Alzheimer’s disease and the implications for treatment.

In terms of the brain’s fuel requirements there is an interchange normally between the ketones and glucose used by the brain, which becomes faulty as we get older. If we look at the infant brain, it cannot develop normally without ketones. Ketones supply 20 to 25 percent of the infant’s brain energy requirements.

The main source of supply the ketones for the infant during lactation, is the medium chain triglycerides that are in human milk. Infants are in mild ketosis during the lactation period.

In the aging brain we can use the ketone energy the new born brain thrives on.

Need a refresher on what a Ketogenic diet is? Please refer to my Blog Comparing common diets: Ketogenic, Paleo, Mediterranean Diets https://2healthyhabits.wordpress.com/2018/03/02/comparing-common-diets-ketogenic-paleo-mediterranean-diets/

Two fuels that are used by the brain:

Blog Apr. 26 -1 glucose pull.png
  1. Glucose,(simple sugar mainly from plants) gets into the brain usinga push strategy.See the little stick person is pulling a glucose molecule into the brain, which is on the right. That process is driven by a falling glucose in the brain cell.
  1. Ketones use a push strategy. When the ketones go up in the blood on the left they are pushed into the brain and this is the way the brain works all the time if glucose goes down because you’ve been fasting for 24 hours and insulin is down and ketones are being produced and they will go into the brain.

As ketones become available in the blood, they will be used by the brain, which is an extraordinarily efficient way of providing a backup fuel for the brain in the fasted state.

Glucose is the main fuelof the brain under most circumstances except under extreme fasting but it’s not the preferred fuel.

Glucose uptake is goes down when there’s sufficient ketones around to go into the brain. This is a very useful glucose sparing effect that in fact occurs on the ketogenic diet.

See the brain scans the control, a healthy adult as compared to a person with Alzheimer’s Disease.

Blog Apr. 26 - 2 brain scans.png

The effects of aging and Alzheimer’s disease is shown by the two little arrows in the scan. In one scan where the arrows are in the scan is basically missing the orange to red color in the parietal lobes over the ears, this is a classic image of what one sees in Alzheimer’s disease.

The glucose problem precedes the cognitive deficit in Alzheimer’s disease.  There are five categories of people with pre-symptomatic brain glucose hypometabolism (decreased life-maintaining processes)that are at risk of Alzheimer’s disease:  Older people, people with insulin resistance independent of age, people with a family history of Alzheimer’s disease, people with that are ApoE4 carriers and the Presenilin-1 mutation.

 This developing glucose hypometabolism is helping with the deterioration of synapses and deterioration and brain function which is associated with cognitive decline and which is going to push down the glucose metabolism further and is going to create a vicious cycle of brain energy exhaustion and progression of the disease.

What about brain ketone uptake in people at risk or with Alzheimer’s disease?

Blog Apr. 26 - 3 glucose and ketone uptake.png

In the brain scan the capacity of the brain to use glucose is higher in the areas where the red and orange colors are shown on the brain and as you go towards Alzheimer (AD) you can see there’s a virtual disappearance of the red, orange and the green is more predominant.  The capacity of the brain to use glucose decreases in Alzheimer’s disease through CTL (normal healthy brain), to MCI (mild capacity impairment) to AD (Alzheimer’s Disease).

If we look at the ketone up taken in exactly the same individuals the capacity is lower than it is for glucose under the normal circumstances but it if anything actually increases as you get towards Alzheimer’s disease.  There is no loss of the capacity to transport ketones into the brain.

Blog Apr. 26 -4 Keto on brain scans.pngIt is encouraging to see that we could use the normal brain ketone uptake capacity to in fact bypass the glucose deficitand potentially have an impact on cognitive function.

Dr. Cunnane discussed treatment with MCT (medium chain triglyceride). Please see the original Youtube post for his findings.

Is there capacity to use ketones normal in mild cognitive impairment? The answer is yes. There is improved episodic memory, processing speed and language.

