• How many grams of carbs should I be eating daily?
    A strict ketogenic diet is <20g of carbs a day, or about 5% of your total calories. It’s recommended to start out with a strict keto diet if you are a beginner so you can get the hang of eating keto foods. Some people eat under 50g of carbs per day and can stay in ketosis just fine. Others do a more low-carb style (Atkins) diet with <100g a day. Once you are settled in after a few weeks of strict keto start raising your carbs until you find the sweet spot for your body.

  • Why KEN™ ?

    The KEN™ is the treatment of obesity and overweight fastest and safest in the world.

    Today, in our busy world, with such high prevalence of obesity, people seeking weight loss will not endure the classic low-calorie diets that lose only a few pounds a month. Dieters want to lose their weight quickly and see results day by day.

    How do you lose weight quickly? Rapid weight loss is achieved by significant negative caloric balance: patients must burn significantly more calories than consuming. Complete fasting would be expected to be the best method to lose weight, but is not feasible for 2 reasons: 1) complete fasting generates such an irresistible hunger that dieters succumb to the temptation to eat and 2) significant loss of muscle mass. A healthy diet is expected to lose fat mass, not muscle mass.

    In 1973, George Blackburn, a researcher at MIT subjected two groups of patients to complete fasting. Group A was continuously infused with 5% glucose solution; group B was continuously infused instead with a protein-sparing solution of amino acids. Group A had a significant negative nitrogen balance, while Group B had neutral or only slightly negative nitrogen balance. Such protein sparing allowed safer rapid weight loss in obese subjects. He designed a protein only diet, the Protein Sparing Modified Fast or “PSMF,” a diet administered by mouth and only during waking hours. The PSMF had two major drawbacks:

    a. Oral dietary intake could not completely eliminate carbohydrates and the presence of carbohydrates stimulated insulin release.
    b. Oral dietary intake was necessarily interrupted during the night.

    The interruption of nutrition during the night is normal human eating behavior and does not cause a breakdown of lean body mass because the reserves of liver glycogen sustain caloric needs at night. During the night liver glycogen is rapidly depleted, so the body uses the dieter’s lean body mass as a source of calories.

    For these reasons, PSMF obtained only a partial protein sparing with suboptimal weight loss and suboptimal conservation of lean mass. Optimal weight loss demanded extending the ketogenic diet, but cardiac arrests occurred while on prolonged PSMF dieting, a complication attributed to cardiac atrophy.

    Ketogenic Enteral Nutrition (KEN) was conceived and developed to optimize weight loss while reducing or eliminating complications. KEN replaces the original oral protein sparing diet with a protein sparing parenteral infusion unavailable at the time of Blackburn’s first experiments. Continuous parenteral infusion obtains much faster weight loss and with less lean body loss. For best results and to avoid cardiac complications, the KEN cycle is limited to 10 days. In one 10-day cycle, patients typically lose 7 to 10% of initial weight. At least 57% of the weight lost is fat.

  • Why during a slimming treatment must not lose muscle mass?

    Lean body mass performs the essential cellular functions of life. Lean body mass must not be reduced or life itself is reduced.

    The body is composed of extracellular fluid, fat mass, and lean mass (muscles and organs). It is fat mass, not muscles and organ tissues, that a dieter wants to lose. Lean body mass consists of parenchymal organ tissues (liver, brain, kidney, spleen, pancreas, etc.) including muscles (which may be increased in obese patient). The cellular functions of this lean mass are essential to life and so reduction of lean body mass must be avoided.

    Loss of lean muscle mass can be not only unhealthy, but also unsightly, causing cosmetic malproportion, loss of body mass in the wrong areas. Loss of lean muscle mass (upper limbs, lower limbs, buttocks, and chest) with preservation of abdominal fat gives the appearance of spindly limbs and a protruberant belly, not typically considered a desirable result. The esthetic effect of such lean body mass reduction is entirely negative, indeed a cachectic appearance. Only a minimal amount of fat mass is necessary for health and the associated healthy appearance.

  • How do you explain the effect of Protein Sparing?

    Blackburn explained that reduced insulin release and production accounted for the observed protein sparing effect. Carbohydrates, especially glucose, stimulate the release and production of insulin thereby promoting protein catabolism and fat deposition, the precise opposites of dieters’ desired outcomes. The infusion of proteins, however, stimulates the production and release of insulin much less, so infusion of proteins spares lean body mass and burns fat, accounting for the observed production of ketone bodies and triglycerides. Through KEN™, obese patients rapidly lose body fat while sparing muscle and vital organs. Too, the ketone bodies from KEN™ reduce or even eliminate hunger.

