    Trans people who desire gender-affirming care and have not been able to access it experience psychological distress, including depression, anxiety, self-harm, and suicidal ideation. The Trevor Project’s 2023 U.S. National Survey on the Mental Health of LGBTQ Young People found that roughly half of trans youth “seriously considered attempting suicide in the past year.”

    A grid shows 10 drawings of people in black and white. Seven of the people are highlighted in purple squares. Text on the image reads,

    How does gender-affirming care improve mental health?

    For trans adults, gender-affirming care can alleviate gender dysphoria, which has been shown to improve both short-term and long-term mental health. A 2018 study found that trans adults who do not undergo HRT are four times more likely to experience depression than those who do, although not all trans people desire HRT.

    Extensive research has shown that gender-affirming care also alleviates gender dysphoria and improves mental health outcomes in trans kids, teens, and young adults. A 2022 study found that access to HRT and puberty blockers lowered the odds of depression in trans people between the ages of 13 and 20 by 60 percent and reduced the risk of self-harm and suicidal thoughts by 73 percent.

    Both the Endocrine Society—which aims to advance hormone research—and the American Academy of Pediatrics recommend that trans kids and teens have access to developmentally appropriate gender-affirming care.

    How can I access gender-affirming care?

    If you’re a trans adult seeking gender-affirming care or a guardian of a trans kid or teen who’s seeking gender-affirming care, talk to your health care provider about your options. You can find a trans-affirming provider by searching the World Professional Association for Transgender Health directory or visiting your local LGBTQ+ health center or Planned Parenthood.

    Some gender-affirming care may not be covered by insurance. Learn how to make the most of your coverage from the National Center for Transgender Equality. Find insurance plans available through the Marketplace that cover gender-affirming care in some states through Out2Enroll.

    Some states restrict or ban gender-affirming care. Learn about the laws in your state by visiting the Trans Legislation Tracker.

    Where can trans people and their families find mental health support?

    In addition to working with a trans-affirming therapist, trans people and their families can find mental health support through these free services:

    • PFLAG offers resources for families and friends of LGBTQ+ people. Find a PFLAG chapter near you.
    • The Trevor Project’s hotline has trained counselors who help LGBTQ+ youth in crisis. Call the TrevorLifeline 1-866-488-7386 or text START to 678-678.
    • The Trans Lifeline was created by and for the trans community to support trans people in crisis. You can reach the Trans Lifeline hotline at 1-877-565-8860.

    For more information, talk to your health care provider.

    If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, call the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.

    This article first appeared on Public Good News and is republished here under a Creative Commons license.

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  • Older, Faster, Stronger – by Margaret Webb

    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.

    The author, now in her 60s, made it her mission in her 50s to become the best runner she could. Before that, she’d been a keen runner previously, but let things slip rather in her 40s. But the book’s not about her 40s, it’s about her 50s and onwards, and other female runners in their 50s, 60s, 70s, 80s, and even 90s.

    There’s a lot of this book that’s about people’s individual stories, and those should certainly be enough to prompt almost any reader that “if they can do it, I can”.

    A lot, meanwhile, is about health and exercise science, training methods, and what has worked for various later-life athletes, including the author. So, it’s also partway instruction manual, with plenty of reference to science and medical considerations too.

    Bottom line: sometimes, life throws us challenges. Sometimes, the best response is “Yeah? Bet” and surprise everyone.

    Click here to check out Older, Faster, Stronger, and become all those cool things!

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  • Edamame vs Brussels Sprouts – Which is Healthier?

    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.

    Our Verdict

    When comparing edamame to Brussels sprouts, we picked the edamame.

    Why?

    We were curious to see if something could unseat Brussels sprouts from the vegetable throne!

    In terms of macros, edamame have more than 3x the protein and and nearly 50% more fiber, for the same amount of carbs. An easy win for edamame.

    In the category of vitamins, edamame have more of vitamins B1, B2, B3, B5, B9, and choline, while Brussels sprouts have more of vitamins A, B6, C, E, and K, meaning a marginal 6:5 win for edamame this time.

    When it comes to minerals, things are quite one-sided: edamame have more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and zinc, while Brussels sprouts have more selenium. Another easy win for edamame!

    Adding up the sections makes it clear that edamame win the day, but of course, by all means, enjoy either or both; diversity is good!

    Want to learn more?

    You might like to read:

    What Do The Different Kinds Of Fiber Do? 30 Foods That Rank Highest

    Enjoy!

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  • Atomic Habits – by James Clear

    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.

    James Clear’s Atomic Habits has become “the” go-to book about the power of habit-forming. And, there’s no shortage of competition out there, so that’s quite a statement. What makes this book stand out?

    A lot of books start by assuming you want to build habits. That can seem a fair assumption; after all, we picked up the book! But an introductory chapter really hammers home the idea in a way that makes it a lot more motivational:

    • Habits are the compound interest of productivity
    • This means that progress is not linear, but exponential
    • Habits can also be stacked, and thus become synergistic
    • The more positive habits you add incrementally, the easier they become because each thing is making your life easier/better

    For example:

    • It’s easier to save money if you’re in good health
    • It’s easier to sleep better if you do not have financial worries
    • It’s easier to build your relationship with your loved ones if you’re not tired

    …and so on.

    For many people this presents a Catch-22 problem! Clear instead presents it as an opportunity… Start wherever you like, but just start small, with some two-minute thing, and build from there.

    A lot of the book is given over to:

    • how to form effective habits (using his “Four Laws”)
    • how to build them into your life
    • how to handle mishaps
    • how to make sure your habits are working for you
    • how to see habits as part of your identity, and not just a goal to be checked off

    The last one is perhaps key—goals cease to be motivating once accomplished. Habits, on the other hand, keep spiralling upwards (if you guide them appropriately).

