[HN Gopher] Can ketones enhance cognitive function and protect b...
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       Can ketones enhance cognitive function and protect brain networks?
        
       Author : XzetaU8
       Score  : 81 points
       Date   : 2024-06-01 08:26 UTC (14 hours ago)
        
 (HTM) web link (www.urmc.rochester.edu)
 (TXT) w3m dump (www.urmc.rochester.edu)
        
       | ozim wrote:
       | 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 wrote:
         | > 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 wrote:
           | 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 wrote:
             | You're confusing sugar and carbs with excess calories.
             | Excess calories are harmful, sugar and carbs are not.
        
               | germinalphrase wrote:
               | Sugar and carbs are very calorie dense, so it's a
               | distinction without a difference on a practical level.
        
               | wathef wrote:
               | A carbohydrate and protein have the same calorie content,
               | around 4kcal per gram. Fat is 9kcal per gram.
        
               | germinalphrase wrote:
               | Again, on a practical level - what's easier to over
               | consume? Carbs and sugars or fats?
        
               | hawk_ wrote:
               | 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.
        
               | nradov wrote:
               | 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.
        
               | layla5alive wrote:
               | And proportion of visceral fat stores, genetics,
               | epigenetics, etc.
        
               | GivinStatic wrote:
               | Calories are pretty much meaningless. The kind of food,
               | proportions of carbohydrates, and other components is
               | very critical. Nutrition =/= filling gas in a car.
        
               | iamacyborg wrote:
               | > Calories are pretty much meaningless.
               | 
               | I think you'll have to expand on what you're trying to
               | say here as taking it at face value is clearly untrue.
        
               | francisofascii wrote:
               | Sugar calories are not equal to say, calories in nuts.
               | The sugar calories are indeed worse. One reason for this
               | is the caloric energy in nuts are not fully absorbed like
               | with sugar. So even though nuts are energy dense, they
               | won't cause obesity like sugar.
        
               | dcow wrote:
               | calories in / calories out is a foolproof way to track
               | weight gain/loss over extended periods of time. So people
               | tend to oversimplify nutrition and diet to this one
               | number.
               | 
               | But it is indisputable that your body processes carbs,
               | protein, and fat in very different ways. If you only eat
               | donuts and bacon and candy consistently, in normal
               | caloric levels, then you will likely develop type 2
               | diabetes (or more precisely insulin resistance). Glucose
               | in your blood is toxic. Are you really going to argue
               | that this diet is perfectly safe?
        
               | iamacyborg wrote:
               | > Are you really going to argue that this diet is
               | perfectly safe?
               | 
               | I'm not sure that I ever claimed it was? All I'm saying
               | is there's no point in vilifying those food types as they
               | can be part of a perfectly healthy diet.
        
               | dcow wrote:
               | There is (and let's not bey coy: arguing all calories are
               | equal implies a sugar diet is perfectly healthy). People
               | literally don't understand how bad excessive sugar intake
               | is because it's not vilified enough. A mature adult
               | understands that everyone has vices and all things are
               | usually fine in moderation, and that's how we should
               | approach sugar. I strongly believe in 20 years sugar will
               | be seen similar to tobacco. And that's okay. You and I
               | can still enjoy an occasional donut.
        
           | riehwvfbk wrote:
           | 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 wrote:
             | 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 wrote:
             | > 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/
             | 
             | [2] https://pubmed.ncbi.nlm.nih.gov/31336509/
        
               | SamoyedFurFluff wrote:
               | > diabetics often do better following a ketogenic diet
               | [2]
               | 
               | Your citation is _a single case study_ over a short
               | period of time. It does not support your claim of
               | "often". This is deceptive citation and undermines your
               | arguments.
        
