A Critical Review of the Ketogenic Diet
What People Get Wrong, and What the Science Gets Right.
Intro!
The Ketogenic Diet (Keto) is a relatively old diet first proposed to treat epilepsy, in recent years however it’s been “elevated” to the status of a weight loss fad diet. The idea behind Keto is a simple one: reduce glucose to the point at which the body begins to burn adipose (fat) tissue. To this end it seems to work with the very large caveat being: when it is done correctly.
A Brief Review of the History
The loose roots of Keto date back to the Ancient Greeks. Due to the somewhat merged concepts of mysticism and science, scholars would observe religious rites and study the physiology of ascetics. These were the few people were willing to place themselves in extreme conditions, provided that it be for the sake of their gods. In 500BC, Hippocrates observed that ascetics who religiously fasted tended not to experience seizures. To test his theory of antiseizure therapy, he suggested that an epileptic patient fast for five days, once a month. This prescription was incredibly effective and prevented further seizures.
Despite its apparent efficacy, I want to make sure that you come out of this knowing I, in no way, condone starving yourself to treat your epilepsy.
At first this doesn’t seem like it has anything to do with Keto, but this observation greatly interested nutritionists in the 1900s. Scientists began to mess around with this theory, forming new diets to induce an effect on seizure frequency. Eventually they found that the secret to seizure prevention was lowering glucose in the brain. Glucose is required for neuron excitation; what is a seizure if not uncontrolled neuron excitation.
Nowadays, Keto is associated more with weight loss, although its still used in epilepsy treatment (especially in Europe). Throughout the 2010s, its popularity grew exponentially, beating out the Paleo, Atkins, and Carnivore diets, as well as incredibly popular weight loss programs like Weightwatchers and the Whole30. My hypothesis for why Keto grew so fast is that it’s profitable, and it’s part of a reaction to the fat-scare.
Doctors and patients alike were told that fat was literally the worst possible thing to ingest. We thought if you had 1 gram of saturated fat over the daily value your eyes would pop out, your hair would turn green, and your fingernails would chip off and regrow every minute. We thought fats were the main stimulus of obesity and everything bad in this world. It turns out that obesity is probably just calories in > calories out — far more simple than imagined.
But What is Keto?
It’s a little more complicated than what I explained in the intro; if it were just lowering carbohydrate intake, then it would be the low-glycemic diet. Keto is a diet with the goal of putting the body under a state called Ketosis. In ketosis your body begins to burn fat and other triglycerides in the form of ketones. This process takes the place of glucose metabolism. The idea makes intuitive sense, if you have too much adipose tissue: force your body to burn it for energy!
Mechanisms
The initial hypothesis of Keto’s effect on weight loss was that the excretion of ketones would represent a greater “calories out” portion of the energy balance. A more likely idea than “we just shit it out lol” is that the metabolism and usage of ketones is incredibly energy intensive. It requires that triglycerides (fats) are transformed into ketones in one cell, then β-Hydroxybutyric, which is transported to another site, then transformed back to ketones within another cell. This is an incredibly inefficient process for the body, but it’s highly efficient from a health standpoint.
Humans have this process for a reason: it was a way to maintain homeostasis between hunts and in winters where fruit bodies are scarce. Ketosis was a state in which humans spent a large portion of their life, thus we evolved adaptations to it. One of these adaptions is an effect on satiety signalling, which refers to the state opposite of hunger. When using ketones for energy, the hormones ghrelin and leptin are suppressed; these two are responsible for signalling that your body needs more energy.
This dual effect of increased caloric expenditure and satiety signalling are the two mechanisms that lead to fat loss in the ketogenic diet.
Keto: Why People Fuck it Up
Contrary to popular belief, not all fats are good for you! In our reactionary screed we have over-corrected our course. In Keto cookbooks, there is always an extreme excess of trans-fats and seed oils. I specify excess because these fats do serve a purpose in the body, but we don’t need to (nor should we want to) supplement them in our diets.
