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Meta analysis of Keto diets. Frontiers in Nutrition, July, 2021

MargaretYakoda
MargaretYakoda Posts: 2,997 Member
Well, looks like the studies are stacking up, and it’s not great news for Keto fans.

Personally I was wary of Keto because the only friend I had who swore by it lost about 120 pounds, then promptly keeled over with a swiftly moving cancer. I wasn’t sure what to make of it.
Now, I’m thinking that year of keto may have been the trigger.
Of course we can never know in my friend’s specific case. And so I won’t discuss that part other than this comment that it made me personally a bit wary of keto.

Anyhow….
Full article in link. But I copied the conclusion section below.
Highlighting the important bits.

https://www.frontiersin.org/articles/10.3389/fnut.2021.702802/full

Conclusion
Ketogenic diets reduce seizure frequency in some individuals with drug-resistant epilepsy. These diets can also reduce body weight, although not more effectively than other dietary approaches over the long term or when matched for energy intake. Ketogenic diets can also lower blood glucose, although their efficacy typically wanes within the first few months.

Very-low-carbohydrate diets are associated with marked risks. LDL-C can rise, sometimes dramatically. Pregnant women on such diets are more likely to have a child with a neural tube defect, even when supplementing folic acid. And these diets may increase chronic disease risk: Foods and dietary components that typically increase on ketogenic diets (eg, red meat, processed meat, saturated fat) are linked to an increased risk of CKD, cardiovascular disease, cancer, diabetes, and Alzheimer's disease, whereas intake of protective foods (eg, vegetables, fruits, legumes, whole grains) typically decreases. Current evidence suggests that for most individuals, the risks of such diets outweigh the benefits.
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Replies

  • kshama2001
    kshama2001 Posts: 28,052 Member
    Interesting. Thanks for posting.

    I have seen earlier studies show that, over time, keto is no more effective for weight loss than other methods of creating a calorie deficit.
  • MargaretYakoda
    MargaretYakoda Posts: 2,997 Member
    kshama2001 wrote: »
    Interesting. Thanks for posting.

    I have seen earlier studies show that, over time, keto is no more effective for weight loss than other methods of creating a calorie deficit.

    Yup. This meta analysis mentioned that. Keto turns out not to be any better for weight loss than a standard diet that a registered dietitian would recommend. And has serious risks that the registered dietitian’s recommended diet doesn’t have.
  • MargaretYakoda
    MargaretYakoda Posts: 2,997 Member
    Physicians Committee for Responsible Medicine makes a statement.
    They’re pretty much in solid agreement. But with stronger words than the measured tone of this journal article.

    https://www.pcrm.org/news/news-releases/most-comprehensive-review-yet-keto-diets-finds-heart-risks-cancer-risk-dangers



  • MargaretYakoda
    MargaretYakoda Posts: 2,997 Member
    ninerbuff wrote: »
    kshama2001 wrote: »
    Interesting. Thanks for posting.

    I have seen earlier studies show that, over time, keto is no more effective for weight loss than other methods of creating a calorie deficit.

    Yup. This meta analysis mentioned that. Keto turns out not to be any better for weight loss than a standard diet that a registered dietitian would recommend. And has serious risks that the registered dietitian’s recommended diet doesn’t have.
    Many of the veteran posters on here have stated that against keto, only to be shunned. Thanks for the study.

    A.C.E. Certified Personal and Group Fitness Trainer
    IDEA Fitness member
    Kickboxing Certified Instructor
    Been in fitness for 30 years and have studied kinesiology and nutrition

    9285851.png



    This meta analysis is so damning of Keto that it makes me wonder if the MFP staff should be contacted with suggestions to not allow such advice on the platform, similarly to how they already don’t allow extreme low calorie/disordered eating topics.
  • lemurcat2
    lemurcat2 Posts: 7,885 Member
    Physicians Committee for Responsible Medicine makes a statement.
    They’re pretty much in solid agreement. But with stronger words than the measured tone of this journal article.

    https://www.pcrm.org/news/news-releases/most-comprehensive-review-yet-keto-diets-finds-heart-risks-cancer-risk-dangers



