Low Carb High Fat - Ketogenic

TLDR: People don't need carbohydrates, ketosis isn't dangerous.

It is pertinent to briefly discuss the enduring misconception that glucose itself represents an “absolutely essential”, “universal fuel” in human physiology, which requires nuanced definition and gradation, but has been perpetuated verbatim and may have been incorporated into the physiology education of currently practicing healthcare professionals [1-7].

We must first address the distinction between endogenous and exogenous sources of glucose. Clinical trials and epidemiological studies of very low to zero carbohydrate diets support the statement of the US National Academies of Sciences that “the lower limit of dietary carbohydrate compatible with life apparently is zero, provided that adequate amounts of protein and fat are consumed” [8-11]. Even so, despite seemingly safe and increasingly popular, the long-term effects of a truly “zero” carbohydrate diet (without micronutrient supplementation) are difficult to ascertain through controlled experimentation, being only inferred from evolutionary biology, observational studies, and mechanistic data [12-14]. With this caveat, it has now been clearly established in large cohorts of patients, both adult and pediatric, that the oral intake of carbohydrates can be chronically very low (< 5-10% of total daily energy), as long as essential micronutrients are obtained from the underlying food selection and/or supplementation [15-18].

During fasting or in the absence of dietary carbohydrates, a steady-state euglycemia will be maintained in a low but physiological range via hepatic and renal gluconeogenesis from endogenous sources, such as lactate, fatty acids (glycerol), gluconeogenic amino acids and odd chain fatty acids [19-21]. From an evolutionary perspective, a minimal threshold of gluconeogenesis was preserved even after indefinite periods of fasting, questioning whether glucose itself is essential [22, 23]. It was not until the seminal work of Cahill et al. corroborating the remarkable metabolic flexibility of human physiology that the absolute requirements of glucose under compensatory ketosis could be quantified [24]. Drenick et al. demonstrated that, after a 2-month fast in obese subjects, insulin stimulation failed to precipitate hypoglycemic reactions with plasma glucose as low as 9 mg/dl (0.5 mM) [25]. During prolonged fasting, blood glucose levels below 30 mg/dL (1.70 mM) have been sustained continuously for several months without adverse effects [22, 23]. It is apparent that glucose requirements can be significantly displaced by fat-derived fuels, assuming a gradual period of ketogenic adaptation proportional to the degree of glucose depletion [26, 27]. Most human tissues require at least 1 to 4 weeks of strict KD adherence for the effective upregulation of ketone body metabolism, a process that can be accelerated through water-only fasting [28-30]. Without ketogenic adaptation, glucose is indeed the “primary metabolic fuel”, as evidenced by hypoglycemic reactions after accidental secretagogue or insulin overdose in diabetic patients following carbohydrate-rich diets, even under conditions of diabetic ketoacidosis [31-33].

Many clinicians fear ketosis due to confusion with diabetic ketoacidosis, defined by the triad of excessive ketogenesis, metabolic acidosis and concomitant hyperglycemia [34]. A low level of ketones (e.g., < 0.5 mM) prior to initiating carbohydrate restriction indicates that the individual is likely not deficient in insulin and therefore not at risk for ketoacidosis [35]. Clinicians may wish to monitor serum bicarbonate during the early stages of ketogenic adaptation. Ketoacidosis does not occur unless ketones coexist with hyperglycemia and decreasing bicarbonate levels, indicating insulin insufficiency (not to be confused with insulin suppression via carbohydrate restriction, which in turn increases insulin sensitivity, as indicated by lower insulin requirements for euglycemia) [36].

In the context of KMT, evolutionary competition for the limited nutrient supply between the tumor and normal tissues may be potentiated [37]. It is important to clarify that the uninterrupted maintenance of very low glucose levels (< 3 mM) is not realistically achievable for most patients following isocaloric KDs and typically requires prolonged fasting or pharmacological interventions. Fortunately, the anti-tumoral benefits of KMT are hypothesized to arise from pleiotropic regulation of energy sensing and growth signaling pathways (PI3K, AKT, AMPK/mTOR, PGC-1α), inflammation, angiogenesis, and autophagy, not solely as the result of reduced glucose availability with compensatory ketosis, which simply serves as a surrogate marker for successful clinical implementation [38-43].

Ok, this isn't a whole paper by itself, its an appendix of Clinical research framework proposal for ketogenic metabolic therapy in glioblastoma But its so well written, it deserves to be highlighted.

Full Original Paper here: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03775-4#Sec31 - Supplementary Material 1 - Appendix 1 - Warning - It's a docx document.

The image in the post is from Resistance to Symptomatic Insulin Reactions after Fasting which is reference 35.

