What are Ketones
Ketones are organic compounds that contain a carbonyl group bonded to two other carbon atoms. They are commonly found in nature and have various uses in both biological systems and industrial applications.
In the context of human metabolism, ketones are produced when the body breaks down fat for energy in the absence of sufficient carbohydrates. This typically occurs during periods of fasting, low carbohydrate intake (such as ketogenic diets), prolonged exercise, or in individuals with certain metabolic conditions like diabetes. When the body is in a state of ketosis, ketones serve as an alternative energy source to glucose for tissues like the brain, heart, and muscles.
The three main types of ketones produced in the human body are acetoacetate, beta-hydroxybutyrate, and acetone. Acetoacetate and beta-hydroxybutyrate are transported in the bloodstream and used as energy by various tissues, while acetone is exhaled through the lungs or excreted in urine.
In industrial chemistry, ketones have diverse applications, including use as solvents, intermediates in chemical synthesis, and as precursors for various chemical reactions.
Overall, ketones play important roles both in human physiology and in various chemical processes.
β-Hydroxybutyrate as an epigenetic modifier: Underlying mechanisms and implications.
"As shown in Fig. 2, studies have shown that BHB plays an important role as an epigenetic regulatory molecule in the pathogenesis and treatment of cardiovascular diseases, complications of diabetes, neuropsychiatric diseases, cancer, osteoporosis, liver and kidney injury, embryonic and fetal development and intestinal homeostasis. Next, we will explain the molecular mechanisms separately".
Review article:
β-Hydroxybutyrate as an epigenetic modifier: Underlying mechanisms and implications https://www.sciencedirect.com/science/article/pii/S2405844023083068
ketogenic / Low-Carb diet
Ketogenic diet.
A ketogenic diet, often referred to as a keto diet, is a low-carbohydrate, high-fat diet that has been shown to help the body enter a metabolic state called ketosis. In ketosis, the body becomes more efficient at burning fat for energy because it lacks a ready supply of carbohydrates. The primary goal of a ketogenic diet is to induce and maintain this state of ketosis.
Here are the key principles of a ketogenic diet:
- Low Carbohydrate Intake: The diet restricts the consumption of carbohydrates, typically to around 20-50 grams per day. This is a significant reduction compared to the carbohydrate intake in a standard diet.
- Moderate Protein Intake: Protein intake is moderate but not excessive. Consuming too much protein can potentially interfere with ketosis, as the body may convert excess protein into glucose through a process called gluconeogenesis.
- High Fat Intake: The majority of daily calories come from fats. Healthy fats such as avocados, olive oil, nuts, seeds, and fatty fish are staples in a ketogenic diet.
- Ketosis:The reduction in carbohydrate intake leads the body to produce ketones from fats, which become the primary source of energy for the body and brain. Ketosis is a metabolic state where ketones circulate in the bloodstream.
- Whole Foods: While some processed foods may fit into the macronutrient profile of a ketogenic diet, the emphasis is often on whole, nutrient-dense foods to ensure a balanced intake of vitamins and minerals.
People adopt ketogenic diets for various reasons, including weight loss, improved blood sugar control, and increased mental clarity. It's important to note that while a ketogenic diet can be effective for some individuals, it may not be suitable for everyone. Individuals with certain medical conditions or those taking specific medications should consult with healthcare professionals before making significant changes to their diet.
Low-Carb Diet.
Low carb diets are usually considered to be those less than 130g in carbohydrates per day.
Low-carb (incl. Keto) more successful than Low fat.
Comparing Low-Carb diets of < 130g carbohydrate per day to Low-Fat diets of less than.
From Public Health Collaboration UK:
" Why are randomised controlled trials important?
Currently, a lot of nutrition science is based on observational data through epidemiology, which presents association but not causation. Randomised controlled trials (RCTs) are the gold standard in evidence because they help establish cause and effect. When looking at nutrition science it’s important to acknowledge whether a study is based on association or causation."
