1
|
Vargas-Molina S, García-Sillero M, Bonilla DA, Petro JL, García-Romero J, Benítez-Porres J. The effect of the ketogenic diet on resistance training load management: a repeated-measures clinical trial in trained participants. J Int Soc Sports Nutr 2024; 21:2306308. [PMID: 38285913 PMCID: PMC10826788 DOI: 10.1080/15502783.2024.2306308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/11/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The effect of low-carbohydrate high-fat dietary manipulation, such as the ketogenic diet (KD), on muscle strength assessment in resistance-training (RT) participants has focused on the one-repetition maximum test (1-RM). However, a pre-specified 1-RM value during an exercise training program disregards several confounding factors (i.e. sleep, diet, and training-induced fatigue) that affect the exerciser's "true" load and daily preparedness. We aimed to evaluate the effect of a 6-week RT program on load control-related variables in trained subjects following a KD intervention. METHODS Fourteen resistance-trained individuals (3F, 11 M; 30.1 [6.2] years; 174.2 [7.6] cm; 75.7 [10.8] kg; BMI 24.8 [2.1] kg·m-2) completed this single-arm repeated-measures clinical trial. Load management variables included volume load, number of repetitions, perceived exertion (RPE), movement velocity loss, and exertion index. These primary outcomes were assessed weekly before, during, and at the end of a 6-week RT program that included traditional RT exercises (bench press, femoral lying down, lat pulldown, leg extension, and back squat). RESULTS There was a significant difference in RPE between weeks (p = 0.015, W = 0.19) with a slight trend in decreasing RPE. We found differences in the volume load per week (p < 0.001; W = 0.73 and p < 0.001, W = 0.81, respectively), with an increase in the last weeks. In the control of the load based on movement velocity, we did not find significant differences between weeks (p = 0.591, W = 0.06), although significant differences were found in the effort index (p = 0.026, W = 0.17). CONCLUSIONS A KD diet in recreational strength participants does not appear to lead to performance losses during a RT program aimed at improving body composition. However, the lack of adherence and familiarity with the ketogenic diet must be considered specially during first weeks.
Collapse
Affiliation(s)
- Salvador Vargas-Molina
- University of Málaga, Physical education and sport area, Faculty of Medicine, Málaga, Spain
- Physical education and sport, EADE-University of Wales Trinity Saint David, Málaga, Spain
| | - Manuel García-Sillero
- Physical education and sport, EADE-University of Wales Trinity Saint David, Málaga, Spain
| | - Diego A. Bonilla
- Dynamical Business & Science Society – DBSS International SAS, Research Division, Bogotá, Colombia
- Universidad de Córdoba, Research Group in Physical Activity, Sports and Health Sciences (GICAFS), Montería, Colombia
| | - Jorge L. Petro
- Dynamical Business & Science Society – DBSS International SAS, Research Division, Bogotá, Colombia
- Universidad de Córdoba, Research Group in Physical Activity, Sports and Health Sciences (GICAFS), Montería, Colombia
| | - Jerónimo García-Romero
- University of Málaga, Physical education and sport area, Faculty of Medicine, Málaga, Spain
| | - Javier Benítez-Porres
- University of Málaga, Physical education and sport area, Faculty of Medicine, Málaga, Spain
| |
Collapse
|
2
|
Panda PK, Sharawat IK. Pediatric refractory epilepsy: Exploring the ketogenic diet's influence on seizure recurrence. Epileptic Disord 2024; 26:269-270. [PMID: 38319018 DOI: 10.1002/epd2.20200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
3
|
Li S, Yuan S, Lin G, Zhang J. Effects of a two meals-a-day ketogenic diet on newly diagnosed obese patients with type 2 diabetes mellitus: A retrospective observational study. Medicine (Baltimore) 2023; 102:e35753. [PMID: 37904380 PMCID: PMC10615408 DOI: 10.1097/md.0000000000035753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/02/2023] [Indexed: 11/01/2023] Open
Abstract
To investigate the effects of a two-meals-a-day energy-restricted ketogenic diet (KD) on newly diagnosed obese patients with type 2 diabetes mellitus. In total, 60 obese patients with newly diagnosed type 2 diabetes mellitus were divided into 2 groups: 1 group followed a 2-meals-a-day KD and the other group followed a conventional diabetic diet. Changes in weight, blood glucose, blood lipids, insulin resistance, and uric acid levels were observed before and after 2 months of adhering to the respective diets under energy restriction. Both groups showed significant reductions in weight, waist circumference, body mass index, total cholesterol, triglycerides, high-density lipoproteins, low-density lipoproteins, fasting blood glucose, fasting insulin, and glycated hemoglobin (P < .05). The twice-daily KD group showed more significant improvements in these parameters compared to the conventional diabetic diet group. In addition, the 2-meals-a-day KD group showed a slight increase in uric acid levels compared to the conventional diabetic diet control group (P < .05). The 2-meals-a-day KD can significantly improve weight, blood glucose, and lipid control in newly diagnosed obese patients with type 2 diabetes mellitus.
Collapse
Affiliation(s)
- Sumei Li
- Department of Endocrinology, The First Hospital of Putian City, Teaching Hospital, Fujian Medical University, Putian, People’s Republic of China
| | - Shouping Yuan
- Department of Endocrinology, The First Hospital of Putian City, Teaching Hospital, Fujian Medical University, Putian, People’s Republic of China
| | - Guoxin Lin
- Department of Endocrinology, The First Hospital of Putian City, Teaching Hospital, Fujian Medical University, Putian, People’s Republic of China
| | - Jintian Zhang
- Department of Pathology, Putian University, Fujian, People’s Republic of China
| |
Collapse
|
4
|
Bubeck AM, Urbain P, Horn C, Jung AS, Ferrari L, Ruple HK, Podlesny D, Zorn S, Laupsa-Borge J, Jensen C, Lindseth I, Lied GA, Dierkes J, Mellgren G, Bertz H, Matysik S, Krautbauer S, Liebisch G, Schoett HF, Dankel SN, Fricke WF. High-fat diet impact on intestinal cholesterol conversion by the microbiota and serum cholesterol levels. iScience 2023; 26:107697. [PMID: 37694136 PMCID: PMC10485154 DOI: 10.1016/j.isci.2023.107697] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/02/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023] Open
Abstract
Cholesterol-to-coprostanol conversion by the intestinal microbiota has been suggested to reduce intestinal and serum cholesterol availability, but the relationship between intestinal cholesterol conversion and the gut microbiota, dietary habits, and serum lipids has not been characterized in detail. We measured conserved proportions of cholesterol high and low-converter types in individuals with and without obesity from two distinct, independent low-carbohydrate high-fat (LCHF) dietary intervention studies. Across both cohorts, cholesterol conversion increased in previous low-converters after LCHF diet and was positively correlated with the fecal relative abundance of Eubacterium coprostanoligenes. Lean cholesterol high-converters had increased serum triacylglycerides and decreased HDL-C levels before LCHF diet and responded to the intervention with increased LDL-C, independently of fat, cholesterol, and saturated fatty acid intake. Our findings identify the cholesterol high-converter type as a microbiome marker, which in metabolically healthy lean individuals is associated with increased LDL-C in response to LCHF.
Collapse
Affiliation(s)
- Alena M. Bubeck
- Department of Microbiome Research and Applied Bioinformatics, Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
| | - Paul Urbain
- Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cathrine Horn
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anna S. Jung
- Department of Microbiome Research and Applied Bioinformatics, Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
| | - Lisa Ferrari
- Department of Microbiome Research and Applied Bioinformatics, Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
| | - Hannah K. Ruple
- Department of Microbiome Research and Applied Bioinformatics, Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
| | - Daniel Podlesny
- Department of Microbiome Research and Applied Bioinformatics, Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
| | - Stefanie Zorn
- Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johnny Laupsa-Borge
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Caroline Jensen
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Gülen Arslan Lied
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jutta Dierkes
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Gunnar Mellgren
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hartmut Bertz
- Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Silke Matysik
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Sabrina Krautbauer
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Gerhard Liebisch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Hans-Frieder Schoett
- Singapore Lipidomics Incubator (SLING), Life Sciences Institute, National University of Singapore, Singapore, Singapore
| | - Simon N. Dankel
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - W. Florian Fricke
- Department of Microbiome Research and Applied Bioinformatics, Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
5
|
Luo W, Zhang J, Xu D, Zhou Y, Qu Z, Yang Q, Lv Q. Low carbohydrate ketogenic diets reduce cardiovascular risk factor levels in obese or overweight patients with T2DM: A meta-analysis of randomized controlled trials. Front Nutr 2022; 9:1092031. [PMID: 36583214 PMCID: PMC9792675 DOI: 10.3389/fnut.2022.1092031] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
Background The purpose of this meta-analysis was to explore the effects of low-carbohydrate ketogenic diets on cardiovascular risk factors in overweight or obese patients. However, there are limited literature data about effects of low-carbohydrate ketogenic diets on cardiovascular risk factors in obese or overweight patients. Methods We systematically searched PubMed, EMBASE, Web of Science, OVID, and Cochrane Library databases (last updated in September 2022) for randomized controlled trials (RCTs) which recruited overweight or obesity patients on ketogenic diets in order to control cardiovascular risk factors (blood glucose, weight, and lipids). The overall effect size for continuous variables was expressed as a weighted standardized mean difference (SMD) with a confidence interval of 95%. Considering type 2 diabetes mellitus (T2DM) status at baseline, subgroup analyses were performed when appropriate, based on T2DM comorbidity among patients. The effect model was selected according to heterogeneity. Results We finally selected 21 studies. Low carbohydrate ketogenic diets exerted a greater impact on cardiovascular risk factors in obese/ overweight patients with T2DM when compared with those on non-ketogenic diets, with lower fasting plasma glucose (FPG) (SMD, -0.75; P < 0.001) and hemoglobin A1c (HbA1c) (SMD, -0.53; P < 0.001) levels identified. Low-carbohydrate ketogenic diets significantly reduced body mass index (BMI) (SMD, -2.27; P = 0.032), weight (SMD, -6.72; P < 0.001), and waist circumference (SMD, -4.45; P = 0.003) in obese/ overweight patients with T2DM. Also, ketogenic diets improved lipid profiles in these patients; triglyceride (TG) (SMD, -0.32; P = 0.013) levels were lowered and high density lipoprotein (HDL) showed an upward trend with the P-value close to statistically significant level (SMD, -0.32; P = 0.052). In general, irrespective of diabetic status at baseline, ketogenic diets were more effective in reducing TG (SMD, -0.2; P = 0.02) and increasing HDL (SMD, 0.11; P = 0.03) levels when compared with non-ketogenic diets. Conclusions Low-carbohydrate ketogenic diets effectively improved cardiovascular risk factors (blood glucose, weight, and lipids) in obese/ overweight patients, especially those with T2DM when compared with non-ketogenic diets.
