Ketogenic Blog Series Part III
Part III - Benefits of the Ketogenic Diet for Disease and Health
Welcome to part three of our ketogenic blog series!
Just to review what we've already covered:
In part one of this series, we covered an overview of the ketogenic diet.
Part two looked at the various applications of the ketogenic diet in regards to cancer.
Today, we're wrapping it up by taking a glance at how the ketogenic diet has been used by healthcare practitioners to have an effect on other conditions as well as how already healthy people are benefiting from going keto.
To be fair, I can't talk about every condition and how the ketogenic diet affects them, because there's a lot. Instead, we're going to narrow this down to a few key areas where studies, as well as our experience, have shown that there are some distinct benefits.
The ketogenic diet was originally used as a therapy to treat epilepsy in the 1920’s. With about 100 years of applied evidence, we can say that ketones absolutely have an effect on the brain.
While the exact anti-seizure mechanism of the ketogenic diet has not been elucidated, there are several proposed mechanisms that could indicate why ketones have direct anti-convulsant effects, including the facts that:
Ketones decrease neuronal excitability
Ketones increase ATP levels
Ketones increase mitochondrial biogenesis
Ketones affect neurotransmitter signaling (2).
Research into the neurological benefits of a ketogenic diet has skyrocketed in the past few years. Scientists are finding that there are many clinical applications when it comes to the ketogenic diet and brain health.
One area of research that's generating a lot of interest is the effect that the ketogenic diet has on people with neurodegenerative diseases.
We're talking about diseases like Parkinson’s, Alzheimer’s, ALS, and dementia; so in my opinion, it's a pretty big deal.
Preliminary research has been very promising in that it's shown that a ketogenic diet can improve outcomes, and in some cases halt the progression of these diseases.
One aspect that many neurological disorders have in common is impaired or abnormal cellular energy utilization (1). This can occur for a multitude of reasons, but enhanced oxidative stress is a common thread underlying many of these disorders.
Parkinson’s disease affects 53 million people across the globe and results in 100,000 deaths yearly (4). The disease develops due to nerve cell damage/death in a part of the brain called the substantia nigra. This area of the brain is responsible for producing dopamine, an important neurotransmitter involved in controlling voluntary movements, mood, addiction and stress (4).
As the number of cells in the substantia nigra is decreased, less dopamine is produced, leading to the common symptoms associated Parkinson’s disease.
Again, we need to underline that the cause of Parkinson’s disease is not currently known. The leading theory, however, is that Parkinson’s disease develops due to damaged mitochondria (3).
While mitochondria are commonly referred to as the powerhouses of the cell, that isn't their only function.
Mitochondria are involved in the production of something called reactive oxygen species (ROS). ROS serves many purposes, such as cell signaling. If mitochondria are damaged, they can overproduce ROS leading to increased levels of oxidation and cause DNA damage and eventually cell death. This overproduction of ROS by damaged mitochondria is one theorized cause of Parkinson’s disease (3).
Research supporting this theory shows that when mice are exposed to the chemical MPTP, which inhibits mitochondrial energy production, cells in their substantia nigra die (6). Furthermore, individuals with Parkinson’s have been found to have impaired glucose metabolism in their brain along with increased inflammation, both of which indicate mitochondrial damage (5).
Ketones may help those suffering from Parkinson’s by:
Protecting neurons from oxidative stress
Decreasing neural inflammation
Improving insulin signaling, and
Increasing the formation of new mitochondria in the brain (Kashiwaya et al., 2000).
When mice were supplemented with ketones before being exposed to MPTP their motor function was restored (6). This indicates that ketones can bypass damaged mitochondrial pathways and help to maintain normal energy production in the brain (10).
One human study looked at 7 individuals with Parkinson’s who were put on a ketogenic diet (9). The five patients who completed the study saw a drastic improvement in their Unified Parkinson's Disease Rating Scale scores after just 28 days (UPDRS) (9).
In certain circles, Alzheimer’s is colloquially called type 3 diabetes or diabetes of the brain.
It has been found that individuals with Type II diabetes are 10x more likely to develop Alzheimer’s disease (AD) (8). The rates of both Type II diabetes and AD have greatly increased in the last century. The impact of this on our society and healthcare system is staggering. Research shows that those with AD have impaired neural glucose utilization (12).
