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Can ketones enhance cognitive function and protect brain networks?

142 points by XzetaU8 2y ago

ozim 2y ago
Reads like beginning of a new fad just like keto diet. My idea is that sugar in quantities we ingest nowadays damages all and makes more problems. It is not that ketones are some magic thing. Only that sugar is rocket fuel for the brain so it should not be used without care.
- iamacyborg 2y ago
  > Reads like beginning of a new fad just like keto diet. It won't be, ketone supplements are too expensive for that. > My idea is that sugar in quantities we ingest nowadays damages all and makes more problems This is nonsense. Sugar is an easily accessed fuel that your body can readily use for a variety of activities.
  - kjksf 2y ago
    It's not nonsense and you're not addressing the main point: overuse. A glass of wine is harmless. A bottle of hard spirit will poison and potentially kill you. Your body can nullify small amounts of alcohol. But if you drink more toxin than what your body can neutralize it poisons you. Sugar and carbs rise glucose level in your blood. When it's small amount your blood will re-distribute it to cells as fuel. But if you eat enough sugar and carbs that your body cannot absorb all the glucose, you become fat and develop diabetes. So yeah, sugar is fuel and tastes good but in modern food products it's used everywhere which makes moderate use very hard to achieve. That's why 99 million of Americans are overweight, 70 million are obese. 29 million have diagnosed diabetes, 10 million estimated undiagnosed diabetes and 115 million pre-diabetes.
    - iamacyborg 2y ago
      You're confusing sugar and carbs with excess calories. Excess calories are harmful, sugar and carbs are not.
      - germinalphrase 2y ago
        Sugar and carbs are very calorie dense, so it’s a distinction without a difference on a practical level.
        wathef 2y ago
        A carbohydrate and protein have the same calorie content, around 4kcal per gram. Fat is 9kcal per gram.
        germinalphrase 2y ago
        Again, on a practical level - what’s easier to over consume? Carbs and sugars or fats?
        hawk_ 2y ago
        It's perhaps more accurate to say sugars and simple carbs are easy to absorb whereas fats and complex carbs are harder to absorb. A single gram fat is the most calorie dense substance by weight that we can consume I think. It's just in practice it's hard to become fat by consuming only excess fat.
      - deleted 2y ago
        [deleted]
      - nradov 2y ago
        High blood glucose levels are literally toxic. This will damage every cell in your body. Your body can buffer sugar intake to an extent in order to maintain homeostasis but over time this tends to cause insulin resistance. A little sugar is fine but larger amounts are poisonous. The exact limit depends on a number of factors such as muscle mass and liver glucagon level.
  - riehwvfbk 2y ago
    Just because something is less pleasant doesn't automatically mean it's good. On the surface, it would be weird for ketones to improve brain activity - after all "keto flu" is a thing, and it is definitely is not a state of high performance. And if ketones were that healthy then diabetics would the the healthiest people of all. Instead, they are poison, and this is well documented.
    - ddorian43 2y ago
      Keto flu happens when you transition because of loosing too much water that was retained by carbs and electrolytes gets flushed with the water. Very easy to fix by taking a electrolyte supplement when starting keto (LMNT etc). > then diabetics would the the healthiest people of all. Instead, they are poison, and this is well documented. It is documented on T1D, where they make no insulin at all! Keto still helps on T1D, you will always need insulin, just less, and have more stable blood glucose (and all the benefits that entails with it). For T2D, it's the best solution for it (see virtahealth.com for a great company that helps on this).
    - fl0ki 2y ago
      > On the surface, it would be weird for ketones to improve brain activity - after all "keto flu" is a thing, and it is definitely is not a state of high performance. Keto flu is from a low level of ketones, not a high level. Once enough ketones become available there is no more keto flu. From there most people feel at least normal, and many feel a bit better than normal because the cycles of both energy and satiety are smoothed out by the change in fuel sources. > And if ketones were that healthy then diabetics would the the healthiest people of all. Diabetics have health complications precisely because they cannot moderate their blood glucose, with or without ketones. Ketones do not regulate blood glucose, insulin does. Unlike glucose, excess ketones are harmlessly urinated out, they do not need insulin to process them. Glucose in the blood is toxic [1] if it isn't metabolised because of lack of insulin, and even most diabetics consume enough carbohydrates for this to be a risk. There is a clear relationship between availability of insulin and safe levels of glucose consumption, in fact injecting insulin is usually the first intervention if blood glucose is at dangerously high levels. Search for insulin in that paper. Ketones don't enter into this picture at all as either a toxin or the solution to toxicity. Precisely the point is that ketones can substitute for most of your glucose needs without risking toxicity like glucose does. If all of that isn't enough, diabetics often do better following a ketogenic diet [2], not worse. When you can't naturally produce enough insulin to process the glucose you consume for daily energy, producing ketones instead is a safe workaround which your body performs naturally. What part of that is evidence for ketones themselves being the problem? [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738809/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738809/ [2] https://pubmed.ncbi.nlm.nih.gov/31336509/ https://pubmed.ncbi.nlm.nih.gov/31336509/
  - onethought 2y ago
    Well, Alcohol is an even more easily accessible fuel that your body can readily use for a variety of activities... but its negatives are well understood...
- ddorian43 2y ago
  > My idea is that sugar in quantities we ingest nowadays damages all and makes more problems. What about little kids with epilepsy? They haven't had years of sugar to get damaged. Maybe they're susceptible for early onset damage? > It is not that ketones are some magic thing. Only that sugar is rocket fuel for the brain so it should not be used without care. The keto diet for epilepsy (psychiatry/cancer mostly copy it as far as I know) needs high ketone levels (at least 2). Even doing carnivore (0 carbs) with medium fat/protein won't help, you won't achieve the blood numbers & won't get results. You NEED to get ~80-90% of calories from fat to achieve consistent blood levels (ketones 2-4+, glucose 4) for epilepsy version. Think of it as a drug dosage. Some people might need lower dosage, but the standard is at the dosage I wrote (blood test GKI 1-2).
