Can ketones enhance cognitive function and protect brain networks?
urmc.rochester.edu
urmc.rochester.edu
I did a cursory read on whatever most recent credible sources existed, and found that… it wasn’t a fad.
I hope I’m largely correct but:
The underlying work was talking about something else entirely - in essence a link between cardiovascular / metabolic health, mental health and diet.
Switching to a low carb diet has helped reduce those metabolic factors, which allowed for a reduced dose of medication in conditions such as ADD, Bipolar disorder, depression.
Having never heard of this before, it smacked 100% of being some fad. But it looks like (diet + health) = better (cardio / energy).
Yes - the conversation did eventually go to Psych is bad, and doctors only want to medicate, and mitochondria misfiring.
The things that help or trigger people are going to differ vastly from person to person. For me:
1. Getting enough magnesium seems to consistently provide subtle positive effects. Makes me more resilient physically and mentally.
2. Too much omega-6 (which includes pork and chicken fat) will eventually result in depression and eczema. While I can tolerate some intermittently with no issues, more than that has repeatedly proven to be asking for trouble.
Basically fixing nutritional deficits or toxicities allows for removing a large swath of problems, either in part of wholesale. This generally allows for reducing medications, fewer side effects, or even (only sometimes) allowing removal of meds.
While definitely not a fad (as I would define it), it’s important to keep in mind that the people making posts about it tend to be very excited about finally experiencing positive effects that border on a miracle after being in a pretty bad way for a long time. As such they can end up understandably making sweeping statements that lack the laundry list of disclaimers that are inherent to the topic, or even outright mistaking the cause. I forget the name of the “fallacy”, but a common thing to see is “x cured my y, so now I’m certain everyone must need x for their y”. While this excitement eventually becomes more reasonable, you’ll need to remember to add disclaimers yourself when reading.
I think it comes down to me just texting negatively to so many things. Legumes, wheat and cranberries in particular. Now that everything seems to have soy in it it's hard.
I have a hard time sticking to restrictions and every time I pay for it. I've also had really bad side effects to most Medicaid I'd ever been on.
My metabolism is pretty much destroyed now. I wish I could tell myself 25-30 years ago to ignore the general advice and just eat more eggs and ruminant meat.
This is my own anecdotal reality. It's also a large part of why I push back against veganism. I can totally see a world where near is outlawed or so highly restricted it's prohibitively costly.
The irony of seeing highly processed foods pressed so hard for maximized profits the past couple years. It's gone up more than animal products in price relatively speaking.
you may need up to 6 month for full keto adaptation according to some internet accounts.
You didn't expect something like "Limitless"-lite, did you?
I did pretty strict keto for 2.5 years. Been off it for about a year now, while many of the habits stick (I eat next to zero added sugar, and generally low carb, less processed food, etc.).
I got rid of a lot of weight and some skin conditions. It was generally very positive. It was weird to have such stable blood sugar that you never feel hungry, even when not eating at all. There were some adverse results too, like zero muscle strength. I also digest carbs worse now it seems like. There might well be ways to avoid those issues with a more carefully managed keto diet.
I'm not sure if I will jump back on a strict keto regimen, it requires quite a bit of effort to plan meals, especially when other people in the household eat a regular diet. I have come to see keto as an intervention, very effective at fixing acute issues. Once you have done that reset, I think a lot of those wins can be maintained through generally healthy habits (which you now understand a lot better).
My pediatrician brother goes off and on keto very successfully. Whenever they need doctors for a test of the keto diet, he goes back on it. Despite being low body fat, he tends to lose more body fat than others on the diet, because he's a home chef and marathoner and very much in control of his diet.
I tend to not make enough effort to balance my diet on keto, which causes issues that take me off of it, for example, I don't respond well to having too much cheese.
But people started noticing good mental and health results, that are not just due to the losing weight part, and as studies started piling in, we see good results for such aspects (conditions such as ADD, Bipolar disorder, depression and so on, but also degenerative stuff like Alzheimers).
My brain feels like it went back 15-20 years in sharpness.
My first fast was difficult, I did not supplement with electrolytes, slept too much and basically spent the duration watching series and feeling awful.
It is much better to go outside, work and try to follow your regular habits.
Electrolytes supplements are a must, and also some paracetamol during the first few days to reduce the inconvenience of your brain switching from glucose to ketones.
