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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Apple vs Pineapple – Which is Healthier?
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Our Verdict
When comparing apple to pineapple, we picked the pineapple.
Why?
An apple a day may keep the doctor away, but pineapples are heavier and armored and spiky and generally much more intimidating.
More seriously, apples are great but we say pineapples have the better nutritional and phytochemical properties overall:
In terms of macros, actually apples win this first round, albeit marginally; the two fruits are equal on carbs, while apple has a little more fiber and pineapple has a (very) little more protein. This makes the fiber content the deciding factor, so apples do win this one, even if by just 1g/100g difference.
When it comes to vitamins, however, apples have more of vitamins E and K, while pineapple has more of vitamins A, B1, B2, B3, B5, B6, B7, B9, C, and choline. The margins of difference are equally generous on both sides, so this is a clear and overwhelming win for pineapple (including 10x more vitamin C than apples, which are themselves considered a good source of vitamin C)
In the category of minerals, apples have slightly more phosphorus, and pineapple has a lot more calcium, copper, iron, magnesium, manganese, potassium, selenium, and zinc. Another easy win for pineapple.
Pineapples are not only also higher in polyphenols, but also contain bromelain, a powerful anti-inflammatory group of enzymes that are unique to pineapple—you can read about it in the link below!
Meanwhile, pineapple wins the day in our head-to-head here, but as ever when it comes to a plurality of healthy things, do enjoy either or both! Diversity is good.
Want to learn more?
You might like to read:
Bromelain vs Inflammation & Much More
Enjoy!
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HBD: The Human Being Diet – by Petronella Ravenshear
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We don’t often review diet books, so why did this one catch our attention? The answer lies in its comprehensive nature without being excessively long and complex.
Ravenshear (a nutritionist) brings a focus on metabolic balance, and what will and won’t work for keeping it healthy.
The first part of the book is mostly informational; covering such things as blood sugar balance, gut health, hormones, and circadian rhythm considerations, amongst others.
The second, larger part of the book is mostly instructional; do this and that, don’t do the other, guidelines on quantities and timings, and what things may be different for some people, and what to do about those.
The style is conversational and light, but well-grounded in good science.
Bottom line: if you’d like a “one-stop shop” for giving your diet an overhaul, this book is a fine choice.
Click here to check out the Human Being Diet, and enjoy the best of health!
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Should You Shower Daily?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
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
❝I read an article that daily showering is “performative” and doesn’t really give any health benefits, what do you say?❞
We looked to find the article you might be referring to, and this seems to be about a BBC article that was then picked up, rehashed in fewer (but more sensational) words, and widely popularized by the New York Post (not the most scholarly of publications, but it seems to have “done numbers”).
Here’s the BBC article:
BBC | There’s no need to shower every day—here’s why
Looking for the science behind the “Experts say…” claims, none of the articles we found linked to any new research. One of them did link to some old (2005) research:
We also see (in the dearth of scholarly research to cite), a Harvard Health article being cited quite a bit, and this is more helpful and informative than the flashy news articles, without requiring to read through a lot of hard science.
To summarize, Harvard’s Dr. Shmerling says daily showering can:
- Cause/worsen dry skin
- Make skin more permeable to pathogens
- Upset our natural balance of bacteria that are supposed to be there
- Weaken our immune system
Read in full: Harvard Health | Showering daily—is it necessary?
But what if I like showering?
Well, don’t let us stop you. But you might consider using less in the way of shower products. We wrote about this previously, in answer to a different-but-related subscriber question:
10almonds | Body Scrubs: Benefits, Risks, and Guidance
PS…
Handwashing, though? Most people could reasonably do that more often:
Would you like this section to be bigger? If so, send us more questions!
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Fruit, Fiber, & Leafy Greens… On A Low-FODMAP Diet!
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Fiber For FODMAP-Avoiders
First, let’s quickly cover: what are FODMAPs?
FODMAPs are fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.
In plainer English: they’re carbohydrates that are resistant to digestion.
This is, for most people most of the time, a good thing, for example:
When Is A Fiber Not A Fiber? When It’s A Resistant Starch.
Not for everyone…
However, if you have inflammatory bowel syndrome (IBS), including ulcerative colitis, Crohn’s disease, or similar, then suddenly a lot of common dietary advice gets flipped on its head:
While digestion-resistant carbohydrates making it to the end parts of our digestive tract are good for our bacteria there, in the case of people with IBS or similar, it can be a bit too good for our bacteria there.
Which can mean gas (a natural by-product of bacterial respiration) accumulation, discomfort, water retention (as the pseudo-fiber draws water in and keeps it), and other related symptoms, causing discomfort, and potentially disease such as diarrhea.
