For years women’s magazines and morning talk shows have told us how to diet properly with every year being a new fad. One diet says you should eat six small meals a day; another tells you to live off maple syrup, cayenne, and lemon juice for 10 days and you’ll feel amazing and refreshed (or miserable and freezing cold, trust me I’ve done it); and they all say, stick to the non-fat or low fat options. But then somebody decided to start eating nothing but salami, butter, and cheese and miraculously lost weight and hit the jackpot; they called it the keto diet. That’s probably not true, I’m sure there was some scientific basis to the trendy ketogenic diet, and it goes FAR beyond the weight loss. The ketogenic diet consists of a high fat, moderate protein, and low carbohydrate diet. Keep in mind this includes healthy saturated fats such as ghee, unrefined coconut oil, and avocado oil and a lot of low carb vegetables like zucchini, spinach, and asparagus.
To my surprise, the ketogenic diet has actually been around for decades as a clinical treatment for epilepsy; and more recently, studies have been conducted examining keto’s effect on neurodegenerative disorders such as Alzheimer’s, Parkinson’s, and ALS. See, on the ketogenic diet, you are training your body to use fat as its primary source of fuel rather than carbohydrates. Let’s face it, we have plenty of fat to go around so why not use it? Plus dietary fat is straight up delicious. Instead of the fast burning and short-lived energy boost that glucose provides as an energy source, the diet rewires our body’s metabolic pathway so that we can convert fatty acids into highly efficient energy molecules called ketone bodies, particularly β-hydroxybutyrate (BHB). In the absence of glucose, the preferred energy source is these ketone bodies (Paoli et al. 2014). This works out especially well for the brain, which requires a ton of energy. Over time, the brain will prefer BHB as its primary source of fuel and those who have experienced ketosis can attest that their brain feels like it’s working at 110%. Instead of feeling that dreaded 2pm brain fog when your glucose stores are depleted, ketones keep your brain energized and functioning for longer periods of time and more efficiently.
So how can these amazing little ketone bodies help with neurodegenerative diseases? While the diseases have varying pathogenesis and features, they have a common mechanism of focal brain hypometabolism that the ketogenic diet can target to ameliorate. By providing an efficient source of energy, the ketogenic diet may decrease the oxidative damage associated with the metabolic stress and increases mitochondrial biogenesis pathways (Paoli et al. 2014). In fact, exposure to a ketogenic diet was found to improve Alzheimer’s pathology in mice. Remember those β -amyloid plaques that inhibit neuronal function? After 43 days of a ketogenic diet, mice experienced a 25% reduction in the levels of the amyloid β peptides responsible for the plaque aggregation. 25%! Aside from the effects on β –amyloid disposition, the high concentration of ketone bodies, especially BHB, associated with the ketogenic diet have been shown to increase spatial recognition learning in Alzheimer’s diseased mice as well as protect them from the β –amyloid plaque aggregation in the first place (Gasior, Rogawski, & Hartman, 2006).
Studies on the effects of the ketogenic diet are ever-increasing, and we are constantly learning more about the effects of these ketones on the brain and body. So enjoy a pad of butter in your coffee, keep your brain sharp, and remember coconut oil really does fix everything.
Gasior, M., Rogawski, M., & Hartman, A. (2006). Neuroprotective and disease-modifying effects of the ketogenic diet. Behavioral Pharmacology. 17(5-6): 431-439.
Paoli, A. et al. (2014). Ketogenic Diet in Neuromuscular and Neurodegenerative Diseases. BioMed Research International. Article ID 474296. DOI: 10.1155.2014.474296.
I noticed that the paper you are referencing from regarding the Beta amyloid plaques are from 2006 regarding the ketogenic diet on mice. After reading the papers and searching through the web, there doesn't seem to be much significant progress since then regarding the ketogenic diet on human Alzheimer's disease. For the progress that has been made, researches were done over the course of 3 months on Alzheimer's disease patients with ketogenic diet administered by caregivers. For those who followed the dietary protocol, Alzheimer's Disease Assessment Scale-cognitive subscale score improved by 4.1 points during the diet (P = .02) and reverted to baseline after the washout. However, even if it reverted, it has proved to be better than any available medication, as it helped the patients improve their cognitive function to the point that there was a 5 point average increase, illustrating that there is further worth in studying ketogenic diet for treating Alzheimer's disease.
