Why I’m Not Keto Or Vegan

This is an opinion piece.  This blog is not going to give you the scientific FACTS to prove that eating keto isn’t good for you or that eating vegan isn’t good for you.  It’s certainly not going to give you the facts to prove that either of them ARE good for you.  But, that’s really part of the whole point of this “op-ed”.  That is, that the things often slung around the internet as facts are nothing of the sort.

So, I’m not going to try to prove to you that my way of eating is the best way for everyone.  I’m simply going to give you my reasons why I’m not keto or vegan.  Some of the reasons will be based in science, some will be based in simple reasoning with very little science, and some will be based in the distrust of supposed science.

Before I get started on the reasons why I’m not keto or vegan, let me say that I actually do support people who choose to go either vegan or keto if they’ve done their research and come to a different conclusion than me.  Our site is filled with keto and vegan recipes and we have both types of eaters as regular members.  It’s just not something I do myself or promote and I certainly don’t believe either is the absolute best way to eat for everyone and this blog is a compilation of my current thought process.  I hate to see people jump into keto because they see someone else lose some weight or go vegan because they watched a documentary on Netflix.  My thought process may change over time but, at this point, I don’t foresee trying to convince people that everyone should be keto or everyone should be vegan.

It’s also important to note that this will only cover my opinions from a nutrition and disease standpoint.  That may cross over into many of the other notable issues espoused by the vegan community such as animal treatment, but it will not be the primary focus.  I am also aware that many like to use the term “whole food plant based” or WFPB instead of vegan when their concern is purely nutrition and health and not as much environmental or animal rights based.  I’ll stick with using vegan in this blog for ease of reading.

Here’s the BLUF (bottom line up front):  We don’t know enough about the intricate details of nutrition and disease to be sure that there is one right way to eat.  We have to use the combination of history and science to do what makes sense.  If you’re looking for scientific proof for the best way to eat, you’re likely not going to find it (yet).

So, let’s get started:

EXAMPLE 1

I’ve been considering writing a blog like this for a long time, but the thing that finally got me to do it (the straw that broke the camel’s back, so to speak) was the 10^th time someone posted this article titled, “’No One Should Be Doing Keto Diet’ says leading cardiologist”.

The title got my attention right away for several reasons (but probably not the ones intended).  I don’t believe the keto diet is a long term solution either, but that’s not why I clicked.

For one thing, the leading cardiologists are the very people that devised our current USDA food pyramid, told us in the 70s that fat was bad, approved the creation of trans fat (oops on that one, although it was JUST banned in 2018 finally), and prompted the creation of every low fat, chemically-laden product you can think of.  The leading cardiologists are not the ones I go to for nutrition advice.  In fact, I’ve had doctors tell me to my face that they know very little about nutrition because it’s simply “not what we do”.  This isn’t to say that I think doctors are bad at all.  Doctors save lives every day, but nutrition is not what they’re trained to do.  Which, in my opinion, is insane, but it is how our healthcare system is structured.  It truly is not what the system trains them to do.  Of course, that doesn’t mean that a leading cardiologist can’t be well-versed in nutrition by studying it him/herself, but the title of cardiologist does not mean that someone knows what to tell you to eat.

Also, as somewhat of a side note, you’ll see that the article and interview are by a plant-based website and the cardiologist is vegan himself, so I wanted to see what proof or evidence would be offered.

Anyway…upon reading this interview with the leading cardiologist, I looked into the studies cited that make him believe that no one should be doing keto.  (Remember, this isn’t a defense of the keto diet.  I don’t do that either.)

The main study (actually a meta-analysis of 17 different studies) cited to show that doing keto is not good for you was THIS ONE.

You can feel free to click the link above and read the abstract and results and conclusions of the analysis, but here are the results and conclusions of that meta-analysis so you don’t have to:

RESULTS:  We included 17 studies for a systematic review, followed by a meta-analysis using pertinent data. Of the 272,216 people in 4 cohort studies using the low-carbohydrate score, 15,981 (5.9%) cases of death from all-cause were reported. The risk of all-cause mortality among those with high low-carbohydrate score was significantly elevated: the pooled RR (95% CI) was 1.31 (1.07–1.59). A total of 3,214 (1.3%) cases of CVD death among 249,272 subjects in 3 cohort studies and 5,081 (2.3%) incident CVD cases among 220,691 people in different 4 cohort studies were reported. The risks of CVD mortality and incidence were not statistically increased: the pooled RRs (95% CIs) were 1.10 (0.98–1.24) and 0.98 (0.78–1.24), respectively. Analyses using low-carbohydrate/high-protein score yielded similar results.

and…

CONCLUSION: Low-carbohydrate diets were associated with a significantly higher risk of all-cause mortality and they were not significantly associated with a risk of CVD mortality and incidence. However, this analysis is based on limited observational studies and large-scale trials on the complex interactions between low-carbohydrate diets and long-term outcomes are needed.

Um…here’s my paraphrase of what that says:  “We looked at a bunch of different studies that did different things and we added all of the data together.  For people that had a high “low-carbohydrate score” (meaning they were eating low- carbohydrate by some standard) there was no statistical increase in cardiovascular events (i.e. they didn’t have more heart attacks and strokes).  BUT….there was a statistical increase in overall deaths of the people with high “low-carbohydrate score”.  In other words, more people with that score died from various reasons during the studies than people without a low-carbohydrate score.”

What does that even mean?  So, if you do keto, you aren’t more likely to have a heart attack (which would be the likely disease that someone would expect to get if keto was bad for you for the reasons usually cited), but you still are probably more likely to die.

The last line of the meta-analysis’ conclusion is telling.  Actually, the entire conclusion is telling.  To me, it basically says that we need to do more studies because this didn’t tell us much.

A similar thing recently caught my attention with this study on alcohol intake.  They reported that the analysis shows that no amount of alcohol intake is good for your health.  Why did they come to this conclusion?  Because any amount of alcohol intake was associated with “all-cause mortality”.  They literally included traffic deaths in this data.  So, the headline is trying to refute the idea that a little alcohol has health benefits by showing that any amount of alcohol increases your chance of dying…but they include things like traffic deaths in the data?  That’s INSANE!  I don’t know anyone claiming that a glass of wine has health benefits who is also claiming that it lowers your possibility of dying in a car accident.

Listen, as I said, I’m not even a proponent of the keto diet being a long term solution and I’m not a supporter of the idea that alcohol is some kind of health food even in moderation, but these headlines and conclusions are just not logical.  These are associations (correlation not causation) that means little to nothing, in my opinion.

EXAMPLE 2

In the full interview of the leading cardiologist (see link in Example 1), the interviewer asks the cardiologist (at 6:38 into the video), “if you were to pick 1 study that best showcased the effect of a whole food, plant-based diet, what would it be?”

Cardiologist’s response:  The Nurses’ Health Study and the Health Professionals Follow Up Study

He claims that these studies together show that there are no safe animal products.  To his credit, he does concede that if people would stop eating processed red meat and stick to fresh red meat like hamburger (as opposed to hot dogs and ham), then it would be better (I completely agree and that’s why processed meats are mostly on our red tier).  But, he still claims the study shows that there are no safe animal products.

Here’s my problem with using these studies as proof:  They are both FFQ studies.  FFQ stands for “Food Frequency Questionnaire”.  This is a notoriously inaccurate way to determine diet-to-disease causality.  So much so that many are calling for doing away with FFQ studies and their use in subsequent meta-analysis.

Basically, an FFQ study is conducted by sending out an FFQ to a cohort of participants on some interval and then tabulating the data.  There are many issues with the accuracy of this kind of a report.  Here’s a list of just a few of the most obvious issues:

• People may not accurately report their consumption of certain foods they currently deem “bad”. The FFQs from the Nurses’ Health Study in the 80’s, for example, may actually have underreported red meat numbers and/or saturated fat numbers because it was during the height of the low-fat craze.  On the other hand, newer iterations may have inaccurate reports of sugar or carbohydrate numbers because of the current social phobia.
• People may not accurately report their consumption simply because they don’t remember. If someone asked you how often in the last year you used a particular food, would you be able to accurately answer?  The answers are things like “never or less than one per month”, “1-3 per month”, “1 per week”, “1 per day”, etc.
• The questions lump foods together in unthinkable ways that can make huge differences in outcomes. For example, on the FFQ sent out for the Health Professionals Follow Up Study, one of the entries as a single answer is “Beef, pork, or lamb as a sandwich or mixed dish, e.g., stew, casserole, lasagna, frozen dinners, etc”.  You’re supposed to answer how often have you had any of those things in the last year.  That’s insanely inaccurate and useless.  Will people also separately report the bread if it was a sandwich they are referring to?  Or how about the noodles if it was lasagna?  Or, when they ask you to report hamburger patty intake (with options of “lean” or “regular”), will you separately report the bread item in the other category or will you just report that McDonald’s hamburger as a regular hamburger patty and call it good?

Those are just a few of the problems with the FFQ method.  You can find the actual FFQ sent out for the Nurse’s Study HERE and the FFQ for the Health Professionals Follow Up Study HERE.  I encourage you to look through them and ask yourself if you think it would give an accurate picture of what someone eats to the degree that you could draw conclusions about the best way to eat.

My biggest objection to these studies is not so much inaccurate reporting by the individual but rather the lumping of foods together.  The whole structure of it is inaccurate to begin with before you even factor in memory or shame by the cohort participants.

The most frustrating part of these forms to me is how they lump animal products together as if they’re all the same when we KNOW that the nutritional quality of animal products varies greatly depending on the level of processing and type of processing.  Organic milk is different than non-organic, farm-raised fish is different than wild-caught fish, grass-fed beef is different than corn-fed beef.  Hormones, GMOs, pesticides…none of that is taken into account in these studies.

It makes me mad that we have so industrialized our farming practices that we now feed cows corn instead of grass (because we have it in abundance and it’s therefore cheaper to do it that way).  They specifically have a rumen for the purpose of digesting grass and turning it into protein, but we feed them corn and use antibiotics to keep them from getting sick on this unnatural diet…and then we do a study where we show that red meat is bad without differentiating between corn-fed and grass-fed red meat and claim that all animal products are unsafe!

NO!  I don’t buy it.  Not from an FFQ study that lumps the grass-fed red meat of nature and our history to the red meat of feedlot, corn-fed cattle.  This is far from scientific proof that a plant based diet is the best.  If this is the landmark proof from those that say a whole food plant based diet is the best, then I’m not on board.

Show me a study that doesn’t use an FFQ (or maybe even one that does) where people ate grass-fed beef, pastured organic eggs, pastured organic chicken, and wild-caught fish and there was still a link to increased mortality or disease.  Is there one?

These two examples I’ve used are decidedly arguing against the vegan diet as a universal solution, but don’t worry…I’ll get to the keto stuff too.

Now, my favorite reason of all time.  It’s my favorite because it isn’t based in scientific studies at all.  Of course, that makes a lot of people uncomfortable, but I get to say what I want in a self-proclaimed opinion piece…so here it is:

Anything that zeroes in on one thing and makes it the most important thing and thereby creates opposition to anything that isn’t concerned with that thing is probably wrong.

In other words, if it can be or often is described as an extreme, the truth is probably somewhere in between.

I love this Michael Pollan quote from “The Omnivore’s Dilemma”:

But either-or is a construction more deeply woven into our culture than into nature, where even antagonists depend on one another and the liveliest places are on the edges, the in-betweens or the both-ands.

Oddly, this quote came from a portion in the book where Pollan is contemplating why a farmer doesn’t take down the forested land on his farm to make room for more cattle and thereby create more profits.  He was seeing the situation as though the grass fields were important but the forests were not.  They seemed to him to be taking up valuable land that could be used to graze cattle.  The farmer explains the important role of the forests in the ecosystem of the farm to Pollan and how they are necessary for the healthy operation of the farm.  The forests provide wind break for the grasses, shade and cooling for animals, birds live on the edges of the trees and help eliminate pests, etc.

I’ve never seen this play out more clearly (except maybe in politics) than with the vegan/keto camps today.  One camp says animal products (and often specifically red meat and saturated animal fat) are to blame for obesity, insulin resistance and diabetes, heart disease, and cancer and decides to get nutrition exclusively from plants.  The other side says carbohydrates and sugars are to blame and subsequently decides to eat essentially none of them, forcing the body to fuel with ketones rather than glucose.

