Female vs Male Dieting
March 26, 2019 6:28 PM   Subscribe

Ketogentic diets are more effective for men than women Hormones, specifically estrogen, plays a role in weight loss.
posted by Yellow (43 comments total) 17 users marked this as a favorite
 
I rub gluten all over my buttery belly.
posted by Jessica Savitch's Coke Spoon at 6:57 PM on March 26, 2019 [27 favorites]


A cool thing that the article doesn't mention is that the lead investigator on this study is an undergrad.
posted by ArbitraryAndCapricious at 7:24 PM on March 26, 2019 [21 favorites]


(That is not in any way meant to call the study into question. I'm just vicariously proud of undergrads, especially undergrads at state universities, who do cool things.)
posted by ArbitraryAndCapricious at 7:28 PM on March 26, 2019 [43 favorites]


(That is not in any way meant to call the study into question. I'm just vicariously proud of undergrads, especially undergrads at state universities, who do cool things.)

Thanks for clarifying, my sarcasm meter was going [???] and I was getting ready to Fight, oops.

Anyway, very curious as to the role estrogen plays in weight loss in general. It would explain... a lot of things.
posted by brook horse at 7:37 PM on March 26, 2019 [2 favorites]


Article summary:

1) Mice responded poorly to the diet in a study, so humans probably shouldn't do the diet;
2) A rehash of 80s nutrition science.

Still a long way to go to mainstream acceptance of high fat low carb; as long as the diet industry remains the huge moneymaker that it is, there will be unending pushback.
posted by MillMan at 7:41 PM on March 26, 2019 [6 favorites]


My metabolism changed at age 8... since then, I've explored seemingly all the popular diets, much of it comparing my results to my mother or my wife, and my personal anecdotal conclusion is: ALL DIETS are more effective for men than women.
posted by oneswellfoop at 7:53 PM on March 26, 2019 [37 favorites]


Mod note: One comment removed, and a general request that folks keep in mind that we've had a whole lot of free-form discussions about diet, weight loss, etc. in the past and this doesn't need to be yet another one. Discussing the actual content of the link is gonna be a better plan than discussing random "here's my take on tangential weight/diet issue x..." offshoots.
posted by cortex (staff) at 8:30 PM on March 26, 2019 [7 favorites]


Given the diet’s long term use in epilepsy patients, we really should know more about it.
posted by congen at 8:42 PM on March 26, 2019 [10 favorites]


My husband, who is a thin person who sometimes gets a little too into candy and pastries, dropped all the 40 pounds he needed to lose (actually he only needed to lose 30) in the time it took me (a fat person who rarely leaves the house and doesn't really keep the white starches around) to lose about 12, on keto (which is still the only way I lose any weight at all). I look forward to future data on estrogen, cortisol, microbiome, and the other tantalizing science that's starting to emerge about weight.
posted by Lyn Never at 8:44 PM on March 26, 2019 [24 favorites]


Maybe the takeaway is that people should keep track of how their livers are doing if they're on a ketogenic diet.
posted by Nancy Lebovitz at 9:22 PM on March 26, 2019 [7 favorites]


Maybe the takeaway is that people should keep track of how their livers are doing if they're on a ketogenic diet.

It sounds as if the correlation is at least complicated.
posted by Joe in Australia at 9:31 PM on March 26, 2019


Two things jumped out at me: The control diet was 7 percent fat, 47 percent carbohydrates, and 19 percent protein by mass. Meanwhile, the keto diet was 75 percent fat, 3 percent carbohydrates, and 8 percent protein by mass.

75% fat ... ... I mean, American culture has been socialized hard out of eating fat. If I were told to drop carbs from my diet, I'm pretty sure my instinct would be to replace them with more meat. Most health-conscious people would instinctively go to salad, probably. Not butter.

Of course this is no more unnatural than any other diet, but it feels really alien to me, and I have a hunch that some regular human people might be "on the keto diet" but not actually.

Then this: Female mice were less likely than males to experience significant fat loss and were more likely to exhibit impaired blood sugar control in their experiments.

My mother was diagnosed as prediabetic a few years ago and was told to keep lowering her carbs to control her blood sugar. Which .... .... ... ... ... .... .... is one element of this diet that apparently impairs blood sugar control.