               | fl0ki wrote:
               | Fair enough, thanks for the criticism. Here a few more
               | studies:
               | 
               | https://nutritionandmetabolism.biomedcentral.com/articles
               | /10...
               | 
               | > The LCKD improved glycemic control in patients with
               | type 2 diabetes such that diabetes medications were
               | discontinued or reduced in most participants.
               | 
               | https://pubmed.ncbi.nlm.nih.gov/22673594/
               | 
               | > The LCD and LCKD had beneficial effects on all the
               | parameters examined.
               | 
               | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6024764/
               | 
               | > LCD can improve blood glucose more than LFD in Chinese
               | patients with T2DM. It can also regulate blood lipid,
               | reduce BMI, and decrease insulin dose in patients with
               | T2DM.
               | 
               | https://pubmed.ncbi.nlm.nih.gov/34338787/
               | 
               | > The VLCK diet appears to control glycemia and decrease
               | body weight for up to 6 months in people with obesity and
               | diabetes. Beneficial changes in serum triglycerides and
               | high-density lipoprotein cholesterol, along with
               | reductions in antidiabetic medications, continued in the
               | VLCK group until 12 months. However, the quality of
               | currently available evidence is not sufficient to
               | recommend VLCK diets. A major limitation of the VLCK diet
               | is patients' lack of adherence to carbohydrate
               | restriction.
               | 
               | So sure, there are issues with adherence and the volume &
               | quality of data here. That doesn't invalidate the trends
               | seen across every study that looks into this. It's more
               | than one study and, within each study, it indeed seems to
               | benefit most participants.
        
               | SamoyedFurFluff wrote:
               | This is much better, thanks. I'm far more convinced now.
        
               | dcow wrote:
               | Furthermore there is some indication that people
               | experiencing type 2 diabetes are suffering from
               | essentially a worn out pancreas. In other words their
               | insulin resistance is a result of constantly eating more
               | sugars/carbs than the organ can keep up with. Switching
               | to a keto diet instead of supplementing insulin gives the
               | organ a break where it can actually start to heal and
               | return to a more normal insulin production routine,
               | ultimately meaning that these people can eat a donut
               | occasionally without requiring the insulin supplement
               | like they otherwise would with a traditional treatment
               | plan where their body hasn't been given a break from the
               | onslaught of glucose. This can be life changing for a
               | type 2 diabetic, because their lifestyle returns to
               | normal outside of paying attention to their diet.
        
               | layla5alive wrote:
               | Insulin resistance is a quality of the cells in your body
               | which cease responding to insulin at their receptors. So
               | higher levels of insulin fail to reduce blood sugar
               | levels. This is the hallmark of T2D.
               | 
               | You are confusing this with beta cell function, which
               | also becomes impaired in many T2D people, where the islet
               | cells become damaged, insulin production is subsequently
               | impaired as well, this is a later stage effect in T2D
               | progression.
               | 
               | T2D likely manifests from prolonged energy surplus
               | leading to oxidative damage to cells and accumulation of
               | excess fat stores, particularly visceral fat stores in
               | the organs - the cell damage and overfull visceral and
               | sometimes subcutaneous fat stores both lead to hormonal
               | and epigenetic changes and directly to insulin
               | resistance.
               | 
               | That's still oversimplified, but it's a useful model.
        
           | onethought wrote:
           | 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 wrote:
         | > 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 wrote:
         | 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-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-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 wrote:
           | 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 wrote:
           | 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 wrote:
             | 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).
        
               | guerby wrote:
               | The definition of nutritional ketosis is just a
               | restriction in carbohydrate intake to accelerate the
               | production of ketones by the body:
               | 
               | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6472268/
               | 
               | There is no specific ketone cutoff level specified, and
               | of course the impact of X g of carbohydrate will vary per
               | individual, during the day and between days.
               | 
               | The paper I cited are the end stage validation that a
               | treatment works: using it on patient in their normal
               | everyday life (instead of being in clinic/laboratory) -
               | note that they see the doctor 3 times 10 minutes per
               | year.
               | 
               | Of course no one knows how much carbohydrate they take
               | but the guidelines (as presented in the paper) are
               | clearly steering them to nutritional ketosis.
               | 
               | As or clinical studies there are many of them done in the
               | past decades, for a ten years ago summary for example:
               | 
               | https://web.archive.org/web/20150702005325/http://www.ome
               | ga3...
               | 
               | Dr Westman (the main author, Past-President and Master
               | Fellow of the Obesity Medicine Association and Fellow of
               | The Obesity Society, he also has a youtube channel) uses
               | 20g/day carbohydrate guideline and does not recommand the
               | use of a ketone meter for his patients.
        
         | throwawaycities wrote:
         | >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 wrote:
           | > 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 wrote:
             | 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 wrote:
               | 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.
        
               | dcow wrote:
               | When you've been unhealthy and struggling to maintain a
               | healthy body for years in a society that indexes way way
               | way to heavily on carbs because they're cheap and equally
               | isn't honest about the toxicity of glucose, you can kinda
               | see why people get so enthusiastic about it. Sure it can
               | be annoying but there are problems on both sides and
               | people that say sugar is fine eat it at will are starting
               | to come off as maliciously delusional to me of late.
        
               | throwawaycities wrote:
               | Discovering health tends to do that to people. It doesn't
               | matter if it's discovering keto, carnivore, vegetarian,
               | vegan, or exercise.
               | 
               | When people commit to improving their health, and begin
               | to experience improvements, for better or worse it is
               | like the second coming of Jesus. Particularly diabetics
               | that make lifestyle changes, lose significant amounts of
               | weight and get off insulin. Nearly everyone who
               | experiences that feels that if they can do it anyone can
               | do it, and they tend to share their experiences
               | enthusiastically and rightfully so.
        
               | shlant wrote:
               | > Something is happening, it's not just a fad
               | 
               | these are not mutually exclusive. It is a fad AND
               | something is happening.
               | 
               | That something comes down to two major things about low
               | carb/carnivore diets:
               | 
               | 1. You are removing processed foods. Going from a
               | Standard American Diet to basically anything that
               | involves more whole foods is going to be healthier for
               | you and make you feel better. This doesn't mean that the
               | new diet is optimal but it can be a step in the right
               | direction.
               | 
               | 2. Restricting your diet down to a few types of food is
               | going to remove a lot of allergens. If you only eat meat
               | for example, you are removing literally every single non-
               | meat allergen in your diet - most people have some sort
               | of food sensitivity (lactose intolerance being a common
               | one) so you are going to feel better when you remove
               | those allergens. However, this does not mean that
               | accidental elimination diets are the long term solution.
               | You should slowly add back foods and see what you react
               | to so you can do something less extreme but still feel
               | good doing it.
               | 
               | So yes a lot of people feel better on these diets but
               | that does not indicate they are healthy long term or
               | superior to other options.
        
             | tharkun__ wrote:
             | And you are probably basing that on the fact that the two
             | standard lipid markers for HDL and LDL went up, right?
             | 
             | And you probably ignored any that the ratio probably
             | improved between "good" and "bad" lipids? I guess you
             | didn't just eat lots of bad fats but also improved the
             | composition of fats you ate?
             | 
             | Lipid research is sponsored by pharma a lot. They need to
             | push their statins.
             | 
             | Anecdotal datum of one: I happen to have high cholesterol
             | no matter what I do. You have to fast in order to do the
             | lipid blood tests. Sometimes I forgot to fast and have even
             | eaten eggs. My lipid profile was better in those cases. I
             | also got muscle cramps from taking statins. The heart is a
             | muscle and those cramps can kill you. Instantly.
        
               | shlant wrote:
               | > And you probably ignored any that the ratio probably
               | improved between "good" and "bad" lipids?
               | 
               | "For predicting your risk of heart disease, many
               | healthcare professionals now believe that determining
               | your non-HDL cholesterol level may be more useful than
               | calculating your cholesterol ratio"[1]. Additionally,
               | "extremely high HDL-C levels are associated with an
               | increased risk of age-related macular degeneration (also
               | genetically), infectious disease, and all-cause
               | mortality."[2]
               | 
               | [1]https://www.mayoclinic.org/diseases-conditions/high-
               | blood-ch...
               | 
               | [2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10119031/
               | 
               | > Lipid research is sponsored by pharma a lot. They need
               | to push their statins.
               | 
               | A comment in a keto/low carb discussion believing in a
               | statin conspiracy? shocked.
               | 
               | > Anecdotal datum of one
               | 
               | Entirely irrelevant
        
