Keto diets and heart disease – 3 Important Facts to Know

March 25, 2022

Keto diets and heart disease...

A paper was recently published in the February 21, 2021 issue of the JACC. Journal of the American College of Cardiology.

Another paper, published in the AHA journal, Circulation, also runs the same theme. Keto diets for heart disease.

Due to popular demand, I have translated both into a layman friendly version:


Questions to ask about keto and heart disease - Heart Failure

Will ketones help or harm the heart? Show me the research!

  1. What about ketone supplements?
  2. Will ketosis help PREVENT heart disease?
  3. Are keto diets good or bad for heart disease?

 

Heart disease appears to have underlying metabolic derangements. Yet, we rarely see metabolic based treatments being used to help prevent or treat heart disease. At first glance, being a usually high fat diet, keto diets and heart disease seem to be a bad idea. Or is it?


Metabolic changes in heart muscle upon birth

During the life of a fetus, the heart does not need very much energy so it relies on simple fuels. Simple fuels like glucose (simple form of sugar). Glucose eventually breaks down to lactic acid. The fetal heart relies on both glucose and lactic acid for its fuel.

Upon being born, the fetus leaves the comfort of the womb and is cut off from the mother's blood supply. The fetus, now called a baby, has to rely on itself to survive. The heart by necessity, changes its fuel preference for higher energy types such as fats. The fats need to be broken down through a process called "oxidation", and this process of fatty acid oxidation has to happen inside the mitochondria.  The mitochondria is the powerhouse ( think of energizer batteries) of the cell. The heart maturation process is accompanied by a sudden increase in energy producing signals, and following this, we see a burst of powerful mitochondrial energy. The number of mitochondria within heart tissue increases, to help the heart gain an amazing ability to pump blood to the different parts of our body. Heart muscles suddenly have to now depend on oxidative phosphorylation OxPhos, which is a process by which higher forms of living life can produce energy

Patients with heart failure develop defects in their metabolism. Their mitochondria become defective, and as a result, the heart cells cannot effectively process fatty acids. So the energy goes down, As a result the heart muscle pumping capacity starts to fail.  Ketones, which are also high energy fuels, might be a form of rescue energy since we do not need mitochondria ( where OxPhos is found) to produce it. The failing heart starts to rely more on ketones. 

 

Ketoacidosis (bad) is not the same as nutritional (good) ketosis

 

When we hear the word “ketones”, the first thing that comes to mind are those nasty, lethal doses of ketones that the human body produces during a state of ‘ketoacidosis”, usually seen in poorly controlled diabetic patients. Ketones can be also be made by following a keto diet, where the levels are not overwhelming, but just right to give the body benefits. Ketone supplements have also recently come into the marketplace.

The research paper discusses the many diverse benefits of ketones. And it is not just about the energy they produce. Will there ever be a role for keto diets and heart disease?

 

Benefits of keto diets for heart disease

 

Among the benefits of ketones are the following:

Regulating blood pressure

Repair of defective heart muscle

Toning down inflammation

Keeping our mitochondria (the powerhouse batteries of our cell) healthy

Help our genes (DNA) repair themselves

Improve blood glucose levels

Normalize body weight

 

Where are ketones made?

Ketones are made in the liver.

Our heart muscles also appear to have the ability to use ketones for their benefit.

Ketones can also be manufactured in other organs, such as the kidneys, nerve cells, and cells of our gut.

In fact, almost every other cell of our body can use ketones.

 

When are ketones made?

When we fast, when we limit our intake of sugar or carbs, or when we don’t have enough food.

Ketones are also produced after extreme exercise.

 

Why are Ketones made?

Ketones, therefore, can also be your friend. Ketones can act as a standby form of supplemental energy in times of starvation. Not only are ketones good for energy, but they are also helpful in preventing heart damage from inflammation. When blood vessels become inflamed, they lose their smooth character and become prone to clot formation, and eventually, heart attacks or strokes might occur. Ketones help maintain the linings of our blood vessels and protect them from losing their smoothness.