    In that they are dedicated to promoting PBDs, that's hardly surprising: https://en.wikipedia.org/wiki/Physicians_Committee_for_Responsible_Medicine
  • kshama2001
    kshama2001 Posts: 28,052 Member
    lemurcat2 wrote: »
    Physicians Committee for Responsible Medicine makes a statement.
    They’re pretty much in solid agreement. But with stronger words than the measured tone of this journal article.

    https://www.pcrm.org/news/news-releases/most-comprehensive-review-yet-keto-diets-finds-heart-risks-cancer-risk-dangers

    In that they are dedicated to promoting PBDs, that's hardly surprising: https://en.wikipedia.org/wiki/Physicians_Committee_for_Responsible_Medicine

    Oh! Physicians Committee for Responsible Medicine are the people that got me to reduce fat and saturated fat for my uterine fibroids because of the estrogen/fibroids connection. Fibroids are not mentioned here, only estrogen - I already knew about the relationship.

    https://www.pcrm.org/good-nutrition/nutrition-information/using-foods-against-menstrual-pain

    I did notice their plant-based bias and confirmed my plan elsewhere before proceeding. Being an omnivore, I didn't follow all of their suggestions, but did drastically reduce red meat (especially fatty) and full fat dairy products, and increased legumes and fruits, especially higher fiber ones like berries.

    Doing this also made it much easier for me to maintain a calorie deficit, and I've lost almost 30 pounds since Jan 2.

    My periods have been less ghastly, except for last month, which I attributed to having missed fat and eating a lot of cheese earlier in my cycle, and otherwise not adhering as well.
  • neanderthin
    neanderthin Posts: 10,264 Member
    edited August 2021
    ninerbuff wrote: »
    kshama2001 wrote: »
    Interesting. Thanks for posting.

    I have seen earlier studies show that, over time, keto is no more effective for weight loss than other methods of creating a calorie deficit.

    Yup. This meta analysis mentioned that. Keto turns out not to be any better for weight loss than a standard diet that a registered dietitian would recommend. And has serious risks that the registered dietitian’s recommended diet doesn’t have.
    Many of the veteran posters on here have stated that against keto, only to be shunned. Thanks for the study.

    A.C.E. Certified Personal and Group Fitness Trainer
    IDEA Fitness member
    Kickboxing Certified Instructor
    Been in fitness for 30 years and have studied kinesiology and nutrition

    9285851.png



    This meta analysis is so damning of Keto that it makes me wonder if the MFP staff should be contacted with suggestions to not allow such advice on the platform, similarly to how they already don’t allow extreme low calorie/disordered eating topics.

    And I though dietary cholesterol was just cholesterol, apparently not according to PCRM.
  • neanderthin
    neanderthin Posts: 10,264 Member
    Where are the actual ketogenic studies and the number of studies in this meta analysis referenced or even mentioned in this article?
  • lorib642
    lorib642 Posts: 1,942 Member
    Where are the actual ketogenic studies and the number of studies in this meta analysis referenced or even mentioned in this article?

    they are listed in the references of OPs first post.

    Keto seems to be working well for me, but I have metabolic issues and am medically supervised.

  • neanderthin
    neanderthin Posts: 10,264 Member
    lorib642 wrote: »
    Where are the actual ketogenic studies and the number of studies in this meta analysis referenced or even mentioned in this article?

    they are listed in the references of OPs first post.

    Keto seems to be working well for me, but I have metabolic issues and am medically supervised.

    I don't see anything in references as to the specific studies or how many they even looked at. The comments were interesting.
  • TwistedSassette
    TwistedSassette Posts: 8,825 Member
    lorib642 wrote: »
    Where are the actual ketogenic studies and the number of studies in this meta analysis referenced or even mentioned in this article?

    they are listed in the references of OPs first post.

    Keto seems to be working well for me, but I have metabolic issues and am medically supervised.

    I don't see anything in references as to the specific studies or how many they even looked at. The comments were interesting.

