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Art & Science Of Low Carbohydrate Living
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Predicted Gene Function For The Gut Microbiota. A: Bar Graph Of Cog…
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Decoding The Science Behind Carb Control And Longevity
By Noushin MohammadifardNoushin Mohammadifard SciProfiles Scilit Preprints.org Google Scholar 1, Fahimeh HaghighatdoostFahimeh Haghighatdoost SciProfiles Scilit Preprints.org Google Scholar 2, * , Mehran RahimlouMehran Rahimlou SciProfiles Google Scholar Sannari SciProfiles, Paula Sanorg SciProfiles. Rodrigues SciProfiles Scilit Preprints. org Google Scholar 4, Mohammadamin Khajavi GaskareiMohammadamin Khajavi Gaskarei SciProfiles Scilit Preprints.org Google Scholar 5, Paria OkhovatParia Okhovat SciProfiles Scilit Preprints.org Google Scholar 6, Cesar de OliveiraCesar de Oliveira SciProfiles SciProfiles Silveira Google Scholar Aporgid ScilitAp. SciProfiles Scilit Preprints.org Google Scholar 7, 8 and Nizal SarrafzadeganNizal Sarrafzadegan SciProfiles Scilit Preprints.org Google Scholar 1, 9
Department of Epidemiology and Public Health, Institute of Epidemiology & Health Care, University College, London WC1E 6BT, UK
Department of Medicine, School of People and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
Paper received: 26 July 2022 / Revised: 20 August 2022 / Accepted: 23 August 2022 / Published: 25 August 2022
Issue No. 132: The ‘shroom Boom
Cardiovascular disease (CVD) and cancer are the first and second leading causes of death worldwide, respectively. Epidemiological evidence has shown that the incidence of cancer is increased in patients with cardiovascular disease and vice versa. However, these conditions are usually seen as separate events despite the fact that there are common risk factors between both diseases, such as metabolic abnormalities and lifestyle. Cohort studies suggested that controlling cardiovascular risk factors may affect cancer rates. Therefore, it could be concluded that interventions that improve CVD and common cancer risk factors could potentially be effective in the prevention and treatment of both diseases. The ketogenic diet (KD), a low-carb, high-fat diet, has been widely prescribed in weight loss programs for metabolic abnormalities. Furthermore, recent studies have investigated the effects of KD in the treatment of numerous diseases, including cardiovascular disease and cancer, due to its role in promoting ketolysis, ketogenesis, and altering many other metabolic processes with potential beneficial health effects. However, the prescription of KD in patients with either CVD or cancer remains highly debated. Given the number of studies on this topic, there is a clear need to summarize the possible mechanisms by which KD may improve cardiovascular health and regulate cell proliferation. In this review, we explained the history of KD, its types and physiological effects, and discussed how it may play a role in CVD and cancer treatment and prevention.
Cardiovascular diseases (CVD) and cancer are the first and second leading causes of death worldwide [ 1 ]. CVD accounted for approximately 17.8 million deaths, followed by cancer with 9.56 million deaths in 2017 [ 1 ]. These situations are usually treated as separate events. However, they share several risk factors, such as obesity, diabetes, hypertension, hyperlipidemia, diet and lifestyle, suggesting a shared biology [ 2 , 3 ]. Among the pathophysiological mechanisms, many common processes between CVD and cancer have been studied, including inflammation, oxidative stress, resistance to apoptosis, cell proliferation, neurohormonal stress, angiogenesis, and genetic instability [ 2 , 4 ]. Epidemiological evidence has shown that the incidence of cancer was increased in patients with cardiovascular diseases, such as heart failure (HF). The opposite was also true, as the increased incidence of HF in cancer survivors may be associated with chemotherapy, radiation therapy, and immunotherapy, often in combination [3].