Collapse
|
6
|
Amanollahi A, Khazdouz M, Malekahmadi M, Klement RJ, Lee D, Khodabakhshi A. Effect of Ketogenic Diets on Cardio-Metabolic Outcomes in Cancer Patients: A Systematic Review and Meta-Analysis of Controlled Clinical Trials. Nutr Cancer 2022; 75:95-111. [PMID: 36110060 DOI: 10.1080/01635581.2022.2117388] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In this systematic review and meta-analysis of clinical controlled trials (CCTs) we aimed to investigate the efficacy of KDs as an adjuvant therapy on cardiometabolic outcomes in patient with cancer compared to conventional non-ketogenic diets. Only CCTs involving cancer patients that were assigned to either a KD or a standard diet control group were selected. Two reviewers independently extracted the data, and a meta-analysis was performed using a random effects model to estimate weighted mean differences (WMDs) and confidence intervals (CIs) in body composition, metabolite, lipid profile, liver and kidney function parameters and quality of life. This meta-analysis showed a significant reduction in body weight (WMD= -2.99 kg; 95% CI: -4.67, -1.31; and P < 0.001), BMI (WMD= -1.08 kg/m2; 95% CI: -1.81, -0.34; P ≤ 0.002) and fat mass (WMD= -1.48 kg; 95% CI: -2.56, -0.40; and P = 0.007) by a KD. KDs significantly decreased glucose (WMD= -5.22 mg/dl; 95% CI: -9.0, -1.44; and P = 0.007), IGF-1 (WMD= -17.52 ng/ml; 95% CI: -20.24, -14.8; and P ˂0.001) and triglyceride (WMD= -24.46 mg/dl; 95% CI: -43.96, -4.95; and P = 0.014) levels. Furthermore, KDs induced ketosis by increasing β-hydroxybutyrate (WMD= 0.56 mmol/l; 95% CI: 0.37, 0.75; and P < 0.001). There were non-significant pooled effects of KDs on improving insulin, C-reactive protein and cholesterol levels and kidney and liver function. Emotional functioning was even increased significantly in the KD compared to the SD groups. In summary we found that KDs result in a greater reduction in glucose, IGF-1, triglycerides, body weight, BMI, and fat mass in cancer patients compared to traditional non-ketogenic diets and improved emotional functioning. The quality of evidence in the meta-analysis was moderate according to the Nutrigrade assessment.
Collapse
Affiliation(s)
- Alireza Amanollahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Khazdouz
- Growth and Development Research Center, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Malekahmadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Department of Clinical Nutrition, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Rainer J Klement
- Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - Derek Lee
- Biology Department, Boston College, Chestnut Hill, MA, USA
| | - Adeleh Khodabakhshi
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran.,Department of Nutrition, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
7
|
Teng L, Lee VW, Murugesu S, Lee J, Ibrahim NS, Ishak MF, Mohamed AR, Khoo T. The Glycemic Biomarkers in Children with Drug‐Resistant Epilepsy on Various Types of Ketogenic Diet Therapies: A Cross‐sectional study. Epilepsia 2022; 63:2011-2023. [DOI: 10.1111/epi.17292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Lip‐Yuen Teng
- Paediatric Neurology Unit Department of Paediatrics Hospital Tunku Azizah Kuala Lumpur Malaysia
| | - Vanessa Wan‐Mun Lee
- Paediatric Neurology Unit Department of Paediatrics Hospital Tunku Azizah Kuala Lumpur Malaysia
| | - Sumitha Murugesu
- Paediatric Neurology Unit Department of Paediatrics Hospital Tunku Azizah Kuala Lumpur Malaysia
| | - Jun‐Xiong Lee
- Paediatric Neurology Unit Department of Paediatrics Hospital Tunku Azizah Kuala Lumpur Malaysia
| | - Nur Sakinah Ibrahim
- Department of Dietetics and Food Services Hospital Tunku Azizah Kuala Lumpur Malaysia
| | - Mohd Fatahudin Ishak
- Department of Dietetics and Food Services Hospital Tunku Azizah Kuala Lumpur Malaysia
| | | | - Teik‐Beng Khoo
- Paediatric Neurology Unit Department of Paediatrics Hospital Tunku Azizah Kuala Lumpur Malaysia
| |
Collapse
|
8
|
Nakamura K, Hagihara K, Nagai N, Egashira R, Takeuchi M, Nakano M, Saito H, Moriguchi M, Tonari S, Watanabe S, Miyake A, Ashida K. Ketogenic Effects of Multiple Doses of a Medium Chain Triglycerides Enriched Ketogenic Formula in Healthy Men under the Ketogenic Diet: A Randomized, Double-Blinded, Placebo-Controlled Study. Nutrients 2022; 14:nu14061199. [PMID: 35334856 PMCID: PMC8955388 DOI: 10.3390/nu14061199] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 02/04/2023] Open
Abstract
Ketogenic diets, which are carbohydrate-restricted high-fat diets, may have therapeutic effects on various diseases, including cancer. However, ketogenic diets are often not standardized and, therefore, results are difficult to interpret. We previously investigated the usefulness of ketogenic diets in cancer therapy, where ketogenic formulas (KF) were used as supplements to enhance blood ketone bodies; however, the amount of KF was determined empirically with reference to blood ketone bodies levels. Here, to determine a standardized optimal amount of KF, we investigated temporal changes in blood ketone bodies (acetoacetic acid (AcAc), β-hydroxybutyrate (BHB)) and safety in 20 healthy individuals when KF was taken repeatedly under the conditions of a ketogenic diet (UMIN000034216). The diurnal variation in total ketone bodies, and AcAc and BHB levels significantly increased after lunch and after dinner, on the 4th day of KF administration. There were no significant safety issues related to KF in the context of anthropometric, metabolic, nutritional, urological and gastrointestinal parameters. In addition, ketogenic diets lead to changes in gut microbiota. KF showed a decrease in phylum Firmicutes. Our study provides baseline data of the usefulness of KF in a ketogenic diet.
Collapse
Affiliation(s)
- Kentaro Nakamura
- Research Team 3, Co-Creation Center, Meiji Holdings Co., Ltd., Tokyo 192-0919, Japan; (K.N.); (K.A.)
| | - Keisuke Hagihara
- Department of Advanced Hybrid Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (R.E.); (M.T.); (M.N.); (H.S.); (M.M.); (S.T.)
- Correspondence: ; Tel.: +81-06-6210-8349; Fax: +81-06-6210-8348
| | - Naoko Nagai
- Division of Nutritional Management, Osaka University Hospital, Osaka 565-0871, Japan;
| | - Ryuichiro Egashira
- Department of Advanced Hybrid Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (R.E.); (M.T.); (M.N.); (H.S.); (M.M.); (S.T.)
| | - Mariko Takeuchi
- Department of Advanced Hybrid Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (R.E.); (M.T.); (M.N.); (H.S.); (M.M.); (S.T.)
| | - Mai Nakano
- Department of Advanced Hybrid Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (R.E.); (M.T.); (M.N.); (H.S.); (M.M.); (S.T.)
| | - Hitomi Saito
- Department of Advanced Hybrid Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (R.E.); (M.T.); (M.N.); (H.S.); (M.M.); (S.T.)
| | - Misaki Moriguchi
- Department of Advanced Hybrid Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (R.E.); (M.T.); (M.N.); (H.S.); (M.M.); (S.T.)
| | - Satoko Tonari
- Department of Advanced Hybrid Medicine, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan; (R.E.); (M.T.); (M.N.); (H.S.); (M.M.); (S.T.)
| | | | - Akimitsu Miyake
- Department of Medical Innovation, Osaka University Hospital, Osaka 565-0871, Japan;
| | - Kinya Ashida
- Research Team 3, Co-Creation Center, Meiji Holdings Co., Ltd., Tokyo 192-0919, Japan; (K.N.); (K.A.)
| |
Collapse
|
9
|
Li S, Lin G, Chen J, Chen Z, Xu F, Zhu F, Zhang J, Yuan S. The effect of periodic ketogenic diet on newly diagnosed overweight or obese patients with type 2 diabetes. BMC Endocr Disord 2022; 22:34. [PMID: 35115003 PMCID: PMC8811985 DOI: 10.1186/s12902-022-00947-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ketogenic diet (KD) is characterized by fat as a substitute of carbohydrates for the primary energy source. There is a large number of overweight or obese people with type 2 diabetes mellitus (T2DM), while this study aims to observe periodic ketogenic diet for effect on overweight or obese patients newly diagnosed as T2DM. METHODS A total of 60 overweight or obese patients newly diagnosed as T2DM were randomized into two groups: KD group, which was given ketogenic diet, and control group, which was given routine diet for diabetes, 30 cases in each group. Both dietary patterns lasted 12 weeks, and during the period, the blood glucose, blood lipid, body weight, insulin, and uric acid before and after intervention, as well as the significance for relevant changes, were observed. RESULTS For both groups, the weight, BMI(body mass index), Waist, TG (triglyceride), TC(cholesterol), LDL (low-density lipoprotein cholesterol), HDL (high-density lipoprotein cholesterol), FBG (fasting glucose), FINS (fasting insulin), HbA1c (glycosylated hemoglobin) were decreased after intervention (P < 0.05), while the decrease rates in the KD group was more significant than the control group. However, UA(serum uric acid) in the KD group showed an upward trend, while in the control group was not changed significantly (P > 0.05).The willingness to adhere to the ketogenic diet over the long term was weaker than to the routine diet for diabetes. CONCLUSION Among the overweight or obese patients newly diagnosed as type 2 diabetes mellitus, periodic ketogenic diet can not only control the body weight, but also control blood glucose and lipid, but long-term persistence is difficult.
Collapse
Affiliation(s)
- Sumei Li
- Department o f Endocrinology, Teaching Hospital, The First Hospital of Putian, Fujian Medical University, Putian, Fujian Province, People's Republic of China.
| | - Guoxin Lin
- Department o f Endocrinology, Teaching Hospital, The First Hospital of Putian, Fujian Medical University, Putian, Fujian Province, People's Republic of China
| | - Jinxing Chen
- Department o f Endocrinology, Teaching Hospital, The First Hospital of Putian, Fujian Medical University, Putian, Fujian Province, People's Republic of China
| | - Zhenxin Chen
- Department o f Endocrinology, Teaching Hospital, The First Hospital of Putian, Fujian Medical University, Putian, Fujian Province, People's Republic of China
| | - Feipeng Xu
- Department o f Endocrinology, Teaching Hospital, The First Hospital of Putian, Fujian Medical University, Putian, Fujian Province, People's Republic of China
| | - Feng Zhu
- Department o f Endocrinology, Teaching Hospital, The First Hospital of Putian, Fujian Medical University, Putian, Fujian Province, People's Republic of China
| | - Jintian Zhang
- Department of Pathology, Putian University, Medical University, Fujian, China
| | - Shouping Yuan
- Department o f Endocrinology, Teaching Hospital, The First Hospital of Putian, Fujian Medical University, Putian, Fujian Province, People's Republic of China
| |
Collapse
|
10
|
Selvaraj S, Seidelmann SB, Soni M, Bhattaru A, Margulies KB, Shah SH, Dugyala S, Qian C, Pryma DA, Arany Z, Kelly DP, Chirinos JA, Bravo PE. OUP accepted manuscript. Eur Heart J Cardiovasc Imaging 2022; 23:1690-1697. [PMID: 35366303 PMCID: PMC9671293 DOI: 10.1093/ehjci/jeac031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/02/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS The ketogenic diet (KD) is standard-of-care to achieve myocardial glucose suppression (MGS) for assessing inflammation using fluorine-18 fluorodeoxyglucose-positron emission tomography (FDG-PET). As KD protocols remain highly variable between centres (including estimation of nutrient intake by dietary logs for adequacy of dietary preparation), we aimed to assess the predictive utility of nutrient intake in achieving MGS. METHODS AND RESULTS Nineteen healthy participants underwent short-term KD, with FDG-PET performed after 1 and 3 days of KD (goal carbohydrate intake <20 g/day). Nutrient consumption was estimated from dietary logs using nutrition research software. The area under receiver operating characteristics (AUROC) of macronutrients (carbohydrate, fat, and protein intake) for predicting MGS was analysed. The association between 133 nutrients and 4 biomarkers [beta-hydroxybutyrate (BHB), non-esterified fatty acids, insulin, and glucagon] with myocardial glucose uptake was assessed using mixed effects regression with false discovery rate (FDR) correction. Median (25th-75th percentile) age was 29 (25-34) years, 47% were women, and 42% were non-white. Median (25th-75th percentile) carbohydrate intake (g) was 18.7 (13.1-30.7), 16.9 (10.4-28.7), and 21.1 (16.6-29.0) on Days 1-3. No macronutrient intake (carbohydrate, fat, or protein) predicted MGS (c-statistic 0.45, 0.53, 0.47, respectively). Of 133 nutrients and 4 biomarkers, only BHB was associated with myocardial glucose uptake after FDR correction (corrected P-value 0.003). CONCLUSIONS During highly supervised, short-term KD, approximately half of patients meet strict carbohydrate goals. Yet, in healthy volunteers, dietary review does not provide reassurance for adequacy of myocardial preparation since no clear thresholds for carbohydrate or fat intake reliably predict MGS.