Trans Fats 🏳️⚧️
Trans Fatty Acids or TFAs in the body are one of many molecules responsible for balancing out the metabolism of lipoproteins. Lipoproteins are the carriers of cholesterol throughout the body as cholesterol esters cannot travel through blood on its own. TFAs specifically stop your body from breaking down or ‘catabolizing’ Apolipoprotein-B. To the American Heart Association, this molecule might as well be Hitler; it doesn’t really do much on its own (characteristically unlike Hitler) but when someone has it in high concentrations it’s a pretty good indicator that something is wrong (like a crumbling democracy). In high concentrations, it bunches up in the arteries and plugs the tubes, disrupting y’know, everything.
This is not to say that you can’t ever have trans fats! It would be ideal, but in America you just can’t escape them. There are two things you can do to limit your intake: either eat more non-processed foods, or move to Denmark where they’re banned. One would think that a person on Keto would be health-conscious enough to attempt this, but nope; every damn recipe calls for exorbitant amounts of butter and other hyper-processed shit.
Seed Oils
I’m not the biggest fan of the label “seed oils” for many reasons but the main ones are:
It’s been co-opted by cryptofascists, those weird naturalist guys who actually just hate Black people and are going Paleo because it’s trendy.
Not all seed oils are bad, and not all omega-6 fatty acids come from seeds.
Seed oils have been the villain of online nutrition discourse, from Ray Peat girls, Huberman Types, Redpilled Carnivore bros, yada yada. And all of them pretty much hate seed oils for roughly the same (wrong) reason: phytoestrogens. Phytoestrogens are compounds that come in roughly three forms; isoflavones, stilbenes, and lignans. Lignans are the main ones present in seeds, so whats up with them? Nothing, other than the fact that they’re incredibly beneficial. There’s a lot of lovely science here, but it’s worth a post on its own.
TL;DR: phytoestrogens are anti-cancer, anti-aging, pro-cognition, pro-dermis, anti-inflammation (the bad kind), pro-weight loss, anti-LDL, pro-everything good in this world, anti-satan and his army of hellspawn.
Omega-6 Fatty Acids
Seeds tend to be very high in concentrations of omega-6 fatty acids. Usually we associate such fats with healthy levels of cholesterol, but this is a psyop by Big Seed! (It wouldn’t feel right to talk about seed oils without getting hyperconspiritorial.) Omega-6 fatty acids also mediate cholesterol transport, but this time from the receiving end. Cells are prompted by Omega-6 intake to transcribe the DNA for the LDL-receptor, therefore cells can receive more “bad” cholesterol and take it out of the bloodstream. So far so good!
I want to make clear that Omega-6 fatty acids don’t have any negative properties in and of themselves. However, when the amount of Omega-6 fatty acids exceed the amount of Omega-3 fatty acids, we begin to see problems in the body. The problem is that both fatty acids compete for the same receptors, yet are responsible for different processes. This competition can be understood by using a ratio of Omega 6 and Omega 3, the optimal range of which is between 1:1 - 5:1. Past that point, risk increases for atherosclerotic inflammation (the condition mentioned in the trans fats section) neuroinflammation, diabetes, and most other inflammatory diseases under the sun.
Conclusion
When starting Keto, do not buy a Keto cookbook, unless you want diabetes1 after you relapse. Instead, eat Mediterranean food, use olive and walnut oil, fast intermittently, go to the gym, eat your spinach, and don’t ever listen to someone on Keto.
I’ve observed vast differences in the literature regarding outcome data between groups. The main confounder is how the sample is selected: either you take a sample of people already using the diet, or you take a sample and give them a set diet. Because of the reasons above, researchers give participants diets low in trans fats and seed oils, but the vast majority of Keto practitioners have diets extremely high in trans fats and seed oils. Among the already practicing group, we see people who are in great relative health but who also have the markers of inflammatory disease down the line. Those who are prescribed the Keto diet do not display a propensity for future disease. There needs to be a meta-analysis that addresses this variable, because otherwise research into the diet nears complete uselessness.
one day i will find ray peat and i will kill him
“i ain’t reading allat🤣” jk ima trans fat ally. i would go to school if grillbert was the teacher.