Keto is more foolish than I even believed…
Published 4.22.2025: This is not related to the vegan seminar, but since my coverage of that is very delayed, and this is relatively current, I'm going with this. Before I get started, I'm getting a distinct Gary Taubesian vibe from these guys… what is with low carbers not believing the research they themselves run?
The trial is known as the keto-CTA trial or cohort, it really wasn't a trial. The research was registered officially with the proposed outcomes. Part of why the study is being dissed is that the authors ignored or downplayed their own stated primary outcomes, because it didn't match their preconceived story.
Alex Leaf is the author of this first piece. For the record, the percentage change in non-calcified coronary plaque volume (NCPV) or soft plaque was the primary outcome to be measured.
Most of this piece is above my pay grade, and I think keto is dumb in any event, but the bottom line is… that being lean doesn't protect you from your diet increasing your risk of heart disease. And these "so-called" lean responders were the healthiest ones in the bunch. This trial took forever to find participants, because most lean mass hyper responders (LMHR) were not as healthy as they thought. The criteria for the trial was very stringent. And still plaque and LDL increased. There was/is no control group— maybe for funding reasons?
In this analysis, LMHR showed a similar decline in heart health (measured in soft plaque) as people with type 2 diabetes. This is not good. Soft plaque is the dangerous plaque, the kind that can break off and cause heart attack or stroke. Dr Nadolsky (who I listen to on his podcast the Docs Who Lift) was involved at first, but quit when the trial didn't adhere to best practices. He is now both a source of how things were done and one of the biggest detractors.
Basically, their own research showed that LMHR phenotype and a keto diet does not mitigate heart disease. And at the end, he does mention Gary Taubes's study that disproved is insulin drives fat gain theory. So I'm not alone in getting Taubesian vibes…
This piece is authored by Kevin Klatt. He starts with the history of the keto diet, which was originally designed to treat epilepsy. Keto is not the same as the low carb diet, though he equates them. Low carbers generally eat a bit of carb, and eat too much protein to be ketogenic. A true keto diet is very high fat.
Anyway, he points out that, even at this late date, we don't have a "smoking gun" as to why sat fat raises cholesterol. And keto fools tend to eat a lot of saturated fat (sat fat). Medical keto diets are 4:1 (4 grams being fat and 1 gram being protein AND carbs)— I did not know that. Typically, keto diets are 85% fat, 10-12% protein and minimal carbs (3-5%) — makes me throw up a bit in my mouth as a type that. The diet is not for me.
I guess the first phase of the Atkins was ketogenic, and then he relaxed things in the maintenance phase. Points out that the low carb space desperately wants LDL-C to be unrelated to heart disease risk, because low carb increases LDL-C in many people.It's not a clean line, because a lot of times there is weight loss, and that hides a lot of sins.
Klatt also knows Nadolsky, and discussed the trial with him. There is no way to know how many they had to screen before getting their cohort of 100. (It's a cohort study, not a trial). He points out that the diet data they report is bovine fecal matter (not what he says, but my interpretation).
Basically he thinks that investigators played shenanigans with the data, and it's not worth a read. He did a statistical test that I don't understand and decided that 100 participants was not enough. I have nothing to say here, it is above my pay grade. I found the first piece easier to read and understand, but he also seemed more open to the study. Klatt ended by saying a lawsuit will follow any heart attack by a participant…
Here is Dietician Nicola Guess's take: (I've listened to her before. Klatt linked to the paper) Guess also stresses the preregistered outcome of the study, which the abstract doesn't mention at all, and it's a huge RED FLAG.
She actually took at a ruler to try and measure the change in 12 months… and it was not good (and got a number very close to what the lead author was forced to admit on what used to be called Twitter. There is no protection of LMHR… on average it accelerates heart disease risk, as measured by soft plaques (again, the kind that causes heart attacks and strokes). The fact that researchers are now looking at secondary results within that first bad result doesn't change the first bad, very bad, terrible, no good result.
This is a conversation with the main author and a YouTuber that I like. Talk about obfuscation… and he disavows almost everything in the paper and on social media. My personal bottom line is unchanged: The "keto" diet is stupid and only a fool would follow it. I have met people in real life who "claim" to be following a keto diet, but I have now way of knowing what they eat. I will just note for the record that all of they were still fat.
