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Ketogenic diet increases arterial stiffness in children and young adults

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#1 rwac

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Posted 14 January 2014 - 07:21 AM


The impact of the ketogenic diet on arterial morphology and endothelial function in children and young adults with epilepsy: A case-control study.

PURPOSE:

The present study aimed to assess the impact of the ketogenic diet on arterial morphology and endothelial function of the big vessels of the neck and on cardiac diastolic function, in a cohort of epileptic children and young adults treated with the ketogenic diet.
METHODS:

Patients were recruited based on the following inclusion criteria: (1) patients who were or had been on the ketogenic diet for a time period of at least six months. Each patient underwent measurement of carotid intima media thickness, carotid artery stiffness, echocardiography, and diastolic function assessment. Patients with drug resistant epilepsy, matched for number, age and sex and never treated with ketogenic diet, were recruited as controls.
RESULTS:

The population study was composed by 43 epilepsy patients (23 males), aged between 19 months and 31 years (mean 11 years). Twenty-three patients were or had been treated with ketogenic diet, and 20 had never been on it (control group). Subjects treated with the ketogenic diet had higher arterial stiffness parameters, including AIx and β-index and higher serum levels of cholesterol or triglycerides compared to those who had never been on the diet (control group) (p<0.001).
CONCLUSIONS:

Arterial stiffness is increased in children and young adults treated with the ketogenic diet, before the increase of the intima media thickness. This supports that arterial stiffness is an early marker of vascular damage.


http://www.ncbi.nlm....pubmed/24380692

I guess the exact composition of the diet is an important question, I wonder if that's in the paper.

Edited by rwac, 14 January 2014 - 07:22 AM.

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#2 Jembe

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Posted 14 January 2014 - 07:56 AM

They could be eating PUFAs. Nothing has helped for my PVCs better than the ketogenic diet plus supplementation. I used to get up to two dozen skipped heartbeats per day.
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#3 Chupo

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Posted 15 January 2014 - 01:39 AM

I don't think we can draw conclusions from this. These are children and young adults. Arteries actually soften at the beginning of atherosclerosis. This could be a sign that the controls, probably on a typical western diet, are the ones developing atherosclerosis.


Having said that, I have seen studies showing that these kids develop high triglycerides and low HDL. This isn't something that we see in the general population. These are sick kids who may have a problem metabolising fats in such a way that it's causing both their epilepsy when on lower fat diets and their dyslipidemia when on higher fat diets.

Edited by Chupo, 15 January 2014 - 01:40 AM.

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#4 JohnD60

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Posted 10 February 2014 - 04:29 AM

People with Epilepsy on Ketogenic diets are on an extreme version of the typical Ketogenic diet. Typical keto diet is 70% Fat, 5 % Carb, 25% protein. Epilepsy keto diet is 90+% fat, 2% carbs, 8% protein.

#5 misterE

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Posted 11 February 2014 - 05:12 AM

Starchy foods which stimulate lots of insulin, will actually stimulate nitric-oxide.

That's right peoples... INSULIN STIMULATES NITRIC-OXIDE!

Now go eat some spuds!

Edited by misterE, 11 February 2014 - 05:13 AM.

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#6 deadwood

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Posted 12 February 2014 - 06:39 PM

You mean eating fat and meat will harm you? No kidding.

Edited by Shepard, 12 February 2014 - 06:50 PM.

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#7 misterE

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Posted 12 February 2014 - 11:37 PM

Ketogenic-diets and other low-carb diets seem to mimic the hormonal state found in type-1 diabetes. Since diabetics cannot utilize glucose as fuel, due to insulin-resistance, the body begins to oxidize fats for energy to stay alive and while this causes a temporary weight-loss, it doesn’t mean the person is getting healthier, but rather they are wasting away due to insulin-deficiency. Ketogenic diets also promote unhealthy amounts of lipid-peroxides which deplete our endogenous antioxidants (like glutathione and vitamin-e).

Ketogenic-diets focus on burning fatty-acids as fuel, that is how the person is suppose to lose weight on that diet. Ketosis and diabetes are so closely related that uncontrolled diabetes would eventually lead to ketosis itself and then if still left untreated, it would lead to ketoacidosis.

One of the largest failures of most diets is that they are catabolic in nature; they focus of losing “weight” instead of adipose. What I think we should be doing is to become more anabolic, but make sure we shuttle energy into lean tissues rather than adipose. I believe this is done with starch.


Diabetes Care. 1999 Jul;22(7):1171-5.

Effect of hyperketonemia on plasma lipid peroxidation levels in diabetic patients.
Jain SK, McVie R, Jackson R, Levine SN, Lim G.

