Latest news with #keto
WebMD
02-06-2025
- Business
- WebMD
Keto Debate: Is Low-Carb a Game Changer or a Risky Gamble?
With one glaring exception. Recent estimates show that 13 million Americans follow a ketogenic diet – a nutrition paradigm based on extremely low carbs and high fats – and its popularity is only growing. "This one's hardly a fad, since it's over 100 years old," said Ethan Weiss, MD, a preventive cardiologist at the University of California, San Francisco. Stores like Costco, Kroger, and Target today advertise "keto-friendly" products to help followers stay the course, and keto snacks are getting more popular among younger consumers. The market size for keto is $13 billion today, and projected to be worth over $16 billion in 2030. Enthusiasts swear by its health benefits: rapid weight loss, better appetite control, lower blood sugar levels, reduced insulin spikes, and decreased inflammation. "Keto diets have been shown over multiple studies to be beneficial in terms of weight loss and, at least to some degree, in helping the treatment of diabetes," said Weiss. Yet keto diets directly challenge decades of research showing that consuming high amounts of fat over long periods harms your health, in particular heart health. Unlike more widely recommended eating patterns, such as the Mediterranean diet and DASH (Dietary Approaches to Stop Hypertension), keto is highly restrictive and hard to maintain, and lacks long-term data. So who's right – mainstream nutrition scientists or keto aficionados? That question has received a lot of attention in recent research. And while a conclusive answer may be years away, current evidence urges caution when it comes to going all in on keto. Ketones as Fuel Originally developed in the 1920s as a treatment for epilepsy, the keto diet dramatically reduces how many carbs you eat. This mimics the metabolic effects of fasting, forcing the body into a state of "ketosis" – when the liver starts converting stored fat into ketone bodies (an alternative energy source when glucose, or sugar, is scarce). Doctors found that the diet could significantly make seizures less frequent and less severe, particularly in children who did not respond well to other treatments. Typically, the U.S. Department of Agriculture recommends people eat a diet consisting of about 45%-65% carbohydrates, 10%-35% protein, and 20%-35% fat. Total calorie intake recommended for Americans is 1,600-2,400 for women and 2,000-3,000 for men. Following a keto diet means shifting the percentages of fats, carbs, and protein to 70%-80% fat, 5%-10% carbs, and 10%-20% protein. If you eat 2,000 calories a day, that amounts to 20-50 grams of carbs (about two to three slices of bread), 75 grams of protein (10 ounces of beef, chicken, or turkey), and 165 grams of fat (11 tablespoons of peanut butter, or 10 avocados). Eating fewer carbs reduces glucose levels, prompting your pancreas to produce less insulin. Since insulin promotes fat storage, having less of it helps keep fat from building up. Combined with ketosis, this fat-burning state can make low-carb diets work better for weight loss than low-fat ones, research suggests. The drastic shift can lead to short-term side effects like fatigue, headaches, crankiness, and brain fog – what some refer to as the "keto flu." This can make the diet hard to follow, as do the very strict guidelines on nutrient proportions. That's part of the reason keto is so appealing to the food industry: Demand is high for products that simplify the preparation of high-fat, low-carb meals. Still, keto backers say once the first few weeks are over, the flu-like symptoms disappear and meal prep becomes second nature. But these challenges aside: Is keto truly a healthy choice? Benefits and Risks of Keto: What the Research Shows A 2023 big-picture review, published in BMC Medicine and covering 17 meta-analyses of 68 randomized trials, found that keto diets can improve triglycerides, body weight, and blood sugar levels in adults with overweight or obesity – and reduce seizures in patients with epilepsy. A 2025 study also highlights how cutting carbs and entering ketosis can lower body mass index, waist size, and visceral fat – highlighting the power of keto for weight management. Other research confirms that the keto diet consistently improves markers of metabolic syndrome – a collection of conditions that raise the risk of heart disease, type 2 diabetes, and stroke. It's also been shown to improve cholesterol levels, reduce inflammation, lower blood pressure, and even slow vascular aging (changes in your blood vessels as you get older). Yet for all the benefits, research also highlights serious concerns, including nutrient deficiency, increased heart disease risk, and higher levels of LDL cholesterol (the kind that can build up in arteries and cause heart problems). The BMC Medicine review, too, found a significant increase in LDL cholesterol, underscoring the need for long-term trials to assess keto diets' impact on the health of the heart and blood vessels. "The concern is that ketogenic diets are going to raise the level of your cholesterol, and that will be harmful for your heart in the long term, even if there are short-term benefits related to weight loss," said Sadiya Khan, MD, a professor of cardiovascular epidemiology at Northwestern University Feinberg School of Medicine. Those happy with their waistline on keto may dismiss the negative effects. "They're trying to convince themselves that what I consider to be an alarming increase in LDL cholesterol is not dangerous," said