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Buga A, Harper DG, Sapper TN, Hyde PN, Fell B, Dickerson R, Stoner JT, Kackley ML, Crabtree CD, Decker DD, Robinson BT, Krystal G, Binzel K, Lustberg MB, Volek JS. Feasibility and metabolic outcomes of a well-formulated ketogenic diet as an adjuvant therapeutic intervention for women with stage IV metastatic breast cancer: The Keto-CARE trial. PLoS One 2024; 19:e0296523. [PMID: 38166036 PMCID: PMC10760925 DOI: 10.1371/journal.pone.0296523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/13/2023] [Indexed: 01/04/2024] Open
Abstract
PURPOSE Ketogenic diets may positively influence cancer through pleiotropic mechanisms, but only a few small and short-term studies have addressed feasibility and efficacy in cancer patients. The primary goals of this study were to evaluate the feasibility and the sustained metabolic effects of a personalized well-formulated ketogenic diet (WFKD) designed to achieve consistent blood beta-hydroxybutyrate (βHB) >0.5 mM in women diagnosed with stage IV metastatic breast cancer (MBC) undergoing chemotherapy. METHODS Women (n = 20) were enrolled in a six month, two-phase, single-arm WFKD intervention (NCT03535701). Phase I was a highly-supervised, ad libitum, personalized WFKD, where women were provided with ketogenic-appropriate food daily for three months. Phase II transitioned women to a self-administered WFKD with ongoing coaching for an additional three months. Fasting capillary βHB and glucose were collected daily; weight, body composition, plasma insulin, and insulin resistance were collected at baseline, three and six months. RESULTS Capillary βHB indicated women achieved nutritional ketosis (Phase I mean: 0.8 mM (n = 15); Phase II mean: 0.7 mM (n = 9)). Body weight decreased 10% after three months, primarily from body fat. Fasting plasma glucose, plasma insulin, and insulin resistance also decreased significantly after three months (p < 0.01), an effect that persisted at six months. CONCLUSIONS Women diagnosed with MBC undergoing chemotherapy can safely achieve and maintain nutritional ketosis, while improving body composition and insulin resistance, out to six months.
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Affiliation(s)
- Alex Buga
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, United States of America
| | - David G. Harper
- School of Kinesiology, University of the Fraser Valley, Abbotsford, British Columbia, Canada
| | - Teryn N. Sapper
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, United States of America
| | - Parker N. Hyde
- Department of Kinesiology, University of North Georgia, Dahlonega, Georgia, United States of America
| | - Brandon Fell
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, United States of America
| | - Ryan Dickerson
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, United States of America
| | - Justen T. Stoner
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, United States of America
| | - Madison L. Kackley
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, United States of America
| | - Christopher D. Crabtree
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, United States of America
| | - Drew D. Decker
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, United States of America
| | - Bradley T. Robinson
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, United States of America
| | - Gerald Krystal
- The Terry Fox Laboratory, BC Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Katherine Binzel
- Department of Radiology, Wright Center of Innovation, The Ohio State University, Columbus, Ohio, United States of America
| | - Maryam B. Lustberg
- Breast Cancer Center, Smilow Cancer Hospital, Yale University, New Haven, Connecticut, United States of America
| | - Jeff S. Volek
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, United States of America
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Buga A, Crabtree CD, Stoner JT, Decker DD, Robinson BT, Kackley ML, Sapper TN, Buxton JD, D'Agostino DP, McClure TS, Berardi A, Cline S, Fleck T, Krout J, Newby D, Koutnik AP, Volek JS, Prins PJ. Metabolic and ruck performance effects of a novel, light-weight, energy-dense ketogenic bar. Exp Physiol 2023; 108:715-727. [PMID: 36915239 PMCID: PMC10988523 DOI: 10.1113/ep091029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/14/2023] [Indexed: 03/15/2023]
