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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Hearing voices is common and can be distressing. Virtual reality might help us meet and ‘treat’ them
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Have you ever heard something that others cannot – such as your name being called? Hearing voices or other noises that aren’t there is very common. About 10% of people report experiencing auditory hallucinations at some point in their life.
The experience of hearing voices can be very different from person to person, and can change over time. They might be the voice of someone familiar or unknown. There might be many voices, or just one or two. They can be loud or quiet like a whisper.
For some people these experiences are positive. They might represent a spiritual or supernatural experience they welcome or a comforting presence. But for others these experiences are distressing. Voices can be intrusive, negative, critical or threatening. Difficult voices can make a person feel worried, frightened, embarrassed or frustrated. They can also make it hard to concentrate, be around other people and get in the way of day-to-day activities.
Although not everyone who hears voices has a mental health problem, these experiences are much more common in people who do. They have been considered a hallmark symptom of schizophrenia, which affects about 24 million people worldwide.
However, such experiences are also common in other mental health problems, particularly in mood- and trauma-related disorders (such as bipolar disorder or depression and post-traumatic stress disorder) where as many as half of people may experience them.
Rawpixel/Shutterstock Why do people hear voices?
It is unclear exactly why people hear voices but exposure to prolonged stress, trauma or depression can increase the chances.
Some research suggests people who hear voices might have brains that are “wired” differently, particularly between the hearing and speaking parts of the brain. This may mean parts of our inner speech can be experienced as external voices. So, having the thought “you are useless” when something goes wrong might be experienced as an external person speaking the words.
Other research suggests it may relate to how our brains use past experiences as a template to make sense of and make predictions about the world. Sometimes those templates can be so strong they lead to errors in how we experience what is going on around us, including hearing things our brain is “expecting” rather than what is really happening.
What is clear is that when people tell us they are hearing voices, they really are! Their brain perceives voice experiences as if someone were talking in the room. We could think of this “mistake” as working a bit like being susceptible to common optical tricks or visual illusions.
There may be differences in the brains of people who hear voices. Triff/Shutterstock Coping with hearing voices
When hearing voices is getting in the way of life, treatment guidelines recommend the use of medications. But roughly a third of people will experience ongoing distress. As such, treatment guidelines also recommend the use of psychological therapies such as cognitive behavioural therapy.
The next generation of psychological therapies are beginning to use digital technologies and virtual reality offers a promising new medium.
Avatar therapy allows a person to create a virtual representation of the voice or voices, which looks and sounds like what they are experiencing. This can help people regain power in the “relationship” as they interact with the voice character, supported by a therapist.
Jason’s experience
Aged 53, Jason (not his real name) had struggled with persistent voices since his early 20s. Antipsychotic medication had helped him to some extent over the years, but he was still living with distressing voices. Jason tried out avatar therapy as part of a research trial.
He was initially unable to stand up to the voices, but he slowly gained confidence and tested out different ways of responding to the avatar and voices with his therapist’s support.
Jason became more able to set boundaries, such as not listening to them for periods throughout the day. He also felt more able to challenge what they said and make his own choices.
Over a couple of months, Jason started to experience some breaks from the voices each day and his relationship with them started to change. They were no longer like bullies, but more like critical friends pointing out things he could consider or be aware of.
A screenshot from HekaVR, the software used in the Australian AMETHYST trial. HekaVR, CC BY-ND Gaining recognition
Following promising results overseas and its recommendation by the United Kingdom’s National Institute for Health and Care Excellence, our team has begun adapting the therapy for an Australian context.
We are trialling delivering avatar therapy from our specialist voices clinic via telehealth. We are also testing whether avatar therapy is more effective than the current standard therapy for hearing voices, based on cognitive behavioural therapy.
As only a minority of people with psychosis receive specialist psychological therapy for hearing voices, we hope our trial will support scaling up these new treatments to be available more routinely across the country.
We would like to acknowledge the advice and input of Dr Nadine Keen (consultant clinical psychologist at South London and Maudsley NHS Foundation Trust, UK) on this article.
Leila Jameel, Trial Co-ordinator and Research Therapist, Swinburne University of Technology; Imogen Bell, Senior Research Fellow and Psychologist, The University of Melbourne; Neil Thomas, Professor of Clinical Psychology, Swinburne University of Technology, and Rachel Brand, Senior Lecturer in Clinical Psychology, University of the Sunshine Coast
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How To Set Anxiety Aside
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How To Set Anxiety Aside
We’ve talked previously about how to use the “release” method to stop your racing mind.
That’s a powerful technique, but sometimes we need to be calm enough to use it. So first…
Breathe
Obviously. But, don’t underestimate the immediate power of focusing on your breath, even just for a moment.
