Resolution of Type 2 Diabetes Mellitus in a 67 Year Old Female Patient Following Subluxation-Based Chiropractic Care: A Case Study

Dan Yachter DC & Michael Jarry DC

Annals of Vertebral Subluxation Research ~ May 11, 2015 ~ Pages 119-124

 

Abstract
Objective: To present a case study of conservative chiropractic care of a female that presented with multiple health issues and following chiropractic care experienced improvement or resolution of several of these issues, most notably her type 2 diabetes.

 

Clinical Features: A 67 year old female presented with several complaints which included type 2 diabetes mellitus that had been diagnosed by a medical physician when she was 40 years of age. The patient was also found to have several vertebral subluxations throughout her spine, along with postural alterations. She had sought care from several providers with no resolution in any of her complaints.

 

Interventions and Outcomes: The patient received specific chiropractic adjustments according to Diversified technique in the regions of the cervical, thoracic, and lumbar spine and also pelvis. Physical rehabilitation exercises were given to address the patient’s postural alterations found on her initial exam. After receiving chiropractic care the patient obtained several positive results. After four visits, the patient returned to her medical doctor and was able to stop taking insulin for her diabetes. Her blood sugar levels remained within normal limits throughout the rest of her care.

 

Conclusion: The use of conservative chiropractic care was shown in this case to be an effective alternative management for a patient with type 2 diabetes mellitus. Further research is required to understand the efficacy of chiropractic in management of this condition.

 

Key Words: Chiropractic, diabetes, type 2 diabetes, diabetes mellitus, adjustment, spinal manipulation, vertebral subluxation

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How to become diabetic

 

Dr. Davis
Wheat Belly Blog
Mon, 28 Apr 2014 08:18 CDT

It’s so easy, anyone can do it! 

“After a number of years of diabetes, think how much more you can contribute to the nation’s economic success when you need a heart catheterization, stents, or bypass surgery, carotid artery surgery, stents in your femoral arteries, hemodialysis, and foot amputations?”

Becoming diabetic and proudly having to finger stick your way to blood sugar control is patriotic, as it builds revenues for Big Pharma. What better way to support your country than to help successful industries grow larger, increase shareholder value, and increase the salary and perks for hard working executives? 

So if you want to join the growing ranks of people who are becoming diabetic, now the largest epidemic of chronic disease ever witnessed in the history of the world, here’s what you do: 

 Cut your fat intake – Because it leaves you unsatiated and hungry, you will be left with cravings and the loss of resolve to consume healthy foods, making those chips and cookies irresistible. Celebrate with Frito Lay and Oreos! 

 Consume high-glycemic index foods – By “high,” I mean any food with a greater than zero or single-digit glycemic index, such as grains and sugars. Also eat more “low-” and “moderate-” glycemic index foods, because they raise your blood sugar to high levels, too!

 Consume modern wheat – Because the gliadin protein yields opiate peptides that stimulate appetite and increase calorie intake by 400 calories per day, every day, making you want more to eat all throughout the day, paving the road to a wonderful and proud collection of visceral fat. 

– Listen to your doctor’s advice to not supplement vitamin D or supplement at low-dose and be content with a 25-hydroxy vitamin D level of 30 ng/ml, the level you would have with minimal sun exposure and no consumption of animal organs. Ignore the fact that healthy, young, sun-exposed people typically have 25-hydroxy vitamin D levels of 70, 80, or 90 ng/ml. And ask your doctor to take the less effective, non-human form of vitamin D available by prescription! 

– Give into the joint pain, lethargy, and depression caused by grains. This allows insulin resistance to gain a foothold, sending up blood sugars. And, anyway, think of all the TV you can catch up on not having to worry about exercising. 

– Eat processed foods made with grains and sugars, also filled with herbicides like glyphosate and imizamox, that causechanges in bowel flora. Cut back on those healthy Lactobacillus and Bifidobacteria species and give equal time to E. Coli , maybe even Clostridium difficile! 

– Eat gluten-free foods made with cornstarch, tapioca starch, rice flour, and potato flour, since they have the highest glycemic indexes of all foods – there’s nothing higher! Your doctor will be shocked at how high your HbA1c can go just by following this simple strategy. Gluten-free foods might even earn you your very own insulin pump! 

You’ll know when you’ve succeeded when you have to shop for larger and larger pants and dress sizes and, best of all, your doctor feels good about himself because he is able to do his job and hand out more prescriptions to treat your high blood sugars, high blood pressure, joint pains, skin rashes, acid reflux, and high cholesterol. Maybe he will even have to put you on antidepressants! Think how much you will add to the bottom line of your friendly neighborhood pharmacy alone. 

You can find a number of roadmaps to accomplish this lifestyle. One way would be to not read nasty books like Wheat Belly that could actually harm the profit making potential of grains and drugs. Another way would be to just follow the advice of the American Diabetes Association and all their friendly supporters in the drug and processed food industry. 

After a number of years of diabetes, think how much more you can contribute to the nation’s economic success when you need a heart catheterization, stents, or bypass surgery, carotid artery surgery, stents in your femoral arteries, hemodialysis, and foot amputations? Your doctor is happy, high-fiving you for all the terrific fees you generate, the hospital adds your name to its mailing list to keep up-to-date on all its new services, while dietitians congratulate you on how well you adhere to their low-fat, grain-based advice. 

See how easy it is?

Is the Ketogenic Diet the cure for multiple diseases?

Health Impact News
Sat, 08 Jun 2013 21:37 CDT

The ketogenic diet was developed at John Hopkins hospital in the 1920s as a natural cure for epilepsy, when drugs failed. It is a high fat diet restricting carbohydrates. The diet fell out of favor during the anti-saturated fat campaign started in the U.S. and codified into official government dietary advice in the 1970s as a result of the McGovern Report. It is still official government dietary policy today, due to the influence of the vegetable oil industry which produces their products from the highly subsidized corn and soy bean crops. 

The Ketogenic Diet in some form or another has been labeled by many different names in recent times, and started gaining traction again with Dr. Atkins and the low-carb fad diets that became popular about 8 to 10 years ago. Today’s latest fad diet, the “paelo diet” is another example of a diet based on the ketogenic principles. 