Of 71 RCT’s, 2 were equal, 7 showed more low-fat weight loss but none showed significantly more, 62 showed more weight loss on a low-carb diet of which 39 showed significantly more weight loss.
The 72 individual trials can be accessed here - Courtesy of Public Health Collaboration.
Systematic Reviews and Meta analyses Comparing Low-Carb Diets to Low-Fat Diets.
Meta-Analyses Comparing Low-Carb Diets Of Less Than 130g Carbohydrate Per Day To Low-Fat Diets Of Less Than 35% Fat Of Total Calories https://phcuk.org/evidence/rcts/
1. Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. M. Hession et al. August
2008. https://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2008.00518.x
2. Effects of low carbohydrate diets on weight and glycemic control among type 2 diabetes individuals: a systemic review of RCT greater than 12 weeks. L.M. Castañeda-González et al. Nov-Dec 2011. https://pubmed.ncbi.nlm.nih.gov/22411372/
3. Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. F. L. Santos, et al. August 2012.
https://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2012.01021.x
4. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta- analysis of randomised controlled trials. N. B. Bueno et al. October 2013.
https://doi.org/10.1017/S0007114513000548
5. Dietary Intervention for Overweight and Obese Adults: Comparison of Low-Carbohydrate and Low-Fat Diets. A Meta-Analysis. J. Sackner-Bernstein et al. October 2015.
https://doi.org/10.1371/journal.pone.0139817
6. Effect of low-fat diet interventions versus other diet interventions on long-term weight change in adults: a systematic review and meta-analysis. D. K. Tobias et al. October 2015.
https://doi.org/10.1016/S2213-8587(15)00367-8
7. Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials. N. Mansoor et al. December 2015.
https://doi.org/10.1017/S0007114515004699
8. Effects of low carbohydrate diets in individuals with type 2 diabetes: systematic review and meta-analysis. Y. Fan et al. June 2016.
http://www.ijcem.com/files/ijcem0023504.pdf
9. Efficacy of low carbohydrate diet for type 2 diabetes mellitus management: A systematic review and meta-analysis of randomized controlled trials. Y. Meng et al. July 2017.
http://dx.doi.org/10.1016/j.diabres.2017.07.006
10. The interpretation and effect of a low-carbohydrate diet in the management of type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials.
R. Huntriss et al. Dec 2017. https://doi.org/10.1038/s41430-017-0019-4
11. Effects of low-carbohydrate- compared with low-fat-diet interventions on metabolic control in people with type 2 diabetes: a systematic review including GRADE assessments. E.J. Van Zuuren et al. July 2018. https://doi.org/10.1093/ajcn/nqy096
12. Effects of carbohydrate-restricted diets on low-density lipoprotein cholesterol levels in overweight and obese adults: a systematic review and meta-analysis.
T. Gjuladin-Hellon et al. December 2018. https://doi.org/10.1093/nutrit/nuy049
13. Impact of a Ketogenic Diet on Metabolic Parameters in Patients with Obesity or Overweight and with or without Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. Y. J. Choi et al. July 2020. https://doi.org/10.3390/nu12072005
14. The Effect of Low-Fat and Low-Carbohydrate Diets on Weight Loss and Lipid Levels: A Systematic Review and Meta-Analysis. S. Chawla et al. December 2020.
https://doi.org/10.3390/nu12123774
15. Effect of a very low-carbohydrate ketogenic diet vs recommended diets in patients with type 2 diabetes: a meta-analysis. M. Rafiullah et al. March 2022.
https://doi.org/10.1093/nutrit/nuab040
16. Dose-dependent effect of carbohydrate restriction for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized controlled trials.
A. Jayedi et al. July 2022. https://doi.org/10.1093/ajcn/nqac066
17. Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors in overweight and obese adults: A meta-analysis of randomized controlled trials.
