Mechanism that Causes Cataracts Discovered in Mice: The Latest in Nutrition and Vision at the HNRCA

by Nusheen Orandi

Although it may be hard to see through seven feet of snow and gray slush, the Human Nutrition Research Center on Aging (HNRCA) is still hard at work, especially in the Nutrition and Vision lab.

The Nutrition and Vision lab, directed by Dr. Allen Taylor, just published a paper in the Janurary Online Early Edition of Proceedings of the National Academy of Sciences about how tinkering with one protein, called ubiquitin, leads to other biochemical reactions that result in the clouding of the eye lens, known as cataracts. Not only is this publication groundbreaking in vision academia, but this knowledge applies to other diseases in the body that are affected by the same process, such as Alzheimer’s and Parkinson’s disease. Dr. Taylor is a Professor of Nutrition at Tufts University Friedman School of Nutrition Science and Policy, Professor of Ophthalmology at the School of Medicine, and part of the faculty of the Department of Developmental, Molecular, and Chemical Biology at the Sackler School of Graduate Biomedical Sciences. He gave insight to the progress of the lab, where nutrition fits in, and where research is going from here.

How does it work?

Many age-related diseases, like cataracts, are related to the accumulation of damaged or abnormal proteins. Ubiquitin is a protein part of a proteolytic (protein breakdown) pathway that regulates this protein buildup to prevent a number of diseases. As Dr. Taylor put it, ubiquitin is important for “cleaning up bad proteins.”

“We’re interested in what forms cataracts and age-related macular degeneration and its nutritional correlate,” he explained. Dr. Taylor and his colleagues examined how damage to the ubiquitin proteolytic pathway can cause the improper degradation of these bad proteins to lead to cataract formation.

In the experiment, Dr. Taylor and his research team identified a mechanism that leads to the formation of cataracts in the mice. The team mutated one of the lysine amino acids of the ubiquitin protein, which altered gap junction proteins called connexins and caused calcium to be retained in the cells of the eye lens. The resulting levels of calcium initiated the biochemical pathway of another protein called calpain, which is a digestive enzyme responsible for shredding proteins. The hyperactivation of calpain in the eye eventually led to the opaqueness of the lens, known as a cataract.

Cataracts are the leading cause of blindness worldwide and affect over 85% of the elderly. The inefficient degradation of proteins that cause cataracts is a significant investigation. The same ineffective ubiquitin proteolytic pathway leads to congenital cataracts as well, which is the leading cause of childhood blindness.

So, what does nutrition have to do with it?

Diet affects many diseases, and cataracts are no exception. Although having cataracts is mainly an age-related disease, nutrition can impact disease development.

“There’s a nutritional correlate to inefficient proteolysis,” Dr. Taylor explained. “It can be caused by anything that causes too much stress in the body. If you have inefficient nutrition, you won’t have enough antioxidants, and this causes oxidative stress. It messes up the proteolytic pathway and disease builds up. You don’t have enough proteolytic machinery to fight these toxic proteins.” An example he gave was having a diet high in sugar and lacking fruits and vegetables. The excess sugar causes oxidative stress on the body that accumulates with age. Without the proper antioxidants, regulatory proteins like ubiquitin can’t operate at maximum capacity. Eat healthfully because it affects your vision!

Is this research only related to vision?

No, and that’s what makes this research even more exciting. The accumulation of toxic proteins and ineffective proteolysis mechanisms is also related to neurodegenerative diseases like Alzheimer’s disease and Parkinson’s disease. Maybe you thought ubiquitin was a curious name for a regulatory protein, but it was actually a conscious term, being ubiquitous, or everywhere, in the body.

“Protein buildup takes place everywhere, like the brain,” offered Dr. Taylor. This relates to Alzheimer’s disease, where without the proper proteolysis mechanisms, plaques can form and cause the gradual neuronal breakdown. Defective ubiquitin proteosome in the brain, caused by oxidative stress and inflammation by the neurotoxin known as MPTP, is associated with one of the causes of Parkinson’s disease.

The Nutrition and Vision Lab at the HNRCA demonstrated the importance of adequate nutrition on age-related diseases, such as cataract formation, giving further indications of a parallel with Alzheimer’s disease and Parkinson’s disease. How we take care of ourselves goes a long way and causes a domino effect of all the biochemical pathways in our body.

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.

9 Reasons to Attend Friedman’s 9th Annual Student Research Conference

by Matt Moore

The Future of Food and Nutrition Graduate Student Research Conference (SRC) takes place on Saturday, April 11. Students from Friedman and across the country will attend and present original research from a range of topics related to nutrition and food systems. Last year’s conference drew over 200 attendees from 30 institutions across the country. The Sprout presents nine reasons for Friedman students to attend.

1. Content

The conference has grown every year, and the planning committee received a record-breaking number of abstract proposals from schools across the country. The final agenda will include something for everyone: presentations are expected to cover a range of domestic- and international-focused topics such as agriculture, nutrition science, policy and programming, food security, climate change, food systems, and epidemiology.

2. Support Friedman

Students who attend will provide an audience for their classmates who are presenting, and it is a great way to discover what colleagues outside their own concentration have been working on. Furthermore, the conference is scheduled to coincide with the accepted student open house, so current Friedmanites will be able to answer questions and recruit for the new class.

3. Collaboration

Students from over 35 colleges and universities across the United States are expected to attend this year. Not only do they share common interests with Friedman students, but they will enrich discussions by bringing new and different ideas and perspectives to the table.

4. Angela TagtowAngela Tagtow, Executive Director, Center for Nutrition Policy and Promotion

The new Executive Director of the USDA’s Center for Nutrition Policy and Promotion (a position first held by Friedman’s own Eileen Kennedy) will present this year’s keynote: “Nutrition Policy at a Crossroads: Dietary Guidelines for Americans Application and Evolution.” Tagtow has a background in sustainable diets and has worked to promote social and environmental justice in the national food system. She founded the Journal of Hunger & Environmental Nutrition, the Iowa Food Systems Council, and the Iowa Food Access & Health Work Group. She is also a former Food & Society Policy Fellow at the Institute for Agriculture & Trade Policy.

5. Expert Panel

In addition to the keynote, an expert panel titled “Sustainable Diets and the Implications for Dietary Guidance in the United States” will tackle the topic of sustainable diets. The panel will be moderated by Parke Wilde and will feature Dr. Miriam Nelson, member of the 2015 Dietary Guidelines Advisory Committee (DGAC) and chair of the Food Sustainability and Safety Sub-Committee, and Dr. Andrew Rosenberg, Director of the Center for Science and Democracy at the Union of Concerned Scientists.

6. Sustainable Diets

The topic of sustainable diets has been at the heart of the national food policy debate. It has caused a bit of controversy in Congress, and almost everyone in the nutrition field has an opinion on whether sustainable diets should be a factor in shaping the Dietary Guidelines. Most recently, the DGAC released its Scientific Report, and the sustainability consideration has been the center of attention. At the SRC, attendees will have a chance to jump in and discuss the issue with people actively working in the field.

7. Networking

Attendees will have a chance to meet with presenters, faculty, and students to engage and further discuss the topics of the day. There will be time for mingling throughout the conference during lunch and refreshment breaks. Then to cap off the event, there will be a post-conference networking reception at Trade, located a short walk from the Friedman Schools (540 Atlantic Avenue). Free food will be provided, of course.

8. Student-Run

The SRC is entirely planned and executed by Friedman students. Led by co-chairs Janeen Madan (FPAN ‘15) and Claire Anglim (NUTCOM ‘16), a group of 25 students has been working since last October to coordinate the conference. Nobody is better qualified to develop a program of content that will appeal to current graduate students than the colleagues they work with every day.

9. Cost

Any Tufts student can attend for just $15, which is grad-school-budget friendly and a bargain for a full-day event, including breakfast, snacks, lunch, and appetizers at the networking reception.

Anyone interested in attending can get more information and register at the SRC website. The final schedule will be released this month, and students can take advantage of early-bird registration until the week of the conference.

Matt Moore is a first-year AFE student who received a lot of help from Abbie Steiner and Janeen Madan in writing this piece. He looks forward to a Spring Break trip to his bed. 

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.


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.

If Vitamins Were Celebrities

by Emily Finnan, RD LDN

Vitamins have received so much media play lately you’d think they were celebrities. But what if vitamins really were celebrities? Would they be the troubled reality star or the all-American movie hero? Read on for our take!

Vitamin D

The current star of the nutrition world, vitamin D has been touted to play a beneficial role in seemingly everything from osteoporosis, some types of cancer, type 2 diabetes, multiple sclerosis, congestive heart failure, rheumatoid arthritis, and more (see Melissa Hudec’s December article in The Sprout for more info). Vitamin D research is hot and trendy much like…

JENNIFER LAWERENCE. She gained superstardom from starring in 2012’s The Hunger Games. From winning an Oscar to her adorable red carpet stumble, America is in love. Forbes even named her the most powerful actress in 2014. However, vitamin D research is still emerging, and Jennifer Lawrence’s blockbuster franchise is ongoing. Time will tell if they will both remain in the spotlight.

Vitamin E

This vitamin’s past reminds us of vitamin D’s stardom. In the 1980s, this antioxidant was thought to be the magic nutrient for conditions like cancer, atherosclerosis, vision loss, and heart disease; though further research did not support this. In some cases even negative effects were shown at large doses. However, this vitamin sprung back into the media recently due to a double-blind, randomized, placebo-controlled trial showing an association between large-dose supplements and a reduction in functional decline for those with Alzheimer’s disease (3). This vitamin’s comeback reminds us of…

MADONNA. Becoming the 80s pop queen with her 1984 hit album Like a Virgin, she revolutionized fashion and women’s role in pop. Madonna has released other albums since, but nothing has compared to her initial celebrity status. Madonna is set to have a new album, Rebel Heart, released this year, so perhaps she too will have a comeback.

Vitamin A

You have a choice with vitamin A: preformed, found in animals and supplements, or provitamin A, found in plants pigments. The most well-known provitamin A is beta-carotene, found in orange and dark green vegetables and fruits. Excess doses of preformed vitamin A, usually from supplements, may lead to serious liver damage. Yet excess beta-carotene can also cause a harmless, though maybe hilarious, orange pigmented skin much like…

SNOOKI, or Nicole Polizzi. Though her orange hue is the result of too much spray tan, rather than excessive intake of beta-carotene, both are harmless and will dissipate over time.

Vitamin K

Present in high amounts in leafy greens, a vitamin K deficiency may result in the blood’s decreased ability to clot. This could result in nosebleeds, bleeding gums, and cuts that take longer to stop bleeding. This would be a problem for most people except for…

ROBERT PATTINSON. He will forever be remembered as Edward Cullen, the hunky vampire from the Twilight series. His character would surely revel in a vitamin K-deficient person, what with all of that easily-accessible blood – YUM. Although deficiencies aren’t common, avoid satisfying Edward, and eat your leafy greens!

Vitamin C

This vitamin is best known for its presence in citrus fruits and its alleged ability to “cure” the common cold. Well, that wishful thinking has not held up in clinical trials, but it stems from the true power of vitamin C as an antioxidant and its role in immune functions. Despite this, Americans still swoon for vitamin C supplements and continue to take mega-doses during flu season. It seems we simply cannot get enough, much like…

TAYLOR SWIFT. This 25-year-old singer/songwriter has been topping the charts since her days as a teenage country star. With seven Grammys to her name, she is the only singer to have three albums selling more than a million copies in their debut week. Just like with Taylor Swift, it’s possible to overdose on vitamin C. Excess intake may lead to gastrointestinal upset, headaches, and kidney stones. What about too much Taylor? Attending concerts and buying all those albums gets expensive!

The B vitamins

This family of eight encompasses a variety of important functions including macronutrient metabolism. Excessive intakes generally have minimal side effects, much like THE KARDASHIAN FAMILY. This group of eight is everywhere, be it on television, over social media, and in celebrity news. Thankfully no side effects have been reported yet…

  • Thiamine (vitamin B1)

Thiamine is found in a variety of foods, with pork and fortified grains being especially great sources. It is the number one B vitamin, just like KRIS JENNER is the first Kardashian. As the mother of the group we wouldn’t know any of these famous faces if it wasn’t for her.

  • Riboflavin (vitamin B2)

This is a major player in making energy for the cell via the electron transport chain (ETC). The ETC occurs in the mitochondria, and the cell works very hard to keep it going. This reminds us of KENDALL JENNER. She is the only one of the family who is currently working at something other than being famous: through a successful modeling career.

  • Niacin (vitamin B3)

Unlike with the other B-vitamins, there is a quick-reacting side effect to excess intakes of niacin known as niacin flush. This typically happens after high-dose supplementation and causes blood capillaries in the face to dilate, resulting in a blush and warm feeling. Perhaps this is the culprit behind KYLIE JENNER’s new pouty lips? Likely not. (8, 9)


  • Pantothenic Acid (vitamin B5)

Pantothenic Acid forms a part of the coenzymes used in many metabolic reactions. Very little attention has been paid to it in scientific research and the media much like ROB KARDASHIAN. Whomp, Whomp.

  • Pyridoxine (vitamin B6 )

This vitamin is necessary in many reactions including the creation of neurotransmitters like serotonin, and a serotonin imbalance has been linked to depression. This is the opposite of KHLOE KARDASHIAN. The jokester of the family, she’s guaranteed to turn any Kardashian pucker into a smile.

  • Biotin (vitamin B7)

Biotin is abundant in the foods we eat, so deficiency is uncommon. You probably don’t need to seek out biotin, much like KIM KARDASHIAN. She’s everywhere, and you probably don’t need to see more. Biotin and Kim also share a startling resemblance…


  • Folate (vitamin B9)

Folate is necessary for a growing fetus, and inadequate amounts may lead to spina bifida, a debilitating birth defect. Getting enough folate probably wasn’t an issue for KOURTNEY KARDASHIAN. With three healthy children she probably consumed her fair share of folate-rich foods like leafy greens and fortified grains.



  • Cobalamin (vitamin B12)

Certain populations are at increased risk for vitamin B12 deficiency, particularly the elderly. Maybe BRUCE JENNER, the elder of the family at age 65, should consider the possibility of a deficiency should he show signs and symptoms like fatigue, pale skin, and easily bruising or bleeding.

Emily Finnan is a first-year biochemical and molecular nutrition student. In her time off from school and working as a pediatric dietitian she enjoys cooking and watching critically-acclaimed documentaries along with the latest realty television shows.

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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