Glucose and fructose produce exactly 36 ATP per molecule; medium-chain fatty acids (fats) produce 50 ATP per molecule; and long-chain fatty acids (also fats) produce 155 ATP per molecule.35 By this measure, fat is a far more efficient fuel source than sugar. Because most of the fat stored in and on the human body consists of triglycerides (one glycerol molecule and three long-chain fatty acids), every molecule of body fat that is burned can produce 465 units of ATP, compared with only 36 ATP received from carbohydrates.35 This is why switching to a high-fat diet often causes energy levels to soar.
When the human body burns glucose, it needs to refuel often, as it has become reliant on fast-burning fuel. This can affect mood, hunger, and energy levels. It also causes chronically elevated insulin levels, chronic fat storage, and weight gain, and can lead to T2DM development.36,37
When the human body is trained to burn fat, overall food intake is eventually reduced. There is also more body fat loss without muscle loss during fat metabolism.38,39 Carbohydrate cravings disappear, and chronic hunger diminishes. Because overall food intake is reduced, all food consumed needs to have much higher nutritional value, including vegetables, in-season fruit, nuts, healthy fats, and animal protein from animals fed a natural diet (see Ancestral diet principles). The human body can go for hours between meals without triggering the feeling of hunger. Even between meals, energy levels can remain high and no fat storage occurs while fasting.
An ancestral diet, or one that mimics what was eaten by our ancestors, such as the paleo diet, includes minimal dietary sugars, lots of vegetables, protein from healthy animals, and other healthy fats. Consuming more healthy fat sources is also very anti-inflammatory, as it decreases glycation and oxidation of free radicals. Glycation is the nonenzymatic reaction between a protein and a sugar. It is believed that excessive glycation is at the root cause of endothelial damage leading to plaque development and CVD.42 Eating little to no sugar and more healthy fat also encourages the release of ketone bodies, resulting in ketosis. The paleo diet can result in increased production of ketones, which are very high-quality fuel (this is not the same as ketoacidosis, which occurs in the absence of insulin, such as in undiagnosed type 1 diabetes). Studies have shown that the brain works just as well on ketones as it does on glucose.43 This may explain why studies of ketosis on cognitive decline are so exciting as a possible treatment for Alzheimer disease.44 Research on disease prevention and symptom improvement using a keto diet has improved chronic diseases such as epilepsy, attention-deficit hyperactivity disorder, Alzheimer disease, migraines, acne, and cancer.45-47 In cancer treatment, the keto diet is particularly promising given that tumor growth is dependent on glucose.48,49
Sugar and salt dominate the American diet rather than vegetables and healthy sources of animal products. Although there are many different diets promoting their superiority over the others, a diet mimicking that of our ancestors has validity for improved health in the current, modern culture of processed foods, fast foods, and artificial foods. NPs can help influence their patients' health and encourage lifestyle modifications toward dietary changes that reflect the fat-burning principles that ancient human beings thrived on for tens of thousands of years (see Major tenets of a paleo lifestyle).
Any changes in lifestyle should be made incrementally; small changes made today can translate into improved health outcomes in the future. NPs can help patients make some changes today and reserve the more difficult ones for later, always keeping an eye on eventually achieving each one for the best results. Often practicing as patients' primary care providers, NPs are well positioned to provide high-quality preventive medical advice to help patients avoid the chronic diseases, such as obesity and T2DM.
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