LIVE and Let DIEt: Taking Stock of the Ketogenic Kalamity

LIVE and Let DIEt: Taking Stock of the Ketogenic Kalamity

David Katz 06/05/2019 4

There is always some popular diet du jour; that, it seems, is how we roll. Atkins; The Zone; South Beach; Sonoma…and so on. No matter how many times weight loss pixie dust has been sprinkled on us before, only to fail, it remains a seller’s market. And somehow, we seem forever inclined to tell ourselves: THIS popular diet is different; this is the ONE.

But of course, it isn’t. And lest you think “popularity” is any kind of proxy for rational, sensible, valid, or even sane- let me remind you about pet rocks, CB radios, Tamagotchis- to say nothing of our enduring fascination with bottled water.

Let’s just take in on the chin, folks: in the hands of marketeers, we are putty. Gullible, malleable nincompoops- and never more so than when promises of rapid weight loss are in the offing.

Still, there are times and places to draw a line we won’t cross- and our toes are up against such a line right now.

Would you accept this proposal: you can DIEt, but the planet DIEs?  Yes, you will get thin, at least (very) temporarily- but while contributing to the harm of everything around you. Gives “live and let die” a whole new meaning. But answer the question: will you make the devil’s bargain?

Apparently, the prevailing answer is yes.

The currently (although I suspect for not much longer) popular ketogenic diet is such a bargain. Never mind that there are innumerable other, equally effective ways to lose weight in the short term. Never mind that this diet is at odds with everything known about food and human health. Just consider that this diet, at scale, is ruinous to the planet.

But let’s start at the beginning.

At best, the ketogenic diet exemplifies the avaricious genius of marketing and gimmickry, and the seemingly infinite bounds of human gullibility- at least with regards to all things “weight loss.” As I’ve pointed out before, while the current round of marketing is new, the diet is anything but. The Atkins’ Diet, first introduced in the 1970s, was the ketogenic diet. Part One of Dr. Atkins’ New Diet Revolution (first published in 1992, but I have the 1999 version), “Why the Diet Works,” is entirely about a “ketogenic” diet.

In some ways, the Atkins’ Diet, misguided though it was, was more realistic than the current incarnation of “keto.” How so? The Atkins plan involved three phases (de rigueur, it seems, for most diet books that go viral). The first phase, responsible for most, and the most rapid, weight loss was explicitly ketogenic. But then Atkins acknowledged that few people if any would sustain such extreme restriction of all plant foods- vegetables, fruits, legumes, grains, nuts, and seeds, and anything made with or from them. So, his diet then migrated to a less restrictive “phase 2,” and an even less restrictive “phase 3” intended for long term maintenance.

There was, of course, a problem when extreme dietary restrictions were relaxed: people tended to start gaining back the weight. Atkins addressed the solution to this explicitly in his book. He recommended going back to the beginning, and starting again. 

I trust the idea of cycling on and off severe dietary restriction for the rest of your life sounds both onerous, and ludicrous- as indeed it was.  Dieting, really, ought to die- and be replaced by living, healthfully; but no, I am not holding my breath while waiting. Instead, it seems we just keep devolving. So, we now have the even more ludicrous ketogenic update: simply adhere to severe dietary restriction permanently. Never again eat fruit, many vegetables, bread, pasta, cereal, lentils, beans, seeds, nuts- or risk throwing yourself out of ketosis.

Yes, of course, severe dietary restriction in virtually any flavor produces rapid weight loss. Eat no carbs, or only carbs; no fat, or only fat; no grains or only grains; no meat or only meat. We have proofrepeated proof, and proof down to the details of our genes that restricting calories with any set of rules causes weight loss comparable to within margins of error, and generally unsustainable into the bargain.

Relative to eating whatever you want whenever you want (i.e., the “see food” diet: I see food, and I eat it…) any application of discipline will tend to produce weight loss. Despite all the hype and marketing claims, keto owns no magic in this space. It simply represents the set of “you can’t eat whatever you want whenever you want” rules currently in vogue. It limits choice, restricts calories, and leads to weight loss for however long you can adhere to it.

