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High fat or ‘ketogenic’ diets could prevent, reverse heart failure

High fat or 'ketogenic' diets could prevent, reverse heart failure
Kyle S. McCommis, Ph.D., is an assistant professor in Biochemistry and Molecular Biology at Saint Louis University. Credit: Saint Louis University

Research from Saint Louis University finds that high fat or “ketogenic” diets could completely prevent, or even reverse heart failure caused by a metabolic process.

The research team, led by Kyle S. McCommis, Ph.D., assistant professor in Biochemistry and Molecular Biology at SLU, looked at a metabolic process that seems to be turned down in failing human hearts.

In an animal model, drastic heart failure in mice was bypassed by switching to high fat or “ketogenic” diets, which could completely prevent, or even reverse the heart failure.

“Thus, these studies suggest that consumption of higher fat and lower carbohydrate diets may be a nutritional therapeutic intervention to treat heart failure,” McCommis said.

The findings, “Nutritional Modulation of Heart Failure in Mitochondrial Pyruvate Carrier-Deficient Mice” were published online Oct. 26 in Nature Metabolism. This research, which was initiated during McCommis’ postdoctoral and junior faculty positions at Washington University School of Medicine, then was completed at Saint Louis University School of Medicine.

The heart’s myocardium requires vast amounts of chemical energy stored in nutrients to fuel cardiac contraction. To maintain this high metabolic capacity, the heart is flexible and can adapt to altered metabolic fuel supplies during diverse developmental, nutritional, or physiologic conditions. Impaired flexibility, however, is associated with cardiac dysfunction in conditions including diabetes and heart failure.

The mitochondrial pyruvate carrier (MPC) complex, composed of MPC1 and MPC2, is required for pyruvate import into the mitochondria. This study demonstrates that MPC expression is decreased in failing human and mouse hearts, and that genetic deletion of the MPC in mice leads to cardiac remodeling and dysfunction.

“Interestingly, this heart failure can be prevented or even reversed by providing a high-fat, low carbohydrate “ketogenic” diet,” McCommis said. “A 24-hour fast in mice, which is also “ketogenic” also provided significant improvement in heart remodeling.”

Diets with higher fat content, but enough carbohydrates to limit ketosis also significantly improved heart failure in mice lacking cardiac MPC expression.

“Our study reveals a critical role for mitochondrial pyruvate utilization in cardiac function, and highlights the potential of dietary interventions to enhance cardiac fat metabolism to prevent or reverse cardiac dysfunction and remodeling in the setting of MPC-deficiency,” McCommis said.Ongoing studies will seek to uncover the importance of ketone body versus fate metabolism in this process of improved cardiac remodeling.

Take-aways

More information:
Kyle S. McCommis et al, Nutritional modulation of heart failure in mitochondrial pyruvate carrier–deficient mice, Nature Metabolism (2020). DOI: 10.1038/s42255-020-00296-1

Journal information:



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High fat or ‘ketogenic’ diets could prevent, reverse heart failure (2020, October 26)
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A ketogenic diet and glioblastoma cancer — Diet Doctor

This story is different. We hear from Tom who found the keto diet in a less than ordinary way, and he ended up losing 105 lbs (48 kg). Fantastically done, but this story has another focus. Read on to take part in this moving story:

I’m going to tell you a story about how an obese 59-year old with high blood pressure, high cholesterol and a 44” (112 cm) waist changed his life. This story will be about doctors, family and the unexpected twists life can take. This story has two endings. Here is how it started.

This is one ending to my story. I am now 61 years old, 192 pounds (87 kg), and I have a 32” (81 cm) waist. My doctors are thrilled, my family is very happy, and my blood pressure has dropped. I have even become more active.

So, what happened during this story? Let me fill in the missing pieces. Everyone assumes this was a vanity move. That I did it for health reasons. I was getting older. I had a dear friend die. Or, I had an HS reunion coming up. All true, but they are not part of this story.

Starch structureI want you to meet my daughter Alina. She was a bright 28-year-old college graduate. She was working as an accountant for CA. She was happy, successful, a picture of health. She had occasional headaches, but the doctors didn’t seem concerned. In September of 2016, we ended up in the emergency room. The doctors found a massive brain tumor. Alina had two surgeries to remove the tumor followed by the devastating news that she had stage 4 glioblastoma, otherwise known as GBM. GBM has been in the news recently because of senator McCain. It is an aggressive, fast-growing brain cancer. The average survival time is 12 months. 25% of patients survive one year, and 5% survive five years.

So what do you do about GBM? Standard treatment begins with surgery. After surgery, you are given radiation and chemo. In the meantime, you take other medications to control the side effects. Tick, tick, tick, GBM makes you acutely aware of clocks ticking. You start searching for medical trials. There are many rules to qualify, most extend life by only a few months. Some have a substantial chance of killing you.

We decided to join a ketogenic diet study.

While I would like to offer a magic bullet for all cancers, a ketogenic diet is not that. The diet does not “cure” cancer. It should not be used to replace traditional treatment. But the diet has shown promise for some cancers especially GBM. So why would a diet help? On a simplistic level, cancer “eats” glucose and needs 20 times more glucose compared to normal cells. Cancer cells cannot make the transition to using ketones, especially in the brain, making them more vulnerable to chemo and radiation.

I won’t sugar coat it. The diet can be hard to start. The first two weeks can be terrible. You give up a lot of comfort foods. Plus, you will need new cookbooks. So, switching to a ketogenic diet isn’t the first thing that pops into your head when you hear cancer. But the diet works. I steadily lost weight without substantial hunger or changes to my limited exercise program. My overall health improved, I slept better, felt better and hopefully look better.

Don’t expect to turn into a muscle-bound. There is unfortunate hype surrounding this diet. There are no magical “ketone” supplements that turn you thin. But studies show it might improve your thinking, help with type 2 diabetes, dementia, seizures and inflammation. Every diet has its detractors. Recent “news” has been particularly harsh with dramatic headlines. Some considered it a “fad.” Others question sustainability. So, are they right?

The diet has been in use since 1930, so it is hardly a fad. While people who eat a lot of meat may have a shorter life, a ketogenic diet is not a meat diet. There have been many studies of this diet for serious medical conditions, and they have shown it can be sustained over time. Diet commercial will tell you; it is all about the food. Here are some sample ketogenic meals that I think anyone would enjoy. You eat lots of good healthy oils, fish, eggs, cheese, some meat, and vegetables. The diet is satisfying and easy to prepare.

Of course, be skeptical of diet-health claims. Here are two websites that will explain the ketogenic diet. Diet Doctor is the best overall with great videos. Charlie Foundation is particularly useful for medical issues. Both have great recipes.

Today, my daughter Alina is a cancer survivor.

I wanted to thank DD for being a great resource for both my daughter and myself during our ketogenic diet.

Congratulations, Tom on your success, and our very best wishes for your daughter in her struggle.

While a ketogenic diet has been proven to help with weight loss and other metabolic issues, the effectiveness (as a compliment to other treatments) for brain cancer is still largely unknown, as no major human study on it has yet been published.

In theory, and in the opinion of some experts, it might have a positive effect used in addition to conventional treatments. We have explored the topic in this article.

Regardless of the outcome, by participating in a study on the ketogenic diet for brain cancer, your daughter will help advance the knowledge on the topic. For the 200,000 people worldwide who get a devastating GBM diagnosis every year, she’ll potentially offer hope.

Get started

Do you want to try to make your own success story? Sign up for our free

Alternatively, use our free keto low-carb guide, or for maximum simplicity try out our with weekly delicious keto menus and shopping lists – it’s free to use for a month.

Do you have a success story you want to share on this blog? Send it (photos appreciated) to frida@dietdoctor.com, and please let me know if it’s OK to publish your photo and name or if you’d rather remain anonymous.

This content was originally published here.

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Babies thrive under a ketogenic metabolism

Some people, even some scientists who study ketogenic metabolism, have the idea that ketogenesis is somehow abnormal, or exceptional; an adaptation for emergencies only. We disagree.

One reason we think a ketogenic metabolism is normal and desirable, is that human newborns are in ketosis. Despite the moderate sugar content of human breast milk, breastfeeding is particularly ketogenic. This period of development is crucial, and there is extensive brain growth during it. Although the composition of breast milk can be affected by diet [1], it is reasonable to assume that breast milk has always been ketogenic, and this is not an effect of modernisation.

When the brain is in its period of highest growth, and when the source of food is likely to be close to what it evolved to be for that period, ketones are used to fuel that growth.

If nothing else, this suggests that learning is well supported by a ketogenic metabolism. It is also consistent with the ability of ketogenic diets to treat a variety of seemingly unrelated brain disorders and brain trauma.

In brief

  • Newborn infants are in ketosis. This is their normal state.
  • Breastfeeding is particularly ketogenic (compared to formula feeding).
  • Breastfeeding longer (up to a point) is associated with better health outcomes.
  • This suggests the hypothesis that weaning onto a ketogenic diet would be healthier than weaning onto a high-carb diet.

(Mark-up ours) https://lh4.googleusercontent.com/-Qkco6a-yHU4/UuLtMjR7QjI/AAAAAAAABzk/pGq63wexS2A/w1042-h468-no/ketonemiaTable.png

Human babies are in ketosis

Soon after birth, human babies are in ketosis, and remain so while breastfeeding [2]. They use ketones and fats for energy and for brain growth.

When this has been studied, in the first couple of hours after birth, babies aren’t immediately in ketosis. There is a short delay [3]. During that brief period before ketogenesis starts, lactate (confusingly not to do with lactation) becomes an important fuel to suppport the brain [4]. Some researchers speculate that this delay in ketogenesis could be because of a limited supply of carnitine, which is supplied by milk, but they also note that glycogenolysis and gluconeogenesis (the process by which glucose is made out of protein) are not active immediately [5]. Therefore, it could simply be the case that ketogenesis takes time to get started. In other words, it may just be keto-adaptation.

Note, though, that the mothers of these babies were unlikely to have been ketogenic. As it happens, if the mother is in ketosis (as has been studied through fasting), ketone bodies will pass through the placenta and be used by the fetus [5], [6]. At the same time, gluconeogenesis is induced in the liver of the fetus, likely as a result of the insulin-to-glucagon ratio [7], [8]. Therefore, it is possible that the fetus of a ketogenic mother would already be independently ketogenic at birth.

Breastfeeding is probably healthy

Many positive associations between exclusive breastfeeding for at least 3-6 months and the later health of the child have been reported. For example, intelligence has been positively correlated with length of time breastfeeding. The data is conflicting and prone to confounds [9], although we found a few studies that appear to have addressed those confounds and still showed an effect [10], [11], [12]. There have also been correlations found between breastfeeding and protection from developing diseases, such as asthma and allergies [13], type 1 and type 2 diabetes [14], and epilepsy [15].

Observational correlations are good sources of hypotheses, but can’t establish causality. Unfortunately, these hypotheses are hard to test. We suppose that breastfeeding is healthy mainly because we clearly evolved to breastfeed.

Breastfeeding is ketogenic

The medical focus in the 20th century was heavily influenced by the discovery of micronutrients, and because of this, we have been looking for the secret of the healthfulness of breast milk by examining what nutrients it contains. However, one significant difference between breastfeeding infants and those drinking formula is that they are in deeper ketosis [16]. It is not known why. It could be a property of the milk, or something else about the feeding. In any case, regardless of mechanism, the fact is that breastfeeding is more ketogenic. It is possible that the reason that longer breastfeeding is generally associated with better health, is because it represents a longer time in ketosis.

Summary

  • The period in which human brains grow the most, and in which food is least likely to be different from evolutionary conditions, is a ketogenic period. This suggests that a ketogenic metabolism is excellent for learning and development.
  • Breastfeeding in humans is particularly ketogenic. We hypothesise that the positive associations between health and longer breastfeeding may be due to extending the period of ketosis in infancy.
[*] Homemade, because it is rich in fat, unlike the boxed varieties which have almost none.

References and notes

[1]

Evidence type: review

Dietary Triacylglycerol Structure and Its Role in Infant Nutrition
Adv Nutr May 2011 Adv Nutr vol. 2: 275-283, 2011

“The fatty acids needed by the mammary gland for synthesis of TG for secretion in milk are obtained by uptake of fatty acids from plasma and de novo synthesis in the mammary gland (7). Fatty acid synthesis in the mammary gland, however, is unusual. Commencing with acetyl CoA, malonyl CoA 2 carbon units are added to the growing fatty acid with elongation terminated at a carbon chain length of 14 or less by the mammary gland-specific enzyme thioesterase II rather than at 16 carbons, as occurs in the liver and other tissues (7, 8). Synthesis and secretion of 10:0, 12:0, and 14:0 into milk is increased in lactating women consuming high-carbohydrate diets, whereas the secretion of the 18 carbon chain unsaturated fatty acids, which are derived by uptake from plasma, is decreased (4, 9, 10). Overall, reciprocal changes in mammary gland-derived medium-chain fatty acids (MCFA) and plasma-derived unsaturated fatty acids allows the milk fat content to be maintained under conditions of varying maternal dietary fat and carbohydrate intake. The levels of unsaturated fatty acids, including 18:1(n-9), 18:2(n-6), 18:3(n-3), 20:5(n-3), 22:6(n-3), and trans fatty acids in human milk, however, vary widely, with the maternal dietary fat composition being one of the most important factors contributing to the differences in the levels of unsaturated fatty acids in the milk of different women (4, 8, 11–14). In contrast, the levels of 16:0 in milk from women in different countries and with different diets is relatively constant at 20–25% of the milk fatty acids regardless of differences in the maternal diet fat content or composition (4). Possible exceptions include lower levels of 14–18% 16:0 described for milk from women in Gambia (15), some vegans and vegetarians (16, 17), and the Arctic Inuit (18).”

[2]

Evidence type: review of experiments in humans and rats

Lactate utilization by brain cells and its role in CNS development.
Medina JM, Tabernero A.
J Neurosci Res. 2005 Jan 1-15;79(1-2):2-10.

“Striking changes in the fuel supply to the tissues occur during the perinatal period because the transplacental supply of nutrients ends with a period of postnatal starvation (presuckling period) followed by adaptation to a fat-rich diet.”

[…]

“Ketone bodies are a major fuel for the brain during the suckling period and hence the stimulation of ketogenesis at birth is an important metabolic event in adaptation of the newborn to extrauterine life. Ketogenesis is active during late gestation in human fetal liver and the activity of ketogenic enzymes sharply increases immediately after birth in the rat (Hahn and Novak, 1985; Bougneres et al., 1986). In addition to modulation of enzyme activities, the control of ketogenesis also depends on the availability of fatty acids. The increase in fatty acid concentrations that occurs after delivery is due to breakdown of triacylglycerol in white adipose tissue present in human newborns at birth. In the rat, however, plasma fatty acids mostly come from hydrolysis of triacylglycerols from the mother’s milk because of the lack of white adipose tissue at birth. Nevertheless, in both species, once lactation is active fatty acids come from the intestinal hydrolysis of milk triacylglycerols, which may be absorbed directly without passage through the lymph (Aw and Grigor, 1980).”