Weiss. "That's the single biggest drawback as to the long-term safety of these diets." Cutting way back on carbs means you likely have to sacrifice whole grains, fruits, and vegetables, leading to deficiencies in fiber, vitamins, and antioxidants that supplements can't make up for, said Khan. Other long-term adverse effects of keto include digestive issues like constipation, bloating, and diarrhea, and a higher risk of kidney stones. The Best Way to Do Keto The contradictory findings point to one conclusion: More research, especially long-term, is needed to make sure the keto diet is safe. So far, it seems that the short-term benefits may not offset the long-term risks. With that in mind, the safest way to make the most of keto may be to take breaks from time to time. A 2024 study found that sticking to a continuous ketogenic diet might age cells – especially in your heart and kidneys – potentially leading to harmful inflammation. But people in the study who took breaks from the diet didn't have these negative effects. "The biggest thing we tried to stress is you don't want to be on it for too long," said study author David Gius, MD, PhD, a professor of radiation oncology at University of Texas Health San Antonio. "Take a break. Take a keto vacation." That means following a keto diet for about four to five days, long enough for most people to enter a state of ketosis, followed by a break of two to three days. But that's not the only precaution to take, Gius said. You also need to talk to your doctor and a dietitian before trying keto, as the diet must be tailored to each person, he said. Ask your doctor for a lipid panel and heart panel, along with a thorough cardiac exam, said Gius, who recommended checking back in every three to six months for updated lipid and heart panels. "Other than the rise in LDL cholesterol, I think keto is safe," said Weiss. He recommends a hybrid model approach: a low-carb, Mediterranean-style diet rich in fruits, vegetables, whole grains, and heart-healthy fats and low in processed foods. Several randomized clinical trials link this eating pattern to a lower risk of chronic diseases, longer lifespan, and the prevention of conditions like heart disease, type 2 diabetes, atrial fibrillation, and breast cancer.
Business Insider
29-05-2025
- Health
- Business Insider
I want to lose weight and build strength. A dietitian said to lift weights and make simple food swaps.
Joanne Erstad, 57, is a public sector worker from Canada who wants to lose weight, and gain strength and flexibility. She sent in an average day of eating, which the registered dietitian and personal trainer Kara Mockler assessed. "I am fairly sedentary, with a desk job, but I work out for one hour two to three times a week (HIIT and Pilates), and I do like to walk, but don't often get out as I work 10-hour days," Erstad said. She said she tries to eat healthily 90% of the time and typically gets seven hours' sleep a night. "I never really had a problem with my weight until I hit menopause, and I've put on over 20 pounds in the last couple of years," Erstad said. Erstad sent what she eats on an average day to Business Insider's Nutrition Clinic. The registered dietitian and personal trainer Kara Mockler said that while her diet is high quality, reducing her portion sizes should help her hit her goals. Erstad's diet is nutritious For breakfast, Erstad typically has half a cup of full-fat plain Greek yogurt with about a quarter cup of berries, half a cup of no-sugar-added granola, one to two teaspoons of dried cranberries, two teaspoons of pumpkin seeds, two teaspoons of walnuts, and one to two teaspoons of sunflower seeds. Lunch is usually chicken breast with salad greens, cucumber, cherry tomatoes, and feta cheese, with no dressing, Erstad said. For dinner, she has a protein source — mostly chicken or fish, occasionally red meat — with either salad or vegetables such as broccoli or cauliflower. Erstad snacks on celery with organic peanut butter and raisins, or nuts. "I eat mostly organic non-GMO whole foods, and try to avoid sugar and UPFs, although I have a sweet tooth and like chocolate," Erstad said. "I try to eat one square of good-quality chocolate if I want something sweet, and I do try to follow a keto- Mediterranean diet." She continued: "I never eat at fast food places, and if I do go out to eat, I try to eat as I would at home, but that is harder to do." Make small swaps to reduce calories Mockler said that Erstad's diet is "very nutritious" thanks to all the plants, quality proteins, and whole foods she eats. "Since one of her goals is to lose weight, we have to look at the quantity of her calorie intake," Mockler said via email. "Something I see quite often is people consuming a lot of healthy foods but forgetting that those foods contain calories, too, and can still be overeaten (in terms of weight management)." At breakfast, for example, Erstad could consider eating one teaspoon each of seeds and nuts rather than two. She could also swap dried fruit for fresh, which is more filling and higher volume for fewer calories. Erstad's go-to snacks are nutritious, but the quantity could be preventing her from losing weight, as peanut butter and nuts are energy-dense. "Little decreases in her portions throughout the day at each meal can add up big time and reduce her overall calorie intake by 300-500 calories per day, which can lead to weight loss," Mockler said. Lift weights to build strength Mockler said a few tweaks to Erstad's fitness routine would help her achieve her fitness goals.. Strength