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Ketogenic Diet

From left, Sam Kleeman, Assistant Professor Tobias Janowitz, Miriam Ferrer Gonzalez and Emma Davidson. Photo by Caryn Koza/CSHL

By Daniel Dunaief

This part one of a two part series.

It’s a bit like shaking corn kernels over an open flame. At first, the kernels rustle around in the bag, making noise as they heat up, preparing for the metamorphosis.

That’s what can happen in any of the many laboratories scattered throughout Long Island, as researchers pursue their projects with support, funding and guidance from lab leaders or, in the science vernacular, principal investigators.

Sometimes, as happened recently at the benches of Cold Spring Harbor Laboratory Assistant Professor Tobias Janowitz, several projects can pop at around the same time, producing compelling results, helping advance the careers of developing scientists and leading to published papers.

PhD graduate Miriam Ferrer Gonzalez and MD/ PhD student Sam Kleeman recently published separate studies.

In an email, Janowitz suggested the work for these papers is “time consuming and requires a lot of energy.” He called the acceptance of the papers “rewarding.” 

In a two-part series, Times Beacon Record News Media will describe the research from each student. This week, the focus is on Ferrer Gonzalez. Check back next week for a profile of the work of Kleeman.

Miriam Ferrer Gonzalez

Miriam Ferrer Gonzalez. Photo by Caryn Koza/CSHL

Miriam Ferrer Gonzalez was stuck. She had two results, but couldn’t seem to figure out how to connect them. First, in a mouse model of the ketogenic diet — heavy on fats, without including carbohydrates —cancer tumors shrunk. That was the good news.

The bad news, which was even more pronounced than the good, was that this diet was not only starving the tumors, but was triggering an earlier onset of cachexia, in which bodies weaken and waste away. The cachexia overpowered the mice, causing them to die sooner than if they had a normal diet.

Ferrer, a student in residence from Spain who was conducting her research at Cold Spring Harbor Laboratory while earning her PhD at the University of Cambridge in the UK, thought the two discoveries were paradoxically uncoupled. A lower tumor burden, she reasoned, should have been beneficial.

In presenting and discussing her findings internally to the lab group, Ferrer received the kind of feedback that helped her hone in on the potential explanation.

“Finding out the mechanism by which a ketogenic diet was detrimental for both the body and the cancer was the key to explaining this uncoupling,” Ferrer explained.

The adrenal glands of mice fed a ketogenic diet were not producing the necessary amount of the hormone corticosterone to sustain survival. She validated this broken pathway when she discovered higher levels of corticosterone precursors that didn’t become functional hormones.

To test this hypothesis, she gave mice dexamethasone, which boosted their corticosterone levels. These mice had slower growing tumors and longer lives.

Ferrer recently published her paper in the journal Cell Metabolism.

To date, the literature on the ketogenic diet and cancer has been “confusing,” she said, with studies that show positive and negative effects.

“In our study, we go deeper to explain the mechanism rather than only talking about glucose-dependency of cancer cells and the use of nutritional interventions that deprive the tumor of glucose,” said Ferrer. She believed those factors are contributing to slower tumor growth, but are not solely responsible.

Thus far, there have been case studies with the ketogenic diet shrinking tumors in patients with cancer and, in particular, with glioblastoma, but no one has conducted a conclusive clinical trial on the ketogenic diet.

Researchers have reported on the beneficial effects of this diet on epilepsy and other neurological diseases, but cancer results have been inconclusive.  For the experiments in Janowitz’s lab, Ferrer and technician Emma Davidson conducted research on mouse models.

Ferrer, who is the first author on the paper, has been working with this system for about four years. Davidson, who graduated from the College of Wooster in Ohio last year and is applying to MD and MD/PhD programs, contributed to this effort for about a year.

Next steps

From left, Emma Davidson, Assistant Professor Tobias Janowitz, Sam Kleeman and Miriam Ferrer Gonzalez. Photo by Caryn Koza/CSHL

Now that she earned her PhD, Ferrer is thinking about the next steps in her career and is considering different institutions across the country. Specifically, she’s interested in eating behavior, energy homeostasis, food intake and other metabolic parameters in conditions of stress. She would also like to focus on how hormonal cycles in women affect their eating behavior.

Originally from a small city in Spain called Lleida, which is in the western part of Catalonia, Ferrer appreciated the opportunity to learn through courses and conferences at Cold Spring Harbor Laboratory.

Until she leaves the lab in the next few months, Ferrer plans to work with Davidson to prepare her to take over the project for the next year.

The follow up experiments will include pharmacologically inducing ferroptosis of cancer cells in mice fed a ketogenic diet. They hope to demonstrate that early induction of ferroptosis, or a type of programmed cell death, prevents tumor growth and prevents the tumor-induced reprogramming of the rest of the body that causes cachexia.