               | tharkun__ wrote:
               | [1] It's funny. My Browser shows I visited that link
               | before ;)                   A comment in a keto/low carb
               | discussion believing in a statin conspiracy? shocked.
               | 
               | I'm not on Keto. I'm not on an actual low carb diet. I'm
               | just not afraid of eating lots of good fats. I'm not
               | afraid of eggs or cream any longer.
               | 
               | I don't believe in a "statin conspiracy". There's no
               | conspiracy needed. We've seen over and over again with
               | lots of things that companies favor funding research that
               | shows something that sells their product or they outright
               | lie (sorry "do marketing"). Leaded gasoline? Milk is good
               | for you, make your children drink more? Butter is bad?
               | 
               | The statins causing muscle cramps are a fact and not a
               | conspiracy. I got statins in ever increasing dosages
               | because they didn't help. When the cramps started, my
               | doctor took me off statins. When I then did try Keto all
               | of my blood markers that were either bad or borderline
               | went into completely normal territory. Except for lipids
               | that did the usual "hover around some really high and
               | absolutely bad for you territory".
               | 
               | Again, a datum of one. But when all the things done to me
               | with evidence from statistically relevant studies and
               | research doesn't help and actually makes things worse but
               | the statistically not significant thing works to improve
               | all of the markers of statistically proven blood testing,
               | then this anecdotal internet person here will stick with
               | what works. YMMV as always.                   Entirely
               | irrelevant
               | 
               | My anecdotal datum of one was marked as such. On purpose.
               | No need for this entirely irrelevant comment of yours.
               | The person I replied to did not and drew a wide ranging
               | societally generalizing argument from his datum of one.
        
             | dawnerd wrote:
             | Keto influencers? My doctor recommended it for weight loss
             | and it's probably saved my life. You're being pretty
             | negative because of your once experience on something that
             | does help people and does have results.
        
             | throwawaycities wrote:
             | I think you are throwing the baby out with the bath water,
             | sure there are probably influencers pedaling keto product,
             | just like corn, eggs, coffee, sugar, cereal, and meat have
             | entire lobbying industries pedaling bad science and bad
             | food stuffs.
             | 
             | But when you reply "yes, exactly" to the fact that the keto
             | diet was developed in a clinical setting over 100 years ago
             | to mimic the benefits of fasting and offer a n=1 anecdote
             | about your lipid panel, that's no better than anyone you
             | are accusing of downplaying possible negative effects.
        
           | shlant wrote:
           | > 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.
           | 
           | I don't know why people still use this as any sort of
           | argument for keto in the general population. Most people are
           | not children with epilepsy and even for children, the
           | keto/low carb diets has many downsides most notably growth
           | retardation, kidney stones and bone mineral loss.
        
             | throwawaycities wrote:
             | When people wrongly claim keto is a new "fad diet" you
             | don't know why people would point out that it's been around
             | for over 100 years highlighting there are ample subjects
             | that had adhered to it their entire lives from childhood?
             | 
             | Are there many diets that have lifelong adherents over
             | their lifetimes over the last 100 years from the general
             | population that have been studied?
        
       | snitch182 wrote:
       | 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 wrote:
         | eat as much fat as you want, just leave out the carbs and sugar
        
           | iamacyborg wrote:
           | Or just take a ketone supplement and eat normal food.
        
             | sgonz wrote:
             | 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 wrote:
               | 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 wrote:
               | Ketoacidosis.
        
               | iamacyborg wrote:
               | I don't think elite cycling teams would be taking these
               | supps if it caused that, do you?
        
               | layla5alive wrote:
               | @sgonz That state results in ketoacidosis, which is
               | fatal.
        
           | croes wrote:
           | "The dose makes the poison"
        
             | pjerem wrote:
             | True.
             | 
             | But contrary to fats (or proteins or fibers), sugar is also
             | addictive, doesn't satiate your body, and ultimately
             | generates hypoglycemia some hours later for you to eat more
             | sugar.
             | 
             | So yes, the dose makes the poison but sugar is the only one
             | poison your body accepts to absorb in immense quantities.
        
           | francisofascii wrote:
           | This. It is hard overeat if your diet consists of fish, nuts,
           | seeds, and olive oil.
        
             | batperson wrote:
             | Nuts, seeds and olive oil are all extremely high in
             | calories.
        
               | francisofascii wrote:
               | It is not intuitive, but a diet high in fat will make you
               | less fat than a diet of sugar and carbs. The calories in
               | nuts are not all absorbed.
        
         | iamacyborg wrote:
         | > Does that mean you do good by your brain when you do a hard
         | burn exercise once in a while ?
         | 
         | There's a whole bunch of stuff happening in your body post
         | strenuous exercise so it'd be hard to isolate ketones
         | specifically from that.
        
           | layla5alive wrote:
           | But yes, exercise is very good for the brain.
        