You can achieve a metabolic rescue of the brain and that the rescue is going to have a functional effect that is going to correlate with the level of ketones achieved both in the blood and in the brain.

People with mild cognitive impairment are going need 45 grams of MCT a day to improve to be between the healthy elderly and the healthy young.  We might be able to get right up to this 100% value with a ketone ester or some other supplement.

Exercise helps get glucose into the brain.It also helps get ketones into the brain without a ketogenic supplement. Being in ketosis and exercising can improve glucose and ketone up take to better than a healthy adult.

People who are on a ketogenic diet are helping to preventtheir glucose deficit in the brain. Prevention is hard to achieve with a MCT supplement but much easier to achieve with a ketogenic diet.

The Ketogenic diet is potentially a cognitive benefit in those that that are not facing aging associated cognitive decline.

Blog Apr. 26 -5 Summary.png

In Summary,in the brain scan, the losses of the red and orange color shown by the arrows, are definitely a consequence of the disease but they’re also contributing to the disease. The losses represented by the arrows are present before the disease starts and it’s a glucose specific problem. Brain energy rescue by ketones is definitely feasible in mild cognitive impairment and in Alzheimer’s disease.  We want to let the brain have the luxury of thriving in a fuel environment (ketones) that you were born into.

Dr. Stephen Cunnane obtained his PhD in Physiology from McGill University and completed post-doctoral research on nutrition and brain development. He has researched fatty acids and their effect on brain development as well as the effect of ketones and ketogenic diets on brain development. Stephen Cunnane has published over 280 peer-reviewed research papers.

This Post has been condensed from this October 2018 video Dr. Stephen Cunnane – Brain Glucose and Ketone Metabolism in Alzheimer’s Disease https://www.youtube.com/watch?v=OU26epaihmw

For more information on Alzheimer’s please go https://www.ncbi.nlm.nih.gov/pubmed

Then go to Full Text Articles and search by “CanKetonesHelpRescueBrainFuelSupplyin LaterLife? Implicationsfor CognitiveHealthduring Agingand the Treatmentof Alzheimer’s Disease.

I invite you to Follow my Blog, Facebook or be added to my email distribution list. My focus is to maximize my physical performance and mental clarity, body composition, and most importantly overall health with a wholesome diet and exercise.

I will bring you compelling articles on Ketogenic and GAPS diets, the Super Slow High-Intensity Exercise Program and supplements.

To follow my Blog, please click the Follow button to receive an email when the next posting is available. Hint: You may have to click the Accept and Close button before follow is available.

I thrive on feedback. Please let me know you are interested in the content by clicking Like, Commenting or sending me a message or email about the Post.

If you wish to contact me by Email, please email lpolstra@bell.net using this form.

May you Live Long Healthy.

Yours truly,

Lydia Polstra

416-428-5285

Email: lpolstra@bell.net

Facebook: https://www.facebook.com/2healthyhabits/

Blog: https://2healthyhabits.wordpress.com

Disclaimer: The content of this email or Post is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations is at the choice and risk of the reader.

Top 5 Nutritional Ketosis Mistakes—And How to Fix Them

Having trouble getting your ketones up, dealing with side effects, figuring out your protein intake, and/or finding the right fats?

Nutritional ketosis is a powerful metabolic state in which your body primarily burns fat and ketones rather than glucose for fuel, which occurs when dietary carbohydrate intake is reduced (not eliminated) to below your personal threshold of carbohydrate tolerance. Once ketosis is achieved and maintained, the metabolic benefits are bountiful: safe and effective weight loss, reduced hunger and cravings, decreased inflammation, lower and more stable blood sugar (thus, reversal of Type 2 diabetes), and beyond.

The length of time it takes a person to adapt to nutritional ketosis varies as each person has a unique biochemistry and varying degrees of metabolic damage needing repair. If weeks or even months have passed and you are still struggling, you may be falling prey to one of these common mistakes that can interfere with nutritional ketosis.

