July 8, 2023
Ketogenic Diet
Slowing Down the Hands of Time: How the Ketogenic Diet May Combat Aging
The ketogenic diet, also known as the keto diet, is a way of eating that focuses on consuming foods that are high in healthy fats, moderate in protein, and very low in carbohydrates. The main goal of this diet is to encourage your body to enter a state called ketosis. In ketosis, your body uses stored fat as its primary source of energy instead of carbohydrates.
When following a ketogenic diet, you would typically prioritize foods like avocados, nuts and seeds, fatty fish, olive oil, and other forms of healthy oils. These foods are rich in healthy fats, which help keep you feeling full and satisfied. On the other hand, you would reduce your intake of grains, sugar, starchy vegetables, and most fruits, as they are higher in carbohydrates.
While it may sound a bit restrictive, many people find the ketogenic diet helpful in managing weight, improving energy levels, and even enhancing mental clarity and focus. However, it's essential to consult with a healthcare professional before making any significant changes to your diet to ensure it's safe and suitable for you.
Why is Sugar Dangerous?
In recent years, there has been increasing concern about the detrimental effects of sugar on our health. Sugar, particularly in the form of added sugars found in processed foods and beverages, has been linked to numerous health problems. Excessive sugar consumption can lead to weight gain, obesity, and associated metabolic disorders such as type 2 diabetes and cardiovascular disease. Also, there is growing evidence suggesting that sugar may have addictive properties and can impact the brain's reward centers, leading to cravings and potentially addictive behaviors. Additionally, high sugar intake has been associated with an increased risk of chronic diseases such as certain cancers and non-alcoholic fatty liver disease. It is crucial to understand the dangers of sugar and take steps to reduce its consumption for overall health and well-being.
Increased risk of obesity and weight gain:
When we consume sugar, it provides calories but lacks essential nutrients. Excess sugar intake can contribute to weight gain and obesity because the body stores excess calories as fat. Sugar is calorie-dense, meaning it provides a high number of calories without offering the necessary nutrients, such as vitamins, minerals, and dietary fiber. These nutrients are crucial for the proper functioning of the body and promoting feelings of satiety. When foods high in added sugars are consumed, they provide a surplus of calories that are often stored as fat if not utilized for energy. (2)
A study published in Circulation examined the association between sugar-sweetened beverages and weight gain in both children and adults. The findings revealed a positive association, suggesting that consumption of sugary drinks increases the risk of weight gain and obesity. Sugar-sweetened beverages, including sodas, energy drinks, and sweetened fruit juices, are commonly consumed in large quantities. These beverages provide excess calories without delivering the necessary nutrients to promote satiety, leading to a higher likelihood of weight gain over time.
A meta-analysis published in the American Journal of Clinical Nutrition also supported the link between high intake of added sugars and weight gain. The analysis concluded that increased consumption of added sugars is associated with weight gain. The nature of added sugars often leads to excessive calorie intake without a corresponding increase in satiety, making it challenging to control overall calorie consumption and contributing to weight gain.
In addition to calorie density and nutrient deficiencies, high sugar intake can impact appetite and satiety regulation. Research suggests that excessive sugar consumption, particularly from added sugars, may disrupt the normal hormonal regulation of appetite and satiety signals. This disruption can lead to increased cravings, overeating, and a lack of satiation, making it more difficult to control calorie intake and resulting in weight gain.
Furthermore, a high sugar diet can influence the body's regulation of fat metabolism. Excessive sugar intake can lead to increased production of insulin, a hormone involved in regulating blood sugar levels. Elevated insulin levels can inhibit the breakdown and utilization of stored fats, potentially contributing to weight gain and difficulty in losing excess weight.
Overall, multiple studies have shown a positive association between high sugar consumption and weight gain. The evidence suggests that excessive sugar intake, particularly from added sugars, can contribute to weight gain and increase the risk of obesity. Managing sugar intake by choosing nutrient-dense foods, minimizing consumption of sugary beverages and processed foods, and maintaining a balanced diet with appropriate portion sizes can play a vital role in regulating calorie intake and supporting weight management.
