Ketogenic Diets: Fat-Filled Lies Won’t Make You Slim (or a Better Athlete)

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How do you turn your body into a fat burning machine, run faster than Usain Bolt, recover from exercise immediately and wake up each day bursting with energy? According to some people, the ketogenic diet is your answer (learn the basics of this diet here). This high-fat, moderate protein diet that is practically void of carbohydrates forces your body to use fat for energy. LeBron James supposedly tried it and offensive lineman decided to give it a shot after an ex-NFL center and O-line coach LeCharles Bentley recommended it. However, the offensive lineman and LeBron weren’t actually following a ketogenic diet. Though these athletes didn’t really know what they were following (no worries LeCharles, I’m sure your nutrition advice is on par with me coaching the O-line), people who actually follow it swear by it. Could this be an unconventional path to weight loss and better health? Unfortunately, the ketogenic diet craze has been fattened with misinformation.

Here is what I am covering in this post:

  • Eat Fat, Lose Fat? Does the ketogenic diet make you lose weight?
  • How does this diet impact muscle?
  • The ketogenic diet and athletic performance.
  • The issue with ketogenic research studies.

I am not covering “training low” or low carbohydrate  / non-ketogenic diets in this article.

Eat Fat, Lose Fat?

During the first several days on a ketogenic diet your weight will take a nosedive. Carbohydrate is stored in the form of glycogen in liver and muscle. Each gram of carbohydrate is stored with 3 – 4 grams of water. Decrease your carbohydrate intake, use glycogen and you’ll lose water weight very quickly. Weight loss, even if from water, can motivate people driven by the number on the scale. Given that adherence is the number one predictor of weight loss when on a diet, we can’t discount psychological effect of the number on the scale going down.

What happens if you stay on the diet? A group of NIH researchers admitted seventeen overweight or obese men to a metabolic ward and placed them on a high carbohydrate baseline diet for four weeks followed by four weeks on an isocaloric ketogenic diet (this diet contained the same amount of calories as the high carbohydrate baseline diet). The men lost weight and body fat on both diets. The ketogenic diet did not lead to greater fat loss as compared to the high carbohydrate diet and in fact body fat loss slowed during the ketogenic diet and subjects lost muscle (1). Time to chuck the “carbohydrates make you fat” books in the recycling bin.

What about other studies showing ketogenic diets help athletes lose body fat and maintain performance? These studies were not actually using a ketogenic diet protocol but instead were high fat, high protein, low carbohydrate diets. Also, none of the studies measured if the study subjects were actually in nutritional ketosis (2, 3, 4).  See the section on The Issue with Ketogenic Research Studies for more information on this topic.

Ketogenic diet and weight

Regardless of the studies indicating the ketogenic diet will not lead to greater weight loss and could result in a decrease in muscle mass, I know I would lose weight on it only because I’d get sick of eating. If faced with eating a fatty steak with melted butter on top for dinner followed by spoonfuls of oil for dessert, I’d rather not eat.

Muscle Up with the Ketogenic Diet?

The ketogenic diet isn’t high enough in protein for maximal muscle gains. Using the lower end of fat intake on a classic ketogenic diet (80% of calories), one could consume 15% of calories from protein (112 grams) on a 3,000-calorie diet. Protein requirements are at least 1.2 – 1.8 grams of protein per kilogram bodyweight (or 0.55 – 0.82 grams per lb. bodyweight) per day if training and eating a diet with enough calories to maintain weight. Protein needs go up if you are cutting calories to spare the breakdown of muscle tissue when dieting. On this diet, 112 grams of protein equals just under 1.3 grams of protein per kg bodyweight for a 200 lb. person and even less for anyone who weighs more.

In addition to inadequate protein intake, “the ketogenic diet reduces many of the signaling molecules involved in muscle hypertrophy (growth),” states Dr. Antonio Paoli, M.D., B.Sc., Associate Professor and Vice Dean of the School of Human Movement Sciences, University of Padova. Without getting too technical, even with sufficient calorie intake, the ketogenic diet suppresses the IGF-1 / AKT / mTOR pathway (5). Using ketones for energy slows muscle breakdown. However it doesn’t stop this process (5).

The Ketogenic Diet and Athletic Performance

Once fully adapted to a ketogenic diet, athletes can supposedly rely on a seemingly endless supply of body fat for energy. No need for carbohydrate gels, beans, gummies and sports drinks every 15-30 minutes during long runs, rides or triathlons to sustain energy levels. Fewer calories consumed may make it easier for some people to stay within their total daily calorie needs (though if you are training that much staying within your calorie requirements shouldn’t be difficult).