Third, last paragraph, Cochran and his colleagues suspect that the weight loss in the male mice was due to compensatory mechanisms that develop in the liver as a consequence of its increased fattiness. The estrogen in females might have protected them from this liver damage — and thus prevented them from losing weight.

maybe the weight loss is secondary to fucking liver damage, lol
posted by Rainbo Vagrant at 10:33 PM on March 26, 2019 [6 favorites]


I have a hunch that some regular human people might be "on the keto diet" but not actually.

Hi, it’s me! I cut sugar and carbs out, and am eating more fat than normally I would be comfortable with, but there’s no fucking way my food is 75% fats. It’s been working for me, but at best it’s like 15-20% fats.
posted by corb at 10:43 PM on March 26, 2019 [9 favorites]


Several women I know have had amazing success on this diet over the past year. Like, astonishing. One of them had/ has lipodema and this is the only way she's ever lost that weight, which is supposedly impossible to do. And two others were having issues with PCOS which are vastly improved. Maybe the study needs to look at some folks who already have some kind of fat storage / metabolizing disorder, be it hormone induced or genetic, and see how that affects their results.
posted by fshgrl at 10:50 PM on March 26, 2019 [12 favorites]


it's a good thing all my estrogen is agender!
posted by the list of suspects is just you at 2:02 AM on March 27, 2019 [8 favorites]


It's worth noting that the diet in question has 75% of the calories from fat. This is not 75% of the weight is fat. There are two things going on that make these very different: the calorie density of fat, and the presence of fiber and water.

Sugar has about 4 calories per gram, and fat has 9. 50% carb, 50% fat foods, by weight, already have 69% of their calories from fat.

The dietary fiber, while technically a carbohydrate, is generally indigestible and provides 0 calories. And then water is heavy and contains no calories at all.

Say you have a salad, and you use an olive oil and vingear dressing. It's easily above 75% of calories from fat. In terms of weight however, you have a lot more fresh vegetables. Fresh vegetables have a lot of fiber and water. This is somewhat strange if you are trying to picture what a 75% fat diet looks like in your mind, as it doesn't have to be 75% butter or 75% deep fried.
posted by cotterpin at 2:39 AM on March 27, 2019 [48 favorites]


this article has four huge weaknesses,
  • it extrapolates a single citated paper from a mouse to a human.
  • it ignores the enormous literature of low-carb diets on male and female humans.
  • it ignores the enormous literature of low-carb diets for disease states that often have no other effective treatment (epilespy, T2D, obesity, NASH, cancer,...)
  • it ignores the enormous literature on low-carb diets effects on brain energy metabolism, which is the most exciting bit to me! ("Inverse relationship between brain glucose and ketone metabolism in adults during short-term moderate dietary ketosis" Courchesne-Loyer A. et al.,2016. 6 men, 4 women).
sorry but you can't take an article from a scientific journal and turn it into an article for the public with wider scope and not completely lose credibility...
posted by dongolier at 3:21 AM on March 27, 2019 [20 favorites]


BTW, I'm male and have been five years on loose-ish ketogenic diet.

When I started out I went from 90kg to 80kg, and could sleep better than before...
  • I had one liver MRI and two DEXA's done for a scientific study and they showed
    • 1.5% liver fat (which is really low for a regular drinker)
    • body fat went from 27% to 18%
    • fasting triglyceride fell from 1.3 to 0.3 mMol
    • fasting glucose fell from 6.2 to 5.3 mMol
posted by dongolier at 3:33 AM on March 27, 2019 [5 favorites]


Well, looks like I owe SOMEONE an apology.
posted by some loser at 6:05 AM on March 27, 2019 [2 favorites]


Nutrition journalist Tamara Haspel:

Over and over, large population studies get sliced and diced, and it’s all but impossible to figure out what’s signal and what’s noise. Researchers try to do that with controlled trials to test the connections, but those have issues too. They’re expensive, so they’re usually small and short-term. People have trouble sticking to the diet being studied. And scientists are generally looking for what they call “surrogate endpoints,” like increased cholesterol rather than death from heart disease, since it’s impractical to keep a trial going until people die. While I hold out hope that we’ll get better at all this, it’s going to take a while.

