How Ketogenic Diets Help Fight Dementia: The Ketone Connection by Vicki Cash, RN, PhD
Originally published in the April 2013 issue of CarbSmart Magazine.
We all expect a low-carb diet to help us lose weight, improve blood pressure, blood sugar and our overall sense of well-being. What one might not expect is that changing what we eat could very well spare our brains from the ravages of dementia.
Dementia can be caused by any medical condition or injury that causes damage to brain cells. In the United States, many cases of dementia in the elderly are attributed to Alzheimer’s Disease; but there are other causes as well: Parkinson’s Disease, Huntington’s chorea, Herpes infections, HIV, stroke or other brain injury. This list is by no means exhaustive.
The scary facts are that one in eight Americans over the age of 65 already has Alzheimer’s Disease, and another person develops the disease every 68 seconds. And this doesn’t even account for the other types of dementia.
According to the Alzheimer’s Association website, Alzheimer’s Disease is now the 6th leading cause of death in the US (up 66 % in the first 8 years of this century) and, “Alzheimer’s Disease is the only cause of death among the top 10 in America without a way to prevent, cure or even slow its progression.”
That’s what the medical establishment says – once mental decline gets to the point of diagnosis, there’s no turning back. Even the pharmaceuticals that have been introduced in the last twenty years, meant to halt the progression of Alzheimer’s Disease, only work for a short time (and only in 50% of patients). These drugs give a brief respite to family members, who know that the disease will pick up where it left off once the meds stop working.
But what if the medical establishment is wrong? What if eating a lower-carb, higher-fat diet could reverse some of the symptoms of AD and perhaps even prevent brain deterioration in the first place? What if just adding a simple oil to one’s diet could stave off this horrible disease?
Insulin Resistance And Dementia
The cause of dementia is not fully understood; it may have multiple causes. Recently, researchers have discovered that a contributing factor to Alzheimer’s and other dementias is insulin resistance.
As a nurse for the last 30 years (and a diabetic for 20 years) I have a vested interest in researching the effects of diet on health. Over time, eating too many carbohydrates can cause insulin resistance, leading to fat deposition, elevated blood sugar and eventually diabetes. Recent research has shown that insulin resistance affects the Blood Brain Barrier (BBB) as well. This may play a part in the development of many types of dementia.
Insulin is a facilitator hormone. It assists the passage of glucose (blood sugar) into our cells, letting the cells use glucose for energy. This crucial hormone is secreted by the pancreas whenever we eat carbohydrates. If a person eats too many carbs (or too many refined or simple carbs) the pancreas can secrete too much insulin. Because there is so much insulin circulating in the bloodstream, the cells of the body are inundated, and stop responding. The insulin is unable to fulfill its transport duties, leaving high levels of glucose in the blood instead of allowing it into the cells where it is needed.
This lack of glucose in the body’s cells leads to fatigue, weakness, mental fogginess – sometimes even coma. High levels of glucose in the blood, on the other hand, can eventually lead to complications of diabetes – neuropathy (damage to the nerves caused by glycation and oxidation) as well as damage to small blood vessels (capillaries), sometimes leading to amputation, kidney failure or blindness.
The problem with insulin resistance in the brain is slightly different. The Blood Brain Barrier is a virtual casing of specialized cell membranes lining the capillary walls which separate the brain circulation from that of the body. The BBB is thought to be a protective mechanism, preventing unwanted substances from crossing into the brain. Insulin does not flow freely across this barrier – it requires active transport through insulin receptors. So, when there is too much insulin in the the body, the BBB senses a threat and shuts down many of these receptors, depriving the brain of insulin.
Glucose, on the other hand, does flow freely across the BBB. So, the same circumstances that lead to decreased insulin in the brain also lead to increased glucose in the brain. The cells of the brain (neurons) are then bathed in sugar-rich blood. Because of the lack of insulin, neurons cannot access glucose for energy and they start to die. In the meantime, all this excess glucose in the brain circulation causes damage to the neurons and leads to the destruction of capillaries, much as high blood sugar does in the body.
Research has shown that people with Alzheimer’s and other types of dementia, have less insulin in their brain circulation than people without dementia. Because the areas of the brain affected by Alzheimer’s have difficulty utilizing glucose (as shown in PET scans), some scientists are now referring to Alzheimer’s disease as type 3 diabetes. This is a huge clue in understanding the puzzling disease of dementia.
Ketones: An Alternative Fuel
Just as carbohydrates are broken down into simple sugar (glucose) in the body, fats or triglycerides can be broken down into smaller components called ketone bodies. Normally, if we are eating the Standard American Diet (SAD) which is high in carbohydrates, our bodies have no need to produce ketones. The fats we eat are partially processed and stored away as fat. We get most of our energy from the carbs we eat.