The following is condensed from the Virta post Top 5 Nutritional Ketosis Mistakes—And How to Fix Them

Anna Barnwell, MPH, MSW, April 25, 2018https://blog.virtahealth.com/top-keto-mistakes/

Be sure to watch the embedded videos.

Mistake #1: Too much protein, not enough fat

A well-formulated ketogenic diet is moderate, NOT HIGH, in protein. Protein has a moderate insulin-stimulating effect, and it can interfere with ketone production by the liver when consumed in excess.Most healthy individuals require between 1.5 and 1.75 grams of protein per kg of ‘reference body weight’ to maintain lean body mass and function during a ketogenic diet. Intakes above 2.0 g/kg reference weight show no additional benefit. Here’s where you can find your protein needs on a ketogenic diet.

How much protein? Dr. Phinney helps you figure that out in this Post.

https://2healthyhabits.wordpress.com/2018/11/09/how-much-protein-do-you-need-in-nutritional-ketosis/

Calories from FAT should make up the majority of your dietary intake in order to feel adequately satisfied. Adding fats like olive oil, butter, cream, coconut, or canola oils to meals without being accompanied by extra protein is critical to achieve both satiety and nutritional ketosis.

Blog -1 Fat ratio to protein, fat.png

Mistake #2: Choosing the wrong kinds of fat

When it comes to consuming dietary fat, it’s not only about quantity, but quality, too.

Fat is essential and two of its primary functions in humans are: 1) as a fuel source, particularly when “keto-adapted,” and 2) to build and maintain vital membranes for all the cells in the body.

On a ketogenic diet, monounsaturated and saturated fats should provide the majority of your dietary fat intake to supply the body with energy, as the body prefers to use these types of fats for fuel.

Monounsaturated fats are found in oils such as olive, avocado, and canola, as well as in some animal fats such as lard. Saturated fats are naturally concentrated in most animal fats such as dairy fat, beef (suet), and lamb, as well as “tropical oils” (e.g., coconut and palm oil). Dietary saturated fats are readily burned off to be used for fuel (i.e., they won’t accumulate in your blood) when a person is keto-adapted.

Polyunsaturated fats are not well-tolerated in large amounts. Therefore, vegetable oils should be limited and avoided. Common sources include soybean, corn, sunflower, safflower, cottonseed, and peanut oils.

The two sub-classes of polyunsaturated fats, omega-6 and omega-3, are essential to consume in small amounts for the purposes of membrane health, as our bodies cannot naturally make them. To consume the recommended amount of omega-3 fatty acid, eat 3 servings of cold-water ocean fish per week or take at least 1 gram of fish oil daily (or flaxseed oil if you are vegetarian or vegan). Consuming excess omega-6 fats, however, will lead to stomach and intestinal upset and possibly increase inflammation.

(Lydia buys fish from Vital Choice which are Certified Purity,the wild fish and shellfish are free of hazardous levels of contaminants; see in the revealing mercury chart here https://www.vitalchoice.com/content/purity-story)

Finally, avoid artificial trans fats all together, such as commercial shortening and margarine, as they are strongly linked to coronary artery disease.

The “right” Fats & Oils chart.

Blog - Fats chart.png

Learn more about health fats at https://2healthyhabits.wordpress.com/2019/02/01/the-sad-saga-of-saturated-fat/

Mistake #3: Not enough salt

Current US dietary guidelines recommend 2300 mg of sodium per day. However, recent research published in mainstream journals like the New England Journal of Medicine highlights that consuming 2300 mg or less of sodium daily actually increases mortality in the general healthy adult population; in fact, for optimal health, most of us need anywhere between 4000-5000 mg of sodium per day – and that’s for people consuming standard diets containing appreciable amounts of carbohydrate.

On a ketogenic diet, consuming adequate sodium becomes all the more critical, as the rate of sodium excretion by the kidneys into the urine increases quite significantly while in nutritional ketosis.This means that most people on a ketogenic diet need to consume closer to 5000 mg (i.e., 5 grams) of sodium (which equals 12 grams or 2.5 teaspoons of salt) per day in order to maintain an adequate balance.

