Sunday, April 3, 2016

The Nutrition Debate #322: Ketosis, the Ketogenic Diet and Supplemental Ketones: An Overview

The National Institutes of Health researcher, Richard L. Veech, addressing KETOSIS, said it best (to Gary Taubes):
"Doctors are scared of ketosis. They're always worried about diabetic ketoacidosis.
 But ketosis is a normal physiologic state. I would argue it is the normal state of man.”
I have been writing about Ketosis and NUTRITIONAL KETOSIS (before it had its new moniker) in various posts for about 5 years. More recently, Amy Berger, a blogger at TuitNutrition.com, put together an excellent 3-part series on the subject starting here. You need go no further than Amy’s series for all you need to know about the similarities and differences between “very low carb” and “keto-adapted.” It’s an excellent source for those who want to lose weight, including those with Metabolic Syndrome, Pre-Diabetes and Type 2 Diabetes.

The therapeutic KETOGENIC DIET has been around since 1921 when Russell Wilder developed it for the treatment of childhood epilepsy. He also developed the formula for the ketogenic/glucogenic ratio (K:G). The keto fraction in the original ratio is about 90% fat, with adequate protein and de minimis carbohydrates.

Both Nutritional Ketosis and the therapeutic Ketogenic Diet are dietary regimens with specific targets; the first is broad and the second narrow but starting to explode. The broad goal of Nutritional Ketosis is primarily 1) easy weight loss without hunger, 2) improved control of glucose metabolism for treatment of metabolic disorders like Pre-Diabetes and Type 2 Diabetes, and 3) huge improvements in lipid (cholesterol) and inflammation markers.

The narrow goal of the therapeutic Ketogenic Diet was (and is) the treatment of drug-resistant epilepsy. Today, however, there is a burgeoning interest in researching the KETOGENIC DIET as an adjunctive therapy for many other serious medical conditions including Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, multiple sclerosis, ALS (Lou Gehrig’s disease), and various types of cancer.

Years ago I heard Eugene Fine lecture on the alternative use of ketones as “brain food” in the treatment of brain cancer, specifically glioblastomas. Brain cancers “feed” on glucose, but while fatty acids (catabolized from triglycerides) can’t cross the blood-brain barrier, ketones, a byproduct of the breakdown, can.

While interesting to me at the time, glioblastomas comprise only about 15% of all brain tumors and brain tumors only about 2% of all cancers. Recently, however, I attended the 1st Annual Nutritional Ketosis and Metabolic Therapeutics Conference in Tampa, FL, and I gained a totally new perspective on ketones. In this 4-part I will share my lay perspectives from this 3-day event with you. Spoiler alert: It has transformed my thinking. I’ve had an awakening.

But today I will just describe what I saw as the component constituencies and then give you my main takeaway. Remember, this is from the perspective of an old, type 2 diabetic; as such, what I shared in common with most people over 50 (before changing my Way of Eating), is a diet-related, genetic expression of a metabolic disorder, and related body-weight issues (obesity), high blood pressure (hypertension) and “high” (they say) cholesterol (dyslipidemia). All these things, epidemiologically speaking, put me at much greater risk of a passel of diseases.

The conference was organized by PhDs at the University of South Florida and was attended by many iconic PhDs and MDs in the field. Subject matter was diverse and included plenary and break-out sessions to accommodate the different constituencies. The two main themes in the break-out sessions were, as the name implies, 1) nutritional ketosis and SUPPLEMENTAL KETONES for performance athletes, and 2) metabolic therapies, also with SUPPLEMENTAL KETONES, for diseases including brain cancer and Alzheimer’s Disease (AD), both for the same reason: Ketone bodies are the preferred “brain food” and easily cross the blood—brain barrier.

In the following columns I will not explore supplemental ketones from the performance athlete’s perspective. I will, however, tell you how I have become newly motivated 1) to not just be very low carb/keto-adapted in my diet (but not particularly interested in how my urine scores on a keto strip – I never was), and also 2) to introduce ketones to my body every day for the rest of my life as a therapeutic and perhaps prophylactic practice.

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