This diet is not new, however, as it was seen as a therapeutic diet that produced better results than drugs in treating epilepsy way back in the 1920s. Today, the diet is being studied in the medical community with applications to all kinds of diseases. Of course, most of the medical interest in the diet is to try and develop a line of “ketone” drugs to mimic the diet. Ketones, which our body can produce during fasting or “starvation,” is an alternative energy source for those who are insulin resistant. Insulin resistance is increasingly being seen as a major cause of many diseases. 

When the Atkins diet gained media popularity several years ago, many critics complained that there were no long-term studies done on the diet. However, there are plenty of studies on the Ketogenic Diet and there has never been any negative effects recorded from long-term use. One study is here. Epidemiological studies on populations that eat high saturated fat diets also abound. So with no side effects from a natural diet, it is highly unlikely that any pharmaceutical products will see the same success the Ketogenic Diet is seeing today. 

The research that is starting to be published on the effectiveness of the Ketogenic Diet in curing disease is nothing less than amazing. This study below is a survey of the diet’s use in a variety of neurological diseases. 

The Ketogenic Diet as a Treatment Paradigm for Diverse Neurological Disorders 

Carl E. Stafstrom1,2 and Jong M. Rho3,4,

Front Pharmacol
. 2012; 3: 59. 

Abstract 

Dietary and metabolic therapies have been attempted in a wide variety of neurological diseases, including epilepsy, headache, neurotrauma, Alzheimer disease, Parkinson disease, sleep disorders, brain cancer, autism, pain, and multiple sclerosis. The impetus for using various diets to treat – or at least ameliorate symptoms of – these disorders stems from both a lack of effectiveness of pharmacological therapies, and also the intrinsic appeal of implementing a more “natural” treatment. The enormous spectrum of pathophysiological mechanisms underlying the aforementioned diseases would suggest a degree of complexity that cannot be impacted universally by any single dietary treatment. Yet, it is conceivable that alterations in certain dietary constituents could affect the course and impact the outcome of these brain disorders. Further, it is possible that a final common neurometabolic pathway might be influenced by a variety of dietary interventions. The most notable example of a dietary treatment with proven efficacy against a neurological condition is the high-fat, low-carbohydrate ketogenic diet (KD) used in patients with medically intractable epilepsy. While the mechanisms through which the KD works remain unclear, there is now compelling evidence that its efficacy is likely related to the normalization of aberrant energy metabolism. The concept that many neurological conditions are linked pathophysiologically to energy dysregulation could well provide a common research and experimental therapeutics platform, from which the course of several neurological diseases could be favorably influenced by dietary means. Here we provide an overview of studies using the KD in a wide panoply of neurologic disorders in which neuroprotection is an essential component. 

Introduction 

The ketogenic diet (KD) is now a proven therapy for drug-resistant epilepsy (Vining et al., 1998; Neal et al., 2008), and while the mechanisms underlying its anticonvulsant effects remain incompletely understood (Hartman et al., 2007; Bough and Stafstrom,2010; Rho and Stafstrom, 2011), there is mounting experimental evidence for its broad neuroprotective properties and in turn, emerging data supporting its use in multiple neurological disease states (Baranano and Hartman, 2008). Even in patients with medically refractory epilepsy who have remained seizure-free on the KD for 2 years or more, it is not uncommon for clinicians to observe that both anticonvulsant medications and the diet can be successfully discontinued without recrudescence of seizures (Freeman et al., 2007). This intriguing clinical observation forms the basis of the hypothesis that the KD may possess anti-epileptogenic properties. 

This review article explores the rationale for using the KD and related dietary treatments in neurological disorders outside of epilepsy, and summarizes the clinical experience to date. An underlying theme of such diet-based therapies is that nutrients and metabolic substrates can exert profound effects on neuronal plasticity, modifying neural circuits and cellular properties to enhance and normalize function. At a fundamental level, any disease in which the pathogenesis is influenced by abnormalities in cellular energy utilization – and this implies almost every known condition – would theoretically be amenable to the KD. It is important to acknowledge that much of the data discussed here are preliminary and anecdotal, and hence need to be validated by well-controlled prospective studies. Nevertheless, that diet and nutrition should influence brain function should not be altogether surprising, and there are already abundant clinical and laboratory data linking defects in energy metabolism to a wide variety of disease states (Waldbaum and Patel, 2010; Roth et al., 2011; Schiff et al., 2011). Thus, the potential for interesting and novel applications of the KD and related dietary therapies is almost limitless (Stafstrom, 2004). 

Neuroprotective Role of the KD 

Over the past decade, investigators have identified numerous mechanisms through which the KD may provide neuroprotective activity. While a comprehensive discussion of such mechanisms is beyond the scope of this chapter, a brief discussion is warranted as such actions are intimately related to disorders that share the common feature of progressive neurodegeneration and/or cellular bioenergetic dysfunction. The reader is referred to recent reviews for more details on this subject (Gasior et al.,2006; Acharya et al., 2008; Masino and Geiger, 2008). 

Two hallmark features of KD treatment are the rise in ketone body production by the liver and a reduction in blood glucose levels. The elevation of ketones is largely a consequence of fatty acid oxidation. Specific polyunsaturated fatty acids (PUFAs) such as arachidonic acid, docosahexaenoic acid, and eicosapentaenoic acid, might themselves regulate neuronal membrane excitability by blocking voltage-gated sodium and calcium channels (Voskuyl and Vreugdenhil, 2001), reducing inflammation through activation of peroxisome proliferator-activated receptors (PPARs; Cullingford, 2008; Jeong et al., 2011), or inducing expression of mitochondrial uncoupling proteins which reduce reactive oxygen species (ROS) production (Bough et al., 2006; Kim do and Rho, 2008). Ketone bodies themselves have been shown to possess neuroprotective properties, by raising ATP levels and reducing ROS production through enhanced NADH oxidation and inhibition of mitochondrial permeability transition (mPT; Kim do et al., 2007). Along similar lines of improved bioenergetics, the KD has been shown to stimulate mitochondrial biogenesis, resulting in stabilized synaptic function (Bough et al., 2006). 

