Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop and welcome to my podcast and videocast station. Today I'd like to talk a little bit about ketogenic diets and their role in cardiac failure. Well, you may or may not be aware, keto diets or ketogenic diets originated back in the 1920s and were used as an alternate treatment for pediatric epilepsy. It turned out that there was a suggestion that it could be beneficial, not only in that situation, but also for neurodegenerative diseases. These are things like multiple sclerosis, Parkinson's disease, also beneficial for diabetes, for non-alcoholic fatty liver disease, this is where fat accumulates in the liver, for some cancers, and importantly, also for weight loss. So ketogenic diets have been around for a while. Well, what does a ketogenic diet look like? In general terms, to be eating keto, you need about 70 or 80% of your intake from fats, about 10 or 20% from protein, and about 5 to 10% from carbohydrate. The impact of this is that the reduction of carbohydrate will... turn down or turn off the role of insulin. And with insulin turned off, then the body can start to release fatty acids from fat cells. Those fatty acids can go to the liver and be turned into ketones, and those ketones can be used as energy around the body. Now, ketosis is not an abnormal state. If you were a marathon runner, you would go into ketosis after about 35 to 45 minutes running. So we tend to use mixed fuel sources in our body. We tend to use glucose preferentially and then move on to ketones. And if you're a long distance runner, you'd probably use up your glucose reserves in about the first 45 minutes of a long distance event. And then your body would move over to ketosis and part of training is really training your body to swap over and use that alternate energy source. Well, one of the things that's particularly interesting is the heart can use ketones in an unregulated way. It can use ketones as energy. Now, if the heart can use ketones as energy in an unregulated way, it's not unreasonable to ask the question, Could a ketogenic diet improve the energy to the heart and therefore improve heart function? While there's been a little bit of work done in that space, we do know from a very important trial called the EMPA-REG outcome trial that modifying glucose and reducing glucose in the bloodstream can certainly improve outcomes for cardiac failure. But what about actual ketotic diets? Well, there's been a little bit of work to suggest that cardiac function can be improved by ketogenic diets and the ability for the heart to directly use available ketones. But really, there's not a lot of work in that space at all. And at the moment, when we think about current dietary guidelines, which include such things as eating a variety of fruits and vegetables and whole grains, then it's in stark contrast to a ketogenic diet, which really focuses on fat and markedly reduces things like grains, fruits and vegetables because of the carbohydrate. So we're in an interesting dilemma where there's tension between what ketones may be able to provide for the heart, but what current recommendations suggest in terms of cardiovascular health. and reduction of risk of heart attack. Well, it turns out that we're probably in a space where we're going to have to simply watch and see what time and research produces in that area. I think there may be people who, if they try a ketogenic diet in the setting of reduced cardiac function, will report a benefit, and in that situation, under close supervision by their local doctor, and in particular their cardiologist, it may not be unreasonable. I'm not sure if a broad adoption of a ketogenic diet is quite the go yet. I think a bit more information is required. In my own practice, I certainly favour people keeping their carbohydrates down, as in a large number of patients that I see that Reduction of carbohydrate can reduce insulin levels and help people drop their weight, improve their HDL cholesterol, their good cholesterol, and lower their triglycerides, which are their bad cholesterols. And with weight loss, raised good cholesterol, reduced triglycerides, we could certainly suggest that those people in the longer term. have improved their cardiovascular risk profile. There is a bit of talk that keto diets will also reduce inflammation, but I don't think we've got a lot of clear data to help advise or inform us in that choice. So for now, from my perspective, I think the role of keeping your carbs down is reasonable and fair. I think it does help with weight reduction. I haven't been advocating it. for cardiac failure, and I've not been advocating ketogenic diets for cardiac failure. I think time will give us more information in that space, but it certainly is an area where we could have some optimism. There are some reasons to believe it could be beneficial, and I think it's important and incumbent on us to figure out the right way to do that. Well, I hope you found today's few minutes on ketogenic diets informative and interesting if you have any queries or questions drop us a note and if you have any suggestions for future podcasts again also let us know for now thank you so much for tuning in i do wish you the very best take care bye for now and good health You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
