Is the Ketogenic Diet Safe?

Written by Dr. Steve Chaney on . Posted in Ketogenic Diet

Is The Ketogenic Diet Effective?

Author: Dr. Stephen Chaney

ketogenic dietThe ketogenic diet has been around for a while. It has been used to control epilepsy in children since the 1920s. Nobody is quite sure why it helps control epilepsy, but it does. Once a mainstay of therapy, it is now primarily used as an adjunct to anti-epileptic drugs.

However, recently the ketogenic diet has gone mainstream. It’s no longer just for epilepsy. It has become the latest diet fad. If you believe the claims:

  • Hunger and food cravings will disappear. The pounds will melt away effortlessly and rapidly.
  • You will feel great. You’ll have greater mental focus and increased energy.
  • Physical endurance will increase. You’ll become superhuman.
  • Type 2 diabetes will disappear.
  • Your blood sugar, cholesterol, and triglyceride levels will improve, reducing your risk of developing diabetes and heart disease.

What’s not to like? This sounds like the perfect diet. But, are these claims true? More importantly, is this diet safe?

What Is Ketosis?

what is ketosisKetosis is a natural metabolic adaptation to starvation. To better understand that statement let me start with a little of what I’ll call metabolism 101.

Metabolism 101:

The Fed State: Here’s what happens to the carbohydrate, protein & fat we eat in a meal.

  • Most carbohydrates are converted to blood sugar (glucose), which is utilized in three ways:
    • Most tissues use glucose as their primary energy source in the fed state.
    • Excess glucose is stored as glycogen in muscle and liver.
    • Glycogen stores are limited, so much of the excess glucose is stored as fat.
  • A few tissues such as heart muscle use fat as an energy source. Excess fat is stored.
  • Protein is also used in three ways:
    • Some of it is used to replace and repair the protein components in muscle and other tissues.
    • In conjunction with exercise, protein can be used to increase muscle mass.
    • Excess protein is converted to fat and stored.

The Fasting State: Between meals:

  • Most tissues switch to fats as their primary energy source. Fat stores are utilized to fuel the cells that can use fat.
  • Brain, red blood cells, and a few other tissues still rely solely on glucose as their energy source.
    • Liver glycogen stores are broken down to keep blood glucose levels constant and provide energy for these tissues. (Muscle glycogen stores are reserved for high intensity exercise).
    • As liver glycogen stores are depleted, the body starts breaking down protein and converting it to glucose.

ketogenic diet problems and solutionsStarvation – The Problem: If the fasting state were to continue for more than a few days, we enter what is called starvation. At this point we have a serious problem. Fat stores and carbohydrate stores (liver glycogen) exist for the sole purpose of providing fuel during the fasting state. Protein, however, is unique. There are no separate protein stores in the body. All protein in our body is serving essential functions.

To make matters worse, our brain is metabolically very active. It consumes glucose at an alarming rate. Thus, large amounts of glucose are needed even in the fasting state. If protein continued to be converted to glucose at the same rate as during an overnight fast, our essential protein reserves would rapidly be depleted. Irreversible damage to heart muscle and other essential organs would occur. We would be dead in a few weeks.

Starvation – The Solution: Fortunately, at this point a miraculous adaptation occurs. Our bodies start to convert some of the fat to ketones.

  • All tissues that use fat as an energy source during fasting can also use ketones as an energy source, sometimes with greater efficiency.
  • Over a period of several days, the brain adapts to ketones as its primary energy source. This greatly reduces the depletion of cellular protein to supply blood glucose.
  • However, red blood cells and a few other cells still require glucose as an energy source. Essential protein reserves are still being depleted, but at a far slower pace.
  • With these adaptations, humans can survive months without food if necessary.

There are a few other adaptations that make sense if we think about the dilemma of going long periods without food.

  • Appetite decreases.
  • Metabolic rate decreases, which helps preserve both protein & fat stores.

 

What Is The Ketogenic Diet?

 

ketogenic diet keytonesProponents of the ketogenic diet advocate achieving a permanent state of ketosis without starving yourself. That is achievable because the real trigger for ketosis is low blood sugar, not starvation.

