Weekly Q & A – Babies. Ketosis. And Misinformation.
Ok guys, for those of you who were following the blog last summer, you’ve probably wondered where the heck I’ve been the last few months. Don’t worry! I’m still around – I’ve just been really busy providing face-to-face care for folks, and I’ve had less time to write and answer questions online. That being said, I have received some questions in recent weeks, and I want to get back to posting regularly. Do YOU have a nutrition question you’d like answered? If so, please send your question(s) to [email protected] Don’t worry – if you’d prefer your name not be published along with your question, simply let me know, and I’ll keep your identity secret. Now, let's check out this week's question . . . Today we're talkin' about infant nutrition. Can we just take a minute, though, to talk about how baby mugshots were a thing in the '80s? The bow scotch-taped to my bald head really makes the picture. #stylin #beforephotoshop This week’s Q & A format is going to be a little different. It’s really more of a myth-busting post. The myth we're busting is all about the infant diet and ketosis. In the last month, I’ve run into multiple people (in several different online nutrition forums, and also a few in person) who have been told at one point or another that infants, from birth, are in ketosis. The long and short of it is this: Myth: Babies are in ketosis and eat keto throughout infancy, until they transition to a solid-food diet. Fact: Babes are NOT in ketosis and are not eating keto during infancy if they are consuming breastmilk or standard infant formula. The only time that babies are maintained in ketosis is during a medically-supervised ketogenic feeding intervention, with special, prescription formula. The first time I ran into this m Continue reading >>
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Ketogenic Diet Guidelines For Infants
History of the Ketogenic Diet in Infants For many decades, the idea of using the ketogenic diet for infants with epilepsy was discouraged. Concerns were raised in chapters and books about the diet that infants were highly likely to become hypoglycemic, have complications, and unlikely to achieve ketosis. Although infants often have seizures, and at times very difficult-to-control seizures, until the 1990s, we also did not have pre-made, commercially-available ketogenic diet infant formulas. Even though most anticonvulsant drugs are not FDA-approved for use in infants, this was the main treatment option for most child neurologists. What’s New Things have changed drastically in the last few years. Published research has shown that not only can infants become ketotic, but they respond very well to dietary therapy. In fact, infantile spasms is one of the established "indications" for ketogenic diet treatment. An article from last year by Dr. Anastasia Dressler from Vienna even stated, "The ketogenic diet is highly effective and well tolerated in infants with epilepsy. Seizure freedom is more often achieved and maintained in infants." Adding to this rising tide of acceptance, the European Journal of Paediatric Neurology published guidelines for the use of ketogenic diets in infancy (defined as less than 2 years of age) this month. This was a group effort from 15 neurologists and dietitians with particular expertise in using ketogenic diet in infancy, convened at a conference in London in April 2015. What does this guideline say? Much of it is information about infants that already has been established and is similar to older children. The authors comment that the ketogenic diet can be helpful for infantile spasms, epilepsy with migrating seizures, and GLUT-1 deficiency (al Continue reading >>
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Initiating And Maintaining The Ketogenic Diet In Breastfed Infants
The ketogenic diet has been used as an effective treatment for intractable epilepsy since 1921. Its efficacy in the treatment of epilepsy in infants has been reported to be similar to that in older children. However, there have been no reports in the literature addressing the possibility of continuing breastfeeding during treatment with the ketogenic diet. The authors performed a retrospective chart review of the patients initiated on the ketogenic diet and identified 5 infants who continued to receive breast milk while on the ketogenic diet treatment. All 5 experienced a >90% reduction of seizures during the first month on the ketogenic diet treatment with continued breastfeeding. Four of the 5 were able to maintain >90% reduction of seizures for the duration of their time receiving breast milk while on the ketogenic diet treatment. Traditionally, infants have discontinued breastfeeding prior to diet initiation because of the concern that the carbohydrates in the breast milk will prevent attaining adequate levels of ketosis. It is the authors’ experience with these 5 patients that infants can continue to breastfeed while successfully using the ketogenic diet for seizure treatment. Nordli DR, Kuroda MM, Carroll J., et al. Experience with the ketogenic diet in infants. Pediatrics. 2001;108:129-133. Google Scholar, Medline Kossoff EH, Pyzik PL, McGrogan JR, Vinig EPG, Freeman JM Efficacy of the ketogenic diet for infantile spasms. Pediatrics . 2002;109:780-783. Google Scholar, Medline Jambaqúe I., Chiron C., Dumas C., Mumford J., Dulac O. Mental and behavioural outcome of infantile epilepsy treated by vigabatrin in tuberous sclerosis patients. Epilepsy Res. 2000;38:151-160. Google Scholar, Medline Freeman JM, Kossoff EH, Freeman JB, et al. The Ketogenic Diet: A Treatme Continue reading >>
Breastfeeding On A Low-carb Diet – Is It Dangerous?
