Diet
Therapeutic Ketogenic Diet For Neuroprotection
Ever taken a trip to the grocery store only to forget why you went there in the first place? Or perhaps you have difficulty concentrating on something you usually enjoy, like reading a book. In either of these cases, you usually don’t feel as if your brain is working normally.
Sound familiar?
Well, I’m here to tell you not to lose hope.
There are ways in which conventional Western medicine is letting us all down. The idea of losing cognitive functions, your memory becoming poorer, or even not being able to recognize the faces of your family, is all pretty scary. Every 65 seconds a patient in the US develops Alzheimer’s disease and there’s no magic pill that cures it.
Fortunately, there’s another way.
As a functional and integrative doctor, I find the issue of cognitive decline to be on my mind regularly. My patients are concerned that they won’t be able to work, socialize, or enjoy hobbies for much longer. They even worry that they’ll have to give up on life.
However, I’m able to help them treat their neurodegenerative progression from the inside. By adopting the ketogenic diet for neurological diseases, you can change your life and turn back the clock.
Dr. Dale Bredesen’s extensive research and treatments have shown that the effects of Alzheimer’s disease can be reversed with simple lifestyle changes. A modified version of the ketogenic diet is the backbone of Dr. Bredesen’s protocol and the science behind this is truly incredible.
While the ketogenic diet is currently very popular due to its fast and effective results related to weight loss, the diet actually started out as a medical therapy in the 1920s.
Doctors saw that fasting was beneficial regarding controlling seizures in epileptic children, but restricting food was not a sustainable solution in the long term.
The doctors reasoned that when you fast, your levels of glucose and insulin drop and ketone bodies appear in your blood and urine. Ketone bodies indicate fat breakdown, so the doctors realized that a high-fat diet could build up levels of ketones that were sufficient enough to mimic the benefits of fasting, thus reducing their young patients’ seizures.
Epileptic children who were prescribed the ketogenic diet did indeed stop seizing. However, the ketogenic diet never became a popularized form of therapy for epilepsy once anticonvulsant drugs were fully researched and then put into production.
The therapeutic ketogenic diet effects were only really rediscovered towards the end of the twentieth century. Many parents of epileptic children that were frustrated with the severe side effects of anticonvulsant drugs, and worried about the impact of seizures on their child’s cognitive abilities, did their research and decided that inducing ketosis through a diet in children was something that they’d like to try.
While the ketogenic diet isn’t the first option that medical practitioners explore when treating children with epilepsy, it has garnered more interest in the medical community as new and exciting applications have been discovered and research is increasingly being undertaken into the neuroprotective characteristics of the low-carbohydrate diet.
It’s important to realize that ketosis isn’t an unusual state for human beings. Infants are naturally in ketosis much of the time, since breast milk is high in medium chain triglycerides or MCT.
We are naturally in ketosis during sleep, fasting and exercise as the body and brain have become accustomed to metabolic flexibility, shifting between glucose and ketones as fuel sources when the need arises.
As human beings become more sedentary and accustomed to eating three meals a day with snacks, often well into the night, these diurnal and seasonal changes became a thing of the past.
Following the ketogenic diet in the treatment is often a game changer for patients suffering from:
You’ll learn more about each of these subjects below.
The ketogenic lifestyle is also a fantastic solution for healthy individuals who wish to avoid neurodegenerative disease or cognitive dysfunction.
The only good way to ensure better health when you’re older is to take action today. Even if you have the APOE4 gene, meaning that you’re more susceptible to developing Alzheimer’s, or have a formal diagnosis, you can benefit from the effect of ketogenic diet. It’s never too late to start.
There are a number of ways in which an effect of a ketogenic diet can protect your brain and even reverse neurodegenerative disease. By severely restricting your carbohydrate intake, reducing protein, exercising regularly, and increasing your consumption of good fats, you encourage your body to look for an alternative energy source to sugars and carbohydrates.
