Is Dark Chocolate Healthy? No, but Cocoa Flavanols Are!

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This post is sponsored by CocoaVia® Brand. chocolate and cocoa flavanols

A dark rich chocolate brownie or smooth, creamy chocolate bar tastes even sweeter when you know it is good for you. After all, chocolate is full of healthy compounds right? Unfortunately, it is not that simple. In its native state, the cocoa bean contains a mixture of compounds that may be beneficial to your health. Processing cocoa beans into cocoa powder or your favorite sweet treat destroys most of these helpful compounds.

Percent Cacao Means Nothing

You can forget choosing dark chocolate based on how bitter or dark it is. The benefits of chocolate come from cocoa flavanols, not from the percent cacao or the darkness of the chocolate. Cocoa flavanols are the beneficial plant-based nutrients (phytonutrients) naturally found in cocoa. No other food on Earth can match cocoa’s unique blend of flavanols. Cocoa flavanols work with your body to maintain healthy levels of nitric oxide. Nitric oxide helps maintain the healthy flow of oxygen and nutrients to all parts of your body. Supporting healthy blood flow is essential to helping you maintain who you are for years to come. In fact, our entire bodies, including our heart, brain, and muscles, depend on healthy blood flow, which helps us feel and perform our best.

How can I Choose Dark Chocolate Rich in Beneficial Compounds?

Don’t look for health benefits from dark chocolate . Most chocolate isn’t nearly as healthy as you may believe. It takes approximately four average dark chocolate bars (more than 700 calories) to get the same amount of cocoa flavanols as you get in a single serving of CocoaVia® cocoa extract supplement. So enjoy chocolate – in moderation, as your sweet treat, but not as your daily source of cocoa flavanols!

CocoaVia Cocoa Flavanols

So if chocolate isn’t a reliable source of flavanols, how about cocoa powder? Unfortunately, most cocoa powders aren’t much better. With no added sugars, less fat, and more fiber than typical chocolate, cocoa powder can be a better option for getting a chocolatey experience. However, cocoa powder might not be a reliable way to get your flavanols. Cocoa flavanols are typically destroyed when cocoa is processed. Any cocoa powder that is Dutched or alkalized contains significantly fewer cocoa flavanols.

Taste Plus Health Benefits

To take the guess work out, you can try CocoaVia®. CocoaVia® cocoa extra supplement delivers the highest concentration of cocoa flavanols in a cocoa extract supplement today – 375mg per serving – . and numerous scientific studies have demonstrated these flavanols promote healthy blood flow from head to toe.

It’s easy to start your day with CocoaVia® supplement. Add one delicious powdered stick pack to the beverage or food of your choice. For more information on CocoaVia® supplement, which is supported by more than two decades of scientific research, visit www.CocoaVia.com. I often start my day with a peanut butter chocolate shake. I mix one stick pack of CocoaVia® Unsweetened Dark Chocolate supplement into my morning smoothie with peanut powder, ice and milk.

 

†The Food and Drug Administration has not evaluated this statement. This product is not intended to diagnose, treat, cure, or prevent any disease.

 

Fuel Your Child for Learning More this School Year

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Kids learning potential skyrockets when they are healthy from head to toe. This school year, support your child’s growth, development and learning by following these 3 tips each day:

Bank on Dairy

From celebrity websites and diet books to popular Instagram feeds and “clean eating” blogs, its trendy to ditch dairy. Yet experts say going dairy-free has multiple downfalls – and it may be downright dangerous – especially for kids and young adults. Kids and teens have a limited time period to build bones. A dairy-free diet during these critical growing years could mean a child doesn’t reach Dairy for growth and learningtheir full height potential, they may have an increase in stress fractures during adolescence, and a greater chance of developing the brittle bone disease osteoporosis as an adult. In addition to 9 essential nutrients, including bone-building calcium and vitamin D, the combination of protein and carbohydrate in dairy will help build and fuel active muscles and minds.

Make Fruits and Veggies Fun

Introducing kids to new foods can be both fun and easy. In addition to offering a food multiple times and modeling healthy eating (eating a wide variety of foods in front of your kids), try pairing less familiar foods with ones that are more familiar. Many kids love getting in the kitchen and helping prepare food, especially when it comes to baking. Why not make muffins, bread or even a cake with vegetables in it. Carrot cake, zucchini muffins and avocado cupcakes taste great and  make a child more familiar with these vegetables. Once kids see them again, sautéed at dinner time, baked into a lasagna or  sliced on top of a sandwich, they will be more likely to eat them.

Pack better Snacks for better Learning

As a kid I played hard then lost steam quickly. Luckily my parents let us snack whenever we felt the need to eat. Frequent snacking can help keep children alert and attentive. Pack snacks that please their taste buds while fueling their bodies with nutrients they need for good health. Naturally sweet fresh or dried fruit, trail mix, yogurt, string cheese and nut butter with whole grain crackers are all excellent options that will satisfy your child’s taste buds while providing the nutrients they need for good health.

 

 

 

Slow Digesting Carbohydrates for Fat Loss and Better Performance?

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Consume fewer calories, use more body fat and feel great during exercise – these are the claims behind slow digesting carbohydrates. Before you ditch your typical sports drink in favor of a slow digesting carbohydrate, check out the truth behind each of these lofty claims.

