Often considered a disease of aging, Alzheimer’s disease is a form of dementia typically diagnosed after the age of 65, though new tests have been devised to detect the disease much earlier in its development. There are a wide range of symptoms, including a decline in thinking and/or memory severe enough to affect one’s ability to perform everyday tasks. 1 in 10 people age 65 and older has Alzheimer’s, and it is the 6th leading cause of death in the United States. Alzheimer’s affects more than 5 million Americans, growing by 89% since 2000; by 2050, the expected number of Americans afflicted with the disease is 16 million.
Alzheimer’s is caused by damage to neurons, or cells in the brain, that disrupts inter-cell communication. When brain cells cannot communicate properly, cognition is impaired. Since this cell death is only visible through analysis of brain tissue under a microscope, doctors diagnose the disease in living subjects by conducting tests to assess cognitive skill. Anatomically, the brain cells in the hippocampus, the region of the brain responsible for learning and memory, are often the first to be damaged. As such, memory loss is frequently the earliest symptom of Alzheimer’s.
There is no cure or treatment that slows the progression of Alzheimer’s, though there are drug treatments that may temporarily improve symptoms. Due to the severity of the problem (an estimated $175 billion dollars worth of taxpayer’s money is spent on patient care in the US) research continues to explore risk factors and possible preventive measures, including cardiovascular health, physical fitness, and diet.
A case for Keto
A 2020 systematic review evaluated data from 10 separate ketogenic therapy studies on patients with Alzheimer’s disease and mild cognitive impairment. The reviewers concluded that while the research is still in its early stages, ketogenic therapy may hold promise for this population. The common findings amongst the studies were improved general cognition with improved episodic and secondary memory. Improvements were not observed in psychological health, executive ability, or attention. A correlation was observed between increase in blood ketone concentrations and the neurocognitive battery.
Alzheimer’s research has begun to uncover the fact that what you eat has a direct impact on brain health. Current evidence suggests that both the ketogenic as well as Mediterranean diets may help protect the brain. Unfortunately, according to the Physicians Committee for Responsible Medicine, avoiding saturated fats and eating a diet rich in carbohydrate from vegetables, legumes, whole grains and fruit are key recommendations to prevent Alzheimer’s disease. Similarly, the current federal dietary guidelines for American adults recommends “fruits, vegetables, whole grains, fat-free and low-fat dairy products, and seafood” and discourages “solid fats.” These recommendations are the opposite of Ketogenic Diets, which rely on fat as the main source of energy. Coconut oil, butter, cream, and nut, seed and olive oils are used lavishly in Ketogenic Diets. Also, Ketogenic Diets eliminate whole grains and, while including vegetables, allow very little fruit.
According to Mary Newport MD, “It is possible, with the introduction of ketones in the body, that some repair and reversal could occur in Alzheimer’s. It seems likely that ketones can stimulate the growth and survival of neurons as well as the extension from neurons (axons and dendrites) thereby increasing the connections between brain cells (synapses). The decrease in synaptic density is likely the primary pathological defect in Alzheimer’s disease”.
The simple progression of aging itself can cause a natural degeneration of neurons, and the circuitry between these neurons. In one study, aging mice were able to navigate mazes and recognize objects better while on a Ketogenic Diet compared to a control group of mice on a regular diet. Another animal study showed that Ketogenic Diet fed to brain-injured juvenile mice protected neurons from damage and even allowed them to regenerate.
The effectiveness of ketogenic therapy for epilepsy has been proven in many clinical studies. Although we do not fully understand how it works to control seizures, there is compelling evidence that many neurological conditions are linked—people with Alzheimer’s disease, for example, have a higher incidence of seizures. Seizures are common in people with diseases with metabolic defects, and studies show that dietary intervention is the most effective treatment.
A 2008 study examining postmortem brains of healthy mice versus those affected by Alzheimer’s revealed the inability of the Alzheimer’s brain to transport glucose (blood sugar) across the blood brain barrier. This research suggests a possible mechanism by which the glucose transporter deficiency may lead to neurodegeneration. In 2008, the term “Type 3 Diabetes” was coined by researchers at Brown University, after finding that resistance to insulin and insulin-like growth factors were a key part of the progression of Alzheimer’s disease in rats. More research is being conducted that shows that people with type 2 diabetes or prediabetes have an increased risk of developing Alzheimer’s disease. In her paper in the Journal of Alzheimer’s Disease, Melissa Schilling, a professor at the NYU, came to a similar conclusion, estimating that 40% of all Alzheimer’s cases are connected to excess levels of insulin relative to glucose in the blood.