The second major biochemical feature of the KD is the decrease in glycolytic flux. Reduction of glycolysis is an essential feature of calorie restriction, which has been shown to suppress seizures (Greene et al., 2001) as well as prolong the lifespan of numerous species, including primates (Kemnitz, 2011; Redman and Ravussin, 2011). While the link between calorie restriction and KD mechanisms remain controversial (Yamada, 2008; Maalouf et al., 2009), it is clear that both treatments result in reduction of blood glucose, likely involving reduced glycolytic flux. In that regard, 2-deoxy-d-glucose (2DG), an analog of glucose that blocks phosphoglucose isomerase and hence inhibits glycolysis, has been shown to block epileptogenesis in the rat kindling model by decreasing the expression of brain-derived neurotrophic factor (BDNF) and its principal receptor, tyrosine kinase B (TrkB; Garriga-Canut et al., 2006). Several other important mechanisms contribute to the neuroprotective consequences of calorie restriction, including improved mitochondrial function and decreased oxidative stress (similar to that seen with ketones and PUFAs), decreased activity of pro-apoptotic factors, and inhibition of inflammatory mediators such as interleukins and tumor necrosis factor alpha (TNFα; Maalouf et al., 2009). 

In the end, there are likely many other mechanisms that could contribute to the neuroprotective properties of the KD. Many of these mechanisms are thought to relate principally to the KD’s anticonvulsant effects, but some if not all of them could contribute to cellular homeostasis and preventing neuronal injury or dysfunction. An important caveat, however, is that yet unidentified mechanisms may operate in diseases outside of epilepsy, and this possibility presents further opportunities for examining the pleiotropic effects of this metabolism-based therapy at a mechanistic level. 

The KD in Epilepsy 

There is no longer any doubt that the KD is effective in ameliorating seizures in patients, especially children, with medically refractory epilepsy (Vining, 1999; Neal et al., 2008; Freeman et al., 2009). After its introduction in 1920, the KD was used as a first or second-line treatment for severe childhood epilepsy. With the introduction of anticonvulsant medications in convenient pill form, the use of the KD waned, only to resurge later in the early 1990s, due largely to the efforts of concerned parents who brought the diet back to greater public awareness (Wheless, 2008). Recent years have witnessed a remarkable surge in research on the KD, including basic science efforts as well as clinical protocols and trials (Kim do and Rho, 2008; Neal et al.,2008; Kessler et al., 2011). The KD has now become an integral part of the armamentarium of most major epilepsy centers throughout the world (Kossoff and McGrogan, 2005). 

The KD in Aging 

Aging involves the gradual decrease in function, and at times outright degeneration, of neurons and neural circuits. It is possible that by altering energy metabolism with the KD, rates of degeneration of certain neural structures and functions might be slowed (Balietti et al., 2010a). However, KDs may induce differential morphological effects in structures such as the hippocampus, perhaps as a consequence of region-specific neuronal vulnerability during the late aging process (Balietti et al., 2008). Specifically, it has been shown that the medium-chain triglyceride (MCT) form of the KD may induce detrimental synaptic changes in CA1 stratum moleculare, but beneficial effects in the outer molecular layer of the dentate gyrus (Balietti et al., 2008). In MCT-fed aged rats compared to aged rats receiving a normal diet, mitochondrial density and function in cerebellar Purkinje cells were significantly increased, suggesting that the KD can rescue age-related mitochondrial dysfunction (Balietti et al.,2010b). These observations imply certain risks, but also potential benefits of the KD for the aging brain. However, the fact that the KD reduces oxidative stress and its downstream consequences provides a reasonable rationale for considering this type of treatment to retard the adverse consequences during aging (Freemantle et al., 2009). As an example, T-maze and object recognition performance were improved in aged rats by KD administration, suggesting a potential functional benefit in cognition (Xu et al., 2010). Finally, it should be noted that because of its similarities to calorie restriction (as noted above), the KD is likely to involve other neuroprotective mechanisms that could ameliorate pathological aging – especially when occurring in the context of neurodegeneration (Contestabile, 2009). 

The KD in Alzheimer Disease 

There is growing realization that neuronal excitability is enhanced in patients with Alzheimer disease (AD; Noebels, 2011; Roberson et al., 2011). While the essential pathological processes of AD involves neuronal degeneration with accumulation of abnormal cellular products such as fibrillary plaques and tangles, recent evidence points to alterations in the function of extant neural circuits and mitochondrial homeostasis (Kapogiannis and Mattson, 2011). This view is bolstered by the higher incidence of seizures in patients with AD as compared to the unaffected population (Palop and Mucke, 2009). Therefore, there is a rationale for hypothesizing that the KD might have a beneficial role in patients with AD (Balietti et al., 2010a), in addition to the potential benefits to the aging process as noted above. One should note, importantly, that if ketone bodies are indeed the primary mediators that counter aging and neurodegeneration in AD, implementation of the KD should be tempered by known age-related differences in the production and extraction of ketones (i.e., this is more efficient in young animals), as well as age-specific regional differences in ketone utilization within the brain (Nehlig, 1999). 

Clinical studies to date have been equivocal but promising. A randomized double-blind, placebo-controlled trial of a MCT KD resulted in significantly improved cognitive functioning in APOε4-negative patients with AD but not in patients with a APOε4 mutation (Henderson et al., 2009). In this study, the primary cognitive end-points measured were the mean change from baseline in the AD Assessment Scale-Cognitive subscale, and global scores in the AD Cooperative Study – Clinical Global Impression of Change (Henderson et al., 2009). This significant clinical improvement was considered to be secondary to improved mitochondrial function, since ketone bodies (specifically, beta-hydroxybutyrate or BHB) have been shown to protect against the toxic effects of β-amyloid on neurons in culture (Kashiwaya et al., 2000). Alternatively, the KD may actually decrease amounts of β-amyloid deposition (VanderAuwera et al., 2005). Interestingly, other diets such as the Mediterranean diet are showing some promise in AD (Gu et al., 2010), possibly through a reduction in systemic inflammation and improved metabolic profiles. 

Recent studies have shown a closer linkage of AD to epilepsy. For example, animal models of AD exhibit neuronal hyperexcitability and enhanced propensity to seizures (Palop et al., 2007; Roberson et al., 2011); these models may ultimately allow for detailed analyses of both cognitive and anticonvulsant effects of the KD or other dietary manipulations such as calorie restriction. Transgenic AD mice fed 2DG demonstrated better mitochondrial function, less oxidative stress, and reduced expression of amyloid precursor protein and β-amyloid compared to control animals (Yao et al., 2011). 

