Ketosis, Epigenetics, and the Brain

It’s long been understood that ketones, specifically beta-hydroxybutyrate (BHB), are a brain superfuel. It’s easy to explain the evolutionary reasons for this. Hunter-gatherers spent much more time in ketosis. This metabolic state tends to occur during periods of low food access. That happens in winter but also throughout the year, as hunter-gatherers tend toward a feast and fast pattern.

After a period of plenty, it might be a while until the next big kill. Some hunting expeditions could take days or weeks. They needed their brains working in top form for a successful hunt. Many hunter-gatherer tribes purposely fast on a regular basis as a demonstration of their toughness, to show that they can go long periods without food, a very important ability for hunters. Even tribal people living amongst food abundance will fast for no particular reason other than it’s part of their culture.

The Piraha, for example, can procure food easily and yet will go without, sometimes simply because they’d rather socialize around the village or are in the middle of communal dancing that can go on for days. They have better things to do than eat all the time. Besides, on a low-carb diet that is typical among hunter-gatherers, it takes little effort to fast. That is one of the benefits of ketosis, one’s appetite is naturally suppressed and so it effortlessly promotes caloric restriction.

Along with improving brain function, ketosis increases general health, probably including extending lifespan and certainly extending healthspan. Some of this could be explained by creating the conditions necessary for autophagy, although there are many other factors. An interesting example of this was shown in a mouse study.

The researchers exposed the rodents to influenza (E. L. Goldberg et al, Ketogenic diet activates protective γδ T cell responses against influenza virus infection). Most of the mice on a high-carb diet died, whereas most on the keto diet lived. In this case, it wasn’t the ketones themselves but other processes involved. Giving exogenous ketones as a supplement did not have the same effect as the body producing its own ketones. We typically think of ketosis only in terms of ketones, but obviously there is much more going on.

Still, in the case of neurocognitive functioning, the ketones themselves are key. It’s not only that they act as a superfuel but simultaneously alter epigenetic expression of specific genes related to memory. On the opposite side, research shows that feeding people sugar literally makes them dumber. Ketosis also decreases inflammation, including inflammation in the brain. Through multiple causal mechanisms, ketosis has been medically used as an effective treatment for numerous neurocognitive conditions: mood disorders, schizophrenia, autism, ADHD, Alzheimer’s, etc.

If ketosis is a biological indicator of food scarcity, why does the body expend extra energy that is limited? This seems counter-intuitive. Other species deal with food scarcity by shutting the body down and slowing metabolism, some going into full hibernation or semi-hibernation during winter. But humans do the opposite. Food scarcity increases physiological activity. In fact, ketosis is actually inefficient, as it burns more energy than is needed with the excess being put off as heat.

Benjamin Bikman, an insulin researcher, speculates this is because ketosis often happens in winter. Hibernating creatures lower their body temperature, but humans don’t have this capacity. Neither do we have thick fur. Humans need large amounts of heat to survive harsh winters. In ketosis, everything goes into overdrive: metabolism, immune system, and brain. This alters the epigenome itself that can be passed onto following generations.

* * *

You Are What Your Mother and Father (and Grandmothers and Grandfathers) Ate
by Mark Sisson

Epigenetic Explanations For Why Cutting Sugar May Make You Feel Smarter
by Caitlin Aamodt

High Fat, Low Carb Diet Might Epigenetically Open Up DNA and Improve Mental Ability
by Bailey Kirkpatrick

Epigenetics May Provide Relief for Fragile X Syndrome and Intellectual Disorders
by Tim Barry

Multiple Sclerosis and Carnivore Diet

Dr. Terry Wahls reversed the symptoms of multiple sclerosis in herself and, through a clinical study, in others. Her Wahls Protocol includes a ketogenic diet with nutrient-dense animal foods, but it also requires massive loads of vegetables. Yet those on the carnivore diet, typically which also means ketosis (if dairy is restricted), others have also experienced similar improvements of multiple sclerosis symptoms, either reversal or stabilization.

Maybe all those vegetables have been irrelevant. The other two main factors would either be the ketosis or all the animal-based nutrition. There would be an easy way to test this. Do a study with multiple groups: 1) ketogenic omnivores (Wahls Protocol), ketogenic vegans, ketogenic carnivores, and non-ketogenic carnivores (add in enough dairy to remain out of ketosis). Control for all other main factors. Find out the results.

My suspicion is that it’s the combination of both ketosis (ketosis promoting metabolic healing and autophagy) and animal-based nutrition (both nutrient-dense and nutrient-bioavailable), quite likely combined with elimination of oxidative and mutagenic seed oils, food additives and farm chemicals (glutamate, propionate, glyphosate, etc). Any of these alone might show some benefits. Right now, mostly all we have to go by are the many people experimenting. The studies Wahls is doing are useful (she is on her second study), but that research is only preliminary.

As further evidence of the anecdotal variety, Mikhaila Peterson has successfully treated her own autoimmune disorder. It’s not multiple sclerosis, but all autoimmune disorders have some similarities. In going ketogenic, inflammation is being eliminated. And in going carnivore, plant anti-nutrients are being eliminated. These two factors also promote other things as well, but simply what they eliminate might be most key. Inflammation, in particular, is understood in its connection to autoimmune disorders.

All the plant foods Dr. Wahls recommends, by the way, increases the antinutrients that would block absorption of nutrients and potentially cause other problems. Maybe her diet is effective as a treatment of serious disease in spite of, not because of, plant foods. The nutritious animal foods are simply at a high enough level to get beyond this obstacle. But if it is not contributing to the healing, why not eliminate them? Or is she right that all of those non-starchy veggies are helping? Until better research is done, this remains speculation on both sides of the debate.

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2/15/20 – I came across a discussion between Dr. Terry Wahls and the carnivore advocate Dr. Paul Saladino. It’s now added as the first video below.

3/2/20 -Here is a Reddit discussion thread about the Wahls and Saladino’s talk:

Paul Saladino interviews Terry Wahls (She offers to run a carnivore study if funding can be arranged)
posted by r/greyuniwave

cookoobandana

YES. I’ve been wanting these 2 worlds to collide for quite awhile now. I have immense respect for Terry Wahls but I got so much worse following her protocol and trying to eat 9 servings of vegetables a day… Even when I eventually gave up on that much veg I still kept coming back to pushing plants, thinking they were incredibly important to eat because of her story.

zoelsie

As a long time (30+yrs,) often debilitating MS’er I followed Dr Wahls protocol for years in the US and did not get significantly better, even after moving to rural France (for the great vegetables and meat as much as the facts that I have citizenship and family here. As soon as I discovered the total carnivore diet some years ago here, taking advantage of all the cheap-ish (pun) local lamb and beef w/no supplements, I GOT BETTER! (100% Remission.) Plants really are poison for me, even the best organic plants on earth from the gardens of lush Provence. Thank you for this interview and to Dr Terry Wahls for accepting this simple WOE for the terrible, misunderstood, and ever fickle “illness” that is MS.

Epilepsy Not Treated With Ketosis

Silas Weir Mitchell was a famous doctor that first learned about neurological disease during his service in the American Civil War. He is most well known for his views on hysteria and neurasthenia, but he was considered an expert on other neurological conditions as well. One area he was respected in was the treatment of epilepsy, for which he preferred to use drugs. “Despite the prevalent views on lifestyle modification as a treatment for epilepsy during this time period, as well as Mitchell’s own development of the “rest cure” for certain disease states, he was not a proponent of these types of interventions for epilepsy” (David B. Burkholder & Christopher J. Boes, Silas Weir Mitchell on Epilepsy Therapy in the Late 19th to Early 20th Centuries).

From his writings on neurasthenia, he had articulated a common view of this disease in terms of nerves and energy, libido and sexuality. And he applied a similar understanding to epilepsy: “Still, in Mitchell’s first discussion of amyl nitrite as an abortive therapy, he clearly agreed with a common thought of the day by attributing the patient’s epilepsy to sexual vices, stating he had partaken in “…great excess, and that the punishment was distinctly born of the offence” (Burkholder & Boes). But in 1912, he questioned his prior causal explanations, having had written that, “It is conceivable that in nerve centres normal or abnormal substances may accumulate until they result in irritative symptoms and discharges of neural energy. But how then could this sequence be arrested by a mere sensory stimulation, like a ligature on an arm, or by abruptly dilating the cerebral vessels with amyl? The explosions would only be put off for the minute; the activating poison would remain.” These doubts were expressed when in his early 80s, after a long career in medicine.

Still, he never suspected any role to be played by diet or lifestyle. This is strange, considering his professional expertise in his having used diet and lifestyle for those suffering from neurasthenia, a neurological disorder like epilepsy. Even in his theorizing, the factors he considered for both overlapped to some degree in specific details and through general framework. Yet for epilepsy, he couldn’t somehow make a connection in the same way between physical health and mental health. Meanwhile, others were attempting to make such connections. There was much experimentation going on with epilepsy, including dietary protocols.

William Spratling, in Epilepsy and Its Treatment (1904), partly shared Mitchell’s assessment in writing that, “have been unable to determine that different foods have any specific effect on epilepsy itself beyond that which they have on the organism in general.” That didn’t stop him from having suggested a mixed/balanced diet that, though not having excluded carbohydrates, did tell epileptics to eat moderately and slowly while avoiding pastries, alcohol and over-sweetened drinks. In certain extreme cases, he went even further by asserting that, “Foods should be in liquid form and highly nutritious from the start. Various preparations of milk, eggs, and beef extracts may be given; but plain peptonized milk is by far the best food of all. It should be given often and in small amounts.”

Spratling’s professional advice for treatment in some cases potentially could have been ketogenic, if not in a systematic manner. The same might’ve also been true of Sir J. Russell Reynolds’ even earlier 1862 epileptic protocol of avoiding “Salted meats, pastry, preserved vegetables, and cheese” (Epilepsy: Its Symptoms, Treatment, and Relation to Other Chronic Convulsive Diseases). Besides openly advocated low-carb diets like that of William Banting, many scientific experts, medical practitioners, public intellectuals and popular writers during that era flirted around the edges of restricting starches and sugar for various reason, though not to treat epilepsy. That is significant, since the average diet was already far lower in carbohydrates than what was seen in the following generations. Some patients would have found relief from seizures through ketosis without realizing what had helped them. The seeming randomness of who did and who did not experience improvements had to have been frustrating to doctors of the time.

In 1914, two years after having fallen into self-questioning, Mitchell would die without having learned of an effective treatment. Only a few years later in 1921, there was the discovery of dietary ketosis (Rollin Woodyatt) and the discovery of the medical use of a ketogenic diet for epileptic seizures (Russel Wilder), although ketosis was used for this purpose through fasting as far back as 500 BC. Despite this failure, like so many others, he approached the territory of a ketogenic diet while entirely missing it, such as in his recommendations of meat and dairy for neurasthenics which potentially could’ve put a patient into a state of ketosis. He came so close, though. After graduating from medical college in 1851, he moved to Paris and spent a year studying under Claude Bernard. About a decade later, the British Dr. William Harvey heard Bernard speak about the relationship between diet and diabetes, and this information he used to formulate a low-carb diet for his patient William Banting to lose weight. Banting then popularized this diet, but at that point it had already been in use by others going back to the 1790s.

During Mitchell’s lifetime, most Americans would have still followed a diet where carbohydrates were a small portion of meals and a small percentage of calories. It’s probable that the majority of the population during the 19th century was regularly in a state of ketosis, as the common diet back then consisted of mostly animal foods — what Nina Teicholz describes as the “meat-and-butter-gorging eighteenth and nineteenth centuries” (The Big Fat Surprise; see context of quote in Malnourished Americans). Mitchell himself might have experienced ketosis at different points in his life without realizing it. This wouldn’t have been an unusual thing for most of human existence, if not from a low-carb diet then from caloric restriction, intermittent eating, and fasting — ketosis isn’t exactly hard to achieve in a traditional setting. For example, it used to be standard for Americans to eat only one meal a day (Abigail Carroll, Three Squares) and that was in the context of a labor-intensive rural lifestyle. Sugary cereals, Pop-Tarts, etc were not available for breakfast. And snacking all day on crackers, chips, and cookies simply was not an option.