training twice a week would be a good place to start — Mockler recommended swapping one hour of her HIIT or Pilates workouts for two 30-minute full-body lifting sessions. "Including cardio (her HIIT workouts), pilates (great for flexibility), and lifting (strength) will give her a well-rounded workout routine," Mockler said. Ideally, Erstad would also try to move more in general, despite her sedentary job. "Getting more steps or non-exercise movement would not only be good for her overall health but would likely help with her goal of weight loss as well," Mockler said. "I'd recommend adding 2,000 steps to whatever her current daily step average is right now as a goal. Then in a few weeks, she can try to increase her step average again until she is around 7,000 to 10,000 steps per day." Creating habits like parking further away from your destination, getting up from your desk every hour, using stairs rather than elevators, and getting a walking pad can help, Mockler said. "Overall, I think Joanne's diet is very nutritious and her fitness routine is in a good place," Mockler said. "With small tweaks to both (decreasing portion sizes, adding strength training, and increasing steps), she will be well on her way to her goals."
Medscape
28-05-2025
- Business
- Medscape
No, KETO-CTA Study Did Not Upend Causal Evidence on ASCVD
Few argue that eating too many carbohydrates is a key cause of the obesity crisis. The ideal solution would be to moderate carbohydrate intake to the amounts consumed by Sicilians. But some people have gone to the extreme of eliminating nearly all carbs. One result of eating only fat and protein is ketosis. Another may be a rise in atherogenic lipid particles, such as low-density lipoprotein cholesterol (LDL-C). Lean-Mass Hyperresponders Authors of the observational KETO-CTA study purport to show that a subgroup of people on keto diets who sustain serious increases in lipids may be protected from progression of atherosclerosis. This, despite nearly a half-century of evidence that higher LDL-C levels lead to coronary artery disease. They deemed this subgroup lean-mass hyperresponders(LMHRs). The idea stems from the observation that there may be heterogeneity in the LDL-C response to a keto diet. A meta-analysis (by some of the KETO-CTA authors) included 41 trials involving low-carbohydrate diets and found that rises in LDL-C turned largely on baseline BMI. Specifically, for trials including patients with a mean baseline BMI < 25, LDL-C increased by 41 mg/dL; for trials with a mean BMI of 25-35, LDL-C did not change; and for trials with a mean BMI ≥ 35, LDL-C decreased by 7 mg/dL. The association of baseline BMI with LDL-C was much stronger than the effect of dietary saturated fat. In the LMHR group, the rise in LDL-C can be striking, sometimes well north of 300 mg/dL. The obvious question is whether (or how much) this raises atherosclerotic risk. The best way to study this question would be long-term trials where people are randomly assigned and are adherent to specific diets. It would take years to sort out the effects because atherosclerosis is slowly progressive. Another way, perhaps the only realistic way, is to use surrogate markers of atherosclerosis, which now include imaging of the vessel itself. The KETO-CTA Study The KETO-CTA study, published in JACC: Advances , garnered lots of attention on social media. First, I will tell you the topline findings and then the critical appraisal. The authors aimed to study the association between plaque progression and its predicting factors in participants with an LMHR pattern. Plaque progression was measured on coronary CT imaging performed at baseline and repeated at 1 year. Images were blindly read, and software was required to quantify plaque characteristics. The authors recruited 100 individuals with the LMHR phenotype who had been on a ketogenic diet for at least 2 years to participate in the single-arm observational study. To qualify, they had to have a low BMI and a keto-induced LDL-C ≥ 190 mg/dL, HDL-C ≥ 60 mg/dL, triglycerides ≤ 80 mg/dL, and evidence of being metabolically healthy (normal CRP and A1c). The keto-induced criteria required that individuals had an LDL-C < 160 mg/dL before adopting the diet. They don't say how many individuals they screened to find these participants. Those included in the study had striking numbers. Despite an average BMI of 22, they had mean LDL-C levels of 254 mg/dL, HDL-C of 89 mg/dL, and triglycerides of 67 mg/dL. The average age was 55 years and most were men. They could not be on lipid-lowering therapy, which is remarkable for patients with very high LDL-C. Adherence to the keto diet was high and confirmed by beta-hydroxy-butyrate levels. Results Over the year, there were no substantial changes in ApoB or BMI, which you would expect because participants were on a stable keto diet. The presentation of the results was peculiar. The authors preregistered the study and declared the primary endpoint as the change in noncalcified plaque volume. But they did not formally present this endpoint. Instead, they gave the median change in percent atheroma volume, which was 0.8%. The primary endpoint was presented in a figure in which a horizontal line represented each individual. No quantification was given, but visual inspection of the graph revealed that most individuals sustained an increase in noncalcified plaque volume. The lack of clear presentation of the primary endpoint caused a stir online. This led the first author to present it in on X. The numerical pooled change in noncalcified