They say that a lifetime passes in what seems like the blink of an eye.

That minute can come and go or create a revelation heard around the world. We
were raised to help inspire people to do the ultimate. We believe this is our calling and that the ketogenic diet is a means to inspire others and change
the world as we know it.

WHERE IT ALL BEGAN: JACOB'S STORY

My story begins in Richmond, California. I was born to Floyd and Anita Wilson, the two best parents A child could hope for. My parents grew up in San
Francisco and had very little when they were children. Working sometimes three or four jobs to take care of us, my dad realized that his children needed
a strong education. I remember that my parents did a great business every time I brought home a drawing, a poem or a piece of paper. They made me
feel like the scribbled portrait I made out of a work that Picasso himself had been proud of! The first Halloween I dressed up for, I must have been five,
my parents bought me a science kit. We had a lab coat, fun glasses, and a chemist. Set The instant I put on my lab coat, I realized my calling: I would be a
scientist. This was not a fleeting moment.
I was the second of two children. As you can imagine, my mother had to be a saint to deal with that much testosterone! My dad was obsessed with
sports, and this led us to play hockey. I liked hockey and memorized every key athlete in NHL history. After graduating high school in two and a half years,
I knew I wanted to take a big shot. My dad encouraged me to go to the mecca of hockey: Canada. Canadian Junior Hockey is the equivalent of college
football in the United States. It is literally a national pastime; The whole country is proud of sports. Up there, the competition is fierce. He was only five
foot eight and weighed 150 pounds soaking wet. This situation caused me to study the impact of nutrition, psychology and training on human
performance and body composition in an effort to gain weight to maximize my performance. I soon became fascinated with these topics and decided to
dedicate my life to them. After several years of hockey, I threw myself into school full time. This passion led me to my PhD, where I studied a substance
called beta-hydroxy-beta-methylbutyrate (HMB), which is very similar to the ketone body beta-hydroxybutyrate (BHB). We found that when HMB was
given to humans, it accelerated recovery, age-related decline in muscle mass and decreased protein synthesis, an important process for building muscle.
In 2008, near the end of my PhD program, I met to Dominic D'Agostino in an experiment biology lecture I noticed that Dr. D'Agostino did not consume
many carbohydrates. In fact, their diet consisted mainly of sardines and coconut oil! I was fascinated and discovered that he was studying BHB. Her strict
ketogenic diet allowed her to eat only twice a day without crashing. The diet fascinated me. After graduating from Florida State University in 2010 with
my PhD in Skeletal Muscle Physiology, I started a research laboratory dedicated to nutrition and human performance at the University of Tampa.
In Tampa, I stayed in touch with Dr. D'Agostino and developed a great relationship with his lab. I was also lucky enough to cross paths with the brightest
star and scientist I have ever encountered. His name is Ryan Lowery. It's rare to find a true genius, but Ryan is one of those people. Soon After meeting in
2010, we attended the National Strength and Conditioning Association (NSCA) national conference, which opened us to a whole new world of research.
Since then, we have published more than 100 articles, book chapters and abstracts together.

BEGINNINGS: THE LOWERY PERSPECTIVE

They say that the people who are crazy enough to think they can change the world are the ones who actually do it. Luckily for me, I'm surrounded by
Jacob and a whole crazy team, all of whom share the same vision: to inspire and change lives through science and innovation. I would never dream of
reaching this point, but very early in my life, I knew I had a greater mission, and when the stars align, anything is possible.
For me, it all started in Butler, New Jersey, a small suburb about an hour outside of New York. City. Butler has that Friday Night Lights feel, where football
takes priority and you know every person in your high school graduating class. Growing up, I was lucky to have a close-knit group of friends who shared
my passion for the sport. These friends, along with my teachers and coaches, pushed me to work hard both in the classroom and on the field.
Fortunately, my relentless work ethic combined with incredible support and guidance allowed me to accomplish great feats that set me on my current
path. I attribute that work ethic to the principles my parents instilled in my brother Steven and I from an early age. My dad, Galen, and my mom, Joan, my
oldest
Supporters and great mentors: They taught us three core values:

1) I respect
2) passion
3) optimism

They instilled in us a commitment to excellence and a sense of humility. I like most teenagers, we thought it was excessive at the time, but as I sit here
writing this, I am very grateful for what they taught me, Above all, my parents stressed the importance of personal education. development and helping
others along the way.
The summer before I entered high school, I fractured my elbow in a freak accident while playing outside. After seeing a physical therapist regularly for
over a year, I decided I wanted to pursue physical therapy as a career. I always knew I wanted to help people and be in and around sports, but I could
never figure out what to do. The vision was being painted; You could see now: Dr. Lowery, DPT. I had that vision before I became a teenager and I still
strive to get there, one day, by a slightly different path. Sometimes things happen in life that just don't make sense and it can take the wind out of our
sails. For me, that crushing blow came in high school, when I experienced the first big loss of my life.
Septicemia, adult respiratory distress syndrome, severe coronary heart disease, multiple organ failure, diabetes and obesity: it pains me to write these
diagnoses from the official autopsy report of Marlayne Makovec, my 62-year-old grandmother, whose life ended too soon and abruptly. The autopsy said:
"She was an obese woman with moderate to severe respiratory distress, lethargic." does not define my grandmother. It does not mention that she was
the most loving, thoughtful and passionate person I had ever met. He doesn't mention that she was the glue that held our entire family together. It fails
to mention that she left behind a loving husband, beautiful children, and numerous grandchildren, all of whom loved her more than you can imagine.
Everything that was written.
They were the reasons why he was no longer here. My grandmother was gone, and it was the first real loss I saw my family endure. As a step? Could it
have been prevented? The experience of losing my grandmother and the questions her death raised stayed with me. through the next few years of my
life. I was your typical high school student-athlete, ranking at the top of my class while also serving as captain of the baseball and football teams.
Although it was hundreds of miles away from my family and friends, I ended up committing to Tampa University to play baseball and earn my college
degree. I was determined to find a way to use my past experiences for good and help change people's lives for the better without having experiences
similar to my grandmother's.
Entering my freshman year health sciences class, I realized that God had a much greater vision for me and that Tampa was exactly where I needed to be
to live out that vision. Much to my surprise, I met a professor who gave a lot of excitement about the same topics I was interested in. I had found a guy
who shared my vision and passion for impacting the world. That teacher was Jacob Wilson. Fortunately for me, he saw the same enthusiasm in me from
the beginning. Jacob took me under his wing and introduced me to the world of research. He has been a mentor to me ever since, and we have never
looked back. Along the way, Jacob and I, along with Shawn Wells, another incredible mentor and friend, attended a national conference that would
ultimately play a vital role in what we are writing this book today.

THE INFLECTION POINT

At the 2011 National Strength and Conditioning Association conference, we attended a lecture by our now good friends and colleagues, Dr. Jeff Volek and
Dr. Steve Phinney, true pioneers in the ketogenic diet field. These scientists gave a phenomenal presentation on the ketogenic diet and performance. At
the end, an audience member stood up and asked, "What data is there on ketogenic diet and resistance training in athletes?" In response, Dr. Volek said,
"We currently do not have any controlled studies on this topic." Almost simultaneously, we looked at each other and said the exact same thing: "We have
a lot of work to do!"
From that point on, we jumped headlong into researching the ketogenic diet, exogenous ketones, and their impact on body composition, molecular
signaling, and performance. We have conducted extensive research not only on the ketogenic diet and resistance training but also on the impact of diet
and exogenous ketones on aging, mitochondrial health and cognitive function. More recently, we broke out of traditional academia and created the most
advanced ones. laboratory in the world for the study of human performance: the Applied Science and Performance Institute (ASPI), located in Tampa,
Florida. Our mission is to help people see the world not as it is but as it could be by redefining the boundaries of science, to truly change lives through
science and innovation and #makepositivitylouder. Every day we strive to help improve lives, educate people, and create a lasting impact that will live far
beyond us.

ABOUT THIS BOOK

This book is the culmination of decades of research broken down in a simple, relatable way. The Keto Bible is aimed at people who are just being
introduced to ketosis, but also appeals to those looking for more scientific information on how ketosis can be applied in certain situations If you have no
idea what ketosis is or if you are a researcher leader in this field, This book is intended to serve as a resource for you.
Because we're scientists, we've included hundreds, if not thousands, of citations throughout. this book. Don't let these quotes intimidate you; rather, see
them as a statement that the information presented here is more than opinion.
We created this book so that if you are interested in understanding more about ketosis, you can equip yourself with the tools necessary to answer any
questions you have or that someone else throws your way. The Keto Bible Features:
• a detailed history of the ketogenic diet
• A general guide to what ketosis and the ketogenic diet are
• areas where the ketogenic diet may be advantageous
• advanced keto recipes as well as quick and easy
• the first material published in a book on exogenous ketones and their role in ketosis
Feel free to skip the book, especially if you are interested in a certain aspect of the ketogenic diet or exogenous ketone supplements. Use this book as a
guide to further your exploration and understanding of ketosis as a whole.
The Keto Bible is the result of countless hours spent both in the lab and interacting with the best minds in the world on this topic. From the bottom of our
hearts, we hope you enjoy reading this book as much as we enjoyed the journey we took to build it.
 KETOSIS: THE BASICS

Since you've read this book, you're probably interested in learning more about the ketogenic lifestyle and what it means to be in a state of ketosis. All our
lives, we have been told that the main source of energy for our bodies is carbohydrates or glucose. However, there is an alternative fuel source that our
bodies can use under various conditions, a more efficient fuel source that is often underutilized. That source is ketones.
Ketone bodies are produced when the body metabolizes or breaks down fat. The body's cells can use these ketones as fuel to help power everyday
functions. There are three types of ketone bodies:
• acetoacetate (AcAc)
• beta-hydroxybutyrate (BHB)
• acetone (acetone is produced by breaking down acetoacetate, making it another byproduct, but for our purposes, it can be considered a ketone body).
Each type of ketone body serves unique functions and can be evaluated. For example, BHB in the blood can be tested using a finger stick, AcAc in the
urine can be measured with a urine strip, and acetone in the breath can be measured with a breath meter.
All of us, at some point in our lives and routinely throughout the day, have a certain amount of ketones in our blood, but you often don't realize it. For
example, if you had dinner at 5 p.m. and you didn't eat again until 10 am The next day, you would probably be in a minor state of ketosis since you had
not eaten food and had been fasting for seventeen hours. Our bodies naturally make ketones under these circumstances; However, most people never
achieve a consistent state of ketosis due to the constant supply of carbohydrates in their diet. Therefore, instead of breaking down and metabolizing fat,
our bodies metabolize carbohydrates, or rather, glucose. In other words, when glucose is available in the blood, the body will use it to produce energy
instead of dietary fat or stored body fat. However, when glucose is not as readily available (glucose is still present but not as high), the body breaks down
into fat and ketones become its main fuel source.
Ketos is, essentially, the state of having elevated levels of ketones, typically greater than 0.5 millimoles per liter, or mmol/L. As a state of ketosis is
induced, how high ketones are in a person's blood and what benefits are derived from that degree of ketosis vary widely from individual to individual.
 Normal Carbohydrate Diet Ketone levels of 0-0.4 mmol/L, blood glucose levels of 80-120. and no change in blood pH.