These experiments will involve working with mice that have smaller and earlier tumors than the ones in the published paper. In addition, they will combine a ketogenic diet, dexamethasone and a ferroptosis inducing drug, which they didn’t use in the earlier experiments.

Janowitz has partnered with Ferrer since 2018, when she conducted her master’s research at the University of Cambridge. As the most senior person in Janowitz’s lab, Ferrer has helped train many of the people who have worked in his lab. She has found mentoring rewarding and appreciates the opportunity to invest in people like Davidson.

Ferrer, who is planning a wedding in Spain in September, is a fitness and wellness fan and has taken nutrition courses. She does weight lifting and running.

Ferrer’s parents don’t have advanced educational degrees and they supported their three children in their efforts to earn their degrees.

“I wanted to be the best student for my parents,” said Ferrer, who is the middle child. She “wanted to make my parents proud.

The hand off

Emma Davidson and Miriam Gonzalez Ferrer examine an adrenal gland sample section from a cachectic mouse. Photo by Caryn Koza/CSHL

For her part, Davidson is looking forward to addressing ways to implement further treatment methods with a ketogenic diet and supplemental glucocorticoids to shrink tumors and prevent cachexia. 

Davidson appreciated how dependable Ferrer was during her time in the lab. Just as importantly, she admired how Ferrer provided a “safe area to fail.”

At one point, Davidson had taken all the cells she was planning to use to inject in mice. Ferrer reminded her to keep some in stock.

“Open lines of communication have been very beneficial to avoid more consequential failures,” Davidson said, ”as this mistake would have been.”

Davidson developed an interest in science when she took a high school class called Principles in Biological Science and Human Body Systems. When she was learning about the cardiovascular system, her grandfather had a heart attack. In speaking with doctors, Davidson acted as a family translator, using the language she had studied to understand what doctors were describing.

Like Ferrer, Davidson lives an active life. Davidson is preparing for the Jones Beach Ironman Triathlon in September, in which she’ll swim 1.2 miles, bike 56 miles and run a half marathon. She plans to train a few hours during weekdays and even more on weekends for a competition she expects could take about six hours to complete.

Davidson started training for these events with her father Mark, an independent technology and operations consultant and owner of Exoro Consulting Group.

Longer term, Davidson is interested in medicine and research. After she completes her education, she will try to balance between research and clinical work.

 

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Ketogenic Diet
Making sense of the latest health trends

By Melissa Arnold

Low fat or full fat? Splenda, stevia or cane sugar? Three large meals or six small ones? New schools of thought and trends surrounding healthy eating are cropping up all the time, and it’s easy to feel overwhelmed or confused, especially when the advice is conflicting. 

Whether you’ve been using a particular weight loss plan with accurate information is key. Dr. Konstantinos Spaniolas, Associate Director of the Stony Brook Medicine Bariatric and Metabolic Weight Loss Center, has given us his take on three of the most popular diet trends, the Ketogenic Diet, Clean Eating and Intermittent Fasting.

The Ketogenic Diet 

(also known as keto)

The basics: The keto diet uses the body’s metabolic processes to its advantage. In keto, carbs are drastically limited, which lowers glucose and insulin levels. Without glucose to use as its typical fuel, the body enters a state called ketosis, where fat is burned almost exclusively. Lots of unsaturated (healthy) fats, dairy products and moderate amounts of protein are central to going keto. Say goodbye to carbs and sugar, not only in forms like bread and pasta, but also in most fruits and some vegetables.

What it’s like: Tom Walheim, Sr., a 56-year-old engineer from Mullica Hill, N.J., started to search for a diet plan in 2018 when he acknowledged he wasn’t feeling as good as he did when he was younger. After trying other diets, he chose keto because it was easy to implement and would fit in well with his lifestyle. All three of Walheim’s children have celiac disease, so their home was already gluten free.

“Having already eliminated carbs, I had already separated myself from the things that would be tough for a lot of people to give up,” Walheim said. The first 15 pounds came off quickly, and within about six months he’d lost 40 pounds. Ultimately, Walheim has maintained a ketogenic diet for more than two years and plans to continue. 

“I love to grill, and I’ve rediscovered cooking through learning different keto recipes, like Instant Pot chili. And I’ve never felt deprived — I will occasionally have a cheat day when celebrating a special occasion with my family. For example, I enjoyed the cake at my daughter’s wedding this fall.”

Pros: Weight loss can be significant and quick, especially early on. Lovers of fatty foods can enjoy plenty of their favorites — keto is sometimes nicknamed the “butter and bacon diet.”

Cons: It takes time for the body to adjust to going keto, and you may feel moody, groggy, constipated or just unwell. The body can rebel when you begin to transition off of keto as well, causing gastrointestinal issues and even weight gain.

Dr. Spaniolas’ take: “In the keto diet, there’s an introductory week that is very low calorie, and that can be a problem for some people. With any diet that restricts certain foods, you can expect a period of adjustment, but most people tolerate it well. It’s important to stay well-hydrated to minimize risk of constipation and boost your overall wellbeing.