In this post I will cover:

  • One big fat myth – slow digesting carbohydrates won’t help you burn body fat
  • Trying to burn fat during exercise is pointless
  • Fast carbohydrates are better for high-intensity athletes
  • Advice for those on a low carbohydrate diet

According to Generation UCAN, makers of a slow digesting starch (a type of carbohydrate), typical high sugar sports nutrition products cause a rapid increase in energy followed by low blood sugar leading to a sharp crash, leaving you feeling tired with a bad case of the munchies (“post-workout cravings” according to their website). Generation UCAN’s starch will keep your blood sugar levels nice and steady while delivering long-lasting energy for hard-working muscles. The payoff? You need fewer carbohydrates (and therefore calories) to fuel activity and your insulin levels (a hormone that helps store body fat among other functions) are kept low so your body can pull from a larger supply of body fat (multiple times larger than the amount of carbohydrate stored in muscle and liver).

All of this sounds great in theory. Yet none of it holds up in real life.

Typical sports nutrition products do not cause a sharp crash (symptoms of low blood sugar) when consumed before or during exercise (1). Instead, your body will use the sugar pretty quickly to fuel hard working muscles (2). What about post-workout cravings? Typical sports drinks, gels and gummies won’t lead to cravings, despite possible changes in blood sugar, even if you consume them when your body doesn’t need them – when you are sitting on the couch scrolling through Snapchat videos (3).

One Big Fat Myth – Slow Digesting Carbohydrates Won’t Help You Lose Body Fat

Trying to burn fat during exercise is pointless (unless you are a ultra distance athlete and therefore relying on large amounts of fat for energy to run for several hours at a time). Otherwise it doesn’t matter if more fat is used during exercise. What matters most if you want to lose weight? The total amount of calories burned over time.

You are better off burning fat while sitting in front of your computer or sleeping then trying to maximize fat used during exercise. Why? Fat is a slow source of energy – if you are seriously tapping into your fat stores during exercise you aren’t exercising very hard and therefore you aren’t burning very many calories. If you want to make the most of your exercise sessions, burning as many calories as possible, you’ll need carbohydrates to help you sustain your exercise intensity. It’s the difference between walking and sprinting. You have to walk for a much longer period of time to burn as many calories as you will if you are sprinting or doing intervals.

Fast Carbohydrates are Better for Athletic Performance

slow digesting carbohydratesCarbohydrates are the best source of energy to keep up with the calorie demand of high-intensity exercise. The less carbohydrate you have stored in your muscle (stored from the carbohydrate you eat each day), the more your body will rely on carbohydrate consumed during exercise in the form of sports drinks, gels, beans, gummies etc. Fast carbohydrates (the mix of sugars in common sports nutrition products) have been successfully used for decades. Yet some athletes get an upset stomach when exercising. Generation UCAN says their product will lower risk of stomach upset. Unfortunately, a well-designed study found athletes actually had greater stomach upset on UCAN (a slow digesting carbohydrate) than they did on traditional sports nutrition drinks (8). If you don’t want the nitty-gritty science, skip the next section and move to the following paragraph.

In this crossover study (each study subject experienced each type of drink) 10 male cyclists consumed 1) 60 grams of carbohydrate from a typical sports nutrition drink (sucrose and glucose blend) 30 minutes before and 60 grams of carbohydrate per hour during exercise (Sports Drink); 2) 60 grams of carbohydrate from UCAN (hydrothermally-modified starch; HMS) before and 60 grams of carbohydrate per hour during exercise (Isocaloric HMS); 3) 60 grams of carbohydrate from UCAN before and 30 grams of carbohydrate per hour during exercise (Low HMS). They spent three hours exercising (one hour at a moderate pace followed by intervals and sprints). There was no difference in performance between the Sports Drink and High HMS. Both the Sports Drink and High HMS resulted in slightly better performance compared to Low HMS (less carbohydrate during exercise). Consuming UCAN, whether 30 or 60 grams per hour, led to greater incidence of nausea compared to consuming 60 grams of carbohydrate per hour from a typical Sports Drink (8).

Typical carbohydrates used in sports nutrition products are digested quickly and used by muscles right away so you can train harder than you would if you relied on slow carbohydrates. The body can use about 30 – 60 grams of carbohydrate per hour, and possibly up to 90 if a mix of different sugars is used. Fat metabolism kicks in after around 20 minutes of aerobic exercise. “After about two hours of continuous endurance exercise, fat is a major source of energy. However, carbohydrate is still essential. Without enough carbohydrate present there is incomplete burning of fatty acids resulting in ketone bodies as a byproduct. When ketones build up, the body’s pH drops (metabolic acidosis) and the body attempts to compensate via respiratory hyperventilation,” states sports dietitian Sally Hara, MS, RD, CSSD, CDE. You won’t improve performance if you consume slow carbohydrates before or during exercise (5).

Fast carbohydrates are also preferential right after exercise – your body can rapidly replenish carbohydrate stores in muscle for use during her next training session. This is very important for athletes who train more than once over the course of an 8-hour period and also important for those who train again less than 24 hours later (6, 7). Anyone who doesn’t train again less than 24 hours later can re-stock their carbohydrate in muscle by consuming enough carbohydrate in their diet from potatoes, rice, quinoa, and other higher carbohydrate foods.

You can function on fewer carbohydrates. However, “there is a difference between functioning and performing your best. Athletes and high-intensity sports to follow a low carbohydrate diet are more likely to get tired early and make mental errors,” states Hara. If you want to perform well and burn more calories while lowering risk of stomach upset, choose a traditional sports nutrition product instead of being swayed by the false marketing promises behind slow digesting carbohydrate products.

