Tuesday, March 5, 2024

Looking at Ted Naiman's (The PE Diet) Sample Menus, and thinking about the term "keto".

 I just searched on youtube, "how do I eat a high satiety diet?" and didn't get very much good advice.  When you search for keto, or low fat, you get recipes, full days of eating...etc.  However 'high satiety' seems to be a new enough concept that it hasn't caught on with the community.  It doesn't help that Hava, the main originator of the idea treats it as a concept that can only be communicated through an app and algorithm.

I will say at the outset, that the menu below pretty much matches what I'm already eating.  Am I keto?  I don't test my BHB level via finger stick, so I don't really know.   I already eat a fair amount of veggies with most meals, and veggies are carbs.  However, I don't eat grains, and I heavily moderate fruit. 

So if the menu below is what I'm already eating, and I call, at least colloquially what I'm eating "keto", then is the menu below keto, or at least "keto"?  If you set aside the underlying theory, is the high satiety diet really vastly different than what we colloquially call keto?

I would argue that what Virta Health, and Steve Phinney are doing, which I call "clinically keto" might be qualitatively different than the diet below.  It is much higher fat, probably lower protein, and more tightly controls carbohydrate.  That diet is actually focused on testing BHB levels and being in the right zone.

Ted Naiman and Andreas Eeinfeld of Diet Doctor co-founded this new app called Hava. My complaint about what DietDoctor.com and Hava are doing is that the old DietDoctor was very good at explaining the low-carb diet, and telling you on a a practical level what to eat.  What Hava says is something different - that is high satiety eating is so complicated that you need an algorithm to tell you what to eat.    To figure out what Hava really means by a high satiety diet, I had to resort to randomly typing foods into the app to see there satiety score.  This is a vastly different approach than the old DietDoctor website.

Anyway, Ted Naiman does explain his version of the high satiety diet in his book. The colorful menu below comes from his book The PE Diet.  If you are already keto or "keto", I would ask you to ask yourself if the diet below really significantly differs from what you are already eating.  (Again, the underlying carb-insulin, or CACO, or brain-driven...whatever hypothesis be damned.)

Excerpt from Ted Naiman's The PE Diet.

Clinically Keto v.s. "Keto" v.s. some other term like "high satiety", or "(very) liberal low carb"

Someone eating a clinically ketogenic diet, say for Epilepsy, would concern themselves with the fat to protein and carb ratio of their food.  That might be 4:1 fat to protein and carbs, or it might just be termed "low carb, high fat".  They would likely be regularly testing blood ketone levels to make sure that what they were eating kept their body generating ketones.  I believe, just by looking at their youtube channel, that this is the starting point for what Virta Health is using to treat diabetes. [edit - I'm not actually sure about whether VH uses 4:1 or a more individual approach around BHB testing]

Now, when say that I am on a "keto" diet I mean something slightly different.  I mean that I am avoiding processed carbs like flour and sugar.  However, I don't avoid most vegetables (except corn and potato), and I don't worry that my vegetable or protein intake might knock me out of ketosis.  I'm also not really adding a lot of extra fat like butter or oil to my diet, unless I'm taking something else away. (E.g. sometimes I think an 11oz sirloin is too much protein for dinner, so I eat a 6 or an 8oz, and put a little butter on top for satiety and because I like it.  Or, if I have the funds, I eat a small cut of much fattier prime rib.)

I am starting to come around to the idea that whole grains might also be OK for my personal level of carb-tolerance.  Maybe if I wanted to intentionally stall my weight loss for a while, just as a diet break, I would regularly eat fruit, and maybe experiment with brown rice, or farrow, or wheat berries.  Now, would I call that diet keto?  Probably not.  

I might term that diet as "high satiety" or use some other term.  It's basically a very liberal low-carb diet that cuts out all of the highly hedonic, and highly processed junk food.  A hallmark of this food is that it is usually comprised of a lot of flour or sugar (along with lots of mystery chemicals that may or may not have been A/B tested to see which ones make you want to eat, and therefor buy more.)

So, why is this important?

15 years ago, when Gary Taubes wrote "Good Calories, Bad Calories", the carbohydrate-insulin model of obesity came to the fore.  That was the basis for the early days of Diet Doctor and the reason keto became popular.  Recently however, that hypothesis has been called into question, with people focused more on how the interaction between hedonic, calorie dense, and/or processed foods drives the brain to overconsume.  The theory is that the brain adapted its homeostatic methods thousands of years ago, and those methods are just getting overridden by the modern food environment.

My contention is though, that if you are not that concerned with the underlying hypothesis, the fact of the matter is that Keto works, and the gradient between Keto and very liberal low carb also works, depending on the individual level of carb-tolerance.     If you have very high, type-2 diabetic blood sugars, you might stick to the Clinically Keto end of that spectrum, if you are like me and have slightly elevated blood sugars, you might stick to the low carb or maybe the liberal low-carb end of the spectrum. (something midway between clinically keto, and liberal low carb seems to allow me to relatively effortlessly lose weight, feel up to exercising, and generally feel healthy.)

It's all colloquially "keto" though as far as the modern culture is concerned.  That may change.