Keto 4: Aren't you worried about...?

Plenty of people have concerns when they hear about my high-fat, low-carb diet. Here are my responses to some of the most common questions and concerns. I'll add to the list as I hear more actual questions and passive-aggressive criticisms.

Cholesterol? 

Well, a little bit. My massive eggy-fatty-yum-yum diet has made me think a little bit more about cholesterol. I really do think this is mostly due to having grown up with the food pyramid and in the middle of the low-fat frenzy that sloshed over America and somehow did not manage to staunch the flood of obesity. (Basically, it is on my mind, but I am not sure whether it should be to the extent that it does.) There are plenty of RCTs out there, and there is a ton of anecdotal evidence, the bulk of which reveal that some people do see an increase in total cholesterol. However, it’s mostly the “good” cholesterol. “Bad” cholesterol often decreases. Up with the good, down with the bad? Sounds good to me. I’ll keep an eye on it.

Vitamins?

No. I eat plenty of vegetables in many colors. If I am heading into a period of time when I know I might not, I grab a multivitamin, just like I would if I were going to travel. Because I live in a place famed for its liquid sunshine, where one does not tan but rusts, I have been supplementing with D, but I probably don’t need to given the amount of D in most eggs and dairy products. I also supplement B12, because I’m pretty sure it will make me immortal. (Coming next century: Single White Highlander Cooks Veggie.)

Protein overconsumption?

My kidneys! Too much protein! It's bad! You may be right... too much protein is bad. I hover right around the recommended daily allowance. NBD. It’s easy to get enough when you eat a lot of fat from whole foods, as most of the whole-foods sources of fats (other than pure fats) also contain protein. While I still do have all of my protein powders (so tasty stirred into the plain yogurt!), I think I may have had a total of one serving in the past month.  For those of you who are interested in numbers, I aim for about 50 g from food and usually wind up somewhere between 30 and 80 g. (Overall, less than 20% of my calories most days.) This may seem low to some people, but so far, it’s working fine. I have no idea how many grams I get from the BCAAs I drink. Each dose contains 5 grams (I think?) and I have 3-4 a day, mostly because it encourages me to drink water. Overall, food and BCAAs, I probably get somewhere between 50 and 70 grams of protein each day. 

Ketoacidosis? 

No. Being neither a Type One Diabetic nor an alcoholic, I am not at risk of ketoacidosis. People who ask this question usually have confused ketosis (which many people experience in the morning) and ketoacidosis (which also involves a lack of insulin). 

Bone density? 

A person who asks this usually knows a bit better what he or she is talking about. The fact of the matter is that the jury is still somewhat out. Because of the suspicion about high-fat diets, there have been relatively few RCTs performed in healthy adults. Most of the data comes from people for whom the ketogenic diet is prescribed as an intervention (primarily people with intractable epilepsy). Results from these diets vary widely and seem to depend upon factors such as age and activity level. For instance, non-ambulatory children with very low BMIs do often see a marked decrease in levels.

http://ajcn.nutrition.org/content/88/6/1678.short

However, in a small study of adults with GLUT-1 deficiency, researchers observed no issues with mineral loss (or body composition) over a 5-year period. 

http://www.nutritionjrnl.com/article/S0899-9007(14)00044-6/abstract