Every recipe here is crafted with purpose—nutrient-dense, blood sugar-friendly, and free from processed ingredients. Whether you’re managing diabetes or just eating for better health, these meals make it easy to stay on track without sacrificing flavor.

https://www.americandiabetessociety.org/recipes

This Printable Recipe

victoriasketokitchen.net/entrees/f/keto-hot-cocoa-powder

• black cocoa
• reg cocoa
• milk powder
• sweetner

TLDR - If you are a ketogenic lean mass hyper responder with high LDL, insist on imaging to determine your atherosclerotic risk, as this study indicates the LDL and ApoB by itself doesn't indicate a growth in plaque.

Background - Changes in low-density lipoprotein cholesterol (LDL-C) among people following a ketogenic diet (KD) are heterogeneous. Prior work has identified an inverse association between body mass index and change in LDL-C. However, the cardiovascular disease risk implications of these lipid changes remain unknown.

Objectives - The aim of the study was to examine the association between plaque progression and its predicting factors.

Methods - One hundred individuals exhibiting KD-induced LDL-C ≥190 mg/dL, high-density lipoprotein cholesterol ≥60 mg/dL, and triglycerides ≤80 mg/dL were followed for 1 year using coronary artery calcium and coronary computed tomography angiography. Plaque progression predictors were assessed with linear regression and Bayes factors. Diet adherence and baseline cardiovascular disease risk sensitivity analyses were performed.

Results - High apolipoprotein B (ApoB) (median 178 mg/dL, Q1-Q3: 149-214 mg/dL) and LDL-C (median 237 mg/dL, Q1-Q3: 202-308 mg/dL) with low total plaque score (TPS) (median 0, Q1-Q3: 0-2.25) were observed at baseline. Neither change in ApoB (median 3 mg/dL, Q1-Q3: −17 to 35), baseline ApoB, nor total LDL-C exposure (median 1,302 days, Q1-Q3: 984-1,754 days) were associated with the change in noncalcified plaque volume (NCPV) or TPS. Bayesian inference calculations were between 6 and 10 times more supportive of the null hypothesis (no association between ApoB and plaque progression) than of the alternative hypothesis. All baseline plaque metrics (coronary artery calcium, NCPV, total plaque score, and percent atheroma volume) were strongly associated with the change in NCPV.

Conclusions - In lean metabolically healthy people on KD, neither total exposure nor changes in baseline levels of ApoB and LDL-C were associated with changes in plaque. Conversely, baseline plaque was associated with plaque progression, supporting the notion that, in this population, plaque begets plaque but ApoB does not. (Diet-induced Elevations in LDL-C and Progression of Atherosclerosis [Keto-CTA]

Full Paper: https://doi.org/10.1016/j.jacadv.2025.101686

Summary

In this episode of the KetoPro Podcast, Richard Smith welcomes back Professor Tim Noakes to discuss the impact of low carbohydrate diets on athletic performance. They explore recent research findings that challenge traditional beliefs about carbohydrates and muscle glycogen, emphasizing the importance of blood glucose levels during endurance activities. The conversation also addresses the adaptation process for athletes transitioning to low carb diets, the health implications of dietary choices for athletes, and the evolving landscape of sports nutrition. In this conversation, the speakers delve into the implications of carbohydrate consumption on athletic performance and overall health. They discuss the hidden dangers of high carbohydrate diets, the efficiency of fat as a fuel source, and the body's macronutrient needs. Personal experiences with zero carb diets are shared, along with insights into the future of research in this area. The conversation also touches on the addiction to carbohydrates among athletes and the genetic factors influencing performance. Ultimately, the speakers advocate for a shift in dietary practices to enhance health and athletic longevity.

Takeaways

• The low carb diet is gaining traction in various sports.
• Carbohydrates can enhance performance, but only during prolonged exercise.
• Muscle glycogen depletion is not as critical as previously thought.
• A small amount of glucose can improve endurance performance.
• Blood glucose levels play a significant role in athletic performance.
• Many studies fail to account for adaptation periods in low carb diets.
• Elite athletes may not always be the best model for dietary studies.
• Health concerns are rising among athletes consuming high carb diets.
• The shift towards low carb diets in sports is inevitable.
• Individual performance improvements matter more than comparisons with elite athletes. High carbohydrate diets can lead to insulin resistance.
• Fat can provide the majority of energy needed for endurance sports.
• The human body is capable of burning fat efficiently.
• Glucose is essential for brain function during exercise.
• Zero carb diets can lead to improved athletic performance.
• Athletes often consume excessive carbohydrates unnecessarily.
• Genetics play a significant role in athletic performance.
• Addiction to sugars is prevalent among athletes.
• Long-term health benefits from a low-carb lifestyle are significant.
• Research on zero carb athletes is needed to understand their performance.

