Monday, May 20, 2013

A bit more on ketones and diabetic nephropathy

Just in haste, sorry for the missed typos! Liz sent me the full pdf of this paper:

Treatment of Diabetes and Diabetic Complications With a Ketogenic Diet

It's primarily a review, both of the work by Phinney and Westman and of the lab animal studies by the group producing the review.

Deranged glucose metabolism appears to be what causes the problems in diabetes, type 1 or 2. More on this when I get back to the chronic hyperglycaemia post. It's not forgotten.

Ketones, the metabolism of which remains normal, appear to be key in replacing abnormal glucose metabolism, more so than simply achieving normoglycaemia without ketosis.

Protein limits ketosis and the use of low carbohydrate diets with unrestricted protein intake may explain some of the failures to maintain the benefits of carbohydrate restriction. I have to say, Jimmy Moore comes to mind here. I like his success with ketosis.

It looks to be as easy to substantially reverse diabetic nephropathy in mice as it is to limit nephropathy progression in humans, but ketones are essential.

Mouse, human, diabetic nephropathy, reversal with ketosis. Shrug.

The take home message is very simple. If you have severe metabolic problems the answer is not simply carbohydrate restriction. It also involves protein limitation, to adequate but not gluconeogenic levels. Low carb, adequate protein, high fat. With the emphasis on the fat.

Taterism is fine for any Tato Head without metabolic problems. As everyone will eventually develop metabolic problems, so Taterism will eventually injure everyone. Some folks probably have dialysis blood on their hands already.

The high fat brigade are correct.



Bill said...

I read that ms and like how they firmly differentiate ketosis from very low carb dieting. Low insulin is helpful, but I think there's something added by the presence ketones.

Also, I'm assuming it was all the exercise that allowed the participants in Phinney's 1983 study to maintain ketosis on 1.7 g/kg protein (>20% of calories!).

Anonymous said...

Jimmy Moore has just completed his year in ketosis. Lots of data. For somebody so metabolically damaged in the past he seems to be making real progress.

Thinking Aloud said...

So Rosedale has been right all along ?

karl said...

I have wondered if the typical high carbohydrate diets cause kidney stones by blocking the normal functions of the kidney - giving that puffy carb face look via fluid retention.

There is the bit that drives some people crazy in that the need for salt goes up - not a good idea to be on a low salt AND low carb diet.

But I'm thinking that there is a beginning of a paradigm shift after seeing this:

That is pretty close to blasphemy for the mainstream medical folks..

Jim said...

My experiments with long-term ketosis suggest that a gradual rise of fasting blood sugar may be a chromium deficiency.

Stan Bleszynski said...

Some people will never give up. If wheat is supposed to be bad then whole grain, if that fails too then then the less bad (potato) becames the new heath fetish, then rice then whatever.

The ability to reason logically is also to a large extent the function of a (healthy) metabolism, so there is some self-reinforcing mechanism why do some people get stuck.

mc_ said...

so, what are "adequate protein levels?"

1gm/kg... less?

"[The answer] also involves protein limitation, to adequate but not gluconeogenic levels. Low carb, adequate protein, high fat. "

Peter said...

Bill, yes and yes.

Nostril, yes.

Karl, no. Acute renal failure from a blocked bladder in cats with CIAB poisoning is bread and butter critical care in practice. No puffy pussies.

GD Laurence appears to go back a long way (if all the pubmed citations are the same person). Cut his teeth on various forms of SOD and on molybdenum enzymes. Pretty evolutionary interesting. A polymath.

Jim, interesting.

Stan, yes...

mc_ At least 40g/d. I run more like 60 most days. Lower would be better but I aim for adequate in life, not perfection. A "bad" day would be 80g. However I am weight stable and in ketosis so I'm probably low enough.


ThisisBetty said...

I've always found protein to be unconsciously quite well regulated compared to fat and and carbs. I don't understand how anyone could overeat an extremely large amount of it.

ThisisBetty said...

* I should say I don't understand how anyone could eat an extremely large amount of it continuously.

John said...

What is it about high protein that decreases benefits? I would guess even 2g/kg would lead high blood ketones but perhaps also higher glucose? I've seen "ketogenic" mice get up to 16% kcal as protein.

MCTs/coconut I guess would complicate things more. I remember seeing that MCT led to something like 4-5x ketones in rats compared to other fats, but they were no better protected from seizures than flax or butter--different but related...

SS Biker said...

I think the the "just how much protein?" question is an interesting one. I'm sold on the idea of not consuming excess however my own experience is that on a far as practicable "zero" carb diet I experience hypo episodes if I drop below 120g protein/day (I weigh 69kg and am pretty lean, plus I bike/run/walk regularly).

I currently consume a VLC diet and IF (in the 1/24hrs sense) and consume 100-110g protein/day. Generally I'm OK unless I do something silly like consume alcohol which screws me up quite quickly to the extent that I pre-emptively consume carbs if I think a night on the sauce is on the cards.

Jeffrey of Troy said...


1/2 g per day for each pound you weigh (at healthy bf %)- approx. 1 g/kg - for avg person.

Standard bell curve distribution for carb tolerance, people on very low tolerance end convert protein to glucose more easily (body then burns glucose instead of stored bf).

Jane said...

'Taterism is fine for any Tato Head without metabolic problems. As everyone will eventually develop metabolic problems, so Taterism will eventually injure everyone.'

Carbs give you metabolic problems? Why don't I have any? I practically live on carbs and saturated fat. No I don't get fat, I stopped getting fat when I stopped eating refined carbs. My metabolism seems to work pretty well, but I don't really know because I haven't seen a doctor for 25 years. Perhaps I'm actually dying?

Interesting programme on British TV last night. Some very fat people found out they had 'obesity genes' but when they stopped eating refined carbs their obesity genes didn't stand a chance. They lost ~20 pounds each in 4 months. One had diabetes and high blood pressure and high cholesterol and doesn't now.

Bill said...

@ John,
There are a lot of factors at play. As mentioned above, in Phinney's 1983 study they were getting >20% of calories from protein but were still ketotic, possibly due to high levels of exercise.

Peter said...

Jane, I would suggest Power Sex and Suicide, by Nick Lane. Mitochondria eventually determine when a given cell dies, and so when we die. Ageing is completely normal and our mitochondria determine this (unless it's our lysosomes, but they may reflect mitochondrial function). It appears to be normal for humans to develop glucose intolerance as we age. You may have the secret to avoiding this. My approach is to side step it, starting 10 years ago.

We are all dying! So far the process has been pretty good for me too, despite a very different approach.


STG said...


When I have a hunger attack, should I reach for the butter or coconut oil instead of the cheese?

Jane said...

Peter, Nick Lane doesn't know about manganese. If he thinks loss of glucose tolerance with age is normal, it's because he doesn't realise Mn is supposed to prevent it and most people don't get enough.

It may be that he was misled about Mn by Mark Purdey like so many people. Even the eminent copper researcher John Sorenson was misled by Purdey. I know you were too.

John said...


If one is able to keep good glucose tolerance, what is the argument that glucose oxidation is superior anyway?

Jane said...

Hi John
I dunno. Do people say that? I suppose they might mean that glucose is part of the antioxidant system (glucose --> pentose phosphate pathway --> NADPH which keeps glutathione reduced).

But actually fats or should I say ketones can also be antioxidant. Beta-hydroxybutyrate is a very efficient scavenger of hydroxyl radicals.

This is very interesting because hydroxyl radicals are the ones produced by excess iron. So either you eat a high manganese diet to protect your mitochondria from excess iron, or a ketogenic diet.