Negative ketosis comments....

[chimponarope]

LOL

How the hell did this turn for a negative of Keto thread into a star trek debate?

[Veritas]

Who brought up a Vulcan thing? Think I missed that one.

Ah, I was thinking XML as in HTML but this was kind of like a SWF which is also vector graphics but you didnt need to use a plugin to view it. It's kinda like looking at an engineering drawing that wasnt a bitmap. That way it would load as fast as, say, text rather than an image, was zoomable and never lost image quality. Real similar to Flash stuff, but not as much as a toy.


Hide the sausage.... I just threw up in my mouth.... heh

[IPR]

Originally posted by Psycorower
On the topic of cholesterol and keto diets, the main bodies of evidence is in stauch support of a favourable changes in lipid profile, especially if an individual has preexisting hyerlipidemia. LDL/HDL ratio is the strongest predictor of heart disease currently available so i think it would always be in everyones intrest to monitor this quite closely when changing diet. Keto diets appear to have a particularily positive effect of VLDL, which is the type of cholesterol most closely linked with heart disease.

The positive effects on lipid profile have only been determined in those individuals who follow the diet strictly over time so having a few too many "cheat days" here and there may not be recommended. Cholesterol problems should not be a feature of keto diets if carefully adhered to.

hmmmm......but do lipid levels actually indicate risk of CHD at all? I believe that is very strongly debated/disproved by the very trials and studies carried out to prove low-fat diets are healthy.

Anyway, the ratios seem to be the best indicator of CHD risk at present. LDL/HDL true, but more importantly Triglycerides/HDL (although slightly unfair as when Tris decrease HDL increases).

Some consider Triglycerides levels to be the important indicator of CHD rather than cholesterol per se, although again this is far from proved.

What does seem to be understood is that it isn't cholesterol thats the problem, but the oxidization of cholesterol which results in plaques in the arterial walls.

One other point, LDL isn't "bad" cholesterol. In fact there are two sub-groups a, and b. An abundance of type a seems to not be associated with CHD whilst type b maybe. On a keto diet ones LDL tends to be mostly type a

[IPR]

Psycorower

I'm in line with Chi's thinking on this, but would like to explore the thinking and evidence behind long-term keto leading to insulin resistance.

Can you post some references or studies that specifically look at this issue.

Thanks

[scorpion]

Is keto good or bad? In the long run will it screw up our insuline and make us all diabetic? No one knows for sure. All these ifs will make anyone crazy. Dont get me wrong i would like to know whats going to happen to me in 10 years but im not gonna lose sleep over it.

I think it should be stressed that keto, while a great fat loss diet seems to be the choice for bodybuilders. Most bodybuilders are in a healthy shape (the serious ones anyways). Its not like some 500lbs person who has all the diseases that are known to man starts eating high fat (prolly would work for him tho....fat ass!).

It seems to me that keto is a cutting diet for bodybuilders and that any bodybuilder that cuts is gonna remove carbs from his diet anyways. Its been done for years. Obviously cardio helps but we are giving our bodies the fuel it was designed for (why else would the body store energy as fat, if it was carbs we'd have a bunch of carb stores) Ya i know thats far fetched!

So i guess what im saying is that i dont see why, in our own forum, we should be defending our choice of nutrients when time after time we all see that its worked amazingly!

But then again this is a negative thread so carry on!

Just my uneducated 2 cents!

[Anxed]

Originally posted by scorpion
(why else would the body store energy as fat, if it was carbs we'd have a bunch of carb stores)[/B]

ROFL! I can just imagine if that were the case... having a stomach made of bread and an ass made of bundt cake.. ROFL!

[bkman4]

Originally posted by Anxed
ROFL! I can just imagine if that were the case... having a stomach made of bread and an ass made of bundt cake.. ROFL!

ROFLMAO!

[Psycorower]

Originally posted by IPR
hmmmm......but do lipid levels actually indicate risk of CHD at all? I believe that is very strongly debated/disproved by the very trials and studies carried out to prove low-fat diets are healthy.

Anyway, the ratios seem to be the best indicator of CHD risk at present. LDL/HDL true, but more importantly Triglycerides/HDL (although slightly unfair as when Tris decrease HDL increases).

Some consider Triglycerides levels to be the important indicator of CHD rather than cholesterol per se, although again this is far from proved.

What does seem to be understood is that it isn't cholesterol thats the problem, but the oxidization of cholesterol which results in plaques in the arterial walls.

One other point, LDL isn't "bad" cholesterol. In fact there are two sub-groups a, and b. An abundance of type a seems to not be associated with CHD whilst type b maybe. On a keto diet ones LDL tends to be mostly type a

Lipid profile is THE indicator of CHD! Lipid profile includes total cholesterol, HDL cholesterol, LDL cholesterol and TAG. High total, low HDL, low cholesterol and elevated TAG = elevated (and very unfavourable) lipid profile.

Also the current thinking on CHD risk associated with raised triglyceride levels is at best unclear. Studies have been trying for years to answer whether triglyceride level is an independent risk factor for CHD (and still no answer) they have all but given up and have now tried to establish more accurately risk levels for CHD, ie, can it affect diagnosis, prognosis, therapy etc. At the moment it is totally unknown whether lowering triglyceride level has any effect on CHD. Trials which have been done with the aim of lowering LDL-C have shown, at best, a weak association between triglyceride lowering and cardiovascular events. In recent studies males with low HDL, normal LDL-C and CHD, any change in triglyceride level was not reflected in CHD events. So all the current evidence certainly doesn't appear to support any direct causal relationship between TAG and CHD. Recent studies also indicate that even knowing a patient's triglyceride level does not help estimate CHD risk. Again, the only good indicator we appear to have is in individuals (women only actually) with a high ratio of LDL:HDL, as well as a high triglyceride level: these women were shown to be at very high CHD risk.

