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Is there an evolutionary medicine explanation for why ketosis is therapeutic for so many conditions?

Answered on August 19, 2014
Created November 11, 2012 at 8:46 PM

Is there an evolutionary medicine explanation for why ketosis is therapeutic for so many conditions? I am not debating whether it is therapeutic. I believe it is, but I'm curious if this is some kind of evolutionary coincidence or why we would have evolved this way?

Medium avatar

(10611)

on November 13, 2012
at 02:28 PM

Occurred is apt. The connection between fasting and religious visions/ecstasies probably relates to the mental effects. And to the rarity of ketotic episodes.

Medium avatar

(10611)

on November 13, 2012
at 02:16 PM

The part about poison is complete nonsense. By the same logic fat is a poison. http://paleohacks.com/questions/137936/fat-intolerance#axzz2C2lisXid

Medium avatar

(10611)

on November 13, 2012
at 02:06 PM

While I can see that northern paleos would have experienced ketosis, there were very few of them and are unlikely to be our actual ancestors. Modern northers such as Inuit are lapsed Neolithics. The dream of perpetual ketosis is very modern. Post Nrolithic thinking.

Medium avatar

(10611)

on November 13, 2012
at 01:21 PM

We remain tri-fuel for our entire lives. Some of us lose our lactose and casein tolerance, but carbs and protein remain digestible.

Medium avatar

(10611)

on November 13, 2012
at 01:16 PM

Thanks for this reminder that ketogenic dieting is specifically useful for ONE specific therapy, for epilepsy. The question implies broad undefined therapeutic benefits. N=1 and evolutionary arguments are interesting to read but hardly vetted by clinical studies.

6120c989fd5b69f42a0834b69b87955b

(24553)

on November 13, 2012
at 05:42 AM

Hmm...I would disagree that glucose is toxic, perhaps when we exceed what we need, but considering we manufacture our own as needed (to a point), I would say this is along the lines of the argument that cholesterol is deadly.

4e6baf393fd5f339ae5a92ffbeadc884

(305)

on November 13, 2012
at 05:26 AM

Yes, the southern UK is not the 'norm' on a global scale but neither is it an 'extreme northern latitude' I only get a handful of nights a year when it gets below zero, and that is at 50 deg N. Still almost no carbs to eat in the woods though.

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on November 13, 2012
at 03:52 AM

Two points: One, I've seen the low end of carbohydrate consumption in hunter-gatherers put at approximately 10% of calories, likely 60+ grams per day, too much to be in ketosis all that much. Two, hunter-gatherer populations are centered around the equator, lower population density nearer the poles. The mean, median, norm is not anywhere 60°N.

4e6baf393fd5f339ae5a92ffbeadc884

(305)

on November 12, 2012
at 06:37 PM

I don't know about that Matt. Here in the UK, there is not much to eat in nature that's got many carbohydrates. And we are not exactly in the Arctic tundra. Maybe berries in the autumn, and aquatic roots now and then. Not exactly a feast of carbohydrates. It seems most likely to me my ancestors were a pretty ketogenic lot.

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on November 12, 2012
at 01:33 PM

I don't think low-carb or ketosis is the norm anywhere except for extreme northern latitudes. The bulk of hunter-gatherers consume a level of carbohydrate that's well above ketotic levels.

77877f762c40637911396daa19b53094

(78467)

on November 12, 2012
at 07:58 AM

this damage to the metabolism you're postulating about, is this intra-generational or an inherited effect?

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on November 11, 2012
at 09:29 PM

Interesting question - looking forward to some interesting answers - I'd probably wager it's effecting the hormonal milieu.

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8 Answers

4
A2c38be4c54c91a15071f82f14cac0b3

(12682)

on November 13, 2012
at 04:26 AM

Starvation is known to increase ketones, so ketosis probably occurred during periods of very low food availability throughout evolution.

Since it's frequently found that ketosis is beneficial to mental health and therapeutic to various mental conditions, maybe this was due to the need for maximal brain function to acquire food when food was scarce. That's my theory anyway.

Medium avatar

(10611)

on November 13, 2012
at 02:28 PM

Occurred is apt. The connection between fasting and religious visions/ecstasies probably relates to the mental effects. And to the rarity of ketotic episodes.

