Ketogenic diet basics - Paul Jaminet, Ph.D & Shou-Ching Shih Jaminet, Ph.D

from the Perfect Health Diet blog:

Extract:

Part 1 - Summary

Ketogenic Diets, I: Ways to Make a Diet Ketogenic | Perfect Health Diet

Three ways to make the diet ketogenic:

1)      Make Wilder’s “ketogenic ratio” high by eating a lot of fat, very few carbs, and not too much protein.
2)      Supplement with the ketogenic amino acids lysine and leucine.
3)      Supplement with coconut oil or another source of short-chain fats.

If we do (2) or (3), then the diet can be ketogenic even if it has a fair number of carbs.

So now we have an arsenal of ways to generate ketones. We have to look at diseases and diet risks to figure out which way of making the diet ketogenic is optimal.


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Part 2 - Summary

 Ketogenic Diets 2: Preventing Muscle and Bone Loss on Ketogenic Diets | Perfect Health Diet

I believe the extreme limits on carb and protein intake in conventional clinical ketogenic diets are responsible for their growth stunting, muscle destroying, fattening effects.

In order to supply sufficient protein and carbs while maintaining ketosis, it is necessary to provide ketogenic short-chain fats and amino acids.

Clinical testing of such supplemented diets has so far produced encouraging results. Providing supplemental amino acids to epileptic children on ketogenic diets improved their health and allowed them to maintain ketosis with higher protein intake. Seizure frequency was reduced even as side effects diminished.

Personally, I wouldn’t attempt a long-term ketogenic diet without the aid of coconut oil (or MCTs), lysine, and the branched chain amino acids.

For the NBIA/PKAN kids, it seems that the amino acid supplements should be some mix of lysine, leucine, isoleucine, and valine, with the isoleucine and valine included solely to reduce leucine toxicity. The optimal amount of isoleucine and valine should be smaller than is found in branched-chain amino acid supplements, since leucine by itself may help prevent iron accumulation and increase ketosis. Also, one rat study [4] indicates that isoleucine alone, excluding valine, might be enough to relieve leucine toxicity. Excluding valine would increase the ketogenicity of the supplement mix.

I think the NBIA/PKAN kids will need to experiment with primarily lysine and leucine, and secondarily isoleucine and BCAA supplements, to see what mix works best for them.

 

References

[1] Owen OE et al. Brain metabolism during fasting. J Clin Invest. 1967 Oct;46(10):1589-95. http://pmid.us/6061736.
[1] Groesbeck DK et al. Long-term use of the ketogenic diet in the treatment of epilepsy. Dev Med Child Neurol. 2006 Dec;48(12):978-81. http://pmid.us/17109786. Hat tip CarbSane.
[2] Ribeiro LC et al. Ketogenic diet-fed rats have increased fat mass and phosphoenolpyruvate carboxykinase activity. Mol Nutr Food Res. 2008 Nov;52(11):1365-71. http://pmid.us/18655006. Hat tip CarbSane.
[3] Evangeliou A et al. Branched chain amino acids as adjunctive therapy to ketogenic diet in epilepsy: pilot study and hypothesis. J Child Neurol. 2009 Oct;24(10):1268-72. http://pmid.us/19687389. Hat tip Nigel Kinbrum.
[4] Tsubuku S et al. Thirteen-week oral toxicity study of branched-chain amino acids in rats. Int J Toxicol. 2004 Mar-Apr;23(2):119-26. http://pmid.us/15204732.
[5] Yudkoff M et al. Brain amino acid requirements and toxicity: the example of leucine. J Nutr. 2005 Jun;135(6 Suppl):1531S-8S. http://pmid.us/15930465.
[6] Mawatari K et al. Prolonged oral treatment with an essential amino acid L-leucine does not affect female reproductive function and embryo-fetal development in rats. Food Chem Toxicol. 2004 Sep;42(9):1505-11. http://pmid.us/15234081.
[7] Tsubuku S et al. Thirteen-week oral toxicity study of L-lysine hydrochloride in rats. Int J Toxicol. 2004 Mar-Apr;23(2):113-8. http://pmid.us/15204731.
Ketogenic Diets | Perfect Health Diet

Ketogenic Diets - Perfect Health Diet blog

by husband-and-wife team from the Perfect Health Diet blog:
Paul Jaminet, Ph.D. and Shou-Ching Shih Jaminet, Ph.D.