Chapters

00:00 Introduction and Guest Welcome
01:40 Exploring Carbohydrates and Athletic Performance
03:04 Research Insights on Low Carb Diets
09:10 The Role of Carbohydrates in Endurance Sports
10:10 Debating Muscle Glycogen vs. Blood Glucose
17:23 Adaptation and Supplementation in Low Carb Diets
20:13 Comparing Elite and Amateur Athletes
28:02 Health Implications of Diet in Athletes
32:00 The Hidden Dangers of High Carbohydrate Diets
34:48 The Efficiency of Fat as Fuel
36:14 Understanding the Body's Macronutrient Needs
37:59 The Role of Glucose in Endurance Sports
39:45 Personal Experiences with Zero Carb Diets
42:05 The Future of Zero Carb Research
45:27 The Impact of Diet on Athletic Performance
48:00 The Addiction to Carbohydrates
50:56 The Genetic Factors in Athletic Performance
53:16 The Importance of Resilience in Endurance Sports

Thomas N. Seyfried received his Ph.D. in Genetics and Biochemistry from the University of Illinois, Urbana, in 1976. He did his undergraduate work at the University of New England, where he recently received the distinguished Alumni Achievement Award. He also holds a Master’s degree in Genetics from Illinois State University. Thomas Seyfried served with distinction in the United States Army’s First Cavalry Division during the Vietnam War and received numerous medals and commendations. He was a Postdoctoral Fellow in the Department of Neurology at the Yale University School of Medicine and then served on the faculty as an Assistant Professor in Neurology.

Other awards and honours have come from such diverse organisations as the American Oil Chemists Society, the National Institutes of Health, The American Society for Neurochemistry, the Ketogenic Diet Special Interest Group of the American Epilepsy Society, the Academy of Comprehensive and Complementary Medicine, and the American College of Nutrition.

Dr. Seyfried previously served as Chair, Scientific Advisory Committee for the National Tay-Sachs and Allied Diseases Association and presently serves on several editorial boards, including those for Nutrition & Metabolism, Neurochemical Research, the Journal of Lipid Research, and ASN Neuro, where he is a Senior Editor.

Dr. Seyfried has over 150 peer-reviewed publications and is the author of the book, Cancer as a Metabolic Disease: On the Origin, Management, and Prevention of Cancer (Wiley, 1st ed., 2012).

Publication List https://scholar.google.com/citations?user=ctSRQrsAAAAJ

Here is the paper the talk is largely based from : https://doi.org/10.3389/fcell.2015.00043 - Cancer as a mitochondrial metabolic disease

Here is the proposed press-pulse protocol : https://pubmed.ncbi.nlm.nih.gov/28250801/ - Press-pulse: a novel therapeutic strategy for the metabolic management of cancer

Here is a application of that protocol for glioblastomas : https://pubmed.ncbi.nlm.nih.gov/39639257/ - Clinical research framework proposal for ketogenic metabolic therapy in glioblastoma

Dr Penny Figtree graduated from the University of Sydney in 1993 with first class honours. With over 20 years in general practice she has now decided to focus on weight loss and diabetes.

This decision was made after seeing the power of a low carbohydrate diet to help people lose weight and for some to even reverse diabetes. Dr Figtree had previously tried to help patients using various diets such as low fat diets, Optifast, the 5:2 fast but nothing really worked. In the end she would just say “as long as you are not gaining weight then that’s great”. Then Dr. Figtree read a book called “Always Hungry” By Professor David Ludwig where he explained the INSULIN CARBOHYDRATE MODEL OF OBESITY.

Dr. Figtree has now been practising low carb medicine for several years. She describes this as the most rewarding part of her career, stopping medications and patients feeling well.

Summarizer

Dr. Penny Figtree discusses the use of continuous glucose monitors (CGMs) in healthy individuals, emphasizing their benefits and addressing concerns about their use. She explains how CGMs provide real-time glucose data, helps in understanding metabolic health, and might reveal undiagnosed conditions. The talk also touches on the controversies surrounding CGM use and practical advice for interpreting glucose readings.

Key Points

Introduction to Continuous Glucose Monitors

Dr. Figtree introduces continuous glucose monitors (CGMs), specifically the Freestyle Libre and Dexcom G6, highlighting how they measure blood glucose levels in real-time, providing valuable information for individuals to understand their metabolic health.

Controversy Over CGMs in Healthy Individuals

The use of CGMs in healthy people has sparked debate, with some experts arguing there is insufficient data to endorse their use outside of diabetic care. Dr. Figtree encourages individuals to consider CGMs as tools for gaining insights into their blood sugar responses and overall health.

Setting Up Alarm Parameters

Dr. Figtree advises users to set custom limits in the CGM app to avoid unnecessary alarm reactions. She explains the differences between sensor readings and blood glucose measurements, emphasizing not to panic over minor fluctuations.