 

Keto Diets and Heart Disease - Preventing Heart Attacks and Strokes, heart failure

 

Keto diets and ketones Improved Blood Flow

 

Heart attacks and strokes also happen when the blood vessel openings constrict. The diameter of the coronary arteries ( the tiny blood vessels that carry oxygenated blood to supply the muscles of the heart) become too narrow, limiting blood flow to the muscle of the heart. Ketones can help dilate ( make the diameter bigger) blood vessels. Animals in the lab were fed ketone supplements and the scientists found that the ketones made the vessels larger and more blood flowed through the brain, kidneys and heart of these animals, improving blood flow by as much as 75%.

 

Keto diets help heart disease by rejuvenating heart tissue

 

Ketones can also improve the delicate oxygen balance within the cells and help prolong the lifespan of heart tissue. Even in animals that already suffered heart failure, they still saw improvement when ketones were fed to these animals after the onset of heart failure. Ketones deactivated signals that caused heart muscle cell death. In effect, ketones prevented the aging of the heart muscle.

 

Ketosis helps curb appetite

 

Ketones also helped animals lose weight by decreasing the levels of the appetite hormones in the body, helping the animals feel full faster.

 

Keto diets improve good cholesterol 

 

As far as cholesterol levels, keto diets when given LONG TERM also increased the “Good (HDL high density lipoprotein) cholesterol “ levels and decreased total and bad cholesterol. This benefit was anticancer because ketones also limited the levels of fatty acid synthase, an enzyme that synthesized or "made" fats and promoted cancer. A 2007 study of the keto diet and heart disease in 83 obese men and women with high body mass indexes ( greater than 35 ), was performed. The subjects all had high blood glucose and cholesterol levels. They followed the ketogenic diet for 24 weeks and they found that there was a significant improvement in their levels of good HDL, and Bad LDL cholesterol. LDL (bad cholesterol) blood levels went down, HDL (good cholestserol) levels went up, serum triglycerides went down. The patients all lost weight and decreased their body mass index significantly.

As a whole, keto diets and heart disease may be compatible. Keto diets seem to benefit animals and possibly, humans. It does so not just by providing energy, but through a host of other benefits.

SGLT type 2 inhibitors

Sodium-glucose cotransporter 2 inhibitors are new an currently on the market as anti diabetic drugs. They improve the body's ability to recognize and use insulin, resulting in better glucose control , blood pressure, and healthy weight loss. Certain cells of the body, such as the kidneys and intestines, have proteins which control the passage of sodium and glucose. These drugs can help diabetics from spilling glucose too much in their urine.

 

 

Main Points of the JACC (Journal of the American College of Cardiology ) and AHA American heart Association " Circulation " Papers:

 

1. Keto diets and heart disease may be a beneficial therapy, and can serve as a rescue form of energy for the failing heart. Ketones might help protect the heart of animals and humans.

 

2. Keto Diets and heart disease plus supplements: Adding ketone supplements may be beneficial.

 

3.  Future studies on PREVENTION are still needed : We still do not know if a keto diet and heart disease is a good preventive strategy.

 

4. The new antidiabetic drugs , sodium-glucose cotransporter 2 inhibitors , have a side effect of producing KETOSIS. So it is interesting to see whether this side effect may be beneficial in treating heart disease of diabetics.

 

Should we be buying and consuming ketone supplements on a regular basis? These are preliminary studies, and are not yet accepted by the medical community as fact. But perhaps it might only be a matter of time?