Abstract

OBJECTIVE: This study was undertaken to examine the effect of ketosis on plasma lipid peroxidation levels in diabetic patients.

RESEARCH DESIGN AND METHODS: Plasma levels of lipid peroxidation products (malondialdehyde) and ketone bodies (acetoacetate and beta-hydroxybutyrate) were determined in diabetic patients (n = 70) and age-matched normal volunteers (n = 25). Diabetic patients with total ketone body levels > 1.0 mmol/l were considered hyperketonemic, and those with levels < or = 1.0 mmol/l were considered normoketonemic.

RESULTS: After normalization versus total lipids, levels of lipid peroxidation were significantly higher in the plasma of hyperketonemic diabetic patients (P < 0.05), but not in normoketonemic diabetic patients, compared with age-matched normal volunteers. In addition, low ketonemia was associated with lower lipid peroxidation levels when lipid peroxidation and ketonemia were determined in the same patient (n = 7) at two different clinic visits.

CONCLUSIONS: This study demonstrated an association between hyperketonemia and increased lipid peroxidation levels in diabetic patients, which suggests that ketosis is a risk factor in the elevated lipid peroxidation levels associated with diabetes. Further investigation is needed to determine whether antioxidant supplementation can be particularly beneficial in reducing lipid peroxidation and complications in type 1 diabetic patients who frequently encounter ketosis.




Diabetes. 1999 Sep;48(9):1850-5.

Hyperketonemia can increase lipid peroxidation and lower glutathione levels in human erythrocytes in vitro and in type 1 diabetic patients.

Jain SK, McVie R.

Abstract

Recent studies have suggested that elevated cellular lipid peroxidation may play a role in the development of cellular dysfunction and other complications of diabetes. People with type 1 diabetes frequently encounter elevated levels of the ketone bodies acetoacetate (AA), beta-hydroxybutyrate (BHB), and acetone (ACE). This study was undertaken to test the hypothesis that ketosis might increase lipid peroxidation and lower glutathione (GSH) levels of red blood cells (RBCs) in diabetic patients. This study demonstrates that incubation of AA with normal RBCs in phosphate-buffered saline (37 degrees C for 24 h) resulted in marked GSH depletion, oxidized glutathione accumulation, hydroxyl radical generation, and increased membrane lipid peroxidation. Increases in oxygen radicals and lipid peroxidation and depletion of GSH in RBCs were not observed with BHB or ACE treatments. Similarly, there was a significant generation of superoxide ion radicals even in a cell-free buffer solution of AA, but not in that of BHB. The presence of BHB together with AA did not influence the capacity of AA to generate oxygen radicals in a cell-free solution or the increase in lipid peroxidation of RBCs incubated with AA. The antioxidants vitamin E and N-acetylcysteine (NAC) blocked increase in lipid peroxidation in AA-treated RBCs. To examine the effects of ketone bodies in vivo, studies were performed that showed a significant decrease in GSH and an increase in lipid peroxidation levels in RBCs of hyperketonemic diabetic patients, but not in normoketonemic type 1 diabetic patients, when compared with age-matched normal subjects. This study demonstrates that elevated levels of the ketone body AA can increase lipid peroxidation and lower GSH levels of RBCs in people with type 1 diabetes.

Edited by misterE, 12 February 2014 - 11:38 PM.

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#8 Chupo

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Posted 13 February 2014 - 03:56 AM

Ketogenic-diets and other low-carb diets seem to mimic the hormonal state found in type-1 diabetes. Since diabetics cannot utilize glucose as fuel, due to insulin-resistance, the body begins to oxidize fats for energy to stay alive and while this causes a temporary weight-loss, it doesn’t mean the person is getting healthier, but rather they are wasting away due to insulin-deficiency. Ketogenic diets also promote unhealthy amounts of lipid-peroxides which deplete our endogenous antioxidants (like glutathione and vitamin-e).



Quite the contrary. The following are appropriate ketogenic diet studies, not studies on diabetes.