- guerby 2y ago
  keto diet is a fad, that's big news! Please write a peer reviewed article in the BMJ about it we all want to know. https://nutrition.bmj.com/content/early/2020/11/02/bmjnph-2020-000072 https://nutrition.bmj.com/content/early/2020/11/02/bmjnph-20... "Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years" Most read paper of the BMJ ever. Follow-up: https://nutrition.bmj.com/content/early/2023/01/02/bmjnph-2022-000544 https://nutrition.bmj.com/content/early/2023/01/02/bmjnph-20... "What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss"
  - SamoyedFurFluff 2y ago
    Neither of these papers are keto diets specifically. It looks like these patients just had way more personal one on one time with their doctors, dedicated group sessions, and carb information. Without actual carb counts there’s no way to know if this is actually keto. Importantly, neither paper specified the high fat part of the keto diet, which makes me think neither paper actually supports keto. Btw I’m not personally an anti-keto guy I just dislike mindless paper citations.
  - Aurornis 2y ago
    You linked two papers about reducing carbohydrate intake, which is not a ketogenic diet. A ketogenic diet involves severe carbohydrate restriction and even major protein restriction. The research you shared isn’t applicable. This is a huge problem in online keto discourse: People share a lot of “research” that isn’t applicable, such as these low-carb papers or other research about treating epilepsy with keto diets. You can’t just look for studies about lower carb with positive conclusions and assume that this implies the keto diet is good.
    - dcow 2y ago
      I was with my wife during her gestational diabetes nutrition session. The diet they recommended was for all intents and purposes a ketogenic diet. The only carbs were from natural sugars in fruits and veggies. They just didn’t push the fat and squeeze the carbs as much as you see in keto enthusiast literature. I have a hypothesis though: the keto community does this as a “failsafe” way to instruct curious people how to experience ketosis for the first time. People practicing keto long term (once they’ve experienced the acute benefits and/or initial weight loss) are almost always landing on their own personal watermark which very likely looks like taking in 60+g of carbs a day in a state of “nutritional” ketosis where there are only slightly elevated levels of keytones (~0.4-1.0 mmol/l) in the blood compared to the level of “therapeutic” ketosis used to treat epilepsy (3.0-5.0 mmol/l).
- throwawaycities 2y ago
  >new fad just like keto diet The keto diet has been around over 100 years and it was developed in a clinical setting for children with epilepsy to reproduce the benefits of fasting - which has been known for thousands of years to prevent seizures - while providing a long term solution and not deprive children of calories. It’s not exactly a fad, it’s just that there are a lot more studies being conducted on the benefits - like fasting studies which lead the discovery of autophagy and the Nobel prize in 2016. The idea sugar is rocket fuel for the brain, is a little misguided. Certain sugars spike insulin triggering anabolic response getting glucose to the cells quickly, but that doesn’t make glucose more efficient for the brain. Ketones are smaller than glucose molecules and more efficient at crossing the blood brain barrier. Rocket fuel for the brain is being in a deep state of ketosis and consuming medium chain fatty acids (e.g. coconut oil) or beta hydroxybutyrate (i.e. exogenous ketones).
  - Aurornis 2y ago
    > The keto diet has been around over 100 years and it was developed in a clinical setting for children with epilepsy Yes, exactly. It was developed and studied in the context of epilepsy treatment. The current wave of keto influencers are pushing it as something else, though. I have tried keto and noticed some interesting effects, but the impact on certain parameters of my lipid bloodwork was undeniably bad no matter what I tried. The keto community works overtime to downplay the possible negative effects of the diet, but actual cardio and lipid researchers have very different opinions.
    - dcow 2y ago
      I don’t think it’s so insidious. People see real benefit and results from highly restricting carbs. Something is happening, it’s not just a fad. Sure, it’s fine to debate the pros and cons but to outright disparage it because there a community of excited people who have had life changing experiences talking about it positively seems overly reactionary.
      - jajko 2y ago
        Yeah, those excited folks go often a bit mental over the board and praise it like second coming of Jesus, that's what most folks have problems with. Rational discussion about pros and cons is rare.
snitch182 2y ago
Does that mean you do good by your brain when you do a hard burn exercise once in a while ? After all those substances are a byproduct of burning fat instead of glucose by your liver. Or do i need a fat rich feast ?
- aszantu 2y ago
  eat as much fat as you want, just leave out the carbs and sugar
  - iamacyborg 2y ago
    Or just take a ketone supplement and eat normal food.
    - sgonz 2y ago
      Has any research been done on what happens when the body is in a state of high glucose and ketones at the same time?
      - iamacyborg 2y ago
        Not that I’m aware of but a number of professional cycling teams have been using them for a few years so there may be something in the works.
        layla5alive 2y ago
        Ketoacidosis.
        iamacyborg 2y ago
        I don't think elite cycling teams would be taking these supps if it caused that, do you?
        2y ago
aszantu 2y ago
not surprising, I've been collecting for a while. I think Brain and Food absolutely is connected. Added the article to the list. https://github.com/cutestuff/FoodDepressionConundrum/blob/main/ArticleCollection.md https://github.com/cutestuff/FoodDepressionConundrum/blob/ma...
gradus_ad 2y ago
Alzheimer's is related to insulin resistance? The article presents this as consensus opinion but is it really?
- lhl 2y ago
