Ketogenic diet

The ketogenic diet, characterized by high fat, moderate protein, and very low carbohydrate intake, offers a contrasting approach to a standard mixed diet or a low carbohydrate diet.It also avoids "low carb limbo" by promoting generation of ketone bodies in the liver.

In extreme gut microbiome dysbiosis cases, changing to a ketogenic diet for a period of time can also be very helpful in reducing fermenting species, however will require commitment to endure an often unpleasant induction (1 week) and then adaptation phase (2 weeks). If your OAT results already show elevated ketone markers, this is much easier. Studies suggest the acute effects of a ketogenic diet on your gut microbiome will last around 12 weeks, before the microbiome adapts. Combining this window of opportunity with other interventions in this protocol can allow you to break the existing cycle with lasting results.

By significantly reducing carbohydrate consumption, this diet limits the substrates available for microbial fermentation. As a result, endogenous ethanol and acetaldehyde production may decrease significantly in response to food intake, alleviating some of the metabolic disruptions caused by GFS.

However, circulating acetaldehyde and other endotoxins will still be experienced, making the first 1-2 weeks of a ketogenic (the induction phase) more unpleasant than it would be for someone without GFS.

A key point of difference is that the ketogenic diet promotes fatty acid oxidation and ketone body production as alternative energy sources. Ketone bodies can cross the blood-brain barrier and provide energy to the brain (much more efficiently after weeks of being on a ketogenic diet), potentially improving cognitive function and reducing fatigue. Additionally, this diet may alter the gut microbiota significantly, reducing fermenting microbial populations and promoting a healthier balance.

Mechanisms of Ketogenic Diet's Impact on GFS

Carbohydrate Restriction

Limiting carbohydrate intake directly reduces the amount of glucose and other fermentable sugars in the gut. This reduction in substrates can lead to decreased microbial fermentation activity, resulting in lower ethanol and acetaldehyde production. With less acetaldehyde burden, the inhibitory effects on metabolic enzymes are alleviated, helping to restore the cellular redox balance and improve the function of gluconeogenesis and fatty acid oxidation pathways.

Fatty Acid Oxidation and Ketogenesis

The ketogenic diet's high-fat composition encourages the body to utilize fats as the primary energy source. This shift promotes the production of ketone bodies in the liver through a process called ketogenesis. Ketone bodies serve as an efficient alternative energy source for various tissues, including the brain and muscles. By providing a consistent energy supply, the diet addresses the energy deficits caused by acetaldehyde-induced metabolic disruptions. Additionally, relying less on impaired glucose production pathways reduces the risk of hypoglycaemia.

Benefits of a Ketogenic Diet in GFS

Implementing a ketogenic diet in GFS management offers several potential benefits. By reducing acetaldehyde levels, the diet can help restore normal metabolic functions, improving energy production and overall well-being. The provision of ketone bodies as an alternative energy source may alleviate symptoms such as fatigue and cognitive impairments. Furthermore, the reduction in carbohydrate intake may lead to favourable shifts in gut microbiota composition, decreasing the population of fermenting microbes responsible for excessive acetaldehyde production.

Potential Challenges

Despite its potential advantages, the ketogenic diet presents challenges that must be carefully considered. The restrictive nature of the diet can make long-term adherence difficult for some people. There is also a risk of nutrient deficiencies, particularly in electrolytes, fibre, vitamins, and minerals, if the diet is not properly managed. Monitoring thyroid function is also helpful, as very low carbohydrate intake can sometimes reduce T3 levels, potentially affecting metabolic rate. Additionally, high-fat diets can impact beneficial gut bacteria, necessitating careful planning to maintain gut health.

A manganese deficiency will significantly impact hepatic gluconeogenesis, as will zinc and magnesium deficiencies. These should be somewhat addressed before attempting keto induction.

NB. The reduction in glucose availability may affect cognitive function where neural hypoxia exists - due to eg. structural issues, coagulation and/or transport issues, severe iron deficiency, and also blocked lymph nodes in the neck and/or nasopharynx (usually relating to localised infection). The reduced glucose affects lactic acid metabolism involved in the Astrocyte-Neuron Lactate Shuttle and ultimately energy availability in neurons.

Strategic Implementation

Successful implementation of a ketogenic diet for GFS requires proper planning to ensure safety and efficacy. A personalised nutritional plan tailored to individual needs and tolerances can enhance adherence and effectiveness. Cronometer is very helpful in planning and visualising a successful day. Setting expectations ahead of time will help allow you to "keep calm and keto on" during unpleasantness.

Supplementation with essential electrolytes, vitamins, minerals, and probiotics like the ones in this protocol may be necessary to address deficiencies and support gut health.

A gradual transition into the diet, by slowly reducing carbohydrate intake, prolongs keto adaptation and exacerbates energy crisis symptoms. It is not recommended.
 
A rapid transition normally creates temporary symptoms of "keto flu", which can be managed by using GoBHB exogenous ketone supplements and essential amino acids (EAAs) during the dietary transition.

Strictly restricting carbohydrate intake is paramount to the diet, which involves eliminating sugars and refined carbohydrates like sweets, sugary drinks, white bread, and pastries. Removing starchy foods such as potatoes, rice, pasta, and grains is also necessary. Instead, consuming non-starchy vegetables like broccoli, cauliflower, kale, and bell peppers (capsicum) provides essential nutrients with minimal carbohydrates. The target daily net carbohydrate (total carbohydrates, minus fibre) upper limit is 25g.

Increasing the intake of healthy fats supports the ketogenic approach. This includes consuming monounsaturated fats found in olive oil, avocados, and nuts, as well as omega-3 fatty acids from fatty fish such as salmon and mackerel. Saturated fats from sources like coconut oil and butter can be included. Butter is also a good source of butyrate, which may trigger rapid, beneficial changes to the microbiome, however, this will also trigger die-off symptoms and potentially induce rapid alcohol withdrawal symptoms.

Protein intake is important for essential amino acids and to allow the liver to perform hepatic gluconeogenesis for brain and other tissues. Balancing protein intake is important because excessive protein can be converted into glucose, potentially triggering an insulin response that inhibits keto induction / adaptation, while also fuelling microbial fermentation, depending on the location of the biofilms. The longer the protein take to digest, the further along the GI tract it will be before potentially feeding the microbiome.

Keto induction is easier with more fats than protein, initially. For example,

During keto induction, you could consume:
170g fat @ 1530 kcal +
100g protein @ 400 kcal
= 1930kcal

After keto induction, you can transition to consuming roughly 1:1 of fat:protein, on a per-gram basis:
150g fat x9 = 1350kcal
150g protein x4 = 600kcal.
= 1950kcal.

(Scale this by your calorific needs.)

High-quality protein sources such as lean meats, poultry, eggs (a great source of lecithin for phosphatidylcholine), and plant-based proteins like nuts (good mineral sources) and tofu (some people may have tolerance issues) are recommended.

Maintaining proper hydration and electrolyte balance is essential. Adequate water intake supports detoxification and metabolic processes, while sufficient electrolytes help prevent imbalances that will reliably occur during the initial stages of a ketogenic diet, as glycogen stores are intentionally depleted.