Keto Diet Advanced Applications 4 — Questions and Answers
Question 1: What is the most common electrolyte lost first and in greatest quantity when transitioning to a ketogenic diet?
- Calcium
- Magnesium
- Sodium (Correct answer)
- Potassium
Correct answer: Sodium
Lowered insulin reduces renal sodium reabsorption, causing rapid urinary sodium loss and the associated 'keto flu' symptoms.
Question 2: Which advanced testing method can directly measure fat versus carbohydrate oxidation during exercise?
- Blood ketone meter
- Indirect calorimetry (metabolic cart) measuring RER (Correct answer)
- Continuous glucose monitor
- DEXA body composition scan
Correct answer: Indirect calorimetry (metabolic cart) measuring RER
Indirect calorimetry calculates the respiratory exchange ratio (RER); values near 0.7 indicate fat oxidation and near 1.0 indicate carbohydrate oxidation.
Question 3: How does protein intake affect ketosis, and what is the proposed mechanism?
- Protein has no effect on ketosis
- High protein directly converts to fat, blocking ketones
- Excess protein can be converted to glucose via gluconeogenesis, potentially reducing ketone production (Correct answer)
- Protein always raises blood glucose above ketogenic threshold
Correct answer: Excess protein can be converted to glucose via gluconeogenesis, potentially reducing ketone production
Amino acids (especially glucogenic ones) can undergo gluconeogenesis in the liver, raising insulin and glucose, which may suppress ketone output.
Question 4: What is 'protein-sparing modified fast' (PSMF) and how does it relate to ketogenic dieting?
- A diet combining high fat and high carbs
- A very low-calorie, high-protein, near-zero fat and carb protocol to preserve lean mass during rapid fat loss (Correct answer)
- Standard keto with added protein shakes
- A cyclical diet alternating keto and PSMF weekly
Correct answer: A very low-calorie, high-protein, near-zero fat and carb protocol to preserve lean mass during rapid fat loss
PSMF is an extreme protocol using lean protein sources only, achieving ketosis through severe caloric and fat restriction to maximize fat loss while sparing muscle.
Question 5: Which liver condition is a contraindication for a high-fat ketogenic diet?
- Mild fatty liver (NAFLD grade 1)
- Acute liver failure or severe hepatic dysfunction (Correct answer)
- Elevated ALT from exercise
- Gilbert's syndrome
Correct answer: Acute liver failure or severe hepatic dysfunction
Severe hepatic dysfunction impairs the liver's ability to perform beta-oxidation and ketogenesis, making high-fat keto dangerous.
Question 6: What is the role of peroxisome proliferator-activated receptor alpha (PPAR-α) in ketogenic metabolism?
- It suppresses fat burning
- It is a transcription factor activated by fatty acids that upregulates genes for beta-oxidation and ketogenesis (Correct answer)
- It promotes glycolysis
- It increases insulin secretion
Correct answer: It is a transcription factor activated by fatty acids that upregulates genes for beta-oxidation and ketogenesis
PPAR-α is activated when fatty acids rise during fasting or keto, turning on genetic programs that increase fat oxidation and ketone body synthesis.
Question 7: When following a ketogenic diet for type 2 diabetes management, what is the primary reason blood glucose improves rapidly in the first days?
- Increased insulin secretion from the pancreas
- Dramatic reduction in dietary carbohydrate eliminating the main blood glucose driver (Correct answer)
- Exercise-induced glucose uptake
- Improved kidney glucose clearance
Correct answer: Dramatic reduction in dietary carbohydrate eliminating the main blood glucose driver
Removing dietary carbohydrates eliminates the primary post-meal glucose load, causing blood sugar to fall within days without requiring more insulin.
Keto Diet Advanced Applications 4
What is the most common electrolyte lost first and in greatest quantity when transitioning to a ketogenic diet?