Maintenance Phase - The Keto Diet

Episode Date: July 6, 2021

So long, root vegetables! This week, we dive into the strange and surprising history of the 100-year-old ketogenic diet. Along the way, we encounter a Victorian bodybuilder, an infamous podcast bro and the possibility of a bad Meryl Streep performance (!). Get in, loser, we're counting macros!Support us:Hear bonus episodes on PatreonDonate on PayPalGet Maintenance Phase T-shirts, stickers and moreLinks!What Is the Keto Diet and Does It Work? (NYT)The Ketogenic Diet for Weight Loss (Today’s Dietitian)Meet the Wackiest Billionaire Ever to Run for President (Money)Trailer for "First, Do No Harm"Keto Diet History - How the Ketogenic Diet Went Mainstream (Men's Health)7 Dangers of the Keto Diet | Health.com (Health Magazine)15 Keto Diet Side Effects to Know – Possible Keto Diet Dangers (Prevention)Ketogenic Diet May Lead to an Increased Risk of Type 2 Diabetes (The Physiological Society)Support the show

[♪ OUTRO MUSIC PLAYING [♪ Hello and welcome to Maintenance Faze, the podcast that butters your coffee. Ha'm Aubrey Gordon. If you'd like to support the show, you can do that at patreon.com slash maintenance phase. We also have t-shirts at T public. Both of those things are conveniently linked for you in the notes for this episode and at maintenance phase.com. And slight announcement.

This month's bonus episode is going to be a FAD diet spectacular. So we are asking our listeners to send us the wackiest FAD diet you've ever tried. We're gonna read a couple of them on the show and we're gonna do some extra research and cover sort of five or six of them in like a lightning round.

Yep. So if you wanna tell us the FAD diet that you tried, email us at maintenancephase at gmail.com and just put FAD diet bonus episode as the subject line and also let us know if you want us to use your name or like you super duper don't want us to use your name either one's totally fine. And as usual you can do that or not do that or support us or not support us. It's totally up to you. Look at that keep listening to

it anyway. Yes today Michael Hobbs we are going to be talking about one of our most requested topics, which is the keto diet. The keto diet. I was very disappointed because sometimes, you know, we do taste tests on the show. I was hoping for this episode, you'd like, make me go by a steak. I can just be here and eat meat by your tummy stuff. Look, get a steak. Put a cube of butter on top while it's still hot. Mike, I need you to make seven strips of bacon. I will say before we dive in, heads up this episode, it's going to be really difficult to talk

about this particular diet without talking about calorie counts, tracking macro nutrients, and that sort of thing. So if that's something you're not up for, this would be one to skip. And if it's something you are up for, welcome. If you're not up for hearing conversations about bread, this is the episode for you. Because we're gonna have zero carbohydrates

in this entire episode. So Mike, tell me what you know about the keto diet. Very little, honestly, because I've ignored this entire thing, because it's just the Ackins diet again, isn't it? It's like a much more restrictive version of the Ackins diet. The Ackins diet, famously easy to live on in a long time.

Yeah. So like, yes, it is like the Ackins diet and like Ed McMahon's diet book. And like, pretty much all the diets that we talk about fall into a handful of categories. One is low fat, which has heavy overlap with low calorie. There's another category that is low carb diets. There's another category that is like cleanses and sort of crash diets that are designed to be very short term. And then there's another one that is just like restricting food groups like nightshades or like restriction based on things other than macronutrients.

Right. There are only like four diets. But they all have utterly bananas origin stories, and that is what we're going to get today. What is your relationship with the keto diet? I have done the keto diet. Have you really? what we're gonna get today. What is your relationship with the keto diet? I have done the keto diet. Have you really? I sure have.

It's real hard. And my experience bear out what I found in the data, which is like any fucking diet, it works for as long as you do it. So where are we starting? Walk me through this tail of low carb, whoa. So the keto diet is high fat, low carb, and limited protein. Wait, what?

Yeah. What? I thought bros were all about like high protein. Gains, bro. What's up? What foods is that? It's high fat, but low protein? That's like, you can't do eggs or nuts, right?

It's high fat, moderate protein. Okay. You're basically limiting your protein and getting as close as possible to eliminating carbohydrates. If you know anybody who talks about tracking their macros, chances are they're doing that for the keto diet. I don't know anybody who's doing that because I don't know anybody because I haven't left the house in a year. Good for you. for you. So the classic keto diet is a four to one ratio. Four parts of your diet should be fat and one part of your diet should be a combined protein and carbohydrates. Okay, give it to me in like Denny's. Like if I if I walk into a restaurant, what am I ordering

if I'm on the keto diet? Probably coffee with butter in it. You're probably doing eggs, they have protein, but they're also pretty significantly fatty. And maybe, maybe, maybe you get a side salad, maybe, maybe you get like two or three berries on the side. So moons over my hammy, but no hash browns. And no toasts. Yeah, that's right. Vegetables are carbohydrates.

So you're also restricting the kinds of vegetables that you're having. What is the meat situation? Am I just eating like a ton of sausage? You can eat quite a bit of sausage. I mean, it's mostly like people eat a lot of cream. They eat a lot of butter. Okay.

Because of the way that the diet is sort of functions, people end up eating a lot of what are called fat buns. So like, you keep trying to get like shoe horn more fat into your diet. It does not hurt more than the Actions diet. Because in the Actions diet, you only had to remember one thing, like no carbs. So it's like, have a big Mac, but take off the bun.