The hallmark of AD is the build-up of amyloid plaques in the brain.
Recent research has found that the build-up of amyloid plaques is due to insulin resistance (7). It is well known that a ketogenic diet can reverse insulin resistance. What is less well know is the brain can function normally on a ketogenic diet (Castellano et al, 2015). It has also been found that the brains of people with AD, who have impaired glucose utilization, can fully utilize ketones (Castellano et al. 2015).
This is an exciting finding because that means we can provide an alternative fuel source for people with AD and can potentially halt the progression of the disease.
One study showed just that.
Individuals with mild-moderate Alzheimer’s were placed on a ketogenic diet for 90 days (11). At the end of 90 days, there was a significant improvement in symptoms.
Traumatic Brain Injury
If you've followed sports in the past 10 years you probably know the controversy around concussions.
Multiple concussion can lead to what is known as a traumatic brain injury or TBI. Multiple TBI’s may lead to chronic traumatic encephalopathy(CTE). Individuals suffering from CTE display many symptoms similar to that of Alzheimer’s disease. In fact, the brains of individuals with CTE contain those same amyloid plaques that we discussed moments ago. It has been found that brains affected by TBI have an increased need for glucose but have a decreased ability to use it (13).
The ketogenic diet may help treat TBI’s by:
Improving mitochondrial function
Decreasing ROS in the brain
Lowering neural inflammation, and
Decreasing cellular death
In fact, it has been found that after a TBI the number of ketone transporters is upregulated in the brain indicating that ketones may be the brains preferred fuel source after a TBI (14).
It is estimated that between 10-15% of the world's population suffer from migraines. Migraines are the 3rd most prevalent illness in the world and 6th most disabling according to the Migraine research foundation. If you're someone who struggles with migraines, you know first hand how powerfully they can impact your life.
Current treatments are effective in only around half the patients (15).
The cause of migraines is currently unknown, however, it has been hypothesized that neuronal excitability, neurotransmitter dysregulation, inflammation, and mitochondrial dysfunction may play roles.
Research shows a ketogenic diet may be an effective tool to treat migraines. In one study, eighteen migraine sufferers were placed on a ketogenic diet for one month (15). After that one month on the ketogenic diet, there was a significant decrease in the intensity, as well as the duration of the migraines that those individuals experienced (15). The same researchers also related that two twins, both suffering from migraines who were placed on a ketogenic diet saw significant improvements as well (16).
Again, the ketogenic diet may not be a cure for headaches and migraines, however, studies are indicating that it might be employed as an effective piece in a larger treatment plan.
As I said at the beginning, we can't touch on everything that the ketogenic diet is good for, but as you can see, there's a lot of research and interest in using the ketogenic diet in connection with neurological disorder treatment plans.
Presently, there is ongoing research looking at the effects of a ketogenic diet on multiple sclerosis, schizophrenia, autism, ALS, Huntington’s disease, PTSD, ADHD, depression, anxiety and other mood and behavioral disorders.
SPECIAL NOTE: Individuals with a neurological disorder will most likely be on multiple medications. We recommend that anyone wishing to start a ketogenic diet first see a healthcare professional trained in the ketogenic diet to make sure it is safe for them. Your medications and supplements may need to be modified when on the diet, which is why we recommend checking in with your doctor regularly.
Research is beginning to show just how beneficial the ketogenic diet can be with regards to metabolic disorders, and in some instances, the results are staggering.
Type II Diabetes
The first post in the series explained the pathophysiological mechanisms of diabetes, so I won't go into detail here. As a quick refresher though, the key concept is insulin resistance leading to pancreatic failure.
Therefore, the key to treating Type II diabetes is glucose control, which leads to insulin control which protects the pancreas.
The ketogenic diet, when used as part of a doctor monitored treatment plan, can be incredibly effective at controlling blood glucose levels.
One thing to note it that diabetics are commonly on numerous medications. Some diabetic medications are incompatible with a ketogenic diet. It is critical that you are monitored by a doctor while on a ketogenic diet.
It's estimated that 10% of the US population has diabetes and that 33% of the US population has pre-diabetes (17). As a society, we need to act, and there is no better place to start than our dinner plates.