Unless, of course, one is insulin resistant. In that case, the normal way of eating (SAD) actually leads to a lack of energy, both in the body and the brain. It’s much like the cursed sailor in the Rime of the Ancient Mariner, adrift at sea, who was dying of thirst although he was surrounded by water. Except in this case it’s: Sugar, sugar everywhere, nor yet a molecule to use.
If, however, we strictly limit the amount of carbohydrates and proteins we eat, our bodies will go into starvation mode and release our stored fat to make ketones, which can then be used as an alternative source of energy for our cells. When this happens, we have ketone bodies floating around in our blood instead of glucose – this state of affairs is called ketosis.
The wonderful thing about ketones is that they are readily absorbed by body cells and neurons alike (without the assistance of insulin) and they cross the Blood Brain Barrier with ease. So, if we can get ketones into our brains, our neurons will not starve, no matter how insulin resistant we are.
This ability to turn stored energy into ketones is what has enabled our species to survive periods of prolonged famine or starvation. It’s a built-in mechanism that most of us never have to use because we live in a country where food is plentiful.
In the early part of the twentieth century, however, this mechanism was actually utilized by the medical community for the benefit of epilepsy patients. (Dana’s Note: It still is. See article this issue.)
Ketosis As Medicine
There was a time, before the development of anti-seizure medicines, when a ketogenic diet was the only hope for people with epilepsy. Doctors discovered that if they placed their patients in a state of ketosis, their seizures lessened dramatically and were sometimes eliminated altogether.
The protocol was very strict. Each meal had to deliver these exact proportions of nutrients: 90 percent of calories from fat, 8 percent from protein (just enough to prevent muscle wasting) and only 2 percent from carbohydrates. It was kind of a prolonged Fat Fast. As you can imagine, it was difficult to stick with. Once reliable drugs were available, most epilepsy patients opted for the meds and went off the diet.
So, short of starvation or a very strict low-carb, low-protein, high-fat diet, how does one produce ketones?
Medium Chain Triglycerides
When I was a neonatal intensive care nurse in the 1980’s, I cared for the tiniest of preemies and was amazed at how well they flourished after their respiratory problems were overcome. Once the babies were able to take nourishment, the preferred food was, of course, Mom’s breast milk. If breast milk was unavailable, our neonatologists would prescribe a special formula high in medium chain triglycerides (MCTs). Formula manufacturers added this MCT oil to their product to simulate the fat makeup of breast milk. MCT’s are not normally produced by our bodies, except during lactation. These fats have been found to be essential to the brain development of infants, and now are added to all infant formulas.
The majority of the fats & oils we eat consist mostly of long chain triglycerides. Besides being found in human breast milk and infant formulas, MCTs are found in cow and goat dairy products, palm kernel oil and coconut oil. The food with the highest concentration by far is coconut oil, with over 60% MCTs.
Unlike long-chain triglycerides, MCTs are very easy for our intestines to digest and absorb – not even needing bile or special enzymes. Once absorbed, MCTs are sent directly to the liver to be converted into ketones and released into the bloodstream, where they can travel to any part of the body (including the brain) to be used for energy.
Dr. Bruce Fife is an expert in coconut oil and advocates using this oil as part of a low-carb diet to prevent and treat dementia in all its forms. His book, Stop Alzheimer’s Now! contains thorough explanations of the myriad contributing factors to dementia, and also explains his comprehensive program for changing one’s lifestyle to maximize and retain brain function.
In her book, Alzheimer’s Disease – What If There Was a Cure? Dr. Mary T. Newport has documented her own case study of her husband Steve and the continual improvement in his Alzheimer’s symptoms after using coconut oil. In fact, major changes were documented after his very first dose – within just hours! She also has amassed many anecdotal reports from readers who have tried coconut oil and have seen improvements in not only Alzheimer’s dementia, but Parkinson’s Disease, seizure disorders, ALS and even glaucoma – without the aid of a low-carb diet. Apparently, neurons love ketones.
We think of dementia as a disease of aging, but much of the brain damage that leads to memory loss is done long before any symptoms appear. Prevention is key. There are currently over 5 million Americans living with the diagnosis of Alzheimer’s Disease. The Alzheimer’s Association projects that by the year 2050, that number will increase to 16 million.
This is a dire prediction. You, as an individual, cannot alter the diets of all Americans at risk for AD, but you can saute some green beans in coconut oil for your family members and keep the carbs to a minimum. Their brains will thank you.
Alzheimer’s Association. 2012 Alzheimer’s disease facts and figures.Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association. March 2012; 8:131–168.
“Stop Alzheimer’s Now!” by Bruce Fife, ND
“Alzheimer’s Disease – What If There Was a Cure?” by Mary T. Newport, MD