An online conversation with a "keto" person

I began by responding to one of Dr. Hyman's Vlogs:

thusly:
Presenting only one side of the type 2 diabetes reversal story "masks" the true cause of insulin resistance, which is "intramyocellular lipids", or more simply, a high fat diet. With a high fat low carb diet insulin resistance in not reversed, it is simply not activated. Type 2 diabetes is also reversed with a low fat high carb diet, ideally a nutrient dense WFPB diet. This approach also has several advantages over the high fat low carb diet: 1.completely eliminates insulin resistance as a factor, meaning carbs are "tolerated"... inadequate language, but we are "stuck" with it for the time being at least (glucose tolerance test). 2.nutrient density (without supplementation) is achieved quite easily. 3.cardiovascular disease is also easily reversed (work of Ornish Esselstyn and increasingly many others). So it begs the question: both "keto diets" and "nutrient dense WFPB diets" reverse type 2 diabetes - which is the more effective (healthier) approach? I think it's pretty obvious the cardiovascular disease factor, not to mention the many other factors that arise in the destructive conditions of "post-industrial" diets, answers this question conclusively. And I am sure you (Dr Hyman) must certainly be aware of these factors, so why do you promote the less effective approach? I for one would like to see you and other "keto" promoting MDs address this "elephant in the room" publicly at some point. I feel your credibility is damaged otherwise, with a level of damage that increases over time as the facts become more obvious to more people. Thank you for your consideration of this important question. Respectfully,

To which Michele replied:
You need to do your own exploration of research, you are repeating a long standing approach which has failed. Failed because the “hook”, high carbohydrates, that leads people into the disease process simply cannot be resisted by 80% of the population long term. Thus the yo-yo dieting that is a very common result. There is a test for insulin response, HOMA IR....it simply isn’t being implemented. Further, periodic sampling of blood glucose does not get to the root of ongoing damage, which is the constant insulin spiking which is a hallmark of most modern lifestyles, regardless of diet composition. The theory of fat blocking entrance of glucose into the cell because it blocks insulin’s effectiveness is also out dated. It is a combination of reduced insulin stimulation over time that restores health to the entire system. We know what stimulates insulin, meals, carbohydrates, stress. I would advise everyone, do not start with an ideology, follow the evidence. When it comes to “evidence “ be aware of the methods used, the funding source and how invested the egos involved are. I most often now turn to European and Scandinavian research which has far less for-profit influencers in the mix. It’s evident that pre-industrial, pre-agricultural humanity was well adapted to quickly use both glucose and ketones as fuel sources. The ability to do so allowed survival in the huge variables of environment, this is how humanity survived. A long term adaptable and sustainable approach for a healthy individual may well be to return to that status. Eat less often, periodically cycle fuel types ketones/glucose. But first, you must survive to fight another day! Longevity for many is a secondary question when they are in immediate health danger.

And then me again:
we are talking past each other. I agree with most of what you say about the mechanisms of disease, but you seems to be unaware these mechanisms simply do not occur in a properly designed high carb low fat diet. Neither do you seem to be aware that diet is more effective in reversing type 2 diabetes, and even in managing type 1, than a high fat keto diet. You do have a point in that most people have no idea what a properly designed high carb low fat diet looks like, ask people to name a carb and they will say pasta. The properly designed diet is whole fresh fruits and vegetables, no refined, fractionated, concentrated food like substances at all - no sugar, oil (another empty calorie), or salt (which stimulates overconsumption in addition to the induction of hypertension and a host of other problems). And BTW, the WFPB diet is not necessarily vegan, animal products in moderation are allowed, and perhaps even better than a strictly vegan approach. After all there has never been a vegan culture as far as we know, but the longest living and healthiest populations have all followed high carb low fat diets. In terms of average macros something like 80% of calories come from whole plant foods (carbs). Best to you, anyone following Dr Hyman is OK in my book, we all want the same thing - a healthy population. I always recommend keto to anyone to whom a WFPB diet would be unimaginable, it is way way better than SAD.