 

References

1 Jeukendrup AE, Killer SC. The myths surrounding pre-exercise carbohydrate feeding. Ann Nutr Metab 2010;57 Suppl 2:18-25.

2 Marmy-Conus N, Fabris S, Proietto J, Hargreaves M. Preexercise glucose ingestion and glucose kinetics during exercise. J Appl Physiol 1996;81:853-857.

3 Schultes B, Panknin A, Hallschmid M, Jauch-Chara K, Wilms B, de Courbiere F, Lehnert H, Schmid SM. Glycemic increase induced by intravenous glucose infusion fails to affect hunger, appetite, or satiety following breakfast in healthy men. Appetite 2016;105(1):562-566.

4 Roberts MD, Lockwood C, Dalbo VJ, Volek J, Kerksick CM. Ingestion of a high-molecular-weight hydrothermally modified waxy maize starch alters metabolic responses to prolonged exercise in trained cyclists. Nutr 2011;27(6):659-665.

5 Burdon CA, Spronk I, Cheng H, O’Connor HT. Effect of Glycemic Index of a Pre-exercise Meal on Endurance Exercise Performance: A Systematic Review and Meta-analysis. Sports Med 2016:1-15.

6 Stephens FB, Roig M, Armstrong G, Greenhaff PL. Post-exercise ingestion of a unique, high molecular weight glucose polymer solution improves performance during a subsequent bout of cycling exercise. J Sports Sci 2007:1-6.

7 Aulin KP, Soderlund K, Hultman F. Muscle glycogen resynthesis rate in humans after supplementation of drinks containing carbohydrates with low and high molecular masses. Eur J Appl Physiol 2000;81:346-351.

8 Bauer DA, Vargas F CS, Bach C, Garvey JA, Ormsbee MJ. Slow-Absorbing Modified Starch before and during prolonged cycling increases fat oxidation and gastrointestinal distress without changing performance. Nutrients 2016;8(392):1-16.

Ketogenic Diets: Fat-Filled Lies Won’t Make You Slim (or a Better Athlete)

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How do you turn your body into a fat burning machine, run faster than Usain Bolt, recover from exercise immediately and wake up each day bursting with energy? According to some people, the ketogenic diet is your answer (learn the basics of this diet here). This high-fat, moderate protein diet that is practically void of carbohydrates forces your body to use fat for energy. LeBron James supposedly tried it and offensive lineman decided to give it a shot after an ex-NFL center and O-line coach LeCharles Bentley recommended it. However, the offensive lineman and LeBron weren’t actually following a ketogenic diet. Though these athletes didn’t really know what they were following (no worries LeCharles, I’m sure your nutrition advice is on par with me coaching the O-line), people who actually follow it swear by it. Could this be an unconventional path to weight loss and better health? Unfortunately, the ketogenic diet craze has been fattened with misinformation.

Here is what I am covering in this post:

  • Eat Fat, Lose Fat? Does the ketogenic diet make you lose weight?
  • How does this diet impact muscle?
  • The ketogenic diet and athletic performance.
  • The issue with ketogenic research studies.

I am not covering “training low” or low carbohydrate  / non-ketogenic diets in this article.

Eat Fat, Lose Fat?

During the first several days on a ketogenic diet your weight will take a nosedive. Carbohydrate is stored in the form of glycogen in liver and muscle. Each gram of carbohydrate is stored with 3 – 4 grams of water. Decrease your carbohydrate intake, use glycogen and you’ll lose water weight very quickly. Weight loss, even if from water, can motivate people driven by the number on the scale. Given that adherence is the number one predictor of weight loss when on a diet, we can’t discount psychological effect of the number on the scale going down.

What happens if you stay on the diet? A group of NIH researchers admitted seventeen overweight or obese men to a metabolic ward and placed them on a high carbohydrate baseline diet for four weeks followed by four weeks on an isocaloric ketogenic diet (this diet contained the same amount of calories as the high carbohydrate baseline diet). The men lost weight and body fat on both diets. The ketogenic diet did not lead to greater fat loss as compared to the high carbohydrate diet and in fact body fat loss slowed during the ketogenic diet and subjects lost muscle (1). Time to chuck the “carbohydrates make you fat” books in the recycling bin.

What about other studies showing ketogenic diets help athletes lose body fat and maintain performance? These studies were not actually using a ketogenic diet protocol but instead were high fat, high protein, low carbohydrate diets. Also, none of the studies measured if the study subjects were actually in nutritional ketosis (2, 3, 4).  See the section on The Issue with Ketogenic Research Studies for more information on this topic.

Ketogenic diet and weight

Regardless of the studies indicating the ketogenic diet will not lead to greater weight loss as compared to a diet composed of the same amount of calories, some may lose weight because they will end up cutting down on their favorite foods. Fewer food choices often means fewer calories consumed.

Muscle Up with the Ketogenic Diet?

The ketogenic diet isn’t high enough in protein for maximal muscle gains. Using the lower end of fat intake on a classic ketogenic diet (80% of calories), one could consume 15% of calories from protein (112 grams) on a 3,000-calorie diet. Protein requirements are at least 1.2 – 1.8 grams of protein per kilogram bodyweight (or 0.55 – 0.82 grams per lb. bodyweight) per day if training and eating a diet with enough calories to maintain weight. Protein needs go up if you are cutting calories to spare the breakdown of muscle tissue when dieting. On this diet, 112 grams of protein equals just under 1.3 grams of protein per kg bodyweight for a 200 lb. person and even less for anyone who weighs more.