It’s like cutting down the forests because you make the most money raising cattle, not realizing that the forests and grazing land work together.  Lowering carbs to 50g or less is like cutting down the forests.  Removing all animal products from your diet is like cutting down the forests.

It ignores the intricacies of the human body and exalts one thing above others.  Plants above other foods or ketones above glucose.  It’s a reductionist mentality that is actually the same one that has given us an industrialized farming and food system where we grow all of our corn in one place and all of our cattle in another when they actually used to complement one another in a fully self-contained ecosystem on the farm.

Our bodies are pretty amazing.  They do some really intricate things to keep us alive and active.  One of those things is blood glucose management (also referred to as blood sugar rather than blood glucose).

The body favors glucose as its primary form of fuel.  Glucose is essentially sugar.  When you eat carbohydrates, your digestive system breaks those carbs down eventually into glucose for use as fuel.  When the glucose gets into the bloodstream, the pancreas secretes a hormone called insulin.  Insulin is like an escort for glucose.  Without insulin, glucose can’t get into the cells where the mitochondria convert it into ATP (energy).  So, insulin escorts the glucose into the cells and you get energy.  If you don’t need more energy but you have more glucose, the insulin will help store the glucose in the muscles and liver as glycogen which it can easily convert back to glucose later.

When your blood sugar drops down too low, the pancreas secretes another hormone called glucagon (basically the opposite of insulin) which tells the liver to turn glycogen back into glucose for use in the cells as energy.

In addition (and this is often overlooked), your body has hormones and mechanisms for turning fat and glycogen stores back into glucose very quickly when you are in an emergency state.  Cortisol (1^st level) and adrenaline (emergency level) will tell the liver to convert everything back to glucose ASAP.  This comes into play later.

Now, if you don’t give your body new sources of glucose from food, it eventually uses up glycogen stores and starts relying more on fat stores for energy.  The problem is that fat can’t be used exclusively to fuel the body (especially in your brain).  So, the liver begins creating an alternative fuel source through a process called ketosis.  Ketones are created from fatty acids and used as fuel.  It seems this prevents your body from catabolizing your muscle tissue to use in the liver to form glucose.

However, even in this state, your body still needs glucose to survive.  It cannot survive on fat and ketones alone.  So, your liver converts lactate, glycerol and amino acids into glucose even when you are in a state of ketosis.

OK, now…if you followed all of that, here is my take:

This (ketosis) seems to me to clearly be a system your body uses as a piece of an intricate system. At times it may be the primary mode but not always.  The body needs glucose to survive.  It has ways of making it from other things if it needs to, but its standard operating procedure is to get adequate glucose from your food intake and buffer with other mechanisms as needed.  The system has enough back up to keep us going pretty well even if we fast for fairly long periods.  You should be going into ketosis during the night when you aren’t eating for the longest period and possibly during the day during periods between meals along with using glucose from healthy carbohydrate sources around meals.

Also, in our society, most of us live in a constantly stressed state and our food supply is full of copious amounts of simple carbohydrates that turn to glucose very quickly.  This combination can leave us with things like insulin resistance (and later diabetes) from constant overproduction of glucose that has nowhere to go but fat stores.  It also results in elevated cortisol levels which not only affect blood sugar but reduce the adrenal glands ability to perform its other functions (reproductive hormones).  This fact has probably made keto seem like a viable solution because blood sugar is more controlled even with the elevated cortisol, but it potentially creates other problems with hormone imbalances (read more on that here).

The solution to this is NOT, in my opinion, to reduce carbohydrate intake to 50g or less and force our bodies to produce ketones and convert non-sugars to glucose.  I believe the solution is to moderate carbohydrate intake (more like 25-40% of intake instead of 10% or less), choose high quality carb sources instead of simple and processed carbs, and REDUCE STRESS so that our stress hormones aren’t piling on top of the blood sugar issue.  I cannot overemphasize the stress component in this equation.

It just doesn’t make sense when you look at the systems the body has in place for managing glucose to force it into this state of ketosis (and most especially not by taking ketone supplements as some are now).  It doesn’t make sense to purposefully avoid ketosis either!  It’s a normal function of the body that works together with healthy carb intake and glucose management.