Cohort studies suggested that controlling cardiovascular risk factors may also influence cancer incidence and outcomes. In the European Prospective Investigation into Cancer and Nutrition (EPIC) study, a large cohort of 23, 153 subjects aged 35 to 65 years followed a healthy lifestyle (no smoking, body mass index (BMI) 3.5 hours per week and healthy diet) resulted in a hazard ratio (HR) of 0.19 (95% confidence interval (CI), 0.07–0.53) for myocardial infarction; 0.50 (95% CI, 0.21–1.18) for stroke; and 0.64 (95% CI, 0.43–0.95) for cancer after 7.8 years of follow-up [ 5 ]. The Atherosclerosis Risk in Communities Study (ARIC), with 13,253 participants aged 45 to 64 between 1987 and 2006, showed that adherence to six of seven criteria for health outcomes reduced the risk of cancer compared to individuals who met zero ideal health measures by 51% [6]. Therefore, interventions that improve CVD and cancer shared risk factors may play a role in the development of combined prevention and treatment strategies for both diseases.
Several nutritional interventions have been tested for the prevention and treatment of cardiovascular disease and cancer [ 7 , 8 , 9 , 10 ]. The ketogenic diet (KD), which consists of a low-carbohydrate and high-fat diet, was developed in the 1920s to successfully treat refractory epilepsy and became popular in the 1970s when it was used in weight loss. KD has recently been studied for the treatment of numerous diseases, including cardiovascular disease and cancer, due to its role in promoting ketolysis, ketogenesis, and altering many other metabolic processes that could lead to beneficial health effects [11]. Considering the number of studies on this topic, there is a clear need to summarize the evidence for the potential therapeutic mechanism of KD on CVD and cancer. This review presented a wide range of studies examining the effects of KD on cardiovascular disease and cancer and their shared risk factors and potential mechanisms involved.
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Over the centuries, fasting has been used as a primary treatment for epilepsy [12]. In the early twentieth century, Guepa and Maria used fasting to treat epilepsy in France [13]. Ten years later, in 1921, Wilder proposed that this treatment of epilepsy might be due to body ketones [14] and therefore introduced the KD, which produced similar biochemical changes to fasting [15] . In the same year, Woodiat reported that during starvation or low carbohydrate, ketone bodies appeared in the blood [16]. KD consists of a significant amount of fat, low carbohydrates and limited protein, which leads to changes in energy metabolism and an increase in the body’s ketones in the blood, which ultimately forces the body to use them to produce energy [17, 18]. The recommended ratio of fat to protein plus carbohydrates is between 4:1 and 2:1 by weight [15]. Later, Wilder and Teperman described this diet as 1 g and 10–15 g per kilogram of body weight of protein and carbohydrates, respectively, with the rest of the required energy from fat [16]. Table 1 shows the different versions of KD.
Generally, four types of KD have been characterized. The first type is the classic or traditional type, with a 4:1 ratio of fat to protein plus carbohydrates. Thus, in this diet, fat intake provides 90% of the energy, which can be difficult and unbearable for the general public [19]. The second type contains medium chain triglycerides (MCT) such as caprylic acid, capric acid, caproic acid and lauric acid [20], with 70% of energy absorption from fat including 10% long chain triglyceride (LCT) fat and 60% MCT fat, 20% from carbohydrates and 10% from protein. Due to the faster membrane distribution of MCT, the absorption process occurs earlier. Since the production rate of ketone bodies is higher than the previous model, for its balanced composition, less fat intake is required [21]. A third type of KD with a 1.1:1 ratio of 65% fat, 10% carbohydrate and 25% protein was developed in 1970 by Dr. Robert Atkins based on carbohydrate restriction for weight loss. It is characterized by greater carbohydrate restriction and high fat consumption without restriction of calories and protein. This diet was called the modified Atkins diet [22]. The fourth type is called a low glycemic index (GI) diet which recommends foods with a GI lower than 50 with a fat to carbohydrate ratio of 6:1 [23].
Decrease in blood sugar during fasting or
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