[…]

“The increase in the activities of ketogenic enzymes together with the increase in the availability of fatty acids occurring immediately after delivery result in enhancement of ketogenic capacity of the liver (Girard,1990). This is responsible for the increase in ketone body concentrations observed postnatally. In fact, plasma ketone body concentrations are the main factor controlling the rate of ketone body utilization by neonatal tissues (Robinson and Williamson, 1980). In addition, activities of enzymes involved in ketone body utilization either increase during the first days of extrauterine life, as in the rat (Page et al., 1971), or are already induced during early gestation, as in the human brain (Patel et al., 1975). Moreover, newborn rat brain contains acetoacetyl-CoA synthetase, a unique enzyme that allows an important portion of carbon atoms from ketone bodies to be incorporated into lipid via a highly efficient cytosolic pathway (Williamson and Buckley, 1973). Indeed, there is a strong correlation between lipid synthesis and the activity of this enzyme during brain development (Yeh and Sheehan, 1985). Moreover, ketone body transport across the blood–brain barrier using the monocarboxylate carrier is maximal during the suckling period, in keeping with the idea that ketone bodies play an important role in brain development (Cremer, 1982; Conn et al., 1983). “Ketone bodies are utilized by the newborn brain as a source of energy and carbon skeletons and are incorporated into fatty acids, sterols, acetylcholine, and amino acids (Robinson and Williamson, 1980; Bougneres et al., 1986). Ketone bodies, however, seem to be the major source of carbon skeletons for sterol synthesis during brain development and play a decisive role in the synthesis of brain structures during myelinogenesis (Robinson and Williamson, 1980; Miziorko et al., 1990). Ketone bodies are utilized evenly by neurons, astrocytes, and oligodendrocytes (Edmond et al., 1987; Lopes-Cardozo et al., 1989; Poduslo and Miller, 1991), indicating that they are ubiquitous substrates for brain cells. Acetoacetyl-CoA synthetase activity, however, is higher in oligodendrocytes than in neurons or astrocytes, confirming the special role of oligodendrocytes in myelinogenesis (Pleasure et al., 1979; Lopes-Cardozo et al., 1989; Poduslo and Miller, 1991).”

[3]

Evidence type: review of experiments

Metabolic adaptation at birth.
Ward Platt M, Deshpande S.
Semin Fetal Neonatal Med. 2005 Aug;10(4):341-50.

“During the first 8 h after birth, newborn infants have been shown to have rather low plasma ketone body concentrations despite adequate levels of precursor free fatty acids (FFAs), reflecting limited capacity for hepatic ketogenesis.30 Thereafter, from 12 h of age, healthy term infants show high ketone body turnover rates (12e 22 mmol kg/min) approaching those found in adults after several days of fasting,14 and during days 2 and 3 after birth they exhibit high ketone body concentrations quantitatively similar to those observed after an overnight fast in older children (Fig. 2).15 Such ketone body concentrations may account for as much as 25% of the neonate’s basal energy requirements during this time. Thus vigorous ketogenesis appears to be an integral part of extrauterine metabolic adaptation in the term human neonate.”

[4]

Evidence type: review of experiments in humans and rats

Lactate utilization by brain cells and its role in CNS development.
Medina JM, Tabernero A.
J Neurosci Res. 2005 Jan 1-15;79(1-2):2-10.

“Although the supply of metabolic substrates is maintained mostly during the perinatal period, there is an apparent lack of mobilization of energy reserves immediately after delivery; i.e., during the presuckling period. During this period, the maternal supply of glucose has ceased and alternative substrates have not yet been released. In the rat, fatty acids come exclusively from the mother’s milk because of the lack of white adipose tissue at birth. Consequently, free fatty acids are not available in the rat before the onset of suckling (Mayor and Cuezva, 1985; Girard, 1990). In the case of human newborns, however, fatty acid mobilization occurs immediately after birth, although the onset of ketogenesis is delayed, probably as a consequence of a limited supply of carnitine, which is provided mainly by the milk (Hahn and Novak, 1985; Schmidt-Sommerfeld and Penn, 1990). In addition, glycogenolysis and gluconeogenesis are not active immediately after birth, resulting in very low concentrations of plasma glucose (Mayor and Cuezva, 1985; Girard, 1990). In these circumstances, lactate may play an important role as an alternative substrate. In fact, lactate accumulates in fetal blood during the perinatal period and is removed rapidly immediately after delivery (Persson and Tunell, 1971; Juanes et al., 1986).”

[5]

Evidence type: presumably this is a review. We could not get the full text, so for us this is evidence by authority

Ketone body metabolism in the mother and fetus.
Fed Proc. 1985 Apr;44(7):2347-51.

“Pregnancy is characterized by a rapid accumulation of lipid stores during the first half of gestation and a utilization of these stores during the latter half of gestation. Lipogenesis results from dietary intake, an exaggerated insulin response, and an intensified inhibition of glucagon release. Increasing levels of placental lactogen and a heightened response of adipose tissue to additional lipolytic hormones balance lipogenesis in the fed state. Maternal starvation in late gestation lowers insulin, and lipolysis supervenes. The continued glucose drain by the conceptus aids in converting the maternal liver to a ketogenic organ, and ketone bodies produced from incoming fatty acids are not only utilized by the mother but cross the placenta where they are utilized in several ways by the fetus: as a fuel in lieu of glucose; as an inhibitor of glucose and lactate oxidation with sparing of glucose for biosynthetic disposition; and for inhibition of branched-chain ketoacid oxidation, thereby maximizing formation of their parent amino acids. Ketone bodies are widely incorporated into several classes of lipids including structural lipids as well as lipids for energy stores in fetal tissues, and may inhibit protein catabolism. Finally, it has recently been shown that ketone bodies inhibit the de novo biosynthesis of pyrimidines in fetal rat brain slices. Thus during maternal starvation ketone bodies may maximize chances for survival both in utero and during neonatal life by restraining cell replication and sustaining protein and lipid stores in fetal tissues.”

[6]

Evidence type:

Lipid Metabolism in Pregnancy and its Consequences in the Fetus and Newborn
Endocrine, Volume 19, Number 1, October 2002 , pp. 43-56(14)

“During early pregnancy there is an increase in body fat accumulation, associated with both hyperphagia and increased lipogenesis. During late pregnancy there is an accelerated breakdown of fat depots, which plays a key role in fetal development. Besides using placental transferred fatty acids, the fetus benefits from two other products: glycerol and ketone bodies. Although glycerol crosses the placenta in small proportions, it is a preferential substrate for maternal gluconeogenesis, and maternal glucose is quantitatively the main substrate crossing the placenta. Enhanced ketogenesis under fasting conditions and the easy transfer of ketones to the fetus allow maternal ketone bodies to reach the fetus, where they can be used as fuels for oxidative metabolism as well as lipogenic substrates.”

[…]

“Increased gluconeogenesis from glycerol and ketogenesis from NEFA may benefit the fetus, which at late gestation is at its maximum accretion rate and its requirements for substrates and metabolic fuels are greatly augmented. The preferential use of glycerol for gluconeogenesis and the efficient placental transfer of the newly formed glucose may be of major importance to the fetus under these fasting conditions (Fig. 2), in which the availability of other essential substrates such as amino acids is reduced (30,34). Placental transfer of ketone bodies is highly efficient (35), reaching fetal plasma at the same level as in maternal circulation (29). Ketone bodies may be used by the fetus as fuels (36) and as substrates for brain lipid synthesis (37).”

[7]

Evidence type: review We could not get the full text, so for us this is evidence by authority

Gluconeogenesis in late fetal and early neonatal life.

“Abstract

Birth in most mammalian species represents an abrupt change from a high-carbohydrate and low-fat diet to a high-fat and low-carbohydrate diet. Gluconeogenesis is absent from the liver of the fetus of well fed mothers, but can be induced prematurely by prolonged fasting of the mother. Gluconeogenesis increases rapidly in the liver of newborn mammals in parallel with the appearance of phosphoenolpyruvate carboxykinase (PEPCK), the rate-limiting enzyme of this pathway. The rise in plasma glucagon and the fall in plasma insulin which occur immediately after birth are the main determinants of liver PEPCK induction. When liver PEPCK has reached its adult value, i.e. 24 h after birth, other factors are involved in the regulation of hepatic gluconeogensis. In order to maintain a high gluconeogenic rate, the newborn liver must be supplied with sufficient amount of gluconeogenic substrates and free fatty acids. An active hepatic fatty acid oxidation is necessary to support hepatic gluconeogenesis by providing essential cofactors such as acetyl CoA and NADH. The relevance of animal studies for the understanding of neonatal glucose homeostasis in man is discussed.”

[8]

Evidence type: review of experiments:

Gluconeogenesis in the fetus and neonate.
Kalhan S, Parimi P.
Semin Perinatol. 2000 Apr;24(2):94-106.

(emphasis ours)

“Studies in human and animal models have consistently confirmed the dependence of the fetus on the mother for supply of glucose so that the fetus in utero under normal physiological circumstances does not produce glucose. However, most gluconeogenic and glycogenolytic enzymes have been shown to be present early in fetal development. The exception is the cytosolic phosphoenol pyruvate carboxykinase, which is expressed (at least in the rat) immediately after birth. 12-14 The appearance of gluconeogenic enzyme activity in the liver in relation to birth in the rat fetus and newborn is displayed in Figure 2. As shown, PC and glucose-6-phosphatase activity are expressed in the fetus, are relatively low at birth, and increase rapidly thereafter. Fructose 1,6-diphosphatase activity increases before birth. In contrast, phosphoenol pyruvate carboxykinase activity is absent in the fetus and rapidly increases immediately after birth, so that hepatic gluconeogenesis is completely absent in utero and appears in the immediate newborn period 2,14,5 GNG, however, can,be induced in utero by prolonged maternal starvation, prolonged hypoglycemia in the mother, or by direct injection of cyclic adenosine monophosphate (cAMP) into the fetus. 16-18 In addition, some studies have showed incorporation of tracer carbon from lactate into glucose in rat fetus and glutamine carbon into hepatic glycogen in sheep fetus. 4,5,19 The significance of these latter observations remains unclear.”

[9]

Evidence type: meta-analysis

Breast milk and cognitive development–the role of confounders: a systematic review.
Walfisch A, Sermer C, Cressman A, Koren G.
BMJ Open. 2013 Aug 23;3(8):e003259. doi: 10.1136/bmjopen-2013-003259.

“The association between breastfeeding and child cognitive development is conflicted by studies reporting positive and null effects. This relationship may be confounded by factors associated with breastfeeding, specifically maternal socioeconomic class and IQ.

Design Systematic review of the literature.

Setting and participants Any prospective or retrospective study, in any language, evaluating the association between breastfeeding and cognitive development using a validated method in healthy term infants, children or adults, was included.

Primary and secondary outcome measures Extracted data included the study design, target population and sample size, breastfeeding exposure, cognitive development assessment tool used and participants’ age, summary of the results prior to, and following, adjustment for confounders, and all confounders adjusted for. Study quality was assessed as well.

Results 84 studies met our inclusion criteria (34 rated as high quality, 26 moderate and 24 low quality). Critical assessment of accepted studies revealed the following associations: 21 null, 28 positive, 18 null after adjusting for confounders and 17 positive—diminished after adjusting for confounders. Directionality of effect did not correlate with study quality; however, studies showing a decreased effect after multivariate analysis were of superior quality compared with other study groupings (14/17 high quality, 82%). Further, studies that showed null or diminished effect after multivariate analysis corrected for significantly more confounders (7.7±3.4) as compared with those that found no change following adjustment (5.6±4.5, p=0.04). The majority of included studies were carried out during childhood (75%) and set in high-income countries (85.5%).

Conclusions Much of the reported effect of breastfeeding on child neurodevelopment is due to confounding. It is unlikely that additional work will change the current synthesis. Future studies should attempt to rigorously control for all important confounders. Alternatively, study designs using sibling cohorts discordant for breastfeeding may yield more robust conclusions.”

[10]

Evidence type: observational

Infant feeding and mental and motor development at 18 months of age in first born singletons.
Florey CD, Leech AM, Blackhall A.
Int J Epidemiol. 1995;24 Suppl 1:S21-6.

“OBJECTIVE: To determine the relationship between type of infant feeding and mental and psychomotor development at age 18 months.

METHOD: A follow-up study of children born to primigravidae living in Dundee and booked into antenatal clinics in the City of Dundee (Local Authority District) from 1 May 1985 to 30 April 1986. The study population was 846 first born singletons, of whom 592 attended for developmental assessment at age 18 months. The main outcome measures were the Bayley Scales of Infant Mental and Motor Development.

RESULTS: Higher mental development was significantly related to breast feeding on discharge from hospital and according to the health visitors’ notes at about 2 weeks after discharge after allowing for partner’s social class, mother’s education, height, alcohol and cigarette consumption; placental weight and the child’s sex, birth weight and gestational age at birth. After adjustment for statistically significant variables, the difference in Bayley mental development index between breast and bottle fed infants was between 3.7 and 5.7 units depending on the source of feeding data. No differences were found for psychomotor development or behaviour.

CONCLUSION: The study provides further evidence of a robust statistical association between type of feeding and child intelligence. However, the literature is replete with suggestions for potential confounding variables which offer alternative causal explanations. To unravel what is an important clinical and public health question, further research should concentrate on randomized trials of supplemented formula feeds for children of mothers opting for bottle feeding and on epidemiological studies designed to disentangle the relation between method of feeding, parental intelligence and social environment.”

[11]

Evidence type: observational

Infant feeding and childhood cognition at ages 3 and 7 years: Effects of breastfeeding duration and exclusivity.
Belfort MB, Rifas-Shiman SL, Kleinman KP, Guthrie LB, Bellinger DC, Taveras EM, Gillman MW, Oken E.
JAMA Pediatr. 2013 Sep;167(9):836-44.

“Breastfeeding may benefit child cognitive development, but few studies have quantified breastfeeding duration or exclusivity, nor has any study to date examined the role of maternal diet during lactation on child cognition.

OBJECTIVES: To examine relationships of breastfeeding duration and exclusivity with child cognition at ages 3 and 7 years and to evaluate the extent to which maternal fish intake during lactation modifies associations of infant feeding with later cognition.

DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study (Project Viva), a US prebirth cohort that enrolled mothers from April 22, 1999, to July 31, 2002, and followed up children to age 7 years, including 1312 Project Viva mothers and children.