The important question — what are we supposed to eat already?! — is still on the table, and I have a suggestion. Let’s give up on evidence-based eating. It’s given us nothing but trouble and strife. Our tools can’t find any but the most obvious links between food and health, and we’ve found those already. Instead, let’s acknowledge the uncertainty and eat to hedge against what we don’t know. We’ve got two excellent hedges: variety and foods with nutrients intact (which describes such diets as the Mediterranean, touted by researchers). If you severely limit your foods (vegan, keto), you might miss out on something. Ditto if you eat foods with little nutritional value (sugar, refined grains). Oh, and pay attention to the two things we can say with certainty: Keep your weight down, and exercise.

posted by Mr.Know-it-some at 6:11 AM on March 27, 2019 [5 favorites]


My father- and mother-in-law started a keto diet in January and, while eating the same foods, he lost 40 pounds and she lost mayyyyybe 4. She's bummed and I keep telling her that a) bodies work differently and b) he didn't need to lose 40 pounds in the first place and should probably start eating some fucking bagels again soon before he wastes away to nothingness. She doesn't need to lose weight either but apparently everyone at work is doing Keto!!!!!!! and you know the rest.

Meanwhile, I (33F) lose weight when I eat pasta regularly so there's that.
posted by lydhre at 6:24 AM on March 27, 2019 [4 favorites]


lydhre: [you] (33F) lose weight when... [you] eat pasta regularly?... perhaps you've got your dad's genes!
posted by dongolier at 6:32 AM on March 27, 2019


A few points I've picked up in my reading (and I'd be interested to know if any of these are very far off base):

(a) For as long as I can remember it's been conventional wisdom that weight loss by any means is easier for men than for women.

(b) Keto is effective for weight loss but only if rigidly practiced, and generally not sustainable for much more than a year before residual effects of ketosis start to pile up and become a threat to overall health.

(c) Even a Keto diet won't work if you're still taking in more calories than you burn.
posted by Flexagon at 6:39 AM on March 27, 2019 [3 favorites]


(b) Keto is effective for weight loss but only if rigidly practiced, and generally not sustainable for much more than a year before residual effects of ketosis start to pile up and become a threat to overall health.

I'd be curious to see a citation on this, I'm wondering to what extent that's just folks with a very animal protein heavy diet. You can (and probably should) do a keto diet that's pescatarian or even vegetarian, where you're eating mostly veggies and healthy fats.
posted by leotrotsky at 7:41 AM on March 27, 2019 [1 favorite]


The article is making me realize I probably should get a full blood work up and liver review to see how I'm doing on Keto. I had a fatty liver when I was in college, but then I was also overweight and eating the junk a college student stereotypically ate. It resolved itself when I started eating a bit more properly, but I do wonder whether I need to question my assumption that losing weight as an overweight person is an overall a net good for your body, liver included.

>(b) Keto is effective for weight loss but only if rigidly practiced, and generally not sustainable for much more than a year before residual effects of ketosis start to pile up and become a threat to overall health.

I'm currently doing keto and have just been wondering exactly how I'm supposed to get off this ride in what I project to be hitting my goal weight in the next three months and maintain the weight, so I'd be interested in seeing where you came across this specific finding.

Going from 200lbs to 178 as male in 3 months (and still not yet at a "healthy BMI" weight, apparently) has been a quite a journey that helped me understand a lot more about my body needs and where my binge triggers were. I eat a lot of leafy greens and fats/proteins and find myself satisfied and not constantly thinking about food like I used to and I'm happy that can be the case and I lose weight, but if there's something that is evidence that ketosis is a threat to my health overall I'd like to take a look.
posted by Karaage at 7:42 AM on March 27, 2019 [3 favorites]


We have a lot to learn about how hormones impact weight- and not just testosterone and estrogen. Cortisol, HGH, Insulin, Leptin, etc. all affect weight. The interdependence of diet, gut biome, hormones, and weight is still pretty new science.
I can't wait until we have a method of monitoring hormone levels in real-time, collecting data for analysis. For instance, insulin pumps are getting better and less invasive. A sub-dermal slow-release implant for diabetics would be revolutionary. There have also been great strides in monitoring blood sugar levels through the skin. We aren't quite there yet and that's just one hormone, one we know a lot about.
posted by domo at 9:02 AM on March 27, 2019 [3 favorites]


