Tag Archives: ketogenic diet

Ketogenic diets are one of the hottest trends in wellness right now. This past year, I even wrote a keto cookbook. In fact, they have become so popular, that many variations of low carb diets are currently spearheading their way into the mainstream. While any focus on a healthier way of eating should be viewed as a positive, rather than a negative – the question remains: are carbohydrates really so bad? There is, of course – a complex scientific answer to this question.

First, we must look at the research. What does it say, what does it not say, and were the methods used to extract these conclusions properly conducted? Secondly – is there conclusive scientific evidence that the type of carbohydrates ingested, makes a difference? Third – is it possible that there is significant sensationalism around keto diets, which may tend to cloud the actual scientific data. Which in turn may be used to support their popularity? Lastly, is a Paleo Diet® actually worse for weight loss than a keto diet – or are there significant benefits to both approaches

To answer these questions, we must do a deep dive into the research of low carbohydrate diets. The newest study to gain widespread attention, focused only on 164 adults – not exactly a large enough sample pool, to say the least. While the media is quick to write attention grabbing headlines (i.e. “new study shows that low carb diets are better for weight loss”) the data rarely – if ever – supports these dramatic conclusions (1, 2, 3, 4, 5, 6, 7, 8, 9, 10).

This study is no different. While the results did show good outcomes for people following a low carbohydrate diet – the study did not come close to proving that all carbohydrate intake is bad. It also did not show that a diet filled with healthy carbohydrates cannot be just as good (if not better) for sustained weight loss. As has been shown in numerous scientific studies, higher carbohydrate diets consistently have better long-term success in terms of compliance (11, 12, 13, 14, 15, 16, 17, 18, 19, 20). In simpler terms, this means that those eating more carbohydrates have a much easier time adhering to a dietary protocol, over the course of years of eating.

This should not be shocking. While keto (and other low carb diets) do typically result in some short-term weight loss – this is sometimes just water weight. Secondly, almost without fail, people do eventually return to consuming carbohydrates (though sometimes it is in a diminished volume). Subsequently, they often do gain back the weight they may have lost (21, 22, 23, 24, 25, 26, 27, 28, 29, 30). Gary Taubes did an excellent job of analyzing and synthesizing nearly a century’s worth of research on this very topic, in his scientific tome Good Calories, Bad Calories.

A different study from earlier this year, showed that a low-carb diet and a low-fat diet both provided nearly identical results for dieters. This study followed 600 people over the course of a year and showed predictable results. The main takeaway from the sum of these studies is the conclusion that limiting sugar and eating high quality nutrient dense foods – a central tenant of The Paleo Diet – is the best strategy for long term weight loss (31, 32, 33, 34, 35, 36, 37, 38, 39, 40).

This means vegetables are the best foods to eat, along with high quality proteins, and anti-inflammatory fats. When it comes to a healthy diet (and especially fat loss) – the body’s delicate biochemistry and neurology must be prioritized. What foods provide the best hormonal response, along with limiting cravings and supporting brain health? Over and over again – the scientific research has pointed to the foods consumed when following a Paleo Diet (41, 42, 43, 44, 45, 46, 47, 48, 49, 50).

Another interesting aspect of these studies – they have highly variable results. For example, in the aforementioned study – one person lost a miraculous 60 pounds – while another gained 20. This shows the genetic variability inherent in all populations. It also illustrates that one specific diet is never going to be the solution for the entire population (51, 52, 53, 54, 55, 56, 57, 58, 59, 60).

Controlling leptin, ghrelin, blood sugar, and limiting consumption of empty calories – are all cornerstones of any healthy dietary approach. This is because scientific data has shown that these elements all quickly lead to rapid weight gain, if not properly controlled (61, 62, 63, 64, 65, 66, 67, 68, 69, 70). One fascinating study even showed that by modulating actual dopamine receptors (in this case, specifically the D2 receptors) – binge eating could be almost completely eliminated. This links in with other fascinating studies, which show that processed foods (like cookies) – may be as psychologically rewarding as hard drugs, like cocaine. It may appear shocking at first, but once the underlying neuronal circuitry is understood, there is truthfully very little difference between how the brain responds to these over-powering stimuli (71, 72, 73, 74, 75, 76, 77, 78, 79, 80).

So, is a high carb/low fat diet the holy grail to weight loss, or is the answer consuming no carbohydrates at all? As with most things, the truth lies somewhere in the middle. Moderate carbohydrate consumption (like the amount consumed in a healthy, properly implemented Paleo Diet) – seems to have the best long-term results (81, 82, 83, 84, 85, 86, 87, 88, 89, 90). This is not to say that low carbohydrate diets do not have their benefits – they do. But as Dr. Cordain has rightly pointed out, there can also be significant issues that may arise in long term implementations of ketogenic diets (91, 92, 93, 94, 95, 96, 97, 98, 99, 100).

In summary – neither approach is wrong, but carbohydrates (especially natural, low sugar forms) – are not bad. In fact, you will usually become very deficient in potassium, very quickly, if you do not consume at least some healthy carbohydrates. Of course, common sense wisdom like this (backed by strong science) – does not sell nearly as well as headlines like ‘lose 20 pounds quickly with the keto diet!’.

High quality protein, healthy fats, and low sugar carbohydrate consumption is really all you need to prioritize, to have a perfectly healthy diet. This is a simple, easy-to-remember paradigm, and it is applicable to anyone – no matter your age or gender. As always – don’t believe the hype. Carbohydrates won’t kill you, or absolutely cause you to gain weight. Sticking to whole, natural carbohydrates (which are low in sugar) is the best approach to a healthy diet. You can certainly experiment with a ketogenic diet, but it is not the only option for sustainable weight loss. For more reading on the fascinating topic of ketogenic diets, please read Dr. Cordain’s excellent piece.