Prolonged Fasting / Ketogenlc Di Ketone levels of 0.5-7 mmol/L, blood glucose levels of 60-120, and no change in blood
pH.
Results in improvements in health.

Diabetic Ketoacidosis
Ketone levels of >15-25 mmol/L,
blood glucose levels of >200, and
very low blood pH.
Can be fatal!

Figure 1.1. Differences in degrees of ketosis.

THE OTHER FUEL

For centuries, scientists have known that the body's cells are fueled by glucose; However, it wasn't until the 1950s that scientists discovered that our
bodies can run on a completely unique energy source: ketones. More than a hundred years ago, in 1915, Dr.Francis Benedict published a landmark
document on fasting and fuel utilization. He discovered that the body can only hold a small amount of glycogen, the stored form of glucose, worth about
2,000 calories. At the time it was believed that after glycogen is depleted, the only way to fuel the body would be to break down the muscles and organs.
(body tissue) at an accelerated rate to provide glucose (Cahill, 2006). (The liver can convert protein to glucose through a process called gluconeogenesis;
more on that here.) The result would be sustained glucose for the brain at the expense of other vital tissues in the body: Certainly not an ideal process.
For a long time, ketones were even believed to be toxic. This misunderstanding dates back to the 1920s and the discovery. Insulin When doctors began
using it to treat diabetes, they discovered that too much insulin caused blood glucose to drop dangerously low, a condition known as hypoglycemia,
which could lead to unconsciousness, coma, and even death. When hypoglycemic patients were given carbohydrates, their symptoms were reversed. (We
have all experienced some form of hypoglycemia. Some people refer to this as "starvation.") This led scientists to believe that the brain and central
nervous system were fueled entirely by glucose (Owen, 2005). Because people with uncontrolled diabetes had ketones in their blood, researchers
believed that the ketones were toxic byproducts of the disease. It wasn't until George Cahill began to challenge this theory in the 1960s that people
began to realize that glucose is not the only fuel for the brain and that previously thought "toxic byproduct" could be an alternative source of fuel for our
bodies (Cahill et al., 1966).
In the mid-1950s, researchers began to consider the use of fasting to treat obesity (Cahill et al., 1966) and began investigating the impact of fasting on
fuel utilization in the brain and other tissues. Dr. Cahill and his colleagues, profound scientists began to question the idea that the brain relies solely on
glucose for energy, especially in the fasting state. Cahill reasoned that since the body can only hold a limited amount of glycogen, if glucose were the
body's only fuel (an expensive emergency backup that would damage the body's tissues), then fasting would result in death within eight to eighteen days.
.
Believing there had to be an alternative explanation for how the body is fueled, Cahill rolled the dice and had six students.
fast for eight days. (A study like this would never be approved today, but it provided incredible findings.) One of two things could happen: either the
students would die or they would live and Cahill would have discovered that there is an alternative source of energy for the brain. Since George Cahill is a
legend in the history books and not a prisoner in the state penitentiary, you can guess the outcome. It found that the students' glucose levels fell from
around 80 mg/dL on day 1 to 65 mg/dL on day 3 and remained at that level for the remaining five days of the study. On day 3, his blood ketone levels had
increased from 0 to 1.6. mmol/L, and by day 8, those levels had increased to 4.2 mmol/L, without negatively affecting the pH or acidity of their blood.
Additionally, their fasting insulin levels dropped by half. Cahill's research provided the first evidence that the brain can use a fuel source other than
glucose: ketones.

DIET-INDUCED KETOSIS AND THE DEFINED KETOGENIC DIET

Fortunately, scientists soon discovered that the absence of carbohydrates, even in the presence of food consumption (i.e., the origins of a ketogenic diet),
could mimic this fasting state and that ketosis could be induced by altering the diet. Soon thereafter, researchers began to focus on the type of diet that
induces ketosis, one that triggers the production of ketones. The ketogenic diet.

KETO CONCEPT
Mrs. B's forty-day fast
Mrs. B., a very intelligent nurse who was overweight (approximately 280 pounds), wanted to change her body composition and improve her health.
Fearing heart failure, he entered a six-week starvation study conducted by a researcher in Dr. Cahill's laboratory named Dr. Owen. When Dr. Owen was
asked why he would undertake such an extreme experiment, he replied: “Jesus fasted forty days and forty nights; and then he was hungry” (Matthew
4:2). What his equipment found was amazing! The results showed that Mrs. B. He got two-thirds of his brain fuel from ketones, while his blood ketone
levels did not exceed 7 mmol/L even after more than forty days of fasting. From here, scientists were confident that ketones could provide an additional
source of energy during times of lower fuel availability and our bodies knew how to properly regulate this fuel.
Diet-induced ketosis without starvation (nutritional ketosis) differs from starvation-induced ketosis in that ketone production is typically lower due to the
fact that food is being consumed. Although it is different for everyone, a well-formulated ketogenic diet is typically high in fat (more than 65 percent) and
extremely low in carbohydrates (5 to 10 percent) (Veech et al. 2004). Research shows that ketone levels tend not to rise above 7 mmol/L during diet-
induced ketosis and generally remain far below this level. For example, Dr. Jeff Volek's lab found that after three and six weeks on the ketogenic diet,
normal weight men had an average blood BHB concentration close to 0.5 mmol (Sharman et al., 2002). These results were confirmed by a study of
individuals with cardiovascular risk factors, which found that after six weeks of a calorie-restricted ketogenic diet, BHB levels had increased by only, on
average, 0.5 mmol (Ballard et al., 2013). . Additionally, our laboratory found that even in highly trained, physically active and healthy men, ketone levels
generally do not exceed 1.5 mmol after eight weeks on a strict ketogenic diet combined with resistance exercise.
So what exactly does a ketogenic diet comprise? There are many different explanations, but they all share one essential one. feature: significantly
reduced carbohydrates. Here are some definitions from published studies:

• Less than 50 grams of carbohydrates per day (or 5 to 10 percent of total daily caloric intake) and dietary fats as high as 90 percent of total daily caloric
intake (Paoli et al., 2013).
• Less than 50 grams of carbohydrates per day, regardless of fat, protein, or calorie intake (Westman et al., 2003).
• Four times more fat than carbohydrates, with proteins regulated so that 90 percent of calories come from fat (Swink et al., 1977).
• Less than 50 grams of carbohydrates per day, or about 10 percent of total daily calories from carbohydrates. (i.e., 200 calories on a 2,000-calorie-per-
day diet) (Accurso et al., 2008).
• High in fat, protein and carbohydrates (Freeman, 1998).
• An ad libitum (“free-feeding”) diet consisting of less than 50 grams of carbohydrates per day (Gregory et al., 2017).

All of these definitions focus on the intake of fats, proteins and carbohydrates, known as macronutrients. This makes sense because consuming
carbohydrates, too much protein, and too little fat can prevent ketone production. (I get closer to optimal macronutrient ratios in Chapter 3.) However,
we want to use a more general definition that doesn't call for specific amounts of macronutrients, but instead focuses on the overall goal of a ketogenic
diet. For our purposes, a ketogenic diet is one in which glucogenic (glucose-producing) substrates (non-fiber carbohydrates and glucogenic amino acids)
are low enough to force the body to rely primarily on fat for fuel and increase body production. ketones. Why not specify macronutrient ratios? You may
have heard people recommend a ketogenic diet that is 80 percent fat, 15 percent protein, and 5 percent carbohydrates. However, it is difficult to know
whether someone will enter ketosis by macronutrient ratios alone without knowing other individualized variables, such as physical activity level, total
caloric intake, and health conditions. For example, a friend of ours was trying to bulk up and wanted to do it through a ketogenic diet. His daily caloric
intake was around 4,500 calories. If he followed the recommendation that 5 to 10 percent of his calories come from carbohydrates, he would have been
consuming between 56 and 113 grams of carbohydrates and 225 to 282 grams of protein a day, likely enough to prevent ketosis, especially if I wasn't
exercising. Setting macronutrient goals can be helpful for someone just starting a ketogenic diet (we offer some suggestions here), but keep in mind that
it needs to be taken in context and take individual goals into account (e.g. e.g., therapeutic use versus sports performance enhancement) versus weight
loss). There is no one-size-fits-all approach to a ketogenic diet and therefore the proportions and, in particular, the current amount of each macronutrient
may vary slightly from person to person depending on goals and health parameters such as insulin sensitivity. , body composition, gender and activity
level.
A ketogenic diet is one in which glucogenic (glucose-producing) substrates (non-fiber carbohydrates and glucogenic amino acids) are low enough to force
the body to rely primarily on fat for fuel and increase production of ketone bodies.