MAIN EXPOSURE: Duration of any breastfeeding to age 12 months. MAIN OUTCOMES AND MEASURES:

Child receptive language assessed with the Peabody Picture Vocabulary Test at age 3 years, Wide Range Assessment of Visual Motor Abilities at ages 3 and 7 years, and Kaufman Brief Intelligence Test and Wide Range Assessment of Memory and Learning at age 7 years.

RESULTS: Adjusting for sociodemographics, maternal intelligence, and home environment in linear regression, longer breastfeeding duration was associated with higher Peabody Picture Vocabulary Test score at age 3 years (0.21; 95% CI, 0.03-0.38 points per month breastfed) and with higher intelligence on the Kaufman Brief Intelligence Test at age 7 years (0.35; 0.16-0.53 verbal points per month breastfed; and 0.29; 0.05-0.54 nonverbal points per month breastfed). Breastfeeding duration was not associated with Wide Range Assessment of Memory and Learning scores. Beneficial effects of breastfeeding on the Wide Range Assessment of Visual Motor Abilities at age 3 years seemed greater for women who consumed 2 or more servings of fish per week (0.24; 0.00-0.47 points per month breastfed) compared with less than 2 servings of fish per week (−0.01; −0.22 to 0.20 points per month breastfed) (P = .16 for interaction).

CONCLUSIONS AND RELEVANCE: Our results support a causal relationship of breastfeeding duration with receptive language and verbal and nonverbal intelligence later in life.”

[12]

Evidence type: observational

A cohort study on full breastfeeding and child neuropsychological development: the role of maternal social, psychological, and nutritional factors.
Julvez J, Guxens M, Carsin AE, Forns J, Mendez M, Turner MC, Sunyer J.
Dev Med Child Neurol. 2014 Feb;56(2):148-56. doi: 10.1111/dmcn.12282. Epub 2013 Oct 1.

“AIM: This study investigated whether duration of full breastfeeding is associated with child neuropsychological development and whether this association is explained by social, psychological, and nutritional factors within families.

METHOD: Participants in this study were a population-based birth cohort in the city of Sabadell (Catalonia, Spain). Females were recruited during the first trimester of pregnancy between July 2004 and July 2006. Information about parental characteristics and breastfeeding was obtained through questionnaires. Full breastfeeding was categorized as never, short term (≤4mo), long term (4-6mo), or very long term (>6mo). A trained psychologist assessed the neuropsychological development of children at 4 years of age (n=434) using the McCarthy Scales of Children’s Abilities (MSCA).

RESULTS: Full breastfeeding showed an independent association with child general MSCA scores after adjusting for a range of social, psychological, and nutritional factors (>6mo, coefficient=7.4 [95% confidence interval=2.8-12.0], p=0.011). Maternal social class, education level, and IQ were also associated with child neuropsychological scores, but did not explain breastfeeding associations. Omega-3 (n3) fatty acid levels were not associated with child neuropsychological scores.

INTERPRETATION: Very long-term full breastfeeding was independently associated with neuropsychological functions of children at 4 years of age. Maternal indicators of intelligence, psychopathology, and colostrum n3 fatty acids did not explain this association.”

[13]

Evidence type: observational

Breast feeding and allergic diseases in infants—a prospective birth cohort study
I Kull, M Wickman, G Lilja, S Nordvall, and G Pershagen
Arch Dis Child. 2002 December; 87(6): 478–481. doi: 10.1136/adc.87.6.478 PMCID: PMC1755833

“Aims: To investigate the effect of breast feeding on allergic disease in infants up to 2 years of age.

Methods: A birth cohort of 4089 infants was followed prospectively in Stockholm, Sweden. Information about various exposures was obtained by parental questionnaires when the infants were 2 months old, and about allergic symptoms and feeding at 1 and 2 years of age. Duration of exclusive and partial breast feeding was assessed separately. Symptom related definitions of various allergic diseases were used. Odds ratios (OR) and 95% confidence intervals (CI) were estimated in a multiple logistic regression model. Adjustments were made for potential confounders.

Results: Children exclusively breast fed during four months or more exhibited less asthma (7.7% v 12%, ORadj = 0.7, 95% CI 0.5 to 0.8), less atopic dermatitis (24% v 27%, ORadj = 0.8, 95% CI 0.7 to 1.0), and less suspected allergic rhinitis (6.5% v 9%, ORadj = 0.7, 95% CI 0.5 to 1.0) by 2 years of age. There was a significant risk reduction for asthma related to partial breast feeding during six months or more (ORadj = 0.7, 95% CI 0.5 to 0.9). Three or more of five possible allergic disorders—asthma, suspected allergic rhinitis, atopic dermatitis, food allergy related symptoms, and suspected allergic respiratory symptoms after exposure to pets or pollen—were found in 6.5% of the children. Exclusive breast feeding prevented children from having multiple allergic disease (ORadj = 0.7, 95% CI 0.5 to 0.9) during the first two years of life.

Conclusion: Exclusive breast feeding seems to have a preventive effect on the early development of allergic disease—that is, asthma, atopic dermatitis, and suspected allergic rhinitis, up to 2 years of age. This protective effect was also evident for multiple allergic disease.”

[14]

Evidence type: review of observational studies

Does breastfeeding influence the risk of developing diabetes mellitus in children? A review of current evidence.
Pereira PF, Alfenas Rde C, Araújo RM.
J Pediatr (Rio J). 2014 Jan-Feb;90(1):7-15. doi: 10.1016/j.jped.2013.02.024. Epub 2013 Oct 16.

“Objective the aim of this study was to perform a review to investigate the influence of breastfeeding as a protective agent against the onset of diabetes in children.

Sources non-systematic review of SciELO, LILACS, MEDLINE, Scopus, and VHL databases, and selection of the 52 most relevant studies. A total of 21 articles, specifically on the topic, were analyzed (nine related to type 1 diabetes and 12 to type 2 diabetes).

Data synthesis the duration and exclusivity of breastfeeding, as well as the early use of cow’s milk, have been shown to be important risk factors for developing diabetes. It is believed that human milk contains substances that promote the maturation of the immune system, which protect against the onset of type 1 diabetes. Moreover, human milk has bioactive substances that promote satiety and energy balance, preventing excess weight gain during childhood, thus protecting against the development of type 2 diabetes. Although the above mentioned benefits have not been observed by some researchers, inaccuracies on dietary habit reports during childhood and the presence of interfering factors have been considered responsible for the lack of identification of beneficial effects.

Conclusion given the scientific evidence indicated in most published studies, it is believed that the lack of breastfeeding can be a modifiable risk factor for both type 1 and type 2 diabetes. Strategies aiming at the promotion and support of breastfeeding should be used by trained healthcare professionals in order to prevent the onset of diabetes.”

[15]

Evidence type: observational

Breastfeeding and risk of epilepsy in childhood: a birth cohort study.
Sun Y, Vestergaard M, Christensen J, Olsen J.
J Pediatr. 2011 Jun;158(6):924-9. doi: 10.1016/j.jpeds.2010.11.035. Epub 2011 Jan 13.

“OBJECTIVE: We asked whether breastfeeding reduces the risk of epilepsy in childhood.

STUDY DESIGN: We included 69 750 singletons born between September 1997 and June 2003 in the Danish National Birth Cohort and observed them to August 2008. Information on breastfeeding was reported by mothers in two computer-assisted telephone interviews at 6 and 18 months after birth. Information on epilepsy (inpatients and outpatients) was retrieved from the Danish National Hospital Register. Cox proportional hazards regression models were used to estimate incidence rate ratios and 95% CIs.

RESULTS: Breastfeeding was associated with a decreased risk of epilepsy, with a dose-response like pattern. For example, children breastfed for 3 to 5, 6 to 8, 9 to 12, and ≥ 13 months had a 26%, 39%, 50%, and 59% lower risk of epilepsy after the first year of life, respectively, compared with children who were breastfed for <1 month. The association remained when we excluded children who had adverse neonatal conditions or children who were exposed to adverse maternal conditions during pregnancy.

CONCLUSIONS: The observed protective effect of breastfeeding may be causal. Breastfeeding may decrease epilepsy in childhood, thereby adding another reason for breastfeeding.”

[16]

Evidence type: controlled human experiments

Nutritional factors that affect the postnatal metabolic adaptation of full-term small- and large-for-gestational-age infants.
de Rooy L, Hawdon J.

“Our summary statistic, median peak kb [(ketone body)] concentration (Table 6), is significantly higher in the BF [(breastfed)] group compared with other feed groups for the SGA [(small for gestational age)] infants analyzed separately. We further explored the relationship between the blood glucose concentration and kb response by finding the kb concentration at the lowest blood glucose level for each infant at >24 hours of age (Fig 3, Table 6). Especially at low blood glucose values, infants who receive breast milk show some of the highest values for blood kb concentration. Our data show that exclusive formula feeding does not necessarily protect against low blood glucose values. Hence, the SGA FF [(formula fed)] infant could be doubly at risk of both low blood glucose values with a reduced kb response. No BF infant had both low blood glucose and low kb levels. For LGA [(large for gestational age)] infants, low blood glucose values were offset by kb concentrations of the same order of magnitude previously demonstrated for AGA [(appropriate for getstaional age)] infants6 (Fig 3).”

[…]

“Mammalian animal studies have shown that the postnatal induction of the enzymes involved in β-oxidation within the mitochondria requires the presence of long-chain fatty acids.15 The carnitine palmitoyltransferase system, which controls movement of long-chain fatty acids into the mitochondria, represents a major rate-limiting step in ketogenesis in the suckling rat. Long-chain fatty acids play a pivotal role in the posttranscriptional regulation of carnitine palmitoyltransferase 1 during the immediate postnatal period. We speculate that a factor present in breast milk but absent in formula milk augments ketogenesis in human neonates in the same way. Carnitine is known to have a central role in β-oxidation of fats: it is responsible for the transport of fatty acyl-coenzyme A across the inner mitochondrial membrane.16 During the suckling period, the demand for carnitine exceeds the rate of endogenous synthesis by up to 50%.17 Indeed, healthy, full-term infants fed formulas devoid of carnitine showed reduction in ketogenesis and an accumulation of fatty acid precursors in the plasma. Although breast milk– and cow’s milk– derived formulas contain equivalent amounts of carnitine,18 it may well be that there are significant differences in bioavailability. When compared with breastfed control subjects, infants who were fed a standard formula that was not supplemented with carnitine demonstrated markers of carnitine deficiency.19 Furthermore, we hypothesized that high intakes of energy and protein associated with early formula feeding may “switch off” or dampen the crucial glucagon surge, central to regulation of fuel availability in the immediate postnatal period.”

http://2.bp.blogspot.com/-LwawYJnqhfY/UuLrg-XQbTI/AAAAAAAABzE/1IsxQzCuQHg/s1600/breastfeedingketosis.png

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keto diet

If you are looking for a great sugar free, low-carb alternative to traditional cream cheese brownies, you’ve found it in these chewy, chocolate, keto cream cheese brownies. Curb your chocolate cravings without the guilt and still stick to your low-carb or ketogenic diet.

Disclosure: This post may contain affiliate links. Making a purchase through a link in this post may earn me a small commission. Don’t worry though! I only link to products I’ve used and love. For more information read my disclosure policy.

If you are looking for a great sugar free, low-carb alternative to traditional cream cheese brownies, you’ve found it in these chewy, chocolate, keto cream cheese brownies. Curb your chocolate cravings without the guilt and still stick to your low-carb or ketogenic diet.

I have made these keto cream cheese brownies several times now. If you have been a reader for any length of time, you know that I love to bake. I would take baking over cooking, crafting, and even DIY any day. So when I started this thing called the Ketogenic Diet, I thought my baking days were over.

Well, luckily for me (and you!) they aren’t over but rather they take a little bit more trial and error. I’ve already learned how typical flours, leavening agents, and sugar behaves in traditional baking, but now I am learning a whole new way to bake.

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See, sugar alcohols like Erythritol and Xylitol** behave differently in recipes than sugar does. It took me making these keto cream cheese brownies a few times to learn that Erythritol needs time to soak in to a liquid. It also tastes much better and less gritty in a recipe if you use powdered. Even if you don’t have powdered, you can grind it up in a food processor or blender to get a powdered consistency.

I’ve also learned that coconut flour absorbs liquid like you wouldn’t believe! That’s why it’s best to add it in to a recipe in small increments rather than at once. A recipe also takes much less of it than it would of regular all-purpose flour.

All of these tips I’ve learned slowly from trial and error, but I know I have so much more to learn when it comes to keto baking. But in the meantime, we can all enjoy these delicious keto cream cheese brownies!

**I just want to add that if you use Xylitol in your household, please please PLEASE be sure that it is out of reach of your four legged friends. Let me go into a little bit of detail about how Xylitol affects our pets. For us, it’s a great sugar substitute and most people actually prefer the taste of it to Erythritol. For our pets though, if they ingest any Xylitol, even in a small amount, it can be fatal. Their bodies react to Xylitol like they would to sugar, secreting insulin to lower their blood sugar levels. The problem is though, that Xylitol doesn’t raise their blood sugar levels. So in fact, the body is producing insulin and lowering their blood sugar level, sending them into hypoglycemia. Hypoglycemia is deadly if not treated immediately. The scary part is that Xylitol is in our sugar free gum (which is easy for a pet to find on the ground)  and even some peanut butters. So please please be very careful with using this around your pets and never give your pet something that has Xylitol in it.

Looking for more low carb and keto desserts? Check out these recipes:

Low Carb Pudding Cookies
Low Carb Pumpkin Cheesecake Bars
Low Carb Snickerdoodles

And be sure to pin this post for later!!

Keto Cream Cheese Brownies

A low carb, sugar free and keto friendly alternative to traditional cream cheese swirled brownies.

  • oz
    cream cheese softened

  • Large egg

  • tsp
    vanilla

  • cup
    powdered erythritol OR 12 drops liquid stevia

  • Large eggs

  • cup
    powdered erythritol
    (or swerve)

  • tbsp
    butter
    unsalted

  • oz
    unsweetened baker’s chocolate

  • tsp
    vanilla

  • cup
    coconut flour

  • tsp
    salt

  • tsp
    baking powder

  1. Preheat oven to 350 and butter an 8×8 pan. Set aside.

  2. In a medium bowl, beat cream cheese until whipped. Mix in egg, vanilla and powdered erythritol OR 12 drops liquid stevia until well combined. Set aside.

  3. In a large bowl, beat eggs until they are frothy. Stir in powdered erythritol and let stand about 5 minutes.

  4. In a small microwave safe bowl, melt butter and chocolate for 30 second intervals stirring between heatings, until chocolate is completely melted.