High blood sugar levels and insulin resistance:
Insulin resistance is a condition in which the body's cells become less responsive to the hormone insulin, resulting in impaired glucose utilization and elevated blood sugar levels. This can have several detrimental effects on health. First and foremost, insulin resistance impairs the body's ability to efficiently take up glucose from the bloodstream, leading to persistent hyperglycemia (elevated blood sugar levels). As a result, the body's cells do not receive an adequate amount of glucose for energy production and other metabolic functions (3).
To compensate for the reduced responsiveness of cells, the pancreas produces and releases more insulin into the bloodstream, a condition known as hyperinsulinemia. Over time, this can lead to higher insulin concentrations in the blood. Elevated insulin levels can have several adverse effects on the body.
Prolonged insulin resistance can eventually lead to the development of type 2 diabetes. When insulin resistance is severe, the pancreas struggles to produce enough insulin to overcome it. Consequently, blood glucose levels remain persistently elevated, resulting in a diagnosis of diabetes. Furthermore, chronic hyperinsulinemia can contribute to the dysfunction and exhaustion of pancreatic beta cells, which produce insulin, thus further worsening blood sugar control.
Insulin resistance is also a core component of metabolic syndrome, a combination of medical conditions that increase the risk of cardiovascular disease and type 2 diabetes. Metabolic syndrome typically includes other factors such as central obesity, high blood pressure, high triglyceride levels, and low levels of high-density lipoprotein (HDL) cholesterol. Insulin resistance is believed to play a crucial role in the development and progression of metabolic syndrome.
Insulin resistance is strongly associated with an increased risk of cardiovascular diseases. Chronic hyperinsulinemia and hyperglycemia resulting from insulin resistance contribute to the development of atherosclerosis (hardening of the arteries), chronic inflammation, elevated blood pressure, abnormal lipid profiles, and impaired vascular function. These factors collectively increase the risk of cardiovascular complications, such as coronary artery disease, heart attacks, and stroke.
Furthermore, insulin resistance is linked to other health problems. It is associated with an increased risk of non-alcoholic fatty liver disease (NAFLD), a condition characterized by excessive fat accumulation in the liver. Insulin resistance can also affect reproductive health, contributing to conditions like polycystic ovary syndrome (PCOS) in women. Emerging research suggests a potential connection between insulin resistance and certain types of cancer, although more studies are needed to understand the exact mechanisms involved.
Addressing insulin resistance is crucial for maintaining optimal health. This can be achieved through lifestyle modifications, including healthy dietary choices, regular physical activity, weight management, and, if necessary, medical treatments. It is essential to consult with healthcare professionals for personalized guidance and appropriate treatment options to address insulin resistance effectively.
Negative impact on heart health:
High sugar consumption has been strongly linked to adverse effects on cardiovascular health. When we consume a diet high in added sugars, it can contribute to several risk factors that increase the likelihood of cardiovascular disease.
This includes elevated triglyceride levels, which are a type of fat found in the bloodstream. A systematic review and meta-analysis published in Advances in Nutrition examined the impact of added sugars, particularly from sugar-sweetened beverages, on blood lipid profiles. The review provided strong evidence of the role of added sugars in negatively affecting blood lipid profiles, including raising triglyceride levels. Elevated triglyceride levels are associated with an increased risk of heart disease and can contribute to the development of atherosclerosis, the buildup of plaque in the arteries (4).
Another review published in Circulation concluded that high sugar intake increases the risk of hypertension and cardiovascular disease. Elevated blood pressure is a significant risk factor for cardiovascular problems such as heart attacks and strokes. Consuming excess sugar, especially in the form of added sugars, has been shown to contribute to elevated blood pressure levels. In addition, chronic consumption of added sugars can lead to chronic inflammation, which is associated with an increased risk of cardiovascular disease (5).
Moreover, a diet high in added sugars has been associated with low levels of HDL (good) cholesterol. HDL cholesterol helps remove low-density lipoprotein (LDL) cholesterol, often referred to as "bad" cholesterol, from the bloodstream. Low HDL cholesterol levels and high LDL cholesterol levels are risk factors for heart disease. Research has consistently shown that high sugar intake, particularly from added sugars, can lower levels of HDL cholesterol, further increasing the risk of cardiovascular problems (5).