Starting in just the first few days of adapting to nutritional ketosis, neglecting to consume 5 grams of sodium can put your circulatory system into disarray and trigger the notorious “keto flu” symptoms: headaches, dizziness, lightheadedness, fatigue and constipation.And here’s an important point:this daily need for 5 grams of sodium continues as long as one remains in nutritional ketosis; it’s not just a temporary need during keto-adaptation.

Fortunately, you can keep these symptoms at bay and improve your overall well-being and function by simply salting your food moderately and consuming 2 servings of broth or bouillon daily. For most people, this results in about 3 grams of sodium from regular food plus 2 grams from broth, totalling 5 grams per day.  Keep in mind that salt and sodium are not the same meaning, 1 teaspoon of salt is the equivalent of 5 grams of salt but contains only 2.3 grams of sodium (the rest is chloride). 

Note: please consult a medical professional if you have high blood pressure or fluid retention due to congestive heart failure or kidney problems to determine the right dietary sodium intake for you.

Mistake #4: Stagnant “macro ratios”

There are three major macronutrients (or “macros”) that supply humans with energy (calories) from foods: carbohydrate, fat, and protein. On a well-formulated ketogenic diet, your daily energy needs should be satisfied by approximately 5-10% carbs, 70-80% fat, and 15-20% protein.

When you initially begin a ketogenic diet and are losing weight, 70-80% of energy will come from burning your own body fat stores from adipose tissue – NOT entirely from dietary sources. As you approach “weight maintenance” the fat needed to supply your daily energy will have to come from your food because you no longer have as much excess fat to lose! The chart below shows food macronutrient intakes plus body fat contributions as one progresses from through the stages of weight loss to eventual weight stability. It is for a 5’6” women going from 180 to 140 lbs.

Blog -4 .png

You will continue consuming approximately the same, moderate amount of protein in addition to non-starchy vegetables.

You will need to eat more of the “right” types of fats as you approach and then achieve weight maintenance. Please watch the video.

Blog - 5.png

Dr. Phinney explains macros in his video: What should my macros be on a Ketogenic diet? https://www.youtube.com/watch?v=NXtRLYntifc

To track grams of carbs, proteins and fat Lydia uses the free version of Carb Manager https://www.carbmanager.com/

Learn more at https://2healthyhabits.wordpress.com/2020/09/11/carb-manager-is-the-most-comprehensive-and-easiest-to-use-net-and-total-carb-counter-2/

Mistake #5: “Needing” to fast

Fasting is being promoted as potent tool for rapid weight loss, enhancing ketone levels and increasing life span. But, much of the research supporting these benefits has been done in mice. Well-done human research on the long-term safety and efficacy of fasting raises important concerns, particularly if one chooses to fast longer than one day. Fasting for more than 2 days can lead to lean tissue loss and even a permanent reduction in reduction resting metabolism (Fothergill, 2016 is cited in the Virta post), among other significant health concerns.

Going in and out of the fasting state while on diabetes or high blood pressure medications can lead to dangerous swings in blood glucose or blood pressure, and this is risky if done without close, expert medical supervision.

In contrast, achieving and maintaining a stable state of nutritional ketosis with real food while avoiding majorly wide swings in your daily caloric intake and medication needs will be safer, more sustainable, and more enjoyable.

I invite you to Follow my Blog, Facebook or be added to my email distribution list. My focus is to maximize my physical performance and mental clarity, body composition, and most importantly overall health with a wholesome diet and exercise.

I will bring you compelling articles on Ketogenic and GAPS diets, the Super Slow High-Intensity Exercise Program and supplements.

To follow my Blog, please click the Follow button to receive an email when the next posting is available. Hint: You may have to click the Accept and Close button before follow is available.

I thrive on feedback. Please let me know you are interested in the content by clicking Like, Commenting or sending me a message or email about the Post.