THE PHYSIOLOGY OF DIET-INDUCED KETOSIS

Why is cutting carbs so important for ketosis? Because it helps create two necessary conditions. First blood glucose levels should decrease, and reducing
carbohydrates through a ketogenic diet has been shown to reduce fasting blood glucose (Brehm et al., 2003; Samaha et al., 2003). Second, the body's
glycogen stores must be depleted. On a ketogenic diet, the glycogen stored in the liver can be depleted in approximately forty-eight hours (Adam-Perrott
et al., 2006).
Both low blood glucose levels and depleted glycogen stores are crucial to ketosis because they force the body to use fuel other than glucose. The body
naturally uses glucose when it is available, either in the bloodstream (from food eating) or the breakdown of stored glycogen. Therefore, by reducing both
the amount of glucose taken in from food and the amount of glucose stored as glycogen, the body can begin to burn fat/ketones as a primary source of
fuel.
 6. Elevated ketone 5. Low glycogen
Figure 1.2 . Carbohydratebodies
restriction reduces blood glucose and insulin levels, which increases fat burning to allow
ketones be produced and used as fuel.

There is a second reason why lowering blood glucose helps induce ketosis. Carbohydrates are the main trigger for the release of the hormone insulin,
which triggers the absorption of glucose from the bloodstream into the cells. Insulin also stops the body from using fat for fuel and promotes its storage,
so when insulin is high, fat is not burned. However, when insulin is low, the body can break down triglycerides (the stored form of fat) to be used as fuel.
Burning fat is, of course, what produces ketone bodies. In summary, the physiology of diet-induced ketosis involves the decrease in blood glucose, stored
glycogen, and insulin. levels. The result is improved release and reliance on fat for fuel. Eventually, these fats are converted into ketone bodies, which can
provide an alternative, more effective fuel source for the body.

DOES NOT EATING FAT MAKE YOU FAT?

“You are what you eat” is a common and overly simplistic phrase that nutritionists use to convey that if you eat “bad” foods, your health will suffer. Most
people take this phrase out of context to say: "If I don't eat fat, I can't get fat. So someone could drink fifteen sodas a day and eat cereal for every meal
and still be a lean machine. It could happen? Maybe for someone who is extremely sensitive to insulin. It is probable? Absolutely not. Let's start by saying
that fat is not the culprit. If we were in court, a not guilty verdict would be issued once the evidence was presented. As mentioned above, if you
drastically reduce your carbohydrate intake, you need to make up for that energy deficit through one or both of the macronutrients: fat and protein.
People often err on the side of caution and take the old Atkins approach of going low carb, but eating super high amounts of protein and only moderate
amounts of fat. Unfortunately, this approach would likely not result in the ability to adapt to using fat for fuel (known as keto-adapted) because the liver
can create glucose from certain amino acids/proteins through the process of gluconeogenesis.
Therefore, instead of consuming only “low carb” and high protein, people on a ketogenic diet eat very low carb and increase their fat intake while
maintaining or slightly increasing their protein intake. The body then adapts to using fat as its primary fuel source All our lives we have been told that high
amounts of dietary fat are what lead to heart disease, diabetes, high cholesterol, and even obesity. It's understandable that people are often hesitant to
adopt a lifestyle where bacon and butter aren't so bad. after all. It's fat that makes us fat, right? Incorrect. If we look at historical obesity rates in the
United States, we see a phenomenon worth noting.
During the 1980s, nutritional guidelines and strategic food marketing convinced people that consuming fat led to serious complications, including obesity.
(We'll talk about why this was the case more in Chapter 2.) Everywhere we turned, low-fat food options were popping up, almost as if fat was a plague
and we needed to avoid it as such. However, at the same time, the prevalence of obesity began to increase dramatically (see Figure 1.3). Following low-
fat recommendations and
Eating faster, packaged foods labeled "low-fat" (which almost always has added sugar to make up for the flavor lost by reducing fat) while exercising less,
our society actually became fatter. How could this be?
 Figure 1.3 . Obesity increased after low-fat recommendations were issued in the 1980s.

Scientists have been scratching their heads over this phenomenon for decades. Is it fat, carbohydrates, or possibly the combination of the two that leads
to obesity and other metabolic problems? A historical experiment may hold the answer. Dr. Robert Wolfe is a leading authority on metabolism. His lab
conducted a study in which fat was observed. infused into the blood of the subjects; showed that when fat is infused by itself, it is used as fuel, and none
of the early indicators of obesity, such as elevated insulin and glucose levels, were observed (Klein et al., 1992). In the next phase of the study, the
researchers infused fats and carbohydrates into the subjects' blood. This time, fat was not used as fuel; instead, both fat and carbohydrate utilization
were affected. The experiment clearly indicated that fat alone is not what is making us fat.
Rather, it is the combination of high amounts of fat and high amounts of carbohydrates. (No wonder this is what makes up to 95 percent of fast foods!)
As we will discuss throughout this book, when carbohydrates (and therefore insulin) are low fat consumption is high, overall results are loss of body fat;
improvements in insulin, glucose and cholesterol levels; and An overall improvement in health.

KETO CONCEPT

IS IT A HIGH FAT DIET OR A FAST FOOD DIET?

In scientific research, if you want to induce a state of obesity, disease, and serious health complications in animals, feed them a "high-fat" diet. However,
what 99 percent of these studies are really looking at is a high-fat, high-carbohydrate, fast-food diet. Most of them involve feeding mice anywhere from
40 to 60 percent of calories from fat, with the rest being mainly carbohydrates. People and news headlines often cite animal research data that “high-fat”
diets are bad for us, but they might as well be saying that a bacon cheeseburger with fries and a soda is Bad for us. we. I think we all know that's the case!
Remember to look at the actual composition of the diet rather than taking the title at face value.

Figure 1.4. A lettuce wrap is an easy way to avoid the combination of fats and carbohydrates found in foods like
cheeseburgers

KETO ADAPTATION

Most of us have been eating a high-carbohydrate diet our entire lives. While fasting or following a ketogenic diet can help you start producing ketones, it
takes time for your body to switch to burning fat as its primary fuel source. Imagine getting a call today and finding out you had to move to a different
country tomorrow and stay for six months. It would take your time to learn the language and adapt to the culture. You could survive, but the longer you
were there, the more you would adapt to the culture and life would be easier. Likewise, when adopting a ketogenic lifestyle, it takes time to really adapt,
but keep in mind that the health implications, from improvements in conditions like obesity and diabetes to improved athletic performance and longevity
can be profound.
Take a moment and imagine a friend of yours who is thin. This individual, like most of us, is probably storing 1,600 to 2,000 calories as glycogen. How
much fat do you think this individual is storing? You may be surprised to know that even a thin person can store 30,000 to 60,000 calories as fat! In an
average-sized individual, this number can go up to 100,000, and someone who is obese may be storing 200,000 calories from fat. Therefore, we do not
have an energy shortage: we all have body fat. However, we often lack the ability to harness and utilize that body fat.
Research shows that infants and children have a significant ability to tap into these fat stores (Coggan et al., 2000; Martinez et al., 1992), but as we age,
we become more dependent on our carbohydrate stores. much smaller (Martinez et al., 1992). In fact, babies are born in a state of ketosis and can use
ketone bodies at a rate of five to forty times. greater than adults (Platt and Deshpande, 2005). We would venture to say that the decreased ability to use
fat for fuel is an impact of our dietary choices, with an emphasis on grains and other carbohydrates. Research shows that high carbohydrate diets begin to
"fix" our metabolisms to prefer carbohydrates for fuel (Volek et al., 2015). You often hear people say that glucose is the body's preferred energy source;
However, an alternative explanation may be that our natural state is to be in ketosis, but our eating habits disrupt this process and program our bodies to
develop a carbohydrate-dependent metabolism. Is there a way to tap into our greater energy reserve again? Yes, and it involves a process called
ketoadaptation.
Keto adaptation is the body's response to carbohydrate restriction. When we are keto-adapted, we have stopped relying primarily on carbohydrates so
that our energy needs rely primarily on fat (and therefore ketones) (Volek et al., 2015).
Research tends to show significant declines in physical performance after one week of following a ketogenic diet; However, performance levels are
restored after approximately six weeks, although it sometimes takes longer (Phinney et al., 1983; Volek et al., 2015). From this, it is generally assumed
that keto adaptation can take anywhere from several weeks to a couple of months. However, based on long-term data collected from elite athletes who
have adopted a very low-carb diet, we maintain that keto adaptations still occur even one year after diet initiation (Volek et al., 2016). (We'll explore this
topic in more depth in Chapter 5.) The series of adaptations that occur after a ketogenic diet is extensive. There is no clear point at which someone is
completely adapted and all of these changes have been made. There are several factors involved, including previous diet, exercise habits, insulin
sensitivity, and much more. Research shows that these keto adaptations include, among others, increasing the number of mitochondria (fat-burning
machinery) in a cell, raising blood levels of ketones, and improving the body's ability to absorb and use ketones at the cellular level (Volek et al., 2015;
Volek et al., 2016)

Figure 1.5 . Our bodies have a limited glycogen storage capacity; Meanwhile, we have almost unlimited fat reserves
to take advantage of.

KETO CONCEPT

THE TRANSITION FROM GLUCOSE ENERGY TO FAT AND KETONE ENERGY

Have you ever tried a ketogenic or low-carb diet and felt miserable in the first few days? You may have experienced a lack of energy or concentration or
even some headaches. This “keto flu” is often part of the process of transitioning from glucose dependence to fat dependence and symptoms begin to
disappear as you complete the transition. People often say they've tried a ketogenic diet and it just didn't work for them, but many times they quit right
in the middle of the transition period. Variables such as exercise intensity, electrolyte manipulation, type of fat in the diet, frequency of eating (i.e.
fasting), and even exogenous ketones can facilitate and facilitate the transition to keto adaptation. We talk more about all of these variables in Chapter 7.