If you eat to a calorie deficit, your body begins breaking down fat stores and inducing a state known as ketosis. The brain prefers ketones to glucose as they cross the blood-brain barrier much easier since they don’t rely on transport proteins.
They also produce less in the way of free radicals or oxidative damage, the key biochemical process underlying most forms of chronic disease including neuroinflammation and neurodegeneration.
However, if you’re eating to maintain your existing weight, the fat is supplied purely through your diet.
Most of your body can use the fat stores or dietary fat to power your cells. However, your brain and the central nervous system can’t access this energy in the same way. As a result, your liver breaks down the fatty acids and a by-product of this chemical process are ketones. These are your body’s alternative energy source.
Ketones are made up of acetone, acetoacetate, and beta-hydroxybutyrate.
Ketone bodies are capable of crossing the blood-brain barrier and are the only source of energy the brain can use that can replace glucose made from carbohydrates.
As such, ketones can fuel up to 75% of the energy needed by your brain. The other 25% or more of your energy continues to be fueled by glucose, but it’s glucose that’s made by your body from the few carbs that you do eat and also by your protein sources.
Ketones are an amazing form of energy for your body and have a host of benefits for your metabolism and health.
Concentrating on neuroprotection, here’s a list of ketosis brain benefits:
Normally, the insulin hormone is produced by the pancreas. Insulin joins your bloodstream to regulate the amount of glucose in your blood.
In a healthy individual, when the insulin detects too much glucose in your blood, it signals muscles, tissues, and your liver to absorb the glucose.
The glucose is then converted into ATP, ready to be used as cellular energy or broken down by your liver. The levels of glucose in your bloodstream need to be controlled because they can be toxic at high levels.
When you have insulin resistance, which is often a precursor to diabetes, your body ignores or resists the insulin signal to absorb glucose.
The levels of glucose build up and your pancreas creates more and more insulin in order to trigger glucose regulation.
Obviously, any condition that may lead to diabetes is a concern, but insulin resistance also has an impact on your neurological health. Sugar is a known inflammatory and inflammation can disrupt the careful balance of your blood-brain barrier.
More crucially, insulin is a signaller that aids neural cell survival. If there are high levels of insulin in your bloodstream, the amount of insulin should be reduced and your body needs several enzymes to break it down.
One enzyme called insulin-degrading enzyme (IDE) can break down insulin.
However, if it’s responsible for working on an overabundance of insulin, the enzyme can’t be used to degrade amyloid beta. Amyloid beta in the brain contributes to Alzheimer’s disease.
However, if you increase your insulin sensitivity, it’s possible to reduce your chances of developing Alzheimer’s disease.
Ketones also modulate your neurons by reducing glutamate toxicity and inhibiting gamma-aminobutyric acidergic (GABAergic) effects, limiting seizures if you’re epileptic.
In integrative and functional medicine approaches, it’s understood just how important the health of the gut is in relation to achieving optimal overall health.
Understanding the connection between your brain and your gut microbiome is crucial to maximizing the neuroprotective conditions of the ketogenic diet.
Sugar causes inflammation and can trigger conditions such as leaky gut. Eating whole foods and reducing your carbohydrates and processed food intake helps to heal your gut. Improving your gut microbiome actually improves your cognitive abilities as well
A lower-carb diet, such as the ketogenic diet, may help reduce your symptoms of sleep apnea or other sleep airway disorders. Quaelity of sleep and deep REM sleep are crucial for keeping your brain healthy.
An airway sleeping disorder usually results in your brain not receiving enough oxygen at night. The effect of a lack of oxygen is that your brain can’t fall into a deeper sleep and your brain is unable to perform certain neuroprotective tasks, such as autophagy where old cell components are recycled.
The recent discovery of the glymphatic system in the brain is of great interest to researchers examining neurodegenerative diseases.
The glymphatic system only works while you’re asleep and removes excess fluid and waste products from the brain and spinal column tissues.
Amyloid beta proteins are a form of waste in the brain that the glymphatic system deals with. Links have been established between these proteins, your cholesterol levels, and the lymphatic system in regard to neurodegenerative diseases.
