For years, most people who exhibited certain cardiometabolic risk factors such as obesity, high LDL cholesterol, high triglycerides, low HDL cholesterol levels, high blood pressure, or diabetes were told by their cardiologists to avoid fats. This standard nutritional advice essentially turned all fats into a “scapegoat” for the rising levels of obesity, diabetes, and heart disease affecting millions of people across North America. For Dr. Blair O’Neill, however, this focus was gravely mistaken. “My focus is strictly on cardiometabolic health,” Dr. O’Neill tells the Paleo Foundation. “I usually see patients who have come to see me in order to lose weight. I tell them that this is usually a happy side effect that comes with adopting the Keto diet. It is one of the most important health benefits that come with fundamentally changing your lifestyle and how you eat.”
Dr. O’Neill has years of experience treating severe metabolic disease, severe obesity, and type II diabetes. While many doctors recommend a low-fat diet to these types of patients, he believes that a Keto or low carb diet can play a fundamental role in reversing diabetes, getting people off insulin, and other medications as well.
“That’s been my focus for the past years: treating patients that have tried and failed with numerous diets and using Keto or low carb diets to improve cardio-metabolic health. Many of my colleagues refer patients to me for nutritional counseling,” he says.
As is often the case, Dr. O’Neill had a personal experience with the health benefits of low-carb lifestyles. “I have been a practicing cardiologist for 30 years, and I’ve always been an advocate for healthy lifestyles,” he says. “I’ve always been a runner, and earlier in my career, I’ve followed the mainstream USDA nutritional guidelines. When it turned 50, however, I found that the pounds kept adding up even though I wasn’t eating unhealthily. I would cut the fat off my meat or avoid eating meats altogether. Basically, I tried to avoid fats as per the mainstream nutritional guidelines.”
After continuing to gain weight, one of Dr. O’Neill’s former trainers, who had lost weight while trying the Keto diet, told him about how he was shedding pounds while eating a high-fat diet. “As doctors, we have very little training in nutrition, so I started reading books on the Keto diet,” Dr. O’Neill admits. He began his Keto diet while on vacation in Hawaii and immediately began to notice tangible results
The lost weight and other health benefits eventually led to a more profound professional interest in how the Keto diet was allowing him to achieve these results.
“After reading lots of books and literature, meeting leaders in the world of Keto dieting, doing my own research, and publishing papers on the subject, I have come to believe that (the Keto Diet) is very heart-healthy,” Dr. O’Neill says.
“We know that small and dense cholesterol is associated with metabolic syndrome, and that is what I focus on when working with patients: changing the fats in their bloodstream. This almost immediately changes when they commit to going on a Keto and real food diet that focuses on healthy fats and above-ground vegetables.”
FAILED STRATEGY FOR THE PREVAILING HEALTH CRISIS OF TODAY
Adopting a high-fat diet is certainly discordant with traditional nutritional guidelines, which tend to make fats the main culprit of the numerous health crises we face. However, Dr. O’Neill’s research and medical experience into the benefits of low-carb diets challenge this conventional medical and nutritional “consensus.”
“The critique that the Keto Diet does not allow for sustainable and long-term weight loss is one of the biggest myths,” he argues. “With low calorie and low-fat diets, only around 20 percent of people are successful at keeping their weight off over two years. That’s certainly not sustainable.”
According to Dr. O’Neill, most people will almost inevitably give up on these low-fat/low-calorie diets because their bodies tell them that they are essentially starving. “These low-fat diet recommendations become self-defeating. Now, if you’re eating the right fuel proteins and fats, then your brain will help you out. Instead of telling you that you’re starving, with a proper and composed Keto diet, your metabolism speeds up and burns more energy, and helps with weight loss. Why is this not considered to be sustainable?” he asks.
Dr. O’Neill also believes that certain claims by some medical professionals that a low-carb and high-fat diet may increase your risk for heart disease or increase your cholesterol levels are simply unproven.