DIABETIC CETOACIDOSIS
Mention the word ketosis to someone, and this question will almost inevitably arise: “Shouldn't I be worried about going? in a state of ketoacidosis? "It is
important to understand the difference between the physiological effects of a ketogenic diet (in other words, ketosis) and ketoacidosis.
Ketoacidosis occurs when there is uncontrolled production of ketones, which is usually accompanied by high concentrations. of blood glucose (i.e.
diabetes). In ketoacidosis, blood ketone levels reach 15 to 25 mmol/L, and blood acidity also increases (Cartwright et al., 2012). The potential cause of
damage comes from the alarming increase in acidity or decrease in pH. of the blood
A healthy human body strictly regulates acid concentrations in the blood. If your blood has a pH below 7, it is acidic; If the pH is greater than 7, it is basic
or alkaline (the opposite of acidic). Human blood is usually slightly alkaline, with a pH ranging from 7.35 to 7.45. Any deviation from this norm, even by
the most modest margins, can prove fatal (see Figure 1.6). The most common form of ketoacidosis is diabetic ketoacidosis. This usually occurs in type 1
diabetics, but can also occur in type 2 diabetics. What is the difference? In type 1 diabetics, the pancreas does not produce insulin. In type 2 diabetics, the
body's cells are resistant to insulin and/or the pancreas produces inadequate amounts of insulin. (We discuss these topics in more detail in Chapter 5.)
It's clear that insulin is a key player in both types of diabetes, but what is its role? The main jobs of insulin are:
1) bring glucose to cells to be used for energy, and
2) keep fat metabolism in check
During fasting or on a low-carbohydrate diet, insulin levels decrease and insulin sensitivity, the ability of insulin to efficiently interact with cells, improves.
In an insulin-sensitive person, less insulin is required to move more glucose into the cells.
However, when insulin is absent (as in people with type 1 diabetes) or cells are resistant to its effects (as in people with type 2 diabetes), glucose is not
absorbed into cells efficiently and, therefore, it cannot be used for energy. Under these conditions, carbohydrate consumption causes blood glucose
levels to skyrocket from a normal level of 80 to 100 mg/dL (during fasting) to levels exceeding 300 mg/dL! Many scientists have referred to this
phenomenon as “starvation versus very much” (Figure 1.7). The energy (glucose) is there, knocking on the cell door, but it can't get in, so the blood floats
around, potentially causing damage.

Figure 1.6. Range of pH levels in blood.

When cells sense that both glucose and insulin are low (or cells simply do not respond to insulin), the liver increases a process known as gluconeogenesis,
literally "making glucose from again." It is the formation of glucose from carbohydrate substrates. To produce this glucose, the body uses amino acids
(either from the diet or from muscle tissues), the glycerol backbone of fat molecules, or lactate produced by muscles. At the same time, since the cells
perceive that they are starving. With no energy coming in, the breakdown of fatty acids increases to produce ketone bodies.
However, in situations involving ketoacidosis, there is a lot of glucose in the blood; the cells simply cannot absorb it (i.e., they are resistant to it). When
blood glucose rises too high, the kidneys cannot properly filter and reabsorb it, leading to glucose being excreted in the urine. Because glucose is not
properly filtered, it brings with it the liquid portion of the blood, which is also excreted in urine. This results in a lower blood volume with a high
concentration of ketone bodies. In this case, these extremely high levels of ketone bodies, which are slightly acidic in nature, increase the acidity of the
blood and must be treated immediately. This is ketoacidosis. It is important to remember that ketoacidosis is generally not seen in healthy people
implementing a ketogenic diet or even supplementing with exogenous ketones, as both are controlled processes that increase blood ketone levels to the
majority, from 5 to 7 mmol/L . Ketoacidosis, on the other hand, is uncontrolled, with blood ketone levels starting at 15 to 25 mmol/L.

KETO CONCEPT
Insulin resistance: "starvation in the face of abundance"
The best way we've found to explain insulin resistance and "starvation versus plenty" is with a silly but simple depiction of a small town called Resistencia.
In Resistance, when it rains (i.e. someone eats carbs), green sludge (i.e. glucose) rises from the ground and floods the streets (i.e. bloodstream). The city
calls in its cleaning crew (i.e., insulin) to clean the streets, and the crew does so by sweeping up the mud in people's homes (i.e., cells). The cleaners knock
on people's doors, people open their doors, the cleaners skim the mud, and then they're on their way. People don't really care, it's not a lot of sludge, and
they know that getting it off the streets benefits the city. But if it starts raining all the time (that is, frequent consumption of carbohydrates constantly
increases blood glucose), the resistance people get tired of all this mud in their houses. Eventually, when the cleaners come to push the mud into the
houses, fewer and fewer people open the door. This is insulin resistance: when cells stop responding to insulin signals. There is so much mud in the street
that the city orders more cleaners (more insulin) to force the mud into the houses. But then the mud starts coming out of the windows. The houses (cells)
already have too much mud and can't take any more, so no matter how hard the cleaners try, they can't push the mud into the houses, and the mud stays
on the street (in the blood). With all this glucose/sludge readily available in the blood, our bodies shut down a process known as lipolysis, or fat
breakdown, and instead of burning fat, we end up storing it.

Figure 1.7 . Insulin resistance explained.

IS THE KETOGENIC DIET JUST ANOTHER LOW CARB DIET?

Unfortunately, the definition of a low-carbohydrate diet is confounded by the fact that there is no minimum recommended daily amount of
carbohydrates. However, a commonly accepted definition is that a low-carbohydrate diet is one that provides less than 50 percent of its calories from
carbohydrates (Feinman et al., 2003). This is in stark contrast to the recommendation of less than 50 grams per day for very low-carb ketogenic diets. (If
the friend we mentioned earlier in the chapter who was eating about 4,500 calories a day used the 50 percent definition, he would be "low carb" if he ate
550 grams of carbs a day! We all know this is anything but carbs.)
As discussed above, a ketogenic diet is one in which glucogenic substrates are low enough to force the body to transition from metabolizing glucose to
burning fat and subsequently producing ketones. So while a ketogenic diet is low in carbs, a low carb diet is not necessarily ketogenic.
A classic study (Young et al., 1971) demonstrated a clear difference between low-carbohydrate and ketogenic diets. The scientists took overweight young
men and placed them on "low-carb" diets consisting of 30, 60, or 100 grams of carbohydrates per day. They found that after nine weeks, the 100 gram
group was not in ketosis at all, while the 30 gram group had achieved high levels of ketosis. Additionally, the 30 gram group lost more fat than the 60
gram group and the 100 gram group. even though there are no differences in total calories or protein consumed. This study clearly demonstrates that not
all low-carb diets are created equal, and certainly not all are ketogenic. You must understand this concept to get optimal benefits from this book.

True Ketogenic Diet Low-Carb Non-Ketogenic Diet

Ketone Levels High

 Fat Loss (kg)
Figure 1.8. Differences in body fat lost between a low-carb diet and a ketogenic diet.
Source: Adapted from Young et al., 1971.

CHAPTER SUMMARY
This chapter provided a solid foundation for understanding ketosis that will be needed for the rest of the book. We explain that ketosis is characterized by
blood ketone levels greater than 0.3 mmol/L. In general, a ketogenic diet is one in which glucogenic substrates (non-fiber carbohydrates and glucogenic
amino acids) are low enough to force the body to rely primarily on fat for energy and increase production of ketone bodies. This type of dietary strategy
allows individuals to enter a state of keto adaptation, in which their fuel source shifts from primarily carbohydrates to mainly fats and ketones. The keto
adaptation process varies in duration and continues to provide benefits the more you eat ketogenic. Fat in itself does not make you fat; Rather, large
amounts of dietary fat in the presence of significant carbohydrates (a hallmark of the standard Western diet) can make you resistant to fat and insulin.
Early research on diabetics found that when the disease state was untreated, blood ketone levels increased greater than 15 mmol/L. The result was
ketoacidosis, a decrease in blood pH due to an uncontrollable increase in ketones, even in the presence of high amounts of glucose. This led researchers
to believe that ketones were a toxic byproduct of metabolic dysfunction and disease. However, research from starvation and ketogenic diet studies has
taught us that ketones are a high-potency energy source that can replace glucose and serve as the body's dominant fuel source.
 Everyone has a doctor in them; We just have to help you in your work. The natural healing force within each of us is the greatest.
force to improve........................................................... Eating when you are sick is feeding your illness.
—Hippocrates

Imagine if Alexander Fleming hadn't left his dirty petri dish in a laboratory sink when he went on vacation in the summer of 1928; maybe not having
penicillin Imagine if Perry Spencer hadn't had a chocolate bar in his pocket that melted when he was standing next to a magnetron (a system that
generates microwaves for radar systems); We may not have the microwave oven. Imagine if John Pemberton hadn't mixed his "headache and addiction
cure" of coca leaves, sugar syrup and kola nuts with carbonated water; We may not have Coca-Cola. You may not know their names, but these people
have affected your life in some way. Likewise, several other key players whose names may be unknown to you have had a significant impact on the
development of the ketogenic diet. Throughout this chapter, we will take a trip back in time and highlight important people and events in the history of
The ketogenic diet, including the first low-carb diet advocates for the emergence of the ketogenic diet, its fall from favor and resurgence, the introduction
of low-fat recommendations, and the development of exogenous ketones.