Also IPR, i'll get some references for you on Friday if that is ok (at worst it should be first thing monday morning), cos i'm working in a childrens hospital this week and the library is at best limited and all the online journals are not available in Full Text, only Abstracts.

Also, scorpion i really wouldn't lose sleep over it. There really are very few negative effects of note. I'm just interested in the long term effects so if you are only doing this sort of diet in a small time frame, i really wouldn't worry.
Your carb storage theory is a bit mad by the way - we store excess energy as fat becuase it is by far the most efficient way. 9.4kcal compared to 4.1kcal per gram. So if we were to store all our energy as glycogen we would have to be over 2 times the weight and size we are now which, now i come to think of it some of you might actually like!

Cheers.

[Chi_town]

Psycorower,

I look forwardto your references .




For those of you who may be interested............

_______________________________________________

Effects of a Low Carbohydrate Diet on Body Weight and Cardiovascular Risk Factors

Reference:
Brehm, B.J., Seeley, R.J., D’Alessio, D.A., et al., "Effects of a Low Carbohydrate Diet on Body Weight and Cardiovascular Risk Factors", College of Nursing and College of Medicine, University of Cincinnati.

This Information was presented at the 2002 Annual Meeting of the American Dietetic Association and the 2001 Annual Meeting of the North American Association for the Study of Obesity. The results have not yet been published.

Summary:

Popular weight loss diets, such as the low carbohydrate, ketogenic diet, are adopted by millions of Americans each year. However, rigorous, well-controlled studies of their efficacy and safety are limited. Thirty-four mildly obese women (BMI of 30-34 kg/m2) were recruited for a six-month clinical study to investigate the effects of a low carbohydrate, ketogenic diet on body weight and cardiovascular risk factors. The study included a three-month weight loss intervention followed by a three-month follow-up period during which no intervention occurred. Subjects were randomly assigned to either an ad libitum low carbohydrate, ketogenic diet that restricted carbohydrate intake to less than 10% of kcal, or a control diet with modest caloric restriction (1200-1500 kcal/d) and recommended distributions of fat (30% of kcal) and carbohydrate (55% of kcal) conforming to recommendations of the American Heart Association. Twenty-six subjects (76%) completed the trial, with an equal number of dropouts from each diet group. Mean weight loss was significantly greater in the ketogenic diet group than in the control diet group at three months (8.0+1.0 vs. 4.4+1.1 kg; p<0.02) and at six months (7.9+1.4 vs. 3.2+1.3 kg; p<0.02). As measured by DEXA scans, the mean percentage body fat decreased in both groups at three months (1.7+.46 vs. 1.3+.48) and at six months (2.2+.58 vs. .74+.49). Blood pressure, total cholesterol, and LDL-cholesterol decreased, and HDL-cholesterol increased, in both groups. Plasma insulin levels decreased in both groups suggesting an improvement in insulin sensitivity. Triglyceride levels decreased significantly more in the ketogenic diet group than in the control diet group (65.3+17.2 vs. 15.2+8.2 mg/dl; p<0.02) at three months. These results indicate that for short periods of time, a low carbohydrate, ketogenic diet is efficacious in causing weight loss and has no deleterious effects on cardiovascular risk factors.
_____________________________________


also.................



Glycaemic Index as a Determinant of Serum HDL-Cholesterol Concentration
Reference:
Frost, G., Leeds, A.A., Dore, C.J., et al., "Glycaemic Index as a Determinant of Serum HDL-Cholesterol Concentration," The Lancet, 353(9158), 1999, pages 1045-1048.

Summary:
The authors of this study begin by stating that diet influences insulin sensitivity and concentrations of HDL(“good”) cholesterol, two predictors of coronary heart disease. Dietary carbohydrates with a high glycemic index cause a strong glucose and insulin response, which is associated with decreased insulin sensitivity. The aim of this study was to examine whether the glycemic index of dietary carbohydrates was linked to HDL cholesterol concentrations. Researchers re-analyzed a British survey of 2,200 adults, examining the relationship between total cholesterol, HDL cholesterol, and LDL (“bad”) cholesterol concentrations and various dietary characteristics, including the type of carbohydrate, its glycemic index and total fat intake. Results indicated that among the 1,420 participants with complete data, there was a negative relationship between HDL-cholesterol concentration and the glycemic index of the diet for both men and women. No other significant relationship was found with total cholesterol or LDL-cholesterol concentration or with any other dietary carbohydrate or fat constituent. Researchers concluded that the glycemic index of the diet was the only dietary variable significantly related to lowering HDL-cholesterol concentration. Thus, the glycemic index of the diet is a stronger predictor than dietary fat intake on HDL-cholesterol concentration.

___________________________________________


and lastly........................



Basal and Postprotein Insulin and Glucagon Levels During a High and Low Carbohydrate Intake and Their Relationships to Plasma Triglycerides
Reference:
Fujita, Y., Gotto, A.M., Phil, D., et al., "Basal and Postprotein Insulin and Glucagon Levels During a High and Low Carbohydrate Intake and Their Relationships to Plasma Triglycerides," Diabetes, 24(6), 1975, pages 552-558.

