Today’s PrimalMed Prescription…Can you build a better brain with butter?
What’s up with ketones and your brain?
At the end of the day, it comes down to this: We don’t want cancer, cardiovascular disease or dementia. These are the major chronic disease states that will negatively impact your healthspan and ensure that your last 10 years will be a never ending merry-go-round of trips to CVS and your doctor. Dementia is a biggie and I would say that the thought of enduring at least even mild cognitive impairment is a source of concern for those in middle age and beyond. If you are younger, now is the time to plant the seeds for a fertile brain well into your 90’s!
WARNING: This one is a bit longer. It may appeal to your inner science geek. If you are so inclined, skip to the TL;DR at the end. I will NOT be offended. After my last posts on the importance of randomness and a little bit of silly, I did want to put a little MED back in the PrimalMed!
PrimalMed attended the Metabolic Health Summit in Santa Barbara this past spring and the focus was on ketogenic therapies for all things related to neurodegenerative conditions. A supervised therapeutic ketogenic diet (very low carb, high fat, and moderate protein) was THE original prescription for seizure disorders well before dilantin and other pharmaceutical interventions. It is being shown to be an important adjunct in the treatment of neurogenic malignancies. But let’s talk about Alzheimer’s Disease.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2898565/
The purpose of this post is NOT to fully discuss and evaluate the pros and cons and nuances of the ketogenic diet but rather to briefly throw out a few musings about WHY I believe there is a role to using ketones as an alternative if not optimal fuel source for brain health and how utilizing the power of ketones can possibly delay the onset or potentially ameliorate the symptoms of Alzheimer’s.
Here’s the deal. It is 2022. No cure yet. Attempts to come up with drugs to attack the amyloid plaque and prevent their build up in the brain have not been the miracle cure we had hoped for. (remember Biogen’s Aduhelm? It was approved by the FDA a few years back to much fanfare with questionable supporting data). Seems that the only therapy to date with some efficacy has been exercise!
This is recent. The article cited above from JAMA again highlights that therapies targeting amyloid plaque and other proteins seen in Alzheimer’s brains such as Tau neurofibrillary tangles are not effective. Is it “Time to move on from Amyloid?” the author asks. A recent study looked at people with mild cognitive impairment. Can you guess what intervention helped? Exercise.
The bottom line is that the failing brain is undergoing an ENERGY CRISIS. The brain normally uses glucose and ketones for energy. When it can’t efficiently utilize the glucose, the engine sputters. Your mighty mitochondria, your cellular powerhouse, malfunction and are mighty no more.
What impairs your brains ability to utilize glucose? Insulin Resistance! Alzheimer’s has been referred to as Type 3 Diabetes or diabetes of the brain. Your brain cannot utilize glucose because it is resistant to the function of insulin. We can’t control aging, which is a risk factor of dementia, but we can control the other risk factors of dementia such as diabetes, obesity and hypertension, all of which can be tied to insulin resistance.
One researcher at the Metabolic Health Summit, Dr. Stephen Cunnane from Quebec, presented PET scan data, that showed impaired glucose uptake in Alzheimer’s patients. PET scans are imaging studies that show how glucose is distributed and taken up in the body. It currently has an important role in cancer imaging and has an increasing role in evaluating patients with dementia. See the image below: the arrows point to decreased areas of glucose uptake in the Alzheimer brain.
Perhaps a PET scan can predict who is at risk for dementia or serial scans can be utilized to follow the progression of regression of disease.
So if the brain isn’t optimally fueling with glucose, what CAN it do? What can WE do?
Behold! The brain can also use KETONES for energy. It gets ketones from the breakdown of fat (fatty acids from your liver, or your diet). The key cell signaling molecule is the ketone known as beta-hydroxybutyrate. Your gut bacteria can synthesize it from breaking down fiber. You can get it from butter, actually more from GOAT butter! You can increase your levels by time-restricted feeding or intermittent fasting (and allowing your body to break down its own fat stores to create ketones for energy). Some researchers are even now looking at how supplementing with ketones exogenously (as opposed to your body making them from your dietary inputs) can aid in mental clarity and improved cognition in those impaired.
