Ketogenic Diet: Blood Sugar, Insulin, and Gluten
The onset of several medical conditions and diseases is associated with blood sugar instability or insulin dysregulation. Blood sugar homeostatic mechanisms, when dysregulated, can alter brain function, gene expression, and even neurotransmitter levels. Gluten, a protein from wheat and a staple of contemporary diets, is associated not only with gastrointestinal upset but also with a whole cascade of symptoms. Excessive consumption of gluten is even thought to cause leakiness of the blood-brain barrier.[1]
Preventative measures such as diet and lifestyle modifications have become a huge area of interest to practitioners and patients. Diets low in carbohydrates are becoming increasingly popular, although the traditional food pyramid places grains and sugars as the largest calorie group.[2] The ketogenic diet (KD), developed in 1924, is a very low-carbohydrate diet used to treat several medical conditions.
Ketogenic Diet: Burns Fat, Not Glucose for Energy
Ketones are a breakdown product of burning fats and amino acids within the cell. They can easily travel through the blood and be used for fuel.[3] When glucose is absent as an energy source to the cell, the body begins to burn fats to fuel metabolic processes.[4] The resultant ketones can provide up to 70% of the brain’s energy requirements, and 50% of the body’s energy requirements.[5] It is important to note that even when the body is in ketosis (the metabolic state induced by KD), glucose is still necessary. However, a reduction of blood glucose levels is associated with longer life expectancy, and ketosis has a whole plethora of beneficial clinical outcomes.[6]
Ketogenic Diet & Epilepsy
The ketogenic diet was initially used for treatment of epilepsy in children. While the mechanism by which ketosis alleviates epileptic episodes is not fully known, it is known that a Ketogenic Diet increases decanoic acid. Medications that increase decanoic acid are used to treat a variety of psychological disorders. It is thought that the Ketogenic Diet’s anticonvulsant effects may be due to the increase in decanoic acid.[7] Additionally, a reduction in blood glucose has been associated with suppression of seizures.[8] Ketone bodies themselves are known to be neuroprotective, anti-inflammatory, and to have anti-oxidant effects.
Ketogenic Diet & Neurodegenerative Disorders
Many neurodegenerative disorders are associated with mitochondrial defects. Ketogenic diets can restore impaired mitochondrial metabolism.[9] Parkinson’s disease, for example, is associated with defects of Mitochondrial Complex I. It is thought that one of the ways KD is effective in treating Parkinson’s disease is that ketone bodies bypass Complex I of the mitochondria.[10] KD has also been shown to increase hippocampal mitochondria by 46%.[11]
Alzheimer’s disease (AD) is one of the most notorious neurodegenerative diseases, affecting over five million Americans.[12] Risk factors in developing AD are not fully understood, and the mechanism by which AD symptomology manifests also remains unclear. It is known, however, that there is a genetic component to AD; the gene APOe4 has gathered attention recently as a major risk factor in AD onset.[13] In APOe4-negative AD patients, KD significantly improves cognitive function.[14]
AD has been referred to as “metabolic syndrome of the brain” and even, by some researchers, as “type III diabetes.” These titles stem from the theory that AD can manifest due to chronic blood sugar elevations and subsequent insulin resistance in the brain.[15]
While there are medications and treatment protocols in place for other diet-induced illnesses such as hypercholesterolemia, obesity, and type II diabetes, there is no pill for Alzheimer’s. KD may be a viable and beneficial option for those suffering from neurodegenerative diseases such as AD and Parkinson’s.
Traumatic Brain Injury & Ketosis
Traumatic brain injuries (TBIs) affect between one and two million Americans every year.[16] Motor vehicle accidents and accidental falls are the most common causes of TBIs. During acute brain injuries, cerebral uptake of ketones is greatly increased.[17] While it is not known exactly why the brain uptake of ketones increases, it may be due to the anti-inflammatory and neuroprotective properties of ketones.[18]
TBIs are also associated with an increase in glutamate, the body’s primary excitatory neurotransmitter. Glutamate is necessary for cognition and many neuronal processes; however, elevated glutamate can be neurotoxic and damaging to brain cells. Ketosis stimulates glutamate to be synthesized into GABA, the body’s main inhibitory neurotransmitter.[19] Thus, KD may be both anti-inflammatory and neuroprotective for TBI patients.
