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Low-carb, ketogenic diet might slightly impair mood and cognition


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#31 Shepard

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Posted 04 February 2010 - 11:06 PM

People with diabetes (particulary Type I, but also in advanced Type II) have to be especially careful with high levels of ketones. In those instances, it can be a life threatening situation.

Every study I've seen shows profound benefits to diabetics (type 2) by reducing carbs. And, this makes sense, no? Why do you think ketones pose a problem to diabetics?


Yeah, what gregandbeaker said. Ketoacidosis is nasty stuff. Untreated Type I and advanced Type II are the main at-risk group. Advanced Type II because you'll actually see a diminished capacity to release insulin from the beta cells.
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#32 Skötkonung

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Posted 04 February 2010 - 11:12 PM

When discussing ketogenic diet, we should clarify that the diets used in the most KD studies are not always analogous to the ad lib KD employed by the lay person to lose weight (such as CKD or Atkins), or otherwise.

In most cases, study of the KD utilizes a the John Hopkins epilepsy protocol. The JH protocol is both severely carbohydrate and protein restricted - something like 8% of daily caloric value each macro-nutrient. Furthermore, it is also usually caloric restricted.

For individuals following an ad lib ketogenic diet with moderate protein (12+ % daily caloric value) the body gradually shifts away from the utilization of ketones and begins using glucose again (derived of course from gluconeogenesis). After several weeks, ketones are usually not detected in the urine or blood.

This was of course a big shock for me. In fact, in animal models, ad lib KD results in higher IGF1 and blood glucose than seen in a uncontrolled diabetic.

As for the paleo diet, it does appear at least according to isotope studies, that humans for a time lived as obligate carnivores. Perhaps eating a diet heavy in meat is the most paleo diet of all. Not sure if it has positive implications for longevity, though...


Do you have a reference showing that people on KDs reestablish glucose as primary fuel? The rising blood sugar could have another explanation - ketones cause peripheral insulin resistance (the body conserving what little glucose there is for the cells that actually need it). Also, could there be another explanation for the disappearance of ketones frm the urine (perhaps more efficient utilization of ketones?). It just strikes me as very odd that the body would waste 40% of the potential energy of protein to turn it into more glucose than it needs, especially when it doesn't do this to start. On the other hand, the reestablishment of glucose as dominant explains why the JH protocol (and Seyfried's brain cancer protocol) require calorie/proten restriction.


I think it may be in here somewhere:
http://www.imminst.o...o...=34020&st=0

..or here. This is a running list of studies I found on the KD:
http://www.imminst.o...o...=33793&st=0

While I was researching carbohydrate restriction I found these study results, which essentially illustrated that a ketogenic diet resulted in elevated glucose and IGF1 in the unrestricted mouse model. These results confounded me as I had always assumed that carbohydrate restriction decreased blood glucose and associated hormones. Later, I found the study regarding methylglyoxal on Atkins, which again implicated increased glycation when undergoing prolonged carbohydrate restriction. Jimmy Moore recently did a podcast with Dr. Thomas Seyfried on the subject of calorie restricted ketogenic diets vs brain cancer and epilepsy. Dr Seyfried is of the opinion that the supposed benefits of ketogenic diets really derive from transient drops in glucose, not necessarily from the ketones themselves. For this reason, extended ad-lib ketogenic eating is just as bad as high-carb eating because gluconeogenesis will result in high glucose levels. He says: "As I have clearly written in my articles, 'more is not better' when it comes to eating the ketogenic diet for either epilepsy or brain cancer." He also says a range of 65-75 mg/dl glucose is required to see the benefits, at least in the case of epilepsy.

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#33 spp

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Posted 05 February 2010 - 01:11 AM

When discussing ketogenic diet, we should clarify that the diets used in the most KD studies are not always analogous to the ad lib KD employed by the lay person to lose weight (such as CKD or Atkins), or otherwise.

In most cases, study of the KD utilizes a the John Hopkins epilepsy protocol. The JH protocol is both severely carbohydrate and protein restricted - something like 8% of daily caloric value each macro-nutrient. Furthermore, it is also usually caloric restricted.

For individuals following an ad lib ketogenic diet with moderate protein (12+ % daily caloric value) the body gradually shifts away from the utilization of ketones and begins using glucose again (derived of course from gluconeogenesis). After several weeks, ketones are usually not detected in the urine or blood.

This was of course a big shock for me. In fact, in animal models, ad lib KD results in higher IGF1 and blood glucose than seen in a uncontrolled diabetic.