The starting point for the ketogenic diet is low-carb, high-fat diets like Atkins. However, ketogenic diets go beyond traditional low-carb, high-fat diets. They restrict carbohydrates even further to <10% of calories so that a permanent state of ketosis can be achieved. Basically, the ketogenic diet:

  • Eliminates grains and sugars.
  • Eliminates most fruits.
  • Eliminates starchy vegetables (root vegetables, corn, peas, beans, squash & yams).
  • Reduces protein intake. That’s because dietary protein will be converted to glucose when blood glucose levels are low.

You are left with a highly restrictive diet that allows unlimited amounts of fats & some vegetables and moderate amounts of meats, eggs, and cheeses.

The Ketogenic Diet Is Not For Wimps

ketogenic diet tough#1: You have to be committed. As noted above, this is a highly restrictive diet. You will have great difficulty following it when you eat out or are invited to a friend’s house for dinner. You will also have to give up many of your favorite foods.

#2: The transition is rough. Physiological adaptation to the ketogenic diet will take anywhere from a couple of days to a week or two. During that time, you will have to endure some of the following:

  • Headaches, confusion & “brain fog”
  • Fatigue
  • Hunger
  • Lightheadedness and shakiness
  • Leg cramps
  • Constipation
  • Bad breath
  • Heart palpitations

#3: There are no “cheat days”. On most diets, you can have occasional “cheat days” or sneak in some of your favorite foods from time to time. The ketogenic diet is different. A single “cheat day” is enough to take you out of ketosis. If you want to resume the ketogenic diet, you will need to go through the transition period once again.

Is The Ketogenic Diet Effective?

ketogenic diet effectiveWith this background in mind, let’s evaluate the claims made by proponents of the ketogenic diet. I’ll rate them on the “Pinocchio Scale”. “Zero Pinocchios” means they are mostly true. “One Pinocchio” means they are half true. “Two Pinocchios” means they are mostly false.

Zero Pinocchios (Mostly True Claims):

  • Reduced hunger. This is part of the starvation response.
  • Improved mental focus and increased energy. In part, this is simply in contrast to the “brain fog” and fatigue of the transition phase. However, you have also eliminated all foods that can cause blood sugar swings from your diet. Blood sugar swings can affect both mental focus and energy levels.
  • Rapid weight loss. If we focus on short term weight loss, this is true because:
    • A lot of the initial weight loss is water. Glycogen stores retain water. As glycogen stores are depleted, the water is lost along with them.
    • Most people inadvertently reduce their caloric intake on a highly restrictive diet like this. For example, fats are often consumed along with carbohydrate-rich foods (butter with toast, sour cream with potatoes, cream cheese with bagels). While it is easy to say that unlimited consumption of healthy fats is allowed, most people reduce their consumption of fats in the absence of their carbohydrate-rich companions.
    • Note: Proponents of the ketogenic diet will tell you that the weight loss associated with the ketogenic diet is because you are burning fat stores. You will only burn fat stores when dietary fat intake is not sufficient to meet your energy needs. In other words, you burn your fat stores when “calories in” are less than “calories out” – just as with any other diet.
  • Reversal of type 2 diabetes. Because carbohydrates are restricted in this diet, blood sugar and insulin levels will be low. If you are on medications, those will need to be adjusted by your physician.

 

One Pinocchio (Half-True Claims):

  • Improved cholesterol and triglyceride levels. The jury is out on this one. Some studies show an improvement on the ketogenic diet. Other studies show them getting worse.
  • Increased physical endurance. This is only true for low-intensity endurance exercise. It is not true for any exercise or event that requires spurts of high intensity exercise. That’s because:
    • The muscle fibers used for low intensity endurance exercise utilize ketone bodies with high efficiency. That means you can run for miles as long as you don’t care how fast you get there.
    • The muscle fibers used for high-intensity, short-duration exercise cannot adapt to use of ketone bodies because they lack sufficient mitochondria. They require glycogen stores, which are depleted on a ketogenic diet. Even in endurance events like marathons most people want to sprint to the finish line. They won’t be able to do that if they are on a ketogenic diet.

 

Two Pinocchios (Mostly False Claims):

  • ketogenic diet mythsLong term weight loss. Some long-term success has been claimed in a highly controlled clinical setting. However, most studies show:
    • People regain some or most of the weight after 6 months to a year.
    • After 1 or 2 years, there is no difference in weight loss between high-fat/low-carb diets and low-fat/high-carb diets.
    • That’s because:
      • Most people cannot stick to restrictive diets long term, and this diet is very restrictive.
      • Once you go off this diet, even for a short time, your glycogen stores will be replenished and the water weight will return along with the glycogen.
      • The reduction in metabolic rate and the reduction in muscle mass associated with the ketogenic diet make it difficult to keep the weight off long term
  • It is a healthy diet.
    • This is a healthy diet only from the point of view that it eliminates most fast foods and processed foods.
    • However, any diet that eliminates 2 and a half food groups (grains, fruits, and starchy vegetables) is setting you up for long term nutritional deficiencies. It is possible to cover some of those deficiencies with supplementation, but supplements can never provide all the nutrients found in real food.

 

Is The Ketogenic Diet Safe?

ketogenic diet safeFor most people the ketogenic diet is likely to be safe for short periods, maybe even a few months. However, I have grave concerns if the diet is continued long term.

  • I have already mentioned the likelihood this diet will create nutritional deficiencies. Long term, those deficiencies could have severe health consequences.
  • Proponents of the diet recommend that protein intake be limited so that “optimal” ketosis can be achieved. If the dieter is successful at doing that, it will result in a gradual depletion of essential cellular protein reserves as discussed above. Long term, that has the potential to weaken heart muscle, compromise the immune system, and damage essential organs.
  • Ketones can damage the kidneys. In the short term, damage is likely to be minimal as long as plenty of water is consumed. However, long term ketosis could be a significant concern for your kidneys.

I have seen proponents of the ketogenic diet shrug this off as a concern only if protein intake is excessive. They are missing the point. The problem is the ketones, not the protein.

  • Long term ketosis has the potential to cause osteoporosis. That is because the so-called “ketones” are actually organic acids except for the small amount of acetone that gives your breath a fruity smell. Organic acids must be neutralized to keep our body pH in the normal range. There are multiple mechanisms for neutralizing organic acids. One of those mechanisms involves dissolving bone and releasing calcium carbonate into the bloodstream. This slow dissolution of bone will continue for as long as someone is in ketosis.

 

Proponents of the ketogenic diet shrug this off by saying that you never get into ketoacidosis on their diet. Again, they are missing the point. Ketoacidosis simply means that the production of organic acids has become so great that all the body’s mechanisms for neutralizing those acids have become overwhelmed. Ketoacidosis occurs in uncontrolled diabetes and can be deadly. The problem is the slow dissolution of bone during long term ketosis, not a short-term crisis like ketoacidosis.

If you are considering the ketogenic diet for weight loss, my recommendations would be to:

  • Consider other equally effective, but less demanding, weight loss programs. Look for programs that help you preserve muscle mass and teach you healthy eating habits that can be sustained for a lifetime.
  • If you do decide to follow the ketogenic diet, only use it for a short period of time to jump start your weight loss. Then switch to a diet program that has been clinically proven to improve your health long term. Examples would be the Mediterranean diet and the Dash diet.

If you are choosing the ketogenic diet for health reasons, I would recommend the Mediterranean diet or Dash diet instead.

 

The Bottom Line

 

