Thursday, October 8, 2020

Low Carbohydrate Diets and Health (An Independent Meta-Analysis of Intervention Trials)


I'm exhausted from this project, so I'll make this short. This meta-analysis is my attempt to bring some sanity and clarity to online and academic discussions/debates regarding ketogenic diets and health. There are many claims made without references, or claims made with references to cherry-picked studies. Fuck that bullshit. I've had enough of it.

This blog article may be educational for anyone looking to learn about how ketogenic diets relate to health. As well as whether or not those health outcomes are independent of duration or weight loss. There are many common effects of low carbohydrate or ketogenic diets that some people just take for granted, such as lower triglycerides or lower blood glucose. However, it is unclear whether or not these effects are independent of weight loss or duration of time spent on the diet.

It is also true that some people expect negative things to happen on a ketogenic diet, like elevated low density lipoprotein cholesterol or impaired thyroid function. It is likewise unclear whether or not these effects are independent of weight loss or time spent on the diet. Hopefully the data below will help settle, or at least inform, some of these potential misconceptions, debates and discussions.

I will also not be including any interpretations of any data, because I lack the expertise and knowledge to be able to do that credibly or accurately. 

Results will be stratified five ways: 
  1. Low carbohydrate ketogenic diets vs low carbohydrate non-ketogenic diets.
  2. Ketogenic diets stratified by duration, compared to control.
  3. Ketogenic diets stratified by duration, compared to baseline.
  4. Ketogenic diets stratified by weight loss, compared to control.
  5. Ketogenic diets stratified by weight loss, compared to baseline.
Inclusion Criteria:
  • Interventional trials involving low carbohydrate or ketogenic diets (definitions below).
  • In the case of trials involving low carbohydrate diets versus low carbohydrate diets or ketogenic diets versus ketogenic diets, change from baseline data will substitute for between group results.
  • Studies must report any relevant biomarkers, carbohydrate intake, duration, and weight changes.
Criteria for low carbohydrate diets:
  • Less than 50% of daily energy derived from carbohydrates.
  • A difference of at least 10% between the low carbohydrate diet and the comparator diet.
  • When a study contains multiple comparator diets, comparator diets are selected such that the contrast in carbohydrate intake is maximized.
Criteria for ketogenic diets:
  • Less than 75g of carbohydrates per day.
  • Less than 14% of daily energy derived from carbohydrates.
  • Comparator diets must be non-ketogenic.
Disclaimer:
This is not a peer-reviewed publication. This blog article is for educational and/or entertainment purposes only. This blog article is not an academic reference, nor does it stand in place of current or future peer reviewed, academic research into ketogenic diets and health. There are multiple methodological limitations that make credible interpretation challenging in many cases. Thank you for your time! Enjoy!

Table of Contents

Anthropometrics
Cardiovascular
Chemistry
Endocrine
Inflammation
Kidney Function
Lipids/Lipoproteins
Liver Function
Thyroid Function
PS. If you've enjoyed what you've read, you can access many more exclusive articles like this one by supporting me on Patreon! Every little bit helps! Thank you for reading!

Anthropometrics

Body Weight 

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)


Body Fat Mass

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Fat Free Mass

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Body Mass Index

Keto vs Non-Keto


Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Waist Hip Ratio

Keto vs Non-Keto

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Visceral Adipose Tissue

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Bone Mineral Density

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Cardiovascular

Systolic Blood Pressure

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Diastolic Blood Pressure

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Flow-Mediated Dilation

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Heart Rate

Keto vs Non-Keto

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Chemistry

Hemoglobin A1C

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Blood Glucose

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Uric Acid

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Fibrinogen

Keto vs Non-Keto


Homocysteine

Keto vs Non-Keto

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Methylglyoxal

Keto vs Non-Keto


Proprotein Convertase Subtilisin/Kexin Type 9

Keto vs Non-Keto


Peptide YY

Keto vs Non-Keto


White Blood Cell Count

Keto vs Non-Keto

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Endocrine

Insulin

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Leptin

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Adiponectin

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Cortisol

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Epinephrine

Keto vs Non-Keto


Ghrelin

Keto vs Non-Keto


Insulin-Like Growth Factor 1

Keto vs Non-Keto


Testosterone

Keto vs Non-Keto

Keto by Duration (vs Control)


Inflammation

C-Reactive Protein

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Tumor Necrosis Factor

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Intercellular Adhesion Molecule 1

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Vascular Cell Adhesion Molecule 1

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Monocyte Chemoattractant Protein-1

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Interleukin 1 Beta

Keto vs Non-Keto


Interleukin 1 Receptor Antagonist

Keto vs Non-Keto


Interleukin 6

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Interleukin 8

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Interleukin 10

Keto vs Non-Keto


Kidney Function

Creatinine

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Urea

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Estimated Glomerular Filtration Rate

Keto vs Non-Keto


Lipids/Lipoproteins

Low Density Lipoprotein Cholesterol

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


High Density Lipoprotein Cholesterol

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Triglycerides

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Apolipoprotein B

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Apolipoprotein A1

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Apolipoprotein C-III

Keto vs Non-Keto


Low Density Lipoprotein Particle Count

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Low Density Lipoprotein Particle Size

Keto vs Non-Keto

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Lipoprotein (a)

Keto vs Non-Keto

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Liver Function

Aspartate Aminotransferase

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Alanine Aminotransferase

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Alkaline Phosphatase

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Gamma-Glutamyl Transferase

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)


Bilirubin

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)


Thyroid Function

Triiodothyronine

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)



Thyroxine

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Free Triiodothyronine

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)


Free Thyroxine

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Reverse Triiodothyronine

Keto vs Non-Keto

Keto by Weight Loss (vs Control)


Triiodothyronine Resin Uptake

Keto vs Non-Keto

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Thyroid Stimulating Hormone

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)


Energetics

Energy Expenditure

Keto vs Non-Keto

Keto by Duration (vs Control)

Keto by Duration (vs Baseline)

Keto by Weight Loss (vs Control)

Keto by Weight Loss (vs Baseline)

13 comments:

  1. would you also be publishing an abstract of your inferences?

    ReplyDelete
  2. Would be nice to read your conclusion of these :) thanks for doing all of it!!

    ReplyDelete
  3. This comment has been removed by a blog administrator.

    ReplyDelete
  4. This comment has been removed by a blog administrator.

    ReplyDelete
  5. I'm joining the chorus: Thanks for your work but some of us need to just read the conclusions drawn from the research!

    ReplyDelete
  6. I'm impressed by how much work you put into this and got really excited to read until I saw that you described a ketogenic diet as less than 75g 😅

    What's the rationale for that number as a cut off?

    All the ketogenic diet conclusions would be rendered unviable because the keto data is mixed with low-carb data.

    The work might still be useful to evaluate the impacts of low carb diets in general though

    ReplyDelete
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