NEW RESEARCH:

By Steve Blechman

ScienceDaily recently reported that, “The often embraced 'cheat day' is a common theme in many diets and the popular ketogenic diet is no exception. But new research from UBC's Okanagan campus says that just one 75-gram dose of glucose -- the equivalent to a large bottle of soda or a plate of fries -- while on a high fat, low carbohydrate diet can lead to damaged blood vessels.” This article was supported by a study that was published in the journal Nutrients on February 26, 2019. ScienceDaily also reported that, “Since impaired glucose tolerance and spikes in blood sugar levels are known to be associated with an increased risk in cardiovascular disease, it made sense to look at what was happening in the blood vessels after a sugar hit.” The researchers in the study concluded, “One week of low-carbohydrate high-fat feeding that leads to a relative impairment in glucose homeostasis in healthy young adults may predispose the endothelium to hyperglycemia-induced damage.”

“Exaggerated supraphysiological postprandial spikes in blood glucose and lipids. This state, called postprandial dysmetabolism, induces immediate oxidant stress, which increases in direct proportion to the increases in glucose and triglycerides after a meal. The transient increase in free radicals acutely triggers atherogenic changes including inflammation, endothelial dysfunction, hypercoagulability, and sympathetic hyperactivity. Postprandial dysmetabolism is an independent predictor of future cardiovascular events even in nondiabetic individuals.” (J Am Coll Cardiol, January 22, 2008)

This year, U.S. News & World Report (January 2nd, 2019) selected the Mediterranean Diet as the best overall diet and healthiest diet for 2019. It was also rated the best diet for preventing heart disease and diabetes. The keto diet was ranked 38 for overall diets! It was tied for first place for fast weight loss but not best in the long run because of the high amount of unhealthy saturated fats, which can raise the risk of cardiovascular disease. These results were based on a panel of 23 experts, and 41 diets based on the scientific literature. The expert panel consisted of the country’s top nutrition experts and physicians specializing in weight loss, diabetes and cardiovascular disease. A meta-analysis in the British Journal of Nutrition (2013) of 13 randomized controlled trials suggested that individuals following very low-carbohydrate ketogenic diets lost more weight compared to low-fat diets. A recent study published in the British Medical Journal (BMJ, 2018) found that very low-carb diets burn 250 more calories per day compared to people who consume low-fat, high-carb diets.

Ketogenic diets have become a popular method for promoting weight loss but are not useful for building muscle! Ketogenic diets lower the anabolic pathways: insulin, IGF-1 and mTOR because of low protein intake. Ketogenic diets are great for weight loss and fat loss but not good for building muscle!

A recent study in the March 2019 issue of the Journal of Circulation found that the more sugar beverages people drank including soft drinks, fruit drinks and energy drinks, the greater the risk of death! Diet drinks linked with sugar substitutes were not linked with the increase of death during the study period. Research has shown that the traditional Mediterranean diet that contained virgin olive oil, fish, beans, legumes, nuts and red wine can help prevent the unfavorable changes in spikes in blood sugar postprandial metabolism and reduced inflammation, endothelial dysfunction, and cardiovascular risk! That’s why I recommend the low-carb Mediterranean diet (see my most recent article.) As I stated in my article, “The Mediterranean low-carb diet was significantly superior to a low-fat diet in decreasing fat storage, including visceral (deep abdominal) liver and heart fat.” Also, “high visceral fat has been shown to increase metabolic syndrome, inflammation, cardiovascular disease and diabetes. Losing deep, subcutaneous visceral fat, as well as haptic (liver) fat, was associated with improved insulin sensitivity and improved lipid profile.”

One way to eliminate spikes in blood sugar after a cheat meal is to take 30 minutes before a meal a low-dose whey protein shake, like AML™ THERMO HEAT® FAT BURNING PROTEIN. Research has shown that taking 6.25g of whey protein with a high dose of leucine (5g) can enhance protein synthesis at the same rate as four times as much whey protein (25g)! Leucine is the key anabolic trigger of muscle protein synthesis. Increases in muscle protein synthesis are dependent on leucine concentration. 5 grams of leucine can increase the anabolic effects of protein synthesis when eating less protein, which is ideal on a ketogenic diet. Research has also shown that pure leucine is more anabolic than leucine in food. Recent research has shown that leucine intake from a supplement may be better for muscle protein synthesis than leucine from a meal! Leucine is the key amino acid for enhancing the mTOR pathway that regulates cell growth and protein synthesis. Leucine is a powerful anabolic trigger— it’s the most potent branched-chain amino acid (BCAA) and a key activator of the mTOR pathway that is critical for muscle protein synthesis that promotes muscle growth. Leucine has many benefits: powering muscle growth, preventing muscle loss, and increasing insulin sensitivity.

