#KetoMedStudy: Nutrient Diffs

In our study we collected a lot of dietary data, primarily to characterize diets & report adherence

In supplemental tables we reported changes in NUTRIENTS on each diet phase

In this 🧵we share the nutrient changes

academic.oup.com/ajcn/article-l…
Two Diet Periods for each Diet Phase

Food Delivery

Self-Provided

For each 12-week phase of the study, participants received food deliveries for the first 4 weeks to maximize adherence.

For the next 8 weeks participants bought and prepared their own food (supported by staff)
Food Delivery Period

Supplement Table 8 from paper

Vitamins, minerals and fiber

Baseline
End of Food Delivery (week #4)

Absolute Standardized Differences (effect sizes) between diets for change from baseline.

~0.2 = small diff
~0.5 = moderate diff
~0.8 = large diff
Food Delivery Period

Change from baseline indicated at least a moderate effect size (>0.5) that favored:

Med-Plus (8) (in blue)
Thiamin, Vit B6, Folate, Vit C, Vit E, Iron, Magnesium, & fiber

WFKD (3) (in orange)
Vit B12, Vit D, Selenium

(See RDA’s, far right, for reference)
Self-Provided Period

Supplement Table 10 from paper

Vitamins, minerals and fiber

Baseline
End of Self-Provided (week #12)

Absolute Standardized Differences (effect sizes) between diets for change from baseline.

~0.2 = small diff
~0.5 = moderate diff
~0.8 = large diff
Self-Provided Period

Change from baseline indicated at least a moderate effect size (>0.5) that favored:

Med-Plus (4) (in blue)
Folate, Vit C, Magnesium, & fiber

WFKD (0)

(See RDA’s, far right, for reference)

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More from @GardnerPhD

Jul 8
Keto-Med Study: LDL size

Our study published today in @AJCNutrition examined several secondary clinical measures: fasting LDL-C, HDL-C, TG, glucose, insulin, ALT & weight

Most significant diffs:
LDL-C better for Med
TG better for Keto

🧵 LDL-size

academic.oup.com/ajcn/article-l…
Keto-Med – Main Results

(Diff in 12-week change from baseline)
p-values above data
 
General summary: for both diets, all measures improved, w/exception of elevated LDL-C for Keto (WFKD) phase.

Decreases on both diets for everything else except HDL-C which increased (good).
Keto-Med – LDL-Size

Much has been written/studied/published on differences in the size & atherogenicity of LDL particles

Small – more atherogenic
Large – less atherogenic

In fact, one of my first published papers was on this topic in 1996 (I feel old)

jamanetwork.com/journals/jama/…
Read 8 tweets
Jul 8
Keto-Med Study – Main results

Thrilled our paper was accepted by @AJCNutrition.
Online version released today.
Open Access – free for all

Brief overview here 🧵

(Separate tweets will be sent out to address likely questions/comments, see end of 🧵)

academic.oup.com/ajcn/article-l…
Keto-Med – Unique contribution

Rather than contrast Keto to Low-Fat, we compared to lowER-carb/highER-fat "Med-Plus" diet

Question: After ⬇️ added sugars & refined grains, & ⬆️ veggies (both diets), is there additional benefit to excluding fruits, legumes & whole intact grains?
Keto-Med – Study Design

Started with 40 participants
21 w/ prediabetes
19 w/ T2D

COVID challenges (4 drop outs)
3 other dropouts

N=33 with complete data, both phases

Cross-over design
Read 10 tweets
Mar 27
PROTEIN MATH GAME

I believe most people who have access to a reasonably diverse diet get ⬆️⬆️ protein than the RDA, especially athletes.

Do you?

Simple math

How much do you weigh?
Doubly-labeled water
% Protein in diet

@mackinprof – please check my math

Wanna play?
Let's start with the % of protein in your diet.
Do you have any idea what that might be?
You don't need to know to play.
If you know great,
If not, have some fun and guess.
Yesterday @ScepticalDoctor provided screen shot below (source?)
Meat eaters ~16%
Vegetarians ~13%
Vegans ~12.5%

@MrBigNoodle noted this:
pubmed.ncbi.nlm.nih.gov/23988511/
with higher amounts (although, in grams).

I find few examples in published lit. of ave’s outside the 15-20% range
Read 13 tweets
Mar 26
Vegans eat the least protein.
That doesn't mean they don't eat enough protein.
The RDA does not reflect individual requirement.

Here is a brief RDA tweetorial.

>50 years ago, individual protein requirements were assessed in rigorous studies.
Requirements ranged...
The estimated average requirement (EAR) was determined to be 0.66 g protein per kg body weight.

Hypothetical question: What if 100 individuals were provided with a day of food that contained EXACTLY the EAR....how many of them would NOT meet their individual requirement?
By definition, half the individuals would meet their requirement.

But there is also another subtle point to be made here, technically, 50% would meet OR EXCEED their requirement.

Get it, the range tends to be a normal distribution. Most people are either above or below ave.
Read 9 tweets
Mar 26
High vs. Low Protein

A few wks ago, @ScepticalDoctor & @theproof brought up this ??. I was too busy @ the time, & it's a tough topic - limited base of quality evidence to draw from.

Got more time now.

Time for a protein tweetorial?

For starters, how high is "high"?

g? %?
And how low is "low"?
There aren't correct answers. There is no consensus on grams or % of what qualifies as "low" or "high".

And there is the important consideration of plant vs. animal protein, and translating "protein" into "food". But I'll save that topic for another day.
Read 12 tweets
Mar 19
It Depends - Coffee vs Tea

I'm working on a book. One of the chapters will be Coffee vs Tea.

Thought it would be fun to preview some of the content. I'll try turning this into a Tweetorial. (17 in 🧵)

Several polls, several fun facts.

Are you a coffee or a tea drinker?
Coffee vs Tea and health

Which do you think is a HEALTHIER choice?

2/17
How many of you paused in trying to answer the previous question thinking.....it depends?

Doesn't it depend on what you add?
Maybe even what type of coffee or tea?

Most common additions, sweetener & dairy

Start with sweetener, do you add:

3/17
Read 16 tweets

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