Ketogenic diet

A recent low carb study engaged in outcome switching to obtain the desired result.

No Significant Effect of Dietary Carbohydrate versus Fat on the Reduction in Total Energy Expenditure During Maintenance of Lost Weight: A Secondary Analysis

Kevin D Hall, Juen Guo

Abstract
The question of whether the ratio of dietary carbohydrates to fat substantially impacts total energy expenditure (TEE) or body fat has been investigated for decades, with most studies pointing to no clinically meaningful effect.

However, a recent study by Ebbeling et al. (https://doi.org/10.1136/bmj.k4583) reported substantial differences in TEE between diets varying in their ratio of carbohydrate to fat. The original pre-registered statistical analysis plan for the primary study outcome of Ebbeling et al. addressed the question of whether the reduction in TEE during weight loss maintenance compared to the pre-weight loss baseline depended on the dietary carbohydrate to fat ratio. However, the final analysis plan was modified to make the diet comparisons with the TEE measurements collected in the immediate post-weight loss period rather than at the pre-weight loss baseline.

Here, we reanalyzed the data according to the original plan we found that the TEE differences were no longer statistically significant between the diet groups and the nominal diet differences of ~100 kcal/d were much smaller than the ~250 kcal/d differences reported in the publication. In other words, when conducting the analysis originally planned by the authors we found that the significant increases in TEE with the low carbohydrate diet that were reported by Ebbeling et al. disappeared. Furthermore, the TEE effect modification by baseline insulin secretion also disappeared.
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https://www.biorxiv.org/content/early/2018/11/28/476655
 
Not directly related to Keto but didn't know which thread to put it on.

I caught some of this program (didn't watch it all) but it was interesting, particularly the stuff on resistant starch and the exercise test that the presenter did.
It's available on iPlayer
Xand and a team of volunteers play 'blood sugar bingo' as they attempt to guess how much sugar a selection of common foods each releases into the bloodstream. Xand discovers that looks can be deceiving - a baked potato is the equivalent of a staggering 19 sugar lumps, whereas a large bowl of strawberries is only four. There is also a simple test that anyone can do at home to determine how well they tolerate starchy carbs like rice, pasta and bread. Simply chew a small, unsalted cracker and time how long it takes to change taste in the mouth.
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The film then sets out to examine whether it is still possible to eat carbs, but in a way that is much healthier for us. There is a little-known type of carbohydrate called resistant starch; like fibre, it helps keep bowel cancer at bay. But a medical exam reveals that, like most people in the UK, Xand doesn't eat enough of this carb. So how should he go about eating more carbs like fibre and resistant starch?
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The programme turns the myth about bread on its head, discovering bakes that are good for us. There is even a way of making white bread healthier by sticking it in the freezer before toasting it - this process turns some of the sugary starch into resistant starch. Scientists have discovered that other starchy carbs like pasta, rice and potatoes can be changed in a very simple way to make them better for us, by cooking and cooling - they become less calorific and vital food for our gut bacteria.

There is a surprise in store for Xand when he heads to the gym with his favourite carb-filled sports drink. He discovers that for exercise lasting less than an hour, there is a very neat trick that fools the brain into thinking that it is going to get carbs, which improves performance. All he has to do is swill the drink and spit it out.

But perhaps most importantly, the programme teams up with a Merseyside GP to trial a healthy-eating plan. Originally devised to help diabetic and obese patients, this plan doesn't count calories but asks participants to be smart with their carbs - swapping 'sugary' carbs for more fibre. The results after just two weeks come as a surprise to Xand and the trial doctors.
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https://www.bbc.co.uk/iplayer/episode/b0b5y6c0/the-truth-about-17-carbs
 
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Cheshire said:
How are you doing all those who tried to go keto?
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It's interesting re-reading this thread, I think.

I did keto for a good, long while, but I struggled sometimes to get the macros right (I was eating too much protein) and over-compensated by adding in too much coconut oil. As a result, I definitely gained weight towards the end when I slackened off.

When I was doing keto, my cholesterol and fasting glucose levels were better. I wasn't over the references ranges. I now don't seem to get the awful blood sugar dips I used to get, either, and that's a benefit that seems to persist (mostly; see below).

Reflecting back on things, I wonder if those of us with certain diabetes-like symptoms but without clinical results to match actually have co-morbid metabolic syndrome, and that it's that responding to keto.

I definitely store weight around my middle, and have a family history of diabetes and related things like polycystic ovaries. I think the American CFIDS charity (I forget the name) highlighted metabolic syndrome as a common co-morbidity, though I haven't seen it referenced elsewhere.

I'm still not eating huge amounts of carbs anyway (maybe two slices of small toast every other day, the odd sweet potato, a bit of butternut squash), but I do let myself eat potatoes, pasta and bread again, in moderation. If I eat sugary things, though, I do feel wretched for a bit afterwards.

Do I think it helped me? Yes, a little, but only for the metabolic syndrome-type symptoms. It hasn't really impacted anything else. Obviously, YMMV and this is all strictly IMO. I know others who've not responded well at all (e.g., the high fat content can be hard on your gut; especially if you get IBS-D symptoms).

Also, it can be hard to plan around, especially if you're away from home, and the calculating and weighing isn't really ME-friendly.
 
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adambeyoncelowe said:
It's interesting re-reading this thread, I think.

I did keto for a good, long while, but I struggled sometimes to get the macros right (I was eating too much protein) and over-compensated by adding in too much coconut oil. As a result, I definitely gained weight towards the end when I slackened off.

