Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet (44 page)

Key Keto Clarity Concepts

• The spontaneous reduction in calories consumed is a major benefit of ketosis.
  
• Weight loss on any diet begins with the loss of water weight before fat loss commences.
  
• The hysteria over very low-carb diets inducing hypothyroidism is unwarranted.
  
• Shifting from focusing on LDL-C and total cholesterol to focusing on LDL particles is better for determining actual heart health risk.
  
• There is no evidence that a ketogenic diet causes a lack of mucus.
  
• Constipation on a low-carb diet can be fixed with vegetables, salt, magnesium, and water.
  
• The notion that a ketogenic diet causes nutrient deficiencies is unfounded as long as you consume a variety of nutrient-rich foods.
  
• Despite the scaremongering, scurvy from a lack of vitamin C isn’t an issue on ketogenic diets.
  
• Kidney stones are the result of a high-carb diet, not a low-carb one.
  
• Very low-carb diets improve insulin sensitivity rather than inducing insulin resistance.
  
• There is no such thing as a “glucose deficiency.”
  

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: Canadian prime minister Lester B. Pearson once said that “misunderstanding arising from ignorance breeds fear.” Perhaps that is what happens when some people, even scientific experts, are asked about low-carb diets. But that is not the appropriate scientific reaction to a lack of knowledge. When there is not a lot of research about a given topic (like low-carb diets), we don’t know if it is good or bad. Low-carb, high-fat diets were simply assumed to be bad, and that led to a taboo about studying them that lasted from 1980 to 2002. But over the last twelve years, low-carb diet research has returned, and the results have been overwhelmingly positive. Using the standards of a court of law, the low-carb, high-fat, ketogenic diet should have been innocent until proven guilty. But instead it was deemed guilty until proven innocent.

Everything you have read about up to this point in the book has been based on our collective experience with ketogenic diets. It is quite possible that you want hard proof that there’s scientific evidence that what we’ve been talking about is true, and that’s perfectly fair—in fact, we encourage you to question anything and everything you’ve heard or continue to hear about nutrition from any so-called health expert. Simply trusting what we have always believed to be true about diet and health doesn’t cut it anymore. We need real evidence, and in the next few chapters we’ll be sharing what the science has proved about low-carb, high-fat diets.

Be a Careful Consumer of Research

Before we begin describing the multitude of studies that support the use of ketogenic diets for a variety of health concerns, we’d like to talk about the different kinds of research that exist and how to sift through and evaluate the overwhelming amount of information that we hear in the news about research. Most journalists do not have the expertise to evaluate the relevance or importance of research studies, so they end up reporting on any press releases they receive from medical journals or research institutes. That research is then regurgitated on the nightly news, in newspapers and magazines, and all across the Internet. The general public, in turn, doesn’t have the deep knowledge and experience needed to decipher what the research really means, and many simply embrace whatever they hear as the gospel truth. After all, they conclude, this is what science is showing us.

The first question to ask regarding any research study is this: “Does this study apply to me?” With that question in mind, it’s easy to only pay attention to research done with human subjects. Unfortunately, much of the dietary research that we hear about in the news has been conducted on rats or mice, and the findings are then extrapolated to apply to humans. A prime example of this was a study published in the November 1, 2013, issue of
American Journal of Physiology—Endocrinology and Metabolism
that concluded that a low-carb, high-fat, ketogenic diet impairs glucose tolerance, which in turn leads to an increase in insulin resistance. Who were the study subjects? Rats! Of course, none of the gleeful negative reporting on this research mentioned this salient fact.

The reality is that these kind of studies aren’t yet ready for prime time—rats and mice just aren’t similar enough to people for the results to be immediately applicable to humans. Instead, these studies help scientists develop theories that warrant further testing on larger animals and perhaps eventually humans (at which point the results will be more applicable to us). The reason so much research is done in rats and mice is that it is relatively inexpensive to conduct and the animals can be sacrificed to make measurements using the entire animal body.

