Cyclical Ketogenic Diets Review

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Anticonvulsant Mechanisms Of The Ketogenic Diet 41 Mechanistic Criteria

Effect of dietary manipulation on electroconvulsive threshold in adult rats. Ordinate Voltage needed to produce a minimal convulsion (brief, massive flexion spasm with forelimb and jaw clonus lasting 1-3 s). Abscissa Experimental day. Animals received standard rat chow until day 0 (arrow), followed by ketogenic diet for 39 d, high carbohydrate diet for 9 d, and, finally, standard rat chow again. The threshold for a minimal convulsion remains constant at about 70 V until about 12 d on the ketogenic diet the threshold then rises steadily to a plateau. After changing to the high carbohydrate diet, minimal seizure threshold falls and more intense (maximal) seizures occur at the same stimulus intensity that previously produced minimal convulsions. Mean body weights are also plotted. (Reproduced with permission from Appleton & DeVivo, 1974.) Fig. 1. Effect of dietary manipulation on electroconvulsive threshold in adult rats. Ordinate Voltage needed to produce a minimal convulsion...

Chronic Effects of the Ketogenic Diet

Kainic-acid-treated rats normally display hyperexcitable hippocampal circuitry (Tauck & Nadler, 1985 Cronin & Dudek, 1988 Mathern et al., 1997). To determine whether the KD could ameliorate KA-induced hyperexcitability changes, we examined hippocampal slices obtained from KA-treated rats on normal and ketogenic diets. Significantly fewer CA1 population spikes were evoked by Schaffer collateral stimulation in slices from KD-fed rats than from controls, suggesting that this neuronal network is less excitable after KD treatment (Stafstrom et al., 1999b). Because slices were perfused in normal artificial cerebrospinal fluid (without ketones), this reduction in excitability is independent of ketosis, reflecting a chronic stabilizing effect of the KD. It is tempting to speculate that such long-term effects may involve membrane lipid alterations.

Ketones And The Ketogenic Diet

*Ketogenic diets are described by the ratio of foods with ketogenic potential (K) versus antiketogenic potential (AK), approximated by the formula K AK F + 0.5P C + 0.1F + 0.6P , where F, P, and C are amounts, by weight, of fat, protein, and carbohydrate. Practically, KDs are usually denoted as 3 1 or 4 1. K AK > 1.5 1 is considered necessary to produce ketosis. The equation adapted from Withrow, 1980. provided mainly in the forms of heavy cream and butter, contributes about 90 of the calories. The fats in the classic KD consist of a mixture of animal and plant-derived fats fatty acids of varying chain lengths are likely to be included, but no attempt is made to specify fat type or chain length. Therefore, the classic KD likely contains an abundance of saturated fatty acids and, possibly, a relative dearth of long-chain PUFAs as discussed, this is of interest because of the roles of PUFAs in brain development and modulation of excitability. There have been attempts to formulate a KD...

Diseasespecific diets

Specifically formulated disease-specific diets have been developed for patients with disorders such as encephalop-athy associated with chronic liver disease, and respiratory failure. Malnourished patients with cirrhosis who present with encephalopathy, or who have a previous history of episodes of encephalopathy, present a difficult problem of nutritional management. Branched-chain amino acid-enriched diets have been advocated to normalize plasma amino acid profiles with the aim of improving nutritional state and preventing worsening of encephalopathy. Patients with respiratory failure on ventilators are adversely affected by diets with high carbohydrate loads which increase CO2 production. Diets with a higher fat energy component allow earlier weaning from artificial ventilator support as a result of decreased CO2 production and reduced respiratory quotient.

Susceptibility to Mood Enhancement by Diet

There is another link between macronutrient intake, stress, and mood. Chronic dysfunction of the stress-sensitive hormone cortisol and its controlling hypothalamic pituitary adrenal (HPA) axis is associated with depression and anxiety and with abdominal obesity. Moreover, protein-rich meals that prevent a meal-induced fall in arousal also stimulate the release of cortisol in unstressed people, and the degree of this effect is positively correlated with the probability of poor psychological well-being. Chronically, a carbohydrate-rich diet is associated with better overall mood state and lower average plasma cortisol than a high-protein diet. Acutely, a carbohydrate preload, but not protein or fat load, enhances cortisol release during stress. This may be related to findings from both human and animal research that suggest that eating carbohydrate-rich and perhaps high-fat foods can help restore normal HPA axis function and gluco-corticoid stress responses. Raised levels of cortisol in...

Health Maintenance And Disease Prevention

The composition of the diet may affect the body's ability to maintain energy (1,11). Especially, diets containing at least 55 of energy from a variety of carbohydrate sources, as compared with high-fat diets, reduce the probability of body fat accumulation. Substantial data suggest those diets high in fat tend to promote consumption of more total energy than diets high in carbohydrates. This effect may be due to the low energy density of high-carbohydrate diets, because total volume of food consumed appears to provide an important satiety cue. Although there are no data to suggest that different types of carbohydrates affect total energy differently, the composition of the diet may affect the proportion of excess energy stored as body fat. The body has a large fat storage capacity, and excess dietary fat is stored very efficiently in adipose tissue. Alternatively the body's capacity to store carbohydrates is very limited, and excess dietary carbohydrates are not efficiently stored as...

Effects on Energy Metabolism

These modifications of energy metabolism were associated with significant increases in serum free fatty acids, glycerol, and lactate concentrations, whereas inconsistent findings were reported for blood glucose levels. Acute administration of caffeine was shown to decrease insulin sensitivity and to impair glucose tolerance, possibly as a result of elevated plasma epinephrine. However, it is not understood why a large and long-term epidemiolo-gical study associated significant lower risks for type 2 diabetes in both men and women with total caffeine intake. The lipolytic effect is generally explained by the inhibition of phosphodiesterase, the release of catecholamine, or adenosine receptor antagonism. The increased availability of free fatty acids and their oxidation may have a glycogen-sparing effect. However, increasingly more results do not support the hypothesis that caffeine improves endurance performance by stimulating lipolysis, and some of the ergogenic effects in endurance...

Synergistic Action Of Pufa

Nevertheless, there are some exciting avenues to explore, of which one is the already mentioned possible role of PUFAs in the ketogenic diet, as is covered in Chapter 17. Another aspect is the enhancement of the action of conventional drugs by nanomolar concentrations of PUFAs. This interesting phenomenon was observed at very low doses

Macronutrient Composition of the Diet

Other sources rich in oleic acid are rape-seed oil (canola oil) and high-oleic forms of saf-flower and sunflower oils. Peanuts and pecans also are high in oleic acid. Animal fats likewise contain a relatively high percentage of oleic acid among all their fatty acids even so, these fats also tend to be rich in saturated fatty acids. When high-carbohydrate diets are consumed, the human body can synthesize fatty acids among these, oleic acid is the predominant fatty acid produced. Carbohydrate When carbohydrates are substituted for oleic acid in the diet, serum LDL cholesterol levels remain unchanged. However, VLDL cholesterol concentrations usually rise and HDL cholesterol concentrations fall on high-carbohydrate diets. Thus, a lack of difference in total serum cholesterol concentrations during the exchange of carbohydrate and oleic acid is misleading. The two categories of nutrients have different actions on lipo-protein metabolism. The differences in response to dietary...

