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Falkenhain K, Oliveira BF, Islam H, Neudorf H, Cen HH, Johnson JD, Madden K, Singer J, Walsh JJ, Little JP. The effect of acute and 14-day exogenous ketone supplementation on glycemic control in adults with type 2 diabetes: two randomized controlled trials. Am J Physiol Endocrinol Metab 2024; 326:E61-E72. [PMID: 37991451 DOI: 10.1152/ajpendo.00332.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/02/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023]
Abstract
Acute ingestion of the exogenous ketone monoester supplement [(R)-3-hydroxybutyl-(R)-3-hydroxybutyrate] lowers blood glucose, suggesting therapeutic potential in individuals with impaired glucose metabolism. However, it is unknown how acute or repeated ingestion of exogenous ketones affects blood glucose control in individuals with type 2 diabetes (T2D). We conducted two randomized, counterbalanced, double-blind, placebo-controlled crossover trials to determine if 1) acute exogenous ketone monoester (0.3 g/kg body mass; N = 18) or 2) 14-day thrice daily premeal exogenous ketone monoester (15 g; N = 15) supplementation could lower blood glucose in individuals living with T2D. A single dose of the ketone monoester supplement elevated blood β-OHB to ∼2 mM. There were no differences in the primary outcomes of plasma glucose concentration (acutely) or serum fructosamine (glycemic control across 14 days) between conditions. Ketone monoester ingestion acutely increased insulin and lowered nonesterified fatty acid concentrations; plasma metabolomics confirmed a reduction in multiple free fatty acids species and select gluconeogenic amino acids. In contrast, no changes were observed in fasting metabolic outcomes following 14 days of supplementation. In the context of these randomized controlled trials, acute or repeated ketone monoester ingestion in adults with T2D did not lower blood glucose when consumed acutely in a fasted state and did not improve glycemic control following thrice daily premeal ingestion across 14 days. Future studies exploring the mechanistic basis for the (lack of) glucose-lowering effect of exogenous ketone supplementation in T2D and other populations are warranted.NEW & NOTEWORTHY Exogenous ketone supplements can acutely lower blood glucose, suggesting therapeutic potential in individuals with impaired glucose metabolism. However, the effect of exogenous ketones on glucose metabolism in adults with type 2 diabetes has not been investigated in a controlled setting. In adults with type 2 diabetes, ketone monoester ingestion did not lower blood glucose acutely in a fasted state and did not improve glycemic control across thrice daily premeal ingestion across 14 days.
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Affiliation(s)
- Kaja Falkenhain
- Faculty of Health and Social Development, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Barbara F Oliveira
- Faculty of Health and Social Development, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Hashim Islam
- Faculty of Health and Social Development, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Helena Neudorf
- Faculty of Health and Social Development, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Haoning H Cen
- Department of Cellular & Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - James D Johnson
- Department of Cellular & Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth Madden
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Singer
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeremy J Walsh
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan P Little
- Faculty of Health and Social Development, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
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Oliveira BF, Chang CR, Oetsch K, Falkenhain K, Crampton K, Stork M, Hoonjan M, Elliott T, Francois ME, Little JP. Impact of a low-carbohydrate versus low-fat breakfast on blood glucose control in type 2 diabetes: a randomized trial. Am J Clin Nutr 2023:S0002-9165(23)48890-9. [PMID: 37257563 DOI: 10.1016/j.ajcnut.2023.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND In type 2 diabetes (T2D), consuming carbohydrates results in a rapid and large increase in blood glucose, particularly in the morning when glucose intolerance is highest. OBJECTIVE We investigated if a low-carbohydrate (LC) breakfast (∼465kcal: 25g protein, 8g carbohydrates, 37g fat) could improve glucose control in people with type 2 diabetes when compared to a low-fat control (CTL) breakfast (∼450kcal:20g protein, 56g carbohydrates, 15g fat). METHODS Participants with T2D (N=121, 53% female, mean age 64 years) completed a remote 3-month parallel-group randomized controlled trial comparing a LC versus standard low-fat guideline CTL breakfast. Change in hemoglobin A1c (HbA1c) was the pre-specified primary outcome. Continuous glucose monitoring, self-reported anthropometrics and dietary information were collected for an intention-to-treat analysis. RESULTS HbA1c was reduced (-0.3%, 95% CI: -0.4% to -0.1%) after 12 weeks of a LC breakfast, but the between group difference in HbA1c was of borderline statistical significance (-0.2, 95% CI: -0.4 to 0.0; P=0.06). Self-reported total daily energy (-242 kcal, 95% CI -460 to -24 kcal; P=0.03) and carbohydrate (-73g, 95% CI: -101 to -44 g; P<0.01) intake were lower in the LC group but the significance of this difference is unclear. Mean and maximum glucose, area under the curve, glycemic variability, standard deviation, and time above range were all significantly lower, and time in range was significantly higher, in the LC group compared to CTL (all P<0.05). CONCLUSIONS Advice and guidance to consume a LC breakfast appears to be a simple dietary strategy to reduce overall energy and carbohydrate intake and improve several CGM variables when compared to a CTL breakfast in persons living with T2D. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04550468.