Part 1 - Summary Ketogenic Diets, I: Ways to Make a Diet Ketogenic | Perfect Health Diet

So we have three ways to make the diet ketogenic:

1) Make Wilder’s “ketogenic ratio” high by eating a lot of fat, very few carbs, and not too much protein.
2) Supplement with the ketogenic amino acids lysine and leucine.
3) Supplement with coconut oil or another source of short-chain fats.

If we do (2) or (3), then the diet can be ketogenic even if it has a fair number of carbs.
So now we have an arsenal of ways to generate ketones. We have to look at diseases and diet risks to figure out which way of making the diet ketogenic is optimal.

References

[1] Owen OE et al. Brain metabolism during fasting. J Clin Invest. 1967 Oct;46(10):1589-95. http://pmid.us/6061736.

------------------------------------------

Part 2 - Summary Ketogenic Diets 2: Preventing Muscle and Bone Loss on Ketogenic Diets | Perfect Health Diet

I believe the extreme limits on carb and protein intake in conventional clinical ketogenic diets are responsible for their growth stunting, muscle destroying, fattening effects.

In order to supply sufficient protein and carbs while maintaining ketosis, it is necessary to provide ketogenic short-chain fats and amino acids.

Clinical testing of such supplemented diets has so far produced encouraging results. Providing supplemental amino acids to epileptic children on ketogenic diets improved their health and allowed them to maintain ketosis with higher protein intake. Seizure frequency was reduced even as side effects diminished.

Personally, I wouldn’t attempt a long-term ketogenic diet without the aid of coconut oil (or MCTs), lysine, and the branched chain amino acids.

For the NBIA/PKAN kids, it seems that the amino acid supplements should be some mix of lysine, leucine, isoleucine, and valine, with the isoleucine and valine included solely to reduce leucine toxicity. The optimal amount of isoleucine and valine should be smaller than is found in branched-chain amino acid supplements, since leucine by itself may help prevent iron accumulation and increase ketosis. Also, one rat study [4] indicates that isoleucine alone, excluding valine, might be enough to relieve leucine toxicity. Excluding valine would increase the ketogenicity of the supplement mix.

I think the NBIA/PKAN kids will need to experiment with primarily lysine and leucine, and secondarily isoleucine and BCAA supplements, to see what mix works best for them.

References

[1] Groesbeck DK et al. Long-term use of the ketogenic diet in the treatment of epilepsy. Dev Med Child Neurol. 2006 Dec;48(12):978-81. http://pmid.us/17109786. Hat tip CarbSane.
[2] Ribeiro LC et al. Ketogenic diet-fed rats have increased fat mass and phosphoenolpyruvate carboxykinase activity. Mol Nutr Food Res. 2008 Nov;52(11):1365-71. http://pmid.us/18655006. Hat tip CarbSane.
[3] Evangeliou A et al. Branched chain amino acids as adjunctive therapy to ketogenic diet in epilepsy: pilot study and hypothesis. J Child Neurol. 2009 Oct;24(10):1268-72. http://pmid.us/19687389. Hat tip Nigel Kinbrum.
[4] Tsubuku S et al. Thirteen-week oral toxicity study of branched-chain amino acids in rats. Int J Toxicol. 2004 Mar-Apr;23(2):119-26. http://pmid.us/15204732.
[5] Yudkoff M et al. Brain amino acid requirements and toxicity: the example of leucine. J Nutr. 2005 Jun;135(6 Suppl):1531S-8S. http://pmid.us/15930465.
[6] Mawatari K et al. Prolonged oral treatment with an essential amino acid L-leucine does not affect female reproductive function and embryo-fetal development in rats. Food Chem Toxicol. 2004 Sep;42(9):1505-11. http://pmid.us/15234081.
[7] Tsubuku S et al. Thirteen-week oral toxicity study of L-lysine hydrochloride in rats. Int J Toxicol. 2004 Mar-Apr;23(2):113-8. http://pmid.us/15204731.
Ketogenic Diets | Perfect Health Diet

by husband-and-wife team from the Perfect Health Diet blog:

Paul Jaminet, Ph.D. Paul was an astrophysicist at the Harvard-Smithsonian Center for Astrophysics, became a software entrepreneur during the Internet boom, and now provides strategic advice to entrepreneurial companies while pursuing research in economics (see pauljaminet.com for more information). Paul’s experience overcoming a chronic illness has been key to our views of aging and disease. Paul can be reached by email to pauljaminet@perfecthealthdiet.com.

Shou-Ching Shih Jaminet, Ph.D. Shou-Ching is a molecular biologist and cancer researcher at Beth Israel Deaconess Medical Center and Harvard Medical School, and Director of BIDMC’s Multi-Gene Transcriptional Profiling Core. Shou-Ching was born in Korea to Chinese parents, grew up in Korea, attended college at National Taiwan University in Taipei, and graduate school at University of Newcastle in Australia, before coming to the US to work at Sloan-Kettering Cancer Center, Children’s Hospital Boston, and Beth Israel Deaconess and Harvard Medical School. Her publications may be found by searching Pubmed for “Shih SC.”

3 year experience on Ketosis and low carbs

Dr Kurt Harris - a detailed account of his 3 year experience experimenting with low carb and ketosis:

Archevore - Archevore Blog - Thoughts on Ketosis - I
Archevore - Archevore Blog - Thoughts on Ketosis - II

(cf: his more hard-line position as in August 2009: here)

Random extracts follow:

I've never advocated anyone eat VLC, only described that I often did. It is not necessary to eat VLC to stop the metabolic damage of the SAD. VLC might only be necessary if you have diabetes or need to lose a lot of weight. PaNu is not intrinsically a weight loss prescription. It is not therapy. It is just eating in a non-damaging way.

I don't routinely measure my CHO intake or anything else. Everyone will want to know, so I will say that my purely speculative idea is that as long as there are enough animal foods in the diet, a range of 15 to 60% carbohydrates (exact numbers not important) are probably all equally healthy as long as the NAD are avoided.

I intend to keep eating at least 20% starch, which is twice the Kwasniewski number, to give myself a buffer against ketosis and because I speculate that this is about the level at which your glycogen stores start to get optimized. I certainly feel that way. The post-workout orthostasis is completely gone*.

Oh, and Rice Krispies (of whatever brand) have have only a few grams of added sugar in a bowl. It's really just toasted white rice. A good sized bowl is maybe 40 g of starch, a few grams of sugar, plus whatever lactose if you add H/H or milk. For lunch and/or dinner add sweet potatoes, white potatoes and whatever green veggies and dessert fruit you eat and that should do it

I have yet to see formal evidence that ketosis is metabolically stressful. When the body enters the least metabolically favorable scenario (starvation) ketosis is developed. It doesnt make sense that ketosis would be developed to be more stressful.

KGH: It is developed to spare our structural proteins and conserve precious glucose for the brain, whether it is "stressful" or not. It certainly involves extra metabolic work. The fact that this happens only when we deprive our bodies of dietary glucose suggests it is stressful. It happens to spare our glycogen - the body is detecting that the glucose reserves are threatened. And it either spares our own muscle or reduces our demand for extra dietary protein to turn into glucose.

Finally, ketonuria does not always correlates to ketonemia.

KGH: Agreed but not my point. Once you are keto-adapted after a few weeks, if you have ketones in the urine it means you are in ketosis enough that you are making more than you burn.