Collapse
Affiliation(s)
- Senthil Selvaraj
- Division of Cardiology, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- Cardiovascular Institute, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sara B Seidelmann
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Meshal Soni
- Division of Cardiology, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Abhijit Bhattaru
- Division of Cardiology, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- Division of Nuclear Medicine, Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kenneth B Margulies
- Division of Cardiology, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- Cardiovascular Institute, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Svati H Shah
- Division of Cardiology, Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Supritha Dugyala
- Division of Nuclear Medicine, Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Chenao Qian
- Division of Cardiology, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel A Pryma
- Division of Nuclear Medicine, Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Zolt Arany
- Division of Cardiology, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- Cardiovascular Institute, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel P Kelly
- Cardiovascular Institute, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Julio A Chirinos
- Division of Cardiology, Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Paco E Bravo
- Corresponding author. Tel: +1 215 220 9494. E-mail:
| |
Collapse
|
11
|
Kumar NK, Merrill JD, Carlson S, German J, Yancy WS. Adherence to Low-Carbohydrate Diets in Patients with Diabetes: A Narrative Review. Diabetes Metab Syndr Obes 2022; 15:477-498. [PMID: 35210797 PMCID: PMC8863186 DOI: 10.2147/dmso.s292742] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/12/2022] [Indexed: 12/13/2022] Open
Abstract
Evidence suggests that low carbohydrate (<130 g/day of carbohydrate) (LCD) and very low carbohydrate, ketogenic diets (typically <50 g/day of carbohydrate) (VLCKD) can be effective tools for managing diabetes given their beneficial effects on weight loss and glycemic control. VLCKD also result in favorable lipid profile changes. However, these beneficial effects can be limited by poor dietary adherence. Cultural, religious, and economic barriers pose unique challenges to achieving nutritional compliance with LCD and VLCKD. We review the various methods for assessing adherence in clinical studies and obstacles posed, as well as potential solutions to these challenges.
Collapse
Affiliation(s)
- Nitya Kalyani Kumar
- Division of Endocrinology, Diabetes, & Metabolism, Duke University, Durham, NC, USA
- Correspondence: Nitya Kalyani Kumar, 30 Duke Medicine Circle Clinic 1A, Durham, NC, 27710, USA, Email
| | - Jennifer D Merrill
- Division of Endocrinology, Diabetes, & Metabolism, Ohio State University, Columbus, OH, USA
| | - Scott Carlson
- Division of Endocrinology, Diabetes, & Metabolism, Duke University, Durham, NC, USA
| | - Jashalynn German
- Division of Endocrinology, Diabetes, & Metabolism, Duke University, Durham, NC, USA
| | - William S Yancy
- Duke Lifestyle and Weight Management Center and Division of General Medicine, Duke University, Durham, NC, USA
| |
Collapse
|
12
|
Woelber JP, Tennert C, Ernst SF, Vach K, Ratka-Krüger P, Bertz H, Urbain P. Effects of a Non-Energy-Restricted Ketogenic Diet on Clinical Oral Parameters. An Exploratory Pilot Trial. Nutrients 2021; 13:nu13124229. [PMID: 34959780 PMCID: PMC8703871 DOI: 10.3390/nu13124229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 01/01/2023] Open
Abstract
Ketogenic diets (KDs) may be a helpful complement in the prevention of and therapy for several diseases. Apart from their non-cariogenic properties, it is still unclear how KDs affect oral parameters. The aim of this study was to investigate the influence of a KD on clinical periodontal parameters. Twenty generally healthy volunteers with an average age of 36.6 years underwent a KD for 6 weeks. Their compliance was monitored by measuring their urinary ketones daily and by keeping 7-day food records. Clinical oral parameters included plaque (PI), gingival inflammation (GI), a complete periodontal status (probing depths, bleeding on probing), and general physical and serologic parameters at baseline and after 6 weeks. The results showed a trend towards lower plaque values, but with no significant changes from baseline to the end of the study with regard to the clinical periodontal parameters. However, their body weight and BMI measurements showed a significant decrease. The regression analyses showed that the fat mass and the BMI were significantly positively correlated to periodontal inflammation, while HDL, fiber, and protein intake were negatively correlated to periodontal inflammation. The KD change did not lead to clinical changes in periodontal parameters in healthy participants under continued oral hygiene, but it did lead to a significant weight loss.
Collapse
Affiliation(s)
- Johan Peter Woelber
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; si.- (S.F.E.); (P.R.-K.)
- Correspondence:
| | - Christian Tennert
- Department of Restorative, Preventive and Pediatric Dentistry, University of Berne, Freiburgstrasse 7, 3010 Bern, Switzerland;
| | - Simon Fabian Ernst
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; si.- (S.F.E.); (P.R.-K.)
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Zinkmattenstr. 6A, 79108 Freiburg, Germany;
| | - Petra Ratka-Krüger
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; si.- (S.F.E.); (P.R.-K.)
| | - Hartmut Bertz
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (H.B.); (P.U.)
| | - Paul Urbain
- Department of Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (H.B.); (P.U.)
| |
Collapse
|
13
|
Dietary-Induced Ketogenesis: Adults Are Not Children. Nutrients 2021; 13:nu13093093. [PMID: 34578970 PMCID: PMC8467931 DOI: 10.3390/nu13093093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 01/01/2023] Open
Abstract
There is increasing interest in the use of a ketogenic diet for various adult disorders; however, the ability of adults to generate ketones is unknown. Our goal was to challenge the hypothesis that there would be no difference between adults and children regarding their ability to enter ketosis. Methods: Two populations were studied, both treated with identical very low-carbohydrate high-fat diets: a retrospective series of children with epilepsy or/and metabolic disorders (2009–2016) and a prospective clinical trial of adults with glioblastoma. Dietary intake was assessed based upon written food diaries and 24-h dietary recall. Ketogenic ratio was calculated according to [grams of fat consumed]/[grams of carbohydrate and protein consumed]. Ketone levels (β-hydroxybutyrate) were measured in blood and/or urine. Results: A total of 168 encounters amongst 28 individuals were analyzed. Amongst both children and adults, ketone levels correlated with nutritional ketogenic ratio; however, the absolute ketone levels in adults were approximately one quarter of those seen in children. This difference was highly significant in a multivariate linear regression model, p < 0.0001. Conclusions: For diets with comparable ketogenic ratios, adults have lower blood ketone levels than children; consequently, high levels of nutritional ketosis are unobtainable in adults.
Collapse
|
14
|
Carbohydrate Restriction with or without Exercise Training Improves Blood Pressure and Insulin Sensitivity in Overweight Women. Healthcare (Basel) 2021; 9:healthcare9060637. [PMID: 34072093 PMCID: PMC8229341 DOI: 10.3390/healthcare9060637] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 12/11/2022] Open
Abstract
Objective: The purpose of this study was to evaluate the effects of a 4-week low-carbohydrate diet (LC) with or without exercise training on cardiometabolic health-related profiles in overweight/obese women. Methods: Fifty overweight/obese Chinese women (age: 22.2 ± 3.3 years, body mass index (BMI): 25.1 ± 3.1 kg·m−2) were randomized to either a LC control group (LC-CON, n = 16), a LC and high-intensity interval training group (LC-HIIT, n = 17), or a LC and moderate-intensity continuous training group (LC-MICT, n = 17). All groups consumed LC for 4 weeks, while the LC-HIIT and LC-MICT groups followed an additional five sessions of HIIT (10 × 6 s cycling sprints and 9 s rest intervals, 2.5 min in total) or MICT (cycling continuously at 50–60% of peak oxygen uptake (VO2peak) for 30 min) weekly. Blood pressure, fasting glucose, insulin sensitivity, and several metabolic or appetite regulating hormones were measured before and after intervention. Results: Significant reductions in body weight (− ~2.5 kg, p < 0.001, η2 = 0.772) and BMI (− ~1 unit, p < 0.001, η2 = 0.782) were found in all groups. Systolic blood pressure was reduced by 5–6 mmHg (p < 0.001, η2 = 0.370); fasting insulin, leptin, and ghrelin levels were also significantly decreased (p < 0.05), while insulin sensitivity was improved. However, there were no significant changes in fasting glucose, glucagon, and gastric inhibitory peptide levels. Furthermore, no group differences were found among the three groups, suggesting that extra training (i.e., LC-HIIT and LC-MICT) failed to trigger additional effects on these cardiometabolic profiles. Conclusions: The short-term carbohydrate restriction diet caused significant weight loss and improved blood pressure and insulin sensitivity in the overweight/obese women, although the combination with exercise training had no additional benefits on the examined cardiometabolic profiles. Moreover, the long-term safety and effectiveness of LC needs further study.
Collapse
|
15
|
Effects of a low-carbohydrate ketogenic diet on health parameters in resistance-trained women. Eur J Appl Physiol 2021; 121:2349-2359. [PMID: 34003364 DOI: 10.1007/s00421-021-04707-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of a ketogenic diet on blood pressure, visceral adipose tissue (VAT), bone mineral content (BMC), and bone mineral density (BMD) in trained women. METHODS Twenty-one resistance-trained women performed an 8-week resistance training program after a 3-week familiarization phase. Participants were randomly assigned to a non-ketogenic diet (n = 11, NKD) or ketogenic diet (n = 10, KD) group. Health parameters were measured before and after the nutritional intervention. Blood pressure was measured using a digital automatic monitor, while VAT, BMC, and BMD changes were measured by dual-energy X-ray absorptiometry. RESULTS There was a significant reduction in systolic blood pressure in KD (mean ± SD [IC 95%], P value, Hedges' g; - 6.3 ± 6.0 [- 10.5, - 2.0] mmHg, P = 0.009, g = - 0.81) but not in NKD (- 0.4 ± 8.9 [- 6.8, 6.0] mmHg, P = 0.890, g = - 0.04). The results on VAT showed no changes in both groups. The KD showed a small favorable effect on BMD (0.02 ± 0.02 [0.01, 0.03] g·cm-2, P = 0.014, g = 0.19) while NKD did not show significant changes (0.00 ± 0.02 [- 0.02, 0.02] g·cm-2, P = 0.886, g = 0.01). No differences in group or in the time × group interaction were found in any of the variables. CONCLUSIONS Consuming a low-carbohydrate high-fat KD in conjunction with a resistance training program might help to promote the improvement of health-related markers in resistance-trained women. Long-term studies are required to evaluate the superiority of a KD in comparison to a traditional diet.
