Lifestyle Matters

In this episode of Lifestyle Matters.

Can we generate a super fuel in our bodies by eating differently? This week we look at the popular keto diet from a medical perspective.

This diet was originally founded in the 1920s by Russel Wilder to treat epilepsy and it worked! Once anti-epileptic medications were discovered, this diet became less popular until recent times when it became evident that it also helps with weight loss. Truth be told, this diet is still used for some refractory epileptic patients under medical guidance.

A keto diet is essentially a diet we consume to put our body in a state of ketosis. But first, what is ketosis? To understand that we must understand what ketones are.

Ketones are products of fatty acid breakdown e.g., acetoacetate, beta hydroxybutyrate and acetone. These molecules are continuously produced in our bodies in small amounts as part of normal physiological processes.

Ketosis or ketogenesis is a process when our body uses these ketone bodies to provide energy for our cells.

When we eat a well-balanced diet, our body uses carbohydrates as the main source of fuel. So, reducing our consumption of carbohydrates and increasing protein (amino acids) and fat intake allows our body to break down these macronutrients to provide us with energy via processes called gluconeogenesis and ketogenesis respectively.

Ketosis can also happen as part of disease processes e. g . starvation, alcoholism, poorly controlled diabetes and even extreme prolonged exercising. This is obviously dangerous to our health and requires treatment.

Most cells in our body can utilise ketones as a source of energy except our red blood cells and liver. The brain is really good at doing this!

This is how a Keto Diet looks like:

Ketones are called a super fuel because:
100 gm of glucose we can generate 8700 gm ATP
100gm of beta hydroxybutyrate generates 10 500 gm ATP
100gm of acetoacetate generates 9400gm ATP

Apart from being a super fuel, it has various other benefits such as:

• Treating difficult to control epilepsy

• Reduce the risk of neurodegenerative conditions e.g. Alzheimer’s Disease

• Reduces insulin production

• Increases leptin levels (hormone that tells us we are full hence suppressing our appetite) -> weight loss

• Reduces LDL, TGL

• Increases HDL

However, there are some limitations to the Keto diet that suggest that it may not be suitable for everyone.

Those who have certain enzyme deficiencies e. g. pyruvate kinase deficiency, liver failure, and pancreatitis, should not be on this diet due to the high levels of fat and protein intake. There has been also some research to suggest this diet may result in osteoporosis, kidney stones, fatty liver and gout. Further, most studies on the Keto diet have only been conducted over 6 months which means the long-term implications of the diet are still being investigated.

The main point to note is that this is undoubtedly a great diet to follow if it suits one’s lifestyle provided there are no medical contra-indications to it. However, once again it is a diet that we would suggest one to adhere to for a short period (6-12 months) as we have sufficient evidence to support this recommendation, for now at least. Post that period, transitioning to a normal well-balanced diet would be advisable. Ideally, following a whole food predominantly plant-based diet would produce the best outcome.

In this episode of Lifestyle Matters.

Benjamin Franklin said that “The best of all medicines are resting and fasting” and we know today that his words have been supported by scientific evidence. Intermittent fasting has been found to reverse early Type 2 diabetes.

The concept of fasting is not new to many especially if we look at the various cultures and religions around the world e.g., Muslims fast during Ramadan, or the various fasts practiced by Hindus and Buddhists. Even Greek philosophers such as Hippocrates and Aristotle have prescribed fasting for various ailments. This week, we look at how and why intermittent fasting works.

We must first understand what happens during the fed and fasted state. When we eat – (predominantly) carbohydrates get broken down into simple sugar molecules. This triggers an insulin response which promotes the uptake of sugar into our cells. Extra sugar (glucose) gets stored in our muscle and fat as glycogen. Leptin levels (which is our satiety hormone) also increases.

When we fast, glucose and insulin levels reduce. This causes our body to search for an alternate source of energy hence processes such as lipolysis and gluconeogenesis begins.
Later on, ketogenesis occurs whereby ketones are produced from the breakdown of fatty acids which is then used a source of energy i.e. ‘the super fuel’

When we fast for prolonged periods of time, our body enters a state of stress adaption whereby it begins certain processes such as cleaning and repairing e.g. DNA repair, protein quality control, increasing expression of anti-oxidant defences etc. As the body enters a fed state, tissue growth and plasticity then begin. However, when we eat ‘normally’ we do not allow our body to switch from a fed to fasting state. Several evidence have pointed the benefits of allowing our body to go through this metabolic switch and these range from:

• Neurodegenerative health: Potentially reducing the risk of dementia as there is an increase in brain derived neurotrophic factor, increased GABA sensitivity etc.
• Improved heart disease profile: Increases HDL (good cholesterol) reduces LDL (bad cholesterol), reduces resting heart rate and blood pressure.
• Reduces risk of diabetes: Reduced insulin resistance as adiponectin levels are increased and leptin levels reduced
• Reduces cancer growth: Mainly documented in glioblastoma multiforme which is an aggressive type of brain tumor, but other cancers are being studied too e.g. breast, ovarian, prostate.

While most studies have been carried out on animals, there are several others underway involving humans. We have observed over time that the profound benefit of this diet is the metabolic switch that occurs and the benefits we can gain from it whether or not there has been weight loss!

It is important to note that this diet is reasonably sustainable and allows us to eat foods we enjoy in moderation. However, no diet is superior if it is not one that suits our lifestyle, and we must always remember that exercise augments the benefits of any diet we follow.

In this episode of Lifestyle Matters.

This week Dr Ferghal and I discuss stress. Some regard it as the modern-day trash which needs to be regularly disposed of to prevent over piling.

13% of Australians above the age of 18 years old describe moderate to high stress levels and there is a lower socioeconomic predominance to this.

But first, what is stress? There are many ways to define it but put simply, it really comes about when the demands placed on a person is so overwhelming that she/he is thrown into a state of worry. The right amount of stress can sometimes lead a person to being more productive. However, when the factors that cause stress are ongoing, this leads to distress whereby one can experience feelings of headaches, nausea and insomnia etc.

The Yerkes-Dodson Law (the inverted U model of arousal) describes this quite well. This is a law that describes the relationship between stress and work performance as pictured below:

Stress at unhealthy levels can have a negative impact on our health such as:

• Mental health: Depression, Anxiety, Forgetfulness
• Cardiovascular: Cardiomyopathy, Hypertension, Tachycardia, low HDL (good cholesterol)
• Respiratory: Hyperventilation, exacerbating pre-existing lung conditions e.g. asthma, chronic obstructive pulmonary disease
• Gastrointestinal: Irritable Bowel Syndrome, stress ulcer
• Endocrine: Poor diabetes control, Metabolic syndrome
• Genitourinary: Low sperm count, reduced libido
• Immune function: Reduces immunity predisposing to infections
• Pain: Reduces pain threshold
• Musculoskeletal: Increases risk of injuries

When one undergoes stress, they can also develop some maladaptive patterns to cope. These include an erratic eating pattern. e.g over or undereating and substance abuse. 38% of people engage in emotional over- eating, while another 38% are ‘starvers’. The remainder have unaffected eating pattern. Women tend to turn to food whilst men on the other hand use tobacco or alcohol to cope with stress. We know the effects of these substances on our health which have been discussed in the previous episodes.

A British study in 2007 demonstrated that people who responded to stress with a higher cortisol level tend to be emotional eaters. The food group of choice is usually a highly caloric food such as simple sugars or carbohydrates as they increase good feeling hormones (endorphins)

As outlined, stress has many effects on our health, and we ought to learn how to manage it better so that we can find a way to use it as a positive influence in our lives. We will discuss this further in the next episode.