         | kjksf wrote:
         | Your body starts producing ketons when you stop eating.
         | Typically it starts 12 to 24 hrs.
         | 
         | It'll start faster if you don't eat carbs / sugar and instead
         | use protein because the body start producing ketons when it
         | runs out of glycogen stores. Sugar and carbs add glucose to
         | your blood. The less of it you have, the faster the body will
         | start producing ketons.
         | 
         | Exercise also helps because it uses glucose faster. Of course
         | assuming you'll not just start eating carbs / sugar after
         | exercise. That includes all drinks that include sugar.
         | 
         | But really you'll get most benefit of exercise just from a walk
         | after meal.
         | 
         | Why after meal? Because that's when glucose spikes and a walk
         | uses glucose faster.
        
           | ericmcer wrote:
           | Don't you produce ketones any time you can't get enough
           | energy from carbohydrates?
        
           | dcow wrote:
           | You have it backwards. Your liver can convert protein into
           | glucose in a process called gluconeogenesis
           | https://en.wikipedia.org/wiki/Gluconeogenesis
        
       | aszantu wrote:
       | 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/ma...
        
       | gradus_ad wrote:
       | Alzheimer's is related to insulin resistance? The article
       | presents this as consensus opinion but is it really?
        
         | lhl wrote:
         | 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.
         | 
         | 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.
         | 
         | 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.
        
       | zx8080 wrote:
       | By the Betteridge's law of headlines [0], the answer should be
       | "no".
       | 
       | [0] -
       | https://en.m.wikipedia.org/wiki/Betteridge%27s_law_of_headli...
        
         | lhl wrote:
         | 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.
         | 
         | 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.
         | 
         | 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.
         | 
         | 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.
         | 
         | 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.
         | 
         | 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.
        
         | mathgeek wrote:
         | 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
         | 
         | > 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.
        
       | grondilu wrote:
       | 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.
        
         | ralfd wrote:
         | 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.
        
         | Topfi wrote:
         | 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.
        
         | Aurornis wrote:
         | If you've been regularly eating meals multiple times per day,
         | it will take your body much longer to start functioning well
         | during a fast.
         | 
         | That said, I think the mental performance benefits of fasting
         | have been excessively hyped. I wouldn't expect a chess player
         | who has been fasting for multiple days to have better mental
         | clarity. The body goes into energy preservation mode when food
         | becomes scarce for days. That includes reduced energy
         | expenditure for the brain.
        
           | wslh wrote:
           | Just yesterday I mentioned here that I train for (olympic)
           | triathlons [1], and in the context of that and this thread I
           | need to eat much more because I lose significant weight AND,
           | I feel much more nervous if I fast, and I am not a nervous
           | person.
           | 
           | If I am not training I have the capacity to easily fast, not
           | issue at all with fasting, not because I follow any
           | intermittent fasting diet, just it is the way it is. Only
           | sample=1 but I never observed any special enhanced cognition
           | doing that while I observe an enhanced cognition function
           | with very basic things like sleeping well.
           | 
           | One more thing, I also find an improvement in cognition more
           | with running than with swimming or biking. There are many
           | studies about that but I give my personal experience not
           | trying to give any conclusion for everyone. YMMV.
           | 
           | [1] https://news.ycombinator.com/item?id=40533944
        
             | mistrial9 wrote:
             | great going and good on you for your health BUT endurance
             | athletics represents only an important but tiny fraction of
             | the lives of adults. General conversation around health,
             | fitness and tuning is easily derailed by outliers and
             | insufficient context!! office workers with weak backs and
             | wrists end up arguing with 20+ hour a week gym people over
             | some aspect of diet, and then they talk past each other..
             | no problems with the comment but perspective and context
             | are everything when talking health.
             | 
             | Most people in good health can practice some version of
             | fasting with some common sense. Zero people with good
             | health can train for "olympic triathalons" starting next
             | week.. so a peek (peak?) at the life of a triathlete is
             | interesting and perhaps commendable, but really needs
             | calling out as an outlier in a general discussion.
        