Collapse
|
16
|
Shaw DM, Merien F, Braakhuis A, Maunder E, Dulson DK. Exogenous Ketone Supplementation and Keto-Adaptation for Endurance Performance: Disentangling the Effects of Two Distinct Metabolic States. Sports Med 2021; 50:641-656. [PMID: 31820376 DOI: 10.1007/s40279-019-01246-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Ketone bodies (KB) provide an alternative energy source and uniquely modulate substrate metabolism during endurance exercise. Nutritional ketosis (blood KBs > 0.5 mM) can be achieved within minutes via exogenous ketone supplementation or days-to-weeks via conforming to a very low-carbohydrate, ketogenic diet (KD). In contrast to short-term (< 2 weeks) KD ingestion, chronic adherence (> 3 weeks) leads to a state of keto-adaptation. However, despite elevating blood KBs to similar concentrations, exogenous ketone supplementation and keto-adaptation are not similar metabolic states as they elicit diverse and distinct effects on substrate availability and metabolism during exercise; meaning that their influence on endurance exercise performance is different. In contrast to contemporary, high(er)-carbohydrate fuelling strategies, inducing nutritional ketosis is rarely ergogenic irrespective of origin and, in fact, can impair endurance performance. Nonetheless, exogenous ketone supplementation and keto-adaptation possess utility for select endurance events and individuals, thus warranting further research into their performance effects and potential strategies for their optimisation. It is critical, however, that future research considers the limitations of measuring blood KB concentrations and their utilisation, and assess the effect of nutritional ketosis on performance using exercise protocols reflective of real-world competition. Furthermore, to reliably assess the effects of keto-adaptation, rigorous dietary-training controls of sufficient duration should be prioritised.
Collapse
Affiliation(s)
- David M Shaw
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand.
| | - Fabrice Merien
- AUT-Roche Diagnostics Laboratory, School of Science, Auckland University of Technology, Auckland, New Zealand
| | - Andrea Braakhuis
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ed Maunder
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
| | - Deborah K Dulson
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
17
|
Beckmann M, Wilson T, Lloyd AJ, Torres D, Goios A, Willis ND, Lyons L, Phillips H, Mathers JC, Draper J. Challenges Associated With the Design and Deployment of Food Intake Urine Biomarker Technology for Assessment of Habitual Diet in Free-Living Individuals and Populations-A Perspective. Front Nutr 2020; 7:602515. [PMID: 33344495 PMCID: PMC7745244 DOI: 10.3389/fnut.2020.602515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022] Open
Abstract
Improvement of diet at the population level is a cornerstone of national and international strategies for reducing chronic disease burden. A critical challenge in generating robust data on habitual dietary intake is accurate exposure assessment. Self-reporting instruments (e.g., food frequency questionnaires, dietary recall) are subject to reporting bias and serving size perceptions, while weighed dietary assessments are unfeasible in large-scale studies. However, secondary metabolites derived from individual foods/food groups and present in urine provide an opportunity to develop potential biomarkers of food intake (BFIs). Habitual dietary intake assessment in population surveys using biomarkers presents several challenges, including the need to develop affordable biofluid collection methods, acceptable to participants that allow collection of informative samples. Monitoring diet comprehensively using biomarkers requires analytical methods to quantify the structurally diverse mixture of target biomarkers, at a range of concentrations within urine. The present article provides a perspective on the challenges associated with the development of urine biomarker technology for monitoring diet exposure in free-living individuals with a view to its future deployment in "real world" situations. An observational study (n = 95), as part of a national survey on eating habits, provided an opportunity to explore biomarker measurement in a free-living population. In a second food intervention study (n = 15), individuals consumed a wide range of foods as a series of menus designed specifically to achieve exposure reflecting a diversity of foods commonly consumed in the UK, emulating normal eating patterns. First Morning Void urines were shown to be suitable samples for biomarker measurement. Triple quadrupole mass spectrometry, coupled with liquid chromatography, was used to assess simultaneously the behavior of a panel of 54 potential BFIs. This panel of chemically diverse biomarkers, reporting intake of a wide range of commonly-consumed foods, can be extended successfully as new biomarker leads are discovered. Towards validation, we demonstrate excellent discrimination of eating patterns and quantitative relationships between biomarker concentrations in urine and the intake of several foods. In conclusion, we believe that the integration of information from BFI technology and dietary self-reporting tools will expedite research on the complex interactions between dietary choices and health.
Collapse
Affiliation(s)
- Manfred Beckmann
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - Thomas Wilson
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - Amanda J. Lloyd
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - Duarte Torres
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- Epidemiology Research Unit (EPIUnit), Institute of Public Health, University of Porto, Porto, Portugal
| | - Ana Goios
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
- Epidemiology Research Unit (EPIUnit), Institute of Public Health, University of Porto, Porto, Portugal
| | - Naomi D. Willis
- Human Nutrition Research Centre, Population Health Sciences Institute, William Leech Building, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Laura Lyons
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - Helen Phillips
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - John C. Mathers
- Human Nutrition Research Centre, Population Health Sciences Institute, William Leech Building, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - John Draper
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| |
Collapse
|
18
|
Changes in body composition and substrate utilization after a short-term ketogenic diet in endurance-trained males. Biol Sport 2020; 38:145-152. [PMID: 33795923 PMCID: PMC7996378 DOI: 10.5114/biolsport.2020.98448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/19/2020] [Accepted: 07/28/2020] [Indexed: 12/15/2022] Open
Abstract
Few studies have investigated the short-term effects of a very low carbohydrate ketogenic diet (KD) on body composition and substrate utilization in trained individuals. This study investigated effects on substrate utilization during incremental exercise, and changes in body composition, in response to seven days ad libitum consumption of a KD by athletes from endurance sports. Nine young trained males (age, 21.8 ± 1.9 y; height, 1.83 ± 0.11 m; body mass, 78.4 ± 13.8 kg; body fat, 14.9 ± 3.9%; VO2peak, 54.3 ± 5.9 mL kg-1 min-1) were assessed before (day 0; PRE) and after (day 7; POST) seven days of consuming an ad libitum KD. Following an overnight fast, body composition was measured by dual x-ray absorptiometry, and substrate utilization was measured during an incremental (3 min stages, 35 W increments) exercise test on a cycle ergometer. After KD, Wmax (PRE, 295 ± 30 W; POST, 292 ± 38 W) and VO2peak (PRE, 4.18 ± 0.33 L min-1; POST, 4.10 ± 0.43 L min-1) were unchanged, whereas body mass [-2.4 (-3.2, -1.6) kg; P < 0.001, d = 0.21], fat mass [-0.78 (-1.10, -0.46) kg; P < 0.001, d = 0.22] and fat-free mass (FFM) [-1.82 (-3.12, -0.51) kg; P = 0.013, d = 0.22] all decreased. The respiratory exchange ratio was lower, and rates of fat oxidation were higher, at POST across a range of exercise intensities. Maximal fat oxidation rate was ~1.8-fold higher after KD (PRE, 0.54 ± 0.13 g min-1; POST, 0.95 ± 0.24 g min-1; P < 0.001, d = 2.2). Short-term KD results in loss of both fat mass and FFM, increased rates of fat oxidation and a concomitant reduction in CHO utilization even at moderate-to-high intensities of exercise.
Collapse
|
19
|
Kong Z, Sun S, Shi Q, Zhang H, Tong TK, Nie J. Short-Term Ketogenic Diet Improves Abdominal Obesity in Overweight/Obese Chinese Young Females. Front Physiol 2020; 11:856. [PMID: 32848830 PMCID: PMC7399204 DOI: 10.3389/fphys.2020.00856] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022] Open
Abstract
The purpose of this study was to examine the effects of a short-term ketogenic diet (KD) on body composition and cardiorespiratory fitness (CRF) in overweight/obese Chinese females. Twenty young females [age: 21.0 ± 3.7 years, weight: 65.5 ± 7.7 kg, body mass index (BMI): 24.9 ± 2.7 kg⋅m–2] consumed 4 weeks of a normal diet (ND) as a baseline and then switched to a low-carbohydrate, high-fat, and adequate protein KD for another 4 weeks. With the same daily caloric intake, the proportions of energy intake derived from carbohydrates, proteins, and fats were changed from 44.0 ± 7.6%, 15.4 ± 3.3%, 39.6 ± 5.8% in ND to 9.2 ± 4.8%, 21.9 ± 3.4%, and 69.0 ± 5.4% in KD. The results showed that, without impairing the CRF level, the 4-week KD intervention significantly reduced body weight (−2.9 kg), BMI (−1.1 kg⋅m–2), waist circumference (−4.0 cm), hip circumference (−2.5 cm), and body fat percentage (−2.0%). Moreover, fasting leptin level was lowered significantly, and serum levels of inflammatory markers (i.e., TNF-α and MCP-1) were unchanged following KD. These findings suggest that KD can be used as a rapid and effective approach to lose weight and reduce abdominal adiposity in overweight/obese Chinese females without exacerbating their CRF.
Collapse
Affiliation(s)
- Zhaowei Kong
- Faculty of Education, University of Macau, Macao, China
| | - Shengyan Sun
- Institute of Physical Education, Huzhou University, Huzhou, China
| | - Qingde Shi
- School of Health Sciences and Sports, Macao Polytechnic Institute, Macao, China
| | - Haifeng Zhang
- College of Physical Education, Hebei Normal University, Shijiazhuang, China
| | - Tomas K Tong
- Department of Physical Education, Hong Kong Baptist University, Hong Kong, China
| | - Jinlei Nie
- School of Health Sciences and Sports, Macao Polytechnic Institute, Macao, China
| |
Collapse
|
20
|
Merrill JD, Soliman D, Kumar N, Lim S, Shariff AI, Yancy WS. Low-Carbohydrate and Very-Low-Carbohydrate Diets in Patients With Diabetes. Diabetes Spectr 2020; 33:133-142. [PMID: 32425450 PMCID: PMC7228825 DOI: 10.2337/ds19-0070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Low-carbohydrate diets have been advocated as an effective method for promoting weight loss in overweight and obese individuals and preventing and treating type 2 diabetes. This article reviews the differences between various low-carbohydrate eating plans and discusses the benefits and drawbacks of such a diet based on available evidence. It also offers practical pointers for clinicians.
