Disclaimer
I'm not qualified in any way to provide health or nutritional advice, so any opinions expressed are just my own thoughts from the information I've come across. I also can't guarantee the accuracy of the information I've come across or anyone's interpretations of that information. I would also like you add that I am not advocating for any particular way of eating, but rather trying to analyse and figure out why certain diets might be making people healthier or sicker.
When it comes to nutrition with regards healing and chronic disease there has become something of a divide between the low carb high fat and the high carb low fat communities. Each has their biases and is inclined to push their way as the best way for everyone. I'm aware I also have my own biases, so I'll share my reasons for those upfront.
By default, the low fat, high carb approach to eating is plant based because there are few animal products that are low fat without being tampered with. I've always had issues digesting certain types of plant foods, namely legumes and wheat, then more recently oats as well. As grains and legumes often make up the main bulk of a plant based diet, it's not a way of eating I've ever done well with. I've heard vegetarians and vegans saying that the body just needs time to adjust, so I gave it time, years in fact, but to no avail. I was often ill and also chronically constipated.
Some people struggle with digesting raw plant foods and there are those who say you just need to take enzymes to aid in their digestion, which hardly seems like a very natural way of eating to me. You could also say that those who are lactose intolerant don't need to stop consuming dairy, they just need to take lactase enzymes before they do so that they can digest it properly. Or maybe we can accept that some people just aren't designed to eat certain foods.
I've also developed some distrust for a low fat narrative that was first perpetuated by the food industry which pushed the food pyramid (now thankfully discarded) and processed low fat foods that have gotten us to this point of chronic illnesses.
So the low fat high carb is a dietary approach that hasn't been favourable for me and I tend to feel a bit perturbed when it's pushed as a viable, healthy diet for everyone. That's not to say that the ketogenic advocates don't also push their way of eating as the best way for everyone, but I find myself leaning more favourably towards that way of eating because it cuts out what I don't do well with.
I've also come across an issue when trying to delve more into the high carb low fat approach that those who propose it will at some point in their interview or presentation inevitably end up attacking the ketogenic approach in a fear mongering way and are derogatory towards the people who discuss it's benefits, often to the point of attacking individual doctors and researchers. Once they start to do that I then struggle to listen to them any more. It's ironic that much of the information I've gotten on how the high carb diet works in a beneficial way has come from keto doctors and researchers.
There are those on the keto side who will criticize plant foods more than necessary, but not usually to the extent of making it personal towards people. Even so, I still prefer to stick to listening doctors and researchers who are more open minded.
Defining the diets
The ketogenic diet is defined as a high fat, low carbohydrate intake which puts the body into a metabolic state of ketosis. This basically means that the body is making high levels of ketones, a fuel made from from fats, for fueling cells and less glucose. By default, this approach to eating will cut out pretty much all of the junk, ultra processed food, but also a lot of plant foods. That said, a ketogenic diet can still be vegetarian or vegan as well as omnivore or carnivore.
I am aware that there are people who have done well with both ways of eating and healed from the chronic conditions caused by our modern, ultra processed diets. Keto doctor Eric Westman made a comment that a ketogenic and a whole food vegan diet actually have more commonalities than differences and the more I learn about how the body processes food the more I think I'm realising what he meant.
At face value the statement seems contradictory, after all they seem to be completely opposite ways of eating. However, they are merely prioritizing different fuel sources. The body uses two fuel sources, glucose and fats. Different organs and cells have preferences for one source over the other. For example, the heart is fueled mostly by fats unless it's in failure then it switches to glucose.
When the body has a lot of glucose readily available it will prioritise using it. One of the roles of insulin is actually to block cells from absorbing fat based fuels until the available glucose has been used up. Excess glucose will be turned to fat storage by the liver ready for lean times. It's often said that the body prefers glucose, but I think this is because on modern high processed sugar diets that's mostly how the body is running, so it has become seen as the normal state. However, it's not how we evolved to run, hence the modem obesity epidemic in the western world. When we change back to eating natural whole foods then the body should return to a natural balance sending the preferred fuel sources to the places they are most desired.
How are keto and high carb low fat similar?
In order to demonstrate the similarities between the ketogenic diet and a low fat, high carb diet I'm going to make the assumption that both are eating natural whole foods. As I mentioned before, that will come by default on a ketogenic diet, for the most part. There are, of course, food companies who will try to get a piece of the pie for any diet that is gaining popularity, but so called "keto friendly" packaged foods usually still contain sugar as they try to take advantage of a generally acknowledged allowance of up to 30g of carbs per day. Keto doctors generally say that if it's in a packet and claiming to be keto friendly, then it's probably not. Yet even these packaged 'keto' options are by no means as common as the convenience foods which can hijak a high carb, low fat diet. Even ready made low fat meals, like Lite n' Easy, promoted as "healthy" will usually contain refined sugar to replace the flavour of the missing fats. So it's incredibly easy to do a low fat diet badly.