Trading carbs for fat seems like a huge benefit for athletes, particularly endurance athletes who train and compete for several hours at a time (6). In addition to utilizing body fat, fat actually produces more energy (ATP) (5). However, fat is a slow source of fuel (see graphic below), the human body cannot access it quickly enough to sustain high-intensity exercise and therefore, this diet is really only (potentially) applicable to ultra-runners and triathletes competing at a relatively moderate to slow pace.

In a ketogenic diet study examining athletic endurance, researchers had subjects cycle at a snails pace (equivalent to a heart rate of about 120 beats per minute for anyone 20-30 years old or 115 for a 40 year old) until they became exhausted before and after 4-weeks on a ketogenic diet. There were no differences in the amount of time they were able to cycle before getting tired prior to or after the four-week ketogenic diet (7). In studies examining high fat diets (not ketogenic and ketones weren’t measured) and endurance performance, study subjects relied on more fat as opposed to carbohydrate during low intensity exercise, yet there was no clear performance advantage on the higher fat diet (8). A recently published study examined 20 elite ultra-marathoners and Ironman distance triathletes. Some were habitually consuming a traditional high carbohydrate diet while the other group was following a ketogenic diet (slightly adjusted macronutrient ratios yet they were in ketosis as measured by blood ketone levels). As expected, those following a higher fat diet used a greater percentage of fat for energy while the higher carbohydrate diet group used more carbohydrate for energy during a 180 minute submaximal running test (I’d call that leisure running intensity). There was no difference in calories burned over the course of the run. Both groups had the same level of perceived exertion and there was no test to determine performance differences between groups (9).

If there’s no performance benefit and we know carbohydrates work, why follow this diet? If your primary goal is weight loss, it doesn’t matter if you use more fat than carbohydrate while exercising (SN: can we please stop talking about the fat burning zone) as long as you’re burning more total calories over the course of the day. Plus, in the interest of (if you are not an ultra endurance athlete) jack up the intensity and burn as many calories in a short period of time as possible. Unfortunately, a ketogenic diet won’t help you do that – when relying on fat for fuel, the intensity of your exercise will drop – the body simply can’t access fat (a slow source of energy) quickly enough to sustain high-intensity exercise. Instead, carbohydrates are necessary for high intensity activity.
ketogenic diet and sports

The Issue with Ketogenic Research Studies

Here’s the issue with many ketogenic research studies and media reports based on them: in most cases, the study subjects were not actually following a ketogenic diet – they were following a higher fat, high-protein low carbohydrate diet (10, 11, 12). Each person’s carbohydrate and protein limits needed to stay in ketosis vary and therefore, measuring ketones through blood or urine is the only definitive way to determine if you are in ketosis. Complicating matters more, low carbohydrate diets (including ketogenic diets) lead to a substantial drop in carbohydrate content, and associated water stored with it, in muscle. This change overestimates the drop in lean body mass as measured by DEXA.

ketogenic and low carbohydrate diets

There are no modifications, higher protein intakes or “on again, off again” (where you go on it one day and off it the next) to this diet. You must be in a state of nutritional ketosis or you will need to decrease carbohydrate and protein intake even further to get into nutritional ketosis and rely on ketones for energy.

Is There Any Benefit?

Ketogenic diets help decrease incidence and severity of seizures in epileptic patients (this is what the diet is intended for). Also, ketogenic diets may be beneficial when implemented soon after a traumatic brain injury (including concussion) (13). In addition, scientists are examining if this diet is beneficial for diseases that affect the brain such as Alzheimer’s.

If you want to lose weight, the ketogenic diet is not superior to a reduced calorie diet. Also, unless you are an ultra endurance athlete who just loves dietary fat, hates eating at social occasions and can put up with the potential side effects from this diet it isn’t for you.
Now where is the O-line? I’ve got some coaching to do…

References

1 Hall KD, Chen KY, Guo J, Lam YY, Leibel RL, Mayer LE, Reitman ML, Rosenbaum M, Smith SR, Walsh BT, Ravussin E. Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. Am J Clin Nutr. 2016 Jul 6. [Epub ahead of print]

2 Zajac A, Poprzecki S, Maszczyk A, Czuba M, Michalczyk M, Zydek G. The effects of a ketogenic diet on exercise metabolism and physical performance in off-road cyclists. Nutrients 2014;6(7):2493-508.

3 Rhyu HS, Cho SY. The effect of weight loss by ketogenic diet on the body composition, performance-related physical fitness factors and cytokines of Taekwondo athletes. J Exerc Rehabil 2014;10(5):326-31.

