Boosting the Ketogenic Diet

Dr. Alexia Harris, ND

Over the years, the ketogenic diet has gained so much popularity in the fitness and weight-loss industry that supplement companies have manufactured a host of nutritional “ketogenic” products designed to support individuals following the diet. In the last decade, the diet has also become popular within the naturopathic medical profession as more research is coming out showing the diet can potentially benefit certain neurodegenerative conditions including brain cancer, Alzheimer’s, multiple sclerosis, Parkinson’s, and epilepsy. With these promising health benefits, medical professionals are also showing interest in the use of ketogenic supplements. There are a variety of ketogenic supplements that have hit the market, and these range from different types of oils to synthetic ketone salts and esters.

Ketogenic Oil

The most popular ketogenic supplements on the market today are coconut oil and MCT (medium chain triglycerides) oil. Ever since Dave Asprey promoted the Bulletproof coffee as part of a high fat, moderate protein, and low carbohydrate diet, the use of coconut oil, butter, ghee and MCT oils has become a huge fad. Coconut oil and MCT oil are promoted as being “ketogenic”, meaning that their fatty acids readily convert to ketones in the liver. However, these oils are not all equal as they have varying ketogenic properties.

 

Coconut Oil

Coconut oil is made up of a complex group of fatty acid chains with varying lengths including caproic acid (6-carbon chain), caprylic acid (8-carbon chain), capric acid (10-carbon chain), and lauric acid (12-carbon chain). Of all these fatty acid chains, caprylic and capric acid chains are the most readily converted to ketones, whereas caproic and lauric acid are much less ketogenic. Although coconut oil contains some MCTs (14 percent caprylic acid and capric acid), about half its fatty acid content comes from lauric acid, which is a long chain fatty acid, so it is not as ketogenic as pure MCT oil. However, coconut oil has become a staple in the ketogenic diet as it is a cheap and easy way to boost fat intake. Coconut oil is also easy to digest, has a pleasant taste and is a great cooking oil as it is resistant to oxidation and is stable at low-medium heat. It is often recommended to add coconut oil to shakes, coffees or to simply eat a tablespoon of coconut oil as a snack while following the ketogenic diet.

 

MCT Oil

MCT oil, on the other hand, is made up of only capric and caprylic acid chains, which have been extracted from coconut oil through a process known as fractionation. This makes MCT oil much more ketogenic then coconut oil and is usually the preferred choice as a supplement. Another difference between MCT oil and coconut oil is that capric and caprylic acid bypass digestion and therefore don’t require digestive enzymes or bile to be broken down and absorbed. Rather they are directly absorbed into the bloodstream from the small intestine, where they go to the liver and are converted to ketone bodies.

MCT oil also has some unique properties that make it a preferred choice over coconut oil. It is liquid at room temperature and when refrigerated, making it easier to add to meals. It has no taste or odour making it palatable. It eases constipation and helps raise HDL (good) cholesterol.

 

Exogenous Ketones

Another class of ketogenic products that are gaining popularity are ketone supplements. There are three types of endogenous (made by the body) ketone bodies including acetoacetate, beta-hydroxybutyrate (âHB) and acetone. Beta-hydroxybutyrate is ketone that is commonly used in exogenous ketone supplements and has been shown to effectively boost ketone levels in people already following a ketogenic diet.

Propriety blends of synthetic ketone salts and esters are collectively referred to as exogenous (i.e., not made by the body) ketones. When exogenous ketones were first developed, they were marketed mainly for weight-loss purposed or as supplements to enhance athletic performance. But with the growing interest in implementing a ketogenic diet for treatment of various neurodegenerative diseases and cancer, health professionals are beginning to investigate the use of exogenous ketones, along with a ketogenic diet, as an adjunct to various medical treatments.

 

Ketone Esters

Ketone esters are considered raw ketones, meaning they are a synthetic form of a pure ketone body. They are immediately absorbed into the body, although they have an unpleasant taste. The benefit of using exogenous ketones esters is that they are even more effective at boosting ketone levels compared to MCT oil since they do not need to be digested and do not involve the liver. This is beneficial for patients with compromised liver function as the ketones directly enter the bloodstream. However, every individual has different needs, and it is important to discuss the option of using these supplements with a doctor.

 

Ketone Salts

Ketone salts are often formulated using âHB and electrolytes including calcium, magnesium, sodium and potassium. When a ketone is bonded to a salt it slows the absorption a little bit but improves the taste. There is also the added benefit of preventing electrolyte imbalances. When the body isn’t using glucose as its main source of fuel, the kidney’s do not get the signal to retain sodium and potassium in the bloodstream and as a result these key electrolytes that regulate blood pressure and water levels in the body are eliminated in the urine at a higher rate. Supplementing with electrolytes is intended to restore the body’s sodium/potassium balance to prevent side effects that often occur when transitioning onto a ketogenic diet. Such side effects include headaches, fatigue, light-headedness, constipation and muscle cramping.

Although the benefits seem promising, caution must always be taken when supplementing with exogenous ketones. Overconsumption can lead to nutritional deficiencies, caloric restriction, gastrointestinal intolerance, and in severe cases, if ketone levels rise too high, it can induce metabolic acidosis (a medical emergency). The use of minerals and electrolytes should also be discussed with a doctor since electrolytes like potassium can interfere with certain medications.

 

Conclusion

Taking supplements such as coconut oil, MCT oil, and exogenous ketones is not necessary while following a ketogenic diet, although there are some circumstances where the body requires an extra boost in order to maintain a ketogenic state. These supplements also allow for more flexibility with the ketogenic diet by allowing for greater consumption of vegetables that would otherwise increase carbohydrate levels. Despite the convenience and benefits of using ketogenic supplements, it is far more important to focus on following the ketogenic diet properly rather than relying on supplements. The ketogenic diet can be very time consuming and difficult to stick to, and since everyone has different metabolic needs, it is important to consult with a doctor to determine whether the ketogenic diet along with ketogenic supplements are right for you.

 

References:

https://examine.com/nutrition/21-of-the-best-arguments-for-and-against-coconut-oil/

Kalamian, M. (2017). Keto for Cancer: Ketogenic Metabolic Therapy as Targeted Nutritional Strategy. Chelsea Green Publishing, White River Junction.

LaManna, J.C.1., Salem, N., Puchowicz, M., et al. Ketones suppress brain glucose consumption. Adv Exp Med Biol. 2009;645:301-6. doi: 10.1007/978-0-387-85998-9_45.

Masino SA, Rho JM (2018). Metabolism and epilepsy: Ketogenic diets as a homeostatic link.

Brain Res. 2018 Jun 5. pii: S0006-8993(18)30325-1. doi: 10.1016/j.brainres.2018.05.049.

Murray, A.J., Knight, N.S., Cole, M.A., et al. Novel ketone diet enhances physical and cognitive performance. FASEB J. 2016;30(12):4021-4032. Doi:10.1096/fj.201600773R.

Vitamins & Supplements Center. WebMD. http://www.webmd.com/vitamins-supplements/default.aspx.

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