Understanding Glucose Variations

The speaker explains that normal glucose responses can vary with exercise, food intake, and other factors. Healthy individuals usually maintain glucose levels below 7.8 mmol/L, but it's normal for levels to fluctuate occasionally.

Reactive Hypoglycemia Insights

Dr. Figtree discusses reactive hypoglycemia, where blood sugar drops significantly post-meal, often causing discomfort. She shares her experience with dietary changes and suggests increasing protein intake to mitigate this issue.

Dawn Phenomenon in Healthy Individuals

The early morning increase in glucose levels, known as the 'dawn phenomenon,' is explained as a natural hormonal response that can influence glucose readings in both diabetics and healthy individuals.

Potential Benefits of Using CGMs

Recent studies suggest that healthy adults may benefit from CGMs to monitor their glucose responses to various foods, which can help in identifying patterns and reducing risks associated with glucose variability.

Conclusion on CGM Usage

Dr. Figtree concludes that while CGMs can be beneficial for healthy individuals, it is essential to interpret the data appropriately and understand personal metabolic responses.

This is IMO the most authentic flavorful enchiladas on a keto diet with my game-changing tortilla recipe! This low-carb, high-fat tortilla is not only perfect for keto enthusiasts but also a great fit for carnivore diets. In this video, we'll show you how to make the perfect keto tortilla from scratch, using two ingredients and easy-to-follow instructions. Whether you're a keto newbie or a seasoned pro, this recipe is a must-try for anyone looking to elevate their keto meal game. So, what are you waiting for? Let's get started and make some amazing keto enchiladas!

Enchilada sauce

• 2 tablespoons butter
• 1 tablespoon quality chili powder
• 1 tablespoon chicken bouillon
• 1 teaspoon onion powder
• 1/2 teaspoon ground cumin

Tortilla

• 4 egg whites
• 2/3 cup pork rinds

Filling

• onions
• cheese
• meat

A accessible conversation on the topic of blood glucose control. Nothing ground breaking here, but a good introduction spoken in plain language going over the papers we have already reviewed.

Summarizer:

Dr. Ford Brewer discusses a step-by-step guide to reversing type 2 diabetes, emphasizing diet and lifestyle changes. He explains how carbohydrates can become detrimental as insulin sensitivity decreases with age and how proper dietary choices can significantly impact blood sugar levels. The conversation also touches on the importance of exercise, particularly muscle-building activities, and the physiological effects of fasting and body composition on diabetes management.

Key Points

Carbohydrates as a Risk Factor

Carbohydrates are not inherently toxic but can become harmful as insulin sensitivity decreases with age. Elevated blood sugar and insulin levels are linked to inflammation and vascular damage.

Dietary Approaches to Reverse Diabetes

A low-carbohydrate diet is essential for reversing diabetes. Cutting out refined sugars and high glycemic index foods can help manage blood sugar levels effectively.

Role of Exercise in Diabetes Management

Exercise, particularly strength training, is crucial for building metabolically active muscle which can utilize glucose without insulin, thereby helping to lower blood sugar levels.

Importance of Body Composition

Reducing body fat and increasing muscle mass are vital for improving insulin receptor sensitivity. A small weight loss can lead to significant improvements in diabetes management.

Intermittent Fasting and Autophagy

Intermittent fasting can promote autophagy, aiding the body's ability to recycle and clean up cellular waste, which is beneficial in managing diabetes.

TLDR: Keto is good for you, and not bad for you. Despite what some agenda based people say the evidence is in favor of keto as good for you, yes even you.

As the prevalence of chronic diseases persists at epidemic proportions, health practitioners face ongoing challenges in providing effective lifestyle treatments for their patients. Even for those patients on GLP-1 agonists, nutrition counseling remains a crucial strategy for managing these conditions over the long term. This paper aims to address the concerns of patients and practitioners who are interested in a low-carbohydrate or ketogenic diet, but who have concerns about its efficacy, safety, and long-term viability. The authors of this paper are practitioners who have used this approach and researchers engaged in its study. The paper reflects our opinion and is not meant to review low-carbohydrate diets systematically. In addressing common concerns, we hope to show that this approach has been well researched and can no longer be seen as a “fad diet” with adverse health effects such as impaired renal function or increased risk of heart disease. We also address persistent questions about patient adherence, affordability, and environmental sustainability. This paper reflects our perspective as clinicians and researchers engaged in the study and application of low-carbohydrate dietary interventions. While the paper is not a systematic review, all factual claims are substantiated with citations from the peer-reviewed literature and the most rigorous and recent science. To our knowledge, this paper is the first to address potential misconceptions about low-carbohydrate and ketogenic diets comprehensively.