References

  1. Obert J, Pearlman M, Obert L, Chapin S. Popular Weight Loss Strategies: a Review of Four Weight Loss Techniques. Curr Gastroenterol Rep. 2017;19(12):61.
  2. Ma Y, Pagoto SL, Griffith JA, et al. A dietary quality comparison of popular weight-loss plans. J Am Diet Assoc. 2007;107(10):1786-91.
  3. Jönsson T, Granfeldt Y, Ahrén B, et al. Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovasc Diabetol. 2009;8:35. Published 2009 Jul 16. doi:10.1186/1475-2840-8-35
  4. Manheimer EW, Van zuuren EJ, Fedorowicz Z, Pijl H. Paleolithic nutrition for metabolic syndrome: systematic review and meta-analysis. Am J Clin Nutr. 2015;102(4):922-32.
  5. Strychar I. Diet in the management of weight loss. CMAJ. 2006;174(1):56-63.
  6. Soeliman FA, Azadbakht L. Weight loss maintenance: A review on dietary related strategies. J Res Med Sci. 2014;19(3):268-75.
  7. Champagne CM, Broyles ST, Moran LD, et al. Dietary intakes associated with successful weight loss and maintenance during the Weight Loss Maintenance trial. J Am Diet Assoc. 2011;111(12):1826-35.
  8. Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360(9):859-73.
  9. Otten J, Stomby A, Waling M, et al. Benefits of a Paleolithic diet with and without supervised exercise on fat mass, insulin sensitivity, and glycemic control: a randomized controlled trial in individuals with type 2 diabetes. Diabetes Metab Res Rev. 2017;33(1)
  10. Pitt CE. Cutting through the Paleo hype: The evidence for the Palaeolithic diet. Aust Fam Physician. 2016;45(1):35-8.
  11. Hu T, Yao L, Reynolds K, et al. Adherence to low-carbohydrate and low-fat diets in relation to weight loss and cardiovascular risk factors. Obes Sci Pract. 2016;2(1):24-31.
  12. Alhassan S, Kim S, Bersamin A, King AC, Gardner CD. Dietary adherence and weight loss success among overweight women: results from the A TO Z weight loss study. Int J Obes (Lond). 2008;32(6):985-91.
  13. Mcclain AD, Otten JJ, Hekler EB, Gardner CD. Adherence to a low-fat vs. low-carbohydrate diet differs by insulin resistance status. Diabetes Obes Metab. 2013;15(1):87-90.
  14. Kitabchi AE, Mcdaniel KA, Wan JY, et al. Effects of high-protein versus high-carbohydrate diets on markers of β-cell function, oxidative stress, lipid peroxidation, proinflammatory cytokines, and adipokines in obese, premenopausal women without diabetes: a randomized controlled trial. Diabetes Care. 2013;36(7):1919-25.
  15. Mcclain AD, Otten JJ, Hekler EB, Gardner CD. Adherence to a low-fat vs. low-carbohydrate diet differs by insulin resistance status. Diabetes Obes Metab. 2013;15(1):87-90.
  16. Kouris A, Wahlqvist ML, Worsley A. Characteristics that enhance adherence to high-carbohydrate/high-fiber diets by persons with diabetes. J Am Diet Assoc. 1988;88(11):1422-5.
  17. Anderson JW, Gustafson NJ. Adherence to high-carbohydrate, high-fiber diets. Diabetes Educ. 1989;15(5):429-34.
  18. Astrup A, Meinert larsen T, Harper A. Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss?. Lancet. 2004;364(9437):897-9.
  19. Pekkarinen T, Kaukua J, Mustajoki P. Long-term weight maintenance after a 17-week weight loss intervention with or without a one-year maintenance program: a randomized controlled trial. J Obes. 2015;2015:651460.
  20. Elfhag K., Rössner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obesity Reviews. 2005;6(1):67–85. doi: 10.1111/j.1467-789X.2005.00170.x.
  21. Blomain ES, Dirhan DA, Valentino MA, Kim GW, Waldman SA. Mechanisms of Weight Regain following Weight Loss. ISRN Obes. 2013;2013:210524.
  22. Mcnay DE, Speakman JR. High fat diet causes rebound weight gain. Mol Metab. 2012;2(2):103-8.
  23. Turk MW, Yang K, Hravnak M, Sereika SM, Ewing LJ, Burke LE. Randomized clinical trials of weight loss maintenance: a review. J Cardiovasc Nurs. 2009;24(1):58-80.
  24. Mobbs CV, Mastaitis J, Yen K, et al. Low-carbohydrate diets cause obesity, low-carbohydrate diets reverse obesity: a metabolic mechanism resolving the paradox. Appetite. 2007;48(2):135-8.
  25. Lamont BJ, Waters MF, Andrikopoulos S. A low-carbohydrate high-fat diet increases weight gain and does not improve glucose tolerance, insulin secretion or β-cell mass in NZO mice. Nutr Diabetes. 2016;6:e194.
  26. Maclean PS, Bergouignan A, Cornier MA, Jackman MR. Biology’s response to dieting: the impetus for weight regain. Am J Physiol Regul Integr Comp Physiol. 2011;301(3):R581-600.
  27. Iacovides S, Meiring RM. The effect of a ketogenic diet versus a high-carbohydrate, low-fat diet on sleep, cognition, thyroid function, and cardiovascular health independent of weight loss: study protocol for a randomized controlled trial. Trials. 2018;19(1):62.
  28. Obesity and Energy Balance: Is the Tail Wagging the Dog? J.C.K. Wells and M. Siervo in European Journal of Clinical Nutrition, Vol. 65, No. 11, pages 1173–1189; November 2011.
  29. Cornier MA. Is your brain to blame for weight regain?. Physiol Behav. 2011;104(4):608-12.
  30. Lean ME. Is long-term weight loss possible?. Br J Nutr. 2000;83 Suppl 1:S103-11.
  31. Stanhope KL. Sugar consumption, metabolic disease and obesity: The state of the controversy. Crit Rev Clin Lab Sci. 2016;53(1):52-67.
  32. Delli bovi AP, Di michele L, Laino G, Vajro P. Obesity and Obesity Related Diseases, Sugar Consumption and Bad Oral Health: A Fatal Epidemic Mixtures: The Pediatric and Odontologist Point of View. Transl Med UniSa. 2017;16:11-16.
  33. Rippe JM, Angelopoulos TJ. Sugars, obesity, and cardiovascular disease: results from recent randomized control trials. Eur J Nutr. 2016;55(Suppl 2):45-53.
  34. Rippe JM, Angelopoulos TJ. Relationship between Added Sugars Consumption and Chronic Disease Risk Factors: Current Understanding. Nutrients. 2016;8(11).