Yep. Whereas with keto, it seems like you're trying to maximize fat. And then like, it's okay to have little bits and pieces of other stuff. It just seems like there's more of a sort of three-dimensional calculation going on. Absolutely. So there are some sort of mnemonics and some devices that folks come up with to help remember all of the rules about Keto.

So one of the big ones is folks will talk about like only vegetables that grow above ground. No root vegetables, no onion or very limited onion. No squash, even though that grows above ground, no like winter squash, right? Leafy greens are okay, but you do have to be careful about which ones you do. So like, Brussels sprouts, for example, are kind of like a yellow light food, but like spinach is fine. It's confusing, frankly. This sounds hard, I have to learn how plants grow. I'm not doing this.

People can sort of like do keto in this way that is like very like lots of salads, veggie heavy. They can do it in a way that resembles other weight loss diets. There's also a way that folks can do it that is like, I eat a bunch of keto branded bagged foods. I'll have bacon, I'll wash it down with diet soda, like that whole thing. That is something that folks who are keto devotees

will refer to as dirty keto. So they're like, you're technically doing it, but you're doing it wrong. I love it when diets start engaging in weird gatekeeping. As soon as you create something, it's like all of a sudden you have to say, like, you're not doing it right. That's the first thing to happen. Yep. Well, I mean, we've also talked about this, that quite a bit of the social aspect of dieting is like a performance of like this is the kind of person I am, right? Yeah, it's like vegan YouTube.

So the goal of a ketogenic diet is to enter ketosis, which is a real thing. It's the state in which your body burns fat for energy instead of burning glucose. And this is where the protein restriction thing comes in. burning glucose, and this is where the protein restriction thing comes in. Amino acids in proteins, especially in meats, can be converted into glucose and can sort of upset that balance. That's why it's so important to limit the protein part. And that's also a part that many people who are sort of casually on this diet,

don't do. I don't know that I have a good understanding of what ketosis actually is. Isn't it like your body going into like basically a starvation state where it starts burning fat? It's really wild. I have a quote for you from today's dietitian. Give it to me. Quote. Essentially, the ketogenic diet promotes a pseudo-fastened state. After three to four days of fasting or following a very low carbohydrate diet, the body deprived of dietary sugar and starch reduces insulin secretion and switches to primarily burning fat for fuel. The resulting overproduction of a CEDAL COA leads to formation

of ketones in a process known as ketogenesis. Whereas the brain can't use fatty acids for fuel, ketones can cross the blood-brain barrier, providing fuel to the typically glucose-hungry brain, as well as to other tissues. The transition to physiological or nutritional ketosis usually takes about a week. So it's basically your're depriving your brain of carbohydrates, which it usually needs. And then your body in response to that starts making this other kind of brain food.

Yep, called ketones. And it starts feeding that to your brain. And it takes about a week to sort of transition. Yes, absolutely. And it's not enough to have some ketones in your blood. You have to have a critical mass to get to ketosis. That's why there's this extraordinary restriction of carbohydrates. You're having less than one slice of bread a day.

And you're just having a ton of fat as much as you can. Do you think that when you were on the ketodiot, you got to ketosis? I thought so at the time, now knowing what I know about this diet. Like, they'll sell these ketone strips that you use for your analysis. What? Yeah, so you pee onto these strips

to tell you how many ketone there are on your urine. What I've read from the research is like, that isn't actually a measure of anything, because you shouldn't, like, it doesn't really matter if they're present in your urine, it matters if they're present in your blood. So the only way to really test for that is with a blood test. And most people don't get blood tests,

and most people kind of fudge the diet because it is so extraordinarily restrictive. So what ends up happening is that folks are maybe in ketosis, probably not, and are just eating a shit ton of very fatty foods. You know those photos that you know aren't photoshopped, but they look photoshopped? Yes. This sounds like a similar thing where I know it's not fake,

but it sounds fake. Like, there's these magical ketone elves in your blood and they're feeding your brain. It sounds like something from the never-ending story. I feel like a YouTube commenter on all of this, just like fake gay. So do you know where the ketogenic diet comes from? No, none whatsoever. It does not come from weight loss, not by a fucking long shot. It does not come from weight loss, not by a fucking long shot. The ketogenic diet was developed as a modified form of fasting.

That's where the sort of pseudo-fastened state comes in. And it was developed in order to treat epilepsy in children. Oh, interesting. So fasting since ancient Greece for hundreds and hundreds of years in many societies, fasting had been used as a treatment for epilepsy, and it seemed to work, particularly in children. But the challenge with that treatment

is epileptic people still need to eat. Ah, footnote, after-isk. So the first time anyone tested and studied fasting as a treatment for epilepsy was in 1911. It was in France. Epleptic people were put on a very low-calorie vegetarian diet, which included phases of both fasting and of purging. So we're in like full eating disorder territory here. Fasting and purging. Of the 20 patients who took part in that study, two of them showed reduced symptoms, and the rest of them, about half of them ended up falling off of the diet altogether,

because it was so incredibly restrictive and hard to stay on, right? So a 90% failure rate. 18 out of 20. Okay. But also, if you're talking about epilepsy and you're talking about people who are having up to 90 small seizures a day, you can imagine there are a lot of things that you would do. Right. You would be up for a lot of things to treat that. In the early 20th century, there's sort of a big boom at that time in what we would now call sort of like wellness stuff, right? The early 20th century is when we get Coca-Cola, which is like considered sort of a health beverage at the time, it's where we get breakfast cereal, post in general mills, which are considered health foods at the time.