Full Paper: https://doi.org/10.3390/nu17061047

Recently we reported similar performances in both progressive tests to exhaustion (VO2max) and 5km running time trials (5KTT) after consuming low-carbohydrate, high-fat (LCHF) or high-carbohydrate, low-fat (HCLF) diets. Accordingly, we tested the null hypothesis that the metabolic responses during both tests would be similar across diets. In a randomized, counterbalanced, cross-over design, seven male athletes (VO2max: 61.9 ± 6.1 mL/kg/min; age: 35.6 ± 8.4 years; height: 178.7 ± 4.1 cm; mass: 68.6 ± 1.6 kg; body fat: 5.0 ± 1.3%) completed six weeks of LCHF (6/69/25% energy carbohydrate/fat/protein) and HCLF (57/28/15% energy carbohydrate/fat/protein) diets, separated by a two-week washout. Substrate utilization and energy expenditure were measured during VO2max tests and 5KTTs. The LCHF diet markedly increased fat oxidation and reduced carbohydrate oxidation, with no associated impairment in either the VO2max tests or the 5KTTs. Following the LCHF diet, athletes generated 50% or more of their energy requirements from fat at exercise intensities up to 90% VO2max and reached the crossover point for substrate utilization at ~85% VO2max. In contrast, following the HCLF diet, carbohydrate provided more than 50% of the total energy consumption at all exercise intensities. During the 5KTT, ~56% of energy was derived from fat following the LCHF diet whereas more than 93% of the energy came from carbohydrate following the HCLF diet. This study provides evidence of greater metabolic flexibility following LCHF eating and challenges the popular doctrines of “carbohydrate dependence” for high intensity exercise and the role dietary macronutrients play in human performance.

Full Paper - https://doi.org/10.5114/biolsport.2023.116452

Compared to highly trained ultra-endurance athletes consuming an HC diet, long-term keto-adaptation results in extraordinarily high rates of fat oxidation, whereas muscle glycogen utilization and repletion patterns during and after a 3 hour run are similar.

Many successful ultra-endurance athletes have switched from a high-carbohydrate to a low-carbohydrate diet, but they have not previously been studied to determine the extent of metabolic adaptations.

Twenty elite ultra-marathoners and ironman distance triathletes performed a maximal graded exercise test and a 180 min submaximal run at 64% VO2max on a treadmill to determine metabolic responses. One group habitually consumed a traditional high-carbohydrate (HC: n = 10, %carbohydrate:protein:fat = 59:14:25) diet, and the other a low-carbohydrate (LC; n = 10, 10:19:70) diet for an average of 20 months (range 9 to 36 months).

Peak fat oxidation was 2.3-fold higher in the LC group (1.54 ± 0.18 vs 0.67 ± 0.14 g/min; P = 0.000) and it occurred at a higher percentage of VO2max (70.3 ± 6.3 vs 54.9 ± 7.8%; P = 0.000). Mean fat oxidation during submaximal exercise was 59% higher in the LC group (1.21 ± 0.02 vs 0.76 ± 0.11 g/min; P = 0.000) corresponding to a greater relative contribution of fat (88 ± 2 vs 56 ± 8%; P = 0.000). Despite these marked differences in fuel use between LC and HC athletes, there were no significant differences in resting muscle glycogen and the level of depletion after 180 min of running (− 64% from pre-exercise) and 120 min of recovery (− 36% from pre-exercise).

Full Paper: https://doi.org/10.1016/j.metabol.2015.10.028

TLDR: The take away from this paper is after a 6 week adaption phase a keto athlete had a higher time to exhaustion then a high carb athlete even with carb loading.

Very-low-carbohydrate diets (LCHF; <50 g/day) have been debated for their potential to lower pre-exercise muscle and liver glycogen stores and metabolic efficiency, risking premature fatigue. It is also hypothesized that carbohydrate ingestion during prolonged exercise delays fatigue by increasing carbohydrate oxidation, thereby sparing muscle glycogen. Leveraging a randomized crossover design, we evaluated performance during strenuous time-to-exhaustion (70% V̇o2max) tests in trained triathletes following 6-wk high-carbohydrate (HCLF, 380 g/day) or very-low-carbohydrate (LCHF, 40 g/day) diets to determine 1) if adoption of the LCHF diet impairs time-to-exhaustion performance, 2) whether carbohydrate ingestion (10 g/h) 6–12× lower than current CHO fueling recommendations during low glycogen availability (>15-h pre-exercise overnight fast and/or LCHF diet) improves time to exhaustion by preventing exercise-induced hypoglycemia (EIH; <3.9 mmol/L; <70 mg/dL), and 3) the “keto-adaptation” time course through continuous substrate monitoring while caloric intake, physical activity, and fat-free mass are maintained. Time-to-exhaustion performance was similar across both dietary interventions. Minimal carbohydrate supplementation prevented EIH and significantly increased time to exhaustion equivalently in LCHF and HCLF interventions (22%). The LCHF diet significantly lowered 24-h glucose concentrations, which normalized after 4 wk, at the same timepoint peak blood ketone (R-β-hydroxybutyrate) concentrations normalized. These findings 1) demonstrate that an LCHF diet sustains strenuous endurance performance, 2) establish that minimal carbohydrate supplementation was sufficient to enhance exercise performance on LCHF and HCLF diets by mitigating EIH, and 3) indicate that a minimum 4-wk adaptation period to an LCHF diet is required to ensure normalization of metabolic homeostasis, glycemic control, and exercise performance.