Fasting is easier the more you do it, partly because of calibrated expectations and less fear but I also think that the body simply adapts.
The only difficult day is the first one, for me.
The mental clarity thing is not a boost, you won't gain IQ points or intellectual stamina, more like slightly enhanced mood and more stable/regulated mental performance.
No, per https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/j.15...
Can’t say whether it’s good for your brain otherwise.
I would not find surprising that chronic headache could be correlated with risk of dementia.
Additionally, during the initial period, you may experience issues such as sugar withdrawal, which can lower your performance.
Your body’s cells will need to switch from predominantly using glucose to using ketones and fatty acids. This process can take weeks to months.
The body is able to use both glucose and ketones; this is called being metabolically flexible. This flexibility can be achieved through intermittent fasting.
So give it time.
...The six-game championship in 2004 left Rustam Kasimdzhanov 17 pounds lighter. And in 2018, one company tracking the heart rate of grandmaster Mikhail Antipov concluded that he had burned 560 calories in just two hours. Sitting still. Playing chess. (An average-sized person would need two hours on a treadmill to break 500.)
Last week, ESPN looked more closely into the toll the stationary sport takes on the body. ESPN spoke with Robert Sapolsky, a Stanford University researcher who studies primates. Sapolsky explained that some chess players respond to the game like any elite athlete, burning upwards of 6,000 calories a day during tournaments, due to tripled breathing rates, elevated blood pressure, and muscle contractions. That means during tournaments they can lose two pounds each day.
Furthermore, the brain is the single most energetically expensive organ in the body. If there were a shortcut metabolic pathway, it seems like it would have been exploited long ago.
[0] https://www.menshealth.com/fitness/a29144951/chess-players-c...
The brain has to run on something, and we store very little glycogen. It wasn't uncommon in the ancestral environment for food to be entirely unavailable, or for the only calories to be in the form of meat, which itself has little glycogen.
So there's a secondary pathway to account for those conditions. A hand-waving argument could be made that in circumstances where there are no calories, it is the most important time for the brain to function well. Glucose is the cheapest, metabolically, that doesn't automatically mean that it's the best.
The reaction someone has to a fast, or to a diet which induces ketosis, is fairly personal. I don't think there are broad sweeping conclusions we can draw here.
My n=1 is that after two days of a fast, I feel pretty sharp. Electrolytes are indeed essential to this; in this context salt is far and away the most important, for whatever reason. I would expect the YMMV factor to dominate though.
That said, I think the mental performance benefits of fasting have been excessively hyped. I wouldn’t expect a chess player who has been fasting for multiple days to have better mental clarity. The body goes into energy preservation mode when food becomes scarce for days. That includes reduced energy expenditure for the brain.
If I am not training I have the capacity to easily fast, not issue at all with fasting, not because I follow any intermittent fasting diet, just it is the way it is. Only sample=1 but I never observed any special enhanced cognition doing that while I observe an enhanced cognition function with very basic things like sleeping well.
One more thing, I also find an improvement in cognition more with running than with swimming or biking. There are many studies about that but I give my personal experience not trying to give any conclusion for everyone. YMMV.
Most people in good health can practice some version of fasting with some common sense. Zero people with good health can train for "olympic triathalons" starting next week.. so a peek (peak?) at the life of a triathlete is interesting and perhaps commendable, but really needs calling out as an outlier in a general discussion.
> Zero people with good health can train for "olympic triathalons" starting next week..
Completely wrong. There are many paths to train for an olympic triathlon that doesn't start running, biking, and swimming and having the correct mindset, endurance, and physical state. It is like saying that a normal kid cannot learn certain things at elementary school. I am not a professional but an amateur.
Photo resembles guy I saw talking in a video about it (video was newer though) - otherwise it's first Google hit for "UK doctors diabetes keto running" and I'm yet to read through the article https://www.diabetes.co.uk/blog/2018/08/gp-type-1-diabetes-r...
And also recently some UK doctors (some of them with diabetes - I mix the types so not sure which one) decided to prove a point by going low carb/keto, while doing long runs daily (about half marathon a day), to be sure they've definitely used up all the potentially stored glycogen.
Jesus people, please stop with the unequivocal statements about equivocal/nuanced/complex things.
No change of diet will "dramatically reduce" metabolism. This is entirely unsubstantiated
They observed that metabolism Increased during fasting.