Theoretical Bases

There is a significant genetic component to the development of obesity, and it is generally believed that some interaction of genetics and environment may predispose selected persons to gain weight. For example, one genotype may predispose someone who consumes a diet high in fat to become obese. Another genotype may predispose someone who consumes a high carbohydrate diet to become obese. The focus of a behavioral intervention incorporates modification of eating behaviors and physical activity to yield energy imbalance. Figure 1 illustrates the relationship between body weight and changes in energy intake and energy expenditure.

Maternal Protein Consumption

Recently, evidence has been provided suggesting that taurine supplementation to the maternal low-protein diet may benefit the health outcomes of the rat offspring. Maternal taurine supplementation was found to restore and normalize the vascularization of the offspring's endocrine pancreas. Despite these findings, there is little evidence to suggest that a maternal high-protein intake has overall beneficial effects on the metabolic health of the offspring. Some human epidemiological studies and human trials involving high-protein dietary supplementation have in fact demonstrated that the consumption of a high-animal-protein, low-carbohydrate diet throughout late pregnancy can lead to metabolic disturbances in the offspring when they reach adulthood. It has been suggested that these high-protein diets stimulate the hypothalamic-pituitary-adrenal axis and cause maternal cortisol levels to increase. As a result, the developing fetus is presented with the metabolic stress of being exposed...

Maternal High Fat Consumption

In today's Western, more affluent society, the in utero environment is likely to be influenced by maternal nutritional insults such as excess fat consumption. There is little dispute regarding the deleterious effects of a high-fat diet. It is well documented that a diet high in fat has played a fundamental role in the prevalence of type 2 diabetes, reaching the epidemic proportions that is seen today. Both human epidemiological studies and experimental animal investigations have demonstrated clear associations between the consumption of a high-fat diet and the increasing prevalence of cardiovascular disease, insulin resistance, and type 2 diabetes. In light of this, a high-fat diet can increase the risk of a pregnant woman developing gestational diabetes. As will be discussed later, it is well established that offspring of diabetic mothers are themselves at an increased risk of developing the disease at an early age. Consumption of a high-fat diet may not only therefore cause...

Macronutrients and Physical Activity Protein

The high-carbohydrate diet recommended for the physically active individual coincides with the recommendations of various expert committees that a healthy diet is one that is high in carbohydrate (at least 55 of energy) and low in fat (less than Fat is an important metabolic fuel in prolonged exercise, especially when the availability of carbohydrate is low. One of the primary adaptations to endurance training is an enhanced capacity to oxidize fat, thus sparing the body's limited carbohydrate stores. Studies where subjects have trained on high-fat diets, however, have shown that a high-carbohydrate diet during a period of training brings about greater improvements in performance, even when a high-carbohydrate diet is fed for a few days to allow normalization of the muscle glycogen stores before exercise performance is measured. It must be recognized, though, that these short-term training studies usually involve relatively untrained individuals and may not reflect the situation of...

Total Saturated Fat Content of Diets

Platelet aggregation and clotting activity of plasma were studied in British and French farmers, who were classified according to their intake of saturated fatty acids. A positive correlation was observed between thrombin-induced aggregation of platelet-rich plasma and the intake of saturated fatty acids. Aggregation induced by ADP or collagen, however, did not correlate with dietary saturated fat intake. In a follow-up study, a group of farmers consuming high-fat diets were asked to replace dairy fat in their diets with a special margarine rich in polyun-saturated fatty acids. Besides lowering the intake of saturated fatty acids, this intervention also resulted in a lower intake of total fat. A control group of farmers did not change their diets. After this intervention the thrombin-induced aggregation of platelet-rich plasma decreased when saturated fat intake decreased. Aggregation induced by ADP, however, increased in the intervention group. From these

The role of dairy products in preventing dental caries

An individual's dietary and social patterns are major contributors to one's oral health. The quality of life can be greatly impacted as a result of poor oral health leaving a negative impact on self-esteem, eating ability, and social functioning (Moynihan, 2005). Several oral diseases can be linked back to poor nutrition, and as teeth deteriorate the conditions are exacerbated. Studies (Johansson et al., 1994, Norlen et al., 1993) have shown edentulous individuals are more apt to have inadequate dietary intake (high carbohydrate, high fat, low nutrient density foods) than dentate individuals. Sugars, specifically sucrose, are recognized as being a major contributor to dental caries' etiology. Other social factors such as alcohol and tobacco use, drug abuse, poor hygiene, and poor nutrition are also cited as being major contributory factors to oral diseases.

Additional Advances In Epilepsy Treatment That Warrant Consideration

The ketogenic diet has been used with increasing frequency in the management of childhood epilepsy. Ketones are an alternative energy source for cerebral metabolism. By severely restricting glucose and increasing fat intake, ketosis can be maintained and seizure control improved. There are several concerns about an emergency department visit that warrant mention. It is necessary to maintain ketosis and, as a result, glucose infusions should be avoided if possible, and prescriptions given should have no measurable carbohydrate content. This is most easily managed by consultation with the prescribing neurologist, associated dietician, and pharmacist. Hematuria and flank pain may be due to renal calculi. Pancreatitis is an uncommon occurrence in children on the ketogenic diet.

TABLE 1234 Causes of Diarrhea

Treatment of diarrhea will vary depending on cause. A suspicion of Hirschsprung or Crohn's disease warrants surgical consultation. Malabsorption, hemolytic-uremic syndrome, cystic fibrosis, or persistent diarrhea with weight loss and failure to thrive warrants pediatric consultation. Other causes may only require 24 h of rehydration solution and avoiding fatty or high-carbohydrate-containing foods for 2 or 3 days. Stool cultures are warranted in children with bloody diarrhea, diarrhea for more than 5 days, or toxic appearance or to track an epidemic form of illness.

TABLE 1253 Clinical Signs of Hypoglycemia

Aberration than a true pathologic syndrome.24 It usually presents in children less than 18 months of age after a period of fasting. Often this is seen on holidays and weekends, when parents sleep late, inadvertently extending the child's usual nighttime fasting period. It is also more common during illnesses preventing normal food intake. These children return to normal after a glucose load and have no suspicious findings in either their history or physical exams. 25 Classically, this problem was thought to arise because these children were small for age, but that idea has been called into question by more recent findings. 24 Currently, alanine, by far the most important amino acid in gluconeogenesis, is thought to play a major role in this disorder. 36 Haymond et al.5 demonstrated lower serum alanine concentrations in these patients as compared with age-matched control groups during fasting. Giving gluconeogenic precursors to these patients during periods of fasting prevents...

Benefits of Low Glycemic Index Carbohydrates on Cardiovascular Disease Risk Factors

High glycemic index foods induce postprandial hyperinsulinemia, which is a powerful predictor for metabolic risk factors and CVD in epidemiological studies. Both cross-sectional and prospective population studies have shown favorable lipid profiles in association with high carbohydrate diets. Initially, these benefits were attributed to a high fiber content. However, when the glycemic index is controlled for, it is the low glycemic index diets rather than high fiber content that have the greatest influence on high-density lipoprotein (HDL) cholesterol, insulin sensitivity, and fibrinolytic parameters. In a cross-sectional study on more than 2000 middle-aged subjects, the glycemic index was a stronger determinant of HDL cholesterol than any other dietary factor, be it carbohydrate or fat. In this study, the HDL cholesterol of the women whose habitual diet was within the lowest quintile for glycemic index was 0.25 mmol l higher than that for women whose dietary carbohydrate was within...