Collapse
Affiliation(s)
- Jennifer D. Merrill
- Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, NC
| | - Diana Soliman
- Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, NC
| | - Nitya Kumar
- Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, NC
| | - Sooyoung Lim
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Afreen I. Shariff
- Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, NC
| | - William S. Yancy
- Duke Diet and Fitness Center, Department of Medicine, Duke University Health System, Durham, NC
- Durham Veterans Affairs Medical Center, Durham, NC
| |
Collapse
|
21
|
Vargas-Molina S, Petro JL, Romance R, Kreider RB, Schoenfeld BJ, Bonilla DA, Benítez-Porres J. Effects of a ketogenic diet on body composition and strength in trained women. J Int Soc Sports Nutr 2020; 17:19. [PMID: 32276630 PMCID: PMC7146906 DOI: 10.1186/s12970-020-00348-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/27/2020] [Indexed: 01/07/2023] Open
Abstract
Background The effect of ketogenic diets (KD) on body composition in different populations has been investigated. More recently, some have recommended that athletes adhere to ketogenic diets in order to optimize changes in body composition during training. However, there is less evidence related to trained women. We aimed to evaluate the effect of a KD on body composition and strength in trained women following an eight-week resistance training (RT) program. Methods Twenty-one strength-trained women (27.6 ± 4.0 years; 162.1 ± 6.6 cm; 62.3 ± 7.8 kg; 23.7 ± 2.9 kg·m− 2) were randomly assigned to either a non-KD group (n = 11, NKD) or a KD group (n = 10, KD). Study outcomes included body composition as measured by dual-energy X-ray absorptiometry (DXA), strength levels measured using one maximum repetition (RM) in back squat and bench press (BP), and countermovement jump (CMJ) measured on a force plate. Results A significant reduction in fat mass was observed in KD (− 1.1 ± 1.5 kg; P = 0.042; d = − 0.2) but not in NDK (0.3 ± 0.8 kg; P = 0.225; d = 0.1). No significant changes in fat-free mass were observed in KD (− 0.7 ± 1.7 kg; P = 0.202; d = − 0.1) or NKD (0.7 ± 1.1 kg; P = 0.074; d = 0.2), but absolute changes favored NKD. No significant changes in BP were observed in KD (1.5 ± 4.6 kg; P = 0.329; d = 0.2), although significant changes were noted in the squat and CMJ (5.6 ± 7.6 kg; P = 0.045; d = 0.5 and 2.2 ± 1.7 kg; P = 0.022; d = 0.6, respectively). In contrast, NKD showed significant increases in BP (4.8 ± 1.8; P < 0.01; d = 0.7), squat (15.6 ± 5.4 kg; P = 0.005; d = 1.4) and CMJ (22.0 + 4.2 cm; P = 0.001; d = 0.5). Conclusions Findings indicate that a KD may help to decrease fat mass and maintain fat-free mass after eight 8 weeks of RT in trained-women but is suboptimal for increasing fat-free mass.
Collapse
Affiliation(s)
- Salvador Vargas-Molina
- Human Kinetics and Body Composition Laboratory, University of Málaga, Bulevar Louis Pasteur, 25, 29010, Málaga, Spain.,EADE-University of Wales Trinity Saint David, Málaga, Spain
| | - Jorge L Petro
- Research Group in Physical Activity, Sports and Health Sciences (GICAFS), Universidad de Córdoba, Montería, Colombia.,Research Division, DBSS INTERNATIONAL SAS, Bogotá, Colombia
| | - Ramón Romance
- Human Kinetics and Body Composition Laboratory, University of Málaga, Bulevar Louis Pasteur, 25, 29010, Málaga, Spain
| | - Richard B Kreider
- Exercise & Sport Nutrition Lab, Human Clinical Research Facility, Texas A&M University, College Station, TX, USA
| | | | | | - Javier Benítez-Porres
- Human Kinetics and Body Composition Laboratory, University of Málaga, Bulevar Louis Pasteur, 25, 29010, Málaga, Spain.
| |
Collapse
|
22
|
Affective and Enjoyment Responses to Short-Term High-Intensity Interval Training with Low-Carbohydrate Diet in Overweight Young Women. Nutrients 2020; 12:nu12020442. [PMID: 32050648 PMCID: PMC7071177 DOI: 10.3390/nu12020442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/15/2022] Open
Abstract
Low-carbohydrate diets (LCs) seem effective on weight reduction and maintenance. However, the affect and enjoyment of exercise during LCs is not clear. The purpose of the present study was to compare the psychological responses to high-intensity interval training (HIIT) and to moderate-intensity continuous training (MICT) during the consumption of a 4-week LC diet in overweight young women. With LCs (~10% carbohydrate, 65%–70% fat, 20%–25% protein), forty-three eligible women (age: 20.9 ± 3.1 years; body weight: 65.8 ± 8.2 kg) were randomly assigned to one of three groups: HIIT (10 sets of 6 s all-out cycling interspersed with 9 s of rest), MICT (30 min cycling at 50%–60% of peak oxygen consumption, V̇O2peak) or no-exercise controls (CON). Anthropometric indices and V̇O2peak were measured pre- and post-training. Feeling Scale (FS), Felt Arousal Scale (FAS), Exercise Enjoyment Scale (EES), and Physical Activity Enjoyment Scale (PACES) scores were collected before and immediately after each training session throughout the study. After intervention, all three groups reduced by more than 2.5 kg of body weight whereas both exercise groups improved ~15% V̇O2peak. Participants in the HIIT and MICT group exhibited similar affect points as indicated by FS and FAS. Post-exercise enjoyment scores in PACES were lower in HIIT (73–78 points) than MICT (83–87 points) despite similarly positive responses being observed in EES (corresponding to ~4 points of a 7-point scale). Short-term LCs were effective in weight loss and exercise training had an additive improvement on cardiorespiratory fitness. The overweight young women had similar affect valence, arousal levels, and comparable pleasurable feelings to HIIT and MICT with LCs. Furthermore, as indicated by PACES, MICT was more enjoyable which may elicit better adherence, whereas HIIT with LCs seems to be more arduous despite its time-efficiency.
Collapse
|
23
|
Buechert M, Lange T, Deibert P, Urbain P. In Vivo Fat Quantification: Monitoring Effects of a 6-Week Non-Energy-Restricted Ketogenic Diet in Healthy Adults Using MRI, ADP and BIA. Nutrients 2020; 12:nu12010244. [PMID: 31963475 PMCID: PMC7019649 DOI: 10.3390/nu12010244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/23/2019] [Accepted: 01/08/2020] [Indexed: 11/20/2022] Open
Abstract
The ketogenic diet (KD) is a very low-carbohydrate, high-fat, and adequate-protein diet that induces many metabolic adaptations when calorie intake is not limited. Its therapeutic use in a range of diseases including cancer is currently being investigated. Our objective was to firstly assess the impact of a 6-week non-energy-restricted KD on the abdominal fat distribution and the hepatic fat composition in healthy adults. Body fat distribution and composition were measured by comparing magnetic resonance imaging (MRI) and spectroscopy (MRS) results with air displacement plethysmography (ADP) and bioelectrical impedance analysis (BIA) measurements. A total of 12 subjects from the KetoPerformance study were recruited for this ancillary study. Body mass index (BMI), total mass, total fat mass, total subcutaneous mass, and subcutaneous fat mass decreased significantly. None of the MRS parameters showed a significant change during the study. Even though the average change in body weight was >2kg, no significant changes in intrahepatic lipid (IHL) content could be observed. Total fat mass and total fat-free mass derived from MRI has a strong correlation with the corresponding values derived from BIA and ADP data. BMI and the absolute fat parameter of all three modalities decreased, but there were no or only minor changes regarding the fat-free parameter. Magnetic resonance imaging provides body composition information on abdominal fat distribution changes during a ketogenic diet. This information is complementary to anthropomorphic and laboratory measures and is more detailed than the information provided by ADP and BIA measures. It was shown that there was no significant change in internal fat distribution, but there was a decrease in subcutaneous fat.
Collapse
Affiliation(s)
- Martin Buechert
- Department of Radiology, Medical Physics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
- Correspondence:
| | - Thomas Lange
- Department of Radiology, Medical Physics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Peter Deibert
- Institute for Exercise—und Occupational Medicine, Center for Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Paul Urbain
- Department of Medicine I, Section of Clinical Nutrition and Dietetics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| |
Collapse
|
24
|
Ketogenic diets in medical oncology: a systematic review with focus on clinical outcomes. Med Oncol 2020; 37:14. [PMID: 31927631 DOI: 10.1007/s12032-020-1337-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/02/2020] [Indexed: 12/30/2022]
Abstract
Preclinical data provide evidence for synergism between ketogenic diets (KDs) and other oncological therapies. The aim of this systematic review was to summarize data from clinical studies that have tested KDs along with other treatments used within medical oncology. The PubMed database was searched using the key words "ketogenic" AND ("cancer" OR "glioblastoma"). A secondary search was conducted by screening the reference lists of relevant articles on this topic. Relevant studies for this review were defined as studies in which KDs were used complementary to surgery, radio-, chemo-, or targeted therapy and at least one of the following four outcomes were reported: (i) Overall survival (OS); (ii) progression-free survival (PFS); (iii) local control rate; (iv) body composition changes. Twelve papers reporting on 13 clinical studies were identified. Nine studies were prospective and six had a control group, but only two were randomized. KD prescription varied widely between studies and was described only rudimentarily in most papers. Adverse events attributed to the diet were rare and only minor (grade 1-2) except for one possibly diet-related grade 4 event. Studies reporting body composition changes found beneficial effects of KDs in both overweight and frail patient populations. Beneficial effects of KDs on OS and/or PFS were found in four studies including one randomized controlled trial. Studies in high-grade glioma patients were not sufficiently powered to prove efficacy. Evidence for beneficial effects of KDs during cancer therapy is accumulating, but more high-quality studies are needed to assess the overall strength of evidence.
Collapse
|
25
|
The Feasibility, Safety and Effectiveness of a Ketogenic Diet for Refractory Status Epilepticus in Adults in the Intensive Care Unit. Neurocrit Care 2020; 30:652-657. [PMID: 30484010 DOI: 10.1007/s12028-018-0653-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Status, refractory status and super refractory status epilepticus are common neurologic emergencies. The objective of this study is to investigate the feasibility, safety and effectiveness of a ketogenic diet (KD) for refractory status epilepticus (RSE) in adults in the intensive care unit (ICU). METHODS We performed a retrospective, single-center study of patients between ages 18 and 80 years with RSE treated with a KD treatment algorithm from November 2016 through April 2018. The primary outcome measure was urine ketone body production as a biomarker of feasibility. Secondary measures included resolution of RSE and KD-related side effects. RESULTS There were 11 adults who were diagnosed with RSE that were treated with the KD. The mean age was 48 years, and 45% (n = 5) of the patients were women. The patients were prescribed a median of three anti-seizure medications before initiating the KD. The median duration of RSE before initiation of the KD was 1 day. Treatment delays were the result of Propofol administration. 90.9% (n = 10) of patients achieved ketosis within a median of 1 day. RSE resolved in 72.7% (n = 8) of patients; however, 27.3% (n = 3) developed super-refractory status epilepticus. Side effects included metabolic acidosis, hypoglycemia and hyponatremia. One patient (20%) died. CONCLUSIONS KD may be feasible, safe and effective for treatment of RSE in the ICU. A randomized controlled trial (RCT) may be indicated to further test the safety and efficacy of KD.