Summary:
In this clinical study, researchers observed the effects of high-carbohydrate and low-carbohydrate gelatin diets on insulin and glucagon levels and the relationship of these two hormones to triglycerides. Twenty-two volunteers (20 women, 2 men) between the ages of 20 and 48 participated in this study. Three dietary regimens were followed for seven days each. The 2,870-calorie low-carbohydrate diet consisted of 12 g carbs, 260 g protein and 190 g fat. The 2,784-calorie moderately high-carbohydrate diet consisted of 390 g carb, 36 g protein and 120 g fat. The 2,843-calorie very-high-carbohydrate diet was comprised of 510 g carb, 72 g fat and 44 g protein. The order in which the diets were fed to individuals varied. On the low-carbohydrate diet, glucose declined by 10 mg/dL after two days and remained in this range through the seventh day. Mean insulin was significantly decreased after seven days while glucagon rose slightly within two days and averaged 80 picograms/ml at the seventh day. Plasma triglycerides declined within 48 hours from 89 to 72 mg/dL and after six days averaged 58 mg/dL. All but one participant on the low-carbohydrate regimen lost weight, the amount ranging from 0.67 to 6.4 pounds. On the moderately high-carbohydrate diet, glucose and insulin levels rose and glucagon declined significantly. Triglycerides increased from 55 to 95 mg/dL, peaking at 120 mg/dL on the 4th day. On the very high-carbohydrate diet, compared to the final values for the low-carbohydrate diet, glucose and insulin significantly increased and triglycerides doubled. Glucagon declined but not to a significant degree. There was no significant gain in weight during this week. Researchers attributed this to the wide variation in weight change resulting from the fact that in some patients the high carbohydrate diet followed a period of carbohydrate restriction.

Commentary:
Following a diet low in carbohydrate, subjects saw decreases in glucose, insulin and triglyceride levels. Subjects on the low-carbohydrate diet experienced greater weight loss than those eating a greater amount of carbohydrate. These subjects also saw an increase in the hormone glucagon. Subjects following a high-carbohydrate diet experienced increases in glucose and insulin levels as well as triglycerides, raising their risk for such conditions as adult-onset diabetes, atherosclerosis and coronary heart disease.

[Psycorower]

Denke, Margo A. MD. Metabolic Effects of High-Protein, Low-Carbohydrate Diets. American Journal of Cardiology. 88(1):59-61, July 1, 2001.

Is a nice and simple review article which while it is not specifically on topic is somewhat informative. Also it's one of the few articles actually available in full text online without paying for it.
Again i appreciate many of you will advocate the high fat specifically approach, but more than a few of you will have a protein intake above 20-30%.

A critique of low-carbohydrate ketogenic weight reduction regimens. A review of Dr. Atkins' diet revolution. JAMA

Is also available on Medline, haven't read it yet but i'm sure it will be of some interest. Might be bollocks but you can make your own mind up in that regard.

I'll get some proper references soon though.
Cheers

[Chi_town]

Psycorower,

Could you please post a link to a Free Full text of the study you mentioned (if not an abstract if that's al there is). All I can find are full text versions for $$$ only.

Thanks,

PEACE

[IPR]

Originally posted by Psycorower
Lipid profile is THE indicator of CHD!

pysco.....I believe this is not the case and the actual studies carried out over the last 30yrs indicate a casual relationship when other factors are present. Conversely, those with very low lipid profiles exhibit higher rates of premature death from ALL causes not only CHD.

This isn't the place to debate this issue, as all agree ketogenic diets improve lipid profiles.

Thanks for the reference.....look forward to reading it if you can post the link.

[Psycorower]

pysco.....I believe this is not the case and the actual studies carried out over the last 30yrs indicate a casual relationship when other factors are present. Conversely, those with very low lipid profiles exhibit higher rates of premature death from ALL causes not only CHD.

I know you suggested this isn't the place to discuss it but you've gotten me curious now. What are the other factors? i'm not arguing as such, just curious. Also i think you meant to write those with high lipid profile exhibit higher rates of premature death. Which is true of course, ischemia, renal failure, diabetes, stroke and atherosclerotic vascular disease, including of course CHD are all causes of premature death with relation to elevated lipid profile. What do you suggest be used instead of lipid profile in evaluating CHD risk?

With regard to the Full Text Link i'll have to copy and paste it if that is ok becuase i use an NHS password to access databases and obviously cant distribute it. I don't actually think much of this paper but it's worth a read. I think you can probably find evidence to disregard much of the inferences in this article but it's best to review all the available literature i guess, i still agree with the conculsion though.

Also i cant get onto JAMA just now cos "the capacity for concurrent users has been reached" or some pish like that, so i'll get it later.

See the next post for the paper.

[Psycorower]

The American Journal of Cardiology
Copyright © 2001 by Excerpta Medica, Inc. All rights reserved.

