More Defending of The Indefensible Ketogenic Diet

Michael Carrato, one of my readers, didn’t like what I had to say about his ketogenic diet regimen.  Carrato writes:

Are you saying that a ketogenic diet CANNOT reverse diabetes and improve markers for CHD? Because it seems that the position of the anti-fat crowd is that keto is positively incompatible with good health, that low fat is the only pathway to curing metabolic illness. Peter Attia and Gary Taubes have challenged that dogma and produced plenty of evidence that the case against fat has NOT BEEN PROVEN sufficiently. In fact, for many people, low carb has been literally a life saver. Count me among them, BTW, so you can fully assess my bias.

I’ve discussed the absolutely massive amount of flaws in Peter Attia’s and Gary Taubes’ lectures here.

Ketogenic diets may improve biomarkers for diabetes and heart disease due to the weight loss they induce. However, some people will be genetically disposed to have worsening atherosclerosis when on a high fat diet, even with associated weight loss and improved blood lipids.

Long term prospective studies done on children who are placed on a ketogenic diet for the treatment of epilepsy show a wide range of side effects, with the most common two being gastrointestinal disturbances (40.6%) and hyperlipidemia (12.8%).

Studies on children and adults have shown increased arterial stiffness on ketogenic diets.  Saturated fat has been directly observed to cause inflammation, as well as impair endothelial function.  So even though ketogenic diets tend to improve lipid profiles, the diet can still damage the arteries.

There have been no prospective studies using coronary artery calcium scans showing that a ketogenic diet can reverse heart disease the way a low fat whole food plant based diet can.  If you follow a ketogenic diet, I highly recommend you get regular coronary calcium scans to ensure you don’t have progressing arterial disease.

Further, there are no long term studies that compare cardiovascular incidents between groups of vegans and people on long term ketogenic diets.  While some studies have shown improvement in biomarkers for people on ketogenic diets, that doesn’t mean they are as good as a vegan diet when it comes to lowering disease risk long term.

When vegans are compared to healthy meat eaters who eat small portions of meat compared to the average population, the vegans have significantly lower rates of cancer, diabetes and heart disease; this was proven in the AHS2 study.

We also know that meat, in particular processed meat, is a known carcinogen.   The current evidence for the carcinogenicity of processed meat places it in the same category of evidence as cigarettes. Animal protein is known to increase IGF-1, a cancer promoting hormone.  When we compare meat eaters to vegans and vegetarians, the vegans have the lowest levels of IGF-1.   We also know that cooked meats produce heterocyclic amines, which are also a known carcinogen.

So I’ve just linked several studies showing how a ketogenic diet, high in saturated fat, can impair endothelial function, stiffen the arteries, increase inflammation and promote cancer growth.  I’m sure you will ignore these as minor side-effects that can be dismissed though – because what matters to you most is not being fat while getting to consume a mountain of animal protein – right?

We know that when people are put on an ad libitum (eat as much as you want) whole food vegan diet, they show improvements in diabetes and cardiovascular disease risk.  They also show a reversal of cancer and heart disease as well.  So here we have proven randomized control trial data, some of the strongest evidence available, showing us that a whole food low fat plant based diet can reverse heart disease and some forms of cancer.

So getting back to your point, the keto diet can indeed improve biomarkers for CVD and diabetes, and I’d say it’s certainly healthier than eating the standard American diet, but that doesn’t mean it is healthy.

Carrato goes on to say,

If, perhaps, Attia were saying something to the effect that “low carb is the ONLY diet for anyone”, then certainly I would be lining up against him too — though perhaps without the immature ad hominems. But he’s NOT saying that, and the low fat people ARE saying it. He is expressing reasonable opposition to what has been such a dogmatic view that it is encoded in national policy and taught to our children!

Attia is promoting a diet that will end up getting some people killed.  Granted, most people would probably have their health improve by switching to a ketogenic diet, but only if they are currently eating a standard American diet.  Do you think it would be reasonable for Attia to tell a whole food vegan to ditch their diet and start eating nothing but dead bodies, cruciferous vegetables and high fat foods?

The data shows us that there will always be a subset of people who will end up having a heart attack or contracting cancer strictly because they were following a meat based ketogenic diet.  To me, this is not a reasonable position to advocate for when we know that a low fat whole food plant based diet can achieve better outcomes.  Doctors should be promoting the best diet, not a second or third best diet.

Admittedly, I am not a libertarian, but I am quite familiar with libertarianism, and your post seems to be 180 degrees diametrically opposed to what your chosen ideology professes. Shouldn’t the evidence be presented from all sides so that people are free to use their own judgement to come to an informed decision on what is best for them?

Libertarianism deals with politics, so I’m not sure what libertarianism has to do with diet advice.  I’m a libertarian because reason and evidence demonstrate free markets are the best means of improving the human condition.  Likewise, I promote a low fat high carb whole food plant based diet because evidence clearly demonstrates this is the ideal diet for humans to consume.

Further, not only is the vegan diet the best for humanity in terms of health, it is undeniably better for the environment, better in terms of efficiency (more human food produced per acre), and clearly has less ethical cognitive dissonance (why not kill and eat dogs?).

So yeah, smart people who think logically eat vegan.  That’s probably why vegetarians have IQ scores that are 10 points higher than meat eaters.