Thread by @DoctorTro

How do seemingly smart people not see what I see? I just don’t understand.

Yet, somehow it doesn’t compute, the data is right there. The eyes see the results, the brain doesn’t understand. “It can’t be right”... it says...

1/n

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This was exactly my problem as an obese, blinded-physician, shackled to data from the dogma of associations & observational studies.

I read about these people with phenomenal weight loss stories online w/ low carb, and I shrugged them off.

“n=1, data says all diets similar”
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How misguided I was!

If you look closely at the head to head trials in ad lib setting, it always favors low carb. But when you look at metabolic ward studies there is no difference. And yet this stands to such stark contrast to the plethora of anecdotal success...

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I asked myself why the disparity. Having having some weight loss and massive weight rebound & further weight gain after plant-based and vegetarian diets in my past. I dug deeper in the literature. The answers were there.

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Why are there Keto zealots, I asked myself? Haven’t they seen the literature ? Yes, low carb is favorable in almost all adlib trial but usually only a pesky couple pounds. And met ward studies show no difference. 🤔

Bunch of crazies right?

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Then I decided to go low carb, follow the literature, for obesity, in adlib settings it’s superior, I don’t live on a metabolic ward after all. And what happened?

6/n

I lost 80lbs in my first year. But my appetite still wasn’t really well controlled. If I added Splenda to Greek yogurt, I could eat two massive tubs easily. If I added ketchup to grilled chicken, I could eat endlessly.

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I looked through the medical literature.
Very clearly peptide YY is preserved in low carb diets versus low fat despite similar weight loss. Peptide yy when infused causes a significant reduction in food intake. But then I dug into the Keto literature...

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Athletes running marathons without eating, gymnasts without any changes in performance, ketogenic specific hormonal changes... becoming “fat-adapted” was bullshit to me until it wasn’t.

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Another MD challenged me to go zero carb for a month and I did. Thanks @SBakerMD and it was the worst month of my life. Tired. Groggy. Felt like withdrawal. What the hell was going on?!?!? I would get mildly light headed in the past, but now gym performance went down

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And low and behold. There is data to support my experience. Take an athlete and put him on a ketogenic diet for 4 days and they will hate you, and according to the literature they preform worse! It seems like it persists until 4 weeks... but then

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But then at 4-6 weeks it seems to come back to baseline and at 3 months it may even be improved in some endurance events. So what happened to me?

In 4-6 weeks my symptoms improved and I came back to baseline, and now felt SIGNIFICANTLY BETTER.

Like a switch just turned on
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How could this happen to me? I was skeptical. I was bound by tenets in evidence based medicine, and here I am, running miles without eating anything and not being hungry, when just 4 weeks prior, I was groggy, light headed and cursing the name of @SBakerMD

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I remember the day I felt different. I had been eating fairly lean cuts of meat for that month of zero carbs, and right when I was ready quit, my wife lovingly made us a breakfast of eggs and bacon, I ate the whole thing, hadn’t eaten bacon in a long time... later that day

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Later that day in the gym, I was a beast. It was legit a new person. Like someone just filled up my tank. Except in reality what happened was my tank was already full, eating carbs was limiting its pipeline to my engine.

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Beast mode on. This a little over 1 year ago, about I had just started getting my feet wet in the gym, I had already lost about 90lbs, but now felt different.

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So what happened? What was this new found energy? I don’t believe in supernatural powers from bacon.

This is what is anecdotally referred to as fat adaption.

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In the literature, in athletes, there is evidence to support this... athletes report subjective increased recovery, decreased soreness.

Fat oxidation takes a week to hit near peak levels, but ffa/ketones take 40-50 days to peak, we don’t know how long it takes the tissues🤔
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What happens next? I have no appetite. Zero. None. I don’t want to eat. My need for food goes way down. I’ve never felt so liberated. I don’t need to eat that box of ice cream, I don’t want to bag of chips. I’m just not hungry 😋

19/n

So I lose another 50 pounds in year 2, and now halfway into year 3 I’ve lost another 15 pounds. WHAT IS GOING ON?! I was supposed to have a heart attack. I’m supposed to see ldl of 200, and yet it’s down. But instead im still losing weight and fat

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Why? Besides improved glycemia, we know transient hypoglycemia from hyperinsulinemia increases desire for hyper palatable foods. But also because my sugar is stable, and I’m not relying on dietary carbs for energy.

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Why else? Besides peptide yy, ketosis has specific effects on ghrelin & other satiety hormones

Im never hungry. I run for miles, workout for hours, & I’m not hungry. And when I am hungry I feast. I eat real foods, high in protein which are known to be satiating so im full

23/n

What does this mean?
✅low carb diets work
✅VLCKD have distinct glycemic & hormonal effects
✅evidence based skeptics can be converted, if they read the data and listen to patients and know what to look for.

Don’t eat sugar kids, no matter what @kevinnbass says
24/n

Sorry in advance for any grammar errors, I didn’t review this.

One last point. These smart people. They still can’t explain why carb restriction effectively treats DM, NAFLD, HTN. They point to China/Japan where the intake of fat has risen & focus on correlations w/ diabetes, yet a low carb, high fat diet in China/japan improves glycemia🤔

I can come up with scenarios where fat restriction is beneficial, but for some reason anti-low carbers can’t seem to find scenarios where low carb is beneficial. 🤔