DISCLAIMER: I am NOT any type of medical professional. Do NOT take medical advice from me!!
The trial is known as the keto-CTA trial or cohort, it really wasn't a trial. The research was registered officially with the proposed outcomes. Part of why the study is being dissed is that the authors ignored or downplayed their own stated primary outcomes, because it didn't match their preconceived story.
Alex Leaf is the author of this first piece. For the record, the percentage change in non-calcified coronary plaque volume (NCPV) or soft plaque was the primary outcome to be measured.
Most of this piece is above my pay grade, and I think keto is dumb in any event, but the bottom line is… that being lean doesn't protect you from your diet increasing your risk of heart disease. And these "so-called" lean responders were the healthiest ones in the bunch. This trial took forever to find participants, because most lean mass hyper responders (LMHR) were not as healthy as they thought. The criteria for the trial was very stringent. And still plaque and LDL increased. There was/is no control group— maybe for funding reasons?
In this analysis, LMHR showed a similar decline in heart health (measured in soft plaque) as people with type 2 diabetes. This is not good. Soft plaque is the dangerous plaque, the kind that can break off and cause heart attack or stroke. Dr Nadolsky (who I listen to on his podcast the Docs Who Lift) was involved at first, but quit when the trial didn't adhere to best practices. He is now both a source of how things were done and one of the biggest detractors.
Basically, their own research showed that LMHR phenotype and a keto diet does not mitigate heart disease. And at the end, he does mention Gary Taubes's study that disproved is insulin drives fat gain theory. So I'm not alone in getting Taubesian vibes…
This piece is authored by Kevin Klatt. He starts with the history of the keto diet, which was originally designed to treat epilepsy. Keto is not the same as the low carb diet, though he equates them. Low carbers generally eat a bit of carb, and eat too much protein to be ketogenic. A true keto diet is very high fat.
Anyway, he points out that, even at this late date, we don't have a "smoking gun" as to why sat fat raises cholesterol. And keto fools tend to eat a lot of saturated fat (sat fat). Medical keto diets are 4:1 (4 grams being fat and 1 gram being protein AND carbs)— I did not know that. Typically, keto diets are 85% fat, 10-12% protein and minimal carbs (3-5%) — makes me throw up a bit in my mouth as a type that. The diet is not for me.
I guess the first phase of the Atkins was ketogenic, and then he relaxed things in the maintenance phase. Points out that the low carb space desperately wants LDL-C to be unrelated to heart disease risk, because low carb increases LDL-C in many people.It's not a clean line, because a lot of times there is weight loss, and that hides a lot of sins.
Klatt also knows Nadolsky, and discussed the trial with him. There is no way to know how many they had to screen before getting their cohort of 100. (It's a cohort study, not a trial). He points out that the diet data they report is bovine fecal matter (not what he says, but my interpretation).
Basically he thinks that investigators played shenanigans with the data, and it's not worth a read. He did a statistical test that I don't understand and decided that 100 participants was not enough. I have nothing to say here, it is above my pay grade. I found the first piece easier to read and understand, but he also seemed more open to the study. Klatt ended by saying a lawsuit will follow any heart attack by a participant…
Here is Dietician Nicola Guess's take: (I've listened to her before. Klatt linked to the paper) Guess also stresses the preregistered outcome of the study, which the abstract doesn't mention at all, and it's a huge RED FLAG.
She actually took at a ruler to try and measure the change in 12 months… and it was not good (and got a number very close to what the lead author was forced to admit on what used to be called Twitter. There is no protection of LMHR… on average it accelerates heart disease risk, as measured by soft plaques (again, the kind that causes heart attacks and strokes). The fact that researchers are now looking at secondary results within that first bad result doesn't change the first bad, very bad, terrible, no good result.
This is a conversation with the main author and a YouTuber that I like. Talk about obfuscation… and he disavows almost everything in the paper and on social media. My personal bottom line is unchanged: The "keto" diet is stupid and only a fool would follow it. I have met people in real life who "claim" to be following a keto diet, but I have now way of knowing what they eat. I will just note for the record that all of they were still fat.
DISCLAIMER: I am NOT any type of medical professional. Do NOT take medical advice from me!!