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Just because insulin resistance is associated with heart disease, and just because keto reduces one marker of insulin resistance (HOMA-IR) (but makes other markers worse), does not mean that keto will prevent heart disease.
Doctors pushing this (without evidence) should stop.
Doctors pushing this (without evidence) should stop.
People seem to be confused about this tweet.
HOMA-IR is not the only marker of insulin resistance. You can also measure insulin resistance by OGTT or euglycemic clamp, both of which show insulin resistance "worsens" on keto.
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HOMA-IR is not the only marker of insulin resistance. You can also measure insulin resistance by OGTT or euglycemic clamp, both of which show insulin resistance "worsens" on keto.
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So if insulin resistance is associated with heart disease, and keto improves one marker of insulin resistance but makes others worse, will keto improve or worsen heart disease risk? Which is it?
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We don't know.
We have a mechanism, but we don't know how that mechanism will translate into risk. Also, even if keto does improve insulin resistance in "a good way", what else does it do? Could other aspects of keto impact heart disease risk negatively?
We don't know.
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We have a mechanism, but we don't know how that mechanism will translate into risk. Also, even if keto does improve insulin resistance in "a good way", what else does it do? Could other aspects of keto impact heart disease risk negatively?
We don't know.
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What's more, even though insulin resistance is associated with heart disease, we don't know to what extent the insulin resistance is causing the heart disease and to what extent the other things that go along with insulin resistance cause the heart disease.
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So will improving insulin resistance in an isolated manner improve heart disease risk? Or will simply improving overall "metabolic health" improve heart disease risk, by improving the things that insulin resistance is associated with (that really cause the increase in risk)?
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We don't know.
To know for sure, we need a randomized controlled trial.
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To know for sure, we need a randomized controlled trial.
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In the meantime, we do know that keto does not result in better weight loss than other diets over the long term, in the average person. So it probably does not improve long-term insulin resistance, and its physiological basis, better than other diets.
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This is because insulin resistance is primarily driven by ectopic fat (fat stored around the organs and muscle and not stored in the normal places), which is primarily driven by overall body fatness.
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Which is not reduced by keto more than by other diets in the long run (because nobody adheres to diets).
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Recap
1. Keto improves some markers of IR but makes others worse;
2. Keto does things other than modulating IR and these things may (or may not) impact risk;
3. Insulin resistance itself may not impact heart disease risk; the biology associated with it might; we don't know;
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1. Keto improves some markers of IR but makes others worse;
2. Keto does things other than modulating IR and these things may (or may not) impact risk;
3. Insulin resistance itself may not impact heart disease risk; the biology associated with it might; we don't know;
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4. In the long run, all diets are equally bad at improving visceral fat, the physiological underpinning of IR, because few people adhere to diets;
5. Without ways of increasing population-level adherence, diet advocacy remains more about entrepreneurship than public health.
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5. Without ways of increasing population-level adherence, diet advocacy remains more about entrepreneurship than public health.
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I hope this cleared things up for folks.
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Enjoy my discussion about evidence in this thread? I go into more detail about why evidence works the way it does in nutrition and medicine here:
https://thedietwars.com/dangerous-and-ineffective/
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https://thedietwars.com/dangerous-and-ineffective/
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You can watch or listen to my recent podcast episode on @MBPowerProject, where I talk about these issues and more in greater depth, in a free-flowing conversation.
https://lnk.to/KevinBass
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https://lnk.to/KevinBass
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