There are many popular breathing exercises, but here’s one of the simplest and most effective, “4–4 breathing”:
- Breathe in for a count of four
- Hold for a count four
- Breathe out for a count of four
- Hold for a count of four
- Repeat
Depending on your lung capacity and what you’re used to, it may be that you need to count more quickly or slowly to make it feel right. Experiment with what feels comfortable for you, but the general goal should breathing deeply and slowly.
Identify the thing that’s causing you anxiety
We’ve also talked previously about how to use the RAIN technique to manage difficult emotions, and that’s good for handling anxiety too.
Another powerful tool is journaling.
Read: How To Use Journaling to Challenge Anxious Thoughts
If you don’t want to use any of those (very effective!) methods, that’s fine too—journaling isn’t for everyone.
You can leverage some of the same benefits by simply voicing your worries, even to yourself:
There’s an old folk tradition of “worry dolls”; these are tiny little dolls so small they can be kept in a pocket-size drawstring purse. Last thing at night, the user whispers their worries to the dolls and puts them back in their bag, where they will work on the person’s problem overnight.
We’re a health and productivity newsletter, not a dealer of magic and spells, but you can see how it works, right? It gets the worries out of one’s head, and brings about a helpful placebo effect too.
Focus on what you can control
- Most of what you worry about will not happen.
- Some of what you worry about may happen.
- Worrying about it will not help.
In fact, in some cases it may bring about what you fear, by means of the nocebo effect (like the placebo effect, but bad). Additionally, worrying drains your body and makes you less able to deal with whatever life does throw at you.
So while “don’t worry; be happy” may seem a flippant attitude, sometimes it can be best. However, don’t forget the other important part, which is actually focusing on what you can control.
- You can’t control whether your car will need expensive maintenance…
- …but you can control whether you budget for it.
- You can’t control whether your social event will go well or ill…
- …but you can control how you carry yourself.
- You can’t control whether your loved one’s health will get better or worse…
- …but you can control how you’re there for them, and you can help them take what sensible precautions they may.
…and so forth.
Look after your body as well!
Your body and mind are deeply reliant on each other. In this case, just as anxiety can drain your body’s resources, keeping your body well-nourished, well-exercised, and well-rested and can help fortify you against anxiety. For example, when it comes to diet, exercise, and sleep:
- Read: Fruit and vegetable intake is inversely associated with perceived stress across the adult lifespan
- Read: Exercise and anxiety: physical activity appears to be protective against anxiety disorders in clinical and non-clinical populations
- Read: Sleep problems predict and are predicted by generalized anxiety/depression
Don’t know where to start? How about the scientifically well-researched, evidence-based, 7-minute workout?
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Black Coffee vs Orange Juice – Which is Healthier?
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Our Verdict
When comparing black coffee to orange juice, we picked the coffee.
Why?
While this one isn’t a very like-for-like choice, it’s a choice often made, so it bears examining.
In favor of the orange juice, it has vitamins A and C and the mineral potassium, while the coffee contains no vitamins or minerals beyond trace amounts.
However, to offset that: drinking juice is one of the worst ways to consume sugar; the fruit has not only been stripped of its fiber, but also is in its most readily absorbable state (liquid), meaning that this is going to cause a blood sugar spike, which if done often can lead to insulin resistance, type 2 diabetes, non-alcoholic fatty liver disease, and more. Now, the occasional glass of orange juice (and resultant blood sugar spike) isn’t going to cause disease by itself, but everything we consume tips the scales of our health towards wellness or illness (or sometimes both, in different ways), and in this case, juice has a rather major downside that ought not be ignored.
In favor of the coffee, it has a lot of beneficial phytochemicals (mostly antioxidant polyphenols of various kinds), with no drawbacks worth mentioning unless you have a pre-existing condition of some kind.
Coffee can of course be caffeinated or decaffeinated, and we didn’t specify which here. Caffeine has some pros and cons that at worst, balance each other out, and whether or not it’s caffeinated, there’s nothing in coffee to offset the beneficial qualities of the antioxidants we mentioned before.
Obviously, in either case we are assuming consuming in moderation.
In short:
- orange juice has negatives that at least equal, if not outweigh, its positives
- coffee‘s benefits outweigh any drawbacks for most people
Want to learn more?
You might like to read:
- The Bitter Truth About Coffee (or is it?)
- Caffeine: Cognitive Enhancer Or Brain-Wrecker?
- Which Sugars Are Healthier, And Which Are Just The Same?
Take care!
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Practical Optimism – by Dr. Sue Varma
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We’ve written before about how to get your brain onto a more positive track (without toxic positivity), but there’s a lot more to be said than we can fit into an article, so here’s a whole book packed full with usable advice.
