How Does a Ketogenic Diet Affect YOU? Part 2: A Deep Look Into Cortisol

by Katie Mark

Recent high hopes for high-fat diets have us further evaluating the ketogenic diet for a wider population. In this three-part series, we’re examining how the ketogenic diet affects biomarkers. Part 1 of this series investigated what ketosis does for fasting glucose and insulin. In Part 2, we look at how a ketogenic diet may affect cortisol levels.

High-fat…high cortisol…high stress?

Cortisol is considered the “stress hormone,” and it influences blood sugar levels, blood pressure, immune response, and stress response. Chronically elevated levels of circulating cortisol can hinder cognitive performance, disrupt sleep, impede immune function, increase abdominal fat, and cause blood sugar imbalances.

Studies have found that cortisol levels increase on a ketogenic diet, but some say the relationship between ketosis and high cortisol needs to be made clearer. First, chronically elevated cortisol correlates with metabolic syndrome, a group of symptoms such as high blood sugar, excess abdominal fat, and abnormal cholesterol levels that increase the risk for diabetes, heart disease, and cancer.

It seems possible that ketogenic diets may cause metabolic syndrome because higher cortisol levels suggest the onset of metabolic syndrome. However, this isn’t the whole picture: It’s also possible that there are multiple forms of cortisol, and their measurements mean different things.

Cortisol is measured in bodily fluids, including urine, saliva, and blood. Multiple forms of cortisol are measured from these samples: cortisone (the inactive form), free cortisol (the active form), and metabolites of cortisone and cortisol resulting from enzyme activity. Equally important, these levels of cortisol biomarkers can vary depending on the time of day.

A holistic understanding of cortisol metabolism relies on looking at the enzymes 11β-hydroxysteroid dehydrogenase (11β-HSD) and 11β-HSD1 (a subtype of 11β-HSD). 11β-HSD1 is found in every cell, but the highest amounts are found deep within fat cells. In fact, it does not matter if a person’s blood cortisol level is low, medium, or high because a highly active 11β-HSD1 will generate a high amount of cortisol inside cells.

Here is a breakdown of cortisol metabolism:

  • Production: 11β-HSD converts cortisol (active) to cortisone (inactive)
  • Regeneration: 11β-HSD1 converts cortisone to cortisol
  • Clearance: Other enzymes help metabolize cortisone and cortisol into metabolites

The cortisol profile of metabolic syndrome, which the ketogenic diet reverses, consists of:

  • High cortisol production
  • High cortisol clearance rates
  • High 11β-HSD1 expression in adipocytes and low 11β-HSD1 expression in the liver (the location that determines where and when cortisol is regenerated)

Now, let’s see how a 24-hour urine proxy is used for detecting cortisol. This proxy results in a less-than-clear picture because cortisol levels are affected by production, regeneration, and clearance. For instance, if clearance decreased or if regeneration increased, cortisol levels could go up if production stayed the same or lowered. This is analogous to simply measuring someone’s total cholesterol without observing LDL and HDL.

Take home message: levels may appear similar when there is a big difference in cortisol metabolism.

One study, published in The Journal of Clinical Endocrinology and Metabolism, used 17 obese men and randomly assigned them to an ad libitum (eat as much as you want) high fat-low carbohydrate (HF-LC) diet (66% fat, 4% carbohydrate) or moderate fat-moderate carbohydrate (MF-MC) diet (35% fat, 35% carbohydrate) for four weeks.

The study found a reversal of the previously described metabolic syndrome cortisol profile for only the HF-LC group: blood cortisol increased, clearance decreased and regeneration increased (due to an increase in 11β-HSD1 activity in the liver). According to the researchers, the ketogenic diet improved the cortisol profile because it was different from the cortisol profile seen in metabolic syndrome.

Furthermore, even though the MF-MC group lost a similar amount of weight, there was no change in 11β-HSD1 activity. This increase in 11β-HSD1 activity in the HF-LC group was independent of the differences in energy intake and weight loss because the same effect was seen in the controls.

A final component to note is that obesity is associated with high cortisol. However, the connection between obesity and elevated serum levels of cortisol has not always been a consistent connection.

Some people with high stress and lots of abdominal fat had normal or low levels of cortisol in their blood. Usually, chronically elevated levels of cortisol leads to increased adiposity; yet, there have been cases of people with high stress and high cortisol, but no obesity. And as we saw in “The Basics of the Ketogenic Diet,” the ketogenic diet has demonstrated effectiveness as a weight loss tool.

What’s the verdict?

We see that diet, especially a carbohydrate-restricted one such as the ketogenic diet, may increase certain forms of cortisol. But blood cortisol levels are only half the story—cortisol levels inside cells illustrate the other half. Also, cortisol will vary depending on the time of day, with levels highest in the morning. Caffeine, stress, and exercise can also increase cortisol levels.

Ultimately, further research is needed to better understand the connections as to why cortisol increases on a ketogenic diet and if cortisol levels are more affected by other variables, such as the activity of the 11β-HSD1 enzyme.

Katie Mark is a first year Nutrition Communication student from Miami, Florida. Due to Boston’s Snowpocalypse, she does not foresee herself living in Boston in the future, so she will return to South Beach following graduation.

How to Become an Expert Gum Taster: My Experience as a Sensory Scientist at Wm. Wrigley Jr. Company

by Disha Gandhi

Warning: the following article requires active participation. Please have 1-2 pieces of gum at your side prior to reading.

The multibillion-dollar food industry provides us with all of the calories and food products we desire. But who within the food industry conceptualizes the vast variety of foods available? Who develops the recipes, evaluates consumer response, and assesses the quality? Food scientists, that’s who.

Prior to working as a food sensory scientist at the Wm. Wrigley Jr. Company, I completed my undergraduate degree in Food Science at the University of Illinois. In fact, most graduates within my program went on to work throughout the food industry. But when we learn about optimal nutrition at the Friedman School, the food industry, creating products for profit, is often positioned as at odds with a healthy diet.

We learn about reducing sodium intake, avoiding processed foods, and returning to the way our grandparents ate. It may seem like food scientists are the monsters that invented and feed the obesity and diabetes epidemics. Though we can argue that this notion seems pretty reasonable, food scientists and their industries do exist and we need them for many reasons.

Believe it or not, the guy who invented gum, William Wrigley Jr., was a food scientist back in 1891. Without his invention the person pushed up against you on a very crowded train would probably have very nasty breath. So in honor of Wrigley, let’s have some fun! Grab those pieces of gum and work through the following:

In answering these four simple questions, base your responses on the following 9-point hedonic scale test:

1-Dislike Extremely
2-Dislike Very Much
3-Dislike Moderately
4-Dislike Slightly
5-Neither Like nor Dislike
6-Like Slightly
7-Like Moderately
8-Like Very Much
9-Like Extremely

Question #1. On a scale of 1-9, please evaluate the overall liking of the gum:
1 2 3 4 5 6 7 8 9

Question #2: On a scale of 1-9, please evaluate the overall liking of the flavor of the gum:
1 2 3 4 5 6 7 8 9

Question #3: On a scale of 1-9, please evaluate the overall liking of the texture of the gum:
1 2 3 4 5 6 7 8 9

Question #4: Continue chewing the gum for roughly five minutes. Please evaluate the overall liking of the flavor intensity of the gum:
1 2 3 4 5 6 7 8 9

Congratulations! You just completed a mini consumer sensory test questionnaire. During my year at Wrigley, my group conducted a number of consumer tests on various Wrigley and Mars products such as Orbit Gum, 5 Gum, Skittles, Starbursts, Snickers Ice Cream Bars, Uncle Ben’s Rice Products, amongst others. We evaluated consumers’ preferences on different scales similar to the one you just completed. Thereafter, we delivered the results to Wrigley’s head sensory scientists who were better able to make decisions regarding their formulations, eventually deciding whether or not the tested product should be released into the market.

Now that you’re aware of how sensory testing occurs, here’s some insight into what I did as a food scientist:

What was a really cool product I worked on?
I definitely have to say that it would be Dove chocolate-covered gum. I had never thought that gum could be covered in chocolate! Not only did the food scientists create gum with a chocolate coating around it, they also created raspberry, chai, and strawberry coated gum. Some formulations tasted very well, while some were vomit-inducing. This product was released to select Dunkin Donuts around the Chicago area. I worked on this product in its early stages, so it might be a while before it gets released nationwide, if at all.

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What was so great about this job?
When you work in research and development, you tend to know a lot of information about the projects that pertain to your team. I was lucky with my position because I was exposed to a whole variety of products that both Wrigley and Mars produced including products from around the world, such as Chinese jasmine flavored mints

My team did not only do consumer acceptance tests, we also did qualitative descriptive analysis. So how does this work?
First, here is a list of basic tastes, flavors, and textures:

Screen Shot 2015-02-28 at 8.29.05 PM

Now, let’s go back to that piece of gum you were/are chewing. Or, if you have another piece handy then start chewing it.

Now ask yourself: after about 30 seconds of chewing the gum, what were the range of flavors you experienced and at what intensity would you rate these flavors on a scale of 0-15? 0 represents no flavor intensity and 15 represents a very high intensity. How about after a minute? What about 12 minutes?

Qualitative descriptive analysis is performed by panelists who evaluate the basic tastes, flavors, and textures each on a scale of 0-15. What was really interesting about these panelists is how they were equally calibrated regarding gum and candy. For instance, a sweetness rating of five represents the sweetness level of 50 grams of sugar in 1L of water. They were given this reference sample daily to ensure their internal calibration was set. Panelists then were able to evaluate the sweetness of a piece gum or candy by referring back to their reference sample. For your general knowledge, the sweetness of a piece of gum starts at an intensity of about 8-9 and as time progresses it lowers to about a 2. So, in the exercise earlier, if you rated the sweetness of your gum at about 8-9, you are already on your way to becoming an expert gum taster! Scientists looked for consistency in the panelists’ ratings of each flavor attribute in order for them to discern the flavor profile of their product. This knowledge helped them decide for example, if a different type of sweetener in Orbit Spearmint Gum made a difference when compared to the control product.

Valuable exposure to sensory science, working with a variety of people, and now knowing almost everything there is to know about gum (except how it’s formulated) made working for Wrigley a wonderful learning experience.

Though Disha Gandhi thinks that sensory science is neat and vital for a company’s well being, her heart lies in food and nutrition. Hence, why she’s studying towards a MSc in Biochemical and Molecular Nutrition at the Friedman School. In her free time she loves to read food blogs and explore restaurants in Boston.

Bulletproof Coffee: the Breakfast of Champions?

by Ally Gallop, BSc, RD, CDE

Imagine waking up in the morning to a breakfast of butter, oil, and coffee. Better known as Bulletproof Coffee, it’s the new rage in the diet world. With proponents noting marked improvements in alertness, hunger suppression, and weight loss, bulletproof coffee and its creator are altering the morning routine. But navigating through these claims, the science doesn’t align.

After a trip to Tibet in 2004, Silicon Valley businessman Dave Asprey tasted Tibetan Yak Butter Tea: a concoction of brewed tea, salt, and yak butter. Upon returning to the U.S., Asprey devised his own version. Now marketed as bulletproof coffee (or BPC), it pairs well with his newly released book The Bulletproof Diet. Advocates for BPC include U.S. Olympic marathoner Ryan Hall, Divergent actor Shailene Woodley, and singer/songwriter Ed Sheeran. BPC is said to be creamier than a latte, prevent hunger before lunch, increase alertness, and be loaded with vitamins A, E, and K2 alongside omega-3 fatty acids. Yet the most enticing reason in opting for this drink is because it seemingly causes weight loss without having to exercise.

The recipe for BPC is simple. In a blender combine many of Asprey’s own products:629px-Bulletproof_Coffee_Starter_Kit

  • At least 2 tablespoons of unsalted grass-fed butter,
  • 1-2 tablespoons of Brain Octane™ Oil, and
  • Bulletproof® Upgraded™ brewed coffee beans.

Keep in mind, BPC is meant as a breakfast replacement. So let’s compare the BPC nutritional content to that of a typical breakfast: two scrambled eggs, an apple, black coffee, and a slice of whole grain toast with a tablespoon of peanut butter.

Typical Breakfast BPC *Unable to find specific nutrient data for grass-fed butter and omega-3 content.**The USDA Foods List only lists information for vitamin K1.
Calories (calories) 491 461
Total Fat (g) 23 51
Saturated Fat (g) 4 43
Omega-3 Fatty Acids (mg) < 1 n/a*
Total Carbohydrates (g) 48 0
Total Fiber (g) 10.4 0
Protein (g) 24 0
Vitamin A (IU) 803 400
Vitamin E (mg) 1.88 0.4
Vitamin K1 (μg) 9.5 0.8
Vitamin K2 (μg) n/a** n/a**
Caffeine (mg) 142 142

Starting the day off with a high-fat brew that shuns hunger and enhances alertness sounds like a great idea. Losing weight is easier when your stomach isn’t grumbling. High-fat BPC in the gut slows the rate of stomach emptying, suppresses ghrelin (the “eat more” hormone), and reduces the amount of calories consumed at subsequent snacks and meals. Since fat takes the longest to leave the stomach and be digested, even in its liquid form, Asprey’s claim makes some sense.

But Asprey’s claims regarding omega-3s and vitamins A, E, and K2 are cloudier. The amount of these nutrients in grass-fed versus conventionally grain-fed beef is higher. Yet only 60% of studies found a statistically significant difference. Further, no research exists on the amount of omega-3 fatty acids in butter- all the research comparing omega-3 contents is in types of beef, not dairy.

Recently, I contacted Kerrygold, a popular brand of grass-fed butter, and asked them to elaborate on the omega-3 content their product. They responded by saying that they have no research on omega-3’s present in butter. While grass-fed dairy may be a wiser nutritional source, there is currently no research that supports Asprey’s supposition that it has more omega-3s.

The caffeine content of BPC is likely the source of increased alertness drinkers report. It’s also possible that if the coffee truly does have a higher omega-3 content, those omega-3s could give the brain extra power.

Asprey’s line of Bulletproof® Upgraded™ coffee beans are touted as being free of mycotoxins (i.e., mold), which he claims are pervasive components of every other coffee on the market. However, coffee producers like Starbucks and Dunkin Donuts have long known about these mycotoxins. That’s why coffee beans are wet-processed, which means that the beans are washed to eliminate the mold. So the upgraded brew is no better than the rest.

But what really stands out about BPC? How about its fat content: the brew fulfills 23% of both your daily total caloric and fat intake. The Institute of Medicine (IOM) recommends 25-35% of daily total calories should come from fat. BPC fulfills that quota on its own. The Canadian Society of Intestinal Research also reminds us how fat is a stimulant for the intestines. Higher intakes may result in abdominal cramping, diarrhea, and floating stools. But that’s never advertised.

Being so high in calories, how can BPC help weight loss? If, like with any diet, fewer calories are consumed, then weight loss may occur. Asprey’s book recommends following a low-carbohydrate diet as to induce ketosis. And food restriction generally leads to weight loss.

In an interview with Runner’s World, University of California Davis’ director of sports nutrition Liz Applegate debunks Asprey’s idea behind Brain Octane™ oil, which is made of medium-chain triglycerides (MCTs). Asprey believes that the oil increases the body’s ability to burn calories because it is processed differently than other fats. Unlike long-chain triglycerides, MCTs pass directly from the gut into the bloodstream and are immediately available to be burned for energy. However, Applegate notes that there is no scientific evidence to support MCTs’ ability to increase metabolism and promote weight loss. If consumed in amounts that surpass the body’s immediate needs, MCTs will still be converted to and stored as fat.

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Breakfast of Champions?

Ultimately, this article wouldn’t be complete without attempting BPC myself. I found it odd watching butter dissolve into my morning cup. The oil slick on top was definitely unsettling. Using coconut oil and regular coffee in place of Asprey’s oil and beans, the concoction was creamy with a subtle hint of coconut. My hunger was suppressed the rest of the day, cravings for carbs were reduced, and I was able to forgo my mid-morning snack. In comparison to my normal routine of breakfast and a snack, I likely saved 120 calories. But due to an injury, I was unable to exercise. Would this daily pattern of high-fat BPC power me through morning exercise sessions?

Should YOU add BPC to your diet?

The typical breakfast provides protein and fiber, long having been touted as essentials for their hunger-suppressing properties. But choose BPC, and neither exist. The idea is you can’t have both food and BPC.

For those who already eat breakfast, replacing it with BPC on a short-term basis or intermittently could be all right. The BPC’s calories are appropriate for a morning meal. Caloric intake may even be less, depending on what one would normally eat. However, the habit of drinking coffee alongside breakfast may return, thereby increasing total calories consumed. In a recent article, Chris Gayomali, a journalist for Fast Company, tried BPC for two weeks. By the end, he was adding toast in addition to his BPC. After two weeks he ditched BPC completely because he missed eating solids.

Diet trends tend to fail due to deprivation. Given that all other meals and snacks consumed throughout the day remain constant, having BPC and food in the morning could lead to weight gain since it is so high in calories.

If you’re adamant about BPC, doing so every-other-day and ensuring intake of higher fiber and protein foods is advised. That way you can indulge while still limiting saturated fat intakes, promoting gut health with fiber, and sparing protein. Following the IOM guidelines, you wouldn’t require any additional fat on a BPC day. On those days opt for vegetable-dishes, lean protein, and unsaturated fats, like those from nuts, plant oils, and avocados.

For those who don’t typically eat breakfast, adding almost 500 calories of BPC in addition to your usual food consumption could lead to significant weight gain.

So what’s the final consensus?

When it comes to Bulletproof Coffee, the science is lacking. Egregious claims that the oil supplies “fast energy for the brain,” “reduces brain fog,” and is responsible for “rebalancing…yeast in the gut” are stated on Asprey’s website. Yet they lack any footnotes for supporting literature.

We also can’t look at foods in isolation. Rather, the whole diet matters. Asprey’s BPC argument focuses on the nutrients in two items: butter and oil. Humans are encouraged to seek variety in the foods we eat. The typical breakfast I detailed above already contains all of the nutrients advertised as part of BPC and more. If for an entire month one were to replace their breakfast with solely BPC they would be missing out on vital nutrients that variety would fulfill.

Like any other diet, BPC is supposedly “universal.” It’s meant to meet the needs of all of its followers. For me, I felt full. Others may be starving after just a couple hours.

And ultimately, Dave Asprey is a businessman. His empire includes a line of pricey oil and coffee beans in addition to travel mugs, T-shirts, and anti-aging skin creams. With a booming business plan, book, and BPC shops in the works, Asprey is raking it in when you drink his breakfast of champions.

Ally Gallop, BSc, RD is a Certified Diabetes Educator and is studying towards an MS/MPH focusing in health communication and epidemiology. She continues to drink black coffee alongside her high-fiber and scrambled egg breakfast.

The Science of MCT Oils

by Mireille Najjar

While medium chain triglyceride (MCT) oils are known to be effective fat substitutes for those with abnormal fat metabolism and absorption, it is unclear whether these fats are effective in increasing energy expenditure and assisting in significant weight loss.

What are MCTs?

Medium chain triglycerides are fats that are naturally found in coconut and palm kernel oil. They have an unusual chemical structure and are easily digestible. Unlike most fats that are broken down in the intestine and remade into a special form that can be transported in the blood, MCTs are absorbed intact and taken to the liver to be used for energy. They are broken down in a manner similar to that of carbohydrates.

One of the unique advantages of MCTs is that they provide about 10% fewer calories than large chain triglycerides (LCTs) – approximately 8.3 calories per gram for MCTs versus 9 calories per gram for LCTs. Additionally, shorter chain length means that MCTs are more quickly metabolized as fuel for immediate use by organs and muscles.

Another advantage of the energy-enhancing properties of MCTs is that, unlike LCTs, they do not require the presence of carnitine, a compound critical in energy production. This results in the production of ketones, which form as a result of fat metabolism. MCTs as a source of ketone bodies make these fats a suitable choice for those with increased energy needs, such as during post-surgery, normal or stunted growth, and for enhanced athletic performance.

Scientific Evidence for MCTs

MCT oils are useful fat substitutes, especially for people with AIDS who need calories but are unable to absorb or metabolize normal fats. For instance, a 1997 double-blind, placebo-controlled study in the Journal of the American Dietetic Association reported that MCTs can help improve AIDS-related fat malabsorption in 24 men and women with AIDS. Another double-blind study in Nutrition found similar results in 24 men with AIDS-related fat malabsorption. Some studies also suggest that MCTs might be helpful for those who have trouble digesting fatty foods because they lack the proper enzymes; however, a 1996 study in the Scandinavian Journal of Gastroenterology found that taking digestive enzymes seems to be more effective.

It has also been reported that MCTs may prevent fat storage. A 2008 paper published in the Asian Pacific Journal of Clinical Nutrition noted that MCTs, particularly when used as cooking oil, might decrease storage of excess calories as fat, since they are immediately burned for energy. Some studies have also found that MCTs might enhance body composition, or the ratio of fat to lean tissue.

The possibility of MCT oil as a valuable energy source during high-intensity physical exercise has also been studied. Since MCTs are more easily digested than other fats, they may quickly produce large amounts of energy after being consumed, which can enhance an athlete’s performance during intense physical activity. Not all scientific data supports this notion, though; the NYU Langone Medical Center reported insufficient evidence to link the effects of MCTs on increased energy expenditure amongst athletes.

MCTs and Weight Loss

Although MCTs have been proposed as a weight loss aid due to their quick digestibility and large energy provision, there have been mixed results linking MCTs and weight loss. According to the NYU Langone Medical Center, studies have generally not supported the use of MCTs for weight loss. Other studies, however, suggest that there is a potential link between MCT consumption and weight loss outcomes. For instance, in a 2008 study in the American Journal of Clinical Nutrition, researchers found that over the four months, overweight subjects that received MCT oil while on a weight-loss plan lost more weight (around four pounds) than those who consumed olive oil and concluded that MCT oil can be useful to enhance weight loss. It is uncertain, though, whether these MCT users would have continued to lose more weight had they continued to consume the oil after the four-month study period. Other small studies that typically lasted one to four months also observed similar results—dieters who used small amounts of MCT oil lost more weight than dieters who used liquid vegetable oil.

In addition to weight loss, scientific studies have suggested that substituting MCTs for other fats in a healthy diet may help to suppress appetite and support healthy weight and body composition. For instance, in a 14-day 1996 study in the International Journal of Obesity and Related Metabolic Disorders, researchers noted that substituting an easily-metabolized fat, such as MCTs, for other fats such as LCTs, in high-fat diets can limit excess weight gain usually produced by energy-dense diets. MCT oil consumption could thus be advantageous for those who want to gain muscle mass and decrease body fat.

What Can We Conclude?

With all of the overlapping evidence, it is difficult to pinpoint the specific functions of MCT oil. While we may not yet know all the benefits of this unconventional fat, what we can extrapolate is that further research with more study subjects is needed to determine how beneficial MCT oil really is for weight loss and increased energy expenditure. It is also apparent that MCT oil can be particularly useful for those who are unable to metabolize and absorb conventional fats.

At this point, we can safely claim that MCT oil can be used as a dietary substitute for salad dressings, sauces, or cooking as a source of beneficial fatty acids.

Mireille Najjar is a first-year NUTCOM student who thoroughly enjoys learning more about the effects of ketosis on weight loss and epilepsy treatment.

How Does a Ketogenic Diet Affect YOU? Part 1 of a 3 part series

by Katie Mark

If you could tap into your approximately 40,000 calories of stored fat during endurance exercise instead of relying on your 2,000 calorie storage of carbohydrate fuel, would you do it?

LeBron James did it by switching to a ketogenic diet.

But for those of us who aren’t athletes, can the ketogenic diet positively impact our health?

The controversial ketogenic diet

A ketogenic diet is a diet high in fats and very low in carbohydrates (less than 50 grams of carbs per day) and causes the body to start burning fat instead of carbohydrates by breaking down fat into molecules called ketones. As we saw in last month’s article, “The Basics of the Ketogenic Diet,” the diet was developed to help treat seizures in children who suffered from epilepsy.

Believe it or not, the brain, usually dependent on glucose from food, can also run using ketones. When you transition to a ketogenic diet, there is a period of time in which your body adapts to the change. Under normal circumstances, skeletal muscle will burn ketones for energy, but as “keto-adaptation” occurs, the muscles switch to burning fatty acids instead. This increases blood ketone levels and allows more ketones to supply energy to the brain. The change in energy sources makes keto-adaptation a gradual process taking at two weeks instead of a few days.

Today some nutritionists believe the ketogenic diet can be a valuable method for improving some health “biomarkers,” or signs of health your body creates. By examining these biomarkers, effects of the ketogenic diet can be measured.

In this part one of the three-part series on “How Does a Ketogenic Diet Affect YOU” we will look at what ketosis does for fasting glucose and insulin.