  I think it's fair at this point to say there is a clear relationship. The earliest article I have in my (relatively cursory) research file on the metabolic relationship for AD is from 1994: Fukuyama, Hidenao, Masafumi Ogawa, Hiroshi Yamauchi, Shinya Yamaguchi, Jun Kimura, Yoshiaru Yonekura, and Junji Konishi. “Altered Cerebral Energy Metabolism in Alzheimer’s Disease: A PET Study.” Journal of Nuclear Medicine 35, no. 1 (January 1, 1994): 1–6. Here are some more recent reviews discussing the connection (recent reviews are good not just because they take into account the latest developments, but they also give you better references to go through for further research). Note, these reviews are from completely different/unrelated research teams from different countries: Yoon, Ji Hye, JooHyun Hwang, Sung Un Son, Junhyuk Choi, Seung-Won You, Hyunwoo Park, Seung-Yun Cha, and Sungho Maeng. “How Can Insulin Resistance Cause Alzheimer’s Disease?” International Journal of Molecular Sciences 24, no. 4 (February 9, 2023): 3506. https://doi.org/10.3390/ijms24043506 https://doi.org/10.3390/ijms24043506. Rhea, Elizabeth M., Manon Leclerc, Hussein N. Yassine, Ana W. Capuano, Han Tong, Vladislav A. Petyuk, Shannon L. Macauley, et al. “State of the Science on Brain Insulin Resistance and Cognitive Decline Due to Alzheimer’s Disease.” Aging and Disease, August 17, 2023, 0. https://doi.org/10.14336/AD.2023.0814 https://doi.org/10.14336/AD.2023.0814. Kshirsagar, Viplav, Chetan Thingore, and Archana Juvekar. “Insulin Resistance: A Connecting Link between Alzheimer’s Disease and Metabolic Disorder.” Metabolic Brain Disease 36, no. 1 (January 2021): 67–83. https://doi.org/10.1007/s11011-020-00622-2 https://doi.org/10.1007/s11011-020-00622-2.
grondilu 2y ago
This is only anecdotal but I had heard about the benefits of fasting for brain performance, so I once tried fasting during a chess tournament. I fasted during the first six days of the tournament. My results were disappointing so I gave up and broke the fast on the seventh day.
- Topfi 2y ago
  Did you do a full "water fast" during those six days or an intermittent approach and did you supplement electrolytes or take any other supplements? Genuinely interested, hope this doesn't read as the often common "you should have done this" reaction I commonly see when discussing certain diets or fasting.
- ralfd 2y ago
  And did you play better? Fasting is different than ketonic diet though. With fasting you also lose constantly salts/minerals/vitamins. Especially salt deficit will make on tired.
  - EasyMark 2y ago
    What do you think about drinking water with electrolytes or those electrolyte “salt”rich tablets that have magnesium, sodium, calcium, etc? (While fasting of course)
    - Rury 2y ago
      It's important while fasting. Your body needs electrolytes or you will have all sorts of health issues. Potassium is the most important one, followed by sodium. Every cell in your body has a sodium/potassium pump, which works to keep potassium inside your cells and sodium outside (creating a battery essentially). About 30% of all energy in your body is used just to maintain this pump. Anyhow, potassium is the big one... many people don't get enough from their diet even while not fasting. And unfortunately supplements give very minuscule amounts of potassium (<=2% of RDI), supposedly because rapid absorption of large amounts of it can cause heart arrhythmias/attacks.
- 2y ago
zx8080 2y ago
By the Betteridge's law of headlines [0], the answer should be "no". [0] - https://en.m.wikipedia.org/wiki/Betteridge%27s_law_of_headlines https://en.m.wikipedia.org/wiki/Betteridge%27s_law_of_headli...
- lhl 2y ago
  And yet the wide-ranging neuroprotective effects of ketones have been quite well documented... Poff, Angela M., Jong M. Rho, and Dominic P. D’Agostino. “Ketone Administration for Seizure Disorders: History and Rationale for Ketone Esters and Metabolic Alternatives.” Frontiers in Neuroscience 13 (2019). https://doi.org/10.3389/fnins.2019.01041 https://doi.org/10.3389/fnins.2019.01041. Bernini, Adriano, Mojgan Masoodi, Daria Solari, John-Paul Miroz, Laurent Carteron, Nicolas Christinat, Paola Morelli, et al. “Modulation of Cerebral Ketone Metabolism Following Traumatic Brain Injury in Humans.” Journal of Cerebral Blood Flow & Metabolism, October 24, 2018, 0271678X18808947. https://doi.org/10.1177/0271678X18808947 https://doi.org/10.1177/0271678X18808947. McDonald, Tanya, Mackenzie Cervenka, Tanya J. W. McDonald, and Mackenzie C. Cervenka. “The Expanding Role of Ketogenic Diets in Adult Neurological Disorders.” Brain Sciences 8, no. 8 (August 8, 2018): 148. https://doi.org/10.3390/brainsci8080148 https://doi.org/10.3390/brainsci8080148. Koppel, Scott J., and Russell H. Swerdlow. “Neuroketotherapeutics: A Modern Review of a Century-Old Therapy.” Neurochemistry International 117 (July 2018): 114–25. https://doi.org/10.1016/j.neuint.2017.05.019 https://doi.org/10.1016/j.neuint.2017.05.019. White, Hayden, Karthik Venkatesh, and Bala Venkatesh. “Systematic Review of the Use of Ketones in the Management of Acute and Chronic Neurological Disorders.” Journal of Neurology and Neuroscience 08, no. 02 (2017). https://doi.org/10.21767/2171-6625.1000188 https://doi.org/10.21767/2171-6625.1000188. Prins, Mayumi L., and Joyce H. Matsumoto. “The Collective Therapeutic Potential of Cerebral Ketone Metabolism in Traumatic Brain Injury.” Journal of Lipid Research 55, no. 12 (December 2014): 2450–57. https://doi.org/10.1194/jlr.R046706 https://doi.org/10.1194/jlr.R046706.
- mathgeek 2y ago
  The answer is more often “yes” when referring to academic studies, as your Wikipedia source calls out via a reference to https://gwern.net/doc/statistics/2016-cook.pdf https://gwern.net/doc/statistics/2016-cook.pdf > A 2016 study of a sample of academic journals (not news publications) that set out to test Betteridge's law and Hinchliffe's rule (see below) found that few titles were posed as questions and of those, few were yes/no questions and they were more often answered "yes" in the body of the article rather than "no". Thankfully the underlying study doesn’t pose a question, and the article we are discussing here is an academic hypothesis more than news.
radford-neal 2y ago
One hears stories of people with dementia having a day or two of mental clarity just before they die. Could this explain that? Perhaps their bodily processes are failing so much that normal glucose production is impaired, leading to ketones being produced instead, and temporary clarity before the failures lead to death...
- mathgeek 2y ago
  Possible, but we’d need more research on Terminal Lucidity at this point in time: https://alz-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/alz.12162 https://alz-journals.onlinelibrary.wiley.com/doi/epdf/10.100...
- agumonkey 2y ago
  I wish i could read about this 'honeymoon' effect, it's so strange.
throwaway22032 2y ago
Does anyone else get the sense that health research is flawed because the scientific process struggles to be holistic e.g. changing multiple variables at the same time is not commonplace or even really realistic? Sometimes I read these studies and it feels a bit like someone reverse engineering a car without knowing what a car is supposed to do. Like - if you don't use oil, the engine is preserved quite well, unless you rotate the wheels, then it gets ruined, but only if the clutch is engaged. But then we do a study, we hold the clutch position constant, say it's disengaged, and then rotate the wheels at different speeds, and find that it doesn't make a difference, and publish that, and then it makes its' way into general understanding that you don't need to use engine oil. People seem to want to seperate the effects of diet, exercise, social interaction, etc, but I don't think this is possible in a complex system like a human being. They all need to be balanced.