  35. Aller EE, Abete I, Astrup A, Martinez JA, Van baak MA. Starches, sugars and obesity. Nutrients. 2011;3(3):341-69.
  36. Dinicolantonio JJ, Berger A. Added sugars drive nutrient and energy deficit in obesity: a new paradigm. Open Heart. 2016;3(2):e000469.
  37. Malik VS, Popkin BM, Bray GA, Després JP, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation. 2010;121(11):1356-64.
  38. Carol S Johnston, Sherrie L Tjonn, Pamela D Swan, Andrea White, Heather Hutchins, Barry Sears; Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets, The American Journal of Clinical Nutrition, Volume 83, Issue 5, 1 May 2006, Pages 1055–1061.
  39. Stanhope KL. Sugar consumption, metabolic disease and obesity: The state of the controversy. Crit Rev Clin Lab Sci. 2016;53(1):52-67.
  40. Yoshida Y, Simoes EJ. Sugar-Sweetened Beverage, Obesity, and Type 2 Diabetes in Children and Adolescents: Policies, Taxation, and Programs. Curr Diab Rep. 2018;18(6):31.
  41. Gómez-pinilla F. Brain foods: the effects of nutrients on brain function. Nat Rev Neurosci. 2008;9(7):568-78.
  42. Wahl D, Cogger VC, Solon-biet SM, et al. Nutritional strategies to optimise cognitive function in the aging brain. Ageing Res Rev. 2016;31:80-92.
  43. Spencer, Sarah & Korosi, Aniko & Layé, Sophie & Shukitt-Hale, Barbara & Barrientos, Ruth. (2017). Food for thought: how nutrition impacts cognition and emotion. npj Science of Food. 1. 10.1038/s41538-017-0008-y.
  44. Volek JS, Sharman MJ, Love DM, et al. Body composition and hormonal responses to a carbohydrate-restricted diet. Metab Clin Exp. 2002;51(7):864-70.
  45. Yurko-mauro K, Alexander DD, Van elswyk ME. Docosahexaenoic acid and adult memory: a systematic review and meta-analysis. PLoS ONE. 2015;10(3):e0120391.
  46. Dauncey MJ. Nutrition, the brain and cognitive decline: insights from epigenetics. Eur J Clin Nutr. 2014;68(11):1179-85.
  47. Moore K, Hughes CF, Ward M, Hoey L, Mcnulty H. Diet, nutrition and the ageing brain: current evidence and new directions. Proc Nutr Soc. 2018;77(2):152-163.
  48. Gardener SL, Rainey-smith SR. The Role of Nutrition in Cognitive Function and Brain Ageing in the Elderly. Curr Nutr Rep. 2018;7(3):139-149.
  49. Lieberman HR. Nutrition, brain function and cognitive performance. Appetite. 2003;40(3):245-54.
  50. Burini, Roberto & Leonard, William. (2018). The evolutionary roles of nutrition selection and dietary quality in the human brain size and encephalization. 43. 19. 10.1186/s41110-018-0078-x.
  51. Stover PJ. Human nutrition and genetic variation. Food Nutr Bull. 2007;28(1 Suppl International):S101-15.
  52. Simopoulos AP. Genetic variation and nutrition. Biomed Environ Sci. 1996;9(2-3):124-9.
  53. Gibney MJ, Gibney ER. Diet, genes and disease: implications for nutrition policy. Proc Nutr Soc. 2004;63(3):491-500.
  54. Kalantarian S, Rimm EB, Herrington DM, Mozaffarian D. Dietary macronutrients, genetic variation, and progression of coronary atherosclerosis among women. Am Heart J. 2014;167(4):627-635.e1.
  55. Stover PJ. Influence of human genetic variation on nutritional requirements. Am J Clin Nutr. 2006;83(2):436S-442S.
  56. Bueno, N., De Melo, I., De Oliveira, S., & Da Rocha Ataide, T. (2013). Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: A meta-analysis of randomised controlled trials. British Journal of Nutrition, 110(7), 1178-1187. doi:10.1017/S0007114513000548
  57. Tay J, Thompson CH, Luscombe-marsh ND, et al. Long-Term Effects of a Very Low Carbohydrate Compared With a High Carbohydrate Diet on Renal Function in Individuals With Type 2 Diabetes: A Randomized Trial. Medicine (Baltimore). 2015;94(47):e2181.
  58. Wylie-rosett J, Aebersold K, Conlon B, Isasi CR, Ostrovsky NW. Health effects of low-carbohydrate diets: where should new research go?. Curr Diab Rep. 2013;13(2):271-8.
  59. Bartáková V, Kuricová K, Zlámal F, Bělobrádková J, Kaňková K. Differences in food intake and genetic variability in taste receptors between Czech pregnant women with and without gestational diabetes mellitus. Eur J Nutr. 2018;57(2):513-521.
  60. Xue Y, Li J, Yan L, Lu L, Liao FF. Genetic variability to diet-induced hippocampal dysfunction in BXD recombinant inbred (RI) mouse strains. Behav Brain Res. 2015;292:83-94.
  61. Ahima RS. Revisiting leptin’s role in obesity and weight loss. J Clin Invest. 2008;118(7):2380-3.
  62. Myers MG, Leibel RL, Seeley RJ, Schwartz MW. Obesity and leptin resistance: distinguishing cause from effect. Trends Endocrinol Metab. 2010;21(11):643-51.
  63. Friedman JM. Leptin and the regulation of body weigh. Keio J Med. 2011;60(1):1-9.
  64. Fleisch AF, Agarwal N, Roberts MD, et al. Influence of serum leptin on weight and body fat growth in children at high risk for adult obesity. J Clin Endocrinol Metab. 2007;92(3):948-54.
  65. Kalra SP. Circumventing leptin resistance for weight control. Proc Natl Acad Sci USA. 2001;98(8):4279-81.
  66. Scarpace PJ, Zhang Y. Elevated leptin: consequence or cause of obesity?. Front Biosci. 2007;12:3531-44.
  67. Weigle DS, Cummings DE, Newby PD, et al. Roles of leptin and ghrelin in the loss of body weight caused by a low fat, high carbohydrate diet. J Clin Endocrinol Metab. 2003;88(4):1577-86.
  68. Rohatgi KW, Tinius RA, Cade WT, Steele EM, Cahill AG, Parra DC. Relationships between consumption of ultra-processed foods, gestational weight gain and neonatal outcomes in a sample of US pregnant women. PeerJ. 2017;5:e4091.
  69. Poti JM, Braga B, Qin B. Ultra-processed Food Intake and Obesity: What Really Matters for Health-Processing or Nutrient Content?. Curr Obes Rep. 2017;6(4):420-431.