               | wslh wrote:
               | I was clear in my comment and in a reference to a
               | previous comment that people are different. I never
               | recommended that you should follow my way of life but I
               | shared some aspects of my healthy life because I
               | considered that I am not doing any exceptional thing,
               | healthy human-wisely.
               | 
               | > Zero people with good health can train for "olympic
               | triathalons" starting next week..
               | 
               | Completely wrong. There are many paths to train for an
               | olympic triathlon that doesn't start running, biking, and
               | swimming and having the correct mindset, endurance, and
               | physical state. It is like saying that a normal kid
               | cannot learn certain things at elementary school. I am
               | not a professional but an amateur.
        
           | Attummm wrote:
           | Contrary to popular belief, fasting actually increases
           | metabolism.
           | 
           | https://www.nature.com/articles/s41598-018-36674-9
        
             | layla5alive wrote:
             | Temporarily, and then it is dramatically reduced.
             | 
             | Jesus people, please stop with the unequivocal statements
             | about equivocal/nuanced/complex things.
        
               | Attummm wrote:
               | Did you read the study? The study is about prolonged
               | fasting, up to 58 hours.
               | 
               | They observed that metabolism Increased during fasting.
               | 
               | > During human fasting, metabolic markers, including
               | butyrates, carnitines, and branched-chain amino acids,
               | are upregulated for energy substitution through
               | gluconeogenesis and use of stored lipids.
        
               | shlant wrote:
               | > Temporarily, and then it is dramatically reduced
               | 
               | No change of diet will "dramatically reduce" metabolism.
               | This is entirely unsubstantiated
        
         | halfcat wrote:
         | I recall someone, maybe Tim Ferriss, saying it typically takes
         | him 6-8 weeks before he can do an equivalent workout on keto,
         | and for high level endurance athletes much longer, like 12-18
         | months of adaptation before they start seeing clear benefits
         | over their previous non-keto baseline.
         | 
         | So there's an adaptation period, which is why it's hard to do
         | studies on this, because people starting keto cold turkey is
         | likely to result in worse performance, mentally and physically,
         | in the short term.
        
           | iamacyborg wrote:
           | High level endurance athletes are unlikely to be going full
           | keto given the need for intra-race nutrition.
        
         | Attummm wrote:
         | The reason why that happened is quite simple. You are currently
         | accustomed to being in a fed state, and it will take a while to
         | adapt to a fasted state.
         | 
         | Additionally, during the initial period, you may experience
         | issues such as sugar withdrawal, which can lower your
         | performance.
         | 
         | Your body's cells will need to switch from predominantly using
         | glucose to using ketones and fatty acids. This process can take
         | weeks to months.
         | 
         | The body is able to use both glucose and ketones; this is
         | called being metabolically flexible. This flexibility can be
         | achieved through intermittent fasting.
         | 
         | So give it time.
        
         | stephc_int13 wrote:
         | I fast once or a twice a year for 3-6 days, and I practice "one
         | meal a day" most of the year.
         | 
         | My first fast was difficult, I did not supplement with
         | electrolytes, slept too much and basically spent the duration
         | watching series and feeling awful.
         | 
         | It is much better to go outside, work and try to follow your
         | regular habits.
         | 
         | Electrolytes supplements are a must, and also some paracetamol
         | during the first few days to reduce the inconvenience of your
         | brain switching from glucose to ketones.
         | 
         | Fasting is easier the more you do it, partly because of
         | calibrated expectations and less fear but I also think that the
         | body simply adapts.
         | 
         | The only difficult day is the first one, for me.
         | 
         | The mental clarity thing is not a boost, you won't gain IQ
         | points or intellectual stamina, more like slightly enhanced
         | mood and more stable/regulated mental performance.
        
           | drivebyhooting wrote:
           | Paracetamol is an anticholinergic isn't it? It's bad for your
           | brain and its usage is associated with dementia.
        
             | toxik wrote:
             | Are you really suggesting paracetamol causes dementia?
        
             | jodleif wrote:
             | Citation needed
        
               | bobmcnamara wrote:
               | "Regular use of paracetamol, but not ibuprofen, was
               | associated with a significantly higher risk of new-onset
               | dementia in the old population, regardless of genetic
               | risks of dementia."
               | 
               | https://pubmed.ncbi.nlm.nih.gov/37633120/
        
               | stephc_int13 wrote:
               | Paracetamol is the default painkiller for most people, I
               | would suspect that regular use means some kind of
               | inflammation.
               | 
               | I would not find surprising that chronic headache could
               | be correlated with risk of dementia.
        