The biggest issue with eating a high processed sugar diet is that it rapidly increases your glucose which spikes your insulin and doing this continually causes your cells and metabolism to go into disfunction. When you cut out carbohydrates this glucose spiking stops completely, bringing you back to a manageable, steady blood sugar level. When you eat a whole food plant based diet, the fibres and proteins will slow the glucose absorption rate to levels that the body can handle much more easily, meaning your insulin also doesn't need to spike as much. It's been found that people who eat a lot of fibre also don't absorb as much of the protein from food, so much of it will come out as waste. As any excess protein absorbed by the body is converted by the liver to glucose, this could be another way in which glucose levels are brought down on a plant based diet.
Once the body isn't constantly flooded with glucose it will begin to return to a balance of fueling with both glucose and fats. Therefore it seems likely that a whole food high carb, low fat diet will put the body into low level ketosis for at least some of the time. A ketogenic diet just means that the body will likely be producing ketones at high levels most of the time. It will still also be producing glucose even if no carbohydrates are consumed at all, because many of our cells need glucose.
It's also worth mentioning that soluble plant fibre is consumed by our gut microbes which convert it into short chain fatty acids. Fatty acids are then converted into ketones if our insulin levels are low enough. So this is another mechanism by which a carbohydrate filled diet can be facilitating ketone production.
The diets used therapeutically
I've come across both types of diets being used therapeutically to control and/or put into remission things like diabetes, cancer and autoimmune conditions. With regards cancer, there have been success stories and failure stories with both approaches. This isn't really surprising because despite the use of one label as a catch all, there are lots of different types of cancers and lots of different causes. I don't believe diet alone will put any cancer into remission and it seems to be multi pronged approaches that have worked in the success stories I've come across.
It's the same case regarding autoimmune disease, they range in severity, symptoms and causes. However, so far I've come across less failure with the ketogenic approach, especially when it comes to the more severe manifestations. This could be down to the body beginning to become intolerant of certain plant compounds.
With regards diabetes, not everyone who uses the high carb, low fat approach has success in controlling their blood sugar, but I've yet to come across someone that didn't have success with the ketogenic approach. This could be down to how each individual reacts to different forms of carbohydrate. With the advent of the continuous glucose monitor (CGM), it's been discovered that what creates a sudden glucose increase to a certain food in one person, for example a banana, might have just a small glucose response in another.
I found an interesting comparison in a couple of stories from people with type 1 diabetes (this is the form of diabetes where the body is no longer able to make enough or even any insulin at all, as opposed to the cells having become insulin resistant despite the body making copious amounts of insulin which is what happens with type 2 diabetes). One type 1 diabetic used the high carb low fat approach to try and control their diabetes and they managed to reduce the amount of insulin they needed to use by 40%. The other used a ketogenic diet and reduced the amount of insulin they used by 65-70%. There are plenty of other stories from the ketogenic side where they've reached the point of needing to take minimal insulin to control their blood sugar levels, but I would love to hear more from the high carb approach side to get a better comparison. After all, a low carb approach to handling diabetes has a long history while the other approach seems fairly new.
One side of the debate argues that sugars are the problem with regards chronic illness while the other argues that it's fats. Then there's another, quieter, voice that occasionally gets heard through all the noise which says the biggest problem is fats and sugars combined. When both of these energy sources are in foods together they create the best tasting and most addictive foods which we are more likely to overindulgence in. This is actually how junk food manufacturers get customers to keep coming back for more. So whichever approach someone chooses they should have at least some improvement in their health as long as they aren't eating highly processed foods.
Choose your own path
Ultimately it's really down to the individual which approach they want to try and even which approach works better for them. For someone who has a preference towards plant based eating it's a no brainer to use the high carb, low fat approach as it gives a higher variety of foods to choose from. Some people are addicted to sugar, however, so eating any form of carbohydrate can leave them craving sugary foods of any kind, then they can end up back in an eating disorder cycle. These types of people will usually find it easier to go for a low carb approach.
Some might try both approaches and see which works best for them. The reality is that we are all different in how our bodies process foods. Despite my bias towards low carb I'm fully aware that there are those who wouldn't do well with this. There are even rare genetic conditions where some people cannot digest fats properly, so they need to avoid consuming them entirely.
When people have reached the point of taking their health and illness into their own hands they need to have as much awareness of how the body functions as possible and as much awareness as possible of all the available options to be able to make their own decisions on what is the best approach for them. We do others a disservice if we try to push our biases on them; which is sadly something I've come across far too often.
More things are being discovered every day in the scientific community, but even they still don't have all the answers and they often have different interpretations of results that come from research and studies. We need to keep our minds open to changes in information as it comes out and be ready to adapt and change. We also need to take responsibility for ourselves in our health and healing, even when we'd rather just have someone else tell us what to do, because it can get exhausting and overwhelming. But most importantly, we need to stand up for ourselves when we've decided on a course of action and not be bullied by others who think that they know what's best for us when deep down we know it's not right for us.
I dedicate this to a beautiful friend who has finally put her stage 4 colon cancer into remission, despite being steered down the wrong path by pressure from others and nearly having that kill her. She now stands her ground and advocates for herself with things that are working for her.