As for the paleo diet, it does appear at least according to isotope studies, that humans for a time lived as obligate carnivores. Perhaps eating a diet heavy in meat is the most paleo diet of all. Not sure if it has positive implications for longevity, though...


Do you have a reference showing that people on KDs reestablish glucose as primary fuel? The rising blood sugar could have another explanation - ketones cause peripheral insulin resistance (the body conserving what little glucose there is for the cells that actually need it). Also, could there be another explanation for the disappearance of ketones frm the urine (perhaps more efficient utilization of ketones?). It just strikes me as very odd that the body would waste 40% of the potential energy of protein to turn it into more glucose than it needs, especially when it doesn't do this to start. On the other hand, the reestablishment of glucose as dominant explains why the JH protocol (and Seyfried's brain cancer protocol) require calorie/proten restriction.


I think it may be in here somewhere:
http://www.imminst.o...o...=34020&st=0

..or here. This is a running list of studies I found on the KD:
http://www.imminst.o...o...=33793&st=0

While I was researching carbohydrate restriction I found these study results, which essentially illustrated that a ketogenic diet resulted in elevated glucose and IGF1 in the unrestricted mouse model. These results confounded me as I had always assumed that carbohydrate restriction decreased blood glucose and associated hormones. Later, I found the study regarding methylglyoxal on Atkins, which again implicated increased glycation when undergoing prolonged carbohydrate restriction. Jimmy Moore recently did a podcast with Dr. Thomas Seyfried on the subject of calorie restricted ketogenic diets vs brain cancer and epilepsy. Dr Seyfried is of the opinion that the supposed benefits of ketogenic diets really derive from transient drops in glucose, not necessarily from the ketones themselves. For this reason, extended ad-lib ketogenic eating is just as bad as high-carb eating because gluconeogenesis will result in high glucose levels. He says: "As I have clearly written in my articles, 'more is not better' when it comes to eating the ketogenic diet for either epilepsy or brain cancer." He also says a range of 65-75 mg/dl glucose is required to see the benefits, at least in the case of epilepsy.



Interesting, but doesn't gluconeogenesis generate the glucose from excess protein in the diet? In that case, the fix for this is easy by reducing protein/increasing fat in the diet.

#34 frederickson

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Posted 05 February 2010 - 02:29 AM

Eh, ketostix are notoriously inaccurate. But, again, ketone concentrations don't stay elevated in the chronic state.

Just for the record, I think this is a pretty poor article for the most part. Anthony seems to be placing his personal issues on an entire community, and some of it is just nit-picking.


i think the readings on ketostix also vary based on activity level and body composition.

in my case, there are days where i have consumed less than 10 carbohydrates at 225 lbs and only measure trace/small amounts in my urine. i have read that since i am muscular and very active means that more ketones are being metabolized for fuel and less make it to the urine. not sure how accurate this line of thinking is?

#35 Skötkonung

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Posted 05 February 2010 - 07:57 AM

When discussing ketogenic diet, we should clarify that the diets used in the most KD studies are not always analogous to the ad lib KD employed by the lay person to lose weight (such as CKD or Atkins), or otherwise.

In most cases, study of the KD utilizes a the John Hopkins epilepsy protocol. The JH protocol is both severely carbohydrate and protein restricted - something like 8% of daily caloric value each macro-nutrient. Furthermore, it is also usually caloric restricted.

For individuals following an ad lib ketogenic diet with moderate protein (12+ % daily caloric value) the body gradually shifts away from the utilization of ketones and begins using glucose again (derived of course from gluconeogenesis). After several weeks, ketones are usually not detected in the urine or blood.

This was of course a big shock for me. In fact, in animal models, ad lib KD results in higher IGF1 and blood glucose than seen in a uncontrolled diabetic.

As for the paleo diet, it does appear at least according to isotope studies, that humans for a time lived as obligate carnivores. Perhaps eating a diet heavy in meat is the most paleo diet of all. Not sure if it has positive implications for longevity, though...


Do you have a reference showing that people on KDs reestablish glucose as primary fuel? The rising blood sugar could have another explanation - ketones cause peripheral insulin resistance (the body conserving what little glucose there is for the cells that actually need it). Also, could there be another explanation for the disappearance of ketones frm the urine (perhaps more efficient utilization of ketones?). It just strikes me as very odd that the body would waste 40% of the potential energy of protein to turn it into more glucose than it needs, especially when it doesn't do this to start. On the other hand, the reestablishment of glucose as dominant explains why the JH protocol (and Seyfried's brain cancer protocol) require calorie/proten restriction.