Is it dangerous to breastfeed while on a low-carb, high-fat diet? Recently, the journal of the Swedish Medical Association published a case report (summary in English) of a woman who, six weeks after giving birth, had to be hospitalized for severe ketoacidosis. Luckily, she recovered quickly and her numbers were back to normal the next day. Ketoacidosis is a dangerous condition, most often seen in type 1 diabetics with acute insulin deficiency. In rare cases, ketoacidosis may occur in non-diabetics after prolonged periods of starvation or inadequate food intake, in which case it typically occurs in combination with stress or other medical conditions. The woman in this case had been eating low-carb, high fat for a long time before the incident. After giving birth however, she had suffered flu-like symptoms of fever, nausea and a complete loss of appetite. Despite this, she was still able to breastfeed her baby, which of course ramped up her nutritional requirements. The case study report brings up the woman’s low-carbohydrate diet as one possible contributing factor to the situation. However, as soon as the media found out, they immediately exaggerated this possible contributing factor to the guaranteed sole cause of the condition (which, as we shall see, is unikely): Metro: Woman Falls Seriously Ill of LCHF Diet During Lactation (Google translated from Swedish) In the woman’s own words The woman described in the case report in the journal contacted me of her own accord through common acquaintances. She tells a different story from the one perpetuated by the media: What isn’t made clear is that I, the breastfeeding woman, had been eating LCHF for approximately six years before this incident, but, because of stress during my second pregnancy and after childbirth I s Continue reading >>
(redirected from lactation ketosis) Also found in: Dictionary, Thesaurus, Encyclopedia. Lactation Definition Lactation is the medical term for yielding of milk by the mammary glands which leads to breastfeeding. Human milk contains the ideal amount of nutrients for the infant, and provides important protection from diseases through the mother's natural defenses. Description Early in a woman's pregnancy her milk-producing glands begin to prepare for her baby's arrival, and by the sixth month of pregnancy the breasts are ready to produce milk. Immediately after the baby is born, the placenta is delivered. This causes a hormone in the woman's body (prolactin) to activate the milk-producing glands. By the third to fifth day, the woman's breasts fill with milk. Then, as the baby continues to suck each day, nursing triggers the continuing production of milk. The baby's sucking stimulates nerve endings in the nipple, which signal the mother's pituitary gland to release oxytocin, a hormone that causes the mammary glands to release milk to the nursing baby. This is called the "let-down reflex." While the baby's sucking is the primary stimulus for this reflex, a baby's cry, thoughts of the baby, or the sound of running water also may trigger the response. Frequent nursing will lead to increased milk production. Breast milk cannot be duplicated by commercial baby food formulas, although both contain protein, fat, and carbohydrates. In particular, breast milk changes to meet the specific needs of a baby. The composition of breast milk changes as the baby grows to meet the baby's changing needs. Most important, breast milk contains substances called antibodies from the mother that can protect the child against illness and allergies. Antibodies are part of the body's natural defense Continue reading >>
Effects Of A Ketogenic Diet During Pregnancy On Embryonic Growth In The Mouse
Abstract The increasing use of the ketogenic diet (KD), particularly by women of child-bearing age, raises a question about its suitability during gestation. To date, no studies have thoroughly investigated the direct implications of a gestational ketogenic diet on embryonic development. To fill this knowledge gap we imaged CD-1 mouse embryos whose mothers were fed either a Standard Diet (SD) or a KD 30 days prior to, as well as during gestation. Images were collected at embryonic days (E) 13.5 using Optical Projection Tomography (OPT) and at E17.5 using Magnetic Resonance Imaging (MRI). An anatomical comparison of the SD and KD embryos revealed that at E13.5 the average KD embryo was volumetrically larger, possessed a relatively larger heart but smaller brain, and had a smaller pharynx, cervical spinal cord, hypothalamus, midbrain, and pons, compared with the average SD embryo. At E17.5 the KD embryo was found to be volumetrically