Pregnancy and Glycemic Index

Throughout pregnancy in well-nourished urbanized women consuming typical Western diets, glucose tolerance deteriorates. During pregnancy, African women living in traditional rural populations and consuming high-carbohydrate low glycemic index diets do not invariably experience deterioration in their glucose tolerance. Clinical studies in the West show that women consuming similar high-carbohydrate low gly-cemic index diets throughout pregnancy also have no deterioration of glucose tolerance despite the physiological increase in insulin resistance that occurs secondary to maternal and placental hormones. When the proportion of dietary carbohydrate increases above 50 in women with gestational diabetes, if no emphasis on low glycemic index carbohydrates is given, glucose tolerance will deteriorate.

Dairy consumption energy intake and body weight

Concentrations of ketones, such as those observed during starvation or high fat, low carbohydrate diets, are associated with suppression of hunger and appetite (Havel et al., 1999 Freedman et al., 2001). In the fed state, lactate concentrations are increased in proportion to the carbohydrate content of the meal and thus could contribute to the suppression of food intake occurring after carbohydrate ingestion (Havel et al., 1999). Pyruvate, an intermediate metabolite of glucose, glycerol and glucogenic amino acids, is at the center of the hepatic hypothesis of feeding that suggests that hepatic receptor discharges, which cause hyperphagia, are inversely related to the concentration of some key metabolite in the liver (Racotta et al., 1984). In addition, because the liver is the first organ that processes nutrients after their absorption from the gut, it has been postulated that this organ plays an important role in the regulation of the satiety response, either through the presence of...

Other Dietary Approaches for the Prevention and Management of CVD

Very Low-Fat High-Carbohydrate Diet and High-Protein Low-Carbohydrate Diet Current interest in the area of weight loss is centered on high-protein low-carbohydrate (high protein) diets. Recently, high-protein diets were shown to result in significantly more weight loss than standard reduced energy diets and were accompanied by more favorable blood lipid profiles (lower triglyceride, higher HDL cholesterol levels). However, by 1 year the advantage in terms of weight loss attributed to the high-protein diet did not persist (Table 2). The major concern with high-protein diets is that in the absence of steady weight loss the higher intakes of saturated fat and cholesterol can ultimately have an adverse effect on LDL cholesterol levels. Ongoing work will most likely resolve some of these issues.

Mct And Smct Transporter Expression

MCT1 gene expression however, the details of this mechanism are unknown. It has been shown that suckling rat pups, where the diet is composed primarily of fats from the mother's milk, have increased levels of MCT1 protein in brain endothelial cells compared to adult rats.29 Additionally, adult rats fed a high-fat diet, which results in high levels of plasma ketones, have increased expression of MCT1 at the blood-brain barrier.30 Furthermore, butyrate greatly enhances MCT1 transcript and protein expression in a human intestinal cell line.31 Exercise training in humans also dramatically affects MCT expression in skeletal muscle. During periods of intense muscle activity in humans, lactate production by glycolytic muscle cells is greatly enhanced. MCT1 in the plasma membrane reportedly increases by as much as 76 , while MCT4 protein content increased by 34 after 8 weeks of exercise training.20 Additionally, in the heart, where lactate is a major fuel source for oxidative...

Adequacy of Nutritional Therapy

Formerly treated patients who are 'off diet' tend to select high-carbohydrate diets and continue their habit of avoiding high-protein foods such as meat, milk, and eggs. Micronutrients previously supplied by the medical food, such as vitamin B12, zinc, and iron, may not be replaced in adequate amounts on such a self-selected diet.

Formation of Ketone Bodies

It is well established that in humans and other mammals the only organ that contributes significant amounts of ketone bodies to the blood is the liver this organ, unlike peripheral tissues, is unable to utilize ketone bodies to any appreciable extent. More recently it has been found that during the suckling period (high-fat diet) the intestine also has the capacity (about 10 of the liver) to produce ketone bodies. Whether ketone bodies are used in situ or are transported via the portal blood to supplement the existing hyperketonemia is an open question.

Extrahepatic Regulation

Insulin has an additional effect on the net release of long-chain fatty acids from adipose tissue in that it stimulates their reesterification to triacylglycerols. Thus after a high-carbohydrate meal, when insulin secretion and its concentration in the plasma is high, the release of fatty acids from adipose tissue is suppressed and their concentration in the plasma is low (Figure 2). In contrast, during stress, when adrenaline and noradrenaline are elevated, the release of fatty acids is increased and their plasma concentration is high.

Physiological Ketosis

Physiological hyperketonemia is found in the suckling neonate (high-fat diet of the milk Figure 1), postexercise (depletion of hepatic glycogen reserves), and after prolonged fasting (more than 24 h Figure 7). All these situations have in common a low hepatic carbohydrate status (depletion of glycogen and or activation of gluconeogenesis) and therefore from a physiological standpoint one would expect an increased rate of ketogenesis. Comparison of the factors which can influence ketogenesis in suckling and fasting (Table 2) shows the expected broad agreement. Fed high-fat diet

Lipid Secretion Pathway II

The fatty acid composition of milk triglycerides reflects differences in maternal diet. Medium-chain (C8-14) fatty acids are synthesized only in the mammary gland using glucose (or acetate in ruminants) as substrate, whereas long-chain fatty acids are derived from the plasma. Nigerian women who have high-carbohydrate, low-fat diets have significantly more medium-chain fatty acids in their milk than Western women who consume a high-fat diet (Table 2).

Clinical Pharmacology Trials

The effects of a high-fat diet on the bioavailability of UFT LV is currently under investigation. Patients were randomized on d 3 to receive therapy with or without a high-fat meal, and then crossed-over to the alternate arm. Subsequently, patients started receiving the standard regimen of UFT 300 mg m2 plus LV 90 mg. Data so far indicate that a high-fat meal reduces plasma levels of uracil and 5-FU and elevates plasma exposures of both LV analytes. Plasma levels of tegafur were not altered significantly. Thus, it appears that UFT LV combination therapy should be taken at least 1 h prior to, or after, a meal. This dosing schedule was followed in the Phase III clinical studies.

Effects of Diet on VLDL Metabolism

It is well-known that diets high in simple carbohydrate increase hepatic secretion of VLDL. This carbohydrate induction of hypertriglyceridemia is the source of the current controversy regarding the optimal diet for subjects at high risk for cardiovascular disease. Some authors have demonstrated that the increased hepatic triacylglycerol secretion induced by high-carbohydrate diets was not accompanied by parallel increases in apo B-100 secretion. In other words, the consumption of low-fat, high-carbohydrate diets did not affect the number of particles but resulted in larger, more triacylgly-cerol-enriched VLDL particles.

