Ludwig DS. The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed. J Nutr [Internet]. 2019 Dec 11 [cited 2019 Dec 12]; Available from: https://academic.oup.com/jn/advance-article/doi/10.1093/jn/nxz308/5673196This paper, by David Ludwig, MD, PhD (@davidludwigmd), gives a far more balanced view of our potential dietary destiny(ies) than others I have read (See:Slide Update: If you’re tied to dogma, what’s your interest in data?).
While it’s popular to dismiss something like a ketogenic diet (or anything that’s misunderstood) as a fad, this is not the mark of an intellectually curious or empathetic profession. I’ve witnessed and documented many examples of our profession’s decision to walk away from knowledge when it didn’t have the/an answer. Much devastation ensued (See: Slide Update: ADA’s website now includes Low-Carbohydrate Diets in Standards of Care, and looking back on the times the medical profession called people/ideas a “fad”)
The paper is worth reading to understand what is known and what is not known about the ketogenic (or very low carbohydrate) diet, from a physician researcher/leader in the field.
Carbohydrate restriction benefits multiple components of the metabolic syndrome, a major CVD risk factor. A low-carbohydrate diet improves hyperglycemia, triglycerides, HDL cholesterol, small dense LDL subclass phenotype, oxidized plasma lipids, and hepatic steatosis, whereas a low-fat diet can adversely affect some of these components.Ludwig DS. The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed. J Nutr [Internet]. 2019 Dec 11 [cited 2019 Dec 12]; Available from: https://academic.oup.com/jn/advance-article/doi/10.1093/jn/nxz308/5673196
Plant-Based or Plant-Free? No, Disease-Free.
As Ludwig points out, there’s a confusing narrative around the approach to restricting carbohydrates, and I’ve read and understand his work to be inclusive of individual choice in protein, fat, and carbohydrate sources.
Polarization might have also arisen from the misconception that ketogenic diets require high intakes of animal products—engendering concern among those who advocate plant-based diets for health, ethical, or environmental reasons. In fact, a ketogenic diet can be vegetarian (containing eggs and dairy products) or vegan, with plant-based fats (e.g., avocado, nuts, seeds, coconut, flax, olive oil), proteins (e.g., tofu, tempeh, seitan, lupini beans, pea protein), nonstarchy vegetables, and limited amounts of low-sugar fruits, as exemplified by the Eco-Atkins diet (50). This flexibility allows individualization of dietary choice on a ketogenic diet for obesity and diabetes.Ludwig DS. The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed. J Nutr [Internet]. 2019 Dec 11 [cited 2019 Dec 12]; Available from: https://academic.oup.com/jn/advance-article/doi/10.1093/jn/nxz308/5673196
In many ways, things can only get better, if you look where we’ve come and where we’re at:
My Why?
The photograph at the top of this post was taken a relatively short time ago in my education. I’m at a medical conference, in a kitchen, in a room full of people who have reversed their metabolic illnesses with food and less pharmaceuticals. Once you see this, you can’t unsee it. I wish this experience on every nurse and doctor in their lifetime.
Potential Conflicts
Author disclosures: DSL, has received royalties for books on obesity and nutrition that recommend a carbohydrate-modified, but not ketogenic, diet, and grants from the NIH and philanthropic organizations unaffiliated with the food industry for obesity-related research.Ludwig DS. The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed. J Nutr [Internet]. 2019 Dec 11 [cited 2019 Dec 12]; Available from: https://academic.oup.com/jn/advance-article/doi/10.1093/jn/nxz308/5673196
My Disclosures
See my disclosures page here. Short version, I have none, with no funding from food, pharma, device, or diagnostics, now or in the past. I am not an advocate or an activist for a particular diet for individuals, only that individuals be able to make the best choice for themselves in partnership with a qualified health professional.
Reference
Ludwig DS. The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed. J Nutr [Internet]. 2019 Dec 11 [cited 2019 Dec 12]; Available from: https://academic.oup.com/jn/advance-article/doi/10.1093/jn/nxz308/5673196
Thank you for making this article open access.