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mccoy

The thread on keto (and low carb) diet

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3 hours ago, Sibiriak said:

Are you talking only about significant amounts of whole grains eaten separately,  or does that also apply to a modest amount of whole grains combined with lower glycemic,  slower-digesting foods in a moderately low calorie meal?  Where's the data?

In any  case,  there doesn't seem to be too much disagreement that for " diabetics and prediabetics a keto diet might be a useful tool to reset glucose homeostasis. "

Sibiriak, since my wife has a family history of T2 and T1 diabetes, she's measuring her glycemia pretty often after whole meals. Her fasting glucose is all right but after meals she often displayed 2 hours peaks at the border of frank diabetics according to teh ADA guidelines 2018 (> 140 mg/dL).

It turns out that, always within a meal context, some vegetables which I wouldn't have associated with high glycaemia, like zucchini, have actually spiked blood glucose. Also, pumpernickel bread, which everyone says it's the best, low GI bread. Whole grains of farro wheat caused similar spikes. Pasta, which should cause lesser peaks than ground cereals, spiked gluocse just the same. The quantity is of course relevant, but I'm speaking usual portions here.

Whereas surprisingly melba toast with jam at breakfast did not cause significant spikes, as well as low-calories ice cream (with carbs). One Apples, legumes, most vegetables even in hearty protions, did not spike blood glucose.

The above measures have been repeated multiple times so they are not the result of random events.

It would seem that Segal and Elinav have it right, the response to carbs ingestion is apparently an highly individual issue and general rules are often reversed. Unfortuntately those accurate, continuos glucometers dispensed to T1 diabetics are not available to the public in general (that I know); that would be a formidable tool to monitor one's glycemic signal throughout the day and design one's regimen accordingly.

We also know that a strong confounding factor here may be due to cortisol peaks, which apparently inhibit pancreas insulin production and are sometimes seen even at night, or in particular stressful situations. They might cause anomalous glycemic peaks not seen in more quiet conditions. 

Takehome lesson seems to be that glucose homeostasis is a pretty complex issue, function of individual repsonse and individual hormonal status , as complex after all as everything else in the body. Hard to define in a single, general rule.

After all Shawn Baker, the zero-carbs carnivore, displayed fasting glucose at the verge of pure diabetes...

 

Edited by mccoy

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5 hours ago, Todd Allen said:

I ate all of those foods today.  And it was damn good, it was mostly fat and I'm deep in ketosis.

My meal was a salad with red leaf lettuce, kale, spinach, avocado, eggplant sauteed in EVOO, sous vide beef heart, parmesan cheese, broccoli sprouts, fenugreek sprouts, olives,  black bean natto, pecans, sunflower seeds,  almond butter, tahini, dried tomatos,  ACV, ground flax, garlic, mustard, cumin, seaweed and salt followed by a desert of kefir'd heavy cream and chia, a raw egg and topped with cacao nibs and shredded coconut.

Todd, yours is an example of healthy keto diet, with a regimen designed after careful study of the literature and you are often monitoring your blood values.

From the Longo-Hyman conversation it is evident that many of the objections raised by Longo are due to the fact that the general public is not so well learned and is not followed by qualified professionals.

Do you remember Jerry Brainum's video, he starts recounting about the boy in the gym who said he was following a keto diet. When Jerry asked him if he was in ketosis, the boy didn't know what to answer. That's an example applicable probably to a high percentage of teh public.

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Lower carbohydrate diets and all-cause and cause-specific mortality: a population-based cohort study and pooling of prospective studies. 
Mazidi M, Katsiki N, Mikhailidis DP, Sattar N, Banach M. 
Eur Heart J. 2019 Apr 19. pii: ehz174. doi: 10.1093/eurheartj/ehz174. [Epub ahead of print] 
PMID: 31004146 
Abstract

thank you Al, does not look good for low carb diets based on the above. In fact if a comparison was made between a healthy carb diet and lcd I am sure it would be even more damning, however this one looks bad enough!

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15 hours ago, mikeccolella said:

thank you Al, does not look good for low carb diets based on the above. In fact if a comparison was made between a healthy carb diet and lcd I am sure it would be even more damning, however this one looks bad enough!

Mike, one must read a study to make an informed judgement of its worth.  Here's a link to the full paper:
http://sci-hub.tw/https://doi.org/10.1093/eurheartj/ehz174

Here are a few of the study's weaknesses as identified by the authors.

Quote

In conclusion, despite the usual limitations of observational data (and so causality impossible to determine), our study highlights an unfavourable association of LCD with overall and cause specific mortality, based on both individual data and pooling previous cohort studies.

...as with other observational studies, some degree of measurement error in reporting dietary and other lifestyle characteristics is inevitable.

...we had no information on the dietary intake of the participants during the Follow-up which might have had an impact on the final results. Also, recall bias cannot be overcome as in such similar studies. Finally, as with many other observational study, reverse causality or residual confounding may potentially explain some findings. 

Studies based on epidemiological data are notoriously weak and inconsistent.  In the intro and discussion they point out other studies of this type with conflicting findings. 

Quote

The effectiveness of diets low in carbohydrate and high in protein and fat to promote weight loss and reduce the cardiometabolic risk was
reported in systematic reviews and meta-analyses.9,10

Nakamura et al. 11 found a lower risk of CVD mortality in Japanese individuals with a higher score of LCD, while they observed no association between LCD score and all-cause death. Another study that involved US women reported null results for the association of LCD with both overall and CVD mortality.14

In the recent analysis of the prospective urban rural epidemiology (PURE) study up to 70% of energy intake was due to refined carbohydrates.45 Of note, the results of the PURE study45 (n= 135 335, aged 35–70 years in 18 countries with a median follow-up of 7.4 years) showed that a higher carbohydrate intake was associated with an increased risk of total mortality [highest vs. lowest category: HR 1.28 (95% CI 1.12–1.46)] but not with the risk of CVD mortality.

 

This study based on admittedly inaccurate data focused on dietary composition of carbohydrates versus non-carbohydrates.  They lump fiber in with carbohydrates as if there was no difference between fiber and sugar.  Most consider fiber healthy and refined sugar unhealthy, including the authors.  Regardless of where one stands on the question of the healthfulness of fiber and sugar there is no questioning that fiber by definition is complex carbohydrates that we do not directly digest.  Our digestion of fiber is mostly limited to fermentation by gut microbes resulting in short chain fatty acids such as acetate, butyrate and propionate.  Equally stupid is lumping everything non-carbohydrate together.  Proteins and fats have very different properties and roles in a thoughtful diet.  There doesn't appear to be any consideration given to dietary quality, to how food was produced, processed or prepared, or to whether diets were nutritionally complete.

This study's cohort are not practicing caloric restriction.  They aren't attempting to optimize nutrition for longevity or any other purpose.  I fail to see how it has any relevance to myself or any other person who prioritizes health when choosing what to eat.  This is a study for people who think taking a daily multivitamin is a good alternative to a nutritionally complete diet.

 

Edited by Todd Allen

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