Familial Type IV and Type V Hypertriglyceridemias

These two disorders may have overlapping pheno-types. In type IV or familial endogenous hypertrigly-ceridemia, triacylglycerol levels are increased and HDL is usually decreased. This disorder appears to be autosomal dominant and relatively frequent in populations consuming high-fat diets. The precise molecular defect has not been defined however, the increase in triacylglycerol is associated with overproduction of triacylglycerol by the liver and often with consequent reduced clearance. Diet should be the first step in therapy, followed if necessary by pharmacotherapy using fibrates or nicotinic acid. Premature CHD has been seen in some but not all cases presenting with this phenotype.

Nutritional Management

Nutritional intervention is associated with better growth and improvement or stabilization of pulmonary function and possibly may improve survival in CF. Malnutrition has several adverse effects, including poor growth, impaired muscle function, decreased exercise tolerance, increased susceptibility to infection, and decreased ventilatory drive. Studies indicate that BMI strongly correlates with lung function, but the exact mechanism of this relationship has not been fully determined. Achieving optimum nutrition and growth may minimize the progressive decline in pulmonary function commonly seen in CF. As early as the 1970s, the Toronto CF clinic was able to show that a high-fat diet promoted a normal growth pattern and improved survival.

Polyunsaturated Fatty Acids Omega6 Fatty Acids

Evidence that certain SFAs raise blood cholesterol levels whereas PUFAs lower them was a justification for several major diet trials designed to lower CHD risk by feeding a high-fat diet (about 40 of calories) that was low in SFA and very high in PUFA (16 to 20 of calories Oslo Diet Heart Study, 19 VA Diet Heart Study, 20 Finnish Mental Hospital Study, 21). These studies all showed that this diet lowered CHD risk by 24 to 53 concomitant with a reduction in serum cholesterol of 13 to 15 . Because of the perception that these diets might be associated with a higher incidence of cancer and also because this diet is not consumed by population groups worldwide to meaningfully assess its safety, it has not widely been recommended for the prevention and treatment of CHD.

Fat Malabsorption Fat and Fat Soluble Nutrients

Historically, patients with pancreatic insufficiency due to cystic fibrosis (CF) were told to minimize symptoms of steatorrhea by limiting dietary fat. However, epidemiologic studies confirmed that this advice led to negative energy balance, undernutrition, and higher mortality rates compared to communities in which CF patients were treated with high-energy, high-fat diets. The introduction of effective pancreatic replacement therapy has been heralded as one of the

Cerebral Energy Metabolism

The most comprehensive biochemical theory of KD action was put forth by DeVivo and colleagues, who studied in detail the brain biochemical changes accompanying KD feeding (Appleton & DeVivo, 1974 DeVivo et al., 1978 DeVivo et al., 1975 Nordli & DeVivo, 1997). Brains of rats fed a KD underwent a metabolic adaptation in switching from carbohydrates to fats as the primary energy source. In these brains, there was an increase in energy charge that is, enzymes and substrates of glycolysis and the tricarboxylic acid cycle were altered so as to increase the relative ATP ADP ratio, resulting in increased energy reserves. The decrease in seizures resulting from this metabolic adaptation was hypothesized to be the result of greater availability of energy in the brain. Serum levels of P-OHB and AcAc were several-fold higher in KD-treated rats than in rats receiving the high-carbohydrate diet. Similarly, brain levels of P-OHB were sevenfold higher in KD-fed rats. The authors concluded that...

Xylulose 5Phosphate Is a Key Regulator of Carbohydrate and Fat Metabolism

Another recently discovered regulatory mechanism also acts by controlling the level of fructose 2,6-bisphos-phate. In the mammalian liver, xylulose 5-phosphate (see Fig. 14-23), a product of the hexose monophosphate pathway, mediates the increase in glycolysis that follows ingestion of a high-carbohydrate meal. The xylulose 5-phosphate concentration rises as glucose entering the liver is converted to glucose 6-phosphate and enters both the glycolytic and hexose monophosphate pathways. Xylulose 5-phosphate activates a phos-phoprotein phosphatase, PP2A, that dephosphorylates the bifunctional PFK-2 FBPase-2 enzyme. Dephospho-rylation activates PFK-2 and inhibits FBPase-2, and the resulting rise in fructose 2,6-bisphosphate stimulates glycolysis and inhibits gluconeogenesis. The increased glycolysis boosts the production of acetyl-CoA, while the increased flow of hexose through the hexose monophosphate pathway generates NADPH. Acetyl-CoA and NADPH are the starting materials for fatty acid...

Biochemical Aspects Of Ketosis

Dietary fats and fatty acids are ordinarily broken down by liver mitochondrial P-oxidation into two-carbon acetyl-CoA molecules. Acetyl-CoA is ordinarily funneled into the tricarboxylic acid (TCA) cycle with eventual production of energy via ATP generation, which is used for biosynthesis and other cellular functions. Ketone production under such normal circumstances is minimal. However, under conditions of fasting, starvation, or provision of high amounts of fat but little carbohydrate (i.e., the ketogenic diet), ketone production is accelerated. Acetyl-CoA cannot enter the TCA cycle because of low availability of key intermediates, the rate-limiting substrate oxaloacetate, and the rate-limiting enzyme a-ketoglutarate, which are diverted to produce glucose via gluco-neogenesis. Instead, acetyl-CoA molecules are used to synthesize the four-carbon ketone bodies p-hydroxybutyrate (P-OHB) and acetoacetate (AcAc). Therefore, both fasting and the KD produce ketosis (i.e., elevated blood...

Flora Nutrient Interactions

There is a complex interaction between food and microflora in a feedback-like system. Different types of diets can lead to changes in fecal flora, and its resultant metabolic activity can be altered. When individuals consuming a vegetarian diet were compared to those on a typical Western diet, the latter had microflora that showed greater hydrolyz-ing ability leading to a more effective metabolism of bile acids and subsequently reduced cholesterol. Similar studies in mice have shown differences with high-fat diets versus low-fat diets.

Dietary Changes Shift in the Overall Structure over Time

The dramatic changes in the aggregate income-fat relationship from 1962 to 1990 are displayed in Figure 7 by the estimated regression lines based on cubic polynomial regressions. Most significantly, even the poor nations had access to a relatively high-fat diet by 1990, when a diet deriving 20 of energy (kcal) from fat was associated with countries having a GNP of only 750 per capita,

Individual Variability

The relationship between nutrition and toxicity is now known to be a major factor affecting toxic response. The effect occurs through altered absorption and renal function and by affecting toxin distribution in tissues. Fasting or low-protein diets may reduce cytochrome P450 activity. This can either increase toxicity (e.g., DDT) or decrease it (e.g., chloroform). Lipids in the diet delay absorption of lipophobic substances and enhance it for lipophilic substances. Essential fatty acids, such as linoleic acid, are important to the cytochrome P450s. Fatty tissues can store lipophilic toxins away from receptors. Thus, obesity actually protects against chronic toxicity of these compounds. However, high-fat diets enhance absorption and retention of lead and fluoride.

New Terminology and Guidelines for Fibre Intake

Burkitt's original hypothesis focused on the effects of indigestible fibre in the colon and its effect on faecal bulk and consistency, intraintestinal pressures, diverticular disease, transit times, atonia, and the effect of bacterial metabolism and bowel cancer. Through research it was seen that substantial proportions of all the components of the plant cell wall, with the exception of lignin, which is a non-carbohydrate, were fermented by microflora in the colon.

Influence of n3 PUFAs on Fat Metabolism Oxidation and Thermogenesis

Jones and Schoeller (1988) showed that when added to a saturated-fat diet, n-3 PUFA increased basal metabolic rate and total energy expenditure. Within minutes of ingestion, n-3 PUFAs upregulate genes involved in lipid oxidation and downregulate genes involved in lipogenesis. Hepatic oxidation of fatty acids increases within 3 d when the diet contains 12-15 fish oil, but does not increase for several weeks when the diet contains n-6 PUFAs. Evidence suggests that unlike intake of a high-fat diet, intake of a diet rich in n-3 PUFAs may promote fat utilization rather than storage (Price, Nelson, & Clarke, 2000).

High Fat Diets and Obesity Possible Influence of n3 PUFAs

Obesity is one of the major health risks for a number of diseases, particularly heart disease and diabetes. It is well known that ingestion of a diet high in saturated fats is one of the major causes of obesity. There are two explanations for this observation. First, diets high in saturated fats do not seem to be as satiating as either high-carbohydrate or highprotein diets (Doucet et al., 1998), even when the high-fat diet is less palatable (Warwick, 1996). Second, whereas increased intake of either carbohydrate or protein causes a concomitant increase in energy expenditure (e.g., nonshivering thermogenesis), increased intake of saturated fat does not cause a similar increase in energy expenditure. Individuals maintained for 1 wk on a high-carbohydrate or high-protein diet have, whereas individuals maintained on a diet high in saturated fat did not have, increased body temperature and ingested fat was mostly sequestered to adipose tissue that is, increased intake of saturated fat...

Pufa A Feasible Epilepsy Treatment

The preceding discussion has established the following (1) PUFAs are an important modulator of neuronal excitability (2) dietary PUFA can alter several aspects of brain function (3) the ketogenic diet is an effective therapeutic modality for some persons with epilepsy (4) the mechanism of the ketogenic diet's seizure protective effect is unknown but may involve lipid components (5) the ketogenic diet is composed of a high volume of fats that contain a variable proportion of PUFA. From these observations, can we make a leap to the hypothesis that PUFA may be an effective anticonvulsant Although such a statement would be premature, there are intriguing parallels between the ketogenic diet and PUFA that warrant further scientific scrutiny. The rationale for exploring this notion further comes from previous studies in both heart and brain. Like the antiarrhythmogenic

Changes in food preferences after infancy

Shifts in eating habits are often driven more by health concerns, fashion and status than real nutritional considerations or availability of the foodstuff. It has been said that our food preferences are defined by socio-cultural rules rather than being influenced by physiological need (Rozin 1982) and the changes in these rules that are peculiarly human, make us behave very differently from a truly neophobic animal. There are several reasons why human beings change their diets during their lives. Nowadays the driving force for change is often health-related and a food or a drink is perceived as being more or less beneficial to general well-being or having a specific health benefit. The growing liking for cranberry juice in the Western world has little to do with the organoleptic qualities of the juice but is much more related to its claimed health benefits. The dramatic shift from high to low fat dairy products was driven by a general and popular concern about blood cholesterol...

Conclusion And Future Prospects

Kubota, N., Terauchi, Y., Miki, H., Tamemoto, H., Yamauchi, T., Komeda, K., Satoh, S., Nakano, R., Ishii, C., Sugiyama, T., Eto, K., Tsubamoto, Y., Okuno, A., Murakami, K., Sekihara, H., Hasegawa, G., Naito, M., Toyoshima, Y., Tanaka, S., Shiota, K., Kitamura, T., Fujita, T., Ezaki, O., Aizawa, S., Kadowaki, T., et al. (1999). PPAR gamma mediates high-fat diet-induced adipocyte hypertrophy and insulin resistance. Mol Cell 4(4), 597-609.

Dietary Management

Current ideas on a reasonable reducing diet are that it should contain at least 100 g carbohydrate to prevent glycogen depletion and ketosis. High-carbohydrate diets are composed of complex carbohydrates and are thus of low energy density, which may aid management of hunger. Since high-carbohydrate diets are low in fat, they have the theoretical advantage of directly reducing the risk of cardiovascular disease. The energetic efficiency with which carbohydrate is converted and stored as fat is lower than that of dietary fat, providing a further advantage. Protein intake must be adequate to maintain lean body mass. Although there is an inevitable fall with weight loss, 0.8 g per kg per day + 1.75 g per 100 calorie deficit of protein (about 44 g daily for women and 56 g daily for men) should be consumed, and fat restricted to less than 30 of total energy. The diet should contain recommended daily intakes of vitamins, minerals, and electrolytes, if necessary by supplementation 20-30 g...

The National Weight Control Registry

Although there is marked heterogeneity in the approaches used for weight loss, there appear to be some common themes for weight loss maintenance. The first common element is consumption of a low-calorie, low-fat diet. Registry participants are consuming an average of 1381 kcal day, with 24 of calories from fat, 19 from protein, and 56 from carbohydrates. Very few (less than 1 ) report consuming a low-carbohydrate diet (less than 24 of calories from carbohydrates).

The Liver Processes and Distributes Nutrients

To meet these changing circumstances, the liver has remarkable metabolic flexibility. For example, when the diet is rich in protein, hepatocytes supply themselves with high levels of enzymes for amino acid catabolism and gluconeogenesis. Within hours after a shift to a high-carbohydrate diet, the levels of these enzymes begin to drop and the hepatocytes increase their synthesis of enzymes essential to carbohydrate metabolism and fat synthesis. Liver enzymes turn over (are synthesized and degraded) at five to ten times the rate of enzyme turnover in other tissues, such as muscle. Extrahepatic

The Flavour and Fragrance Industry Challenges and Opportunities

In this context, the potential of a number of diverse ingredients with significant potential as flavour enhancers or masking agents have to be mentioned. In particular, special minus-diets, e.g. low-carbohydrate or low-fat diets, change the taste, texture and sensory qualities of a product and therefore require corresponding alterations to endow the products with the properties called for by the consumer. Flavour enhancers are defined as 'natural substances which are components of proteins or cell tissue. They have no typical taste or smell, but their presence potentiates other flavours present in the food.' In this field more and more studies are looking at the synergistic abilities of flavour-enhancing substances and the possibility of flavour masking.

Basil And Functional Food Applications

The long-term goal of this project is to use the tools of biotechnology to develop improved clonal lines of dietary herbs and improved fermentation process for dietary legumes to generate consistent, nontoxic, and clinically relevant levels of phenolic metabolites for use as antimicrobials against chronic diseases caused by ulcer-associated Helicobacter pylori and urinary tract infection-associated Escherichia coli. Plant phenolic metabolites such as capsaicin from diet are known to be associated with low rate of ulcers through inhibition of H. pylori (49), and currently available synthetic drug treatments have significant side effects (50,51). Phenolics from cranberry have potential for use against urinary tract infections linked to E. coli (52). Use of dietary source of diverse antimicrobial-type plant phenolics could lead to reduced use of antibiotics and therefore reduce the potential increase in antibiotic-resistant, disease-causing bacteria. In addition, plant phenolic...