But finding the right studies to listen to is a little more complicated than just focusing on human research. There is also something called the “hierarchy of clinical research,” which means that some human research is more relevant to an individual than others.

Anecdotal evidence deals with issues where it is hard to make explicit something that is understood intuitively. The best method of research is the one that answers the question, and some questions are well answered by anecdotal evidence.

– Dr. Richard Feinman

An n=1 case study tells the experience of one individual (for our purposes, usually someone making a change in his or her diet). While most people downplay the importance of a study like this, a lot of information can be obtained from one person’s experience—especially if that experience is new or unusual. For example, if an alien being came to Earth and we studied it very carefully, would we dismiss the information gleaned simply because the research was done on just one alien? Of course not! And if an explorer reached the North Pole alone and documented that experience, does the fact that he or she did it singlehandedly negate the discoveries made along the way? Not a chance.

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: I look at Jimmy’s n=1 experiment, described in chapter 9, like the observations of one of the first Arctic explorers. While his results might not be the same as yours, in my experience, most people who try something similar have similar results.

Then there are several types of research—observational, case-control, cohort, epidemiological—that are intended to be hypothesis-generating; they establish the groundwork that others use by coming up with theories to test in controlled clinical trials. Epidemiological studies, in particular, look at a large amount of data, apply different parameters, and look for patterns, from which they generate a hypothesis that can be tested in future studies. Due the limitations of such research, they are most definitely not relevant to an individual. Their purpose isn’t to answer certain questions but rather to set the stage for research that can be applicable to an individual.

Observational studies tend to find correlations between things. But let’s be clear (and you may have heard this before): correlation does not equal causation. Just because two things happen at the same time doesn’t mean that one thing causes the other. Health blogger and author Denise Minger shared an excellent example of this in a guest blog post on
Mark’s Daily Apple
. She noted that cholesterol levels began to fall the year Justin Bieber was born. But as soon as Facebook was invented, the levels went back up again. Therefore, this is “evidence” that Facebook cancelled out the cholesterol-lowering effects of Justin Bieber. Yes, this sounds preposterous, as it should. And yet these kind of “correlation equals causation” relationships are made often in nutrition studies.

Research on the ketogenic diet has been relatively limited because research-funding committees are either ignorant of its potential benefits or biased against it. Therefore, very few people are encouraged to follow this approach.

– Dr. Keith Runyan

Nutritional epidemiological research is a kind of cohort, hypothesis-generating research that has been used inappropriately to draw conclusions about what foods are healthy or unhealthy. For instance, an April 2014 study published in the
Journal of Epidemiology & Community Health
concluded that eating seven or more portions of fruit and vegetables a day reduces your risk of death at any point in time by 42 percent compared to eating less than one portion. How did the researchers come to this revelation? They examined the self-reported food logs of 65,226 British people who participated in an annual survey from 2001 to 2008. These people weren’t in a controlled environment, and the study relied heavily on the participants recalling what they ate over the previous year. What the researchers should have done was take the information gathered from their epidemiological research and use the results to form new hypotheses to test in a controlled, clinical setting. That didn’t happen. Instead, the headlines all touted the finding of “new evidence linking fruit and vegetable consumption with lower mortality.” This is incredibly misleading to the general public, but unfortunately most people don’t know this.

Another study, published by Harvard School of Public Health researchers in
Archives of Internal Medicine
on March 12, 2012, concluded that red meat consumption is associated with an increased risk of total, cardiovascular, and cancer mortality. That study pooled the data from 37,698 men from the Health Professionals Follow-up Study for up to 22 years and 83,644 women in the Nurses’ Health Study for up to 28 years who were free of cardiovascular disease and cancer at baseline. Here’s the kicker: their diets were assessed through questionnaires distributed every four years. Once again, recall of food consumed over the past few years was heavily relied on to generate the information used to make these correlations. But do you remember what you had to eat for lunch two weeks ago, much less three or four
years
ago? No, me either. And yet headlines boldly state “Red meat consumption linked to increased risk of total, cardiovascular, and cancer mortality,” making everyone scared to death of eating a steak or hamburger!