- illuminant 2y ago
  Yes. "Science has just discovered processed foods and refined sugars are bad for you!" Wisdom and insight is something more than scientific credulity. Potential underlies state. State does not ultimately underlie potential.
intended 2y ago
This is so incredibly strange - I just connected with someone who had disappeared for a while, and they were dealing with mental health challenges. They were facing challenges, and they were trying their damndest to connect with people working on Metabolic Psychiatry. I did a cursory read on whatever most recent credible sources existed, and found that… it wasn’t a fad. I hope I’m largely correct but: The underlying work was talking about something else entirely - in essence a link between cardiovascular / metabolic health, mental health and diet. Switching to a low carb diet has helped reduce those metabolic factors, which allowed for a reduced dose of medication in conditions such as ADD, Bipolar disorder, depression. Having never heard of this before, it smacked 100% of being some fad. But it looks like (diet + health) = better (cardio / energy). Yes - the conversation did eventually go to Psych is bad, and doctors only want to medicate, and mitochondria misfiring.
- adaptbrian 2y ago
  That's me as well, getting into ketosis has absolutely changed my life for the better.
- QuantumGood 2y ago
  I started trying fasting in the 1980's, and later keto. I've been watching people try it for a very long time. Almost everyone who tries keto successfully, says something akin to "I never realized how poorly my brain was working!" Definitely life changing for me (in combination with S-Acetyl Glutathione)
  - Paul-Craft 2y ago
    Have you, or anyone you know, been able to stay on it successfully long term? I know a couple who have tried it, had good results, but later stopped, but none who have stayed on it long term.
    - johnyzee 2y ago
      That is the general experience, I think. I did pretty strict keto for 2.5 years. Been off it for about a year now, while many of the habits stick (I eat next to zero added sugar, and generally low carb, less processed food, etc.). I got rid of a lot of weight and some skin conditions. It was generally very positive. It was weird to have such stable blood sugar that you never feel hungry, even when not eating at all. There were some adverse results too, like zero muscle strength. I also digest carbs worse now it seems like. There might well be ways to avoid those issues with a more carefully managed keto diet. I'm not sure if I will jump back on a strict keto regimen, it requires quite a bit of effort to plan meals, especially when other people in the household eat a regular diet. I have come to see keto as an intervention, very effective at fixing acute issues. Once you have done that reset, I think a lot of those wins can be maintained through generally healthy habits (which you now understand a lot better).
Projectiboga 2y ago
Yeast is what is targets. I know a psychiactric dr who found promose in feeding patients refined coconut oil. The craprylic acid is what makes up the triglicerides in it. Those kill yeast.
m463 2y ago
The article said: Researchers then administered D-βHb, a form of ketones, a byproduct released by the liver when the body burns fat instead of glucose for energy. They found that the synaptic activity that was previously impacted by acute insulin resistance was rescued, looking further, D-βHb seems to be an exogenous ketone: Exogenous ketones are a class of ketone bodies that are ingested using nutritional supplements or foods. ... Under physiological conditions, ketone concentrations can increase due to starvation, ketogenic diets, or prolonged exercise, leading to ketosis.[2] However, with the introduction of exogenous ketone supplements, it is possible to provide a user with an instant supply of ketones even if the body is not within a state of ketosis before ingestion.[1] However, drinking exogenous ketones will not trigger fat burning like a ketogenic diet. ... When exogenous ketone bodies are ingested, acute and nutritional exogenous ketosis is produced.[4][9] https://en.wikipedia.org/wiki/Exogenous_ketone https://en.wikipedia.org/wiki/Exogenous_ketone so, how do we supplement our diet?
yoaviram 2y ago
Sharing my personal single data point experience, in the hope it helps others. I started low carb then keto about 5 months ago when my migraines turned chronic (a few times a week). I haven't had a migraine in the past 3.5 months. Also lost weight and generally feel great. I was following the advice in this book: https://www.amazon.com/Migraine-Miracle-Sugar-Free-Gluten-Free-Inflammation/dp/1608828751?ref=d6k_applink_bb_dls&dplnkId=3f8b1721-4818-432d-956c-06e0f3ffc207 https://www.amazon.com/Migraine-Miracle-Sugar-Free-Gluten-Fr...
- unstatusthequo 2y ago
  Same. I have been low carb for years, but at one point, I decoded to go full actual ketogenic. I never remember being more productive and focused than in true ketosis. Note that getting there is something you need to test for. I did blood drop tests at home with a device to measure ketone levels. Also recommend some materials from Tim Ferris on this topic including the Dom D’Agostino part of Tools of Titans and I think some podcasts on the topic.
- ddmf 2y ago
  Reducing carbs has really helped with my migraines too.
rdlecler1 2y ago
We recently invested in https://www.drinkkey.com/ https://www.drinkkey.com/ I’ve been drinking it daily and I usually fast until 2-4pm. Anecdotally it’s helped with headaches and fatigue. I can’t rule out placebo effect, but I feel great.
- jasfi 2y ago
  The first thing I noticed when I read the story was that the ketones were administered and not the result of a diet. Good luck with your investment, the business sounds like a good idea. They need to do a ton of marketing though. I also suspect that as others enter the market those involved will end up competing heavily on price.
- J_Shelby_J 2y ago
  My notes as an exo-keto enjoyer: At least until exo-ketones are mainstream you should consider that you are competing for people well aware of the product. That said, you should really seek to differentiate yourself from other products. You have a single, unsourced line about how your product is superior. Ok, cool. I’m not going to do your marketing teams job and look up studies to prove it out. Also, powder > shots > full drinks. Shipping adds up and flexibility in consumption is probably the easiest way to get people to integrate your product into their daily routine. For example, we love ketone salts combined with collagen and caffeine mix in the morning. I’ll probably order some of your product though. Good luck!
  - rdlecler1 2y ago
    Agree, will pass this on to the team. Thanks for the feedback