  5. Add vanilla, salt, baking powder and melted chocolate to the bowl with the eggs and stir well.

  6. Slowly stir in coconut flour (in 1 tbsp increments works best)

  7. Once mixed, spread 3/4 of the brownie mixture into the prepared pan.

  8. Spoon the cream cheese mixture on top and smooth it around.

  9. Spread the rest of the brownie mixture on top of the cream cheese mixture to create a marbled look.

  10. Bake 25-30 minutes or until a toothpick insterted in the center comes out clean

NET carbs 2g Protein 4.4g Fat 18.8g Calories 210

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Keto cream cheese brownies are SO good. Totally my new go to low carb brownie recipe

  1. Do you have the nutrition facts for this ?

  2. Hi! Do these freeze well?

  3. Just took these out of the oven! Can’t wait to try, I used Lindt 90% dark instead of bakers chocolate. They look and smell amazing. I think your calorie count is off. 125 calories for 1/9th of the recipe is so low. Just the butter and cream cheese alone is 155 calories per serving . . .

  4. This recipe is out of the park amazing! My go-to for my sweet tooth. Thank you!!

  5. Can I substitute almond flour for the coconut? I just don’t like coconut flour. Seems to overwhelm the recipe when I use it.
    Thanks!

  6. I found these very salty and a bit ‘eggy’.

  7. Love these! I have made them 3 times now. I think it is important to make sure everything is whipped up very well. I also add a little heavy whipping cream to the brownie mixture to get it to spread…this is an excellent recipe! Thanks for sharing!!

  8. I am new to keto and this is my first sweet to attempt. I bought Lily’s chocolate chips that are sweetened with stevia, would that be okay? I sure hate to waste them because they were quite expensive. This just looks amazing and I want to try it right away!!

  9. Could you use the liquid stevia in the brownie portion as well? Thank you!

  10. Made them for the first time and I absolutely love them…… they are so delicious, I would make them even if I wasn’t keto….. thank you so much

  11. Tried this recipe also using my fitness pal app and he counts seen different than yours. I come up with 17 g carbs per brownie and 235 calories per brownie. Not sure what the problem is. But obviously at that carb count I won’t be able to have these on a Keto diet

  12. I tried these out yesterday, put powdered stevia instead of erythritol and cooked them for about 45 minutes. The brownie part turned out really bitter but the cream cheese part balanced the whole thing (kind of). Still, I would give my try of the recipe a 6/10 since i’m not throwing these out and could satisfy my craving of brownies. They look great, they just don’t taste that good. I’ll try to find a recipe that only uses Splenda next time.

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keto diet

The Power And Pitfalls Of The Popular Ketogenic Diet For Patients

But it presents tremendous difficulties for those who try to follow it — from families like the Johnsons to everyday dieters.

The point of the ketogenic diet is to shift your body from burning glucose as fuel to burning compounds called ketone bodies. From an evolutionary perspective, this ability to shift fuel was a hedge against starvation, for when food wasn’t available and the body needed to burn its own fat.

Essentially, though, to make the switch, you have to trick the body into thinking it’s starving. If the body perceives more than a tiny amount of carbohydrates, it will stick with burning glucose.

That’s why people on the diet, including Gloria, have to eat almost no carbs  — the equivalent of a few saltines per day — and only a moderate amount of protein, because the body can convert larger amounts to glucose. (In that way it differs from the Atkins diet, in which people are told to indulge in bacon cheeseburgers, hold the bun.)

Eating a ketogenic diet can generally be safe, says Harvard’s Dr. David Ludwig, a leading nutrition expert. There are entire populations of people — like the Inuit and Laplanders — who naturally ate a ketogenic diet most of their lives, he says.

And he thinks the processed carbohydrates that fill the typical American plate are a disaster. Eating tons of processed carbs programs the body to gain fat, he says.

“It’s just a battle between mind and metabolism that we’re destined to lose because metabolism is stronger,” he says. A ketogenic diet may help restore a healthy metabolism, he adds: “Lower carbohydrate diets, and especially ketogenic diets, may put metabolism back on our side.”

But, Ludwig says, it can be tough for people used to American diets to make the shift. He’s tried it himself a few times.

“I love how I feel on a ketogenic diet,” he says, “especially the mental clarity and the sense of stability of energy. But it is restrictive and especially during the summer,” when there are sweet peaches, plums and cherries to enjoy.

He also warns against trying the ketogenic diet without first checking with a doctor and getting some expert guidance on how to follow it. The diet has some side effects, he says, and “you also want to really commit to doing it consistently, because if you pop in and out of ketosis,” you might not have enough energy to fuel your brain cells. “And that’s not a place that people typically feel good.” (As celebrity dieters confirm, describing headaches and low energy, particularly when they started the diet.)

Mostly, Ludwig thinks more research is needed to show whether sticking to a ketogenic diet is really worth the effort, and for whom.

His group at Boston Children’s is eager for volunteers for a clinical trial to begin this fall: They’re going to bring 125 overweight people to a residential center in western Massachusetts for three months, feed them different diets — including the ketogenic diet — and see what happens.

For the Johnson family, the ketogenic diet means there’s no such thing as spontaneity. No weekend trips without hours of grocery shopping, food prep and packing Tupperware.

“There are so many parents who just don’t want to cook every once in a while and it’s like I can’t be lazy,” says April Johnson, sitting with her husband Josh after dinner. “I just want one time when I can be lazy.”

“And you can’t give her a bowl of Cheerios in the morning too,” Josh adds.

“Right. I can’t say to her older brother: ‘Hey, just pour some cereal,’ like before she was on the diet.”

And because Gloria has to eat the same number of calories every day, her parents spoon-feed her to be sure, though she’s perfectly capable of feeding herself.

Gloria has already suffered from a typical side effect: kidney stones. A high-fat diet can be very constipating, so she has to take medication for that, too. And she’s developed reflux.

But there’s no question that the keto diet works for her.

Once, at their wits’ end, the Johnsons tried stopping it. Within a few days, Gloria had a huge, minute-long seizure at a birthday party and then another at home.

“Those two episodes were enough for me to be like, ‘The diet works, and it works really well,’ ” April Johnson says. “It’s really unfortunate — but fortunate that we have something we can turn to, because medication has failed time and time and time again.”

The biggest mystery about the ketogenic diet is why it works.

Dr. Thiele’s husband, Dr. Gary Yellen, was so intrigued by the benefits he saw in his wife’s patients that he transformed his research at Harvard Medical School and now focuses on the biochemistry of the ketogenic diet.

Yellen says that once kids’ brains get into the habit of seizing, it’s very hard to break the pattern. “The brain is really good at learning to do seizures,” he says. Yet the ketogenic diet can sometimes succeed at breaking that cycle where medications fail.

“We think it might be this change in fuel source that puts the neurons of the brain in a different physiologic state that allows them to resist seizures better,” Yellen says.

He believes that when brain cells burn less glucose, that activates an anti-seizure mechanism that is meant to turn on when someone is drowning or oxygen-deprived. But the ketogenic diet turns it on at a lower threshold, thereby stopping the seizures.

Although the research is still very preliminary, Yellen says the ketogenic diet could also help some cancer patients by depriving their fast-growing cancer cells of glucose, making it easier for the body to suppress them. Theoretically, it could help Parkinson’s disease patients as well, by providing their brain cells with an alternative energy source.

But because the diet is so hard to stick to, Yellen focuses his research on finding alternative ways to trigger the same benefits. He’s hoping to find a way to manipulate the body’s metabolism to burn less glucose and more ketone bodies while still eating carbs.

April Johnson says she’d love to give Gloria a pill every day instead of struggling with scales, plastic containers and spoon feeding.

She admits that she gets annoyed with the current popular enthusiasm for the ketogenic diet — knowing what she knows about its hassles and side effects.

“Honestly that bothers me a little bit,” she says.

Her husband, Josh, says he couldn’t stick to the limited diet that his daughter follows — mostly without complaint.

“I watch what she eats. I have no desire,” he says. “I would have given up a long time ago and voted for seizures.”

Gloria Johnson was born missing part of the right side of her brain. Now a talkative, bubbly fourth-grader, she has daily seizures. But not nearly as many as the 50 or 60 electrical storms that used to course through her brain every day.

“So, is that why you eat special foods?” her mom, April Johnson, prompts her during a recent dinner at their home in Stratham, New Hampshire.

“Yeah,” she says, squirming in her high chair.

“Can you tell me what they are? Use your words,” her father, Josh, adds.

Gloria Johnson with her father, Joshua (Karen Weintraub for WBUR)

Gloria eats an unusual diet for a 9-year-old — very heavy on fats, with virtually no carbs. And none of the typical childhood treats like French fries, candies or chips. She can only have a slice or two of her current favorite food: apples.

That restrictive menu is called a ketogenic diet, and these days it’s widely considered one of the hottest food fads in America.

But a century before the ketogenic diet became fodder for  like the Kardashians and LeBron James, doctors began using it as medicine for patients like Gloria. And it clearly works. But as her family’s experience shows, and many casual keto dieters are finding out, it is extraordinarily challenging to follow.

“The ketogenic diet is probably the best treatment we have for epilepsy,” says Dr. Elizabeth Thiele, Gloria’s neurologist and the director of the Pediatric Epilepsy Program at Massachusetts General Hospital.

Most kids who try the ketogenic diet have already been on four to six medications — and are still seizing, Thiele says. They also may have side effects from the drugs, including liver damage, weight changes or behavior shifts. Some turn into zombies.

In about one-third of them, eating a ketogenic diet ends their seizures entirely.

“The diet for them can be a game changer,” she says.

This content was originally published here.

Categories
keto diet

Can a Ketogenic Diet Prevent Migraines? – Migraine Again

Can a ketogenic diet prevent migraines? A few studies and anecdotes say yes but there is no guarantee

The auras, debilitating pain, nausea, and sensitivity to noise and light means that Migraine warriors will do almost anything to ward off an attack. A specialized diet has created a buzz, leaving many of us who are desperate for relief to ask: can a ketogenic diet prevent migraines? Several recent studies exploring the potential of a ketogenic diet show anecdotal promise of less-frequent attacks, but they aren’t yet conclusive.

What is a Ketogenic Diet?

Sometimes referred to as “Atkins Light” or “The Bacon Diet,” a ketogenic diet is a diet that is low carbohydrate, moderate protein, and high fat. Typical macronutrients for someone on a ketogenic diet is 5% carbs, 25% protein, and 75% fat (yes, you read that right), with the actual amount of grams and calories consumed dependent on the individual’s needs.

As Laura West, Migraine warrior and author of the blog @MigraineKetoTherapy explains “it seemed very simple: eat a lot of fat, moderate protein, and as few carbs as possible.

The fact is, it really is that simple. Follow these basic principles and sooner or later you will find yourself in a state of ketosis, in which you are fueling your body primarily with fat instead of carbohydrates. Burning fat for fuel produces ketone bodies that help prevent the build-up of glutamate in the brain that wreaks havoc on the brains of many of us migraine sufferers.”

Can a ketogenic diet help migraines? One doctor is convinced it can: “We’ve only just begun to see glimpses of the therapeutic potential of ketogenic diets beyond the treatment of epilepsy, including cancer, neurodegenerative disorders (Alzheimers, Parkinsons, etc.), obesity, and migraine” predicts Dr. Josh Turknett, neurologist and author of The Migraine Miracle.

Proven Medical Success for Epilepsy

For years now, doctors have been prescribing a ketogenic diet to patients who suffer from epilepsy, as it has been shown to lessen the frequency and severity of epileptic seizures. Though epilepsy and migraines are separate medical issues, they are both neurological brain disorders with attacks, often responding to similar classes of medications.

Don’t miss Angel Moreno, NP discuss the keto diet for Migraine on the Migraine World Summit – Watch here

People with Migraine may also benefit from using a ketogenic diet to reduce their attacks, although it is important to check with your doctor who can monitor and assess the continued use of any medications you have been prescribed.

More Magnesium

On a ketogenic diet, it is important that you monitor your electrolyte intake, as your body will flush out excess water and electrolytes when it uses up its glycogen stores.

Consuming adequate amounts of sodium, potassium, and magnesium will keep you from feeling tired, having achy muscles, and suffering from additional headaches. Proper magnesium intake can help avoid migraines.

Luckily, many ketogenic foods, such as avocados, spinach, kale, and almonds are all high in magnesium, although some migraine patients find nuts and avocados to be migraine triggers.

Clean Eating

Since many migraines are aggravated by food triggers, it’s beneficial to get back to basics with your diet. Healthful keto consists of natural proteins, such as cuts of chicken, fish, beef, or pork, with an emphasis on fresh, leafy green vegetables. Fat will make up a large portion of your calories, so it’s important to eat healthful, natural fats, like avocado, extra virgin olive oil, or coconut oil.

Don’t worry about having to eat bland or boring meals; a variety of spices will keep your taste buds happy, while also helping alleviate migraine symptoms. Fresh ginger will also liven up any dish while also acting as a migraine-vanquishing superhero.

Avoiding Blood Sugar Spikes

Reactive hypoglycemia, the sudden surge of insulin levels after you eat a meal high in carbohydrates, is one of the least known food-related triggers for migraine attacks. If you’re eating high-carb, sugar-laden foods, your body’s insulin levels will continually be spiking and dipping, and your head will pay the price.

In our report, Can High-Glycemic Foods Increase Your Migraines?  you’ll discover how sugar and other high-glycemic foods are detrimental to your health, so it’s time to kick the habit. A ketogenic diet is the perfect way to decrease the amount of sugar and high-glycemic foods in your diet.

Dr. David Ludwig, M.D., PhD., is a professor of Nutrition at Harvard and also a director of an obesity prevention center at Boston Children’s Hospital, and he advises “The fastest way to stabilize blood glucose and lower insulin levels is to reduce carbohydrates. For many people, these low carbohydrate diets have produced tangible benefits, for sound scientific reasons.”

When you eliminate starchy foods, like potatoes, breads, and sugars, you’ll conquer your cravings and begin to view food as fuel for your body rather than a reward or treat.

The Weight Loss Part Works

Kerrie Smyres, author of the popular blog @TheDailyHeadache, and shares her personal trial with a ketogenic diet. “Managing a ketogenic diet for migraine feels like trying to contain a series of wildfires” Kerrie posted on March 28, 2016. “As soon as I think one fire is under control, another part of the forest goes up in flames … But I keep hoping that after some of the fires are under control, I will feel better enough that the improvements are worth the risk.”

Her story underscores that, while keto can be very effective for dropping extra pounds, weight loss isn’t always desirable and the diet can have some side effects.

Can a ketogenic diet prevent migraines? There is no guarantee. But following a ketogenic diet could potentially reduce the frequency and severity of the attacks. At a minimum, it may help you lose weight, which is a key risk factor in the progression of episodic to chronic migraine. Each case is different.

