Alzheimer’s disease (AD) reportedly affects up to 70% of people with dementia, thus making it the most common type of dementia (Alzheimer’s Australia n. d.).
30% of people aged over 85 have dementia (Alzheimer’s Australia n. d.). Klaus et al. (2016) convey that Alzheimer’s is a progressive neurodegenerative disorder that is linked to: amyloid β-peptide plaques; neurofibrillary tangles; hypometabolism; and poor cerebral glucose uptake.
Klaus et al (2016) interestingly state that the decreased metabolism happens before the onset of AD signs. Therefore, clinical studies have begun to focus on this phenomena with normal glucose supply being supplemented with ketones (as the brain can metabolise these) (Klaus et al. 2016).
University Health News (UHN) (2017) explain that ‘a ketogenic diet is a high-fat, adequate-protein, and low-carbohydrate diet that produces ketones – compounds the body can use to produce energy. Ketones have been shown in studies to be neuroprotective.’
Craft et al. (2016) say that despite not being fully understood as to why, ketones appear to be neuroprotective and decrease neuronal hyperexcitability. ‘In small pilot studies, interventions that elevate ketones improve memory in adults with MCI and AD’ (Craft et al, 2016); with MCI referring to mild cognitive impairment, and AD to Alzheimer’s Disease.
Klaus et al. (2016) highlight that there is ‘limited evidence’ for using ketogenic diets for Alzheimer’s Disease but that further clinical research regarding this approach is warranted.
What is the Ketogenic Diet?
WebMd (2017) acknowledges that ketogenic diets like the Atkins Diet have been used for weight loss and involve the participant getting 30-50% of their calories from proteins. In Australia, the Eat For Health guidelines recommend less proteins than this for a healthy diet (National Health and Medical Research Council 2013). The idea of a ketogenic diet is that it burns fat for fuel, instead of carbohydrates, due to ketosis (WebMd, 2017).
What are the dangers?
- Potential for increased cholesterol levels from consuming more dairy and fatty meats – but conversely, WebMd (2017) also state that the Atkins diet decreased bad cholesterol levels in participants for <2yrs
- Kidney issues from too much protein (WebMd 2017)
- People most at risk of dangerously high ketosis include those that are breastfeeding, have type 1 diabetes, have hypertension (and on medications), and, have type 2 diabetes that take SGLT-2 inhibitor medications (Eenfeldt 2017)
- The ‘keto flu’ may develop when people go from burning sugars to fats (e.g. fatigue, nausea, headaches, cramps etc) – thereby Eenfeldt (2017) suggests easing into a ketogenic diet
- The development of ketoacidosis is life-threatening and requires emergency medical treatment – call 000 if you suspect that you or someone else may have this condition
What insight and recommendations can we gather from this?
- Only commence the ketogenic diet under the advice and supervision of an appropriate, qualified medical officer and dietitian
- Monitor hydration and electrolyte balance
- Monitor for ketoacidosis
- Be aware of the signs of ketoacidosis prior to commencing the supervised diet, to promote safety and early intervention
- Immediately call emergency medical attention (000) if you think that you or someone else may be showing signs of ketoacidosis
- People with poor health (e.g. decreased kidney function) may be more at risk of harm from this diet
- People with Alzheimer’s disease and other conditions that affect cognition, mental health and/or physical health, may be more difficult to monitor, assess and/or treat (e.g. they may be unable to express that they are feeling unwell or need help) and should be under constant supervision
- Klaus et al. (2016) mentioned that the supporting evidence was limited for using ketogenic diets for Alzheimer’s disease and that it needs further research
Ketoacidosis Key Points:
- Linked to illness or hyperglycaemia in type 1 diabetes
- Ketoacidosis develops over hours or days
- Can be a sign of insufficient insulin
- Moderate-heavy ketones in the urine can be a sign of ketoacidosis
- other signs include abdominal pain/discomfort, flushed cheeks, vomiting, rapid breathing, dehydration
- Australian helpline is 1300136588
(Diabetes Australia n.d.; Diabetes Australia 2015)
- Alzheimer’s Australia n. d., Alzheimer’s Disease, viewed 17 July 2017, https://www.fightdementia.org.au/about-dementia/types-of-dementia/alzheimers-disease
- National Health and Medical Research Council 2013, Australian Dietary Guidelines Summary, National Health and Medical Research Council, Department of Health and Ageing, Canberra, viewed 17 July 2017, https://www.eatforhealth.gov.au/guidelines
- Craft, S, Neth, BJ, Mintz, A, Sai, K, Shively, N, Dahl, D, Baker, LD, Cunnane, S, Register, TC & Gage, HD 2016, ‘Ketogenic diet effects on brain ketone metabolism and Alzheimer’s disease CSF biomarkers’, The Journal of the Alzheimer’s Association, vol. 12, no. 7, pp. 342-3, viewed 17 July 2017, http://www.alzheimersanddementia.com/article/S1552-5260(16)30935-9/abstract
- Diabetes Australia 2015, Ketoacidosis, viewed 17 July 2017, https://www.diabetesaustralia.com.au/ketoacidosis
- Eenfeldt, A 2017, ‘A ketogenic diet for beginners’, Diet Doctor, viewed 17 July 2017, https://www.dietdoctor.com/low-carb/keto
- Klaus, LW, Lange, KM, Makulska-Gertruda, E, Nakamura, Y, Reissmann, A, Kanaya, S & Hauser, J 2016, ‘Ketogenic diets and Alzheimer’s Disease’, Food Science and Human Wellness, vol. 6, no. 1, pp. 1-9, viewed 17 July 2017, http://www.sciencedirect.com/science/article/pii/S2213453016301355
- University Health News 2017, ‘Ketogenic Diet Shows Promising Results for All Dementia Stages’, UHN Daily, 24 July, viewed 17 July 2017, https://universityhealthnews.com/daily/memory/ketogenic-diet-shows-promising-results-for-all-dementia-stages/
- WebMd 2017, High-protein, low-carb diets explained, viewed 17 July 2017, http://www.webmd.com/diet/guide/high-protein-low-carbohydrate-diets