It’s a singularly bad set of rules. High intake of meat and low intake of fruits and vegetables are among the factors linked to premature death around the world. Routine intake of whole grains is robustly linked to reduced cardiovascular risk. Reliance on beans and other legumes as a primary source of protein is associated with reduced risk of all chronic disease and premature death; enhanced vitality, and noteworthy longevity. The keto diet generally emphasizes the foods most linked to chronic disease and premature death in modern countries, and excludes nearly all of the foods that promote lasting health. 

But yes, even so, it can and does produce short term weight loss, because all “diets” do that, and it can and does reverse type 2 diabetes in the short term, because starvation, rapid weight loss, and many life-threatening illnesses can all do that as well.

We are being played, and it’s nearly incredible how “playable” we are. As I write this, I am sitting on a plane- where I was just given a bag of salted almonds. My little bag of almonds barely had room on its front for the font in which it declared to me that it was “gluten free.”

Of course almonds are gluten free! They are also cholesterol free, because all plant foods are- and not too long ago, they might have declared that to me instead. But this tells us nothing of any use about nutrition, health, or almonds- and only serves to tell us: we are being played. My almonds, by the way, were also “radish free,” not to mention armadillo free- but I had to figure that out for myself.

The food industry helps to create, and then exploits, our fatuous dietary fixations. If we are fixated on gluten, they will tell us our almonds, or marshmallows for that matter, have none. But they may as well tell us that tuna fish is chocolate free; chocolate is cauliflower free; cauliflower is chicken free; chicken is blueberry free. If ever there was a tale signifying nothing, these “we will tell you whatever you most want to hear about food” marketing messages are it.

Yet none of this- the fact that the ketogenic diet is just a new name for a diet that couldn’t stick around the last two times it was this popular; the fact that it is at odds with everything known about lasting health; the fact that the marketing of it is simply exploitation of fashion, fad, and mass gullibility (stupidity?)- is my primary concern.

My primary concern is that the keto diet has already stuck around long enough to insult our intelligence while doing disastrous injury to the planet. This is the real calamity. We diet, while the planet dies.

We are getting the message, loudly, clearly, and repeatedly, that our diets have a major impact on climate, aquifers, rain forests, and biodiversity. With the escalating awareness of these critical concerns, and the ranks of blinkered deniers shrinking daily in tandem with the world’s glaciers and polar ice, we might actually be seeing meaningful, global dietary shifts in a direction friendly to the health of people and planet alike. But the popularity of a diet diametrically opposed to all that is scientific, sensible, salutary and urgent is poisoning the moment of pivotal change, and shrouding the narrow window of opportunity. 

Which brings me back to my original proposition. The ketogenic diet is nutritional nonsense, wrapped up in the customary ribbons and bows of marketing legerdemain. 

But even if all the unsubstantiated or overtly confabulated claims of dietary greatness were true, would you really want to diet while the earth dies? Do you really care more about how you look in a bathing suit at the seashore than whether there’s any life left in the seas? 

If you want to lose weight, or reverse your diabetes- you could do it just as effectively with dietary practices known to be good not just for losing weight in the short term, but also finding health in the long; you could do it with dietary practices easier on the land, air, water, forests, and glaciers that enliven our common home; you could do it with dietary practices that are kinder and gentler to our fellow creatures. 

If you choose instead to diet and let die- leave some time in your schedule for the temporarily-thinner-version-of-yourself to explain it to your children, and everybody else’s.

Dr. David L. Katz is a 2019 James Beard Foundation Award nominee in health journalism, and author most recently of The Truth about Food. All book proceeds go to support the True Health Initiative, a federally authorized 501c3 non-profit.

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  • Sophie Wright

    Isn't it strange that when you go back to a diet that made you fat in the first place you gain the weight back?

  • Jason Douglas

    I'll have to tell all my friends who have done Keto for nearly a decade that they too should give up using food for medicine and go back to being unhealthy.

  • Fiona Harper

    Maintaining any weight loss is hard

  • Adam Warren

    Keto is great, long term it’s great, you get used to it and lose those cravings.

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David Katz

Science Guru

David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the Founding Director (1998) of Yale University’s Yale-Griffin Prevention Research Center, and current President of the American College of Lifestyle Medicine. He has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both preventive medicine, and nutrition. He has made important contributions in the areas of lifestyle interventions for health promotion; nutrient profiling; behavior modification; holistic care; and evidence-based medicine. David earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates.

   

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