In addition to inadequate protein intake, “the ketogenic diet reduces many of the signaling molecules involved in muscle hypertrophy (growth),” states Dr. Antonio Paoli, M.D., B.Sc., Associate Professor and Vice Dean of the School of Human Movement Sciences, University of Padova. Without getting too technical, even with sufficient calorie intake, the ketogenic diet suppresses the IGF-1 / AKT / mTOR pathway (5). Using ketones for energy slows muscle breakdown. However it doesn’t stop this process (5).

The Ketogenic Diet and Athletic Performance

Once fully adapted to a ketogenic diet, athletes can supposedly rely on a seemingly endless supply of body fat for energy. No need for carbohydrate gels, beans, gummies and sports drinks every 15-30 minutes during long runs, rides or triathlons to sustain energy levels. Fewer calories consumed may make it easier for some people to stay within their total daily calorie needs (though if you are training that much staying within your calorie requirements shouldn’t be difficult).

Trading carbs for fat seems like a huge benefit for athletes, particularly endurance athletes who train and compete for several hours at a time (6). In addition to utilizing body fat, fat actually produces more energy (ATP) (5). However, fat is a slow source of fuel (see graphic below), the human body cannot access it quickly enough to sustain high-intensity exercise and therefore, this diet is really only (potentially) applicable to ultra-runners and triathletes competing at a relatively moderate to slow pace.

In a ketogenic diet study examining athletic endurance, researchers had subjects cycle at a snails pace (equivalent to a heart rate of about 120 beats per minute for anyone 20-30 years old or 115 for a 40 year old) until they became exhausted before and after 4-weeks on a ketogenic diet. There were no differences in the amount of time they were able to cycle before getting tired prior to or after the four-week ketogenic diet (7). In studies examining high fat diets (not ketogenic and ketones weren’t measured) and endurance performance, study subjects relied on more fat as opposed to carbohydrate during low intensity exercise, yet there was no clear performance advantage on the higher fat diet (8). A recently published study examined 20 elite ultra-marathoners and Ironman distance triathletes. Some were habitually consuming a traditional high carbohydrate diet while the other group was following a ketogenic diet (slightly adjusted macronutrient ratios yet they were in ketosis as measured by blood ketone levels). As expected, those following a higher fat diet used a greater percentage of fat for energy while the higher carbohydrate diet group used more carbohydrate for energy during a 180 minute submaximal running test (I’d call that leisure running intensity). There was no difference in calories burned over the course of the run. Both groups had the same level of perceived exertion and there was no test to determine performance differences between groups (9).

If there’s no performance benefit and we know carbohydrates work, why follow this diet? If your primary goal is weight loss, it doesn’t matter if you use more fat than carbohydrate while exercising (SN: can we please stop talking about the fat burning zone) as long as you’re burning more total calories over the course of the day. Plus, in the interest of (if you are not an ultra endurance athlete) jack up the intensity and burn as many calories in a short period of time as possible. Unfortunately, a ketogenic diet won’t help you do that – when relying on fat for fuel, the intensity of your exercise will drop – the body simply can’t access fat (a slow source of energy) quickly enough to sustain high-intensity exercise. Instead, carbohydrates are necessary for high intensity activity.
ketogenic diet and sports

The Issue with Ketogenic Research Studies

Here’s the issue with many ketogenic research studies and media reports based on them: in most cases, the study subjects were not actually following a ketogenic diet – they were following a higher fat, high-protein low carbohydrate diet (10, 11, 12). Each person’s carbohydrate and protein limits needed to stay in ketosis vary and therefore, measuring ketones through blood or urine is the only definitive way to determine if you are in ketosis. Complicating matters more, low carbohydrate diets (including ketogenic diets) lead to a substantial drop in carbohydrate content, and associated water stored with it, in muscle. This change overestimates the drop in lean body mass as measured by DEXA.

ketogenic and low carbohydrate diets

There are no modifications, higher protein intakes or “on again, off again” (where you go on it one day and off it the next) to this diet. You must be in a state of nutritional ketosis or you will need to decrease carbohydrate and protein intake even further to get into nutritional ketosis and rely on ketones for energy.

Is There Any Benefit?

Ketogenic diets help decrease incidence and severity of seizures in epileptic patients (this is what the diet is intended for). Also, ketogenic diets may be beneficial when implemented soon after a traumatic brain injury (including concussion) (13). In addition, scientists are examining if this diet is beneficial for diseases that affect the brain such as Alzheimer’s.

If you want to lose weight, the ketogenic diet is not superior to a reduced calorie diet. Also, unless you are an ultra endurance athlete who just loves dietary fat, hates eating at social occasions and can put up with the potential side effects from this diet it isn’t for you.
Now where is the O-line? I’ve got some coaching to do…

References

1 Hall KD, Chen KY, Guo J, Lam YY, Leibel RL, Mayer LE, Reitman ML, Rosenbaum M, Smith SR, Walsh BT, Ravussin E. Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. Am J Clin Nutr. 2016 Jul 6. [Epub ahead of print]

2 Zajac A, Poprzecki S, Maszczyk A, Czuba M, Michalczyk M, Zydek G. The effects of a ketogenic diet on exercise metabolism and physical performance in off-road cyclists. Nutrients 2014;6(7):2493-508.

3 Rhyu HS, Cho SY. The effect of weight loss by ketogenic diet on the body composition, performance-related physical fitness factors and cytokines of Taekwondo athletes. J Exerc Rehabil 2014;10(5):326-31.