smaller with a relatively smaller heart and thymus, but with enlarged cervical spine, thalamus, midbrain and pons. A ketogenic diet during gestation results in alterations in embryonic organ growth. Such alterations may be associated with organ dysfunction and potentially behavioral changes in postnatal life. Keywords Ketogenic dietLow-carbohydrate dietEmbryonic developmentCD-1 mouseMouse imagingOptical projection tomographyMagnetic resonance imaging Background The Ketogenic Diet (KD) is a high fat, low carbohydrate, adequate protein diet, which has been gaining support as a lifestyle diet for weight maintenance  and body-building purposes in healthy adults . Classically, the diet has been primarily used as a therapeutic measure for intractable pediatric epilepsy. However, due to its high efficacy and significant advantages over anti-ep Continue reading >>
Your Brain On Ketones
The modern prescription of high carbohydrate, low fat diets and eating snacks between meals has coincided with an increase in obesity, diabetes, and and increase in the incidence of many mental health disorders, including depression, anxiety, and eating disorders. In addition, many of these disorders are striking the population at younger ages. While most people would agree that diet has a lot to do with the development of obesity and diabetes, many would disagree that what we eat has much to do with our mental health and outlook. I believe that what we eat has a lot to do with the health of our brains, though of course mental illness (like physical illness) has multifactorial causes, and by no means should we diminish the importance of addressing all the causes in each individual. But let's examine the opposite of the modern high carbohydrate, low fat, constant snacking lifestyle and how that might affect the brain. The opposite of a low fat, snacking lifestyle would be the lifestyle our ancestors lived for tens of thousands of generations, the lifestyle for which our brains are primarily evolved. It seems reasonable that we would have had extended periods without food, either because there was none available, or we were busy doing something else. Then we would follow that period with a filling meal of gathered plant and animal products, preferentially selecting the fat. During the day we might have eaten a piece of fruit, or greens, or a grub we dug up, but anything filling or high in calories (such as a starchy tuber) would have to be killed, butchered, and/or carefully prepared before eating. Fortunately, we have a terrific system of fuel for periods of fasting or low carbohydrate eating, our body (and brain) can readily shift from burning glucose to burning what ar Continue reading >>
What Is A Ketogenic Diet?
What Is a Ketogenic Diet? If medicine doesn't control seizures in epilepsy, sometimes doctors prescribe a ketogenic (or keto) diet. A ketogenic diet is a strict high-fat, low-carbohydrate diet that can reduce, and sometimes stop, seizures. It's called "ketogenic" because it makes ketones in the body. Ketones are made when the body uses fat for energy. By replacing carbs with fat in the diet, the body burns more fat and makes more ketones. The ketogenic diet is prescribed by a doctor. Kids on the diet need to be followed closely by a dietitian to make sure they follow the diet and get the nutrients they need. The diet starts with fasting during an overnight hospital stay. Who Needs a Ketogenic Diet? Children with seizures that are not well-controlled by medicines (called intractable epilepsy) and severe epilepsy syndromes (such as infantile spasms or Lennox-Gastaut syndrome) might benefit from a ketogenic diet. Studies show that the ketogenic diet also may help treat other conditions, such as diabetes, obesity, and even cancer. How Does a Ketogenic Diet Work? Although the ketogenic diet for epilepsy has been around since 1920, doctors aren't exactly sure how the higher ketone levels works. Some seizure types seem to respond better than others to the ketogenic diet. In babies, the keto diet is given in formula. Young children may be fed by a tube that is place in the stomach by a surgeon. This helps the child stay on the diet. How Long Do Kids Need a Ketogenic Diet? You should know if a ketogenic diet works for your child within a few months. If it does, your doctor may recommend weaning your child off the diet after 2 years of seizure control. The weaning process is done over several months to avoid triggering seizures. Some people stay on a ketogenic diet for years. Are Continue reading >>
Neonatal Ketosis Is Not Rare: Experience Of Neonatal Screening Using Gas Chromatography-mass Spectrometry.