The ketogenic diet (KD) is a high-fat, low carbohydrate diet that is used as a therapy for intractable epilepsy. However, the mechanism(s) by which the KD achieves neuroprotection and/or seizure control are not yet known. We sought to determine whether the KD improves mitochondrial redox status. Adolescent Sprague-Dawley rats (P28) were fed a KD or control diet for 3 weeks and ketosis was confirmed by plasma levels of beta-hydroxybutyrate (BHB). KD-fed rats showed a twofold increase in hippocampal mitochondrial GSH and GSH/GSSG ratios compared with control diet-fed rats. To determine whether elevated mitochondrial GSH was associated with increased de novo synthesis, the enzymatic activity of glutamate cysteine ligase (GCL) (the rate-limiting enzyme in GSH biosynthesis) and protein levels of the catalytic (GCLC) and modulatory (GCLM) subunits of GCL were analyzed. Increased GCL activity was observed in KD-fed rats, as well as up-regulated protein levels of GCL subunits. Reduced CoA (CoASH), an indicator of mitochondrial redox status, and lipoic acid, a thiol antioxidant, were also significantly increased in the hippocampus of KD-fed rats compared with controls. As GSH is a major mitochondrial antioxidant that protects mitochondrial DNA (mtDNA) against oxidative damage, we measured mitochondrial H2O2 production and H2O2-induced mtDNA damage. Isolated hippocampal mitochondria from KD-fed rats showed functional consequences consistent with the improvement of mitochondrial redox status i.e. decreased H2O2 production and mtDNA damage. Together, the results demonstrate that the KD up-regulates GSH biosynthesis, enhances mitochondrial antioxidant status, and protects mtDNA from oxidant-induced damage.

The ketogenic diet increases mitochondrial glutathione levels.


This is a nice summary of this study (PDF):

The researchers wanted to determine whether increased levels of βOHB actually reduced oxidative stress in vivo. To do this, they implanted mice with a subcutaneous βOHB pump, which supplied a steady release of βOHB. Researchers then injected a chemical, paraquat, which induces build up of reactive oxygen species. Compared to control mice (with no βOHB pump), βOHB mice had an impressive 54% reduction in reactive oxygen species.

Researchers also evaluated a maker of oxidative stress in these mice, 4-hydroxynonenal (4-HNE). 4-NHE is a product of polyunsaturated lipid degradation and accumulates in response to oxidative stress. The control mice had a three-fold increase in 4-NHE, indicating high levels of oxidative stress. This increase was completely suppressed in βOHB mice, indicating that high levels of βOHB protect against oxidative stress.


The level of BHB used in the study yeilded a blood ketone level of about 1.2 mm, which is toward the lower end of the nutritional ketosis range.




Ketogenic-diets focus on burning fatty-acids as fuel, that is how the person is suppose to lose weight on that diet. Ketosis and diabetes are so closely related that uncontrolled diabetes would eventually lead to ketosis itself and then if still left untreated, it would lead to ketoacidosis.


If you are not a type I diabetic, you will produce enough insulin to inhibit ketogenesis. In a healthy individual, ketones and fatty acids inhibit the uptake of glucose on a ketogenic diet. This is a good thing otherwise your blood sugar would drop to coma-inducing levels. The title of a recent study says it all.. almost: Impaired glucose tolerance in low-carbohydrate diet: maybe only a physiological state.


One of the largest failures of most diets is that they are catabolic in nature; they focus of losing “weight” instead of adipose. What I think we should be doing is to become more anabolic, but make sure we shuttle energy into lean tissues rather than adipose. I believe this is done with starch.


Ketogenic diets spare protein. Muscle-building branched-chain amino acids are increased by 50% on a ketogenic diet vs a high carb diet, vis a vis calories and protein.

The effects of a 4-day isocaloric isoprotenic dietary replacement of carbohydrate by fats were studied in six healthy subjects, the experimental diet being preceded and followed by a 3-day period of balanced diet. During the ketogenic regimen, the concentrations of fat derived substrates (free fatty acids, glycerol and 3-hydroxybutyrate) rose significantly and glucose levels decreased by 16.5 +/- 3.2% (mean +/- SEM). The hormonal pattern switched towards a catabolic mode with a fall in insulin levels (-44.0 +/- 6.3%) and a rise in glucagon concentration (+39.0 +/- 10.4%). A significant fall in triiodothyronine and rise in reverse triiodothyronine were observed, while thyroxine levels remained unchanged. The average levels of the most important gluconeogenic amino acids (alanine, glutamine, glycine, serine and threonine) were reduced by 8-34% while those of the branched chain amino acids increased by more than 50%. Since these changes reproduce those observed after a few days of total fasting, we suggest that it is the carbohydrate restriction itself which is responsible for the metabolic and hormonal adaptations of brief fasting.

Hormonal and metabolic changes induced by an isocaloric isoproteinic ketogenic diet in healthy subjects.

This may be in part due to protein recycling or autophagy. This is also most likely why people who are starving to death do not die of protein deficiency. Dr. McDougall has written about this.