Exploring the Link Between Cancer and Weight Loss:

March 14, 2024
Breaking Down the Fear  Ketogenic diets often result in weight loss. Cancer patients frequently lose weight. Does this mean that keto diets are harmful to use in cancer patients? Cancer and weight loss are two topics that often come hand in hand, yet the relationship between them can be complex and sometimes frightening. Weight loss, particularly unexplained or rapid, can evoke fear in many individuals, often signaling underlying severe health concerns. However, when it comes to cancer, weight loss can sometimes be one of the earliest signs of the disease. In today's blog, we delve into the connection between cancer and weight loss, unraveling why the latter often instills fear and how understanding this relationship can lead to better health outcomes. Understanding Cancer and Weight Loss: Cancer involves uncontrolled cell growth and abnormal spread of cells throughout the body. These invading cells affect various organs and systems and disrupt their normal function. Weight loss can be very subtle or profound depending on the type of organ invaded. As cancer takes root and establishes itself, it also spews out cytokines (unique inflammatory proteins) that also serve as signal messengers, signaling muscles to lose volume, resulting in a weight loss phenomenon known as cachexia. Cachexia is a complex syndrome. Inflammation is often at the root of this problem, of profound muscle wasting, generalized fatigue, and poor appetite, Why Are We Afraid of Weight Loss? Weight loss, in general, is often perceived negatively in society. There's a prevailing notion that thinness equates to health, beauty, and success, while weight loss may imply illness or a lack of control. However, when weight loss occurs without intentional dieting or exercise, it can be a red flag for underlying health issues, including cancer. In cancer, especially, the presence of weight loss is disturbing because we traditionally associate it with illness. Association with Illness: Unexplained weight loss is commonly associated with illness, particularly severe conditions like cancer. The fear of the unknown and the potential implications of such weight loss can be daunting for individuals. To be of "normal" weight is equated with health. Loss of Control: Weight loss, especially rapid or involuntary, can make individuals feel like they've lost control over their bodies. This loss of power can be unsettling and exacerbate feelings of anxiety or fear. Uncertainty: Weight loss without a clear cause can be perplexing and raise questions about what might happen within the body. The uncertainty surrounding the underlying cause can contribute to fear and anxiety. During chemotherapy, however, weight loss is inevitable because we are in a catabolic state. The active cancer is making us lose weight. The key is to control or snuff out the underlying cancer. Once you weaken the tumor, less cytokine release and less inflammation will follow. As this occurs, the "source" of the cytokine release will die, and weight gain should naturally recover. Therefore, loading up on carbohydrates to make us appear to be of "normal weight" is incorrect. Loading up on sugary treats will only strengthen the cancer and will only be counterproductive! Conclusion: The fear of weight loss, particularly in the context of cancer, is understandable, given the potential implications for health and well-being. However, by understanding the complex relationship between cancer and weight loss and challenging societal stigmas, we can accept some form of healthy weight loss during chemotherapy. We can learn to recognize unhealthy weight loss (loss of muscle mass) and differentiate it from healthy weight loss during a ketogenic diet (most of which is weight loss from fat and excess water). As long as one feels energetic, with normal blood parameters and no indication of significant liver or kidney failure, anemia, or marrow failure, then some healthy weight loss during chemotherapy or implementation of a ketogenic diet CAN be acceptable.

GINGER ALE DURING CHEMOTHERAPY

March 4, 2024
Are you still drinking "ginger ale" during your chemotherapy sessions? You know, those gleaming, chilled cans of sparkly soda that your cheerful chemotherapy nurse hands out along with your anti nausea pills?  The scent and the taste of ginger help nausea stay away. But did you know that your "ginger ale" contains no ginger? Worse, the HFCS high fructose corn syrup, a highly processed sugar, can do you more harm than good. And making your cancer cells really happy. Next time you go for your chemo session, ask for water instead. Or better yet, bring your own ginger-infused drink from home. Here is some background about ginger. For centuries, ginger has been used as a remedy for nausea and digestive issues, and some scientific evidence supports its effectiveness. Here are some examples. Morning Sickness: Pregnant women often experience morning sickness, and ginger has been traditionally used to alleviate these symptoms. Several studies have shown that ginger can reduce nausea and vomiting during pregnancy. For example, a meta-analysis published in the Journal of Obstetrics and Gynaecology Research in 2014 concluded that ginger supplementation significantly reduced the severity of nausea and vomiting in pregnant women without any significant side effects. Motion Sickness: Ginger is effective in reducing motion sickness. A study published in Aviation, Space, and Environmental Medicine 1986 found that ginger was more effective than a placebo in reducing symptoms of motion sickness. Subsequent studies have supported these findings, suggesting ginger can alleviate symptoms like nausea, vomiting, and cold sweating associated with motion sickness. Chemotherapy-Induced Nausea: Cancer patients undergoing chemotherapy experience nausea and vomiting. The Journal of Alternative and Complementary Medicine 2009 published a review that analyzed several randomized controlled trials and found that ginger supplementation could reduce the severity of chemotherapy-induced nausea. Postoperative Nausea: Nausea and vomiting are common after surgery. A meta-analysis published in the journal Integrative Cancer Therapies in 2012 found that ginger effectively reduced postoperative nausea and vomiting compared to a placebo. However, we need more research to fully understand its mechanisms and best dosage. Everyone responds differently, but ginger, in its natural form, is usually safe to take during chemotherapy. Just make sure its the real thing! Photo credit Dan Sorum @ unsplash