  • Can the production of ketone bodies during Protein Sparing KEN diet harm the patient?

    No, not at the low ketone body levels observed in KEN™. Ketone bodies and the resultant acidosis become dangerous only with the high levels observed in patients with inadequate insulin response, as in uncompensated diabetes. Non-diabetics with intact insulin response do not reach the high levels of ketone bodies seen in diabetics and diabetic ketoacidosis (DKA).

    An increase in blood ketone bodies, ketonemia, is observed whenever body fat is catabolized. When the catabolism of fat is slow, the increase in ketone bodies is slight. When the catabolism of fat is rapid, the increase in ketone bodies is significant and metabolic acidosis occurs. In the normal non-diabietic patient, ketonemia stimulates insulin production, slowing the mobilization of fat and preventing ketonemia from rising dangerously. The ketonemia becomes dangerous only when it occurs in patients with reduced insulin response, as in uncompensated diabetes. The slight ketonemia of KEN™ is helpful during the weight loss program because it reduces the appetite for food and so increases patient tolerance of the KEN™ fast.

    Prolonged ketogenic diets are used safely in refractory epileptic patients. In such cases there is no risk to health and brain activity, such as cognitive abilities or task performance, such as driving a car.

  • Why is each KEN™ cycle limited to 10 days?

    To avoid the reduced weight loss observed when KEN™ is continued beyond 10 days, there is a rest period during which the patient resumes controlled oral feedings.

    After 10 days of KEN’s marked sustained reduction in caloric intake, body metabolism shifts towards a series of homeostatic defense mechanisms that cause markedly lower energy expenditure—reduction of general motility, decreased heart rate, and a tendency to stupor. To abort the counter-productive lower energy expenditure, a 2 week rest period of resumed controlled oral feedings is interposed between cycles of KEN™. The 2 week rest period is sufficient to reacquire the original rapid weight loss response when KEN#8482; is resumed.

    Limiting KEN™ cycles to 10 days also serves to avoid the risk of cardiac complications that were observed with PSMF diets. In final analysis, the reported PSMF cardiac arrests were attributed to the use of a solution of improperly balanced protein (the "last chance diet"), not a comprehensive formulation of amino acids as was claimed.

    KEN™ uses improved protein formulations that are complete and balanced. The improved formulation allows KEN™ to be used even continuously for months at a time without any side effects whatsoever. Rest periods were instituted to optimize rapid weight loss and to increase patient satisfaction and acceptance. Patient satisfaction and net weight loss are greater with a series of 10-day KEN cycles than with continuous KEN™. The rest periods provide a psychological relief to the patient who can return to a normal life. Rest periods are utilized to train the patient in developing dietary and lifestyle modifications necessary to manage weight once the treatment is discontinued.

  • During KEN™ cycles, why may patients may take only water, tea, chamomile tea and coffee without sugar or other sweeteners?

    Carbohydrate intake, as already described, interferes with fat catabolism.

    The fewer carbohydrates consumed, the greater the reduction of insulin which would otherwise tend to conserve fat and waste muscle and vital organs. Elevated insulin would also increase the sense of hunger, leading towards treatment failure: the patient would suffer and resign to the temptation to cease the diet. Of course we cannot completely eliminate carbohydrates. There are small amounts of carbohydrates in the KEN™ solution and in some prescriptions that the patient may take. It’s important that any carbohydrates taken are of a type slowly absorbed. Prescription tablets containing small amounts of carbohydrates that are absorbed slowlyare prefrred to the same drugs taken in the form of a soluble powder or soluble tablets contain a quantity of sweeteners that are absorbed more rapidly and therefore are more at risk of stimulating insulin.

  • Should patients take plenty of fluids during KEN?

    Normal (unforced) hydration and urine output is encouraged.

    We advise patients to drink when thirsty and not to force the fluid intake. Recall that we already administer 2 liters of fluid per day through the KEN infusion pump. Diuresis accentuates the urinary loss of ketone bodies, corresponding to a small additional loss of unnecessary calories. Since the urinary levels of ketones during KEN is very low, even doubling the loss of urinary ketone is not a huge factor and can entail a greater sacrifice for patients who are already subjected to frequent urination, especially at night.

    Some patients tend to drink fluids heavily even though we do not recommend it. This can lead to a reduction in the ketonuria that is recorded daily. Recall that the urine dipstick measures the ketone concentration, not the total amount of ketones eliminated. In principle a value 2+ of Ketur test is to be considered acceptable.

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