    I can see 123 references at the bottom of the article. Right above the comment section.
  • neanderthin
    neanderthin Posts: 10,264 Member
    I see those, that's not what I'm talking about. "A meta analysis is a quantitative statistical analysis of several separate but similar experiments or studies in order to test the pooled data for statistical significance". This article should supply those studies that they are analyzing, which they haven't. No biggy really considering who they are and their stance on anything low carb or animal.
  • MargaretYakoda
    MargaretYakoda Posts: 2,997 Member
    edited August 2021
    lorib642 wrote: »
    Where are the actual ketogenic studies and the number of studies in this meta analysis referenced or even mentioned in this article?

    they are listed in the references of OPs first post.

    Keto seems to be working well for me, but I have metabolic issues and am medically supervised.

    Wise. And I mean that for anyone who is needing to lose more than forty pounds, using any diet method.
  • 33gail33
    33gail33 Posts: 1,155 Member
    I see those, that's not what I'm talking about. "A meta analysis is a quantitative statistical analysis of several separate but similar experiments or studies in order to test the pooled data for statistical significance". This article should supply those studies that they are analyzing, which they haven't. No biggy really considering who they are and their stance on anything low carb or animal.

    Those are the studies they used in their analysis, that's why they referenced them.

    "considering who they are" - do you mean the journal printing it? Or the authors?

    So for example author listed at #6 - from the School of Public Health in Loma Linda California - are you suggesting that they have a pre-existing stance on "low carb or animal" that would invalidate their analysis?
  • MargaretYakoda
    MargaretYakoda Posts: 2,997 Member
    I see those, that's not what I'm talking about. "A meta analysis is a quantitative statistical analysis of several separate but similar experiments or studies in order to test the pooled data for statistical significance". This article should supply those studies that they are analyzing, which they haven't. No biggy really considering who they are and their stance on anything low carb or animal.
    33gail33 wrote: »
    I see those, that's not what I'm talking about. "A meta analysis is a quantitative statistical analysis of several separate but similar experiments or studies in order to test the pooled data for statistical significance". This article should supply those studies that they are analyzing, which they haven't. No biggy really considering who they are and their stance on anything low carb or animal.

    Those are the studies they used in their analysis, that's why they referenced them.

    "considering who they are" - do you mean the journal printing it? Or the authors?

    So for example author listed at #6 - from the School of Public Health in Loma Linda California - are you suggesting that they have a pre-existing stance on "low carb or animal" that would invalidate their analysis?

    I think that neanderthin is conflating the journal article in my original post with the public statement from a different organization that I shared in a comment.

  • kshama2001
    kshama2001 Posts: 28,052 Member
    edited August 2021
    I see those, that's not what I'm talking about. "A meta analysis is a quantitative statistical analysis of several separate but similar experiments or studies in order to test the pooled data for statistical significance". This article should supply those studies that they are analyzing, which they haven't. No biggy really considering who they are and their stance on anything low carb or animal.

    Are you looking at the link in the OP? As stated upthread, there are 123 studies at the end of the article, above the comments.

    https://www.frontiersin.org/articles/10.3389/fnut.2021.702802/full

    i3xzs95ikd3n.png

    No other links in this thread were to a meta analysis - the other articles had no need to cite studies.

    This was a press release that links to the study:

    https://www.pcrm.org/news/news-releases/most-comprehensive-review-yet-keto-diets-finds-heart-risks-cancer-risk-dangers
  • MargaretYakoda
    MargaretYakoda Posts: 2,997 Member
    edited August 2021
    kshama2001 wrote: »
    I see those, that's not what I'm talking about. "A meta analysis is a quantitative statistical analysis of several separate but similar experiments or studies in order to test the pooled data for statistical significance". This article should supply those studies that they are analyzing, which they haven't. No biggy really considering who they are and their stance on anything low carb or animal.

    Are you looking at the link in the OP? As stated upthread, there are 123 studies at the end of the article, above the comments.

    https://www.frontiersin.org/articles/10.3389/fnut.2021.702802/full

    i3xzs95ikd3n.png

    For what it’s worth I wondered how reliable the journal Frontiers In Nutrition was as a scientific journal. So I dug a bit and it appears that, although it’s a relatively new scientific publishing house, they’re peer reviewed and well respected in the scientific community. Which is kind of key here.
  • lynn_glenmont
    lynn_glenmont Posts: 10,097 Member
    edited August 2021
    kshama2001 wrote: »
    I see those, that's not what I'm talking about. "A meta analysis is a quantitative statistical analysis of several separate but similar experiments or studies in order to test the pooled data for statistical significance". This article should supply those studies that they are analyzing, which they haven't. No biggy really considering who they are and their stance on anything low carb or animal.

