Low-carb is bad but Ketones are good?
Let’s bust some health myths around low carb diets and ketone supplements.
Low Carb is Bad? What the heck!
Research that a low carb diet is dangerous recently hit mainstream news. If you look closely at this study you’ll notice the method used is one of the most inaccurate ways to draw conclusions. This subject is already difficult to research mostly because people are notoriously bad at reporting what they eat.
The Lancet study is an observational study based on questionnaires. There is no control in this kind of research. Only twice were the participant’s diets assessed in the 25 year period of the study. Specific interventions are not directed on the subject (ie a low-carb diet) to discover the outcome. Instead, the researchers just look at populations of people to make guesses about the effects of a diet or lifestyle variable.
Correlation is not Causation
We simply can’t draw conclusions from this kind of study. We can only generate hypotheses. Why? Because correlation is not causation. For instance, take a look at this statement, “Students who get extra help at school do worse on exams.” Obviously students who need extra help will improve the score on their own exam. This doesn’t mean they’ll score highest in the class. We can’t draw conclusion because correlation is not causation.
Given the sheer number of randomized control trials that show benefits for epilepsy, diabetes, hormone imbalance and irritable bowel, its worth taking a deeper look at this study that hit the headlines.
The Healthy Bias & Other Flaws
The healthy participant bias is real and is rarely controlled for. Behaviours that are popularly perceived as healthy like exercising, not smoking, avoiding sugar and red meat are all lumped together. Therefore in the general population anyone who eats red meat also has multiple risk factors already. The nuance of those who eat grass-fed meat as part a whole food diet and a healthy lifestyle gets missed.
Other problems are people tend underreport foods socially considered bad, like meat and alcohol. They overreport foods considered good, such as vegetables and fruits. Ingredients in restaurant or prepared foods are often unreported or unknown. Most people don’t measure portion sizes and forget some of what they eat. Tracking every bite and meal is inconvenient so a lot gets left out.
Finally, diets change over long periods of time and this study went on for 25 years. Researchers only had to control for 3 variables out of these: age, sex, obesity, diabetes, hypertension, hypercholesterolemia, cardiovascular disease and family history of cardiovascular disease. What this means is someone could have up to 5 major risk factors and still be part of the study. This explains why the outcomes they came up with were so bleak.
Macronutrients, Whole Food & the Ancestral Diet
We have significant evidence from much more reliable studies that people can thrive on any macronutrient ratio when eating unprocessed foods similar to what our ancestors ate. Low carbohydrate with high fat or protein can result in a thriving population. High carbohydrate for shorter periods of time also works. In fact, one population consumes honey as its main source of nutrient for part of the year.
Eating in a way that is adapted to your environment, the seasons, activity level and social support system is key. We are incredibly resilient. Why low carb works so well in our day and age is because the amount of processed junk we have access to is mostly carb based foods that are highly palatable. By simply avoiding these we also avoid a long list of health complications. It also makes us thrive and allows us to give back to our communities. Win, win!
So a Ketone Supplement is Good?
When a number of people approach me asking about a new supplement my eyebrows go up a bit. Ketosis is a approach to nutritional therapy that is not new however there is a resurgence in its popularity right now. In fact its searched in google more than any other diet right now! I have colleagues who have been using it with patients for nearly 30 years.
Here are the thoughts I had for the people who asked me about ketone salts. The first question I asked about this particular supplement is how is it being marketed? Is it direct sales/multi level marketing? Does it say its safe and effective for everyone? Do they want people using it long-term? Yes, yes and yes.
Another question I have is does it contain caffeine? Yes.
Finally its worth noting that electrolytes are important for anyone going into ketosis but supplementation is not. One patient who tried this supplement reported feeling very thirsty from it. I wonder why a ketone supplement would create thirst. It should do the opposite.
Sleep & Metabolic Disorders
Caffeine is going to make most people feel better temporarily. It is also going to inhibit appetite and sleep. What many don’t realize is that 50% of people don’t metabolize caffeine so it doesn’t clear the system. Insomnia is a major contributor to metabolic disorders like insulin resistance and diabetes. Lost sleep will increase inflammation and also make it more difficult to maintain a healthy weight. Missing meals inhibits your ability to rest, rejuvenate and experience deep sleep.
Three sign of pre-diabetes are increased thirst, hunger and urination. One of the people who asked me about this supplement told me she experienced all three.
Today’s Biggest Health Concerns
High stress, insomnia and blood sugar dysregulation. They are connected. A caffeinated supplement is not the answer. For someone who is healthy and metabolizes caffeine well this supplement may not cause harm. I’d rather have people learn to manage their stress, sleep better and eat regularly in a way that supports their lifestyle than rely on any supplement.
I do have patients who are in ketosis. Usually these are people with very low stress like those who are retired. Occasionally its a person struggling with a serious illness where ketosis is indicated as a viable intervention. I don’t recommend ketosis to parents, business owners or those who are very active. The benefits roll out for those who are in the right stage of life to do it.