🚨Keto vs weight loss medications: What works better?

The use of weight loss medications (GLP-1 agonists) and ketogenic diets for fat loss is expanding.

So which one is a more powerful weight loss intervention?

A new paper tries to answer this question.

50 people were selected based on “greatest medical need” - often with a BMI > 40 kg/m2.

They had to follow either a ketogenic diet (< 30 g carbohydrates/day) without calorie restriction for 1 year, and were provided education and community support. Those on GLP-1 agonists could continue taking them.

All the 50 patients lost weight, with average weight loss of around 43 pounds over the year (around 15.5% of body weight).

What’s more impressive is that:

• 82% of volunteers stuck to the intervention in full, highlighting the feasibility of the ketogenic diet

• Weight loss was even greater in those who stuck with the diet for the whole year. An extra 1.1% decrease in body weight on average

• Weight loss in patients taking weight loss medications was comparable to those who didn’t. When weight loss medications were taken away, patient’s didn’t gain back weight. This is likely because patients who followed the diet developed healthy and sustainable habits that allowed them to ‘keep the weight off’ once off the medications.

🥊 Punchline

This study shows the efficacy of a ketogenic diet at aiding weight loss in those with very high BMI with or without the use of weight loss medications, posing the question if weight loss medications are really worth the cost?

❤️ Are ketogenic diets safe for people with chronic kidney disease?

People with chronic kidney disease are often recommended to follow a protein restricted diet.

This approach hasn’t been challenged for a long time, even with emerging research disproving existing recommendations.

A novel study in patients with metabolic syndrome AND advanced chronic kidney disease (stage 3 and 4) who were on a very low carbohydrate diet (< 30 g carbohydrates/day).

Following a very low carbohydrate diet for at least 3 months led to:

• Lower BMI and better blood sugar levels

• Lower use of blood pressure and diabetic medications

• Better renal health (measured through eGRF improvements) in 15 out of 18 people, even if increasing the intake of animal proteins

No patients deteriorated to a more advanced stage of kidney disease, even those without improvements in their renal health.

This suggests how a very low carbohydrate diet is safe and can help minimise worsening of advanced chronic kidney disease, representing a paradigm shift from the current dietary advice which focusses on dietary protein restriction.

This study paves the way for more robust scientific trials to explore the accurate effectiveness (if any) of very low carbohydrate diets in people with chronic kidney disease.

🥊 Punchline

For the first time, the very low carbohydrate diet was demonstrated to reduce BMI, blood pressure, blood glucose levels and medication burden in patients with chronic kidney disease stages 3–4 without evidence of kidney damage.

🧠 Can a ketogenic diet help treat Parkinson’s Disease?

Some background first. Parkinson’s disease is caused by the death of dopamine producing neurons in the brain, and as more neurons die… the disease gets worse.

Current treatment is to replace the missing dopamine in some form, but this does address the cause and so does not slow the death of dopamine neurons and therefore disease progression.

Research on ketogenic diets in human revealed some interesting findings:

• 30-day pilot study on an extreme ketogenic diet (90% calorie from fat) improved Parkinson’s symptoms in all patients

• Ketone supplementation in Parkinson’s patients improved exercise performance by 15% to 33%

But how can a ketogenic diet help treat Parkinson’s Disease?

To simplify the argument, the famous dopamine neurons are huge, relatively few and very needy of energy. This makes them very sensitive to energy deprivation.

The theory is: If we could fix the energy deprivation, we may have a chance to save dopamine neurons.

This is where ketones come in.

Or better, a ketone body - D-β-hydroxybutyrate - known for its action as a signalling molecule.

The metabolism of D-β-hydroxybutyrate may help neurons replenish their depleted energy stores and protect neurons against energy deficit, reducing oxidative damage and neuro-inflammation.

🥊 Punchline

The shift from using glucose as the main source of energy (from sugar and starch) to using fat (when adopting a keto diet), or the supplementation with ketones, could be a neuro protective approach to help prevent or treat Parkinson’s Disease. More research is needed.