If you wish to contact me by Email, please email lpolstra@bell.net using this form.

May you Live Long Healthy.

Yours truly,

Lydia Polstra

416-428-5285

Email: lpolstra@bell.net

Facebook: https://www.facebook.com/2healthyhabits/

Blog: https://2healthyhabits.wordpress.com

Disclaimer: The content of this email or Post is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations is at the choice and risk of the reader.

Does Your Thyroid Need Dietary Carbohydrates?

Blog - April 12 thyroid.png

Thyroid hormones have an important role in regulating metabolic rate. When some people adopt a low-carbohydrate lifestyle, their thyroid hormone levels may change. Several factors may contribute to the thyroid response.

Firstly,eating fewer calories than you expend, causing weight loss, prompts the body to reduce thyroid function to slow its metabolism. That’s because the body interprets any form of energy restriction from any cause as a sign of famine, leading it to reduce metabolism by 5-15% to conserve energy stores.

Secondly,even when energy is not restricted, a ketogenic diet seems to result in improved thyroid hormone sensitivity (i.e., it takes less hormone to produce the same effect), and puts less of a burden on thyroid hormone (T4) production in the thyroid gland and its conversion to T3 in the liver.

It has been repeatedly demonstrated that a well-formulated ketogenic diet (WFKD) improves insulin sensitivity, often dramatically so in people with insulin resistance or type 2 diabetes. There is also strong evidence that the brain’s sensitivity to the satiety hormone leptin is improved during nutritional ketosis as well. Thus an improved thyroid hormone response during a low-carb, high-fat eating diet would be quite consistent with these other documented improvements in hormone sensitivity.

How many published studies from well designed, prospective human trials have shown that impaired thyroid function (i.e., hypothyroidism) occurs on a ketogenic diet? The answer to this question is quick and simple – NONE!

It is common to find recommendations on the internet for daily carb intakes at or above 100 grams per day to maintain “normal thyroid function.” But here’s the key question: are these higher thyroid hormone levels really normal, or is this a relatively hyperthyroid state (compared to nutritional ketosis) driven by excess dietary carbohydrates?What if the lower T3 levels associated with a WFKD are indicative of optimum T3 sensitivity and thus the true physiologic norm for humans?

The other proposed “cure” for this “problem” is to intermittently eat lots of carbs. What sense does it make to be jerking the body back to deal with the disposal of high carbohydrate loads? Given that blood beta-hydroxybutyrate levels characteristic of nutritional ketosis reduce oxidative stress and inflammation, why would you want to shut down this beneficial effect even part of the time?

If carbohydrate-restricted diets were having a negative effect on thyroid function, it would be predicted that a disproportionate number of people would develop clinically obvious cases of thyroid failure (hypothyroidism) while following a ketogenic diet.Let’s look and see how many new cases of low-carb-induced hypothyroidism were reported in a number of large randomized studies published in the last decade.  Please see the CHARTBlog - April  chart.png

While these studies were not purposefully designed to look for thyroid dysfunction, overt hypothyroidism is hard to miss. These studies were all run by (or involved monitoring by) top-notch physicians, so a new case of hypothyroidism would definitely have been reported as a “serious adverse event” associated with the LCHF diet. And yet, out of 350 closely monitored patients, there were none!

Studies:Along with his early mentors and collaborators, Dr. Phinney was involved in three studies of ketogenic diets in which they measured one or more parameters of thyroid hormone response. The first study involved six subjects on a very low-calorie ketogenic diet (VLCKD) for six weeks, the second evaluated nine men given a weight-maintenance ketogenic diet for 4 weeks, and the third studied 12 adults given a VLCKD with or without exercise training for 4-5 weeks.

In addition, in 2005 Yancy et al. published a study (Nutr & Metab) of 28 diabetics given a LCHF diet for four months, during which their mean TSH values did not change significantly (1.6 to 1.4 uU/L).