I think it may be in here somewhere:
http://www.imminst.o...o...=34020&st=0

..or here. This is a running list of studies I found on the KD:
http://www.imminst.o...o...=33793&st=0

While I was researching carbohydrate restriction I found these study results, which essentially illustrated that a ketogenic diet resulted in elevated glucose and IGF1 in the unrestricted mouse model. These results confounded me as I had always assumed that carbohydrate restriction decreased blood glucose and associated hormones. Later, I found the study regarding methylglyoxal on Atkins, which again implicated increased glycation when undergoing prolonged carbohydrate restriction. Jimmy Moore recently did a podcast with Dr. Thomas Seyfried on the subject of calorie restricted ketogenic diets vs brain cancer and epilepsy. Dr Seyfried is of the opinion that the supposed benefits of ketogenic diets really derive from transient drops in glucose, not necessarily from the ketones themselves. For this reason, extended ad-lib ketogenic eating is just as bad as high-carb eating because gluconeogenesis will result in high glucose levels. He says: "As I have clearly written in my articles, 'more is not better' when it comes to eating the ketogenic diet for either epilepsy or brain cancer." He also says a range of 65-75 mg/dl glucose is required to see the benefits, at least in the case of epilepsy.



Interesting, but doesn't gluconeogenesis generate the glucose from excess protein in the diet? In that case, the fix for this is easy by reducing protein/increasing fat in the diet.

Exactly, according to the JH protocol, that reduced level of protein is about 8% on a calorie restricted KD. Not something that is very feasible for most people. It seems like it would be more effective to simply do prolonged (7 day) fasts once a year. That is what Dr. Seyfried recommends.

#36 JLL

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Posted 05 February 2010 - 08:53 AM

Do you have a reference showing that people on KDs reestablish glucose as primary fuel?


There's that paper that shows Eskimos are not in ketosis most of the time, despite eating a ketogenic diet.

#37 cheesycow5

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Posted 05 February 2010 - 12:44 PM

Do you have a reference showing that people on KDs reestablish glucose as primary fuel?


There's that paper that shows Eskimos are not in ketosis most of the time, despite eating a ketogenic diet.


Do you have a link?

#38 DukeNukem

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Posted 05 February 2010 - 05:09 PM

While I was researching carbohydrate restriction I found these study results, which essentially illustrated that a ketogenic diet resulted in elevated glucose and IGF1 in the unrestricted mouse model.


I'm not a fan of relying on mice in a great many dietary comparisons, because mice did not evolve to eat meats and certain fats like hominids/humans. Likewise, in the 50's/60's, the laboratory use of rabbits to draw human conclusions on cholesterol and saturated fat was quite a blunder, too.

#39 cheesycow5

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Posted 05 February 2010 - 05:43 PM

While I was researching carbohydrate restriction I found these study results, which essentially illustrated that a ketogenic diet resulted in elevated glucose and IGF1 in the unrestricted mouse model.


I'm not a fan of relying on mice in a great many dietary comparisons, because mice did not evolve to eat meats and certain fats like hominids/humans. Likewise, in the 50's/60's, the laboratory use of rabbits to draw human conclusions on cholesterol and saturated fat was quite a blunder, too.


Agreed.

#40 Skötkonung

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Posted 05 February 2010 - 06:01 PM

While I was researching carbohydrate restriction I found these study results, which essentially illustrated that a ketogenic diet resulted in elevated glucose and IGF1 in the unrestricted mouse model.


I'm not a fan of relying on mice in a great many dietary comparisons, because mice did not evolve to eat meats and certain fats like hominids/humans. Likewise, in the 50's/60's, the laboratory use of rabbits to draw human conclusions on cholesterol and saturated fat was quite a blunder, too.

It's not only mice models, do you really think the JH and other KD cancer protocols would intentionally restrict protein in children and sick adults to borderline dangerous levels if it wasn't absolutely necessary to induce maximum ketone production?

I find it absurd you can call such studies a "blunder" when you likely haven't even reviewed the research. Yes, I concede mice aren't little humans, but these same processes have been observed in humans.

It seems a true ketogenic state can only be maintained when fasting (to preserve muscle mass) and when under strict protein / carbohydrate / calorie restriction. If you don't believe me, I challenge you to start a unrestricted ketogenic diet (one is that calorically analogous to your current regimen) and monitor your blood glucose. After two or three weeks, you'll notice it is unusually high (or higher than would be expected).

I've noticed this same effect in myself.