  1. The ketogenic diet is the latest diet fad. I give it a C+ compared to other popular diets.
  2. This is not a diet for wimps.
    • It is a highly restrictive diet
    • The transition period as you adjust to the diet is rough.
    • There are no “cheat days”
  3. Some of the claims made for the ketogenic diet are mostly true, some are half-true, and some are mostly false. I help you sort them out in the article above.
  4. Short term, the diet is probably safe for most people. However, long term I have several concerns.
    • The diet is likely to create nutritional deficiencies. Long term, those deficiencies could have severe health consequences.
    • The diet is likely to gradually deplete essential cellular protein reserves. Long term, that could weaken heart muscle, compromise the immune system, and damage essential organs.
    • The diet has the potential to damage the kidneys.
    • The diet has the potential to cause osteoporosis.
    • The metabolic rationale for those concerns is discussed in the article above.
  5. If you are considering the ketogenic diet for weight loss, my recommendations would be to:
    • Consider other equally effective, but less demanding, weight loss programs. Look for programs that help you preserve muscle mass and teach you healthy eating habits that can be sustained for a lifetime.
    • If you do decide to follow the ketogenic diet, only use it for a short period of time to jump start your weight loss. Then switch to a diet program that has been clinically proven to improve your health long term. Examples would be the Mediterranean diet and the Dash diet.
  6. If you are choosing the ketogenic diet for health reasons, I would recommend the Mediterranean diet or Dash diet instead.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Comments (5)

  • Eroca Zeviar

    |

    Love your detailed specicifity and clarity. With so many group things online ie Betrayal system and group anti cancer infos, many different diets being promoted without the public really knowing enough to make an informed choice based on real proven knowledge.

    Thanks for your valued presentation.

    Reply

  • Merlena Cushing

    |

    Thank you so much for an incredibly compelling and thorough article. I will simply say I second the accolades given by Eroca…she put it very well. We are indebted to you for your continued articles here and on FB and your generosity in sharing them with all of us. Bless you!

    Reply

  • Judy LaBrune

    |

    Thank you for clarifying the Ketogenic diet! I’ve heard several people talking about how great it is. This article will be very helpful in sharing the myths and truths.

    judy

    Reply

  • Bonnie zeman

    |

    We use keto but it is with two life shakes a day. Also the life strip. I suppose it is not true keto. But they are losing a pound a day. We really pay attention to fats, butter, mayo, 100% cold pressed virgin olive oil and coconut oil. Purified water every hour. So far it has worked great. All top grade meats, fish, chicken and eggs. And huge amts of veggies. We also check on them every week.

    Reply

    • Dr. Steve Chaney

      |

      Dear Bonnie,
      It looks more like the Atkins diet to me. As I said in the article, it will succeed short term, but it will be hard to maintain that weight loss long term. I would also remind you that the only diets proven to be healthy long term are the Mediterranean and DASH.
      Dr. Chaney

      Reply

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Latest Article

What Is The Best Diet For You?

Posted May 23, 2017 by Dr. Steve Chaney

Sorting Through The Dueling Diets

Author: Dr. Stephen Chaney

battle over best dietDiets are a lot like politics in today’s world. Everyone is absolutely convinced their diet is the best and absolutely convinced the other diets are terrible.

Remember the nursery rhyme: “Jack Sprat could eat no fat. His wife could eat no lean…”? Today’s diets remind me of that. They run the gamut from no fat to no carbohydrates. Surely, both extremes couldn’t be healthy. Or could they?

Some diets eliminate whole food groups. That couldn’t be a good thing. Or, could it?

So, what is the best diet for you?

In today’s article, I will give you the pros and cons of these dueling diets. Before I do that, however, let me give you some principles to put things into perspective.

General Principles For Evaluating Diets

How do you sort out the claims and counterclaims associated with the various diets? More importantly, how do you know which of the claims are true and which are misleading? Here are some general principles to help you separate the wheat from the chaff.  What’s the right diet for you?

We are omnivores. We can adapt to a wide variety of diets and do reasonably well. That means most people will do well on any of these diets short term.

wings proteinAnything is better than the standard American diet (SAD). It is high in sugar and refined carbohydrates. It is also high in saturated and trans fats. That is why proponents of every diet can claim that you will feel better and be healthier when you switch to their diet.

Processed and convenience foods are part of the problem. Most diets recommend “clean eating” (elimination of processed and convenience foods). Any diet that eliminates processed and convenience foods is likely to help you lose weight and get healthier. Caution: As soon as a diet becomes popular, food manufacturers rush in to provide pre-packaged, convenience foods to support that diet. Avoid the temptation to use those foods. Big Food Inc. does not have your best interests in mind. They are not your friends.