One of the things that always struck me was how people on the various iterations of a low carb diet who broke discipline and ate a bowl of pasta (or whatever) would put on what seemed like a huge amount of weight just from one meal. This was something many adherents/proponents of the diet interpreted as reinforcing its correctness, but then I read the following passage from a 2004 Tufts University School of Nutrition "Health and Nutrition Newsletter" (the article was about the Atkins Diet, but the information certainly seems to apply to keto diets):
Consider that carbohydrates are stored in the body attached to water molecules. When carbs are not taken in with the diet, every carb that comes out of storage to fuel the various organs and other tissues releases water, which ends up in urine and creates weight loss on the scale that can be confused with fat loss.
This helped me to understand that the carb-fueled weight gain was simply the reacquisition of water that happened because the body was finally able to store carbohydrate molecules again.
posted by slkinsey at 9:03 AM on March 27, 2019 [6 favorites]


Anecdataly: I've been on a low-carb, highish-protein diet since November, lost 9 Kg so far. Started out following the 'Always Hungry' book, but it's a lot of prep work and too much fat. Basically, I cut out all sugar, wheat flour, potatoes and rice.
I'm not a purist, I might nibble on something sweet or a pastry every now and then, but I don't really feel the urge to go off diet.
I eat more meat but also much more veggies. I usually try to have at least as much salad as non-salad. I do eat more fat than before, but am trying to avoid beef and pork in favor of chicken and fish. Also use olive oil with reckless abandon.
I feel better, look better, have more energy, optimism, etc.
I'm lucky that I can afford to eat 'real' food, and there's no hardship, I eat a lot of tasty things. My wife on the same diet has lost about half as much as me.
I am scheduling an appointment with my endocrinologist, want to have my liver and cholesterol checked out.
posted by signal at 9:11 AM on March 27, 2019


Nutrition journalist Tamara Haspel:

The important question — what are we supposed to eat already?! — is still on the table, and I have a suggestion. Let’s give up on evidence-based eating. It’s given us nothing but trouble and strife....

Oh, and pay attention to the two things we can say with certainty: Keep your weight down, and exercise.


I will keep my weight down as soon as there is an EVIDENCED-BASED EATING PLAN that will let me lose the fucking weight and keep it off.

Holy contradictory fucking directives, Batman!
posted by tzikeh at 9:42 AM on March 27, 2019 [15 favorites]


The article is problematic for reasons others have already pointed out. But it is worth noting that some (many?) women on keto find more success and better hormone balance when they do "carb ups." Leanne Vogel, who tends to focus on women's keto, rather than keto in general, has talked about this fairly often on her podcast and, I think, in her book.
posted by asnider at 9:58 AM on March 27, 2019


What happens to women on keto if they are post-menopausal?
posted by King Sky Prawn at 10:08 AM on March 27, 2019 [3 favorites]


Anyway, very curious as to the role estrogen plays in weight loss in general. It would explain... a lot of things.

Well, there's a reasonable sized group of people who have A/B tested this: Trans people

I'm utterly fascinated by this and was shocked by the utter lack of any kind of study or formal text out there to read regarding it. I weighed the exact same amount from 8th grade until well after i was out of college, like not even +-10lbs

Being on estrogen for a while, with no testosterone in my system really drastically changed how my body not just distributes, but stores fat, and how various diet changes effect me. Even just like "eating more of this for an extended period will majorly effect my energy levels etc in a way it never did before"

Friends have experienced similar things, and none of us we're told more than in the absolute lightest passing at a glance that this was a thing. It was like, "your ass might get bigger" if anything. We all poked around online and didn't find jack.

This seems like a hugely overlooked opportunity for study of this sort of thing
posted by emptythought at 10:51 AM on March 27, 2019 [16 favorites]


I hope there are more studies that deeply focus on the hormonal aspect of women struggling to lose weight, especially later in life. I did well on keto when I was younger, but eventually plateaued. It was hard for me to stick with keto when I stopped losing weight, like what is the point of all of this restriction and social awkwardness if I'm getting nothing out of it?