4 Paoli A, Grimaldi K, D’Agostino D et al. Ketogenic diet does not affect strength performance in elite artistic gymnasts. JISSN 2012;9:34.

5 Paoli A, Bianco A, Grimaldi KA. The ketogenic diet and sport: a possible marriage? Ex Sports Sci Reviews 2015.

6 Volek J, Noakes T, Phinney SD. Rethinking fat as a fuel for endurance exercise. Eur J Sport Sci 2014;2:1-8.

7 Phinney SD, Bistrian BR, Evans WJ, Gervino E, Blackburn GL. The human metabolic response to chronic ketosis without caloric restriction: preservation of submaximal exercise capability with reduced carbohydrate oxidation. Metabolism 1983;32(8):769-76.

8 Burke LM, Kiens B. “Fat adaptation” for athletic performance: the nail in the coffin? J Appl Physiol 2006;100(1):7-8.

9 Volek J, Freidenreich DJ, Saenz C, Kunces LJ, Creighton BC, Bartley JM, Davitt pm, Munoz CX, Anderson JM, Maresh CM, Lee EC, Schuenke MD, Aerni G, Kraemer WJ, Phinney SD. Metabolic characteristics of keto-adapted ultra-endurance runners. Metab Clin Exp 2016;65(3):100-110.

10 Tinsley GM, Willoughby DS. Fat-Free mass changes during ketogenic diets and the potential role of resistance training. Int J Sport Nutr Exerc Metab. 2015 Aug 12. [Epub ahead of print]2 Rouillier MA, Riel D, Brazeau AS, St. Pierre DH, Karelis AD. Effect of an Acute High Carbohydrate Diet on Body Composition Using DXA in Young Men. Ann Nutr Metab 2015;66:233-236

11  Paoli A. The ketogenic diet and sport: a possible marriage? Ex Sci Sports Sciences Rev 2015;43(3):153-62.

12  Johnstone AM, Horgan GW, Murison SD, Bremner DM, Lobley GE. Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. Am Society Clin Nutr 2008;87(1):44-55.

13 Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel (2011). The National Academies Press, Institute of Medicine. Washington DC. 2011 http://www.nap.edu/read/13121/chapter/15

 

Yikes! Are there Antibiotics or Hormones in Your Milk & Dairy Foods?

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milk

Are antibiotics and hormones used in dairy cows contributing to the obesity epidemic, early puberty and antibiotic resistance? Before going down that road, we have to first we have to first ask if there are any antibiotics or hormones in milk and dairy products.

In this blog post I will cover:

  • Why are antibiotics given to cows?
  • Antibiotics are not in milk, here’s why.
  • Why are growth hormones given to cows? Are there any hormones in my milk and dairy food?
  • What are the cows Eating?

Why are Antibiotics given to Cows?

Antibiotics are used on farms to treat animals who are sick just like you would give an antibiotic to your child if he or she gets sick or take one yourself. There is no reason for dairy farmers to give antibiotics to cows who are not sick. Doing so costs additional money,  serves no clear purpose and arbitrarily giving animals antibiotics could contribute to antibiotic resistance. Now imagine you are a farmer and your life depends on the health of your cows – would you want to run the risk of antibiotic resistance and your cows getting sick with fewer treatment options?

Some antibiotics are also used for animal growth. The FDA is phasing out this practice so medically important antimicrobial drugs (antibiotics) will no longer be allowed to enhance growth or feed efficiency. In the future antibiotics will only be allowed to treat, control or prevent disease and of course require a prescription from a licensed veterinarian. Regardless of whether or not the antibiotic is used for growth or treatment of disease, no traces of antibiotic residues are allowed in milk or dairy products.

Antibiotics are Not in Milk, Here’s Why.

Any cow that gets an antibiotic is milked separately from the rest of the herd and the milk is thrown out. That milk will never be sold or consumed. All antibiotics have a different period of time before all traces of the medication leaves the body (whether we are talking about a cow or a human). Once this period is up and the cow is completely healthy again, the farmer tests her milk. Milk cannot be sold until it is completely clear of all drug residues. Whether organic or conventional, all milk is tested several times before making it to market. It is tested on the farm and at the milk processing plant. Any milk that tests positive for any medication residue, including antibiotics, is thrown out (1).

According to national Milk Drug Residue Data Base compiled for the years 2013 to 2014, 0% of milk tested positive for drug residues. In 2015, the FDA’s Center of Veterinary Medicine surveyed 1,918 raw milk samples (before pasteurization) from across the country. Samples were tested for residues of 31 drugs including the antibiotics, NSAIDs (ibuprofen etc.) and an antihistamine. They found 99% of sampled milk was free of any drug residues. Keep in mind the 1% of milk with residues must be thrown out – it cannot be sold (1, 2).