Collapse
|
26
|
Herber DL, Weeber EJ, D'Agostino DP, Duis J. Evaluation of the safety and tolerability of a nutritional Formulation in patients with ANgelman Syndrome (FANS): study protocol for a randomized controlled trial. Trials 2020; 21:60. [PMID: 31918761 PMCID: PMC6953273 DOI: 10.1186/s13063-019-3996-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 12/13/2019] [Indexed: 01/12/2023] Open
Abstract
Background Ketogenic and low-glycemic-index diets are effective in treating drug-resistant seizures in children with Angelman syndrome. Cognition, mobility, sleep, and gastrointestinal health are intrinsically linked to seizure activity and overall quality of life. Ketogenic and low-glycemic diets restrict carbohydrate consumption and stabilize blood glucose levels. The ketogenic diet induces ketosis, a metabolic state where ketone bodies are preferentially used for fuel. The use of exogenous ketones in promoting ketosis in Angelman syndrome has not been previously studied. The study formulation evaluated herein contains the exogenous ketone beta-hydroxybutyrate to rapidly shift the body towards ketosis, resulting in enhanced metabolic efficiency. Methods/design This is a 16-week, randomized, double-blind, placebo-controlled, crossover study to assess the safety and tolerability of a nutritional formula containing exogenous ketones. It also examines the potential for exogenous ketones to improve the patient’s nutritional status which can impact the physiologic, symptomatic, and health outcome liabilities of living with Angelman syndrome. Discussion This manuscript outlines the rationale for a study designed to be the first to provide data on nutritional approaches for patients with Angelman syndrome using exogenous ketones. Trial registration ClinicalTrials.gov, ID: NCT03644693. Registered on 23 August 2018. Last updated on 23 August 2018.
Collapse
Affiliation(s)
- Donna L Herber
- Disruptive Nutrition, LLC, 300 West Morgan Street, Suite 1510, Durham, NC, 27701, USA
| | - Edwin J Weeber
- PTC Therapeutics, Inc., 100 Corporate Court, South Plainfield, NJ, 07080-2449, USA
| | - Dominic P D'Agostino
- Morsani College of Medicine, Department of Molecular Pharmacology and Physiology, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA.,Institute for Human and Machine Cognition, Ocala, FL, USA
| | - Jessica Duis
- Division of Medical Genetics & Genomic Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, 37232-2578, USA.
| |
Collapse
|
27
|
Valsdottir TD, Henriksen C, Odden N, Nellemann B, Jeppesen PB, Hisdal J, Westerberg AC, Jensen J. Effect of a Low-Carbohydrate High-Fat Diet and a Single Bout of Exercise on Glucose Tolerance, Lipid Profile and Endothelial Function in Normal Weight Young Healthy Females. Front Physiol 2019; 10:1499. [PMID: 31920704 PMCID: PMC6931312 DOI: 10.3389/fphys.2019.01499] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/25/2019] [Indexed: 01/07/2023] Open
Abstract
Low-carbohydrate-high-fat (LCHF) diets are efficient for weight loss, and are also used by healthy people to maintain bodyweight. The main aim of this study was to investigate the effect of 3-week energy-balanced LCHF-diet, with >75 percentage energy (E%) from fat, on glucose tolerance and lipid profile in normal weight, young, healthy women. The second aim of the study was to investigate if a bout of exercise would prevent any negative effect of LCHF-diet on glucose tolerance. Seventeen females participated, age 23.5 ± 0.5 years; body mass index 21.0 ± 0.4 kg/m2, with a mean dietary intake of 78 ± 1 E% fat, 19 ± 1 E% protein and 3 ± 0 E% carbohydrates. Measurements were performed at baseline and post-intervention. Fasting glucose decreased from 4.7 ± 0.1 to 4.4 mmol/L (p < 0.001) during the dietary intervention whereas fasting insulin was unaffected. Glucose area under the curve (AUC) and insulin AUC did not change during an OGTT after the intervention. Before the intervention, a bout of aerobic exercise reduced fasting glucose (4.4 ± 0.1 mmol/L, p < 0.001) and glucose AUC (739 ± 41 to 661 ± 25, p = 0.008) during OGTT the following morning. After the intervention, exercise did not reduce fasting glucose the following morning, and glucose AUC during an OGTT increased compared to the day before (789 ± 43 to 889 ± 40 mmol/L∙120min–1, p = 0.001). AUC for insulin was unaffected. The dietary intervention increased total cholesterol (p < 0.001), low-density lipoprotein (p ≤ 0.001), high-density lipoprotein (p = 0.011), triglycerides (p = 0.035), and free fatty acids (p = 0.021). In conclusion, 3-week LCHF-diet reduced fasting glucose, while glucose tolerance was unaffected. A bout of exercise post-intervention did not decrease AUC glucose as it did at baseline. Total cholesterol increased, mainly due to increments in low-density lipoprotein. LCHF-diets should be further evaluated and carefully considered for healthy individuals.
Collapse
Affiliation(s)
- Thorhildur Ditta Valsdottir
- Department of Medicine, Atlantis Medical University College, Oslo, Norway.,Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Christine Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nancy Odden
- Department of Nutrition, Atlantis Medical University College, Oslo, Norway
| | - Birgitte Nellemann
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Per B Jeppesen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jonny Hisdal
- Oslo Vascular Center, Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Ane C Westerberg
- Department of Nutrition, Atlantis Medical University College, Oslo, Norway.,Institute of Health Sciences, Kristiania University College, Oslo, Norway
| | - Jørgen Jensen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| |
Collapse
|
28
|
Non-Energy-Restricted Low-Carbohydrate Diet Combined with Exercise Intervention Improved Cardiometabolic Health in Overweight Chinese Females. Nutrients 2019; 11:nu11123051. [PMID: 31847246 PMCID: PMC6950598 DOI: 10.3390/nu11123051] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/10/2019] [Indexed: 12/18/2022] Open
Abstract
This study aimed to examine the effects of four weeks of a low-carbohydrate diet (LC) and incorporated exercise training on body composition and cardiometabolic health. Fifty-eight overweight/obese Chinese females (age: 21.2 ± 3.3 years, body mass index (BMI): 25.1 ± 2.8 kg/m2) were randomly assigned to the control group (CON, n = 15), the LC control group (LC-CON, n = 15), the LC and high-intensity interval training group (LC-HIIT, n = 15), or the LC and moderate-intensity continuous training group (LC-MICT, n = 13). Subjects consumed a four week LC, whereas LC-HIIT and LC-MICT received extra training 5 d/week (LC-HIIT: 10 × 6 s cycling interspersed with 9 s rest, MICT: 30 min continuous cycling at 50–60% VO2peak). After intervention, the three LC groups demonstrated significant reductions in body weight (−2.85 kg in LC-CON, −2.85 kg in LC-HIIT, −2.56 kg in LC-MICT, p < 0.001, η2 = 0.510), BMI (p < 0.001, η2 = 0.504) and waist-to-hip ratio (p < 0.001, η2 = 0.523). Groups with extra training (i.e., LC-HIIT and LC-MICT) improved VO2peak by 14.8 and 17.3%, respectively. However, fasting glucose and blood lipid levels remained unchanged in all groups. Short-term LC is a useful approach to improve body composition in overweight/obese Chinese females. Incorporated exercise training has no additional effects on weight loss, but has additional benefits on cardiorespiratory fitness, and HIIT is more time efficient than the traditional MICT (2.5 min vs. 30 min).
Collapse
|
29
|
Caprio M, Infante M, Moriconi E, Armani A, Fabbri A, Mantovani G, Mariani S, Lubrano C, Poggiogalle E, Migliaccio S, Donini LM, Basciani S, Cignarelli A, Conte E, Ceccarini G, Bogazzi F, Cimino L, Condorelli RA, La Vignera S, Calogero AE, Gambineri A, Vignozzi L, Prodam F, Aimaretti G, Linsalata G, Buralli S, Monzani F, Aversa A, Vettor R, Santini F, Vitti P, Gnessi L, Pagotto U, Giorgino F, Colao A, Lenzi A. Very-low-calorie ketogenic diet (VLCKD) in the management of metabolic diseases: systematic review and consensus statement from the Italian Society of Endocrinology (SIE). J Endocrinol Invest 2019; 42:1365-1386. [PMID: 31111407 DOI: 10.1007/s40618-019-01061-2] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/07/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Weight loss is a milestone in the prevention of chronic diseases associated with high morbility and mortality in industrialized countries. Very-low calorie ketogenic diets (VLCKDs) are increasingly used in clinical practice for weight loss and management of obesity-related comorbidities. Despite evidence on the clinical benefits of VLCKDs is rapidly emerging, some concern still exists about their potential risks and their use in the long-term, due to paucity of clinical studies. Notably, there is an important lack of guidelines on this topic, and the use and implementation of VLCKDs occurs vastly in the absence of clear evidence-based indications. PURPOSE We describe here the biochemistry, benefits and risks of VLCKDs, and provide recommendations on the correct use of this therapeutic approach for weight loss and management of metabolic diseases at different stages of life.
Collapse
Affiliation(s)
- M Caprio
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, Rome, Italy.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
| | - M Infante
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, ASL Roma 2, University of Rome Tor Vergata, Rome, Italy
| | - E Moriconi
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, Rome, Italy
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Armani
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, Rome, Italy
| | - A Fabbri
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, ASL Roma 2, University of Rome Tor Vergata, Rome, Italy
| | - G Mantovani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - S Mariani
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - C Lubrano
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - E Poggiogalle
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Migliaccio
- Section of Health Sciences, Department of Movement, Human and Health Sciences, "Foro Italico" University of Rome, Rome, Italy
| | - L M Donini
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Basciani
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Cignarelli
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - E Conte
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - G Ceccarini
- Endocrinology Unit, Obesity and Lipodystrophy Center, University Hospital of Pisa, Pisa, Italy
| | - F Bogazzi
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - L Cimino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - R A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - S La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - A Gambineri
- Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - L Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, AOU Careggi, Florence, Italy
| | - F Prodam
- Endocrinology, Department of Translational Medicine and Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - G Aimaretti
- Endocrinology, Department of Translational Medicine and Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - G Linsalata
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Buralli
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Aversa
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - R Vettor
- Department of Medicine, Internal Medicine 3, University Hospital of Padova, Padua, Italy
| | - F Santini
- Endocrinology Unit, Obesity and Lipodystrophy Center, University Hospital of Pisa, Pisa, Italy
| | - P Vitti
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - L Gnessi
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - U Pagotto
- Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - F Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - A Colao
- Section of Endocrinology, Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - A Lenzi
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
30
|
Berrington A, Schreck KC, Barron BJ, Blair L, Lin DDM, Hartman AL, Kossoff E, Easter L, Whitlow CT, Jung Y, Hsu FC, Cervenka MC, Blakeley JO, Barker PB, Strowd RE. Cerebral Ketones Detected by 3T MR Spectroscopy in Patients with High-Grade Glioma on an Atkins-Based Diet. AJNR Am J Neuroradiol 2019; 40:1908-1915. [PMID: 31649157 DOI: 10.3174/ajnr.a6287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/04/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Ketogenic diets are being explored as a possible treatment for several neurological diseases, but the physiologic impact on the brain is unknown. The objective of this study was to evaluate the feasibility of 3T MR spectroscopy to monitor brain ketone levels in patients with high-grade gliomas who were on a ketogenic diet (a modified Atkins diet) for 8 weeks. MATERIALS AND METHODS Paired pre- and post-ketogenic diet MR spectroscopy data from both the lesion and contralateral hemisphere were analyzed using LCModel software in 10 patients. RESULTS At baseline, the ketone bodies acetone and β-hydroxybutyrate were nearly undetectable, but by week 8, they increased in the lesion for both acetone (0.06 ± 0.03 ≥ 0.27 ± 0.06 IU, P = .005) and β-hydroxybutyrate (0.07 ± 0.07 ≥ 0.79 ± 0.32 IU, P = .046). In the contralateral brain, acetone was also significantly increased (0.041 ± 0.01 ≥ 0.16 ± 0.04 IU, P = .004), but not β-hydroxybutyrate. Acetone was detected in 9/10 patients at week 8, and β-hydroxybutyrate, in 5/10. Acetone concentrations in the contralateral brain correlated strongly with higher urine ketones (r = 0.87, P = .001) and lower fasting glucose (r = -0.67, P = .03). Acetoacetate was largely undetectable. Small-but-statistically significant decreases in NAA were also observed in the contralateral hemisphere at 8 weeks. CONCLUSIONS This study suggests that 3T MR spectroscopy is feasible for detecting small cerebral metabolic changes associated with a ketogenic diet, provided that appropriate methodology is used.