Another pathophysiological mechanism hypothesized to operate in AD ties together altered mitochondrial function and glucose metabolism, i.e., accumulation of advanced glycation endproducts (AGE; Srikanth et al., 2011). AGE accumulation is a process of normal aging that is accelerated in AD; proteins are non-enzymatically glycosylated and this cross-linking of proteins accentuates their dysfunction. One proposed mechanism is increased ROS and free radical formation, which, as discussed above, hampers mitochondrial function. The intriguing possibility that AGE inhibitors (e.g., aminoguanidine, tenilsetam, carnosine) could act in concert with the KD or antioxidants in retarding AD progression remains speculative at this time. 

Thus, there is growing evidence that the KD may be an effective treatment for AD through a variety of metabolism-induced mechanisms that reduce oxidative stress and neuroinflammation, and enhance bioenergetic profiles – largely through enhanced mitochondrial functioning. However, caution should be exercised in extrapolating findings in animals to humans, as discrepancies in terms of both clinical efficacy and untoward side-effects have been noted. For example, adverse reactions to calorie restriction have been reported in some rodent models (Maalouf et al., 2009), and in hippocampus, abnormal morphological synaptic changes have been observed in CA1 stratum moleculare (Balietti et al., 2008). 

The KD in Parkinson Disease 

The primary pathophysiology in Parkinson disease (PD) is excitotoxic degeneration of dopaminergic neurons in the substantia nigra, leading to abnormalities of movement, and to an increasing extent, in cognition and other cortical functions. How could the KD benefit patients with PD? Based on the recognition that ketone bodies may bypass defects in mitochondrial complex I activity that have been implicated in PD, a small clinical study demonstrated that 5 of 7 affected patients showed improved scores on a standard PD rating scale (Vanitallie et al., 2005); however, given the small sample size, a placebo effect cannot be ruled out. In animal models of PD produced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), BHB administration ameliorated the mitochondrial respiratory chain damage that ordinarily results from that toxin (Kashiwaya et al., 2000). Additional evidence supporting the potential benefits of ketone bodies in PD is provided by in vitro experiments demonstrating the protective effects of these substrates against mitochondrial respiratory chain dysfunction induced exogenously by complex I and II inhibitors rotenone and 3-nitropropionic acid, respectively (Kim do et al., 2010), and even anti-inflammatory actions of the KD on MPTP-induced neurotoxicity (Yang and Cheng, 2010). It would be of interest to determine whether commercially available treatments that augment ketonemia – e.g., the MCT-based formulation used in a recent Alzheimer’s clinical trial (Henderson et al., 2009) – might benefit patients with PD. 

The KD in Amyotrophic Lateral Sclerosis 

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive disease due to degeneration of motor neurons of the cortex and anterior horn of the spinal cord. As a consequence, voluntary motor activity gradually deteriorates, leaving the affected individual profoundly weak despite largely retained cognitive functioning. The essential pathophysiological mechanisms that underlie this relentless disorder are yet to be fully elucidated, but similar to other neurodegenerative disorders, the involvement of energy-producing systems likely play a role and mitochondrial dysfunction probably contributes to disease pathogenesis. In this regard, the KD may be a promising adjunctive treatment for this devastating disease (Siva, 2006), as evidenced in a mouse model of ALS, produced by knocking out the gene encoding the copper/zinc superoxide dismutase SOD1-G93A, causing progressive muscle weakness and death by respiratory failure. Administration of a KD to these mutant mice led to both histological (higher motor neuron counts) and functional improvements (preserved motor function on the rotorod test) compared to non-KD fed animals (Zhao et al., 2006). However, the KD did not extend survival time compared to non-KD fed control mice. Mitochondria from these mutant mice demonstrated increased ATP synthesis, countering the inhibition of complex I of the electron transport chain. It is important to note that approximately 20% of the familial cases of ALS have SOD1 mutations, and hence the possibility arises that the KD may be of benefit to patients with ALS. 

One potentially important consideration in this regard – applicable to all neurodegenerative diseases – is determining whether timing of intervention is crucial for a protective effect by KD treatment. Neurological disorders in late stages of progression may have such extreme neuronal dysfunction and death to allow a “re-fueling” with metabolic substrates to help recover integrity and function. Certainly, this appears to be the case in a small pilot study of KD treatment in patients with Lafora body disease (Cardinali et al., 2006). 

The Kd in Cancer 

Cells that exhibit the most active metabolic rates (i.e., cancer cells) are most sensitive to the lack of metabolic energy to fuel their activity, a well-recognized biochemical phenomenon known as the Warburg effect. Theoretically, depriving rapidly dividing, highly metabolic cancer cells of their usual fuel supply, e.g., glucose (by use of the KD or 2DG), could be clinically therapeutic (Aft et al., 2002; Pelicano et al., 2006; Otto et al., 2008). Despite this well documented cellular observation, the KD has only recently been considered as a clinical treatment in the oncology field. 

Pioneering work by Seyfried et al. (2011) over the past decade has shown that animals with experimentally produced brain tumors placed on a KD exhibit markedly decreased tumor growth rates, and these remarkable effects appear to be a consequence of calorie restriction (i.e., reduced blood glucose levels) rather than KD-induced ketosis (i.e., fatty acid oxidation) as the principal mechanism. Other investigators have found similar effects of the KD in animal models. One group found that the KD reduces ROS production in malignant glioma cells, and gene microarray expression profiling demonstrated that the KD induces an overall reversion to patterns seen in non-tumor specimens and a reduction in the expression of genes encoding signal transduction pathways and growth factors known to be involved in glioma growth (Stafford et al., 2010). It is also interesting to note that PPARα-activated by nutrients such as fatty acids – is now a target for developing anti-cancer drugs that target mitochondrial metabolism (Grabacka et al., 2010). 

While clinical validation of this phenomenon is not yet forthcoming, there are several case reports suggesting that the KD may be efficacious in humans with brain tumors. Nebeling et al. (1995) reported beneficial effects of an MCT-based diet in two pediatric patients with advanced stage malignant astrocytomas. More recently, Zuccoli et al. (2010) described a case study of an elderly woman with glioblastoma multiforme who was treated with standard radiotherapy plus concomitant temozolomide therapy together with a calorie-restricted KD, and a complete absence of brain tumor tissue was noted on FDT – PET and MRI imaging after 2months of treatment – results the authors attributed in part to the adjunctive dietary treatment. Further, in a pilot trial of the KD in 16 patients with advanced metastatic tumors, six individuals reported improved emotional functioning and less insomnia, indicating that in some instances, the KD may lead to improved quality of life (Schmidt et al., 2011). In contrast, a retrospective examination of five patients with tuberous sclerosis complex treated with the KD indicated either a lack of tumor suppression or further tumor growth (Chu-Shore et al., 2010). Thus, it may be that distinct tumor types within different organ systems may respond differently to the KD or other dietary treatments and that such differences may reflect variations in the metabolic vulnerability of specific tumor types, perhaps through intrinsic differences in the expression of metabolism-related genes (Stafford et al., 2010). 