Studies looking at the effects of a ketogenic diet on type II diabetes are, in my opinion, nothing short of astounding.
One study placed obese diabetic men on a low carbohydrate ketogenic diet for 14 days (19). At the end of the 14 days the men had normalized blood glucose levels, their HgbA1C fell from 7.3% to 6.8% and their insulin sensitivity improved by 75% (19).
Another study placed 28 obese, type II diabetic, men on a ketogenic diet for 16 weeks (18). At the end of 16 weeks, insulin was discontinued in 7 men, decreased in 10 and unchanged in 4 other (18). Additionally, HgbA1C fell by 16% and triglycerides fell by 42% of participants (18).
Needless to say, we've seen these results first hand, and we agree that the ketogenic diet can be a powerful tool to use when our patient's circumstances indicate it.
Polycystic Ovarian Syndrome
Polycystic ovarian syndrome (PCOS) is the most common cause of infertility in women (20).
Symptoms of PCOS include obesity, insulin resistance, increased androgen levels, infertility and ovulatory dysfunction (20).
The syndrome disproportionately affects obese women compared to lean women (80% vs 20%)(20). One study looking at CPOS placed 11 women with PCOS on a ketogenic diet for 24 weeks (25). Five women completed the study and were found to have a 12% reduction in body weight, 22% decrease in testosterone levels and a 54% reduction in insulin levels (25). Two women who previously were unable to conceive became pregnant during the study (25).
In part two of this series, I talked about how a ketogenic diet may result in a decrease in caloric consumption. I want to expand on this a little more thoroughly. A ketogenic diet can lead to weight loss through multiple mechanisms including:
Ketogenic diets typically contain more protein than a standard American diet. Protein has been found to be more satiating than other micronutrients (24)
The ketogenic diet has profound effects on hormone and nutrient levels responsible for appetite (23). This is not well understood and is an active area of research
Ketone bodies may play a direct role in appetite suppression (Johnstone et al., 2008)
Eating a high-fat diet leads to the increased burning of fat while at rest (22)
A ketogenic diet reduces the amount of fat stored and increases the amount of fat burned in the body (21)
Consuming a higher protein diet leads to increased metabolism via thermic effects (26).
There are numerous studies showing that a low carbohydrate/ ketogenic diet can lead to substantial weight loss.
Like me, most of you were probably raised to believe that it was fat intake that predominantly caused heart disease. In fact, it has been found that dietary cholesterol has little impact on blood cholesterol levels (Fernandez, 2012). With that in mind, you can rest easy and keep eating your butter and steak (in moderation of course), knowing that in the past few years this has been widely debunked in the scientific literature. In fact, the research that started this myth was dubious in the first place!
In part 1 of this blog series, I detailed how a ketogenic diet increases HDL, decreases VLDL, decreases LDL concentration, and increases LDL particle size. It has also been found that a ketogenic diet can drastically lower triglycerides (28)(30). Compared to a low-fat diet, a low-carbohydrate diet has been found to better improve lipid profiles (29). In fact, numerous research studies have shown that high carbohydrate consumption leads to elevated blood triglyceride levels (Parks et al., 2001).
Large-scale studies still need to be performed, however, it appears that a high-fat diet may be more heart-healthy than a high carbohydrate diet!
Once again if you are taking medication for cardiovascular disease your dosages may need to be adjusted while on a ketogenic diet. Therefore, it is important to speak with your physician before starting the diet.
The Ketogenic Diet and Healthy People
So far, we've talked about how the ketogenic diet interacts with various specific illnesses and conditions, but let's talk a little bit about why even healthy people have taken an interest in going keto. After all, even though the ketogenic diet has a lot of potential for disease management, most of the recent upsurge in interest in the ketogenic diet is being driven by healthy adults.
In fact, one particularly passionate group of individuals who champion a low carb/ketogenic diet are athletes.
Exercise and performance
What do basketball, mixed martial arts, gymnastics, cycling, endurance running, bodybuilding have in common?
Athletes in each of those separate sports are trying out low carb/ketogenic diets and seeing benefits in their performance.
It's estimated that the average person has around 2000 calories stored as glycogen in their muscles and liver. Whereas even lean people have around 40,000 calories stored as fat.