Volume 88(1) 1 July 2001 pp 59-61

Metabolic Effects of High-Protein, Low-Carbohydrate Diets
[Editorial]
Denke, Margo A. MD
From the Division of Endocrinology and Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.
Manuscript received October 16, 2000; revised manuscript received and accepted February 6, 2001.
Address for reprints: Margo A. Denke, MD, Center for Human Nutrition, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9052. E-mail: mdenke@mednet.swmed.edu.
Weight-losing diets appeal to the growing population of overweight Americans. Fad diets promise rapid weight loss, easy weight loss, limited restrictions on portion sizes of favorite foods, and above all an enhanced sense of well being. The popularity of fad diets points out the honest promises of traditional weight loss diets. Traditional weight loss diets promise slow weight loss of 0.45 to 0.9 kg/week. The weight loss is nothing but easy, because portion sizes of nearly all foods except low-calorie "free foods" must be continuously evaluated and tracked. Claiming an enhanced sense of well being is hardly appropriate for a traditional diet-most patients report dissatisfaction from the constant vigilance over dietary intake. Through discipline and perseverance, traditional weight loss programs try to teach a patient a new lifestyle of healthy eating. Unfortunately, 70% of successful weight losers return to their old habits and within 2 years regain at least half of the weight lost. These patients typically have little insight into the reasons why the weight was regained, and consider themselves "failures" to traditional diet programs. They become prime targets for diets promising rapid and easy weight loss.

PROTOTYPES OF THE HIGH-PROTEIN, LOW-CARBOHYDRATE DIETS
High-protein, low-carbohydrate diets have a long history of cyclic popularity. Greek Olympians ate high meat, low vegetable diets >2,000 years ago to improve athletic performance. Dr. William Harvey recommended a diet prohibiting sweet and starchy foods and permitting ad lib consumption of meats for patients who needed diuresis. As the basic understanding of nutrition and essential vitamins developed, these diets fell out of favor. They regained popularity in the late 1960s and early 1970s with the publication of the Atkins' Diet, Stillman's Diet, The Drinking Man's Diet, the Scarsdale Diet, and the Air Force Diet. The American Medical Association strongly criticized these diets,1 leading to their submergence on the popular diet trend.

Resurgence of low carbohydrate diets has been fueled by rising obesity and insulin resistance in the general population. Although the Atkins' Diet is the prototype of the low carbohydrate diet, The Sugar Busters Diet, Carbohydrate Addicts Diet, Protein Power Diet, and the Zone Diet are all variations on this common theme.

Several diets promise that, as long as you restrict carbohydrates, you will lose weight and you can eat as much food as you want. There may be a kernel of truth to this claim. For some patients, high-protein intake suppresses appetite.2 For other patients, ketosis from carbohydrate restriction suppresses appetite. Restricting carbohydrate eliminates some popular foods that are often consumed in excess such as bread, cereal, soft drinks, french fries, and pizza. By simply excluding carbohydrate foods, patients following the Atkins diet typically consume 500 fewer calories a day.3

HOW LOW-CARBOHYDRATE DIETS PRODUCE INITIALLY GREATER WEIGHT LOSS
Reducing caloric intake by 500 kcal/day should result in a 0.45- to 0.9-kg weight loss each week. However, low-carbohydrate, high-protein diets typically produce a 2- to 3-kg weight loss in the first week. This added weight loss is not due to the miracle of "switching the body's metabolism over to burning fat stores." It is due to a diet-induced diuresis. When carbohydrate intake is restricted, 2 metabolic processes occur, both of which simultaneously reduce total body water content. The first process is mobilization of glycogen stores in liver and muscle. Each gram of glycogen is mobilized with approximately 2 g of water. The liver stores approximately 100 g of glycogen and muscle has 400 g of glycogen. Mobilization glycogen stores result in a weight loss of approximately 1 kg. Patients notice this change as a reduction in symptoms of "bloating" and are very pleased with the effect. The second process is generation of ketone bodies from catabolism of dietary and endogenous fat. Ketone bodies are filtered by the kidney as nonreabsorbable anions.4 Their presence in renal lumenal fluids increase distal sodium delivery to the lumen, and therefore increase renal sodium and water loss.

In a study comparing an 800-calorie mixed diet with an 800-calorie low-carbohydrate, high fat diet,5 10-day weight loss was 4.6 kg on the ketogenic diet and 2.8 kg on the mixed diet. Energy-nitrogen balanced studies documented that the difference in weight lost was all accounted for by losses in total body water.

LONG-TERM WEIGHT LOSS IS INFLUENCED BY CALORIC RESTRICTION, NOT CARBOHYDRATE RESTRICTION
The diuretic effect of low-carbohydrate intake is limited to the first week of the diet. The remaining weight loss is a function of the laws of energy balance. Calories from any source determine the success of additional weight loss.

In the only published study of Atkins diet, patients following the diet reduced caloric intake by 500 kcal/day. The average weight loss was 7.7 kg at 8 weeks, which is no greater than that expected from caloric restriction alone.6 The ability of low carbohydrate intake to generate ketones has been touted as a relative advantage for losing weight. However, this advantage was not confirmed in a 1-month study comparing ketogenic with nonketogenic hypocaloric diets.7 Most comparison studies have evaluated the relative advantages of either a low carbohydrate or low fat hypocaloric diets; some studies found a slight 1- to 3-kg greater weight loss on a low-carbohydrate diet,8,9,10,11 others a slight advantage with a high-carbohydrate diet,12 but most studies have observed no statistical advantage of a low-carbohydrate diet.13-18 The preponderance of evidence suggests that as long as caloric intake remains constant,19 there is no intrinsic advantage to cutting carbohydrate intake.20

UNTOWARD METABOLIC EFFECTS
Complications from ketosis: Eucaloric ketogenic diets have been prescribed as part of an antiepileptic regimen in children with refractory seizure disorders. Children following these ketogenic diets have higher rates of dehydration, constipation, and kidney stones. Other reported adverse effects include hyperlipidemia, impaired neutrophil function, optic neuropathy, osteoporosis, and protein deficiency.21