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Taylor MK et al. Feasibility and efficacy data from a ketogenic diet intervention in Alzheimer’s disease. Alzheimer’s & Dementia: Translational Research & Clinical Interventions. 2018;4:28-36.
Great post Sydney! I started to looking into the keto diet and research has shown that people with type 2 diabetes can benefit a lot from it. Type 2 diabetes is becoming more common, especially with Americans, due to our outrageous diets, and some studies have evidence that show a keto diet can help manage type 2 diabetes. The biggest benefit is weight loss, which is one of the first interventions used when someone has type 2 diabetes. The keto diet has also been shown to reverse diabetic neuropathy, which is nerve damage that typically occurs in the hands and feet of people with diabetes. However, the mechanism as to how the keto diet reverses diabetic neuropathy is still up for debate. It's pretty cool that a simple dietary change can benefit someone in such a substantial way.
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Azar ST, Beydoun HM, Albadri MR. (2016). Benefits of Ketogenic Diet for Management of Type Two Diabetes: A Review. Journal of Obesity and Eating Disorders. 2(2).
Poplawski, M. M., Mastaitis, J. W., Isoda, F., Grosjean, F., Zheng, F., & Mobbs, C. V. (2011). Reversal of Diabetic Nephropathy by a Ketogenic Diet. PLoS ONE, 6(4), e18604.
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ReplyDeleteBefore I suggest that the promise of the ketogenic diet isn't quite what it is often made out to be, I want to preface the following with this-- I had a single lecture from a biochemistry professor about why the ketogenic diet really doesn't work. He didn't cite any papers, and I haven't submerged myself into the literature either.
ReplyDeleteThat being said, it was explained to us that, while being in ketosis can certainly give us some of the beneficial impacts that you highlighted in your post, the actual act of getting your body into ketosis is rather difficult. In fact, it is likely too difficult to be a reliable treatment or medically-indicated recommendation. The biochemical explanation behind this is that, in order to enter ketosis, your body has to almost completely eliminate available stores of glucose and, in effect, glycogen. However, due to high concentrations of glycogen found throughout the average human body, and because it is very difficult to avoid carbohydrates in the average diet, it can take weeks of eating rather attenuated and somewhat bland diets to actually see ketosis occur. Likewise, it is very easy to exit ketosis, as a minor slip-up (a cookie, for example) can restart the multi-week process of entering ketosis.
So frankly, unless a diabetic is extremely motivated and conscientious of their diet, they are unlikely to see any benefit. Since a large portion of diabetics are stereotyped (whether true or not) as having a history of generally not being over-zealous about watching their intake, the ketogenic diet may be unlikely to ever see the center stage of dietary treatments. Now perhaps this isn't correct and my professor was making this up, and I am looking forward to delving further into this in the future. In the mean time, does anybody else have some light to shine on this issue?
As you mentioned above, ketogenic diets have been around for quite a while and have demonstrated potential health benefits in a wide variety of physical and mental ailments. I've always found it interesting, as a result, that I had never heard of a ketogenic diet until last fall. Even more interesting was the reason I stumbled across it, searching for ways to improve my performance as an endurance athlete. To this day Dr. Campisi remains the only person I have talked to in person that has mentioned ketogenic diets and their potential performance benefits for endurance athletes (although he did not make this connection directly, he often alludes to it).
ReplyDeleteOne study I found specifically examined this affect and did indeed find that a high fat diet (AKA a ketogenic diet), with a carbohydrate consumption accounting for 7% of caloric intake, led to an improved resistance to muscle fatigue and an increased sparing of endogenous glycogen in trained cyclists during exercise that ranged from low to moderate. Although the sample size was incredibly small (n=5) it was encouraging to read about yet another benefit of the famed ketogenic diet.
Lambert, E. V., Speechly, D. P., Dennis, S. C., Noakes, T.D. (1994). Enhanced endurance in trained cyclists during moderate intensity exercise following 2 weeks adaptation to a high fat diet. European Journal of Applied Physiology and Occupational Physiology, 69(4), 287-293.