Recent studies raise the possibility that elements of the Ketogenic Diet may provide symptomatic relief and even delay the onset of Alzheimer’s. In one such study, a 53-year-old man who developed early-onset Alzheimer’s had significant memory improvement with the addition of medium-chain triglycerides, in the form of a highly ketogenic oil, to his diet. His physician wife Mary Newport, a neonatologist, had used this oil in her practice to improve weight gain in infants. In 2010 Dr. Newport published a review of people with dementia who had medium-chain triglycerides added to their diets. Of the 60 people in this study, 90% of their caregivers reported improvement in one or more areas including memory, cognition, social interaction, speech, resumption of lost activities, sleep, appetite and vision.
In a randomized, placebo-controlled trial of 152 people with moderate Alzheimer’s, a ketone agent extracted from medium-chain triglyceride oil was given as a medication along with a normal diet. The degree of memory improvement was significant in the study group who had genetic indications of Alzheimer’s and was positively correlated with the blood levels of the ketone agent.
Scientists now agree that dietary alterations play a large role in neurological diseases. We who are at risk for developing neurological disorders should take a proactive role in health management. A diet of whole foods including sufficient protein, natural sources of carbohydrate and healthy fat while eliminating processed foods and refined sugars is a sound nutrition practice that can be adopted by all.
Think the Ketogenic Diet is right for you? Talk to your doctor before adopting a Ketogenic Diet, or connect with one of our qualified diet professionals to determine a course of action that is right for you.
What are the benefits of Ketosis?
Achieving a state of ketosis can have many benefits from treating chronic illnesses to optimizing performance. While the benefits are well documented, the underlying mechanism of action is not entirely known. The diet seems to enhance the ability of mitochondria, the power plants of our cells, to deliver our bodies’ energy needs in a manner that reduces inflammation and oxidative stress. Through optimizing the way our body uses energy, we fortify our bodies’ ability to take on the ever-growing stressors of our modern way of living.
Can a high fat diet be healthy?
According to David Diamond PhD, “Saturated fat does not clog the arteries: Coronary heart disease is a chronic condition, the risk of which can be effectively reduced from healthy lifestyle interventions. We have known for 150 years that a high carbohydrate diet contributes to fat in the blood and contributes to obesity.” He goes on to say, “the poor science that was used to support the idea that increased fat intake increases cholesterol and damages arteries was authored by Ancel Keys who had no background in nutrition, but did have a BA in Economics and a PhD in Fish Physiology. Keys’ theory that fat in diet causes increased risk for high cholesterol and heart attack was based on extremely flawed science and “became dogma without ever being rigorously assessed.” “A generation of citizens has grown up since the Diet/Heart Hypothesis (of Ancel Keys) was launched as official dogma. They have been led by the greatest scientific deception of our times: the notion that consumption of animal (saturated) fat causes heart disease.” George Mann MD, Nutrition Today, 1985. “The belief that atherosclerosis is due to high cholesterol has been perpetuated by powerful forces using tactics to preserve the profits and reputations of those who promote them.” Paul Rosch M.D, Scandinavian Cardiovascular Journal, 2008. “The diet heart hypothesis is sustained by social, political and financial institutions which have little to do with science and established success in public health.” Uffe Ravnskov MD PhD, 2008.
Ready to get started? Learn the basics…
The Ketogenic Diet, also referred to as the ketosis diet, or Keto for short, is a way of eating that mimics the effects of fasting. By consuming a diet rich in quality fats, adequate in protein, and low in net carbohydrates (total carbs minus fiber), the body’s metabolism begins to utilize fat as its main source of fuel, rather than carbs. This shift has profound effects on metabolism for both the sick and healthy alike. The diet shows promise for improving or reversing many neurological conditions and metabolic disorders. For the healthy, the diet represents a tool for preventing chronic disease, as well as optimizing cognition and body composition (i.e. fat loss).