Again: for most people this is not so (usually: quite the opposite; resistant starches improve things down there), but for those for whom it’s a thing, it’s a Big Bad Thing™.
Hold the veg? Hold your horses.
A common knee-jerk reaction is “I will avoid fruit and veg, then”.
Superficially, this can work, as many fruit & veg are high in FODMAPs (as are fermented dairy products, by the way).
However, a diet free from fruit and veg is not going to be healthy in any sustainable fashion.
There are, however, options for low-FODMAP fruit & veg, such as:
Fruits: bananas (if not overripe), kiwi, grapefruit, lemons, limes, melons, oranges, passionfruit, strawberries
Vegetables: alfalfa, bell peppers, bok choy, carrots, celery, cucumbers, eggplant, green beans, kale, lettuce, olives, parsnips, potatoes (and sweet potatoes, yams etc), radishes, spinach, squash, tomatoes*, turnips, zucchini
*our stance: botanically it’s a fruit, but culinarily it’s a vegetable.
For more on the science of this, check out:
Strategies for Producing Low FODMAPs Foodstuffs: Challenges and Perspectives ← table 2 is particularly informative when it comes to the above examples, and table 3 will advise about…
Bonus
Grains: oats, quinoa, rice, tapioca
…and wheat if the conditions in table 3 (linked above) are satisfied
(worth mentioning since grains also get a bad press when it comes to IBS, but that’s mostly because of wheat)
See also: Gluten: What’s The Truth?
Enjoy!
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Feta Cheese vs Mozzarella – Which is Healthier?
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Our Verdict
When comparing feta to mozzarella, we picked the mozzarella.
Why?
There are possible arguments for both, but there are a couple of factors that we think tip the balance.
In terms of macronutrients, feta has more fat, of which, more saturated fat, and more cholesterol. Meanwhile, mozzarella has about twice the protein, which is substantial for a cheese. So this section’s a fair win for mozzarella.
In the category of vitamins, however, feta wins with more of vitamins B1, B2, B3, B6, B9, B12, D, & E. In contrast, mozzarella boasts only a little more vitamin A and choline. An easy win for feta in this section.
When it comes to minerals, the matter is decided, we say. Mozzarella has more calcium, magnesium, phosphorus, and potassium, while feta has more copper, iron, and (which counts against it) sodium. A win for mozzarella.
About that sodium… A cup of mozzarella contains about 3% of the RDA of sodium, while a cup of feta contains about 120% of the RDA of sodium. You see the problem? So, while mozzarella was already winning based on adding up the previous categories, the sodium content alone is a reason to choose mozzarella for your salad rather than feta.
That settles it, but just before we close, we’ll mention that they do both have great gut-healthy properties, containing healthy probiotics.
In short: if it weren’t for the difference in sodium content, this would be a narrow win for mozzarella. As it is, however, it’s a clear win.
Want to learn more?
You might like to read:
- Making Friends With Your Gut (You Can Thank Us Later)
- Is Dairy Scary? ← the answer is “it can be, but it depends on the product, and some are healthy; the key is in knowing which”
- How Too Much Salt May Lead To Organ Failure
Take care!
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Ageless Aging – by Maddy Dychtwald
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Maddy Dychtwald, herself 73, has spent her career working in the field of aging. She’s not a gerontologist or even a doctor, but she’s nevertheless been up-to-the-ears in the industry for decades, mostly as an organizer, strategist, facilitator, and so forth. As such, she’s had her finger on the pulse of the healthy longevity movement for a long time.
This book was written to address a problem, and the problem is: lifespan is increasing (especially for women), but healthspan has not been keeping up the pace.
In other words: people (especially women) are living longer, but often with more health problems along the way than before.
And mostly, it’s for lack of information (or sometimes: too much competing incorrect information).
Fortunately, information is something that a woman in Dychtwald’s position has an abundance of, because she has researchers and academics in many fields on speed-dial and happy to answer her questions (we get a lot of input from such experts throughout the book—which is why this book is so science-based, despite the author not being a scientist).
The book answers a lot of important questions beyond the obvious “what diet/exercise/sleep/supplements/etc are best for healthy aging” (spoiler: it’s quite consistent with the things we recommend here, because guess what, science is science), questions like how best to prepare for this that or the other, how to get a head start on preventative healthcare for some things, how to avoid being a burden to our families (one can argue that families are supposed to look after each other, but still, it’s a legitimate worry for many, and understandably so), and even how to balance the sometimes conflicting worlds of health and finances.
Unlike many authors, she also talks about the different kinds of aging, and tackles each of them separately and together. We love to see it!
Bottom line: this book is a very good one-stop-shop for all things healthy aging. It’s aimed squarely at women, but most advice goes for men the same too, aside from the section on hormones and such.
Click here to check out Ageless Aging, and plan your future!
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