The Ketogenic Diet and Brain Health

There have been many diets that have revolved in and out of the diet door for centuries. The high fat, very low carbohydrate, moderate protein diet is known as the “ketogenic” diet and it’s not new. What’s new is the overwhelming research that is coming out on it’s protective benefits for brain health.

Ketogenic type diets have been used by many weight loss proponents, such as the infamous Dr. Atkins, but very little people know that it’s been used for decades to help those with epilepsy and seizure disorders.

The ketogenic diet came to fruition in 1920’s as an alternative to anticonvulsant medications that would not work in people with convulsant type disorders. The reason ketogenic diets work with this population comes down to how the body metabolizes fuel. The soul fuel of energy for the brain is glucose. The brain is made up of mainly fatty acids. When glucose is low or deficient in the diet, the body must maintain brain function by utilizing protein and ketones (a byproduct of fatty acid metabolism).

Ketone metabolism influences neurotransmitter balance in our brains, but especially in those with altered metabolism.  Most people go in and out of ketosis as they sleep and even throughout the day. Some people will admit that they feel more alert and less sluggish when they eat a low carbohydrate diet or practice intermittent fasting, but some people have genetic mutations, poor gut health and other inflammatory processes going on that may cause an imbalance in neurotransmitters in their brain.

Glutamate is a byproduct of metabolism that is associated with the intellectual and responsive part of our brains. Glutamate is considered an “excitatory” neurotransmitter, whereas GABA is “inhibitory”. GABA is associated with calmness and social aspects of our brain  These two neurotransmitters are intended to balance each other.  When one of these is thrown off balance, it can lead to neurotoxicity and cell damage.

The people who experience disorders in this balance can experience a wide range of brain and mood disorders. There are many factors that can contribute to this imbalance. Currently, research is looking at the link between gut microbiome and it’s relation to poor digestion and carbohydrate metabolism. One of the side effects of poor digestion is inflammation as well as the accumulation of propionic acid from the “bad” gut bacteria. Excessive levels of propionic acid can shunt metabolim towards creating more excitotory metabolites (glutamate) leading to neurotoxicity.

Another area of study is looking at genetic mutations and how they contribute to “kinks” in metabolism also contributing to inflammation and neurotoxicity  Lastly, the study of environment on inflammation and blood sugar dysregulation are high on the list for contribution to neurotoxicity.  You will see more studies coming out on the reason why neuropathy is so predominant in the diabetic population.

Studies today are starting to look at the benefits of a ketogenic diet beyond epilepsy and seizure disorders. The focus is moving toward autism, Alzheimer’s, dementia, TBI, bipolar, anxiety and depression, etc. I should note that there is no one size fits all diet or therapy. Many of the brain and mood disorders I listed above are also being recovered through multiple modalities such as advanced nutrient therapy, exercise therapy and cognitive therapy.

The ketogenic research has lead to the use of brain friendly medium chain fatty acids  (MCT coconut oil) vs the non-healthy long chain fatty acids (soy and corn oils).  Most children with seizure disorders struggle with a 4:1 fat to carbohydrate type diet, so supplements are available to help them accomplish the strict diet goals. Many with brain disorders may not have to stick to something so strict.  They can practice what is called a “modified” ketogenic diet that’s closer to a 2:1 or 3:1 by adding more MCT and reducing starches.  For example, a person experiencing anxiety may just need to practice a low inflammatory diet instead of a strict ketogenic diet.

Low inflammatory diets generally have the goal to reduce foods that may be creating too much glutamate, high blood sugars, and inflammation. Food sensitivities need to be addressed along with gut flora imbalances, and environmental toxins. It’s important to point out that additives, preservatives, and medications can contribute to excessive glutamate. Low inflammatory diets may exclude  or reduce certain foods such as grains, cow milk, identified food sensitivities, and any food that may feed poor gut flora such as legumes, fruits, starchy vegetables, yeast products, etc.

The very low intake of carbohydrates can come with side effects. This type of diet typically leads to a lower fluid and fiber intake, as well as nutrient deficiencies. The catch 22 is constipation. With constipation, you can have intestinal inflammation. The elimination of carbohydrates helps reduce fermentation in the gut but that doesn’t mean inflammation isn’t persisting. Gut flora also changes, but how this influences brain health is still being studied.  The low fluid intake and strain of fatty acid and amino acid metabolism can increase the incidence of kidney stones. People may need to supplement with fiber support as well as potassium citrate to help with these complications. Obviously, hydration is important so drinking water throughout the day is imperative.  Nutrient therapy should be part of the protocol based on the individual’s needs. Supplementation is individualized.

Muscle wasting can become a side effect if protein is not adequate or calories are not being met along with a sedentary lifestyle. Regular exercise of cardio (also brain protective) and resistance training is recommended.  Prolonged high intensity exercise may be difficult due to low muscle glucose stores.

Lastly, what about just using the ketogenic diet for weight loss? Ketogenic diets are being used more and more to promote fat loss. The side effects are the same as I listed above. For the athlete who is trying to make strength gains or run longer and faster, ketogenic cycling may be a better option. The reason is, muscle uses glucose for energy. Yup, that’s right, if you want gains, you have to fuel your muscles with what it needs to develop.  Protein still needs to be sufficient as it is used for healing and repair.

I actually use a ketogenic diet plan that cycles a ketogenic type diet with a low inflammatory diet bi-monthly.  If people are dedicated enough to the ketogenic part, they do very well with fat loss. Adjustments are made to their fitness plan while they cycle. People also do very well with a low glycemic-low inflammatory diet plan, so don’t think you can’t get the same results without a ketogenic diet. The ketogenic diet tends to get you there slightly faster. If you have insulin resistance and poor blood glucose control, both a low glycemic- low inflammatory diet or ketogenic cycling is a great lifestyle option.

 

Stay tuned for more brain protection info: Omega 3’s DHA and TBI

 

Related References:

http://www.ncbi.nlm.nih.gov/pubmed/25956238

http://www.impactaging.com/papers/v6/n9/full/100690.html