A brief history of low carb and keto movement
Trends and fads come and go. Ideas rise in popularity when someone discovers something that works. A few people apply this initial idea and get great results.
In time, entrepreneurial people realise there is money to be made and scramble to sell things to make it ‘easier’ and ‘more enjoyable’. Often these marketers play fast and loose with the facts (or don’t understand them to start with).
Later, once the benefits of the original insights become diluted, or more people move beyond the initial stage, where the idea works magically, the trend begins to die. Before long, something fresh rises to take its place as people search for a new, quick and easy fix.
Over the years, there have been several iterations of low carb and keto, each with their own unique emphasis (e.g. ketones, insulin, protein, fat etc). Before we dive into dissecting the dogma and conflicting theories in nutrition, I thought it would be useful to give you a quick tour of the different versions that have come and gone.
See if you can spot the common themes and differences.
One of the earliest versions of low-carb was the ‘Banting Diet‘ prescribed to William Banting by Dr Harvey in 1862. Harvey recommended a lower carb, protein-focused, whole food diet that became super popular in the day.
The term ‘Banting’ made a comeback in 2014 (as shown in the chart from Google Trends below), spearheaded by South African Professor Tim Noakes who advocated a low-carb, high-fat version and was careful not to overemphasise protein to keep insulin levels low.
My family owes a massive debt of gratitude to the work of Dr Richard Bernstein and his followers. Dr Bernstein, who is thriving with Type 1 Diabetes at the age of 86, is an excellent example of the power of reducing carbs for people who are injecting insulin. Dr B (as he is known by his followers) also walks the talk in terms of maintaining strength to maximise insulin sensitivity and resilience.
Bernstein, who has had Type 1 Diabetes since he was 12, was initially trained as an engineer. Through his wife, who was a doctor, he was able to obtain one of the first glucose meters in 1969 (pictured below).
Bernstein, an avid self-experimenter, measured his blood sugars 6 times a day. Over time, he gained an understanding of how much a certain amount of carbohydrate raised his blood glucose levels, and conversely, how much a certain amount of insulin lowered them.
By reducing the carbohydrates in his diet, he was able to stabilise his blood sugars and insulin doses. Bernstein’s early learnings formed the basis of the basal/bolus insulin dosing calculations built into the insulin pumps used today by most people with Type 1 Diabetes.
Bernstein initially published The Glucograf Method for Normalizing Blood Sugar in 1981. At 45 years of age, he went to medical school and became a doctor to have his methods recognised. He published Dr Bernstein’s Diabetes Low Carbohydrate Solution in 2005 and Dr Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars in 2011.
Bernstein’s recommended diet is protein-focused to promote the growth of lean muscle mass as well as non-starchy veggies to ensure you can get adequate micronutrients. Dr Bernstein emphasises the importance of injecting sufficient insulin to maintain stable blood sugars after eating protein (i.e. about half as much as required for carbohydrates).
Bernstein’s approach to managing insulin and blood sugars revolves around ‘The Law of Small Numbers’. That is, that large inputs of refined carbohydrates require large doses of insulin. Due to the numerous variables involved, it is incredibly hard to precisely calculate the dosing of insulin needed for large amounts of carbohydrates.
To illustrate what this looks like in practice, the chart below the blood sugars of someone with Type 1 Diabetes on a typical high-carb diet. Reducing the inputs of nutrient-poor processed carbohydrates enables the minimisation of errors and reduces the wild swings in blood sugar and insulin dosing.
The next chart shows the type of blood sugar control that can be achieved once the inputs of processed carbohydrates are reduced. Once we reduce the variability in blood sugars, we can bring down the average blood sugar overall without fear or low blood sugars (hypoglycaemia).
Monica and I were fortunate enough to be introduced to the Type One Grit Facebook Group in 2015 and became believers after seeing the fantastic results that could be achieved for people living with Type 1 Diabetes. The changes in Moni’s blood sugars, mood, energy and weight as we have applied these principles have been life changing. We are immensely grateful!
Interest in ‘Low Carb’ peaked in popularity largely thanks to the work of Dr Robert Atkins, who published his carbohydrate-restricted diet for weight loss in 1972.
While the definition of ‘low carb’ can range from 20 to 150 grams of carbohydrates per day, Dr Atkins’ plan was protein-focused and recommended an initial low carb induction phase with less than 20 grams of carbs per day (without emphasising extra dietary fat). Atkins’ initial induction phase was followed by the introduction of some carbs from nuts and non-starchy vegetables (so long as the desired progress continued).
After Atkins died, interest in low carb slumped to a low in 2008. Since then, low carb has steadily grown in popularity, with each new wave of New Year’s resolutions bringing a fresh surge of interest in how to quickly shed the Christmas pounds.