Abstract
NEW FINDINGS What is the central question of the study? Can a novel, energy-dense and lightweight ketogenic bar (1000 kcal) consumed 3 h before exercise modulate steady-state incline rucksack march ('ruck') performance compared to isocaloric carbohydrate bars in recreationally active, college-aged men? What is the main finding and its importance? Acute ingestion of either nutritional bar sustained ∼1 h of exhaustive rucking with a 30% of body weight rucksack. This proof-of-concept study is the first to demonstrate that carbohydrate bars and lipid bars are equally feasible for preserving ruck performance. Novel ketogenic nutrition bars may have military-relevant applications to lessen carry load without compromising exercise capacity. ABSTRACT Rucksack marches ('rucks') are strenuous, military-relevant exercises that may benefit from pre-event fuelling. The purpose of this investigation was to explore whether acute ingestion of carbohydrate- or lipid-based nutritional bars before rucking can elicit unique advantages that augment exercise performance. Recreationally active and healthy males (n = 29) were randomized and counterbalanced to consume 1000 kcal derived from a novel, energy-dense (percentage energy from carbohydrate/fat/protein: 5/83/12) ketogenic bar (KB), or isocaloric high-carbohydrate bars (CB; 61/23/16) 3 h before a time-to-exhaustion (TTE) ruck. Conditions were separated by a 1-week washout. The rucksack weight was standardized to 30% of bodyweight. Steady-state treadmill pace was set at 3.2 km/h (0.89 m/s) and 14% grade. TTE was the primary outcome; respiratory exchange ratio (RER), capillary ketones (R-β-hydroxybutyrate), glucose and lactate, plus subjective thirst/hunger were the secondary outcomes. Mean TTE was similar between conditions (KB: 55 ± 25 vs. CB: 54 ± 22 min; P = 0.687). The RER and substrate oxidation rates revealed greater fat and carbohydrate oxidation after the KB and CB, respectively (all P < 0.0001). Capillary R-βHB increased modestly after the KB ingestion (P < 0.0001). Neither bar influenced glycaemia. Lactate increased during the ruck independent of the condition (P < 0.0001). Thirst/fullness perceptions changed independent of the nutritional bar consumed. A novel KB nutritional bar produced equivalent TTE ruck results to the isocaloric CBs. The KB's energy density relative to CB (6.6 vs. 3.8 kcal/g) may provide a lightweight (-42% weight), pre-event fuelling alternative that does not compromise ruck physical performance.
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Affiliation(s)
- Alex Buga
- Department of Human SciencesThe Ohio State UniversityColumbusOHUSA
| | | | - Justen T. Stoner
- Department of Human SciencesThe Ohio State UniversityColumbusOHUSA
| | - Drew D. Decker
- Department of Human SciencesThe Ohio State UniversityColumbusOHUSA
| | | | | | - Teryn N. Sapper
- Department of Human SciencesThe Ohio State UniversityColumbusOHUSA
| | | | - Dominic P. D'Agostino
- Department of Molecular Pharmacology & PhysiologyUniversity of South FloridaTampaFLUSA
- Human Health, Resilience, and PerformanceInstitute of Human and Machine CognitionPensacolaFLUSA
| | - Tyler S. McClure
- Human Health, Resilience, and PerformanceInstitute of Human and Machine CognitionPensacolaFLUSA
| | - Anthony Berardi
- Department of Exercise ScienceGrove City CollegeGrove CityPAUSA
| | - Shawn Cline
- Department of Exercise ScienceGrove City CollegeGrove CityPAUSA
| | - Trevor Fleck
- Department of Exercise ScienceGrove City CollegeGrove CityPAUSA
| | - Jared Krout
- Department of Exercise ScienceGrove City CollegeGrove CityPAUSA
| | - Doran Newby
- Department of Exercise ScienceGrove City CollegeGrove CityPAUSA
| | - Andrew P. Koutnik
- Department of Molecular Pharmacology & PhysiologyUniversity of South FloridaTampaFLUSA
- Human Health, Resilience, and PerformanceInstitute of Human and Machine CognitionPensacolaFLUSA
| | - Jeff S. Volek
- Department of Human SciencesThe Ohio State UniversityColumbusOHUSA
| | - Philip J. Prins
- Department of Exercise ScienceGrove City CollegeGrove CityPAUSA