WHERE EVERYTHING BEGAN

The concept of restricting carbohydrates to lose weight and improve health dates back to the mid-1800s. Jean Anthelme Brillat-Savarin, a French lawyer,
politician, and "father of low-carbohydrate diets," was the first to connect obesity and carbohydrates. In his 1825 book The Physiology of Taste, he states
that one of the main causes of obesity "are the floury and starchy substances that man makes as raw ingredients in his daily diet." All animals that
live on farinaceous foods gain weight involuntarily; and man is no exception to the universal law."
Not long after, English businessman William Banting began following a low-carbohydrate diet on the advice of Dr. William Harvey. Numerous medical
treatments, starvation diets and extreme exercise had not worked for this five-foot-five, 202-pound, sixty-five-year-old boy, but by limiting
carbohydrates, his diet reduced bread, sugar, potatoes, milk and beer. —He underwent an incredible transformation. Banting was so ecstatic with his
weight loss that in 1863 he published A Letter on Corpulence, which sold thousands of copies. By 1866, London and much of Europe were experiencing
Banting mania. Although not the same as a ketogenic diet, The Banting Diet paved the way for later carbohydrate restriction strategies and remains
extremely popular in South Africa, with advocates such as Dr. Tim Noakes, co-author of the book The Real Meal Revolution. Despite the Banting diet
trend, to fully understand the origins of the ketogenic diet, we must start with fasting, whose health benefits ultimately led researchers and doctors to
the ketogenic diet as we know it today.
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In ancient times, fasting was used as a sacred and nutritional therapy for various conditions, including epilepsy. Many accounts dating to the 5th century
BC describe abstinence from food as an effective cure for epileptic seizures (Temkin, 1994). In the King James Version of the Bible, Mark describes Jesus
healing a boy who experienced seizures, saying, "This kind [of an evil spirit] come out for nothing, but by prayer and fasting" (Mark 9:17–29) . In the
modern era, doctors and scientists recognized that fasting is beneficial for a variety of health conditions and therefore attempted to dig deeper and
discover exactly why it has these effects. The last question was: is it possible to receive the benefits of fasting while consuming calories? The story begins
with an unlikely hero: Bernarr Macfadden. In today's age of social media, fitness enthusiasts can be found on every platform, from Instagram to Facebook
to Snapchat. Everywhere you turn, familiar faces fill our screens with their incredible physiques, showing off the phenomenal work they've done in the
gym, in the kitchen, and sometimes in Photoshop. However, in the early 20th century, Macfadden was the health and fitness guru for both the medical
and fitness communities. Dubbed “Body Love” by Time magazine, it paved the way for our current understanding of fasting and ketosis (Hunt, 1989).
Growing up, Macfadden faced many difficulties at home. His father was an abusive alcoholic, and his mother suffered from depression. When he was
eleven years old, both of his parents had died. Macfadden had no real family, so he spent a year in an orphanage, where he was vaccinated using a
medically unsound method and nearly perished, leading to lifelong distrust of the conventional medical community. Macfadden was a weak and sickly
child, but in his late teens he began experimenting with weights, walking three to six miles a day, and using natural remedies to heal his body. Against all
odds, he ended up making a name for himself. in what was the beginning of a large fitness industry (Hunt, 1989).

Weakness is a crime
Don't be a criminal."
—Bernarr Macfadden

Macfadden disagreed with conventional medical practices and objected to doctors' lack of understanding of naturopathic medicine. treatments such as
fasting. This, along with his infatuation with bodybuilding and physical fitness, led Macfadden in 1899 to launch his own magazine, Physical Culture, which
set out to educate readers about the importance of being physically active, eating healthy and limiting tobacco, alcohol. and even white bread
(Macfadden called it the "staff of death"). By 1903, the magazine's circulation had reached more than 100,000 copies a month, ultimately establishing
Macfadden as America's first health guru. Shortly after achieving widespread acceptance, Macfadden began making incredible promises that his tactics
could cure any disease and allow people to live to be over 100 years old. His formula was simple: exercise, sunbathe, avoid alcohol and tobacco, monitor
diet and regularly fast for a period of three days to three weeks. He believed that following these rules could alleviate and cure almost any disease,
including asthma, bladder disease, diabetes, prostate disease, epilepsy, impotence, paralysis, liver and kidney disease, and even eye problems (Hunt,
1989).
Feeling overwhelmingly confident in his abilities, Macfadden opened the Bernarr Macfadden Sanitarium in Battle Creek, Michigan, in 1907. (It was later
moved to Chicago and renamed Bernarr Macfadden Healthatorium.) It operated for several decades serving more than 300,000 people actively seeking
to improve their health (Interestingly, Macfadden's Sanitarium competed with Harvey Kellogg's famous Sanitarium, also in Battle Creek. It was eventually
purchased by Kellogg. Not surprisingly, Kellogg's sanatorium encouraged a low-fat, low-protein diet with an emphasis on whole grains.) This sanctuary
was unlike any other, and contained reading rooms, state-of-the-art fitness equipment, and even a sixty-foot swimming pool. Macfadden and his leading
osteopathic physician, Hugh Conklin, were known for calling out conventional doctors with their slogan: “We will take those you have given up on and
cure them.” Although he received a lot of negative press for his bold claims about his ability to heal people (he was even arrested on obscenity charges
for discussing sexually transmitted infections and premarital sex on Physical Culture), Macfadden's popularity increased thanks to clients like Upton
Sinclair , who fiercely advocated for Macfadden and published the book The Fasting Cure in 1911. Most importantly, Macfadden drew attention to the
need for research to improve our understanding of the effects of fasting, sex, and physical activity on general health (Bennett, 2013). Fast forward a
decade to 1921 and meet Rawle Geyelin, a prominent New York physician who had a quick personal interest. His young cousin had been dealing with
epilepsy for four years, and had observed all the treatments recommended by the leading doctor in the field, such as bromide and phenobarbital
(Luminal, a brand name of phenobarbital, was one of the most popular epilepsy medications). , it didn't work. Dr. Geyelin and his cousin's family sought
advice from two people who claimed to have answers: Bernarr Macfadden and Dr. Hugh Conklin in Battle Creek, Michigan.
 “When the importance of physical culture is recognized, it will enter into every phase of human life.” There is hardly a question in life [of] which
the
physical culture should not be part of it.
—Bernarr Macfadden

Dr. Conklin took Dr. Geyelin's young cousin under his care and made him fast for several days over the next few months. Only when the family thought
that a solution would never be found, the boy's seizures stopped on the second day after he began fasting. He remained seizure-free for more than two
years without drugs, only periodic fasting (Geyelin, 1921). Impressed by the results, Geyelin began using the same fasting treatment with a group of
epilepsy patients to see if he could confirm the results. cousin had seen it. After putting thirty patients on a twenty-day fast, he found that 87 percent
became seizure-free. Geyelin went on to declare: "When one wanted to convert a cloudy mentality into a clear one, it could almost always be done by
fasting" (Geyelin, 1929).

Figure 2.1. A cover of Physical Culture magazine making claims about health and beauty.

Because of the great novelty and excitement of his findings, Dr. Geyelin shared his results with an audience at a Restaurant Medical Association
Convention. You can imagine the gasps of the doctors in the auditorium who saw scientific data supporting this ridiculed, self-proclaimed healer, Bernarr
Macfadden. Prior to Geyelin's data, numerous absurd and even barbaric therapies modalities, such as bloodletting, trepanation (drilling a hole in the
skull), removing the ovaries and adrenal glands, and countless herbs and drugs had been used in an attempt to cure the which at the time seemed to be
an incurable condition. The idea that a simple treatment such as restricting food could cure epilepsy was met with skepticism and frustration (Wheless,
2008), even though fasting had eliminated seizures in 87 percent of Geyelin's patients and the Dr. Conklin reported that his "water diet" (fasting) had
cured epilepsy in 90 percent of the children he treated who were under ten years of age. (And in 80 percent of adolescents between ten and fifteen years
old, 65 percent of patients between fifteen and twenty-five, and 50 percent of patients between twenty-five and forty. Above the age of forty, the
percentage was very low).
Despite Conklin and Geyelin's successes, their explanation for why fasting worked as a treatment for epilepsy, clearing the body of harmful toxins: was
unfounded. Astonished by the fact that some of the world's best doctors had overlooked this form of treatment, in 1919 Charles Howland, the father of
Geyelin's cousin, gave it to his brother, Dr. John Howland, a professor of pediatrics. at Johns Hopkins, a $5,000 grant to determine whether there was
scientific justification for the success of the "starvation" treatment that helped heal his son (Wheless, 2004). With these initial funds, Howland set up his
lab and—because, like any other reputable researcher can tell you, you're only as good as the team around you—he recruited Dr. James Gamble, a
clinical chemist who helps observe metabolic and biochemical responses. to fasting.
Gamble set up a series of studies to examine various blood and tissue markers in response to short-term fasting. He noted that patients undergoing
fasting had differences in electrolyte balance and acid/base balance, but failed to come up with an explanation for why fasting had beneficial results for
epilepsy. The door was beginning to open. However, no one could determine exactly what was happening that could be the key answer that would pave
the way for decades to come (Wheless, 2004).
In 1921, Dr. Rollin Woodyatt, an endocrinologist in Chicago, was fascinated by the fact that fasting removes glucose from the bloodstream, even in
diabetics. He attempted to determine the effects of shifting the majority of a diabetic's nutrition from carbohydrates to fat. His theory was that this (like
fasting) would allow the body to "rest" the pancreas (since the pancreas produces insulin to control glucose from carbohydrates) and use fat for fuel. In
doing so, he discovered that even in healthy, non-diabetic subjects, ketone bodies such as beta-hydroxybutyrate (BHB) and acetone were present.
At the same time, more than 300 miles to the north, Dr. Russel Wilder of the Mayo Clinic was also looking at fat as the key to receiving benefits from
fasting while consuming calories. When the body metabolizes fat, particles called ketone bodies are produced, and it is these ketones that the body uses
as fuel. Wilder proposed that the benefits Conklin saw with his patients were likely due to ketonemia, or high levels of ketones in the blood. With that in
mind, Wilder suggested that this state (which would eventually become known as ketosis) could be achieved by means other than fasting, such as
minimizing carbohydrate intake and having a high fat intake.
Wilder immediately began putting his epileptic patients on a ketone-producing diet and coined the term by which we know it today:

"Ketogenic diet."