Ketogenic Diets for Mental Health
Many individuals who are not suffering from a neurodegenerative disorder, TBI, or epilepsy may also benefit from ketogenic diets. Studies have found KD to greatly improve anxiousness and stress behaviors, and even reduce the risk of developing low mood.[20] Age-related cognitive decline affects people with or without neuronal degeneration or brain injuries. KD has been shown to improve cognition and age-related brain degeneration.[21]
Additionally, clinical outcomes for those suffering from bipolar disorder and ADHD who use KD are promising. Research has even suggested that KD may be a viable alternative to opiates in treating chronic pain.[22] For more information on Ketogenic Diets, see Sanesco’s recent blog post reviewing the ketogenic diet. Consult your health care practitioner before attempting the ketogenic diet, as it is not suitable for everyone. Those who successfully utilize KD may experience greater quality of life, cognitive function, and overall well-being.
References:
[1] Hamblin, J. (2013, December 20). This Is Your Brain on Gluten. Retrieved September 11, 2017, from https://www.theatlantic.com/health/archive/2013/12/this-is-your-brain-on-gluten/282550/
[2] Korczak, R., Jones, J. M., Peña, R. J., & Braun, H. J. (2016). CIMMYT Series on Carbohydrates, Wheat, Grains, and Health: Carbohydrates and Their Grain Sources: A Review on Their Relationships to Brain Health 1, 2. Cereal Foods World, 61(4), 143-156.
[3] Vieira, G. (2017, July 15). Why DKA & Nutritional Ketosis Are Not The Same. Retrieved September 07, 2017, from https://www.diabetesdaily.com/blog/2014/11/dka-nutritional-ketosis-are-not-the-same/
[4] Gasior, M., Rogawski, M. A., & Hartman, A. L. (2006). Neuroprotective and disease-modifying effects of the ketogenic diet. Behavioural pharmacology, 17(5-6), 431.
[5] White, H., & Venkatesh, B. (2011). Clinical review: ketones and brain injury. Critical Care, 15(2), 219.
[6] Stafstrom, C. E., & Rho, J. M. (2012). The ketogenic diet as a treatment paradigm for diverse neurological disorders. Frontiers in pharmacology, 3.
[7] Bostock, E. C., Kirkby, K. C., & Taylor, B. V. (2017). The Current Status of the Ketogenic Diet in Psychiatry. Frontiers in psychiatry, 8.
[8] Stafstrom, op. cit.
[9] Abdelwahab, M. G., Lee, S. H., O’Neill, D., Thompson, R. J., Duff, H. J., Sullivan, P. G., & Rho, J. M. (2015). Ketones prevent oxidative impairment of hippocampal synaptic integrity through KATP channels. PloS one, 10(4), e0119316.
[10] Stafstrom, op. cit.
[11] Lima, P. A. D., Sampaio, L. P. D. B., & Damasceno, N. R. T. (2014). Neurobiochemical mechanisms of a ketogenic diet in refractory epilepsy. Clinics, 69(10), 699-705.
[12] Alzheimer’s Association. (2017). 2017 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 13(4), 325-373.
[13] Stafstrom, op. cit.
[14] Stafstrom, Ibid.
[15] Hamblin, op. cit.
[16] Rutland-Brown, W., Langlois, J. A., Thomas, K. E., & Xi, Y. L. (2006). Incidence of traumatic brain injury in the United States, 2003. The Journal of head trauma rehabilitation, 21(6), 544-548.
[17] White, op. cit.
[18] Masino, S. A., & Ruskin, D. N. (2013). Ketogenic diets and pain. Journal of child neurology, 28(8), 993-1001.
[19] Lima, op. cit.
[20] Bostock, op. cit.
[21] Stafstrom, op. cit.
[22] Masino, op. cit.
Clinical Contributor
Sophie Thompson
Clinical Support Specialist at Sanesco International, Inc.
Sophie recently obtained her degree in Biology from UNCA in Asheville. Born and raised in Asheville, her hobbies include painting, writing and spending quality time with her dog and her family.