If you feel a migraine coming on, mentally review your diet over the past few days. Have you allowed your carb intake to creep up and knock you out of ketosis? Are you keeping up with the essential electrolytes? Though a ketogenic diet can be difficult to adhere to at times and the diet will not work for everyone, it may be the answer for you.

Helpful resources:

Keto Recipes and Meal Plans via Tasteaholics

Comments? Can a ketogenic diet prevent migraines? Have you considered cutting carbs or adopting a ketogenic diet?

This content was originally published here.

Categories
keto diet

30 Day Ketogenic Diet Plan | Ruled Me

Hey guys! So I know you’re all looking for something that’s easy to follow and I set out to make something that’s exactly that. A full one month meal plan of the ketogenic diet, the breakdown, the overview, and of course – the meals. Included are all recipes, all breakdowns of final macros, and the daily breakdown of what you should be eating.

Tips Before Starting

Some people don’t believe in counting calories on a ketogenic diet, but I am one of the few that does.

For most normal people, the amounts of fats and protein will be enough to naturally keep you satiated and naturally keep you in a calorie deficit. Though, the average American is not always normal. There’s tons of hormone, endocrine, and deficiency problems that we need to take into account.

That said, it doesn’t always allow you to lose weight when you are consuming more than your own body is expending.

“Macros” is a shortened version of macronutrients. These are the “big 3” – fats, proteins, and carbs. You can use a calculator to find out how much or how little of each you need in order to attain your goals. You can find the calculator on the navigation bar of the site!

A lot of people take their macros as a “set in stone” type of thing. You shouldn’t worry about hitting the mark every single day to the dot. If you’re a few calories over some days, a few calories under on others – it’s fine. Everything will even itself out in the end. It’s all about a long term plan that can work for you, and not the other way around.

I wanted to put it out there that I made this meal plan specifically with women in mind. I took an average of about 150 women and what their macros were. The end result was 1600 calories – broken down into 136g of fat, 74g of protein, and 20g net carbs a day. This is all built around a sedentary lifestyle, like most of us live. If you need to increase or decrease calories, you will need to do that on your own terms.

To increase calories, it’s quite easy – increase the amounts of fat you eat. Olive oil, coconut oil, macadamia nuts, and butter are great ways to increase fats without getting too much of the other stuff in the way. Drizzle it on salads, slather it on vegetables, snack on it, do what you need to do to make it work in your favor!

To decrease calories, you will have to think about what you need. Most likely, you will need less protein as well. So, keep in mind the portions of sizes of meals. Decrease them as you need to, or see fit.

Last, but certainly not least, is sticking to the diet! Ketosis is a process that happens in your body. You can’t just have “that one” cheat meal. If you do, it can hamper progress for up to a week before your body is back in ketosis and normally functioning again.

You want to keep your cheats to none. Be prepared, make sure you’re eating what you need to be satiated (“full”), and make sure you’re satisfied with what you’re eating. If you have to force yourself to eat something, it will never work out in the end. This is just a guideline on how you can eat on a ketogenic diet, so you’re very welcome to change up what kind of foods you eat!

Meal Plan Introduction

I tried to scale the recipes as best as I could in this meal plan, but not every recipe will be scaled, and some recipes will give leftovers. Make sure you look a few days ahead in the meal plan, as some leftovers are used. Freeze things if you have too much leftovers. You can always re-use this food later on!

Some of the food, for example the Not Your Caveman’s Chili, is used in the first week and then again in the last week. You could use the same batch you cook in the first, which not only saves you energy and time, but also saves money. Just freeze it and bring it out to defrost as needed.

I initially intended to keep the net carb count around 20 a day, but it ended up working out even better than that. The 28 day average for the net carbs is 11.2g Net Carbs per day. The total carbs, on average, is 19.6g per day. Even if you’re not counting net carbs, this would be a great way to quickly get yourself into ketosis.

Although I wanted to get as close to the macros as I could, I was off by a little bit. The 28 day average across all days comes out to 1597 Calories – broken down into 136g Fats, 19.6g Carbs, 8.4g Fiber, 11.2g Net Carbs, and 74.9g Protein.

I get many questions about intermittent fasting, the health benefits, the weight loss benefits, and the like. People normally use intermittent fasting for both the energy and mental clarity it can offer. But it’s not just good for that. It can offer breakthroughs of plateaus and even benefits in nutrient uptake in exercise. We go more in depth to intermittent fasting in Week 3 and 4, so keep your eyes peeled!

Now, Week 1’s shopping list is going to be long. I have to make the assumption you have nothing in your house. Many of the items are common items that most people will have already. These are all staples in my everyday cooking for keto, and should be considered an investment for your health. Once you have all of the items from week 1, there won’t be too much else to buy.

As you move on to Week 2 and beyond, take a look ahead. Some of the items you bought in Week 1 will need to be restocked. Whether it’s beef, chicken, or some kind of vegetables. In fact, you’ll be going through a lot of spinach on this meal plan – so make sure you keep your pantry restocked!

The last thing I suggest doing is buying the speciality items prior to needing them. Normally some of these items you can only find online, and by the time you need them, you’ll actually have them. There are no speciality items used in Week 1 for that reason. Make sure you order what you need and have it by the time you need it.

Below, you can find links to the products that I use regularly (and in the meal plan):

Get the 30 Day Ketogenic Diet Plan

Since this is my full-time job, donations really help me keep afloat and allow me to post as much to the website as I do. I really appreciate any donation you want to give, but you can change the price yourself. I’ve added in $15 as the suggested price. I think that’s a very fair price considering other websites are charging in the hundreds of dollars, and I’ve seen what they are like on the inside.

I have put a lot of work into this and revised it many times, but if you want it for $20, $0 or $15, feel free to put whatever you want in the amount! You can always download it for free and if you agree that the quality is worth paying for, come back and give a small donation to help me keep doing what I’m doing.

* You will receive the PDF  digital files.

Week 1 & What to Expect

Our main goal here is to stay pretty simple at first. In my eyes, simplicity is key for someone that is just starting out on a low carb diet. You don’t want it to be a difficult transition (kitchen-wise), because it will be hard to just get rid of your cravings.

Leftovers will be another thing we will take into consideration. Not only is it easier on you, but why put yourself through the hassle to cook the same food more than once? Breakfast is something I normally do leftover style, where I don’t have to worry about it in the morning and I certainly don’t have to stress about it. Grab some food out the fridge, pre-made for me, and head out the door. It doesn’t get much easier than that, does it?

The first signs of ketosis are known as the “keto flu” where headaches, brain fogginess, fatigue, and the like can really rile your body up. Make sure that you’re drinking plenty of waterand eating plenty of salt. The ketogenic diet is a natural diuretic and you’ll be peeing more than normal. Take into account that you’re peeing out electrolytes, and you can guess that you’ll be having a thumping headache in no time. Keeping your salt intake and water intake high enough is very important, allowing your body to re-hydrate and re-supply your electrolytes. Doing this will help with the headaches, if not get rid of them completely.

If you need to, drink water with a sprinkling of salt in it. Just keep drinking water (I recommend 4 liters a day), and keep eating salt. It will help, trust me. If you’re worried about high blood pressure and salt, don’t be! Recent studies show that the sodium intake and blood pressure are not as correlated as we so once believed.

Breakfast.

For breakfast, you want to do something that’s quick, easy, tasty, and of course – gives you leftovers. I suggest starting day 1 on a weekend. This way, you can make something that will last you for the entire week. The first week is all about simplicity. Nobody wants to be making breakfast before work, and we’re not going to be doing that either!

Lunch.

We’re also going to keep it simple here. Most of the time, it’ll be salad and meat, slathered in high fat dressings and calling it a day. We don’t want to get too rowdy here. You can use leftover meat from previous nights or use easy accessible canned chicken/fish. If you do use canned meats, try to read the labels and get the one that uses the least (or no) additives!

Dinner.

Dinner will be a combination of leafy greens (normally broccoli and spinach) with some meat. Again, we’ll be going high on the fat and moderate on the protein.

P.S. No dessert for the first 2 weeks.

Week 2 & What to Expect

Wow, week 1 is over. I hope you’re still doing well on the diet and have found it pretty easy breezy to keep on track with everything!

This week we’re going to be keeping it simple for breakfast again. We’re going to introduce ketoproof coffee. It’s a mixture of coconut oil, butter, and heavy cream in your coffee. If this repulses you – and I know some of you are saying “WHAT?” – just put some trust in me!

This concoction is not as strange as it sounds. Butter, after all, is made out of cream. So when you blend the oil, butter, and cream together it just adds a decadent richness to your coffee that I am quite sure you’ll really like!

Breakfast.

For breakfast, we are going to change it up a bit. Here’s where we introduce ketoproof coffee. Now, don’t get me wrong – I know some of you won’t like it. If you’re not a fan of coffee, then try it with tea. If you’re not a fan of the taste (which is very rare), then try making a mixture of the ingredients by themselves and eating it like that. So, why ketoproof coffee?

Feel free to add sweetener and spices to this if you’re not the biggest fan of the taste. Cinnamon, stevia, vanilla extract. Whatever you’d like to make it great tasting. You can even switch up the taste each and every day so you don’t get bored!

If this is your first time drinking ketoproof coffee, I suggest taking 1-2 hours or so to drink it down. Normally when people have a large exposure to coconut oil and they’re not used to it, it can make them go to the bathroom quite often. Make sure you build a tolerance to coconut oil before drinking it within a 20 minute time frame.

Lunch.

We’re still keeping simple here. We can incorporate more meat from the previous night of cooking into each lunch we do. Green vegetables and high fat dressings (or vinaigrettes) are key. Making sure to balance out the fats with the amounts of protein is very important.

Dinner.

Dinner, again, will be pretty simplistic. Meats, vegetables, high fat dressings are the center of our life. Maybe even a slathering of butter on our vegetables since we’re getting friskier. Don’t over think things in the first 2 weeks; simple is success.

P.S. No dessert for this week either, but we’ll be delving into that next week!

Week 3 & What to Expect

This week we’re introducing a slight fast. We’re going to get full on fats in the morning and fast all the way until dinner time. Not only are there a myriad of health benefits to this, it’s also easier on our eating schedule (and cooking schedule). I suggest eating (rather, drinking) your breakfast at 7am and then eating dinner at 7pm. Keeping 12 hours between your 2 meals. This will help put your body into a fasted state.

In a fasting state, our bodies can break down extra fat that’s stored for the energy it needs. When we’re in ketosis, our body already mimics a fasting state, being that we have little to no glucose in our bloodstream, so we use the fats in our bodies as energy.

Intermittent fasting is using the same reasoning – instead of using the fats we are eating to gain energy, we are using our stored fat. That being said, you might think it’s great – you can just fast and lose more weight. You have to take into account that later on, you will need to eat extra fat in order to keep out of a starvation mode state.

There are a number of benefits shown that come from intermittent fasting. Some of these include blood lipid levels, longevity, and the much needed mental clarity.

If you find that you can’t do a fast, then no big deal. Go back to week 1 and experiment as you see fit. You can eat what you want as long as it fits into your macros.

This is where things start to get more fun – less to worry about, more deliciousness to cook!

Breakfast.

We’re going full on fats with breakfast, just like we did last week. This time we’ll double the amount of ketoproof coffee (or tea) we drink, meaning we double the amount of coconut oil, butter, and heavy cream. It should come to quite a lot of calories, and should definitely keep us full all the way to dinner. Remember to continue drinking water like a fiend to make sure you’re staying hydrated.

Lunch.

No lunch, oh no! Don’t worry – the fats from the morning should keep you feeling energized and full all the way through lunch. Normally people start hitting a wall at first at around 2pm, so make sure you have plenty of water to drink, drink, and drink.

Dinner.

Well, dinner is staying the same. Meats, vegetables, and fats are almost always going to be the dinnertime norm. But don’t worry – we’ll mix in some bread-y type things!

And guess what, we get to eat dessert this week! Woo! We’ll be creating some low carb and great tasting treats that will reward you ever so much for doing the fasting. Sweets, treats, and losing weight – lucky us, right?

Week 4 & What to Expect

This week we’re getting stricter with our fasting. We had a full week of intermittent fasting and now we’re going to skip breakfast and lunch. Water is our BEST friend here! Don’t forget that you can drink coffee, tea, flavored water, and the like to get your liquids in. Keep drinking to make sure you’re not thinking about your stomach. It MIGHT start growling, just ignore it – your body will adjust with time.

Now, if you’re the kind of person that can’t fast then you can go back and follow week 2 again. That’s no big deal. Though fasting does take some time for the body to get used to, so I suggest putting your best efforts into it. Not only are the health benefits fantastic, the self-control that you gain from doing so is really a great thing.

This is by far my favorite week because it most closely resembles how I eat on a daily basis. I normally set a window of 6 hours for myself to eat in. From waking up until 5pm, I fast. After that, I am open to eating until 11pm. This is where the real fun begins. Eating copious amounts of food and being full all the way through the next day.

You get to start experimenting more with dessert and dinner. You get to snack as you please inside your window and best of all – you get to eat that protein laden chicken that you’ve been missing so much of!

Breakfast.

We’re fasting! Black coffee if you’re a caffeine addict like me. Tea, if you are not into the coffee so much. Tea can add great health benefits like coffee also. Some of the great benefits of green tea are:

Lunch.

Water, water, and then some more water. You don’t get to eat lunch and you don’t get to eat breakfast. So make sure you keep yourself VERY hydrated. It’s imperative here that you do a good job with your hydration. Remember – I recommend 4 liters a day.

Dinner.

Lots and lots of food with dessert to cover the bases! Dinner is a fantastic time for me. I suggest breaking your fast with a small snack, then after 30-45 minutes eat to your hearts content. Normally I need 2 meals to get to my macros, and I think you’ll need to do the same.

Week 5

This is where we have to depart! Sorry to say but you’re on your own. You should have plenty of leftovers that are frozen, ready, and waiting! I know a lot of you out there have trouble with timing and are busy people – so making sure that some nights you make extras to freeze is important. All those leftovers you have in the freezer? Use them up! Create your own meal plan, at first using this as a guide, and then completely doing it yourself. Once you get the hang of it, it’ll be a sinch – I promise you 🙂

Get the 30 Day Ketogenic Diet Plan

Since this is my full-time job, donations really help me keep afloat and allow me to post as much to the website as I do. While I do really appreciate any donation you want to give, you can enter $0 in the amount given to download it for free! I’ve added in $5 as the suggested price. I think that’s a very fair price considering other websites are charging in the hundreds of dollars and I’ve seen what they are like on the inside.

I have put a lot of work into this and revised it many times, but if you want it for $5 or $10 or $0, feel free to put whatever you want in the amount – I have no hard feelings! You can always download it for free and if you agree that the quality is worth paying for, come back and give a small donation to help me keep doing what I’m doing.