Collapse
Affiliation(s)
- A Berrington
- From the Russell H. Morgan Departments of Radiology and Radiological Science (A.B., D.D.M.L., P.B.B.)
| | - K C Schreck
- Neurology (K.C.S., L.B., A.L.H., E.K., M.C.C., J.O.B., R.E.S.)
| | - B J Barron
- Institute of Clinical and Translational Research (B.J.B.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - L Blair
- Neurology (K.C.S., L.B., A.L.H., E.K., M.C.C., J.O.B., R.E.S.).,Pediatrics (L.B., A.L.H.)
| | - D D M Lin
- From the Russell H. Morgan Departments of Radiology and Radiological Science (A.B., D.D.M.L., P.B.B.)
| | - A L Hartman
- Neurology (K.C.S., L.B., A.L.H., E.K., M.C.C., J.O.B., R.E.S.).,Pediatrics (L.B., A.L.H.)
| | - E Kossoff
- Neurology (K.C.S., L.B., A.L.H., E.K., M.C.C., J.O.B., R.E.S.)
| | - L Easter
- Clinical and Translational Science Institute (L.E., R.E.S.)
| | | | - Y Jung
- Departments of Radiology (C.T.W., Y.J.)
| | - F-C Hsu
- Biostatistics and Data Science (F.-C.H.), Division of Public Health Sciences
| | - M C Cervenka
- Neurology (K.C.S., L.B., A.L.H., E.K., M.C.C., J.O.B., R.E.S.)
| | - J O Blakeley
- Neurology (K.C.S., L.B., A.L.H., E.K., M.C.C., J.O.B., R.E.S.)
| | - P B Barker
- From the Russell H. Morgan Departments of Radiology and Radiological Science (A.B., D.D.M.L., P.B.B.) .,F. M. Kirby Research Center for Functional Brain Imaging (P.B.B., R.E.S.), Kennedy Krieger Institute, Baltimore, Maryland
| | - R E Strowd
- Neurology (K.C.S., L.B., A.L.H., E.K., M.C.C., J.O.B., R.E.S.).,Clinical and Translational Science Institute (L.E., R.E.S.).,Departments of Neurology, Hematology and Oncology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, North Carolina.,F. M. Kirby Research Center for Functional Brain Imaging (P.B.B., R.E.S.), Kennedy Krieger Institute, Baltimore, Maryland
| |
Collapse
|
31
|
Di Lorenzo C, Pinto A, Ienca R, Coppola G, Sirianni G, Di Lorenzo G, Parisi V, Serrao M, Spagnoli A, Vestri A, Schoenen J, Donini LM, Pierelli F. A Randomized Double-Blind, Cross-Over Trial of very Low-Calorie Diet in Overweight Migraine Patients: A Possible Role for Ketones? Nutrients 2019; 11:E1742. [PMID: 31357685 PMCID: PMC6722531 DOI: 10.3390/nu11081742] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 01/03/2023] Open
Abstract
Here we aimed at determining the therapeutic effect of a very low-calorie diet in overweight episodic migraine patients during a weight-loss intervention in which subjects alternated randomly between a very low-calorie ketogenic diet (VLCKD) and a very low-calorie non-ketogenic diet (VLCnKD) each for one month. In a nutritional program, 35 overweight obese migraine sufferers were allocated blindly to 1-month successive VLCKD or VLCnKD in random order (VLCKD-VLCnKD or VLCnKD-VLCD). The primary outcome measure was the reduction of migraine days each month compared to a 1-month pre-diet baseline. Secondary outcome measures were 50% responder rate for migraine days, reduction of monthly migraine attacks, abortive drug intake and body mass index (BMI) change. Only data from the intention-to-treat cohort (n = 35) will be presented. Patients who dropped out (n = 6) were considered as treatment failures. Regarding the primary outcome, during the VLCKD patients experienced -3.73 (95% CI: -5.31, -2.15) migraine days respect to VLCnKD (p < 0.0001). The 50% responder rate for migraine days was 74.28% (26/35 patients) during the VLCKD period, but only 8.57% (3/35 patients) during VLCnKD. Migraine attacks decreased by -3.02 (95% CI: -4.15, -1.88) during VLCKD respect to VLCnKD (p < 0.00001). There were no differences in the change of acute anti-migraine drug consumption (p = 0.112) and BMI (p = 0.354) between the 2 diets. A VLCKD has a preventive effect in overweight episodic migraine patients that appears within 1 month, suggesting that ketogenesis may be a useful therapeutic strategy for migraines.
Collapse
Affiliation(s)
| | - Alessandro Pinto
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Roma, Italy
| | - Roberta Ienca
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Roma, Italy
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, 04100 Latina, Italy
| | | | - Giorgio Di Lorenzo
- Laboratory of Psychophysiology and Cognitive Neuroscience, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- IRCCS Fondazione Santa Lucia, 00142 Rome, Italy
| | | | - Mariano Serrao
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Roma, Italy
| | - Alessandra Spagnoli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00161 Rome, Italy
| | - Annarita Vestri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00161 Rome, Italy
| | - Jean Schoenen
- Headache Research Unit, University Department of Neurology CHR, Citadelle Hospital, University of Liège, 4000 Liège, Belgium
| | - Lorenzo M Donini
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Roma, Italy
| | - Francesco Pierelli
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Roma, Italy
- IRCCS-Neuromed, 86077 Pozzilli (IS), Italy
| |
Collapse
|
32
|
Durkalec-Michalski K, Nowaczyk PM, Siedzik K. Effect of a four-week ketogenic diet on exercise metabolism in CrossFit-trained athletes. J Int Soc Sports Nutr 2019; 16:16. [PMID: 30953522 PMCID: PMC6451242 DOI: 10.1186/s12970-019-0284-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/26/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The ketogenic diet is becoming a popular nutritional model among athletes. However, the relationship between its use and metabolism during exercise seems to have not been fully investigated. METHODS The aim of the study was to assess the effects of a four-week ketogenic diet (KD) on fat and carbohydrate (CHO) utilization during an incremental cycling test (ICT) in CrossFit-trained female (n = 11) and male (n = 11) athletes. During the ICT (while consuming the customary diet and after the KD), oxygen uptake and carbon dioxide exhalation were registered, and CHO and fat utilization as well as energy expenditure were calculated. RESULTS In males, the KD led to an increase in fat utilization (g·min- 1·kgFFM- 1 and % oxidation). It was particularly noticeable at exercise intensities up to 80% of VO2max. An increase in the area under the curve (AUC) was seen in males but not in females at up to ≤65% VO2max of fat utilization. CONCLUSIONS Male CrossFit-trained athletes seem to be more prone to shifts in macronutrient utilization (in favor of fat utilization) during submaximal intensity exercise under a ketogenic diet than are female athletes. TRIAL REGISTRATION Clinical Trials Gov, NCT03665948 . Registered 11 September 2018 (retrospectively registered).
Collapse
Affiliation(s)
- Krzysztof Durkalec-Michalski
- Institute of Human Nutrition and Dietetics, Poznan University of Life Sciences, Wojska Polskiego 31, 60-624 Poznań, Poland
- Department of Food and Nutrition, Poznan University of Physical Education, 61-871 Poznań, Poland
| | - Paulina M. Nowaczyk
- Institute of Human Nutrition and Dietetics, Poznan University of Life Sciences, Wojska Polskiego 31, 60-624 Poznań, Poland
| | - Katarzyna Siedzik
- Institute of Human Nutrition and Dietetics, Poznan University of Life Sciences, Wojska Polskiego 31, 60-624 Poznań, Poland
| |
Collapse
|
33
|
Ding J, Xu X, Wu X, Huang Z, Kong G, Liu J, Huang Z, Liu Q, Li R, Yang Z, Liu Y, Zhu Q. Bone loss and biomechanical reduction of appendicular and axial bones under ketogenic diet in rats. Exp Ther Med 2019; 17:2503-2510. [PMID: 30906438 PMCID: PMC6425126 DOI: 10.3892/etm.2019.7241] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/13/2018] [Indexed: 12/12/2022] Open
Abstract
A ketogenic diet (KD) is composed of low-carbohydrate, high-fat and adequate levels of protein. It has been used for decades as a method to treat pediatric refractory epilepsy. However, recently, its side effects on the bones have received increasing attention. In order to comprehensively evaluate the effect of KD on the microstructures and mechanical properties of the skeleton, 14 male Sprague-Dawley rats were equally divided into two groups and fed with a KD (ratio of fat to carbohydrate and protein, 3:1) or a standard diet for 12 weeks. Body weight, as well as blood ketone and glucose levels, were monitored during the experiment. Bone morphometric analyses via micro-computerized tomography were performed on cortical and trabecular bone at the middle L4 vertebral body, the proximal humerus and tibia. The compressive stiffness and strength of scanned skeletal areas were calculated using micro-finite element analysis. The KD led to higher ketone levels and lower glucose levels, with reduced body weight and total bone mineral density (TBMD). After 12 weeks, the diet reduced the bone volume fraction, the trabecular number of cancellous bone, cortical thickness, total cross-sectional area inside the periosteal envelope and the bone area of cortical bone in the tibia and humerus, while increasing trabecular separation. However, KD may not affect the L4 vertebral body. The serum calcium or phosphate concentrations in the blood remained unchanged. In addition, bone stiffness and strength were clearly decreased by the KD, and significantly correlated with the BMD and bone area at all scanned sites. In conclusion, KD led to significant bone loss and reduced biomechanical function in appendicular bones, with a lesser impact on axial bones.
Collapse
Affiliation(s)
- Jianyang Ding
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xiaolin Xu
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xiuhua Wu
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Zucheng Huang
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Ganggang Kong
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Junhao Liu
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Zhiping Huang
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Qi Liu
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Rong Li
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Zhou Yang
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Yapu Liu
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Qingan Zhu
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| |
Collapse
|
34
|
Guzel O, Uysal U, Arslan N. Efficacy and tolerability of olive oil-based ketogenic diet in children with drug-resistant epilepsy: A single center experience from Turkey. Eur J Paediatr Neurol 2019; 23:143-151. [PMID: 30497921 DOI: 10.1016/j.ejpn.2018.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 10/20/2018] [Accepted: 11/13/2018] [Indexed: 11/15/2022]
Abstract
PURPOSE Ketogenic diet (KD) is an effective non-pharmacological treatment for drug-resistant epilepsy. The aim of this study was to investigate the efficacy, tolerability and complications of olive oil-based KD in epileptic children. METHOD In this single-center, prospective study, patients were followed up at 1, 3, 6 and 12 months after KD initiation. Initially, blood ketone levels were measured daily, and as needed thereafter to maintain the levels between 4 and 5 mmol/L. Patient demographics, seizure frequency, serum biochemistry, abdominal ultrasonography and adverse effects were recorded. Efficacy of KD was defined as ≥50% seizure reduction. RESULTS A total of 389 patients with drug-resistant epilepsy receiving KD from 2012 to 2016 were included. One hundred patients (25.7%) stopped the diet for different reasons in the first year, and 369, 314, 225 and 160 patients have been receiving KD treatment for 1, 3, 6 and 12 months, respectively. At 1, 3, 6 and 12th months, 65.8% (243/369), 74.7% (235/314), 70.6% (159/225) and 83.1% (133/160) of the patients were responders, respectively. None of the children had an increased seizure-frequency. Hyperlipidemia (50.8%), selenium deficiency (26.9%), constipation (26.2%), sleep disturbances (20.0%), nephrolithiasis (3.0%), hyperuricemia (3.0) and hepatic side effects (2.6%) were the most common complications of KD. Previous adrenocorticotropic hormone (ACTH) use due to epileptic encephalopathy and presence of constipation at baseline or during KD treatment were found the predictors of treatment efficacy. CONCLUSION KD is an effective and well-tolerated treatment option for patients with drug-resistant epilepsy. Previous history of ACTH use and constipation during KD treatment are important factors that affect the efficacy of KD treatment.
Collapse
Affiliation(s)
- Orkide Guzel
- Behçet Uz Children Hospital, Division of Pediatric Neurology, Izmir, Turkey; Mediterranean Ketogenic Diet Center, Izmir, Turkey
| | - Utku Uysal
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Nur Arslan
- Dokuz Eylul University, Division of Pediatric Metabolism and Nutrition, Izmir, Turkey.
| |
Collapse
|
35
|
Cannataro R, Perri M, Gallelli L, Caroleo MC, De Sarro G, Cione E. Ketogenic Diet Acts on Body Remodeling and MicroRNAs Expression Profile. Microrna 2019; 8:116-126. [PMID: 30474543 DOI: 10.2174/2211536608666181126093903] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/18/2018] [Accepted: 11/16/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND The Ketogenic Diet (KD) promotes metabolic changes and optimizes energy metabolism. It is unknown if microRNAs (miRs) are influenced by KD in obese subjects. The screening of circulating miRs was performed with the FDA approved platform n-counter flex and blood biochemical parameters were dosed by ADVIA 1800. OBJECTIVES The aim of this study was to evaluate mir profile under 6 weeks of biphasic KD in obese subjects. We enrolled 36 obese subjects (18 females and 18 males) in stage 1 of Edmonton Obesity Staging System (EOSS) parameter. RESULT Any correlation was found between biochemical parameter and three miRs, hsa-let-7b-5p, hsa-miR-143-3p and hsa-miR-504-5p influenced in an equal manner in both sexes. The KD resulted safe and ameliorate both biochemical and anthropometric factors in obese subjects re-collocating them into stage 0 of EOSS parameters. CONCLUSION The miRs herein identified under KD might be a useful tool to monitor low carbohydrate nutritional regimens which reflect indirectly the regulatory biochemical mechanisms and cell signaling that orchestrate metabolic and signaling pathways.
Collapse
Affiliation(s)
- Roberto Cannataro
- GalaScreen SRL, Department of Pharmacy Health and Nutritional Sciences, University of Calabria, Via Savinio, Edificio Polifunzionale, 87036 Rende (CS), Italy
| | - Mariarita Perri
- GalaScreen SRL, Department of Pharmacy Health and Nutritional Sciences, University of Calabria, Via Savinio, Edificio Polifunzionale, 87036 Rende (CS), Italy
| | - Luca Gallelli
- Department of Health Sciences, University of Magna Graecia, Via Venuta Germaneto, 88100 Catanzaro, Italy
| | - Maria Cristina Caroleo
- Department of Pharmacy Health and Nutritional Sciences, University of Calabria, Via Savinio, Edificio Polifunzionale, 87036 Rende (CS), Italy
| | - Giovambattista De Sarro
- Department of Health Sciences, University of Magna Graecia, Via Venuta Germaneto, 88100 Catanzaro, Italy
| | - Erika Cione
- Department of Pharmacy Health and Nutritional Sciences, University of Calabria, Via Savinio, Edificio Polifunzionale, 87036 Rende (CS), Italy
| |
Collapse
|
36
|
Pfützner A, Klonoff D, Heinemann L, Ejskjaer N, Pickup J. Euglycemic ketosis in patients with type 2 diabetes on SGLT2-inhibitor therapy-an emerging problem and solutions offered by diabetes technology. Endocrine 2017; 56:212-216. [PMID: 28303514 DOI: 10.1007/s12020-017-1264-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/06/2017] [Indexed: 01/24/2023]
Abstract
Diabetic ketoacidosis is an infrequent but life-threatening acute complication of diabetes, affecting predominantly patients with type 1 diabetes, children, and pregnant women, where ketosis is usually associated with marked hyperglycemia. Recently, an increasing number of cases have been reported of euglycemic diabetic ketoacidosis in patients with type 2 diabetes receiving sodium-glucose cotransporter 2 inhibitor treatment in routine practice. There is a minor, but not negligible diabetic ketoacidosis risk associated with this drug class, which was not seen in randomized clinical trials. However, sodium-glucose cotransporter2 inhibitors increase the risk of ketosis by increasing glucagon secretion in the pancreas and decreasing the renal excretion of 3-hydroxybutyrate and acetoacetate. When used in addition to insulin, any insulin dose reduction required to avoid hypoglycemia may lead to insufficient suppression of lipolysis and ketogenesis. sodium-glucose cotransporter2 inhibitor-induced loss of urinary glucose encourages euglycemia. Normo-glycemic or near-normoglycemic diabetic ketoacidosis represents a major threat to the health and well-being of a patient, because it may occur undetected and without any indicative hyperglycemia. In consequence, patients on sodium-glucose cotransporter2 inhibitors are recommended to perform regular blood ketone tests since they are not alerted to incipient diabetic ketoacidosis by glucose testing alone. This option is offered by several blood glucose meters that can also measure ketones with a separate ketone strip or in one case by an automatic parallel ketone assessment from the same strip. The need for extra testing and the associated costs may be a barrier to patient acceptance of this risk mitigation procedure. However, patients who are at risk for euglycemic diabetic ketoacidosis when being treated with sodium-glucose cotransporter2 inhibitors should be specially advised to monitor blood ketone levels on a regular basis.
Collapse
Affiliation(s)
- A Pfützner
- Pfützner Science & Health Institute, Mainz, UK.
| | - D Klonoff
- Mills Peninsula Healthcare Services, San Mateo, USA
| | | | - N Ejskjaer
- Department of Endocrinology, Clinical Institute, Aalborg University, Aalborg University Hospital, Aalborg, UK
| | - J Pickup
- Division of Diabetes and Nutritional Sciences, King's College London, Guy's Hospital, London, UK
| |
Collapse
|
37
|
Urbain P, Strom L, Morawski L, Wehrle A, Deibert P, Bertz H. Impact of a 6-week non-energy-restricted ketogenic diet on physical fitness, body composition and biochemical parameters in healthy adults. Nutr Metab (Lond) 2017; 14:17. [PMID: 28239404 PMCID: PMC5319032 DOI: 10.1186/s12986-017-0175-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/16/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The ketogenic diet (KD) is a very low-carbohydrate, high-fat and adequate-protein diet that without limiting calories induces different metabolic adaptations, eg, increased levels of circulating ketone bodies and a shift to lipid metabolism. Our objective was to assess the impact of a 6-week non-energy-restricted KD in healthy adults beyond cohorts of athletes on physical performance, body composition, and blood parameters. METHODS Our single arm, before-and-after comparison study consisted of a 6-week KD with a previous preparation period including detailed instructions during classes and individual counselling by a dietitian. Compliance with the dietary regimen was monitored by measuring urinary ketones daily, and 7-day food records. All tests were performed after an overnight fast: cardiopulmonary exercise testing via cycle sprioergometry, blood samples, body composition, indirect calorimetry, handgrip strength, and questionnaires addressing complaints and physical sensations. RESULTS Forty-two subjects aged 37 ± 12 years with a BMI of 23.9 ± 3.1 kg/m2 completed the study. Urinary ketosis was detectable on 97% of the days, revealing very good compliance with the KD. Mean energy intake during the study did not change from the habitual diet and 71.6, 20.9, and 7.7% of total energy intake were from fat, protein, and carbohydrates, respectively. Weight loss was -2.0 ± 1.9 kg (P < 0.001) with equal losses of fat-free and fat mass. VO2peak and peak power decreased from 2.55 ± 0.68 l/min to 2.49 ± 0.69 l/min by 2.4% (P = 0.023) and from 241 ± 57 W to 231 ± 57 W by 4.1% (P < 0.001), respectively, whereas, handgrip strength rose slightly from 40.1 ± 8.8 to 41.0 ± 9.1 kg by 2.5% (P = 0.047). The blood lipids TG and HDL-C remained unchanged, whereas total cholesterol and LDL-C increased significantly by 4.7 and 10.7%, respectively. Glucose, insulin, and IGF-1 dropped significantly by 3.0, 22.2 and 20.2%, respectively. CONCLUSIONS We detected a mildly negative impact from this 6-week non-energy-restricted KD on physical performance (endurance capacity, peak power and faster exhaustion). Our findings lead us to assume that a KD does not impact physical fitness in a clinically relevant manner that would impair activities of daily living and aerobic training. However, a KD may be a matter of concern in competitive athletes. TRIAL REGISTRATION DRKS00009605, registered 08 January 2016.
Collapse
Affiliation(s)
- Paul Urbain
- Department of Medicine I, Section of Clinical Nutrition and Dietetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr 55, 79106 Freiburg, Germany
| | - Lena Strom
- Department of Medicine I, Section of Clinical Nutrition and Dietetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr 55, 79106 Freiburg, Germany.,Institute of Agricultural and Nutritional Sciences, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Lena Morawski
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Anja Wehrle
- Institute for Exercise- und Occupational Medicine, Center for Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Deibert
- Institute for Exercise- und Occupational Medicine, Center for Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hartmut Bertz
- Department of Medicine I, Section of Clinical Nutrition and Dietetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr 55, 79106 Freiburg, Germany.,Department of Medicine I, Hematology, Oncology and Stem Cell Transplantation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|