> During human fasting, metabolic markers, including butyrates, carnitines, and branched-chain amino acids, are upregulated for energy substitution through gluconeogenesis and use of stored lipids.
58 hours is not a long fast in terms of total adaptability to fasting- humans can fast much longer, sometimes for months, and the biggest down regulation of metabolism usually happens later than this.
The study that I linked examines a fasting period of 58 hours. Fasting for 58 hours is considered a form of prolonged fasting. Prolonged fasting refers to an extended period without consuming food, typically lasting more than 24 hours.
I am an academic PI whose lab studies metabolism... however I use common speech when talking online so people know what I mean, I would only use more specific terminology when talking with other metabolism researchers. In many cases the common terms and academic jargon are strictly at odds, but even a researcher wouldn't say "increases metabolism" when talking about fasting adaptations, they would talk about increased metabolic flux through specific pathways and/or changes in metabolite concentrations.
The 58 hours is another example of the same- it isn't long enough to observe many of the adaptations to fasting, especially the pronounced fall in T3 and resulting decrease in metabolic rate. The fact that 58 hours would be called "prolonged" in a journal article is not relevant to the point I was making.
Let's go over some excerpts that will answer your questions.
* Metabolism increases during fasting.
> Thus diverse, pronounced metabolite increases result from greatly activated catabolism and anabolism stimulated by fasting.
* The hormone t3 produced by the thyroid is used to control metabolism. In this study they instead looked at markers for actual metabolism.
> We performed non-targeted, accurate semiquantitative metabolomic analysis of human whole blood, plasma, and red blood cells during 34–58 hr fasting of four volunteers. During this period, 44 of ~130 metabolites increased 1.5~60-fold. Consistently fourteen were previously reported. However, we identified another 30 elevated metabolites, implicating hitherto unrecognized metabolic mechanisms induced by fasting.
* The study also mentioned prolonged fasting. Which is earlier stated longer then 24 hours.
> Quantification of blood metabolites from 4 volunteers during prolonged fasting. (a) Experimental procedures employed to study metabolomic changes during human fasting for 58 hr.
> In biochemistry, a metabolite is an intermediate or end product of metabolism.
* Metabolomics[1]
> Metabolomics is the scientific study of chemical processes involving metabolites, the small molecule substrates, intermediates, and products of cell metabolism.
[0]https://en.m.wikipedia.org/wiki/Metabolite [1]https://en.m.wikipedia.org/wiki/Metabolomics
Researchers sometimes try to mitigate this limitation by measuring lactate levels in the blood, which can provide some insight into anaerobic metabolism, particularly in muscles. However, blood lactate levels primarily reflect anaerobic glycolysis and do not fully account for other anaerobic processes involving fatty acids and creatine phosphate. There are formulas to estimate these processes, but they are still approximations.
Metabolomics, on the other hand, looks directly into the cells and is not limited to only aerobic processes or anaerobic lactate production. Instead, it can identify and quantify a wide range of metabolites, which are the intermediates and end products of metabolic reactions. Thus, metabolic rate measurements provide an estimate of energy expenditure but do not directly assess the complex metabolic processes occurring within cells, whereas metabolomics offers a more direct and detailed view of cellular metabolism.
As such, the study published in Nature is within the field of metabolism and uses the latest technology to study metabolism directly. Therefor it constitutes our latest understanding of metabolism during fasting.
Fasting is different than ketonic diet though. With fasting you also lose constantly salts/minerals/vitamins. Especially salt deficit will make on tired.
Anyhow, potassium is the big one... many people don't get enough from their diet even while not fasting. And unfortunately supplements give very minuscule amounts of potassium (<=2% of RDI), supposedly because rapid absorption of large amounts of it can cause heart arrhythmias/attacks.
Genuinely interested, hope this doesn't read as the often common "you should have done this" reaction I commonly see when discussing certain diets or fasting.
So there’s an adaptation period, which is why it’s hard to do studies on this, because people starting keto cold turkey is likely to result in worse performance, mentally and physically, in the short term.
I was following the advice in this book: https://www.amazon.com/Migraine-Miracle-Sugar-Free-Gluten-Fr...
Note that getting there is something you need to test for. I did blood drop tests at home with a device to measure ketone levels.