4 Paoli A, Grimaldi K, D’Agostino D et al. Ketogenic diet does not affect strength performance in elite artistic gymnasts. JISSN 2012;9:34.

5 Paoli A, Bianco A, Grimaldi KA. The ketogenic diet and sport: a possible marriage? Ex Sports Sci Reviews 2015.

6 Volek J, Noakes T, Phinney SD. Rethinking fat as a fuel for endurance exercise. Eur J Sport Sci 2014;2:1-8.

7 Phinney SD, Bistrian BR, Evans WJ, Gervino E, Blackburn GL. The human metabolic response to chronic ketosis without caloric restriction: preservation of submaximal exercise capability with reduced carbohydrate oxidation. Metabolism 1983;32(8):769-76.

8 Burke LM, Kiens B. “Fat adaptation” for athletic performance: the nail in the coffin? J Appl Physiol 2006;100(1):7-8.

9 Volek J, Freidenreich DJ, Saenz C, Kunces LJ, Creighton BC, Bartley JM, Davitt pm, Munoz CX, Anderson JM, Maresh CM, Lee EC, Schuenke MD, Aerni G, Kraemer WJ, Phinney SD. Metabolic characteristics of keto-adapted ultra-endurance runners. Metab Clin Exp 2016;65(3):100-110.

10 Tinsley GM, Willoughby DS. Fat-Free mass changes during ketogenic diets and the potential role of resistance training. Int J Sport Nutr Exerc Metab. 2015 Aug 12. [Epub ahead of print]2 Rouillier MA, Riel D, Brazeau AS, St. Pierre DH, Karelis AD. Effect of an Acute High Carbohydrate Diet on Body Composition Using DXA in Young Men. Ann Nutr Metab 2015;66:233-236

11  Paoli A. The ketogenic diet and sport: a possible marriage? Ex Sci Sports Sciences Rev 2015;43(3):153-62.

12  Johnstone AM, Horgan GW, Murison SD, Bremner DM, Lobley GE. Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. Am Society Clin Nutr 2008;87(1):44-55.

13 Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel (2011). The National Academies Press, Institute of Medicine. Washington DC. 2011 http://www.nap.edu/read/13121/chapter/15

 

The Ketogenic Diet Craze: Fat-Filled Lies, Part 1

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ketogenic diPicture this: a thick, juicy, tender eventeak grilled to perfection with melted butter glazed on top, gently dripping down the sides. Lying next to the steak there’s a side of dark green asparagus sautéed in coconut oil and dusted with a sprinkle of sea salt. Could a diet loaded with fat help you lose diet-resistant body fat that’s been taunting the seams of your dress pants and poking through buttons on your shirt? Will eating fat turn you into an all-star athlete? This is part 1 of a 2 part series on the ketogenic diet.

Here is what I will cover in this blog post:

  • What is the ketogenic diet?
  • Adverse health effects.

Here is what I will cover in tomorrow’s blog on this topic:

  • The issue with ketogenic research studies.
  • Is the ketogenic diet superior for losing fat?
  • How will the ketogenic diet affect muscle?
  • How will the ketogenic diet impact athletic performance?

What is the Ketogenic Diet?

For nearly a century, epileptic patients have used ketogenic diets to control seizures when common medications provide no relief. Scientists aren’t sure why following a ketogenic diet decreases the incidence and severity of seizures but it works.

The ketogenic diet contains – 80-90% of calories from fat, 15% from protein and 5% from carbohydrate (1, 2). Food choices may include heavy cream, bacon, eggs, non-starchy vegetables, mayonnaise and sausage while fruits, starchy vegetables, breads, pasta, cereal and other carbohydrate-rich foods are not allowed.

During the first several days on a ketogenic diet, your body’s limited supply of carbohydrate stored in liver and muscle tissue decreases dramatically. As a result, you will feel like you have mono – exhausted, with headaches and easy exercise will feel like you’re climbing Mount Everest (3). Once your stored carbohydrate has dwindled, ketones, formed from the breakdown of dietary fat, become the primary source of energy for brain and body. Ketogenic means “ketone forming.” It takes at least seven days to reach nutritional ketosis and several weeks to fully adapt to the diet (12). If you aren’t in nutritional ketosis (as measured by blood, urine or breath ketones; ketone levels > 0.5 mmol/L), then you aren’t following a ketogenic diet, you are on a low carbohydrate diet.

Adverse Health Effects from the Ketogenic Diet

Much of the research on adverse effects comes from studies in epileptic children since they have been on the diet for long periods of time. These studies show soon after starting a ketogenic diet, blood cholesterol levels and artery stiffness increase (4, 5). High total and LDL cholesterol are risk factors for cardiovascular disease (diseases of the heart and blood vessels). When arteries are stiff, they cannot expand as well in response to changes in blood pressure. Think of this like a garden hose when you turn up the water pressure, your hose either expands or the water bursts out of the space between the faucet and the hose. When arteries cannot open widely to accommodate increases in blood flow, blood pressure increases leading to microscopic tears on artery walls, development of scar tissue and the perfect surface for plaque buildup (6). Blood cholesterol levels returned to normal in patients who went off the diet and in those who stayed on it, they returned to normal after 6 to 12 months. Artery stiffness returned to normal after 24 months on a ketogenic diet.5 Studies in obese patients suggest ketogenic diets improve blood sugar and blood cholesterol levels over time, either due to the diet, weight loss from the diet, a combination of the two or carbohydrate restriction (7, 8). Lose weight, regardless of what you eat and blood cholesterol, blood pressure, inflammation, blood sugar and many other disease risk factors will improve.

