Background
Although the brain only represents about 2% of body weight, it consumes at least 20% of the body’s total calories. It’s the most energy-hungry and energy producing organ in the body, needing a constant energy supply to keep itself in proper working order; a mere 10 seconds without a blood supply can result in unconsciousness, and oxygen deprivation of as little as 5 minutes can cause brain damage and death. The brain is also the fattiest organ, comprised of 60% fat. While the connection between diet and physical health has long been understood, the roll of diet in brain health is a lesser known. While physical and mental health are often perceived as separate concepts, they are completely interrelated. Many symptoms thought to be physical can often be attributed to psychological influences. An estimate of 70% of U.S. doctors’ office visits are related a cognitive ailment.
Mental illnesses are often debilitating and can manifest in a myriad of ways, including mood swings, delusions, dementia, and death. Treating these conditions are a major financial burden in the U.S. Nearly 1 in 5 adults is diagnosed with a mental illness each year. Alzheimer’s Disease, a form of dementia, is now the 6th leading cause of death in the U.S., doubling in incidence since the 1980s, costing taxpayers over $175 billion in 2016. Over 18% of Americans experience at least one episode of anxiety each year, while 11% of children are diagnosed with Attention Deficit Hyperactive Disorder (ADHD), most of whom are treated with stimulant drugs. Mood disorders such as depression affect an estimated 10% of the U.S. population, while Post-Traumatic Stress Disorder (PTSD) and Schizophrenia affect 3.5% and 1.1% of Americans, respectively.
Brain and Metabolism – a Case for Keto
The cause of mental illness can be rooted deep in the cells of the brain. Irregular cell structure and/or function negatively impacts normal communication between neurons, which are essential for good brain function. While it is evident that genetic, epigenetic, and environmental abnormalities are a hallmark of mental illness, the underlying mechanisms causing these disorders are not well known. One of the leading theories identifies metabolism as a contributor, to mental illness, as poor metabolism, known as metabolic dysregulation, often occurs with symptoms. In recent research, ketogenic therapies show promise for enhancing brain health and reducing the symptoms of mental illness. While many science text books state that the brain runs exclusively on glucose, research shows that ketones can supply up to 75% of the brain’s total energy needs. Various theories have been proposed for the positive results that have occurred with Ketogenic Diet therapy and brain function improvement.
Alternative Energy
Lack of energy to brain cells has been found to be a common cause of mental illness in animal studies. This energy problem stems from the body’s inability to properly use glucose. Glucose is the energy molecule that comes mostly from carbohydrate. Once glucose is released into the blood stream it combines with insulin to get into every cell of the body. Due to the high carbohydrate diet of most Americans, the constant demand for insulin results in a condition known as “insulin insensitivity” which typically leads to diabetes. Over 43% of American adults are currently living with diabetes or prediabetes, with incidence increasing with age. This energy disruption has grave implications throughout the body, and is thought to be a large contributing factor to mental illness and other chronic disease. Ketones, which serve as an alternative energy source, can be beneficial in reversing this disrupted energy crisis and restoring health. Since ketones do not require insulin to enter cells, the energy problem is solved, and the brain can run at full capacity.
Mitochondrial Enhancement
Mitochondria are the micro-cells that create energy in almost every cell in the body. The brain has the highest concentration of mitochondria of any organ in the body. When the total number of mitochondria are healthy, cells are better able to deal with stress, and, thus, more likely to stay healthy and alive. Ketogenic Diets can increase the amount and efficiency of mitochondria. In addition to more mitochondria, ketones are better than glucose in providing more energy, and less waste in the form of Reactive Oxygen Species (ROS, a waste product of energy use). More ROS production means more stress on the cell, and if the cell cannot keep up with its waste management processes, the cell will degenerate and/or die. This inability to properly manage cellular waste is a hallmark of mental illness. Additionally, metabolizing fat has a lower inflammatory response versus glucose, staving off a major contributing factor to cell stress, dysfunction, and/or death.
Neuro-modulation
Our brains function through a signaling system that occurs between neurons; a process that transmits information between brain cells and the rest of the body. The two neurotransmitters that are responsible for regulating this system are glutamate and Gamma-aminobutyric acid (GABA). The former is excitatory and causes a neuron to “fire”, sending a signal to all connected neurons. The latter calms and inhibits neurons from firing and, thus, communicating with connected neurons. This balance of excitation and inhibition is important to keep the brain in proper working order; too much glutamate can lead to excitotoxicity, causing a host of problems including depression, stroke, and dementia. Simply put, hyper-activity causes toxicity. Research shows that ketones prevent neurons’ ability to store glutamate, decreasing excitatory transmission. Ketones have also been shown to increase GABA levels, further enhancing the calming and neuroprotective qualities of the diet by limiting excitotoxicity.
Evidence
There are several randomized controlled studies in process on mood disorders to examine the efficacy of Ketogenic Therapy. Preliminary studies have been the backbone of hope. In a study of Type I Diabetics who were experiencing reduced mental performance due to hypoglycemia (low blood sugar), the introduction of ketones through intake of Medium Chain Triglyceride (MCT) oil were shown to restore mental performance to normal levels. In another study, a group of memory-impaired adults saw memory improvements that were associated with blood-ketone levels. Several studies also show cognition improvement and a slowing of disease progression with Alzheimer’s patients. Studies in healthy adults show improved verbal memory performance. In addition, there’s anecdotal evidence showing a link between ketosis and a feeling of wellbeing and euphoria, as well as a treatment for substance abuse.
It’s not yet known what degree of ketosis is necessary to have such beneficial brain effects. In clinical practice, some patients receive benefit from mild ketosis while others require higher ketosis for benefit. More studies are needed to assist in determining the optimal degree of ketosis and thus the ideal diet for each condition. Common to all variations in ketogenic therapies is the elimination of sugar and foods with natural sugars including sweeteners, syrups, most fruit, starchy vegetables, and milk. Sugar additives such as maltodextrin, malt, cornstarch and sugar alcohols are also eliminated. Removing these sugars from your diet can be very effective in improving your health. Ensuring that you are consuming healthy fats is an additional measure that you can take. Avocado, coconut, olive, and macadamia oils, and butter are all healthy fats; each with unique nutrition qualities. Removing sugars and incorporating healthy fats are two steps that can improve your total body health dramatically. These steps can also prepare you for a ketogenic therapy if you chose to take that route.
Learn more about keto for mental health conditions at www.metabolicmind.org
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. While a Ketogenic Diet may not be right for everyone, removing sugars, processed foods, and trans fats from one’s diet can produce similarly remarkable health outcomes for people eating a typical western diet. Our diet professionals are prepared to help you with this and other diet modalities, not just Keto.
Getting started – what is the Ketogenic Diet?
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 > 0.5 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 is the amount of calories that come from protein, carbs and fat, which are called “macronutrients”. 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. 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, too 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
Getting Started
If you think you can benefit from adopting a Ketogenic Diet, we encourage you to consult one of our nutritionists, visit a participating hospital, or contact us so that we may guide you towards the most fruitful option given your specific needs.