Edited by Skotkonung, 05 February 2010 - 06:08 PM.


#41 Skötkonung

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Posted 05 February 2010 - 06:05 PM

Do you have a reference showing that people on KDs reestablish glucose as primary fuel?


There's that paper that shows Eskimos are not in ketosis most of the time, despite eating a ketogenic diet.


Do you have a link?


I do, here it is:
www.jbc.org/content/80/2/461.full.pdf

"In his analysis of the ketogenic and antiketogenic factors, the balance between which seems to determine the appearance or non-appearance of ketosis, Shaffer (1) has considered the Eskimo, dietary, using the data reported by Krogh (2). According to his analysis the metabolism of the foodstuffs contained in the Eskimo dietary would not be expected to cause ketosis, because the calculated antiketogenic effect of the large protein ingestion was somewhat more than enough to offset the ketogenic effect of fat plus protein."

#42 gregandbeaker

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Posted 05 February 2010 - 07:02 PM

While I was researching carbohydrate restriction I found these study results, which essentially illustrated that a ketogenic diet resulted in elevated glucose and IGF1 in the unrestricted mouse model.


I'm not a fan of relying on mice in a great many dietary comparisons, because mice did not evolve to eat meats and certain fats like hominids/humans. Likewise, in the 50's/60's, the laboratory use of rabbits to draw human conclusions on cholesterol and saturated fat was quite a blunder, too.

It's not only mice models, do you really think the JH and other KD cancer protocols would intentionally restrict protein in children and sick adults to borderline dangerous levels if it wasn't absolutely necessary to induce maximum ketone production?

I find it absurd you can call such studies a "blunder" when you likely haven't even reviewed the research. Yes, I concede mice aren't little humans, but these same processes have been observed in humans.

It seems a true ketogenic state can only be maintained when fasting (to preserve muscle mass) and when under strict protein / carbohydrate / calorie restriction. If you don't believe me, I challenge you to start a unrestricted ketogenic diet (one is that calorically analogous to your current regimen) and monitor your blood glucose. After two or three weeks, you'll notice it is unusually high (or higher than would be expected).

I've noticed this same effect in myself.


I think I also posted this in Skot's other Keto thread, but I also noticed a rise from low 80's to mid 90's in my fasting blood glucose level after a couple of weeks of strictly sub 20 grams of any carbs (with no protein or fat restriction). Upping my vegetable based carbs up to the 50g to 80g range renormalized them. I repeated the test again and got the same results. It surprised me also. I wonder if the glucose generated from neoglucogenesis doesn't signal insulin release in the same manner as dietary intake does.

#43 Jay

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Posted 06 February 2010 - 01:03 AM

Skot, I think you could be right, but I'm not 100% convinced. I'm also a little confused about what's speculation (very interesting/good speculation I might add) and what's more established opinion (not that this couldn't be wrong). Have ketosis experts (not sure who these would be) come to the conclusion that glucose is reestablished eventually as the primary fuel?

#44 spp

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Posted 06 February 2010 - 02:05 AM

When discussing ketogenic diet, we should clarify that the diets used in the most KD studies are not always analogous to the ad lib KD employed by the lay person to lose weight (such as CKD or Atkins), or otherwise.

In most cases, study of the KD utilizes a the John Hopkins epilepsy protocol. The JH protocol is both severely carbohydrate and protein restricted - something like 8% of daily caloric value each macro-nutrient. Furthermore, it is also usually caloric restricted.

For individuals following an ad lib ketogenic diet with moderate protein (12+ % daily caloric value) the body gradually shifts away from the utilization of ketones and begins using glucose again (derived of course from gluconeogenesis). After several weeks, ketones are usually not detected in the urine or blood.

This was of course a big shock for me. In fact, in animal models, ad lib KD results in higher IGF1 and blood glucose than seen in a uncontrolled diabetic.

As for the paleo diet, it does appear at least according to isotope studies, that humans for a time lived as obligate carnivores. Perhaps eating a diet heavy in meat is the most paleo diet of all. Not sure if it has positive implications for longevity, though...


Do you have a reference showing that people on KDs reestablish glucose as primary fuel? The rising blood sugar could have another explanation - ketones cause peripheral insulin resistance (the body conserving what little glucose there is for the cells that actually need it). Also, could there be another explanation for the disappearance of ketones frm the urine (perhaps more efficient utilization of ketones?). It just strikes me as very odd that the body would waste 40% of the potential energy of protein to turn it into more glucose than it needs, especially when it doesn't do this to start. On the other hand, the reestablishment of glucose as dominant explains why the JH protocol (and Seyfried's brain cancer protocol) require calorie/proten restriction.


