Saturday, January 4, 2020

Retrospective #322:The Therapeutic Ketogenic Diet and Nutritional Ketosis

In an interview with Gary Taubes, the National Institutes of Health senior researcher, Richard L. Veech, said it best:
"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, a moniker it acquired a few years ago to allay fears, for about 9 years. A few years ago, Amy Berger, a blogger at, put together an excellent 3-part series on the subject. Google it. 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 incipient Insulin Resistance, 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. Wilder 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. The therapeutic Ketogenic Diet was effective, but it was replaced after WWII with drugs. Today it is still used at Johns Hopkins and elsewhere in the treatment of drug-resistant epilepsy, where it is effective in about 50% of cases where drugs fail.
The broad goal of NUTRITIONAL KETOSIS is primarily 1) improved control of glucose metabolism for treatment of metabolic disorders like Pre-Diabetes and Type 2 Diabetes, 2) easy weight loss without hunger, and 3) reversal of lipid (cholesterol) and chronic systemic inflammation abnormalities and metabolic disorders.
Many years ago, I heard cancer researcher Eugene Fine lecture on the alternative use of ketones as “brain food” in the treatment of brain cancer, specifically glioblastoma multiforme. Brain cancers “feed” on glucose, so finding an alternative brain food to glucose would be an effective therapy. Fatty acids (broken down from triglycerides), the other fuel the body uses, can’t cross the blood-brain barrier, but ketones, a byproduct of the breakdown, can. So, ketones produced by nutritional ketosis are being used as brain food in patients with these brain cancers.
Today, however, there is a burgeoning interest in researching the KETOGENIC DIET as an adjunctive therapy for many other serious metabolic conditions including Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, multiple sclerosis, ALS (Lou Gehrig’s disease), various types of cancer of the alimentary canal, and brain cancer.
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. So, this is a niche treatment, but the implications for those patients and others are huge.
For example, as the population ages, Alzheimer’s disease, a form of dementia, is increasing. People with Alzheimer’s lose function in parts of the brain because glucose, the main brain food, isn’t taken up. This is how Alzheimer’s has come to acquire the sobriquet, “Type 3 diabetes.” But ketone bodies are taken up from the lymph system, not capillary blood, thus ketones can pass the blood-brain barrier as we’ve said. So, the ketogenic diet is being studied as an alternative way to feed the brain in people who have evidence of Mild Cognitive Impairment, the first phase of AD.
In January 2016 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 forthcoming series I will share my perspectives from this 3-day event with you. Spoiler alert: It has transformed my thinking. I hope this series will do the same for you.
The conference was organized by PhDs at the University of South Florida and was attended by many iconic figures (both PhDs and MDs) in the field. I may have been the only “fly on the wall” at the meeting. 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, 1) therapeutic METABOLIC THERAPIES, 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, and 2) NUTRITIONAL KETOSIS for weight loss, blood sugar control and for performance athletes.
In the following columns I will not explore Supplemental Ketones from the performance athlete’s perspective. I will, however, tell you how I became newly motivated 1) to follow a Very Low Carb/keto-adapted Way of Eating, and also 2) why I plan to introduce ketones to my body every day for the rest of my life as both a prophylactic practice

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