4
E253f8ac1d139bf4d0bfb44debd1db21

on November 12, 2012
at 04:53 AM

It could be that low carb availability was the norm then and ketosis was on more often than not..

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on November 13, 2012
at 03:52 AM

Two points: One, I've seen the low end of carbohydrate consumption in hunter-gatherers put at approximately 10% of calories, likely 60+ grams per day, too much to be in ketosis all that much. Two, hunter-gatherer populations are centered around the equator, lower population density nearer the poles. The mean, median, norm is not anywhere 60°N.

4e6baf393fd5f339ae5a92ffbeadc884

(305)

on November 13, 2012
at 05:26 AM

Yes, the southern UK is not the 'norm' on a global scale but neither is it an 'extreme northern latitude' I only get a handful of nights a year when it gets below zero, and that is at 50 deg N. Still almost no carbs to eat in the woods though.

32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on November 12, 2012
at 01:33 PM

I don't think low-carb or ketosis is the norm anywhere except for extreme northern latitudes. The bulk of hunter-gatherers consume a level of carbohydrate that's well above ketotic levels.

4e6baf393fd5f339ae5a92ffbeadc884

(305)

on November 12, 2012
at 06:37 PM

I don't know about that Matt. Here in the UK, there is not much to eat in nature that's got many carbohydrates. And we are not exactly in the Arctic tundra. Maybe berries in the autumn, and aquatic roots now and then. Not exactly a feast of carbohydrates. It seems most likely to me my ancestors were a pretty ketogenic lot.

Medium avatar

(10611)

on November 13, 2012
at 02:06 PM

While I can see that northern paleos would have experienced ketosis, there were very few of them and are unlikely to be our actual ancestors. Modern northers such as Inuit are lapsed Neolithics. The dream of perpetual ketosis is very modern. Post Nrolithic thinking.

2
32f5749fa6cf7adbeb0b0b031ba82b46

(41757)

on November 13, 2012
at 03:23 AM

It doesn't appear there's a known and well-studied answer to this question. A few interesting reviews on the subject:

http://www.ncbi.nlm.nih.gov/pubmed?term=17241207

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367001/

Seems the science is a little scattered, concepts I saw: stimulation of mitochondrial biogenesis, mitigating glutamate-mediated toxicity, increased GABA, positive effects on antioxidant status, prevention of apoptosis, anti-inflammatory properties, etc...

Medium avatar

(10611)

on November 13, 2012
at 01:16 PM

Thanks for this reminder that ketogenic dieting is specifically useful for ONE specific therapy, for epilepsy. The question implies broad undefined therapeutic benefits. N=1 and evolutionary arguments are interesting to read but hardly vetted by clinical studies.

2
96440612cf0fcf366bf5ad8f776fca84

(19413)

on November 13, 2012
at 02:08 AM

I think one of the big reasons why we are such great survivors is that we can adapt. We made several adaptations from carb eaters to hunters (and ice age survivors) along the way, but still retained the ability to switch to carbs as needed. It's not complete as red blood cells, and very long nerve cells require carbs as they lack mitochondria. But as long as we have enough animal foods (or the required protein stores in muscles), we can make enough glucose.

The remaining cells can burn either glucose, triglycerides, or ketones as fuel. However, when we make ATP via burning carbs instead of beta oxidation (fat burning), the result is lots of ROS, for which we need some antioxidants. We have an awesome one built it: glutathione. But it does get depleted after a while.

The rest of the issue is that glucose levels have to be very carefully maintained since high blood glucose is very damaging to eyes, nerves, and kidneys (since they're a backup plan to dump glucose out of the body.) The fact that we have this mechanism really does point us to the fact that high carb intake is a very bad idea long term. Both Drs Jaminet, and Mark Sisson arrived at the conclusion that about 150g/600kcals of glucose is a good amount and too much over that has negative effects.

Humans, like most well adapted critters not only adapt over long periods of time via evolutionary pressures in response to environment, but we also adapt individually as can be seen by folks who, after decades of high carb consumption have trouble going back to burning fats and ketones. Just as muscles without the hormetic stimulation of exercise, atrophy, so it seems also does our mitochondria, and so do our cells become more insulin resistant.

