User:Jdlambert/sandbox

Proposed title: Ketogenic diets

A ketogenic diet is any diet that is low enough in carbohydrates to cause the body to change from a state of glycolysis to a sustained state of ketosis. The state of ketosis fuels the body's cells primarily by fatty acids and ketones in addition to the reduced amounts of glucose. Consumption of dietary fat is increased to compensate for the reduced consumption of carbohydrates, while maintaining protein levels, and are therefore often referred to as High-Fat, Adequate-Protein, Low-Carb diets.

Every ketogenic diet is a low-carb diet because the level of carbohydrates has to be low enough for the liver to begin producing substantial amounts of ketones, but not every low-carb diet is a ketogenic diet because the level of carbs might be lower than usual, but not low enough to induce ketosis, and there are some less common reasons that even a very-low carb diet might not be ketogenic. Most no-carb diets are ketogenic diets because the liver manufactures only the glucose needed using the process of gluconeogenesis, getting the necessary components from fatty acids and proteins. Every ketogenic diet is a high-fat diet because the loss of carbohydrate calories must be made up fats. If the lost carb calories were made up by consuming extra proteins instead of extra fats, gluconeogenesis could increase enough to drop ketone production below the threshold of ketosis. Not every high-fat diet is ketogenic, because it may still include too many carbohydrates to induce ketosis.

Total calories in a ketogenic diet may be high enough to gain weight, low enough to lose weight, or just enough to sustain weight.

Ketogenic diets are used to improve athletic performance, especially in endurance sports, to improve general health, such as improved mitochondrial metabolism, the treatment of epilepsy, the treatment of diabetes, weight loss, and is being investigated as potential treatment for variety of other medical issues, including cancer and neurodegenerative diseases such as Alzheimer's.

The term ketogenic is derived from the word ketone, which in turn is derived from Aketon, an old German word for acetone. Acetone is one of the forms of ketone bodies produced by ketosis.

History
Ancient diets

Aboriginal diets

Initial scientific assessments

Success in treating epilepsy

William Harvey
Inspiration to Banting

William Banting
In 1863, Banting wrote a booklet called Letter on Corpulence, Addressed to the Public which contained the particular plan for the diet he followed. It was written as an open letter in the form of a personal testimonial. Banting accounted all of his unsuccessful fasts, diets, spa and exercise regimes in his past, then described the dietary change which finally had worked for him, following the advice of a physician. His own diet was four meals per day, consisting of meat, greens, fruits, and dry wine. The emphasis was on avoiding sugar, saccharine matter, starch, beer, milk and butter. Banting’s pamphlet was popular for years to come, and would be used as a model for modern diets. Banting's booklet remains in print as of 2007.

Elliott P. Joslin
In 1916 Elliot P. Joslin wrote The Treatment of Diabetes Mellitus and in 1918  Diabetic Manual — for the Doctor and Patien, these books described a ketogenic diet used to treat Diabetics before the invention of insulin in 1922. The diet contains only about 10 grams of carb per day. 

A.W. Pennington
In 1953 A.W. Pennington published a paper in The American Journal of Clinical Nutrition describing a diet for treatement of obesity limiting carbohydrates so much that ketogenesis occurs. The abstract of the paper read. "Restriction of carbohydrate, alone, appears to make possible the treatment of obesity on a calorically unrestricted diet composed chiefly of protein and fat. The limiting factor on appetite, necessary to any treatment of obesity, appears to be provided by increased mobilization and utilization of fat, in conjunction with the homeostatic forces which normally regulate the appetite. Ketogensis appears to be a key factor in the increased utilization of fat. Treatment of obesity by this method appears to avoid the decline in the metabolism encountered in treatment by caloric restriction. Details of diet and regimen are given."



Atkins
Dr. Atkins partial use of keto for easy, sustainable weight loss; Atkins diet popularity increase and decline

Revival of use for epilepsy
Increased scientific studies on keto diets for weight loss, athletic performance, general health, and many diseases.

Increased generalized popularity of keto

Ketosis
see-also link to ketosis article

Ketosis is defined as ketonemia or ketonuria. induced ketosis gluconeogenesis

ketone bodies, a form of sugar derived from fatty acids rather than from carbohydrates

Adjustment period
weeks, effects keto-flu, treatments

Metabolic changes
Pancreas, eg insulin Liver, eg gluconeogenesis Kidneys, eg flushing salts faster Mitochondria, eg energy

Measurements
urine testing, blood testing

net carbs note that in Europe, nutrition labels include total carbs with fiber carbs already subtracted, so you can see a label that shows 1 g total carb while showing 2 g fiber

Other diseases
investigations into other medical issues

Dementia
Dietary ketosis enhances memory in mild cognitive impairment. ''Abstract: We randomly assigned 23 older adults with mild cognitive impairment to either a high carbohydrate or very low carbohydrate diet. Following the 6-week intervention period, we observed improved verbal memory performance for the low carbohydrate subjects (p = 0.01) as well as reductions in weight (p < 0.0001), waist circumference (p < 0.0001), fasting glucose (p = 0.009), and fasting insulin (p = 0.005). Level of depressive symptoms was not affected. Change in calorie intake, insulin level, and weight were not correlated with memory performance for the entire sample, although a trend toward a moderate relationship between insulin and memory was observed within the low carbohydrate group. Ketone levels were positively correlated with memory performance (p = 0.04). These findings indicate that very low carbohydrate consumption, even in the short term, can improve memory function in older adults with increased risk for Alzheimer's disease. While this effect may be attributable in part to correction of hyperinsulinemia, other mechanisms associated with ketosis such as reduced inflammation and enhanced energy metabolism also may have contributed to improved neurocognitive function. Further investigation of this intervention is warranted to evaluate its preventive potential and mechanisms of action in the context of early neurodegeneration.''

Cancer
From "Is There a Role for Carbohydrate Restriction in the Treatment and Prevention of Cancer?" Over the last years, evidence has accumulated suggesting that by systematically reducing the amount of dietary carbohydrates (CHOs) one could suppress, or at least delay, the emergence of cancer, and that proliferation of already existing tumor cells could be slowed down. This hypothesis is supported by the association between modern chronic diseases like the metabolic syndrome and the risk of developing or dying from cancer. CHOs or glucose, to which more complex carbohydrates are ultimately digested, can have direct and indirect effects on tumor cell proliferation: first, contrary to normal cells, most malignant cells depend on steady glucose availability in the blood for their energy and biomass generating demands and are not able to metabolize significant amounts of fatty acids or ketone bodies due to mitochondrial dysfunction. Second, high insulin and insulin-like growth factor (IGF)-1 levels resulting from chronic ingestion of CHO-rich Western diet meals, can directly promote tumor cell proliferation via the insulin/IGF1 signaling pathway. Third, ketone bodies that are elevated when insulin and blood glucose levels are low, have been found to negatively affect proliferation of different malignant cells in vitro or not to be usable by tumor cells for metabolic demands, and a multitude of mouse models have shown antitumorigenic properties of very low CHO ketogenic diets. In addition, many cancer patients exhibit an altered glucose metabolism characterized by insulin resistance and may profit from an increased protein and fat intake.

Weight loss
On a ketogenic diet, the proportions of what kinds of food you eat is not the only change, and for many people using keto for weight loss, there is a major difference in how easy it is to reduce your total calories compared to many other types of diets. That's because for many people on a ketogenic diet, their tastes change -- the desire for breads and other grains and the desire for sugars goes down, and cravings for high-carbohydrate foods can even stop entirely, while enjoyment of high-fat foods often increases. And one of the biggest advantages of keto for weight-loss is that fats and proteins are very filling, so people tend to eat less because they are less hungry.

Dr. Robert Atkins's quest for a pleasant, sustainable diet for weight loss and weight maintenance resulted in the Atkins Diet, in four phases, the first of which is a ketogenic diet.

There are over 130,000 subscriber's to the Reddit /r/keto subthread, with most participants using the thread to discuss and promote using ketogenic diets to lose weight.

Macro nutrients
daily grams of net carbs

.7 to .9 grams of protein per pound of body weight remainder of calories from fats, high in saturated and monounsaturated fats while still getting adequate polyunsaturated. Ideal ranges of each type of dietary fat has yet to be scientifically determined, but adipose tissue (body fat) is approximately 55% monounsaturated, 27% saturated, and 18% polyunsaturated.

Micro nutrients
All vitamins & minerals HFLC causes the body to flush salts faster, so greater salt intake is needed to keep up. Instead of lowering salt to equal deficient levels of potassium, increase potassium to equal robust levels of salt.

Dietary supplements
Potassium limited to 99 mg in USA, European version of FDA says there is no risk of adverse affects from 3g of potassium supplement per day.

Ketogenic food examples
meats fish diary vegetables creative alternatives to favorite high-carb foods

Foods avoided
Any types of carbs can reduce the level of ketones produced while in ketosis if the total carbs are high enough.

Sugars Grains (including all forms of bread) Alcohol, small amounts of low-carb alcohols can be consumed without stopping ketosis

Myths
Some common myths about ketogenic diets are perpetuated by some dieticians, other nutrition experts, or doctors. Many of these myths apply equally to other form of low-carbohydrate diets.

LDL count as a risk for heart disease when it is the size of the LDL particles that determines the risk, with ketogenic diets increases average LDL size, thereby reducing heart disease risk.

ketosis vs. ketoacidosis

For next 10, see http://authoritynutrition.com/10-things-dietitians-say-about-low-carb-diets/ for info and references: Ketogenic diets are hard to stick to Ketogenic Diets Exclude Food Groups That Are Essential Ketogenic Diets Lead to a State Known as Ketosis, Which Causes Harm Ketogenic Diets Are High in Saturated Fat and Therefore Dangerous Ketogenic Diets Are Not Proven to be Safe in The Long Term Most of The Weight Loss on Ketogenic Diets is Water Weight Ketogenic Diets Lead to Deficiencies in Vital Nutrients Ketogenic Diets Don’t Supply Carbs That The Brain Needs to Function Ketogenic Diets Raise Your Risk of Heart Disease Ketogenic Diets Are Not Proven to Work

Controversies
Confusing "high" fat diet studies with ketogenic studies when the so-called high-fat diets allow too many carbs to induce ketosis or do not conduct the study long enough for the 2–4 weeks necessary for the body to fully switch from glycolysis to ketosis.

Doctor supervision required