The glymphatic system also delivers central building block nutrients, some of which are used in improving your cognitive functions. Unfortunately, with sleep apnoea your body is unable to undertake these functions, leading to neurodegeneration.
Macronutrients are another term for the basic food groups:
Both the standard American diet and calorie restrictive low-fat diet are heavily slanted toward the consumption of carbohydrates.
In the ketogenic diet, the values are flipped on their head. On the keto diet, you aim for a high-fat intake, medium to low amounts of protein, and low levels of carbohydrates.
A good rule of thumb is to not eat foods with a glycemic index of more than 35. Here is a link to a food glycemic index database that should be useful.
The original ketogenic diet for epileptic children focused on a 4:1 ratio, or four parts fat to one part carbohydrates and protein. However, this is at the extreme end of the ketogenic diet and is usually too difficult to attempt at home.
Generally, you should aim for your intake to be:
Use a quality online ketogenic calculator to adjust your macros. This one has options for eating to maintain weight, lose weight, or gain weight.
To track whether your body is in the state of ketosis that’s creating ketones and using them as your body’s main source of energy, it’s advisable that you invest in a good ketone and glucose meter.
By using it, you can keep an eye on what foods your body responds to after a meal. Tracking your ketones through beta-hydroxybutyrate levels in your blood is the most accurate way to keep tabs on whether you’re in ketosis. Unfortunately, ketone breathalyzers or keto sticks aren’t accurate enough to be reliable.
Although an outsider may think the mainstream version of the ketogenic diet is mostly made up of bacon, the focus is actually on plant-based foods to promote the diet’s neuroprotective benefits.
While it’s true that many vegetables contain high amounts of carbohydrates, these are usually tempered by fiber and the resistant starches that are found in complex carbohydrates.
Your body has a harder time breaking down complex carbohydrates, so they don’t raise your glycemic index so sharply.
Simple carbohydrates, on the other hand, are sugars or carbohydrates that break down easily into glucose.
Here’s a guide to vegetables and fruit on a ketogenic diet for neuroprotection:
The majority of the diet should consist of organic, non-GMO, seasonal, local, colorful, deeply pigmented non-starchy vegetables with a limited amount of starchy vegetables.
Cruciferous vegetables – These contain sulfur, an important building block for production of amino acids, especially glutathione, which is the main brain antioxidant.
These types of vegetables are ideally consumed after being lightly sautéed at medium heat or lightly steamed.
Leafy green vegetables – These are at the top of the list for the ketogenic diet. They contain high levels of nutrients beneficial to your brain health, such as vitamins, minerals, polyphenols, carotenoids.
Mushrooms – These contain sulfur and beta-D-glucan, which may help the reversal of cognitive decline through immune enhancing effects. There are many varieties, including Portobello, shitake, reishi, oyster, and white button mushrooms. Add them to sauces, stews, and for flavour when cooking other vegetables.
Resistant starches – The good bacteria in your gut microbiome can feast on resistant starches and fibre and they excrete short-chain fatty acids crucial for your wellbeing.
Herbs and spices – These contain antiviral and antimicrobial properties and are an essential part of a ketogenic diet. This extensive list includes ginger, turmeric, basil, bay leave, chives, cilantro cinnamon, coriander, cumin, lavender, marjoram, mint, oregano, parsley, rosemary, saffron, sage, thyme and more. Herbs and spices have been widely studied to determine their medicinal properties.
Nuts and Seeds – These are rich in vital brain protective nutrients and contain excellent sources of fat, protein, vitamins, minerals, and fibre. These should be raw, fresh, organic, and soaked if possible, thus reducing lectins and phytates. Use dry, roasted nuts where possible if you’re unable to roast them yourself. Roast at low temperatures (77-104 degrees C) while frequently turning the nuts during the process. Nuts that have already been roasted in added oils are usually rancid and oxidized, increasing the risk of inflammation. All nuts and seeds should be stored in the freezer or refrigerator to retain maximum freshness.