These findings emphasize the negative impact of high sugar consumption on heart health. A diet high in added sugars can lead to adverse blood lipid profiles, including elevated triglyceride levels and low levels of HDL cholesterol. This, along with the potential to raise blood pressure and promote chronic inflammation, increases the risk of cardiovascular disease.
Reducing sugar intake, particularly from added sugars, and choosing a balanced diet that emphasizes whole foods, fruits, vegetables, lean proteins, and healthy fats can help support heart health. It is important to be mindful of added sugars in processed foods, beverages, and condiments, and to make informed choices for long-term cardiovascular well-being. (5).
Association with chronic diseases:
Excessive sugar intake has been associated with various chronic diseases. For instance, high sugar consumption is a risk factor for non-alcoholic fatty liver disease (NAFLD). A study published in Cell Metabolism found that dietary sugars, especially fructose, promote the development of NAFLD by altering mitochondrial function and gene expression in the liver (6). Furthermore, a study published in the Japanese Journal of Cancer Research demonstrated that sucrose (table sugar) accelerated the progression of hepatocellular carcinoma in rats (7). Excess sugar intake has also been linked to an increased risk of certain cancers, such as pancreatic and colorectal cancer, although more research is needed in this area (8). Lastly, consuming a high-sugar diet is strongly associated with dental cavities due to increased oral bacteria growth and acid production (9).
Addiction-like properties and impact on the brain:
Sugar's impact on the brain's reward centers has led to suggestions that it can evoke cravings and potentially addictive behaviors. Sugar activates the reward pathways in the brain, eliciting feelings of pleasure and reinforcing the desire to consume more. Similar to drugs of abuse, sugar has been proposed to have addiction-like effects on the brain.
Animal studies have provided insights into how sugar affects the brain's reward system. Research has shown that sugar consumption can lead to an increase in dopamine release, a neurotransmitter associated with reward and pleasure pathways. Dopamine plays a critical role in motivation, reinforcement, and the experience of pleasure. It has been observed that the activation of dopamine release by sugar can create a rewarding and reinforcing response, potentially leading to addictive behaviors.
In a study published in PLOS ONE, researchers found that intense sweetness from sugar could surpass the reward value of cocaine in rats. The study demonstrated that sugar produced even stronger effects on dopamine release in the brain's reward centers compared to cocaine (10). These findings highlight the highly rewarding nature of sugar and its potential impact on the brain.
A review published in Neuroscience and Biobehavioral Reviews discussed the evidence supporting sugar addiction based on behavioral and neurochemical effects. The review compiled research from animal and human studies, suggesting that sugar can induce addictive-like behavior patterns. It highlighted similarities between sugar addiction and the effects of drugs of abuse, including changes in brain reward systems, neurochemical responses, and withdrawal-like symptoms (11).
While the concept of sugar addiction is still a topic of ongoing scientific investigation, studies suggest a potential link between sugar consumption, the brain's reward systems, and addictive-like behaviors. These findings emphasize the rewarding nature of sugar and its potential impact on the brain, contributing to cravings, overconsumption, and difficulties in moderating intake.
It's important to note that the addictive potential of sugar may vary among individuals, and not everyone experiences addiction-like behaviors toward sugar. However, recognizing the brain's response to sugar and being mindful of consumption patterns can help promote a healthy relationship with food and support overall well-being.
These points collectively highlight the potential negative effects of excessive sugar consumption on various aspects of health.
Why Ketogenic Diet is Powerful? Are there any Risks?
Weight loss:
The ketogenic diet promotes weight loss through various physiological mechanisms. When carbohydrate intake is reduced to a very low level, the body's preferred fuel source, glucose, becomes limited. As a result, the liver produces ketone bodies from stored fats through a process called ketogenesis. These ketones are then used by the body, including the brain, as an alternative fuel source. Ketosis shifts the body's metabolism to primarily burning stored fat for energy, which can lead to increased fat loss. Research has shown that ketogenic diets are effective for weight loss. A systematic review and meta-analysis of randomized controlled trials published in the British Journal of Nutrition found that individuals on a ketogenic diet experienced significantly greater weight loss compared to those on a low-fat diet (12).