What is ketosis?
The term ketosis refers to a byproduct of the breakdown of fat into useable energy, called ketone bodies, or ketones for short. This fat can be derived directly from the food we eat, or adipose tissue stored throughout your body (otherwise known as body fat). Ketones are used directly by the body to power itself. This breakdown of fat into useful energy is similar to the process that dietary carbohydrates undergo in producing glucose to fuel the body. In other words, ketones are to fat what glucose is to carbohydrates. Ketosis is defined as having blood ketone levels > .5 millimolar/L.
How do I get into ketosis?
There are two methods to make the metabolic shift from using glucose to ketones as your main source of energy.
Fasting – the method of complete cessation of caloric intake for a prolonged period of time has been used to treat disease as far back as 400 B.C. when Hippocrates, the Father of Modern Medicine, employed the method for a myriad of ailments. Though this should be done under medical supervision, fasting is a safe, effective (and, some would say, the easiest) way to get into ketosis, quickly. For the average adult, a 48-hour fast will generally result in ketosis. After this fast, adopting a Ketogenic Diet will allow you to stay in ketosis. We recommend starting the fast at least 3 hours before bedtime on the first day, and eating at the same time 2 days later. While fasting means many things to many people, we define it here as the total restriction of macronutrients. We recommend boosting water consumption in order to avoid dehydration, and many find black coffee or plain tea to help maintain focus and performance during the fast. Children go into ketosis much faster and therefore can be started on the diet without fasting.
Diet – adopting a high fat, moderate protein, and low net-carb diet, will result in ketosis, and will take 2-3 weeks to achieve this state, as defined above. The diet is most basically explained by the ratio of macronutrients (fat, protein and net-carbs) in your diet, as it relates to fat. A classic Ketogenic Diet has a ratio of 4 parts fat, to 1 part protein + carbs (referred to as a 4:1 ratio). This 4:1 ratio is the high end of the spectrum as it relates to fat intake, though modifications to the diet can see this ratio go as low as 2:1. The ratio you adopt depends on the therapeutic benefit you are trying to achieve as well as the diet that is achievable for your lifestyle. We will go into diet options below, but you can also link to them here.
How long should I be on the diet?
We at the Charlie Foundation believe that a 3-month commitment to the diet is a minimum commitment to allow your body to fully acclimate to the new fat based fuel source. Since most people following a western diet are not proficient at metabolizing fat optimally, this period allows the body time to become “fat-adapted”, utilizing dietary fat efficiently and effectively. There are a variety of nutritional plans that will enable a ketogenic lifestyle, and flexibility is one of the hallmarks of the diet that make it easy to adopt as a life-long tool to enhance your health. Our nutritionists can help figure out both the short and long-term options best suited for you and your lifestyle.
Am I a candidate for the Ketogenic Diet?
While the short answer is yes for the majority of people consuming a western diet, we urge you to consult your general practitioner prior to making the switch to Keto. The Charlie Foundation will provide you with the information and tools necessary to adopt the diet, and partnering with your doctor during this process will ensure the most therapeutic outcome. We also suggest that you connect with a diet professional who can help you form a plan in collaboration with your doctor, who may be less familiar with the diet.
Types of Ketogenic Diets
There are a variety of diets that will allow you to get into ketosis. The major differentiating factor between them all is the amount of calories that come from protein, carbs and fat, which are what we call “macronutrients”, or nutrients in our food that have a caloric value. The three macronutrients differ in many ways, namely, their caloric values, as well as how the body uses them. Fat is the most calorically dense macronutrient, having 9 calories per gram, compared to 4 calories per gram for both carbs and protein. In a homeostatic state, the body utilizes fat and carbs for energy production, while it uses protein to rebuild the cells of our body. While this is generally the case, an overconsumption of protein can lead the body to break down the excess protein into glucose (which is what carbs break down into)
- Classic Ketogenic Diet
- Modified Ketogenic Diet
- MCT Oil Diet
- Modified Atkins
- Low Glycemic Index Diet (LGIT)
- Intermittent Fasting
If you think you can benefit from adopting a Ketogenic Diet, we encourage you to consult one of our dietitians, visit a participating hospital, or contact us so that we may guide you towards the most fruitful option given your specific needs.