Most diets lead to a fairly rapid initial weight loss. This is because they restrict food choices and eliminate processed foods. When you eliminate familiar foods from someone’s diet, they instinctively eat less without even thinking about it. This rapid initial weight loss is part of the allure of almost every diet program. However, over time most people start adding back some of their favorite foods or find new foods they like, and the weight comes back.

Weight loss leads to improved blood parameters irrespective of diet composition. That is why every diet, no matter how bizarre, can claim it lowers your blood pressure, improves your blood sugar, lowers your cholesterol, and lowers your triglycerides.

Long term weight loss is virtually identical on every diet. Numerous clinical studies have compared long term weight loss on low fat diets, low carbohydrate diets, and virtually everything in between. Initial weight loss is more rapid on the low-carbohydrate diets. However, at the end of one or two years there is not a dime’s worth of difference in weight loss between any of the diets. The exception is the Vegan diet. Long term Vegans typically weigh less than their meat-eating counterparts, probably because the foods in the Vegan diet have low caloric density (fewer calories per serving).

Healthy carbs and healthy fats are more important than low carb or low fat diets. Ignore the claims and counter claims about low fat and low carb diets. Focus instead on diets that provide moderate amounts of whole grains instead of refined grains & sugar. Also focus on diets that provide moderate amounts of monounsaturated and polyunsaturated fats, especially the omega-3 polyunsaturated fats, instead of saturated and trans fats.

Focus on well balanced meals rather than individual foods. For example, moderate amounts of healthy carbohydrates will have relatively little effect on blood sugar and triglyceride levels as part of a plant-based meal that provides plenty of fiber and protein. However, those same carbohydrate-rich foods by themselves may cause a spike in both blood sugar and triglycerides.

best diet for youPlant-based diets rule. The Ornish diet (a very restrictive form of the Vegan diet) is the only diet that has been shown to reverse atherosclerosis in some people. The Vegan diet and the Mediterranean diet, which is largely plant-based, have been shown to be healthy long term. On the other hand, we simply don’t know whether low carbohydrate diets are healthy long term. Those clinical studies have not been done.

Saturated and trans fats are not your friends. They increase inflammation, which can have many serious long-term health consequences. In addition, the foods that are rich in saturated fats are often acid-forming foods, which can upset your acid-base balance.

We have 5 food groups for a reason. Each food group provides valuable nutrients (vitamins a & minerals) and phytonutrients. You may be able to replace the missing nutrients with supplementation, but you are unlikely to replace the phytonutrients with supplements – even those supplements that claim to be made from whole foods. You should be concerned about the long-term health consequences of any diet that eliminates whole food groups.

Low fat diets aren’t necessarily healthy. Whole food, low-fat diets like the Vegan diet are extremely healthy. However, as soon as health experts started recommending low-fat diets, Big Food Inc. stepped in to offer convenient low fat options. They simply replaced the fat with refined carbohydrates, sugar, and a witch’s brew of chemicals (Remember the part about Big Food Inc. not being your friend?). As a result, the low-fat diet consumed by most Americans is anything but healthy.

The supposed advantages of low carbohydrate diets are misleading. Low carbohydrate diets look very good when you compare them to the Big Food Inc version of the low-fat diet. However, when you compare them to something like the Vegan diet the advantages disappear.

Avoid sugar-sweetened and diet beverages. This should go without saying. Choose water instead. Add carbonation and/or a little lemon or lime juice for flavoring if necessary. Fortunately, most of the major diets exclude sugar-sweetened and diet beverages.

 

The Pros and Cons Of The Major Diets

It is not possible to cover each diet in depth in a single article, so this is meant to be a very brief overview of the major diets.

Low Fat Diets

The Dean Ornish Diet. This is a variation of the Vegan Diet that eliminates all oils, even vegetable oil.

Pros:

  • Whole food, plant-based diet.
  • All the advantages of the Vegan diet, plus it is the only diet shown to reverse atherosclerosis.

Cons:

  • Very restrictive.
  • Long-term adherence is low.

 

vegetablesThe Vegan Diet. This is a whole food, plant based diet. It uses plant proteins instead of meat and plant substitutes for dairy and eggs.