Appetite control:
The high-fat content and adequate protein intake of the ketogenic diet can enhance satiety and help control appetite. Fat is known to induce a feeling of fullness, and protein is also highly satiating. Several studies support the appetite-suppressing effect of ketogenic diets. For example, a study published in the American Journal of Clinical Nutrition compared the effects of a low-carbohydrate, high-fat diet with a low-fat diet and found that participants on the low-carbohydrate, high-fat diet reported reduced hunger and greater fullness (13).
Blood sugar control:
Carbohydrates are the primary macronutrient that raises blood sugar levels. By significantly reducing carbohydrate intake, the ketogenic diet minimizes blood sugar spikes and reduces the body's need for insulin, a hormone that regulates blood sugar levels. This can be particularly beneficial for individuals with insulin resistance or type 2 diabetes, as it improves insulin sensitivity. A randomized controlled trial published in Nutrition & Metabolism demonstrated that a ketogenic diet resulted in significant improvements in glycemic control, insulin sensitivity, and blood lipid profiles in individuals with type 2 diabetes compared to a low-glycemic index diet (14).
Potential cognitive benefits:
The ketogenic diet has shown promise in benefiting cognitive function and certain neurological conditions. The brain can utilize ketones as an alternative energy source when glucose availability is limited. Ketones provide a more stable and efficient fuel source for the brain and may have neuroprotective effects. Research has shown potential cognitive benefits of the ketogenic diet in older adults with mild cognitive impairment. A study published in Aging and Mechanisms of Disease found that a ketogenic diet improved memory and cognition in older adults (15). Additionally, the ketogenic diet has been used as an effective treatment for drug-resistant epilepsy in children (16).
Metabolic health:
The ketogenic diet has shown promise in improving various markers of metabolic health. Research suggests that the diet can lead to decreased triglyceride levels and increased HDL (good) cholesterol levels. This may occur as a result of the diet's focus on healthy fats, which can positively impact lipid profiles and contribute to a decreased risk of heart disease (20)(21). Furthermore, the ketogenic diet has been found to reduce markers of inflammation and oxidative stress, such as C-reactive protein (CRP) and reactive oxygen species (ROS), which may have implications for the prevention of chronic diseases (22).
Type 2 diabetes management:
The ketogenic diet's low carbohydrate content can be beneficial for individuals with type 2 diabetes. By minimizing carbohydrate intake, the diet helps to reduce the need for insulin and stabilize blood sugar levels. This occurs because carbohydrates are the primary macronutrient that raises blood sugar levels. With limited carbohydrate intake, blood sugar levels tend to be more stable, leading to improved glycemic control and insulin sensitivity. Additionally, the ketogenic diet encourages the use of ketones as an alternative fuel source, which can help reduce insulin resistance and support diabetes management (23)(24).
Polycystic ovary syndrome (PCOS):
PCOS is a hormonal disorder affecting women of reproductive age, characterized by insulin resistance and hormonal imbalances. The ketogenic diet may have potential benefits for women with PCOS. By reducing carbohydrate intake, the diet can help control blood sugar levels and insulin response, addressing the underlying insulin resistance that often accompanies PCOS. This may lead to improved hormone balance, weight loss, and normalization of menstrual cycles (25)(26).
Mental health conditions:
Although research in this area is still developing, evidence suggests that the ketogenic diet may have potential benefits for certain mental health conditions such as anxiety and depression. The mechanism behind these potential benefits is not fully understood but may involve improved brain energy metabolism and reduced inflammation. The ketones produced during ketosis are thought to provide an alternative energy source for the brain, potentially enhancing brain function and alleviating symptoms in some individuals (27)(28).
Anti Aging:
The ketogenic diet has shown anti-aging effects through various biological mechanisms. One key aspect is its impact on mitochondrial function and oxidative stress. With age, there is typically a decline in mitochondrial function and an increase in oxidative stress, which contribute to cellular aging. The ketogenic diet is believed to enhance mitochondrial function and reduce oxidative stress through efficient energy production and a decrease in reactive oxygen species (ROS) production.