  70. Oginsky MF, Goforth PB, Nobile CW, Lopez-santiago LF, Ferrario CR. Eating ‘Junk-Food’ Produces Rapid and Long-Lasting Increases in NAc CP-AMPA Receptors: Implications for Enhanced Cue-Induced Motivation and Food Addiction. Neuropsychopharmacology. 2016;41(13):2977-2986.
  71. Berridge KC. ‘Liking’ and ‘wanting’ food rewards: brain substrates and roles in eating disorders. Physiol Behav. 2009;97(5):537-50.
  72. Wise RA. Role of brain dopamine in food reward and reinforcement. Philos Trans R Soc Lond, B, Biol Sci. 2006;361(1471):1149-58.
  73. Murray S, Tulloch A, Gold MS, Avena NM. Hormonal and neural mechanisms of food reward, eating behaviour and obesity. Nat Rev Endocrinol. 2014;10(9):540-52.
  74. Blum K, Gardner E, Oscar-berman M, Gold M. “Liking” and “wanting” linked to Reward Deficiency Syndrome (RDS): hypothesizing differential responsivity in brain reward circuitry. Curr Pharm Des. 2012;18(1):113-8.
  75. Swiecicki L, Scinska A, Bzinkowska D, et al. Intensity and pleasantness of sucrose taste in patients with winter depression. Nutr Neurosci. 2014.
  76. Kellerer M, Lammers R, Fritsche A, et al. Insulin inhibits leptin receptor signalling in HEK293 cells at the level of janus kinase-2: a potential mechanism for hyperinsulinaemia-associated leptin resistance. Diabetologia. 2001;44(9):1125-32.
  77. Bellisle F, Drewnowski A. Intense sweeteners, energy intake and the control of body weight. Eur J Clin Nutr. 2007;61(6):691-700.
  78. Caffaro CE, Hirschberg CB. Nucleotide sugar transporters of the Golgi apparatus: from basic science to diseases. Acc Chem Res. 2006;39(11):805-12.
  79. Willett WC, Ludwig DS. Science souring on sugar. BMJ. 2013;346:e8077.
  80. Grant JE, Potenza MN, Weinstein A, Gorelick DA. Introduction to behavioral addictions. Am J Drug Alcohol Abuse. 2010;36(5):233-41.
  81. Lindeberg S, Jönsson T, Granfeldt Y, et al. A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia. 2007;50(9):1795-807.
  82. Klonoff DC. The beneficial effects of a Paleolithic diet on type 2 diabetes and other risk factors for cardiovascular disease. J Diabetes Sci Technol. 2009;3(6):1229-32.
  83. Kowalski LM, Bujko J. [Evaluation of biological and clinical potential of paleolithic diet]. Rocz Panstw Zakl Hig. 2012;63(1):9-15.
  84. Gotsis E, Anagnostis P, Mariolis A, Vlachou A, Katsiki N, Karagiannis A. Health benefits of the Mediterranean Diet: an update of research over the last 5 years. Angiology. 2015;66(4):304-18.
  85. Tosti V, Bertozzi B, Fontana L. Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms. J Gerontol A Biol Sci Med Sci. 2018;73(3):318-326.
  86. Romagnolo DF, Selmin OI. Mediterranean Diet and Prevention of Chronic Diseases. Nutr Today. 2017;52(5):208-222.
  87. Widmer RJ, Flammer AJ, Lerman LO, Lerman A. The Mediterranean diet, its components, and cardiovascular disease. Am J Med. 2015;128(3):229-38.
  88. Ma Y, Olendzki B, Chiriboga D, et al. Association between dietary carbohydrates and body weight. Am J Epidemiol. 2005;161(4):359-67.
  89. Wal JS, Mcburney MI, Moellering N, Marth J, Dhurandhar NV. Moderate-carbohydrate low-fat versus low-carbohydrate high-fat meal replacements for weight loss. Int J Food Sci Nutr. 2007;58(4):321-9.
  90. Sasakabe T, Haimoto H, Umegaki H, Wakai K. Association of decrease in carbohydrate intake with reduction in abdominal fat during 3-month moderate low-carbohydrate diet among non-obese Japanese patients with type 2 diabetes. Metab Clin Exp. 2015;64(5):618-25.
  91. Reddy ST, Wang CY, Sakhaee K, Brinkley L, Pak CY. Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism. Am J Kidney Dis. 2002;40(2):265-74.
  92. High protein diet brings risk of kidney stones. BMJ. 2002;325(7361):408.
  93. Macdonald HM, New SA, Fraser WD, Campbell MK, Reid DM. Low dietary potassium intakes and high dietary estimates of net endogenous acid production are associated with low bone mineral density in premenopausal women and increased markers of bone resorption in postmenopausal women. Am J Clin Nutr. 2005 Apr;81(4):923-33.
  94. New SA, MacDonald HM, Campbell MK, Martin JC, Garton MJ, Robins SP, Reid DM. Lower estimates of net endogenous non-carbonic acid production are positively associated with indexes of bone health in premenopausal and perimenopausal women. Am J Clin Nutr. 2004 Jan;79(1):131-8
  95. Willi SM, Oexmann MJ, Wright NM, Collop NA, Key LL Jr. The effects of a high-protein, low-fat, ketogenic diet on adolescents with morbid obesity: body composition, blood chemistries, and sleep abnormalities. Pediatrics. 1998 Jan;101(1 Pt 1):61-7.
  96. Wynn E, Krieg MA, Lanham-New SA, Burckhardt P. Postgraduate Symposium: Positive influence of nutritional alkalinity on bone health. Proc Nutr Soc. 2010 Feb;69(1):166-73.
  97. Cicero AF1, Benelli M2, Brancaleoni M3, Dainelli G3, Merlini D3, Negri R3. Middle and long-term impact of a very low-carbohydrate ketogenic diet on cardiometabolic factors: A multi-center, cross-sectional, clinical study. High Blood Press Cardiovasc Prev. 2015 Dec;22(4):389-94.
  98. Clifton PM, Condo D, Keogh JB. Long term weight maintenance after advice to consume low carbohydrate, higher protein diets–a systematic review and meta-analysis. Nutr Metab Cardiovasc Dis. 2014 Mar;24(3):224-35.
  99. Bielohuby M, Matsuura M, Herbach N, et al. Short-term exposure to low-carbohydrate, high-fat diets induces low bone mineral density and reduces bone formation in rats. J Bone Miner Res. 2010;25(2):275-84.
  100. Carol S Johnston, Sherrie L Tjonn, Pamela D Swan, Andrea White, Heather Hutchins, Barry Sears; Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets, The American Journal of Clinical Nutrition, Volume 83, Issue 5, 1 May 2006, Pages 1055–1061, https://doi.org/10.1093/ajcn/83.5.1055.