It's where we got health spas. Yeah, I saw a documentary about that starring Matthew Broderick. The sausage king of Chicago. Yes, Matthew Broderick. The sausage king of Chicago. Yes, Matthew Broderick. So by the 19 teens and 20s, fasting in particular is being popularized for everyone by a couple of doctors who are disciples of this guy who is absolutely not

a fucking doctor whose name is absolutely not a fucking doctor. Whose name is Bernard McFadden. Okay. He was born Bernard with a D at the end, but he liked the name Bernard with two R's at the end, because he said it sounded like a lion roaring. What? Surprise. This is now a mystery episode,

at least just for a little bit, because I found out about this guy, and I was like, sorry, we're talking about this guy for a while. Deep dive. He is fucking bananas. He is a wild ride. So, Burnarmic Fadden is credited as being kind of like

the godfather of physical fitness culture in the US. He is a sort of early American bodybuilder. He's considered, I think, a precursor to folks like Jack LaLane and Charles Atlas. He didn't have formal training in fitness or nutrition. But in 1899, he founded this magazine called Physical Culture, which was sort of like a proto-men's fitness. It was also a little bit like Oprah Magazine

because he was on almost every cover. Nice. And because almost every story was illustrated by photos of him. And actually, I'm going to send you a couple of these photos. Okay. Oh. Oh.

Oh. Wow. Okay. So you sent me the one where it looks like he's wearing a diaper first. I feel like he did that on purpose. I mean, they all look like he's wearing a diaper. Oh my God. He's wearing these weirdly high waisted underpants, basically.

So we've got a photo of this white dude who looks to be in his mid-forties or something. Yup. And in one photo, he's wearing a sort of a jock strapping, but it's like a jock strapped with a girdle. So it goes up, past, almost past his belly button, and it's sort of holding his waist in, and then his junk looks upset. It's all packed in there.

And then in the other one, he really looks like an adult diaper. Yep. And he has a sort of like Joe Pesci kind of looked to him. He does have a Joe Pesci look to him. I can also tell from his proportions that this is a short king. It's also a really interesting look, I think, at sort of like, what are the muscular ideals at the time? Yes.

So he's like a dude who has, I would say, fairly muscular legs, fairly muscular arms, not really pecs. Yes, and sort of a little bit of abs. It's also, yeah, the beauty centers for men are so fascinating because they've grown up around sort of the invention of fitness culture and the invention of gyms.

And so previously like fit men, quote unquote, they didn't have like giant pecs, like they didn't look like the rock because the techniques of going to the gym and specifically working out like that didn't really exist then yeah you were doing a lot of calisthenics and sort of more gymnasticky techniques yeah I mean looking at these photos other than the pose that he's in you wouldn't necessarily think like this is obviously a fitness guy right you're like, yeah, he seems like a fit enough guy, but that's not like the first thing you notice about him. The first thing you notice is the diaper.

Yeah, this is the pre-he-man era of men's musculature. So what I'll say about McVaddon, oh, there's so many things to say about this guy. He started this magazine, physical culture. He then started one called sport, which was kind of like a proto sports illustrated. And he had the wildest fucking takes. I have a quote for you from Money magazine. If you're ready to hear it. McFadden remained obsessed with health,

both his own and the nations. He issued coffee, alcohol, tobacco, white bread, hats, bad for the hair, and often shoes. He opposed vaccines apparently due to a bad experience he'd had as a boy and expressed nothing but contempt for the medical profession which returned the compliment. He was a big believer in fasting, milk drinking, high fiber food, lots of chewing, sleeping on hard floors, and of course, Bernard McFadden.

By following his own advice, he believed he could easily live to 125, possibly 150. I feel like some of the people that were taking his diet advice should have been like, wait a minute, this guy is against shoes. Maybe some other stuff that he's saying also isn't super credible. Hats are bad for your hair! I mean so much of this stuff has the same sort of masculine, like let's puffing up our boys,

you know, society is getting soft. All that sort of like sleeping on a hard board on the floor. It's just like discomfort for discomfort sake. Absolutely. There's always like a weird morality wrapped up in this. Yeah, and it feels like not dissimilar from sort of health and wellness trends now, right?

But there's like this belief that like, celery juice works more because it tastes like garbage, right? Yeah, it's also just like totally a scientific, right? Like there's this belief that celery juice works more because it tastes like garbage, right? Yeah, it's also just totally a scientific, right? Like there's not really data on not wearing shoes. Sleeping on hard floors? Yeah. Well, though we did get those tow shoe running shoes. Oh my God.

10 years ago, do you remember those? Dude, the worst date I've ever been on, I made the mistake of criticizing those shoes. And now that I've 15-minute monologue. I'm uninterrupted. Wait, what was the headline of the monologue? They're good and you should shut up. Ha-ha-ha.

