Fasting and diurnal blood ketonemia and glycemia responses to a six-week, energy-controlled ketogenic diet, supplemented with racemic R/S-BHB salts

Buga, Alex; Kackley, Madison L.; Crabtree, Christopher D.; Bedell, Teryn N.; Robinson, Bradley T; Stoner, Justen T; Decker, Drew D; Hyde, Parker N.; LaFountain, Rich A.; Brownlow, Milene; O’Connor, Annalouise; Krishnan, Dilip; McElroy, Craig A.; Kraemer, William J.; Volek, Jeff S.

doi:10.1016/j.clnesp.2023.01.030

Cited by 4 publications

(2 citation statements)

References 28 publications

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“…All meals and groceries were provided ad libitum and customized to individual participant preference. The primary benchmark of Phase I was to achieve blood ketones ≥0.5 mM βHB, as determined by fasting capillary finger sticks performed each morning and alike to prior methods [ 36 ]. In addition to the initial education session, the study team was in daily communication with participants via phone, emails, and/or text messages, to monitor adherence and support participants in maintaining nutritional ketosis.…”

Section: Methodsmentioning

confidence: 99%

Feasibility and metabolic outcomes of a well-formulated ketogenic diet as an adjuvant therapeutic intervention for women with stage IV metastatic breast cancer: The Keto-CARE trial

Buga,

Harper,

Sapper

et al. 2024

PLoS ONE

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Purpose Ketogenic diets may positively influence cancer through pleiotropic mechanisms, but only a few small and short-term studies have addressed feasibility and efficacy in cancer patients. The primary goals of this study were to evaluate the feasibility and the sustained metabolic effects of a personalized well-formulated ketogenic diet (WFKD) designed to achieve consistent blood beta-hydroxybutyrate (βHB) >0.5 mM in women diagnosed with stage IV metastatic breast cancer (MBC) undergoing chemotherapy. Methods Women (n = 20) were enrolled in a six month, two-phase, single-arm WFKD intervention (NCT03535701). Phase I was a highly-supervised, ad libitum, personalized WFKD, where women were provided with ketogenic-appropriate food daily for three months. Phase II transitioned women to a self-administered WFKD with ongoing coaching for an additional three months. Fasting capillary βHB and glucose were collected daily; weight, body composition, plasma insulin, and insulin resistance were collected at baseline, three and six months. Results Capillary βHB indicated women achieved nutritional ketosis (Phase I mean: 0.8 mM (n = 15); Phase II mean: 0.7 mM (n = 9)). Body weight decreased 10% after three months, primarily from body fat. Fasting plasma glucose, plasma insulin, and insulin resistance also decreased significantly after three months (p < 0.01), an effect that persisted at six months. Conclusions Women diagnosed with MBC undergoing chemotherapy can safely achieve and maintain nutritional ketosis, while improving body composition and insulin resistance, out to six months.

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Section: Methodsmentioning

confidence: 99%

Feasibility and metabolic outcomes of a well-formulated ketogenic diet as an adjuvant therapeutic intervention for women with stage IV metastatic breast cancer: The Keto-CARE trial

Buga,

Harper,

Sapper

et al. 2024

PLoS ONE

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“…When compared to salts, ketone monoesters had more potent effects in raising BHB level [50]. The increase in BHB following only ketone supplementation is short-term, whereas daily racemic KS (ketone salts) consumption during a KD (ketogenic diet) maintains ketonemia [51]. Ketone salt formulations with caffeine and amino acid additions provided high-intensity exercise performance in healthy candidates that was comparable to keto-adapted athletes [52].…”

Section: Strategies To Modulate Beta-hydroxybutyratementioning

confidence: 99%

Modulation of beta-hydroxybutyrate in traumatic brain injury

Arora,

Shastri,

Patel

et al. 2024

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of review Traumatic brain injury (TBI) is a significant public health concern with substantial morbidity and mortality rates in the United States. Current management strategies primarily focus on symptomatic approaches and prevention of secondary complications. However, recent research highlights the potential role of ketone bodies, particularly beta-hydroxybutyrate (BHB), in modulating cellular processes involved in TBI. This article reviews the metabolism of BHB, its effect in TBI, and its potential therapeutic impact in TBI. Recent findings BHB can be produced endogenously through fasting or administered exogenously through ketogenic diets, and oral or intravenous supplements. Studies suggest that BHB may offer several benefits in TBI, including reducing oxidative stress, inflammation, controlling excitotoxicity, promoting mitochondrial respiration, and supporting brain regeneration. Various strategies to modulate BHB levels are discussed, with exogenous ketone preparations emerging as a rapid and effective option. Summary BHB offers potential therapeutic advantages in the comprehensive approach to improve outcomes for TBI patients. However, careful consideration of safety and efficacy is essential when incorporating it into TBI treatment protocols. The timing, dosage, and long-term effects of ketone use in TBI patients require further investigation to fully understand its potential benefits and limitations.

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Effect of weight-maintaining ketogenic diet on glycemic control and insulin sensitivity in obese T2D subjects

Merovci,

Finley,

Hansis-Diarte

et al. 2024

BMJ Open Diab Res Care

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IntroductionLow carbohydrate ketogenic diets have received renewed interest for the treatment of obesity and type 2 diabetes. These diets promote weight loss, improve glycemic control, and reduce insulin resistance. However, whether the improvements in glycemic control and insulin sensitivity are secondary to the weight loss or result from a direct effect of hyperketonemia is controversial.Research design and methods29 overweight obese subjects were randomized to one of three dietary interventions for 10 days: (1) Weight-maintaining standard diet; (2) Weight-maintaining ketogenic diet; (3) Weight-maintaining ketogenic diet plus supplementation with the ketone ester of beta-hydroxybutyrate (β-OH-B), 8 g every 8 hours. At baseline, all subjects had oral glucose tolerance test, 2-step euglycemic insulin clamp (20 mU/m2.min and 60 mU/m2.min) with titrated glucose and indirect calorimetry.ResultsBody weight, fat content, and per cent body fat (DEXA) remained constant over the 10-day dietary intervention period in all three groups. Plasma β-OH-B concentration increased twofold, while carbohydrate oxidation decreased, and lipid oxidation increased demonstrating the expected shifts in substrate metabolism with institution of the ketogenic diet. Glucose tolerance either decreased slightly or remained unchanged in the two ketogenic diet groups. Whole body (muscle), liver, and adipose tissue sensitivity to insulin remained unchanged in all 3 groups, as did the plasma lipid profile and blood pressure.ConclusionIn the absence of weight loss, a low carbohydrate ketogenic diet has no beneficial effect on glucose tolerance, insulin sensitivity, or other metabolic parameters.

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Fasting and diurnal blood ketonemia and glycemia responses to a six-week, energy-controlled ketogenic diet, supplemented with racemic R/S-BHB salts

Cited by 4 publications

References 28 publications

Feasibility and metabolic outcomes of a well-formulated ketogenic diet as an adjuvant therapeutic intervention for women with stage IV metastatic breast cancer: The Keto-CARE trial

Feasibility and metabolic outcomes of a well-formulated ketogenic diet as an adjuvant therapeutic intervention for women with stage IV metastatic breast cancer: The Keto-CARE trial

Modulation of beta-hydroxybutyrate in traumatic brain injury

Effect of weight-maintaining ketogenic diet on glycemic control and insulin sensitivity in obese T2D subjects

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