I think it may be in here somewhere:
http://www.imminst.o...o...=34020&st=0

..or here. This is a running list of studies I found on the KD:
http://www.imminst.o...o...=33793&st=0

While I was researching carbohydrate restriction I found these study results, which essentially illustrated that a ketogenic diet resulted in elevated glucose and IGF1 in the unrestricted mouse model. These results confounded me as I had always assumed that carbohydrate restriction decreased blood glucose and associated hormones. Later, I found the study regarding methylglyoxal on Atkins, which again implicated increased glycation when undergoing prolonged carbohydrate restriction. Jimmy Moore recently did a podcast with Dr. Thomas Seyfried on the subject of calorie restricted ketogenic diets vs brain cancer and epilepsy. Dr Seyfried is of the opinion that the supposed benefits of ketogenic diets really derive from transient drops in glucose, not necessarily from the ketones themselves. For this reason, extended ad-lib ketogenic eating is just as bad as high-carb eating because gluconeogenesis will result in high glucose levels. He says: "As I have clearly written in my articles, 'more is not better' when it comes to eating the ketogenic diet for either epilepsy or brain cancer." He also says a range of 65-75 mg/dl glucose is required to see the benefits, at least in the case of epilepsy.



Interesting, but doesn't gluconeogenesis generate the glucose from excess protein in the diet? In that case, the fix for this is easy by reducing protein/increasing fat in the diet.

Exactly, according to the JH protocol, that reduced level of protein is about 8% on a calorie restricted KD. Not something that is very feasible for most people. It seems like it would be more effective to simply do prolonged (7 day) fasts once a year. That is what Dr. Seyfried recommends.



Thanks for the reply. I agree excess glucose production could be a problem, but am not so sure that the increase in methoglyoxal cited for the Atkins diet is really an argument against that diet. According to Brief critical overview of biologic effects of Methoglyoxal, methoglyoxal has a strong anti-cancer effect in the cells. This increase is probably required by the body when the glycerol backbone of the triglyceride molecule is being cracked as one way the body (inefficiently) raises glucose in the absence of carbohydrates during lipolysis. Methogyloxal on Atkins has a more detailed explanation. As reported by Peter at Hyperlipid, this glycolysis inhibition provided by methoglyoxal is a similar mechanism to that seen in the C. elegans life extension. Glucose Restriction Extends C elegans Life Span

Anyway, it struck me that the amount of protein restriction required to minimize gluconeogenesis is similar to the macronutrient ratios recommended by the Optimal Diet advocated by Jan Kwasniewski and followed by Peter at Hyperlipid. In that case, protein/fat/carb ratios are 1:2.5-3.5:0.5 in grams, which corresponds to about 10.7% protein in calories for the higher fat ratio, which is not far from the 8% you talked about above. This seems doable, just more fat that most people are used to.

#45 Sillewater

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Posted 06 February 2010 - 03:08 AM

and monitor your blood glucose. After two or three weeks, you'll notice it is unusually high (or higher than would be expected).

I've noticed this same effect in myself.


I have noticed this effect myself. After a couple of months on a low-carb diet with unrestricted protein intake my fasting glucose went up to 5.2mmol/L (93mg/dL) which is much higher than I expected it to be. I remember while reading about the Kitavans their fasting glucose is around 4.0mmol/L (72mg/dL). I think Peter over at Hyperlipid has a pretty high fasting glucose too.

#46 DukeNukem

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Posted 18 February 2010 - 01:02 AM

Thread revival...

High-Fat Ketogenic Diet to Control Seizures Is Safe Over Long Term, Study Suggests
ScienceDaily (Feb. 17, 2010) — Current and former patients treated with the high-fat ketogenic diet to control multiple, daily and severe seizures can be reassured by the news that not only is the diet effective, but it also appears to have no long-lasting side effects, say scientists at Johns Hopkins Children's Center.

"Despite its temporary side effects, we have always suspected that the ketogenic diet is relatively safe long term, and we now have proof," says senior investigator Eric Kossoff, M.D., a pediatric neurologist and director of the ketogenic diet program at Hopkins Children's. "Our study should help put to rest some of the nagging doubts about the long-term safety of the ketogenic diet," he adds.
http://www.scienceda...00216163531.htm

I've not seen any plausible reason to believe a ketogenic diet is harmful in the long-run. I hope more studies, like this one, back this up.