Investigative journalist Gary Taubes’ 640-page tome Good Calories, Bad Calories (2007) created a comprehensive story around why carbs and insulin (rather than fat) could be the reason for the obesity epidemic.
Taubes pointed to the way hormones during growth spurts and pregnancy trigger appetite as well as the correlation between the introduction of sugar and refined grains into the native American diet (i.e. Pima Indians) and the subsequent growth in obesity.
After realising that there were plenty of populations who had been doing fine on a high-carb low-fat diet, Taubes published The Case Against Sugar (2016), painting sugar as the primary perpetrator of our metabolic woes.
These books have played important roles in cementing fear of insulin and carbohydrates in the psyche of low carb and keto followers. Taubes’ expansive narrative makes sense if you want to characterise one macronutrient as good vs bad. Good vs evil is imperative to any compelling story.
When you look at the change in carbohydrates intake between the 1960s and 2000, we can see that the increase in carbohydrates correlates with the growth in obesity (at least, up until 1999).
However, this ‘single macronutrient’ ‘good vs bad’ viewpoint neglects the fact that refined oils have been on the rise in our food system for a century.
When we look at the change in energy from all three macronutrients (as shown in the chart below created using data from US Department of Agriculture Economic Research ServiceUnited States Department of Agriculture Economic Research Service and the Centres for Disease ControlCentres for Disease Control), we can see that the increase in obesity aligns with the change in total calories (mainly from fat and carbs together).
It’s also worth noting that our consumption of sugar has significantly decreased since high fructose corn syrup (HFCS) fell out of fashion and was replaced by artificial sweeteners from 1999. While a constant supply of glucose and fructose (which is converted to fat in the liver) from sugar is certainly not optimal, this lack of correlation weakens the case against carbohydrates (and sugar) as the only culprit in the diabesity epidemic.
Taubes, along with Dr Peter Attia, formed the Nutritional Science Initiative (NuSI) with the hope of bringing clarity to the fat vs carbs debate. Funded mainly by the Arnold Foundation NuSi was able to instigate a number of studies to test the validity of the Carbohydrate-Insulin Hypothesis of Obesity. Admirably, to avoid confirmation bias, NuSI chose lead researchers that weren’t necessarily already proponents of the hypotheses that they were trying to prove.
One was the DIETFITs Study lead by Professor Christopher Gardener at Stanford (which we’ll discuss later). Another was the Calorie for Calorie, Dietary Fat Restriction Results in More Body Fat Loss than Carbohydrate Restriction in People with Obesity led by Kevin Hall of the National Institutes of Health.
There has been plenty of debate around the interpretation of the study results, including between Taubes and Hall, who seem to have had a rocky relationship since. It’s as if Hall has gone on a vendetta, supported by an enviable research budget and all the resources of the NIH, to single-handedly slay the Carbohydrate Insulin Hypothesis, with some fascinating study results ensuing. Unfortunately, it doesn’t appear that many of the learnings from the studies that Taubes designed, arranged funding for, and instigated have influenced his original narrative which he reiterated in his recent book, The Case for Keto.
How our metabolism is like the stock market
As an aside, the Linda and John Arnold Foundation, NuSI’s primary funding source, was initially financed by natural gas trader John Arnold. Back before the 2008 Global Financial Crisis, I was fascinated by the art, science and psychology of trading and spent a few years learning everything I could about the topic.
Before long, I realised that there was no way I could know everything about the market. Any news that came out in the major press had already been factored into the price. Large investment funds have massive resources working to understand the fundamentals of markets to make predictions of where the price will go in the future (and still often get it wrong). While it’s impossible for smaller traders to match this firepower, they can jump on trends that emerge. I spent a couple of years designing and testing my trading systems on all the data I could get my hands on.
In a similar way, human metabolism is incredibly complex. There is no way we can understand all the moving parts and exactly how they interact. Whenever we try to apply a single simple theory, we fail. But we can stand back and look at the inputs (i.e. macronutrients and micronutrients) to understand how they influence the outcomes (i.e. energy intake). We don’t have to understand everything about how it works. And although it’s always useful to understand what we can about the basic science, it’s often more helpful to use the most powerful levers that make the most difference and follow in the footsteps of the other people who have attained the results we are looking for.
In retrospect, I think that experience, along with my engineering background, gave me the best foundation and training to approach quantified nutrition to identify the levers that we can pull that will make the most significant difference to our health while discarding the theories that are less helpful.
While it’s great to do the research and look at studies to understand how things work in theory, you need to verify your theories with as much data as you can get your hands on to see if they help you achieve your goal in the real world.
The Paleo Diet gained popularity from 2009, spearheaded by research biochemist Robb Wolf’s book The Paleo Solution (2010), and interest peaked in January 2013. Sadly, Paleo never really escaped the wealthy, white, CrossFit scene to penetrate the mainstream.