“We don’t have the evidence that Keto diets make you live longer,” he admits. “But we do have evidence that shows that Keto is the only diet to put you in remission from type II diabetes, one of the main factors for dementia and heart disease. I think it’s only a matter of time before we show this a reduction in risk of diabetes and dementia, and heart disease, as well. We have heard about the supposed risks of high-fat diets for too long, but with very little supporting evidence. We have substituted fats with cheap and easy carbs, which, along with too much sugar intake, is causing obesity, insulin resistance, and type II diabetes.”
THE NEED FOR DEEPER CULTURAL CHANGES
Sustainable, long-term weight loss, along with any healthy change in diet or lifestyle, requires more than a simple technical fix. Simply giving people a set of dietary recommendations without helping them find the cultural and practical supports they need to uphold and continue the diet is bound for failure.
“I tell my patients that if you’re going to be successful with your weight loss or greater health goals, you need to get over your fear of fat,” Dr. O’Neill says. “I think you only need to fear fat if you don’t give up these high levels of carb intake that characterizes our modern diet. Fat and carbs are obviously a bad combo.”
Beyond simply changing attitudes and approaches to nutrition, Dr. O’Neill also thinks that people need practical tools for adopting a low-carb lifestyle. “We live in carb heaven, and people are always surrounding us with these bad foods. Sugar is addictive, and most people simply do not have enough supports. A typical cardio program will talk about restricting calories, but without any sort of support, we’d all fall of the wagon,” he says.
“We need to get advice on how to do a good low carb diet. Good fat and protein will help you lose weight effortlessly. Eating healthy shouldn’t be about counting calories. Rather, we need to tell people just to eat normally. Instead of restricting people, we should focus on creating supports that encourage people to cook and eat real food. That takes time, and most of us live a time-compressed lifestyle. We need to develop the habits to cook in bulk so we can freeze things and avoid the temptations with the doughnuts that people bring into work, or the quick pizza we pick up after a long day away from home,” he advises.
Another challenge that people on the Keto diet face is the lack of low-carb meal preparation knowledge and routines. Most families go through a repertoire of 7 to 8 meals that they eat on a rotational basis. Without practical experience in preparing new meals, many low-carb dieters will run into a wall. “When adopting a low carb diet, we need to focus on how to help people incorporate those new 7-8 meal preps that you’re going to use on a daily basis,” Dr. O’Neill recommends. “That way, you’ll always have stuff in the fridge and on hand. The Keto diet can be sustainable, but it takes support and certain changes. In fact, of all the diets available to us, I think that the Keto Diet is the most sustainable, and we need to learn how to create the cultural supports and changes that make it easier to follow.”
Besides websites with good recipes that offer a wide variety of Keto food options, Dr. O’Neill also believes that independent certifying agents can play an important role in helping people on a low-carb diet find reputable and trustworthy healthy food options. “The central premise should be on eating natural foods. The downside is that we have busy lives, and not everyone can dedicate hours to cooking home-cooked meals from raw ingredients. Having good quality products that are safe and healthy meal replacements is extremely important, and certifications can help people make good and informed decisions,” he says.
According to an article in Food Business News, “the number of global product launches featuring a Keto claim increased 239 percent year-over-year in 2019… Nearly a fourth of sports nutrition products introduced last year had a Keto claim. New cereals, snacks, and soft drinks with a Keto claim grew 150%, 169%, and 212%, respectively, in 2019.” This growth in Keto-branded products should only help people improve their access to healthy, low-carb food items, thus increasing the necessary supports that are fundamental to changing dietary paradigms.
A NEED FOR MORE SCIENTIFIC EVIDENCE ON THE LONG-TERM HEALTH BENEFITS OF THE KETO DIET
Despite the benefits that come with adopting Keto and other low-carb diets, Dr. O’Neill also finds that there is some ill-advised information, tendencies, and products related to the Keto diet. Empty, illusory claims aren’t helpful for any diet, and Dr. O’Neill expresses the need for reputable, scientific evidence to help prove the health benefits of low-carb lifestyles.
