That’s my primary assessment of an article I read in Current Opinion on Clinical Nutrition and Metabolic Care. The title is “Low-carbohydrate ketogenic diets, glucose homeostasis, and nonalcoholic fatty liver disease.”
Don’t assume mouse physiology is the same as human’s
The article’s more about mice than my patients.
The authors share some stats about nonalcoholic fatty liver disease (NAFLD):
- the earliest stage is fat build-up in the liver
- 15% of the nonobese population has NAFLD
- 65% of the obese have NAFLD
- it can progress to an inflammatory disorder (nonalcoholic steatohepatitis (NASH)
- about two out of 10 NASH patients progress to cirrhosis within 10 years
- NAFLD is an independent predictor of heart and vascular disease, an even stronger predictor than overall body fat mass (even visceral fat)
- insulin resistance is strongly linked to NAFLD
The Washington University School of Medicine authors say good things about low-carbohydrate ketogenic diets for weight loss and seizure control. They spend the rest of the article talking about rodent physiology and lab chows—right up Carbsane Evelyn‘s alley. But not mine. Bores me to tears.
They do mention the small Browning study that showed a very-low-carb ketogenic diet superior to a calorie-restricted diet for reducing liver fat in humans. Weight loss by various methods is a standard recommendation for humans with NAFLD; I wouldn’t be surprised multiple different diets worked. It may be the weight loss, not the diet, that does the trick. We have just one human study thus far indicating a ketogenic diet is more effective short-term.
Here’s the full Browning study if you care to read it yourself.
If I were obese and had NAFLD, I’d go on a very-low-carb ketogenic diet (like this one).
Steve Parker, M.D.
Reference: Schugar, Rebecca, and Crawford, Peter. Low-carbohydrate ketogenic diets, glucose homeostasis, and nonalcoholic fatty liver disease. Curr Opin Clin Nutr Metab Care, 2012, vol. 15. doi: 10.1097/MCO.0b013e3283547157
Two diet books in one: 1) portion control, and 2) ketogenic
Ketogenic diets help many folks lose excess weight, return blood sugar levels toward normal, and move HDL cholesterol and triglycerides to a healthier range. I include a ketogenic diet as an option in my Advanced Mediterranean Diet (2nd Ed.). They are not for everybody.
Read about Franziska Spritzler’s experience with a ketogenic diet (not my version). Some quotes:
Well, after consistently consuming 30-45 grams of net carbs a day for six months, I have only positive things to say about my very-low-carb experience. Not only are my blood sugar readings exactly where they should be — less than 90 fasting and less than 130 an hour after eating — but I truly feel healthier, less stressed, and more balanced than ever.
My diet consists of lots of fat from avocados, nuts and nut butters, olive oil, and cheese; moderate amounts of fish, chicken, beef, Greek yogurt, and eggs; and at least one serving of nonstarchy vegetables at every meal and a small serving of berries at breakfast. It’s truly a rich, satisfying, and luxurious way to eat.
Don’t wait to take action until it’s too late
High blood insulin levels and insulin resistance promote age-related degeneration of the brain, leading to memory loss and dementia according to Robert Krikorian, Ph.D. He’s a professor in the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati Academic Health Center. He has an article in a recent issue of Current Psychiatry – Online.
Proper insulin signaling in the brain is important for healthy functioning of our brains’ memory centers. This signaling breaks down in the setting of insulin resistance and the associated high insulin levels. Dr. Krikorian makes much of the fact that high insulin levels and insulin resistance are closely tied to obesity. He writes that:
Waist circumference of ≥100 cm (39 inches) is a sensitive, specific, and independent predictor of hyperinsulinemia for men and women and a stronger predictor than body mass index, waist-to-hip ratio, and other measures of body fat.
Dr. Krikorian thinks that dietary approaches to the prevention of dementia are effective yet underutilized. He mentions reduction of insulin levels by restricting calories or a ketogenic diet: they’ve been linked with improved memory in middle-aged and older adults.
Dr. K suggests the following measures to prevent dementia and memory loss:
- eliminate high-glycemic foods like processed carbohydrates and sweets
- replace high-glycemic foods with fruits and vegetables (the higher polyphenol intake may help by itself)
- certain polyphenols, such as those found in berries, may be particularly helpful in improving brain metabolic function
- keep your waist size under 39 inches, or aim for that if you’re overweight
I must mention that many, perhaps most, dementia experts are not as confident as Dr. Krikorian that these dietary changes are effective. I think they are, to a degree.
The Mediterranean diet is high in fruits and vegetables and relatively low-glycemic. It’s usually mentioned by experts as the diet that may prevent dementia and slow its progression.
Read the full article.
I’ve written before about how blood sugars in the upper normal range are linked to brain degeneration. Dr. Krikorian’s recommendations would tend to keep blood sugar levels in the lower end of the normal range.
Steve Parker, M.D.
PS: Speaking of dementia and ketogenic, have you ever heard of the Ketogenic Mediterranean Diet? (Free condensed version here.)
Posted in Alzheimer Disease, Dementia, Glycemic Index, Ketogenic Mediterranean Diet, Overweight & Obesity, Uncategorized
Tagged berries, body mass index, dementia, diet, fruit, glycemic index, low carb, Mediterranean diet, memory loss, obesity, Robert Krikorian, vegetables
You get it?
Registered Dietitian Franziska Spritzler recently reviewed the concept of low-carb ketogenic diets. She thinks they are a valid approach to certain clinical situations. Among dietitians, this puts her in a small but growing minority.
One of your weight-loss choices in my Advanced Mediterranean Diet (2nd Edition) is a ketogenic diet. Here’s the basic program.
I hesitate to mention this, but I will anyway. Many, if not most, dietitians too easily just go along with the standard party line on low-carb eating: it’s rarely necessary and quite possibly unhealthy. Going along is much easier than doing independent literature review and analysis. I see the same mindset among physicians.
Franziska breaks the mold.
Steve Parker, M.D.
I answered this question last year at the Diabetic Mediterranean Diet Blog, based on research from the Department of Pediatrics, University of Colorado.
It’s an important question. Childhood obesity in the U.S. tripled from the early 1980s to 2000, ending with a 17% obesity rate. Overweight and obesity together describe 32% of U.S. children. Some experts believe this generation of kids will be the first in U.S. history to suffer a decline in life expectancy, related to obesity.
Steve Parker, M.D.
Fish is a major feature of my Ketogenic Mediterranean Diet as well as a healthy component of the traditional Mediterranean diet.
Darya Pino over at Summer Tomato wrote about eating fish: health aspects, which are best to eat, shopping, and sustainability. I recommend it to you, even though I don’t agree with everything. For instance, I think in general the risk of mercury contamination is overblown. (I know that’s little consolation for those few who have suffered mercury poisoning from fish.)
Steve Parker, M.D.