Tag Archives: ketogenic diet

Too Much Mouse and Molecular Biochemistry!

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

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

Dietitian Franziska Spritzler’s Six-Month Ketogenic Diet Trial Results

Steve Parker MD, Advanced Mediterranean Diet

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.

Low-Carb Ketogenic Diet Appears Safe and Effective for Children and Adolescents

A ketogenic diet was safe and effective for weight loss in children and adolescents, according to a small study in the Journal of Pediatric Endocrinology and Metabolism.  Fifty-six children were placed on either a ketogenic diet or a calorie-restricted diet.  The investigators judged the low-carb ketogenic diet more effective.

I don’t treat children, so I don’t normally follow the pediatric scientific literature.  Thanks to Diet Doctor Andreas Eenfeldt for bringlng this to my attention.  I’ve not read the full research report.

In 2010 I reported on research showing a low-carb, high-protein diet was safe and effective for severely obese adolescents.

What Do Dietitians Think About Ketogenic Diets?

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.

Ketogenic Diet for Alzheimers Disease?

Ketogenic diets have seen a resurgence in the last two decades as a treatment for childhood epilepsy, particularly difficult-to-control cases not responding to drug therapy. It works, even in adults. That’s why some brain experts are wondering if ketogenic diets might be helpful in other brain disorders, such as Alzheimer’s disease and Parkinson’s disease.

I’ll save you some time and just give you the conclusion of a 2006 scientific article I read: maybe, but it’s way too soon to tell.

The article is called “Neuroprotective and disease-modifying effects of the ketogenic diet,” from researchers at the National Institutes of Health’s National Institue of Neruological Disorders and Stroke. Sounds promising doesn’t it?

The article goes into detail about how the ketogenic diet might be good for brain health. Dr. Emily Deans would be very interested in that, but most of my readers not. Two-and-a-half pages on non-human animal studies, too.

What is this “Ketogenic diet” used for epilepsy?

The most common ketogenic diet for childhood epilepsy is the one developed by Wilder in 1921. It was a popular treatment for epilepsy in the 1920s and 1930s. Fats provide 80 to 90% of the calories in the diet, with sufficient protein for growth, and minimal carbohydrates. Since carbs are in short supply, the body is forced to use fats as an energy source, which generates ketone bodies—acetoacetate, acetone, beta-hydroxybutyrate, largely from the liver.

So what?

Not much. This article may have been written to stimulate future research, and I hope it does. I just searched PubMed for “ketogenic diet AND Alzheimer” and came up with nothing new since 2006.

Could the Ketogenic Mediterranean Diet prevent or alleviate Alzheimer’s disease? At this point, just flip a coin.

Steve Parker, M.D.

Reference: Gasior M, Rogawski MA, & Hartman AL (2006). Neuroprotective and disease-modifying effects of the ketogenic diet. Behavioural pharmacology, 17 (5-6), 431-9 PMID: 16940764

What’s Our Preferred Fuel?

Dr. Jay Wortman has been thinking about whether our bodies prefer to run on carbohydrates (as a sourse of glucose) or, instead, on fats. The standard American diet provides derives about half of its energy from carbs, 35% from fats, and 15% from proteins. So you might guess our bodies prefer carbohydrates as a fuel source. Dr. Wortman writes:

Now, consider the possibility that we weren’t meant to burn glucose at all as a primary fuel. Consider the possibility that fat was meant to be our primary fuel. In my current state of dietary practice, I am burning fat as my main source of energy. My liver is converting some of it to ketones which are needed to fuel the majority of my brain cells. A small fraction of the brain cells, around 15%, need glucose along with a few other tissues like the renal cortex, the lens of the eye, red blood cells and sperm.Their needs are met by glucose that my liver produces from proteins. The rest of my energy needs are met with fatty acids and these come from the fats I eat.

Dr. Wortman, who has type 2 diabetes, in the same long post also writes about oolichan grease (from fish), an ancestral food of Canandian west coast First Nations people.

Folks eating a very-low-carb diet such as the Ketogenic Mediterranean Diet get most of their energy from fats.

Steve Parker, M.D.