Pros:

  • Whole food, plant-based diet.
  • Associated with lower blood pressure, blood sugar, cholesterol, triglycerides, and inflammation.
  • Clinical studies show that the onset of major diseases like heart disease, cancer, and diabetes are delayed by at least 5-10 years. People on this diet live healthier, longer.

Cons:

  • Long-term adherence is relatively low, but some people stick with this diet for a lifetime.

 

Healthy Fat, Healthy Carb Diets

The Mediterranean Diet. This diet emphasizes fresh fruits & vegetables, whole grains, fish, nuts, seeds, legumes and olive oil. It includes cheese, poultry and eggs in moderation.

whole food dietPros:

Cons:

  • Not designed specifically for weight loss. You will need to watch portion sizes and track calories if you want to lose weight on this diet.

 

The DASH Diet. This diet was specifically designed to help reduce the risk of hypertension and stroke. It is similar to the Mediterranean diet except that it restricts sodium and includes a wider range of lean meats and low-fat dairy products. It does not specifically include olive oil.

Pros:

  • Whole food diet.
  • Clinically proven to lower blood pressure  as effectively as some blood pressure medications.
  • Relatively easy to follow. Includes foods familiar to Americans.

Cons:

  • Not designed specifically for weight loss. You will need to watch portion sizes and track calories if you want to lose weight on this diet.

 

Low Carb Diets

meat protein dietThe Paleo Diet. The Paleo diet is supposedly based on the diet of our paleolithic hunter-gatherer ancestors. The diet is high in protein & fat, and low in carbohydrates. The diet eliminates grains, sugars, refined oils, dairy, legumes, and starchy fruits & vegetables. Most of the protein comes from meats, but the animals must be grass-fed. This reduces, but does not eliminate, saturated fat and gives a modest increase in omega-3 polyunsaturated fat. Thus, the meats included in this diet are healthier than the meats in other low carbohydrate diets. However, it does not turn red meats into health foods.

Anthropologists tell us that the premise of the Paleo diet is faulty. The diet of our paleolithic ancestors was highly dependent on the foods available in their environment. Some were hunters and gatherers. Others lived in areas where fruits & vegetables were prevalent and game was scarcer. Still others lived in areas where starchy root vegetables were an important part of their diet. Furthermore, the enzymes required for digestion of starches are inducible. We can easily adapt to the introduction of grains into our diet.

Pros:

  • Whole food diet.
  • The Paleo diet is associated with several short-term benefits including weight loss, improved blood sugar control and reduced cholesterol, triglycerides & blood pressure.

Cons:

The Atkins Diet. The Atkins diet is the granddaddy of the low-fat diets. It is a very low carbohydrate diet that restricts sugars, grains, high carbohydrate fruits and vegetables. The allure of the diet is that it includes as much fatty meats and saturated fats as you want.

Pros:

  • The Atkins diet is associated with several short-term benefits including weight loss, improved blood sugar control and reduced cholesterol, triglycerides & blood pressure.

Cons:

  • There are no studies evaluating the long-term benefits and risks of the Atkins diet.
  • Weight loss at the end of one or two years is no better than for the low-fat diets.
  • The high intake of saturated fat has the potential to increase the risk of heart disease and cancer.
  • It is a very restrictive diet. Long-term adherence to this diet is poor.

The Ketogenic Diet. The Ketogenic diet is even more restrictive than the Atkins diet. I have covered the pros and cons of the Ketogenic diet in a recent post, so I will refer you to that article, Is the Ketogenic Diet Safe for details. In short, the Ketogenic diet has some short-term benefits and some potential long-term risks. Ketone supplements mimic some, but not all, of the short-term benefits of the Ketogenic diet. Their long-term health risks are unknown.

 

What Is The Best Diet For You?

what diet is right for youWe are all different, so there is no perfect diet for everyone. Want to know how to find a diet that works for you?  Here are some things to think about.

