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

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.