142 points by XzetaU8 2y ago

ozim 2y ago

Reads like beginning of a new fad just like keto diet. My idea is that sugar in quantities we ingest nowadays damages all and makes more problems. It is not that ketones are some magic thing. Only that sugar is rocket fuel for the brain so it should not be used without care.

iamacyborg 2y ago
> Reads like beginning of a new fad just like keto diet. It won't be, ketone supplements are too expensive for that. > My idea is that sugar in quantities we ingest nowadays damages all and makes more problems This is nonsense. Sugar is an easily accessed fuel that your body can readily use for a variety of activities.
- kjksf 2y ago
  It's not nonsense and you're not addressing the main point: overuse. A glass of wine is harmless. A bottle of hard spirit will poison and potentially kill you. Your body can nullify small amounts of alcohol. But if you drink more toxin than what your body can neutralize it poisons you. Sugar and carbs rise glucose level in your blood. When it's small amount your blood will re-distribute it to cells as fuel. But if you eat enough sugar and carbs that your body cannot absorb all the glucose, you become fat and develop diabetes. So yeah, sugar is fuel and tastes good but in modern food products it's used everywhere which makes moderate use very hard to achieve. That's why 99 million of Americans are overweight, 70 million are obese. 29 million have diagnosed diabetes, 10 million estimated undiagnosed diabetes and 115 million pre-diabetes.
  - iamacyborg 2y ago
    You're confusing sugar and carbs with excess calories. Excess calories are harmful, sugar and carbs are not.
    - germinalphrase 2y ago
      Sugar and carbs are very calorie dense, so it’s a distinction without a difference on a practical level.
      - wathef 2y ago
        A carbohydrate and protein have the same calorie content, around 4kcal per gram. Fat is 9kcal per gram.
        germinalphrase 2y ago
        Again, on a practical level - what’s easier to over consume? Carbs and sugars or fats?
      - hawk_ 2y ago
        It's perhaps more accurate to say sugars and simple carbs are easy to absorb whereas fats and complex carbs are harder to absorb. A single gram fat is the most calorie dense substance by weight that we can consume I think. It's just in practice it's hard to become fat by consuming only excess fat.
    - deleted 2y ago
      [deleted]
    - nradov 2y ago
      High blood glucose levels are literally toxic. This will damage every cell in your body. Your body can buffer sugar intake to an extent in order to maintain homeostasis but over time this tends to cause insulin resistance. A little sugar is fine but larger amounts are poisonous. The exact limit depends on a number of factors such as muscle mass and liver glucagon level.
- riehwvfbk 2y ago
  Just because something is less pleasant doesn't automatically mean it's good. On the surface, it would be weird for ketones to improve brain activity - after all "keto flu" is a thing, and it is definitely is not a state of high performance. And if ketones were that healthy then diabetics would the the healthiest people of all. Instead, they are poison, and this is well documented.
  - ddorian43 2y ago
    Keto flu happens when you transition because of loosing too much water that was retained by carbs and electrolytes gets flushed with the water. Very easy to fix by taking a electrolyte supplement when starting keto (LMNT etc). > then diabetics would the the healthiest people of all. Instead, they are poison, and this is well documented. It is documented on T1D, where they make no insulin at all! Keto still helps on T1D, you will always need insulin, just less, and have more stable blood glucose (and all the benefits that entails with it). For T2D, it's the best solution for it (see virtahealth.com for a great company that helps on this).
  - fl0ki 2y ago
    > On the surface, it would be weird for ketones to improve brain activity - after all "keto flu" is a thing, and it is definitely is not a state of high performance. Keto flu is from a low level of ketones, not a high level. Once enough ketones become available there is no more keto flu. From there most people feel at least normal, and many feel a bit better than normal because the cycles of both energy and satiety are smoothed out by the change in fuel sources. > And if ketones were that healthy then diabetics would the the healthiest people of all. Diabetics have health complications precisely because they cannot moderate their blood glucose, with or without ketones. Ketones do not regulate blood glucose, insulin does. Unlike glucose, excess ketones are harmlessly urinated out, they do not need insulin to process them. Glucose in the blood is toxic [1] if it isn't metabolised because of lack of insulin, and even most diabetics consume enough carbohydrates for this to be a risk. There is a clear relationship between availability of insulin and safe levels of glucose consumption, in fact injecting insulin is usually the first intervention if blood glucose is at dangerously high levels. Search for insulin in that paper. Ketones don't enter into this picture at all as either a toxin or the solution to toxicity. Precisely the point is that ketones can substitute for most of your glucose needs without risking toxicity like glucose does. If all of that isn't enough, diabetics often do better following a ketogenic diet [2], not worse. When you can't naturally produce enough insulin to process the glucose you consume for daily energy, producing ketones instead is a safe workaround which your body performs naturally. What part of that is evidence for ketones themselves being the problem? [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738809/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738809/ [2] https://pubmed.ncbi.nlm.nih.gov/31336509/ https://pubmed.ncbi.nlm.nih.gov/31336509/
- onethought 2y ago
  Well, Alcohol is an even more easily accessible fuel that your body can readily use for a variety of activities... but its negatives are well understood...
ddorian43 2y ago
> My idea is that sugar in quantities we ingest nowadays damages all and makes more problems. What about little kids with epilepsy? They haven't had years of sugar to get damaged. Maybe they're susceptible for early onset damage? > It is not that ketones are some magic thing. Only that sugar is rocket fuel for the brain so it should not be used without care. The keto diet for epilepsy (psychiatry/cancer mostly copy it as far as I know) needs high ketone levels (at least 2). Even doing carnivore (0 carbs) with medium fat/protein won't help, you won't achieve the blood numbers & won't get results. You NEED to get ~80-90% of calories from fat to achieve consistent blood levels (ketones 2-4+, glucose 4) for epilepsy version. Think of it as a drug dosage. Some people might need lower dosage, but the standard is at the dosage I wrote (blood test GKI 1-2).
guerby 2y ago
keto diet is a fad, that's big news! Please write a peer reviewed article in the BMJ about it we all want to know. https://nutrition.bmj.com/content/early/2020/11/02/bmjnph-2020-000072 https://nutrition.bmj.com/content/early/2020/11/02/bmjnph-20... "Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years" Most read paper of the BMJ ever. Follow-up: https://nutrition.bmj.com/content/early/2023/01/02/bmjnph-2022-000544 https://nutrition.bmj.com/content/early/2023/01/02/bmjnph-20... "What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss"
- SamoyedFurFluff 2y ago
  Neither of these papers are keto diets specifically. It looks like these patients just had way more personal one on one time with their doctors, dedicated group sessions, and carb information. Without actual carb counts there’s no way to know if this is actually keto. Importantly, neither paper specified the high fat part of the keto diet, which makes me think neither paper actually supports keto. Btw I’m not personally an anti-keto guy I just dislike mindless paper citations.
- Aurornis 2y ago
  You linked two papers about reducing carbohydrate intake, which is not a ketogenic diet. A ketogenic diet involves severe carbohydrate restriction and even major protein restriction. The research you shared isn’t applicable. This is a huge problem in online keto discourse: People share a lot of “research” that isn’t applicable, such as these low-carb papers or other research about treating epilepsy with keto diets. You can’t just look for studies about lower carb with positive conclusions and assume that this implies the keto diet is good.
  - dcow 2y ago
    I was with my wife during her gestational diabetes nutrition session. The diet they recommended was for all intents and purposes a ketogenic diet. The only carbs were from natural sugars in fruits and veggies. They just didn’t push the fat and squeeze the carbs as much as you see in keto enthusiast literature. I have a hypothesis though: the keto community does this as a “failsafe” way to instruct curious people how to experience ketosis for the first time. People practicing keto long term (once they’ve experienced the acute benefits and/or initial weight loss) are almost always landing on their own personal watermark which very likely looks like taking in 60+g of carbs a day in a state of “nutritional” ketosis where there are only slightly elevated levels of keytones (~0.4-1.0 mmol/l) in the blood compared to the level of “therapeutic” ketosis used to treat epilepsy (3.0-5.0 mmol/l).
throwawaycities 2y ago
>new fad just like keto diet The keto diet has been around over 100 years and it was developed in a clinical setting for children with epilepsy to reproduce the benefits of fasting - which has been known for thousands of years to prevent seizures - while providing a long term solution and not deprive children of calories. It’s not exactly a fad, it’s just that there are a lot more studies being conducted on the benefits - like fasting studies which lead the discovery of autophagy and the Nobel prize in 2016. The idea sugar is rocket fuel for the brain, is a little misguided. Certain sugars spike insulin triggering anabolic response getting glucose to the cells quickly, but that doesn’t make glucose more efficient for the brain. Ketones are smaller than glucose molecules and more efficient at crossing the blood brain barrier. Rocket fuel for the brain is being in a deep state of ketosis and consuming medium chain fatty acids (e.g. coconut oil) or beta hydroxybutyrate (i.e. exogenous ketones).
- Aurornis 2y ago
  > The keto diet has been around over 100 years and it was developed in a clinical setting for children with epilepsy Yes, exactly. It was developed and studied in the context of epilepsy treatment. The current wave of keto influencers are pushing it as something else, though. I have tried keto and noticed some interesting effects, but the impact on certain parameters of my lipid bloodwork was undeniably bad no matter what I tried. The keto community works overtime to downplay the possible negative effects of the diet, but actual cardio and lipid researchers have very different opinions.
  - dcow 2y ago
    I don’t think it’s so insidious. People see real benefit and results from highly restricting carbs. Something is happening, it’s not just a fad. Sure, it’s fine to debate the pros and cons but to outright disparage it because there a community of excited people who have had life changing experiences talking about it positively seems overly reactionary.
    - jajko 2y ago
      Yeah, those excited folks go often a bit mental over the board and praise it like second coming of Jesus, that's what most folks have problems with. Rational discussion about pros and cons is rare.

snitch182 2y ago

Does that mean you do good by your brain when you do a hard burn exercise once in a while ? After all those substances are a byproduct of burning fat instead of glucose by your liver. Or do i need a fat rich feast ?

aszantu 2y ago
eat as much fat as you want, just leave out the carbs and sugar
- iamacyborg 2y ago
  Or just take a ketone supplement and eat normal food.
  - sgonz 2y ago
    Has any research been done on what happens when the body is in a state of high glucose and ketones at the same time?
    - iamacyborg 2y ago
      Not that I’m aware of but a number of professional cycling teams have been using them for a few years so there may be something in the works.
      - layla5alive 2y ago
        Ketoacidosis.
        iamacyborg 2y ago
        I don't think elite cycling teams would be taking these supps if it caused that, do you?
        2y ago

aszantu 2y ago

not surprising, I've been collecting for a while. I think Brain and Food absolutely is connected. Added the article to the list. https://github.com/cutestuff/FoodDepressionConundrum/blob/main/ArticleCollection.md https://github.com/cutestuff/FoodDepressionConundrum/blob/ma...

gradus_ad 2y ago

Alzheimer's is related to insulin resistance? The article presents this as consensus opinion but is it really?

lhl 2y ago
I think it's fair at this point to say there is a clear relationship. The earliest article I have in my (relatively cursory) research file on the metabolic relationship for AD is from 1994: Fukuyama, Hidenao, Masafumi Ogawa, Hiroshi Yamauchi, Shinya Yamaguchi, Jun Kimura, Yoshiaru Yonekura, and Junji Konishi. “Altered Cerebral Energy Metabolism in Alzheimer’s Disease: A PET Study.” Journal of Nuclear Medicine 35, no. 1 (January 1, 1994): 1–6. Here are some more recent reviews discussing the connection (recent reviews are good not just because they take into account the latest developments, but they also give you better references to go through for further research). Note, these reviews are from completely different/unrelated research teams from different countries: Yoon, Ji Hye, JooHyun Hwang, Sung Un Son, Junhyuk Choi, Seung-Won You, Hyunwoo Park, Seung-Yun Cha, and Sungho Maeng. “How Can Insulin Resistance Cause Alzheimer’s Disease?” International Journal of Molecular Sciences 24, no. 4 (February 9, 2023): 3506. https://doi.org/10.3390/ijms24043506 https://doi.org/10.3390/ijms24043506. Rhea, Elizabeth M., Manon Leclerc, Hussein N. Yassine, Ana W. Capuano, Han Tong, Vladislav A. Petyuk, Shannon L. Macauley, et al. “State of the Science on Brain Insulin Resistance and Cognitive Decline Due to Alzheimer’s Disease.” Aging and Disease, August 17, 2023, 0. https://doi.org/10.14336/AD.2023.0814 https://doi.org/10.14336/AD.2023.0814. Kshirsagar, Viplav, Chetan Thingore, and Archana Juvekar. “Insulin Resistance: A Connecting Link between Alzheimer’s Disease and Metabolic Disorder.” Metabolic Brain Disease 36, no. 1 (January 2021): 67–83. https://doi.org/10.1007/s11011-020-00622-2 https://doi.org/10.1007/s11011-020-00622-2.