Brain Systems Controlling Eating

Although exactly how these transmitter signals are integrated during normal eating is still unclear, it is assumed that these chemical signals reflect food-relevant information derived from the periphery. For example, consider the regulation of carbohydrate intake. A high-carbohydrate meal increases tryptophan uptake in the brain and ultimately the synthesis of serotonin, for which tryptophan is the precursor. Increased serotonin activity, as discussed earlier, suppresses food intake, particularly carbohydrates. Thus increased carbohydrate intake eventually feeds back negatively on further carbohydrate intake (probably through serotonin's action in the PVN), providing a mechanism for the short-term regulation of carbohydrate intake.

Overview of the Culture

Until the last few decades, the Shipibo economy has largely been one of subsistence supported by fishing, hunting, gathering, cultivation of high-carbohydrate plants such as yucca (at least two varieties of manioc, Manihot esculenta sp.), plantain, and a large purple sweet potato (Bergman, 1980). More recently, rice and corn have been sown and cultivated for market as well as consumption. Chiclayo (black-eye pea) is sown and cultivated on the exposed river beaches in the dry season.

Dairy components and food intakesatiety

GLP-1 may also play a role in milk protein-induced satiety. Both carbohydrate and fat are potent stimulators of GLP-1 (Brubaker and Anini, 2003) but milk proteins stimulate GLP-1 release independent of carbohydrate and fat. However, whey appears to be the stronger and its secretagogue effect might be enhanced in the presence of other macronutrients. A high protein breakfast (58 of total energy) consisting mainly of dairy products enriched with whey protein isolate resulted in higher GLP-1 concentrations over 3 hours than a high carbohydrate breakfast (19 of total energy from protein) consisting mainly of plain yoghurt (predominantly casein) (Blom et al., 2006). Similarly, when protein preloads of 50 g were given with an additional 200 kcal from fat and carbohydrate, whey protein ingestion resulted in higher plasma concentrations of GLP-1 than casein for up to 3 hours in humans (Hall et al., 2003). However, with time it may be that casein has a stronger effect than whey in analogy with...

Classes of Carbohydrates

Natural foods with high carbohydrate levels can be carriers of naturally occurring toxicants. For example, honey can contain materials toxic to humans because of the varieties of plants the honey bees may visit. Honey producers take extreme care to see that their bees avoid potentially problematic plants and do not become contaminated with toxicants.

Effects of Diet on Chylomicron Metabolism

The effects of dietary carbohydrates on postprandial lipoproteins have also been studied. Most protocols have used diets very high in simple carbohydrates. In general, high carbohydrate intake has been associated with increased levels of fasting triacylglycerols and increased postprandial levels of chylomicrons and chylomicron remnants.

Increased standard of living leading to deleterious health behaviors

The global availability of cheap vegetable oils and fats has resulted in greatly increased fat consumption in low-income countries in recent years.28 The transition now occurs at lower levels of the gross national product than previously, and is further accelerated by rapid urbanization. In China, for example, the proportion of upper income persons who were consuming a relatively high-fat diet (> 30 of daily energy intake) rose from 22-8 to 66-6 between 1989 and 1993. The lower and middle income groups too showed a rise (from 19 to 36-4 in the former, and from 19-1 to 51-0 in the latter).28 The Asian countries, traditionally high in carbohydrates and low in fat, have shown an overall decline in the proportion of energy from complex carbohydrates along with an increase in the proportion of fat.28 The globalization of food production and marketing is also contributing to the increasing consumption of energy-dense foods that are poor in dietary fiber and several micronutrients.29

Adipose Tissue Stores and Supplies Fatty Acids

Like other cell types, adipocytes have an active glycolytic metabolism, use the citric acid cycle to oxidize pyruvate and fatty acids, and carry out oxidative phos-phorylation. During periods of high carbohydrate intake, adipose tissue can convert glucose (via pyruvate and acetyl-CoA) to fatty acids, convert the fatty acids to TAGs, and store them as large fat globules although, in humans, much of the fatty acid synthesis occurs in hepatocytes. Adipocytes store TAGs arriving from the liver (carried in the blood as VLDLs see Fig. 21-40a) and from the intestinal tract (carried in chylomicrons), particularly after meals rich in fat.

Mucus Mucin Glycoproteins

Mucus is continuously produced by goblet cells to lubricate and protect the GI epithelium. The primary gene identified that is located in the goblet cell and predominantly responsible for the production and secretion of mucus and its resulting sugar, mucin, is the MUC2 gene. This is through an elaborate process of encoding a peptide modified by o-glyco-sidic bonds to a variety of carbohydrate residues to amino acids serine or threonine resulting in a glyco-protein with high carbohydrate content that provides the potential to bind sites for both indigenous and pathogenic bacteria. Mucin, the resulting glyco-protein, forms a viscous gel that coats the epithelial surface of the intestine protecting it from chemical and mechanical stress. Coating of the epithelia thus denies pathogenic bacteria the opportunity to adhere preventing an inflammatory response. This is the first line of defense of the intestine against pathogenic microbes. Indigenous bacteria also utilize the carbohydrate...

Health Effects of Carbohydrates

Several studies have been conducted to establish an association between sugar ingestion and total energy intake. There have been consistent reports of a negative association between sugar intake and body mass index in adults and children. However, this observation could be confounded by the correlation of dietary fat and obesity, since high-fat diets are usually low in carbohydrates. Some ad libitum dietary studies have shown that diets low in sugar are associated with weight loss, maybe as a result of reduced calorie intake. Nevertheless, in human metabolic studies, no effect on weight or energy expenditure High intakes of NSP, in the range of 4-32 gday-1, have been shown to contribute to the prevention and treatment of constipation. Population studies have linked the prevalence of hemorrhoids, diverticular disease, and appendicitis to NSP intakes, although there are several dietary and lifestyle confounding factors that could directly affect these relationships. High-carbohydrate...

Nutrition Intervention

Dietary long-chain (ra-3) fatty acids from fish oil and low-intensity exercise have been reported, independently, to inhibit tumor growth in rats and is perhaps related to alterations in immune function. Individually, but not in combination, long-chain (ra-3) fatty acids and low-intensity exercise may be advantageous by augmenting cell-mediated immune function and NK cell cytotoxicity in healthy rats (Robinson and Field, 1998). Lipid sources could alter the development of autoimmune diseases and the life-span of short-lived mice (Fernandes, 1995 Venkatraman and Fernandes, 1993). The decline in autoimmune disease found with fish oil (FO) is linked to the decrease in ra-6 PUFAs, such as 18 2,20 4, that serve as precursors for proinflammatory prostaglandins of the E series. FO is also reported to decrease the levels of c-myc and c-Ha-ras oncogenes expression in the spleens of autoimmune mice and increase the levels of TGF-p 1 (Chandrasekar et al., 1995 Fernandes et al., 1994 Venkatraman...

