#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)

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 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?

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.

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...

https://twitter.com/ScepticalDoctor/status/1507798355648335877

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?

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"?

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

#KetoMedStudy
Week #5
1/5

For past 4 wks, we've been sharing study design details of forthcoming Keto vs Mediterranean Study

This week, we want to share the 36-wk time point & get your thoughts.

Poll on next post in thread - vote on time point you think is most interesting 🤔 2/5
Which is most interesting?

Adherence best at Wk #4 of each phase (food delivered)
⬆️rigor (efficacy)

Wk #12 of each phase
⬆️generalizabilty

36 wk - reality check (effectiveness)
Who is following what?

1/9
Just completed trial
Keto vs Mediterranean

Just submitted Design & Adherence paper PRIOR to main results paper

While waiting for reviews & decision…
 ~10 weekly mini-threads - #KetoMedStudy

⬆️design understanding &
⬆️twitter civility?🙏
 
Week #1
Main study question 2/9
US calories: 1999-2016
pubmed.ncbi.nlm.nih.gov/31550032/

Low quality carbs
Added sugars, refined grains: ~40%

High quality carbs (whole grains, legumes, fruits): ~10%

3 types fat: ~10% each

Protein: Animal ~10%; plant ~5%

***Biggest impact potential - ⬇️ low quality carbs

Series of 6 papers published today in Ann Int Med from “NutriRECS” group.

They recommend people continue to consume unprocessed & processed red meat at current rates

I disagree, in USA

My perspective - in 17 tweets
#ReduceRedMeat in USA

n.pr/2mkxWN7 2 of 17

I seek to dispute it
As does @TrueHealthINIT & @HSPHnutrition

It isn’t hard

Apologies for not responding sooner with specifics to @bigfatsurprise @ProfTimNoakes with specifics.
Here are some...... Fundamental flaw
Yes, RCT’s are design w/ highest causal inference
But many topics can’t be studied w/ RCT
Can’t randomly assign & follow until morbidity/mortality:
*Cigarettes & lung cancer
*Parachutes when sky diving
*Vegan/Vegetarian
Lack of RCT does not = lack of evidence