NEW & NOTEWORTHY This study examines the belief that very-low-carbohydrate diets (LCHF) impair prolonged exercise performance during strenuous exercise by comparing it with high-carbohydrate diets in competitive triathletes. After 6-wk diet adaptation, time-to-exhaustion (TTE) performance was similar across both diets. Minimal carbohydrate supplementation (10 g/h) during exercise eliminated exercise-induced hypoglycemia and improved TTE by 22% on both diets. These findings suggest that LCHF diets do not impair exercise performance and require a 4-wk adaptation period for metabolic homeostasis.

Full Paper: https://doi.org/10.1152/ajpcell.00583.2024

So many of our beloved Seniors could drastically improve their health and return to productive life with a few simple changes in diet and lifestyle. We go over what it takes to optimize Senior health in this video. Elderly folks have so much wisdom and love to share with their family, but they can't do it if they are stuck in a dark nursing home, taking 20 medications a day and eating a junk diet...

Summary:

Hal Cranmer currently owns and operates four assisted living homes in very unique ways. He doesn't believe in warehousing our elderly until they die... website: aparadiseforparents.com/assisted-living

Main Topic: Improving the health of elderly individuals to enable them to return to independent living, focusing on diet and lifestyle changes as alternatives to nursing homes.

Key Points:

• Many elderly individuals in assisted living or nursing homes could significantly improve their health and return home with simple changes in diet and lifestyle.
• A significant percentage (estimated 20-30% or potentially higher) of nursing home residents could improve enough to return home with a proper diet (low-carb, ketogenic, or carnivore) and increased sunlight exposure.
• The speaker, Hal Cranmer, owner of assisted living facilities, shares his experiences successfully helping residents return home through dietary changes (low-carb, ketogenic, incorporating Maria Emmerich's recipes), regular exercise, sunlight exposure, and oxygen therapy.
• Early intervention is crucial. The earlier changes are implemented, the greater the chance of success.
• Addressing insulin resistance and inflammation is key, as these contribute to conditions like Alzheimer's and dementia.
• Deprescribing unnecessary medications is a significant factor in improving health and cognitive function.
• Sunlight exposure has shown remarkable benefits, including improved immune response (evidenced by low COVID-19 mortality rates among residents during the pandemic).
• Addressing Sundowner's syndrome can be improved with a combination of healthy diet, exercise, and morning sunlight exposure.
• Financial incentives often discourage nursing homes and assisted living facilities from improving resident health, as higher levels of care mean higher payments. However, a focus on improving resident health can lead to increased occupancy and longer-term residents.
• Families can advocate for changes in their loved ones' care by seeking out smaller, independent assisted living facilities more open to implementing holistic approaches.

Highlights:

• Hal Cranmer's success in helping numerous residents return home from his assisted living facilities.
• The significant reduction in COVID-19 mortality among his residents during the pandemic, attributed to sunlight exposure and a healthy diet.
• The dramatic reduction in medication for some residents (one case involved reducing medication from 54 to 22).
• The emphasis on a holistic approach combining diet, exercise, sunlight, and medication reduction.
• The importance of early intervention and the potential for reversing or mitigating chronic conditions.
• The call to action for families to advocate for better care for their elderly relatives.

Not all medical research is created equal, so how do we know which studies to trust?

The phrase _evidence-based medicine_ (EBM) is often misunderstood and misused. What does it truly mean to rely on evidence in clinical decision-making?

Dr. Gordon Guyatt, the father of the term evidence-based medicine, explains how to assess scientific studies, understand the strength of different types of evidence, and apply findings to clinical decisions.

Want to make better-informed health decisions? This interview will help you learn how to critically assess medical evidence for yourself. In this conversation, Dr. Guyatt breaks down:

• ✅ Why some studies are more trustworthy than others\
• ✅ The limitations of observational studies in nutrition and medicine\
• ✅ How the GRADE framework categorizes evidence from high to low certainty\
• ✅ How to critically assess nutrition and mental health research\
• ✅ The importance of patient values in clinical decision-making

As new chronic disease treatments emerge from rapidly evolving research, understanding the quality of evidence is more important than ever. The ability to distinguish robust data from weak correlations isn’t just a skill—it’s essential for making informed, effective decisions in patient care.

