Ketogenic Diet and Neurocognitive Health

Below is a passage from Ketotarian by Will Cole. It can be read in Chapter 1, titled “the ketogenic diet (for better and worse)”. The specific passage is to be found on pp. 34-38 in printed book (first edition) or pp. 28-31 in the Google ebook. I share it here because it is a great up-to-date summary of the value of the ketogenic diet. It is the low-carb diet pushed to its furthest extent where you burn fat instead of sugar, that is to say the body prioritizes and more efficiently uses ketones in place of glucose.

The brain, in particular, prefers ketones. That is why I decided to share a passage specifically on neurological health, as diet and nutrition isn’t the first thing most people think of in terms of what often gets framed as mental health, typically treated with psychiatric medications. But considering the severely limited efficacy of entire classes of such drugs (e.g., antidepressives), maybe it’s time for a new paradigm for treatment.

The basic advantage to ketosis is that, until modernity, most humans for most of human evolution (and going back into hominid evolution) were largely dependent on a high-fat diet for normal functioning. This is indicated by how the body more efficiently uses ketones than glucose. What the body does with carbs and sugar, though, is to either to use it right away or store it as fat. This is why hunter-gatherers would, when possible, carb-load right before winter in order to fatten themselves up. We have taken this knowledge in using carbs to fatten up animals before the slaughter.

Besides fattening up for winter in northern climes, hunter-gatherers focus most of their diet on fats and oils, in that when available they choose to eat far more fats and oils than they eat meat or vegetables. They do most of their hunting during the season when animals are the fattest and, if they aren’t simply doing a mass slaughter, they specifically target the fattest individual animals. After the kill, they often throw the lean meat to the dogs or mix it with fat for later use (e.g., pemmican).

This is why, prior to agriculture, ketosis was the biological and dietary norm. Even farmers until recent history were largely dependent in supplementing their diet with hunting and gathering. Up until the 20th century, most Americans ate more meat than bread, while intake of vegetables and fruits was minor and mostly seasonal. The meat most Americans, including city-dwellers, were eating was wild game because of the abundance in nearby wilderness areas; and, going by cookbooks of the time, fats and oils were at the center of the diet.

Anyway, simply in reading the following passage, you will not only become more well informed on this topic than average American but, sadly, also the average American doctor. This isn’t the kind of info that is emphasized in medical schools, despite it being fairly well researched at this point (see appended section of the author’s notes). “A study in the International Journal of Adolescent Medicine and Health assessed the basic nutrition and health knowledge of medical school graduates entering a pediatric residency program and found that, on average, they answered only 52 percent of eighteen questions correctly,” as referenced by Dr. Cole. He concluded that, “In short, most mainstream doctors would fail nutrition” (see previous post).

Knowledge is a good thing. And so here is some knowledge.

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NEUROLOGICAL IMPROVEMENTS

Around 25 percent of your body’s cholesterol is found in your brain, (19) and remember, your brain is composed of 60 percent fat. (20) Think about that. Over half of your brain is fat! What we have been traditionally taught when it comes to “low-fat is best” ends up depriving your brain of the very thing it is made of. It’s not a coincidence that many of the potential side effects associated with statins—cholesterol-lowering drugs—are brain problems and memory loss. (21)

Your gut and brain actually form from the same fetal tissue in the womb and continue their special bond throughout your entire life through the gut-brain axis and the vagus nerve. Ninety-five percent of your happy neurotransmitter serotonin is produced and stored in your gut, so you can’t argue that your gut doesn’t influence the health of your brain. (22) The gut is known as the “second brain” in the medical literature, and a whole area of research known as the cytokine model of cognitive function is dedicated to examining how chronic inflammation and poor gut health can directly influence brain health. (23)

Chronic inflammation leads to not only increased gut permeability but blood-brain barrier destruction as well. When this protection is compromised, your immune system ends up working in overdrive, leading to brain inflammation. (24) Inflammation can decrease the firing rate of neurons in the frontal lobe of the brain in people with depression. (25) Because of this, antidepressants can be ineffective since they aren’t addressing the problem. And this same inflammatory oxidative stress in the hypothalamic cells of the brain is one potential factor of brain fog. (26)

Exciting emerging science is showing that a ketogenic diet can be more powerful than some of the strongest medications for brain-related problems such as autism, attention deficit/hyperactivity disorder (ADHD), bipolar disorder, schizophrenia, anxiety, and depression. (27) Through a ketogenic diet, we can not only calm brain-gut inflammation but also improve the gut microbiome. (28)

Ketones are also extremely beneficial because they can cross the blood-brain barrier and provide powerful fuel to your brain, providing mental clarity and improved mood. Their ability to cross the blood-brain barrier paired with their natural anti-inflammatory qualities provides incredible healing properties when it comes to improving traumatic brain injury (TBI) as well as neurodegenerative diseases. (29)