Smaller whey protein supplements with added leucine may represent an advantageous approach for people on ketogenic diets where protein levels must be kept low. Normally ketogenic diets contain at least 70% fat, approximately 20% protein and 10% or less carbohydrates. Daily carbohydrates intake on ketogenic diets contain 50 grams of carbohydrates or less. Research has shown low-dose whey protein taken before a meal is effective in reducing glycemia (elevated blood sugar) after a meal (Nutrients, 2016; Proceedings of the Nutrition Society, September 2017; American Journal of Clinical Nutrition, 2018; British Journal of Nutrition, February 2019). As I’ve said in previous articles, people consuming a diet high in protein or high-dose whey protein supplements on a ketogenic diet can potentially throw their body out of ketosis. People following the ketogenic diet try to keep protein levels low to maintain ketosis. Like we mentioned earlier, a spike in blood sugar can cause acute hyperglycemia and impair endothelial function in healthy individuals after a “cheat meal.” Leucine administration has recently been shown to prevent hyperglycemia-meditated endothelial dysfunction in humans. (Exp Clin Endocrinol Diabetes, June 11, 2018)

AML™ THERMO HEAT® FAT BURNING PROTEIN also contains 5 grams of citrulline per serving. Citrulline increases nitric oxide, which can improve vasodilator function. Citrulline is a more effective supplement than arginine for promoting intracellular nitric oxide! Research has also shown that citrulline supplementation reduces blood sugar production in the liver and stimulated abdominal fat loss. Citrulline supplementation has also been shown in the research to benefit vascular health by modulating chronic low-grade inflammation in humans. A most recent study in BMC Research Notes, February 25, 2019, showed that 12 weeks of supplementation with two grams per day of citrulline lowered inflammation and inflammatory markers (c-reactive protein and tumor necrosis factor) in patients with non-alcoholic fatty liver disease or NAFLD. (Mol Nutr Food Res, 2014; J BMC Complement Altern Med 2015; Nutr Sci Diet, 2016; Nutrients, 2018)

Drinking red wine with a cheat meal has been shown to lower postprandial glycemia. Recent research has shown that drinking red wine with a high-carbohydrate meal such as a big bowl of pasta and bread can lower postprandial glycemia from a high carbohydrate meal. So, with your cheat meal that is rich in carbs and sugar, try and drink a glass of red wine with it. That may be the reason why the French drink red wine with their meals and have a lower risk of heart disease and diabetes according to the traditional French diet. (Lipids, 2000; ScienceDaily, 13 October 2015; Annals of Internal Medicine, 2015)

Bottom line: do I have to give up my cheat meal on a ketogenic diet? No way! Just drink a low whey protein drink such as AML™ THERMO HEAT® FAT BURNING PROTEIN containing 6.25 grams of whey protein, 5 grams of leucine and 5 grams of citrulline, before the cheat meal with a glass of red wine with your cheat meal. I don’t recommend frequent cheating on a ketogenic diet, but people will cheat – it is only normal behavior. If you must cheat, here is some advice that may help. It is my personal recommendation to follow the low-carb ketogenic/Mediterranean diet that contains healthy good fats, not bad fats, which could also lower your cardiovascular risk. Enjoy. Cheers!

References:

1. University of British Columbia Okanagan campus. "On the keto diet? Ditch the cheat day: Just one dose of carbohydrates can damage blood vessels." ScienceDaily. ScienceDaily, 27 March 2019. www.sciencedaily.com/releases/2019/03/190327112657.htm 

2. Cody Durrer, Nia Lewis, Zhongxiao Wan, Philip Ainslie, Nathan Jenkins, Jonathan Little. Short-Term Low-Carbohydrate High-Fat Diet in Healthy Young Males Renders the Endothelium Susceptible to Hyperglycemia-Induced Damage, An Exploratory Analysis. Nutrients, February 26, 2019; 11 (3): 489 DOI: 10.3390/nu11030489

3. Vasanti S. Malik, Yanping Li, An Pan, Lawrence De Koning, Eva Schernhammer, Walter C. Willett, Frank B. Hu. Long-Term Consumption of Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults. Circulation, 2019; DOI: 10.1161/CIRCULATIONAHA.118.037401 

4. Audrey Chanet, Sjors Verlaan, Jérôme Salles, Christophe Giraudet, Véronique Patrac, Véronique Pidou, Corinne Pouyet, Nordine Hafnaoui, Adeline Blot, Noël Cano, Nicolas Farigon, Anke Bongers, Marion Jourdan, Yvette Luiking, Stéphane Walrand, Yves Boirie, Supplementing Breakfast with a Vitamin D and Leucine-Enriched Whey Protein Medical Nutrition Drink Enhances Postprandial Muscle Protein Synthesis and Muscle Mass in Healthy Older Men, The Journal of Nutrition, Volume 147, Issue 12, December 2017, Pages 2262-2271, https://doi.org/10.3945/jn.117.252510 

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9. Pharmacokinetic and pharmacodynamic properties of oral L-citrulline and L-arginine: impact on nitric oxide metabolism. Schwedhelm E, Maas R, Freese R, Jung D, Lukacs Z, Jambrecina A, Spickler W, Schulze F, Böger RH. Br J Clin Pharmacol. 2008 Jan; 65(1):51-9. 