#MetabolicMind #EvidenceBasedMedicine #MedicalResearch #NutritionScience #GRADEMethod #HealthDecisions

*Expert Featured:*
Dr. Gordon Guyatt, MD
https://x.com/GuyattGH
guyatt@mcmaster.ca

*Resources Mentioned:*
Core GRADE Workshop
- https://hei.healthsci.mcmaster.ca/events/core-grade-workshop/

*Timestamps:*
0:00 - Introduction to Dr. Gordon Guyatt and evidence-based medicine. Explanation of the GRADE approach: Grading of Recommendations Assessment, Development and Evaluation.
2:32 - How does Dr. Guyatt define evidence-based medicine? How has the definition evolved over time?
4:45 - When should patient preferences and values come into play with evidence-based medicine?
8:17 - How does the quality of evidence affect what treatments can be considered “evidence-based medicine?”
11:52 - What is the impact of hazard/odds ratios on determining the quality of a piece or pieces of evidence?
17:00 - How does “healthy user bias” impact the quality of studies?
19:54 - Breaking down the Bradford Hill criteria and the GRADE criteria. Has the GRADE criteria had a strong effect on research and treatments?
28:26 - How does the “dose response” of a study affect the quality of evidence?
30:14 - Are observational studies helpful in the negative?
33:11 - How are average people supposed to know what evidence to trust?
39:55 - Can clinicians effectively apply the GRADE criteria with individual patients?
43:16 - Where can people learn more from Dr. Gordon Guyatt?

TLDR: Type 2 Diabetes reversal using only ketosis

Aims: This study assessed the five-year effects of a continuous care intervention (CCI) delivered via telemedicine, counseling people with type 2 diabetes (T2D) on a very low carbohydrate diet with nutritional ketosis.

Results: Twenty percent (n = 24) of the five-year completers achieved remission, with sustained remission observed over three years in 15.8 % (n = 19) and four years in 12.5 % (n = 15). Reversal to HbA1c < 6.5 % without medication or only metformin was seen in 32.5 % (n = 39). Sustained improvements were noted in body mass (-7.6 %), HbA1c (-0.3 %), triglycerides (-18.4 %), HDL-C (+17.4 %), and inflammatory markers, with no significant changes in LDL-C and total cholesterol.

Conclusions: Over five years, the very low carbohydrate intervention showed excellent retention and significant health benefits, including diabetes remission, weight loss, and improved cardiometabolic markers.

Full Paper: https://pubmed.ncbi.nlm.nih.gov/39433217/

Robert Lustig is a Professor of Paediatric Endocrinology and a public health expert on the impact of sugar on our health. He is the author of bestselling books such as, ‘Fat Chance’, ‘Metabolical’, and ‘The Hacking of the American Mind’.

Peter Brukner OAM, MBBS, FACSP, FACSM, FASMF, FFSEM is a specialist sports and exercise physician and the founding partner at the Olympic Park Sports Medicine Centre in Melbourne. Peter is a world renowned sports medicine clinician and researcher. His most recent team appointments have been as Head of Sports Medicine and Sports Science at Liverpool Football Club and, until 2017, Team Doctor for the Australian cricket team.

Peter is Professor of Sports Medicine at the La Trobe Sport & Exercise Medicine Research Centre at La Trobe University, Melbourne. Peter has published widely internationally with a number of books, book chapters and over 100 original research articles. He is the co-author of Clinical Sports Medicine, a best selling general sports medicine text in its fifth edition as well as Stress Fractures, Food for Sport, Encyclopedia of Exercise and Sport Health and Clinical Sports Anatomy.

Prof. Brukner is the founder of the public health campaign SugarByHalf and is committed to the challenge of improving Australia’s health with improved diet and increased physical activity. The profits from Peter's book 'A Fat Lot Of Good' will help to fund the campaign sugarbyhalf.com

https://victoriasketokitchen.net/entrees/f/keto-thin-mint-cookies

Rats addicted to cocaine - when giving the choice of cocaine or sugar, overwhelmingly chose sugar.

Our findings clearly demonstrate that intense sweetness can surpass cocaine reward, even in drug-sensitized and -addicted individuals. We speculate that the addictive potential of intense sweetness results from an inborn hypersensitivity to sweet tastants. In most mammals, including rats and humans, sweet receptors evolved in ancestral environments poor in sugars and are thus not adapted to high concentrations of sweet tastants. The supranormal stimulation of these receptors by sugar-rich diets, such as those now widely available in modern societies, would generate a supranormal reward signal in the brain, with the potential to override self-control mechanisms and thus to lead to addiction.

Full Paper https://doi.org/10.1371/journal.pone.0000698

Can a Ketogenic Diet Help Treat Parkinson’s Disease? Speaking as someone who completed his PhD on this topic, my answer is “Yes.”  In this video, I’ll break down why I believe this is the case, review the mechanistic science and human trials, and share insights on how you can start a ketogenic diet today, whether you have Parkinson’s or not.