Clean Eating 
Paleo Diet

(also known as the Paleo Diet or Whole30, among others)

The basics: Generally speaking, eating clean is about sticking to foods that are in their natural, whole or unprocessed form. According to the Paleo Diet’s official website, this healthy eating strategy emphasizes foods eaten by our hunter-gatherer ancestors. That means lots of veggies, fruits, meat, eggs and some fats and oils are in, whole grains, dairy, processed foods and refined sugars are out. Different plans will vary their lists of acceptable foods.

What it’s like: As a captain in the U.S. Air Force, Gemma Fiduk works hard to ensure she remains healthy and fit. When it comes to dieting, she takes a balanced approach of eating well-rounded, nutritious meals along with occasional treats.

“In 2015, I was stationed in Little Rock, Arkansas. I was a physical training officer at the time, so I was trying to take a lot of courses on fitness and nutrition to better support my airmen,” said Fiduk, who’s now stationed in Fairborn, Ohio. “The gym on base offered a lot of different seminars and workshops, and one of them was about Whole30.”

Armed with information from the seminar and the official Whole30 book by Melissa Hartwig Urban, Fiduk said she was excited to give the program a try. 

“The program doesn’t hide that it takes discipline, but they prepare you well for the experience and I love a good challenge. Besides, it’s only 30 days,” she said. “I came away with a better understanding of my own body and the foods that were and weren’t best for me.”

While she didn’t weigh herself after completing Whole30, Fiduk noted a definite reduction in bloating and positive changes in her figure. After the initial cravings passed, she loved the sense of physical wellbeing and accomplishment that came along with cooking at home.

She admits that it can be easy to fall into eating the same meals repetitively or feeling bored with the menu, but said it’s easy to find a wealth of clean recipes online for those willing to look. The Whole30 website offers meal planning and grocery delivery services for a fee.

Pros: In the case of Whole30, the diet has a defined start and end date.

Cons: Lots of advance planning and shopping is required, and finding compliant ingredients or condiments can be tricky in regular grocery stores.

Dr. Spaniolas’ take: “The idea with clean eating is to take yourself back to the most basic nutrients. It’s less about weight loss than it is about overall wellbeing, and in the case of Whole30, it’s not meant to be a forever plan — you take it on for a set period of time and then return to eating normally.

Intermittent Fasting
Intermittent Fasting

(Also known as intermittent energy restriction)

The basics: Fasting is as simple as it sounds — not eating anything for a set period of time. By restricting the time spent eating, the body is said to better regulate blood sugar and increase the ability to burn fat. Options abound with fasting, including daily fasts of 12 to 20 hours, restricting eating hours only on certain days, or not eating at all for one or two days each week. During eating periods, a normal diet is consumed — calories are not restricted.

Pros: You can eat whatever you want — there are no forbidden foods. Fasting requires little preparation and can be started and stopped as your lifestyle requires.

Cons: Getting used to hunger pangs can be tough, and social situations might be hard to deal with if you’re the only one not eating.

What it’s like: Jeena Rudy, 26, of Setauket, was a college athlete and swim coach in her native California before becoming a missionary three years ago. She admitted her work with college students can make it too easy to make unhealthy food choices or overeat.

“One of my brothers is two years older than I am, and a few years ago he mentioned that his cholesterol was too high,” Rudy said. “I started to gain a little weight once I wasn’t swimming 40 hours a week, and I didn’t want to end up developing health issues. That conversation really motivated me to try intermittent fasting.”

Rudy fasted daily for 16 to 20 hours over a period of several months. She ultimately lost some weight and said she became more mindful about what she was eating.

“Fasting changed the way I think about food. I learned more about what foods help me to feel my best, too. Like right now I need to eat breakfast and could just grab a bagel, but making eggs would be a better, healthier option for me. I’m planning to take up fasting again in the future.”

Dr. Spaniolas’ take: “Again, staying hydrated will help you in fasting because it can quell hunger pains by keeping something in your stomach. I tell people to aim for at least 64 ounces a day, and if they can get closer to 100 ounces, that’s even better. Very low caloric plans, where people consume 600 calories a day for extended periods of time, should only be done under medical supervision, especially if you have health issues.

The best dietary plan is the one that works well for you. But just because a particular plan works well for one person doesn’t mean it will be the right one for someone else. For some people, giving up carbohydrates is easy, while others can’t give up fruits or go longer periods without eating. It’s about finding what fits best with your preferences, habits and lifestyle, and ultimately whether or not you can stick with it. 

Try something out for a week or two and see how you like it, but don’t combine diets. For some, dieting isn’t the best way to lose weight. If you’re having difficulty losing weight on your own, checking in with a physician to consider more targeted options can help. Remember to stay active as well, aiming for at least 10,000 steps a day or 30 minutes of exercise several times a week.” 

Remember to talk with your doctor before making any significant changes to your diet or exercise routine.