KETO CONCEPT

THE UNEXPECTED DRUG OF SLEEP

Luminal, also a popular sleep aid, is a popular anti-epileptic medication that is still prescribed today. It is interesting to note that a young medical student
named Alfred Hauptman came across this medication as a treatment after his residency in an epilepsy ward. He kept looking for ways to make his
patients fall asleep. He found that after taking Luminal, they slept soundly. This was the beginning of what would lead to several decades of pharmacy
practice for a possible pill that could help with seizures and the side effects associated with seizures.

While the scientific community was eagerly waiting to see data on the results of Wilder's ketogenic diet, Dr. Mynie Peterman, a May clinical pediatrician,
tested the diet on several of his pediatric epileptic patients in 1925. To say the results were incredible is an understatement. Children on the diet
experienced a significant drop in the number of seizures and in some cases became seizure-free completely. Even more surprising was the fact that he
tested the diet on several of his pediatric epileptic patients in 1925. To say the results were incredible is an understatement. Children on the diet
experienced a significant drop in the number of seizures and in some cases became seizure-free completely. Even more surprising was the fact that they
seemed to sleep better, were less irritable, and showed increased alertness (Peterman, 1925). News of Peterman's results spread quickly, and by the late
1920s, doctors across the country were prescribing the ketogenic diet for the treatment of epilepsy. For families and doctors, the choice was simple:
implement a ketogenic diet or give patients sedatives, which brought brutal side effects.
With the 1930s came the Great Depression and, eventually, the collapse of scientific funding. Research money was scarce, so animal studies became
more frequent because they were much easier to control and therefore allowed researchers greater flexibility to examine complex conditions such as
those that occur with epilepsy. The ketogenic diet remained the treatment of choice for epilepsy until the brilliant team of neurosurgeon Tracy Putnam
and neurologist Houston Merritt began looking for alternatives to phenobarbital, the sedative discussed above. One of those alternatives, a phenobarbital
derivative called phenytoin, seemed mildly sedating but held great promise for treating seizures. Brand name Dilantin, it became the first truly
anticonvulsant drug, and by 1940, doctors were prescribing it as a first-line treatment for epilepsy. This scientific discovery may go down in history as one
of the best/worst breakthroughs: while it led researchers to find new and beneficial anti-seizure medications, it also led to a reduction in the use of the
ketogenic diet (2004).
Over the next decade, dozens of anti-seizure compounds were discovered and pharmaceutical companies competed to develop the best "cure in a pill."
However, Putnam and Merritt soon realized that their discovery, as important as it was, created a major obstacle to scientific research into the root cause
of epilepsy and why the ketogenic diet was an effective therapy for it. (Doctors felt they had a strong cure and were therefore less proactive in trying to
identify and address the root cause rather than mask it with pharmaceutical agents.) Over the years, fewer and fewer children were put on a ketogenic
diet; instead, they were given combinations of several drugs. Soon after, few doctors, nutritionists, or researchers paid attention to the ketogenic diet.
especially after learning about research done by a man that would change our food industry for years to come. His name was Ancel Keys.

THE STUDY HEARD AROUND THE WORLD

If you're familiar with the name Ancel Keys, it's probably because of the "Great Man" theory of history: the idea that history changes "Strong personalities
direct events using their own personal charisma, intelligence, wisdom, or wit." (Teicholz, 2014). In the history of nutrition, Ancel Keys was by far the
greatest man. Keys, an influential nutrition scientist, had an interesting career: he began studying fish physiology and then developed the famous seven-
country study. Little did he know the impact his work would have for decades to come.
Until Keys' work in the early 1950s, the current theory about the cause of arterial plaque, a key risk factor for heart disease, was based on studies
conducted in the early 1900s by Russian pathologist Nikolaj Anitschkow. These studies pointed out the notion that consuming large amounts of
cholesterol can induce atherosclerosis and plaque formation in the arteries (Bailey, 1916). Despite several limitations in the study design, they paved the
way for years of research that led to a negative perception of dietary cholesterol. But in the early 1950s, Keys debunked this theory: He fed subjects up to
3,000 milligrams of cholesterol per day (the equivalent of about sixteen eggs) and found that it had no significant effect on blood cholesterol levels. blood
(Keys, 1950). Many other studies had similar results showing that high dietary cholesterol (cholesterol consumed in the diet) did not necessarily lead to
high blood cholesterol levels, and the focus on dietary cholesterol began to fade.
However, heart disease was on the rise, and scientists were struggling to find a solution to stop the epidemic. They were looking for a scapegoat, and it
happened that they closed their eyes in a room full of people, randomly picked and named an innocent individual known as fat as the culprit. Keys led the
charge: in 1952, he shifted his focus from dietary cholesterol to dietary fat and thus began the development of his "diet heart hypothesis," which
ultimately linked dietary fat and heart disease in the minds of millions and led to a low-fat craze that persisted for decades.
 "No other variable in life, other than dietary fat, shows anything like the consistent relationship with mortality rate from disease
coronary
or degenerative heart disease."
—Ancel Keys, 1954.

It was time for Ancel Keys to take his stand. In 1953, he published an article titled "Atherosclerosis: A Problem in the New Public Health" in which he
began to associate fat consumption with mortality from heart disease. In 1955, at the World Health Organization, Keys was questioned by British
physician Sir George Pickering. Pickering asked Keys to provide evidence for his hypothesis that dietary fat consumption was associated with heart
disease. Keys referred to a graph from his article on atherosclerosis in which he compared fat intake and mortality from heart disease in six countries: the
United States, Canada, Australia, England, Italy, and Japan (Keys, 1953). The results, he believed, were clear: Americans consumed the most dietary fat
and had the most deaths from heart disease. The Japanese ate the least fat and had the fewest deaths from heart disease. Therefore, fat in the diet
caused heart disease. After asking a lot about this correlation, Keys left the conference feeling defeated and set out on a quest to prove his point to his
colleagues. If only he could do a larger study, he thought, maybe that would "prove it to them."

Degenerative Heart Disease

Males, 1948-49

Fat calories as % of total calories

Age 55-59 — Age 45-49

• Japan Oltaly □ England and Wales O Australia ♦Canada To USA

Figura 2.2. Ancel Keys Correlative Study Shows Higher Fat Consumption Was Associated with Higher Mortality Rates
 Mortality from Arteriosclerotic and Degenerative
Heart Disease and Percent of Total Calories from Fat
Males age 55-59, 1950

Fat calories as % of total calories

1. Australia 7. Finland 12. Italy 18. Portugal

2. Austria 8. France 13. Japan 19. Sweden
3. Canada 9. German Fed. 14. Mexico 20. Switzerland
4. Ceylon Rep. 15. Netherlands 21. United Kingdom
5. Chili 10. Ireland 16. New Zealand 22. United States
6. Denmark 11. Israel 17. Norway

Figura 2.3. The relationship between fat calories and heart disease in twenty-two countries.

Around this same time, President Dwight Eisenhower suffered his first heart attack and interest in nutrition and his impact on heart health grew
exponentially. More researchers jumped into the fold, seeking to find the magic bullet to help our president, our country, and ultimately, our own hearts.
In 1957, Jacob Yerushalmy and Herman Hilleboe, two attendees at the WHO meeting, wrote a rebuttal to the keys titled "Dietary Fat and Mortality from
Heart Disease: A Methodological Note." twenty-two countries instead of just the six Keys had looked at. Yerushalmy and Hilleboe still found a positive
correlation between calories from fat and the incidence of heart disease, but their conclusions were very different from Keys's. For example, the
mortality rate from heart disease in Finland was more than twenty times higher than in Mexico, even though fat consumption rates in the two nations
were similar. When researchers looked at deaths from all causes rather than isolating heart disease, they found that mortality had a negative effect.
Correlation with fat intake: People in countries with higher fat intake actually lived longer. When all data were presented, the only positive correlation
with deaths from all causes was carbohydrate consumption (Yerushalmy and Hilleboe, 1957). ).

It is well known that the indirect method simply suggests that there is an association between the characteristics studied and mortality rates. . . No
It is in itself proof of a cause-effect relationship.
—Yerushalmy and Hilleboe, 1957.

But perhaps the most important thing to remember about these studies is that correlation does not equal causation. An example we like to use is that
the murder rate is highly correlated with an increase in ice cream sales. In this case, someone could make the same argument as Keys and claim that
eating ice cream makes people become murderers. Obviously, this is not the case, but this example demonstrates the importance of knowing the
difference between correlation and causation. Ice cream sales tend to increase in the summer months; Crime rates also increase during this time for
numerous reasons. However, a cookie dough ice cream with chocolate chips won't make someone murderous (unless it doesn't have sprinkles, of
course).

“The collector walks with blinders on; "He sees nothing but the prize."
—Anne Morrow Lindbergh
 I insulated my
home to protect
me from A.

...eventually CONCLUSION: Research

making it suggests A is correlated with
to... B (p< = 0.05) given C,
assuming D and under E
Scientists find potential link
conditions.
between A and B (under

I START certain conditions).

HERE... ...which is
then picked
THE SCIENCE up by...
NEWS CYCLE
I ...and
caught on...

News Wire
Organization
yes 'A causes B.'
say scientists.
...who are
-the n A is very deadly
read by...
noticed by. Recent studies have shown
that A is extremely deadly and
is definitely related to B.

Figura 2.4. How correlational research can be taken out of context.

