Addressing Fatty Liver and Metabolic Health Issues

Dominic D’Agostino is a University of South Florida professor who does research in areas such as ketone ester and supplementation technologies and muscle development. One topic featured on Dominic D’Agostino’s site, KetoNutrition.org, centers on fatty liver and metabolic health.

A vital metabolic organ, the liver is tasked with receiving and processing blood as it exits the stomach and intestines. This enables drugs and alcohol to be broken down into easily used forms. The liver also removes excess glucose from the circulatory system, storing it as glycogen, which is an energy storage unit. Additionally, the liver ensures that the blood has proper levels of amino acids and removes unwanted toxins, excreting bile.

Fatty liver occurs when excess fat builds up within the liver, which impairs the organ’s function. Non-alcoholic fatty liver disease (NAFLD) can involve inflammation that results in fibrosis, or scarring, and makes it more likely to develop liver cancer. Impacting a third of adults across the United States, NAFLD often occurs after the liver develops selective insulin resistance, with glucose lingering in the blood stream rather than being processed and triggering the liver to produce fat.

Reducing the buildup of fat in the liver is possible through a combination of exercise and a high-protein, low-carb diet. A low-carb, ketogenic diet has been shown to be effective in shifting liver fat metabolism in a positive manner, as well as improving gut microbiota and boosting levels of circulating folate, the latter of which powers beneficial forms of metabolism and gene expression within the liver.

In addition, a reduction of triglycerides and cholesterol intake can have a beneficial effect on one’s health. For those with elevated liver enzymes (revealed in blood tests), alcohol and fructose intake should be moderated. In addition, exogenous ketone supplements should be considered. Because there are no FDA-approved therapies for NAFLD, these steps are vital in addressing the serious issue of fatty liver, which can result in both cardiovascular and liver failure.

For more information, please visit KetoNutrition.org

Getting Enough Omega-3 Fatty Acids on a Keto Diet

 Teaching at the University of South Florida, Dominic D’Agostino has a research focus on ketone supplementation and ketone ester, and the effect of a ketogenic diet on metabolism and muscle growth. One area that Dominic D’Agostino explored in a KetoNutrition article is how a keto diet affects one’s omega-3 fatty acid intake.

As a meat eater following a keto diet, the arithmetic is relatively simple: two or three servings of fatty fish each week should fulfill one’s docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) requirements. Both DHA and EPA are omega-3s that have been linked to a variety of positive health outcomes.

As a vegan, obtaining omega-3s is more challenging. Those who make the effort to eat walnuts, flax seeds, and chia on a regular basis may feel that that they have all the bases covered. Unfortunately, these foods are only rich in the omega-3 fatty acid alpha linolenic acid (ALA), which is a precursor to the even more vital DHA and EPA. While there is a slow enzymatic process by which the body does complete the conversion to the desirable omega-3, it would take large quantities of such foods to produce a sufficient quantity.

One plant-based solution is to eat microalgae in an accessible form such as the spirulina tablet ENERGYbits. Similar microalgae are consumed by fish such as sardines and salmon, who then store the DHA and EPA as fat. For more in depth discussion abotu this topic and other topics related to ketogenic nutrition be sure to check out KetoNutrition.org website and blog.

A Plant-Based Pathway for a Ketogenic Diet

 Dominic D’Agostino is a University of South Florida associate professor who undertakes clinical research in areas such as ketone ester and supplementation, and muscle performance. One of Dominic D’Agostino’s areas of expertise is a plant-based approach to a ketogenic diet, which is detailed on the KetoNutrition website.

While most people associate a keto lifestyle with abundant meat consumption, this is not necessarily the case. The classic strict 4:1 ketogenic diet has caloric intake of 90 percent fat, 6 to 10 percent protein, and 2 to 4 percent carbs. This makes significant vegetable consumption a challenge. However, today’s modified versions of the keto diet are more lenient, with 65 to 85 percent of daily calories derived from fat, 15 to 35 percent from protein, and as much as 10 percent from carbs.

A sustainable vegan keto diet is possible with this configuration. It starts with removing or severely limiting all legumes, grains, and fruit. Without the fat that meat and dairy provide, make healthy oils such as those from coconut, walnut, and avocado an integral part of your daily diet. At the same time, remove all root vegetables from the diet, such as beets or potatoes, as they are not fibrous and are typically high in carbohydrates. Once an ideal diet is in place, carefully track the macronutrient ratios (not calories) required for sustaining nutritional ketosis.