The KD in Stroke 

To date, no clinical trials of the KD have been performed in patients with stroke, but several animal studies of hypoxia-ischemia support the potential beneficial effect of the diet. Most of these models entail pre-treatment with the KD (or with BHB), resulting in decreased structural and functional damage from the stroke. For example, Tai et al. (2008) utilized a cardiac arrest model in rats and found significantly reduced Fluoro-Jade staining in animals that underwent 25 days of pre-treatment with the KD. These investigators later determined that these effects were not due to involvement of plasmalemmal ATP-sensitive potassium channels (Tai et al., 2009), which have been implicated in ketone body action (Ma et al., 2007). Other researchers have hypothesized that the neuroprotective properties of ketone bodies might be related to up-regulation of hypoxia inducible factor (HIF1-α) which is important in angiogenesis and anti-apoptotic activity (Puchowicz et al., 2008). In that study, pre-treatment with BHB (via intraventricular infusion, followed by middle cerebral artery occlusion) led to significant increases in brain succinate content, as well as elevations in HIF1-α and Bcl-2, an anti-apoptotic protein. To be clinically meaningful, of course, a positive effect must be demonstrable after, and not before, an ischemic event. Nevertheless, such studies imply that biochemical alterations that favor energy metabolism would be protective against acute forms of severe brain injury. 

The KD in Mitochondrial Disorders 

As mentioned above, given the growing evidence that the KD enhances mitochondrial functioning and biogenesis (Bough et al.,2006; Maalouf et al., 2009; Kim do et al., 2010), it is logical to ask whether patients with known mitochondrial cytopathies might derive a benefit from the KD and/or ketone bodies such as BHB. At the same time, it must be considered that inherent mitochondrial dysfunction might predispose individuals to adverse toxicities from high fatty acid loads that could overwhelm β-oxidation within the mitochondrial matrix. Experimental data described above attest to significant improvements in mitochondrial function, and many lines of evidence point to the rationale of therapeutically targeting mitochondrial bioenergetics for other disease states (Wallace et al., 2010), but is there any clinical evidence in patients with intrinsic mitochondrial disorders? Kang et al. (2007) reported that the KD was both safe and effective in 14 pediatric patients with established mitochondrial defects in complexes I, II, and IV, all of whom had medically intractable epilepsy. These authors observed that half of these patients became seizure-free on the KD, and only four patients failed to respond. Hence, these preliminary data suggest that the KD is not necessarily contraindicated in patients with mitochondrial respiratory chain abnormalities. However, KD treatment is not recommended in individuals with primary carnitine deficiencies [including mutations in carnitine palmitoyl transferase (CPT) I or II and mitochondrial translocase] and fatty acid β-oxidation abnormalities (e.g., medium-chain acyl dehydrogenase deficiency; Kossoff et al., 2009). Thus, it is critical to determine the specific mitochondrial defect when considering treatment with the KD, to avert clinical deterioration. 

The KD in Brain Trauma 

Unfortunately, the incidence of brain injury is increasing in both civilian and military contexts. Brain injury, either due to a penetrating injury or to blunt/blast trauma, can lead to severe cognitive and motor consequences. Further, the occurrence of epilepsy months to years following brain trauma adds to the morbidity of affected individuals, and speaks to the emergence of hyperexcitable neuronal circuits over time. Hence, in light of the clinical problem of post-traumatic epileptogenesis and the fact that the KD can reduce seizure activity, the notion has emerged that dietary therapy might ameliorate brain injury and possibly, long-term consequences such as epilepsy. 

Several recent animal studies support this idea, and investigators have principally focused on ketone bodies (Prins, 2008a). Using a controlled cortical impact (CCI) injury model, Prins et al. (2005) showed that pre-treatment with a KD significantly reduced cortical contusion volume in an age-related manner that correlated with maturation-dependent differences in cerebral metabolism and ketone utilization. Later, they showed that cognitive and motor functioning was also improved with KD treatment (Appelberg et al., 2009). Further, using a weight drop model, Hu et al. (2009) showed that the KD pre-treatment reduced Bcl-2 (also known as Bax) mRNA and protein levels 72h after trauma, indicating that apoptotic neurodegeneration could be prevented with this diet. Consistent with these observations, it was found that fasting – which shares the key feature of ketosis with the KD – led to significant tissue sparing in brain following CCI injury, and that again ketosis (with improved mitochondrial functioning) rather than the relative hypoglycemia seen with fasting was the important determinant of neuroprotection (Davis et al., 2008). 

With respect to anti-epileptogenesis following head injury, the data regarding KD effects are mixed. KD treatment – either before or after fluid percussion injury in rats – did not alter later seizure sensitivity to fluorothyl, even though the degree of hippocampal cell loss was reduced by pre- but not post-treatment (Schwartzkroin et al., 2010). Similarly, in the lithium – pilocarpine model of temporal lobe epilepsy, KD treatment prior to induction led to morphological neuroprotection in the hippocampus but did not affect latency to onset of spontaneous recurrent seizures (Linard et al., 2010). In contrast, Jiang et al. (2012) recently reported that the KD increased after-discharge thresholds and reduced generalized seizure occurrence in a rat amygdala kindling model. Thus, at this juncture, there is no consensus regarding whether the KD is anti-epileptogenic following a variety of traumatic insults and manipulations. However, given the recent finding that the KD inhibits the mammalian target of rapamycin (mTOR) pathway (McDaniel et al., 2011), which has been linked to modulation of epileptogenesis (McDaniel and Wong, 2011), further studies in different animal models are clearly warranted. What is unambiguous, nevertheless, is the age-dependence of the effects of the KD in ameliorating the consequences of head injury (Prins, 2008b; Deng-Bryant et al., 2011). 

