Keto Considerations

Every time I mention 'keto,' I brace myself for various reactions. It tends to evoke strong feelings in many individuals. To clarify my stance: I am not particularly enthusiastic about the keto craze. While I acknowledge that a ketogenic diet can be beneficial for certain neurological disorders, I don’t advocate it as a general solution. Importantly, therapy does not mean prevention. Just because keto might aid in treating a specific illness doesn’t imply it will prevent that illness in healthy people (similar to suggesting everyone undergo chemotherapy to avert cancer).

People's experiences with keto can vary. If you find that following a ketogenic diet works wonders for you and does not negatively impact your health markers, that’s fantastic. Stick with what suits you best.

Keto diets can vary significantly. Although all ketogenic diets derive a significant portion of their calories from fats, the type of fats consumed can differ. You may choose between saturated or unsaturated fats, as well as plant or animal sources. Your focus can greatly influence the diet’s outcomes.

Keto Diet for Alzheimer's

So, why consider a ketogenic diet for Alzheimer’s Disease? Research indicates that glucose metabolism in the brains of Alzheimer’s patients tends to malfunction. Due to issues related to the blood-brain barrier, glucose struggles to reach brain cells effectively, and those cells become less efficient in converting glucose into ATP (the energy currency of cells). This results in a chronic energy deficit in the brains of those affected by Alzheimer’s.

What if we offered an alternative source of energy? This is the rationale behind utilizing a ketogenic diet to potentially slow the progression of Alzheimer’s Disease by supplying the brain with ketones instead of glucose—essentially activating an emergency backup generator. Some studies also suggest that low carbohydrate intake may trigger stress proteins that help combat oxidative damage and lessen mitochondrial dysfunction, which can be beneficial for compromised brain function.

What Does the Research Indicate?

A recent review analyzed clinical and randomized controlled trials that aimed to induce ketosis through diet or supplements in individuals with Alzheimer's. It’s important to note that the number of trials is still limited, and many suffer from small sample sizes.

In trials utilizing a keto diet rich in "eggs, meats, nuts, seeds, creams, natural oils, and green vegetables," the findings include:

• Positive outcomes: While there was no significant cognitive improvement from baseline, participants reported notable enhancements in daily activities and overall quality of life, along with weight loss. Additionally, triglyceride levels mostly remained stable, and HDL cholesterol increased.
• Challenges: However, LDL and total cholesterol levels rose significantly (perhaps excessively), and some caregivers reported feeling overwhelmed by the dietary requirements to sustain ketosis, along with gastrointestinal issues.

It's worth mentioning that these studies often included just 13 to 15 participants and lasted for only a few months. Interestingly, in some cases, about half of the participants chose to continue the keto diet after the trial concluded. Overall, while it's not a miracle solution, some benefits are evident.

Keto Supplementation

Another method to introduce ketones into the bloodstream and brain is through supplements, typically ketone monoesters or medium-chain triglycerides (MCTs), which can be converted into ketones.

• Positive outcomes: These supplements have shown cognitive improvements and increased blood flow to the brain, making them less burdensome for patients and caregivers.
• Challenges: The benefits appear to be much less pronounced or even absent in individuals carrying the APOE4 gene, and some experience gastrointestinal discomfort.

Keto Diet Plus?

There are additional modifications to consider. The authors of the review emphasize the necessity of a multifaceted approach. Combining diet with exercise and cognitive training is likely to yield meaningful benefits.

This leads to the question: is it necessary to adopt a strict keto diet to experience these advantages? Perhaps not. For instance, the FINGER study (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) reported cognitive improvements without participants following a keto regimen. Instead, they engaged in an exercise program, cognitive training, and improved their diets (with 25–35% of calories from fat, 45–55% from carbohydrates, 10–20% from protein, and 23–35 grams of fiber, primarily from unsaturated fats, alongside limited alcohol and salt).

One might wonder how these participants would have fared on a keto diet alongside the same training regimen. Hopefully, future studies will explore this.

The review concludes by noting the lack of large-scale, long-term, randomized controlled trials regarding the effects of ketogenic diets on individuals at risk for or experiencing mild cognitive impairment and Alzheimer's Disease.

More research is essential, as the scientific community often reiterates. While I may reluctantly concede that ketogenic diets could have a role in this area, further investigation is crucial.

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