plaque burden was an increase of 18.8 mm3. In the manuscript, they emphasized the correlations and lack of correlations. Neither the change in ApoB throughout the study nor the ApoB at the beginning of the study was associated with the change in noncalcified plaque volume. There was also no correlation between LDL-C and change in noncalcified plaque volume. The main finding was that the baseline coronary artery calcium score was positively associated with change in noncalcified plaque volume as was baseline plaque. They list four differences between the LMHR subgroup and people with elevated lipids from other metabolic risk factors: Difference 1: Their LDL-C and ApoB elevations are dynamic and result only from the metabolic response to carb restriction. Their LDL-C and ApoB elevations are dynamic and result only from the metabolic response to carb restriction. Difference 2: They are normal weight and metabolically healthy (ie, they don't have obesity, diabetes or insulin resistance). They are normal weight and metabolically healthy (ie, they don't have obesity, diabetes or insulin resistance). Difference 3: Their high LDL-C and ApoB are part of a lipid triad that includes high HDL-C and low triglycerides, representing a metabolic signature of a distinct physiologic state. Their high LDL-C and ApoB are part of a lipid triad that includes high HDL-C and low triglycerides, representing a metabolic signature of a distinct physiologic state. Difference 4: The degree of this phenotype appears inversely related to BMI ('leanness'), consistent with the idea that it is a metabolic response to carbohydrate restriction that is accentuated in leaner, more metabolically healthy persons. The authors go on to make highly provocative conclusions, such as: Conclusion 1: The LMHR population constitutes a unique and important natural experiment evaluating the lipid heart hypothesis in an unprecedented manner. The LMHR population constitutes a unique and important natural experiment evaluating the lipid heart hypothesis in an unprecedented manner. Conclusion 2: The data are consistent with the notion that elevated ApoB, even at extreme levels, does not drive atherosclerosis in a dose-dependent manner in this population of metabolically healthy individuals. The data are consistent with the notion that elevated ApoB, even at extreme levels, does not drive atherosclerosis in a dose-dependent manner in this population of metabolically healthy individuals. Conclusion 3: These insights can facilitate personalized treatment and risk-mitigation strategies based on modern, cost-effective cardiac imaging. For instance, LMHRs with CAC = 0 at baseline (n = 57) constitute a low-risk group for plaque progression, despite high LDL-C. These insights can facilitate personalized treatment and risk-mitigation strategies based on modern, cost-effective cardiac imaging. For instance, LMHRs with CAC = 0 at baseline (n = 57) constitute a low-risk group for plaque progression, despite high LDL-C. Conclusion 4: Because of the strong correlation of baseline coronary calcium with progression of noncalcified plaque, they coin the phrase plaque begets plaque. 6 Reasons the Keto-CTA Conclusions Are Problematic You don't have to be an expert in lipids, atherosclerosis, or imaging to oppose these conclusions. The study has limitations, but the main problem is the authors' outsized claims. I will outline six reasons why their conclusions are problematic: First, the primary endpoint of change in noncalcified plaque volume went up. The increase of 18.8 mm3 was 2.5 times higher than they predicted in their study protocol. If you believe that this endpoint is a great surrogate, the results are ominous. Second, imaging tests are almost always terrible surrogates. To assess risk, you need to measure cardiovascular events. Small, uncontrolled studies are fine, but you cannot claim clinical importance just because you weaved a nice story about high LDL-C in LMHRs being different from high LDL-C in other patients. Third, we have about 70 years of data supporting LDL-C being causal for atherosclerosis. Nearly every Bradford Hill criterion for causation is met for LDL-C and atherosclerosis. To claim an exception, you need more rigorous evidence than KETO-CTA. Fourth, assuming you believe the plaque images are precise, reproducible, and clinically relevant, KETO-CTA suffers from a lack of control. All they had to do is recruit a group of people eating another type of diet (eg Mediterranean diet) and make a comparison. Fifth, the authors don't tell us how many people they screened to find these 100 LMHRs. I get the sense they are a highly selected bunch. Sixth, the question of heart health from a specific diet will be difficult to sort out. Nutritional studies always are. A randomized trial in a prison might work, but cardiac event rates in young people, even with keto-induced-high LDL-C, will be infrequent. What's more, the LMHR group surely do other things that affect heart disease, like exercise, not smoking, etc. One final comment on the authors' messaging. It's been egregious and antiscientific. Their rhetoric and spin outdo some of the most hyped late-breaking trials. This was a small, noncontrolled observational study wherein the primary endpoint went the wrong way. It's nowhere near close to upending decades of causal evidence on the role of LDL-C and atherosclerosis. The journal editors and peer reviewers failed to modulate the outsized conclusions. I don't know what the solution is for this type of behavior, but I oppose it in the strongest terms.
