Ketogenic Diet: Dispelling the myths
Written by Madelyn Huttner December 8, 2017
Myth: All fat is bad!
Don't let the word 'fat' scare you.
Fat, a short, three letter word with a negative connotation. It may be easy to assume that consuming fat is bad for your body and your health, but not all fats are bad. Our bodies require fat as a source of energy, essential for cell membranes, and a vital component of our brain composition.
Myth: All fats are created equal!
Fact: Fats come in all different shapes and sizes.
Fats are all composed of fatty acids and glycerol. Fatty acids are carboxylic acids attached to long chains of carbons and hydrogens. The differences in the fatty acid tails are what make certain fats saturated, trans-unsaturated, cis-unsaturated, monounsaturated, and polyunsaturated. I’m sure you’ve seen these three categories of fats on nutrition labels of food, but what do they really mean?
Saturated fats have long fatty acids tails without carbon-carbon double bonds, which is where they get their name. The carbons are all saturated with as many hydrogen atoms as possible. The chemical composition and structure of fatty acid tails will determine if the fat will be a solid or liquid state at room temperature. For example, saturated fats, like butter and coconut oil, are solid at room temperature, unlike olive oil, a unsaturated fat, is liquid at room temperature.
Unsaturated fats contain double bonds, which reduce the number of hydrogen atoms attached to the carbons involved in the double bond. Trans-unsaturated fats’ have are double bonds that have opposite hydrogens from each other while cis-unsaturated fats’ have double bonds with hydrogens on the same side. Cis-unsaturated fats tend to have “kinks” in their chains due to the orientation of the hydrogens. The cis-double bonds cause the unsaturated fats to be liquid at room temperature. Trans fats are commonly found in fried foods, cakes, and margarine. On the other hand, sources of mono and polyunsaturated fats include olive oil, avocados, and nuts.
Furthermore, the names monounsaturated fats contain one double bond, but polyunsaturated fats contain more than one double bond. For example, omega-3 and omega-6 fatty acids are polyunsaturated fatty acids because they have three or six double bonds.
Fats may also be categorized by their chain length: short-chain fatty acids (SCFA), medium-chain fatty acids (MCFA), long-chain fatty acids (LCFA), and very long-chain fatty acids (VLFCA).
Because all fats are not created equally, they do not all need to be avoided.
Myth: Carbohydrates are the only source of fuel for our bodies.
Fact: Fat is a fuel source for the body.
Our bodies derive energy from three sources: fats, carbohydrates, and protein. Glucose is our primary fuel source most commonly derived from the carbohydrates that we eat. These carbs are broken down into sugars which are used immediately as fuel or stored as glycogen for later use. While terms like “carbo-loading” are commonly used amongst athletes preparing for competitions, carbohydrates are not the only and may not be the preferred source of energy.
Reducing your carbohydrate intake and increasing your healthy fat intake makes your body use different metabolic pathways to use and burn fat as your fuel source. When your body does not have enough glucose or glycogen stores to use as energy, your body starts to burn stored fat. Yes, you read that right, your body derives energy from the fat that’s hanging around your hips and belly. The breakdown of stored fats leads to ketosis or the buildup of ketones in your body. This can happen after prolonged exercise, fasting, or low-carb diets. The three main ketones are 𝛽-hydroxybutyrate, acetoacetate, and acetone.
Part 2: The Better Fuel Source
Myth: The brain can only run on glucose.
Fact: The brain can utilize both ketones than glucose, but which fuel source is better?
Your brain on glucose:
The breakdown of carbohydrates results in glucose, a simple sugar. Glucose functions as the primary energy source for every cell in the body, including the brain, and brain functions including memory and learning are closely linked to glucose levels and how efficiently the brain uses its fuel. For example, hypoglycemia, or low blood glucose levels, is linked to poor attention and decreased cognitive function as a result of less energy for the brain. On the other hand, excess glucose is not the solution to increasing brain function. Studies have increased glucose and fructose are linked to memory and cognitive deficiencies and the aging of cells, respectively.
Your brain on ketones:
Although your brain is primarily dependent on glucose, it can still use ketones. Fat yields 9 calories per gram while carbohydrates and proteins both only contain 4 calories per gram. Fats in the form of ketones can provide more energy per unit of oxygen consumed. One specific ketone, 𝛽-hydroxybutyrate, can cross the blood-brain barrier and lead to increased mental acuity. 𝛽-hydroxybutyrate is also suggested to increase levels of brain-derived neurotrophic factor in areas of the brain that are responsible for memory.
It is also thought that ketone bodies function as neuroprotectors due to their ability to improve metabolic efficiency. Ketones also have the ability to positively affect neurotransmitters. Glutamate, the primary excitatory neurotransmitter in the brain can become gamma-Aminobutyric acid (GABA) an inhibitory neurotransmitter.
If the balance between glutamate and GABA, excitatory and inhibitory neurotransmitters, is thrown off and there is too much glutamate present, neurotoxicity can occur. Both brain fog and a lack of focus can be attributed to having too much glutamate and not enough GABA to reduce stimulation. When your brain uses glutamate and glutamic acid for energy, there is not enough left to produce GABA. With ketosis, your brain has the ability to efficiently produce GABA and result in better focus and clarity.
Remember, fatty acids are important for the brain.
Fatty acids such as omega-3 and omega-6, which include arachidonic acid and docosahexaenoic acid, are all vital components of the brain. They comprise the majority of brain tissue and also are important for brain function and have a direct link to learning, memory, and sensory performance.