So, in addition to all of this, he ran a little sort of wellness empire, including a chain of what he called health atoriums, where people could go and get trained up on his like real garbage health takes. He opened one of New York's first vegetarian restaurants, which included a bunch of raw food options. He started a couple of sort of military-style boarding schools,

focused on physical education. And they were advertised, I believe in the New York Times using the slogan, to meet the needs of a nation at war. Was it M-E-A-T? To meet the needs? That would've been lit. So basically McFadden and a number of other

sort of like health and wellness dudes, they're all dudes, are promoting fasting as being generally a healthy thing to do as much as you can. And that popularization of fasting broadly set into doing some more studying of fasting as a treatment for childhood epilepsy in particular. So he's a fasting guy, not a keto guy. That's correct. He's a fasting all the way. He's like, just stop eating food

and you'll live 250 is essentially his vibe. The initial sort of theory behind why fasting worked for childhood epilepsy was that it caused dehydration. That sort of got disproved. Then they thought maybe it was acidosis, which has increased acidity in the blood. That kind of got disproved. And within a few years, they pursued this new theory

of ketosis. Basically, the folks at the Mayo Clinic figured out that the body didn't need to fast completely. It just needed to enter this sort of state of ketosis, and that appeared to be the mechanism that kind of reduced these seizures. Right, so what they're looking for is the effective fasting, but something sustainable, because obviously you can't just not eat forever. So the Mayo Clinic runs the first trial of the ketogenic diet in 1921.

Their findings at that time was that a strict ketogenic diet reduced seizures in 95% of epileptic kids, which is kind of incredible. It's still on the books as a treatment and it's still something that folks use. It's popularity kind of takes a dip in the late 30s when they discover and sort of introduce more effective anti-convulsive drugs. Prior to the sort of late 30s, the only anti-convulsants were like really heavy-duty sedatives, like phenobarbital.

So if you're taking an anti-convulsive, you are also asleep for 24 hours. Just like that, right? And because the ketogenic diet had this really specific use, that was kind of the end of the diet for decades to come, right? Some people still used it as a treatment for epilepsy. If that epilepsy was like drug resistant

or their kid didn't do well on the drugs, they would go, okay, ketogenic diet. But it really sort of died out until the 1990s. Oh. We're going to go on a little Hollywood interlude here. Oh. It's fun. The number of characters in this story is really through the roof.

Is it going to be popularized by Mel Gibson or something? You're so close. Oh, God. There is a movie producer called Jim Abrams. It's 1992. His son Charlie has been diagnosed with epilepsy and he's looking for treatments and looking for treatments and looking for treatments.

And he goes back through old literature and sees reference to old studies at Johns Hopkins and at the Mayo Clinic about the ketogenic diet. He puts his kid on the ketogenic diet and says that within a matter of weeks, he fully stops having seizures. Okay. So he starts this foundation called the Charlie Foundation for ketogenic therapies around this time because of who this guy is who's like relatively prominent. Date line does an episode on the ketogenic diet as treatment for epilepsy.

Oh no. And there's quite a bit of public interest in response to that. So Jim Abrams, being a movie producer does not stop there. He directs a movie about his family's experience. And that movie was lethal weapon part four. So in February of 1997, ABC airs this made for TV movie called First Do No Harm. Okay. I'm not going to say anything about it. I will just say I live for a trailer for a 1997 made for TV movie. Oh yes. And you and I are going to watch one.

Oh please give it to me. You and I are gonna watch one. Oh, please! Somebody help us! This is Dr. Neves. He knows a lot about epilepsy. Epilepsy? When modern medicine can't find the answer, maybe he's going to die. How much suffering would you endure? He's in status epilepticus. He run an overwhelming rest with permanent brain damage. Even death.

That's the choice. There's something wrong here. There's something really, really, really wrong. How far would you go? Matt, Matt, excuse me. Do you know what would happen if he hadn't stopped you? I'm a son, mother. The institution can petition for legal guardianship

of any child who's interested in well-being they feel aren't being served by his parents. Well, what if I feel that his interests are not being served by the institution? I've been doing some reading, and I've come across a treatment for epilepsy. She needed an answer. They took 58 sickest kids, put them on the ketogenic diet,

and almost a third of them had their seizures go away. There's absolutely no scientific evidence this diet works. I'm just doing what I think is right. What you found? Yeah, you're good! I think he's coming back to a state. Was a miracle. First, do no harm.

Okay. Tell me your reactions. I have never said something like this cancel the on the show before, but Meryl Streep is not good in this. She's bad at acting in this and I don't know why. I will also say, I feel very uncomfortable. Allison Janney is a meme doctor. Right. Very intense.

Well, there's Janney being in this. So here's the interesting thing about this is that there's this whole throughline of like modern medicine, doesn't have the answers, and blah, blah, blah. And it's like, no, no, this was medically studied. There is evidence. Right, it's weird because they're saying

there's no evidence for this, but what she's holding in her hand, the piece of paper is literally evidence. It's a study from Johns Hopkins. Clearly, this is like a deeply, deeply, deeply personal project for Jim Abrams. I have no concept of what it's like to be a parent to an epileptic child, and I have no desire to like dunk on that.

Here's what I will say is a little bit funny about the background story here. Jim Abrams is not at this point known for writing and producing and directing dramas. He is known for writing and producing and directing dramas. He is known for writing and producing and directing comedies. Oh, is he Zucker in Abrams? You got it. Did he do airplane? He wrote airplane, top secret, the naked gun, hot shots, part D D and scary movie four. I didn't know it was that Abrams, oh my God. Uh-huh.