Starving People Die of Fat, Not Protein, Deficiency In 1981, 10 Irish prisoners from the Republican Army (IRA) went on a hunger strike. Nine out of 10 of these men died between 57 and 73 days (mean of 61.6 days) of starvation after losing about 40% of their body weights (the remaining striker died of complications of a gunshot wound).16,17 This experience gave doctors a chance to observe first hand the metabolic changes that occur during starvation. Protein stores were generally protected during starvation, with most of the energy to stay alive being derived from the men’s fat stores. It was estimated that the hunger strikers had lost up to 94% of their body-fat levels, but only 19% of their body-protein levels at the time of death.16 They died when they ran out of fat. Since fat is more critical than protein, people should be asking, “Where do you get your fat (on any diet)?



By the way, BCAA supplementation has been found to extend life in mammals.

Recent evidence points to a strong relationship between increased mitochondrial biogenesis and increased survival in eukaryotes. Branched-chain amino acids (BCAAs) have been shown to extend chronological life span in yeast. However, the role of these amino acids in mitochondrial biogenesis and longevity in mammals is unknown. Here, we show that a BCAA-enriched mixture (BCAAem) increased the average life span of mice. BCAAem supplementation increased mitochondrial biogenesis and sirtuin 1 expression in primary cardiac and skeletal myocytes and in cardiac and skeletal muscle, but not in adipose tissue and liver of middle-aged mice, and this was accompanied by enhanced physical endurance. Moreover, the reactive oxygen species (ROS) defense system genes were upregulated, and ROS production was reduced by BCAAem supplementation. All of the BCAAem-mediated effects were strongly attenuated in endothelial nitric oxide synthase null mutant mice. These data reveal an important antiaging role of BCAAs mediated by mitochondrial biogenesis in mammals.


http://www.ncbi.nlm....pubmed/20889128
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#9 Chupo

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Posted 13 February 2014 - 02:31 PM

Starchy foods which stimulate lots of insulin, will actually stimulate nitric-oxide.

That's right peoples... INSULIN STIMULATES NITRIC-OXIDE!

Now go eat some spuds!


In this study, the low carb group had improved vascular function both fasting and after a high fat meal while it worsened in the low fat group.

Posted Image





The brachial artery reactivity protocol used in this study is
generally considered an index of nitric oxide bioavailability
[34]. Insulin resistance in endothelial cells is due to
impairment in the phosphatidyl inositol 3-kinase–dependent
signaling pathway that leads to production of nitric oxide
[35], which is consistent with work showing that insulin
resistance is associated with vascular dysfunction [36]. The
beneficial effect of a CRD compared with reducing fat on
vascular function in this study is consistent with our thesis
that carbohydrate restriction targets features of insulin
resistance [12,13]. The finding that FMD was improved by
a low-carbohydrate diet in a rat model of obesity-induced
impairment of coronary endothelial function [37] is further
support for carbohydrate restriction having a positive effect
on vascular function.


If you look at the last study [37] cited in the quote above, it appears that you might not even need NO for improved vascular function on a low carb diet. The researchers inhibited NO and endothelial function still returned to normal on the low carb diet.

A popular diet used for weight reduction is the low-carbohydrate diet, which has most calories derived from fat and protein, but effects of this dietary regimen on coronary vascular function have not been identified. We tested the hypothesis that obesity-induced impairment in coronary endothelial function is reversed by a low-carbohydrate diet. We used four groups of male Zucker rats: lean and obese on normal and low-carbohydrate diets. Rats were fed ad libitum for 3 wk; total caloric intake and weight gain were similar in both diets. To assess endothelial and vascular function, coronary arterioles were cannulated and pressurized for diameter measurements during administration of acetylcholine or sodium nitroprusside or during flow. When compared with lean rats, endothelium-dependent acetylcholine-induced vasodilation was impaired by approximately 50% in obese rats (normal diet), but it was restored to normal by the low-carbohydrate diet. When the normal diet was fed, flow-induced dilation (FID) was impaired by >50% in obese compared with lean rats. Similar to acetylcholine, responses to FID were restored to normal by a low-carbohydrate diet. N(omega)-nitro-L-arginine methyl ester (10 microM), an inhibitor of nitric oxide (NO) synthase, inhibited acetylcholine- and flow-induced dilation in lean rats, but it had no effect on acetylcholine- or flow-induced vasodilation in obese rats on a low-carbohydrate diet. Tetraethylammonium, a nonspecific K(+) channel antagonist, blocked flow-dependent dilation in the obese rats, suggesting that the improvement in function was mediated by a hyperpolarizing factor independent of NO. In conclusion, obesity-induced impairment in endothelium-dependent vasodilation of coronary arterioles can be dramatically improved with a low-carbohydrate diet most likely through the production of a hyperpolarizing factor independent of NO.








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