And as I've been saying, the ketogenic diet is a profoundly potent tool to be used among the first line of treatments for any cancer and any brain degenerative condition. If I had cancer--boom!--keto all the way. Starve those cancer cells of glucose, and insure the lowest systemic inflammation possible, since cancer requires fertilizer-like inflammation to spread itself like weeds in a garden.

And brain disorders especially respond well to keto diets.

The key is to eat healthy fats, of which most doctors are entirely misguided on. But that's been covered in other threads.

#47 mitomutant

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Posted 24 March 2010 - 10:19 AM

Thread revival...

High-Fat Ketogenic Diet to Control Seizures Is Safe Over Long Term, Study Suggests
ScienceDaily (Feb. 17, 2010) — Current and former patients treated with the high-fat ketogenic diet to control multiple, daily and severe seizures can be reassured by the news that not only is the diet effective, but it also appears to have no long-lasting side effects, say scientists at Johns Hopkins Children's Center.

"Despite its temporary side effects, we have always suspected that the ketogenic diet is relatively safe long term, and we now have proof," says senior investigator Eric Kossoff, M.D., a pediatric neurologist and director of the ketogenic diet program at Hopkins Children's. "Our study should help put to rest some of the nagging doubts about the long-term safety of the ketogenic diet," he adds.
http://www.scienceda...00216163531.htm

I've not seen any plausible reason to believe a ketogenic diet is harmful in the long-run. I hope more studies, like this one, back this up.

And as I've been saying, the ketogenic diet is a profoundly potent tool to be used among the first line of treatments for any cancer and any brain degenerative condition. If I had cancer--boom!--keto all the way. Starve those cancer cells of glucose, and insure the lowest systemic inflammation possible, since cancer requires fertilizer-like inflammation to spread itself like weeds in a garden.

And brain disorders especially respond well to keto diets.

The key is to eat healthy fats, of which most doctors are entirely misguided on. But that's been covered in other threads.

Interesting thread.

I came to this thread after seeing my fasting glucose levels to go up after a 6 month period in a paleo diet. I started at mid-eighties and I am now in upper nineties. Peter at hyperlipid wrote an excellent  post about this.

What is happening? Well, the first thing is that LC eating rapidly induces insulin resistance. This is a completely and utterly normal physiological response to carbohydrate restriction. Carbohydrate restriction drops insulin levels. Low insulin levels activate hormone sensitive lipase. Fatty tissue breaks down and releases non esterified fatty acids. These are mostly taken up by muscle cells as fuel and automatically induce insulin resistance in those muscles. There are a couple of nice summaries by Brand Miller (from back in the days when she used her brain for thinking) here and here and Wolever has some grasp of the problem too.


In the context of my disease (mitochondrial myopathy), ketogenic diet seems beneficial.


Ketogenic diet slows down mitochondrial myopathy progression in mice
Sofia Ahola-Erkkilä1, Christopher J. Carroll1, Katja Peltola-Mjösund1, Valtteri Tulkki1, Ismo Mattila2, Tuulikki Seppänen-Laakso2, Matej Orei2, Henna Tyynismaa1 and Anu Suomalainen1,3,*

1 Research Program of Molecular Neurology, Biomedicum-Helsinki, University of Helsinki, Helsinki 00290, Finland, 2 VTT Technical Research Centre of Finland, Espoo FI-02044 VTT, Finland and 3 Department of Neurology, Helsinki, University Central Hospital, Helsinki, Finland

* To whom correspondence should be addressed at: Biomedicum-Helsinki, r.C523B, Haartmaninkatu 8, 00290 Helsinki, Finland. Tel: +358 947171965; Fax: +358 919125610; Email: anu.wartiovaara@helsinki.fi