Ketogenic diets are typically low in calcium, vitamin D, potassium, magnesium, folic acid and fiber. There are several potential consequences associated with consistently low intake of each of these micronutrients including softening of the bones, decreased bone density, muscle damage, muscle weakness or spasms, and abnormal heart rhythm. However, with careful planning, a fiber supplement, multivitamin and under the guidance of a physician who may prescribe potassium and sodium supplements (blood sodium could drop to dangerously low levels while on this diet), nutrient needs can be met. Also, to prevent constipation when on a ketogenic diet, a fiber supplement may be necessary along with more water / fluid intake then you are used to.

Here are some other potentially bad side effects from following a high fat diet:

  • Harm to your Brain. Studies in mice show a high fat diet, even when followed for as little as two months leads to chronic inflammation, sedentary immune cells in the brain – these cells typically act like janitors picking up trash and infectious compounds but when they become sedentary they stop doing their job, leading to cognitive impairment (9). Does this happen in humans and resolve over time? We don’t know.
  • Mad Bacteria in Your Gut. A diet with no probiotics (healthy bacteria) and low in prebiotics (certain types of fiber that the healthy bacteria much on for food keeping them happy) will likely change the composition of bacteria in your gut so you have more harmful and less beneficial bacteria.
  • Leaky Gut. High saturated fat meals increase bacterial toxins (endotoxins) in the intestines and intestinal permeability. In other words: leaky gut (10, 11). If you are on this diet, consider opting for foods lower in saturated fat and higher in unsaturated fats (liquid oils, avocado, nuts, seeds, olives).
  • Free radicals in overdrive? If you can’t eat a number of colorful foods including blueberries, beets, corn, oranges, and more, chances are you won’t get a wide array of antioxidant compounds to quench free radicals (compounds that are important for good health but can wreck your body when they aren’t tamed by antioxidants) as well as other plant-based compounds that keep your arteries, muscles and other parts of your body healthy. Will your body adapt? We don’t know at this time.

Are the side effects and potential negative side effects worth it if you can lose weight on this diet? Stay tuned for tomorrow’s post on how the ketogenic diet impacts body fat and athletic performance.

References

1 Freeman JM, Freeman JB, Kelly MT. The ketogenic diet: a treatment for epilepsy. 3rd ed. New York, NY: Demos Health; 2000.

2 Paoli A, Bianco A, Damiani E, Bosco G. Ketogenic Diet in Neuromuscular and Neurodegenerative Diseases. BioMed Research International 2014, Article ID 474296, 10 pages, 2014.

3 White AM, Johnston CS, Swan PD et al. Blood ketones are directly related to fatigue and perceived effort during exercise in overweight adults adhering to low-carbohydrate diets for weight loss: a pilot study. J Am Diet Assoc 2007;107(10):1792-6.

4 Tanakis M, Liuba P, Odermarsky M, Lundgren J, Hallböök T. Effects of ketogenic diet on vascular function. Eur J Paediatr Neurol 2014;18(4):489-94.

5 Coppola G, Natale F, Torino A et al. The impact of the ketogenic diet on arterial morphology and endothelial function in children and young adults with epilepsy: a case-control study. Seizure 2014;23(4):260-5.

6 Cecelja M, Chowienczyk P. Role of arterial stiffness in cardiovascular disease. JRSM Cardiovascular Disease 2012;1(4):1-10.

7 Dashti HM, Mathew TC, Hussein T, Asfar SK, Behbahani A, Khoursheed MA, Al-Sayer HM, Bo-Abbas YY, Al-Zaid NS. Long-term effects of a ketogenic diet in obese patients. Exp Clin Cardiol 2004; 9(3): 200–205.

8 Volek JS, Feinman RD. Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond) 2005;2:31.

9 Hao S, Dey A, Yu X, Stranahan AM. Dietary obesity reversibly induces synaptic stripping by microglia and impairs hippocampal plasticity. Brain Behav Immun 2016 Jan;51:230-9.

10 Mani V, Hollis JH, Gabler NK. Dietary oil composition differentially modulates intestinal endotoxin transport and postprandial endotoxemia. Nutr Metab (Lond) 2013; 10: 6.

11 Lam YY, Ha CW, Campbell CR, Mitchell AJ, Dinudom A, Oscarsson J, Cook DI, Hunt NH, Caterson ID, Holmes AJ, Storlien LH. Increased gut permeability and microbiota change associate with mesenteric fat inflammation and metabolic dysfunction in diet-induced obese mice. PLoS One 2012;7(3):e34233.

12 Paoli, A, Grimaldi K, D’Agostino D, Cenci L, Moro T, Bianco A, Palma A. Ketogenic diet does not affect strength performance in elite artistic gymnasts. J Int Soc Sports Nutr 2012;9:34.

Tackling Concussions Head-On: How Nutrition Can Improve Outcomes

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football

I sat on the floor hunched over and crying. My elbows were raised – close to my eyes as my arms hugged my head, hands clenched at the base of my neck. My brain felt like a percussion instrument shaking inside my skull. As the pounding grew more intense the pain became unbearable. I had a concussion, my second in two years, which earned me a night in the ER.

