By Marika Sboros
It’s not just parents who fear the “k” word – ketosis – for kids. Many, if not most, paediatricians and paediatric dietitians are also not fans.
Ketogenic diets are very low in carbs and very high in healthy fats (VLCHF) and designed to achieve ketosis. The very idea of putting kids – specially infants – on keto diets worries many paediatricians and dietitians.
Yet US neuroscientist Dr Angela Stanton will tell you that babies are born in ketosis. She will also tell you that mother’s milk is very high-fat – and low-carb, relatively. And that this is the “magic’ that keeps newborns in ketosis all through breastfeeding – as long as it is exclusive.
Stanton is author of Fighting The Migraine Epidemic: Complete Guide: How to Treat & Prevent Migraines Without Medicines. She focuses much of her research on how simply dietary changes can significantly affect health and disease outcomes.
Here’s what she has to say on the topic of kids and ketosis. Spoiler alert: she’s a fan. She says that’s because she goes with the evidence and does not favour a carbohydrate-centric approach to nutrition for kids.
By Angela Stanton
Some time ago, I was reading the book Metabolic regulation: A Human Perspective by Keith N Frayn (3rd edition). In chapter 2.1 and 2.2 I came to a very unusual section that made me jump.
It states the following:
“…fatty acids are usually a preferred fuel (over glucose) for skeletal muscle… Fatty acid release is very effectively switched off by insulin, so muscles no longer have the option of using fatty acids… The brain, in contrast, has a pathway for utilizing glucose at a rate that is relatively constant whatever the utilizing glucose concentration, a very reasonable adaptation since we would not want to be super-intelligent only after eating carbohydrate, and intellectually challenged between meals.”
This was revolutionary to me. Skeletal muscles actually prefer to use fat rather than glucose?
We have a very carbohydrate-centric view of nutrition. Yet our muscles and some other organs may prefer fat to glucose as fuel. Also, the brain has no problems switching to ketones.
Ketosis, ketones and primary fuel
Few professionals, even within the field of nutrition, realize that ketones are not our backup fuel. Ketones are not any more backup than glucose is the primary fuel.
The human body has no primary or backup fuel. It has two fuels. I presume that the urgency for glucose use — meaning the urgent removal of glucose from the blood — is misleading.
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It makes people think that if the body switches to using glucose the moment it is provided, it must be its primary fuel. But this is a mistaken argument. It assumes that the first task that has to be done is the preferred task.
It is true that when we add glucose to our blood by, for example, eating carbohydrates, the body must immediately switch to remove that glucose from the blood.
The maximum comfort level for glucose in the blood is 99 mg/dL (5.5 mmol/L). If we eat carbohydrates such that this is exceeded, it is literally an emergency and the body must remove it from there. Too much glucose in the blood for extended time is toxic.
However, having to remove glucose immediately does not make it into the primary fuel. It just makes it into an urgent task.
Why glucose is not the preferred fuel
As an example, assume you need to go to the dentist because you have a huge toothache. While you most certainly would much rather go to dinner with family and friends or some party or a game than to the dentist, you must go to the dentist first. This doesn’t mean that you prefer the dentist.
It merely means the urgency with which we must respond to the situation is dependent upon its outcome.
The same is true with blood glucose. Glucose is not the preferred fuel, but it must urgently be removed, else it can have dire consequences.
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We can see that glucose is not the primary fuel because babies are born in ketosis. And mother’s milk is low-carb, high-fat (LCHF). This keeps the newborn in ketosis all through nursing.
(Breast) milk gets more glucose as it matures. And at full maturation, its nutritional content per cup (8 oz) is 10.77 gr fat, 2.53 gr protein, 16.95 gr carbohydrates (in the form of lactose) and total energy of 172 kcal. It also contains 87.5 gr water.
Subtracting the water and looking at macronutrient ratios only, this glass of mature nursing milk is 55.5% fat, 5.57% protein, and 38.71% carbohydrates (in lactose so not free sugar).
In terms of fatty acid composition: 4.942 gr saturated fat, 4.079 gr monounsaturated fat, and 1.223 gr polyunsaturated fat, which in percentages: 48.24% saturated fat, 39.82% monounsaturated fat, and 11.94% polyunsaturated fat.
One must agree that mothers don’t feed their babies poison. And that Nature didn’t provide nursing milk such that it is toxic. In fact, we can see that babies grow very rapidly on nursing milk. And we know from studies that nursed babies have a better chance for survival, grow healthier, faster, and their brain develops better.
Metabolically flexible babies
As babies grow, they retain metabolic flexibility. This means that they stay in ketosis for periods of time that change by age and how often they are fed. They may also temporarily enter the carbohydrate metabolic process when they eat.
The figure (right) is telling. On the vertical axis, you find β-hydroxybutyrate (BHB), the level of ketones measured in blood. On the horizontal axis, time is passing in hours and days between feeding times.
The graph contains people of all age groups and both genders. Officially, a fed person (with carbohydrate-containing food) has 0 amount of BHB in her/his blood.
As time passes, say the person fasts for a blood test or a medical procedure, BHB starts showing up in the blood.
The clinically accepted level of BHB in the blood that is not considered to be ketosis is up to 0.3 mmol/L. Healthy individuals can easily reach this as a result of such fasting.
Anything above 0.3 mmol/L, or 0.3 mmol/L continuously, is considered to be ketosis.
Babies in ketosis
Note that babies are born with 0.5 mmol/L or higher level of BHB and remain in ketosis until they are fed. In the case of infants, the needs for energy arises very quickly, as shown in Figure 1. In approximately 20 minutes after feeding the baby is back in ketosis.
Thus ketosis, in one scenario, is a state into which our metabolism reverts when food is not immediately available on demand. This is labeled “starvation”. However, studies on the fetus in utero, which is never under nutritional duress, is also in ketosis from time to time. And there are ketones in the placenta.
Therefore, it is very difficult to suggest that ketones are a backup fuel of any kind if even the fetus is in ketosis from time to time in the womb. Clearly, being in ketosis provides some benefits that are not possible to achieve using the glucose metabolic process.
The ketogenic and the glucogenic metabolic processes have distinct functions, each specialized to benefit us in some way.
To conclude the importance of ketosis, anecdotal evidence suffices. In my Facebook migraine group, we have asked migraineurs to run a special blood glucose and blood ketone test that lasts for five hours postprandial.
There are many children, aged between two to 18 with migraines whose parents are in the group. So many require parental help.
In addition, migraineur moms of children who may or may not have migraines also run the test.
Thus, over time, I have had the opportunity to evaluate the five-hour test results of children of all ages. I have yet to see a blood ketone test of a child that doesn’t show ketosis both before and after a meal. That’s even if the meal had fruits and dairy in it.
I suppose few people have the same opportunity in being able to measure the blood ketones of various ages of children for five hours postprandial plus fasting and pre-meal measures.
Proof of importance of ketosis?
And so, ignorance is bliss…
Thus, while today in most countries around the world any type of food is just a short walk or drive away 24/7 and we need not experience hunger and starvation, our children are still in ketosis 24/7.
Shouldn’t that tell us something about the importance of ketosis?