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Improved Lipoprotein Profile Although higher probability of weight loss is a major benefit of a ketogenic diet medicine buddha mantra discount dulcolax 5 mg visa, there are also profound changes in lipoprotein metabolism (Volek et al 7r medications buy dulcolax from india. The reduced conversion of carbohydrate to fat in the liver (lipogenesis) plus the low insulin state enabling accelerated fat oxidation are major factors contributing to the improvements in processing of lipoproteins commonly observed medicine you cant take with grapefruit order dulcolax mastercard. The most consistent response is a sharp decrease in plasma triglycerides medications 122 purchase 5mg dulcolax free shipping, most dramatically in those with preexisting hypertriglyceridemia. A ketogenic diet also demonstrates a striking reduction in the postprandial lipemic response to a high-fat meal (Volek et al. For example, there are few placebocontrolled randomized control trials, few studies of very low carbohydrate intake, and even fewer studies that allowed adequate time to adapt to a low-carbohydrate diet. Carbohydrate loading has not shown improved performance in all studies, despite significantly increased muscle glycogen levels (Burke et al. The most obvious fact that has been downplayed in prior research has been the profound effect of carbohydrate intake on inhibition of fat utilization, and the perspective that fat is a preferred fuel. Brief History More than 70 years ago (Christensen and Hansen, 1939) described that consumption of a high-carbohydrate diet, compared to a high-fat diet, for 1 week prior to a submaximal event was associated with enhanced performance. Nearly 3 decades later, Bergstrom and Hultman (1966, 1967) discovered that muscle glycogen depletion was associated with fatigue, and that a high-carbohydrate diet maintained muscle glycogen and performance. This set the stage for the next 40+ years, during which time the supremacy of carbohydrate has become deeply embedded in the minds of most scientists, coaches, and athletes (Hargreaves et al. There has been a strong confirmation bias to support high-carbohydrate diets, reinforced by a burgeoning sports beverage industry profiting from this paradigm. It needs to be acknowledged that a lot of great work has been done by many researchers detailing how carbohydrate affects exercise metabolism and performance, but there has been a surprising lack of recognition, or willful neglect, Fat as a Premium Fuel Conventional wisdom has been that carbohydrate is the preferred source of fuel for exercise, but this perspective is rapidly changing considering the many benefits associated with emphasizing fatty acids and ketones as primary fuels, and relegating blood sugar and glycogen to secondary status. Ten hypothetical reasons a high capacity to utilize lipid-based fuels might be beneficial for athletes are listed here: 1. Fat is stored in adipose tissue in greater quantities than carbohydrates by at least an order of magnitude (>20,000 kcal in even the thinnest athlete vs. A key element contributing to deteriorating cognitive and physical performance during physically demanding exercise is reduced carbohydrate availability coupled with an inability to effectively utilize the thousands of calories stored as fat. Paradoxically, deteriorating performance associated with glycogen depletion occurs in the presence of an abundance of fuel stored as body fat that the athlete cannot access efficiently, unless they have previously keto-adapted for several weeks. A molecule of palmitic acid has over twice as many carbons as a molecule of glucose, and over twice the energy per unit weight. Fat is also more efficient, since it is not stored along with a lot of extra water weight like glycogen. Finally, ketones have been shown to have greater efficiency in providing cellular energy and work output. Relying on body fat for energy significantly decreases the need to fuel during exercise. It also alleviates the gastrointestinal problems associated with fueling during exercise that are common among endurance athletes. When oxidized inside the mitochondria, ketones generate less reactive oxygen species relative to glucose or other fuels, in essence making them a cleaner burning fuel (Maalouf et al. Deriving greater amounts of energy from fat at higher exercise intensities translates into less reliance on limited glycogen stores, glycolysis, and generation of hydrogen ions. Making fat the primary fuel often results in greater ease of fat loss and improved body composition, which translates into improved efficiency and power-toweight ratio. Hypothetically this would be advantageous for endurance as well as many strength/power athletes. When ketone concentrations increase to the 15 mmol/L range, the brain will begin to preferentially oxidize ketones (Cahill et al. In a non-keto-adapted athlete, continuous exercise often results in profound mental confusion. A brain adapted to extracting the majority of its energy requirements from ketones is resistant to this energy crisis, since ketones are derived from fatty acids and actually increase in concentration as exercise duration increases. A keto-adapted brain is able to tolerate extraordinarily low levels of blood sugar without any signs or symptoms hypoglycemia (Cahill and Aoki, 1980; Drenick et al. One of the most common perceived benefits following keto-adaptation is enhanced recovery from exercise. This is frequently demonstrated by an expedited return to training and competition following physically demanding events and long training sessions. This area of research has not been investigated thoroughly, but we speculate that less oxidative stress and the anti-inflammatory effects of a ketogenic diet may contribute to the perceived improvement in recovery by many athletes.
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