Concussions are common in sports and recreation. Though considered a mild type of traumatic brain injury because they are usually not life-threatening, all concussions should be taken seriously. A single blow to the head can result in short-term loss of brain functioning or long-term changes in thinking, language, emotions and sensations including taste, touch and smell (1). Repeated concussions can be very dangerous and may lead to permanent changes in brain functioning or in extreme cases, death (2). Though widely recognized in football players, concussions happen in all sports – even in everyday activities – and they are occurring at younger ages. Athletes who have had one concussion have a greater risk (2 – 5.8 times higher) of experiencing another concussion (3). Multiple blows to the head could lead to chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease associated with poor memory, changes in personality, behavior, speech and gait (4). Posthumous examination of some former NFL players in addition to a few college football players who committed suicide revealed CTE. In March 2016, the NFL acknowledged the link between traumatic brain injury and CTE. The movie ‘Concussion,’ set for release in late December, 2015 highlights concussions in former NFL players though the league has gone to great lengths to make today’s game safer.

Decreasing the Damaging Effects from Concussions

Anyone who experiences a blow to their head or body (a forceful blow to the body can cause the brain to shake inside the skull) should be immediately examined by a physician with experience in the evaluation and management of concussions. Though the person may say they feel fine and can continue with regular activities, symptoms of concussion do not always appear immediately and may instead be delayed for several hours. Continuing to play or perform mental tasks like studying can increase severity or symptoms and cause complications including the possibility of developing permanent brain damage.

Symptoms of Concussion may include:

  • Confusion
  • Headache
  • Vision changes
  • Memory loss
  • Difficulty with coordination, clumsiness or stumbling
  • Dizziness
  • Irritability
  • Personality changes
  • Slurred speech
  • Delayed response to questions
  • Nausea or vomiting
  • Sensitivity to light and noise
  • Problems sleeping
  • Seizures
  • Loss of consciousness

In addition to the symptoms that occur soon after a concussion, some people experience Post-Concussion Syndrome (PCS) days or weeks later. PCS can cause many of the same symptoms experienced after a concussion as well as trouble concentrating, apathy, depression and anxiety. Symptoms may last a few weeks. If you suspect PCS, have the patient evaluated by a psychiatrist (5).

Nutrition Management

In addition to rest, following a graduated return-to-play and school protocol, and other steps you should take to treat concussions, emerging research suggests nutrition may play an important role. Certain nutrients seem to help reduce some of the damaging effects from concussions:

Protein: 1 – 1.5 grams of protein per kg body weight per day is recommended along with sufficient calories to reduce the inflammatory response (6).

EPA and DHA Omega-3 Fatty Acids: EPA and DHA, omega-3 fatty acids found in fish and algae, increase fluidity of cell membranes, reduce inflammation and enhance cerebral blood flow (which is reduced for up to a month or longer in athletes that recover slowly) (7). Cell membranes are like gateways allowing substances to enter cells or blocking their entry. When cell membranes are more fluid (and therefore less rigid), they perform better, opening the gate for nutrients to come in. DHA, in particular, makes up 97% of the omega-3 fatty acids in the brain and is essential for normal brain functioning (8). Several animal studies show EPA and DHA supplementation before or after a traumatic brain injury helps limit structural damage and decline in brain functioning (9, 10, 11, 12, 13, 14, 15).

There is no clear consensus regarding optimal intake of EPA and DHA prior to or after a concussion. Given that many Americans do not eat enough fish and an estimated 75% of American diets are too low in EPA and DHA, it makes sense to start by meeting the general guidelines for recommended intake of EPA and DHA by:

  • Consuming fatty fish varieties that contain high levels of omega-3s, including salmon, tuna, mackerel and herring at least twice per week;
  • Take an omega-3 supplement providing EPA+DHA daily (be sure to look for high-quality fish oil, algal oil or krill oil supplements in your local grocery or health store);
  • Eat and drink DHA omega-3-fortified foods and beverages, including milk, 100% juice, and yogurt.

Research has yet to identify exactly how much EPA + DHA may be helpful after a concussion. However, according to the Food & Drug Administration (FDA), doses of EPA + DHA up to 3 grams per day are considered safe.

Zinc is necessary for optimal brain functioning while a deficiency of this mineral may compound oxidative damage from concussions. Though zinc supplementation may be an effective treatment modality, additional research needs to determine if zinc supplementation is safe after concussions. The Upper Limit for zinc is 40 mg per day.

Animal and human studies suggest creatine helps prevent secondary brain injury after traumatic brain injury. However, animal studies show long-term creatine intake may decrease its beneficial effects on the brain after injury. Future research needs to better elucidate the relationship between creatine pre-TBI and creatine post-TBI and outcomes.

Other potential approaches to addressing concussions through nutrition include ketogenic diets which are very high-fat, minimal-carbohydrate diets that are effectively used to decrease both the incidence and severity of seizures in children with epilepsy. Ketogenic diets provide an alternate energy source for brain functioning – ketones derived from the breakdown of fat. This may be important since available glucose, the primary energy source for brain functioning, may be decreased after a concussion.

Current research supports the integration of a dietitian into the team of health professionals treating concussions. Though nutrition interventions are considered preliminary at this time, consideration should be given to nutrition strategies that may reduce long-term effects while causing no further harm.

Disclosure: I am a GOED/Omega-3 Science Advisory Council Member supporting the research behind omega-3 EPA and DHA for a healthy brain, heart and eyes.

References

1 What are the Potential Effects of TBI? Injury Prevention & Control: Traumatic Brain Injury. CDC. http://www.cdc.gov/TraumaticBrainInjury/outcomes.html

Concussion (Traumatic Brain Injury). Pubmed Health.