Welcome to all our new members

January 30, 2023
Welcome to all our new members

Getting Started On A Keto Diet

May 17, 2022
Getting started on the keto diet usually sounds like someone is trying to lose weight? When you add cancer to that recipe, it becomes a whole new ball game. Do any of these thoughts sound familiar? “ I want to fight my cancer , and I heard that this diet can help me heal “ “ I’m confused because the keto diet will make me lose weight” “I’m afraid to lose more weight.” “I can’t afford to lose weight! “ “When is weight loss just right, and when is it too much? “ Is there real hope for me? Over the past two decades, I’ve seen my share of cancer patients. Yup, the whole package - diagnosis, anxiety, chemo, radiation, hair loss, weight loss, and, failures. But, I also saw many patients who achieve clean CT scans, remission, happy news, hair growth, and of course, the coveted weight gain. I have my own collection of patients with stage four cancers, a few have actually reached their ten to twelve year anniversary with me. Most of them have made it past five years and some are in complete remission. Yes, stage four to stage zero! How did they do it? You may have come to this website, searching for answers. I wish that I could tell you all that I know, in one sentence, but I can’t. It usually takes me several office visits to educate my patients. For now, you can stick around, and try to absorb the knowledge from current posts. Take time to read through my past blogs. Signup for a keto conference. There is one coming up very soon. The MHS 2022 in Santa Barbara California. May 5 to 8. Read books, and more books. You might be surprised. Not all books are the same. Some are full of dense material, while some are mostly fluff. But eventually, you will find the right book for you. Join me in one of my subgroups. But you need to fit the profile and be past the beginners stage when you join. Or you might get bored! I do show up there from time to time, to break the ice. And by the way, when you are stuck and can’t find the answers you are looking for...you need to make your voice heard and post your questions. What if my cancer doctor doesn’t approve? If your cancer doctor doesn’t know much about the keto lifestyle, or about metabolic approaches to cancer, don’t lose hope. Try to educate them, Share your knowledge. Even if they are at first resistant, with time, some will marvel at your progress and will notice that you are doing better than their average patients. Finally... the number one question that shows up on my blog.... What diet is best for me? I’m so CONFUSED! “ Dr. XXX on YouTube said that a keto diet and weight loss is good for cancer, but another doctor YYY said the opposite, that I should eat, healthy carbs, more plants, fruit , avoid fat and protein, try to gain weight. “ Dr. WWW advocates a vegan diet, but Dr ZZZ said do a carnivore diet.... , help!!!! Let me know your thoughts in the comments below!