    Are you looking at the link in the OP? As stated upthread, there are 123 studies at the end of the article, above the comments.

    https://www.frontiersin.org/articles/10.3389/fnut.2021.702802/full

    i3xzs95ikd3n.png

    No other links in this thread were to a meta analysis - the other articles had no need to cite studies.

    This was a press release that links to the study:

    https://www.pcrm.org/news/news-releases/most-comprehensive-review-yet-keto-diets-finds-heart-risks-cancer-risk-dangers

    Those are what in other contexts are referred to footnotes. They are meant as the source or evidence for various statements in the article. The ones toward the beginning of the article cover things like how a keto diet should be defined. Some are to the studies they cite to support their argument, but others are not.

    As for the statement that no other links in this thread were to a meta analysis:

    In a 2020 meta-analysis of 38 studies lasting 6–12 months and including 6,499 participants, low-carbohydrate diets, defined here as <40% of energy from carbohydrate, led to a small weight loss, compared with low-fat diets, defined as <30% of energy from fat (mean difference −1.30 kg; 95% CI, −2.02 to −0.57), with considerable variability between individuals and between studies. More than half of included studies met criteria for a general ketogenic diet, as defined in Table 1, for part or all of the low-carbohydrate intervention (24).

    A 2013 meta-analysis of randomized controlled trials testing very-low-carbohydrate ketogenic diets (≤50 g carbohydrate/day or ≤10% kcal from carbohydrates) against diets based on modest reductions in fat intake (<30% kcal from fat) for at least 1 year found that ketogenic diets led to marginally more weight loss than reduced-fat diets (weighted mean difference: −0.91 kg; 95% CI, −1.65 kg to −0.17 kg, p = 0.02). However, no statistically significant difference in amount of weight lost was seen between the 2 diets in trials following people for at least 2 years (3).


    A 2017 meta-analysis of 9 trials echoed these findings. In studies <12 months long, low-carbohydrate diets (<130 g carbohydrate/day or <26% kcal from carbohydrates) were seen to lead to greater weight loss in people with type 2 diabetes relative to normal- or high-carbohydrate control diets (weighted mean difference: −1.18 kg; 95% CI, −2.32 kg to −0.04 kg; p = 0.04). No advantage was seen relative to control diets in studies of longer duration (weighted mean difference: −0.24 kg; 95% CI, −2.18 kg to 1.7 kg; p = 0.81) (32).


    A recent meta-analysis showed that reductions in hemoglobin A1c achieved with carbohydrate-restricted diets typically wane after a few months and that such diets are not more effective than other diets (47).

    A recent meta-analysis of 5 studies showed that, in individuals with type 2 diabetes, ketogenic diets led to, on average, no substantial change in LDL-C (96).


    Treatment-induced HDL-C elevations were examined in a meta-analysis of 108 studies including 299,310 participants, which found no associated reduction in the risk of coronary heart disease events, coronary disease mortality, or total mortality (102).

    There are many more such references, but I don't see any point to making this longer than it already is.



    Edited to fix the coding for the quotes.
  • lynn_glenmont
    lynn_glenmont Posts: 10,097 Member
    Strictly speaking, I'm not sure the base article referenced in the OP qualifies as a meta-analysis. It seems more like a literature survey.
  • neanderthin
    neanderthin Posts: 10,264 Member
    edited August 2021
    33gail33 wrote: »
    I see those, that's not what I'm talking about. "A meta analysis is a quantitative statistical analysis of several separate but similar experiments or studies in order to test the pooled data for statistical significance". This article should supply those studies that they are analyzing, which they haven't. No biggy really considering who they are and their stance on anything low carb or animal.

    Those are the studies they used in their analysis, that's why they referenced them.

    "considering who they are" - do you mean the journal printing it? Or the authors?

    So for example author listed at #6 - from the School of Public Health in Loma Linda California - are you suggesting that they have a pre-existing stance on "low carb or animal" that would invalidate their analysis?