Also recommend some materials from Tim Ferris on this topic including the Dom D’Agostino part of Tools of Titans and I think some podcasts on the topic.
Sometimes I read these studies and it feels a bit like someone reverse engineering a car without knowing what a car is supposed to do. Like - if you don't use oil, the engine is preserved quite well, unless you rotate the wheels, then it gets ruined, but only if the clutch is engaged. But then we do a study, we hold the clutch position constant, say it's disengaged, and then rotate the wheels at different speeds, and find that it doesn't make a difference, and publish that, and then it makes its' way into general understanding that you don't need to use engine oil.
People seem to want to seperate the effects of diet, exercise, social interaction, etc, but I don't think this is possible in a complex system like a human being. They all need to be balanced.
Wisdom and insight is something more than scientific credulity.
Potential underlies state. State does not ultimately underlie potential.
https://github.com/cutestuff/FoodDepressionConundrum/blob/ma...
Fukuyama, Hidenao, Masafumi Ogawa, Hiroshi Yamauchi, Shinya Yamaguchi, Jun Kimura, Yoshiaru Yonekura, and Junji Konishi. “Altered Cerebral Energy Metabolism in Alzheimer’s Disease: A PET Study.” Journal of Nuclear Medicine 35, no. 1 (January 1, 1994): 1–6.
Here are some more recent reviews discussing the connection (recent reviews are good not just because they take into account the latest developments, but they also give you better references to go through for further research). Note, these reviews are from completely different/unrelated research teams from different countries:
Yoon, Ji Hye, JooHyun Hwang, Sung Un Son, Junhyuk Choi, Seung-Won You, Hyunwoo Park, Seung-Yun Cha, and Sungho Maeng. “How Can Insulin Resistance Cause Alzheimer’s Disease?” International Journal of Molecular Sciences 24, no. 4 (February 9, 2023): 3506. https://doi.org/10.3390/ijms24043506.
Rhea, Elizabeth M., Manon Leclerc, Hussein N. Yassine, Ana W. Capuano, Han Tong, Vladislav A. Petyuk, Shannon L. Macauley, et al. “State of the Science on Brain Insulin Resistance and Cognitive Decline Due to Alzheimer’s Disease.” Aging and Disease, August 17, 2023, 0. https://doi.org/10.14336/AD.2023.0814.
Kshirsagar, Viplav, Chetan Thingore, and Archana Juvekar. “Insulin Resistance: A Connecting Link between Alzheimer’s Disease and Metabolic Disorder.” Metabolic Brain Disease 36, no. 1 (January 2021): 67–83. https://doi.org/10.1007/s11011-020-00622-2.
It'll start faster if you don't eat carbs / sugar and instead use protein because the body start producing ketons when it runs out of glycogen stores. Sugar and carbs add glucose to your blood. The less of it you have, the faster the body will start producing ketons.
Exercise also helps because it uses glucose faster. Of course assuming you'll not just start eating carbs / sugar after exercise. That includes all drinks that include sugar.
But really you'll get most benefit of exercise just from a walk after meal.
Why after meal? Because that's when glucose spikes and a walk uses glucose faster.
But contrary to fats (or proteins or fibers), sugar is also addictive, doesn’t satiate your body, and ultimately generates hypoglycemia some hours later for you to eat more sugar.
So yes, the dose makes the poison but sugar is the only one poison your body accepts to absorb in immense quantities.
It is rare without ketone supplementation, because unless you're fasting, eating a ketogenic diet, or are diabetic, the body doesn't usually have a high concentration of circulating endogenous ketones.
Diabetics can become so insulin resistant that their cells no longer uptake glucose, so they must fall back to burning ketones for energy, even while blood sugar is very elevated and food intake is normal. This is why DKA is so dangerous and (relatively) common.
Nothing about ketoacidosis is limited to diabetics - its just not common in non-diabetics, because how would you get such high concentrations of ketones? ...
Again, believe what you want just make sure you understand that you’re not making a sound argument.
It's a sliding scale from no harm to performance benefits to death. Clearly they are intelligent and educated and those teams expend effort to stay to the left of death...
There's a whole bunch of stuff happening in your body post strenuous exercise so it'd be hard to isolate ketones specifically from that.
At least until exo-ketones are mainstream you should consider that you are competing for people well aware of the product. That said, you should really seek to differentiate yourself from other products. You have a single, unsourced line about how your product is superior. Ok, cool. I’m not going to do your marketing teams job and look up studies to prove it out.