Starchy vegetables
Nightshades – These inflammatory vegetables contain solanine, a toxin that plants produce to deter animals from eating them. Solanine can stimulate the acetylcholine neurotransmitter in your brain and nervous system. For most people, this is of no concern, but for a patient facing early-onset Alzheimer’s disease, an imbalance in neurotransmitters can complicate matters.
Legumes – Eat these with caution as legumes can raise glucose levels in the blood and shouldn’t be eaten in the early weeks of adopting the ketogenic diet. Depending on the severity of your insulin resistance, you may not be able to eat them.
Fruits – Small berries contain polyphenol compounds that can play a role in reducing cognitive decline:
You may find it easy to go overboard with animal-based protein when beginning the ketogenic diet, but it’s crucial to calculate your daily allowance of protein.
It’s advisable to employ the one gram of protein for each kg of your weight equation. For example, if you weigh 80kg you can consume up to 80g of protein per day.
Eating protein to excess ensures that some protein is converted to glucose, increasing the levels of insulin in your bloodstream.
Think of your controlled amount of protein in the same way as when your ancestors would share a part of the communal hunting kill, only eating a small part of the animal. The rest of the time it was possible to get enough protein through plant-based food sources and this remains true today.
As much as possible, ensure that the protein you eat is organic, grass fed, grass finished, hormone and antibiotic free, and that the animals are not subjected to the stresses and toxins of concentrated feeding operations.
To prevent muscle wasting, ensure weight training and weight bearing exercises are incorporated into your routine.
On a neuroprotective ketogenic diet, vegetarians need to get their protein from vegetables, nuts, seeds, tempeh, and beans. However, these are often incomplete proteins and vegetarians will need to supplement with omega-3’s, vitamin B’s, Vitamin D, and choline.
Oily fish – These are rich in Omega-3 and Omega-6 and both are excellent for brain health. Farmed fish or shrimp should be avoided.
The least contaminated fish, which are smaller and don’t live as long, are known as the SMASH fish.
Free range eggs – These are full of protein and good fats, especially choline, which is a key nutrient for acetylcholine, the main neurotransmitter for memory. However, eggs can trigger a histamine response so caution may be warranted. A list of foods high in histamine and possible substitutes may be found here.
Processed meats often contain hidden sugars, histamine, wheat, gluten, and other inflammatory ingredients.
Fish containing high levels of mercury, since this is known to cause cognitive decline.
Dairy can be highly inflammatory as the lectin in dairy can irritate the gut, so dairy should be avoided as much as possible.
Alcohol is a known neurotoxicant and solvent and should be avoided, especially if you have the APOE4 gene.
Alcohol will slow down fat loss in those patients that use the ketogenic diet for weight loss reasons.
Many alcohol drinks such as beer, wine, cocktails, mixers, and flavoured liquors contain carbohydrates. Alcohol is ethanol, which is easily broken down into sugar.
Peanuts are a legume known to be moldy and inflammatory. If you’ve been exposed to mold, download my mold exposure guide here.
Although the ketogenic diet is high in fat, not all fats are created equally.
Developing an awareness of the different varieties of fat and what foods are good sources of fat ensures that you’ll find it easier to maintain the neuroprotective ketogenic diet in the long term.
Monounsaturated fatty acids (MFUA)
Polyunsaturated fatty acids (PUFA) that include Omega-3 and Omega-6.
Saturated fatty acids (SFA)
Cocoa butter and nuts
Trans fats and synthetic hydrogenated fats result in raised low-density lipoprotein (LDL) cholesterol levels.
High levels of LDL cholesterol can occur at the onset of Alzheimer’s disease in middle age.
With regards to fatty acid intake, it’s best not to engage in a guessing game regarding which fats you need in what ratios. It’s advisable to conduct the Kennedy Krieger fatty acids analysis through a company called Body Bio.