    Yes, they put their argument (agenda) to paper, then used the references to support their argument. That is not a meta analysis that is just opinion. This article was written by pcrm which is a vegan and animal rights activist organization. The AMA doesn't recognize them and calls them a fringe group. Their agenda is well known and it's always good to do research other than just look at headlines and click bait. imo

  • MargaretYakoda
    MargaretYakoda Posts: 2,997 Member
    33gail33 wrote: »
    I see those, that's not what I'm talking about. "A meta analysis is a quantitative statistical analysis of several separate but similar experiments or studies in order to test the pooled data for statistical significance". This article should supply those studies that they are analyzing, which they haven't. No biggy really considering who they are and their stance on anything low carb or animal.

    Those are the studies they used in their analysis, that's why they referenced them.

    "considering who they are" - do you mean the journal printing it? Or the authors?

    So for example author listed at #6 - from the School of Public Health in Loma Linda California - are you suggesting that they have a pre-existing stance on "low carb or animal" that would invalidate their analysis?

    Yes, they put their argument to paper, then used the references to support their argument. That is not a meta analysis that is just opinion. This article was written by pcrm which is a vegan and animal rights activist organization. The AMA doesn't recognize them and calls them a fringe group. Their agenda is well known and it's always good to do research other than just look at headlines and click bait. imo

    The original post was not the pcrm opinion piece.
  • MargaretYakoda
    MargaretYakoda Posts: 2,997 Member
    33gail33 wrote: »
    I see those, that's not what I'm talking about. "A meta analysis is a quantitative statistical analysis of several separate but similar experiments or studies in order to test the pooled data for statistical significance". This article should supply those studies that they are analyzing, which they haven't. No biggy really considering who they are and their stance on anything low carb or animal.

    Those are the studies they used in their analysis, that's why they referenced them.

    "considering who they are" - do you mean the journal printing it? Or the authors?

    So for example author listed at #6 - from the School of Public Health in Loma Linda California - are you suggesting that they have a pre-existing stance on "low carb or animal" that would invalidate their analysis?

    Yes, they put their argument to paper, then used the references to support their argument. That is not a meta analysis that is just opinion. This article was written by pcrm which is a vegan and animal rights activist organization. The AMA doesn't recognize them and calls them a fringe group. Their agenda is well known and it's always good to do research other than just look at headlines and click bait. imo

    The original post was not the pcrm opinion piece.

    There are 7 authors at the top of the article. Beside their names are numbers that identify their affiliations. 5 of the 7 have ties with pcrm with Barnard being it's founder and Shivam Joshi is an MD of plant based medicine. Who did you think wrote this?

    Who do you think did the peer review on the paper in the OP?
    Surely it wasn’t the authors. Or all members of some nefarious vegan PHD cabal?
  • neanderthin
    neanderthin Posts: 10,264 Member
    33gail33 wrote: »
    I see those, that's not what I'm talking about. "A meta analysis is a quantitative statistical analysis of several separate but similar experiments or studies in order to test the pooled data for statistical significance". This article should supply those studies that they are analyzing, which they haven't. No biggy really considering who they are and their stance on anything low carb or animal.

    Those are the studies they used in their analysis, that's why they referenced them.

    "considering who they are" - do you mean the journal printing it? Or the authors?

    So for example author listed at #6 - from the School of Public Health in Loma Linda California - are you suggesting that they have a pre-existing stance on "low carb or animal" that would invalidate their analysis?

    Yes, they put their argument to paper, then used the references to support their argument. That is not a meta analysis that is just opinion. This article was written by pcrm which is a vegan and animal rights activist organization. The AMA doesn't recognize them and calls them a fringe group. Their agenda is well known and it's always good to do research other than just look at headlines and click bait. imo

    The original post was not the pcrm opinion piece.

    There are 7 authors at the top of the article. Beside their names are numbers that identify their affiliations. 5 of the 7 have ties with pcrm with Barnard being it's founder and Shivam Joshi is an MD of plant based medicine. Who did you think wrote this?

    Who do you think did the peer review on the paper in the OP?
    Surely it wasn’t the authors. Or all members of some nefarious vegan PHD cabal?

    This is near the bottom if your interested.