The subtitle claims “the art, science, and practice of…”, but mostly it’s the science of. If there’s art to be found here, then this reviewer missed it, and as for the practice of, well, that’s down to the reader, of course.
However, it is easy to use the contents of this book to translate science into practice without difficulty.
If you’re a fan of acronyms, initialisms, and other mnemonics (such as the rhyming “Name, Claim, Tame, and Reframe”), then you’ll love this book as they come thick and fast throughout, and they contribute to the overall ease of application of the ideas within.
The writing style is conversational but with enough clinical content that one never forgets who is speaking—not in the egotistical way that some authors do, but rather, just, she has a lot of professional experience to share and it shows.
Bottom line: if you’d like to be more optimistic without delving into the delusional, this book can really help a lot with that (in measurable ways, no less!).
Click here to check out Practical Optimism, and brighten up your life!
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The Kitchen Prescription – by Saliha Mahmood Ahmed
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One of the biggest challenges facing anyone learning to cook more healthily, is keeping it tasty. What to cook when your biggest comfort foods all contain things you “should” avoid?
Happily for us, Dr. Ahmed is here with a focus on comfort food that’s good for your gut health. It’s incidentally equally good for the heart and good against diabetes… but Dr. Ahmed is a gastroenterologist, so that’s where she’s coming from with these.
There’s a wide range of 101 recipes here, including many tagged vegetarian, vegan, and/or gluten-free, as appropriate.
While this is not a vegetarian cookbook, Dr. Ahmed does consider the key components of a good diet to be, in order of quantity that should be consumed:
- Fruits and vegetables
- Whole grains
- Legumes
- Pulses
- Nuts and seeds
…and as such, the recipes are mostly plant-based.
The recipes are from all around the world, and/but the ingredients are mostly things that are almost universal. In the event that something might be hard-to-get, she suggests an appropriate substitution.
The recipes are straightforward and clear, as well as being beautifully illustrated.
All in all, a fine addition to anyone’s kitchen!
Get your copy of The Kitchen Prescription from Amazon today!
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What Menopause Does To The Heart
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World Menopause Day: Menopause & Cardiovascular Disease Risk
Today, the 18th of October, is World Menopause Day.
The theme for this year is cardiovascular disease (CVD), and if your first reaction is to wonder what that has to do with the menopause, then this is the reason why it’s being featured. Much of the menopause and its effects are shrouded in mystery; not because of a lack of science (though sometimes a bit of that too), but rather, because it is popularly considered an unimportant, semi-taboo topic.
So, let’s be the change we want to see, and try to fix that!
What does CVD have to do with the menopause?
To quote Dr. Anjana Nair:
❝The metabolic and clinical factors secondary to menopause, such as dyslipidemia, insulin resistance, fat redistribution and systemic hypertension, contribute to the accelerated risk for cardiovascular aging and disease.
Atherosclerosis appears to be the end result of the interaction between cardiovascular risk factors and their accentuation during the perimenopausal period.
The increased cardiovascular risk in menopause stems from the exaggerated effects of changing physiology on the cardiovascular system.❞
Source: Cardiovascular Changes in Menopause
See also: Menopause-associated risk of cardiovascular disease
Can we do anything about it?
Yes, we can! Here be science:
- Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association
- Cardiovascular risk in menopausal women and our evolving understanding of menopausal hormone therapy: risks, benefits, and current guidelines for use
This (in few words: get your hormone levels checked, and consider HRT if appropriate) is consistent with the advice from gynecologist Dr. Jen Gunter, whom we featured back in August:
What You Should Have Been Told About The Menopause Beforehand
What about lifestyle changes?
We definitely can do some good things; here’s what the science has to say:
- Mediterranean diet: yes, evidence-based
- High soy consumption: mixed evidence, unclear. So, eat it if you want, don’t if you don’t.
- Supplements e.g. vitamins and minerals: yes, evidence-based.
- Supplements e.g. herbal preparations: many may help, but watch out for adverse interactions with meds. Check with your pharmacist or doctor.
- Supplements; specifically CBD: not enough evidence yet
- Exercise: yes, evidence-based—especially low-impact high-resistance training, for bone strength, as well as regular moderate-intensity exercise and/or High-Intensity Interval Training, to guard against CVD.
For a full low-down on all of these:
Revealing the evidence-based lifestyle solutions to managing your menopause symptoms
Want to know more?
You can get the International Menopause Society’s free downloadable booklet here:
Menopause & Cardiovascular Disease: What Women Need To Know
You may also like our previous main feature:
What Does “Balance Your Hormones” Even Mean?
Take care!
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