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Buga A, Kackley ML, Crabtree CD, Bedell TN, Robinson BT, Stoner JT, Decker DD, Hyde PN, LaFountain RA, Brownlow ML, O'Connor A, Krishnan D, McElroy CA, Kraemer WJ, Volek JS. Fasting and diurnal blood ketonemia and glycemia responses to a six-week, energy-controlled ketogenic diet, supplemented with racemic R/S-BHB salts. Clin Nutr ESPEN 2023; 54:277-287. [PMID: 36963874 DOI: 10.1016/j.clnesp.2023.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Single doses of exogenous ketone salts (KS) transiently increase circulating beta-hydroxybutyrate (BHB) (∼1 mM; 1-2 h) regardless of starting levels of ketosis; however, no studies have explored how sustained use of KS influences measures of ketonemia and glycemia. OBJECTIVES To determine the response to a hypocaloric, well-formulated ketogenic diet (KD), with and without the inclusion of two daily racemic KS doses (6 g R-BHB + 6 g S-BHB per serving) on 1) daily fasting capillary R-BHB and glucose (R-BHB/GLUfast), 2) bi-weekly 13 h diurnal BHB and glucose (R-BHB/GLUdiur), 3) three-hours post-KS ingestion kinetics (R-BHBKS), and 4) bi-weekly fasting plasma enantiomer-specific BHB (R/S-BHBplasma). METHODS Non-diabetic adults with overweight and obesity were randomized to receive a precisely measured hypocaloric KD (∼75 %en of maintenance) for six weeks, supplemented twice-daily with KS or placebo (PL). A non-randomized comparison group was provided an isonitrogenous/isoenergetic low-fat diet (LFD). All meals were provided to subjects. Capillary blood was collected daily to measure R-BHB/GLUfast and hourly for R-BHB/GLUdiur. Plasma was collected to measure R/S-BHBplasma, insulin, fasting glucose, and insulin resistance (HOMA-IR). Total AUC was calculated using the trapezoidal method. RESULTS Mean R-BHBfast increased significantly during KD + PL (1.0 mM BHB), an effect enhanced 26% during KD + KS. GLUfast AUC was -6% lower during KD + KS versus LFD. Mean R-BHBdiur increased 40% in KD + KS versus KD + PL, whereas GLUdiur decreased 13% during both KDs versus LFD. R-BHBKS peaked (Δ: ∼1 mM) 1 h after the morning KS dose, but not following the afternoon dose. Both R/S-BHBplasma increased during KD independent of KS inclusion. R-BHBplasma was 50-times greater compared to S-BHBplasma, and the KS augmented S-BHBplasma 50% more than PL. Fasting insulin and HOMA-IR decreased after 14 days independent of diet. CONCLUSIONS A hypocaloric KD was effective at reducing diurnal glucose compared to a LFD independent of weight loss, but twice-daily racemic KS ingestion during KD augmented ketonemia, both as R- and S-BHB, and decreased mean fasting glucose beyond a KD alone. The hypoglycemic effects of KD in combination with exogenous ketones merit further investigation.
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Affiliation(s)
- Alex Buga
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Madison L Kackley
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | | | - Teryn N Bedell
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Bradley T Robinson
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Justen T Stoner
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Drew D Decker
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Parker N Hyde
- Department of Kinesiology, University of Northern Georgia, Dahlonega, GA 30597, USA
| | | | - Milene L Brownlow
- National Institute of Environmental Health Sciences, Durham, NC 27709, USA
| | | | - Deepa Krishnan
- College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA
| | - Craig A McElroy
- College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA
| | - William J Kraemer
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Jeff S Volek
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA.
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Abstract
Temperature control of various cryogenic liquids in the range from their boiling points to near or below their freezing points has been achieved by injecting a noncondensing gas, helium. The process is more easily accomplished than the usual vapor-pumping technique and is applicable in the range from 15 degrees to 300 degrees K. Interesting ice formations were observed in liquid argon.
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