Also, powder > shots > full drinks. Shipping adds up and flexibility in consumption is probably the easiest way to get people to integrate your product into their daily routine. For example, we love ketone salts combined with collagen and caffeine mix in the morning.
I’ll probably order some of your product though. Good luck!
Good luck with your investment, the business sounds like a good idea. They need to do a ton of marketing though. I also suspect that as others enter the market those involved will end up competing heavily on price.
My idea is that sugar in quantities we ingest nowadays damages all and makes more problems. It is not that ketones are some magic thing. Only that sugar is rocket fuel for the brain so it should not be used without care.
The keto diet has been around over 100 years and it was developed in a clinical setting for children with epilepsy to reproduce the benefits of fasting - which has been known for thousands of years to prevent seizures - while providing a long term solution and not deprive children of calories.
It’s not exactly a fad, it’s just that there are a lot more studies being conducted on the benefits - like fasting studies which lead the discovery of autophagy and the Nobel prize in 2016.
The idea sugar is rocket fuel for the brain, is a little misguided. Certain sugars spike insulin triggering anabolic response getting glucose to the cells quickly, but that doesn’t make glucose more efficient for the brain.
Ketones are smaller than glucose molecules and more efficient at crossing the blood brain barrier. Rocket fuel for the brain is being in a deep state of ketosis and consuming medium chain fatty acids (e.g. coconut oil) or beta hydroxybutyrate (i.e. exogenous ketones).
Yes, exactly. It was developed and studied in the context of epilepsy treatment.
The current wave of keto influencers are pushing it as something else, though.
I have tried keto and noticed some interesting effects, but the impact on certain parameters of my lipid bloodwork was undeniably bad no matter what I tried. The keto community works overtime to downplay the possible negative effects of the diet, but actual cardio and lipid researchers have very different opinions.
And you probably ignored any that the ratio probably improved between "good" and "bad" lipids? I guess you didn't just eat lots of bad fats but also improved the composition of fats you ate?
Lipid research is sponsored by pharma a lot. They need to push their statins.
Anecdotal datum of one: I happen to have high cholesterol no matter what I do. You have to fast in order to do the lipid blood tests. Sometimes I forgot to fast and have even eaten eggs. My lipid profile was better in those cases. I also got muscle cramps from taking statins. The heart is a muscle and those cramps can kill you. Instantly.
"For predicting your risk of heart disease, many healthcare professionals now believe that determining your non-HDL cholesterol level may be more useful than calculating your cholesterol ratio"[1]. Additionally, "extremely high HDL-C levels are associated with an increased risk of age-related macular degeneration (also genetically), infectious disease, and all-cause mortality."[2]
[1]https://www.mayoclinic.org/diseases-conditions/high-blood-ch...
[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10119031/
> Lipid research is sponsored by pharma a lot. They need to push their statins.
A comment in a keto/low carb discussion believing in a statin conspiracy? shocked.
> Anecdotal datum of one
Entirely irrelevant
A comment in a keto/low carb discussion believing in a statin conspiracy? shocked.
I don't believe in a "statin conspiracy". There's no conspiracy needed. We've seen over and over again with lots of things that companies favor funding research that shows something that sells their product or they outright lie (sorry "do marketing"). Leaded gasoline? Milk is good for you, make your children drink more? Butter is bad?
The statins causing muscle cramps are a fact and not a conspiracy. I got statins in ever increasing dosages because they didn't help. When the cramps started, my doctor took me off statins. When I then did try Keto all of my blood markers that were either bad or borderline went into completely normal territory. Except for lipids that did the usual "hover around some really high and absolutely bad for you territory".
Again, a datum of one. But when all the things done to me with evidence from statistically relevant studies and research doesn't help and actually makes things worse but the statistically not significant thing works to improve all of the markers of statistically proven blood testing, then this anecdotal internet person here will stick with what works. YMMV as always.
Entirely irrelevant
these are not mutually exclusive. It is a fad AND something is happening.
That something comes down to two major things about low carb/carnivore diets:
1. You are removing processed foods. Going from a Standard American Diet to basically anything that involves more whole foods is going to be healthier for you and make you feel better. This doesn't mean that the new diet is optimal but it can be a step in the right direction.