How Ketone Bodies Fuel Muscle Adaptation

 Instructing at the University of South Florida, Dominic D’Agostino is a professor who pursues basic science research and clinical applications of ketone ester supplementation, ketone salts and related ketone technologies. A particular area of interest for Dominic D’Agostino is muscle function and its pivotal role in augmenting performance and overall metabolic health. When a body goes into ketogenesis under carb-restricted dietary conditions, ketone bodies such as beta-hydroxybutyrate (BHB), acetoacetate (AcAc), and acetone are generated by the liver and provide a energetic reserve and important tissue signaling functions.

During exercise, the muscles no longer primarily rely on glycogen (high intensity workout) or lipids and muscle protein amino acids (low intensity workout) for generating the fuel adenosine triphosphate (ATP). Rather, ketone bodies are gradually employed by working muscles as fuel, with the capacity to oxidize the ketone bodies for energy increasing as muscle is trained. Part of being in a keto-adapted state is the increases levels of ketogenesis, ketone transport and tissue ketone utilization (ketolysis).

Beyond this muscle-fueling purpose, ketone bodies serve as signaling molecules for regulating the body’s gene expression and adaptive responses to energetic stress and exercise intervention. One study demonstrated that ketone BHB offers a shield against oxidative stress. It prevents the accumulation of intramuscular fat and decreases muscle wasting, while boosting oxidative metabolism as one ages. In tandem with this, BHB was shown to upregulate the genes associated with muscle atrophy and reduce anabolic gene expression. In this context the elevation of ketones helps to spare energy reserves. Ultimately, it is shown that the ketogenic diet has different effects on skeletal muscle that are partially explained by muscle fiber type, while the ketogenic diet can lead to a change in the fiber type ratio in the muscle itself. While currently the data is contradictory on the ketogenic diet’s benefits and adverse effects on muscle tissue, there is still room for discovery to be made in how the ketogenic diet impacts muscle metabolism in states outside of prolonged fasting and starvation. Based upon what we know about the anti-catabolic effects of ketones, and their multifunctional role during starvation, the benefits of being in ketosis appear to have the greatest effect during metabolic stress associated with disease states and exercise-induced stress. In this context the ketone-induced effects are protective and may confer a longevity advantage when it comes to longevity and long term preservation of muscle structure and function.

Continuous Glucose Monitors Enhance Education of Medical Students

 Teaching at the University of South Florida at the Morsani College of Medicine and performing research in ketogenic diet and ketone supplementation, Dominic D'Agostino possesses extensive knowledge on exogenous ketone supplementation and ketone technologies that help muscle performance and resilience. Dominic D'Agostino follows the latest findings in his field, including an American Journal of Lifestyle Medicine report on a pilot metabolic immersion program that employed continuous glucose monitors (CGMs) in medical students as part of a "metabolic immersion" program to enhance awareness and best practices within metabolic medicine and diabetes management.

The study involved 13 healthy students at Harvard Medical and Dental training on CGMs while being screened for underlying health issues. The students used the CGMs for 30 to 40 days while their dietary intake was tracked, in addition to a number of other variables that would help to assess the utility of CGMs for medical training.

Questionnaires revealed that participants felt the CGMs provided important insights into how the body reacts to food intake and aided with their medical education. In particular, CGMs made them more aware of how they could assist patients with diabetes battling elevated glucose levels. The CGM also encouraged them to alter their eating habits. Such devices, which encourage lifestyle modification and nutrition, may also inform the choices of those who opt for a low-glucose/ low carbohydrate ketogenic diet. For more information, please visit Levels Health and KetoNutrition.org.

New Research Links Ketogenic Diet to Gut Microbiome, Neurologic Health

 

An accomplished scientist and associate professor at the University of South Florida, Dr. Dominic D’Agostino researches ways of improving human neurology and physiology through the ketogenic diet. Dominic D’Agostino has broad knowledge of ketone esters, ketone supplementation, and ketone technologies. He shares his knowledge on KetoNutrition.org. One of his recent articles is on the gut-brain axis (GBA).

The gut-brain axis (GBA) refers to the physiological highway connecting the brain’s central nervous system (CNS) with the enteric nervous system (ENS) in the intestines. The ENS is responsible for body functions that do not require thinking about like digesting food, breathing, and circulating blood. The vagus nerve is the physiological highway between these two systems.