The ketogenic diet does what to my fasting glucose and insulin?

When we eat food, the carbohydrates we eat are converted to glucose and transported throughout the body to give us energy. Fasting blood glucose (sugar) measures the amount of glucose one has in his blood after fasting for at least eight hours.

Normally after we eat, our blood glucose increases as carbohydrates are digested. Then, sensing glucose in the blood, the hormone insulin is released which allows glucose in blood to enter cells and be used as energy.

However, on a ketogenic diet, there is very little carbohydrate. In this case, what happens to fasting glucose and insulin?

One study, published in the journal Nutrition and Metabolism, reported that people on a very low-carbohydrate, high-fat, low-calorie diet experienced decreased insulin levels. This was significant, because another group, also eating low calorie, but consuming a high-carbohydrate, low-fat diet did not experience the same level of change. There was a third group of men who ate a low calorie diet that was high in carbohydrate and high in unsaturated fats. All three groups ate low-calorie diets for eight weeks, then increased their calories to maintain their weight for another four weeks.

All groups experienced a decrease of 2% in fasting glucose with weight loss, independent of diet. Yet, those eating the very low-carb diet experienced a 33% decrease in fasting insulin concentration. This high-unsaturated fat diet had a decrease of only of 19% and the very low-fat diet experienced a 15% increase.

Post-meal insulin (as opposed to “fasted” insulin) was also lower in the low-carbohydrate diet group than in the other two groups. Researchers suggested that the high amount of fat may have delayed gastric emptying (when food leaves the stomach and enters the small intestine) of protein and weakened the release of insulin.

The study concluded that as long as there is weight loss, carbohydrate-restricted diets might be more effective than traditional weight loss diets in improving fasting and post-meal glucose concentrations and improving insulin sensitivity (which means how well body tissues “listen” to insulin and take in glucose from the blood).

Another study, published in the journal Experimental & Clinical Cardiology, examined the long-term effects of the ketogenic diet on weight loss and fasting blood glucose, as well as other various biomarkers, in 83 obese individuals. The ketogenic diet consisted of 20 – 30 g of carbohydrate (green vegetables and salad) and 80 – 100 g of protein (meat, fish, eggs, cheese, fowl and shellfish). Polyunsaturated and monounsaturated fats were also included. After 12 weeks, 20 g of carbohydrate were added for a total of 40 – 50 g of carbohydrate.

The subjects underwent fasting blood tests following eight, 16 and 24 weeks of treatment. Among other biomarkers looked at, the study found a significant decrease in the level of blood glucose, especially at week 24. The researchers concluded that using the ketogenic diet for a relatively long (24 weeks) period of time is safe. Yet, further studies need to examine the molecular basis of nutritional ketosis as this will help determine the potential therapeutic benefits from a ketogenic diet.

Now what?

As we see, a ketogenic diet may decrease both fasting glucose and insulin concentrations, with a potential increase in insulin sensitivity (how well our cells uptake glucose).

So why is this important to people? When carbohydrate consumption is restricted below a threshold in which it is not converted to fat, insulin sensitivity can often improve because less glucose is coming in. This is especially important for diabetic individuals because insulin resistance (the inability of muscle cells to take in glucose) is the main feature of type 2 diabetes.

Yet, diabetics are not the only ones who should monitor their fasting glucose and insulin. It’s important to control our blood sugars because type 2 diabetes develops over time when our body either doesn’t produce enough insulin or our body can’t use it properly. And if our body cannot use insulin, glucose remains in our blood at higher levels than normal, and this can cause many health complications.

How do you know what is a normal level? A normal level in fasting (of at least 12 hours) blood glucose test should be between 70 and 100 mg/dL. A level between 100 and 125 mg/dL is considered prediabetic and a level higher than 126 mg/dL signifies diabetes.

It’s important to keep in mind that every individual is different and may respond differently to the effects of this diet. Restricting carbohydrates can be very difficult. Therefore, focusing more on “good” carbohydrates, such as those with high fiber, may be a good option if you’re wondering what to do with this information, especially if you do not want to restrict carbohydrates. In the next part of this series, we’ll look at cortisol (the “stress hormone”) to see whether it goes up or down when the body adapts to nutritional ketosis.

Katie Mark is a first year Nutrition Communication student from Miami, Florida. She is a Cuban coffee connoisseur and has traveled to Cuba, where she hopes to live one day.

Turmeric: The Health Benefits of a Spicy Life

by Nusheen Orandi

What if adding only a fraction of a teaspoon of something to your cooking could prevent and treat Alzheimer’s disease while also having anti-cancer, antioxidant, and anti-inflammatory properties? This is no magical drug, but a spice that comes in a delectable shade of orange in your local grocery store. Turmeric, that is.

Turmeric, a powder derived from grinding up dried rhizomes (roots) of the turmeric plant, is a widely used spice in the Indian, Asian, and Middle Eastern cultures. However, research behind turmeric is largely aimed at curcumin, the most active component of turmeric that makes up 2-5% of it.

Turmeric

Could turmeric (curcumin) be the first treatment for Alzheimer’s disease?

It’s probably not a coincidence that India has one of the lowest rates of Alzheimer’s disease in the world. The relative lack of the disease in India, where turmeric (and thus curcumin) is a commonly consumed spice, has led researchers to conduct epidemiological studies that examine the effect of curcumin. Alzheimer’s is a devastating illness that deteriorates cognitive function. Researchers believe that one of the first pathologies of Alzheimer’s disease is the accumulation of plaques (protein fragments) in the brain. The build up of these plaques can kill nerve cells and produce free radicals that damage nerve cells, which is what leads to Alzheimer’s disease.

Where does curcumin come in? As an anti-inflammatory and antioxidant agent, curcumin could reduce or prevent these plaques from forming, thus preventing the neuronal breakdown that leads to Alzheimer’s disease. This could make a difference to millions of seniors worldwide who are at risk for or fall victim to this disease.

Is “curcumin” also “anti-cancer?”

A possible cure for cancer?

The discovery of this medical Holy Grail has been the dream of physicians and research labs alike. Although curcumin is likely not the whole answer, its anti-tumor properties give hope to the realm of oncology research.

Curcumin’s anti-tumor qualities seem to be derived from its ability to “inhibit the proliferation and survival of almost all types of tumor cells.” Evidence demonstrates that curcumin can initiate apoptosis (or programmed cell death) in tumor cells, known as “curcumin-induced cell death.” This reduction of cell growth prevents tumors from occurring. Curcumin has also been shown to inhibit the growth and proliferation of cancer cell growth. Researchers are not sure why curcumin targets only cancer cells instead of normal cells, but continue to dive into its many biochemical pathways. The ongoing studies of the anti-cancer chemical properties of curcumin could lead to the development of a drug or synthetic extract to treat certain cancers and protect patients from harmful chemotherapies. Perhaps turmeric could indeed personify its nickname, given for its color, “the golden spice.”

Move over blueberries, curcumin is the new antioxidant in town

At this time of year, we become hyper-aware of our health, keeping a fair distance from sniffling strangers on the T and packing in antioxidant-rich foods. Berries are not your only friends! Curcumin is a free radical scavenger, preventing oxidative damage to the lipid membranes of our cells. This process, known as lipid peroxidation, can lead to the destruction of DNA and proteins, which can cause damage that leads to a spectrum of ailments. Whether it’s protection from the common cold or from chronic diseases such as cancer, atherosclerosis and neurodegenerative diseases, curcumin plays an important antioxidant role. So, if you feel yourself getting sick, dash a bit of turmeric in your soup!

Looking for natural ways to prevent disease and maximize health is an evident goal of nutrition. What’s even better is if it’s as accessible as cooking with a spice a little more often. Often times, consumers try to look for answers in the form of a supplement or pill (curcumin, in this case), which can contain a much higher dosage than the natural form (contained in turmeric) and yet not exceed the benefit of just using the turmeric spice, as cultures around the world do. Research continues to look for answers to show just how far curcumin’s anti-flammatory and antioxidant properties can go. In fact, it’s only a matter of time before turmeric becomes as trendy as coconut oil in the market and we begin to see turmeric water, turmeric-infused oils or turmeric hair care. Until then, embrace the power of yellow curry.

If you’re looking for a way to use turmeric, check out this recipe from Eating Well to get you started!

Nusheen Orandi is a first-year student from California in the Nutrition Communication program and likes to spend her time tea-shop hunting, tensely watching the Tottenham Hotspurs, and cooking and eating with friends and family.

The Basics of a Ketogenic Diet

by Mireille Najjar

The ketogenic diet remains one of the most extreme types of low carbohydrate diets, yet its potential role in tumor regression and pediatric epilepsy treatment has become an increasing topic of study among researchers and health professionals worldwide.

What is the Ketogenic Diet?

The ketogenic diet is a low-carbohydrate, moderate-protein, high-fat diet often used to control seizures in children with epilepsy. In such cases, the diet is usually recommended when two or more anti-seizure medications fail to control the seizures or result in harmful side effects. The diet requires careful monitoring by a medical support team, including a pediatrician, a neurologist and a dietitian. After two to three years, a normal diet is reintroduced gradually, depending on the progress of the child. A doctor may also slowly reduce the dosage of medications at this time.

High fat sources common in the ketogenic diet

High fat sources common in the ketogenic diet

Some individuals follow the diet to lose weight and have reported successful short-term weight loss after several months by eating low-carbohydrate, high-fat meals daily. Several studies have also reported unknown or beneficial long-term effects of the diet, particularly in obese patients with high cholesterol. While it can induce rapid weight loss, it is always important to consult a doctor or dietitian before beginning a ketogenic diet.

How Does the Diet Work?

The ketogenic diet works by shifting the body’s energy source from carbohydrates to fat. When the body is in a fasting state, it creates molecules called ketone bodies that build up as the body burns fat for energy—a process called ketosis. The exact reason is unknown, but researchers believe that the high production of ketone bodies improves seizure control in some epileptic children who show no signs of improvement with medication. Some studies, such as a 2010 case report in Nutrition & Metabolism, also show evidence of reduced tumor growth in cancer patients who receive chemotherapy and radiation along with the ketogenic diet.

Characteristics of the Diet

In general, the ratio of fat to carbohydrates and proteins is four to one (4:1) and must be tailored specifically for each individual. This is approximately 60 percent of calories from fat, 35 percent from protein, and 5 percent from carbohydrates. When starting out, it is recommended to limit net carbohydrate intake, which is the amount of carbohydrate in a food that the body is able to use for energy, to 20 grams per day to help the body enter ketosis. Afterwards, it should be limited to less than 50 grams per day. The amount of net carbohydrates per day is dependent on an individual’s own metabolism and activity level.

Many people—particularly adults—find the ketogenic diet difficult to follow since it is very limited in the types and variety of food it allows. The diet is based mostly on fat, protein and vegetables (specifically green leafy vegetables) that provide most of the carbohydrates you eat. Since the diet does not supply sufficient amounts of vitamins and minerals, people usually need to take vitamin and mineral supplements. They must also be completely committed to following the diet for it to work effectively.

Below are some tips on what you should and should not eat, as well as general tips, while on the ketogenic diet:

Foods to Eat

  • Eat plenty of green leafy vegetables like spinach, lettuce, cabbage, broccoli, cauliflower, celery and cucumbers. Limit vegetables like red and yellow peppers, onions and tomatoes, and avoid starchy vegetables like potatoes since they contain higher amounts of carbohydrates.
  • Consume peanut butter, cheese or boiled eggs as a snack. Nuts (with the exception of macadamias and walnuts) should be consumed in moderation since they are rich in inflammatory omega-6 fatty acids.
  • Meat, such as beef, pork and lamb, can be cut or prepared any way you like.
  • Leave the skin on poultry (chicken, turkey, quail, duck, etc.) to increase the fat content. It can also be prepared any way you like.
Beef stir fry, an easy-to-prepare ketogenic meal

Beef stir fry, an easy-to-prepare ketogenic meal

Foods to Avoid

  • Avoid low-fat foods. Since you are getting most of your calories and energy from fat, you need to make sure you are eating enough high-fat products, such as bacon, full-fat dairy (including raw and organic milk products, such as heavy whipping cream, sour cream, cottage cheese, cream cheese, hard and soft cheese, full-fat yogurt, etc.), mayonnaise, oil and butter.
  • If you choose to drink coffee, avoid extra sugar and milk. Instead of sugar, use a sweetener such as Stevia or EZ-Sweetz®. Replace milk with almond milk or heavy cream for a low-carbohydrate alternative.
  • Do not eat fresh, dried or frozen fruit since fruit is high in carbohydrates and fructose, the natural sugar found in fruit. If you choose to eat something sweet, you can eat one or two strawberries, but the fructose might prevent ketosis.
  • Avoid all grains and grain products, juices made from fruit and vegetables, beer, milk (1 percent and skim), beans and lentils, which are all high in carbohydrates.

Important Tips to Consider

  • Check the carbohydrate content of everything you eat. Some foods, such as processed sausages, cheeses, and sauces, contain hidden carbohydrates. For example, added honey and artificial sweeteners in regular low-carbohydrate mustard can increase its carbohydrate content. Be sure to check the carbohydrate content of mayonnaise and oil-based salad dressings, too.
  • Keep track of your daily food and carbohydrate intake. Keep a spreadsheet, use an online food intake tracker, or record the foods you eat in a journal. Write down how you felt each day and any changes you made. If you go off track, you can look back and see what was successful for you.
  • Always choose the lowest carbohydrate options to make sure you do not exceed your daily carbohydrate limit of 50 grams per day. Also, check food labels for net carbohydrates, which are the total carbohydrates minus the amount of fiber.
  • Take a daily multivitamin to replenish the nutrients lost while following the diet.

1-Day Sample Menu (4:1 ratio, approximately 1,884 calories)

Breakfast: Eggs (4 whole eggs, ½ avocado)

Total calories: 419
Fat: 31 g
Protein: 25 g
Net carbohydrates: 5 g

Lunch: Chipotle salad, no dressing (lettuce, chicken, mild salsa, cheese, sour cream and guacamole)

Total calories: 585
Fat: 38 g
Protein: 45 g
Net carbohydrates: 9 g

Snack: Large spinach salad (spinach, olive oil and vinegar dressing)

Total calories: 340
Fat: 32 g
Protein: 4 g
Net carbohydrates: 2 g

Dinner: Cheesy chicken (2 grilled chicken breasts, ½ cup cheese)

Total calories: 380
Fat: 15 g
Protein: 62 g
Net carbohydrates: 4 g

Snack: 24 almonds

Total calories: 160
Fat: 15 g
Protein: 6 g
Net carbohydrates: 3 g

Daily Totals:

Calories: 1,884
Fat: 131 g (63.7% of calories from fat)
Protein: 140 g (30.9% of calories from protein)
Net carbohydrates: 23 g (5.4% of calories from carbohydrates)

Mireille Najjar is a first-year Nutrition Communication student originally from Lebanon. She has a background in nutrition and dietetics and hopes to further strengthen her true passion—writing—here at Friedman.

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