2. Restricting your diet down to a few types of food is going to remove a lot of allergens. If you only eat meat for example, you are removing literally every single non-meat allergen in your diet - most people have some sort of food sensitivity (lactose intolerance being a common one) so you are going to feel better when you remove those allergens. However, this does not mean that accidental elimination diets are the long term solution. You should slowly add back foods and see what you react to so you can do something less extreme but still feel good doing it.
So yes a lot of people feel better on these diets but that does not indicate they are healthy long term or superior to other options.
Don't care. A single anecdote for 3 months is not even kind of relevant when determining if a diet is healthy long term
When people commit to improving their health, and begin to experience improvements, for better or worse it is like the second coming of Jesus. Particularly diabetics that make lifestyle changes, lose significant amounts of weight and get off insulin. Nearly everyone who experiences that feels that if they can do it anyone can do it, and they tend to share their experiences enthusiastically and rightfully so.
But when you reply “yes, exactly” to the fact that the keto diet was developed in a clinical setting over 100 years ago to mimic the benefits of fasting and offer a n=1 anecdote about your lipid panel, that’s no better than anyone you are accusing of downplaying possible negative effects.
I don't know why people still use this as any sort of argument for keto in the general population. Most people are not children with epilepsy and even for children, the keto/low carb diets has many downsides most notably growth retardation, kidney stones and bone mineral loss.
Are there many diets that have lifelong adherents over their lifetimes over the last 100 years from the general population that have been studied?
Again, these are not mutually exclusive. Even if the idea of a keto diet has been around for 100 years, that doesn't mean that right now it is not a fad (a style, activity, or interest that is very popular for a short period of time). It was never popular before, it is now and it almost certainly won't be in 10 years or so.
>Are there many diets that have lifelong adherents over their lifetimes over the last 100 years from the general population that have been studied?
who are these people who have done keto their whole lives and have been studied? Can you share the case studies?
>Keto is a fad >no it’s a diet developed in clinical setting been around more than 100 years >I don’t know why people bring up that its not relevant >yes, it directly contradicts what OP said >it’s no mutually exclusive, sure it’s been around 100 years, but it’s a far and won’t be around in 10
>Are there diets that have life long adherents over the last 100 years that have been studied? >show your studies
I think someone like you would be better off googling. You should easily find studies supporting as many as 70% of epilepsy patients who are treated with keto as children can get off of keto after 5 years without any seizures and no longer need any medication. You should also be able to find studies of long term keto diets, ‘long term’ as defined within the studies themselves, covering various types of individuals and get yourself a healthy perspective on the overwhelmingly positive outcomes and to a fat lesser extent the negative outcomes.
Good luck!
https://nutrition.bmj.com/content/early/2020/11/02/bmjnph-20...
"Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years"
Most read paper of the BMJ ever.
Follow-up:
https://nutrition.bmj.com/content/early/2023/01/02/bmjnph-20...
"What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss"
Btw I’m not personally an anti-keto guy I just dislike mindless paper citations.
A ketogenic diet involves severe carbohydrate restriction and even major protein restriction. The research you shared isn’t applicable.
This is a huge problem in online keto discourse: People share a lot of “research” that isn’t applicable, such as these low-carb papers or other research about treating epilepsy with keto diets.
You can’t just look for studies about lower carb with positive conclusions and assume that this implies the keto diet is good.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6472268/
There is no specific ketone cutoff level specified, and of course the impact of X g of carbohydrate will vary per individual, during the day and between days.
The paper I cited are the end stage validation that a treatment works: using it on patient in their normal everyday life (instead of being in clinic/laboratory) - note that they see the doctor 3 times 10 minutes per year.
Of course no one knows how much carbohydrate they take but the guidelines (as presented in the paper) are clearly steering them to nutritional ketosis.
As or clinical studies there are many of them done in the past decades, for a ten years ago summary for example:
https://web.archive.org/web/20150702005325/http://www.omega3...
Dr Westman (the main author, Past-President and Master Fellow of the Obesity Medicine Association and Fellow of The Obesity Society, he also has a youtube channel) uses 20g/day carbohydrate guideline and does not recommand the use of a ketone meter for his patients.
What about little kids with epilepsy? They haven't had years of sugar to get damaged. Maybe they're susceptible for early onset damage?
