Dominic D’Agostino, PhD

Health Benefits of the Ketogenic Diet

Date Aired: May 25, 2018

Nutritional Ketosis

  • Is a therapeutic state marked by the elevation of blood ketone levels
  • Achieved by diet high in fat relative to
  • Low protein 8 – 12 % protein
    • Standard American Diet has 28 % to 40 % protein
  • Is restricted in carbohydrates and sugar
  • Mimics fasting state which research shows is good for the health
  • When ketones get to level of 0. 5 milli molar is known as ketosis
  • Different from diabetes ketoacidosis from lack of insulin in diabetes type
  • Classic ketogenic diet is used in pediatric epilepsy

Making Ketone bodies

  • Elevated fat oxidation (burning) in the liver creates ketones
  • Fats are metabolized so fast are creating excess of acetyl co A
  • 2 acetyl co A molecules can create acetyl acetate which can make beta hydroxyl butyrate
  • Liver lacks an enzyme succinyl-co A transferase that prevents liver from using the ketones so ketones go into blood stream
  • Brain consumes ketones and glucose
  • Ketones have benefits for brain
  • Too much protein increases insulin and kicks a person out of ketosis
    • Proteins include ketogenic amino acids as well as glucogenic amino acids
    • Glucogenic amino acids
      • activate liver to pump out glucose through gluconeogenesis
      • release insulin can decrease fat oxidation in liver and the body

How to get into Ketosis

  • In past induction was done by fasting for 24 hours
    • Studies show that fasting is good for the health
  • Intermittent fasting or time restricted eating
  • Or eat meals that have meals
    • 70 – 80 % fat
    • 10- 20 % protein
    • less than 10 % carbohydrates in form of fibrous vegetables
  • salads, leafy vegetables, avocados, nuts, nut butter have high fiber and low glucose
    • the fiber delays gastric absorption and prevents a release of insulin

Going back into ketosis

  • Carbohydrates kick us out of ketosis
  • Going in and out of ketosis is ideal
  • He can go back into ketosis by intermittent fasting (not eating until 2 PM
    • This does not work after eating a lot of carbs due to stored carbs

Short cuts back into ketosis

  • Bulletproof diet
  • Medium Chain Triglyceride Oils (particularly C 8 caprylic triglyceride)
    • Can be put into coffee, salad dressing, and foods
    • These are transported quickly into hepatic portal circulation system right to the liver
      • The liver can burn this fat quickly which produces ketones
      • These increase ketones by .1
    • Long chain fats are packaged into cylo microns and transported into lymphatic systems
  • Exogenous ketone products
    • Help people transitioning from high carbs because brain can be going through glucose withdrawal giving head aches and brain fog

Gender Differences in ketosis

  • Research used males
  • Transitioning into ketosis is more difficult for females
  • Anecdotally females have a more varied response especially with initiation
  • Females have reactive response to hypoglycemia which might occur at start resulting in
    • Dizziness
    • Orthostatic hypotension
    • Liberally use salt
    • When they calorie restrict at the same time , this lowers active T 3

Chocolate Lindt

  • One or two small pieces at least 80 % does not kick him out of ketosis

Atkins diet

  • Is high in protein
  • Can be ketogenic if calorie restricted
  • Does not have clearly defined guidelines

Modified ketogenic diet

  • used for adult seizure patients
  • Can increase protein to 20 %
  • Increases compliances
  • Can achieve nutritional ketosis
  • Can elevate protein to 20 %
  • This amount of protein is less than Standard American Diet (28 % protein)
  • Some fats can increase ketone levels

Health Benefits of Ketosis

  • Weight loss and decrease diabetes
  • Suppresses insulin, mTOR and IGF-1
  • Non alcoholic fatty liver disease (has high rates – due to toxins?)
  • Helps glucose transporter deficiency
  • Epilepsy
  • Acne
  • Polycystic Ovary disease (PCOS)
  • Extends longevity in animals (Journal cell Metabolism)
  • Cancer
    • Is associated with elevated glucose consumption and Warburg effect
    • Is associated with fermentation – is pumping out a lot of lactate due to damaged mitochondria and a dysregulation of the energy systems that are fundamental to the cell
    • Ketogenic diet targets cancer metabolism by
      • reducing glucose availability to cancer
      • cancer cells make ample glutathione by the pentose phosphate pathway which is associated with replenishing glutathione
        • limiting glucose impairs this pathway
      • Elevates ketones
        • Most cancer cells are deficient in enzymes to metabolize ketones
      • Decreases IGF 1 and insulin which are drivers for cancer growth once tumour starts
      • Suppresses mTOR pathway
      • Takes the foot off the gas peddle
    • Hyperbaric oxygen therapy (HBOT) enhances oxidative stress in cancer cells
      • 2- 2.5 atmospheres of oxygen three times per week for one hour
      • Tumour cells are used to low oxygen. When the tumour sees hyperbaric oxygen, they over produce superoxide anion and hydroxyl radical which drive the fentanyl reaction
      • radiation works by increasing oxidative stress but has a lot of collateral damage
      • This with ketogenic diet which cripples cancer cells anti oxidation capacity
    • Metformin decreases chances of getting pancreatic cancer
      • Mimics pathways of fasting, gene transcription
    • Stress increases risk for cancer because immune system is dealing with stress rather than other cells
    • Neuro degenerative Diseases
      • Stabilized disease even after brain atrophy
      • Increased motor function
      • Use ketone ester earlier delayed accumulation of tau plaques
      • Can use before disease starts, and can control symptoms of process
      • Angelmans disease defect of house cleaning gene
        • Ketogenic diet cured this especially cured the seizures
        • Enhanced the cognitive functions
      • Anti Inflammatory Benefits
        • Suppresses NLRP inflammasome
          • which elevates inflammatory cytokines associated with chronic illnesses
          • autoimmune illnesses are associated with this inflammasome
        • His c reactive protein went down significantly
      • Autoimmune Disease
        • Partially by healing gut
        • Ketogenic diet eliminates foods that challenge the immune system
        • Ketogenic diet enhances tumour associated immunity
        • Ketogenic diet makes immune system more vigilent.
          • Coaches immune system to recognized cells that have transferred to pre cancer cells and destroy them

Intermittent ketosis

  • significantly delayed cognitive related illness, suppressed tumours
  • One week on ketosis, one week off ketosis

Loss of Cognitive Function

  • Cognitive capacity decreases with age
    • Due to neuro-metabolic effect ?
    • Bredesen believes 1/3- 1/2 of Alzheimer’s etiology is linked to a neuro metabolic impairment
    • Alzheimer’s Disease is classified by accumulation of beta amyloid plaques
    • D’Agostino believes nuero-inflammation is trigger for accumulation of these toxic plaques
    • He also believes that breaking down these plaques is an energy intensive process which decreases when brain energy process is impaired
      • low energy and low blood flow impairs removing these plaques
  • ketogenic diet can protect us
  • HIV and herpes viruses shedding causes inflammation
  • When shingles outbreaks some people find that a fast helps these lesions to go away.

Measuring Ketosis 

  • Blood levels 

Downside of ketosis

  • Crp, homocsyteine can go down
  • Increase hormone binding
  • Kidney stones especially if not hydrated.
    • Went down when supplemented with calcium citrate
    • Use potassium and magnesium
    • Constipation or diarrhea
  • Can increase LDL cholesterol
    • Increases the larger more boyant, less damaging LDL
    • The small LDL don’t elevate as smuch
    • A;; the other biomarkers are going in the right direction.
  • Transports triglycerides and phospholipid particles
    • Needed to transport
    • Body and cell walls contain cholesterol