Alzheimer’s disease and the implications for treatment.

In terms of the brain’s fuel requirements there is an interchange normally between the ketones and glucose used by the brain, which becomes faulty as we get older. If we look at the infant brain, it cannot develop normally without ketones. Ketones supply 20 to 25 percent of the infant’s brain energy requirements.

The main source of supply the ketones for the infant during lactation, is the medium chain triglycerides that are in human milk. Infants are in mild ketosis during the lactation period.

In the aging brain we can use the ketone energy the new born brain thrives on.

Need a refresher on what a Ketogenic diet is? Please refer to my Blog Comparing common diets: Ketogenic, Paleo, Mediterranean Diets https://2healthyhabits.wordpress.com/2018/03/02/comparing-common-diets-ketogenic-paleo-mediterranean-diets/

Two fuels that are used by the brain:

Blog Apr. 26 -1 glucose pull.png
  1. Glucose,(simple sugar mainly from plants) gets into the brain usinga push strategy.See the little stick person is pulling a glucose molecule into the brain, which is on the right. That process is driven by a falling glucose in the brain cell.
  1. Ketones use a push strategy. When the ketones go up in the blood on the left they are pushed into the brain and this is the way the brain works all the time if glucose goes down because you’ve been fasting for 24 hours and insulin is down and ketones are being produced and they will go into the brain.

As ketones become available in the blood, they will be used by the brain, which is an extraordinarily efficient way of providing a backup fuel for the brain in the fasted state.

Glucose is the main fuelof the brain under most circumstances except under extreme fasting but it’s not the preferred fuel.

Glucose uptake is goes down when there’s sufficient ketones around to go into the brain. This is a very useful glucose sparing effect that in fact occurs on the ketogenic diet.

See the brain scans the control, a healthy adult as compared to a person with Alzheimer’s Disease.

Blog Apr. 26 - 2 brain scans.png

The effects of aging and Alzheimer’s disease is shown by the two little arrows in the scan. In one scan where the arrows are in the scan is basically missing the orange to red color in the parietal lobes over the ears, this is a classic image of what one sees in Alzheimer’s disease.

The glucose problem precedes the cognitive deficit in Alzheimer’s disease.  There are five categories of people with pre-symptomatic brain glucose hypometabolism (decreased life-maintaining processes)that are at risk of Alzheimer’s disease:  Older people, people with insulin resistance independent of age, people with a family history of Alzheimer’s disease, people with that are ApoE4 carriers and the Presenilin-1 mutation.

 This developing glucose hypometabolism is helping with the deterioration of synapses and deterioration and brain function which is associated with cognitive decline and which is going to push down the glucose metabolism further and is going to create a vicious cycle of brain energy exhaustion and progression of the disease.

What about brain ketone uptake in people at risk or with Alzheimer’s disease?

Blog Apr. 26 - 3 glucose and ketone uptake.png

In the brain scan the capacity of the brain to use glucose is higher in the areas where the red and orange colors are shown on the brain and as you go towards Alzheimer (AD) you can see there’s a virtual disappearance of the red, orange and the green is more predominant.  The capacity of the brain to use glucose decreases in Alzheimer’s disease through CTL (normal healthy brain), to MCI (mild capacity impairment) to AD (Alzheimer’s Disease).

If we look at the ketone up taken in exactly the same individuals the capacity is lower than it is for glucose under the normal circumstances but it if anything actually increases as you get towards Alzheimer’s disease.  There is no loss of the capacity to transport ketones into the brain.

Blog Apr. 26 -4 Keto on brain scans.pngIt is encouraging to see that we could use the normal brain ketone uptake capacity to in fact bypass the glucose deficitand potentially have an impact on cognitive function.

Dr. Cunnane discussed treatment with MCT (medium chain triglyceride). Please see the original Youtube post for his findings.

Is there capacity to use ketones normal in mild cognitive impairment? The answer is yes. There is improved episodic memory, processing speed and language.

You can achieve a metabolic rescue of the brain and that the rescue is going to have a functional effect that is going to correlate with the level of ketones achieved both in the blood and in the brain.

People with mild cognitive impairment are going need 45 grams of MCT a day to improve to be between the healthy elderly and the healthy young.  We might be able to get right up to this 100% value with a ketone ester or some other supplement.

Exercise helps get glucose into the brain.It also helps get ketones into the brain without a ketogenic supplement. Being in ketosis and exercising can improve glucose and ketone up take to better than a healthy adult.

People who are on a ketogenic diet are helping to preventtheir glucose deficit in the brain. Prevention is hard to achieve with a MCT supplement but much easier to achieve with a ketogenic diet.

The Ketogenic diet is potentially a cognitive benefit in those that that are not facing aging associated cognitive decline.

Blog Apr. 26 -5 Summary.png

In Summary,in the brain scan, the losses of the red and orange color shown by the arrows, are definitely a consequence of the disease but they’re also contributing to the disease. The losses represented by the arrows are present before the disease starts and it’s a glucose specific problem. Brain energy rescue by ketones is definitely feasible in mild cognitive impairment and in Alzheimer’s disease.  We want to let the brain have the luxury of thriving in a fuel environment (ketones) that you were born into.

Dr. Stephen Cunnane obtained his PhD in Physiology from McGill University and completed post-doctoral research on nutrition and brain development. He has researched fatty acids and their effect on brain development as well as the effect of ketones and ketogenic diets on brain development. Stephen Cunnane has published over 280 peer-reviewed research papers.

This Post has been condensed from this October 2018 video Dr. Stephen Cunnane – Brain Glucose and Ketone Metabolism in Alzheimer’s Disease https://www.youtube.com/watch?v=OU26epaihmw

For more information on Alzheimer’s please go https://www.ncbi.nlm.nih.gov/pubmed

Then go to Full Text Articles and search by “CanKetonesHelpRescueBrainFuelSupplyin LaterLife? Implicationsfor CognitiveHealthduring Agingand the Treatmentof Alzheimer’s Disease.

I invite you to Follow my Blog, Facebook or be added to my email distribution list. My focus is to maximize my physical performance and mental clarity, body composition, and most importantly overall health with a wholesome diet and exercise.

I will bring you compelling articles on Ketogenic and GAPS diets, the Super Slow High-Intensity Exercise Program and supplements.

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Lydia Polstra

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Email: lpolstra@bell.net

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Disclaimer: The content of this email or Post is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations is at the choice and risk of the reader.

Why We Don’t Need Carbohydrates

Myth 1:  The human brain burns 600 kcal per day glucose to meet its energy needs.

Myth 2:  No one can follow a ketogenic diet long term.

Blog - Apr. 5 delete-1.png

The need for dietary carbohydrates is often a topic of misunderstanding and misinformation. Although some specific tissues in the body do have certain glucose requirements, these requirements are easily met by gluconeogenic sources within the body without the need for dietary carbohydrate intake. The fatigue, stress, impaired cognition and reduced performance that are often used to argue for the need for carbohydrate are more aptly attributable to improper implementation of a well-formulated ketogenic diet (WFKD), inadequate electrolyte replacement, and/or insufficient time for keto-adaptation. When used correctly, a ketogenic diet can be a safe and sustainable therapeutic tool as well as a means to help promote wellness and performance.

The specific topic that we want to address here is how both the brain and body can function as well – or even better – on a diet with little or no dietary carbohydrate compared to the typically promoted low fat, high carbohydrate ‘healthy diet.’

Published science has shown that ketones that are produced from either dietary fats or triglycerides stored in our adipose (fat) tissue reserves are an excellent fuel for the brain. Further, we now know that these ketones produced by the liver also have multiple beneficial effects on the heart, kidneys, and other organs that appear to translate into improved longevity.

Additionally, new research has highlighted that skeletal muscles, even those of competitive athletes, are not solely dependent on high dietary carbohydrate intake for glycogen replenishment and performance.

Ketones are a cleaner-burning fuel (i.e., producing fewer free-radicals) than glucose when used by the brain and other organs. The primary ketone beta-hydroxybutyrate (BOHB) can also function as a signal to activate genes that regulate our defenses against oxidative stress and inflammation.

The shifting they body’s energy source from carbohydrates to fats, which we have named ‘keto-adaptation,’ starts within days but takes a considerable period of time to fully develop. The result is maintenance of normal blood glucose and muscle glycogen levels that can be sustained without the need for dietary carbohydrate intake.

Physiologic Role of Carbohydrates

The presumed requirement for glucose by the brain is a conditional need that is based on the fuel sources dictated by one’s choice of diet. A ketone-suppressing diet (i.e., any diet supplying >30% of energy from the combined intakes of carbohydrate and protein) essentially forces the brain to rely on glucose for fuel.

It is true that some cells within the body do require glucose. But in all of these cases where glucose is broken down to lactate, the body can recycle that lactate back to glucose.

Evidence That the Brain Can Function on Ketones

The simplest experiment that demonstrates the brain’s ability to function on ketones is the observation that humans can tolerate total fasting with normal mental function for durations of 30-60 days. Elegantly done studies that measured glucose and ketone levels in arterial blood going into the brain compared to these fuels in the jugular vein coming out of the brain, indicated that ketones are in fact able to supply the great majority of the brain’s energy.

See the original Virta post for the studies.

What these studies demonstrated is clear evidence of normal brain function in the virtual absence of glucose when sufficient ketones are available. This offers us the unique perspective that when consuming a carbohydrate-rich diet the predominate source of fuel for the brain is glucose; not because it is needed but because the other natural and highly effective brain energy source has been shut off.Butunder conditions of consistent nutritional ketosis, the brain adapts to the presence of ketones by enhancing their uptake and oxidation, thus protecting cognitive and CNS (central nervous system) function.