It’s interesting to note that meat-and-butter or rather meat-and-milk was what Mitchell, working as a doctor in the 19th century, told his neurasthenic patients to eat. But for unexplained reasons, he didn’t advise the same or a similar eating pattern to his epileptic patients. Low-carb and animal-based dieting was popular in his lifetime and was used by many doctors for various conditions, often for obesity but far from limited to that. It’s odd that no one made the connection of the ancient practice of fasting for epileptic seizures with the 19th century practice of potentially ketogenic diets. No one managed to figure this out until the 1920s and not for a lack of experimentation with diverse alimentary regimens. Then when it was finally discovered, after a short period of research, it was mostly forgotten about again for another three-quarters of a century. Yet even now drugs remain the primary treatment for epilepsy, despite ketosis being the most effective, not to mention safest, treatment; and, if ketosis is the normal state of physiological functioning, we might call it a cure for many people.

Felice Jacka Defends Boundaries of Allowable Dietary Thought

Felice Jacka is an Australian professor of epidemiology. In her official capacity as an expert, she made a public health warning from her Twitter account: “If your/an MD is advocating an extreme diet of any type, please understand that they may NOT be the best person to listen to.” In her other tweets that followed, it was made clear that doctors had no right to recommend any diet other than whatever is officially declared healthy by the appropriate government and medical institutions.

She made this statement after watching a video of Dr. Shawn Baker informally discuss the carnivore diet, as if in doing so he was a public threat and an immoral actor who must be publicly called out and shamed. Her professional assessment was that he wasn’t being scientific enough. Fine. If she wanted a more scientific analysis of the evidence, she could have turned to talks given by Georgia Ede, Zoe Harcombe, Amber L. O’Hearn, and Paul Saladino. Her damning indictment of the carnivore diet was rather strong after watching a single Youtube video of a casual talk. That doesn’t seem like a scientific response.

Or she could have checked out the informal survey that Dr. Baker himself recently did in exploring people’s experience with the carnivore diet. Her complaint was that his experience was merely anecdotal. Sure. But he isn’t alone, which was the purpose of the survey he did. Look at the carnivore groups on social media, some of which have hundreds of thousands of members.

Carnivore is not a minor diet. She calls it “extreme”. It’s no more extreme than veganism and certainly far less extreme than the modern industrial standard American diet (SAD). I’d also go so far as to say, in terms of history and evolution, carnivore is also not nearly as extreme as the diet advocated by the AHA and USDA, the diet that the data shows Americans have been mostly following and that has led to a disease epidemic.

It’s not only the carnivore diet Jacka targets. In her book Brain Changer, she has a small section on the ketogenic diet in relationship to schizophrenia. She writes that, “Until we have the evidence from such studies, however, we would definitely not recommend such a diet, as it’s extremely strict and demanding and requires close medical supervision.” There she goes again: “extremely” — as if she were talking about potentially violent political activists. Her language is consistent in talking about any diet that dares to cross the line.

Let me set one thing straight. No, the ketogenic diet isn’t extremely strict or particularly demanding. Those who go on it often find it to be the easiest diet they ever tried, as hunger and cravings tend to decrease. It still allows for a wide variety of animal and plant foods. If ketosis is all you care about, you don’t even have to worry about the quality of the food, as long as it is low enough in carbs. Go out to fast food and eat the hamburger but without the bun. And if you want snack foods, have a bag of pork rinds instead of a bag of potato chips. Plus, there are all kinds of prepared products now marketed as keto, from protein bars to cauliflower pizzas, and nearly all stores carry them.

So, why all this fear-mongering about alternative dietary approaches? In response to Jacka, Dr. Ara Darakjian tweeted, “This seems overly restrictive on a physician’s freedoms. Why should there be a gag rule? If a physician believes differently they have to stick to the party line? I’ve never recommended carnivore but I don’t think it’s wrong for other MD’s to advocate based on anecdotal evidence” That is a good point. Why not allow doctors to use their best judgment based on their own professional experience?

A light went off in my head when I saw that mention of a “gag rule”. The specific doctor she is criticizing, Dr. Shawn Baker, was the target of a witch-hunt that involved a several year legal battle and resulted with the state board temporarily taking away his license to practice. So, it seems like no accident that he still is being targeted. It turns out he was vindicated and his license was reinstated. Still, he was forced out of work during that time and, along with severe disruption in his life and his family, because of legal costs he lost his house.

His sin in that earlier situation, however, wasn’t about the carnivore diet. He was simply recommending lifestyle changes as a prevention for surgery. By the way, he doesn’t only recommend a carnivore diet but also keto and moderate low-carb, even plant-based in some cases. He treats his patients as individuals and seeks the best treatment according to his knowledge. Sometimes that involves a particular dietary approach or another, but according to Felice Jacka that should not be allowed, a powerful message considering the doctor she chose to use as an example.

When I first saw her tweet, I didn’t know she was Australian. It occurred to me to see where she was from. I wondered this because I knew some other major cases of witch-hunts. The moment I saw that she is employed at an Australian university, another light bulb went off in my head. One of the worst witch-hunts against a low-carb advocate sought to destroy the career of the Australian doctor Gary Fettke. I don’t know if she was involved in that witch-hunt or supported it in any way, but it seems likely she wouldn’t been on the side defending Dr. Fettke’s rights.

I also left some tweets in that thread she started. I brought up some criticisms of the field of nutrition studies itself. She defended her field of expertise since, after all, her authority rests upon it. She said to me that, “I don’t agree that there is (largely) not consensus among nutrition professionals and researchers. But it’s not the point I’m making. MDs are charged with practising evidence-based medicine. Whether or not you or they dont agree with the evidence for whatever reason.”

Responding back to her, I wrote: “Consensus from evidence-based medicine in a field suffering from one of the worst replication crises in scientific history is precisely part of the problem.” That was a tougher criticism than it might seem, since the main replication failure of nutrition studies has been epidemiology, Jacka’s sole area of expertise. After that simple comment, she blocked me. There was nothing else I said that was mean or trollish. The closest I came to being antagonistic was in saying that I’d rather trust the expertise of those who are world-leading experts in keto and low-carb diets: Benjamin Bikman, Jason Fung, etc; also, Tim Noakes (another victim of a witch-hunt, as shown in the documentary The Magic Pill, in Daryl Ilbury’s book The Quiet Maverick, and in Noakes’ own book Lore of Nutrition). She obviously is not in favor of open scientific debate and inquiry.

There are powerful interests seeking to maintain the status quo. A simple tweet might not seem like anything to be concerned about. Then again, Tim Noakes troubles began with a single innocent tweet that was used as evidence. He fought back, but it also took years and immense amounts of money. If he wasn’t such a brilliant and determined guy, the powers that be might have been successful. Still, the attack did effectively make Noakes into an example. Few people could have stood up to that kind of organized and highly funded onslaught. When someone like Felice Jacka complains about someone like Dr. Shawn Baker, there is always an implied threat. Most doctors probably remain silent and keep their heads down. Otherwise, the consequences might mean the ending of one’s career.

 

Is Ketosis Normal?

Humans are born into ketosis and will remain in ketosis while breastfeeding, whether or not the mother is in ketosis. For hunter-gatherers, breastfeeding commonly lasts for the first couple of years, the most important time for growth and development, especially the brain. So, evolution has created ketosis as a protected state for infancy. But it goes far beyond that.

Unlike other carnivores, evidence indicates humans remain in ketosis even while eating higher amounts of protein. We are capable of gluconeogenesis, a necessary function turning protein into glucose, but we don’t so heavily rely upon it. Under normal evolutionary conditions, humans would spend much, probably most, of their time in ketosis. No other species so easily goes into and remains in ketosis. The human brain, in fact, preferentially uses ketones. And it is probably because of our large, energy-hungry brains that we are so ketosis-prone in the first place. That is likely why babies are born so fat, so that they can have a ready supply of ketones.

It was a trade-off of the human brain growing larger as the gut grew smaller, as it requires a lot of energy to digest plant matter and that energy was needed for the evolutionary development of a larger brain. So, humans turned to eating fat from animals, to replace a digestive system needed to break down fibrous plants to produce fat. Herbivores are forced to spend all day eating vast amounts of plant matter and it is energy intensive work. Ketosis freed humans from this activity and simultaneously freed up immense energy to be used for other purposes, specifically greater neurocognitive functioning and higher thought.

The benefits and advantages of ketosis are amazingly numerous. It protects against or improves epilepsy, along with other neurocognitive disorders and mental illnesses, from bipolar disorder to ADHD, not to mention much more serious diseases such as Alzheimer’s. It also shows benefit for autoimmune disorders, cancer, and trauma. There is no health condition I can think of, besides type 1 diabetes, that would be worsened by ketosis. And if one were on a ketogenic diet in the first place, one would be unlikely to develop type 1 diabetes and so that is moot.

One would be forgiven for thinking that ketosis might be the natural state of the human species. Still, whatever one thinks of evolutionary arguments, no one can deny that ketosis is a far healthier state to be in, or at least there is no evidence to the contrary. That said, one doesn’t have to be in constant ketosis to see many of these benefits. Even in epilepsy, after a period of healing, some patients can stop a ketogenic diet and stay free of seizures. There are many mechanisms for this healing power of ketosis, such as the related autophagy, but the general anti-inflammatory effect might be more important considering inflammation is found in so many diseases.

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By Amber L. O’Hearn:

Babies thrive under a ketogenic metabolism

Optimal Weaning from an Evolutionary Perspective

Ketosis Without Starvation: the human advantage

I’d love to see this question approached systematically, but the survey does at least suggest that protein levels above our minimum needs based on positive nitrogen balance still support ketosis. […]

Obligate carnivores are always on very low carb diets, so you might think they are always in ketosis, but that’s not at all the case. In fact they are specialised at gluconeogenesis, that is, getting all their energy needs met by converting protein into glucose. Protein needs tend to be high.

Cats have much higher protein needs than omnivores and surprisingly, they don’t adapt well to reduced protein or fasting [Cen2002]. They don’t seem to have good mechanisms to compensate for the various amino acid and vitamin deficiencies that develop, so they suffer from ammonia toxicity, methylation problems, and oxidative stress. They do produce ketones fasted, but they don’t seem to use them in a productive way. and they actually accumulate fatty acids in the liver when fasted; the opposite of what humans do, Because they are still producing glucose, they become like human type two diabetics.

Dolphins are particularly interesting because they have really large brains, and they eat a diet that would be expected to be ketogenic if fed to humans. However, they don’t seem to even generate ketone at all, not even when fasting. Instead, they ramp up gluconeogenesis [Rid2013].

They keep their bodies and their brains going by increased glucose.

When faced with this observation that humans use ketosis even when they don’t have to for glucose production, one obviously wonders how this happens from a mechanistic standpoint. I have never seen the question raised in the literature, let alone answered. If I were to take a guess, I’d say it probably happens somewhere in this process.

CPT1A is a kind of gatekeeper, transporting fatty acids into the mitochondria for oxidation. This is normally a necessary step in the creation of ketone bodies. The coenzyme malonyl-CoA inhibits CPT1A [Fos2004]. The functional reason it does that is because malonyl-CoA is a direct result of glucose oxidation and is on the path to de novo lipogenesis. It could be inefficient to be both generating fat and oxidizing it. So this is a convenient signal to slow entry of fat into the mitochondria.

However, its action is not stictly linear. It uses hysteresis. Hysteresis is a way of preventing thrashing back and forth between two states at the threshold of their switch. For example, if you set your thermostat to 20°C, you would not want the heater to be turned on when the temperature drops to 19.999 and turned off again at 20. This would result in constant switching. Instead, a thermostat waits until the temperature drops a little lower before activating the heater, and heats it a little more than required before deactivating it.

Hysteresis is implemented in CPT1A by its becoming insensitive to malonyl-CoA when levels of it are low [Ont1980][Bre1981][Gra1988][Gre2009][Akk2009]. That means that once CPT1A becomes very active in transporting fatty acids, it takes time before the presence of malonyl-CoA will inhibit CPT1A at full strength again. That means that fluxuations in glucose oxidation, or small, transient increases in glucose oxidation don’t disturb the burning of fatty acids or the production of ketones.

It could be the case that humans develop more insensitivity to malonyl-CoA under ketosis than other species do, allowing them to metabolise more protein without disturbing ketosis. Among humans, this is case in populations such as some Inuit with the Artic variant of CPT1A. That mutation slows down CPT1A activity immensely. This was permitted by their diet which was very high in polyunsaturated fats from sea mammals. Polyunsaturated fats upregulate fatty acid oxidation by a large proportion compared to saturated fats [Cun2002][Fra2003][Fue2004], so this mutation would not necessarily have been disruptive of ketosis in that population when eating their natural diet [Lem2012]. But a second effect of the same gene further decreases the sensitivity of CPT1A to inhibition by malonyl-CoA. That means they are less likely to be knocked out of ketosis by high protein intake. […]

But it’s not just epilepsy that ketosis is good for. Epilepsy is just the condition with the most research, and the widest acknowledgment.

Other conditions for which at least some evidence supports improvement via a ketogenic diet include neurological disabilities in cognition and motor control [Sta2012]; the benefit here may have to do with the proper maintenance of brain structures such as myelination (Recall phases: tear down damage, rebuild)

Survival after brain damage, the hypoxia of stroke or blows to the head is improved in animal models [Sta2012]. There is even animal evidence that brain damage due to nerve gas is largely mitigated by being in a state of ketosis during the insult [Lan2011]. Again, this suggests a structural support and resilience provided by a ketogenic metabolism. Resilience comes in part from not being as susceptible to damage in the first place, and that could be from reduced oxidative stress when using ketones for fuel.

Ketogenic diets as a treatment for cancer are controversial, but some of the best evidence in support of it comes from glioblastomas. See e.g. [Zuc2010][Sch2012]. This could be due mostly to the hypoglycemia stalling the rate of tumour development.

And to venture into an area less well studied, but of critical importance given the epidemic that would be more apparent were it less taboo, there is preliminary evidence in the form of case studies that ketogenic diets may be promising treatments for many psychiatric illnesses too, for example, [Kra2009][Phe2012]. Given that anticonvulsants are also used to treat bipolar, and the solid results of ketogenic diets on epilepsy, this may not be surprising. Additionally, the enhanced availability of AA and DHA may play a crucial role Because these fatty acids are critical for the brain, and dysregulation in their flux has been associated with bipolar disorder and schizophrenia. See e.g. [McN2008] and [Pee1996].

I would almost like to call a ketogenic diet a brain-growth mimicking diet.

The question of how and why humans are so ketosis prone may lead to interesting new insights about us as a species. We seem to avoid giving up ketosis as long as possible. only halting it when we take in so much glucose exogenously that we have to store it.

It seems likely that it facilitated the evolution of our brains, that organ that makes us so different from other animals that we sometimes forget we are animals.

A Fun Experiment

I’ve written a lot about diet lately, but let me get personal about it. I’ve had lifelong issues with diet, not that I thought about it that way when younger. I ate a crappy diet and it was the only diet I knew, as everyone else around me was likewise eating the same basic crappy diet. Even my childhood sugar addiction didn’t stand out as all that unique. Though I didn’t know it at the time, looking back at it now, I’m sure an unhealthy diet with nutrient-deficiencies and food additives (maybe along with environmental toxins or other external factors) was likely contributing factors to my learning disability and word finding difficulties (WFD) — see previous posts: Aspergers and Chunking; and Specific Language Impairment. As early as elementary school, there were also signs of what would later be diagnosed as depression. I knew something was wrong with me, but felt at a loss in that there was no way to explain it. I was just broken, inferior and inadequate. I didn’t even understand that I was depressed during my youth, although my high school art teacher once asked me if I was depressed and, in my ignorance, I said I wasn’t. Being depressed was all I knew and so it just felt normal.

I didn’t have the insight to connect my neurocognitive and psychological struggles to physical health. The crappiness of my diet only became apparent to me in adulthood, although I’m not sure when I started thinking about it. I grew up in churches where people were more health-conscious and my mother tried to do what she thought was healthy, even as good info was lacking back then. Still, a basic mentality of healthfulness was instilled in me, not that it initially did me much good. It took a while for it to lead to anything more concrete than doing what was the height of “healthy eating” in those day, which was skim milk poured over bran cereal and an occasional salad with low-fat dressing. That simply would’ve made my depression and learning disabilities worse as it surely was fucking up my neurocognition precisely as my brain was developing, but mainstream advice asserted that this USDA-approved way of eating would cure all that ails you. Fat was the enemy and fiber was a health tonic. Few at the time realized that fat-soluble vitamins were key to health nor that a high-fiber diet can block nutrient absorption.

Everything fell apart after high school. I despised life and wanted to escape the world. I dropped out of college and seriously considered becoming a hermit, but the prospect was too lonely and after moving out to Arizona I felt homesick. Then in going back to college, I attempted suicide. I failed at that as well and earned myself a vacation in a psychiatric ward. I was bad off, but having been raised in New Thought Christianity I was always looking for answers in self-help books and similar things. It would’ve been maybe in my early to mid 20s when I first read books that were explicitly about diet, nutrition, and health. I do recall, for instance, a book I picked up on low-carb diets and it wasn’t about the Atkins diet — it might have been an old copy of Vilhjalmur Stefansson’s Not By Bread Alone or it could have been something else entirely. Around that time, there was a minor incident that comes to mind. I told my friend that fast food was unhealthy and he didn’t believe me. It sounds odd now, but this was back in the 1990s. His mother was a nurse and regularly bought him fast food as a child. So how could it be bad? Many people at the time didn’t have much sense of what made food healthy or not, but obviously something had got me thinking about it. I knew that some foods were not healthy, even as what a healthy diet should look like was a bit hazy in my mind, beyond the nostrum of eating more fruits and veggies.

I lacked knowledge and there weren’t many sources of knowledge prior to my getting internet. Still, based on what limited info I could glean, I did start experimenting during that period. I began trying supplements to deal with my depression with the related low energy and low motivation, as therapy and medications had failed to put a dent in it. Around 1998, four years after graduating high school and a couple years after the suicide attempt, I tried vegetarianism for a time, maybe for a year or so, but it mainly involved eating as a regular meal a mix of Ramen noodles, eggs, and frozen vegetables cooked in the microwave — it was a poverty diet as I was living in poverty. I probably also was eating plenty of junk food as well, considering most cheap processed foods are vegetarian. Avoiding meat certainly doesn’t guarantee health — it didn’t fill me with joy and vitality. A bit later on I did finally try a low-carb diet, but it mainly consisted of eating processed meat because I was too depressed to cook. Even then, I might not have been getting many fat-soluble vitamins, as I didn’t understand nutrient-density. I wasn’t procuring pasture-raised meat, much less emphasizing organ meats, bone broth, wild-caught fish, etc.

My experiments weren’t well-informed and so weren’t done under optimal conditions. There was no one around to offer me guidance and so it didn’t work out all that well. I don’t give up easy, though. I went looking for guidance from dozens of psychiatrists, therapists, energy healers, body workers, and even a shaman. In my desperation, I’d try anything. Then I went to massage school where I learned Shiatsu massage and traditional Chinese theory, along with some other modalities. Even that didn’t change anything. My massage teachers were alternative health practitioners, one being a naturopath, but it seemed like no one understood what was wrong with me and so nothing could make a difference. My depression was an incomprehensible mystery. Rather than something being wrong with me, I was the problem in being inherently defective, so it seemed in my lingering dark mood.

The only thing that made much of a difference was exercise. I found that I could keep the worst symptoms of depression at bay through jogging, if only temporarily. At some point, I learned to jog before eating anything in the morning and I found that my hunger and cravings were less for the rest of the day. I had accidentally discovered ketosis and didn’t know what it was. It didn’t make sense that physical exertion minus food would lead to such results — rather counterintuitive. I was also occasionally fasting around then which also would’ve contributed to ketosis. That isn’t to say ketosis while in nutrient deficiency is a good thing. I’d have been better off in having avoided ketosis entirely and, instead, having filled up on nutrient-dense fatty animal foods. I needed healing and only high dosage of nutrition was going to accomplish that. I had been too malnourished for far too long at that point. Ketosis would’ve been great after a period of deep nourishment, but I didn’t understand either the significance of key nutrients nor how to implement ketosis in a more beneficial way.

At some point, I read Sally Fallon Morrell’s Nourishing Traditions (1995) where I was introduced to nutrient-density and fat-soluble viatmins along with traditional food preparation, but I was too depressed and too isolated to fully and successfully implement what I was learning. Depression is a real kick in the ass. Still, I was slowly accruing basic knowledge and making small changes when and where I felt able. I was limiting some of the worst problematic foods. In particular, I began cutting back on junk food, especially candy. And I replaced sugar with such things as stevia. Simultaneously, I increased healthier foods like probiotics and Ezekiel bread, although I’m not sure that the latter really is all that healthy (it has vital gluten added to it and it mostly starchy carbs). I tried to limit my sugar intake to foods that were relatively better, such as yogurt and kefir. I still was experimenting a bit with supplements, but wasn’t getting any clear results. My depression persisted and I see now that, even with these changes, I continued to lack nutrient-density. It just wasn’t clicking together for me. Maybe my depression had moderated ever so slightly, to the degree that I was a functional depressive and not in the total gloom and doom of my late teens to early twenties. I figured that was as good as it was going to get. I had survived that far and figured I’d be depressed for the rest of my life. Let me put this in perspective. This slightly lessened depression was, nonetheless, chronic and severe. For example, suicidal ideation persisted — maybe more as a background noise to my thoughts, but there, always there. I had this suspicion that eventually depression would catch up with me and then that would be the end of me. Suicide remained a real possibility in my mind, a persistent thought. It was hard for me imagine myself surviving into old age.

I carried on like this. I managed my life at a bare minimal level. I held down a job, I sort of kept my apartment clean, I fed my cats and sometimes changed their litter, and I more or less paid my bills on time. But depression had kept me working minimal hours and barely staying above poverty. There wasn’t only the depression for, over the decades, a crippling sense of shame had accumulated. I felt worthless, a failure. I wasn’t taking care of myself or at least wasn’t doing it well. Everything felt like a struggle while nothing I did seemed to make a difference. It was shitty and I knew life was just going to get worse as I aged and thinking about that made me feel more hopeless. To add to that general anxiety and despair, as I drifted through my thirties, I began gaining weight. I had always thought of myself as athletic. I played soccer from 1st grade to 11th grade and was always slim and trim, although I remember at one point after high school having been so inactive for a number of years that I felt winded just by walking up a hill — that was a strange experience for me because I had never been out of shape before that time. That was why I came to focus so much on exercise. Yet with age, mere exercise wouldn’t stop the weight gain, much less help with weight loss… nor any of the other symptoms of declining health. I was jogging multiple times a week for long periods, sometimes while wearing a heavy backpack as I hoofed it out to my parent’s place on the far edge of town. Still, the excess fat remained. That was rather dispiriting. Yet from a conventional viewpoint, my diet was balanced and my lifestyle was generally healthy, at least by American standards. I was doing everything right, as I understood it. Just the expected results of aging, most doctors would likely have told me.

I realize now that insulin resistance probably had set in quite a while back. I was probably prediabetic at that point, maybe even in the early stages of diabetes (I sweated a lot, in the way my grandmother did before her diabetes was managed with insulin shots). I know that I no longer handled sugar well, which helped keep my sugar addiction in check. About a decade ago, my friend and I visited a nearby donut shop and I got several fine specimens. Upon eating them, I felt sick with a slight headache. No more donuts for me. Sugar or not, my diet was still fairly high-carb, but I wasn’t yet fully aware of how starches and sugars sneak into everything. Then last year I randomly came across the paleo documentary The Magic Pill and watched it without any expectation. I suppose it was just basic curiosity, as is my habit. Something about it resonated with me. I showed it to my parents and they too found it inspiring. So, we all set about changing our diets — having mutual support from family was surely an important factor for motivation. The diet portrayed is standard paleo with a combination of low-carb and nutrient-density. What made the documentary compelling was how a wide variety of people were followed as they tried the paleo diet: a woman living alone with various health problems, a family with a young daughter with severe autism, and an Australian Aboriginal community that had lost their traditional way of life. It demonstrated the significant changes that could occur through diet. The transformation of the autistic girl was particularly impressive. The entire documentary was motivational. After that, I looked for some other documentaries to watch with my parents: The Perfect Human Diet, Carb Loaded, etc. Learning more reinforced this new view and brought together all that I had learned over the decades. I finally had a broader framework of understanding.