Also, Meryl Streep in the performance of a lifetime was nominated for a Golden Globe and an Emmy for this performance. Okay, I'm clearly incorrect about my read and consideration from this trailer. I mean, I will say, okay, circling slightly back to not wanting to dunk on people who are like trying to do the best for their kids.

Yes. Like, it seems like what he's done is totally understandable. Yeah, totally. But then, sort of, it seems like the issue here is when these stories get turned into TV, ready, Meryl Streep, ready narratives, then it's like they have to play up all of the conflict. Like they have to make it seem for the sort of third act triumph. Right. They have to make it seem like the entire medical establishment was against her, and they

were going to put her kid in jail and like take him away. And like play up the degree to which the medical authorities were opposed to it. Those kinds of triumph over medical adversity stories end up getting into the public bloodstream and just planting this idea that doctors don't actually care what's best for their patients. Right. That plus mean doctor Alison Janney really feels like a real, now that's what I call maintenance phase kind of moment. Right. Where you're like, doctors are mean and they don't care about you. And you got it, like, you know best, like they don't know shit. Right.

It didn't feel like this was like a thing that had happened and that he was sort of documenting in this way. It felt like we need a plot for this movie that is more than I did some research and I found this and it worked for my kid. Yeah. Essentially, what happens from here is that this leads to this major spike in research around the ketogenic diet as treatment for epilepsy. So there's a study that comes out in 1998, once again, from Johns Hopkins University,

they published an update in 2001. This was a larger study. There were 150 participants. And basically, their findings were a more modest version of what had been discovered in the 20s, that the diet could reduce seizures in epileptic kids, but that the biggest stumbling block was just being able to stick to a very restrictive

and often very costly diet, right? So after a year of this study, almost half of their subjects had dropped off of the diet. So they could be measuring. They could be measuring. It's effects, because folks couldn't stick with it. It's like a metaphor for all diets, right? That whether or not they're effective

is kind of secondary to the fact that most people can't maintain this level of restriction over the long term. So it's almost like irrelevant whether it works or not, because like no one's ever going to be able to do it forever. Totally. So currently the ketogenic diet is approved for use by the NHS in the UK. It's covered by many US insurance plans. It's pretty mainstream.

Although it's usually these days considered sort of a last resort for kids with drug resistant epilepsy that sort of you get to drugs before you get to a dietary sort of fix. They know that it works, but they don't know why it works, and they don't know why it only works for some kids. Like why it isn't sort of universal applicable. It's like why do some people fart on a lester and some people don't? Basically. It's exactly like that.

Yes, thank you. I needed that to tell me understand it. Here is where things take a turn. We've got this, like, you know, the lion's share of a century. This diet has been specifically for children who have this one specific health condition. Right. And something happens where it sort of takes a turn into weight loss land. It turns out all those kids are thin and fit, look and amazing.

They're ripped. Yeah, these ripped ass kids. So, low carb diets had already been a thing. As you noted, we had like the Atkins diet, the first, Dr. Atkins first book came out in 1972. There was a big wave of popularity then. There was another big wave of popularity of Atkins in the sort of like late 90s early odds.

There is in 1976, there's another low-carb diet comes out called the last chance diet, which is a real creepy name. So this is a quote from Men's Health magazine. In 1976, a ketosis leveraging method called the last chance diet took off. ketosis leveraging method called the last chance diet took off. It's rule, you drink a fat and protein rich concoction until you lose your desired amount of weight. Oh. The diet's creator, osteopath Robert Lynn, sold $40 million worth of his elixir.

But you were also supposed to have a physician's supervision to ensure that you were getting the necessary vitamins and minerals. Few people did. Robbed of minerals, your body can't perform certain functions, like sending electrical impulses to your heart. Oh. As a result, the last chance diet contributed to the deaths of at least 60 people.

Oh, what? The Fallout included new regulations, a negligence lawsuit for Dr. Lynn, and research on ketosis being banished to academic Siberia. Wow. Well, yeah. You kill 60 people. People aren't gonna cite your publication, Chad.

Totally fucking wild. The entire paradigm of that is ridiculous. Drink a shake until you reach the desired weight. Okay, great. Then what? Right. You're gonna go off the shake and you're just gonna gain all the weight back because that's what bodies do.

Or you're gonna stay on the shake and you're going to die. And you're gonna die. Like fuck, dude. Those are your options. There is this sort of like false economy of like thin people thinking that the mechanisms to lose 10 pounds and the mechanisms for fat people to lose 100 pounds

are sort of the same. So they're like, you just do it more, right? So because of that kind of phasologic, which I get how folks get there, there's also like, I would bet you money that a lot of the people who died were fat people, right? Right. I also, I should say, I have people in my life

that have been on low-carb diets for years. Sure. I think most people, they sort of started doing it on during the Atkins wave, and have ended up adopting a modified version of it that more fits in with your life that you have to go to social events and you have to be a person and eat at restaurants sometimes.

I don't think anybody can maintain the amount of restriction that was prescribed by Atkins or Keto, but it's like some modified version of just like eating sort of, I don't know, half or a quarter of the carbs that most people eat. Like that is actually a lifestyle that works for people. Yeah, totally, and that's like fine. If you want to eat less bread or less pasta or whatever.