In this way, your exact fatty acid dietary deficiencies and excesses can be measured and managed effectively through the correct ratios of biologically active fats, either through food, cooking, or supplementation.
Phosphatidyl choline is an essential fat for cardiovascular, mitochondrial, and cognitive health and the levels are best measured before embarking on an extensive therapeutic fatty acid regime.
People with the ApoE4 gene need to be cautious when using increased amounts of saturated fats, as these are known to raise LDL particle number and APOB, a lipoprotein associated with increased cardiovascular disease.
Although the increased saturated fats may increase cognitive health, in the long term it may lead to increased cardiovascular risk factors that are not beneficial. Therefore, it is advised that one monitors one’s cardiovascular risk factors including but not limited to APOB, oxidised LDL, LDL particle number and size, and HDL particle number and size.
Increased saturated fats are known to lower triglycerides, increase HDL, and shift LDL particle size from the smaller dangerous particle size to the more advantageous larger ‘fluffy’ type, which is known to be cardioprotective.
The way you cook your food is almost as important as the food you choose to eat. Many everyday methods of cooking food can result in advanced glycation end products (AGE).
These glycotoxins are produced when there’s a reaction between protein or fat and sugars, so AGEs can instigate inflammation and are bad news for brain health.
Methods To Use:
Methods to avoid:
Fats to cook with:
GRAINS AND GLUTEN
Grains are dense in carbohydrates, contain lectins that are known to be associated with ‘leaky gut’, phytates, and enzyme inhibitors. Gluten is a known inflammatory agent, especially when it provokes an autoimmune inflammatory response to brain proteins such as myelin and tubulin. Foods to avoid include:
DAIRY
Dairy foods are inflammatory particularly as the dairy cows in the United States are A1 cows that produce a protein similar to lectin. A2 cows do not contain these lectins. Furthermore, casein and whey, the two milk proteins, are frequently cross-reactive with gluten.
SUGARY OR CARBOHYDRATE LADEN FOOD
The glycemic index is too high with these types of foods:
PROCESSED FOODS
FRUIT WITH HIGH GLYCEMIC INDEX
Food Intolerances and allergies – All patients that are using the ketogenic diet for cognitive health should be extensively tested for food sensitivities, gut ecology and permeability, leaky blood brain, and antibodies to brain proteins (detected using Cyrex labs 2, 10x, 12 and 20).
This diet is typically recommended for most people and is very effective. The diet focuses on high consumption of:
Keep in mind that there’s no set limit to the fat because energy requirements vary from person to person, depending on their daily physical activities.
The majority of your calories still need to come from fats and you still need to limit your consumption of carbohydrates and protein for your diet to become a standard ketogenic one.
This is generally geared towards fitness enthusiasts. In this approach, you eat the entirety of your allocated carbohydrates for the day in one meal, around 30 to 60 minutes before engaging in exercise.
With this modified ketogenic diet the idea is to use the energy provided by the carbohydrates effectively before it disrupts ketosis.
You eat carbs that are easily digestible with a high glycemic index to avoid upsetting your stomach.
When you’re done exercising, increase your intake of protein to help with muscle recovery then continue consuming your fats afterward.
This one is generally focused more on athletes and body builders
Cycling between a normal ketogenic diet, followed by a set number of days of high carbohydrate consumption, also known as “carbo-loading”
The diet takes advantage of the carbohydrates to replenish the glycogen lost from your muscles during athletic activity or working out.
This usually consists of five days of SKD, followed by two days of carb-loading.
During the ketogenic cycle, carbohydrate consumption is around 50 grams, but when you reach the carb-loading cycle, the amount jumps to 450-600 grams.
This method isn’t recommended for people that don’t have a high rate of physical activity.
This method is a variant of SKD, in which you increase the ratio of protein consumption to 10% and reduce your healthy fat consumption by 10%.
In a study involving obese men that tried this method, researchers noted that it helped reduce their hunger and lowered their food intake significantly, resulting in weight loss.
If you’re overweight or obese, this diet may help you initially, before you can transition to SKD after you normalize your weight.