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Affiliation(s)
- Barbara F Oliveira
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada (BFO, KF, KC, MS, JPL)
| | - Courtney R Chang
- School of Medical, Indigenous and Health and Sciences, University of Wollongong, Wollongong, NSW, Australia (CRC, KO, MEF); Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia (CRC, KO, MEF)
| | - Kate Oetsch
- School of Medical, Indigenous and Health and Sciences, University of Wollongong, Wollongong, NSW, Australia (CRC, KO, MEF); Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia (CRC, KO, MEF)
| | - Kaja Falkenhain
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada (BFO, KF, KC, MS, JPL)
| | - Kara Crampton
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada (BFO, KF, KC, MS, JPL)
| | - Matthew Stork
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada (BFO, KF, KC, MS, JPL)
| | | | - Thomas Elliott
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (TE)
| | - Monique E Francois
- School of Medical, Indigenous and Health and Sciences, University of Wollongong, Wollongong, NSW, Australia (CRC, KO, MEF); Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia (CRC, KO, MEF)
| | - Jonathan P Little
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada (BFO, KF, KC, MS, JPL).
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Avelino PP, Bazeia D, Losano L, Menezes J, Oliveira BF. Junctions and spiral patterns in generalized rock-paper-scissors models. Phys Rev E Stat Nonlin Soft Matter Phys 2012; 86:036112. [PMID: 23030985 DOI: 10.1103/physreve.86.036112] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 07/16/2012] [Indexed: 06/01/2023]
Abstract
We investigate the population dynamics in generalized rock-paper-scissors models with an arbitrary number of species N. We show that spiral patterns with N arms may develop both for odd and even N, in particular in models where a bidirectional predation interaction of equal strength between all species is modified to include one N-cyclic predator-prey rule. While the former case gives rise to an interface network with Y-type junctions obeying the scaling law L∝t1/2, where L is the characteristic length of the network and t is the time, the latter can lead to a population network with N-armed spiral patterns, having a roughly constant characteristic length scale. We explicitly demonstrate the connection between interface junctions and spiral patterns in these models and compute the corresponding scaling laws. This work significantly extends the results of previous studies of population dynamics and could have profound implications for the understanding of biological complexity in systems with a large number of species.
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Affiliation(s)
- P P Avelino
- Centro de Astrofísica da Universidade do Porto, Rua das Estrelas, 4150-762 Porto, Portugal
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Sabadin PK, Malosetti M, Boer MP, Tardin FD, Santos FG, Guimarães CT, Gomide RL, Andrade CLT, Albuquerque PEP, Caniato FF, Mollinari M, Margarido GRA, Oliveira BF, Schaffert RE, Garcia AAF, van Eeuwijk FA, Magalhaes JV. Studying the genetic basis of drought tolerance in sorghum by managed stress trials and adjustments for phenological and plant height differences. Theor Appl Genet 2012; 124:1389-402. [PMID: 22297563 DOI: 10.1007/s00122-012-1795-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 01/05/2012] [Indexed: 05/25/2023]
Abstract
Managed environments in the form of well watered and water stressed trials were performed to study the genetic basis of grain yield and stay green in sorghum with the objective of validating previously detected QTL. As variations in phenology and plant height may influence QTL detection for the target traits, QTL for flowering time and plant height were introduced as cofactors in QTL analyses for yield and stay green. All but one of the flowering time QTL were detected near yield and stay green QTL. Similar co-localization was observed for two plant height QTL. QTL analysis for yield, using flowering time/plant height cofactors, led to yield QTL on chromosomes 2, 3, 6, 8 and 10. For stay green, QTL on chromosomes 3, 4, 8 and 10 were not related to differences in flowering time/plant height. The physical positions for markers in QTL regions projected on the sorghum genome suggest that the previously detected plant height QTL, Sb-HT9-1, and Dw2, in addition to the maturity gene, Ma5, had a major confounding impact on the expression of yield and stay green QTL. Co-localization between an apparently novel stay green QTL and a yield QTL on chromosome 3 suggests there is potential for indirect selection based on stay green to improve drought tolerance in sorghum. Our QTL study was carried out with a moderately sized population and spanned a limited geographic range, but still the results strongly emphasize the necessity of corrections for phenology in QTL mapping for drought tolerance traits in sorghum.
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Affiliation(s)
- P K Sabadin
- Embrapa Maize and Sorghum, Rod. MG 424, Km 65, Sete Lagoas, MG 35701-970, Brazil
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Abstract
The aging of organisms is characterized by a gradual functional decline of all organ systems. An appropriate theory must explain four main characteristics of aging: it is progressive, endogenous, irreversible, and deleterious for the individual. The aging of the immune system, or immunosenescence, is manifested by an increased susceptibility to infections with increased morbidity and mortality. Phagocytic capacity, synthesis of reactive oxygen intermediaries, and the intracellular killing efficiency of neutrophils are impaired in the elderly. Among all aging theories, the most updated one describes the free radicals. It implies that progressive aging is associated with higher levels of oxidative biomolecules reacted with free radicals. Although reactive oxygen species (ROS) are predominantly implicated in causing cell damage, they also play a major physiological role in several aspects of intracellular signaling and regulation. ROS include a number of chemically reactive molecules derived from oxygen. Not only oxygen, but also nitrogen can be deleterious species. The overproduction of reactive nitrogen species (RNS) is called nitrosative stress. ROS/RNS are known to play a dual role in biological systems since they can be either harmful or beneficial to living systems.
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Affiliation(s)
- Barbara F Oliveira
- 1Biochemistry of Aging and Correlated Diseases, Biochemistry and Immunology Department, Biological Sciences Institute, Federal University of Minas Gerais, and Santa Casa Hospital of Belo Horizonte, MG, Brazil.
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