Myth: Glucose gives you more energy.
Fact: Burning fat is better for the mitochondria
Fat produces almost 70% more cellular energy than glucose.
Mitochondria known as the powerhouse of the cell produce our body’s energy in the form of adenosine triphosphate (ATP) and regulate cellular metabolism. An important study tested a ketogenic diet in rats and found increases in genes that encode proteins involved in mitochondrial metabolic and intracellular signal transduction pathways.
Additionally, brown adipose tissue, or brown fat, generates heat by burning calories. The brownish color comes from the high amount of iron and mitochondria within this type of fat. Ketones have also been shown to increase brown fat.
Myth: Diets are only meant to help you lose weight
Fact: Diets, like KGD, can help improve many chronic and neurodegenerative diseases
The ketogenic diet has been used for those with Epilepsy, Autism Spectrum Disorder, neurodegeneration, and other conditions. The ketogenic diet was first used as a therapy for pediatric epilepsy back in the 1920s, but lost its tracking due to the invention of anticonvulsant drugs. Epilepsy, the fourth most common neurological disorder among all ages, is characterized by chronic, unprovoked and unpredictable seizures. When drugs fail to control epilepsy, doctors and patients turn to the ketogenic diet. According to the Epilepsy Foundation, over 50% of children on the ketogenic diet have at least a 50% reduction in the number of seizures, and 10-15% become seizure-free and remove the need for medication completely.
Studies also show that this diet acts in a variety of ways to promote neuroprotection in neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease, and even traumatic brain injury and stroke.
Alzheimer’s Disease (AD) is the most common form of dementia associated with a loss of memory and decline in other cognitive functions. The key features of AD are 𝛽-amyloid plaque accumulation, twisted 𝜏-proteins, loss of connections among brain cells, inflammation, and death of brain cells. Although there is no current cure for AD, different approaches have been researched and tested to help alleviate some of the symptoms and side effects of this subclass of dementia. A 20 person study tested the effects of medium-chain triglycerides (MCT, a form of dietary fat) on those with AD or mild cognitive impairment. The study showed that 90 minutes after consumption of the MCT, higher ketone levels were associated with greater improvement in paragraph recall compared to placebo. Furthermore, another study showed long term improvement with a ketogenic compound in those with mild Alzheimer’s Disease.
Parkinson’s Disease (PD) is a disorder that affects movement resulting in the trembling of hands, legs, arms, jaw, and face, stiffness of arms, legs, and trunk, bradykinesia, and poor balance and coordination resulting in decreased ability to walk, talk, and perform daily tasks. PD is a result of the loss of dopaminergic neurons. There is also no cure for PD at this time, but medications as well as lifestyle changes are being researched. One human study showed that volunteers with PD saw Unified Parkinson's Disease Rating Scale score improvement.
Autism Spectrum Disorders (ASD) are characterized by neurological and developmental symptoms that begin in childhood. The “spectrum” in ASD refers to the differing degrees of disability. A definitive cause or cure for ASD has yet to be discovered.
All of the aforementioned diseases are debilitating and serious, but lack a cure, which is where the ketogenic diet comes into play. The mechanisms behind why and how the ketogenic diet works to stop seizures long term, provide neuroprotective benefits against Alzheimer’s and Parkinson’s, and benefit those with Autism are not fully understood. There are many proposed theories that may explain why the ketogenic diet is so beneficial. A study performed in children aged 4-10 with ASD showed that adherence to a ketogenic diet improved Childhood Autism Rating Scale in 60% of the volunteers.
Some explanations include:
Fasting was shown to have antiseizure properties because while in starvation mode the body metabolizes fat stores and the fatty acids become 𝛽-hydroxybutyrate, acetoacetate, and acetone through beta-oxidation. These three ketone bodies are used as the body’s fuel source.
The ketogenic diet affects energy metabolism, glutamate-mediated toxicity, 𝛄-aminobutyric acid systems, antioxidant mechanisms, programmed cell death, and inflammation, which may explain how it benefits epilepsy as well as other neurological disorders. The ketogenic diet increases the amount of hippocampal genes that encode energy metabolism and mitochondrial enzymes stimulating mitochondrial biogenesis.
There have also been ties shown between autism and epilepsy-associated diseases due to the metabolic dysfunction of both diseases.
Ketone bodies, such as the ones produced during ketosis, inhibit reactive oxygen species by increasing NADH oxidation. This occurs and is beneficial possibly due to the production of NADPH via the glutamate decarboxylase/𝛾-aminobutyric acid (GABA, the main excitatory neurotransmitter) pathway, which may buffer the changes accumulated during stress.
Additionally, the lack of carbohydrates and glucose from the ketogenic diet may be why the diet has been so successful in diseases like Alzheimer’s. Scientists have discovered that excess glucose known as hyperglycemia, which is associated with diabetes and obesity, leads to an increased risk in Alzheimer’s Disease
Read more about why Alzheimer’s Disease is now considered type 3 diabetes
Dr. Bredesen has developed the Bredesen Protocol™, which evolved from the MEND Protocol™, which stands for metabolic enhancement for neurodegeneration. It involves the combination of over 25 different treatments, including optimizing your diet, enhancing ketogenesis, reducing stress, exercise, brain stimulation, and many more. This multi-faceted approach has been successful in reversing early onset Alzheimer’s. Although these protocols have been successful for reversing cognitive decline, adhering to the “everything including the kitchen sink” program and implementing lifestyle changes are complicated.