Because ketogenic diets effect the central nervous system, it has been suspected that ketogenic diets may alter cognitive function. In a randomized weight loss study comparing a ketogenic with a nonketogenic hypocaloric diet, subjects consuming the ketogenic diet had impairments in higher order mental processing and flexibility than those following the nonketogenic diet.7

Complications from high saturated fat intake: Despite the beneficial effects of weight loss, diets that promote liberal intake of high fat meats and dairy products raise cholesterol levels. In a study 24 subjects following the Atkins'-type 4-week induction diet, then 4 weeks maintenance diet,6 low-density lipoprotein cholesterol levels increased significantly from 127 to 151 mg/dl. Similar increases in total cholesterol (13%) were reported in a study of patients following the Stillman diet.22

Complications from high fat intake: High fat diets increase free fatty acid flux and circulating free fatty acids. Fasting plasma free fatty acids may have a pro-arrhythmic effect in cardiac muscle. A number of mechanisms have been suggested including a possible detergent effect of circulating free fatty acids on cell membranes and direct effects of acylcarnitine on cellular ion channels and exchangers.

Complications from exclusion of fruits, vegetables, and grains: Because they exclude fruits, vegetables, and grains, low-carbohydrate, high-protein diets are deficient in micronutrients. Children consuming low-carbohydrate ketogenic diets have reduced intakes of calcium, magnesium, and iron.21 Two sailors following a low-carbohydrate, high-protein hypocaloric diet during an extended voyage developed optic neuropathy from thiamine deficiency.23 Although vitamin deficiencies can be circumvented by supplemental multivitamins, even supplemented low-carbohydrate diets will still be deficient in a growing number of important, biologically active phytochemicals present in fruits, vegetables, and grains.

Complications from high-protein intake: Increasing the protein content of a diet significantly increases glomerular filtration rate.24,25 Increases in glomerular filtration rate are likely explained by increased renal capillary permeability. Unfortunately, this compensatory response to the greater production of nitrogen is insufficient to clear protein by-products, and blood urea nitrogen levels increase. High protein diets significantly lower urinary pH by increasing titratable acid concentrations.25,26 High protein intakes provide a greater uric acid load to the kidney. Despite increases in urinary uric acid excretion, increases in serum uric acid are observed.6,26

[Psycorower]

UNTOWARD LONG-TERM EFFECTS
Development of nephrolithiasis: Hypercalciuria is a risk factor for nephrolithiasis. High-protein diets induce hypercalciuria by several different mechanisms. High-protein diets increase glomerular filtration rate and decrease renal tubular reabsorption of calcium. The relation between dietary protein intake and calcium excretion is clearly linear.27

The stone-forming propensity of the hypercalciuria induced by high-protein diets is aggravated by other changes in urine composition. A high animal protein diet reduces gastrointestinal alkali absorption, leading to reduced urinary citrate.28 Hyperuricemia and hyperuricosuria are also associated with excess intake of animal protein. Animal protein is a rich source of sulfur-containing amino acids; amino acids have a greater propensity to lower urinary pH.

Adding a carbohydrate restriction to a high-protein diet exacerbates many of these parameters. Low-carbohydrate intake further reduces urinary pH by inducing ketosis. Limiting the intake of vegetables and fruits further reduces urinary citrate by reducing dietary sources of alkali. Thus, high-protein, low-carbohydrate diets are associated with hypercalciuria, hyperuricosuria, and hypocitraturia, which can all contribute to renal calculi formation.

Development of osteoporosis: High-protein, low-carbohydrate diets generate a high acid load, resulting in a subclinical chronic metabolic acidosis. Metabolic acidosis promotes calcium mobilization from bone.29 Osteoclasts and osteoblasts respond to small changes in pH in cell culture; thus, a small decrease in pH results in a large burst of bone resorption.

The effects of varying dietary protein intakes on bone turnover has been carefully documented in young women consuming metabolic diets. High-protein diets increase renal calcium excretion, raised parathyroid hormone levels, and raise urinary N-telopeptide concentrations. Markers of bone formation (alkaline phosphatase and osteocalcin) remain steady, suggesting that high-protein diets increase bone resorption without affecting the rate of bone formation.27 These effects may be exaggerated in older persons who tend to have decrements in renal clearance of acid and higher serum parathyroid hormone concentrations.29

Progression of chronic renal insufficiency: In several small, randomized, controlled dietary trials, dietary protein restriction retarded the progression of diabetic nephropathy to end-stage renal disease.30 High-protein, low-carbohydrate diets have a weak effect at reducing creatinine clearance over time, and could potentially hasten renal failure in patients with baseline renal insufficiency.

Patients are inherently attracted to the simple, permissive dietary instructions: eat as much as you want of foods containing fat and protein, but don't eat foods containing carbohydrate. As promised, almost everyone loses weight during the first week. Low-carbohydrate diets cause a greater initial weight loss from a physiologic diuresis accompanying the obligate loss of glycogen stores and renal clearance of ketone bodies. Once glycogen stores have been liberated, and a new steady state for total body sodium has been achieved, these diets hold no greater promise for weight loss than any other caloric restricted diet. High-fat, low-carbohydrate diets can be harmful. The diet plan is deficient in micronutrients. Consuming ad libitum fatty meats raises total and low-density lipoprotein cholesterol levels. High-protein, low-carbohydrate intakes create a subclinical metabolic acidosis, and increase blood urea nitrogen and uric acid levels. Resultant urine acidification, hyperuricosuria, and hypercalciuria increase urine lithogenicity. Trying to convince a devotee to stop the diet uncovers yet another deleterious effect; ketogenic diets impair higher order cognitive function. High-protein, low-carbohydrate diets have untoward clinical consequences for patients with coronary artery disease, including progression of diabetic nephropathy, exacerbation of gouty diathesis, increases in circulating free fatty acids, and increases in low-density lipoprotein cholesterol levels. High-protein, low-carbohydrate diets are not superior weight-losing diets and should not be recommended.

1. Anonymous. A critique of low-carbohydrate ketogenic weight reduction regimens. A review of Dr. Atkins' diet revolution. JAMA 1973;224:1415-1419.

2. Johnstone AM Effect of overfeeding macronutrients on day-to-day food intake in man. Eur J Clin Nutr 1996;50:418-430.

3. Yudkin J The treatment of obesity by the high fat diet. Lancet 1960;2:939-941.

4. Kolanowski J. On the mechanisms of fasting natriuresis and of carbohydrate-induced sodium retention. Diabetes Metab 1977;3:131-143.

5. Yang MU, Van Itallie TB. Composition of weight lost during short-term weight reduction. Metabolic responses of obese subjects to starvation and low-calorie ketogenic and nonketogenic diets. J Clin Invest 1976;58:722-730.

6. LaRosa JC, Fry AG, Muesing R, Rosing DR. Effects of high-protein, low-carbohydrate dieting on plasma lipoproteins and body weight. J Am Diet Assoc 1980;77:264-270.

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8. Lewis SB, Wallin JD, Kane JP, Gerich JE. Effect of diet composition on metabolic adaptations to hypocaloric nutrition: comparison of high carbohydrate and high fat isocaloric diets. Am J Clin Nutr 1977;30:160-170.

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10. Alford BB, Blankenship AC, Hagen RD The effects of variations in carbohydrate, protein, and fat content of the diet upon weight loss, blood values and nutrient intake in adult obese women. J Am Diet Assoc 1990;90:534-540.


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19. Skor AR, Toubro S, Ronn B, Holm L, Astrup A Randomized trial on protein vs. carbohydrate in ad libitum fat reduced diet for the treatment of obesity. Int J Obes 1999;23:528-536. [Medline Link] [BIOSIS Previews Link] [Context Link]

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[chimponarope]

Originally posted by Psycorower
Trying to convince a devotee to stop the diet uncovers yet another deleterious effect; ketogenic diets impair higher order cognitive function.

Well this is BS for sure, yes at first your can get kinda foggy, but myself and quite a few more on the board will attest to the fact that we run at least at the same level as on carbs, and some people find their mental state is improved.

[RonJ73]

The problem is, his studies are short term. They don't show people living in ketosis for extended periods of times. Short term, yes you do get fuzzy. But if you also notice, the studies mention 800 calories a day, no veggies, no fruits. On ketosis you DO eat veggies. And you eat WAY more than 800 calories.

[Psycorower]

Originally posted by chimponarope
Well this is BS for sure, yes at first your can get kinda foggy, but myself and quite a few more on the board will attest to the fact that we run at least at the same level as on carbs, and some people find their mental state is improved.

I'll agree with you completely on this point. The author is trying to argue that individuals are unable to make rational descisions because their carb intake is low, a little far fetched i think. Then again, the potential reduction in cognitive function is feasable. The percieved increase in mental acuity many individuals report may purely be down to the weight loss itself as the majority of individuals report they feel they have more energy after the loss of unwanted weight.

The 800 kcal a day thing i agree with also, i don't think whoever conducted this study should have been given ethical approval to go ahead with it.

[chimponarope]

Originally posted by Psycorower
The percieved increase in mental acuity many individuals report may purely be down to the weight loss itself as the majority of individuals report they feel they have more energy after the loss of unwanted weight.

The 800 kcal a day thing i agree with also, i don't think whoever conducted this study should have been given ethical approval to go ahead with it.

It could be that this is the reason for the improved mood etc but I doubt it would create the 'sharper' mental functions some people experience.

Yeah no kidding after doing 800 cals myself a few years ago I wouldn't dare put someone else on it.

Well so far I think we've proved that Keto is neither CONCLUSIVELY healthier or worse than a 40/40/20 type diet, but what I do know is that its been the easiest diet for me to stick to so far which IMO is the best thing about keto.

The best diets are the ones you can keep and if keto is what you can stick to, do it IMO, better with the fat off and fitter than overweight and worrying what MIGHT happen 50 years down the line.

Besides the way the worlds going these days none of us will be around to see who's right

[Psycorower]

Originally posted by chimponarope
It could be that this is the reason for the improved mood etc but I doubt it would create the 'sharper' mental functions some people experience.

Yeah no kidding after doing 800 cals myself a few years ago I wouldn't dare put someone else on it.

Well so far I think we've proved that Keto is neither CONCLUSIVELY healthier or worse than a 40/40/20 type diet, but what I do know is that its been the easiest diet for me to stick to so far which IMO is the best thing about keto.

The best diets are the ones you can keep and if keto is what you can stick to, do it IMO, better with the fat off and fitter than overweight and worrying what MIGHT happen 50 years down the line.