While not specifically low carb by definition, Paleo tends to be lower in carbohydrates than most diets because it eliminates refined grains. Wolf was also influenced by the work of Dr Bernstein, and he personally thrives on a lower-carb diet.
Wolf’s second book, Wired To Eat (2017) included a 7 Day Carb Test where people are encouraged to check blood sugar after meals to understand if they need to titrate back their carbohydrates to achieve healthy blood sugar levels.
Paleo seemed to flourish so long as people saw it as foods ‘Grok the caveman’ or your grandmother would have recognised. But once everyone started asking ‘is it Paleo?’, creating paleo comfort foods and discovered that they could drown their sweet potato in butter or combine dates, honey and coconut oil to make taste sensations that you just can’t stop eating, paleo seemed to lose its efficacy and declined in popularity.
If low carb is good, then zero carb must be better, right?
There has been interest in zero carb for a while, but the ‘carnivore diet’ has have overtaken zero carb over the past few years. While some people incorporate seafood and dairy, many simply advocate for ‘eat meat, drink water’.
Amber L O’Hearn was one of the early advocates for this way of eating to manage her depression and to control weight creep after doing low carb. More recently, others such as Dr Shawn Baker, Mikhaila Peterson, Paleo Medicina and Dr Paul Saladino have joined the carnivore tribe.
Many people who have autoimmune issues have benefitted from eliminating plant-based foods and had great results. The carnivore diet provides plenty of bioavailable protein, which is likely the reason for many of its benefits. However, there is still plenty of argument over the balance between protein vs fat due to the cross-pollination with the keto community.
Some carnivore diet proponents advocate a ‘nose to tail’ approach, which emphasises organ meats to maximise nutrient density while many others live by the mantra of ‘eat meat, drink water’.
While most people tend to thrive with more bioavailable protein, there may be limitations in the ability to obtain optimal levels of some micronutrients on a diet consisting of primarily red meat. For more discussion on this topic see:
- The Carnivore Diet: Pros and cons, nutritional analysis, recipes and food lists
- Optimising Dr Shawn Baker’s carnivore diet from first principles
- Optimising Dr Paul Saladino’s carnivore diet
- Manifesto for Agnostic Nutrition
The high-fat ketogenic diet initially began as a way to treat epilepsy in children in the 1920s. But after the development of drugs to treat epilepsy, the popularity of the keto diet declined. However, over the last 5 years, keto has outstripped low carb, paleo, carnivore, and Banting combined.
Google Trends indicates that keto may have peaked in January 2019. Only time will tell if it will power on or fade out because:
- too many people encounter the limitations of ‘keto’,
- have a limited understanding of why it works, or
- don’t understand how to tweak it to ensure their progress continues.
‘Keto’ means a lot of different things to the many people who have passionately embraced it to describe their way of eating.
- For some, ‘keto’ means 5% or less than 20 grams of carbohydrates.
- Others define ‘keto’ as any diet that produces a blood ketone level (i.e. beta-hydroxybutyrate) of greater than 0.5 mmol/L.
- Still, others embrace fat as a ‘free food’ because it doesn’t elicit a significant insulin response.
This lack of clear definition means that many people identify as ‘keto’ or keto-curious, even though their fundamental beliefs about what it is and how to do it may differ significantly.
My journey through low carb and keto land
Back in 2013, before keto was all the rage, I was an avid fan of Jimmy Moore. I followed his Livin’ La Vida Low Carb Blog and his year-long n = 1 weight loss keto experiment. I listened to hundreds of his podcasts as he shared his journey and interviewed the thought leaders of the keto universe.
I enthusiastically devoured Keto Clarity when it finally came out in August 2014 and started adding butter, cream, cheese and MCT oil to everything in pursuit of higher ketones.
Much of the early keto movement built on The Art and Science of Low Carbohydrate Living (2011) and The Art and Science of Low Carb Performance (2012) by Dr Stephen Phinney and Dr Jeff Volek. Both Phinney and Volek contributed to the New Atkins New You (2010) with Cholesterol Clarity and Keto Clarity co-author, Dr Eric Westman.
‘Keto’ initially flourished as an underground movement rather than any government or official nutritional advice. People who follow a keto diet may see themselves and as rebels whose diet breaks the conventional rules. Now, there are seemingly endless ‘keto’ groups, all with slightly different beliefs (not to mention the numerous books, podcasts and conferences).
Keto thrived as an alternative to the processed ‘healthy’ grain-based nutrition dogma that is not working. Sadly, the diabesity epidemic that is threatening to bankrupt us in the foreseeable future due to spiralling health care costs and decreased productivity.