Components from skimmed milk and weight loss 121 Calcium and weight loss

Protein plays a satiety, thermogenic and lean muscle preservation role during weight loss. Skov et al. (1999) compared a control group to two treatment groups that consumed either a high carbohydrate and low protein (12 energy) diet or a high protein (25 energy) and low carbohydrate diet. Both groups were on reduced fat diets and obtained 30 of their energy from fat. Foods that had the desirable protein, carbohydrate and fat levels were designated for each group. Each group consumed the various food products 'ad libitum'. After a six-month time period the high protein group lost more (8.7 kg) than the high carbohydrate group (5.0 kg). Part of the difference was attributed to a protein satiety effect. The high protein group consumed less food energy (9.3 MJ day) compared to the high carbohydrate group (11.2 MJ day). It was also pointed out that the thermogenic effect of protein is much higher than carbohydrate (30 versus 4-8 ) resulting in more calories being 'burned' when protein is...

Relevance of phenolic antioxidants for functional food and comparative metabolic biology considerations

Phenolics and specific phenolic-like salicylic acid levels increase in response to infection, acting as defense compounds, or to serve as precursors for the synthesis of lignin, suberin, and other polyphenolic barriers (116). Antimicrobial phenolics called phytoalexins are synthesized around the site of infection during pathogen attack and, along with other simple phenolic metabolites, are believed to be part of a signaling process that results in systemic acquired resistance (111-113). Many phenylpropanoid compounds such as flavo-noids, isoflavonoids, anthocyanins, and polyphenols are induced in response to wounding (117), nutritional stress (118), cold stress (119), and high visible light (120). UV irradiation induces light-absorbing flavonoids and sinapate esters in Arabidopsis to block radiation and protect DNA from dimerization or cleavage (121). In general, the initiation of the stress response arises from certain changes in the intracellular medium (122) that transmit the...

Energy Substrates

The chronic ingestion of high-fat diets also elevates blood ketone body concentrations, promoting their use by the brain for energy production. However, extremely high levels of fat must be consumed, and such diets are unpalatable. Hence, diet is not thought normally to influence cerebral energy production via dietary fat manipulation of ketone body supply to brain. Very high-fat diets are occasionally used clinically to treat intractable seizures. Though the beneficial effect is linked to levels of circulating ketone bodies, the mechanism is presently unknown.


Adults A high carbohydrate fat ratio is associated with better maintenance of body weight. However, this may reflect increased fat accumulation rather than an increase in protein synthesis. Hyperglycemia alone can increase alanine efflux from skeletal muscle, without stimulating protein synthesis. Euglycemia, using exogenous insulin with high glucose delivery, can inhibit amino acid oxidation and favor amino acid synthesis. This may reflect an effect of IGF-1, which is released in response to insulin. In addition, hyper-glycemia stimulates hepatic lipogenesis and increased CO2 production, which may prevent weaning from ventilatory support. Hyperglycemia must therefore be prevented.

Exercise Training

The balance between pro-oxidants and antioxidants is altered with aging (Ji et al., 1998). Exercise increases the disturbances of intracellular pro-oxidant-antioxidant homeostasis that poses a serious stress threat to the cellular antioxidant defense system (Ji et al., 1998). The elderly demonstrate a less resilient leukocytosis and a different lymphoproliferative response following acute maximal exercise (Ceddia et al., 1999). Insulin-like growth factor-I (IGF-1) declines with age, as does aerobic power, but they are not related (Haydar et al., 2000). Acute exercise may stress the immune system, whereas chronic exercise training may enhance it. Exercise-induced changes in the immune system include the release of inflammatory mediators, the activation of various white blood cells, and the complement and induction of acute-phase proteins (Venka-traman et al., 2000 Venkatraman et al., 2000a). There are signs of immunosuppression, such as decreased T- and B-cell function or impaired...


However, tube feeding or dietary supplementation with standard liquid medical nutritional products can compromise the metabolic control of patients with abnormal glucose tolerance. This occurs because rapid gastric emptying of liquid formulas and efficient absorption of nutrients supplied by these products result in a rapid elevation of blood glucose. Standard enteral formulas empty from the stomach at least twice as fast as an isocaloric solid-food meal (61) and have been shown to produce a peak blood glucose response equivalent to that seen when an equivalent solution of pure glucose is fed (62). Rapid gastric emptying of formulas and rapid absorption of nutrients can complicate metabolic control of hyperglycemic patients. A number of clinical studies have shown that high-carbohydrate, low-fat diets may be inappropriate for many patients with diabetes (6365). Moreover, recent research has demonstrated that substitution of MUFA for CHO can...

Ovarian Cancer

Cancers of the ovary and fallopian tube are discussed together because of the rarity of fallopian tube cancer and similarity in gross and microscopic appearance, pattern of spread, and disease process. Approximately 26,800 women were diagnosed with ovarian cancer in 1997 in the United States, with about half dying from the disease. A woman has a 1 to 2 percent chance of developing ovarian cancer in her lifetime with no family history. Peak incidence occurs between the ages of 55 and 65 although some types occur earlier. The following risk factors have been identified infertility, low parity, high-fat diet, lactose intolerance, history of breast or colon cancer, and a family history of site-specific ovarian cancer or its associated syndromes. Oral contraceptives seem to be protective against ovarian cancer. Cancers of the ovary and fallopian tube come in three main histologic types epithelial (85 percent), germ cell tumors (10 percent), and sex-cord stromal tumors (5 percent). Certain...

Ketosis and Fasting

KD mechanism were inferred from clinical studies (Bridge & Iob, 1931). The earliest theory held that seizure protection was a result of a sedative effect of ketones, akin to the action of phenobarbital accordingly, the anesthetic or sedative effect engendered by ketone bodies could be overcome by glucose, which, in effect, destroyed the ketones (Helmholz & Keith, 1930). However, children maintained on the KD rarely became sedated, and the idea later arose that the beneficial effect was directly related to the ketosis produced by either fasting or the high-fat diet. It was thought that mild ketonemia was protective in mild epilepsy and that a larger degree of ketosis was necessary for seizure control in severe cases. Most subsequent reports have shown an association of seizure control with ketosis, although a causal relationship has not been proven. Ketosis occurs rapidly upon fasting or KD feeding, usually within 1 d (Keith, 1933 Dodson et al., 1976 Huttenlocher, 1976). Seizures...


High-fat diets reduce lymphocyte proliferation compared to low-fat diets, but the precise effects depend on the amount and type of fat. There are two major classes of polyunsaturated fatty acids (PUFAs) the n-6 and the n-3 families. Linoleic acid is the precursor of the n-6 family, and is found in plant oils, including corn and soybean oil. In animals, linoleic acid is converted to arachidonic acid, which can account for 25 of the total fatty acids in the plasma membranes of immune cells. The amount of arachidonic acid in the plasma membrane of immune cells is important because it is the precursor of several prostaglandins and leukotrienes that have potent inflammatory effects. The precursor of the n-3 PUFAs is a-linolenic acid, which in animal tissues is converted to eicosapentaenoic and docosahexaenoic acids. As op


A sufficient reduction in pH can only be obtained if carbohydrate is included in the sausage recipe, as the concentration of glucose and phosphorylated glycolytic intermediates in raw meat is low, usually < 0.1 (5). Fermentable carbohydrate, most often glucose, is added at a level of approximately 0.5 or higher. Sucrose might substitute glucose, and more slowly metabolized carbohydrates such as lactose or dextrin may be added as an extra carbohydrate source or as fillers. Efficient fermentation is achieved by homofermentation, where the carbohydrate added is metabolized via glycolysis, with lactic acid virtually being the only end product. Lactic acid bacteria for sausage fermentation are facultatively heterofermentative (6). This means that under certain conditions (eg, carbohydrate depletion), the lactic acid bacteria may switch to heterofermentation, resulting in formation of acetic acid and carbon dioxide in addition to lactic acid. Such compounds lead to defects in dry-cured...