Besides the way the worlds going these days none of us will be around to see who's right

Agree completely.
If you cant stick to a "normal" diet and you are overweight, by all means do keto.

The only main point i've been trying to argue this whole thread is that if you have a choice of doing a 40/40/20 type diet and a keto diet and you have the will power to carry either of the diets through, do the 40/40/20 (all the other discussions are purely consequential).

The keto carries with it POTENTIAL side effects whereas the 40/40/20 does not. That is the ONLY point i've considered in making my descision but then again, i'm not overweight and have never had a problem with adhering to "normal" diets. The benefits certainly outweigh the possible side effects if the keto diet reduces an individuals weight towards that for clinical normality and health.

[Chi_town]

Give me some time and I'll comment on the post by Psycorower.

I'm busy at work today and it may take a few hrs.

LOL

PEACE

[Psycorower]

Originally posted by Chi_town
Give me some time and I'll comment on the post by Psycorower.

I'm busy at work today and it may take a few hrs.

LOL

PEACE

That sounds like bad news!! LOL
"Run for the hills!!"
Look forward to it though.

[bkman4]

Originally posted by Psycorower
Agree completely.
If you cant stick to a "normal" diet and you are overweight, by all means do keto.

The only main point i've been trying to argue this whole thread is that if you have a choice of doing a 40/40/20 type diet and a keto diet and you have the will power to carry either of the diets through, do the 40/40/20 (all the other discussions are purely consequential).

The keto carries with it POTENTIAL side effects whereas the 40/40/20 does not. That is the ONLY point i've considered in making my descision but then again, i'm not overweight and have never had a problem with adhering to "normal" diets. The benefits certainly outweigh the possible side effects if the keto diet reduces an individuals weight towards that for clinical normality and health.

This will just take a minute...

POTENTIAL side effects?!?! Prove it. The potential side effects of 40/40/20 include are the same as keto. If these diets are followed correctly, they are both safe. I say, if you have the will power to follow either one, and are in good shape, go keto all the way. Since keto uses fat for fuel, you will burn your body fat faster then on a 40/40/20. This way you can get off the whole diet train even faster, and can get back to eating the proper amount of calories. Keto is also more muscle preserving. As a matter of FACT a number of members of this board(including myself) can't seem to loose much weight on keto, just FAT. This must mean that this "diet" allows us to burn body fat, and build muscle. Let me see you do that on a 40/40/20.

[Chi_town]

Originally posted by Psycorower
"Run for the hills!!"

Never !!! I will admit I was wrong b4 that . It's not about ego with me it's about learning. I have an open mind and will look at any (just about) data presented by a reasonable person.

PEACE

[Psycorower]

I was talking about me! (running for the hills that is)
I am really enjoying discussing this topic, especially with people who obviously have a good understanding of it (likely more so than myself in most regards).
Also, i don't enter into discussions with the sole intention of winning, first and foremost i'm here to learn and if my worries about keto diets are all ill founded, it's something else i've learned. I believe it's more likely that the evidence will be overwhelmingly in favor of keto but i still think its worth looking at the evidence or theories to the contrary. I just hope we can get somewhere a bit closer to a possible conclusion rather than just create further questions!

bkman4,
I have at no time said i have unequivocal proof of side effects regarding keto diets. I have stated NONE of my arguments as FACT, please extend the same courtesy and refrain from stating things as fact unless they are 100% true. You have asked me for proof, which i at no time said i could provide. I have however tried (and will try) to provide EVIDENCE for and against the argument at hand. Please will you provide your PROOF for all of the statements you made in your last post, and something other than "members of the board say...." would be appreciated.
Also, can you please supply a list of the possible side effects of a 40/40/20 diet, after which time i will supply you with one for keto diets, and we shall see how they compare. If they are identical, very well, but i very much doubt they will be.

Thanks.

[bkman4]

Originally posted by Psycorower

bkman4,
I have at no time said i have unequivocal proof of side effects regarding keto diets. I have stated NONE of my arguments as FACT, please extend the same courtesy and refrain from stating things as fact unless they are 100% true. You have asked me for proof, which i at no time said i could provide. I have however tried (and will try) to provide EVIDENCE for and against the argument at hand. Please will you provide your PROOF for all of the statements you made in your last post, and something other than "members of the board say...." would be appreciated.
Also, can you please supply a list of the possible side effects of a 40/40/20 diet, after which time i will supply you with one for keto diets, and we shall see how they compare. If they are identical, very well, but i very much doubt they will be.

Thanks.

I will go point by point.

1. I never accused you of stating fact. You said, "The keto carries with it POTENTIAL side effects whereas the 40/40/20 does not." There is NO maybe there. So...PROVE IT.

2. The members of this board are very knowledgeable on this subject. We are living this diet, and know what it does to our bodies. If the experiences of 10+ people who live what you are theorizing about, are not usable evidence to you, then I suggest you tell me what is.

3. No I will not provide you with a list of side effects. I am not your secretary. They will include all the same effects that all diets produce.

I suggest you look at the way you are trying to confuse people. Everyone with a real mastery of this language is not impressed, rather annoyed, at your constant barrage of useless rhetoric. This is not a contest to see who can sound the smartest. If you try and phrase things in direct, CONCISE manner, you will see a much better response.

[Psycorower]

Originally posted by bkman4
I will go point by point.