Of course, like, you know, however you want, eat whatever you want. I mean, like the number one sort of gateway into disorder eating and full on eating disorders is diets. So like, that's the other thing to know is I think people have this idea that like a diet is just sort of a benign thing that you do for a while and that there aren't really consequences to it. And as we will see, like, there are really significant consequences to diets broadly, but to this one

in particular, fucking tread lightly. Yeah, especially when we're talking about kids. Yes. I don't know. That's always the scariest thing is people, people, anybody under 18, but especially like little or kids. Sorry, you don't like experimenting on children? I know.

Interesting. So, the sort of turn into keto specifically around weight loss really starts in 2013 and continues throughout the sort of 20 teens. Oh, we're getting to the Instagram chapter of the story. Oh, buddy. It's not Instagram. Ooh. It's actually podcasts. What?

We're the real enemy, Mike. That's right. That's right. Maintenance base comes out. Podcasts are trash. Do not believe anything you hear in your ear, buddy. Basically, there is a study published in Science in 2013. There's a press release sort of attached

to the release of this study. And the press release says that the keto diet can, quote, slow the aging process, and may one day allow scientists to better treat or prevent age-related disease, including heart disease, Alzheimer, and many forms of cancer. Wait, this was in Science?

Yep, this sounds like some Dr. Oz citation needed shit. So this, of course, shit like this, catches the ear of a bunch of biohacker kind of dude bros. Mm-hmm. The first and at the time biggest person to get on board is Tim Ferris. Oh no, as soon as you said podcast, I was like, oh, don't let it be the six hour work week guy. There it Oh, no. As soon as you said podcast, I was like,

oh, don't let it be the six hour work week guy. There it is. Four hours. How dare you? I was able to do this. Okay. Yeah. Yeah. Do you want to say something about Tim Ferris for folks who are for the uninitiated? I mean, among us.

I just associate him with the TED talkification wave between 2000 and I want wanna say like 2015. I think it was before any of the sort of very realistic cynicism about technology that we all have now really kicked in. It was a time when you could just say stuff like all college will be online in 15 years or like all cars will be self-driving in five years.

You could just say stuff like that. And people would be like, yeah, that sounds about right. Tim Paires, whose podcast I've never listened to and like I'm sure he's a nice guy and I'm sure he means well, he was kind of part of that wave. There just was a decade there where there was just a lot of like pop science coming out

that people just bought hook line and sinker. Yeah, it was an era of like science telling you what you want to hear. Yeah. And you being like, that sounds great. Moving on. But yeah, it sounds like this would very much fit into that framing because a lot of the science stories we heard at the time were very like silver bullet-ish and something like

the keto diet. Like, we already know what the ideal diet for humans is. We already know the way that everybody can lose weight, we'll solve the obesity epidemic. We have it right here. Like, it just seems very tailor-made for that time and that platform. Yes. Tim Ferris has this doctor on, Peter Atia, who makes kind of a hell of a pitch for the benefits of a ketogenic diet.

A little bit after that, Tim Ferris has Dr. Dom Dagostino on, who's a professor of pharmacology and physiology. He's one of the biggest proponents even now of a ketogenic diet for kind of anybody. At that point, Tim Ferris has about a million listeners each month. So the diet starts taking off as sort of a weight loss thing, but also sort of like an optimization thing. As we've said, science communications is hard. And there is a particular way in which Tim Ferriss's show kind of beefs it. Here's a quote from Men's

Health magazine about the episode with Dr. Dagestino. It says, quote, Ferris told the story of a friend with testicular cancer who would fast for three days entering into ketosis before chemotherapy. Oh my fucking god. Dagestino. Just wait for it, buddy. Dagestino noted that anyone with cancer needs medical supervision of their diet, but also said, quote, if you put your physiology into a state of fasting ketosis, that puts

tremendous metabolic stress on cancer cells that are highly dependent for survival and growth on high levels of glucose and insulin. By subtracting them from those growth needs, they can die and you could potentially purge yourself of some pre-cancerous cells. Ugh. I hate this shit. There's always this like perfunctory,

like no, I'm not saying it's gonna cure cancer, followed by basically it'll cure cancer. And then if anybody calls you on it, you're like well, I never said it was gonna cure cancer. But like, of course, that's the impression you're leaving people with. Dr. Dagestino now says cancer is, of course, like, much more complicated than just, like, starved of sugar and you'll be fine, right?

Really? But this, like, particular episode is released with the title, Dom Dagestino on Fasting,etosis and the End of Cancer. Oh, fuck, right. So there is a pipeline from Tim Ferris to other garbage podcasters. Do you want to take a guess? Oh, I know we're going to need a Joe Rogan appearance in the subcutaneous.

No, it. Next up. Tell me what you would say for the uninitiated. I'm thinking particularly of folks listening in other countries. What would you say about Joe Rogan? Uh, Joe Rogan is a actor, stand up comedian, commentator guy who ended up starting a podcast and has become, I believe he's the most popular podcaster in the country. He does, I think like four or five episodes a week, like he's unbelievably prolific, and he has guests on who some of them are really good. Like he has like smart people on,

and then he also like every fourth guest is just like a fucking crackpot, and he doesn't like really push back. Yeah. So just have like Alex Jones on, who's like, yeah, like the aliens are shooting lasers at us, and Joe Rogan's like, oh, interesting. Wow. Yeah, I'm like Jordan Peterson or whoever right where you're just like, no, why? I know. Why are these the dudes? And also he's very, very popular with like a specific tranche of dudes who are probably 18 to 34 straight white lean conservative, but don't necessarily identify as conservative. There's like a massive group of like this type of bro in the country who really like a show.