> It is not that ketones are some magic thing. Only that sugar is rocket fuel for the brain so it should not be used without care.
The keto diet for epilepsy (psychiatry/cancer mostly copy it as far as I know) needs high ketone levels (at least 2).
Even doing carnivore (0 carbs) with medium fat/protein won't help, you won't achieve the blood numbers & won't get results.
You NEED to get ~80-90% of calories from fat to achieve consistent blood levels (ketones 2-4+, glucose 4) for epilepsy version.
Think of it as a drug dosage. Some people might need lower dosage, but the standard is at the dosage I wrote (blood test GKI 1-2).
It won't be, ketone supplements are too expensive for that.
> My idea is that sugar in quantities we ingest nowadays damages all and makes more problems
This is nonsense. Sugar is an easily accessed fuel that your body can readily use for a variety of activities.
Keto flu is from a low level of ketones, not a high level. Once enough ketones become available there is no more keto flu. From there most people feel at least normal, and many feel a bit better than normal because the cycles of both energy and satiety are smoothed out by the change in fuel sources.
> And if ketones were that healthy then diabetics would the the healthiest people of all.
Diabetics have health complications precisely because they cannot moderate their blood glucose, with or without ketones. Ketones do not regulate blood glucose, insulin does. Unlike glucose, excess ketones are harmlessly urinated out, they do not need insulin to process them.
Glucose in the blood is toxic [1] if it isn't metabolised because of lack of insulin, and even most diabetics consume enough carbohydrates for this to be a risk. There is a clear relationship between availability of insulin and safe levels of glucose consumption, in fact injecting insulin is usually the first intervention if blood glucose is at dangerously high levels. Search for insulin in that paper.
Ketones don't enter into this picture at all as either a toxin or the solution to toxicity. Precisely the point is that ketones can substitute for most of your glucose needs without risking toxicity like glucose does.
If all of that isn't enough, diabetics often do better following a ketogenic diet [2], not worse. When you can't naturally produce enough insulin to process the glucose you consume for daily energy, producing ketones instead is a safe workaround which your body performs naturally. What part of that is evidence for ketones themselves being the problem?
You are confusing this with beta cell function, which also becomes impaired in many T2D people, where the islet cells become damaged, insulin production is subsequently impaired as well, this is a later stage effect in T2D progression.
T2D likely manifests from prolonged energy surplus leading to oxidative damage to cells and accumulation of excess fat stores, particularly visceral fat stores in the organs - the cell damage and overfull visceral and sometimes subcutaneous fat stores both lead to hormonal and epigenetic changes and directly to insulin resistance.
That's still oversimplified, but it's a useful model.
Your citation is a single case study over a short period of time. It does not support your claim of “often”. This is deceptive citation and undermines your arguments.
https://nutritionandmetabolism.biomedcentral.com/articles/10...
> The LCKD improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants.
https://pubmed.ncbi.nlm.nih.gov/22673594/
> The LCD and LCKD had beneficial effects on all the parameters examined.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6024764/
> LCD can improve blood glucose more than LFD in Chinese patients with T2DM. It can also regulate blood lipid, reduce BMI, and decrease insulin dose in patients with T2DM.
https://pubmed.ncbi.nlm.nih.gov/34338787/
> The VLCK diet appears to control glycemia and decrease body weight for up to 6 months in people with obesity and diabetes. Beneficial changes in serum triglycerides and high-density lipoprotein cholesterol, along with reductions in antidiabetic medications, continued in the VLCK group until 12 months. However, the quality of currently available evidence is not sufficient to recommend VLCK diets. A major limitation of the VLCK diet is patients' lack of adherence to carbohydrate restriction.
So sure, there are issues with adherence and the volume & quality of data here. That doesn't invalidate the trends seen across every study that looks into this. It's more than one study and, within each study, it indeed seems to benefit most participants.
> then diabetics would the the healthiest people of all. Instead, they are poison, and this is well documented.
It is documented on T1D, where they make no insulin at all! Keto still helps on T1D, you will always need insulin, just less, and have more stable blood glucose (and all the benefits that entails with it).
For T2D, it's the best solution for it (see virtahealth.com for a great company that helps on this).
A glass of wine is harmless. A bottle of hard spirit will poison and potentially kill you.
Your body can nullify small amounts of alcohol. But if you drink more toxin than what your body can neutralize it poisons you.