As mentioned earlier, ketogenic diet can be an effective weapon against cancer. For this method to be effective, you need to be on a restricted ketogenic diet for the treatment.
By restricting your carbohydrate and calorie intake, your body loses glycogen and starts producing the ketones that your healthy cells can use as energy. Cancer cells are unable to use these ketones and starve to death.
Please note that the above ratios would be determined based on a fatty acid test
Fasting and exercising aren’t optional when undergoing the ketogenic diet for neuroprotection. The good news is that neither has to be conducted to the extreme on order to get results.
Fasting is an effective way to stimulate ketogenesis, the process that produces ketones. Fasting also enables autophagy, as discussed above in the section about sleeping. Autophagy is an advantageous function that removes damaged proteins from the brain, protecting it from a dangerous build-up. Fasting has also been shown to have a number of other health benefits, including improved cardiovascular health, reduced cancer risk, increasing longevity (by increasing the sirtuin gene) and repairing damaged DNA.
Here are the easiest ways to incorporate fasting into your daily routine, without feeling like you’re missing out or that you’re going to be hungry:
Remember that once you are fully in ketosis you won’t experience hunger pangs in the same way. In fact, you may be able to go even longer between meals.
Exercise is crucial for neuroprotection as it helps reduce insulin resistance, aids ketosis, and reduces stress.
A combination of aerobic exercise and weight training can improve your sleep at night via vascular function in your brain and protect the hippocampus, which can often shrink in those suffering with Alzheimer’s disease. Start slowly and build your way up to a full program of activity.
Individuals with insulin resistance may have a harder time inducing ketosis and may suffer from carbohydrate cravings.
Ask your doctor to measure your insulin, fasting glucose, and hemoglobin A1c levels. HbA1c is a measurement of your average glucose levels over three months. Using high dose medium chain triglyceride fats (MCT) or coconut fats assists in helping you overcome sugar cravings and glycotoxicity.
One has to increase these fats slowly and use fat digesting enzymes containing lipase and emulsification aids such as ox-bile to initially assist in the increased fat load.
Another way to combat the initial sugar cravings is to increase fats in your diet such as nuts and seeds, avocado, or non-starchy vegetables cooked in ghee, coconut, or avocado oil.
As mentioned above in the section about the mind-gut connection, your brain and gut have a special relationship.
In order to achieve neuroprotection, it’s necessary to heal your gut by encouraging your good bacteria to take charge. The best way to improve your gut microbiome is to take probiotics and prebiotics.
Probiotics contain the good bacteria that are able to take carbohydrates and convert them into lactic acid, which suppresses your bad bacteria.
Probiotic should be used with caution if histaminic but include:
Prebiotics comprise food that’s indigestible for you, but it can be digested in your colon by your good bacteria.
The bacteria break probiotics down into materials that aid the maintenance of your gut. Many of the resistant starches and fibrous plants listed above count as prebiotics.
Here are a few further examples of prebiotic supplements:
When you begin the ketogenic diet it takes a few days to achieve ketosis.
In the meantime, you may experience some side effects, often referred to as ‘keto-flu’ by some people. With this condition, patients often experience:
All of these symptoms are perfectly normal, considering that you’re detoxing from sugar, training your body to run off ketones, and often experiencing the loss of electrolytes and dehydration.
However, there are ways to combat this as follows:
You’ll discover that following the ketogenic diet is extremely rewarding because you’ll begin to feel some benefits within weeks.
However, it may take at least six months to begin to feel the full advantages when attempting to reverse cognitive decline.
The modified ketogenic diet to improve neuroprotection is a powerful tool in your quest for optimal health. Too often we treat the symptoms of disease when we could have headed off the condition years or decades earlier.
Your body is amazing and can reverse the impact of poor diet, stress, and sometimes even genetics if you make the necessary changes.
What do you have to lose !
Schedule an appointment at the Hoffman Centre For Integrative and Functional Medicine and get started with the ketogenic diet today.