When I was doing keto, my cholesterol and fasting glucose levels were better. I wasn't over the references ranges. I now don't seem to get the awful blood sugar dips I used to get, either, and that's a benefit that seems to persist (mostly; see below).

Reflecting back on things, I wonder if those of us with certain diabetes-like symptoms but without clinical results to match actually have co-morbid metabolic syndrome, and that it's that responding to keto.

I definitely store weight around my middle, and have a family history of diabetes and related things like polycystic ovaries. I think the American CFIDS charity (I forget the name) highlighted metabolic syndrome as a common co-morbidity, though I haven't seen it referenced elsewhere.

I'm still not eating huge amounts of carbs anyway, but I do let myself eat potatoes, pasta and bread again, in moderation. If I eat sugary things, though, I do feel wretched for a bit afterwards.

Do I think it helped me? Yes, a little, but only for the metabolic syndrome-type symptoms. It hasn't really impacted anything else. Obviously, YMMV and this is all strictly IMO. I know others who've not responded well at all (e.g., the high fat content can be hard on your gut; especially if you get IBS-D symptoms).

Also, it can be hard to plan around, especially if you're away from home, and the calculating and weighing isn't really ME-friendly.
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I also meant to add, I've read a few things recently that suggest that even diets of moderate-to-low carbs (say, 100-150g per day) can have a beneficial effect without going the whole hog. It might just be what we've known all along: that starchy foods are better than simple sugars at keeping our blood sugar levels even.
 
I’m still eating keto/low carb. Have been eating this way about 15 months now, have lost about 15lbs without feeling hungry (this was weight I had recently gained), and my weight has now been stable for the last 8 months, again without having to feel I am actively curtailing the amount I eat.

I had been on a downturn physically when I started keto, and that dip reversed in the first few months on keto. I had hoped the upward trend would continue, but in reality it has not really given me extra stamina from the approximate wobbly level of functioning I’ve had over the past 3 or 4 years. Who knows if keto has actually helped, but this way of eating seems to suit me, so I’m continuing.

In truth, I’m probably more “low carb” now than strict keto. I don’t eat bread, potatoes, rice, pasta, root veg, most fruit (other than a few berries) or anything with sugar in the recipe. However I take milk in my coffee (milk is actually quite high in lactose), and enjoy eating nuts as a treat. I don’t track my carbs in any meaningful way either.
 
Keela Too said:
I’m still eating keto/low carb. Have been eating this way about 15 months now, have lost about 15lbs without feeling hungry (this was weight I had recently gained), and my weight has now been stable for the last 8 months, again without having to feel I am actively curtailing the amount I eat.

I had been on a downturn physically when I started keto, and that dip reversed in the first few months on keto. I had hoped the upward trend would continue, but in reality it has not really given me extra stamina from the approximate wobbly level of functioning I’ve had over the past 3 or 4 years. Who knows if keto has actually helped, but this way of eating seems to suit me, so I’m continuing.

In truth, I’m probably more “low carb” now than strict keto. I don’t eat bread, potatoes, rice, pasta, root veg, most fruit (other than a few berries) or anything with sugar in the recipe. However I take milk in my coffee (milk is actually quite high in lactose), and enjoy eating nuts as a treat. I don’t track my carbs in any meaningful way either.
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I think that's probably the best way to do it. Any diet has to feel intuitive/satisfying, or you won't stick to it.
 
adambeyoncelowe said:
Reflecting back on things, I wonder if those of us with certain diabetes-like symptoms but without clinical results to match actually have co-morbid metabolic syndrome, and that it's that responding to keto.
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This! I really don’t react well to sugary foods.

I also did some blood sugar testing a couple of years back and reckoned I was pre-diabetic. I have done a few spot blood sugar tests since starting keto/low carb, and the readings are now much better.
 
Cheshire said:
How are you doing all those who tried to go keto?
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It helps me with my post meal symptoms that come on from carbs so pretty good. Those symptoms where pretty brutal and I suspect it was nothing to do with gut problems or diabetes but problems with using glucose for energy. One of the reasons I believe this is because I can significantly attenuate symptoms by taking MCT with carbs.
 
sb4 said:
It helps me with my post meal symptoms that come on from carbs so pretty good. Those symptoms where pretty brutal and I suspect it was nothing to do with gut problems or diabetes but problems with using glucose for energy. One of the reasons I believe this is because I can significantly attenuate symptoms by taking MCT with carbs.
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I've always wondered if the post-prandial symptoms are possibly something else, as they don't feel the same as the blood sugar dips. Maybe hormonal (to do with wakefulness, fullness, hunger, etc).

You could be right about a general difficulty with metabolising carbs in some cases, though as some of the research posted earlier in this thread has suggested, there could equally be a flaw in fat metabolism too.

Maybe neither is universal, but perhaps represent possible subsets?
 
Sarah94 said:
I assumed it's just to do with energy being used on digestion and so less energy for other things?
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It could be that too. I was remembering that Cort maybe wrote something about orexin and/or leptin after eating? I can't seem to find that right now.

It might none of these things, or all of these things in different people, and we might never know. But I think it's an interesting clue.
 
adambeyoncelowe said:
You could be right about a general difficulty with metabolising carbs in some cases, though as some of the research posted earlier in this thread has suggested, there could equally be a flaw in fat metabolism too.

Maybe neither is universal, but perhaps represent possible subsets?
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If I remember right Ron T mentioned something about Harvard OMF group looking at carbohydrate and fat metabolism in the IIME video I watched in last day or so. Could have got that wrong tho my concentration is poor in the hot weather
 
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