Thank you so much for the link! Those are amazing results for diabetics in terms of most cardiovascular health markers. I’m going to address the weight loss part of it and why I don’t consider it an example of successful weight loss.
First up: all participants had type 2 diabetes. I’m going to brush that away because my main point is even if this holds for the general population, it’s not a method that works for a majority of people even in the study for 10% loss and 10% isn’t that much over 5 years.
Among five-year completers, 61.3 % and 39.5 % of the participants sustained 5 % and 10 % weight loss.
The original study started with 262 participants, all of whom that type 2 diabetes. This was down to 122 at the end of the five years. Drop outs in studies are normal, and having done keto myself, it’s really hard. Let’s ignore the drop outs since we don’t have data on if they stopped doing keto or just stopped being in the study. Just wanted to mention that we’re down by half already.
Of the remaining participants, at the end of 5 years of keto, only ~40% lost and kept off 10% of their body weight. They used a baseline of 128.7kg (~280 lbs). Using that as a starting point for this example, the best case scenario for weight loss is 116kg (256 lbs) if you’re in the lucky~40% of people that can stick to the diet for 5 years and are in the group it works for. Even if you’re 7 feet tall, 116kg is still considered overweight. You’ve maybe changed your BMI category (BMI sucks btw). You are still fat.
I wouldn’t consider having less than a coin toss’s chance at 10% loss after 5 years a method that consistently turns fat people into not fat people.
(Note I’m not trying to move the goalposts here and quibble about what percentage is significant, etc., it’s just nowhere close to bariatric surgery.
In comparing the body weight of the 64 followed patients 5 years after surgery and before surgery, 62 patients (93.9%) experienced weight loss (31.50 (20.00–44.25) kg)
That’s closer to 25% loss, most of which happens in the first 6 months. That’s more than double the percentage loss of keto and more than doubles the success rate of the greatest loss category.)
Thank you for actually reading the paper, it’s gratifying to be able to discuss it in detail.
Surgery is a option, I just wanted to give you a example of 5 years of consistent weight loss that didn’t involve surgery.
As far as the diabetic group in the study went, I think the goal of people in the study was just controlling diabetes, any weight loss would be a side benefit rather then the primary goal.
I’m firmly in the camp that people should not try to lose weight as the goal, getting healthy is the goal - Fixing a poor diet is necessary even with surgery, so why not try fixing the diet first?
I note in the above surgery paper, the hypertensive cases went from 29 -> 23… That tells me even if these people are less obese, they are still metabolically unhealthy and still should improve their diet.
Bariatric surgery comes with a ton of problems as well including the possibility of malnutrition. Definitely not something to take lightly nor am I championing it.
Health is definitely a better goal than weight. Smokers are typically lower weight than non smokers, but I wouldn’t recommend that, either. Decoupling health from weight is a challenge when it comes to healthcare (in terms of doctors and insurance).
Again, thanks for the interesting article; I had previously heard about the negative cardiovascular effects of keto, but it might be time to update some of those conceptions.
Happy to talk about keto to any degree you like: If you remember the issues you heard I can point you at the current literature for the concern.
LDL is the one interesting metric on low carb that might be the issue your remembering, for overweight people it goes down, but for lean people some of them fall into the LMHR (lean mass hyper responder) type and their LDL goes 3-4x above the current guidelines. The current literature heavily indicates that LDL is not a concern by itself, only damaged (oxidized and glycated) LDL is a indicator of a problem. for the LMHR group their elevated LDL is the type-A totally healthy LDL.
Thank you so much for the link! Those are amazing results for diabetics in terms of most cardiovascular health markers. I’m going to address the weight loss part of it and why I don’t consider it an example of successful weight loss.
Full text of the study linked in the article at https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(24)00808-8/fulltext
First up: all participants had type 2 diabetes. I’m going to brush that away because my main point is even if this holds for the general population, it’s not a method that works for a majority of people even in the study for 10% loss and 10% isn’t that much over 5 years.
The original study started with 262 participants, all of whom that type 2 diabetes. This was down to 122 at the end of the five years. Drop outs in studies are normal, and having done keto myself, it’s really hard. Let’s ignore the drop outs since we don’t have data on if they stopped doing keto or just stopped being in the study. Just wanted to mention that we’re down by half already.
Of the remaining participants, at the end of 5 years of keto, only ~40% lost and kept off 10% of their body weight. They used a baseline of 128.7kg (~280 lbs). Using that as a starting point for this example, the best case scenario for weight loss is 116kg (256 lbs) if you’re in the lucky~40% of people that can stick to the diet for 5 years and are in the group it works for. Even if you’re 7 feet tall, 116kg is still considered overweight. You’ve maybe changed your BMI category (BMI sucks btw). You are still fat.
I wouldn’t consider having less than a coin toss’s chance at 10% loss after 5 years a method that consistently turns fat people into not fat people.
(Note I’m not trying to move the goalposts here and quibble about what percentage is significant, etc., it’s just nowhere close to bariatric surgery.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7761683/
That’s closer to 25% loss, most of which happens in the first 6 months. That’s more than double the percentage loss of keto and more than doubles the success rate of the greatest loss category.)
Thank you for actually reading the paper, it’s gratifying to be able to discuss it in detail.
Surgery is a option, I just wanted to give you a example of 5 years of consistent weight loss that didn’t involve surgery.
As far as the diabetic group in the study went, I think the goal of people in the study was just controlling diabetes, any weight loss would be a side benefit rather then the primary goal.
I’m firmly in the camp that people should not try to lose weight as the goal, getting healthy is the goal - Fixing a poor diet is necessary even with surgery, so why not try fixing the diet first?
I note in the above surgery paper, the hypertensive cases went from 29 -> 23… That tells me even if these people are less obese, they are still metabolically unhealthy and still should improve their diet.
Bariatric surgery comes with a ton of problems as well including the possibility of malnutrition. Definitely not something to take lightly nor am I championing it.
Health is definitely a better goal than weight. Smokers are typically lower weight than non smokers, but I wouldn’t recommend that, either. Decoupling health from weight is a challenge when it comes to healthcare (in terms of doctors and insurance).
Again, thanks for the interesting article; I had previously heard about the negative cardiovascular effects of keto, but it might be time to update some of those conceptions.
Happy to talk about keto to any degree you like: If you remember the issues you heard I can point you at the current literature for the concern.
LDL is the one interesting metric on low carb that might be the issue your remembering, for overweight people it goes down, but for lean people some of them fall into the LMHR (lean mass hyper responder) type and their LDL goes 3-4x above the current guidelines. The current literature heavily indicates that LDL is not a concern by itself, only damaged (oxidized and glycated) LDL is a indicator of a problem. for the LMHR group their elevated LDL is the type-A totally healthy LDL.