Yeah, I would say folks who say, I don't really subscribe to a particular political party. I like to think for myself. Yeah, yeah, yeah. So according to Men's Health magazine, at this point, Tim Ferriss had a million monthly listeners, Joe Rogan had 30 million monthly listeners. Christ. Rogan also has the same guy, Dom Dagestino on, but it's the first of many guests that

he has on to talk about keto diets. Some of them are doctors and researchers and other scientists, but a lot of them are like athletes and sort of biohacking, bro, God, that's right. And all the while, you can pretend that all you're doing is asking questions. It's this built-in defense mechanism where it's like, well, we're not necessarily saying everybody should go on the keto diet, we're just dedicating hours every month to saying, well, will it improve sports performance? Will it cure cancer?

And so the amount of attention that you're placing on this one very specific thing is in many ways like more important than what you're actually saying about it. Totally. So it also, I will say, is like astonishingly marketable. Yeah. Here's another quote from this great men's health piece. Within a year of the Rogan podcast, Orion Research estimated keto as a $5 billion industry. And because people on keto often lack nutrients like vitamin C, magnesium, and fiber, there's been a supplement gold rush for brands behind products that make staying

on the diet easier. So it's a diet that seems a little bit faddish. We have a turn for this. So what do we have? Some sort of pithy phrase that we use when diets peak in interest. I will say I did some searches for Joe Rogan Keto just to see sort of what's out there.

And the like top responses were Keto, food, and supplement brands who've done some SEO being like, were Joe Rogan's favorite keto supplement? Sure. So, overwhelmingly, the responses were folks figuring out how to market their product around Joe Rogan in particular.

It's also the perfect fad diet structure because it's like cleanses. It's almost impossible to maintain. Yes. So people are going to end up breaking the rules because they can't handle it. And then it's never the diet that failed. It's you who failed.

That's right. That's essentially how we get to today, right? Is it becomes this big thing amongst men ages 18 to 34, which is an extraordinarily desirable advertising demographic. It sort of blows up as an industry and it becomes one of the most popular diets in the United States. Is that where it is now? Is it still, has it crashed or is it still peaking?

It's still up there. But what is often missing from conversations about the keto diet, even in the research, honestly, is discussion of sort of the risks of the diet. Yeah. The laundry list of considerations is sort of astonishing. So I found a bunch of research and a bunch of popular media articles that were like, here are like three or five things to know before you go on the keto diet. All of those listed different things. Like here are like three or five things to know before you go on the keto diet.

All of those listed different things. And almost all of them said, you don't really have to worry because you'll be losing weight and that what matters the most. Oh my God. Including in the research, like including researchers are saying like,

it's not that big a deal because you're losing weight and really what you need to do is lose weight. Nice. So here are the things that they're saying are not that big a fucking deal. The first one that folks do talk about quite a bit more is something called the keto flu.

Is this a phrase you've heard before? No. The sort of theory is that this is sort of, like you get run down while your body is figuring out how to operate without glucose. Side effects include dizziness, fatigue, headaches, nausea, vomiting, insomnia, lowered tolerance for exercise, lethargy, and constipation. Another one that folks talk about a fair amount is bad breath.

Folks will describe it as being kind of fruity, but like bad fruity. Bad fruity? Doesn't even look like me in high school. I was going to say that's how I identify bad fruity? Those people call me in high school. I was gonna say that's how I identify bad fruity. There is also a phenomenon that is mostly anecdotal so there hasn't been research into it, but I wanted to include it because it's so gross. Is that it?

Thank you. You're welcome. I know what you like, Mike. And you like talking about vaginal odor. Oh, while the smell stuff? I don't get it. There are these sort of anecdotal reports of something called keto crotch, which I hate.

And that is essentially like people with vulvas reporting that they have vaginal discharge that has a stronger and more unpleasant smell. So are we learning this whole time throughout human history? Carbs were what kept our junk fresh That was it like now. No Just use them as air fresheners just like dangle a bagel I knew there was a reason for carbs in addition to losing fat on the keto diet

folks will lose muscle mass. So folks do lose fat, like lose body fat, but they also lose more muscle mass than on other diets, which is really interesting to me, given that it is sort of popularized by like shred bros, like Joe Rogan, right? But keep in mind, they're also disgusting to make out with, or go down on. And let's our chicken be irritable and maybe vomiting. So, in addition to all of this, the keto diet has been linked to really significant liver, kidney, and gall bladder problems. Because all three of those things are processing macronutrients in your body and all three of those things

can get really fucked up by radically changing how much work they have to do. So if you have any liver issues like fatty liver disease, like cirrhosis, like whatever, adding so much fat to metabolize could make those worse. And if you don't have them, it can increase your risk for future liver issues. Your kidneys metabolize protein. So when folks don't get those sort of protein balance, just right, the keto diet can cause

major kidney issues. It can also cause kidney stones. Those hurt. And your gall bladder is responsible for producing bile to break down fat and eating that much fat, especially abruptly, can overwhelm it. Holy shit. Yeah, so it's real rough. Like these are serious side effects that are for keeps, right?