Chapters\
0:00 – A Ketogenic Diet for Parkinson’s Disease\
1:12 – What is Parkinson’s Disease?\
2:24 – How Common is Parkinson’s Disease?\
3:10 – Why this video, now? My background.\
5:32 – What Causes Parkinson’s Disease?\
8:14 – Ketogenic Diet Holds Hope for Parkinson’s Disease\
9:30 – Mechanism 1. Ketogenic diet and Brain Energy\
10:45 – Mechanism 2. Sneaking in the Energetic Backdoor\
12:04 – Mechanism 3. Enhancing Antioxidant Defenses\
13:08 – Mechanism 4. Boosting Dopamine Synthesis\
14:23 – Human Trials for Keto in Parkinson’s\
16:08 – Slowing or Stopping Disease Progression\
18:04 – Personal Patient Example\
19:21 – How to do a Ketogenic Diet for Parkinson’s disease

Norwitz et al. References

Ketones for Parkinson’s Disease Review: https://pubmed.ncbi.nlm.nih.gov/31139630/
Exercise Randomized Controlled Trial: https://pubmed.ncbi.nlm.nih.gov/33100965/
Neuroketotherapeutics Textbook Chapter: https://pubmed.ncbi.nlm.nih.gov/32854853/

What are your experiences?

The vast majority of people I know who do lchf don't do it because they read about it, or because of media. Every one of them, every single one of them, including the doctors, had a problem that they couldn't fix so they tried it out of desperation... And it worked.

"Everyone has a million problems until they have a health issue, then they have one problem"

That is why people are so invested in the science, and why we don't care if it's unpopular, it fixes problems that are unfixable....

My direct experiences

• fixed my high blood pressure, eczema, weight
• reversed my friends type 2 diabetes (now insulin free)
• resolves my other friends monthly migraine headaches (low carb plus potassium)
• reduced my other other friends gout events (cgm, plus reducing carb spikes)
• helped yet another friend resolve their PCOS after 4 months

That's 5 lives it's improved in otherwise unfixable situations... And that is just my direct 1:1 experience

What experiences have you had or seen?

Dr James Muecke AM is a South Australian based ophthalmologist and visiting consultant at Royal Adelaide and Women’s and Children’s Hospitals. Dr. Muecke graduated with Honours from the University of Adelaide Medical School in 1987. Following his internship, James lived and worked as a doctor in Africa and subsequently as an eye surgeon in the Middle East, battling malaria, wild animals, and rebel soldiers. He founded 'Sight For All' in 2008, turning his boundless energy into a fight against blindness in the Aboriginal communities of Australia and some of the poorest countries of Asia and Africa.

Dr. Muecke's commitment to social impact and humanitarian endeavours has earned him a string of awards. He received an Outstanding Service to the Prevention of Blindness award by the Asia-Pacific Academy of Ophthalmology in 2011, a Member of the Order of Australia in 2012, a South Australian Community Achievement Award in 2013, the Australian Medical Association’s President’s Leadership Award in 2013, Ernst & Young’s Social Entrepreneur for Australia in 2015 and The University of Adelaide’s Distinguished Alumni Award in 2019. In 2020, Dr. Muecke was named Australian of the Year and vowed to use his platform to advocate for measures to tackle preventable blindness caused by diabetes.

TLDR: Ketone levels above 2mmol/l show significant improvements in patients with Euthymic bipolar disorder.

Of 27 recruited participants, 26 began and 20 completed the ketogenic diet. For participants completing the intervention, mean body weight fell by 4.2 kg (P < 0.001), mean body mass index fell by 1.5 kg/m2 (P < 0.001) and mean systolic blood pressure fell by 7.4 mmHg (P < 0.041). The euthymic participants had average baseline and follow-up assessments consistent with them being in the euthymic range with no statistically significant changes in Affective Lability Scale-18, Beck Depression Inventory and Young Mania Rating Scale. In participants providing reliable daily ecological momentary assessment data (n = 14), there was a positive correlation between daily ketone levels and self-rated mood (r = 0.21, P < 0.001) and energy (r = 0.19 P < 0.001), and an inverse correlation between ketone levels and both impulsivity (r = −0.30, P < 0.001) and anxiety (r = −0.19, P < 0.001). From the MRS measurements, brain glutamate plus glutamine concentration decreased by 11.6% in the anterior cingulate cortex (P = 0.025) and fell by 13.6% in the posterior cingulate cortex (P = <0.001).

These findings suggest that a ketogenic diet may be clinically useful in bipolar disorder, for both mental health and metabolic outcomes. Replication and randomised controlled trials are now warranted.

Full Paper: https://doi.org/10.1192/bjo.2024.841