The KD in Psychiatric Disorders (Depression) 

Mood stabilizing properties of the KD have been hypothesized (El-Mallakh and Paskitti, 2001), but no clinical studies have been conducted as of this writing. The potential role of the KD in depression has been studied in the forced choice model of depression in rats, which led to a beneficial effect similar to that afforded by conventional antidepressants (Murphy et al., 2004; Murphy and Burnham, 2006). 

The KD in Autism 

Autism is a neurodevelopmental disorder that affects language development and social function. The heterogeneous etiologies leading to autism spectrum disorders, plus the uncertainty about what causes autism in the majority of “idiopathic” cases, has hampered the development of a universally beneficial treatment, aside from symptomatic treatment of autism-related behaviors such as aggression or anxiety. Now, limited clinical evidence raises the intriguing possibility that the KD might be helpful to alleviate some of the abnormal behaviors seen in children with autism spectrum disorders. Using a KD variant consisting of MCT, 10 of 18 autistic children demonstrated moderate or significant behavioral improvement (by a blinded rater) after a 6-month trial of providing the diet for 4weeks of KD diet treatment alternating with 2weeks of normal diet, in 6-week cycles (Evangeliou et al., 2003). This study was carried out on the island of Crete, where the frequency of autism is high but the possibility of genetic inbreeding is also significant. Therefore, these findings need to be interpreted cautiously and larger longitudinal studies are needed. The potential involvement of adenosine, an endogenous neuromodulator and anticonvulsant, in ameliorating autistic behaviors raises the possibility of overlap with KD mechanisms (Masino et al., 2011). As a caveat, many children with autism poorly tolerate changes in dietary and other routines, which could impact implementation of dietary therapies, which require strict adherence. 

The KD in Migraine 

Migraine is a paroxysmal neurological disorder having considerable clinical phenotypic overlap with epilepsy (Rogawski, 2008). Although the intrinsic mechanisms underlying seizures and migraine attacks differ in many fundamental respects, there are theoretical reasons to consider the KD for chronic migraine. Both disorders involve paroxysmal excitability changes in the brain, and there is considerable overlap in the array of pharmacological agents used to treat these conditions. Although it might seem unlikely that an individual with migraine would undertake such a complicated dietary regimen as the KD, in light of suboptimal alternatives, this choice is worthy of consideration, particularly in the medically refractory population (Maggioni et al., 2011). 

Interestingly, the first report of using the KD for migraine came in 1928, only a few years after the diet’s first use for epilepsy (Schnabel, 1928). Nine of 28 patients reported “some improvement,” although the validity of this clinical study is uncertain and some patients admitted poor compliance. Compliance might be better with the less restrictive modified Atkins diet, which has also shown promise for migraine treatment (Kossoff et al., 2010). Other case reports exist but there are no large clinical series or trials. Notwithstanding this limitation, laboratory investigations have found that both short-term and long-term treatment with either MCT or long-chain triglyceride forms of the KD resulted in a significant reduction in the velocity of cortical spreading depression (CSD) velocity in immature rats (de Almeida Rabello Oliveira et al., 2008). Another intriguing aspect of this study was the observation that triheptanoin – an anaplerotic substrate that enhances tricarboxylic acid cycle function – had a notable effect in retarding CSD, consistent with a later report that triheptanoin supplementation raised pentylenetetrazol tonic seizure threshold and delayed the development of corneal kindled seizures (Willis et al., 2010). 

Summary 

Despite the relative lack of clinical data, there is an emerging literature supporting the broad use of the KD (and its variants) against a variety of neurological conditions. These preliminary studies are largely based on the fundamental idea that metabolic shifts may lead to neuroprotective actions (Gasior et al., 2006; Maalouf et al., 2009). How can a simple dietary change lead to improvement in disorders with such a huge span of pathophysiological mechanisms? Alterations in energy metabolism appear to be a common theme. So while the mechanisms through which the KD exerts such effects are likely diverse (Maalouf et al.,2009; Rho and Stafstrom, 2011), there may indeed be one or more common final pathways that are mechanistically shared. Ultimately, the details of how that altered metabolism reduces neuronal excitability, abrogates ongoing neurodegeneration, or mitigates functional disability remain unknown. Herein lay rich opportunities for further investigation, in both the laboratory and the clinic, in the broad realm of translational neurosciences. 

Conflict of Interest Statement 

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. 

Read the full study here 

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Diabetes Blood-Glucose Level Lowered 6% With Two Teaspoons of Household Item

Controlling glucose levels for people who have type 2 diabetes or have a hard time with their waking glucose counts might be as easy to fix as a 30-second organic solution at bedtime.

And, in contrast to expensive pharmaceuticals your doctor might prescribe, this solution is found in the aisles of practically every grocery store in the world- and is inexpensive.

For many years, the benefits of adding apple cider vinegar to mealtimes for diabetics has been shown in countless studies, but a different timing of ingestion was recently studied by Researchers at Arizona State University.

Instead of looking at the effects of vinegar on glucose levels after it had been included at mealtime, they wanted to see if there would be an effect when 2 tablespoons were taken at bedtime.

Measuring glucose levels of participants who were not taking insulin therapy at the time of the study, the scientists were able to show that taking apple cider vinegar at bedtime had a noticeable effect on waking blood glucose levels.

In fact, the participants in the study showed an average improvement of more than 6% in waking levels after just 2 days.

Participants took the vinegar with an ounce of cheese at bedtime, but changed nothing else about their diets. The control group that ate the cheese and only had water, not vinegar, showed no improvement.

Good way to consume apple cider vinegar is to add 2 tablespoons in half a glass (full glass if you dislike the taste) of water. Many health experts also claim that apple cider vinegar with ‘mother’ (not filtered as much) is better.

Type 2 Diabetes Completely Reversed Using ONE Vitamin

A new study out of America’s Heartland has shown that by simply increasing the intake of ONE needed vitamin, type 2 diabetes can be reversed without having to resort to dangerous prescription drugs.

Researchers out of the University of Missouri were even more surprised at the findings when they discovered this vitamin worked just as well for participants who were overweight and obese and didn’t lose weight.

So what is this powerful vitamin?

The research team found encouraging evidence to suggest that even when body weight and Body Mass Index are unchanged, simply adding vitamin D supplement to the diet can not only prevent type 2 diabetes from developing, but it also can reverse it if it has already appeared.