The closer I get to 40 the more I gain in my mid-section even without drastically increasing my calorie intake. I have recently decided to go off the pill and see what happens. I realized I've been on it for 20 years and I can't help but wonder about the cumulative effect that has had on my overall hormone (im)balance. My depression has hit an all-time high, I'm hypothyroid, no libido, exhausted even with thyroid supplementation, and late last year I gained probably 20 lbs out of nowhere - the only change I made was trying to take the pill continuously to avoid horrible periods. So now, I'm curious if completely removing the hormonal birth control will "correct" things.

Meanwhile, my husband can drop 5-10 pounds in a week just by decreasing his beer consumption from 2 cans of PBR a night to 1.
posted by joan_holloway at 11:05 AM on March 27, 2019 [7 favorites]


carb-fueled weight gain was simply the reacquisition of water that happened because the body was finally able to store carbohydrate molecules again.

This is pretty well known in a lot of Keto circles. The first dramatic round of weight loss is really just water weight. It is a useful form of positive reinforcement, but you shouldn't get too excited about it.

In grad school I inadvertently did an intermittent fasting + sorta keto diet during the week: my GI system acts up based on my cycle, especially when stressed, so I just wouldn't eat until I got home and for whatever reason I would just wind up not eating a lot of carbs. Combined with walking a couple miles a day and I was probably at my skinniest.

Once I got a real job, I found doing keto during the week (this time deliberately) kept me at a reasonable weight despite my horrible commute making any kind of physical activity difficult.

I like doing little bouts of "Keto" (Not sure you can count it as Keto if you're cheating on the weekend) every so often. It sort of resets my appetite and palate. A little bit of sugar goes a long way after a couple weeks of low carb weekdays.
posted by ghost phoneme at 11:44 AM on March 27, 2019 [1 favorite]


King Sky Prawn I found an abstract from 1981 which says women are more ketogenic upon fasting (very similar to low-carbing), postmenopausal women who take hormone replacement surpass their premenopausal counterparts who in turn surpass all males in ketogenic response to fasting. The abstract is old enough that it would be neat to hear more from a more recent study...but I couldnt find any... they point out that perhaps women are more sensitive to fasting" because of this but what this means is not clear (hate fasting more, can't fast as easily, drop into ketosis more easily, ???)

"Metabolic response to starvation. II. Effects of sex steroid administration to pre- and postmenopausal women."

posted by dongolier at 11:53 AM on March 27, 2019


It's called cyclical ketogenic diet (ckd) if you're carbing up weekly
posted by some loser at 11:59 AM on March 27, 2019 [2 favorites]


Meanwhile, I (33F) lose weight when I eat pasta regularly so there's that.

Me too, turns out I am Celiac and not naturally skinny.

I do think that for women there isbkind of a tipping point where you gain enough fat that you start to make more estrogen and store more fat etc etc. You have to get below that tipping point and stay there for lasting change. After all, in the past women spent a lot more time pregnant or lactating than we do now. And birth control definitely makes women gain weight in odd ways, things like Depo in particular.
posted by fshgrl at 1:10 PM on March 27, 2019 [3 favorites]


Keto has worked miracles for me (30kg weight loss) but it can be rough going at times and, yes, I do worry about my blood and organs and keep meaning to get a workup. I did lose a ton of "water weight" but I undeniably lost a ton of fat as well, and I've maintained this all relatively successfully.

Biggest problem with keto is how damn expensive it is. Second biggest problem (for me) is how difficult it makes it to eat out. Third biggest (for me) is I enjoy Bighead, but sorely miss full-flavoured beers.
posted by turbid dahlia at 3:08 PM on March 27, 2019 [2 favorites]


> I do think that for women there isbkind of a tipping point where you gain enough fat that you start to make more estrogen and store more fat etc etc

Interesting idea! I thought it was aging, for me, but maybe it's the tipping point. My body seems to have suddenly decided that it wants to be at a certain weight, which is about 15 lbs more than the weight it naturally settled at 10 years ago, which is 15 lbs more than 10 years before that.
posted by The corpse in the library at 3:28 PM on March 27, 2019


What happens to women on keto if they are post-menopausal?

It stops weight gain and provides moderate weight loss.

Here's my experience--I'm 54, have been post-menopausal for 5 years and each of those years, despite calorie counting, exercise and eating mostly vegan, managed to put on 40 lbs.