grondilu 2y ago

This is only anecdotal but I had heard about the benefits of fasting for brain performance, so I once tried fasting during a chess tournament. I fasted during the first six days of the tournament. My results were disappointing so I gave up and broke the fast on the seventh day.

Topfi 2y ago
Did you do a full "water fast" during those six days or an intermittent approach and did you supplement electrolytes or take any other supplements? Genuinely interested, hope this doesn't read as the often common "you should have done this" reaction I commonly see when discussing certain diets or fasting.
ralfd 2y ago
And did you play better? Fasting is different than ketonic diet though. With fasting you also lose constantly salts/minerals/vitamins. Especially salt deficit will make on tired.
- EasyMark 2y ago
  What do you think about drinking water with electrolytes or those electrolyte “salt”rich tablets that have magnesium, sodium, calcium, etc? (While fasting of course)
  - Rury 2y ago
    It's important while fasting. Your body needs electrolytes or you will have all sorts of health issues. Potassium is the most important one, followed by sodium. Every cell in your body has a sodium/potassium pump, which works to keep potassium inside your cells and sodium outside (creating a battery essentially). About 30% of all energy in your body is used just to maintain this pump. Anyhow, potassium is the big one... many people don't get enough from their diet even while not fasting. And unfortunately supplements give very minuscule amounts of potassium (<=2% of RDI), supposedly because rapid absorption of large amounts of it can cause heart arrhythmias/attacks.
2y ago

zx8080 2y ago

By the Betteridge's law of headlines [0], the answer should be "no". [0] - https://en.m.wikipedia.org/wiki/Betteridge%27s_law_of_headlines https://en.m.wikipedia.org/wiki/Betteridge%27s_law_of_headli...

lhl 2y ago
And yet the wide-ranging neuroprotective effects of ketones have been quite well documented... Poff, Angela M., Jong M. Rho, and Dominic P. D’Agostino. “Ketone Administration for Seizure Disorders: History and Rationale for Ketone Esters and Metabolic Alternatives.” Frontiers in Neuroscience 13 (2019). https://doi.org/10.3389/fnins.2019.01041 https://doi.org/10.3389/fnins.2019.01041. Bernini, Adriano, Mojgan Masoodi, Daria Solari, John-Paul Miroz, Laurent Carteron, Nicolas Christinat, Paola Morelli, et al. “Modulation of Cerebral Ketone Metabolism Following Traumatic Brain Injury in Humans.” Journal of Cerebral Blood Flow & Metabolism, October 24, 2018, 0271678X18808947. https://doi.org/10.1177/0271678X18808947 https://doi.org/10.1177/0271678X18808947. McDonald, Tanya, Mackenzie Cervenka, Tanya J. W. McDonald, and Mackenzie C. Cervenka. “The Expanding Role of Ketogenic Diets in Adult Neurological Disorders.” Brain Sciences 8, no. 8 (August 8, 2018): 148. https://doi.org/10.3390/brainsci8080148 https://doi.org/10.3390/brainsci8080148. Koppel, Scott J., and Russell H. Swerdlow. “Neuroketotherapeutics: A Modern Review of a Century-Old Therapy.” Neurochemistry International 117 (July 2018): 114–25. https://doi.org/10.1016/j.neuint.2017.05.019 https://doi.org/10.1016/j.neuint.2017.05.019. White, Hayden, Karthik Venkatesh, and Bala Venkatesh. “Systematic Review of the Use of Ketones in the Management of Acute and Chronic Neurological Disorders.” Journal of Neurology and Neuroscience 08, no. 02 (2017). https://doi.org/10.21767/2171-6625.1000188 https://doi.org/10.21767/2171-6625.1000188. Prins, Mayumi L., and Joyce H. Matsumoto. “The Collective Therapeutic Potential of Cerebral Ketone Metabolism in Traumatic Brain Injury.” Journal of Lipid Research 55, no. 12 (December 2014): 2450–57. https://doi.org/10.1194/jlr.R046706 https://doi.org/10.1194/jlr.R046706.
mathgeek 2y ago
The answer is more often “yes” when referring to academic studies, as your Wikipedia source calls out via a reference to https://gwern.net/doc/statistics/2016-cook.pdf https://gwern.net/doc/statistics/2016-cook.pdf > A 2016 study of a sample of academic journals (not news publications) that set out to test Betteridge's law and Hinchliffe's rule (see below) found that few titles were posed as questions and of those, few were yes/no questions and they were more often answered "yes" in the body of the article rather than "no". Thankfully the underlying study doesn’t pose a question, and the article we are discussing here is an academic hypothesis more than news.

radford-neal 2y ago

One hears stories of people with dementia having a day or two of mental clarity just before they die. Could this explain that? Perhaps their bodily processes are failing so much that normal glucose production is impaired, leading to ketones being produced instead, and temporary clarity before the failures lead to death...

mathgeek 2y ago
Possible, but we’d need more research on Terminal Lucidity at this point in time: https://alz-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/alz.12162 https://alz-journals.onlinelibrary.wiley.com/doi/epdf/10.100...
agumonkey 2y ago
I wish i could read about this 'honeymoon' effect, it's so strange.