Just because we can burn carbs, or for that matter protein, doesn't mean that it's an efficiently used calorie source for us from an overall health perspective.

Insulin itself isn't damaging, but if you're trying to lean out, the more insulin there is in the blood stream, the less access you have to the energy stored inside fat cells. On the other hand, too little glucose, and you'll start signaling cortisol to produce glucose. That in itself isn't bad, except that cortisol disables repair and the immune system, and raises stress levels if you get into this state for too long.

Insulin resistance is probably something that can be reset by going to both extremes. That is, you'd go into ketosis often, and allow for autophagy, which is a clean up mechanism that's very beneficial for us, and then you'd have a day or two per week where you'd have a higher carb load - preferably an hour or so after a large workout. Or you can skip breakfast and do a carb backloading session at night. This way you get the best of both worlds.

You can't have autophagy unless you fast, and if you're adapted to carb burning only, you'll suffer a low carb flu, but if you're ketone-adapted, you won't even get hungry, and would probably feel more clear headed and calm.

One thing that's interesting is that if we miss sleep we tend to be as insulin resistant the next day or so, as a type 2 diabetic (as per Robb Wolf podcast), so I wonder if that's related to sleep and some mechanism that's part of sleep, or rather, because we don't sleep, we eat more, and thus miss a period of fasting, which allows for depletion of glycogen stores, and thus an increased insulin sensitivity. Might be worth avoiding carbs, and also limit proteins a bit if you miss sleep and use fat as a substrate if you miss sleep.

2
510bdda8988ed0d4b0ec0b738b4edb73

(20898)

on November 12, 2012
at 07:55 PM

I wouldn't explicitly attribute it to the ketosis part, I believe it's more correlative. That is, you don't get into ketosis until you are low-carb for a significant amount of time. Sugar is pretty toxic and the standard diet is so high in sugar, everyone is slowly poisoning themselves. To go ketogenic, you cut the sugar and effectively stop poisoning yourself. Since the sugar-poisoning shows up in so many different way, it then looks like ketosis magically fixes so many different things whose root cause really is the chronically high sugar.

There are some other things like the brain working more efficiently on ketones and that can directly help things like epilepsy and alzheimers, but for most things, I attribute it to the lack of sugar rather than the presence of ketones.

Medium avatar

(10611)

on November 13, 2012
at 02:16 PM

The part about poison is complete nonsense. By the same logic fat is a poison. http://paleohacks.com/questions/137936/fat-intolerance#axzz2C2lisXid

6120c989fd5b69f42a0834b69b87955b

(24553)

on November 13, 2012
at 05:42 AM

Hmm...I would disagree that glucose is toxic, perhaps when we exceed what we need, but considering we manufacture our own as needed (to a point), I would say this is along the lines of the argument that cholesterol is deadly.

2
B3173217a49b5b0116078775a17eb21d

(11488)

on November 12, 2012
at 11:14 AM

As a keto-controlled T2 diabetic, it seems to me that the western diet has tricked us into putting the wrong fuel into our bodies.

On the one occaision that I accidently put a small amount of petrol into my diesel car, it still drove around for a few days, but with nasty plumes of blue smoke trailing behind, before the glow plugs eventually packed up.

Don't think that our metabolism is wired for a refined carbohydrate diet.

1
7a6529ea25b655132fe58d793f95547a

(2030)

on November 12, 2012
at 06:07 PM

Possibly because of the use of Beta-Hydroxybutyrate in the developing human fetus.

http://www.ncbi.nlm.nih.gov/pubmed/1114894

I would think we would retain the ability to run on ketones throughout life and maybe this is why lc promotes growth and repair in most people.

1
77877f762c40637911396daa19b53094

(78467)

on November 12, 2012
at 04:59 AM

My suspicion would be the pendulum effect. We went too sugary, too high-carb and damaged part of our metabolism. Now we have to switch fuel sources. We were all dual-fuel at birth...

77877f762c40637911396daa19b53094

(78467)

on November 12, 2012
at 07:58 AM

this damage to the metabolism you're postulating about, is this intra-generational or an inherited effect?

Medium avatar

(10611)

on November 13, 2012
at 01:21 PM

We remain tri-fuel for our entire lives. Some of us lose our lactose and casein tolerance, but carbs and protein remain digestible.

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