It was this low-carb paleo diet that was the starting point for me, although my mother never was quite on board with it. After looking online, she was drawn to the FODMAP diet in hoping it could help with her gut issues, specifically GERD and belching, but also osteoporosis (and indeed it did seem to work for her, as her former high-fiber diet apparently was the source of her problems), although her diet had some overlap with paleo. Going into my typical obsessive-compulsive mode, I gathered dozens of books on the subject, voraciously took in all the info I could find online, and began following various people on social media. I quickly figured out the basics and what was most essential while determining the points of disagreement and uncertainty. What I liked about the paleo and low-carb community was the attitude of curiosity, of exploration and experimentation. Try something and see what happens. And if it doesn’t work, try something else. There was no failure, a much more positive attitude about health. Within three months of implementing the paleo diet, I had lost 60 pounds of fat and I did it without starving myself. I simply figured out how to tap into the body’s natural mechanisms for fat-burning and hunger signalling. As I switched from general low-carb to ketogenic, my experience improved even further. It finally dawned on me that my depression had gone away, simply and utterly disappeared, decades of depression along with a lifetime of sugar addiction no longer an issue. I didn’t need to struggle against it. I wasn’t even trying to cure my depression, not that I realized this even was a possibility. It was a complete surprise.

It’s been a little over a year now. I’m still coming to terms with this new state of being. It’s strange. Depression had become part of my identity, as had sugar addiction and the roller coaster hangriness of insulin resistance. I now simply wake up in the morning feeling perfectly fine. It’s not that I go around feeling ecstatic, but the extreme low moods and funks no longer happen. I feel more balanced and relaxed. I used to fall into long periods of apathy and despair where all I could do was isolate myself until it passed, sometimes requiring days or weeks before I could rejoin humanity. How I functioned at all in such a state is kind of amazing, but not nearly as amazing as the miracle of its drama-free disappearance. Depression was there and then it wasn’t. I didn’t really notice it going away, until after it was gone. This leaves me in a strange position, as the decades of depressive thought and behavioral patterns remain. It’s hard for me to know how to not be a depressed person. I can’t quite wrap my mind around it. I don’t remember the last time I had any suicidal tendencies or fantasies. Yet the decades of damage to my body also remains as a reminder.

That hasn’t stopped me from getting back in shape and beyond. In fact, I’m in better shape now as I move toward middle age than ever before in my life. It’s not simply that I’ve been working out but that I enjoy working out. It feels good to me and I enjoy doing physical activity, pushing myself to the point of exhaustion. Unsurprisingly, I’m looking better. People notice and tell me. This sometimes makes me uncomfortable, as I’m not used to getting compliments. Just today I went to a picnic with a large crowd, some people I knew and some I didn’t. I met a friendly young woman and she was obviously flirting with me as we talked. It was a nice day and, having been out in a kayak, I had my shirt off. She told me that I looked “gorgeous” — the exact word she chose.* I’ll be blunt about this. No one has ever said anything like that to me in my entire life. I had never been a buff guy before and now I actually have muscles. It changes how I carry myself, how I feel.

It makes me realize why some fat people, after losing a bunch of weight, will sometimes gain their weight back just to feel normal again. The person I am now is not the person I’ve known myself for as long as I can remember. And I don’t know what to do with people relating to me differently. I’m sure people treat me differently not only because I look different but probably because I’m putting off a different vibe. I’m less sullen and dissociated than I used to be. An easygoing friendliness comes more naturally to me now. I don’t feel so crappy in no longer being on a crappy diet, but I’m not sure what it might mean to be healthy and happy. That is an odd concept to my mind. What if I could really be different? I take this seriously. In the past, I didn’t feel capable of being different, but all of that has changed. I don’t feel so irritable, frustrated, and angry. In place of that, I find myself wanting to be kinder and more forgiving. I want to be a good person. I realize that, in the past, how I could be an asshole and I was often open in admitting this basic fact of my former state, sometimes apologizing for my antagonistic moods. My life didn’t always feel like a net gain for the world and I’m sure some people might have agreed with that assessment. I could be harshly critical at times and that doesn’t make others feel better — I seriously harmed a number of relationships.

Now here I am. It’s a bit late in my life, but I have a second chance to try to do things differently. It will take some further experimentation beyond diet to find better ways of relating to others and to myself. That said, I’ll go on tinkering with my diet and lifestyle. It’s an ongoing experiment, all of it. Most importantly, it’s a fun experiment. The idea that I can try various things and discover what works is new to me. I’m more used to failure, but now I’m starting to see ‘failure’ as simply part of the experiment. There is no failure. Life doesn’t have to be hard. And I’m realizing that I’m not alone in this, as I’ve come across hundreds of stories just like mine. Sometimes simple changes can have profound effects.


* I must admit that it was a disconcerting experience. A young beautiful woman telling me in no uncertain words that I’m attractive. That is not the kind of thing I’ve grown accustomed to. I handled the situation as well as I could. It was kind of an amusing scenario. She was with her family. Along with her parents, she was visiting from Tunisia in order to see her sister who now works at the local university.

So, this young woman wasn’t going to be around long. Developing a romantic relationship didn’t seem to be in the cards, even if I had wanted it, but I feel ambivalent about romantic relationships these days. I’ve become comfortable in my bachelorhood with its lack of complications. Even so, I played along with the flirtation. As I sat near her with her family at the picnic table, she kept wanting to feed me. And how I could I decline food offered by a beautiful woman, even when she offered me carbs. That is my new plan for carb cycling — I’ll eat carbs every time a beautiful woman feeds them directly to me.

Anyway, combined with introversion and shyness, the lifetime of depression has made me reticent. I’m not confident around the opposite sex, but I’ve had long years of training in hiding any anxieties. Still, I didn’t know what purpose there was in flirting with this nice-looking person who would soon be gone. She said she might be back to visit again in a few years and that seems like a long time when you just met someone. I convinced myself there was no point and didn’t give her my contact info or ask for hers. But now I feel some regret.

I was acting according to my old self, the one who was ruled by his depression. Maybe it was irrelevant that I might not see her again. I should have left the door open for the possibility. These are the kinds of habits I need to learn.

The Ketogenic Miracle Cure

Why do we hear so little about the ketogenic diet? At this point, there has probably been thousands of studies done on it going back a century. In the 1920s, it was first demonstrated effective as a medical treatment for epileptic seizures. And since then, it has been studied with numerous other health conditions, especially for weight loss in obesity.

The results are often dramatic. Dr. Terry Wahls, in using a ketogenic diet in a clinical study, was the first to prove that multiple sclerosis could be put into remission. Dr. Dale Bredesen, also through a ketogenic diet in a clinical study, was able to reverse Alzheimer’s which has never before been accomplished, in spite of all the massive funding that has gone into pharmaceuticals.

Dr. Paul Saladino talked with Dr. Chris Palmer about metabolic disorders and psychiatric disorders (Paradigm shiftng treatment of schizophrenia and bipolar with Ketogenic diets. Chris Palmer, MD). Indicating this connection, many antipsychotics and antidepressants affect not only mood but also metabolism, such as weight gain (e.g., see how “a common class of antidepressants works by stimulating activity in the gut and key nerves connected to it rather than the brain as previously believed”; from Michelle McQuigge, New study suggests role of the gut is important in treating depression).

This connection is also seen in how depressives have higher rates of diabetes and diabetics have higher rates of depression, and to emphasize this point those with both conditions tend to have more severe depression. Unsurprisingly, the keto diet has been useful for treating depression.

It likewise has been used to treat other neurocongnitive conditions, including major psychiatric disorders like bipolar disorder and schizophrenia, arguably the same. Lessening of symptoms has been seen with schizophrenics on a keto diet (Chris Palmer, Chronic Schizophrenia Put Into Remission Without Medication). And in one case, 53 years of schizophrenia went entirely into remission and remained in remission for years following. That patient, after doing a keto diet under the care of Dr. Eric Westman in order to lose weight, found she was able to stop taking all psychiatric medications and became independent in no longer needing assistance to do daily tasks.

Now Dr. Stephen Phinney has done the same thing with diabetes, although less surprising as ketogenic research on diabetes goes back several generations. What has been the response from government health officials, non-profit health organizations, and mainstream doctors? A combination of silence and fear-mongering. A revolution in medicine is happening and few seem to be paying attention. But think how many lives could have been saved and improved, if the promising research on the keto diet hadn’t been shut down earlier last century.

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Ketones are fascinating. They are far more than an alternative or, if you prefer, primary fuel in the body. The energy produced is different as well, in being more efficient and cleaner. Furthermore, they don’t merely shift metabolism and can promote effortless fat-loss. Ketones act like master hormones and alter gene expression. This is why they are so powerful in reversing and curing serious diseases. But it isn’t miraculous, as it is entirely natural. This is how the body is supposed to function.

The Mechanisms by Which the Ketone Body D-β-Hydroxybutyrate May Improve the Multiple Cellular Pathologies of Parkinson’s Disease
by Nicholas G. Norwitz, Michele T. Hu, and Kieran Clarke

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What If They Cured Diabetes and No One Noticed?
If the ketogenic diet can reverse diabetes, why isn’t your doctor recommending it?
by Piper Steele

Keto Diet Puts Diabetics in Remission

After Inkinen’s pre-diabetes diagnosis in 2012, he spent the next few years researching the disease and treatments and ultimately teaming up with Stephen Phinney, MD, Ph.D in 2014 to form Virta Health, a research and virtual medical clinic whose mission is to reverse type 2 diabetes.

Phinney has been researching the keto diet and publishing studies on it for over 40 years. But last month, Virta published the results of what may be the most comprehensive study of the diet yet, a two-year intervention tracking 349 people who were divided into two groups. One followed a keto diet, the other followed their usual care for diabetes.

The results are impressive. At the end of two years, the keto group saw incredible improvements: 55% were able to reverse their diabetes and stop all medications except Metformin, and 18.5% were able to achieve remission. That is, they were both officially out of the diabetic range and off of all diabetes medications. Plus they maintained that state for at least one year.

The keto dieters were also able to lose weight (an average of 12% of body weight), reduce their dependence on insulin — dosages dropped 81% — and reduce triglycerides, inflammation and other markers for metabolic syndrome.

By contrast, just 10.5% of the participants in the control group were able to reverse their diabetes, and none was able to achieve full remission.

The control group also gained an average of 5% of their body weight, had a 13% increase in insulin dosages, and saw only modest improvements in triglycerides, inflammation and metabolic syndrome markers.

It’s also worth noting that this research is entirely self-funded — Virta receives its funding from venture capital investors.

“Online Revolt” Infuriates Diabetes Establishment
by Christopher James Clark

Last week, we saw the news that the world’s largest diabetes organizations, including the International Diabetes Federation, the American Diabetes Association, the Chinese Diabetes Society, and Diabetes India, are embracing bariatric surgery as a radical new approach to treating type-2 diabetes. According to these experts, surgery should be the standard protocol for many patients.

At the same time, these experts are becoming increasingly dismissive of diet and lifestyle approaches to reversing type-2 diabetes. The crux of the problem is that “the experts” recommend a low-fat, higher-carbohydrate approach, which simply doesn’t cut the mustard when compared to low-carb, higher-fat approaches.

In the information era, however, the truth always comes out.

Today, The Times is reporting on what they are referring to as “an online revolt by patients.” Diabetes.co.uk, a health organization that opposes the official dietary guidelines for diabetes treatment, launched a study, which included over 120,000 participants, the majority of whom suffer from weight related type-2 diabetes.

These people ate low-carb diets for 10 weeks, in defiance of the UK government’s Eatwell Guidelines, which mimic official US guidelines.

Over 70% of participants lost weight and improved their blood glucose levels.

“The results from the low-carb plan have been impressive and this is a solution that is clearly working for people with type 2 diabetes,” said Arjun Panesar, chief executive officer of diabetes.org.uk

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Ketone bodies mimic the life span extending properties of caloric restriction
by Richard L. Veech Patrick C. Bradshaw Kieran Clarke William Curtis Robert Pawlosky M. Todd King

Aging in man is accompanied by deterioration of a number of systems. Most notable are a gradual increase in blood sugar and blood lipids, increased narrowing of blood vessels, an increase in the incidence of malignancies, the deterioration and loss of elasticity in skin, loss of muscular strength and physiological exercise performance, deterioration of memory and cognitive performance, and in males decreases in erectile function. Many aging‐induced changes, such as the incidence of malignancies in mice 82, the increases in blood glucose and insulin caused by insulin resistance 39, 78, and the muscular weakness have been shown to be decreased by the metabolism of ketone bodies 18, 83, a normal metabolite produced from fatty acids by liver during periods of prolonged fasting or caloric restriction 12.

The unique ability of ketone bodies to supply energy to brain during periods of impairment of glucose metabolism make ketosis an effective treatment for a number of neurological conditions which are currently without effective therapies. Impairment of cognitive function has also been shown to be improved by the metabolism of ketone bodies 84. Additionally, Alzheimer’s disease, the major cause of which is aging 20 can be improved clinically by the induction of mild ketosis in a mouse model of the disease 85 and in humans 86. Ketosis also improves function in Parkinson’s disease 87 which is thought to be largely caused by mitochondrial free radical damage 19, 88. Ketone bodies are also useful in ameliorating the symptoms of amyotrophic lateral sclerosis 89. It is also recognized that ketosis could have important therapeutic applications in a wide variety of other diseases 90 including Glut 1 deficiency, type I diabetes 91, obesity 78, 92, and insulin resistance 20, 39, 93, and diseases of diverse etiology 90.

In addition to ameliorating a number of diseases associated with aging, the general deterioration of cellular systems independent of specific disease seems related to ROS toxicity and the inability to combat it. In contrast increases in life span occur across a number of species with a reduction in function of the IIS pathway and/or an activation of the FOXO transcription factors, inducing expression of the enzymes required for free radical detoxification (Figs. 1 and 2). In C. elegans, these results have been accomplished using RNA interference or mutant animals. Similar changes should be able to be achieved in higher animals, including humans, by the administration of d‐βHB itself or its esters.

In summary, decreased signaling through the insulin/IGF‐1 receptor pathway increases life span. Decreased insulin/IGF‐1 receptor activation leads to a decrease in PIP3, a decrease in the phosphorylation and activity of phosphoinositide‐dependent protein kinase (PDPK1), a decrease in the phosphorylation and activity of AKT, and a subsequent decrease in the phosphorylation of FOXO transcription factors, allowing them to continue to reside in the nucleus and to increase the transcription of the enzymes of the antioxidant pathway.

In mammals, many of these changes can be brought about by the metabolism of ketone bodies. The metabolism of ketones lowers the blood glucose and insulin thus decreasing the activity of the IIS and its attendant changes in the pathway described above. However, in addition ketone bodies act as a natural inhibitor of class I HDACs, inducing FOXO gene expression stimulating the synthesis of antioxidant and metabolic enzymes. An added important factor is that the metabolism of ketone bodies in mammals increases the reducing power of the NADP system providing the thermodynamic drive to destroy oxygen free radicals which are a major cause of the aging process.

What causes health?

What causes health? It’s such a simple question, but it’s complex. The causes are many and the direction of causality not always clear. There has been a particular challenge to dietary ideology that shifts our way of thinking. It has to do with energy and motivation.

The calorie-in/calorie-out (CICO) theory is obviously false (Caloric Confusion; & Fung, The Evidence for Caloric Restriction). Dr. Jason Fung calls it the CRaP theory (Caloric Reduction as Primary). Studies show there is a metabolic advantage to low-carb diets (Cara B. Ebbeling, Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial), especially ketogenic diets. It alters your entire metabolism and endocrine system. Remember that insulin is a hormone that has much to do with hunger signaling. Many other hormones are involved as well. This also alters how calories are processed and used in the body. More exercise won’t necessarily do any good as long nothing else is changed. The standard American diet is fattening and the standard American lifestyle makes it hard to lose that fat. Even starving yourself won’t help. The body seeks to limit energy use and maintain energy stores, especially when it is under stress (NYU Langone, Researchers Identify Mechanism that May Drive Obesity Epidemic). All that caloric restriction does is to slow down metabolism, the opposite of what happens on carbohydrate restriction.

We associate obesity with disease and rightly so, but that isn’t to say that obesity is the primary cause. It too is a symptom or, in some cases, even a protective measure (Coping Mechanisms of Health). The body isn’t stupid. Everything the body does serves a purpose, even if that purpose is making the best out of a bad situation. Consider depression. One theory proposes that when there is something wrong we seek seclusion in order to avoid further risks and stressors and to figure out the cause of distress — hence the isolation and rumination of depression. It’s similar to why we lay in bed when sick, to let the body heal. And it should be noted that depression is a symptom of numerous health conditions and often indicates inflammation in the brain (an immune response). Insulin resistance related to obesity also can involve inflammation. When the cause of the problem is permanent, the symptoms (depression, obesity, etc) become permanent. The symptoms then become problems in their own right.

This is personal for me. I spent decades in severe depression. And during that time my health was worsening, despite struggling to do what was right. I went to therapists and took antidepressants. I tried to improve my diet and exercised. But it always felt like I was fighting against myself. I was gaining weight over time and my food cravings were persistent. Something was missing. All that changed once I got into ketosis. It’s not merely that I lost weight. More amazingly, my depression and food addictions went away, along with my tendencies toward brooding and compulsive thought (The Agricultural Mind). Also, everything felt easier and more natural. I didn’t have to force myself to exercise for it now felt good to exercise. Physical activity then was an expression of my greater health, in the way a child runs around simply for the joy of it, for no other reason than he has the energy to do so. Something fundamentally changed within my body and mind. Everything felt easier.

This touches on a central theory argued by some low-carb advocates. It’s not how many calories come in versus how many go out, at least not in a simple sense. The question is what is causing calories to be consumed and burned. One thing about ketosis is that it forces the body to burn its own energy (i.e., body fat) while reducing hunger, but it does this without any need of willpower, restraint, or moral superiority. It happens naturally. The body simply starts producing more energy and, even if someone eats a high-calorie diet, the extra energy creates the conditions where, unless some other health condition interferes, increased physical activity naturally follows.

It’s not merely that being in ketosis leads to changed activity that burns more energy. Rather, the increased energy comes first. And that is because ketosis allows better access to all that energy your body already has stored up. Most people feel too tired and drained to exercise, too addicted to food that trying to control it further stresses them. That is the typical experience on a high-carb diet, mood and energy levels go up and down with the inevitable crashes becoming worse over time. But in ketosis, mood and energy is more balanced and constant. Simply put, one feels better. And when one feels better, one is more likely to do other activities that are healthy. Ketosis creates a leverage point where health improvements can be made with far less effort.

In the public mind, diet is associated with struggle and failure. But in its original meaning, the word ‘diet’ referred to lifestyle. Diet shouldn’t be something you do so much as something that changes your way of being in and relating to the world. If you find making health changes hard, it might be because you’re doing it wrong. Obesity and tiredness is not a moral failing or character flaw. You aren’t a sinner to be punished and reformed. Your body doesn’t need to be denied and controlled. There is a natural state of health that we can learn to listen to. When your body hungers and craves, it is trying to tell you something. Feed it with the nutrition it needs. Eat to satiety those foods that contribute to health. Lose excess weight first and only later worry about exercise. Once you begin to feel better, you might find your habits improving of their own accord.

This is a challenge not only to dietary belief systems but an even more radical challenge to society itself. Take prisons as an example. Instead of using prisons to store away the victims of poverty and inequality, we could eliminate the causes and consequences of poverty and inequality. We used to treat the mentally ill in hospitals, but now we put them into prisons. This is seen in concrete ways, such that prisoners have higher rates of lead toxicity. As a society, it would be cheaper, more humane, and less sociopathic to reduce the heavy metal poisoning. Similarly, studies have shown the prison population tends to be extremely malnourished. Prisons that improve the diet of prisoners result in a drastic reduction in aggressive, violent, anti-social, and other problematic behaviors. A similar observation has been made in studies with low-carb diets and children, as behavior improves. That indicates that, if we had increased public health, many and maybe most of these people wouldn’t have ended up in prison in the first place (Physical Health, Mental Health).

We’ve had a half century of unscientific dietary advice. Most Americans have been doing what they’ve been told. Saturated fat, red meat, and salt consumption went down over the past century. In place of those, fruits and vegetables, fish and lean chicken became a larger part of the diet. What has been the results? An ever worsening epidemic of obesity, diabetes, heart disease, autoimmune disorders, mood disorders, and on and on. In fact, these kinds of health problems were seen quite early on, following the fear toward meat that followed Upton Sinclair’s 1906 muckraking journalism on the meatpacking industry in The Jungle. Saturated fat intake had been decreasing and seed oil intake had been increasing in the early 1900s, in the decades leading up to the health epidemic that began most clearly around the 1940s and 1950s. The other thing that had increased over that time period were grains, sugar, and carbs in general. Then the victims who followed this bad advice were blamed by the experts for being gluttonous and slothful, as if diet were a Christian morality play. We collectively took the hard path. And the more we failed, the more the experts doubled down in demanding more of the same.

Do we want better lives for ourselves and others? Or do we simply want to scapegoat individuals for our collective failures? If you think we can’t afford to do the right thing, then we really won’t be able to afford the consequences of trying to avoid responsibility. The increasing costs of sickness, far from being limited to healthcare, will eventually bankrupt our society or else cause so much dysfunction that civil society will break down. Why choose such a dark path when an easier choice is before us? Why is the government and major health institutions still pushing a high-carb diet? We have scientifically proven the health benefits of low-carb diets. The simplest first act would be to change our dietary guidelines and all else would follow from that, from the food system to medical practice. What are we waiting for? We can make life hard, if we choose. But why not make it easy?

* * *

I’ve long wondered why we humans make life unnecessarily hard. We artificially construct struggle and suffering out of fear of what would happen if people were genuinely free from threat, punishment, and social control. We think humans are inherently bad and must be controlled. This seeps into every aspect of life, far from being limited to demented dietary ideology.

We are even willing to punish others at great costs to ourselves, even to the point of being highly destructive to all of society. We’d rather harm, imprison, kill, etc millions of innocents in order to ensure one guilty person gets what we think they deserve. And we constantly need an endless parade of scapegoats to quench our vengeful natures. Innocence becomes irrelevant, as it ultimately is about control and not justice.

All of it is driven by fear. The authoritarians, social dominators, and reactionaries — they prey upon our fear. And in fear, people do horrific things or else submit to others doing them. Most importantly, it shuts down our ability to imagine and envision. We go to great effort to make our lives difficult. Struggle leads to ever more struggle. Suffering cascades onto suffering. Worse upon worse, ad infinitum. As such, dietary ideology or whatever else pushed by the ruling elite isn’t about public good. It’s social control, pure and simple.

But let all of that go. Let the fear go. We know from science itself that it doesn’t have to be this hard. There are proven ways to do things that are far simpler and far easier and with far better results. We aren’t bad people who need to be punished into doing the right thing. Our bodies aren’t fallen forms that will lead us into sin. What if, instead, we looked to the better angels of our nature, to what is inherently good within us?

Here is some of what I’ve written before about the easy versus the hard, about freedom versus social control:
Public Health, Public Good
Freedom From Want, Freedom to Imagine
Rationalizing the Rat Race, Imagining the Rat Park
Costs Must Be Paid: Social Darwinism As Public Good
Denying the Agency of the Subordinate Class
Capitalism as Social Control
Substance Control is Social Control
Reckoning With Violence
Morality-Punishment Link
Unspoken Connection: Fundamentalism and Punishment
What If Our Economic System Conflicts With Our Human Nature?
An Invisible Debt Made Visible

About imagining alternatives, I’ve been reading Edward Bellamy’s Looking Backward. It’s a utopian novel, but in many ways it isn’t all that extreme. The future portrayed basically is a Nordic-style social democracy taken to the next level. That basic model of governance has already proven itself one of the best in the world, not only for public good but also wealth and innovation.

In reading about this fictionalized world, one thing stood out to me. The protagonist, Julian West, was put into trance to aid his sleep. He was in a sealed room underground and apparently the house burned down, leaving behind an empty lot. As a leap of imagination for both author and reader, this trance state put him into hibernation for more than a century. His underground bedchamber is discovered by the Leete family who, in the future world, lives on his old property although there house was built on a different location.

The father is Doctor Leete who takes particular interest in Julian. They have many conversations about the differences between the late 19th and early 21st centuries. Julian struggles to understand the enormous changes that have taken place. The world he fell asleep in is no longer recognizable by the world he woke up in. When he questions something that seems remarkable to him, Doctor Leete often responds that it’s more simple than it seems to Julian. The contrast shows how unnecessarily difficult, wasteful, and cruel was that earlier society.

The basic notion is that simple changes in social conditions can result in drastic changes in public good. The costs are miniscule in comparison to the gains. That is to say that this alternative future humanity chose the easy path, instead of continually enforcing costly punishment and social control. It’s quite amazing that the argument I make now was being made all the way back in 1888 when Bellamy began writing it. From the novel, one example of this other way of thinking is the description of the future education system in how it relates to health:

I shall not describe in detail what I saw in the schools that day. Having taken but slight interest in educational matters in my former life, I could offer few comparisons of interest. Next to the fact of the universality of the higher as well as the lower education, I was much struck with the prominence given to physical culture, and the fact that proficiency in athletic feats and games as well as in scholarship had a place in the rating of the youth.

“The faculty of education,” Dr. Leete explained, “is held to the same responsibility for the bodies as for the minds of its charges. The highest possible physical, as well as mental, development of everyone is the double object of a curriculum which lasts from the age of six to that of twenty- one.”

The magnificent health of the young people in the schools impressed me strongly. My previous observations, not only of the notable personal endowments of the family of my host, but of the people I had seen in my walks abroad, had already suggested the idea that there must have been something like a general improvement in the physical standard of the race since my day ; and now, as I compared these stalwart young men and fresh, vigorous maidens, with the young people I had seen in the schools of the nineteenth century, I was moved to impart my thought to Dr. Leete. He listened with great interest to what I said.

“Your testimony on this point,” he declared, “is invaluable. We believe that there has been such an improvement as you speak of, but of course it could only be a matter of theory with us. It is an incident of your unique position that you alone in the world of to-day can speak with authority on this point. Your opinion, when you state it publicly, will, I assure you, make a profound sensation. For the rest it would be strange, certainly, if the race did not show an improvement. In your day, riches debauched one class with idleness of mind and body, while poverty sapped the vitality of the masses by overwork, bad food, and pestilent homes. The labour required of children, and the burdens laid on women, enfeebled the very springs of life. Instead of the these maleficent circumstances, all now enjoy the most favourable conditions of physical life ; the young are care fully nurtured and studiously cared for ; the labour which is required.of all is limited to the period of greatest bodily vigour, and is never excessive ; care for one’s self and one’s family, anxiety as to livelihood, the strain of a ceaseless battle of life, all these influences, which once did so much to wreck the minds and bodies of men and women, are known no more. Certainly, an improvement of the species ought to follow such a change, In certain specific respects we know, indeed, that the improvement has taken place. Insanity, for instance, which in the nineteenth century was so terribly common a product of your insane mode of life, has almost dis appeared, with its alternative, suicide.”

* * *

Bonus Article:
Here’s What Weight-Loss Advice Looked Like Nearly 100 Years Ago
by Morgan Cutolo, Reader’s Digest

I’m throwing this in for a number of reasons. It is showing how low-carb views are basically the same as dietary advice from earlier last century. Heck, one can find advice like that going back to the 1800s and even 1700s. Low-carb diets were well known and mainstream until the changes at the AHA and FDA over the past 50 years or so.

The return of low-carb popularity is what inspires such articles from the corporate media. Reader’s Digest would’t likely have published something like that 10, 20, or 30 years ago. Attitudes are changing, even if institutions are resistant. Profits are also changing as low-carb products become big biz. Corporate media, if nothing else, will follow the profits.

Here is what really stood out to me. In the article, two major dietary experts are quoted: Dr. Jason Fung and Dr. Robert Lustig. Both of them are leading advocates of low-carb diets with Dr. Lustig being the most influential critic of sugar. But neither of them is presented as such. They are simply used as authorities on the topic, which they are. That means that low-carb has become so acceptable as, in some cases, to go without saying. They aren’t labeled as low-carb gurus, much less dismissed as food faddists. No qualifications or warnings are given about low-carb. The article simply quotes these experts about what the science shows.

This is a major advance in news reporting. It’s a positive sign of changes being embraced. Maybe we are finally turning off the hard path and trying out the easier path instead. Some early signs are indicating this. The growing incidence of diabetes might be finally leveling out and even reversing for the first time in generations.

Diabetic Confusion
Low-Carb Diets On The Rise
American Diabetes Association Changes Its Tune
Slow, Quiet, and Reluctant Changes to Official Dietary Guidelines
Official Guidelines For Low-Carb Diet
Obese Military?
Weight Watchers’ Paleo Diet

“Is keto safe for kids?”

“Can my kids do keto too? Yes, kids can do keto. In fact, ketogenic diets were first tested on children that had epilepsy, and it was found to be safe and effective.”
~from Ruled.me

How come no one ever asks if sugary breakfast cereal, grape juice, and white bread with margarine is “safe for kids?” We have entered bizarro world when we’re asking if it’s safe for kids to not eat sugar or carb-load like they’re about to run a marathon. As I explain here, there is nothing — no vitamin, mineral, or other essential nutrient — that you can get from high-carb foods that you cannot get from LOW-carb foods.

He feels people don’t understand that carbohydrates are not a food. Carbohydrates are a highly neuroactive drug that we’ve now placed in our food system and we’ve told our population that this highly neuroactive drug is healthy for them. People don’t have a relaxation methodology. Babies are weaned onto carbohydrate rich foods so they’re getting this wonderfully neuroactive euphoria that is satisfying even before they know they’re human. And so they develop this euphoric relationship with a drug called carbohydrates. They seek it in their diet and society gives it to them. Society condones it.
from LowCarbUSA, Keto For Kids, Autism and ADHD

Ketosis for ChildrenKetosis for Children
from Perfect Keto, fact checked by Dr. Anthony Gustin

As far as nutrition on the ketogenic diet, there are some specific ways ketogenic foods are beneficial for kids:

Infants, toddlers, and growing children need a good amount of iron [*] and fat [*] in their diet for proper growth. Healthy ketogenic foods provide plenty of both. These are important for brain development and growth as well as absorbing and using fat soluble vitamins and building nerve tissue [*].

With refined, high-carbohydrate foods widely available and affordable, it’s unfortunately no surprise that one in six U.S. kids and teens are obese and type 2 diabetes is now seen so commonly in children. The connection between the intake of these foods and high blood glucose and insulin resistance is reason enough for parents to show concern about the high-carb foods their children are consuming.

If you look at these foods’ labels, you’ll see they’re fortified with vitamin and minerals for this exact reason—on their own, they’re very nutritionally poor.

Our Kids Are In Ketosis
by Angela A Stanton

We can see that glucose is not the primary fuel because babies are born in ketosis(1) and mother’s milk is low carbs high fat (LCHF), which keeps the newborn in ketosis all through nursing. Milk gets more glucose as it matures, and at full maturation, its nutritional content per cup (8 oz) is 10.77 gr fat, 2.53 gr protein, 16.95 gr carbohydrates (in the form of lactose) and total energy of 172 kcal; it also contains 87.5 gr water. Subtracting the water and looking at the macronutrient ratios only, this glass of mature nursing milk is 55.5% fat, 5.57% protein, and 38.71% carbohydrates (in lactose so not free sugar). In terms of fatty acid composition: 4.942 gr saturated fat, 4.079 gr monounsaturated fat, and 1.223 gr polyunsaturated fat, which in percentages: 48.24% saturated fat, 39.82% monounsaturated fat, and 11.94% polyunsaturated fat(2). One must agree that babies are not fed poison by their mothers and that Nature didn’t provide nursing milk such that it is toxic. In fact, we can see that babies grow very rapidly by nursing milk and we know from studies that babies who are nursed, have a better chance for survival, grow healthier, faster, and their brain develops better.

As babies grow, they retain metabolic flexibility, meaning they stay in ketosis for periods time, which changes by age and how often they are fed, and they may temporarily enter the carbohydrate metabolic process when they eat (1,3,4). […] Note that babies are born with 0.5 mmol/L or higher level of BHB and remain in ketosis until they are fed. In the case of infants, the needs for energy arises very quickly, as shown in Figure 1, and in approximately 20 minutes after feeding the baby is back in ketosis.

Thus ketosis, in one scenario, is a state into which our metabolism reverts to when food is not immediately available on demand — this is labeled “starvation”. However, studies on the fetus in utero show that the fetus, which is never under nutritional duress, is also in ketosis time to time(5,6) and there are ketones in the placenta(7). Therefore, it is very difficult to suggest that ketones are a backup fuel of any kind if even the fetus is in ketosis time to time in the womb. Clearly, being in ketosis provides some benefits that are not possible to achieve using the glucose metabolic process. The ketogenic and the glucogenic metabolic processes have distinct functions, each specialized to benefit us in some way.

Children in Ketosis: The Feared Fuel
by Angela A. Stanton

And here is the important part. The human body is a smart one. It had millions of years in which to figure out the order via evolution. It picks based on an order of urgency, and priority will be given to the most dangerous of fuels, which have negative consequences if they remain in the body for long. The body will use the dangerous fuel first over fuel that can be stored without negative consequences.

So what will the order of preference be in burning the 3 fuels?

Alcohol, glucose, and then fat (aka ketones).

And this is in order of urgency and not based on which is primary.[…]

In the original article, you will find discussion on Cahill’s landmark article (1), which you may or may not be familiar with. His work is focused mostly on ketosis during starvation. By starvation, understand “fasting” in modern terms. Babies, for example are in ketosis all through their early teenage years–as per Cahill–even 20 minutes between feeding initiates starvation responses in babies. But there are articles showing that the fetus is also in ketosis in the womb, where there is no starvation, and babies remain in ketosis even after eating–clearly no starvation there. So there is more to ketosis than meets the careless eye. […]

With all due respect, I disagree with glucose as the primary human fuel. Glucose is not primary or secondary or any-ary. It is a fuel that is urgent to be used up as fast as possible and so it gets used first (after alcohol) but not because it is primary but because we need to get rid of it faster than fat.

If Ketosis Is Only a Fad, Why Are Our Kids in Ketosis?
by Angela A. Stanton

I have had the opportunity to evaluate the 5-hour blood test results of children of all ages—I think the youngest was 5 years old and the oldest 16, so far. I have yet to see a blood ketone test of a child anywhere in this age group that is not showing ketosis both before and after a meal—even if the meal has fruits and dairy in it.

I suppose ignorance is bliss. Few doctors or researchers have the same opportunity I have in being able to measure the blood ketones of various ages of children for five hours postprandial plus fasting and premeal measures, therefore, most don’t realize just how much our kids are in ketosis.

Thus, while today in most countries around the world any type of food is just a short walk/drive away 24/7, and we need not experience hunger and starvation, our children are still in ketosis 24/7. Shouldn’t that tell us something about the importance of ketosis?

Why babies need animal fat
— and are born on the ketogenic diet.
by Maria Cross

As well as needing fat for fuel, a baby’s brain requires specific fat for normal cognitive development and intellectual skills. Without that specific fat, there is the serious risk of developing brain dysfunction.

There are two fats that are essential for optimal brain function in the developing foetus and the newborn baby: the omega-3 fatty acid DHA (docosahexaenoic acid) and the omega-6 fatty acid ARA (arachidonic acid).

Both these fats form part of each cell membrane, and control what passes in and out of each nerve cell. They help develop the central nervous system. They are involved in communication between nerve cells, the firing of neurons, the regulation of neurotransmitters and the development of cognitive skills. […]

What happens without enough of these two fatty acids?

Only two mammalian species have disproportionately large brains and advanced cognition — humans and bottlenose dolphins. Both depend on DHA for that cognition.

Children who lack DHA are more likely to have increased rates of neurological disorders, in particular attention deficit hyperactivity disorder (ADHD), and autism.
“It is our contention that the movement in the 19th to 21st centuries away from traditional use of sea foods and increased emphasis on land based food supply is a likely cause in the rise in brain disorders including mental ill-health, stress, and other psychiatric disorders.”(Crawford et al 2014).

Today, ADHD is the most frequently diagnosed neuro-behavioural disorder of childhood, and it is becoming increasingly prevalent. In 2014, the Centers for Disease Control and Prevention confirmed that there had been a 42% increase in the number of children diagnosed with the condition since 2006. In America today, 11% of children aged 4 to 17 live with ADHD.

There is a growing body of evidence to suggest that ADHD may be preceded by low DHA in the womb.

The link between dietary fat and autism is also strong, and low levels of both DHA and ARA have been found in children on the autistic spectrum. In a study published in 2015 in International Journal of Molecular Sciences, the fatty acid profile of 121 autistic children, aged 3–7, was analysed and compared with children without the condition. The autistic children were found to have levels of ARA and DHA that were “particularly decreased”, compared to the non-autistic controls.

* * *

Bonus Information:

This reminds me of the case, in South Africa, brought against Tim Noakes. He recommended a low-carb diet to a pregnant woman. Public officials considered it to be a crime against humanity that must be harshly punished. After the first attack on him failed, he was forced to endure a second trial. The government spent millions of dollars persecuting him and he not only proved his innocence but proved that the low-carb diet was scientifically valid. It was the greatest boost for the low-carb diet since Ancel Keys led his crusade against it.

Tweet that landed Noakes in hot water ‘scientifically correct’ – lawyer
by Alex Mitchley

Tim Noakes Found Not Guilty Of Misconduct Over Advising Mother To Get Her Baby Onto The Banting Diet
from Huffington Post

Professor Noakes Found Innocent (Again)!
from Nutrition Coalition

Lore of Nutrition
by Tim Noakes & Marika Sboros
pp. 32-34, Introduction by Marika Sboros
(see more at: The Creed of Ancel Keys)

This is the story of a remarkable scientific journey. Just as remarkable is the genesis of that journey: a single, innocuous tweet.

In February 2014 , a Twitter user asked a distinguished and world-renowned scientist a simple question: ‘Is LCHF eating ok for breastfeeding mums? Worried about all the dairy + cauliflower = wind for babies??’

Always willing to engage with an inquiring mind, Professor Tim Noakes tweeted back: ‘Baby doesn’t eat the dairy and cauliflower. Just very healthy high fat breast milk. Key is to ween [ si c ] baby onto LCHF.’

With those few words, Noakes set off a chain of events that would eventually see him charged with unprofessional conduct, caught up in a case that would drag on for more than three years and cost many millions of rands. More difficult, if not impossible, to quantify is the devastating emotional toll that the whole ordeal has taken on him and his family, as critics attacked his character and scientific reputation at every turn.

At the time, it was open season on Tim Noakes. Doctors, dietitians and assorted academics from South Africa’s top universities had been hard at work for years trying to discredit him. They did not like his scientific views on low-carbohydrate, high-fat foods, which he had been promoting since 2011 . His opinions contrasted sharply with conventional, orthodox dietary ‘wisdom’, and the tweet provided the perfect pretext to amp up their attacks and hopefully silence him once and for all.

Within 24 hours of his tweet, a dietitian had reported him to the Health Professions Council of South Africa for giving what she considered ‘incorrect’, ‘dangerous’ and ‘potentially life-threatening’ advice. To Noakes’s surprise, the HPCSA took her complaint seriously.

Noakes is one of the few scientists in the world with an A 1 rating from the South African National Research Foundation (NRF) for both sports science and nutrition. In his home country, he has no equal in terms of expertise in and research into LCHF. Few can match his large academic footprint – quantified by an H-index of over 70 . The H- or Hirsch index is a measure of the impact of a scientist’s work. Noakes’s impact is significant. He has published more than 500 scientific papers, many of them in peer-reviewed journals, and over 40 of which deal exclusively with nutrition. He has been cited more than 17 000 times in the scientific literature.

Yet, remarkably, the HPCSA chose to back the opinion of a dietitian in private practice over an internationally renowned nutrition research scientist. They charged him with ‘unprofessional conduct’ for providing ‘unconventional advice on breastfeeding babies on social networks’ and hauled him through the humiliating process of a disciplinary hearing.

The public quickly dubbed it ‘the Nutrition Trial of the 21 st Century’. I’ve called it Kafkaesque. The HPCSA insisted that it was a hearing, not a trial, but the statutory body’s own conduct belied the claim.

At the time of Noakes’s tweet, I wanted to give up journalism. After more than 30 years of researching and writing about medicine and nutrition science, I was frustrated and bored. People were growing fatter and sicker, and the medical and dietetic specialists I wrote about weren’t making much difference to patients’ lives. Neither was my reporting.

Then I started investigating and writing about the HPCSA’s case against Noakes. The more questions I asked, the more walls of silence came up around me, and from the most unexpected sources. There’s an old saying that silence isn’t empty, it is full of answers. I found that the silence was loudest from those with the most to hide. I could not have foreseen the labyrinthine extent of vested inter ests ranged against Noakes, or the role played by shadowy proxy organisations for multinational sugar and soft-drink companies in suppressing and discrediting nutrition evidence.

It took a US investigative journalist to join many of the dots I had identified. Russ Greene’s research led to the International Life Sciences Institute (ILSI), a Coca-Cola front organisation. In an explosive exposé in January 2017 , Greene showed how the ILSI has worked to support the nutrition status quo in South Africa, as well as the health professionals and food and drug industries that benefit from it. It has opened a branch in South Africa and has funded nutrition congresses throughout the country. It has also paid for dietitians and academics opposed to Noakes and LCHF to address conferences abroad . *

Of course, it might be coincidence that so many doctors, dietitians and academics with links to the ILSI became involved, directly and indirectly, in the HPCSA’s prosecution of Noakes. Then again, maybe not.

The HPCSA’s conduct throughout the hearing and since its conclusion has been revelatory. To a large extent, it confirms the premise of this book: that those in positions of power and influence in medicine and academia were using the case to pursue a vendetta against Noakes. The trial highlighted the inherent perils facing those brave enough to go against orthodoxy.

Tim Noakes: The Quiet Maverick
by Daryl Ilbury
pp. 166-172

Into this turgid culture of food and identity stepped Tim Noakes on 5 February 2014, when he replied to a question posted two days earlier on Twitter, addressed to him and Sally-Ann Creed, a nutritional therapist (and co-author with Noakes of The Real Meal Revolution ). It was from a breastfeeding mother, Pippa Leenstra: ‘Is LCHF eating ok for breastfeeding mums? Worried about all the dairy + cauliflower = wind for babies??’ Noakes’s reply was the following: ‘Baby doesn’t eat the dairy and cauliflower. Just very healthy high fat breast milk. Key is to ween [ sic ] baby onto LCHF.’

It’s neither an offensive tweet by any stretch of the imagination, nor does it fall foul of any media law – it’s not libellous and there’s no encouragement of harm to others. People could disagree with him and had a voice to do so; that’s the point of social media: it is a platform for public discussion. And people did disagree, quite vocally, and there were others who supported his advice, equally vocally. Importantly, the question demanded a public, not private, response, which the person asking the question was free to accept or reject. And, as a medical doctor, Noakes didn’t cross any ethical boundaries in replying on a public platform. He didn’t publish any confidential patient information or dispense a diagnosis for a specific patient without seeing that patient; he simply provided generalised nutritional advice based on scientific evidence. Breast milk is high in fat, and there is scientific evidence to support the benefits of an LCHF diet. There is also evidence to the contrary, but, as we’ve realised, that’s science for you. The secret in making sense of science is context, and this is where it clashes with social media.

The character limitation of Twitter is one of its selling points; it demands concise expression, a sub-editor’s dream. It also means that tweets can be short on context, unless accompanied by click-through links to supporting evidence. Therefore tweets can be open to interpretation. However, this misses the main point of the brevity of Twitter messages: they are designed to encourage debate. Whether Noakes should have said ‘Key is to wean a baby …’ as opposed to ‘Key is to wean baby …’ is a matter for retrospective semantic debate. The fact is he provided a broad opinion on a public platform as a scientist and researcher of human nutrition.

Importantly, in her original tweet, to which Noakes replied, Pippa Leenstra never referred to herself or her baby. She spoke of ‘breastfeeding mums’. She was doing the media equivalent of asking a question in a town hall where the discussion was around LCHF. At that moment, Leenstra was a media consumer of medical or health information.

Not everyone saw it that way. One of those was Claire Julsing-Strydom, who at that time was president of the Association for Dietetics in South Africa (ADSA), the professional organisation for the country’s registered dietitians. Julsing-Strydom’s reaction was to register a complaint with the Health Professions Council of South Africa. It was a decision that would effectively threaten to destroy Noakes’s career, and make Julsing-Strydom the focus of a social media witch-hunt.

According to its website, the HPCSA provides the public with the right to request an investigation of any registered health practitioner whom they believe has acted unethically or caused harm. The site includes a downloadable form and an email address for Legal Med, the department within the HPCSA that handles complaints. To make sure that no health professional is a victim of a truculent member of the public with a hefty doctor’s bill in one hand and an axe to grind in the other, there is a due process of investigation and assessment before any measure of disciplinary action is followed. Only the most serious cases demand a professional-conduct committee hearing, which is what Tim Noakes would be called before.

As I said at the beginning of this book, I am not going to go into the trial in detail; instead, I will focus on the following: the complaint, the charge that resulted, two key components in the case against Noakes, and the unexpected outcome of the hearing. The main focus will be on how this was all covered in the media.

By now you know that whereas content is king, context is King Kong, and in this case the context behind the complaint makes for interesting reading, for two reasons: firstly, it shows that Noakes’s tweet was judged in isolation, and, secondly, it suggests that the complaint may not have been thought through.

What most people may not know is that directly after Noakes’s reply on Twitter to Pippa Leenstra, someone else entered the discussion: Marlene Ellmer, a paediatric dietitian and someone well known to Julsing-Strydom. Ellmer tweeted the following: ‘Pippa, as a paeds dietician I strongly advise against LCHF for breastfeeding mothers.’ Leenstra replied by posing the following question to both Noakes and Ellmer: ‘Okay, but what I eat comes through into my milk. Is that not problematic for baby and their winds at newborn stage?’ Ellmer responded by tweeting another message with her email address, encouraging Leenstra to contact her directly. Noakes didn’t do this, which is important to note, as we shall soon see. Leenstra tweeted to Ellmer that she would contact her, and after the discussion played out further with various people providing input, Leenstra tweeted: ‘Thanks, but I will go with the dietician’s recommendation.’ This she did, rejecting Noakes’s LCHF suggestion.

Let’s summarise: at that point Leenstra had posted a question on a public forum, received different opinions, including from two health professionals – one of them a registered dietitian – and been provided with the contact details of one of those professionals with an invite to get hold of her. Leenstra was free to choose which one to follow up with, and she agreed, publicly, to contact the registered dietitian. Theoretically, things could have stopped there.

However, the day after Ellmer’s invite for Leenstra to contact her, Julsing-Strydom entered the discussion and reacted with a tweet directed to Noakes, written thus: ‘I AM HORRIFIED!! HOW CAN YOU GIVE ADVICE LIKE THIS??’ For those unfamiliar with the idiosyncrasies of social media, the use of uppercase letters is normally reserved to express a strong feeling of annoyance, displeasure or hostility. On its own, Julsing-Strydom’s use of uppercase in a tweet is perfectly acceptable; it shows how she must have felt reading Noakes’s tweet, and there are possible reasons for that. Firstly, she had a four-month-old daughter she was breastfeeding, so she had a personal as well as a professional interest in the topic under discussion. Secondly, as she would later testify, she had had a strongly worded engagement the previous month with Noakes over what she saw as his dispensing nutritional advice to breastfeeding mothers during a talk. It’s easy to imagine that for Julsing-Strydom the tweet was the last straw, and so she submitted her complaint, including screenshots of Noakes’s tweet, to Legal Med. The accompanying email read:

‘To whom it may concern. I would like to file a report against Prof Tim Noakes. He is giving incorrect medical [nutrition therapy] on Twitter that is not evidence based. I have attached the Tweet where Prof Noakes advises a breastfeeding mother to wean her baby on to a low carbohydrate high fat diet. I urge the HPCSA to please take urgent action against this type of misconduct as Prof Noakes is a celebrity in South Africa and the public does not have the knowledge to understand that the information he is advocating is not evidence based. It is specifically dangerous to give this advice for infants and can potentially be life-threatening. I await your response. Claire Julsing-Strydom.’

The wording is a little breathless, and the reason for that would emerge in the hearing.

The complaint contains many factors that Legal Med would have considered, but five pertain to focus points covered so far in this book: the limits to the public’s understanding of science, in this case that of human nutrition; the complexity and unreliability of academic research behind that science; the media profile of Tim Noakes, and the idea that he is a ‘celebrity’; that the complaint related to something said within a disrupted media environment; and the suggestion that nutritional advice is a clear-cut case of right or wrong.

What the legal department would have known when they received the complaint was that the complainant was another health professional; this wasn’t just someone with a beef about their proctologist having cold hands. This meant that the complainant would have understood the potential outcomes of submitting her complaint, especially one claiming that an act by a fellow health professional was ‘life-threatening’. The fact of the matter is that Legal Med saw sufficient seriousness in the complaint to investigate.

However, inconsistencies in Julsing-Strydom’s complaint soon came to light. She supposedly submitted it on behalf of ADSA, and yet didn’t make that clear in the complaint. When questioned in the HPCSA hearing that her complaint triggered, she replied that it was the first time she had registered a complaint, saying, ‘I was not aware that this email would actually be, you know, used at this level.’

Now, after 30 years of interviewing people for the media, if there’s something I’ve learnt it’s that the most honest comments are usually unconsidered – made as an aside, when thoughts are wandering, or if a little flustered. Perhaps, I thought, Julsing-Strydom hadn’t really thought through what was going to happen once she submitted the complaint.

Furthermore, a forensic analysis of Twitter timelines and the submission date and time of the complaint shows that Julsing-Strydom publicly expressed her horror on Twitter on 6 February 2014 at 07:48, and sent her email to Legal Med less than an hour later, at 08:47. It’s fair to say that Julsing-Strydom was upset when she wrote that email.

Based on the findings of a preliminary committee of inquiry, the legal department of the HPCSA sent a letter to Noakes on 28 January 2015, saying that he was to be summoned before the Professional Conduct Committee of the Medical and Dental Professions Board. The charge against him was attached to the letter, and it makes for puzzling reading: ‘That you are guilty of unprofessional conduct, or conduct which, when regard is had to your profession is unprofessional, in that during February 2014, you acted in a manner that is not in accordance with the norms and standards of your profession in that you provided unconventional advice on breastfeeding babies on social networks (tweet).’

It is so badly written that it would send any sub-editor reaching for a stiff shot of whisky, so it was invariably presented in the media thus: ‘charged with providing unconventional advice on social media to breastfeeding mothers’.

When I first read the charge, that part about ‘social networks’ intrigued me the most. Providing advice on a public social media platform is an ethical catch-22 for any clinician: if they provide generalised information, they can be accused of not taking into consideration the specifics of the patient; yet if they ask for specifics, they risk encouraging the sharing of confidential information on a public platform. There’s also the ethical conundrum that if they open a consultative dialogue with someone other than a patient, they can be charged with supersession, essentially ‘stealing’ a patient; and for the HPCSA, that is grounds for discipline. How is that for irony?

I sensed confusion in the poorly worded charge. On a hunch I contacted the HPCSA and asked for a copy of their guidelines for how registered health practitioners should engage with the public on social media – if the HPCSA were charging Noakes because of his use of social media, they’d obviously have the necessary guidelines in place. I received the following reply: ‘Kindly note that the HPCSA doesn’t have guidelines around how registered health practitioners should engage with the public on social media.’ The HPCSA was clearly in unfamiliar territory. I thought it didn’t bode well for a speedy, clear-cut course for the hearing; and I was right.

What started on 4 June 2015, and was supposed to be wrapped up in little over a week, would drag on for almost two years, and if its aim was to deliver a swift, unsparing and public reprimand of a dissident scientist, it failed.

Getting Into Ketosis

Here is some information about ketones, ketosis, and ketogenic diets. The focus is on treating Alzheimer’s, although the topic applies to many other conditions as well. Let me begin by explaining the basics.

Ketosis is the primary burning of fat, dietary fat or body fat, to produce ketones that the body uses. A ketogenic diet is sometimes called nutritional ketosis, as opposed to ketosis through other means such as fasting. When ketone levels are high enough, it is called ketosis — the term being used more strictly for medical purposes. The body has two main options for fuel, glucose and ketones. With Alzheimer’s as type 3 diabetes, insulin resistance in the brain decreases the ability to use glucose and so the brain slowly starves. Ketones can mostly replace glucose, especially for brain cells. Some argue they’re the preferred source of energy, since for most of human evolution there were limited amounts of carbohydrates in the diet. This is shown in how, when both glucose and ketones are available, the brain prioritizes the latter. Ketones are a more efficient and steady source of energy because few people have to worry about running out of dietary or body fat to make ketones.

Ketones are a superfuel that allows the brain function at a higher level. In ketosis, not only does metabolism change but so does brain functioning. This is why ketogenic diets have been medically used to treat diverse neurocognitive conditions: epileptic seizures, autism, ADHD, depression, multiple sclerosis, Alzheimer’s, etc. Part of this has to do with inflammation, as ketosis is anti-inflammatory. This is important because inflammation is often involved in problems with brain health and many other problems as well (arthritis, autoimmune disorders, etc). I can vouch for this in my own experience when my depression disappeared after going low-carb. Partly that is because my glucose, insulin and serotonin levels would have stabilized, but cutting back my carbs further to go into ketosis definitely made a difference. I generally feel better.

Immediately below is a chart comparing ketogenic strategies and the resultant increase in ketones. If multiple strategies are combined, ketone levels can be higher still. Ketoacidosis is thrown in the chart below for comparison, but it only happens to diabetics and it is harmful — it’s an entirely separate condition from ketosis, although both involve ketones. People sometimes confuse ketoacidosis with ketosis, but what causes each is separate. As you can see below, ketoacidosis raises ketone levels to a degree that nothing else does. Unless one is diabetic, that isn’t a concern.

Ketogenic Strategy                             —>               Ketone Levels (mmol/L)

Caffeine                                                    —>               0.2 to 0.3

Coconut Oil                                              —>               0.3 to 0.5

Vigorous Exercise                                  —>              0.3 to 0.5

Overnight Fast                                        —>              0.3 to 0.5

MCT Oil                                                      —>             0.3 to 1.0

Branched Chain Amino Acids            —>             0.3 to 1.0

Ketone Mineral Salts                            —>             0.5 to 1.0

Classic Ketogenic Diet                          —>             2 to 6

Starvation/Long-Term Fasting       —>             2 to 7

Ketone Esters (Oral or IV)                   —>             2 to 7 or higher

Diabetic Ketoacidosis                           —>            10 to 25

This chart and most of the other info I share here comes from Mary T. Newport’s book, The Complete Book of Ketones. There is also good info available in Dale E. Bredesen’s The End of Alzheimer’s, Amy Berger’s The Alzheimer’s Antidote, and Bruce Fife’s Stop Alzheimer’s Now. All I’m discussing below is the most basic info. For a more in-depth approach, I’d recommend checking out Dr. Bredesen, the author mentioned above, who is an Alzheimer’s researcher and clinician at UCLA. He has a complex protocol, going beyond ketosis, that requires working with a doctor trained in it. The clinical trial he did is the only confirmed reversal of Alzheimer’s. But back to increasing ketones and suppressing mental loss.

How to get into ketosis:

The most dependable method of entering into ketosis and maintaining it is through diet. Put in the simplest terms, there needs to be strict limits on starchy carbs and sugar (bread, crackers, noodles beans, potatoes, fruit, fruit juice, pop, candy, most processed foods, etc) combined with moderate amounts of protein and lots of fat/oil. Specific details can be found below. It is not necessarily easy, since those are some of the foods we enjoy most. Even so, it still allows a fair amount of diversity. Many foods are low in carbs: non-starchy vegetables, fruits like olives and avocados, most nuts and seeds, etc. The difficult part is that many convenience foods aren’t allowable other than as occasional foods eaten in limited amounts.

Of course, there are simpler methods of increasing ketones. Here are three:

(1) Exogenous ketones can be taken directly and will give a quick mental boost that doesn’t last long, but it is easy for the body to use since it is already in the needed form. A single dose peaks out in 30-60 minutes with the body fully eliminating them in a few hours. Exogenous ketones would need to be regularly taken in smaller amounts throughout the day to maintain higher ketone levels. One thing to keep in mind is that as ketone levels go up blood sugar and insulin levels drop. This can be an issue for people with diabetes or pre-diabetes. There are two options of exogenous ketones: ketone esters and ketone salts. The former are more easily used by the body, but the latter are more available on the market. I haven’t found ketone esters in any local store. They can be obtained online, though. I’d probably stick to the ketone salts, as there is much more research done showing their safety. Exogenous ketones are of more limited use since most people can’t safely handle more than one or two servings a day.

(2) Or one can use MCTs (medium chain triglycerides) which turn into ketones without much effort. MCT oils and powders can be added throughout the day and the body uses them fairly quickly. There are also MCTs in coconut oil and Mary T. Newport found that, in treating her husband’s Alzheimer’s, that coconut oil had a longer lasting effect. She used a combination of all three: exogenous ketones, MCT oil, and coconut oil. This gave a more steady level of ketones throughout the day. Her husband showed improvement despite her not doing anything else initially, not otherwise changing his diet. As a side note, Newport says to use cold-pressed coconut oil for reasons of general health. The main advantage is that greater amounts of MCTs and coconut oil allow the body to produce ketones even when carbs aren’t as restricted, not that one can eat carbs unlimited.

(3) An even simpler way is fasting, although easier still if one is already in ketosis (trying to go from a high-carb diet to fasting can be a challenge). A person is guaranteed to go into ketosis by not eating. Even a full night of sleep is enough to begin increasing ketone levels. Skip a meal or an entire day of eating and ketone levels will keep going up to a much more noticeable degree. If you break your fast with a ketogenic meal of low-carb and high-fat, that will extend ketosis into the rest of the day. Starting your day with fat in your coffee can be even better, as caffeine will also boost ketones (I add ghee and MCT oil to my coffee and mix it up with a battery-powered frother). In fasting for ketogenic purposes, one can do a fat fast by eating only fat, such as drinking fat-filled coffee all day. Without starches and sugar, the body is forced to burn fat and produce ketones. There isn’t anything easier than a fat fast nor as satiating.

The only potential downside is not everyone digests and metabolizes fat equally well. MCT oils, in particular, can require some adaptation. Too much can cause diarrhea for those sensitive to it. It’s best to start off with small amounts (1/2 to 1 tsp or less at a time, once or twice a day) and build up a tolerance (upwards of 1 to 2 tbsp or possibly higher, two to four times a day). If sensitive, take MCT oils with other foods, such as mixing it into cottage cheese or Greek yogurt. Coconut oil is easier for the body to handle, as it is a mix of other fats such as lauric acid that has some of the traits of MCTs. There is evidence that lauric acid works as a ketogenic fat directly in the brain. Coconut oil also helps with the thyroid and Alzheimer’s patients often develop thyroid problems.

By the way, here is what Mary T. Newport writes: “When Steve [her husband with Alzheimer’s took just coconut oil in the morning, his ketone levels peaked at about three hours but had returned to nearly normal after eight to nine hours, just before dinner time. With just MCT oil, Steve’s ketone levels went higher, peaked at about ninety minutes, but were gone within three hours.” So, she used both in a 4:3 ratio (MCT to coconut oil) to maintain stable ketone levels throughout the day. Newport suggests gradually increasing coconut oil (and MCT) intake up to 4-6 tablespoons a day or even as high 8 tablespoons, but gradually is the key part.

If one wants to ensure ketosis, there are ways to measure ketone levels. I’ve never done this, but I keep my carbs so low that there is no way for me to avoid ketosis. Without a ketogenic diet, it will be more difficult keeping ketone levels elevated and stable. Still, any greater amount of ketones is better than nothing when it comes to how the brain is starving for fuel in Alzheimer’s or in relation to many other conditions. If you want to try a ketogenic diet, here are some variations explained in detail and with good visuals about what the macronutrient (carb, protein, & fat) ratios should look like as a plate of food: Diet Plans – Charlie Foundation. Also, keep in mind protein levels, which can be an issue for with diabetes, pre-diabetes, etc: Too Much Protein?

Eating in such a way that ketosis is frequent is not always easy, although it can be the easiest diet in the world. It is not easy for many people because such diets reduce the foods they ‘love’ (sugar and carbs), reduce the foods they know how to prepare, and reduce the food options found in most restaurants. Further, these diets run contrary to the traditional food pyramid that we have been trained on for years. They seem downright unhealthy, when in fact, current research is showing they have been healthier all along. It requires changing how one thinks about food. In short, one must be very intentional. One cannot coast along and provide optimal brain nutrition. The first step for most people is breaking their food addiction, but it’s worth the effort.