Information flow along the vagus nerve is two-way. The brain communicates its needs to the gut through the vagus nerve while the gut microbiome in the ENS produces key neurotransmitters that travel to the brain and eventually regulate neurologic, metabolic, and immune functions. A healthy gut microbiome, therefore, is essential to overall wellness.

The health of the gut microbiome is influenced by a number of things, key among them diet. Emerging research points to the benefits of a ketogenic diet to the gut microbiome and neurological health. Research on children with epilepsy has shown that a ketogenic diet improves regulation of immune factors central to controlling seizures. Additional research has linked the ketogenic diet to enhanced mental health. Specifically, when ketones become the brain’s primary source of energy, as is the case in a ketogenic diet, levels of the calming neurotransmitter GABA increase while those of the excitatory neurotransmitter glutamate fall. The diet further elevates adenosine levels, which also contributes to neurologic health.

Ketogenic Diets Come to the Fore for Health and Appetite Control

An associate professor at the University of South Florida Morsani College of Medicine, Dominic D’Agostino, PhD, has a focus on ketone research, supplementation, and emerging ketone technologies. Dominic D’Agostino’s ketone ester studies explore mechanisms by which KetoNutrition can fight cancer, preserve muscle, and contribute to overall metabolic wellness. 

Dr. D’Agostino was featured in a recent Men’s Health article, “Inside the Rise of Keto: How an Extreme Diet Went Mainstream,” that brings focus to a diet that strictly limits carbs, fruits, and vegetables. The common misconception is that the ketogenic diet is a high protein diet, but it is often capped at or below 100 grams daily (1 gram protein/kg) with up to 90 percent of calories coming from fat in the form of foods such as eggs, fish, steak, bacon, butter, nuts and coconut oil. The modified ketogenic diet has been gaining more popularity, even clinically, and it is characterized by more liberal amounts of protein that can be as high as 30% of calories. 

This dearth of carbohydrates, low to moderate protein, combined with abundant fat, results in the body entering a state of ketosis, in which fat and ketones, rather than glucose, is primarily burned for energy. Beneficial effects on health biomarkers are seen in blood pressure, blood glucose, triglyceride levels, HDL cholesterol and fasting insulin. Crucially, the diet reduces hunger, as fat and carbs ingested together trigger dopamine release, which provides the brain circuits with extra motivation to consume food. Additionally, the elevation of blood ketones helps to regulate the neurometabolic and neuropharmacological state of the brain towards homeostasis, which not only prevents cravings, but helps to improve moods and preserve a more balance psychological state.

Ketogenic Research Efforts at the University of South Florida

A former research scientist at the University of Medicine and Dentistry of New Jersey, Dominic D'Agostino serves as a traveling research scholar for the Florida Institute for Human and Machine Cognition (IHMC). Also an associate professor at the University of South Florida, Dominic D'Agostino has assisted with research for KetoNutrition, Ketone Technologies, and the development and testing of exogenous Ketone Supplementation (Ketone Esters).

In 2015, the Hyperbaric Biomedical Research Laboratory at the University of South Florida employed a unique combination of ketone supplementation and a ketogenic diet with hyperbaric oxygen therapy for cancer management. The study, undertaken on mice with advanced metastatic cancer, demonstrated that ketosis has beneficial effects against cancer cells, which cannot transform ketones into energy as healthy cells do. Further testing is being done on other cancer models to determine what types of cancer will be most responsive to this treatment. 

Ketosis is the metabolic process whereby the body obtains its energy from fatty acids rather than carbohydrates. In that process, the liver produces molecules known as ketones from the fatty acids. Ketones serve as an alternative fuel for the brain and have important signaling roles on gene expression and suppression (e.g. HDACI) of anti-inflammatory pathways (e.g. NLRP3). 

For the pre-clinical mouse study, researchers divided the mice into one group that received a typical diet high in carbohydrates and another group that received a modified ketogenic diet with ketone supplements alongside hyperbaric oxygen therapy. Those in the second group lived significantly longer than those in the control group and had reduced tumor burden. 

Since completing this initial research, the University of South Florida has continued to pursue research for treating cancer through therapeutic ketosis and ketone supplements. The university's researchers have also partnered with other researchers, including those at Moffitt Cancer Center, in preparing for clinical trials with humans. They collaborated on a rreview paper that was recently published in Seminars in Cancer Biology.