Both the keto diet and the paleo diet are all the rage right now, with many people choosing one or the other in an effort to change their eating habits, get healthier, and be better able to enjoy their lives. For many people, however, it can be difficult or even confusing to understand the differences between the two and how to manipulate their eating habits in order to achieve their goals. If you’re thinking about a drastic lifestyle change, consider how going paleo compares to going keto–and how those dietary changes can impact your life.

The Similarities

Both the keto diet and the Paleo Diet@ focus on reducing carbohydrate consumption. While the paleo diet aims at eating primarily the foods that would have been found in an earlier, caveman-era period of the human diet, the keto diet restricts carbs in an effort to send the body into ketosis, a state in which the body burns ketones for fuel. Ketones are derived from our fat stores. The carb restriction in both diets often leads to quick weight loss, especially early after making a dietary change. This carb restriction, however, often causes Keto and Paleo to be lumped into the same category–which can in turn be highly confusing for dieters. Both diets also restrict sugar and legumes and encourage dieters to consume diets high in animal protein and healthy fats.

The Differences

In order to choose the diet that’s right for you, it’s important to understand the key differences between keto and paleo.

Difference #1: Keto Relies Heavily on Macronutrient Balance

The keto diet works by keeping your body in that state of ketosis: the state at which, instead of burning carbohydrates for energy, the body swaps over and begins burning stored fat, instead. In order to maintain ketosis, it’s necessary to eat a diet high in healthy fats, moderate in protein, and extremely low in carbohydrates. The Paleo Diet, on the other hand, allows you to balance your macronutrients according to your personal needs.

Difference #2: The Paleo Diet Focuses on Removing Foods that are Hard to Digest

One of the key attributes of the paleo diet is its restriction of items like processed foods, dairy, and sugar, all of which can be difficult for the body to digest. Swapping to a paleo-based diet can help reduce inflammation throughout the body and lead to increased gut health. The keto diet, on the other hand, allows–and in some cases even encourages–full-fat dairy consumption.

Difference #3: The Paleo Diet Encourages Whole, Healthy Foods

The focus of the paleo diet is on eating whole, healthy foods that are good for your body and will give you the fuel you need to accomplish your daily tasks. The keto diet, on the other hand, primarily focuses on keeping your body in ketosis.

Difference #4: The Keto Diet is Unforgiving

Everyone ends up having a cheat day or a slip-up every now and then. That barbecue sauce turned out to have sugar in it that you weren’t anticipating; you didn’t know your soup had barley; you ended up eating a slice of birthday cake that wasn’t appropriate for your diet. On the keto diet, that means you’ll instantly fall out of ketosis and start over on your dietary approach. The paleo diet, on the other hand, doesn’t rely on a state that takes days or even weeks to achieve in order to meet your goal.

Which One is Right for You?

To learn more about the ketogenic diet and why we feel it is not a healthy diet for the long term, check out this thorough article by Dr. Loren Cordain.

For most people, the Paleo Diet is a great choice for improving overall health and sticking with a health-centered diet that will help reduce inflammation and make weight loss easier. The paleo diet doesn’t require regular counting and calculations; instead, it sets you up for success by providing you with a list of the foods that you should be avoiding and a list of the foods that can help you meet your dietary goals. The paleo diet also focuses heavily on removing highly processed foods that are difficult to digest, while many people who adhere to a keto diet choose to dodge some of the restrictions by consuming artificial sweeteners and other unhealthy dietary additions that can actually make it harder to lose weight.

The keto diet was originally intended to help manage a range of medical conditions, including epilepsy. The high-percentage weight loss is a side effect that many people enjoy, but it wasn’t its original intent. The paleo diet, on the other hand, takes people back to the diet that they were originally intended to eat, and brings a number of health benefits with it. By understanding the paleo diet more fully, you’ll discover that it can be a highly effective way to meet your dietary goals.  Most importantly, it is the diet you were intended to eat for a lifetime of optimum health.

 

Gilbert's Syndrome: Can a Paleo Diet Reverse An Irreversible Condition?

Gilbert’s Syndrome (GS) is a relatively common condition characterized by increased levels of bilirubin in the blood. Bilirubin is a naturally occurring yellow pigment that forms when red blood cells break down. GS is a genetic condition whereby a single gene mutation prevents the liver from properly removing bilirubin from the blood. Between 5 – 10% of the population may have GS, but around one-third don’t have symptoms.1

Normally, when red blood cells reach the end of their approximately 120 day life span, they break down into bilirubin. The liver then processes the bilirubin, readying it for elimination. Bilirubin gives urine its yellow tinge and stools their dark brown color. For those afflicted by GS, however, the liver sometimes processes bilirubin at a slower rate. Buildups can occur, sometimes resulting in jaundice (a yellowing of the eyes and skin).

GS is regarded as common and harmless, but is associated with numerous unpleasant symptoms, including fatigue, itching, gastrointestinal symptoms, and increased risk for gallstones. Because it’s a hereditary condition, scientists have generally presumed there is no cure. But could the Paleo diet or other dietary interventions help?

A Hungarian researcher team started investigating this question several years ago. Just this month, they published their findings in the American Journal of Medical Case Reports.2 While their study involved just one patient, the researchers were successful in reversing her GS symptoms.

In 2006, doctors diagnosed the patient, then 30 years old, with GS. At that time, she had a 10 year history of frequent migraines (about three/month) and a 10 year history of dermatitis. She also exhibited persistent fatigue, constipation, and yellowing of the eyes.

In 2010, she began with the Paleo diet, excluding dairy, grains, legumes, refined carbohydrates, and vegetable oils. After one year, her bilirubin levels returned to the normal range, her jaundice and constipation resolved, and her migraines reduced to roughly one every two months. Her fatigue and dermatitis, however, persisted.

She followed the standard Paleo diet for a total of 20 months. On the advice of the researchers, she then switched to a ketogenic version of the Paleo diet. Ketogenic diets, of course, involve greatly reduced carbohydrate consumption. Her Paleo-keto diet, which she maintains to this day, includes mostly animal fat, meat, eggs, organ meats, and less than 30% vegetables and fruit. At least twice per week she consumes organ meats. Since beginning her Paleo-keto diet, her fatigue has disappeared, as has her dermatitis. Her migraines have further reduced to roughly twice per year.

Of course, this n=1 study doesn’t prove the Paleo/Paleo-keto diet cures GS. Nevertheless, the study is significant because it’s the first documented case of successfully treating GS through dietary intervention. This study could potentially open the door to larger studies, which could test the hypothesis that Paleo/Paleo-keto can cure GS (or greatly mitigate its symptoms). And on an individual level, GS patients, with the help of their physicians, could implement Paleo/Paleo-keto principals and perhaps improve their conditions.

Christopher James Clark, B.B.A.
@nutrigrail
Nutritional Grail
www.ChristopherJamesClark.com

Christopher James Clark | The Paleo Diet TeamChristopher James Clark, B.B.A. is an award-winning writer, consultant, and chef with specialized knowledge in nutritional science and healing cuisine. He has a Business Administration degree from the University of Michigan and formerly worked as a revenue management analyst for a Fortune 100 company. For the past decade-plus, he has been designing menus, recipes, and food concepts for restaurants and spas, coaching private clients, teaching cooking workshops worldwide, and managing the kitchen for a renowned Greek yoga resort. Clark is the author of the critically acclaimed, award-winning book, Nutritional Grail.

 

REFERENCES

[1] Owens, D, et al. (June 1975). “Population studies on Gilbert’s syndrome.” Journal of Medical Genetics, 12(2). Retrieved from //www.ncbi.nlm.nih.gov/pubmed/1142378

[2] Tóth, C, and Zsófia, C. (April 2015). “Gilbert’s Syndrome Successfully Treated with the Paleolithic Ketogenic Diet.” American Journal of Medical Case Reports, 3(4). Retrieved from //pubs.sciepub.com/ajmcr/3/4/9/

Anti-Inflammatory Effects of a Ketogenic Diet | The Paleo Diet

Many are aware that ketogenic diets offer a plethora of health benefits.1,2,3,4,5 Among the ketogenic diet’s best properties are its anti-inflammatory effects.6,7 However, despite the emerging popularity of the diet, the scientific community is still relatively uncertain about the exact beneficial mechanisms behind this dietary approach.8,9,10 Recently however, a new study was published which looked at the potential mechanisms underlying the specific anti-inflammatory properties of ketosis.11

Anti-Inflammatory Effects of a Ketogenic Diet | The Paleo Diet

Eitel, Julia. “Innate Immune Recognition and Inflammasome Activation in Listeria Monocytogenes Infection.” Frontiers. N.p., n.d. Web. 19 Feb. 2015.

For those unfamiliar, a ketogenic diet is one which contains very little – if any – carbohydrate.12 One classic example of this dietary approach is seen in the Inuit people.13 The Inuit are indigenous people, who live in the Arctic region.14 Alaska, Canada and Greenland all have Inuit populations.15 In one of the more famous nutrition stories of recent times, Dr. Vilhjalmur Stefansson ate nothing but meat for one year, after being inspired by living with the Inuit, and seeing their remarkably low rate of disease.16,17,18 This was despite the Inuit’s (then) controversial diet of nothing but meat, whether it came from fish or other sources. Stefansson saw no ill effects from a year of an all meat diet, with basically zero carbohydrate. He also consumed no vegetables. It is worth noting, that he also became very ill when he consumed only low fat meat, and nothing else. When he added the fattier meat back in, he immediately felt better.

The many reported benefits of the ketogenic diet include, but are not limited to: less hunger while dieting, improved cognitive function in those who are cognitively impaired, improved LDL cholesterol levels, improved weight loss, and improved levels of HDL cholesterol.19 This is in addition to the aforementioned anti-inflammatory effects. When we look to the scientific literature, we see that the anti-inflammatory nature of the diet has been studied for many years.20,21,22,23,24 The ketogenic diet has also been established as an adequate anticonvulsant therapy.25

This newly published research looks specifically at the ketone metabolite beta-hydroxybutyrate, which seems to inhibit the NLRP3 inflammasome.26 Since the NLRP3 inflammasome was previously found to have been linked to obesity and inflammation, as well as insulin resistance, inhibiting it would make mechanistic sense.27 The resultant weight loss and anti-inflammatory effects, commonly seem (at least anecdotally) when adopting a ketogenic diet, would then make sense as well. The NLRP3 inflammasome also drives the inflammatory response in several disorders including autoimmune diseases, type 2 diabetes, Alzheimer’s disease, atherosclerosis, and autoinflammatory disorders.28,29

Anti-Inflammatory Effects of a Ketogenic Diet | The Paleo Diet

Kossoff, Eric H. “More Fat and Fewer Seizures: Dietary Therapies for Epilepsy.” The Lancet. N.p., July 2014. 

Anti-Inflammatory Effects of a Ketogenic Diet | The Paleo Diet

Menu, P, and J E Vince. “The NLRP3 Inflammasome in Health and Disease: The Good, the Bad and the Ugly.” Clinical and Experimental Immunology 166.1 (2011): 1–15. PMC. Web. 19 Feb. 2015.

Could it all be so simple? Possibly, though there is certainly likely more to be more scientific discoveries, relating to the beneficial effects of this specific dietary approach. Moving away from glucose and instead utilizing ketone bodies as a source of metabolic fuel, results in many profound changes, of which we are only beginning to scratch the surface of, scientifically.30,31,32

This new discovery will likely be the first of many new findings regarding the ketogenic diet, and its abundance of benefits. If you are looking to adopt a ketogenic approach, simply follow the many nutritious tenets of the Paleo Diet, and then lower your carbohydrate intake to below 100g per day. How low you need to go for optimum quality of life is highly variant, and many people report different results with different amounts of carbohydrates. Dialing in the best nutrition plan for you, when adopting a ketogenic diet, is integral. Be sure to consult with a professional to avoid possible nutrient deficiencies.

 

REFERENCES

[1] Dashti HM, Mathew TC, Hussein T, et al. Long-term effects of a ketogenic diet in obese patients. Exp Clin Cardiol. 2004;9(3):200-5.

[2] Paoli A. Ketogenic diet for obesity: friend or foe?. Int J Environ Res Public Health. 2014;11(2):2092-107.