3  Harmon KG, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med 2013;47:15-26. http://www.amssm.org/Content/pdf%20files/2012_ConcussionPositionStmt.pdf

4  McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte T, Gavett BE, Budson AE, Santini VE, Lee H, Kubilus CA, Stern RA. Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy following Repetitive Head Injury. J Neuropathol Exp Neurol 2009; 68(7): 709–735.

Post-Concussion Syndrome. PubMed Health 

6 Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel. The National Academies Press. 2011. http://www.nap.edu/catalog/13121/nutrition-and-traumatic-brain-injury-improving-acute-and-subacute-health

7  Meier TB, Bellgowan PS, Singh R, Kuplicki R, Polanski DW, Mayer AR. Recovery of cerebral blood flow following sports-related concussion. JAMA Neurol 2015;72(5):530-8.

8 Salem N Jr, Litman B, Kim HY, Gawrisch K. Mechanisms of action of docosahexaenoic acid in the nervous system. Lipids 2001; 36(9):945-59.

9 Mills JD, Hadley K, Bailes J. Dietary supplementation with the omega-3 fatty acid docosahexaenoic acid in traumatic brain injury? Neurosurgery 2011;68:474–81

10 Wu A, Ying Z, Gomez-Pinilla F. Omega-3 fatty acid supplementation restores mechanisms that maintain brain homeostasis in traumatic brain injury. J Neurotrauma 2007;24:1587–95

11 Wu A, Ying Z, Gomez-Pinilla F. Dietary omega-3 fatty acids normalize BDNF levels, reduce oxidative damage, and counteract learning disability after traumatic brain injury in rats. J Neurotrauma 2004;21:1457–67

12 Wang T, Van K, Gavitt B, Grayson J, Lu T, Lyeth B, Pichakron K. Effect of fish oil supplementation in a rat model of multiple mild traumatic brain injuries. Restor Neurol Neurosci 2013;31:647–59

13 Mills JD, Bailes J, Sedney C, Hutchins H, Sears B. Omega-3 fatty acid supplementation and reduction of traumatic axonal injury in a rodent head injury model. J Neurosurg 2011;114:77–84

14 Wu A, Ying Z, Gomez-Pinilla F. The salutary effects of DHA dietary supplementation on cognition, neuroplasticity, and membrane homeostasis after brain trauma. J Neurotrauma 2011;28:2113–22

15  Wu A, Ying Z, Gomez-Pinilla F. Exercise facilitates the action of dietary DHA on functional recovery after brain trauma. Neuroscience 2013;248:655–63

Go Green for Earth Month & Improve Your Diet at the Same Time

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You don’t have to run out and hug a tree or play hackie sack while barefoot in the park to celebrate Earth Month. Instead, Earth Day and Month were designed to designed to inspire awareness for our environment. What’s in it for you? A polluted environment leads to pollution in our food and water supply that ends up on our plates and in our bodies. And therefore, a healthier earth means a healthier you. You can do your part by recycling, disposing of hazardous wastes properly (so they don’t end up in the water you drink or on the plants you eat) and changing your diet by incorporating foods that are not only good for you but also use fewer environmental resources to produce and/or are produced in an earth-friendly manner. On a recent segment on WBAL NBC Baltimore MD, I shared the top 3 steps you can take right now to help protect the environment and improve your diet at the same time:

1) Choose green seafood – seafood that’s both good for you and good for the ocean.  The DC-based Environmental Working Group has a guide to seafood that is high in omega-3 fats and low in methylmercury. This is especially important for pregnant women and young children. Growing fetuses are exposed to methylmercury in the womb when their mom eats fish and shellfish that contain methylmercury. Methylmercury can harm a baby’s growing brain and nervous system. Recent government data suggests an estimated 1.4 million women of reproductive age have blood mercury concentrations that may increase the risk of learning disabilities in their unborn children. Exposure to mercury is harmful to all people and may have toxic effects on the nervous, digestive and immune systems, and on lungs, kidneys, skin and eyes. EWG top choices for lower mercury omega-3 rich seafood: wild salmon, sardines, Atlantic mackerel, mussels and rainbow trout.

2 ) Go Meatless. Now, I’m not suggesting everyone go completely meatless (because animal based sources of protein are typically better for building and maintaining muscle) but, adding more plant based proteins or going completely meatless for 1 day a week has the environmental impact of taking your car off the road for 320 miles, according to the Environmental Working Group. How does this help your body? Plant based sources of protein are typically lower in calories yet they are packed with good nutrition including vitamins, minerals, and dietary fiber. How can you get enough protein – choose soy, beans, lentils and nuts. I often mix animal-based proteins with plant-based proteins at meals.

3) Cook with canned foods. Americans throw away approximately 15 to 20 percent of the fresh fruits and vegetables they purchase every year. Stock up on canned foods because they help reduce food waste, saving us time and money, and reducing our impact on the environment. Canned food portion sizes are just right for both individuals and families, and most recipes are designed around these sizes. Plus, metal cans are endlessly recyclable and in fact, are the most recycled containers in America today, keeping metal out of landfills and saving significant energy. Looking for convenient, wallet-friendly sources of protein? Check out this resource (and easy recipes) Quality Protein – It’s in the Can – Fact Sheet 

Marie Spano, MS, RD, CSCS, CSSD is a proud Can-bassador – helping educate and communicate the benefits of cooking with canned foods.