"The Magic Pill" is a documentary that explores the potential benefits of the ketogenic diet. Initially released in May 2017 and later added to Netflix, the documentary has introduced a wider audience to the ketogenic lifestyle. The film follows several individuals as they adopt a ketogenic diet and documents the changes in their health. While the documentary has been praised for sparking conversations about diet and health, it has also faced criticism for its anecdotal approach and lack of scientific rigor.
Anecdotal Accounts vs. Scientific Evidence
The documentary showcases anecdotal accounts of people experiencing positive health changes after adopting a ketogenic diet. These include individuals with type II diabetes mellitus, neuropathy, autism, cancer, and an indigenous tribe in Australia with a high rate of diabetes. They reported improvements in their health, decreases in body mass, and reduction or elimination of medications. While these accounts can be inspiring, it is crucial to remember that everyone responds differently to dietary changes.
The mainstream media criticized the documentary for relying too heavily on anecdotal evidence rather than emphasizing the research and science behind the ketogenic diet. A stronger emphasis on the metabolic process of ketosis, how to achieve it, how to formulate a well-balanced ketogenic diet, and its effects on the body and common disease processes would have been beneficial.
Guidelines Presented in the Documentary
The documentary provides several guidelines for following a ketogenic lifestyle. While most of these are generally considered good practices, some are not essential, and others are incomplete:
- Eat whole foods: This is a widely accepted and beneficial guideline. Whole foods provide essential vitamins and minerals and are free of hidden fillers.
- Choose organic: While opting for organic foods is a good choice, it may not be feasible for everyone due to budget constraints. Additionally, many small local farms may practice organic farming without formal certification.
- Eliminate processed foods: This is a crucial guideline, as processed foods often contain filler ingredients that are not keto-friendly or only appear keto in small, unsatisfying amounts.
- Eliminate grains and legumes: This is a standard practice for those strictly following the ketogenic diet, as most grains and legumes are high in carbohydrates. Peanuts are an exception, and some people in the ketogenic community consume them in moderation.
- Embrace healthy fats: Fat is the primary fuel source on a ketogenic diet, which is a significant shift from conventional dietary advice. Contrary to outdated beliefs, fat does not necessarily cause weight gain or heart disease. The documentary correctly emphasizes that not all fats are equal and that it is important to consume healthy fats from good sources.
- Avoid dairy, and if you must consume it, choose full-fat and organic: Dairy in moderation is generally acceptable for most people. However, some individuals may be sensitive to dairy, experiencing inflammation, weight-loss stalls, or reduced ketone levels. The same considerations apply to organic dairy as to meat and produce.
- Choose naturally raised, pastured animals and wild sustainably caught seafood: While this is a desirable practice, it may be too restrictive for some. Prioritizing organic and local options is encouraged when possible, but it is not essential for achieving ketosis or experiencing the benefits of a ketogenic diet.
- Eating nose to tail and fermented foods: While organ meats, bone broths, and pickled foods offer many benefits, some people may find them unpalatable.
- Intermittent fasting: While intermittent fasting can be beneficial for some, it is not safe for everyone. Individuals with certain pre-existing medical conditions may need medical supervision.
Shortcomings of the Documentary
Despite its value in initiating conversations about the ketogenic diet, "The Magic Pill" has several shortcomings:
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- Lack of scientific evidence: The documentary does not provide enough peer-reviewed scientific research to support its claims, especially when contradicting established dietary advice.
- Vague description of the ketogenic diet: The documentary does not adequately explain the ketogenic diet, which is a high-fat, low-carbohydrate, moderately-low protein diet.
- No discussion of macros or tracking: The documentary fails to address the importance of macronutrient ratios, tracking, and the metabolic process of ketosis.
- Missed opportunity to educate viewers: The documentary could have better educated viewers about the ketogenic diet and its mechanisms.
The Controversy Surrounding the JACC: Advances Study
A recent research paper published in JACC: Advances has ignited a debate within the nutrition field regarding the relationship between cholesterol and the ketogenic diet. The study examined the effects of a ketogenic diet on 100 subjects who had been following it for at least two years and had unusually high cholesterol levels.
The study's author, Dave Feldman, an engineer and entrepreneur, claimed that the study found no association between LDL cholesterol and plaque in the patients, suggesting that their keto diets were not raising their risk of plaque. However, many doctors and researchers reached the opposite conclusion, citing concerns about "selective reporting" of data, the study's lack of a comparator group, the validity of the statistical modeling used, and the weakness of using a one-year timeframe.
The study was also criticized for seemingly masking its original focus on the percentage change in non-calcified plaque volume (NCPV). Critics allege that researchers could cobble together any data once the experiment has been done, without clarifying what they were initially looking for, and try to pass this off as evidence of something.
The Lipid Energy Model
Feldman proposed a new alternative theory-the lipid energy model-in which high LDL is thought to be unconcerning in LMHRs because their bodies have become more efficient in transporting cholesterol while running primarily on fat.
Nadolsky, though a believer in the consensus view on cholesterol, was still interested in getting some data on the effects of LDL cholesterol in LMHRs, and a study investigating Feldman’s theory was a way to reach across the aisle to get it.
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But in putting together a study to test Feldman’s hypothesis they faced difficulty, Nadolsky explains. It would be shot down by an institutional review board, as it would require people with extremely high LDL cholesterol levels to go untreated, when this is known to be potentially dangerous.
Health Conditions and the Ketogenic Diet
Preliminary research suggests that the keto diet may be helpful for certain health conditions:
- Type 2 Diabetes: By lowering carb intake, the keto diet can reduce blood glucose levels and improve insulin sensitivity.
- Metabolic Syndrome: The keto diet may help manage metabolic syndrome by controlling insulin resistance and improving risk factors.
- Obesity: The keto diet may promote weight loss and preserve lean body mass during weight loss.
- Epilepsy: A ketogenic diet may help patients with epilepsy.
- Migraines: By reducing inflammation, the keto diet may be useful in reducing headache days.
- Polycystic Ovary Syndrome (PCOS): The keto diet may help with inflammation and insulin resistance, which play a big role in PCOS.
- Autism: A modified keto diet may help improve some behavioral symptoms associated with autism spectrum disorder.
- Dementia and Alzheimer’s Disease: The ketogenic diet may help preserve cognitive function and memory in people who are at a relatively higher risk for dementia.
- Parkinson’s Disease: The ketogenic diet may help preserve cognitive function and memory in people who are at a relatively higher risk for dementia.
- Bipolar disorder, epilepsy, and schizophrenia: A ketogenic diet focused on increased protein and decreased carbohydrates has shown positive results for patients with bipolar disorder, epilepsy and schizophrenia.
However, the ketogenic diet is not safe or effective for everyone:
- Type 1 Diabetes: People with type 1 diabetes should not put themselves on keto.
- Eating Disorders: If you have a history of an eating disorder or disordered eating, you should not be following a restrictive diet.
- Binge-Eating Disorder (BED): BED cannot be treated with a restrictive diet.
- Gallbladder Removal: If you’ve had your gallbladder removed, you may feel awful on keto.
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