Obviously, this point is aimed mostly at the keto diet, but the vegan diet can easily promote the overuse of carbohydrate and make the insulin resistance issue worse.  That does not HAVE to be the case though.  You can do a vegan diet without spiking your blood sugar constantly and causing these issues, but it is very easy to eat excessive amounts of carbs on a vegan diet.

If history were to support one of the two diets more than the other, I would have to say that it would be the keto diet (but don’t take that as an endorsement).

I don’t see evidence of a single, multi-generational vegan society anywhere in written history.  I might be missing it, but I haven’t seen any account of it.  I think that is pretty telling.

There was actually a dentist in the 1930s named Weston Price who visited dozens of peoples and tribes around the world who were untouched by modern civilization (no industrialized farming practices, refined and processed foods, sugar, etc).  These people were all still eating their ancestral diets.  Dr. Price studied their overall health, dental issues, and their diets to try to figure out why we were seeing such an increase in dental cavities in the United States.  He wrote a book of his discoveries called “Nutrition and Physical Degeneration”.  Oddly enough, he actually expected to find vegan and vegetarian populations thriving.  It seemed to make sense that eating plants was the right way to go.  However, that’s not what he found.  He couldn’t find any completely vegan or even vegetarian native peoples.  He did find thriving and healthy groups eating meat, milk, and other animal products.  In some cases, he found peoples that ate almost exclusively animal products.

The Inuit people of northern Canada and Alaska are one example of a people that had excellent health while eating almost exclusively animal products.  In some areas, once these people had access to the western diet via trade, their health deteriorated.  Nina Teicholz records this in her book “The Big Fat Surprise” as well.

NOTE:  I’m not advocating eating only animal products as healthy.  There’s more to the stories of those people that seemed to only eat animal products (such as eating animal organs and glands rich in vitamins).  The point of this is not to go into detail on that but rather to point out that no vegan groups were found.

In addition, just a simple look at the trends in the United States over the past 50 or so years doesn’t really support the idea specifically that red meat is the problem.  While total meat consumption has gone up a little bit since the mid 70s, red meat consumption has gone down (mostly replaced with chicken).  However, obesity, heart disease, and other diseases have only gone up.  You know what we have consumed more of since the 60s and 70s?  Corn and wheat (and our meat has consumed more corn too…more on that later).  To say that red meat and saturated animal fat are the main problems when we’ve decreased consumption but seen increases in disease just doesn’t make sense.

There is history of groups of people with an absence (or low occurrence) of many of the diseases we face today, but little to no evidence for a vegan diet being a factor.

Vegan:  There simply are no viable, non-animal sources of vitamin B12.  This vitamin is essential to health and has undergone some debate in vegan circles, but to my knowledge (and according to many vegan sites including THIS ONE and nutrition books I’ve read), the only way for a vegan to get a reliable source of B12 is with fortified foods or supplements.

Of course, if you choose to be vegan for various reasons, you can certainly go the supplement route and I’m not opposed to that.  But, if we’re discussing if eating vegan is the best way to eat for health, the fact that you can’t get an essential vitamin from this diet rules it out, in my opinion.

Keto:  I don’t think there are any micronutrients you can’t get on a keto diet (although you are purposefully nearly cutting out an entire macronutrient).  However, because you limit fruits on a keto diet, it’s easy to end up with vitamin deficiencies if you aren’t careful.  As this article points out, “Thiamin, folate, calcium, iron, potassium, and magnesium are typically inadequate in low-carb diets.”

Again, I’ll agree that this doesn’t have to be the case for the keto diet.  I do believe you can get all that you need (even without supplementing as the article suggests), but it takes more care than a more varied diet, in my opinion.

Being vegan is a viable option for just about anyone in America today even with the B12 issue (supplements).  However, without our industrial food system, this probably wouldn’t be the case.  Michael Pollan points out in “The Omnivore’s Dilemma” that much of the land in New England, for example, is suitable for grazing livestock but not for growing crops (even in warmer months).