Received November 12, 2009; Accepted February 16, 2010

Mitochondrial dysfunction is a major cause of neurodegenerative and neuromuscular diseases of adult age and of multisystem disorders of childhood. However, no effective treatment exists for these progressive disorders. Cell culture studies suggested that ketogenic diet (KD), with low glucose and high fat content, could select against cells or mitochondria with mutant mitochondrial DNA (mtDNA), but proper patient trials are still lacking. We studied here the transgenic Deletor mouse, a disease model for progressive late-onset mitochondrial myopathy, accumulating mtDNA deletions during aging and manifesting subtle progressive respiratory chain (RC) deficiency. We found that these mice have widespread lipidomic and metabolite changes, including abnormal plasma phospholipid and free amino acid levels and ketone body production. We treated these mice with pre-symptomatic long-term and post-symptomatic shorter term KD. The effects of the diet for disease progression were followed by morphological, metabolomic and lipidomic tools. We show here that the diet decreased the amount of cytochrome c oxidase negative muscle fibers, a key feature in mitochondrial RC deficiencies, and prevented completely the formation of the mitochondrial ultrastructural abnormalities in the muscle. Furthermore, most of the metabolic and lipidomic changes were cured by the diet to wild-type levels. The diet did not, however, significantly affect the mtDNA quality or quantity, but rather induced mitochondrial biogenesis and restored liver lipid levels. Our results show that mitochondrial myopathy induces widespread metabolic changes, and that KD can slow down progression of the disease in mice. These results suggest that KD may be useful for mitochondrial late-onset myopathies.


Mechanism of action seems to be an increase in mitochondrial biogenesis. This is also the hypothesis in the treatment of epilepsy

Mitochondrial Biogenesis in the Anticonvulsant Mechanism of the Ketogenic Diet
Bough KJ, Wetherington J, Hassel B, Pare JF, Gawryluk JW, Greene JG, Shaw R, Smith Y, Geiger JD, Dingledine RJ.
Ann Neurol 2006;60:223–235. [PubMed]
OBJECTIVE
The full anticonvulsant effect of the ketogenic diet (KD) can require weeks to develop in rats, suggesting that altered gene expression is involved. The KD typically is used in pediatric epilepsies, but is effective also in adolescents and adults. Our goal was to use microarray and complementary technologies in adolescent rats to understand its anticonvulsant effect.
METHODS
Microarrays were used to define patterns of gene expression in the hippocampus of rats fed a KD or control diet for 3 weeks. Hippocampi from control- and KD-fed rats were also compared for the number of mitochondrial profiles in electron micrographs, the levels of selected energy metabolites and enzyme activities, and the effect of low glucose on synaptic transmission.
RESULTS
Most striking was a coordinated upregulation of all (n = 34) differentially regulated transcripts encoding energy metabolism enzymes and 39 of 42 transcripts encoding mitochondrial proteins, which was accompanied by an increased number of mitochondrial profiles, a higher phosphocreatine/creatine ratio, elevated glutamate levels, and decreased glycogen levels. Consistent with increased energy reserves, synaptic transmission in hippocampal slices from KD-fed animals was resistant to low glucose.
CONCLUSION
These data show that a calorie-restricted KD enhances brain metabolism. We propose an anticonvulsant mechanism of the KD involving mitochondrial biogenesis leading to enhanced alternative energy stores.


I have just orderered a HbA1c test. If the results are normal I rather prefer to stay in mild ketosis, even with a FG in the upper nineties.

Note that my overall energy levels have sky-rocketed after switching to Paleo and after going through a difficult 10-week period of ketoadaption. This is relevant, as one of my symptoms was a low, CFS like, energy level. 

#48 full_circle

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Posted 24 March 2010 - 12:47 PM

i am not sold low carb diet has any merit. if so, most far east asians should be unhealthy and have candidiasis (i am from south korea).

i do see though, some problems in "quality" of western carb foods.
here are a couple of things i noticed while i was living 10 years in the US (i got physics degree in MA)

to cut to the chase, American foods are much more moldy. koreans/japanese keep rice in air-tight metal or plastic container and cooks rice in cookers with air-tight lid whereas many rice cookers being sold in the US are not equipped with air tight lid, not to mention rice is almost never stored tightly sealed regardless cooked or uncooked (rice-a roni is even sold in brown paper box!)
on top of that, breads, baguettes, spaghetti, tortillas etc, all are stored exposed to air. Americans also eat much more salads(uncooked, air-exposed vegi) and also lots of raw nuts.
we all know air is filled with mold/fungi.

Americans are also fond of "organic" foods which are inherently moldy.

Edited by full_circle, 24 March 2010 - 12:49 PM.


#49 PhDStudent

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Posted 25 March 2010 - 10:35 PM

but is there evidence that a fasting glucose in the 90s is bad? I thought only spikes (like postprandial spikes above 110-120) start to do damage. Amino acids are so important, only 8-10% protein seems a little low to me for long run.

Also have people tried to eat only lean meat (say at 2000-3000kcal) but adding enough vitamins to avoid any deficiencies? What happens then?

Edited by PhDStudent, 25 March 2010 - 10:37 PM.