1. I never accused you of stating fact. You said, "The keto carries with it POTENTIAL side effects whereas the 40/40/20 does not." There is NO maybe there. So...PROVE IT.

2. The members of this board are very knowledgeable on this subject. We are living this diet, and know what it does to our bodies. If the experiences of 10+ people who live what you are theorizing about, are not usable evidence to you, then I suggest you tell me what is.

3. No I will not provide you with a list of side effects. I am not your secretary. They will include all the same effects that all diets produce.

I suggest you look at the way you are trying to confuse people. Everyone with a real mastery of this language is not impressed, rather annoyed, at your constant barrage of useless rhetoric. This is not a contest to see who can sound the smartest. If you try and phrase things in direct, CONCISE manner, you will see a much better response.

1. You are asking me to provide PROOF on a THEORY. Now if you have read through any of the posts made you will realise that these theories are perfectly feasible. The theory is generally sound (apart from a few questionable assumptions), but whether this applies to real life situations ramains to be seen. I have cited references which have demonstrated possible unfavourable metabolic disturbances, but whether these references provide strong evidence is certainly open to argument, which is what this discussion is about.

2. A well desinged epidemiological study in which all possible factors can be corrected or accounted for. This would contain a large sample size of perhaps thousands of individuals of all socioeconomic classes, genders and ethnic backgrounds. Also i am very confused as to how your 10+ friends have accurately measured all the metabolic changes within their bodies, please explain? Again i never suggested these individuals would exhibit clear side effects from this diet over a short period of time. If you read some literature on the subject you will realise that the side effects proposed would occur generally over the long term and would be changes in metabolism, and therefore generally not percievable.

Ten of my friends all eat ice cream in summer and none of them get flu in summer, whereas when they don't eat ice cream in winter they seen to get flu. Is that evidence that increased ice cream consumption prevents flu? I really dont think so.

3. Why wont you provide me with a list? This forum is for the exchange of knowledge and i would really like to know what i am doing to my body on a 40/40/20 diet. I have yet to come across any potentially harmful side effects but would be obviously concerned if you have evidence of any. It's in everyones interest that if you have found evidence for side effects associated with a 40/40/20 diet that you post it.

Why do you think i'm trying to sound smart? My god man just because i don't insult people in my posts hardly means i'm trying to take the intellectual high ground. Please feel free to reword any of my dialogue if you think it will help the argument but i have at no time tried to confuse anyone and i apologise if anyone is confused. If you don't understand something, please ask and i'll explain it as simply as i can.

You appear to be taking this very personally. It is not my intent to insult anyone, just to provide an opposing veiw. I apologise if you have been offended by anything i have said.

[bkman4]

1. You tried to make a statment...there was no maybe or theory in what you said. I'm still waiting...either prove that: "The keto carries with it POTENTIAL side effects whereas the 40/40/20 does not." or admit it was a theory with no proof.

2. Well, I am trying to help. If you want to fund such a study, I will be more then happy to carry it out. Until then we will have to rely on what we know/have proof of already. And what long term metabolic changes are you refering to?? Could it be that not eating carbs causes desireable long term changes? Eating carbs all of your life obviously has caused some great changes in america...diabetes, man what a great change.

3. Diets cause bodily changes. 40/40/20 is no exception. If keto has any side effects that would not happen on any other diet, I would be suprised. So, give me one side effect of keto that would not be applicable to the 40/40/20.

I understand everything you have tried to say. Maybe you just like to type. If are trying to provide an opposing view, I'm waiting for damaging info on high fat diets/CKD. All you info seems to be about high protein diets, which CKD is not.

[Psycorower]

1. I've got to admit i'm really confused on this point. I've presented feasable theories based on well established evidence. If i were to present proof on a theory, would it not then cease to be a theory?

2 & 3. Ketosis has been shown to cause: constipation, impaired neutrophil function, optic neuropathy, osteoporosis, protein deficiency (rare), altered cognitive function and have also been shown to aggravate diabetes mellitus in those genetically predisposed (in that the development of diabetes mellitus is associated with the activation of the glucose-fatty acid cycle).

Many highly respected individuals including my friend and collegue John Reilly feel overwhelmingly that the current data available is not conclusive.

As you all know, ketosis induces a simulated diabetic state. In ketosis, the primary source of energy is fat. Again as i'm sure you are all aware that this will cause a higher mobilisation of fat. This will result in a higher lipid content in the bloodstream which OVER TIME is thought to likely lead to deposits in arterial walls etc. This theory is supported by a number of individuals and until it is proven otherwise I would rather treat the area with some caution. Although cholesterol goes down, and this has been shown to in a great number of studies, fat needs to be mobilised and transported before it is used as energy. When it is mobilised it is perfectly reasonable that it may deposit in the arteries, and that fat & cholesterol which is not deposited is used for energy production, therefore circulating lipids are low. I think it is a perfectly reasonable argument and while i have explained it very simplistically i'm sure you can appreciate it is possible.

I appreciate these theories have yet to carry with them a great deal of proof but i think you can appreciate the concern is quite real given that doctors and dieticians in this country are advised NOT to recommend this diet to individuals or at least do so with caution until such time that all questions have been answered.
Again, I'm sure you can appreciate why I choose to NOT advocate this diet, but that by no means should prevent others from doing something they find useful in losing unwanted weight.

[Psycorower]

Also see how many times you can use the word "appreciate" in your response. I managed it 4 times in 5 lines! If that's not mastery of the English language i don't know what is.
Someone get me a thesaurus!