“I cannot tell my patients that I will prove to you that you will live longer. We need more studies about that,” Dr. O’Neill admits.
“The only diet that has proven longevity benefits is the Mediterranean diet, which has been shown to reduce risk from heart disease. I think it is important to get reliable data for that on the Keto diet. We do, however, have data that shows that low-fat diets tend to worsen your blood parameters and trends towards cardiovascular issues and diabetes. Low-fat diets should not be recommended to anyone. There is absolutely no evidence that fat causes heart disease. Despite this fact, our guidelines stick to this religion and dogma. It’s not about science. For some reason, we have a fear of fat that is ingrained in the dogma of what we tell our patients.” Furthermore, the current popularity of the Keto diet across North America has perhaps lead to certain popular beliefs and practices that are not medically grounded and could pose a problem to the health of people who follow these types of diets.
“In my opinion, the bad Keto products are the fat bombs or Keto supplements whose main aim is to get your ketone levels up. These types of products tend to fall apart because calories still count. If you’re taking extra fat or ketones as an energy source, you’re also taking in extra calories. With Keto, you want to burn your own fat and lose weight by getting metabolically healthy. These extra supplements to get your ketone levels up aren’t usually necessary unless you’re a high-performance athlete. For a regular person, eating real, low-carb foods can allow you to burn your fat without taking on enormous levels of extra fat,” he states.
Unfortunately, extravagant marketing props are often a great selling point in the increasingly competitive low-carb food market. It’s unfortunate that many people associate the Keto Diet with ketone supplements instead of natural, wholesome foods. “I think that people can get led astray by some products that supposedly seek to help you boost your fat-burning potential. For example, nuts can certainly be healthy. Still, if you are not careful, they can be a trigger food, and you can eat a whole bag of nuts leading to way too many calories,” Dr. O’Neill mentions.
However, Dr. O’Neill also recognizes that the time constraints faced by many people are a real barrier to successfully adopting and maintaining a low-carb diet. “There is certainly a need for healthy meal supplements,” he recognizes. “People get busy in their lives, and this is what triggers the thought: I’m starving, so I’m going to order pizza. If you had a healthy, high-fat, and high-protein bar on hand that could help you get through those cravings, that could certainly help avoid the temptations. Eating real food is key, but people need a realistic option for healthier options to eat during our busy lives.”
MEETING PEOPLE WHERE THEY ARE
Low-carb ketogenic diets can be a pathway to better cardiometabolic health. However, instead of a strict, dogmatic focus on burning fats and shunning all foods with even minimal levels of carbs, Dr. O’Neill believes the main focus should be on eating real food. As a medical practitioner, he also believes in the importance of meeting people where they are. In many ways, the restrictive parameters of avoiding fats and counting calories that characterize traditional, low-fat diets are similar in nature to those uncompromising Keto fanatics who demonize any type of carbohydrate intake.
For many of his patients, Dr. O’Neill has recommended a sort of hybrid Keto-Mediterranean Diet. “We all love olive oil and avocados,” he says. “Whole grains and fish are healthy, so I tend to recommend this type of diet focused on low carbs and real foods.”
However, he also knows that individual circumstances are different, and practical health benefits are only possible when people have a clear and attainable pathway for successfully adhering to a low-carb diet.
To end our conversation, Dr. O’Neill told us a story about a long-haul truck driver who had no cooking skills and only ate at fast-food restaurants and truck stops along his route; not exactly places filled with nutritious, low-carb, health food products. Despite this challenge, the long-haul truck driver was able to lose and keep off over 100 pounds by carefully choosing low-carb options at the food places he had at his disposal.
Though a Big Mac meal without the bun and French fries is not an ideal diet for anyone, Dr. O’Neill tells us that nutritionists and health professionals “need to meet people where they are. Not everyone has to be on Keto,” he says, “but we all need to cut refined carbs.”