There can be no argument that countless people have benefited from ‘keto’ and low carb through greater satiety and better blood sugar control. ‘Keto’ would not have exploded the way it has if it didn’t provide benefit to many. You will find plenty of critical reviews of keto from ‘outsiders’ who themselves have not lived and breathed either the diet or the community. I don’t want to add to that noise.
Keto has also had its fair share of detractors from mainstream dietary circles as well as the low-fat and plant-based camps. However, this debate has likely only fuelled the growth of the keto movement because controversy gets clicks.
My aim here is not to argue the value of low carb and keto, but rather to share the insights from my journey. I hope we can continue to evolve our understanding of how it works so we can adapt and evolve to help more people who desperately need it!
Any growing community needs to reflect and adapt as new insights come to light. Any group that refuses to change and becomes entrenched in dogma will not grow. Eventually, without refinement and adaption, they will fade away, and eventually die.
While there are plenty of valuable insights that have been uncovered by the biohackers, n=1 self-experimenters and gurus in the low-carb and keto communities, there are also plenty of half-truths that have flourished.
While harmless in small doses, much of the keto dogma can become dangerous if taken to the extreme, especially if you follow the ‘keep calm and keto on’ mantra while ignoring the sometimes-detrimental effects. Hopefully, this book will add some nuance around these beliefs and will help you get what you need over the long term.
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What people are saying about Big Fat Keto Lies
Marty Kendall enjoys one of the highest vantage points in the entire nutritional landscape.
Thanks to an open mind and a keen eye for seeing patterns in data, Marty has managed to entirely reverse engineer eating.
In his book, ‘Big Fat Keto Lies’, Marty sifts through the quagmire of diet religion and deftly plucks all of the essential gems out of a huge pile of unhelpful dietary dogma.
Ted Naiman MD
Marty, this book is brilliant! This is my message to the world also!
You continue to inform people with honest and accurate information and self-experimentation. We are all learning together. Thank you for your contributions.
Nutrient density is where it’s at, and I agree entirely that each person needs to figure out their own carbohydrate tolerance.
Professor Mark Cucuzzella MD FAAFP
Professor West Virginia University School of Medicine
WVU Centre for Diabetes and Metabolic Health
There are many myths and misconceptions on low carb and ketogenic diets. Learning how to do the diet correctly from the beginning will make a big difference, especially on your medium to long term results and health.
Keto can be a great tool to improve your health, but more so if done correctly from the start. In his book, Marty does an excellent job at reviewing, correcting and explaining in an easy to understand way, the most prevalent myths in the low carb/keto community.
Big Fat Keto Lies is a must-read for anyone who has stalled on their path to health and optimal weight. Data-driven engineer Marty Kendall unpacks the common keto dietary conventions that typically cause people to fail in the long-term.
Marty, through easy to follow discussions, explains the often neglected but importance of focusing on dense foods to control appetite – beyond simply looking at macros and calories.
If optimizing your health and nutrition is your goal, you will not be disappointed.
Jeffry Gerber, MD
Family Physician, Denver’s Diet Doctor
Denver Colorado, USA
Every popular diet contains some truth and, as time goes on, ever greater outlandish, hyperbolic and inaccurate claims.
Marty Kendall does a superb job at dispelling the many myths of the keto diet that have grown up over the past few years but offers us a legitimate solution based upon tens of thousands of his analysis of many large data sets.
Big Fat Keto Lies is an essential read for anyone wanting to step out of all pop culture diet trends and embrace a truly agnostic form of nutrition for health.
Master’s in Nutrition and Functional Medicine
If your goal is to healthfully lose body fat using the most up to date nutrition science and don’t know where to start, I highly recommend Big Fat Keto Lies, by Marty Kendall.
As a Harvard-trained radiation oncologist, integrative oncologist and functional medicine practitioner, I have spent nearly two decades counselling patients on the importance of reducing body fat and insulin resistance. During this time, I have witnessed countless patients try unsuccessfully to lose weight or maintain their weight loss using the latest “weight loss diets” (including the popular ketogenic diet and intermittent fasting). Once you read Big Fat Keto Lies, you will understand why these approaches, often don’t work.
Marty explains in a very approachable manner, the reasons why people are biologically programmed to fail on most weight-loss diets or calorie restriction. In Big Fat Keto Lies, you will also learn practical, effective, healthful and sustainable approaches to fat loss that are simple to understand and implement. I will be recommending this book for all of my patients who want to optimize their metabolic health, lose body fat and improve their anticancer biological terrain.
Dr Brian Lewenda, MD
Medical Director, Northwest Cancer Clinic
National Director of Integrative Oncology and Cancer Survivorship
GenesisCare, Kennewick, WA
Marty is the best. Like a watchmaker who understands every little cog in and wheel of nutrition.
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