"Ketone Bodies" a trendy word

Written by Dr Harold Gunatillake –Health writer - FRCS, MBBS, FACS, AM(Sing), FIACS

It sounds a trendy word like “cholesterol” and “inflammation’, a medical term that could be exploited by slimming diet advocates.

Ketosis is a normal process where excessive ketone bodies formed, a crucial organic compound- acetoacetate, when human body is starved of carbohydrates for energy requirements. Plan B in the body under such strained situations would be to use fatty acids stored in the body as triglycerides to burn its own fat for fuel, for energy requirements in the liver, heart and kidneys, due to the restriction of energy from carbohydrates. The process of ketones production in humans is called ketogenesis. In the brain, they are a vital source of energy during fasting when the body is deprived of carbohydrates. Brain cells would prefer energy from sugars, being much more physiological. So, we have to understand that ketone body formation is a natural event under carbohydrate deprived situation (plan B).
Description: Description:   Ketosis may shed weight, but it’s also associated with headaches, irritability, nausea, kidney trouble, and heart palpitations
Ketosis presents a danger to some patients, having liver and kidney damage, and also type 1 diabetic.

When people restrict their carbohydrate consumption, as in situations of starvation, lost in the jungle, or deliberate, the body turns to fat (Plan B), as an energy source. So as mentioned the fats are broken down to fatty acids to form chemicals- aceto-acetic, beta- hydroxyl-butyric acid and acetone.

Same mechanism- production of excessive ketones can be activated by making people restrict their carbohydrates to very low levels and increasing the fat and protein consumption to a most un-physiological unnatural consumption situation. These are not balanced diets and a juggle with carbohydrates, proteins and fats. Late Dr Robert Atkins advocated this diet to slim, and many variations of this ketogenic diet appeared in the market, subsequently. The rationale involved here is that when carbohydrates are restricted the body turns to fat for energy requirements (plan B), thus hoping to slim through loss of body fat (triglycerides)

It is also seen that most people may have some degree of the presence of ketone bodies in their blood. The most sensitive test for ketosis (“NMR” and “blood ketone level”) shows that most people will have some ketone bodies at certain times of the day, those who don’t eat in the night, or after a brisk walk to work, or fasting regimes due to religious customs. Most supermodels may be having heaps. These ketone bodies do not participate in energy production under normal circumstances.

Some believe that when fatty acids are absorbed through the gut as triglycerides, the glycerin is separated from the fatty acids and the fatty acids are broken into pieces called ketone bodies in the liver.

We believe that the triglycerides transported as chilo-microns or liposomes are converted by the liver into various lipoprotein forms (not ketone bodies) such as VLDL and LDL. This provides the mechanism for absorption of LDL into the cell and for its conversion into free fatty acids, cholesterol and other components of LDL.
Ketones are produced from body fat stored as triglycerides, as an intermediary product.

Description: Description: Ketogenic diet Affect Kidney Function  People with kidney disease should consult a doctor before starting a high-protein diet. Research suggests people with impaired kidneys may lose kidney function more rapidly if they eat excessive amounts of protein -- especially animal protein.    It is the overproduction of ketones within the human body that worries the medical profession. Ketones, though, is crucial for human body, its excessive production is much noxious as it triggers many new health complications suddenly depleting the reserve of glycogen in the liver extensively. Glycogen is the stored form of glucose in the liver which is utilized in times of deprivation.

Sudden excess scarcity of carbohydrates in the body causes health disorders or disease, identified as the side effect of ketosis. At the same time the fats in the body stored as triglycerides are also mobilized and you would tend to lose weight.

Now the entrepreneur steps in and attempts to make a quick buck. How? He would start promoting a trendy  ketone body slimming diet by marketing ketone bodies, as supplements or diets. Robert Atkins much respected doctor did not sell products but he advocated the theory that if you restrict carbohydrates you will mobilize the fat reserves for energy and he recommended his high protein, high fat diet.

Since then, many modified versions of the ketogenic diet for weight loss have appeared in the market, as mentioned above.

In simple terms, the ketogenic diet is a high fat, sufficient protein, and low carbohydrate diet. While there is plenty of material written on various types of ketogenic diets, it is important that you consult your doctor or dietician before you decide to follow a ketogenic diet? Owing to the rigid nature of the ketogenic diet, dieters may require medical supervision to monitor their health. Pre-diet, your doctor may recommend blood tests and metabolic tests to check on your liver and kidney functions and blood sugar levels. In addition to these tests, your doctor may also check for any allergies or any specific food intolerance. As you progress through different phases of the ketogenic diet, ensure that you get a regular health checkup.
Description: Description:   High protein fat diets are high in saturated fats and low in fiber, This combination can increase cholesterol levels and raise the risk of heart disease and stroke.  The American Heart Association does not recommend high-protein, high fat diets for weight loss
Ketone bodies production in the body when starved of carbohydrates may not lead to ketoacidosis, which is a life threatening situation. So long as your kidneys are functioning well, mostly as in young people, the excess ketones are excreted through the urine and their presence can be measured by testing the urine with a ketone stick. If you take sufficient carbohydrates in your diet there is no place for such adjustments to occur and you do not have to worry about ketone bodies.