Health Line
28-05-2025
- Health
- Health Line
The Best Deodorants for Psoriasis
The keto flu, or carb flu, is used to describe symptoms often experienced by those beginning a keto diet. Here's what the keto flu is, why it happens…
Health Line
22-05-2025
- Health
- Health Line
What's the Difference Between Dirty and Clean Keto?
Clean keto focuses on nutrient-dense foods, while dirty keto includes highly processed items. To achieve the best weight loss results, choose clean keto, which provides more essential micronutrients needed for good health. The ketogenic (keto) diet is a very low carb, high fat diet that has recently grown in popularity due to its proposed health benefits. Many people follow this eating pattern to promote weight loss and manage type 2 diabetes. Dirty and clean keto are two types of this diet, but it's not always clear how they differ. Thus, you may want to know more about what each one entails. This article addresses the main differences between dirty and clean keto. What is clean keto? Clean keto focuses on whole, nutrient-dense foods. It puts more emphasis on food quality than the traditional keto diet, which comprises no more than 50 grams of carbs per day, a moderate protein intake of 15–20% of daily calories, and a high fat intake of at least 75% of daily calories. Restricting carbs puts your body into ketosis, a metabolic state in which you start burning fat for energy instead of carbs. This may lead to several potential health benefits, including weight loss, reduced blood sugar levels, and even a lower risk of certain cancers. Clean keto consists mainly of whole foods from quality sources, such as grass-fed beef, free-range eggs, wild-caught seafood, olive oil, and non-starchy vegetables. High-carb foods, including grains, rice, potatoes, pastries, bread, pasta, and most fruits, are severely restricted or banned. Clean keto also minimizes your processed food intake, though it can still be eaten in moderation. What is dirty keto? Although dirty keto is still low in carbs and high in fat, its food sources are often not as nutritious. While you can technically attain ketosis and garner some of the keto diet's benefits using this approach, you may miss out on several key nutrients and increase your risk of disease. Contains processed foods Dirty keto is also called lazy keto, as it allows for highly processed and packaged foods. It's popular among individuals who want to achieve ketosis without spending lots of time prepping clean keto meals. For instance, someone on dirty keto might order a double bacon cheeseburger without the bun instead of grilling a grass-fed steak and making a low carb salad with a high fat dressing. Dirty keto meals are often high in sodium. For people who are sensitive to salt, high sodium intake is associated with high blood pressure and an increased risk of heart disease. Processed foods are also likely to have far more additives and fewer micronutrients your body needs. What's more, they are associated with several adverse health effects, including weight gain, diabetes, overall mortality, and heart disease. Moreover, the added sugars in many processed foods may prevent you from reaching and maintaining ketosis. May lack micronutrients Dirty keto foods are lacking in vitamins and minerals that your body requires. By choosing processed foods over nutritious, whole foods, you may become deficient in micronutrients like calcium, magnesium, zinc, folic acid, and vitamins C, D, and K. While these nutrients can be obtained from supplements, studies suggest that your body digests and utilizes them better from whole foods. What are the main differences? The dirty and clean versions of the keto diet differ vastly in food quality. Whereas the clean keto diet focuses on high fat, nutritious, whole foods — with only the occasional processed item — the dirty version allows for large quantities of packaged convenience foods. For example, people following clean keto fill up on non-starchy vegetables like spinach, kale, broccoli, and asparagus — while those on dirty keto may eat very few veggies at all. Dirty keto also tends to be significantly higher in sodium. Generally speaking, it's best to avoid dirty keto due to its adverse long-term health effects, such as an increased risk of disease and nutrient deficiencies.