Medium-chain triglycerides (MCTs), found in coconuts (a healthy fat option in the Ketotarian diet), increase beta-hydroxybutyrate and are proven to enhance memory function in people with Alzheimer’s disease (30) as well as protect against neurodegeneration in people with Parkinson’s disease. (31) Diets rich in polyunsaturated fats, wild-caught fish specifically, are associated with a 60 percent decrease in Alzheimer’s disease. (32) Another study of people with Parkinson’s disease also found that the severity of their condition improved 43 percent after just one month of eating a ketogenic diet. (33) Studies have also shown that a ketogenic diet improves autism symptoms. (34) Contrast that with high-carb diets, which have been shown to increase the risk of Alzheimer’s disease and other neurodegenerative conditions. (35)

TBI or traumatic brain injury is another neurological area that can be helped through a ketogenic diet. When a person sustains a TBI, it can result in impaired glucose metabolism and inflammation, both of which are stabilized through a healthy high-fat ketogenic diet. (36)

Ketosis also increases the brain-derived-neurotrophic factor (BDNF), which protects existing neurons and encourages the growth of new neurons—another neurological benefit. (37)

In its earliest phases, modern ketogenic diet research was focused on treating epilepsy. (38) Children with epilepsy who ate this way were more alert, were more well behaved, and had more enhanced cognitive function than those who were treated with medication. (39) This is due to increased mitochondrial function, reduced oxidative stress, and increased gamma-aminobutyric acid (GABA) levels, which in turn helps reduce seizures. These mechanisms can also provide benefits for people with brain fog, anxiety, and depression. (40)

METABOLIC HEALTH

Burning ketones rather than glucose helps maintain balanced blood sugar levels, making the ketogenic way of eating particularly beneficial for people with metabolic disorders, diabetes, and weight-loss resistance.

Insulin resistance, the negative hormonal shift in metabolism that we mentioned earlier, is at the core of blood sugar problems and ends up wreaking havoc on the body, eventually leading to heart disease, weight gain, and diabetes. As we have seen, healthy fats are a stronger form of energy than glucose. The ketogenic diet lowers insulin levels and reduces inflammation as well as improving insulin receptor site sensitivity, which helps the body function the way it was designed. Early trial reports have shown that type 2 diabetes symptoms can be reversed in just ten weeks on the ketogenic diet! (41)

Fascinating research has been done correlating blood sugar levels and Alzheimer’s disease. In fact, so much so that the condition is now being referred to by some experts as type 3 diabetes . With higher blood sugar and increased insulin resistance comes more degeneration in the hippocampus, your brain’s memory center. (42) It’s because of this that people with type 1 and 2 diabetes have a higher risk of developing Alzheimer’s disease. This is another reason to get blood sugar levels balanced and have our brain burn ketones instead.

Notes:

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I came across something interesting on the Ketogenic Forum, a discussion of a video. It’s about reporting on the ketogenic diet from Dateline almost a quarter century ago, back when I was a senior in high school. So, not only has the ketogenic diet been known in the medical literature for about a century but has even shown up in mainstream reporting for decades. Yet, ketogenic-oriented and related low-carb diets such as the paleo diet get called fad diets, and the low-carb diet has been well known for even longer, going back to the 19th century.

The Dateline show was about the ketosis used as treatment for serious medical conditions. But even though it was a well known treatment for epilepsy, doctors apparently still weren’t commonly recommending it. In fact, the keto diet wasn’t even mentioned as an option by a national expert, instead focusing on endless drugs and even surgery. After doing his own research for his son’s seizures, the father discovered the keto diet in the medical literature. The doctor was asked why he didn’t recommend it for the child’s seizures when it was known to have the highest efficacy rate. The doctor essentially had no answer other than to say that there were more drugs he could try, even as he admitted that no drug comes close in comparison.

As one commenter put it, “Seems like even back then the Dr’s knew drugs would always trump diet even though the success rate of the keto diet was 50-70%. No drugs at the time could even come close to that. And the one doctor still insisted they should try even more drugs to help Charlie even after Keto. Ugh!” Everyone knows the diet works. It’s been proven beyond all doubt. But there is a simple problem. There is no profit to be made from an easy and effective non-pharmaceutical solution.

This doctor knew there was a better possibility to offer the family and chose not to mention it. The consequences to his medical malfeasance is the kid may have ended up with permanent brain damage from seizures and from the side effects of medications. The father was shocked and angry. You’d think cases like this would have woken up the medical community, right? Well, you’d be wrong if you thought so. Yet quarter of a century later, most doctors continue to act clueless that these kinds of diets can help numerous health conditions. It’s not a lack of information being available, as many of these doctors knew about it even back then. But it simply doesn’t fit into the conventional medicine nor within the big drug and big insurance framework.

Here is the video: