Keto Vs Fiber

January 22, 2019 in Health, Mediterranean, Nutrition, Uncategorized by Joyce Bunderson

Last week I wrote about what is considered the best diet in 2019 – the Mediterranean Eating Style; which of course, is full of whole grains, fruits and vegetables, legumes, nuts and seeds, resulting in lots of dietary fiber. This week I want to write about the low carbohydrate (low carb) eating style (it comes by many names (Keto; Atkins, Paleo, Last Chance Diet, Optifast, Stillman and so on) and how that relates to newly released research.

If you’re interested in reading the super interesting story of how the fad keto diet hit the tipping point and became an ordinary phenomenon read Michael Easter’s January 10, 2019 article called: Inside the Rise of Keto: How an Extreme Diet Went Mainstream. Fascinating!!!

It is indeed fascinating to see how a combination of popular presentation from influencers with large audiences, mixed in with deceptive science reporting and appeal to the human desire for quick fixes, can so quickly promote something harmful to large audiences.  Only one so far, the promoter of the Last Chance Diet, has been held accountable in part, but not in proportion to the documented deaths. It is also sobering to see the estimate of $5 Billion as the worth of the industry with so many components promoting it.

Let me clarify one issue quickly, here toward the beginning. The low carb/keto diets can support rapid weight loss; there is no question about that. But being well-nourished is a major goal of my nutrition advice and there are short falls with the low and very-low carb eating styles. The low carb eating styles are, in my mind, not an optimal eating strategy for the general public. When I managed clinical nutrition at Children’s Hospital Los Angeles, we had children with uncontrolled seizure disorder who were closely supervised by Registered Dietitians who were specifically trained in the ketogenic diet, neurology specific nursing and neurologists – medical doctors. There was, of course, a very serious reason to consider a ketogenic diet for these children. The concern for the general public is the emphasis on foods with saturated fat and the lack of nutrients. We’re just beginning to have some research that has justified people like me, who have been apprehensive about the low carb eating plans in spite of the obvious benefits (reduced hunger, increased focus and rapid weight loss) of the ketogenic diet. Some of the new research is helping me answer the big question: Can you stay on a low carb/keto diet for years and be healthy in the long run?

The first study that caught my eye recently was pooled research presented at the European Society of Cardiology’s 2018 Congress in August. It concluded that low carbohydrate diets are unsafe and should not be recommended. The lead author Maciej Banach, of the Medical University of Lodz Poland, said: “We found that people who consumed a low carbohydrate diet were at greater risk of premature death. Risks were also increased for individual causes of death including coronary heart disease, stroke, and cancer. These diets should be avoided.” Those in the study who had the lowest carbohydrate intake had a 32 percent higher risk of all-cause mortality over an average of 6.4 years follow-up, while the risk of mortality due to cardiovascular disease, cerebrovascular disease, and cancer increased by 50 percent, 51 percent, and 35 percent, respectively. Let’s face it; those are not small numbers.

Although the research was based in the UK, Poland, Sweden, and Greece, 24,825 participants were Americans. In addition to the primary study, the researchers also performed a meta-analysis of seven prospective cohort studies (totaling 447,506 participants); which validated their own findings.

Now let me share one of my big concerns – the relatively low amount of fiber in the low carb/keto diets. Interestingly, a brand-new meta-analysis of 40 years’ worth of research, commissioned by the World Health Organization (WHO) has just been published in The Lancet. The lead researcher and colleagues examined the data which included 185 observational studies (the number of person years added up to 135 million; and also included were 58 clinical trials (the clinical trials involved over 4,600 people).

What they found was that the people who consumed the most fiber in their diet were 15 to 30 percent less likely to die prematurely from any cause or a cardiovascular condition, compared with those who eat the least fiber. Fiber-rich foods include whole grains, fruit, vegetables, peas, beans, lentils, chickpeas, nuts, and seeds; of course, many of these foods are not included on the low-carb/keto diets.

Here’s the wake-up call: the analysis revealed that the amount of fiber that people should consume daily to reap the benefits is 25 to 29 grams. Unfortunately, adults in the US, on average, consume 15 grams. Although the researchers say 25 to 29 grams can do the job, they also said that people should not be limited by the 29 grams of fiber and more may be beneficial. For every additional 8 grams of dietary fiber a person consumes, the risk of non-communicable disease (heart disease, stroke, type 2 diabetes, and/or colon cancer drop by another 5 to 27 percent.) Note: If a person has an iron or other mineral deficiency, they should probably talk to a registered dietitian prior to a big increase in fiber in their diet.

The researchers say that their findings “provide convincing evidence for nutrition guidelines to focus on increasing dietary fiber and on replacing refined grains with whole grains. This reduces incidence risk and mortality from a broad range of important diseases.” (Jim Mann, University of Otago, in New Zealand) Because of the design of the study, the researchers cannot really say if the entire effect is from the fiber or the nutrients that come with foods that provide the fiber. Just think of all the thousands of phytonutrients that come with the same foods that contain fiber. In addition to the direct benefits of fiber in the diet, there is also the fact that fiber is what your microbiome (talking the gut bacteria, here) munches on. Maybe it’s complex; it may include the nutrients from the fibrous foods, the nutrients produced by the microbiome and the benefits of the structure of the fiber itself. That’s what I expect. So, don’t run out and buy a bottle of Metamucil for fiber, but continue eating the same diet of high animal products and processed food, and call it good.

Andrew Reynolds, the lead author of the fiber study, said; “The health benefits of fiber are supported by over 100 years of research into its chemistry, physical properties, physiology and effects on metabolism.” This is not a new idea – that fiber benefits human life; it’s just quantifying the facts.

There are many charts of fiber in foods – here’s one to get you started. You can get an idea of about how much fiber you’re eating on average.

Moving off the very low carb or keto diet, would be a great first step toward decreased health risks; and a wonderful second step might be to get on a Mediterranean-style menu that will help you get the fiber and nutrients that you need to keep your risk low.