  • If you are like most Americans, almost any of these diets is better than your current diet.
  • The good thing about all the diets reviewed in this article is:
    • They replace refined carbohydrates & sugars with healthier alternatives (The best of the diets also replace saturated & trans fats with healthier alternatives).
    • They emphasize whole foods rather than processed and convenience foods.
    • They eliminate sugar-sweetened and diet beverages.
    • They emphasize fresh vegetables and most include fresh fruit.
  • If you are looking for rapid initial weight loss:
    • The very restrictive diets at either extreme (very low fat or very low carb) are best because they eliminate familiar foods from the diet.
    • The very low carb diets are slightly more effective than low fat diets initially because of water loss, but weight loss on most low carb and low fat diets is identical after 1-2 years.
    • Because both the Mediterranean and DASH diets involve many familiar foods, you will need to pay more attention to portion sizes and total calories on these diets if your primary goal is to lose weight.
  • If you are looking for long term weight control, the Vegan diet is best, probably because most foods in the Vegan diet have low caloric density. Multiple studies have shown that Vegans weigh less than their meat-eating counterparts.
  • If you are looking for long term health benefits:
    • The Vegan and Mediterranean diets are clearly your best choices. They are backed by multiple clinical studies showing they reduce the risk of heart disease, cancer, diabetes, dementia and other diseases.
    • The DASH diet is probably equally healthy. However, because it was designed to control blood pressure, most clinical studies have focused only on how well it reduces blood pressure.
    • There is no evidence that the low carb diets have any long-term health benefits, and there is reason to suspect they may have some long-term health risks.
  • I have serious concerns about long-term health risks for any diet that:
    • Eliminates whole food groups.
    • Is high in saturated and trans fats.
  • The effectiveness of any diet is dependent on how well you stick with it:
    • The long-term adherence to any of the very restrictive diets (either low carb or low fat) is low, although some people do stick with the Vegan diet for a lifetime.
    • Adherence is best with the Mediterranean and DASH diets, probably because many of the foods are familiar and readily available.

 

The Bottom Line

 

In this article I have reviewed the major low fat diets (the Dean Ornish diet and the Vegan diet), the major healthy carb, healthy fat diets (the Mediterranean diet and the DASH diet), and the major low carb diets (the Paleo diet, the Atkins diet, and the Ketogenic diet). In summary:

 

  • If you are like most Americans, almost any of these diets is better than your current diet.
  • The good thing about all these diets is:
    • They replace refined carbohydrates & sugars with healthier alternatives (The best of the diets also replace saturated & trans fats with healthier alternatives).
    • They emphasize whole foods rather than processed and convenience foods.
    • They eliminate sugar-sweetened and diet beverages.
    • They emphasize fresh vegetables and most include fresh fruit.
  • If you are looking for rapid initial weight loss:
    • The very restrictive diets at either extreme (very low fat or very low carb) are best because they eliminate familiar foods from the diet.
    • The very low carb diets are slightly more effective than low fat diets initially because of water loss, but weight loss on most low carb and low fat diets is identical after 1-2 years.
    • Because both the Mediterranean and DASH diets involve many familiar foods, you will need to pay more attention to portion sizes and total calories on these diets if your primary goal is to lose weight.
  • If you are looking for long term weight control, the Vegan diet is best, probably because most foods in the Vegan diet have low caloric density. Multiple studies have shown that Vegans weigh less than their meat-eating counterparts.
  • If you are looking for long term health benefits:
    • The Vegan and Mediterranean diets are clearly your best choices. They are backed by multiple clinical studies showing they reduce the risk of heart disease, cancer, diabetes, dementia and other diseases.
    • The DASH diet is probably equally healthy. However, because it was designed to control blood pressure, most clinical studies have focused only on how well it reduces blood pressure.
    • There is no evidence that the low carb diets have any long-term health benefits, and there is reason to suspect they may have some long-term health risks.
  • I have serious concerns about long-term health risks for any diet that:
    • Eliminates whole food groups.
    • Is high in saturated and trans fats.
  • The effectiveness of any diet is dependent on how well you stick with it:
    • The long-term adherence to any of the very restrictive diets (either low carb or low fat) is low, although some people do stick with the Vegan diet for a lifetime.
    • Adherence is best with the Mediterranean and DASH diets, probably because many of the foods are familiar and readily available.
  • For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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