10. Joffin, N., Jaubert, A., Durant, S., Bastin, J., De Bandt, J., Cynober, L., Moinard, C., Coumoul, X., Forest, C. and Noirez, P. (2014), Citrulline reduces glyceroneogenesis and induces fatty acid release in visceral adipose tissue from overweight rats. Mol. Nutr. Food Res., 58: 2320-2330. doi:10.1002/mnfr.201400507

11. Barkhidarian, B.; Seyedhamzeh, S.; Hashemy, S.I.; Nematy, M.; Rahbari, A.; Ranjbar, R.; Safarian, M. Effects of arginine and citrulline supplementation on inflammatory markers in critically ill patients. J. Nutr. Sci. Diet. 2016 

12. Yoshitomi H, Momoo M, Ma X, et al. L-Citrulline increases hepatic sensitivity to insulin by reducing the phosphorylation of serine 1101 in insulin receptor substrate-1. BMC Complement Altern Med. 2015;15:188. Published 2015 Jun 18. doi:10.1186/s12906-015-0706-4

13. Effects of whey proteins on glycaemia and insulinaemia to an oral glucose load in healthy adults; a dose-response study. UJ Gunnerud, E M Östman, I M E Björck. European Journal of Clinical Nutrition. May 1, 2013 DOI: 10.1038/ejcn.2013.88

14. King, DG, Walker, M, Campbell, MD, et al. (2018) A small dose of whey protein co-ingested with mixed-macronutrient breakfast and lunch meals improves postprandial glycemia and suppresses appetite in men with type 2 diabetes: a randomized controlled trial. Am J Clin Nutr 107, 550-557. 

15. Cara B Ebbeling, Henry A Feldman, Gloria L Klein, Julia M W Wong, Lisa Bielak, Sarah K Steltz, Patricia K Luoto, Robert R Wolfe, William W Wong, David S Ludwig. Effects of a low carbohydrate diet on energy

expenditure during weight loss maintenance: randomized trial. BMJ, 2018; k4583 DOI: 10.1136/bmj.k4583

16. The Effect of the Oral Administration of Leucine on Endothelial Function, Glucose and Insulin Concentrations in Healthy Subjects. Georgia Argyrakopoulou, Paraskevi Kontrafouri, Ioanna Eleftheriadou, Alexander Kokkinos, Christina Arapostathi, Despoina Kyriaki†, Despoina Perrea, Constantinos Revenas, Nicholas Katsilambros, Nicholas Tentolouris. Exp Clin Endocrinol Diabetes. June 2018. DOI: 10.1055/a-0597-8985

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18. Dietary Strategies for Improving Post-Prandial Glucose, Lipids, Inflammation, and Cardiovascular Health. James H. O’Keefe, Neil M. Gheewala, Joan O. O’Keefe. Pages 249-255 https://www.ncbi.nlm.nih.gov/pubmed/18206731 

19. Bueno, N., De Melo, I., De Oliveira, S., & Da Rocha Ataide, T. (2013). Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: A meta-analysis of randomised controlled trials. British Journal of Nutrition, 110(7), 1178-1187. doi:10.1017/S0007114513000548 

20. American Associates, Ben-Gurion University of the Negev. "Red wine with dinner can improve cardiovascular health of people with type 2 diabetes: Both red and white wine can improve sugar control depending on genetic profile." ScienceDaily. ScienceDaily, 13 October 2015. www.sciencedaily.com/releases/2015/10/151013095414.htm 

21. Yftach Gepner, Rachel Golan, Ilana Harman-Boehm, Yaakov Henkin, Dan Schwarzfuchs, Ilan Shelef, Ronen Durst, Julia Kovsan, Arkady Bolotin, Eran Leitersdorf, Shoshana Shpitzen, Shai Balag, Elad Shemesh, Shula Witkow, Osnat Tangi-Rosental, Yoash Chassidim, Idit F. Liberty, Benjamin Sarusi, Sivan Ben-Avraham, Anders Helander, Uta Ceglarek, Michael Stumvoll, Matthias Blüher, Joachim Thiery, Assaf Rudich, Meir J. Stampfer, Iris Shai. Effects of Initiating Moderate Alcohol Intake on Cardiometabolic Risk in Adults With Type 2 Diabetes. Annals of Internal Medicine, 2015; DOI: 10.7326/M14-1650

22. Cuevas, A. M., Guasch, V., Castillo, O., Irribarra, V., Mizon, C., Martin, A. S., Strobel, P., Perez, D., Germain, A. M. and Leighton, F. (2000), A high‐fat diet induces and red wine counteracts endothelial dysfunction in human volunteers. Lipids, 35: 143-148. doi:10.1007/BF02664763

23. THE THERMO HEAT® LOW-CARB MEDITERRANEAN DIET: WHY IT’S THE HEALTHIEST & BEST DIET FOR 2019 by Steve Blechman, https://advancedmolecularlabs.com/blogs/news/the-thermo-heat%C2%AE-low-carb-mediterranean-diet-why-it-s-the-healthiest-best-diet-for-2019