Kids and Ketones

Whether from a ketogenic diet or exogenous ketones, ketone bodies have provided tremendous benefits for adults young and old. The question now becomes, ‘how to get a child to either stick with a ketogenic diet or safely ingest exogenous ketones to also benefit from low-to-mid level ketosis?’.

The ketogenic diet has been shown to have beneficial impacts in children after cessation of the diet (Patel et al, 2010)[1]. Hence it must be considered that it is the energy substrate of ketone bodies that has a left a lasting impact at the mitochondrial-level. This energy substrate has been shown to be “an effective treatment for children and adults with refractory epilepsy.”[2] A study in which Ketone bodies were given to 20 young adult test subjects between the ages of 18 years to 35 years of age [10 males and 10 females] demonstrated that exogenous ketone supplementation could have therapeutic application in the “management and prevention of metabolic diseases.”[3] With these benefits from ketogenic diets and more specifically the benefits culminating from ketone bodies, the question of whether children can safely adhere to a ketogenic diet and/or ingest exogenous ketones has become quite the chatter in the keto community. Children need significant amounts of fat to build nerve tissue and utilize fat soluble vitamins and iron—utilized in a myriad of bodily systems—in order to achieve proper growth and brain development. There has been widespread anecdotal evidence that with a limitation (limiting carbohydrates to below 75 grams per day) but not restriction of carbohydrates (maintaining carbohydrates below 25-50 grams per day); consuming only fruits high in vitamins/fat/oil [e.g avocadoes, olives, tomatoes] as well as nutrient-rich berries; and eating appropriate amounts of high fat protein, a child or young adult will show positive signs of being in low-level ketosis. These signs include waking in the morning without sluggishness; having more energy and focus throughout the day; as well as a lower frequency of snacks or even feeling hungry. Many parents allow their children to cycle on and off the ketogenic diet but have found that their children still tend to eat less of the ‘wrong’ foods even when access is easy. [4]   

In one study completed in 2007, it was found that it was the presence of the ketone body, specifically BHB [that results from either diet or exogenous supplementation] and not the processes of ketosis that benefitted weight loss, and mental acuity. The study concluded that it is the presence of the ketone body not the development levels of precursors that benefits the body at the cellular level. This infers that the ketogenic diet can produce increased ketone levels, but the benefit is from the level of ketone bodies in the blood and not the presence of the precursors or the process of producing ketones.[5]  Hence exogenous ketones can be a useful supplement when seeking to maintain a low-to-mid level of ketosis.

As ketone ester can be unpalatable, many prefer ketone salts. In her 2016 doctoral thesis, Brianna Stubbs at the University of Oxford studied the “Metabolism of Exogenous Ketones.” She studied the effects of ketone ester and ketone salt drinks on blood BHB (beta-hydroxybutyrate) levels as well as levels of glucose, lipids, electrolytes and pH in healthy humans. In her work to extend the understanding of the metabolism of exogenous ketones, she found that BHB levels for both the ester and the ketone salt drink were similar, both delivering the L-isoform, “which was only slowly removed from the blood.” Stubbs also noted that peak D-BHB levels were repeatable between and within subjects at rest “but were lower after a meal, although blood acetoacetate, breath acetone, and urine BHB were unaffected by [eating].”[6]                  

In chapter 3 of the 1985 publication of Cerebrospinal Fluid Analysis: Metabolic, Brain Damage and Immunological Aspects, the topic of discussion is “The Concentration of Blood Components Related to Fuel Metabolism During Prolonged Fasting in Children”. In this chapter, there is a study based on the measured levels of energy substrates crossing the blood/brain barrier. The data in this study was collected from the cerebrospinal fluid [CSF]. In this study there were 13 boys aged 3-5 years of age, fasted for 24 hours, and 58 children aged 6-15 years of age [33 boys and 25 girls] fasted for 40 hours. In this study the objective measurement was about ketone levels and other energy substrates achieved through fasting as well as the interrelationship between levels of glucose, ketones, and age of young children. The older children [6-15 years] also demonstrated a hormonal [gender-based] connection to the level of ketone/blood ratio. It was demonstrated in this study that after 40-hour fasting in contrast to 24-hour fasting, girls develop a lower level of ketone bodies than boys. By measuring CSF for fuel related substrates of cell energy, namely glucose, acetoacetate, and BHB in all the children, it was found that ketone levels (as in blood/ketone ratio) were not related to age and that in the children 3-5 years old ketone levels compensated for diminished glucose levels. The study sought information “about CSF concentrations of fuel related substrates, the CSF/blood ratios for these components, the CSF caloric homeostatis at the end of a prolonged fast in children and the relation of age and sex.”(p57)[7] In its conclusion, the study states that ketone bodies have a crucial role  in supplying fuel for brain energy requirements in order to spare glucose. Hence with the overriding capacity of ketone bodies to lower the use of glucose as an energy substrate, the idea of using exogenous ketones for children on a regular diet can be useful in providing the energy needed, the appetite control desired, in addition to higher mental acuity.

Products such as fruit-flavored gummi bears, spicy fat bombs, lollipops, drinks, and other exogenous ketone-bearing products targeting the child’s diet may be the best way to get the benefits of ketones without offending the child’s palate or forcing overly excessive diet restrictions.  

 

ENDNOTES


[1] Amisha Patel, and Pyzik, PL, Turner Z, Rubenstein JE, Kossoff EH.  “Long-term outcomes of children treated with the ketogenic diet in the past”, Epilepsia. 2010

[2] Thammongkol, Sasipa and Vears DF, Bicknell-Royle J, Nation J, Draffin K, Stewart KG, Scheffer IE, Mackay MT. “Efficacy of the ketogenic diet: Which epilepsies respond?”, Epilepsia 2012

[3] Etienne Myette-Cote, and Neudorf H, Rafiel H, Clarke K, Little JP. “Prior ingestion of exogenous ketone monoester attenuates the glycemic response to an oral glucose tolerance test in healthy young individuals.” Journal of Physiology, 2018 April 15:596(8):1385-1395. 

[4] https://www.ketovangelist.com/keto-and-kids/. Mandy Pagano blog, “Ketovangelist: Keto and Kids”, downloaded 18 July 2018.

[5] Maciej Gasior and French A, Joy MT, Tang RS, Hartman AL, Rogawski MA. “The Anticonvulsant Activity of Acetone, the Major Ketone Body in the Ketogenic Diet, Is Not Dependent on Its Metabolites Acetol, 1,2‐Propanediol, Methylglyoxal, or Pyruvic Acid”, Epilepsia  26 March 2007

[6] Stubbs, Brianna. Doctoral thesis, Metabolism of exogenous ketones. University of Oxford. Oxford, England. 2016

[7] The Concentration of Blood Components Related to Fuel Metabolism During Prolonged Fasting in Children. A thesis by Karel Joseph Bernardus Lamers, Redboud University Netherlands. 1985. Pp42-80.

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