    There’s lots more we could say, but it’s a one-minute book review, so we’ll just close by saying:

    This book can help you to become the kind of person who genuinely gets a little better each day, and reaps the benefits over time.

    Get your copy of Atomic Habits from Amazon today!

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  • Mental illness, psychiatric disorder or psychological problem. What should we call mental distress?

    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 talk about mental health more than ever, but the language we should use remains a vexed issue.

    Should we call people who seek help patients, clients or consumers? Should we use “person-first” expressions such as person with autism or “identity-first” expressions like autistic person? Should we apply or avoid diagnostic labels?

    These questions often stir up strong feelings. Some people feel that patient implies being passive and subordinate. Others think consumer is too transactional, as if seeking help is like buying a new refrigerator.

    Advocates of person-first language argue people shouldn’t be defined by their conditions. Proponents of identity-first language counter that these conditions can be sources of meaning and belonging.

    Avid users of diagnostic terms see them as useful descriptors. Critics worry that diagnostic labels can box people in and misrepresent their problems as pathologies.

    Underlying many of these disagreements are concerns about stigma and the medicalisation of suffering. Ideally the language we use should not cast people who experience distress as defective or shameful, or frame everyday problems of living in psychiatric terms.

    Our new research, published in the journal PLOS Mental Health, examines how the language of distress has evolved over nearly 80 years. Here’s what we found.

    Engin Akyurt/Pexels

    Generic terms for the class of conditions

    Generic terms – such as mental illness, psychiatric disorder or psychological problem – have largely escaped attention in debates about the language of mental ill health. These terms refer to mental health conditions as a class.

    Many terms are currently in circulation, each an adjective followed by a noun. Popular adjectives include mental, mental health, psychiatric and psychological, and common nouns include condition, disease, disorder, disturbance, illness, and problem. Readers can encounter every combination.

    These terms and their components differ in their connotations. Disease and illness sound the most medical, whereas condition, disturbance and problem need not relate to health. Mental implies a direct contrast with physical, whereas psychiatric implicates a medical specialty.

    Mental health problem, a recently emerging term, is arguably the least pathologising. It implies that something is to be solved rather than treated, makes no direct reference to medicine, and carries the positive connotations of health rather than the negative connotation of illness or disease.

    Therapist talks to young man
    Is ‘mental health problem’ actually less pathologising? Monkey Business Images/Shutterstock

    Arguably, this development points to what cognitive scientist Steven Pinker calls the “euphemism treadmill”, the tendency for language to evolve new terms to escape (at least temporarily) the offensive connotations of those they replace.

    English linguist Hazel Price argues that mental health has increasingly come to replace mental illness to avoid the stigma associated with that term.

    How has usage changed over time?

    In the PLOS Mental Health paper, we examine historical changes in the popularity of 24 generic terms: every combination of the nouns and adjectives listed above.

    We explore the frequency with which each term appears from 1940 to 2019 in two massive text data sets representing books in English and diverse American English sources, respectively. The findings are very similar in both data sets.

    The figure presents the relative popularity of the top ten terms in the larger data set (Google Books). The 14 least popular terms are combined into the remainder.

    Relative popularity of alternative generic terms in the Google Books corpus. Haslam et al., 2024, PLOS Mental Health.

    Several trends appear. Mental has consistently been the most popular adjective component of the generic terms. Mental health has become more popular in recent years but is still rarely used.

    Among nouns, disease has become less widely used while illness has become dominant. Although disorder is the official term in psychiatric classifications, it has not been broadly adopted in public discourse.

    Since 1940, mental illness has clearly become the preferred generic term. Although an assortment of alternatives have emerged, it has steadily risen in popularity.

    Does it matter?

    Our study documents striking shifts in the popularity of generic terms, but do these changes matter? The answer may be: not much.

    One study found people think mental disorder, mental illness and mental health problem refer to essentially identical phenomena.

    Other studies indicate that labelling a person as having a mental disease, mental disorder, mental health problem, mental illness or psychological disorder makes no difference to people’s attitudes toward them.

    We don’t yet know if there are other implications of using different generic terms, but the evidence to date suggests they are minimal.

    Dark field
    The labels we use may not have a big impact on levels of stigma. Pixabay/Pexels

    Is ‘distress’ any better?

    Recently, some writers have promoted distress as an alternative to traditional generic terms. It lacks medical connotations and emphasises the person’s subjective experience rather than whether they fit an official diagnosis.

    Distress appears 65 times in the 2022 Victorian Mental Health and Wellbeing Act, usually in the expression “mental illness or psychological distress”. By implication, distress is a broad concept akin to but not synonymous with mental ill health.

    But is distress destigmatising, as it was intended to be? Apparently not. According to one study, it was more stigmatising than its alternatives. The term may turn us away from other people’s suffering by amplifying it.

    So what should we call it?

    Mental illness is easily the most popular generic term and its popularity has been rising. Research indicates different terms have little or no effect on stigma and some terms intended to destigmatise may backfire.

    We suggest that mental illness should be embraced and the proliferation of alternative terms such as mental health problem, which breed confusion, should end.

    Critics might argue mental illness imposes a medical frame. Philosopher Zsuzsanna Chappell disagrees. Illness, she argues, refers to subjective first-person experience, not to an objective, third-person pathology, like disease.

    Properly understood, the concept of illness centres the individual and their connections. “When I identify my suffering as illness-like,” Chappell writes, “I wish to lay claim to a caring interpersonal relationship.”

    As generic terms go, mental illness is a healthy option.

    Nick Haslam, Professor of Psychology, The University of Melbourne and Naomi Baes, Researcher – Social Psychology/ Natural Language Processing, The University of Melbourne

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

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