Looking at blood levels of vitamin D in participants, the team found that people who are overweight and obese tend to have deficiencies in this very critical vitamin. Adding it as a simple supplement was shown in the study to be critical in reversing type 2 diabetes, even when weight was unchanged.

For many patients, conventional treatment has always pointed to weight loss as the key factor in reversing or preventing the disease, but that never took into account the people who are of normal weight or those who are underweight who still develop diabetes.

While cutting weight for those who are obese is a good idea for many other health reasons, the University of Missouri study highlights the need to focus on nutrient supplementation as a critical first step in treatment, instead of running straight to the prescription pad.

This is more proof that type 2 diabetes can be completely cured without medications and even without losing weight

Salt, sugar, and fat: Why we can’t quit junk food’s holy trinity

Claire Thompson
Grist
Thu, 21 Mar 2013 14:55 CDT

Veteran New York Times journalist Michael Moss entered the world of food reporting when he covered a salmonella outbreak in a Georgia peanut factory, a story he came to see as being about “loss of control by the food industry.” He followed up on that theme with an investigation of E. coli-tainted Cargill hamburger, which earned him a Pulitzer Prize in 2010. Around that time, he says, a close source told him, “As bad as these contamination incidents are, there’s this other public-health crisis out there that’s caused by the stuff we intentionally put it into processed foods, and have absolute control over.” Meaning, of course, salt, sugar, and fat – the “holy trinity” of processed-food ingredients, and the namesake of Moss’ new book. 

Salt Sugar Fat: How the Food Giants Hooked Us traces how these ingredients worked their way into our food in ever-larger amounts, not by accident but as part of a concerted effort by food companies to make their products as irresistible and addictive as possible. Moss profiles the food scientists whom corporations like Kellogg and Kraft pay to formulate exact combinations of ingredients that target consumers’ “bliss point”: where food is as tasty as possible without being so satisfying that we stop wanting more. Think junk food like Cheez-Its, movie-theater popcorn, and Oreos: You can kill a whole bag of the stuff without even noticing. 

Moss reveals how fundamental these ingredients have become to the processed-food industry’s entire model: how sugar intensifies our cravings; how fat and sugar work together to make products vastly more tasty than either ingredient could alone; how fat plays up a given food’s most desirable traits (such as smooth texture) while masking others (like the acidity of sour cream), and how salt smothers the chemical tinge that would otherwise make most junk food inedible. Salt, sugar, and fat also make possible the long shelf life and easy preparation that inspired the term “convenience food” and sold it to a new generation of working moms. 

We got a chance to chat with Moss when he stopped by the Grist office last week. Here are some highlights from our conversation. (Interview has been condensed and edited.) 

Q. Salt Sugar Fat reveals parallels between the food industry and tobacco industry’s efforts to get us hooked on their products – not just through creative marketing, but by focusing on the way our bodies react to key ingredients. Does this mean we could legally go after food companies in the same way? 

A. The processed-food industry is entirely confident it can withstand tobacco-type litigation. I think their confidence comes from the difference between tobacco and food, inherently, and the difficulty that a lawyer would have blaming any one company or any one product for the obesity crisis or diabetes

That said, there’s certainly nothing stopping the states from going after processed food collectively, because the estimates are that obesity is causing as much as $300 billion in extra medical expenses and lost productivity every year. So it’s probably a [bigger] issue financially for the health system than even tobacco. 

What really struck me in reporting the book was how the tobacco industry plays another role. Philip Morris, the largest tobacco company, became the largest food manufacturer in North America, by buying first General Foods and then Kraft. Starting in the late ’90s, Philip Morris kind of gets religion on tobacco – it’s under increasing regulatory pressure, it starts worrying that it’s losing the public trust, it’s constantly polling consumers, and its reputation is plummeting. It becomes the first tobacco company to embrace government regulation as a way of avoiding complete disaster. So they turn to their food division, and said to them, you guys are going to face as great, if not a greater, problem with salt, sugar, and fat as we are with nicotine and tobacco. You’ve got to start doing something to reexamine your dependence on [those ingredients]. 

I found it really startling that tobacco would be the entity warning the food companies about obesity. 

Q. In the book, you emphasize how hooked the food companies themselves are on salt, sugar, and fat. How much of a barrier is that dependence to efforts to change the industry from within? 

A. The industry makes a convincing argument that it never wanted to make us obese or otherwise ill. The problem lies in their collective zeal to do what companies do, which is make as much money as possible by selling as much product as possible, and on their dependence on these three ingredients to make their products ultra-convenient, ultra-low-cost, as well as utterly, irresistibly tasty. These three ingredients to them are miracle ingredients. Sugar, for example, will allow long shelf time, and will also add bulk and color to cookies and donuts and breads. Salt is perhaps the most magical of all three. It’s really cheap – 10 cents a pound – and it allows them to avoid using more costly ingredients like fresh herbs and spices. And salt masks some of these awful tastes that are inherent to processed foods. Meat, for example: They have to cook it once, and then they’ll put it in the box or the can, and when you reheat it, it emits what’s called warm-over flavor. Food scientists describe the taste as being like wet dog hair, maybe a little cardboard, too. Salt acts as a masking agent for all that. 

All of this [became] really clear to me when Kellogg invited me to taste special versions of their icons that they had prepared without salt. We started with Cheez-It crackers, which normally I could eat day in and day out, but without salt they were just god awful. They stuck to the roofs of our mouths. Then we went to the frozen waffles, popped them in the toaster, and they came out looking and tasting like straw. And then the clincher was the cereal. We put it in the bowl, added milk, and before I could say anything, the company spokeswoman [who also tasted the cereal] gets this look of horror on her face and she goes, “Metal. I taste metal. M-E-T-A-L.” 

Q. That begs the question, then, whether these companies can make their food healthier without changing their entire product lines and business model. What does that say about how much power we as consumers have? 

A. Certainly in my life, I’m not seeing an ability to get away from processed foods. My wife works outside the home and I have two young boys. Our strategy is more to gain control over these foods rather than avoid them. My wife recently said, “Look, guys, let’s try to limit ourselves to cereal that has five grams or less sugar per serving.” When you engage them that way, now when we go shopping, it’s a bit of an Easter egg hunt for them. They’ll grab the box and look on the label and look for five grams or less. 

They’ll have to reach low on the shelf, or I’ll have to reach high, because strategically, the less sugary cereals are put out of eyesight. The industry’s done research – they put devices on people’s heads to measure their eye movements – and they know that when you hit the aisle, your eyes go right to the middle part of the aisle, at eye level. So if you’re looking for plain oatmeal, it’s likely going to be either way up or down, toward the ends of the aisles, where you’re less apt to see it. 

Q. Couldn’t they just put all the healthy food in the middle of the aisle, then? Do unprocessed foods just need better advertising? 

A. Another problem in the grocery store is the processed foods are so much cheaper than the fruits and vegetables. The White House is looking at not necessarily taxing the processed food or its main ingredients, but shifting subsidies that already exist that benefit processed foods over to the fruits and vegetables – as a way of avoiding the nanny-state label that Mayor Bloomberg of New York doesn’t mind getting hit with. 

[Former Philip Morris CEO Geoffrey Bible said to me], I’m no friend of government regulation, but what you’re seeing with the food industry is that anytime one of these companies tries to do the right thing individually, the competitors swoop in. He said in this case, it’s pretty clear that unless the industry can get together – which I don’t think is going to happen – regulation may make sense, if only to give them cover from Wall Street. That’s one of the huge forces here. 

When you’re inside these companies, they’re not evil, they’re just doing their jobs as best as they possibly can. 

Q. What has industry reaction to the book been like? 

A. It’s been pretty quiet. I’d like to think it’s because the reporting is fair and balanced and it’s already incorporated all of [the food companies’] main arguments. The notion that they themselves are dependent on [salt, sugar, and fat], they saw as a defense, but in fact it sort of turns on them when you put it into the right context. 

Knock on wood. They may be sitting right now and plotting.

Your brain on fructose

Emily Deans, MD

Primal Docs
Sat, 09 Mar 2013 11:40 CST
 
Right on the heels of the little case study I wrote about last time came a paper in JAMA that made a bit of a splash in the news: Effects of Fructose vs Glucose on Regional Cerebral Blood Flow in Brain Regions Involved With Appetite and Reward Pathways

I know. Sounds like a nail-biter. 

The paper is a Tale of Two Sugars, glucose and fructose. Fructose is somewhat sweeter than glucose, and it is metabolized differently (as those in the paleosphere are no doubt agonizingly aware). Fructose, for example, only causes slight bumps in insulin, which is known to work in the central nervous system to increase the satiety and decrease the reward value of food. Compared to glucose, fructose also doesn’t increase a satiety hormone glucagon-like polypeptide 1, and fructose doesn’t decrease levels of ghrelin, an appetite stimulating hormone. 

Let’s translate into something simple rather than paperspeak: 

Glucose: Increases insulin, increases GLP-1, decreases ghrelin: all of which increase satiety and decrease reward seeking behavior. 

Fructose: Barely increases insulin, doesn’t increase GLP-1, and doesn’t decrease ghrelin, so after ingestion you will presumably still be hungry and looking for the next bag of skittles. 

In rats, if you inject fructose into the brain, it stimulates food-seeking behavior. If you inject glucose into the brain, rats decrease their food intake. Please do not inject fructose or glucose into your brain. And while that rat factoid is certainly interesting, I’m hoping that when you drink a vat of agave nectar*, much of the fructose doesn’t get past the liver anyway, as it is pretty oxidizing and toxic in the bloodstream. 

In human and rat brains, appetite is controlled in the hypothalamus. Sleep kinda lives there too. It’s also part of the HPA axis that makes up our stress response. And the researchers hypothesized that if fructose stimulates appetite more than glucose, it will increase blood flow in the hypothalamus and other reward areas of the brain. They rustled up some humans and stuck them in a functional MRI to measure brain blood flow, and out came some data. 

20 normal weight, non-diabetic “healthy” volunteers were used, 10 men and 10 women, average age 31.The women were all scanned during the follicular phase of their menstrual cycle. Each volunteer was scanned and blood samples were taken after an overnight fast. Then they drank a glucose and (on a separate day) a fructose sweetened drink and were scanned again after 60 minutes. The order of drinks was blinded and randomized. The drinks are described as 75g** of sweetener, plus cherry flavored water. Participants were asked to rate fullness, and serum levels of glucose, appetite hormones, insulin, etc. were measured at 10 minute intervals after injestion through the scanning. Serum levels of fructose were also examined, to see how much got past the liver. 

In a complimentary rodent experiment, they gave rats fructose IV and then measured the amounts of fructose that were in the brain to see if some made it through the blood brain barrier. Interesting. 

The results! Well, hypothalamic blood flow tended to decrease after ingestion of glucose (within 15 minutes) ingestionwheras it did not with fructose. At all time points, blood flow in the hypothalamus was decreased after glucose compared to fructose drinks (presumably meaning that appetite was decreased after the glucose ingestion but not decreased with fructose ingestion). Glucose also decreased activity in the brain’s striatum, which fructose did not. Predictably, both plasma glucose and insulin increased with glucose ingestion, whereas there was very little increase with fructose ingestion. 

Plasma fructose in humans did increase after fructose ingestion compared to glucose (scary, and, duh), but levels of ghrelin and leptin were not different in the two groups. Another hormone, PYY, and then lactate was higher in the fructose drinkers. The glucose drinkers felt less hungry and more sated after drinking, whereas fructose drinkers still felt somewhat hungry and not quite as satisfied after the drink. 

In the rodent study, fructose in the plasma did translate to an increase in fructose in the brain (compared to a saline IV), and they found that the RNA for fructose transporters (GLUT5) were expressed in the hypothalamus, liver, and kidney. 

So, for a small study, rather interesting. Big difference in straight up fructose vs. glucose in how the brain and appetite centers react, and one would tend to think from the results that glucose decreases appetite and reduces food-seeking behaviors, whereas fructose doesn’t really fill you up. Of course, no one drinks straight fructose unless you are glopping agave nectar into your tea, and it would have been interesting to see what the soda version of HFCS (from memory, I think it is 55% fructose, 42% glucose) did compared to straight-up glucose. And fizzy (hard to blind that one)! And cherry-flavored! Someone get me some healthy volunteers and an enormously expensive functional MRI machine! 

*don’t drink a vat of agave nectar 
** the typical oral glucose tolerance test is 50g of dextrose in an orange-flavored concoction.