New drug for relapsed Glioblastoma, a deadly form of brain cancer

March 30, 2022
There is exciting news on the horizon for glioblastoma, which is a deadly form of brain cancer. Have you heard of activated T cell therapy? It is similar to the car-T cell therapies that you often hear about for blood cancers. Well, this form of therapy is now available for patients with brain cancers. The catch is, you must enroll in a clinical trial. It is not yet available to the public. To qualify, one must have glioblastoma, a form of brain cancer , and cancer must have relapsed after the first diagnosis. Patients who are interested are now able to ask for information about enrolment at the Cedars Sinai Medical Centre in Los Angeles. This trial will be classified under a Phase one type of clinical trial. The drug company, Kairos pharma is the sponsor. This exciting new therapy, otherwise known as KROS 201, is a form of activated T cell therapy. The patient’s white blood cells are first harvested. Blood is removed by a simple intravenous blood draw, and then sent off to the lab to be processed in a cell culture. In the lab, the white blood cells are primed by exposing them to small protein substances called cytokines. This process will in turn activate the white blood cells, specifically the killer T cells. Once activated, these cells can now fight cancer by inactivating cancer stem cells. The T cells are returned to the patient’s body by intravenous infusion. The link for enrolment is not yet available but do keep checking on www.clinicaltrials.gov

Mistletoe plus chemotherapy in non small cell lung cancer

March 25, 2022
Iscador, a type of mistletoe preparation was tested by a medical team in Israel alongside conventional chemotherapy in the treatment of patients with advanced non small cell lung cancer. Although no improvement in survival or quality of life was noted,non hematological side effects from the chemotherapy and hospitalizations were less in the group which received the mistle toe preparation. Possible yet unproven mechanisms of action include improvement of immune function via increasing the number of NK natural killer cells as well as improve the function of Tumor Necrosis Factor Alpha. Fever which is also a noted side effect of this preparation has been described prior to spontaneous regression of certain cancers such as melanoma implying a possible role of immunotherapy in the fight against cancer. No randomized trials on cancer patients have yet been published. 

Brain cancer – Challenges with the ketogenic diet

March 25, 2022
We made little progress in the way of survival in the treatment of malignant brain tumors, specifically the deadly glioblastoma multiform. Despite aggressive surgery followed by radiation therapy and precautionary chemotherapy, they relapse early and survival is measured in months. Patients rarely survive beyond a year. Alternative therapies abound with few successes. Some patients attempt to enroll in clinical trials in search of new drugs that might make a difference in their survival.  There is a biologic treatment available. It is the monoclonal antibody called Bevacizumab. It supposedly controls the growth of blood vessels that supply nutrition to the brain tumor. Shrinking the blood supply supposedly starves the tumor. Very exciting, but nonetheless isn't a cure. Long term survivors still remain a rarity. There is mounting interest in metabolic basis of cancer development. In this respect, I do feel that ketogenic diets have potential benefit in brain cancer patients. The role of sugar and carbohydrates in the progression of brain tumors is interesting. Since most patients also are on steroids to improve brain swelling. It is also bad for them because this also increases their blood glucose. I wonder, if we are indeed adding fuel to the fire. A few case reports of brain tumor patients who were offered the ketogenic diet showed that some tumors stopped growing while others improved their survival. Notably, upon discontinuation of the diet, the tumor was noted to again progress, only to regain control upon reinitiation. Currently there are 4 clinical trials ongoing in the United States involving the ketogenic diet in the treatment of various forms of cancer. Another is ongoing in Germany. More clinical trial participation is desperately needed if we are going to move ahead and forge any progress with this deadly cancer. =