             | jprival wrote:
             | > Paracetamol is an anticholinergic isn't it?
             | 
             | No, per https://agsjournals.onlinelibrary.wiley.com/doi/10.
             | 1111/j.15...
             | 
             | Can't say whether it's good for your brain otherwise.
        
         | fbdab103 wrote:
         | Supposedly chess layers burn excessive calories playing. From
         | one popular culture article[0]                 ...The six-game
         | championship in 2004 left Rustam Kasimdzhanov 17 pounds
         | lighter. And in 2018, one company tracking the heart rate of
         | grandmaster Mikhail Antipov concluded that he had burned 560
         | calories in just two hours. Sitting still. Playing chess. (An
         | average-sized person would need two hours on a treadmill to
         | break 500.)       Last week, ESPN looked more closely into the
         | toll the stationary sport takes on the body. ESPN spoke with
         | Robert Sapolsky, a Stanford University researcher who studies
         | primates. Sapolsky explained that some chess players respond to
         | the game like any elite athlete, burning upwards of 6,000
         | calories a day during tournaments, due to tripled breathing
         | rates, elevated blood pressure, and muscle contractions. That
         | means during tournaments they can lose two pounds each day.
         | 
         | I have done several fasts, and I am quite dubious of the
         | supposed mental improvements. My brain has spent 99%+ of its
         | existence no more than 12 hours away from a steady supply of
         | glucose. I personally feel physically and mentally sluggish.
         | While probably erring much on the side of caution, I avoid
         | driving during a 5+ day fast because I feel my reaction speed
         | is diminished.
         | 
         | Furthermore, the brain is the single most energetically
         | expensive organ in the body. If there were a shortcut metabolic
         | pathway, it seems like it would have been exploited long ago.
         | 
         | [0] https://www.menshealth.com/fitness/a29144951/chess-
         | players-c...
        
           | samatman wrote:
           | Ketosis isn't a shortcut, it's a critical part of the human
           | organism.
           | 
           | The brain has to run on something, and we store very little
           | glycogen. It wasn't uncommon in the ancestral environment for
           | food to be entirely unavailable, or for the only calories to
           | be in the form of meat, which itself has little glycogen.
           | 
           | So there's a secondary pathway to account for those
           | conditions. A hand-waving argument could be made that in
           | circumstances where there are no calories, it is the _most_
           | important time for the brain to function well. Glucose is the
           | cheapest, metabolically, that doesn 't automatically mean
           | that it's the best.
           | 
           | The reaction someone has to a fast, or to a diet which
           | induces ketosis, is fairly personal. I don't think there are
           | broad sweeping conclusions we can draw here.
           | 
           | My n=1 is that after two days of a fast, I feel pretty sharp.
           | Electrolytes are indeed essential to this; in this context
           | salt is far and away the most important, for whatever reason.
           | I would expect the YMMV factor to dominate though.
        
           | QuantumGood wrote:
           | I've played chess in the U.S. Open, NY Open, World Open in
           | the 1980's (finished in the money in 2 out of 3). Really
           | leaves you starving after playing for hours.
        
         | srik wrote:
         | Did you take your electrolytes? If you don't supplement on
         | Magnesium/Potassium/Sodium you'll have to deal with severely
         | unpleasant effects on any water fast that spans beyond 2-3
         | days.
        
           | grondilu wrote:
           | No, I didn't take any electrolyte, as it seems artificial to
           | me.
        
       | radford-neal wrote:
       | 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 wrote:
         | Possible, but we'd need more research on Terminal Lucidity at
         | this point in time: https://alz-
         | journals.onlinelibrary.wiley.com/doi/epdf/10.100...
        
         | agumonkey wrote:
         | I wish i could read about this 'honeymoon' effect, it's so
         | strange.
        
       | throwaway22032 wrote:
       | 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 wrote:
         | 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 wrote:
       | 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 wrote:
         | That's me as well, getting into ketosis has absolutely changed
         | my life for the better.
        
         | QuantumGood wrote:
         | 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)
        
         | AndyNemmity wrote:
         | Same for me, fasting or low carb, whatever keeps you in ketosis
         | makes my memory sharper, my brain function better, and is for
         | me at least, non optional for living a productive life.
        
       | Projectiboga wrote:
       | 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.
        
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