So let’s query these data from three perspectives:

1) failure of the thyroid to make enough T4,

2) failure of the liver to turn enough T4 into T3, and

3) markedly improved T3 sensitivity.

Starting with the latest data from Yancy et al. first, if either the thyroid gland or the liver were failing to maintain adequate thyroid hormone effect, TSH should increase. It does not, but this was only measured in one study. Second, if the liver is failing to make enough T3, then TSH and T4 values should rise. In both our 1980 and 1988 reports, T4 went down slightly. And third, in all three studies blood T3 levels went down sharply (from a mean of 151 to 92) but clinical signs and symptoms were not indicative of overt hypothyroidism.

Case in point: Dr. Volek ran some thyroid tests on 14 overweight/obese men whose other results were reported in a 2004 study. Eight of these men consumed a reduced energy ketogenic diet for six weeks and then switched to a low-fat diet for another six weeks. Six other men consumed the low-fat diet first and then switched to a ketogenic diet. Average free T3 concentrations in the 14 individuals were significantly lower after the ketogenic plan than the low-fat diet (3.5 vs 4.2 pmol/L). Regardless of diet order, free T3 concentrations were lower during the ketogenic diet in 13 out of 14 men (see figure). However, despite the lower free T3 levels, the measured resting metabolic rates of these subjects were not different between diets.

And finally, although it was a relatively short 11-day study, Bisschop et al. fed six men weight-maintaining diets containing 85%, 44%, and 2% of energy as carbohydrates. Although TSH and REE did not decline, serum T3 values plummeted, these results again show a disconnect between circulating T3 and REE in the context of a ketogenic diet.

The only viable interpretation of these data is that ketogenic diets markedly increase tissue sensitivity to T3, and thus serum T3 levels decline while the physiological response to T3 remains normal. In this scenario, both the thyroid and the liver have to do far less “work” to maintain a normal thyroid physiologic response. Taking this one step further, why would anyone want to force their thyroid or liver to greater levels of thyroid hormone production by eating lots more carbohydrates? Forcing the pancreas to make more insulin by eating more carbs clearly doesn’t do a lot of good for type 2 diabetics, and we think the same logic applies here for thyroid function.

It’s understandable why some people may be concerned or misled by the changes in thyroid hormones that occur when one adopts a low-carb high-fat lifestyle. Don’t be pressured into eating more carbs than you really need on the mistaken assumption that they are required to maintain normal function of your thyroid gland.

SOURCE: Does Your Thyroid Need Dietary Carbohydrates?by Stephen Phinney, MD, PhD on May 3, 2017

https://blog.virtahealth.com/does-your-thyroid-need-dietary-carbohydrates/

To learn more about Hypothyroidism please read:

  1. Metabolic Syndrome X and Hypothyroidismhttps://2healthyhabits.wordpress.com/2018/03/09/metabolic-syndrome-x-and-hypothyroidism/
  1. The Ketogenic Diet for Healthhttp://www.ketotic.org/2014/12/the-effect-of-ketogenic-diets-on.html

Conclusion: There is no evidence that we are aware of indicating that ketogenic diets cause hypothyroid, or negatively impact thyroid function. The fact that T₃is lower in ketogenic dieters is probably part of the mechanism that protects lean mass when fat is being lost. Moreover, low T₃may possibly even be an indicator of a life extending effect, an effect we have suggested elsewhere when examining the cortisol profile of ketogenic dieters.

I invite you to Follow my Blog, Facebook or be added to my email distribution list. My focus is to maximize my physical performance and mental clarity, body composition, and most importantly overall health with a wholesome diet and exercise.

I will bring you compelling articles on Ketogenic and GAPS diets, the Super Slow High-Intensity Exercise Program and supplements.

To follow my Blog, please click the Follow button to receive an email when the next posting is available. Hint: You may have to click the Accept and Close button before follow is available.

I thrive on feedback. Please let me know you are interested in the content by clicking Like, Commenting or sending me a message or email about the Post.

If you wish to contact me by Email, please email lpolstra@bell.net using this form.