Another significant factor is the diet's power to reduce inflammation and support immune function. Chronic low-grade inflammation is a hallmark of aging and age-related diseases. The ketogenic diet has been associated with reduced levels of pro-inflammatory markers and modulation of pro-inflammatory pathways, such as the NLRP3 inflammasome. By decreasing systemic inflammation, the diet can contribute to slowing down the aging process.
Metabolic regulation plays a role in the anti-aging effects of the ketogenic diet. Age-related metabolic changes, such as insulin resistance, can have a negative impact on overall health and accelerate aging. The ketogenic diet's low carbohydrate content promotes metabolic flexibility and improves insulin sensitivity, thereby supporting stable blood sugar levels and metabolic function. By minimizing fluctuations in insulin and blood sugar levels, the diet can mitigate the detrimental effects of insulin resistance and metabolic dysfunction related to aging.
The ketogenic diet is also being explored for its neuroprotective effects against age-related cognitive decline and neurodegenerative diseases. The brain's utilization of ketone bodies as an alternative fuel source may enhance energy metabolism and support mitochondrial function, thereby offering protection against cognitive decline.
Potential risks and considerations of the ketogenic diet:
Nutrient deficiencies:
The restriction of certain food groups in the ketogenic diet, particularly carbohydrate-rich foods, can increase the risk of nutrient deficiencies if not properly managed. Such deficiencies can arise from limited intake of fruits, vegetables, whole grains, and legumes, which are rich sources of vitamins, minerals, and dietary fiber. It is important to prioritize nutrient-dense, low-carbohydrate foods and consider appropriate supplementation and regular monitoring of nutrient intake to avoid deficiencies. A systematic review published in the journal Nutrients highlighted concerns about inadequate micronutrient intakes, particularly for vitamins D, E, K, and various minerals, in individuals following a ketogenic diet (17).
Potential side effects:
Transitioning to a ketogenic diet can lead to temporary side effects commonly known as the "keto flu." These side effects are generally experienced during the initial phase when the body adapts to using ketones as the primary fuel source. Symptoms may include fatigue, dizziness, headaches, constipation, and electrolyte imbalances. These side effects are often attributed to carbohydrate withdrawal and water and electrolyte losses. Adequate hydration, electrolyte supplementation, and gradual adaptation to the diet can help minimize these symptoms (18).
Compliance and sustainability:
The strict nature of the ketogenic diet, particularly the significant reduction in carbohydrate intake, can pose challenges in long-term adherence and sustainability. Eliminating or strictly limiting many common carbohydrate-rich foods may be difficult for some individuals to maintain over an extended period. Adherence to the diet may require careful meal planning, awareness of food choices, and flexibility in adapting the diet to personal food preferences. A review published in the Journal of Clinical Lipidology highlighted concerns about compliance, potential adverse effects, and long-term sustainability of the diet (19).
Impact on certain health conditions:
Although the ketogenic diet may offer benefits for weight loss and certain health conditions, it may not be suitable for everyone and may pose risks for individuals with specific health conditions, such as those with pancreatitis, known liver disease, or rare metabolic disorders. It is essential to consult with a healthcare professional before adopting a ketogenic diet, especially for those with existing health conditions, to ensure it is safe and tailored to individual needs.
Here are some research papers.
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20. Volek JS, et al. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids. 2009;44(4):297-309.
21. Westman EC, et al. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab. 2008;5:36.
22. Paoli A, et al. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013;67(8):789-796.
23. Taylor R, et al. Dietary carbohydrates, insulin resistance, and the prevalence of type 2 diabetes in the NHLBI Family Heart Study. Diabetes Care. 2001;24(3):523-528.
24. Paoli A, et al. Insulin sensitivity indices of glucose and lipids: physiological basis and clinical relevance. Adv Exp Med Biol. 2012;771:21-30.
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26. Mavropoulos JC, et al. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab. 2005;2:35.
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