I can imagine this was an issue in many parts of the world before we could fly fresh produce in from Argentina or Chile in the middle of winter or to areas where good soil wasn’t available.  If we wanted to live a non-industrial vegan lifestyle where we aren’t dependent on fossil fuels to truck and fly in fresh foods, our choices for where to live would shrink dramatically.

As I said, this isn’t a problem for us today, but the fact that it would be a problem just 100 years ago tells me that it doesn’t make sense as the best way for us to eat.

Here’s a bonus reason for you to ponder.  I’ve been pondering it for just a few weeks now and I’m not even 100% sold on it, but it is an interesting thought nonetheless so I thought I’d run it by you.

We can think of eating as our only way of harnessing the energy of the sun for use in our bodies.  That’s basically what it is.  We can’t do what plants do.  Plants can directly convert energy from the sun through photosynthesis.  So, we rely on plants to convert that energy and then we eat them to get the energy.  OR…animals eat the plants and then we eat them.  Either way, the energy comes from the sun through plants first.

Here’s the part I’ve really been pondering though:

Grass is one of the most plentiful (if not the most plentiful) plant on the planet.  In the U.S. we have 4 times more grass than we do corn (which is our largest irrigated production crop).  Of course much of that is useless pretty lawns, but still.

Interestingly, we cannot digest grass.  We do not possess the ability to eat grass and utilize the energy it has produced through photosynthesis.  Ruminant animals can digest grass though (cows, sheep, deer, etc.).  These animals have something called a rumen (hence “ruminant”) that is designed perfectly for turning grass into protein.  Eating these animals is the only way we have to use the massive amount of energy obtained from the sun by the most common plant on the planet as fuel for our bodies.

Now, of course one could simply argue that we just aren’t supposed to use that energy to fuel our bodies and I couldn’t give any kind of hard evidence to say that isn’t true, but it makes me think.

Reasons 1-5 are enough for me to show why I’m not keto or vegan.  Reasons 6 and 7 are bonuses.  Take them or leave them.

In summary, I’m not vegan because the studies used to say that animal products are unhealthful are far too confounded and misused, there isn’t history to support the idea, and you miss an entire essential nutrient. I don’t promote keto because I feel that ketosis is not a primary mode of our blood sugar and fuel system (it is a part of a whole).

I’ve used a vegan cleanse program in the past that I’ve found to be very helpful.  I’ve also used keto diets with clients for short periods of time to deal with hypoglycemia.  I just don’t believe these are long term solutions for optimal health for everyone.

Based on the information I have, I believe the primary reason for the rise in disease and obesity is due to a departure from natural, whole, nutrient-dense foods.  We’ve industrialized and processed everything to extend shelf life, cut costs, and increase yield and it’s killing us.

The food guidelines in 90/10 are intended to be the first major step in getting away from those processed foods (one could certainly go further than our current guidelines).  This includes both animal and plant foods (and technically fungi too) in forms as close to their original form as possible.  The closer you can get to the original form the better.  In the future, we may develop a second step to help people get even closer to natural, real food.

This, in my opinion, is where health lies.  If you’ve come to a different conclusion through your research than I have in this blog, we’ll likely still support you here but we’ll continue to promote this ideal of healthful eating.

The Big Fat Surprise – Nina Teicholz

Nina’s book is not, by any means, the ultimate guide to nutrition, but it does give you an in-depth look at how we got to the low-fat guidance of the late 70s that gave us things like margarine and trans fats.  It’s a good book to read and get you thinking about how the food industry influences health advice.

The Omnivore’s Dilemma – Michael Pollan

This book is fascinating and eye-opening.  You’ll get a scarily detailed look at the American corn machine, an eye-opening look at a truly sustainable farm in Virginia, and finally a fun look at the hunter-gatherer from a modern perspective.  The first two parts of the book are specifically worth your time.

Nutrition and Physical Degeneration – Weston Price

I’m not all the way through this one yet, but Dr. Price’s insights into health through the world of Dentistry are underrated at best.

Robb Wolf’s review of “What The Health”

If you’ve watched the documentary “What the Health” and it made you think about going vegan, please read through Robb’s blog on the subject.  He’s a bit snarky and he is a paleo guy so he definitely has a bias, but we all do and he does a great job of dissecting many parts of the film.