Don't Believe the Hype: Ketogenic Diets vs. Plant-Based Diets

Key Points:

1. For general longevity, weight loss, cost effectiveness, and more, there is a large amount of evidence which indicates a plant based diet is the best approach. The bulk of your diet should consist of things with roots.
2. There are some very interesting positive effects, especially on neurological disorders, that ketogenic style diets seem to have on people.
3. There appears to be conflicting evidence in mainstream over the pros and cons of different dietary approaches.
4. Data exists showing positive and negative affects of high fat/ketogenic diets
5. Key point: stay aware of how each food affects you.

There has been a debate over the most natural, most healthy diet since ancient Greek philosophers contemplated over the subject. One of the fundamental essences of life has been debated over for seemingly all of recorded history. Socrates was one ancient individual who recognized the negative affects of consumption of animals, questioning, "...if we pursue this way of living, will we not have need to visit the doctor more often?" Plato was another ancient Greek who recommended limiting consumption of animals. On the contrary, meat consumption has been viewed as an act of power and sacrifice by many ancient (and contemporary) societies.

Ancient knowledge and contemporary scientific literature has not stopped society from progressing to our current patterns of food consumption. We undoubtedly kill and consume more animals than we ever have in history. This is a result of a growing population as well as increasingly efficient (and detrimental by some estimates) means of harvesting meat. When this wanes, there has always been a resurgence in consumption of meat. Whether it was the Atkins diet, or the latest and greatest in the 'Paleolithic' or ketogenic diet, there is always a new mode giving people reason to eat meat. Many have questioned whether this is a physiological and primordial demand or a vestigial and unnecessary desire, resultant of targeted marketing.

Archaeological data shows evidence of any and each diet (aside from the obvious: any diet which includes any type of processed food). There is evidence that our ancestors where primarily starchivores, that they where vegetarians, and that there were (and still are, IE the Inuits) carnivores. This span of time could merit a number of evolutionary adaptations to different food sources.

We can also study and observe demographics and environment as a signpost for what someone should eat. For example we can see what a dominant food source is in a certain area which your particular ancestors thrived. This can give you some ideas, but genetic mixing as well as our rapid rate of evolution blurs this line significantly. It is easy to assume that we would need hundreds of thousands of years of evolution for us to adapt to something as a certain food source. This is often cited with carbohydrate consumption, and is by-and-large inaccurate. We can look at the Sherpa people as a quick example of a rapid physiological change. The Sherpa are a mountainous people who adapted to a low oxygen environment in less than 3000 years. If a person living at sea level moved to this altitude, they would get altitude sickness or worse. There have been records of consumption of grains as far back as 100,000 years ago. Not to mention the mechanism for letting glucose (which make up glucose polymers, a.k.a. carbohydrates) into the cell is well known: the GLUT receptor family. This is regulated by insulin release, one action of the pancreas. Genetic adaptations can be passed on from a single generation. Up-regulation and down-regulation of hormones or receptors can happen over the course of years.

Some insight can potentially be gained by looking at a couple people who are and where the bigger names in nutrition and see if their principles reflect health in themselves. For this idea we will look at two bigger names in nutrition in the past century: Robert Atkins and John McDougall. Both physicians, both running their own practices, and both having great success in treating patients with diametrically opposed nutritional practices.

John Atkins, a renowned cardiologist, was a proponent of a high fat low carbohydrate diet. Atkins died at age 72 in 2003. The official cause of death was blunt force trauma after a fall. Despite claims that he had no cardiovascular abnormalities, he had a history of heart attack and congestive heart failure. Although, his circulatory maladies have been attributed to cardiomyopathy by his doctors as opposed to dietary repercussions. His clinic has treated thousands of individuals with the exact diet that some nutritionists and doctors would find unrealistic: a high fat diet loaded with animal products, but also vegetables. While this may seem unsustainable in the long term, it was reported that many of Atkins patients had success. People continue to derive benefits from this diet approach. Additionally, there is more science emerging that ketogenic style diets can be advantageous. This has been and still is true for the opposite end of the spectrum.

High fat diets cause weight loss. I have had personal experience with this. That said, it had large impact my peak power (costing over 300 watts on a Wingate test, from over 1000w to around 700w). This study on cyclists shows a similar outcome. For my experiment on myself, it was after more than 4 months on the diet, which included positive and negative affects. These included (and are common in general): weight-loss, improved regulation of energy, constipation, and electrolyte imbalance.

Some claim miraculous benefits on a ketogenic style diet, and you may see these benefits as well. This is all relative to a balanced diet, or a diet similar to one which the next doctor I am going to talk about emphasizes.