Essentials of Keto-Adaptation – Glucose Conservation and Salvage

Just because one doesn’t consume dietary carbohydrate does not mean the body is completely lacking in glucose. Whether fasting or on a meat-and-fat-only ketogenic diet, blood glucose values remain in the normal range both at rest and during exercise. This occurs because the body is quite capable of synthesizing all of the glucose it needs from various gluconeogenic precursors, while at the same time strictly limiting its rate of carbohydrate oxidation.

There are at least five sources of these glucose precursors:

  1. breakdown of muscle to supply amino acids for gluconeogenesis;
  2. breakdown of dietary protein to supply amino acids for gluconeogenesis,
  3. glycerol released from the hydrolysis of adipose tissue triglyceride or dietary triglyceride;
  4. recycling lactate and pyruvate from glycolysis; and
  5. acetone produced by the spontaneous breakdown of acetoacetate to acetone that can be used for gluconeogenesis.

The conditions for and the amounts provided by these various sources of gluconeogenesis are shown in the following table.

BLOG - APR. 5  - TABLE – SOURCES OF GLUCOSE.png

What this table clearly demonstrates is that whether during a total fast or a ketogenic diet without carbohydrate containing foods, new or recycled gluconeogenic substrates provide for the generation of anywhere from 100-200 g/d of glucose. Add to this up to 50 g/d of dietary carbohydrate as part of a WFKD, and it becomes clear why nutritional ketosis is well tolerated under a variety of challenging conditions.

Lessons from Low Carbohydrate Athletes

Dr. Volek’s group recruited 20 competitive ultra-runners, 10 of whom followed a traditional high carbohydrate diet and the other 10 had been following a ketogenic diet for at least 6 months.

After baseline testing, these runners were asked to do a 3-hour run at race-pace on a treadmill. Surprisingly, both groups had similar muscle glycogen levels before the run, and they also both mobilized similar amounts (about 80%) of their glycogen during 3 hours on the treadmill.

But almost 90% of ketogenic runner’s net energy use was from fat. This is an astonishing example of being able to maintain normal muscle glycogen while consuming very little carbohydrate.

Please refer to the original Virta post for 2 more in depth studies.

Why Some Experts Still Claim that We Need Dietary Carbohydrates

There are some other arguments used to support the idea that we need to consume carbohydrates above levels that facilitate nutritional ketosis.

Thyroid dysfunction:The blood level of the active thyroid hormone T3 typically falls by 30-40% in the first few weeks of a WFKD, but this is not accompanied by any signs or symptoms of clinical hypothyroidism. This change is due to a marked reduction in thyroid hormone resistance during nutritional ketosis, which can be eased with adequate electrolytes intake. Therefore, this is a healthy response and not a sign of endocrine dysfunction.

Sleep patterns are disturbed by a ketogenic diet. In our study we found that global sleep quality, sleep disturbances, and daytime dysfunction parameters all were significantly improved. In addition, the proportion of patients reporting poor sleep was significantly reduced after 1 year.

We need more dietary fiber than is possible on a ketogenic diet.What we point out in our blog post on fiber is that the production of BOHB can provide many-fold more SCFAs to the brain than a very high fiber diet combined with an optimized microbiome. Thus, the moderate level of fiber that one can achieve with a real-food WFKD should be more than adequate to maintain health.

To learn more, please see my Blog Post, Fiber and Colon Health On A Well-Formulated Ketogenic Diet https://2healthyhabits.wordpress.com/2019/03/08/fiber-and-colon-health-on-a-well-formulated-ketogenic-diet-new-insights-question-its-role-as-an-unconditional-requirement/

This Post has been condensed from the original Virta Post: Why Humans Don’t Need Dietary Carbohydrates to Thrive By Stephen Phinney, MD, PhD, Brooke Bailey, Ph.D Jeff Volek, PhD, RD https://blog.virtahealth.com/why-dont-need-dietary-carbohydrates/?fbclid=IwAR0gDnfRCWEimOQgsK8sCEY7-Rh5R6E5TyyISAOd3VbSj71OsKOEekmTTO0

I invite you to Follow my Blog, Facebook or be added to my email distribution list. My focus is to maximize my physical performance and mental clarity, body composition, and most importantly overall health with a wholesome diet and exercise.

I will bring you compelling articles on Ketogenic and GAPS diets, the Super Slow High-Intensity Exercise Program and supplements.

To follow my Blog, please click the Follow button to receive an email when the next posting is available. Hint: You may have to click the Accept and Close button before follow is available.

I thrive on feedback. Please let me know you are interested in the content by clicking Like, Commenting or sending me a message or email about the Post.

If you wish to contact me by Email, please email lpolstra@bell.net using this form.

May you Live Long Healthy.

Yours truly,

Lydia Polstra

416-428-5285

Email: lpolstra@bell.net

Facebook: https://www.facebook.com/2healthyhabits/

Blog: https://2healthyhabits.wordpress.com

Disclaimer: The content of this email or Post is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations is at the choice and risk of the reader.