May you Live Long Healthy.

Yours truly,

Lydia Polstra

416-428-5285

Email: lpolstra@bell.net

Facebook: https://www.facebook.com/2healthyhabits/

Blog: https://2healthyhabits.wordpress.com

Disclaimer: The content of this email or Post is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations is at the choice and risk of the reader.

Why We Don’t Need Carbohydrates

Myth 1:  The human brain burns 600 kcal per day glucose to meet its energy needs.

Myth 2:  No one can follow a ketogenic diet long term.

Blog - Apr. 5 delete-1.png

The need for dietary carbohydrates is often a topic of misunderstanding and misinformation. Although some specific tissues in the body do have certain glucose requirements, these requirements are easily met by gluconeogenic sources within the body without the need for dietary carbohydrate intake. The fatigue, stress, impaired cognition and reduced performance that are often used to argue for the need for carbohydrate are more aptly attributable to improper implementation of a well-formulated ketogenic diet (WFKD), inadequate electrolyte replacement, and/or insufficient time for keto-adaptation. When used correctly, a ketogenic diet can be a safe and sustainable therapeutic tool as well as a means to help promote wellness and performance.

The specific topic that we want to address here is how both the brain and body can function as well – or even better – on a diet with little or no dietary carbohydrate compared to the typically promoted low fat, high carbohydrate ‘healthy diet.’

Published science has shown that ketones that are produced from either dietary fats or triglycerides stored in our adipose (fat) tissue reserves are an excellent fuel for the brain. Further, we now know that these ketones produced by the liver also have multiple beneficial effects on the heart, kidneys, and other organs that appear to translate into improved longevity.

Additionally, new research has highlighted that skeletal muscles, even those of competitive athletes, are not solely dependent on high dietary carbohydrate intake for glycogen replenishment and performance.

Ketones are a cleaner-burning fuel (i.e., producing fewer free-radicals) than glucose when used by the brain and other organs. The primary ketone beta-hydroxybutyrate (BOHB) can also function as a signal to activate genes that regulate our defenses against oxidative stress and inflammation.

The shifting they body’s energy source from carbohydrates to fats, which we have named ‘keto-adaptation,’ starts within days but takes a considerable period of time to fully develop. The result is maintenance of normal blood glucose and muscle glycogen levels that can be sustained without the need for dietary carbohydrate intake.

Physiologic Role of Carbohydrates

The presumed requirement for glucose by the brain is a conditional need that is based on the fuel sources dictated by one’s choice of diet. A ketone-suppressing diet (i.e., any diet supplying >30% of energy from the combined intakes of carbohydrate and protein) essentially forces the brain to rely on glucose for fuel.

It is true that some cells within the body do require glucose. But in all of these cases where glucose is broken down to lactate, the body can recycle that lactate back to glucose.

Evidence That the Brain Can Function on Ketones

The simplest experiment that demonstrates the brain’s ability to function on ketones is the observation that humans can tolerate total fasting with normal mental function for durations of 30-60 days. Elegantly done studies that measured glucose and ketone levels in arterial blood going into the brain compared to these fuels in the jugular vein coming out of the brain, indicated that ketones are in fact able to supply the great majority of the brain’s energy.

See the original Virta post for the studies.

What these studies demonstrated is clear evidence of normal brain function in the virtual absence of glucose when sufficient ketones are available. This offers us the unique perspective that when consuming a carbohydrate-rich diet the predominate source of fuel for the brain is glucose; not because it is needed but because the other natural and highly effective brain energy source has been shut off.Butunder conditions of consistent nutritional ketosis, the brain adapts to the presence of ketones by enhancing their uptake and oxidation, thus protecting cognitive and CNS (central nervous system) function.

Essentials of Keto-Adaptation – Glucose Conservation and Salvage

Just because one doesn’t consume dietary carbohydrate does not mean the body is completely lacking in glucose. Whether fasting or on a meat-and-fat-only ketogenic diet, blood glucose values remain in the normal range both at rest and during exercise. This occurs because the body is quite capable of synthesizing all of the glucose it needs from various gluconeogenic precursors, while at the same time strictly limiting its rate of carbohydrate oxidation.