Doug McDougall seems to be a picture of health. He is 70, slim, and seems in overall good health. He did not escape arteriosclerosis (the hardening of the arteries) and stroke early in life, which he attributed to consumption of animal products. The diet he promotes also has a strong scientific base. There are many peer reviewed studies showing positive effects of starch based/plant based/vegan diets low or absent of animal fat and protein. On the flip side, there is little to no peer-reviewed science showing negative effects. Anecdotal evidence exists for detrimental effects, but often seems to be the result of a marked energy deficit (too few calories).

It is worth noting that if you do eat a plant based diet and are otherwise healthy, the differences in disease rates are small, but present. Genetics can and do play a role. There are various factors outside of your own health which go into what you consume, such as our overall carbon footprint. For the research provided, human health was the focus.

Plant Based Diets: The Evidence

These data include meta-analyses and articles from marked institutions which support starch based or plant based diets. Based on the evidence, plant based diets can help with making you less likely to die, clearing of the vascular system of plaques, and weight loss.

1. Low-carbohydrate diets and all-cause and cause-specific mortality

Two cohort Studies. This analysis includes data on about 130,000 test subjects over the course of 26 years. The results showed a modest increase in mortality in the high carbohydrate diet group.

2. Low-Carbohydrate Diets and All-Cause Mortality: A Systematic Review and Meta-Analysis of Observational Studies.

This is another meta-analysis which includes data from 17 different studies which shows the same result as above. It correlates low carbohydrate diets with greater all cause mortality. The issue is heterogeneity across the test subjects. That in mind, the analysis includes nearly 500,000 test subjects including 221,000 women in the analysis. Observational study design can include various other potential biases.

3. Here is a nutritional guideline update for physicians by the NIH (2013), suggesting plant based diets. This was created in light of evidence.

4. Finally, this is a study which analyzes the mechanism which plant based diets utilize to reduce cardiovascular disease.

These few points include dozens of studies and hundreds of thousands of subjects, but there are many more studies which have demonstrated benefits of a plant based diet. These studies are easy to find. This goes along with a number of cardiologists who recommend plant based/vegan diets to reverse heart disease. Industrial bias is often cited in argument against this camp, especially among high fat dieters. There are noteworthy exceptions to the contrary, including Robert Atkins and Robert Lustig.

Fat Based Diet: The Evidence

There is evidence which indicates that animal products and saturated fat are less harmful than previously believed, or even not harmful at all. Additionally, for many individuals, a high fat diet can have aesthetic benefits. Some data even illustrate interesting effects on the brain, such as their affect on epileptics. Ketogenic-style diets are recommended by the Epilepsy Foundation. Along this vein, there is a range of beneficial neurological effects which researchers have observed in high fat diets. Evidence suggests that a high fat diet approach can cause disease. These pathologies include heart disease and diabetes. Data continues to be produced which support both sides of the nutritional spectrum.

1. Ketogenic Diet for Obesity: Friend or Foe?

This analysis encompasses close to 100 studies and includes biochemical mechanisms for weight loss while utilizing a high fat diet.

2. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease.

There is no debate that processed meats cause disease. Evidence that unprocessed animal foods, and more specifically, saturated fat, do not cause detrimental effects exist. One example of this is this meta-analysis which encompasses 347,747 subjects in two cohort studies which found no correlation between saturated fat consumption and cardiovascular disease.

3. There is also this article from the American College of Cardiology which suggests that the evidence on fats causing heart disease is incomplete.

4. Ketone bodies are speculated to increase mitochondrial efficiency in cells by supplementing glucose metabolism. By design, fatty acids are packed full of energy (but it is important to consider all the metabolic pathways which must be initiated to create glucose).

5. Ketogenic Diet Recommended by the Epilepsy Foundation

I included this recommendation by the Epilepsy Foundation to further illustrate the effectiveness of high fat diets in certain situations.

6. The ketogenic diet as a treatment paradigm for diverse neurological disorders.

This is another study which suggests ketogenic diets for a treatment of a range of neurological disorders, even brain trauma.

7. Robert Atkins treated thousands of patients at his facility. Their conditions ranged from obesity to high blood pressure.

There are specific instances where a high fat diet may really shine. The potential effects on brain health make some sense due to the composition of brain matter. As cited above, some science has shown an increase in efficiency when ketones are utilized (but the opposite effect has also been shown). Further, fat has many functions in human physiology. The significant amount of scientific evidence that high fat low carbohydrate diets negatively impacts health cannot be ignored. It is also important to note that a large amount of data has had to do work to show that this diet approach actually isn't harmful. Ultimately, if you want to optimize your diet, it is your duty to figure out what foods have the most beneficial impact on your health.

If you want to keep your vascular system clean, lose weight, and promote good health in general, consume mostly plant foods. If it works for you, a ketogenic diet can be beneficial. Overall, pay attention to how your body and mind reacts to foods if you want to find out what really works. Nutrition is individual through an objective lens. While there can be suggestions for the best diet in general (plant based), it's up to each person to pay attention to how they react to foods, namely, whether it makes you fat, makes you sick, sluggish, or makes you feel good.