and now Michelle again:
hey, thanks! I think I may not have explained my version of “healthy Keto “. I don’t actually count carbohydrates that are present in greens and vegetables I can tolerate. I also don’t bother with net carb calculations. The carbs I absolutely avoid are high carb items without other merits. I find it easy to maintain a low level of ketones, while eating large salads, significant amounts of vegetables, smalls meat potion and reasonable amounts of healthy fats. Also, ketosis is a means to an end...reclaiming insulin sensitivity! I also believe a flexibility to smoothly transition between burning either fuel source is an excellent approach, since fasting puts you in that mode with the added benefit of autophagy ( nicely enhances meditation and spiritual practice too). All that said, we didn’t have time to waste in reversing my husbands diabetes. Once his insulin sensitivity has returned we will moderate his macro mix accordingly. I feel there are at least three issues being tangled here. Intervention for acute situations, reversal of chronic conditions, and longer term maintenance. I would also allow for genetic variations, male/female differences and stage of life requirements. The one thing I will continue to protest against is the rubber stamp demand that a one-size-fits-all miracle diets must be promoted to all! Thanks for attempting a civil discussion. 🖖✌️ P.S. I am highly aware of the precepts you mentioned, as I mentioned somewhere (cannot remember quite where at this point), besides being vegetarian, then vegan for 10+ years, I taught a health and nutrition course at the college level. I have spent many years digging through PubMed and other sources. Probably the biggest cause for my change of direction was how perplexing my health decline was, but after genetic testing, I had to conclude veganism would not support my genetic makeup. Finally, I will always be open to tweaking everything when new solid evidence presents itself.

and then, finally, me again:
You're welcome! Civil discourse is where it's at. It is all about reclaiming insulin sensitivity, we are absolutely on the same page on that critical point. And perhaps we could agree on another point - if all one did was to consume only whole foods with enough variety to produce sufficient nutrient density for long term health, most of the reason for a keto vs WFPB "debate" to begin with could be relegated to a lower priority. You mention being vegetarian/vegan for 10+ years, with a health decline. This is so common as to be a "thing", and it IMHO is the primary reason to be skeptical of tightly held religio/ethical perspectives on diet. My dear old dad, 90 years and still going strong, had a saying "if you are fanatic you are wrong". I see nothing wrong personally with intelligent consumption of moderate levels of animal products. If one needs DHA is it better to use a supplement or a whole food source? There is a supporting web of interactive nutrition in whole foods we do not know nearly enough about yet...how important is this "factor" for health? Where are we likely to agree to disagree? Let's begin with fruit, I notice you do not mention it as part of your keto diet, and of course this is typical for keto people, for good reason. But fruit is the one food type high in both calories and micronutrients, which makes it a very useful food source, assuming one can consume it without problem. It is not difficult to achieve the desirable condition "no problem with fruit consumption" on a low fat WFPB diet because "insulin resistance" in not merely "parked" (not activated by high levels of carb consumption), it is reversed completely, and rather quickly at that, at the point of dietary transition to nutritionally dense low fat WFPB. I think it's worth mentioning a point that is typically not taken into consideration by proponents of either keto or WFPB, which is that "keto" people can "tolerate" oils in moderation (one would not want to drink the stuff, way too many empty calories just for starters), as low fat plant based folks can "tolerate" moderate levels of refined sugar consumption with no ill effect (but one would not to consume mountains of the stuff, again, just for starters, all those empty calories would displace too many nutrient dense calories). Not that I would recommend oils or sugars to anyone, they are both empty calorie substances, and in combinations of high concentration, lethal. Well that's the good old standard american diet isn't it? We also agree on benefits of fasting and autophagy, a tremendous boost to any dietary pattern. Recently Alan Goldhamer, Director of True North Health Center, a leader on clinical fasting and research for decades, has said the research is leaning in the direction of 5 to 10 days fasting periods having the most benefit for most people. They also continue to go longer for folks with certain progressed conditions. I also personally follow an easy intermittent fasting routine, which amounts basically to skipping breakfast. And here will be my final point: I've noticed quite a few instances of "keto folks" suffering heart attacks or other coronary related problems. Why is that? To begin with the obvious, we are a culture that has the beginning stages of cardiovascular disease by the early teen years, and unfortunately the age of onset appears to be falling. So most folks who pick up keto (or WFPB) are already progressed into the latter stages of undetected cardiovascular disease. And as we all know CAD is still our biggest killer, still a big problem. I will not be at all surprised if "ketos having heart attacks" (or other cardiovascular problems) also becomes "a thing" on a going forward basis. But a very high percentage folks who adopt and continue an Ornish-Esselstyn oriented WFPB approach do reverse CAD conclusively, and in large numbers.