Abstract The causes and effects of transient neonatal ketosis, discovered during a pilot study of screening for abnormalities in neonatal metabolism using gas chromatography-mass spectrometry, were investigated. Of the 21,342 neonates that were screened, 47 had significant ketosis. The organic acid profile accompanying ketosis in the urine of neonates followed the pattern of ketotic dicarboxylic aciduria in approximately half of the cases. Ketosis was more often found in neonates nourished by breast feeding (33 out of 47). Over half of the neonates showing ketosis (28 out of 47) were asymptomatic. When normal neonates and neonates testing positive for ketosis were compared, no statistically significant correlations were found with regard to birth mass, gestational period, or gender. However, neonates with ketosis tended to have low mass gain rates in the 5 days from birth and a statistically significant difference was found in this regard in comparison to normal neonates (P<0.0001). From the above results, development of ketosis in neonates was found to be possible even in normal subjects. Most ketosis in neonates was also found to depend largely on nourishment after birth. Existence of an asymptomatic ketosis category was also suggested. Continue reading >>
Ketosis In Infants And Children+
Summary The biochemical reactions related to the formation of ketone bodies have been reviewed. An attempt has been made to indicate the metabolic interrelationship of fats, carbohydrates, and hormones. Although there has been notable progress in the field of fat metabolism in the last 10 years, there remain many unanswered questions. In relation to ketosis the fundamental question is the mechanism of regulation of acetoacetate synthesis. The following are some of the factorswhich need to be considered when studying the mechanisms involved in the accumulation of ketone bodies: 1.The mobilization of fatty acids. Several clinical conditions associated withketosis are briefly surveyed, and it is found that the factors noted above vary in degree and in different situations. Attention is directed to the resistance of small infants to ketosis, and the possible mechanisms involved are discussed. To access this article, please choose from the options below Continue reading >>
Experience With The Ketogenic Diet In Infants
Abstract Objective. To evaluate the effectiveness, tolerability, and adverse effects of the ketogenic diet in infants with refractory epilepsy. Methods. A retrospective review of 32 infants who had been treated with the ketogenic diet at a large metropolitan institution. Results. Most infants (71%) were able to maintain strong ketosis. The overall effectiveness of the diet in infants was similar to that reported in the literature for older children; 19.4% became seizure-free, and an additional 35.5% had >50% reduction in seizure frequency. The diet was particularly effective for patients with infantile spasms/myoclonic seizures. There were concomitant reductions in antiepileptic medications. The majority of parents reported improvements in seizure frequency and in their child's behavior and function, particularly with respect to attention/alertness, activity level, and socialization. The diet generally was well-tolerated, and 96.4% maintained appropriate growth parameters. Adverse events, all reversible and occurring in one patient each, included renal stone, gastritis, ulcerative colitis, alteration of mentation, and hyperlipidemia. Conclusion. The ketogenic diet should be considered safe and effective treatment for infants with intractable seizures. The incidence of seizures is higher during the first 2 years of life than during any other period of childhood.1Outcome with regard to seizure control and development is poor.2–6 Several severe catastrophic epilepsies present in infancy, including early myoclonic epilepsy, early infantile epileptogenic encephalopathy, West syndrome, and severe infantile myoclonic epilepsy. Seizures in these disorders may be difficult to control—sometimes only at the expense of multiple and toxic levels of antiepileptic medications. Whe Continue reading >>
Here’s What Research Says About Keto While Breastfeeding
Did you know that soon after babies are born they enter a natural state of ketosis? Yep, you read that right — research shows that newborn infants are in ketosis and remain in this normal, healthy state while breastfeeding[*][*]. Furthermore, research confirms that breast milk from healthy mothers is actually made up of 50-60% fat, and the cholesterol in breast milk supplies babies with almost six times the amount that most adults consume in their diets [*]. So, if babies are naturally born in ketosis and benefit from using fat and ketones for fuel, then why would it be an issue for a breastfeeding mother to follow a ketogenic diet/lifestyle? What Does the Research Say About Keto While Breastfeeding? Unfortunately, the current scientific literature surrounding the ketogenic diet and breastfeeding is extremely limited. However, one study performed in 2009 compared a low-carbohydrate, high fat (LCHF) diet to a high-carbohydrate, low fat (HCLF) diet in breastfeeding women[*]. Results from this study showed the following: Regardless of the diet, daily breast milk production and daily infant breast milk intake remained the same. Neither diet had an effect on milk lactose or protein concentration; however, milk fat concentration and the energy content of milk were higher during the LCHF diet than the HCLF diet. Infants’ energy intake (kcal/day) was higher during the LCHF diet than during the HCLF diet. The estimated average maternal energy expenditure and the sum of maternal energy expenditure plus milk energy content were higher during the LCHF diet than during the HCLF diet. Based on these results, researchers concluded that breastfeeding mothers could lose more weight while consuming a LCHF diet than a HCLF diet without affecting milk production and still supplying the Continue reading >>