High Fat Formulations

The average fat content of enteral formulations is approximately 30 of total energy. The main source of energy in these formulations is carbohydrate. The high carbohydrate has two relevant metabolic effects. First, it increases the need for insulin secretion. Second, when fed in amounts that exceed energy requirements, it increases CO2 production. Diabetics potentially would therefore have reduced insulin requirements and a lower risk of hyperglyce-mia if fed high-fat formulations. Similarly, malnourished patients with chronic obstructive pulmonary disease (COPD) would have a lower risk of CO2 retention if given a high-fat diet with a high calorie intake to promote weight gain. Therefore, high-fat formulations have been developed to feed patients with diabetes and COPD. However, there is little evidence that they are significantly better than standard formulations.


The relationship of dietary carbohydrates to CVD appears to be mediated through indirect mechanisms contribution to total energy and its effect on overweight and obesity influence on central obesity effects on plasma lipids, especially triglycerides and effects on glycemic control. The balance between carbohydrates and fat as sources of energy as well as the fiber component of the diet are also areas of interest while considering this relationship. In feeding experiments, an increase in dietary energy from carbohydrates is usually associated with a moderate increase in fasting plasma triglyceride levels in the first few weeks but these return to near original levels in the first few weeks. Epidemiologically, high carbohydrate intakes are associated with low plasma cholesterol and variable plasma triglyceride concentrations.43 The effect of a high carbohydrate diet on HDL cholesterol and thereby on the total LDL to HDL cholesterol ratio as well as on the particle size of LDL are...

Nausea and Vomiting

Morning sickness or nausea is common in the early months of pregnancy. It is rarely a condition to cause alarm, except when there is excessive vomiting. In this situation, an acute protein and energy deficit and loss of minerals, vitamins, and electrolytes may result. Treatment of this condition is by consuming small frequent meals and a low-fat, high-carbohydrate diet. Prolonged, persistent vomiting (hyperemesis gravidarum) occurs in approximately 2 of pregnant women. Hospitalization is usually required, with intravenous fluid and electrolyte replacement to prevent dehydration.

Urinary Excretion

Relation between intake and excretion rate have recently shown that this index is sufficiently sensitive to distinguish riboflavin requirements between people on low-fat, high-carbohydrate diets and the slightly higher requirement associated with high-fat, low-carbohydrate diets. Metabolic states associated with general tissue catabolism can sometimes result in liberation of riboflavin during cell turnover this increases its urinary excretion, even though dietary intake may be low.


Carbohydrate sweeteners (glucose, maltose, etc) generally are less potent than sucrose. As such, CSE values for carbohydrate sweeteners usually exceed that of sucrose. During the past century, many high-potency non-carbohydrate sweeteners have been discovered. As a consequence, very low CSE values are often realized for these sweeteners. For illustration, consider sodium saccharin, which currently is available in the United States for a wholesale price of 3.90 lb (18) and exhibits Pw (8) in water of 180 times that of sucrose. The CSE of sodium saccharin, used in water at an 8 sucrose sweetness equivalent level, would therefore be 3.90 180 2.2 cents lb. This contrasts quite sharply with sucrose, which is presently available for a wholesale price of 36 cents lb (18). Clearly, such cost factors attainable with high-potency sweeteners offer food manufacturers substantial increased profitability in the low-calorie sector of product categories. Although sweetener cost is certainly an...

Postnatal Nutrition

Postnatal growth curves of offspring from mothers fed either ad libitum (AD) or undernourished throughout gestation (UN). After weaning offspring of AD and UN mother were fed either a standard chow diet or a high fat diet. Note the rapid diet-induced catch-up growth in the UN offspring fed a high fat diet. Figure 2. Postnatal growth curves of offspring from mothers fed either ad libitum (AD) or undernourished throughout gestation (UN). After weaning offspring of AD and UN mother were fed either a standard chow diet or a high fat diet. Note the rapid diet-induced catch-up growth in the UN offspring fed a high fat diet. high fat diet during postnatal life. The direction of the interactions between prenatal and postnatal influences is most likely dependent on timing and severity of each factor.

Pulmonary Disease

To address the nutritional needs of these patients, a formula was designed containing ingredients that could help control or reduce lung damage from inflammation and oxidation. Preclinical studies have shown that high-fat, low-carbohydrate diets containing omega-3 fatty acids from fish oil and y-linolenic acid from borage oil rapidly modulate the fatty acid composition of inflammatory cell membranes (36-38), reduce the synthesis of important proin-


In fed-batch fermentation, additional carbohydrate is supplied to the batch fermentation during the run (28). High carbohydrate concentrations in the initial culture medium are toxic to many microorganisms. Thus, an optimal carbohydrate concentration is employed initially, which permits maximum culture growth to late log phase. When the carbohydrate concentration is reduced to almost zero, additional sterile carbohydrate is injected into the bioreactor to bring the carbohydrate concentration back to the starting level. When this is consumed, the process is repeated until end product inhibition forces the whole bioconversion to stop. Ideally, at the end of the fermentation you will have a product concentration which is three to four times greater than single batch fermentation with no residual carbohydrate. This will generate the highest yield possible. Also, due to increased end product accumulation with each carbohydrate addition, culture production rates will decrease. Thus, the...


An exaggerated diurnal weight gain is a feature of idiopathic edema normal women gain approximately 0.6 kg during the day, whereas women with idiopathic edema gain more than 1.4 kg 1 , Concern about weight can lead to intermittent fasting and binging in some patients which may be a factor in causing the edema. Fasting suppresses the sympathetic nervous system, and the natriuresis of fasting is in part due to decreased renal sympathetic nerve activity. Carbohydrate feeding results in increased sympathetic activity with subsequent sodium reabsorption. Edema can occur in normal women going from a low to a high carbohydrate diet if sodium intake is high 12 .

Acid and Alkali Load

There is surprisingly little information on the direct contributions of individual foods to the acid burden. However, this source of dietary acid is of increasing importance in view of current popular weight reduction diets (e.g., the Atkins diet). The major acids contained in food are citric acid (in fruit, fruit juices), acetic acid (as a preservative, pickles, vinegar), lactic acid (yogurt, fermented foods), malic acid (fruit), oxalic acid (vegetables that contain smaller amounts of citric and malic acids), and tartaric acid (wine). Oxalic acid precipitates in the gut to form calcium salts, which are excreted in the stool and little is absorbed. The other acids are absorbed but quickly metabolized and present an acid burden in the form of CO2. The largest source of fixed acid comes from the metabolism of amino acids (particularly those from animal proteins - see above). The significance of this source of acid is readily demonstrated in patients consuming a high-protein diet...


Being a good indicator of likelihood of success. Recent success with low-carbohydrate diets rather than the traditional low-fat diet advice suggests the importance of the role of satiety in maintaining caloric restriction. Most commercial diet plans promise short-term weight loss, but very few long-term studies have shown these to keep weight off for more than 6-12 months. As adolescents naturally

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