Lonsurf, newly approved colon cancer drug

March 25, 2022
Three weeks ago I got word that another new chemotherapy drug has been approved for the treatment of colorectal cancer. Ideal candidates for this drug are patients who failed previous chemotherapy involving one of the following drugs: 5-Fluorouracil, Oxaliplatin, Irinotecan, Cetuximab (also known as Erbitux) and Avastin ( also known as Bevacizumab).This new drug has two active components, trifluridine and tipiracil. Trifluridine is a new nucleoside analog. In other words, a nucleoside is a nitrogen containing biologic compound linked to a sugar, which when phosphorylated, turns into a nucleotide, which is a vital part of the DNA backbone. Trifluridine therefore is a nucleoside analog, meaning it isn't but acts like a nucleoside. It incorporates itself into the DNA structure and interferes with cell growth and proliferation. Tipiracil inhibits the enzyme thymidine phosphorylase, which catalyzes the degradation of Trifluridine, thus allowing it to last longer. Thymidine phosphorylase by itself has pro-angiogenic properties, meaning it promotes blood vessel formation and encourages better blood supply of tumors, so Tipiracil directly stops this advantage. Furthermore, Tipiracil by stopping thymidine phosphorylase, prevents the formation of thymine and 2-deoxy-alpha-D-ribose 1-phosphate. 2DARP is a strong reducing sugar product of thymidine catabolism and causes increased oxidative stress within tumors, promotes release of more tumor blood vessel promoting factors ( angiogenic growth factors) such as interleukin-8, vascular endothelial growth factors VEGF, and matrix metalloproteinase-1 an enzyme which breaks down collagen and extracelular matrix, which is key in promoting tumor metastases. This three mode action of tipiracil ( inhibits thymine production, thymidine phosphorylase VEGF activity, stops ROS and MMP-1 , VEGF and cytokine production)- makes it more attractive since it can potentiate the action of the common colorectal chemotherapy drug 5- fluorouracil whose main action is to inhibit formation of thymine. The RECOURSE trial, a —international, randomized, double-blind, placebo-controlled study conducted in patients with previously treated metastatic colorectal cancer apparently resulted in statistically significant improvement in overall survival and progression free survival . The drug is given orally, twice a day, for two straight weeks, minus weekends, followed by a two week break. Side effects are listed as anemia, neutropenia, asthenia/fatigue, nausea, —thrombocytopenia, decreased appetite, diarrhea,vomiting, abdominal pain,—pyrexia. Since it is barely a month since FDA approval ( Sept. 24, 2015) it still has not hit our pharmacy shelves. I am however eager to try this. Will update you again in a few months. 

Getting into ketosis

March 25, 2022
How long does it take to get into a state of clinical ketosis? By ketosis, I mean the levels of beta-hydroxybutyric acid reaching to above normal levels yet not high enough to bring you into a medical emergency such as ketoacidosis. As little as a day is all it takes. You an achieve this in different ways. The most common and sure fire method is to simply stop eating. If you fast and only limit your intake to water or sugarless herbal , which technically has ZERO calories, you will achieve a state of ketosis in no time. Another way is to try fasting for 15 hours a day, or roughly, just eat one full meal daily. this should bring you into ketosis too, though not all 24 hours are involved. If you try a ketogenic diet, that means, you will be limiting your carbohydrate intake to approximately 20% of your total daily intake, and take the rest in the form of fats ( 70-75%) and proteins (5 to 10%).  Monitoring your progress will be helpful. A simple glucometer will suffice. Individual serum Ketone sticks, readily available from Amazon.com or special order through your pharmacy can be used to check your ketone levels throughout the week.

Update on clinical trials of the ketogenic diet in cancer

March 25, 2022
Several clinical trials are ongoing throughout the United States at the moment.  The University of Iowa Department of Radiation Oncology is running a couple of Phase I trials on the use of the ketogenic diet plus radiation and chemotherapy in head and neck cancers, and they also have another which studies the ketogenic diet plus chemoradiation in non-small cell lung cancers and pancreatic cancer. Michigan State University has one which recruited brain cancers, also known as glioblastomas, a very deadly type of brain cancer. Duke University recently began a randomized trial studying the ketogenic diet plus androgen deprivation therapy in prostate cancer , using the ketogenic diet versus a control standard diet. Unfortunately per recent info posted on the clinicaltrials.gov website, the trial was terminated as of December 2015, due to lack of funding, and due to the principal investigator leaving . Closer to home, the Veterans Affairs Medical Center in Pittsburgh has their own trial which recently concluded in 2015. This trial recruited patients with advanced solid tumors across broad tumor types and patients dieted up to 16 weeks or until tolerated. The results have not yet been publicly released as it is currently under manuscript review.
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