Ketogenic Diet Myth #1: Are Babies In Ketosis? Findings & Implications
I’ve heard several times now about this idea that babies are in ketosis, and in other words are “keto-adapted.” This idea is then used to support the ketogenic diet in human adults. Let’s break this idea down here and examine its veracity. It’s important to define our terms. I’ve heard the saying “babies are in ketosis” rather than “infants are in ketosis” or “infants less than 6 months old are in ketosis.” What age group are we talking about? Infants are rapidly growing little people. Thus it become problematic already to assume that just because we have been in ketosis for a period of time during our breastfeeding careers we may be able to continue it as our bodies grow in every way and direction. So we’re really talking about infants, and more specifically, the typical age that breastfeeding occurs. Since this is pretty variable I can’t specify an exact age, but I’m guessing 12 months or less. It would also be interesting to discuss how the energy needs of infants may change as they develop physically. I would expect that as they learn to crawl, walk, and run, their bodies might start to prefer glucose. Adults who go on ketogenic diets typically go through an adaptation phase for the first two weeks of the diet. This adaptation period usually brings some discomfort, GI symptoms like constipation, and fatigue (which is often corrected with additional electrolytes). After this period, many people feel better and it is believed they have “adapted” to ketosis. Infants however are in a state of mild-ketosis. Their brains use ketones more so than the adult brain. From this paper (which has a very strong point of view and suggests that brains “prefer” ketones, which is up for debate): “Postnatally, the brain’s dependence on ketones Continue reading >>
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Babies Thrive Under A Ketogenic Metabolism
Some people, even some scientists who study ketogenic metabolism, have the idea that ketogenesis is somehow abnormal, or exceptional; an adaptation for emergencies only. We disagree. One reason we think a ketogenic metabolism is normal and desirable, is that human newborns are in ketosis. Despite the moderate sugar content of human breast milk, breastfeeding is particularly ketogenic. This period of development is crucial, and there is extensive brain growth during it. Although the composition of breast milk can be affected by diet , it is reasonable to assume that breast milk has always been ketogenic, and this is not an effect of modernisation. When the brain is in its period of highest growth, and when the source of food is likely to be close to what it evolved to be for that period, ketones are used to fuel that growth. If nothing else, this suggests that learning is well supported by a ketogenic metabolism. It is also consistent with the ability of ketogenic diets to treat a variety of seemingly unrelated brain disorders and brain trauma. Newborn infants are in ketosis. This is their normal state. Breastfeeding is particularly ketogenic (compared to formula feeding). Breastfeeding longer (up to a point) is associated with better health outcomes. This suggests the hypothesis that weaning onto a ketogenic diet would be healthier than weaning onto a high-carb diet. (Mark-up ours) Human babies are in ketosis Soon after birth, human babies are in ketosis, and remain so while breastfeeding . They use ketones and fats for energy and for brain growth. When this has been studied, in the first couple of hours after birth, babies aren't immediately in ketosis. There is a short delay . During that brief period before ketogenesis starts, lactate (confusingly not to do Continue reading >>
Ketosis: What Is Ketosis?
Ketosis is a normal metabolic process. When the body does not have enough glucose for energy, it burns stored fats instead; this results in a build-up of acids called ketones within the body. Some people encourage ketosis by following a diet called the ketogenic or low-carb diet. The aim of the diet is to try and burn unwanted fat by forcing the body to rely on fat for energy, rather than carbohydrates. Ketosis is also commonly observed in patients with diabetes, as the process can occur if the body does not have enough insulin or is not using insulin correctly. Problems associated with extreme levels of ketosis are more likely to develop in patients with type 1 diabetes compared with type 2 diabetes patients. Ketosis occurs when the body does not have sufficient access to its primary fuel source, glucose. Ketosis describes a condition where fat stores are broken down to produce energy, which also produces ketones, a type of acid. As ketone levels rise, the acidity of the blood also increases, leading to ketoacidosis, a serious condition that can prove fatal. People with type 1 diabetes are more likely to develop ketoacidosis, for which emergency medical treatment is required to avoid or treat diabetic coma. Some people follow a ketogenic (low-carb) diet to try to lose weight by forcing the body to burn fat stores. What is ketosis? In normal circumstances, the body's cells use glucose as their primary form of energy. Glucose is typically derived from dietary carbohydrates, including: sugar - such as fruits and milk or yogurt starchy foods - such as bread and pasta The body breaks these down into simple sugars. Glucose can either be used to fuel the body or be stored in the liver and muscles as glycogen. If there is not enough glucose available to meet energy demands, th Continue reading >>