Sugar and carbs rise glucose level in your blood. When it's small amount your blood will re-distribute it to cells as fuel.
But if you eat enough sugar and carbs that your body cannot absorb all the glucose, you become fat and develop diabetes.
So yeah, sugar is fuel and tastes good but in modern food products it's used everywhere which makes moderate use very hard to achieve.
That's why 99 million of Americans are overweight, 70 million are obese.
29 million have diagnosed diabetes, 10 million estimated undiagnosed diabetes and 115 million pre-diabetes.
But it is indisputable that your body processes carbs, protein, and fat in very different ways. If you only eat donuts and bacon and candy consistently, in normal caloric levels, then you will likely develop type 2 diabetes (or more precisely insulin resistance). Glucose in your blood is toxic. Are you really going to argue that this diet is perfectly safe?
I'm not sure that I ever claimed it was? All I'm saying is there's no point in vilifying those food types as they can be part of a perfectly healthy diet.
I think you'll have to expand on what you're trying to say here as taking it at face value is clearly untrue.
Researchers then administered D-βHb, a form of ketones, a byproduct released by the liver when the body burns fat instead of glucose for energy. They found that the synaptic activity that was previously impacted by acute insulin resistance was rescued,
looking further, D-βHb seems to be an exogenous ketone:
Exogenous ketones are a class of ketone bodies that are ingested using nutritional supplements or foods.
...
Under physiological conditions, ketone concentrations can increase due to starvation, ketogenic diets, or prolonged exercise, leading to ketosis.[2] However, with the introduction of exogenous ketone supplements, it is possible to provide a user with an instant supply of ketones even if the body is not within a state of ketosis before ingestion.[1] However, drinking exogenous ketones will not trigger fat burning like a ketogenic diet.
...
When exogenous ketone bodies are ingested, acute and nutritional exogenous ketosis is produced.[4][9]
https://en.wikipedia.org/wiki/Exogenous_ketone
so, how do we supplement our diet?
[0] - https://en.m.wikipedia.org/wiki/Betteridge%27s_law_of_headli...
Poff, Angela M., Jong M. Rho, and Dominic P. D’Agostino. “Ketone Administration for Seizure Disorders: History and Rationale for Ketone Esters and Metabolic Alternatives.” Frontiers in Neuroscience 13 (2019). https://doi.org/10.3389/fnins.2019.01041.
Bernini, Adriano, Mojgan Masoodi, Daria Solari, John-Paul Miroz, Laurent Carteron, Nicolas Christinat, Paola Morelli, et al. “Modulation of Cerebral Ketone Metabolism Following Traumatic Brain Injury in Humans.” Journal of Cerebral Blood Flow & Metabolism, October 24, 2018, 0271678X18808947. https://doi.org/10.1177/0271678X18808947.
McDonald, Tanya, Mackenzie Cervenka, Tanya J. W. McDonald, and Mackenzie C. Cervenka. “The Expanding Role of Ketogenic Diets in Adult Neurological Disorders.” Brain Sciences 8, no. 8 (August 8, 2018): 148. https://doi.org/10.3390/brainsci8080148.
Koppel, Scott J., and Russell H. Swerdlow. “Neuroketotherapeutics: A Modern Review of a Century-Old Therapy.” Neurochemistry International 117 (July 2018): 114–25. https://doi.org/10.1016/j.neuint.2017.05.019.
White, Hayden, Karthik Venkatesh, and Bala Venkatesh. “Systematic Review of the Use of Ketones in the Management of Acute and Chronic Neurological Disorders.” Journal of Neurology and Neuroscience 08, no. 02 (2017). https://doi.org/10.21767/2171-6625.1000188.
Prins, Mayumi L., and Joyce H. Matsumoto. “The Collective Therapeutic Potential of Cerebral Ketone Metabolism in Traumatic Brain Injury.” Journal of Lipid Research 55, no. 12 (December 2014): 2450–57. https://doi.org/10.1194/jlr.R046706.
> A 2016 study of a sample of academic journals (not news publications) that set out to test Betteridge's law and Hinchliffe's rule (see below) found that few titles were posed as questions and of those, few were yes/no questions and they were more often answered "yes" in the body of the article rather than "no".
Thankfully the underlying study doesn’t pose a question, and the article we are discussing here is an academic hypothesis more than news.