There are at least five sources of these glucose precursors:

  1. breakdown of muscle to supply amino acids for gluconeogenesis;
  2. breakdown of dietary protein to supply amino acids for gluconeogenesis,
  3. glycerol released from the hydrolysis of adipose tissue triglyceride or dietary triglyceride;
  4. recycling lactate and pyruvate from glycolysis; and
  5. acetone produced by the spontaneous breakdown of acetoacetate to acetone that can be used for gluconeogenesis.

The conditions for and the amounts provided by these various sources of gluconeogenesis are shown in the following table.

BLOG - APR. 5  - TABLE – SOURCES OF GLUCOSE.png

What this table clearly demonstrates is that whether during a total fast or a ketogenic diet without carbohydrate containing foods, new or recycled gluconeogenic substrates provide for the generation of anywhere from 100-200 g/d of glucose. Add to this up to 50 g/d of dietary carbohydrate as part of a WFKD, and it becomes clear why nutritional ketosis is well tolerated under a variety of challenging conditions.

Lessons from Low Carbohydrate Athletes

Dr. Volek’s group recruited 20 competitive ultra-runners, 10 of whom followed a traditional high carbohydrate diet and the other 10 had been following a ketogenic diet for at least 6 months.

After baseline testing, these runners were asked to do a 3-hour run at race-pace on a treadmill. Surprisingly, both groups had similar muscle glycogen levels before the run, and they also both mobilized similar amounts (about 80%) of their glycogen during 3 hours on the treadmill.

But almost 90% of ketogenic runner’s net energy use was from fat. This is an astonishing example of being able to maintain normal muscle glycogen while consuming very little carbohydrate.

Please refer to the original Virta post for 2 more in depth studies.

Why Some Experts Still Claim that We Need Dietary Carbohydrates

There are some other arguments used to support the idea that we need to consume carbohydrates above levels that facilitate nutritional ketosis.

Thyroid dysfunction:The blood level of the active thyroid hormone T3 typically falls by 30-40% in the first few weeks of a WFKD, but this is not accompanied by any signs or symptoms of clinical hypothyroidism. This change is due to a marked reduction in thyroid hormone resistance during nutritional ketosis, which can be eased with adequate electrolytes intake. Therefore, this is a healthy response and not a sign of endocrine dysfunction.

Sleep patterns are disturbed by a ketogenic diet. In our study we found that global sleep quality, sleep disturbances, and daytime dysfunction parameters all were significantly improved. In addition, the proportion of patients reporting poor sleep was significantly reduced after 1 year.

We need more dietary fiber than is possible on a ketogenic diet.What we point out in our blog post on fiber is that the production of BOHB can provide many-fold more SCFAs to the brain than a very high fiber diet combined with an optimized microbiome. Thus, the moderate level of fiber that one can achieve with a real-food WFKD should be more than adequate to maintain health.

To learn more, please see my Blog Post, Fiber and Colon Health On A Well-Formulated Ketogenic Diet https://2healthyhabits.wordpress.com/2019/03/08/fiber-and-colon-health-on-a-well-formulated-ketogenic-diet-new-insights-question-its-role-as-an-unconditional-requirement/

This Post has been condensed from the original Virta Post: Why Humans Don’t Need Dietary Carbohydrates to Thrive By Stephen Phinney, MD, PhD, Brooke Bailey, Ph.D Jeff Volek, PhD, RD https://blog.virtahealth.com/why-dont-need-dietary-carbohydrates/?fbclid=IwAR0gDnfRCWEimOQgsK8sCEY7-Rh5R6E5TyyISAOd3VbSj71OsKOEekmTTO0

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Lydia Polstra

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Disclaimer: The content of this email or Post is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations is at the choice and risk of the reader.