[3] Zajac A, Poprzecki S, Maszczyk A, Czuba M, Michalczyk M, Zydek G. The effects of a ketogenic diet on exercise metabolism and physical performance in off-road cyclists. Nutrients. 2014;6(7):2493-508.

[4] Hussain TA, Mathew TC, Dashti AA, Asfar S, Al-zaid N, Dashti HM. Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes. Nutrition. 2012;28(10):1016-21.

[5] Millichap JG, Yee MM. The diet factor in attention-deficit/hyperactivity disorder. Pediatrics. 2012;129(2):330-7.

[6] Schugar RC, Crawford PA. Low-carbohydrate ketogenic diets, glucose homeostasis, and nonalcoholic fatty liver disease. Curr Opin Clin Nutr Metab Care. 2012;15(4):374-80.

[7] Masino SA, Kawamura M, Wasser CD, Wasser CA, Pomeroy LT, Ruskin DN. Adenosine, ketogenic diet and epilepsy: the emerging therapeutic relationship between metabolism and brain activity. Curr Neuropharmacol. 2009;7(3):257-68.

[8] Poff AM, Ari C, Seyfried TN, D’agostino DP. The ketogenic diet and hyperbaric oxygen therapy prolong survival in mice with systemic metastatic cancer. PLoS ONE. 2013;8(6):e65522.

[9] Krilanovich NJ. Benefits of ketogenic diets. Am J Clin Nutr. 2007;85(1):238-9.

[10] Mandel A, Ballew M, Pina-Garza JE, Stalmasek V, Clemens LH. Medical costs are reduced when children with intractable epilepsy are successfully treated with the ketogenic diet. J Am Diet Assoc 2002;102:396–8.

[11] Youm YH, Nguyen KY, Grant RW, et al. The ketone metabolite β-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease. Nat Med. 2015;

[12] Rogovik AL, Goldman RD. Ketogenic diet for treatment of epilepsy. Can Fam Physician. 2010;56(6):540-2.

[13] Phinney SD. Ketogenic diets and physical performance. Nutr Metab (Lond). 2004;1(1):2.

[14] Bjerregaard P, Dewailly E, Young TK, et al. Blood pressure among the Inuit (Eskimo) populations in the Arctic. Scand J Public Health. 2003;31(2):92-9.

[15] Helgason A, Pálsson G, Pedersen HS, et al. mtDNA variation in Inuit populations of Greenland and Canada: migration history and population structure. Am J Phys Anthropol. 2006;130(1):123-34.

[16] Stefansson V: Not by bread alone. The MacMillan Co, NY 1946. Introductions by Eugene F. DuBois, MD, pp ix-xiii; and Earnest Hooton PhD, ScD, pp xv-xvi.

[17] McClellan WS, DuBois EF: Clinical calorimetry XLV: Prolonged meat diets with a study of kidney function and ketosis. J Biol Chem 1930, 87:651-68.

[18] McClellan WS, Rupp VR, Toscani V: Clinical calorimetry XLVI: prolonged meat diets with a study of the metabolism of nitrogen, calcium, and phosphorus. J Biol Chem 1930, 87:669-80.

[19] Pérez-guisado J. [Ketogenic diets: additional benefits to the weight loss and unfounded secondary effects]. Arch Latinoam Nutr. 2008;58(4):323-9.

[20] Yang X, Cheng B. Neuroprotective and anti-inflammatory activities of ketogenic diet on MPTP-induced neurotoxicity. J Mol Neurosci. 2010;42(2):145-53.

[21] Masino SA, Kawamura M, Wasser CD, Wasser CA, Pomeroy LT, Ruskin DN. Adenosine, ketogenic diet and epilepsy: the emerging therapeutic relationship between metabolism and brain activity. Curr Neuropharmacol. 2009;7(3):257-68.

[22] Gasior M, Rogawski MA, Hartman AL. Neuroprotective and disease-modifying effects of the ketogenic diet. Behav Pharmacol. 2006;17(5-6):431-9.

[23] Kim do Y, Hao J, Liu R, Turner G, Shi FD, Rho JM. Inflammation-mediated memory dysfunction and effects of a ketogenic diet in a murine model of multiple sclerosis. PLoS ONE. 2012;7(5):e35476.

[24] Masino SA, Ruskin DN. Ketogenic diets and pain. J Child Neurol. 2013;28(8):993-1001.

[25] Bough KJ, Rho JM. Anticonvulsant mechanisms of the ketogenic diet. Epilepsia. 2007;48(1):43-58.

[26] Youm YH, Nguyen KY, Grant RW, et al. The ketone metabolite β-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease. Nat Med. 2015;

[27] Vandanmagsar B, Youm YH, Ravussin A, et al. The NLRP3 inflammasome instigates obesity-induced inflammation and insulin resistance. Nat Med. 2011;17(2):179-88.

[28] Menu P, Vince JE. The NLRP3 inflammasome in health and disease: the good, the bad and the ugly. Clin Exp Immunol. 2011;166(1):1-15.

[29] Zhou R, Yazdi AS, Menu P, Tschopp J. A role for mitochondria in NLRP3 inflammasome activation. Nature. 2011;469(7329):221-5.

[30] Guzmán M, Blázquez C. Ketone body synthesis in the brain: possible neuroprotective effects. Prostaglandins Leukot Essent Fatty Acids. 2004;70(3):287-92.

[31] Laffel L. Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev. 1999;15(6):412-26.

[32] Henderson ST. Ketone bodies as a therapeutic for Alzheimer’s disease. Neurotherapeutics. 2008;5(3):470-80.

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