Ketosis is an adaptive state that beats the alternative of glycogen depletion or muscle wasting that it is designed to counter. This makes it "good". In the same way, muscle wasting to keep your brain supplied with glucose is "good". Good in the sense of beating the alternatives. That does not mean we should seek to live continuously in either state, though does it?

For a good discussion of mostly short term adverse effects of ketosis, based on a conversation I had with Peter a while ago, you can go here.

I will allow that there could be theoretical benefits to spending some time in ketosis. And there are therapeutic uses of ketogenic diets for people who are sick. But those who propose that a metabolic state that evolved as a response to a dietary deficiency is per se a desirable state to be in all the time have the burden of proof. This is the same burden of proof faced by those advocating anything that is outside the known evolutionary history of our species.

Synthetic resveratrol, megadoses of fish oil, 10,000 units a day of vitamin D year-round, statins, deriving the majority of your fuel needs from coconut oil, any supplement to a real food diet - for all of these things the advocates have the burden of proof.

So, once more for emphasis. Ketosis* can be useful therapeutic maneuver, but there is no evidence using current knowledge of metabolism or evolutionary reasoning that we should strive to be in this atypical state all the time.

* I define Ketosis in the usual paleosphere way. Eating a low enough digestible carbohydrate intake to induce serum levels of ketones much higher than those eating a carbohydrate replete diet. This will usually be a carbohydrate intake below the amount that would be necessary to run your brain on nothing but glucose, but still higher than the basal glucose requirement of the brain once keto-adapted, where the brain is running as much as half on ketones. We usually use ketones in the urine (ketonuria) as evidence of ketosis, but this is not 100% reliable, as the rate they are burned influences how many are spilled into the urine. The carbohydrate amount necessary to keep out of significant ketosis varies, but Kwasniewski uses 10% of kcal, and Lutz uses 70 g/day which is roughly the same if you are 2800 kcal/day but more if you eat less. Bernstein uses 30g/day for his diabetes diet, but this is meant to ensure micronutrient intake from non-starchy veggies and will not keep you out of ketosis.

Ketogenic - diets & Ketogenesis explained

Ketone bodies may be used as an alternative to glucose (ie. from dietary carbohydrates) for brain/muscle fuel.  A diet based on this approach is known as a ketogenic diet, and as Dr Hilary Jones explains:

 "....all the research that has been carried out over the last 10 years has thrown previous research on its head. we now know that a ketogenic diet can actually be very healthy, [ ] it can increase the level of good cholesterol, [ ] its safe for our kidneys, its safe for our livers, [ ] can help prevent diabetes, [ ] all in all its safe and effective and could actually improve our health"

Ketogenesis - the process by which ketone bodies are produced from the breakdown of fatty acids.

since the 1920's, ketogenic diets have been used successfully by traditional medicine to treat epileps. it is recognised at least in that context by the conservative Mayo Clinic - ie. see "puff-piece" below:



some bodybuilders use a form of ketogenic diet as part of their regime: http://www.bodybuildingdungeon.com/forums/nutrition/2156-ckd-cyclical.html

Ketogenesis - and Ketogenic diets explained

Ketogenesis - the process by which ketone bodies are produced from the breakdown of fatty acids.

Ketone bodies may be used as an alternative to glucose (ie. from dietary carbohydrates) for brain/muscle fuel.  A diet based on this approach is known as a ketogenic diet, and as Dr Hilary Jones explains:

 "....all the research that has been carried out over the last 10 years has thrown previous research on its head. we now know that a ketogenic diet can actually be very healthy, [ ] it can increase the level of good cholesterol, [ ] its safe for our kidneys, its safe for our livers, [ ] can help prevent diabetes, [ ] all in all its safe and effective and could actually improve our health"

since the 1920's, ketogenic diets have been used successfully by traditional medicine to treat epileps. it is recognised at least in that context by the conservative Mayo Clinic - ie. see "puff-piece" below:




some bodybuilders use a form of ketogenic diet as part of their regime: http://www.bodybuildingdungeon.com/forums/nutrition/2156-ckd-cyclical.html