throwaway22032 2y ago

Does anyone else get the sense that health research is flawed because the scientific process struggles to be holistic e.g. changing multiple variables at the same time is not commonplace or even really realistic? Sometimes I read these studies and it feels a bit like someone reverse engineering a car without knowing what a car is supposed to do. Like - if you don't use oil, the engine is preserved quite well, unless you rotate the wheels, then it gets ruined, but only if the clutch is engaged. But then we do a study, we hold the clutch position constant, say it's disengaged, and then rotate the wheels at different speeds, and find that it doesn't make a difference, and publish that, and then it makes its' way into general understanding that you don't need to use engine oil. People seem to want to seperate the effects of diet, exercise, social interaction, etc, but I don't think this is possible in a complex system like a human being. They all need to be balanced.

illuminant 2y ago
Yes. "Science has just discovered processed foods and refined sugars are bad for you!" Wisdom and insight is something more than scientific credulity. Potential underlies state. State does not ultimately underlie potential.

intended 2y ago

This is so incredibly strange - I just connected with someone who had disappeared for a while, and they were dealing with mental health challenges. They were facing challenges, and they were trying their damndest to connect with people working on Metabolic Psychiatry. I did a cursory read on whatever most recent credible sources existed, and found that… it wasn’t a fad. I hope I’m largely correct but: The underlying work was talking about something else entirely - in essence a link between cardiovascular / metabolic health, mental health and diet. Switching to a low carb diet has helped reduce those metabolic factors, which allowed for a reduced dose of medication in conditions such as ADD, Bipolar disorder, depression. Having never heard of this before, it smacked 100% of being some fad. But it looks like (diet + health) = better (cardio / energy). Yes - the conversation did eventually go to Psych is bad, and doctors only want to medicate, and mitochondria misfiring.

adaptbrian 2y ago
That's me as well, getting into ketosis has absolutely changed my life for the better.
QuantumGood 2y ago
I started trying fasting in the 1980's, and later keto. I've been watching people try it for a very long time. Almost everyone who tries keto successfully, says something akin to "I never realized how poorly my brain was working!" Definitely life changing for me (in combination with S-Acetyl Glutathione)
- Paul-Craft 2y ago
  Have you, or anyone you know, been able to stay on it successfully long term? I know a couple who have tried it, had good results, but later stopped, but none who have stayed on it long term.
  - johnyzee 2y ago
    That is the general experience, I think. I did pretty strict keto for 2.5 years. Been off it for about a year now, while many of the habits stick (I eat next to zero added sugar, and generally low carb, less processed food, etc.). I got rid of a lot of weight and some skin conditions. It was generally very positive. It was weird to have such stable blood sugar that you never feel hungry, even when not eating at all. There were some adverse results too, like zero muscle strength. I also digest carbs worse now it seems like. There might well be ways to avoid those issues with a more carefully managed keto diet. I'm not sure if I will jump back on a strict keto regimen, it requires quite a bit of effort to plan meals, especially when other people in the household eat a regular diet. I have come to see keto as an intervention, very effective at fixing acute issues. Once you have done that reset, I think a lot of those wins can be maintained through generally healthy habits (which you now understand a lot better).

Projectiboga 2y ago

Yeast is what is targets. I know a psychiactric dr who found promose in feeding patients refined coconut oil. The craprylic acid is what makes up the triglicerides in it. Those kill yeast.

m463 2y ago

The article said: Researchers then administered D-βHb, a form of ketones, a byproduct released by the liver when the body burns fat instead of glucose for energy. They found that the synaptic activity that was previously impacted by acute insulin resistance was rescued, looking further, D-βHb seems to be an exogenous ketone: Exogenous ketones are a class of ketone bodies that are ingested using nutritional supplements or foods. ... Under physiological conditions, ketone concentrations can increase due to starvation, ketogenic diets, or prolonged exercise, leading to ketosis.[2] However, with the introduction of exogenous ketone supplements, it is possible to provide a user with an instant supply of ketones even if the body is not within a state of ketosis before ingestion.[1] However, drinking exogenous ketones will not trigger fat burning like a ketogenic diet. ... When exogenous ketone bodies are ingested, acute and nutritional exogenous ketosis is produced.[4][9] https://en.wikipedia.org/wiki/Exogenous_ketone https://en.wikipedia.org/wiki/Exogenous_ketone so, how do we supplement our diet?

yoaviram 2y ago

Sharing my personal single data point experience, in the hope it helps others. I started low carb then keto about 5 months ago when my migraines turned chronic (a few times a week). I haven't had a migraine in the past 3.5 months. Also lost weight and generally feel great. I was following the advice in this book: https://www.amazon.com/Migraine-Miracle-Sugar-Free-Gluten-Free-Inflammation/dp/1608828751?ref=d6k_applink_bb_dls&dplnkId=3f8b1721-4818-432d-956c-06e0f3ffc207 https://www.amazon.com/Migraine-Miracle-Sugar-Free-Gluten-Fr...

unstatusthequo 2y ago
Same. I have been low carb for years, but at one point, I decoded to go full actual ketogenic. I never remember being more productive and focused than in true ketosis. Note that getting there is something you need to test for. I did blood drop tests at home with a device to measure ketone levels. Also recommend some materials from Tim Ferris on this topic including the Dom D’Agostino part of Tools of Titans and I think some podcasts on the topic.
ddmf 2y ago
Reducing carbs has really helped with my migraines too.

rdlecler1 2y ago

We recently invested in https://www.drinkkey.com/ https://www.drinkkey.com/ I’ve been drinking it daily and I usually fast until 2-4pm. Anecdotally it’s helped with headaches and fatigue. I can’t rule out placebo effect, but I feel great.

jasfi 2y ago
The first thing I noticed when I read the story was that the ketones were administered and not the result of a diet. Good luck with your investment, the business sounds like a good idea. They need to do a ton of marketing though. I also suspect that as others enter the market those involved will end up competing heavily on price.
J_Shelby_J 2y ago
My notes as an exo-keto enjoyer: At least until exo-ketones are mainstream you should consider that you are competing for people well aware of the product. That said, you should really seek to differentiate yourself from other products. You have a single, unsourced line about how your product is superior. Ok, cool. I’m not going to do your marketing teams job and look up studies to prove it out. Also, powder > shots > full drinks. Shipping adds up and flexibility in consumption is probably the easiest way to get people to integrate your product into their daily routine. For example, we love ketone salts combined with collagen and caffeine mix in the morning. I’ll probably order some of your product though. Good luck!
- rdlecler1 2y ago
  Agree, will pass this on to the team. Thanks for the feedback