How Ketogenic Diets Curb Inflammation in the Brain | Hacker News Reader

How Ketogenic Diets Curb Inflammation in the Brain

ucsf.edu

95 pointsdtawfik128 comments

The problem with basically all of the keto science (this study included) is that it doesn't adequately differentiate between the effects of a ketogenic diet and simple caloric restriction:

> In rodents, ketogenic diets – and caloric restriction, in general – are known to reduce inflammation,

While there is some science showing differences in calorically balanced diets that vary in macronutrient composition, the truth is it is not strong, not well reproduced and there reasonable logical models that strongly bring the keto claims into question.

That doesn't mean keto is stupid or not worth studying. It's just that the interesting things about keto aren't really the metabolic changes (which are controversial, and small even if existent), but the behavioral controls. Obviously it's an oversimplification to draw a strict line between metabolism and compliance, but the point is the important difference with keto is that for some people it helps them comply to a calorically balanced diet, not that the macronutrient composition is making a difference.

Another problem is keto seems difficult to sustain over the long term. People drop off and regain all of their weight.

I've tried tons of diets over the years and keto is by far the only one I've had success with maintaining long term. Even when I take a cheat day, carbs just don't taste that good any more so I end up feeling bloated and go right back on keto.

I've noticed this too, not even with full keto even. When I eat healthier things regularly (veggies and chicken instead of burgers and fries, etc), sweet or carby things taste good but they don't compel me, UNLESS I lapse for a few days. Then the carb cravings come back and I have to work and fight them for days or weeks to reset back to healthy mode.

Depends on how you do it. If you completely limit your diet, that's not sustainable. There are alternative versions, such as the CKD. (Which means you have a regular cheat day)

> People drop off and regain all of their weight.

That's pretty much true with all diets.

Exactly.

Oh hey, I have incurable brain inflammation Let’s not do Keto because it’s unsustainable, I’ll just have oh so sustainable brain inflammation instead

Every article states this, but personally the keto diet foods are exactly what I normally crave and want to gorge on: meat, fish, nuts, avocado, butter, double cream, low carb root vegetables, cured meats, cheese, what's not to love? It doesn't take long at all to retrain your palate to understand that rich flavours come from high fat food, not sugars.

Some people find it easier to sustain a ketogenic diet when eating only from the animal kingdom: https://www.reddit.com/r/zerocarb/

This doesn't seem to be as big a problem with keto as with other forms of diet adaptation, though. (Although, I'd provide evidence for that, if I had anything but anecdotes to back it up with..)

Another anecdote here, for what it’s worth (not much)

Modified keto where a higher amount of protein is permitted is much easier to stick to (i.e. 30% protein).. to stay within 0.5-1.5 mmol/L BHB

I thought the only real limit for keto was on non fiber carbs? Is there typically a max ratio on protein too?

Gluconeogenesis can work off excess protein, too. Also, excess protein raises insulin, which is tied directly to weight gain.

Not easier to stick to economically though...

> the point is the important difference with keto is that for some people it helps them comply to a calorically balanced diet, not that the macronutrient composition is making a difference.

The whole point of Keto diets is that the macronutrient composition is what makes compliance easy. So, you can’t really extricate macronutrient composition since a diet needs to be followed in order to be effective.

Sure, mind body connection is everything, but there are many keto proponents that argue that controlling for calories, keto still produces superior outcomes. Outside of extreme cases like epilepsy, there is not really any reason to think that's true.

Keto is one of many strategies that people use to comply to consuming the right number of calories.

> but there are many keto proponents that argue that controlling for calories, keto still produces superior outcomes

The high fat, low carbs position is that excessive carbs create an endocrine disorder where the body is storing incoming calories in fatty tissue, thus making it unavailable as energy. This causes the body to respond in two ways: 1) eating more food, and 2) expending less energy. The key is that the energy balance equation has two variables, not one. There is the amount of calories that are consumed and then the amount of calories that are expended.