Ketogenic diets include foods that are low in carbohydrates, and recommended high in fat content.

While medical practitioners preached the benefits of the classic ketogenic diet to treat epilepsy, today modified versions of the ketogenic diet may help bodybuilding and athletic fitness.

Ketosis produced by such diets also suppresses your appetite and as a consequence the desire for food is less.

Ketogenic diets include small servings of fruits and vegetables to provide low carbohydrates. Protein intake constitute beef, veal, lamb, pork, chicken and turkey which under normal circumstances the doctors would request you to restrict especially among the older people to prevent heart disease, stroke, cancer and even kidney disease, among others.
The strain on the physiological metabolic pathways is completely confused by these diets. Vegetarians being considered the healthiest people, more than those who eat meat, goes for a six. Rich sources of fat like fatty meat, butter, cheese cream and oil are recommended. You are not allowed to eat grain or whole grain products, oats, brown rice, being mainly carbohydrates. So you are bound to miss your cereal breakfast, which we all enjoy so much to provide energy for the day.

You are recommended to drink much fluid to flush the excess ketone bodies from the body that can harm you. Alcohol should be avoided on ketogenic diets. (There goes ketogenic diet over the wall!)

Runners and long distance cross country runners use their glycogen stores in the liver and muscles for quick energy. It is a stored form of glucose for emergency situations. These reserves can be used for about 60-90minutes only. That is why untrained runners get into deep trouble. Trained muscles among runners seem to store more glycogen than untrained runners.
Side effects
Constipation could be a problem with these diets due to lack of fiber in the diet. Meat has no fiber at all.

Rapid ketosis
Rapid ketosis may lead to ketoacidosis, an emergency situation, sometimes difficult to diagnose, and may be fatal.
You are dehydrated. You may feel weak, light headed with nausea and vomiting, are early symptoms of ketoacidosis. Later dilemma and confusion with poor concentration would occur if not detected and treated early.
Ketoacidosis gives an offensive smell (sweet smell) in the breath due to overproduction of ketones.

Kidney and heart damage
These diets can affect adversely on your kidneys heart and form kidney stones and gall stones. This is mainly due to a substance called methylglyoxal which contributes to stone in the gall bladder and kidneys.
Your blood cholesterol increases and that could cause early atherosclerosis (thickening of arteries).

Liver damage
Ketosis in extreme situations can cause damage to the liver.

Calcium deficiency is another problem with these diets. In the long term would result in osteoporosis and dental problems, and other muscular-skeletal disorders.

Women may experience menstrual disorders.
Description: Description: Losing Calcium  People on high-protein diets excrete more calcium through their urine than do those not on a high-protein diet. If a person sticks to a high-protein diet long term, the loss of calcium could raise their risk of developing osteoporosis.    Regular use of ketone supplements may cause headache, giddiness and poor mental concentration

Amidst all these side effects, Ketogenic diets are used to treat Alzheimer’s disease, Parkinson’s disease and epilepsy seizures affecting mainly children.

Coconut oil and ketogenic diet
All fatty acids are chains of carbon atoms linked with hydrogen atoms. There are (a) short chain, (b) medium chain and (c) long chain fatty acids according to the number of carbon atoms.
Coconut fat has medium chain carbon atoms composed of less than 12 carbon atoms. Some refer to them as medium chain triglycerides (MCT). Some say they are ketogenic and states coconut oil rich in MCT’s, provide around half the calories.

Medium chain fatty acids in coconut are composed of about 50% lauric acid a monoglyceride (not triglyceride) innocent and harmless compared to triglycerides. The rest of the acids are myristic and capric acids, too are monoglycerides.

So why some call the fatty acids in coconut as triglycerides (MCT) and ketogenic cannot be explained?

Coconuts are part of the staple diets or components of staple diet among Asians and those living in the Pacific basin, cannot be considered as a ketogenic diet

Obviously, this is a campaign to promote MCT oil emulsions promoted by some interested parties as a part of a ketogenic slimming diet...

Ketone bodies as a therapy for Alzheimer’s disease
There was a time when statins were slogged as a cure for Alzheimer’s disease, as was written by a journalist in the Time magazine, many years back. The rationale was that statins being “anti-inflammatory” could help AD as some believed that beta amyloids formation may have some anti-inflammatory origin.. I suppose the big cats made their quick buck and laid down the theory to rest, for posterity.

Now coming back to ketone body therapy for Alzheimer’s disease, it is believed that one feature of AD is the region-specific declines in brain glucose metabolism. Inhibition for long term may profoundly affect the brain functions. So, supplement the normal glucose supply of the brain with ketone bodies which includes acetoacetate, beta-hydroxy-butyrate and acetone.

It is assumed that ketone bodies will be produced by the body by further restricting carbohydrates and giving a high fat and protein diet or direct by infusions  will miss the patient’s rice and curry in addition to loss of his memory. In any case, he wouldn’t remember that he had or did not have his home cooked rice and curry  enjoyed for a life time. God bless these researchers!

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