    Author Contributions
    LC and NDB contributed to the organization of the manuscript, reviewed, and approved the submitted version. LC composed the outline and drafted the manuscript. LC, BD, SJ, MJ, JP, MN, and NDB wrote sections of the manuscript. All authors had full access to data and revised and approved the manuscript for publication.

    Funding
    This work was funded by the Physicians Committee for Responsible Medicine.

    Conflict of Interest
    LC is an employee of the Physicians Committee for Responsible Medicine in Washington, DC, a non-profit organization providing educational, research, and medical services related to nutrition. LC also declares that a trust for her benefit previously held stock in 3M, Abbot Labs, AbbVie, Johnson and Johnson, Mondelez, Nestle, and Walgreens; she is the author of a food and nutrition blog, Veggie Quest; and she is former publications editor and current chair for the Women's Health Dietetic Practice Group within the Academy of Nutrition and Dietetics. MJ and JP received compensation from the Physicians Committee for Responsible Medicine while working on this manuscript. MN is an employee of the Physicians Committee for Responsible Medicine. NDB is an Adjunct Professor of Medicine at the George Washington University School of Medicine. He serves without compensation as president of the Physicians Committee for Responsible Medicine and Barnard Medical Center in Washington, DC, non-profit organizations providing educational, research, and medical services related to nutrition. He writes books and articles and gives lectures related to nutrition and health and has received royalties and honoraria from these sources.

  • 33gail33
    33gail33 Posts: 1,155 Member
    33gail33 wrote: »
    I see those, that's not what I'm talking about. "A meta analysis is a quantitative statistical analysis of several separate but similar experiments or studies in order to test the pooled data for statistical significance". This article should supply those studies that they are analyzing, which they haven't. No biggy really considering who they are and their stance on anything low carb or animal.

    Those are the studies they used in their analysis, that's why they referenced them.

    "considering who they are" - do you mean the journal printing it? Or the authors?

    So for example author listed at #6 - from the School of Public Health in Loma Linda California - are you suggesting that they have a pre-existing stance on "low carb or animal" that would invalidate their analysis?

    Yes, they put their argument (agenda) to paper, then used the references to support their argument. That is not a meta analysis that is just opinion. This article was written by pcrm which is a vegan and animal rights activist organization. The AMA doesn't recognize them and calls them a fringe group. Their agenda is well known and it's always good to do research other than just look at headlines and click bait. imo

    When I looked at it I saw that the first author was affiliated with PCRM, the others appeared to be affiliated with what seems to be various reputable medical schools and public health departments etc - I didn't realize that they also had affiliations to PCRM. Some deep digging you did there! Thanks.
  • neanderthin
    neanderthin Posts: 10,264 Member
    33gail33 wrote: »
    33gail33 wrote: »
    I see those, that's not what I'm talking about. "A meta analysis is a quantitative statistical analysis of several separate but similar experiments or studies in order to test the pooled data for statistical significance". This article should supply those studies that they are analyzing, which they haven't. No biggy really considering who they are and their stance on anything low carb or animal.

    Those are the studies they used in their analysis, that's why they referenced them.

    "considering who they are" - do you mean the journal printing it? Or the authors?

    So for example author listed at #6 - from the School of Public Health in Loma Linda California - are you suggesting that they have a pre-existing stance on "low carb or animal" that would invalidate their analysis?

    Yes, they put their argument (agenda) to paper, then used the references to support their argument. That is not a meta analysis that is just opinion. This article was written by pcrm which is a vegan and animal rights activist organization. The AMA doesn't recognize them and calls them a fringe group. Their agenda is well known and it's always good to do research other than just look at headlines and click bait. imo

    When I looked at it I saw that the first author was affiliated with PCRM, the others appeared to be affiliated with what seems to be various reputable medical schools and public health departments etc - I didn't realize that they also had affiliations to PCRM. Some deep digging you did there! Thanks.

    Thanks but it actually wasn't deep digging it was in plain view all along. Regardless of that fact if someone was to read the text it would or should immediately become suspicious based on their logic. Nutrition and the science behind it is a mind field and understanding the science makes it easier to navigate. The big problem is trying not to become biased and take a stance because you will be reading science that will contradict most if not all of those beliefs.