Dispelling nutrition myths, ranting, and occasionally, raving


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To keto or not to keto

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I feel like there’s one thing missing from a lot of the discussion about the keto diet (and similar extreme diets, really). Everyone talks a lot about whether or not it “works” with proponents on both sides, research supporting both sides, arguing that it does or doesn’t work for weight loss. The problem with this is the assumption that weight loss is the most important feature of a good diet. It’s not. You can lose weight eating lots of things that are not going to provide you with the nutrients you need. Weight loss is not the most important thing for health, despite what the media, the “wellness” industry, society, and even many health care professionals have lead us to believe.

Just because you feel good on a ketogenic diet and are losing weight doesn’t mean that it’s a good idea. As a dietitian, this is something that I really struggle with. It’s our job to support people. We can tell them that keto is a difficult diet to follow, that it may not be advisable, but when it comes down to it, they decide if it’s something they want to pursue or not. And if they do decide to pursue it, we can’t say “well, good luck, I wash my hands of you”. We have to help them undertake it in as healthy a way as possible. Which kind of blows my mind (and makes me glad that I don’t work in a counselling role) because if someone came to us with an eating disorder we wouldn’t support them in that. How can it be ethical for us to support people in following a diet that may cause them harm?

A little history of keto: the ketogenic diet originated as a treatment for epilepsy in children in the 1920s. It was intended to mimic the effects of fasting through the generation of ketones. In recent years this concept has caught on with people desiring to lose weight. After all, if ketones are produced during fasting, then if a specific diet can promote the production of ketones, it may also lead to weight loss. Not illogical. In some children with epilepsy who do not experience a reduction in seizures with medications, the ketogenic diet can be an effective treatment. However, there are potential side-effects.

A few long-term studies (1, 2) have looked at the effects of the ketogenic diet in children and have found such side-effects as: kidney stones, slowed growth, dyslipidemia, and fractures. There are also short-term risks (2, 3, 4) associated with the diet in children with epilepsy including: acidosis, hypoglycemia, gastrointestinal distress (including vomiting, constipation, diarrhoea, and abdominal pain) dehydration, hypoproteinemia, and lethargy. All of these studies have found low long-term adherence among children. There are many reasons for this: some children see improvement in symptoms, even after discontinuing the diet, others find it difficult to adhere to the diet, for some it’s not effective.

Of course, adults who wish to lose weight are not the same as children who have epilepsy. It’s hard to say if slowed growth in children would have a similar counterpart in an adult. However, many of the short-term side effects may be seen in adults, as may some of the other long-term side effects. In addition, there is potential for nutrient deficiencies when following such a restricted diet. Unfortunately, we don’t have research into the long-term effects of a ketogenic diet on adults using it for weight loss. We have some short-term studies that primarily look at it from the standpoint of whether or not it’s an effective weight loss diet. Maybe it’s perfectly safe, but maybe it’s not. Given that the vast majority of people who lose weight on the diet end up regaining it, and often more, is it really worth taking that risk? By following a keto diet you’re basically enrolling yourself in an uncontrolled experiment.

I think it would be interesting to know what the long-term effects of a ketogenic diet for weight loss are in adults. What I’d really like to know though is why we have become so obsessed with being thin that we are willing to adopt disordered eating habits at the expense of other aspects of our health and well-being. Why is it when we talk about a diet “working” we de facto mean weight loss? Why have we come to value weight loss over every other indicator of health? Why can’t we just value ourselves enough to properly nourish our bodies?


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Protein: the latest killer lurking in your food

Image by noodles and beef on flickr. Used under a Creative Commons Licence.

Image by noodles and beef on flickr. Used under a Creative Commons Licence.

Oh good, just what we all need, more fear mongering. That’s one thing we certainly don’t get enough of as part of our current diet. So, what’s the latest to spark fear into the tummies of eaters everywhere? Protein. Yep, apparently, our “obsession” with protein is actually making us sick. This according to Garth Davis, a surgeon, and author of the forthcoming book Proteinaholics. Cute name, no? Right up there with Grain Brain and Wheat Belly.

