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Why Be In Ketosis? Part XIII: How Ketones Modulate Pain

DocMuscles in Downtown Denver

I traveled to downtown Denver, Colorado, this week.  It gave me the opportunity to talk to a number of really great people.  A number of those people that I chatted with were searching for relief from pain and other aliments.  Not surprisingly, being in the mile-high city, many of those were using derivatives of marijuana (pun not intended).  I was actually surprised at the number of people who spontaneously admitted to using tetrahydrocannabinol (THC) or cannabinol (CBD).  They use it in various forms to treat their pain or other complaints.  Only a handful of those that I had the pleasure of talking to had ever heard of nutritional ketosis as an approach to pain control. This got me thinking about my patients and their pain control.  Many of them have had significant improvement in pain using a ketogenic diet and exogenous ketones.

Nutritional Ketosis as a Method of Pain Treatment

I started using nutritional ketosis as an adjunctive treatment to disease twelve years ago. Quite a few of my patients reported improvements in their overall pain using this approach.  I started to see 50-60% improvement in the inflammatory types of pain, and 40-50% improvement in neuropathic pain.

Ketosis and Forms of Pain

There are a number of forms of pain: thermal, inflammatory, and neuropathic. Looking over the scientific literature, there is no strong data showing that ketogenic diets reduce thermal pain, however, there is data showing improvement in inflammatory pain.  Within two days of dietary changes, inflammatory pain and secondary swelling, as well as plasma extravasation (excess fluid accumulation around the area of swelling) show measured improvement.

Watch my four minute vlog below about pain control being one of the twenty-five reasons to use nutritional ketosis (This video has a mic problem, so turn your sound all the way up):

Even though the published science has not caught up to fully clarified what we are seeing clinically, evidence demonstrates that ketones improve nerve pain. When ketones are present in increased amounts in the blood stream, the current evidence points to a number of poorly understood mechanisms.  Ketones compete with chloride ions in the peripheral nerve cells.  When ketones bind instead of chloride, there is a decrease in glutamate production, a key amino acid necessary in the signaling of pain fibers.  The lower glutamate level causes a rise in gama-aminobutyric acid (GABA). . . leading to decreased sensation of pain.

This is the same pathway that stops intractable seizures and may play a very significant role in dietary treatment of autism.

Denver is ranked No. 3 by Zagat on the list of “Foodie Capitals” of America. And, the downtown scene is absolutely beautiful, but I walked by eight different restaurants specializing in “carbage” while walking just two blocks.  Encouraging cities to eat less bread may be a challenge.   But, hey, you get to eat more bacon!  And, bacon is the duct tape of the culinary world.

Bacon Boy loves to travel. Click Here to take him on your next photo opportunity.

Coconut Oil – Duct Tape for the Broken Metabolism

Coconut oil can be found in just about every grocery store, health food store and coffee shop near you.  It was made popular in the last few years by the highly advertised Bullet Proof Coffee claims of health and taste over the last few years.  But in the last few days, the news outlets through video and print have made it clear that the American Heart Association (AHA) isn’t happy with our use of this “duct tape for one’s metabolism.” The AHA has long been a proponent of education against activities increasing the risk of heart disease.  Since 1961 the AHA has decried the use of saturated fat, based on their support of Ansel Key’s diet heart hypothesis, and leading to over 60 years of preaching against the use of saturated fats from the pulpits of science.  The claim is that 85% of coconut oil is saturated fat (this is the fat deemed “evil” by those “disciples of the low-fat cloth”).   Yes, coconut oil is predominantly a saturated fat.  And approximately 75% of that is medium chain triglycerides, the form that converts most efficiently into ketones, for those of us using ketogenic nutritional approaches to health.  But is coconut oil really bad for your heart health?

Those of us using ketogenic diets know that LDL-C will commonly rise with increased saturated fat intake.  And, we’ve know this for over twenty years. This is to be expected, because LDL-C is really comprised of three different LDL sub-particles (big fluffy, medium, and small dense).  We’ve known for the last twenty years that increased saturated fat actually causes a shift in these particles to bigger “fluffier” particles.  We also know that it’s the small dense LDL particles are the atherogenic/inflammatory particles participating in the formation of vascular disease (arterial blockage) and their presence in the blood is directly correlated with the level of triglyceride, and that the big “fluffy” particles actually reduce the risk of vascular disease. Those of us following ketogenic lifestyles and treating disease with these protocols also know that triglycerides levels are increased directly by increasing levels of insulin.

The 2015 British Medical Journal published a study reviewing the relevant 19 peer reviewed medical articles that included over 68,000 participants.  This review showed that there is no association of high LDL-C (a calculated value of all the LDL sub-particles) with mortality (meaning that an elevated LDL-C does not lead to an increased risk of death from heart disease).  In stark contrast to this landmark review, The American Heart Association’s Presidential Advisory published this week in the June 20, 2017 issue of Circulation states that saturated fat is the cause of increased LDL-C and elevated LDL-C is associated with an increase in death by cardiovascular disease.  This boldfaced claim is based on a single small 4 year (2009-2013) literature review completed by the World Health Organization with a whopping 2353 participants, most of these studies only lasting 3-5 weeks (not nearly long enough to see fully effective cholesterol changes) and none of which had any focus on carbohydrate intake, insulin levels or LDL sub-particle measurement.  From this singular study, the AHA concludes that elevated LDL-C is an indicator of increased cardiovascular mortality.  That’s the equivalent of saying, “you know cars drive on the roads and cause pot holes, so we should all STOP driving cars because it is causing our freeway system to have increased pot holes.”

You can’t extrapolate mortality risk based on a single small study that doesn’t actually identify correlation or causation.  But the AHA did exactly that in 1961, and they are trying to do it again today.   The MR-FIT study, largest study ever completed, is incessantly quoted as the study that demonstrates reduction in cholesterol leads to reduction in cardiovascular disease, but this trial was actually a failure and did not demonstrate improved risk by lowering cholesterol.  In fact, the Director of the study, Dr. William Castelli actually stated, “. . . the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol…”

“We found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories weighed the least and were the most physically active,” he said.

Isn’t that interesting?

So, is coconut oil, or any other food high in saturated fat to blame?  Absolutely not!  There is no solid evidence to support these facts and there hasn’t been in over 65 years.   In fact, clinically, I find that the addition of coconut oil lowers triglycerides, decreases appetite, improves energy, improves skin tone, and plays a huge role in shifting the Omega 3/6 ratios to a more normal 2:1 level.

Is coconut oil, or any other food high in saturated fat to blame? Absolutely not! There is no solid evidence to support these facts and there hasn't been in over 65 years. #docmusclesClick To Tweet

So, how does coconut oil help the broken metabolism?  The majority of people I see in my office have insulin resistance to some degree.  Insulin resistance is an over production of insulin in response to any form of carbohydrate or starch.  Increasing your saturated fat, does two things.  It provides a fantastic form of fuel, one your body can use very easily.  And second, it will decrease your craving for starches and carbohydrates, naturally decreasing production of insulin and helping to improve insulin resistance over time.

If you want to learn more about using fat and improving insulin resistance, see my previous blog post here.

You can learn more about how our acceptance of bad science has lead to an obesity and diabetes epidemic in our country over the last 65 years by reading these books below: