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Mark Hyman, MD, Head of Strategy and Innovation, Cleveland Clinic, Center for Functional Medicine talks further with Sarah Hallberg, DO, about the ketogenic diet and the effects on patients with diabetes. To view part 1, please click https://youtu.be/cFMKCmYGwNE ▶Share this video with others: https://youtu.be/6yCR40Mxiv0 ▶For more Grand Round videos from Functional Medicine: https://www.youtube.com/playlist?list=PLMG0zKOgNqNnio4ejnB5oXJGMri8raB1U ▶Subscribe to learn more about Cleveland Clinic: https://www.youtube.com/user/ClevelandClinic?sub_confirmation=1

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Sources and recommended reading “Grain Brain” David Perlmutter - https://amzn.to/2QJwZZ7 “Brain Maker” David Perlmutter - https://amzn.to/2QN8fit “Keto Clarity” Jimmy Moore - https://amzn.to/2QQbyW3 “Cholesterol Clarity” Jimmy Moore - https://amzn.to/2PUJobi “The Art and Science of Low Carbohydrate Performance” Jeff Volek & Stephen Phinney - https://amzn.to/2QMxfXn “Pure, White and Deadly” by John Yudkin - https://amzn.to/2PWXPf0 “Fat Chance” Robert Lustig - https://amzn.to/2MRX98P I have narrowed down my top 3 to: Green Tea or more specifically its most active ingredient EGCG , Branched Chain Amino Acids perhaps most predominately Leucine, and Medium chain triglycerides namely the 8-carbon saturated fatty acid called Caprylic Acid. Let me explain why! Green Tea I definitely wouldn't say that green tea is the most popular synergistic supplement with a ketogenic diet, but it is highly effective in its ability to reduce the tendency to absorb fat and increase the ability to burn fat. It comes down to the potent fat oxidation that green tea promotes from it being a rich source of polyphenol catechins. In particular EGCG or epigallocatechin gallate is the most active of the catechins in green tea and is primarily responsible for the antioxidant, anti inflammatory, and metabolic effects. To break this down even further the boost in fat metabolism comes from EGCG's direct effect on proteins and phospholipids in the plasma membrane that up regulate mitochondrial function, which we know is the energy factory for all cells in our body, therefore increasing the rate at which fatty acids are metabolized. Or in other words increasing our use of fat to produce energy. In a ketogenic diet where we are primarily depending on fat metabolism for energy, we can see how this boost in fat oxidation can provide improvements in ketone production and can promote further weight loss in the form of body fat or adipose tissue. In addition the naturally occurring caffeine in green tea works synergistically to boost metabolism. BCAA The branched chain amino acids consist of three essential amino acids, meaning they must be consumed and can not be manufactured inside the body, these 3 are: leucine, isoleucine, and valine. We know that in metabolism fueled by glucose protein and amino acid breakdown is inevitable which is what prompts athletes trying to build lean muscle mass to supplement BCAAs. While the ketogenic metabolism has been proven to spare these BCAAs, they also play larger rolls, making their heightened levels even more valuable. As discussed in the "ketogenic effects of muscle building" video, Leucine is able to take on the role of insulin, that is suppressed in a ketogenic diet, and effectively promote muscle protein synthesis. On a smaller cellular level these BCAAs are able to replenish the intermediates for cellular energy cycles, which is a huge benefit in a ketogenic diet were glycolysis is lowered and cellular pyruvate is not as available. In other words BCAAs are able to be broken down into important substrates for cellular energy production, which aids in overall higher energy levels. MCT's Medium Chain Triglycerides are some what of a staple of the ketogenic diet. The structure that allows MCT's to be metabolized quickly, provides pathways for ketone production even in unadapted individuals. The uses of MCTs can range from a daily ketone boost to aiding in the elimination of the tough to deal with side effects of keto adaptation. Tryglycerides in general are made up of a glycerol bound to three fatty acids, and are ingested, stored and more commonly referred to as fats. The differentiating factor between long chain and medium chain triglycerides are the length of the fatty acids that make up their structure. These shorter, medium chain fatty acids, are metabolized in the liver so readily that they are pushed to the front of the line even before simple carbohydrates, resulting in ketone production even when carbs and glucose are present. This is the mechanism that helps decrease the lack of energy and brain fog during the short keto adaptation phase. The MCT's promote ketone production before nutritional ketosis has been reached, making up for the deficit in energy due to the considerable reduction in available energy from carbohydrates when switching to a ketogenic diet. The fact that these MCTs are broken down even before carbohydrates makes them a promising supplement even for a diet regimen including carbs, as a way to reap the benefits of the small increase in ketone production without achieving nutritional ketosis. Keto Science!

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Patients with obesity often struggle to find effective treatments for weight loss. One emerging option is the use of medications like Ozempic and Semaglutide, which belong to a class of drugs called GLP-1 receptor agonists. These medications work by mimicking the effects of a hormone called glucagon-like peptide-1 (GLP-1) in the body, which can help regulate blood sugar levels and reduce appetite. In recent years, both Ozempic and Semaglutide have gained popularity for their potential to aid in weight loss in addition to their primary use in managing diabetes. But how do these medications compare when it comes to weight loss efficacy and user experiences?

Ozempic: A Promising Option for Weight Loss

Ozempic (semaglutide) is a once-weekly injectable medication that has been approved by the FDA for both diabetes management and weight loss. Clinical trials have shown that Ozempic can lead to significant weight loss in patients with obesity, with some studies reporting an average weight loss of over 10% of initial body weight. The medication works by slowing down gastric emptying, reducing appetite, and promoting a feeling of fullness.

One of the key advantages of Ozempic is its convenience as a once-weekly injection, making it easier for patients to adhere to their treatment regimen. Additionally, Ozempic has been well-tolerated by many patients, with few reports of side effects such as nausea and diarrhea. Overall, Ozempic has shown promising results in helping patients achieve their weight loss goals while also improving metabolic health.

Semaglutide: A Strong Contender in the Weight Loss Arena

Semaglutide, the active ingredient in Ozempic, is also available in a higher dose formulation specifically for weight loss under the brand name Wegovy. Like Ozempic, Semaglutide has shown significant efficacy in promoting weight loss, with some studies reporting an average weight loss of around 15% of initial body weight. Semaglutide works by acting on the GLP-1 receptors in the brain to reduce appetite and food intake.

In addition to its weight loss benefits, Semaglutide has been associated with improvements in cardiovascular health markers such as blood pressure and cholesterol levels. However, Semaglutide does come with a higher risk of gastrointestinal side effects compared to Ozempic, including nausea, vomiting, and diarrhea. Despite these side effects, many patients find Semaglutide to be a powerful tool in their weight loss journey.

Comparing Ozempic and Semaglutide: Considerations for Weight Loss

When deciding between Ozempic and Semaglutide for weight loss, patients and healthcare providers should consider several factors. Firstly, the dosing regimen may play a role in treatment adherence, with Ozempic offering a once-weekly option compared to Semaglutide’s daily administration. Patients should also discuss their tolerance for potential side effects, as Semaglutide may be associated with more gastrointestinal issues than Ozempic.

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