* You will receive the PDF  digital files.

Create Your Own Keto Diet Plan!

You can use my plan as a guideline to help you create something that fits into your life and schedule. Keep in mind that hitting your daily macros is the most important thing when it comes to dieting.

Keep in mind that should usually never go above a 15% calorie deficit (to lose weight) or surplus (to gain muscle).

This content was originally published here.

Categories
keto diet

The Ketogenic Diet: Does it live up to the hype? The pros, the cons, and the facts about this not-so-new diet craze.

If you believe the buzz, ketosis—whether via the almost-zero-carb ketogenic diet or via ketone supplements—can curb appetite, enhance performance, and cure nearly any health problem that ails you. Sound too good to be true? It probably is.

++++

Wouldn’t it be awesome if butter and bacon were “health foods”?

Maybe with a side of guacamole and some shredded cheese on top?

“I’m doing this for my health,” you could purr virtuously, as you topped your delectably marbled, medium-rare steak with a fried egg.

Well, many advocates of the ketogenic diet argue exactly that: By eating a lot of fat and close to zero carbohydrates you too can enjoy enhanced health, quality of life, performance, brain function, and abs you can grate that cheese on.

So, in this article, we’ll explore:

  • What are ketones, and what is ketosis?
  • What, exactly, is a ketogenic diet?
  • What evidence and scientific research supports the ketogenic diet?
  • Do ketone supplements work?
  • Is the ketogenic diet or ketone supplementation right for me?

How to read this article

If you’re just curious about ketogenic diets:

  • Feel free to skim and learn whatever you like.

If you want to change your body and/or health:

  • You don’t need to know every detail. Just get the general idea.
  • Check out our advice at the end.

If you’re an athlete interested in performance:

  • Pay special attention to the section on athletic performance.
  • Check out our advice for athletes at the end.

If you’re a fitness pro, or interested in geeking out with nutritional science:

  • We’ve given you some “extra credit” material in sidebars throughout.
  • Check out our advice for fitness pros at the end.

It all started with the brain.

If you’ve called Client Care at Precision Nutrition, you might have spoken to Lindsay.

Aside from being an incredibly helpful and friendly voice on the other end of the phone, Lindsay is also a tireless advocate for a health condition that has shaped her life in many ways: epilepsy.

Epilepsy is an ancient brain phenomenon, known to medicine thousands of years ago. To manage it, our Neolithic ancestors drilled holes in one another’s skulls, perhaps trying to let the bad stuff out—a practice known as trepanation.

Around 400 BCE, the ancient Greek doctor Hippocrates observed a man who had seizures for five days. On the sixth day, he noted, as the patient “abstained from everything, both gruel and drink, there were no further seizures.”

About 1,400 years later, in 1000 CE, the famous Persian physician Avicenna—who coined the term “epilepsy”, from the ancient Greek verb epilambanein (to seize or attack, as the neurological condition caused seizures), speculated that “overfeeding” might be a risk factor for epilepsy.

By 1911, a pair of Parisian doctors were trying fasting as a treatment for children with epilepsy, and in the United States, physical culturist Bernarr McFadden was claiming that fasting for three days to three weeks could cure anything.

Despite not having the tools and insight of modern neuroscience, these and other people who explored fasting and dietary prescriptions for neurological disorders were on to something.

We now know that there may be a dietary connection
—not just between epilepsy and what we eat (or don’t), but also with many other brain disorders.

Unfortunately, fasting isn’t fun. We evolved with a pretty strong aversion to starvation, and our brains and GI tracts have lots of ways to make sure we eat enough.

Which raises the question:

Could we get the health benefits of fasting another way?

In other words:

Could there be “fasting without fasting”?

In 1921, two things happened.

One: Endocrinology researcher Rollin Woodyatt noted that the same chemical environment happened with both starvation and a diet that was very low in carbohydrates and very high in fat.

Two: Dr. Russell Wilder wondered:

Could a person get the health benefits of fasting without actually fasting?

He and other doctors at the Mayo Clinic experimented with what Wilder called the “ketogenic diet” during the early 1920s. Not only did children with epilepsy seem to improve overall with this type of diet, they seemed to think and behave better as well.

Proven by several notable medical authorities, a ketogenic diet as a treatment for childhood epilepsy found its way into medical textbooks by around 1940, and stayed there throughout the 20th century.

Nowadays, aging, contact sports, and modern warfare present us with new populations of people whose brains might benefit from a ketogenic diet:

  • people with neurodegenerative disorders (such as multiple sclerosis, Parkinson’s, and Alzheimer’s); and
  • people with traumatic brain injury (TBI) from events such as explosions or concussions.

First the brain, then the body.

There was another group of people who became curious about ketogenic diets some time in the 1980s and 1990s: bodybuilders and physique athletes.

These folks weren’t too concerned about brain health or longevity. They wanted to be ripped.

The ketogenic diet seemed like a magic bullet: a way to eat butter, bacon and cream, and still get abs.

Today, what’s old is new again.

Physique- and performance-conscious people, as well as people looking to maximize lifespan and life quality, have rediscovered this old-school dietary paradigm and are wondering:

  • Could a ketogenic diet help me perform better?
  • Could a ketogenic diet help me live longer?
  • Could a ketogenic diet help me look great on the beach?

The answer?

It depends. (Don’t you hate that? But it’s true.)

To understand why, we’ll look at:

  • the science of ketosis;
  • what a ketogenic diet looks like in “real life”;
  • who it might work for (and might not work for); and
  • what this means for you.

Let’s start by clarifying just what a ketogenic diet is.

What does a ketogenic diet look like?

It might be hard to translate “low carb, high fat” into everyday foods.

To give you a better idea of the ketogenic diet in real life, here’s a comparison:

Protein Carb Fat
PN Mixed Meal  ~30% ~40% ~30%
Paleo Meal ~40% ~20% ~40%
Low-Carb Meal ~40% ~10% ~50%
Ketogenic Meal ~20% ~5% ~75%

And here’s what that might look like translated into meals.

Notice a few things.

Protein

For the first three meals, protein is more or less the same, with a little variation.

Ketogenic diets, on the other hand, include less protein—usually closer to 10 or 20 percent of total daily intake.

Extremely low in carbohydrates

The Precision Nutrition plate suggests high-fiber, slow-digesting carbohydrates, such as whole grains, beans and legumes, fruits, and starchy vegetables.

The Paleo plate may contain slightly fewer carbohydrates (early human diets often had plenty of them), but eliminates the grains and beans / legumes.

The “low carb” plate will have fewer carbohydrates than the first two, but still have a small amount, likely from vegetables.

The ketogenic meal shoots for near-zero carbs. Most estimates suggest around 10-15 grams of carbs a day. To give you an idea of what this looks like, that’s about one fist-sized portion of cooked carrots, or about 10-15 grapes. For the whole day.

Very high in fat

The Precision Nutrition plate suggests about 1-2 thumb-sized portions of fat-dense foods (like nuts, cheese, avocado, olive oil, etc.) per meal, depending on body size, activity level, and goals.

The Paleo and low-carb plates may be roughly similar, with a little variation.

We might call all three of these “moderate fat”. Indeed, some indigenous diets (aka variations on the “Paleo” concept) are often quite low in fat, especially saturated fat.

The ketogenic meal, on the other hand, is high fat—even up to 90 percent of total energy intake. That means if you’re eating a 500-calorie spinach and mushroom salad, you get about 2 thumb-sized pieces of chicken breast on top, and then pour about 3-4 glugs of olive oil on top… Yum yum!

Highly restrictive

A ketogenic diet is the most restrictive and limited of all four of these styles of eating. Here’s what you can eat on a ketogenic diet:

A small amount of protein, such as:

  • meat
  • poultry
  • fish
  • seafood
  • eggs

A large amount of high-fat foods, such as:

  • avocado
  • coconut and coconut milk or oil
  • olive oil and any other oil
  • nuts and nut butters
  • bacon
  • egg yolks
  • butter
  • cheese

A very small amount of very-low-carbohydrate vegetables, such as:

  • leafy greens
  • brassicas: broccoli, cauliflower, Brussels sprouts, cabbage
  • asparagus
  • cucumber
  • celery
  • tomatoes
  • peppers
  • mushrooms
  • zucchini

Here’s what you can’t eat on a ketogenic diet:

  • Most dairy (except high-fat items like butter and certain cheeses)
  • Fruit
  • Grains
  • Beans and legumes
  • Starchy vegetables (such as sweet potatoes)
  • Slightly-sweet vegetables such as winter squash, beets, or carrots
  • Most processed foods (with the notable exception of pork rinds)

So, let’s recap:

Ketogenic menus:

  • Vary in the proportion of protein but are generally low.
  • Stay as close to no-carb as possible.
  • Are very high in fat.
  • Are very limited in food choices.

So why go to all this effort?

Well, for particular groups of people, ketosis may indeed be helpful.

(For other people, of course, it may not be helpful… and it may be actively harmful. We’ll talk more about that in a moment.)

To understand why this is true, let’s look at how ketosis actually works.

What is ketosis?

The role of ketones

Ketones are a group of organic compounds with a specific structure.

The term “ketone” was actually coined around 1850 by German chemist Leopold Gmelin, along with the term “ester”. (See? Not as new as you’d think!)

We can use two types of ketones as energy sources, acetoacetate and D-β-hydroxybutyrate. (The β sign means “beta”.)

Our body can make ketones through a complex biochemical pathway.

The pathway to ketosis

Put very simply, when the conditions are right (for instance, during starvation or fasting, or when our carb intake is very low):

  • Our body releases fatty acids from our stored body fat.
  • These fatty acids enter other cells.
  • Fatty acids are combined with co-enzyme A to form acetyl-CoA chains.
  • These chains move into the mitochondria (our cells’ energy factories).
  • The chains are broken down into acetyl-CoA units by a sequence of reactions known as β-oxidation.
  • Chemical magic happens.
  • Acetyl-CoA forms your friends the ketones: acetoacetate and β-hydroxybutyrate, along with acetone (the same smelly stuff in your nail polish remover).
  • Ketones are released by the liver into the blood.
  • Almost any cell that needs energy can grab it from these circulating ketones. Again, our brain will be the greediest for these nummy little molecules.
Let’s take an even deeper look

The shape and orientation of molecules is important.

Stereoisomers are molecules with the same chemical makeup, but different shapes and configurations. You can imagine your right hand as a “stereoisomer” of your left: they both share the same components, just arranged differently.

Shape and orientation matter to molecules and their actions, just like having right-handed and left-handed gloves or shoes matters.

The ketone D-β-hydroxybutyrate is not the same as its stereoisomer L-β-hydroxybutyrate.

This difference in molecular configuration matters for several parts of the conversion process.

For instance, when D-β-hydroxybutyrate is converted back to acetyl-CoA, its intermediate form D-β-hydroxybutyrate-CoA isn’t the same thing as L-β-hydroxybutyrate-CoA (an intermediate of β- oxidation).

Each stereoisomer uses different enzymes for conversion, much like each lock has its own unique key.

This difference also matters for ketone supplementation (see below).

You want to supplement the right stereoisomer, rather than a random pile of ketone types. Usually in test tube chemistry, you get a mix of stereoisomers (often around half one type, and half another type), unlike our body, which only uses and makes one version. 

Ketosis happens when blood ketones are higher than normal either through dietary changes (which lead to very low blood glucose) or through supplementation (independent of blood glucose concentrations).

Some people like to think of ketone bodies as the fourth energy source for humans (in addition to carbohydrates, fats and proteins).

That’s technically true, but the alcohol in booze (aka ethanol) can also be used for energy. Just because we can metabolize something doesn’t always mean we should.

Let’s take an even deeper look

Ketosis, which just means having more ketone bodies than normal, should not be confused with ketoacidosis, which is a potentially dangerous metabolic situation of uncontrolled ketosis.

Normally, our body is very good at self-regulating.

If it senses acid levels rising (as happens in ketosis), it responds by buffering with more alkaline molecules (such as bicarbonate), changing blood levels of CO2, absorbing hydrogen ions, or telling the kidneys to excrete more dihydrogen phosphate and ammonium ions.

However, if for some reason our body can’t compensate, and blood pH drops below about 7.35 (in other words, becoming more acidic), we’re in trouble.

This usually happens in diabetics and alcoholics, since their normal metabolic mechanisms may not work properly.

For the average healthy person, dietary ketosis or even brief fasting is generally safe

How do we get into ketosis?

Method 1: Ketogenesis

We can make our own ketone bodies naturally, through the process of ketogenesis.

Our ancestors kicked off ketogenesis the good old fashioned way: by starving. About 72 hours into starvation, ketogenesis is happening and you’re in ketosis. Congratulations!

Ketosis is essentially an effect of fasting. This means that many of the health effects of fasting may be due to ketosis itself, rather than something like energy restriction.

Let’s take an even deeper look

Interestingly, how quickly ketosis happens varies by age and species.

Other mammals don’t seem to go into ketosis nearly as quickly as humans (your friendly neighborhood hibernating bear or squirrel who doesn’t eat for weeks to months at a time? No ketosis.)

Babies, on the other hand, go into ketosis within a few hours of not eating.

This may have to do with our energy-hungry human brains. About 20 percent of our overall energy intake is devoted to feeding our brains. Although bears and squirrels are clever enough to get into the garbage, they don’t have brains as large as we do.

It seems that ketogenesis is a human backup system that provides enough energy (via ketone bodies) to the ol’ noggin in times of starvation.

And it may be this particular evolutionary adaptation—which perhaps began as a way to keep the thinking factory upstairs working when food was scarce—that also enables the brain-benefiting effects of the ketogenic diet. 

Stored glucose (our sugar-based fuel) is actually rather heavy. We don’t carry around much of it. Our body prefers to store most of our excess energy as body fat.

When we eat normally, our brain gets enough energy from glucose that can easily pass the blood-brain barrier.

When we stop eating, we run out of stored glucose (as glycogen) within 2-3 days (faster if we’re active), and have to find some other fuel source.

By the way, the relative heaviness of stored glycogen is why many people report fast weight loss on a ketogenic or low-carb diet: their body has dumped a little extra weight in the form of glycogen and water (which tags along with glycogen in a 3 parts water to 1 part glycogen ratio). Unfortunately, this water and glycogen comes right back once we start eating normally again.

Method 2: A ketogenic diet

Most people frown on starving children with epilepsy, so a ketogenic diet is the next best thing.

By cutting off the body’s carbohydrate (aka glucose) supply, but providing energy and nutrients in the form of fat (plus a little protein), we can get the same effects as straight-up starvation: ketosis.

As with starvation, it usually takes some time to get into ketosis once we stop eating carbs.

Let’s take an even deeper look

Many people like to measure their ketosis with Ketostix, which test for ketones in the urine. This is not always a reliable indicator, since all it tells you is whether you’re excreting excess ketones, not whether you’re actually in ketosis per se.

In addition, Ketostix only measure the presence of excreted acetoacetate, not the presence of D-β-hydroxybutyrate.

Over time, our body’s excretion of ketones can change, even if we’re still in ketosis. Therefore, you may see different readings on the Ketostix, regardless of what is actually happening in your body. 

Method 3: Supplement with ketones

If ketones are what we want, why not just take them instead of making our own by fasting or cutting out carbohydrates?

Great idea, and totally new… except it isn’t.

As early as 1953, there were studies looking into whether we could “artificially” produce ketosis by supplementation.

Today, we know that by supplementing with ketone bodies (usually D-β-hydroxybutyrate or certain esters) you can raise the level of ketone bodies in the blood without being in ketogenesis.

This has a lot of cool possibilities. If ketone supplementation can give us the health benefits of ketosis without us having to fast / starve or follow a very restrictive diet, that could be a win-win.

Unfortunately, we still don’t have conclusive human studies on this that would give us clear direction. Check back in 10 years.

Is ketone supplementation effective?

The buzz is that ketone supplements can make you thin and cure whatever ails you. But what you read about in the media or on the interwebs isn’t always what scientists actually found in the lab.

If you didn’t know better, you’d think ketone supplementation just started. Actually, research on this topic goes back to the 1950s. All of it has been conducted using rats. Here are the findings.

Weight loss

D-β-hydroxybutyrate supplementation made some types of rats eat less and lose weight, but not other types of rats.

Some evidence kinda sorta indicates that D-β-hydroxybutyrate supplementation might activate brown fat (a metabolically active fat that is, in part, responsible for thermogenic adaptations) via the sympathetic nervous system, but there was no follow-up.

Blood glucose regulation

Another showed that ketone supplementation with either 1, 3-butanediol acetoacetate diester or sodium/potassium β-hydroxybutyrate decreased blood glucose with no changes in cholesterol or blood triglycerides (the not-so-great side effects of the ketogenic diet).

Traumatic brain injury

In one study, infusing D-β-hydroxybutryate into adult rats after traumatic brain injuries showed improved energy (ATP) levels.

In another study, D-β-hydroxybutryate didn’t improve things and actually caused damage to the blood-brain barrier, even in healthy rats.

Epilepsy

New evidence suggests that it may not be D-β-hydroxybutryate or acetoacetate preventing seizures; rather, it might be the relatively short-chain fatty acids (nanoeic and decanoic acids) in the diets when on a ketogenic diet crossing the blood-brain barrier, inhibiting seizures.

But in another study that exposed rats to high-pressure oxygen containing ketone esters such as R,S-1,3-butanediol acetoacetate diester, the rodents saw increased blood β-hydroxybutryate and decreased seizures.

Cancer

A recent study found that ketone supplementation extended survival in mice with metastatic cancer. But while it’s true that most cancers have a highly anaerobic metabolism, this in not universal. If proven to be effective, it’s likely that ketone supplementation would be an additional treatment rather than a stand alone treatment for cancer, because of its robust nature.

For now, almost no studies on ketone supplementation have used human clinical trials. So if anyone tells you that ketone supplementation is a miracle cure, ask if you can get some for your pet rat… if it’s the right kind of rat. 

Will ketosis help me?

Ketogenesis and ketosis are easy to study.

All you have to do is starve people, or feed them a high-fat/low-carb diet, and wait. Then you see if it changes whatever you’re interested in fixing.

Since we’ve known about fasting and ketosis for quite a long time, and it’s relatively easy to research, there are probably good reasons why it’s not yet considered a miracle cure.

And it’s not because Big Pharma or Carbohydrate Corporation or The Cancer Conspiracy have vested interests. (Trust me, we scientists can barely keep the grad students from contaminating the super-purified water by leaving the lid off the jug, never mind organize an evil cabal of ketosis deniers.)

To be fair, the introduction of anti-epileptic drugs in the late 1930s onward did lead to less interest in dietary ketosis as a treatment for epileptic children.

But we don’t yet use ketosis (or ketone supplementation) to fix everything from muffin tops to hangnails because:

  • For many populations, ketosis has little or no effect.
  • It may only work for particular types of people, with particular needs and health conditions.
  • It may take too long to see a measurable effect.
  • For many people, a ketogenic diet is too hard to consistently follow.

That being said, here are some interesting and promising new avenues for ketosis… as well as some “don’t bother” examples.

Probable benefit: Metabolic diseases

We know that fasting is often an effective short-term treatment for metabolic dysfunction such as poor glucose control / early Type 2 diabetes, chronic inflammation, or hypertension.

We don’t know for sure yet whether this is because of ketosis or some other mechanism (such as programmed cell death, aka apoptosis).

However, research suggests that in some cases, such as type 2 diabetes, ketosis may be useful as a short-term treatment or a “boost” that helps return metabolic processes back to a more normal and well-regulated state.

In these specific situations, a ketogenic diet or a structured intermittent fasting program done under close medical supervision for a specific objective, may be a useful as part of a multi-pronged treatment program that probably should include other therapeutic tools such as medication or other well-established health procedures.

Notice all our italics here. What we mean is:

  • Don’t use ketosis or fasting alone to try to cure stuff.
  • Don’t use ketosis or fasting just to randomly “get healthy”.
  • “Medical supervision” does not mean Dr. Google.

Verdict: Could help in some cases, but should be done with a clear purpose and carefully monitored. Not a long-term “cure-all” for most people.

Let’s take an even deeper look

Why does ketosis seem to help some types of metabolic dysfunction?

Ketones may help, in part, because they decrease oxidative stress, boost antioxidants and scavenge free radicals.

Oxidation is a natural part of cellular metabolism, but too much oxidation, too fast, without the balance of antioxidants, contributes to many metabolic and other diseases.

Many metabolic disorders are related to this process of oxidation, in which our cells essentially “rust” from the inside. If we can slow and regulate oxidation, it may improve our health and longevity. 

Probable benefit: Neurodegeneration and brain injuries

We know ketosis for epilepsy is a win—can ketosis help other types of brain illnesses and injuries?

Recent research suggests that many brain disorders (such as Alzheimer’s and Parkinson’s, among other neurodegenerative diseases) are related to other metabolic disorders such as diabetes, obesity, non-alcoholic fatty liver disease (NAFLD).

These metabolic and neourodegenerative diseases show common features, such as oxidative stress, mitochondrial dysfunction, and inflammation. In fact, Alzheimer’s is now often described as “diabetes of the brain”, or “Type 3 diabetes”.

The presence of ketones also seems to improve outcomes from traumatic brain injury (TBI). However, right now, most of these studies have been done on rats.

Still, based on what we’ve seen with epilepsy and rat studies, chances are good that ketones may be a low-risk treatment—and perhaps even a preventive strategy—to improve brain health. See above about getting medical supervision from someone other than Dr. Google.

Verdict: Probably can’t hurt, might help people with neurodegeneration and/or mild to moderate brain injury.

Unclear benefit: Longevity

We know that caloric restriction (CR) improves longevity in most organisms studied. We know that intermittent fasting seems to have some of the same benefits, sometimes.

But right now, we don’t know if ketosis works the same way.

The real question here is: Who’s willing to find out?

Would you stick to a ketogenic diet in the name of advancing knowledge, achieving scientific glory as a “ketonaut”? Most of us wouldn’t.

Plus, without a control group (say, your identical twin who lives exactly the same lifestyle as you, in the exact same environment, with only your diets being different), it’s hard to know for sure whether your 100th birthday was due to ketosis or something else.

For now, any longevity benefits would be mostly speculative. And your 100th birthday cake would have to be a block of butter.

Verdict: You could try this one and get your next of kin to report back… but most people wouldn’t want to.

Interesting, but probably no advantage for most people: Athletic performance

Athletes need fuel to perform.

Could we possibly enable people to tap into their stored body fat more effectively, and require less re-fueling from stuff like sugary energy gels?

Ketosis lets you avoid glycogen depletion (aka bonking, hitting the wall), because you aren’t using glycogen as your energy source, so you don’t need to take in carbs as you compete. Instead you’re using fat and ketone bodies. You increase fat oxidation, spare glycogen, produce less lactate and use less oxygen at submaximal rates.

All this sounds great, but the exercise physiologists’ consensus is that while all these adaptations are true, the problem is that with fat and ketone bodies as fuel, you’re not going to go as fast as you can when using with glucose and carbohydrates.

The bottom line for athletes is performance, and so far there is only one very new study showing a small improvement in cyclist’s performance with ketone supplementation combined with carbohydrate supplementation (compared to just carbohydrate supplementation alone).

It seems that combining ketones with carbs, rather than exclusively using one or the other, might offer some benefit.

Cutting Edge Research: Carb + Ketone Supplementation Improve Aerobic Performance

A recent study compared the effect of drinking just carbs to drinking carbs + ketones in male and female elite cyclists.

After not eating overnight (about 16 hours) the cyclists came to the lab and drank either a carb drink or a carb + ketone (c + k) drink.

Carb drink:

  • 40% dextrose
  • 40% fructose
  • 20% maltodextrin

C + k drink

  • 60% dextrose
  • 40% ketone ((R)-hydroxybutyl (R) -3-hydroxybutyrate ketone ester).

Total amount of substrate in both drinks were 573 mg/kg body weight.

The cyclists drank half of their drink, rode for 1 hour at 75% of their max power output. Then they drank the other half of their drink and biked as far as they could in 30 minutes.

After a week, the cyclist repeated the experiment with the opposite drink.

Results

When drinking the c + k drink the cyclists biked, on average, 2 percent (400 meters) farther longer over the 30 minutes.

There were some metabolic differences to note in with the c+k drink:

  • less lactate
  • more fatty acids in the blood
  • more D- β- hydroxybutyrate

Bottom line: Supplementing with a combination of carbohydrates and ketones may improve performance in aerobic competitions. 

Verdict: Some intriguing possibilities, particularly for aerobic performance, but to date there very little evidence to improve overall athletic performance.

No real advantage: Losing fat

Oh, insulin, you naughty monkey! You have been getting yourself in so much trouble lately!

Low-carb advocates in the late 1990s and early 2000s thought maybe they had stumbled on the key to fighting flab: insulin. Insulin is mainly a storage hormone: Its job is basically to help nutrients get into cells.

The low-carb / insulin hypothesis, dramatically oversimplified, went like this:

  • Insulin makes stuff go into cells.
  • Stuff that goes into fat cells makes us fat.
  • If we don’t help stuff go into cells, then we won’t get fat. We might even lose fat.
  • Carbs (in their digested form of glucose) stimulate insulin release.
  • Therefore eating fewer carbs = less body fat.

Now, this theory did have some merits.

For one thing, it got some of us unhooked from processed sugary and starchy treats, and thinking more about fiber content and healthy fats.

Unfortunately, insulin is not the only player. There’s never only one player in the team sport and complex system that is your body.

Nor does insulin act alone. Energy storage is governed largely by our brain, not a single hormone.

The other upside to the low-carb approach was that people often ate more protein and more fat. When we eat protein and fat, we release satiety hormones, particularly CCK, which is one of the main hormones that tells us we’re full.

More protein and fat means we’re often less hungry. Which means we eat less. Which means we lose fat. It’s the “eating less” part (not the insulin part) that actually matters.

On top of this, if you’ll recall, carbohydrates are relatively heavy to store. Lower the carb intake, and our body will eventually release some water and glycogen.

Result: Weight loss. Magic!

Yet being in ketosis doesn’t seem to have any special advantage for losing body fat (rather than just weight), especially if we consider the lifestyle and behavior aspect to this.

You may find it easy to eat less when all you can eat is protein and fat. But after a while, you may grow tired of bringing your own whole salmon to parties, and wonder what the other 95% of the grocery store is up to. You may start to have fantasies about a threesome: you, Oreos, and chocolate sauce. Not only that, you may be getting some serious scurvy and other nutrient deficiencies.

For women in particular, lowering carbohydrate intake seems to have negative effects.

Women’s bodies go on high alert faster when they sense less energy and fewer nutrients coming in. Many women have found that the low-carb diet that worked great for their husband not only didn’t work for them, but it knocked out their menstrual cycle on the way out the door.

Verdict: We don’t recommend the ketogenic diet for sustainable fat loss.

Let’s take an even deeper look

As part of the carb-insulin hypothesis, people thought that maybe metabolism would also increase during ketosis.

A recent study looked at whether or not there was a significant increase in metabolic rate when going from a high-carbohydrate diet (48% carbohydrate) to a ketogenic diet (6% carbohydrate), with protein being the same (around 16-17%).

With this dietary change, insulin went down while fatty acids and ketone bodies went up. Basal metabolism (energy expenditure) went up by about 100 kcal per day.

Seems obviously good—but not so fast.

Figuring out what this actually means is complicated.

Researchers had to correct metabolism based on body weight, which as you’ve read, tends to drop when water is lost on low-carb diets.

The authors concluded that while there was a small increase in metabolism initially, that disappeared over the four weeks while insulin levels were still low.

So their study didn’t support the insulin-carb hypothesis.

Is protein actually the key factor?

The authors of the study think that differences found in other studies comparing high and low-carb diets are because of differences in protein intake rather than carbohydrate intake in those studies.

Protein promotes satiety and takes the most energy to digest and absorb, so differences in weight loss may be net calories absorbed, rather than decreases in insulin or increases in metabolism.

Definitely no advantage: Gaining lean mass

As you may have read above, insulin is mainly a storage hormone. It’s also considered an anabolic hormone. As in building things. As in getting swole.

For the most part, we need insulin—along with other hormones, such as growth hormone and testosterone—to create an anabolic, muscle-building environment. Trying to build muscle while in ketosis is like stepping on the gas and the brake at the same time.

However, as with athletic performance, we may discover that there is some benefit to supplementary ketones while building muscle. We don’t know yet.

Verdict: Build muscle with a more appropriately anabolic diet that includes carbohydrates (particularly around training), and supplement with ketones if you want to experiment.

What this means for you

If you’re a “regular person” who just wants to be healthy and fit:

  • Enjoy reading about ketosis if you like. Try it, if you’re curious. But you can be perfectly fit, lean, and healthy without it.
  • Don’t believe everything you read on the internet. (Except this article, of course.) Remember that the plural of “personal anecdote” is not “scientific data”. Be a critical reader and consumer.

