Metabolic Health Summit

In a crossover randomized trial, exogenous ketones improved glucose tolerance during an oral glucose tolerance test (OGTT). An OGTT is used to measure an individual’s response to glucose, which represents how well we can take in glucose from our blood, and is indicative of how well we metabolize sugar or carbohydrates in our diet. This can be used to diagnose disorders of carbohydrate metabolism such as diabetes and insulin resistance. In short, the procedure involves measuri...ng a patient’s fasting blood glucose before consuming a glucose load (75 grams was used in this study), followed by additional blood glucose measurements to see how long it takes for levels to return to normal. In this study, blood glucose was tested every 15 minutes over a three hour period. Nine adults with impaired glucose tolerance underwent an OGTT with or without the ingestion of exogenous ketones on two separate occasions. When participants consumed the ketone supplement, blood ketones rose to an average maximum of 2.4 mmol/L at 90 minutes. The ketone supplement drink also significantly reduced blood glucose levels compared to control. Interestingly, the researchers found the ketone supplement increased insulin secretion during the first half of the OGTT. While excess insulin secretion is detrimental over time, remember that just like glucose, insulin is a normal and important component of our metabolism and physiology. In fact, individuals with impaired glucose tolerance often have decreased early phase insulin secretion. This insulin is an important signal to the liver to stop producing its own glucose. Without an appropriate early phase insulin response, glucose consumed through food (or drink) in addition to the glucose that your liver is producing in the fasted state, can result in postprandial hyperglycemia. The authors suggest that the enhancement in insulin levels and insulin secretion caused by the ketone supplement may be a possible mechanism for why it improved OGTT results. Of course, this was a small trial, but these findings are certainly interesting and add to our increasing understanding of why exogenous ketones may help manage blood glucose levels. To learn more visit: https://onlinelibrary.wiley.com/doi/pdf/10.1111/jdi.13423

A 2018 review, entitled Ketogenic diet as a metabolic therapy for mood disorders: Evidence and developments, provides evidence to suggest that it just might! Since its inception as an anticonvulsant therapy for epilepsy, scientists have been exploring how the ketogenic diet affects the brain and whether it can help other neurological conditions, such as mood disorders. Mood disorders fall within the category of chronic mental illnesses and include conditions such as major d...epressive disorder and bipolar disorder. Despite their prevalence and advancements in biological psychiatry, current treatment options are met with several barriers, including high rates of treatment resistance. Through changes in brain energy metabolism, antioxidant status, and its effects on neurotransmitters, research suggests that ketosis represents a novel potential treatment against several underlying features of mood disorders. Specifically, ketosis may stabilize the neurotransmitters GABA and glutamate, both of which are altered in several mental disorders. Ketosis encourages increased GABA (calming neurotransmitter) to glutamate (excitatory neurotransmitter), which may have anti-anxiety effects. Ketosis can also support the health and function of our mitochondria which has widespread effects on brain function. Interestingly, mitochondrial dysfunction is observed in animal models of depression and post mortem brain samples in those with mood disorders. In addition to these effects, ketosis may reduce oxidative stress, insulin dysfunction, and inflammation - all of which are related to mood disorders. In regard to human findings, evidence from preclinical trials and case reports have reported antidepressant and mood-stabilizing effects of ketogenic diets. Based on the available data, ketogenic diets can be considered a promising possible intervention for mood disorder treatments, though more research is needed. Learn more here: https://pubmed.ncbi.nlm.nih.gov/30075165/

Did you know that burning ketones can provide antioxidants to our cells!? Our cells are constantly generating free radicals that are swept up by our body’s antioxidants, like glutathione. When free radicals exceed the capacity of antioxidants to manage, that’s when problems arise because the accumulation of free radicals can contribute to cell damage. This is referred to as oxidative stress. Interestingly, the way ketone bodies interact with our mitochondria may increase leve...ls of glutathione, meaning more defense against free radicals, therefore reduced risk of cell damage. This can be taken a step further when we consider that the metabolism of ketone bodies produces less free radicals in the first place - double the protection! So, while you can get antioxidants from your foods, like vitamin C in fruits and vegetables, or even take them as a supplement, the ingestion of such compounds may not actually have the effect we would hope for as far as scavenging free radicals go, and improving our cells innate antioxidant capabilities may be a better strategy. In mice, the theory that ketosis may reduce free radical damage was put to the test by administering exogenous ketones 24 hours after being exposed to radiation - a method of generating free radicals. The treatment led to a 50% decrease in markers of radiation-induced cell damage; damage that would otherwise be toxic to our cells. Since the accumulation of free radicals plays a central role in accelerated aging and is a component of several, if not all, metabolic diseases, finding ways to reduce or mitigate their damaging effects is an area of research being explored. Evidence suggests that through the decreased generation of free radicals and increase in glutathione, ketosis may be a strategy for protecting us against the damaging effects of excess free radicals.

Did you know that fasting is one of the most ancient healing practices known to humans? It has quite a long and impressive history! In ancient Greece, fasting was used for spiritual practices. Ancient religious texts include stories on the benefits of fasting for the mind and spirit, and many religions still engage in fasting today as part of religious practice. It wasn’t until the end of the 19th century that scientists began investigating what happens when a human stops eat...ing. There are reports in the 1800s of individuals fasting for up to 40 days. In the early 1900s, reports on the effects of fasting were documented extensively by early investigators, and throughout the 1900s the research continued to expand. While the influence of fasting on psychological well-being has been reported since antiquity, we are only now beginning to truly understand the therapeutic and health benefits of fasting. The most prominent observations on fasting went on to spur the development of the ketogenic diet in 1921, as fasting had been long known to quell epileptic seizures. It was thought that the starvation-induced ketone bodies were responsible for the anticonvulsant effect of fasting. We now know that this is only part of the story, as a multitude of mechanisms appears to be at play. Today, fasting is now being investigated for its therapeutic potential in obesity, type-2 diabetes, cancer treatments, polycystic ovarian syndrome (PCOS), Alzheimer’s disease, among other metabolic disorders. Research is revealing novel aspects of fasting that may have future therapeutic and clinical applications - often that overlap with the therapeutic potential of ketogenic diets! But keep in mind, fasting comes with its own set of caveats, and proper oversight by a nutritional medical professional is always important - especially when you have a medical condition.

Neurosurgeon, Dr. Kris Smith, says his brain cancer patients unfortunately often suffer from more than one health issue. Alongside standard of care, Dr. Smith often suggests that they try the ketogenic diet as an additional therapy. With this increased focus on lifestyle and overall health, he's found it can provide patients with both empowerment and improved quality of life. Dr. Smith graduated at the top of his class of 1989 from the University of Nevada, School of Medicine.... He distinguished himself in research during medical school by developing a new animal model of chronic epilepsy related to a cholesterol biosynthesis inhibitor. This led to his first of many peer-reviewed publications and presentations at local, national and international meetings regarding the basic understanding and treatment of medically refractory epilepsy. He was trained in state of the art neurosurgery at the renowned Barrow Neurological Institute in Phoenix, Arizona and graduated residency in 1996. He received subspecialty training in Gamma Knife radiosurgery at the University of Pittsburg and the Karolinska Institute in Stockholm. He also received specialty training in the surgical treatment of Epilepsy at the Cleveland Clinic. Throughout his career at BNI, he has been an early adopter of advanced neurosurgical techniques including stereotaxy, endoscopy, computer-image guidance, brain mapping, deep brain stimulation (DBS), stereo-EEG electrodes, laser interstitial thermal therapy (LITT) and radiosurgery. He has pioneered minimally invasive surgical approaches for epilepsy, glioma and skull base surgery which decreases patient discomfort and the risks of complications. He has numerous publications regarding brain tumor treatments and has been the principal investigator or co-author of numerous clinical trials. His current passion is to further the advancement of the use and understanding of metabolic and nutritional therapies in the treatment of brain cancers. His wife, Tracy, is a registered dietitian who specializes in the ketogenic diet and studies nutritional genomics and supports his patients in the nutritional supplementation of standard cancer treatments. Stay tuned for more great clips from The Charlie Foundation filmed at MHS 2020 by following #ketoexpertvideos!

With 1 in 8 women expected to be diagnosed with invasive breast cancer in their lifetime, we at Metabolic Health Summit are participating in Breast Cancer Awareness Month, an annual campaign to increase awareness of the disease. Breast cancer is known to be influenced by our genetic makeup, and while there are genetic factors that increase one’s risk of breast cancer, it’s also been suggested that up to 75% of cases are also a result of lifestyle factors. Epidemiological and ...mechanistic evidence points to the role of metabolic health in both prevention and survival outcomes in women with breast cancer. Data from the Women’s Health Initiative, which examined over 15,000 participants, identified a strong link between weight gain between the ages of 18 to 50, obesity, and increased risk of breast cancer. In addition, a higher mortality rate has been found among breast cancer patients with obesity and insulin resistance, suggesting a powerful metabolic component to breast cancer. Only within the last decade have metabolic therapies been heavily considered in breast cancer research, stemming from both purported benefits on weight loss and metabolic health, in addition to the observations that like most cancers, breast cancers demonstrate heightened glucose metabolism to meet their growth requirements. A 2020 randomized controlled trial (RCT) demonstrated the feasibility, safety, and beneficial effects of an MCT-based ketogenic diet for breast cancer treatment. The ketogenic diet combined with chemotherapy improved body composition and overall survival in breast cancer patients with no severe adverse side effects. In another study of breast cancer patients undergoing radiation therapy, a ketogenic diet led to fat loss while preserving muscle mass - an important factor to consider for cancer patients undergoing therapy. The research is still in its infancy and much more is needed to determine optimal protocols and prescriptions for metabolic-based therapies for breast cancer when it is appropriate. However, based on the hypotheses for ketogenic and metabolic therapies to target several underlying metabolic conditions associated with breast cancer survival, the research suggests that there is an opportunity for these types of interventions to improve the quality of life and outcomes in these patients. To learn more, click on the links below and please share this post to help us spread the word! https://pubmed.ncbi.nlm.nih.gov/32703721/ https://pubmed.ncbi.nlm.nih.gov/31496287/ https://etd.ohiolink.edu/pg_10

Psychiatrist and Harvard Medical School Assistant Professor of Psychiatry, Dr. Christoper Palmer, says most of his patients are on a ketogenic diet, especially those who are treatment resistant and suffering from a mental illness like depression. In this video, he further explains how using nutrition therapy often provides his patients with empowerment and hope in finding relief from their symptoms. While medications can save lives, Dr. Palmer says his many years of work in p...sychiatric care has made it clear that some people may need other options to thrive... and nutritional ketosis may help. He says that this idea resonates with his patients when he explains that many epilepsy medications are already being used for psychiatric illnesses, and that the ketogenic diet was first developed for epilepsy. His patients also like the idea of being able to contribute to their own medical care. Dr. Palmer is the director of the Department of Postgraduate and Continuing Education at McLean Hospital and an Assistant Professor of Psychiatry at Harvard Medical School. He is a psychiatrist working at the interface of metabolic and mental disorders in order to better understand the overlap between disorders like diabetes, obesity, heart disease, and mental illness. Dr. Palmer believes that this work may lead to a better understanding of what causes mental illness and how to provide more effective treatments. Dr. Palmer has been a practicing psychiatrist for 25 years now, in addition to doing research and teaching. His clinical practice has focused on treatment-resistant cases, and he says he is painfully aware of the shortcomings of our current approaches. In hopes of improving the state of care, Dr. Palmer is pioneering the use of the ketogenic diet in psychiatry. To learn more about Dr. Palmer's important work, please visit www.chrispalmermd.com. Please also stay tuned for more great clips from The Charlie Foundation filmed in partnership with MHS by following the hashtag #ketoexpertvideos.

How can a ketogenic diet be so therapeutic in so many different settings? From diabetes to Alzheimer’s, to cancer.. What’s the connection? Is there a unifying mechanism of action unique to ketosis? A recent paper suggests there might be! In this particular paper, the authors examine the link between metabolism and health, and the impact of ketogenic diets to uncover any common mechanisms that could explain why it might be applied to such a diverse range of conditions. What th...ey found was that ketosis increases the levels of NAD+, and thus alters our cells’ NAD+/NADH ratio. We know that sounds like a lot of science jargon, but let us explain! Nicotinamide adenine dinucleotide (NAD+) is a molecule that can be found in every single living cell of your body. Its fundamental role in numerous metabolic processes is critical to life itself. NAD exists in its oxidized form (NAD+) and reduced form (NADH). In order to produce energy from either glucose or ketones, we need NAD+, and once it’s used it’s reduced to NADH. The metabolism of glucose requires more NAD+ than that of ketone bodies. In theory, this means burning ketones may spare our cellular pool of NAD+. Why does this matter? Well for starters, this makes NAD+ more available for energy production. But NAD+ isn’t only involved in energy metabolism, it’s also used by our cells to express genes, to combat oxidative stress, to maintain calcium homeostasis, and repair cell damage, among other roles. Recently, improved NAD+ levels has been linked to anti-aging and longevity effects, which are suggested to be the result of enhanced mitochondrial function, as well as protection against oxidative stress, as NAD+ plays an intimate role in these processes. These same pathways are also involved in the development of metabolic diseases. This paper proposes that the alteration of the ratio of NAD+ to NADH when ketones are metabolized as a main source of energy is responsible in part for the antiseizure, neuroprotective, and disease-altering effects of ketogenic diets, since NAD+ is at the center of metabolic health and disease. To read more, visit this link: https://www.sciencedirect.com//a/abs/pii/S0920121120305192 https://pubmed.ncbi.nlm.nih.gov/23256455/

Did you know that low carbohydrate diets were the principal therapy for diabetes before the discovery of insulin? Before the discovery of insulin, the first approach to diabetes management was a low-carb diet. Both type-1 and type-2 diabetes are characterized by impaired carbohydrate metabolism and high blood sugar levels. Since high blood sugar is the most salient feature of diabetes, and dietary carbohydrates have the greatest effect on blood sugar levels, low carb diets we...re used to keep blood sugar levels stable and reduce the body’s insulin requirements. The discovery of insulin was a miracle for many, saving the lives of thousands of type 1 diabetic patients who are unable to produce any of this vital hormone on their own. Insulin therapy is also used sometimes in treating type 2 diabetic patients, whose bodies have stopped responding to normal levels of insulin because of insulin resistance. Nearly a century later, both patients and providers are looking to further improve quality of life and health outcomes by marrying these two strategies. Within the last few decades, a number of publications have demonstrated the impressive glycemic control that low-carb and often ketogenic diets can offer to diabetic patients. Virta Health is leading this revolution with a remote medical care service that is successfully treating type 2 diabetes patients with individualized nutrition therapy (the ketogenic diet). Even in type 1 diabetes, where transitioning to the use of low carbohydrate diets requires meticulous planning and often medical oversight, encouraging results from a survey study led Harvard researchers to strongly support further investigation into this therapeutic strategy. A few years ago, the American Diabetes Association released a consensus statement stating that low carbohydrate diets were an effective treatment option for patients with diabetes, opening the doors for many previously hesitant providers to begin utilizing such therapies in their practice. There remain a number of barriers and controversies to overcome before low carb diets will become fully accepted as a popular approach to diabetes management, but we are excited to see the progress being made!

Today is #WorldHeartDay and we at Metabolic Health Summit want to take this day as an opportunity to talk about how our metabolic health influences heart health. Considering that cardiovascular diseases (CVD) are responsible for 31% of all deaths globally, taking the lives of 17.9 million people each year, more awareness, preventative strategies, and treatments are desperately needed. These diseases manifest commonly as heart attacks and strokes, often brought on by smoking, ...poor diet, physical inactivity, and alcohol abuse. Such lifestyle habits promote high blood pressure, elevated blood sugar, insulin resistance, inflammation, and obesity - all factors that increase one's risk of heart complications. Our metabolic health is likely one of the best preventative strategies against heart disease - this means preventing the features and components of metabolic syndrome described above as risk factors. Indeed, those with metabolic syndrome (i.e., obesity and insulin resistance) are at an increased risk of coronary heart disease and heart attack. More recognition is being given to the role of chronic inflammation in cardiovascular diseases, triggered or at least exacerbated by metabolic syndrome. While elevated blood pressure & blood sugar, insulin resistance, inflammation, and obesity, all increase the risk of heart disease, we are excited that emerging research suggests well-formulated low carb ketogenic diets may help with all of these risk factors! Heart health and metabolic health are one in the same, and any diet and lifestyle that supports our metabolic health may reduce risk of heart disease