So, it is correct to say that a ketogenic diet, when compared to another diet consisting of the same number of calories, cannot lead to more weight loss as a result of calorie intake. But the ketogenic diet could, in theory, produce comparatively more weight loss by fixing the endocrine system disorder and allowing calories stored in fatty tissue to be used as energy. This would manifest itself as the person on the ketogenic diet being more active and feeling like they have more energy.

I'm not saying that this is, in fact, what is happening, just that it is a plausible theory. In my opinion, the theoretical underpinnings of the low carb, high fat hypothesis seem more plausible to me, but neither side can actually claim that the science supports them, because the studies that need to be done (randomized controlled trials of various types of diets), have simply never been done.

Also: people are not rodents

See rats & vitamin c for an example

https://en.wikipedia.org/wiki/Ketogenic_diet

"The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. [...] Almost half of children, and young people, with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet."

doesn't sound like just a fad.

Definitely not a fad per se. They way it is packaged (Keto) and delivered to the masses makes it seem fad-ish as all quickly ramped-up-to-make-money deals tend to be. I've used keto myself several times though only as short-term diet change. I myself never fully seemed to recover from the Keto-flu even after months of eating strict keto. Adding back natural complex carbs helped me immensely in that regard.

As trevyn says, you need to make sure you get enough sodium. Ketogenic diet accelerates excretion of sodium ("natriuresis of fasting"). Look up Steve Phinney's videos or books if you want more info -- he recommends drinking a few full-sodium stock cubes every day. Another common issue during adaption seems to be not eating enough fat.

Won't adding salt to meals and perhaps a pinch to water in the morning be sufficient?

Did you intentionally up your salt intake? Apparently this is important for energy on keto for some reason.

kinda related: Richard Veech (not in OP article) is probably the doctor/researcher (to my knowledge) has done the best research into ketosis, imo.

https://irp.nih.gov/pi/richard-veech

http://drveech.com/

He's found some very interesting results about the improvement of cellular energy efficiency (thermodynamic improvement)/cellular homeostasis due to keto throughout his career:

- neurons were less thermodynamically wasteful in terms of excess heat generated (because more efficient delta-G/easier ionic potentials); and therefore, due to neuronal metabolic dysfunctions induced by concussions, ketosis was good for treating concussion. DARPA has apparently sunk quite a lot of money into his research of the treatment of concussions/TBI (because of IEDs, etc) - e.g., this paper sponsored by DARPA https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102124/

- cardiac cells too performed more efficiently with ketone bodies

(- if I recall correctly (which I'm not sure that I do..) some breeds of mice were able to hold their breath underwater for something ridiculous like 150% (or more?) of the normal length of time than control group mice could. I can't seem to find the source for this.. [although, anecdotally, there have been 4 or 5 times when (in ketosis) I could hold my breath for >2 minutes (timed) with ease, whereas out of ketosis I'd be barely capable of doing so after, say, 45 seconds..])

Work in this area is interesting but to me seems like pharma money as the focus is on messing with things that suck money for a long time and then end in cancer. Or put another way what happens to the carbs that are blocked from getting processed. Knowing which cell types are the most resistant to this intervention may have lots of value, but a new block buster drug would be a crime. So suck it up and learn to truly get into a ketogenic state then see where in the world you are. There is little research on multiyear ketogenic cohorts. Fasting which has many comparators to ketosis has been in most cultures for years. A general theme here is insulin sensitivity or better put lack there of. I do not see how this pathway disrupting mechanism helps to return insulin sensitivity for a person eating the diets recommended by pretty much all governments globally.

Can someone explain me what does "extreme low-carbohydrate" mean exactly? Is it 10% 20% of the daily intake?

A ketogenic diet usually means < 20g of carbohydrates per day.

Roughly 10%, where fiber makes up half of that or so. The limit I've seen is 20-40g of non fiber carbs.

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