L. Lei et al. August 2022. https://doi.org/10.3389/fnut.2022.935234
18. Effect of carbohydrate restriction on body weight in overweight and obese adults: a systematic review and dose–response meta-analysis of 110 randomized controlled trials.
A. Jayedi et al. December 2023. https://doi.org/10.3389/fnut.2023.1287987
Courtesy Public Health Collaboration https://phcuk.org/evidence/rcts/
supportive statements for Low carb diet.
Supportive Statements from Established Associations - Collated by the Public Health Collaboration.
A variety of eating patterns (combinations of different foods or food groups) are acceptable for the management of diabetes.
Until the evidence surrounding comparative benefits of different eating patterns in specific individuals strengthens, health care providers should focus on the key factors that are common among the patterns:
- Emphasize non starchy vegetables.
- Minimize added sugars and refined grains.
- Choose whole foods over highly processed foods to the extent possible.
Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the
most evidence for improving glycemia and may be applied in a variety of eating patterns
that meet individual needs and preferences.
"For select adults with type 2 diabetes not meeting glycemic targets or where reducing antiglycemic medications is a priority, reducing overall carbohydrate intake with low, or very low-carbohydrate eating plans is a viable approach.”
Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report.
American Diabetes Association. May 2019. https://doi.org/10.2337/dci19-0014
“The current evidence suggest that low-carb diets can be safe and effective for people with Type 2 diabetes. They can help with weight loss and glucose management, and reduce the risk of cardiovascular disease. So, we can recommend a low-carb diet for some people with Type 2 diabetes. But there is no consistent evidence that a low-carb diet is any more effective than other approaches in the long term, so it shouldn't be seen as the diet for everyone.”
Low-carb diets for people with diabetes. Diabetes UK. May 2017. https://www.diabetes.org.uk/professionals/position-statements-reports/food-nutritionlifestyle/low-carb-diets-for-people-with-diabetes
"Healthy* low- or very-low-CHO diets can be considered as one healthy eating pattern form individuals living with type 1 and type 2 diabetes for weight loss, improved glycemic control and/or to reduce the need for antihyperglycemic therapies."
Diabetes Canada Position Statement on Low-Carbohydrate Diets for Adults With Diabetes: A Rapid Review. April 2020. https://doi.org/10.1016/j.jcjd.2020.04.001
"Total dietary replacements (TDR) and low carbohydrate diets have been demonstrated as being effective in facilitating weight loss and remission of T2DM”; and "low carbohydrate diets, if appropriately supported, are considered safe and should not be avoided in suitable individuals who find these approaches acceptable. Clinicians should therefore aim to support their use within clinical practice as part of person-centred diabetes care."
Dietary strategies for remission of type 2 diabetes: A narrative review. Joint position paper from British Dietetic Association, Diabetes UK, Public Health Collaboration, XPERT Health. February 2022. https://doi.org/10.1111/jhn.12938
"For adults living with T2D and overweight or obesity, a lower carbohydrate diet can be
recommended by clinicians as an effective short-term option (up to 6 months) for
improving glycaemic control and serum TAG concentrations."
Lower carbohydrate diets for adults with type 2 diabetes
Diabetes UK. March 2022. https://doi.org/10.1111/dme.14674
40 keto myths debunked by clinical trials - Dr James McCarter.
Dr McCarter directed the Virta clinical trial proving diabetes reversal at scale resulting in changes to the American Diabetes Association 2019 standards of care and creating a paradigm shift in T2D treatment.
What is a Ketogenic Diet?
The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used to treat difficult-to-control (refractory) epilepsy in children.
The diet forces the body to burn fats rather than carbohydrates.
Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain function.
However, if there is very little carbohydrate in the diet, the liver converts fat into fatty acids and ketone bodies.
The ketone bodies pass into the brain and replace glucose as an energy source.
Some of us need to be "in ketosis” to help repair metabolic health, for others simply going “low carb” is enough.
T2 Reversal - Personal responses.