Your brain always needs some glucose but that can be derived from fat and protein (gluconeogenesis) and not necessarily excessive carbs and certainly not from those dastardly ultra processed carbs. Remember an older post about choosing and balancing fuel sources for metabolic flexibility and health, fat vs. carbs? Same holds true for the brain!
How does it work? The brain cells (neurons) have a separate transport system that allows ketones in to the mitochondria and create ATP or energy that is separate and distinct from the transport system that relies on insulin to bring in glucose. If all you give the brain is glucose and that glucose pathway is clogged, jammed and broken, then your brain is starved for fuel. It is a hot mess of a traffic jam. No bueno. But ketones can get in and save the day! They can provide the broken brain its much needed input to create ATP/energy.
The much heralded beta amyloid plaques (seen in the brain at autopsy and subsequently targeted in drug trials) come to the scene to repair the inflammatory damage. An analogy is that they literally act as reparative duct tape. Those plaques are indeed found in the brain of the Alzheimer patient BUT perhaps, just perhaps, they are not the CAUSE of Alzheimer’s, but rather a down-stream consequence of the underlying metabolic dysfunction.
Perhaps the amyloid cascade hypothesis (“Hmmm, we see amyloid plaques present in Alzheimer’s brains therefore it MUST be the cause!) from 30 years ago is wrong! Clinging to that hypothesis is perhaps why drug therapies targeting amyloid are misdirected. If all you do is target drugs to attack the band-aid and not the root cause, then of course the clinical results will be disappointing. The ROOT CAUSE may well be insulin resistance in the brain.
Please note these studies are in their infancy and there is still so much more we DON”T know. To me, however, this just makes a LOT OF SENSE! Small studies do show improvement in patients with mild cognitive impairment implementing ketogenic diets. Patients with a certain genetic marker called ApoE4 do show a higher risk for developing Alzheimer’s and in these patients, the benefit of supplementing with ketones or ketogenic diets was more pronounced.
If you are interested, read or listen to Dr. Mary Newport’s account of her husbands battle with Alzheimer’s and the success of her using coconut oil and ketones (as part of a ketogenic diet) in mitigating his symptoms. She has given many a TED talk. I also recommend Amy Berger’s ‘The Alzheimer’s Antidote.’ I read that one a few years ago. You can look up the links yourself. Keep your brain humming.
*Please note that this post is not a medical endorsement for a ketogenic diet as a panacea for all, but rather, simply an opportunity to discuss how ketogenic principles and ketones play a key role in understanding how novel therapies can meet the challenge of the dementia epidemic “head-on.”
SO HERE IT IS folks, the long awaited TL;DR !!! Today’s PrimalMed Prescription.
-We don’t want cognitive impairment and dementia.
-Dementia and Alzheimers MAY be thought of as a type of inefficient insulin usage problem in the brain. The brain is undergoing an energy crisis. To date the meds used to treat dementia are not very effective. Exercise programs and ketogenic diets and therapies have been shown to be more effective.
-We must first prevent insulin resistance from becoming an issue in the body and our brain by avoiding the Standard American Diet replete with ultra-processed food-like substances. See previous musings about fueling your body with quality real food Nana would eat.
-So step one is DON’T BECOME insulin resistant. Prioritize protein! Include healthy fats. Don’t be a carb-o-phobe and DO eat like a responsible adult. If you are insulin sensitive, your brain will use glucose and fat efficiently and your risk of dementia MAY be much lower!
-Focus on the ROOT cause. Teach your body to use FAT as a fuel by not nibbling and snacking all day long. Creating times when you are not always pumping out insulin will help your body and certainly help your brain.
AND
-If you one day find your keys in the fridge, don’t panic. Just blend some goat butter in your morning coffee for a ketone brain boost!
In memory of Queen Elizabeth II. Sharp as a tack until her passing:
Right on Nancy ! Thanks for reading and your comments. Sound Body = Sound Mind right? 90 is the new 40 !!!
Dr Metzger.. I Have a 95 year old friend who is also a Holocaust survivor. This woman works out five days a week, walks lifts weights , yoga and when I was with her last week her mind is sharp as a tack so I think the studies are right on