Anecdotally, post-menopause women on Keto shouldn't eat as much fat as the calculators recommend. Instead, we have to up our protein to about 100 grams daily, lower total carbs to about 20 g or less, and use maybe 2T fat but no more.

We don't get the massive water weight loss and we lose weight at a far lower rate, like maybe 2 lbs a month, but we do lose weight.
posted by yes I said yes I will Yes at 3:18 AM on March 28, 2019


It's called cyclical ketogenic diet (ckd) if you're carbing up weekly.

After strict keto for a year, I tried ckd for a while and it did not work at all for me. It took me on average 2-3 days to reach ketosis, which meant I was only in it for 3-4 days at a time before blowing it away on my cheat day. I started gaining weight again. Of course, YMMV.

This article I ran across yesterday describes a study (disclaimer: very small sample size) that suggests cheat days while on a keto diet can can damage blood vessels.

Here's a link to the study: Short-Term Low-Carbohydrate High-Fat Diet in Healthy Young Males Renders the Endothelium Susceptible to Hyperglycemia-Induced Damage, An Exploratory Analysis
posted by zakur at 8:05 AM on March 28, 2019 [1 favorite]


My son is 16 months old and on a medically-supervised strict classical ketogenic diet to control his intractable epilepsy syndrome.

Our dietician was right up front with us about how not healthy this diet is. The keto diet, when done as originally conceived (as opposed to how it is practiced in the mainstream which, let's face it, is basically Atkins, and there's a reason the medical version of it also used for epilepsy is called the Modified Atkins Diet) is totally different. My son is on a 2:1 ratio - that is the ratio at which is he is producing enough ketones to keep his seizures at bay - which means for every one gram of net carbohydrate and/or protein, he has to consume 2 grams of fat, within the same meal. So there's no daily net carbs, no cheating, and no spreading things out during the day. Every meal, every snack, 2:1 ratio. And protein counts as much as carbs, unlike mainstream keto. A common ratio for older kids and adults on the therapeutic diet is 4:1; we have it "easy."

He has to have this much fat with every meal because it maintains a consistent level of ketosis (going in and out can be a seizure trigger) and also because he is a growing baby and needs to gain weight, not lose it. Because of this he's at risk for kidney, liver, and gall bladder issues, high cholesterol, etc, in addition to acidosis. He has regular bloodwork to monitor him and we have to do urine testing of his ketones a few times a week. He has to be supplemented with straight baking soda twice a day to manage the blood CO2 levels and take a special low-carb multivitamin to make up for the nutrients he can't get through grains and the amounts of fruit and veg most kids can have. And we have to count every possible source of carb - he can't eat play-dough. We can't use Aveeno moisturizer for his eczema because with the oatmeal it contains it has a high carb count that can be absorbed through his skin. We can't use OTC children's liquid medicines and instead have to have low-carb versions compounded every time he needs ibuprofen. Etc.

It is really effing hard to do this right and also not healthy for him. And yeah, even practiced in a mainstream way with lower proportions of fat, it's not really healthy. It's stressful on your body - your body is literally in "oh no, starvation, let's survive!" mode, and we don't know what long-term effects that may have. It's not balanced. Yes, you may lose weight or balance your blood sugar, but there are other effects that aren't well studied that may bite you in the (nice trim) ass later on. The only good tracking of this diet that exists is in the epilepsy community and the choice there is "lots of organ function risk versus uncontrolled seizures, I guess let's go for the organ function risk" and dieticians and doctors are extremely up front about this fact to anyone using it for medical treatment.

Anyway, I thought this study was interesting because anecdotally, it sounds like kids with life-long epilepsy have a particular problem as they enter puberty - especially girls - and I wonder how the presence or increase of estrogen at that point affects things, if it also seems to have an effect on/be affected by the gut microbiome changes on the keto diet as shown in this study. No one's quite sure the exact mechanism of how the keto diet affects seizure frequency, but the link to hormones on both sides is really really interesting.
posted by olinerd at 8:33 AM on March 28, 2019 [18 favorites]


My wife is kicking my ass on keto. She's lost roughly twice what I have in six months, and my weight loss is measurable.
posted by DrAstroZoom at 1:38 PM on April 1, 2019


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