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Ketogenic Diet Beneficial for Vascular Disease

re: Michael Eades

Michael Eades is a terrific follow.

Michael Eades, The Arrow #101: Ketogenic Diet Beneficial for Vascular Disease

2022-12-08. Emphasis added.

Welp, we have all heard for years and years and years that high-fat diets are bad for the heart and the arteries. And we’ve heard it from all kinds of people with various degrees of eduction including those at the highest levels of academia. It has always amazed me how so many people can not think clearly where diet is involved.

If you ask most nutritionists...Having lived with this for years, imagine my surprise when I happened upon the mention of a paper titled Fat not so bad? The role of ketone bodies and ketogenic diet in the treatment of endothelial dysfunction and hypertension. As we all know, ketogenic diets are high-fat, very-low carbohydrate diets, and—wonder of wonders—here is a paper saying all that fat was good for arterial function and high blood pressure.

I had to get my hands on it.

...The paper mainly discusses the affect that ketones have on the endothelium. The endothelium is the single cell layer lining the inside of all the blood vessels in the body... Directing blood flow is only one of the many tasks of the endothelium. Here is a diagram from the paper showing many of the tasks of the endothelium and how ketones positively affect them:

Possible effects of the KD to combat hypertension and other obesity-related cardiovascular conditions
Possible effects of the KD to combat hypertension and other obesity-related cardiovascular conditions

Fig. 4. Possible effects of the KD to combat hypertension and other obesity-related cardiovascular conditions. Ketogenic diet feeding pattern results in metabolic shift by increasing fatty acids and reducing glucose levels. Elevated fatty acids induce mild ketosis and mediate the reduction of inflammatory responses, reduction of blood insulin level and attenuated endothelial activation. Ketogenic diets also increase the activity of uncoupling proteins, leading to the reduction of ROS and stimulating mitochondrial biogenesis thus leading to enhanced energy reserves at the molecular level and results in changes the physiological parameters of multiple metabolic disorders. Abbreviations: IL – interleukin, eNOS – endothelial nitric oxide synthase, ROS – reactive oxygen species, TNFα – tumor necrosis factor alpha, UCPs – uncoupling proteins.

...One of the things I hadn’t known, but learned from this paper was that ketones markedly improve congestive heart failure, which is a brutal disorder. The authors discussed a study published in Circulation in 2019 that I somehow missed...

The researchers in the Circulation paper above studied 16 patients with average ejection fractions of 37 percent. They infused these patients with enough beta-hydroxybutyrate (BHB), the most common ketone, to raise their blood levels from ~0.4 mM, which is pretty standard for people on a typical diet, to 3.3 mM, which is about the level of nutritional ketosis found after adaptation to a ketogenic diet.

At the same time—and this is important—it did so without increasing the oxygen consumption of their hearts.

This level of BHB increased their ejection fraction by 8 percent, bumping them up almost to the lower end of normal. It jacked their cardiac output by 2 liters/min, a 40 percent increase, which is huge.

...Why is this important? Because people who have heart failure can increase the activity of their hearts by beating faster. But that requires more oxygen to fuel their heart muscle, which adds to the growing oxygen deficit. These study patients increased their cardiac output without increasing their hearts’ requirements for oxygen...

On a final note, I looked up endothelium in Wikipedia hoping I would find what I found. Sure enough, there it was:

High-fat diets adversely affect the endothelial function.

Jesus wept.

WIND: cut out all added sugars, eat fruit modestly, increase saturated fats (strictly avoid PUFAs eg seed oils), and eat whole unprocessed foods, which means no snack bars, few to no restaurants, etc.

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