The ketogenic diet has been used as a metabolic therapy for epilepsy for nearly 100 years. Since its creation, ongoing research has shown us that nutrition and metabolic-based therapies may be a safe and effective treatment, not only for seizures, but for an increasing number of other health conditions too. So... why isn't the ketogenic diet more widely used as a line of defense against disease? In this video, Dr. Dominic D’Agostino describes the process of how ongoing resea...rch and its publication and presentation at medical conferences are key steps to its continued study, use, and acceptance in the medical community. Dominic D'Agostino, Ph.D. is an Associate Professor at the University of South Florida where he teaches students of the Morsani College of Medicine and the Department of Molecular Pharmacology and Physiology. He is also a Research Scientist at the Institute for Human and Machine Cognition (IHMC) to assist with their efforts towards optimizing the safety, health, and resilience of the warfighter and astronaut. The main focus of his lab over the last 10 years has been understanding the anticonvulsant and neuroprotective mechanism of the ketogenic diet and ketone metabolite supplementation. The shift in brain metabolism (from glucose to ketones) reduces neuronal hyperexcitability, oxidative stress, and enhances brain energy metabolism. This approach can be used to treat a wide variety of pathologies linked to metabolic dysregulation, including cancer. Other areas of interest include researching drugs that target cancer-specific metabolic pathways. He was a research investigator and crew member on NASA’s Extreme Environment Mission Operation (NEEMO 22) and has a personal interest in environmental medicine and methods to enhance safety and physiological resilience in extreme environments. His research is supported by the Office of Naval Research (ONR), Department of Defense (DoD), private organizations, and foundations. To learn more about Dr. D'Agostino, visit his website at www.ketonutrition.org. Be sure to also follow the hashtag #ketoexpertvideos, to see all of these great interviews filmed by Jim Abrahams of The Charlie Foundation at Metabolic Health Summit 2020!

While the Classic Ketogenic Diet remains the most well studied ketogenic therapy, throughout the last couple of decades, this diet has evolved to offer variations that induce nutritional ketosis while also improving patient compliance, tolerability, and mitigating some of the side effects associated with the classic ketogenic diet. This new spectrum of ketogenic diet therapies include macronutrient ratios that range from 4:1 to 1:1 of fats to protein plus carbohydrates (by ...weight), and the use of ketogenic agents such as medium chain triglycerides (MCTs) and exogenous ketone supplements (e.g., ketone esters and ketone salts). Collectively, these metabolic treatments are referred to as ketogenic metabolic therapies, and as the research continues to grow, so too does our understanding of how effective these treatments are and where they are best applied. This evolution of ketogenic metabolic therapies has expanded into several other areas of health and disease, most notably type-2 diabetes, cancer, and neurological disorders, and the evolving spectrum of ketogenic metabolic therapies continues to expand the application of nutritional ketosis. Certain modified versions of the ketogenic diet have been used in research, particularly epilepsy, and have proven to be effective at inducing a state of nutritional ketosis and eliciting a therapeutic response. Additionally, the use of ketone supplements is a rapidly growing area of research with a lot of promise. It is pretty neat to see how the ketogenic diet has evolved over the past century, and how the application of ketogenic metabolic therapies continues to grow.

Did you know that blood levels of leucine increase in the keto-adapted state? Muscle-building enthusiasts will probably understand that a primary driver of muscle protein synthesis (aka muscle growth) is the availability of the essential amino acids, especially leucine. It’s been shown that infusing ketone bodies (BHB) into healthy adults reduces nitrogen excretion during prolonged starvation (nitrogen excretion is used as a marker of protein breakdown), and increases circula...ting levels of the branched chain amino acids (BCAA), leucine, isoleucine, and valine. MHS speaker, Dr. Stephen Phinney, has shown that circulating BCAA levels rise with keto-adaptation in athletes, compared to high carbohydrate diets. BCAAs typically act as a fuel when the energy demand of exercise increases, however it appears that this is reduced in the presence of ketones. In one of Dr. Phinney’s follow up studies, he found that the higher level of circulating leucine was the result of it being used less as fuel. Altogether, research suggests that ketones spare the oxidation of leucine, increasing its availability to muscles, preventing muscle protein breakdown and supporting muscle growth in the ketotic state.