In 1958, Keys and several of his colleagues around the world initiated the Seven Country Study, which examined the association. between diet
(particularly saturated fat consumption) and cardiovascular disease, comparing the health and diets of nearly 13,000 middle-aged men in the United
States, Japan, and Europe. Keys determined that countries in which people consumed large amounts of saturated fat in meat and dairy had higher levels
of heart disease than those in which people ate more grains, fish, nuts, and vegetables (Keys, 1980 ). This led to what became known as the heart diet
hypothesis: that eating saturated fat increases blood cholesterol and therefore increases the risk of heart disease. In Keys's eyes, it was as if (in an
anachronistic analogy) he were the hero of Rocky II, beaten to the canvas by his colleagues but persevering to become the last man standing at the end of
the fight.
Except there was one big problem: Rocky beat Apollo fair and square, but in this case, Keys rigged the fight. A strategic fighter, Keys found advantages in
the form of what researchers call "selection bias." Instead of selecting countries at random, Keys chose to report and discuss only those that are likely to
support his hypothesis, including Yugoslavia, Finland, and Italy. It excluded countries such as France, Switzerland, Sweden and West Germany, where
people consumed a lot of fat but did not suffer high rates of heart disease. In any case, keep in mind that the Seven Countries Study focused on
correlation, not causation. At no time has it been determined that eating fat causes heart disease; The study simply looked for a correlation between
heart disease rates and saturated fat consumption.
Despite these major problems, the damage had already been done. Based on the Seven Countries Study, Americans began to believe that eating fat
increased the risk of heart disease. Ancel Keys may not have predicted the impact his work would have on nutrition, but it was tremendous: his results
led the US government to USA to establish food labeling guidelines, policies and procedures that demonized fat, particularly saturated fat, and still exist
today. . . for now.
 Figure 2.5. Dr. Ancel Keys on the cover of Time magazine.

The year 1961 turned out to be one of the most important in the history of nutrition. Keys sealed the fate of saturated fat by landing a position on the
American Heart Association's nutrition committee and instituting the nation's first nutrition guidelines advising limited intake of saturated fat. He
appeared on the cover of Time magazine for his philosophies and findings on resolving health crises, and the idea that eating fat was linked to poor
health spread quickly. In 1977, Dr. Mark Hegsted, nutrition researcher. and a strong supporter of Keys's conclusions, helped persuade Senator George
McGovern, chairman of the Senate Committee on Nutrition and Human Needs, to include a recommendation to limit fat intake in that year's dietary goals
for the United States. . These guidelines, which were based on observational studies, "biased" science, and questionable methodologies, had severe
limitations. Hegsted, who was named Administrator of Human Nutrition for the Department of Agriculture in 1978, stated: "Significant benefits could be
expected from following low-fat recommendations. And because of the risks? None can be identified." If only he could have looked into the future, I'm
sure he would have taken those words back.

KETO CONCEPT

DO HUNTER-GATHERERS EAT KETOGENICS?

One of the biggest debates is whether our hunter-gatherer ancestors ate keto. If we had only had food tracking apps back then, we might have a better
idea. We do know that meat, tubers, vegetables and fruits were popular foods, and it is clear that some states of ketosis must have been achieved in
times of famine (Milton, 2000). The discussion about whether hunter-gatherers were ketogenic as we think of it today, relying on fat instead of sugar for
fuel is beyond the scope of this book, but we can tell you one thing: our ancestors weren't eating candy, cookies, and fries all day long.

HELLO FROM THE OTHER SIDE

Not all scientists agreed that fat is the main culprit in heart disease. One British scientist in particular was screaming at the top of his lungs that another
macronutrient was the real driving force, yet no one wanted to listen. In 1972, John Yudkin stated in his book Pure, White and Deadly: “If only a small
fraction of what we know about the effects of sugar were revealed in relation to any other material used as a food additive, that material would quickly
be banned” ( Yudkin, 1972). Yudkin kept trying to figure it out. how everyone overlooked the health implications of sugar, a pure carbohydrate devoid of
fiber and nutrition that had been part of the Western diet for only a couple hundred years. While most health authorities called saturated fats
scapegoats, Yudkin postulated that it was probably the recent introduction of sugar that was making people sick. Not only were the low-fat
recommendations wrong, they could actually be dangerous if they encouraged people to consume more sugar. In 1974, The Lancet, a British medical
journal, warned against significantly reducing dietary fat, reinforcing the idea that the cure should not be worse than the disease. These scientists knew
that if dietary fat were drastically reduced, there would be an equally drastic increase in one of the other two macronutrients, and it wouldn't be protein.
First, protein is significantly more expensive, and second, sugar can make even the worst of the worst carbs taste sweet. But Yudkin was shot down by
Keys and various government agencies every time he tried to present new evidence pointing to sugar, not fat, as the culprit in heart disease (Yudkin,
1964).

KETO CONCEPT

THE SUGARGATE SCANDAL

In the 1950s and 1960s, nutrition debates were reaching their peak. In one corner was Ancel Keys, who pointed to fat as the cause of heart disease.
disease, and on the other were Yudkin and others, who stated that the problem was sugar. Noted Harvard nutritionist Mark Hegsted on the side of the
keys. In addition to urging the government to advocate reducing fat intake in its official recommendations, Hegsted was paid the equivalent of $48,000 by
a trade group called the Sugar Research Foundation to write a literature review (an analysis of multiple studies conducted on single issue) aimed at
countering early research linking sucrose (table sugar) to coronary heart disease. As all criminal defense attorneys know, the key to a good defense is
providing an alternative theory of the crime: a narrative with some coherence and probability that lays the blame at the feet of someone other than the
accused. Hegsted certainly understood this. To counter the claim that sugar was linked to heart disease, he shifted the focus to dietary fat and cholesterol
consumption. Their study was published in 1967 in the New England Journal of Medicine (McGandy et al., 1967). At the time, researchers did not have to
disclose conflicts of interest, so no one knew about Hegsted's big payday. His pay-to-play deal with the sugar industry is a classic example of how an
ethically irresponsible decision can have an effect for generations to come.

It was David against Goliath, except in this case, there were ten Goliaths and only one David; Yudkin and his colleagues were vastly outnumbered by
disciples of Keys's work. During the 1960s and 1970s, researchers and individuals who opposed Keys' work tended to lose support and funding, which had
a negative impact on their ability to continue conducting research. It was almost as if someone who opposed Keys' work was committing suicide with
scientific funds. In the mid-20th century, a wealth of data was gathered that could and should have freed us from the perception that saturated fat was
the culprit. Unfortunately, the ideology with the loudest voice won, and that voice belonged to Ancel Keys.

THE RESURGENCE OF THE KETOGENIC DIET

"It is not a measure of health to be well adapted to a deeply sick society."
—Jiddu Krishnamurti

Despite the development of anti-seizure medications and the demonization of fat, some weird places never let the ketogenic diet die. The Johns Hopkins
Hospital spearheaded the ketogenic charge in the 1970s under the leadership of neurologists Dr. Samuel Livingston and Dr. John Freeman and dietician
Millie Kelly, who together refined the ketogenic diet specifically to treat epilepsy in children. New studies emerged on the effects of fasting, the ketogenic
diet, and elevations in ketone levels on several health markers. One such study (Drenick et al., 1972) took a group of obese men with negligible levels of
blood ketones and injected them with insulin to observe clinical signs of hypoglycemia. The subjects then fasted for two months straight, losing an
average of 33 kilograms (72.6 pounds). Their blood ketone levels rose to around 8 mmol/L, and the researchers eventually repeated insulin. injections
that expect to see similar results, with signs of hypoglycemia and potentially even reaching the point of coma. Amazingly, there were no adverse
responses in the men, even when insulin caused their blood glucose levels to drop "dangerously low." One study pointed to the fact that when ketones
are elevated to a significant degree, they can offer protection against hypoglycemia. providing an alternative source of fuel for the brain. Scientists were
increasingly fascinated with ketones, the therapeutic benefits. of fasting and the potential benefits of raising ketones through nutritional means. It's the
latter that would ultimately lead to the ketogenic diet's resurgence.
Ask anyone if they've ever tried a low-carb diet and you'll often hear them say, "Yeah, I've done Atkins before." Atkins was an American doctor and
cardiologist who was battling obesity and decided to try the diet recommended by Dr. Alfred. Pennington In the years after World War II, Pennington had
been hired by DuPont, a large American chemical company, to discover the reasons behind a rapidly growing obesity problem among its staff. He
concluded that obesity was not simply due to overeating, but also to the body's inability to properly use glucose. Basically, he recommended that instead
of seeing it as an energy balance issue, we should focus on what our bodies do with the food we eat: burn it or store it as fat. Pennington's diet became
popularly known as the DuPont Diet and was published by Holiday magazine in the 1950s. Pennington published an editorial in the New England Journal
of Medicine in 1953 discussing the role of carbohydrates in obesity.

KETO CONCEPT

WAS THERE A REVOLUTION PRIOR TO ATKINS?

Pennington was not the only doctor to advocate a low-carbohydrate diet in the 1950s. In 1958, Dr. Richard Mackarness, a doctor at an obesity and food
allergy clinic in Britain, published Eat Fat and Grow Slim, which argued that carbohydrates, rather than calories, were the real offenders responsible for
weight gain. weight. A couple of years later, Dr. Herman Taller published his book Calories Don't Count. Taller was one of the first to say that diets must
be individualized, since not everyone responds to food in the same way. Rather, he stated, "The crux of the matter is not how many calories we consume,
but what our bodies do with those calories." Not everyone can tolerate carbohydrates to the same degree; instead, we need to personalize nutrition.
These two books were popular, but they didn't make the headlines that Robert Atkins would make with his book a decade later.
Atkins found immediate and lasting weight loss on Pennington's diet and began prescribing a similar approach for his patients who struggled to lose
weight. In 1965, he promoted his weight loss plan on The Tonight Show, and in 1972 he published Dr. Atkins' Revolution Diet, which became an instant
bestseller. The diet was not necessarily ketogenic (although the two often overlap): Atkins The focus was on high protein, fat inclusion, and low
carbohydrates. The low-carb craze took the world by storm, and the idea of losing weight without severely restricting calories became extremely popular.
Atkins was certainly not the first person to recommend this type of diet, but he left a huge impression on the nutrition industry that lasted for years and
paved the way for scientists and researchers to investigate the effects of a low-carb and eventually ketogenic diet.