Davis proposes that we’re all eating too much protein and that it’s having dire health consequences. According to the article an average 150 lb adult in the US consumes the equivalent of more than 6 eggs worth of protein in a day. I’m not sure how the math was done to obtain this conclusion (I guess that “more than” must be integral) as I have six large eggs clocking in at 6 grams of protein a piece which would be 36 grams of protein for the day which is actually less than the recommended 0.8 g/kg of body weight per day. In fact, it leaves our “average adult” about 18 grams of protein shy of the recommended adequate intake. Not to mention the fact that while the AI is expected to meet, or exceed, the needs of most individuals, it doesn’t account for those who have increased nutrient needs such as athletes, those who are injured (particularly people suffering from burns), pregnant women, the elderly, etc. To the article author’s credit, she does go on to mention that there are some researchers who believe that the AI for protein should be increased, providing some balance to the article if you manage to read the whole piece.

Another good point made in the article is that we get protein from many foods, particularly foods that people don’t think of as protein sources. Things like grains and vegetables. However, this is undermined by the example provided comparing the protein content of a packet of Mr Noodles with the protein in a Clif Bar. An unfortunate choice because your standard Clif Bar isn’t a protein bar, it’s an energy bar. This may sound like a minor quibble but when most protein supplements provide around 20 grams of protein per serving, comparing an energy bar with 11 grams of protein (still nothing to sniff at) to Mr Noodles (which have 10 grams in the chicken flavour used for comparison but as few as 4 grams in some other flavours) is rather foolish. To digress from protein for a moment… While the Clif Bar is also high in sugar (about 5 teaspoons!) it does contain other vitamins and minerals and fibre while your packet of Mr Noodles will give you more than half a day’s worth of sodium. I know that the focus of the article was protein but it’s important not to make the focus of nutritional comparisons single nutrients.

Onto the dangers of our proteinaholic diets. Ketosis. Which, based on the article, you would think occurs after consuming a single protein supplement (sans carbs) and leads to nausea, fatigue, and headaches. Apparently feeling miserable is why you lose weight, you’re simply less inclined to eat. While I’m not a supporter of ketosis for weight loss (I love carbs and I don’t think that very-low carb diets are sustainable) I think that there may be some confusion between ketosis and ketoacidosis here. Ketosis is the result of following a low-carb diet (not necessarily a high-protein diet) and may initially result in symptoms such as frequent urination, dry mouth, and headache. People who are in ketosis often report a sense of euphoria and a lack of hunger once these initial symptoms pass. Nausea and vomiting may occur in the case of ketoacidosis which is when ketones build-up in the blood, making it acidic. This can happen to people with diabetes, during starvation, and in conjunction with other medical condition, not on a low-carb diet.

Animal proteins apparently also make you fat, cause cancer and diabetes. Also, the amino acids (which are building blocks of proteins) leach calcium from muscles and bones. To address the first statement: animal protein might cause you to gain weight, if you consume too much of it. So might cookies. Consuming excessive calories from any source can lead to weight gain. Animal protein might be a factor in cancer development, certainly processed meats and burnt meat have been identified as risk factors. As for diabetes, there has been an association noted between higher consumption of meat and type 2 diabetes; however, there has been no causal link made to date. To address the second statement: this myth has been around for a number of years. Recent research indicates that protein consumption does not reduce bone density, in fact, it may actually help to boost calcium retention.

“Although it’s necessary for us to grow, it also helps grow cancer cells. It’s instructive that breast milk, which humans consume during the fastest growing period of our lives, derives just five per cent of its calories from protein.”

Funny, I thought it was sugar that was feeding cancer. If you believed all of the fear mongering out there you wouldn’t be able to eat anything. Do I really need to tell you that infants are different than adults? If breastmilk was the optimal way for humans beyond the age of 2 years to obtain nutrition then we’d all be drinking breastmilk on the daily. As we age, our nutrient needs change; in connection with increased caloric needs we also see increased protein needs.

We’ve seen so many diets purporting that this or that macronutrient is evil. I’m not saying eat more meat, most Canadians could certainly benefit from consuming less. However, it seems to me that people like Davis are conflating protein with meat. You can’t paint all protein-containing foods with the same brush and his message only serves to scare people away from protein in general. In my mind, this is not promoting a healthy way of eating. Nor am I saying that protein supplements are necessary, sorry Vega, they’re really not.

Davis says, “If I can’t convince you that protein is bad for you, I can’t convince you that water is wet.” Awesome. I’m looking forward to no longer having to towel off after I shower.