Cheese and yogurt are made from milk and therefore, there are no antibiotics in your cheese or yogurt either.

If you want to learn more about what farmers are doing about antibiotic resistance, Minnesota Farmer Wanda Patsche wrote an excellent blog on this topic.

Growth Hormones in Dairy Cows

Growth hormones are approved for use in dairy cows to improve milk production. Greater milk production means fewer environmental resources used to raise cows for milk. Bovine somatotropin (bST; also called bovine growth hormone or rBGH) is perhaps the most well recognized growth hormone used on dairy farms. bST is “a protein hormone produced in the pituitary gland of animals, including humans, and is essential for normal growth, development, and health maintenance.” Very little bST is used in dairy cows and there is no test that can distinguish between cows treated with bST and naturally occurring bST (3). Humans do not have receptors for bST and therefore it is passed through your body intact without being absorbed (4). As a result, there are no known side effects or health issues associated with consuming dairy from cows treated with bST. IGF-1 (insulin like growth factor 1) concentrations are slightly higher in cows treated with bST. However, the human body synthesizes IGF-I and drinking 1.5 L of milk is equivalent to an estimated 0.09% of the IGF-I produced by adults each day (5, 6, 7, 8).

USDA organic dairy products are “produced without antibiotics fed or administered to the animal at any point in its life” (9). There are no meaningful nutrition differences between organic and conventional dairy products. I covered that topic in this post.

What are the Cows Eating?

Cows’ diets also vary depending on many of the same factors that influence your food choices. However, unlike humans, all cows have the benefit of seeing a nutrition expert (like dietitians, animal nutrition experts are specialists). Many consumers also have questions about how cows are fed. Cows are fed nutritious diet to ensure health of cow and nutrition of milk. Typical feed mixtures may include haylage (grass with a higher water content), corn silage, sugar beet pulp and a protein mineral mix.

Rest assured, your dairy products are safe. In fact, the dairy product that says it is made with cows not treated with antibiotics is the exact same as the one from a cow that may have been treated with antibiotics. Both contain no antibiotic residues. Growth hormones used in dairy also pose no known threat to human health. The human body does not even recognize the main hormone used in cows. So, regardless of what milk, yogurt, or cheese you choose, all have been produced and extensively tested to ensure they are safe for human consumption.

This post was written as part of my ongoing sponsored partnership with U.S. Farmers & Ranchers Alliance. All opinions expressed are my own and per the usual, took me hours to research and double check my facts.References (if not cited via a hyperlink in the text of this post)

References

1 Questions and Answers: 2012 Milk Drug Residue Sampling Survey. FDA.

2 NATIONAL MILK DRUG RESIDUE DATA BASE FISCAL YEAR 2014 ANNUAL REPORT October 1, 2013 – September 30, 2014 http://www.fda.gov/downloads/food/guidanceregulation/guidancedocumentsregulatoryinformation/milk/ucm434757.pdf

3 Bovine Somatotropin (BST) http://www.fda.gov/AnimalVeterinary/SafetyHealth/ProductSafetyInformation/ucm055435.htm

4 Bovine Somatotropin. National Institutes of Health, Technology Assessment Conference Statement. December 5-7, 1990. https://consensus.nih.gov/1990/1990BovineSomatotropinta007html.htm

5 Joint FAO/WHO Expert Committee on Food Additives (JECFA). 1998. Toxicological evaluation of certain veterinary drug residues in food; Summary and conclusions. 50th report of the Joint FAO/WHO Expert Committee on Food Additives. World Health Organization, Geneva, Switzerland.

6 Collier RJ, Bauman DE. Update on human health concerns of recombinant bovine somatotropin use in dairy cows. J Animal Sci 2013; 92(4): 1800 – 1807. https://www.animalsciencepublications.org/publications/jas/articles/92/4/1800

7 Recombinant Bovine Growth Hormone. http://www.cancer.org/cancer/cancercauses/othercarcinogens/athome/recombinant-bovine-growth-hormone                  

8 Report on the Food and Drug Administration’s Review of the Safety of Recombinant Bovine Somatotropin. Food and Drug Administration. http://www.fda.gov/animalveterinary/safetyhealth/productsafetyinformation/ucm130321.htm

9 Stacy Sneeringer, James MacDonald, Nigel Key, William McBride, and Ken Mathews. Economics of Antibiotic Use in U.S. Livestock Production, ERR-200, U.S. Department of Agriculture, Economic Research Service, November 2015. http://www.ers.usda.gov/media/1950577/err200.pdf