If you’re an athlete:

  • Know your body and the demands of your sport. Unless you’re an ultra-endurance athlete, becoming fat-adapted or adopting a ketogenic diet probably won’t improve your performance.
  • Don’t add stress. Training is a good stress, but still a stressor. Fasting and restricting energy (i.e. calories) or a particular nutrient are also stressors. Stress adds up. Don’t add nutritional stress from a stringent diet to the mix, particularly if you’re female.
  • Make meeting your nutritional needs your priority. If you’re active, you need more fuel and nutrients than the average person. Rather than taking stuff out of your diet, look for where you can add good stuff in: protein, vitamins, minerals, fiber, fatty acids, phytonutrients, water, etc. from whole, minimally processed foods.

If you’re a fitness professional / nutrition coach:

  • Help people understand as much as they need to understand in order to make an informed choice, with your guidance. Your clients will likely have questions. Prepare your answers in advance.
  • Refer out: If you think a client might benefit from a ketogenic diet or ketone supplementation for a health condition, work with their doctor to support things like meal planning and keeping a food journal that looks for correlations between diet and how they feel.

If you have a specific health problem that a ketogenic diet (or ketone supplementation) may help with:

  • Consult your doctor first. Discuss any research findings or potential dietary modifications with someone who actually went to med school. If you’re on any medications, make sure nothing you do will interfere with their effect.
  • Carefully monitor and track any dietary modifications. First, you want to stay safe; second, you want to know if what you’re doing is having any effect. So decide how you’ll know if your dietary changes are “working”, and track those indicators closely.

After reading this article, you might feel like nutrition is more complex than you thought. We get it. In the age of 24/7 health news and fitness-celeb podcasts, it’s tough to get the real story.

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References

Click here to view the information sources referenced in this article.

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Arnott, Robert, Stanley Finger, and Chris Smith. Trepanation: History, Discovery, Theory. The Netherlands: Swets and Zeitlinger, 2003.

Asadi-Pooya AA, Nikseresht AR, Yaghoubi E. Old Remedies for Epilepsy: Avicenna’s Medicine. Iranian Red Crescent Medical Journal. 2012;14(3):174-177.

Bailey EE, Pfeifer HH, Thiele EA. The use of diet in the treatment of epilepsy. Epilepsy Behav. 2005 Feb;6(1):4-8.

Chang P, Augustin K, Boddum K, Williams S, Sun M, Terschak JA, Hardege JD, Chen PE, Walker MC, Williams RS. Seizure control by decanoic acid through direct  AMPA receptor inhibition. Brain. 2016 Feb;139(Pt 2):431-43.

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D’Agostino DP, Pilla R, Held HE, Landon CS, Puchowicz M, Brunengraber H, Ari
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Hall KD, Chen KY, Guo J, Lam YY, Leibel RL, Mayer LE, Reitman ML, Rosenbaum M, Smith SR, Walsh BT, Ravussin E. Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. Am J Clin Nutr. 2016.

Hashim SA, VanItallie TB. Ketone body therapy: from the ketogenic diet to the oral administration of ketone ester. J Lipid Res. 2014 Sep;55(9):1818-26. doi: 10.1194/jlr.R046599.

Henderson ST. Ketone bodies as a therapeutic for Alzheimer’s disease. Neurotherapeutics. 2008 Jul;5(3):470-80. doi: 10.1016/j.nurt.2008.05.004.

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The post The Ketogenic Diet: Does it live up to the hype? The pros, the cons, and the facts about this not-so-new diet craze. appeared first on Precision Nutrition.

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Categories
keto diet

The 43+ health benefits of ketogenic dieting (in addition to weight loss)

For those unfamiliar, ketogenic dieting is any diet plan “low-carb” enough to switch your body into a state of producing and burning a significant amount of ketones , specifically acetoacetate (AcAc) and its derivatives beta-hydroxybutyrate (BHB) and acetone .
For those interested in background reading, I’ve previously written summary articles about the science of fat metabolism and ketosis here and here .
These molecules, especially AcAc and BHB, are used by the brain and other tissues for energy, and facilitate a number of health benefits that I’ll address below.
While the biological processes involved are extremely complex, I’d invite you to use this as the beginning of an important conversation for you and your doctor to explore together. Indeed, ketogenic dieting may or may not be appropriate for you, so please consult with your doctor before experimenting on yourself.
Click here to join my newsletter and I’ll keep you posted when I get new articles up (FYI: as a heads up, I also write about entrepreneurship and web development . I started writing about fat metabolism and ketogenic dieting here at KetoSchool out of pure hobby interest, as there are relatively few resources out there that teach the underlying science).

Focusing the brain (increased memory, cognition, clarity, and seizure control; less migraines)

Ketogenic diets were notably first used at the Mayo Clinic in the 1920s to treat children with epilepsy. While the exact mechanism of seizure prevention on a ketogenic diet is still a mystery, researchers believe it has something to do with the increased stability of neurons and up-regulation of brain mitochondria and mitochondrial enzymes .
Related to this research, some serious attention has been given to ketogenic dieting and Alzheimers Disease. Scientists have discovered increased cognition and enhanced memory in adults with impairments in these areas, and a growing body of research shows improvement at all stages of dementia . Ketosis has been shown to be effective against Parkinson’s disease as well.
For a broader audience of dieters, the often-reported side effects of increased mental clarity and focus and less frequent and less intense migraines are likely related to the more stable blood sugar and altered brain chemistry that improves memory and cognition as well.

Fighting some types of cancer

Dom D’Agostino’s lab published an article in 2014 entitled “ Ketone supplementation decreases tumor cell viability and prolongs survival of mice with metastatic cancer .”
Here is important background from the abstract:

Cancer cells express an abnormal metabolism characterized by increased glucose consumption owing to genetic mutations and mitochondrial dysfunction. Previous studies indicate that unlike healthy tissues, cancer cells are unable to effectively use ketone bodies for energy. Furthermore, ketones inhibit the proliferation and viability of cultured tumor cells.

Here is a good overview article of recent animal studies, which includes this 2013 article from Dom’s lab :
Of course, please do not ignore your doctor’s advice when it comes to cancer treatment, but — like many of the topics addressed in this article — it may be helpful for you to bring up the conversation.

Preventing Heart Disease (lower blood pressure, lower triglycerides, better cholesterol profiles)

Again, related to the downstream effects of keeping blood glucose low and stable, ketogenic dieting helps keep blood pressure in check and lowers triglyceride levels .
While it may seem counterintuitive that eating a higher percentage of fat in your diet lowers triglycerides, it turns out that the consumption of excess carbs (especially fructose ) is the key driver of increasing triglycerides .
And regarding HDL and LDL particles (which the body uses to move fat and cholesterol around), ketogenic dieting helps raise HDL (“good cholesterol”) and improve the profile of LDL (“bad cholesterol”).

Decreasing inflammation (which improves acne, arthritis, eczema, psoriasis, IBS, pain, etc…)

A Nature Medicine article last year found a likely mechanism behind what people have known for decades: ketogenic dieting is profoundly anti-inflammtory and helps with a host of related health problems.
The researchers found that “the anti-inflammatory effects of caloric restriction or ketogenic diets may be linked to BHB-mediated inhibition of the NLRP3 inflammasome .”
In other words, the key player in many inflammatory diseases is suppressed by BHB, which is one of the main ketones produced from a ketogenic diet.
Thus the implications on arthritis , acne , psoriasis , eczema , IBS , and other diseases involving inflammation and pain are significant enough that it is prompting more research attention.

Improving energy levels and sleep

By day 4 or 5 on a ketogenic diet, most people report an increase in general energy levels and a lack of cravings for carbs. The mechanism here involves both a stabilization of insulin levels and readily available source of energy for our brain and body tissues.
Sleep improvements are a bit more of a mystery. Studies have shown that ketogenic dieting improves sleep by decreasing REM and increasing slow-wave sleep patterns. While the exact mechanism is unclear, it likely is related to the complex biochemical shifts involving the brain’s use of ketones for energy combined with other body tissues directly burning fat.

Keeping uric acid levels in check (helping kidney function and preventing gout)

The most common cause of kidney stones and gout is elevated uric acid, calcium, oxalate, and phosphorus levels as result of a complex combination of unlucky genetics, dehydration, obesity, sugar consumption ( especially fructose ), and eating/drinking things with a lot of purines and alcohol (e.g. meat and beer).
An important caveat is that ketogenic diet temporarily raises uric acid levels — especially when dehydrated — but over time they come down :

…uric acid goes up promptly in the same time frame that ketones go up, but after 4–6 weeks, despite ketones staying up, uric acid starts to come back down. Based on these data and my clinical observations in thousands of patients, uric acid returns to or below pre-diet baseline within 6–12 weeks despite the person remaining is a state of nutritional ketosis.

Assisting gastrointestinal and gallbladder health (less heartburn and acid reflux, less risk for gallstones, improved digestion, less gas and bloating)

It is well known that grain-based foods, nightshade vegetables like potatoes and tomatoes, and sugary foods increase the likelihood of acid reflux and heartburn. Therefore, it’s not surprising that eating a low-carb diet improves these symptoms and actually confronts the root problems of inflammation, bacterial issues, and autoimmune responses .
Related to this, it is known that changes in diet rapidly and reproducibly alters the human gut microbiome . Dr. Eric Westman describes at length how a host of problems are significantly reduced or removed as a result of microbiome changes on a ketogenic diet.

…by taking away the carbohydrate in the food, I can pretty much fix every gastrointestinal problem that affects people today.

Research also shows that carbs in the diet is one of the key ingredients for gallstones. Somewhat counter-intuitively, eating a sufficient amount of fat when carb intake is down helps clear out the gallbladder and keep things running smoothly to prevent gallstones from forming.

Battling a wide variety of neurologic and metabolic diseases

Kristin W. Barañano , MD, PhD and Adam L. Hartman , MD published a review in 2008 discussing the potential mechanisms of how a ketogenic diet can treat the following diseases:
Serious attention is also being given to treating Multiple Sclerosis with a ketogenic diet based on similar mechanisms.

Assisting Women’s Health (increased fertility, stabilizing hormones)

An extensive review published in 2013 looked at the research and evidence of ketogenic diets enhancing fertility (long story short, it looks promising). Studies also show that Polycystic Ovary Syndrome (PCOS) can be treated effectively with low-carb dieting, which reduces or eliminates symptoms such as infrequent or prolonged menstrual periods, acne, and obesity.
Overall, keeping blood sugar levels low and stable, which results in lower overall levels of insulin in the blood, helps equilibrate and stabilize other hormone levels, especially in women . This naturally has downstream benefits on a wide variety of metabolic pathways related to insulin , such as hunger and energy utilization.

Helping the eyes (more stable vision; less risk for cataracts)

As any diabetic will tell you, it is well known that high blood sugar has a detrimental effect on eyesight and leads to an increased risk for cataracts . It’s therefore not surprising that keeping blood sugar levels low improves eye and vision health, as a gazillion people have shared online , and as related diabetes research has proven.

Gaining muscle and improving endurance

BHB, specifically, has been shown to promote muscle gain . Combined with tons of anecdotal evidence over the years, there is an entire movement behind bodybuilders using a ketogenic approach to gain more muscle and less fat (typically muscle gain also comes with fat gain, so there’s understandable attention being given toward preventing this).
In addition, Dr. Stephen Phinney and Dr. Jeff Volek have a number of papers published about ketogenic dieting for ultra-endurance athletes . In short, once these athletes are fully fat-adapted, there is evidence to suggest that mental and physical performance is significantly improved beyond a “normal” carbohydrate-rich diet.

And last but not least, curbing diabetes, obesity, and metabolic syndrome while sparing muscle loss

Of course, there are over 160 research papers currently on Pubmed with the words “diabetes” and “ketosis” or “ketogenic” in the title alone. It’s beyond clear that ketogenic dieting is extremely effective for many people with both type I and type II diabetes for all the reasons discussed above related to keeping blood sugar levels and insulin in check.
In addition, recent papers within the last few years investigating the effect of ketogenic dieting on obesity conclude that it’s an extremely effective way to not only lose fat, but spare muscle loss while curbing many disorders related to obesity as well (many of which have been discussed above), including the set of symptoms and risk factors known as Metabolic Syndrome (i.e. abdominal obesity, diabetes, hypertension , and elevated cholesterol)

For further reading, I would recommend this 2013 review article from the European Journal of Clinical Nutrition: Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets
Author’s note: I want to stress again the importance of consulting with your doctor before you try ketogenic dieting. The more I study this area of science, the more I realize that every individual is extremely unique when it comes to health issues and there are a ton of reasons why you should NOT go full-on keto (especially if you are prone to kidney, heart, or gallbladder issues). That being said, for many people this form of eating is life changing, and the amount of scientific research supporting a ketogenic lifestyle is significantly increasing. Subscribe to my newsletter to stay posted when I publish new articles, and I’d appreciate any and all feedback/corrections on the content I’ve written above. Thanks! ( Image credit )

This content was originally published here.

Categories
keto diet

Ketogenic diet helps tame flu virus

influenza
Electron microscopy of influenza virus. Credit: CDC

A high-fat, low-carbohydrate diet like the Keto regimen has its fans, but influenza apparently isn’t one of them.

Mice fed a ketogenic diet were better able to combat the flu virus than mice fed food high in carbohydrates, according to a new Yale University study published Nov. 15 in the journal Science Immunology.

The ketogenic diet—which for people includes meat, fish, poultry, and non-starchy vegetables—activates a subset of T cells in the lungs not previously associated with the immune system’s response to influenza, enhancing mucus production from airway cells that can effectively trap the virus, the researchers report.

“This was a totally unexpected finding,” said co-senior author Akiko Iwasaki, the Waldemar Von Zedtwitz Professor of Immunobiology and Molecular, Cellular and Developmental Biology, and an investigator of the Howard Hughes Medical Institute.

The research project was the brainchild of two trainees—one working in Iwasaki’s lab and the other with co-senior author Visha Deep Dixit, the Waldemar Von Zedtwitz Professor of Comparative Medicine and of Immunobiology. Ryan Molony worked in Iwasaki’s lab, which had found that immune system activators called inflammasomes can cause harmful immune system responses in their host. Emily Goldberg worked in Dixit’s lab, which had shown that the ketogenic diet blocked formation of inflammasomes.

The two wondered if diet could affect immune system response to pathogens such as the flu virus.

They showed that mice fed a ketogenic diet and infected with the influenza virus had a higher survival rate than mice on a high-carb normal diet. Specifically, the researchers found that the ketogenic diet triggered the release of gamma delta T cells, immune system cells that produce mucus in the cell linings of the lung—while the high-carbohydrate diet did not.

When mice were bred without the gene that codes for gamma delta T cells, the ketogenic diet provided no protection against the influenza virus.

“This study shows that the way the body burns fat to produce ketone bodies from the food we eat can fuel the immune system to fight flu infection,” Dixit said.

More information:
E.L. Goldberg el al., “Ketogenic diet activates protective γδ T cell responses against influenza virus infection,” Science Immunology (2019). immunology.sciencemag.org/look … 6/sciimmunol.aav2026

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