As an athlete, it would be advantageous to be able to tap into this immense source of caloric power. There is a long-standing myth in athletic circles that carbs are king. However, the paradigm is changing, and the fat-fueled athlete is looking like a serious contender.
Many of the past studies looking at performance and the ketogenic diet have been short term.
The problem with short-term studies of athletic performance on the ketogenic diet is that it takes time for your body to switch from burning glucose to burning fat. During this transition time, performance may decrease; and it was within this transition timeframe that many studies in the past were performed.
Fortunately, there have been many high-quality studies in the past few years that took a longer look, and the results have revolutionized sports medicine.
In 2016 Dr. Jeff Volek studied 20 ultra-marathon runners and Ironman athletes (31). Ten were placed on a high-carbohydrate diet and ten were placed on a high-fat diet for an average of 20 months (31). At the end of 20 months, individuals ran for 3 hours at 65% VO2 max (31). The results showed that the high-fat group burned fat at a rate 2.3x higher than the high carb group and both groups had similar levels of muscle glycogen at the end of the 3 hours (31).
This study was extraordinary on two accounts.
One is that it showed that fat adapted individuals can burn fat at rates previously believed impossible.
Two is that it showed that high-fat diets don’t negatively impact glycogen stores.
Another study looked at gymnasts on a ketogenic diet. The results showed that once the gymnasts became fat adapted, not only did their performance not decrease, but they had improved body composition (32).
Powerlifters placed on a ketogenic diet for 8 weeks had improved body composition and improved their strength (Chatteron et al, 2017).
Another study looked at athletes performing cross training on a ketogenic diet for 12 weeks (34). At the end of 12 weeks, the athletes on the ketogenic diet had lost more fat mass without a decrease in muscle mass or performance (34).
We understand that a ketogenic diet is not for everyone. As an athlete, you need a personalized plan that helps you meet your goals. That plan may include a higher amount of carbohydrates. That being said, recent studies have honestly raised awareness that a ketogenic diet is a viable choice in performance athletics.
Aging and Longevity
After all the health benefits that we have discussed in this blog series, is it a surprise that a ketogenic diet may be beneficial when it comes to aging and longevity?
This section gets a little speculative because no one has been doing a ketogenic diet long enough, consistently, to determine its effects on aging and longevity. However, based on the effects it has on various body systems we can extrapolate that it may lead to long-term benefits.
Caloric restriction and fasting are two of the biggest areas of research when it comes to aging. Animal studies show that animals that consume fewer calories end up living longer. It has been proposed that one of the benefits of a ketogenic diet is through similar mechanisms (36).
The most important way the ketogenic diet may affect aging is that it can help to keep the mind sharp into old age. I already wrote about how a ketogenic diet affects our brains, so I won’t go deep into that again. The point is that research suggests that for the elderly, a ketogenic diet can improve memory, visual acuity, and task switching (37).
As we age, our immune systems gradually deteriorate. A ketogenic diet has been shown to enhance immune system function, which would be good for anyone; but would especially benefit the elderly whose immune function may naturally be less effective (35).
Other proposed mechanisms of how a ketogenic diet may affect aging are:
Decreasing reactive oxygen species (ROS)
Decreasing advanced glycation end products (AGEs)
Decreasing growth signals (IGF1)
Elevating levels of antioxidants (CoQ10), and
It remains to be seen whether the ketogenic diet will enhance lifespan, but even if it doesn’t enhance longevity, depending on your particular circumstances, it may improve the quality of whatever years are left.
This wraps up part 3 of our 3-part blog series on the ketogenic diet. Thank you very much for reading and I hope it was informative! As I previously stated we do not believe a ketogenic diet is for everyone. Nor is it a cure-all, and it should be implemented in the context of a comprehensive treatment plan.
Furthermore, I strongly advise anyone wishing to start a ketogenic diet to first talk with their healthcare team, since you will need to be monitored with blood work, and your medications may need to be modified. The doctors at our clinic would be more than happy to speak with you about the ketogenic diet. Please contact us if you have further questions!
(Our blog isn't meant to provide specific medical advice or replace a medical professional. We do not recommend starting a new diet plan, such as the ketogenic diet without checking with your physician first. If you have any specific questions about your health, how to make changes responsibly, or would like to set up an appointment with our clinic, head to our 'Contact Us' page and let us know)!
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