Figure 2.6. Grocery store shelves are filled with “low-fat” marketing phrases to entice customers with “health” benefits.
Products

Although Atkins was making waves by recommending a high-fat, high-protein diet, his voice was drowned out by the voices of Hegsted and McGovern,
who issued the new dietary guidelines with low-fat recommendations just a couple of years after Atkins published his book. With the government placing
the blame for cardiovascular disease on fat consumption, several large food corporations took the opportunity to claim that their products were healthy
by changing their formulations so they could advertise that they were "low-fat" (Wartella et al., 2010). Beginning in the late 1970s and continuing to this
day, food companies have attempted to capture consumers' attention with bold claims on product labels suggesting that products promote good health
because they are "low in saturated fat."
 Figure 2.7. Obesity rates have continued to increase since the introduction of these low-fat recommendations.
Source: National Center for Health Statistics (USA). USA). Health, United States, 2008: with special attention to the health of young adults Hyattsville
(MD): National Health Center
Statistics (USA) USA); 2009 Mar. Chartbook.

Over the next twenty years, research on the ketogenic diet exploded due to the popularity of Atkins and a renewed interest in epilepsy. At the same time,
the government's dietary recommendations didn't seem to be working; Obesity continued to increase at a steady rate. In 1992, Atkins published Dr.
Atkins' New Diet Revolution, an update of the 1972 bestseller. Shortly after, Barry Sears released The Zone, a popular diet book that distinguished
between good and bad carbohydrates, and Drs. Michael and Mary Dan Eades published Protein Power, which advocated a high protein, low carbohydrate
diet. Both books allude to the fact that the advice to eat low-fat was not ideal and that processed carbohydrates were causing many of the health
problems plaguing society. But in 1992, the USDA launched its Food Guide Pyramid recommending that Americans Eat six to eleven daily servings of
bread, cereal, rice, pasta and other grains while using fats and oils "in moderation." What we really needed was to turn that pyramid upside down.

Figure 2.8. The USDA Food Pyramid.

ONE LAST CHANCE

In 1993, Charlie Abrahams, the son of Hollywood movie producer Jim Abrahams, and his wife, Nancy, faced an incredible challenge. At just one year old,
Charlie had been diagnosed with epilepsy. As time went by, his situation worsened, so much so that within twenty months, he was having up to 100
attacks per day. Charlie took one medication after another, without success. Jim Abrahams later said in an interview with Dateline: "Pour drugs down
your child's throat despite the fact that there's something inside that says, 'Wait a minute, this can't be right.'" dead end. Charlie's health was rapidly
deteriorating, but giving up was never an option. After searching hundreds of epilepsy books for a solution, Abrahams came across Seizures and Epilepsy
in Childhood: A Guide for Parents, by Dr. John Freeman, one of the pediatric neurologists at Johns Hopkins who had been using a diet. ketogenic to treat
epilepsy. Deep in this book, Dr. Freeman briefly mentions a dietary protocol he used to treat condition. Charlie had traveled thousands of miles to see
some of the best doctors in the world, taken some of the most powerful medications, undergone surgery, and even seen quacks and herbalists to no
avail. With no other options, the Abrahamses packed bags and flew to Baltimore to see Dr. Freeman and learn about his diet that had been successful in
treating epilepsy: the ketogenic diet. Charlie was immediately put on a strict ketogenic diet. Within forty-eight hours, his attacks had stopped completely.
As the days, weeks, and even months passed, Charlie remained seizure-free and his growth and development improved rapidly (Wheless, 2004). the
The ketogenic diet was the answer the Abrahams had been looking for. To spread the word to other families struggling with epilepsy, Jim Abrahams
created the Charlie Foundation, an organization that has released videos and other content to raise awareness about the ketogenic diet as a treatment
for epilepsy and has funded research into the use of ketogenic therapies for a wide variety of conditions.
The ketogenic diet received a big boost in October 1994, when an episode of the popular TV show Dateline featured the movie Charlie's Incredible Story,
raising awareness and spurring the research community to further explore the ketogenic diet. Then in 1997, Abrahams produced a television movie
starring Meryl Streep called. . . First Do No Harm, featuring Charlie Abrahams' experience with the ketogenic diet More than eight million viewers
watched the film the night it aired. Parents and children from around the world began flocking to Johns Hopkins to try the ketogenic diet, and in 2001 a
study there concluded that more than 150 children with epilepsy had seen notable improvements on the ketogenic diet. Abrahamses' defense was
exactly what scientists and researchers in the keto space needed. It was a sign of hope and highlighted the significant impact that the ketogenic diet can
have on health. In the 1990s and early 2000s, thousands of studies on the ketogenic diet investigated its effect on everything from epilepsy to cancer,
Alzheimer's disease, and body composition and performance. Throughout this book, we will delve into each of these areas in more detail and discuss new
research and emerging support for the ketogenic diet.

EXOGENOUS KETONES: AN EMERGING AREA OF RESEARCH

Throughout the history of the ketogenic diet, scientists have found that elevations in ketone production cause some unique effects. physiological
responses that can offer health benefits (which we will explore more in the rest of this book). It is not always easy to increase our level of ketones by
altering our diet. But what if we could achieve elevated ketones by taking exogenous ketones? that are consumed orally rather than produced by the
body, in a food or supplement? To find the first example of research on this in practice, we have to go back more than seventy years to a study on bull
sperm motility. (Yes, you read that correctly: bull sperm. Lardy and Phillips (1945) found that beta-hydroxybutyrate (BHB) and acetoacetate (AcAc), two
ketone bodies, increased sperm motility while decreasing cellular oxygen consumption. This interesting finding would remain unexplained until legendary
German physician and biochemist Hans Krebs decided to advise a student to further investigate how ketones could increase the metabolic efficiency of
cells. Krebs is credited with discovering the key sequences of energy-producing metabolic reactions within our cells, now called the Krebs cycle, for which
he earned a Nobel Prize in 1953. Krebs was also a colleague of Otto Warburg, whom you will read a lot about when we talk about cancer in Chapter 5. In
the late 1950s, Krebs worked with a scientist named Richard Veech to determine the redox state of the cell: how much energy is used and wasted and
whether the cell is efficient at what it is supposed to do. This research laid the foundation for how taking ketones could impact human health by
improving cell efficiency. In the early 1990s, Veech and his colleagues began publishing more of their studies showing that ketone bodies were having
positive effects on cardiac efficiency and improving energy production in mitochondria (the powerhouse of a cell). (Kashiwaya et al., 1997). Around the
same time, other studies showed that BHB not only reduced food intake and body weight (we will discuss this more in the body composition and appetite
section), but also improved insulin sensitivity (Arase et al., 1988). ; Amiel et al., 1991). Would it be possible for people to receive the health benefits of
ketones even if they did not adhere to a strict ketogenic diet? In 2000, Veech and his colleagues published a study on the effects of a type of ketone on
neurons that are representative of Alzheimer's and Parkinson's Disease (Kashiwaya et al., 2000)? Shortly after, in 2004, the US Defense Advanced
Research Projects Agency. USA (DARPA) gave several groups, including Dr. Veech and his lab, $2 million each year as part of a competition to find a
"superfuel" for US special forces to use. USA use them in combat. Veech and his research partner, Kieran Clarke, rose to the top of the competition and
received more funding from DARPA to delve deeper into the effects of using ketones on performance. This eventually led to the development of an FDA-
approved food: ketone esters (discussed further in Chapter 4). A couple of years later, Dr. Dominic D'Agostino began researching the impact of the
ketogenic diet on simulated Navy SEAL diving missions. These divers tend to develop oxygen rebreather-related seizures because they dive to significant
depths and constantly It breathes excess oxygen from its tanks. Dr. D'Agostino was looking for ways to prevent these seizures. One possible solution was
to develop a method to help stabilize the brain during deep dives. D'Agostino analyzed the effects of different ketone esters in animal studies that
simulated what Navy SEAL divers do on a deep dive with an oxygen rebreather (D'Agostino et al., 2013) Just one dose of the ketone ester significantly
delayed the onset of seizure activity. There are very few "aha" moments in the life of a scientist, and this was surely one for Dr. D'Agostino and his team.
It was clear that something very interesting was happening with brain energy metabolism and exogenous ketones. D'Agostino and several others Since
then, researchers have conducted numerous studies investigating the effects of exogenous ketones on various conditions. (In Chapters 4 and 5, we delve
into those studies, the different forms of exogenous ketones [esters, salts, etc.], and emerging data on dosing, timing, and applications.)
Unfortunately, ketone esters have two drawbacks: one, they are currently very expensive and two, they taste like jet fuel. To sell exogenous ketones to
the public, something necessary to change. Chemist Patrick Arnold brought to the market a tastier ketone solution of mineral salts (BHB-sodium, BHB-
calcium, BHB-magnesium and BHB-potassium). Although it was available, many people still did not understand what ketones were, what they could be
used for, and what the long-term implications of their use were. However, soon after, a network marketing company called Pruvit set out to bring
ketones to the masses. Fast forward to today, and Pruvit has delivered over 30 million servings of exogenous ketones to people with incredible results
and has begun running research trials to further analyze their product Other network marketing companies, along with traditional brick and mortar
stores and mortar, now carry products containing exogenous ketones. It's only a matter of time before exogenous ketones become widespread; We
would be surprised if you don't see them in your local health food store or even supermarkets in the very near future. More studies investigating the
impact of ketone. Mineral salts, ketone esters, and other ketogenic agents on human health and performance are rapidly emerging (which we will discuss
later in this book), and we promise you this is just the beginning.
CHAPTER SUMMARY
In this chapter, we took a journey over a century to see the origin of fasting, how it was used in the early 1900s, and why fat was demonized. We discuss
the resurrection of the ketogenic diet and even present an overview of the new hot topic of exogenous ketones. We hope you now have a better
understanding of why we are in this situation and why the current diet guidelines read the way they do. Read on for a scientific overview of ketosis, the
ketogenic diet, its implications, and delicious ketofriendly recipes.