#50 PhDStudent

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Posted 25 March 2010 - 10:41 PM

My n=1 experience is that my body loves ketosis and does very well on sub 20g of carbs a day. I swing in and out of it all of the time these days as I average about 50g of carbs in the form of mostly greens and veggies. I don't think I walk around smelling like a bull elephant with dragon breath.

Skotonung has surveyed quite a bit of the research done on Ketosis and shared several of the studies with me recently. Sorry I don't have the url's to the actual studies, perhaps skot will throw them out there. The first study showed a decrease in postprandial lipemia, which has been brought up in other discussions here on imminst as a lingering concern about high fat diets.

Study: A Ketogenic Diet Favorably Affects Serum Biomarkers for Cardiovascular Disease in Normal-Weight Men
“Very low-carbohydrate (ketogenic) diets are popular yet little is known regarding the effects on serum biomarkers for cardiovascular disease (CVD). This study examined the effects of a 6-wk ketogenic diet on fasting and postprandial serum biomarkers in 20 normal-weight, normolipidemic men. Twelve men switched from their habitual diet (17% protein, 47% carbohydrate and 32% fat) to a ketogenic diet (30% protein, 8% carbohydrate and 61% fat) and eight control subjects consumed their habitual diet for 6 wk. Fasting blood lipids, insulin, LDL particle size, oxidized LDL and postprandial triacylglycerol (TAG) and insulin responses to a fat-rich meal were determined before and after treatment. There were significant decreases in fasting serum TAG (-33%), postprandial lipemia after a fat-rich meal (-29%), and fasting serum insulin concentrations (-34%) after men consumed the ketogenic diet. Fasting serum total and LDL cholesterol and oxidized LDL were unaffected and HDL cholesterol tended to increase with the ketogenic diet (+11.5%; P = 0.066). In subjects with a predominance of small LDL particles pattern B, there were significant increases in mean and peak LDL particle diameter and the percentage of LDL-1 after the ketogenic diet. There were no significant changes in blood lipids in the control group. To our knowledge this is the first study to document the effects of a ketogenic diet on fasting and postprandial CVD biomarkers independent of weight loss. The results suggest that a short-term ketogenic diet does not have a deleterious effect on CVD risk profile and may improve the lipid disorders characteristic of atherogenic dyslipidemia.”

Study: Body composition and hormonal responses to a carbohydrate-restricted diet.
“The few studies that have examined body composition after a carbohydrate-restricted diet have reported enhanced fat loss and preservation of lean body mass in obese individuals. The role of hormones in mediating this response is unclear. We examined the effects of a 6-week carbohydrate-restricted diet on total and regional body composition and the relationships with fasting hormone concentrations. Twelve healthy normal-weight men switched from their habitual diet (48% carbohydrate) to a carbohydrate-restricted diet (8% carbohydrate) for 6 weeks and 8 men served as controls, consuming their normal diet. Subjects were encouraged to consume adequate dietary energy to maintain body mass during the intervention. Total and regional body composition and fasting blood samples were assessed at weeks 0, 3, and 6 of the experimental period. Fat mass was significantly (P <or=.05) decreased (-3.4 kg) and lean body mass significantly increased (+1.1 kg) at week 6. There was a significant decrease in serum insulin (-34%), and an increase in total thyroxine (T(4)) (+11%) and the free T(4) index (+13%). Approximately 70% of the variability in fat loss on the carbohydrate-restricted diet was accounted for by the decrease in serum insulin concentrations. There were no significant changes in glucagon, total or free testosterone, sex hormone binding globulin (SHBG), insulin-like growth factor-I (IGF-I), cortisol, or triiodothyronine (T(3)) uptake, nor were there significant changes in body composition or hormones in the control group. Thus, we conclude that a carbohydrate-restricted diet resulted in a significant reduction in fat mass and a concomitant increase in lean body mass in normal-weight men, which may be partially mediated by the reduction in circulating insulin concentrations. Copyright 2002, Elsevier Science (USA). All rights reserved.”

Study: Ketones inhibit mitochondrial production of reactive oxygen species production following glutamate excitotoxicity by increasing NADH oxidation
"Dietary protocols that increase serum levels of ketones, such as calorie restriction and the ketogenic diet, offer robust protection against a multitude of acute and chronic neurological diseases. The underlying mechanisms, however, remain unclear. Previous studies have suggested that the ketogenic diet may reduce free radical levels in the brain."


Very interesting articles. How would you describe your cognitive abilities while on ketosis?

i wonder what exactly is meant by "the heart and brain operate 25% more efficiently using ketones as a source of energy" in http://en.wikipedia.org/wiki/Ketone




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