Like those are long term issues. On top of all of that, the keto diet is one that is very low in fiber because you can't eat beans, you can't eat grains, you can't eat a lot of vegetables. So that can cause both constipation and diarrhea depending on which direction your body goes with it. So either way, you're going to have weird poops. It can lead to mood instability and reduce cognitive function, again, because your brain needs sugar to function. And the last one, which is fucking wild as shit,

is that it has been linked to an increased risk of diabetes and heart disease. Oh my God. This is one of those moments where it's like, oh cool, we're throwing everything out the window for the promise of weight loss, right? There's one doctor in a piece that I read who called it a cardiologist nightmare. Do we have a sense of what it does to be on this ketosis for a long time?

Yeah, we don't really. In part because this level of popularity is very new, right? We're talking about the last six years' tops. I mean, luckily nobody can do it for very long. Totally. That reduces the risk that no one can like last more than a month or two on this. So almost all of the research, what they found is that it works well for weight loss for somewhere between two and six months.

Oh, and then after that, it kind of levels off and performs the same as a low fat diet or as like any other diet that you might go on, right? And like, it's the same kinds of numbers that you see from those diets, right? It has a bunch of that splashy, like it works twice as well, but it's like instead of three quarters of a pound lost in a month, you'll lose a pound and a half. There is also, according to prevention magazine, keto can increase the likelihood of eating disorders and particularly of binging behaviors. Yeah, that makes sense. Yes, totally. So this is from Prevention magazine, quote, cutting out carbs can cause the brain to release a chemical called neuropeptide Y, which tells the body that we need carbs.

When we don't get those carbohydrates, our body needs, this chemical builds up and can intensify cravings, which can increase the risk of developing disordered eating patterns. It has nothing to do with not having enough willpower. It's more to do with the body's biological response to deprivation, says Laura U, a registered dietitian. Yeah, I mean, there's a reason why we have these three

macronutrients, and like most, you know, there's vast diversity between diets around the world, like different world regions, have different crops, but the ratio of these different macronutrients is like reasonably consistent, and there's probably like a biological reason for that. Yeah, there totally is. And this level of fixation on which food groups you can or can't eat for optimal health and for weight loss and all of that sort of stuff is in the scope of human

history, like extraordinarily recent. Yes, yes. So here is the final side effect. Are you ready? Early death. This is a quote from Health Magazine. Quote, a 25,000 person study presented at the European Society of Cardology, Congress, suggested that people on the lowest carb diets had the highest risk of dying from cancer, cardiovascular conditions, and all other causes.

A weird. Another study published this month in the Lancet also found that people who followed diets that were low in carbs and high in animal proteins, typical of the keto diet, had a higher risk of early death compared to those who consumed carbs in moderation. Yes, but most of that risk is because they're listening to Joe Rogan and they fall off of a ladder. There's not paying attention to those surroundings.

It was really overwhelming to me to look at these. Aside from Fenn Fenn, we have not looked at a diet or a cleanse that has been like one of the side effects is you might die from like four different things right right it's kind of fucking bananas I know it's funny compared to the Halo Top episode where it's like the worst thing was that the ice cream was just okay like you know might not be as good as briars. Yeah, that's exactly right. So US News and World Reports every year ranks the best and worst diets for overall health via a panel of doctors and dietitians and other healthcare providers. They ranked 39 diets last year. Keto was ranked number 37. Oh, wow. What was the best diet? So the number one diet is the Mediterranean diet wow. What was the best diet?

So the number one diet is the Mediterranean diet. Number two is the dash diet. A number tied for number two is the flexitarian diet. So basically the diets that like allow you to live a semi-normal life are the ones that are the most sustainable. Shock horror. And the ones that include pretty much every food group. Right. The other thing that I will say that we haven't really touched on much here is, and this is just anecdotal from my own personal experience on this diet.

I was astonished at how costly it was and how time consuming it was. Yeah. Because you can't really get food at restaurants because you don't know for sure what they're putting in their burger patty. Do they have fillers in there? Do they have bread crumbs to bind it or egg or whatever? You have to prepare your own food overwhelmingly. And that food is fucking expensive. My grocery bill just about doubled.

Yeah. So it could be the skeleton key for all kinds of things. It probably isn't, right? But even if it was, like, you would then have to grapple with, okay, we already know that minority stress increases the risk of almost every disease. So the people who are the poorest and have the greatest barriers to accessing basic needs in their life are at the greatest risk for those disease. How are they going to pay twice as much

for a diet that they can't stick to and that most research says you should probably only stay on it for two to six months. And that's before we even get to the cost of all the febri's for your crotch. Yeah, your summer's Eve bill is gonna be astronomical. And then like the last thing I would say on all of this is like fucking Joe Rogan likes

it. Yeah, Jesus Christ. And do you really want to agree with Joe Rogan on like anything? I don't really. Anything that sits adjacent to like an hour and a half long conversation about race and IQ, you should probably just like discard on its face. Right, versus us having a two hour and 15 minute conversation about the keto diet.

I know. But like, yes, totally, right? Like, don't, that's not the guy. So if you're on, I was gonna say, so if you're on the keto diet, stay on it, but no. If you're on the keto diet, stop. I mean, listen, I'm not here to tell you, don't eat the keto diet. And even if I did, fucking class house, I did it.

This is a place where it's really worth sort of digging in on what the actual research actually says and like straight up like doing your own research into some primary sources. And also, anyone who is trying to sell you on this diet, first check whether or not they are wearing shoes. That's the first place to go. Thank you. you