Can we use diet and lifestyle to protect us from the threat of cognitive decline from Alzheimer’s? This is a vital question that many people need to find some kind of answer to as they advance in years. After years where little or no progress was made, the situation is fasting changing now. We are living in a time of revolution in our approach to this problem. Many of the approaches through pharmaceuticals have failed horribly but new research into the influence of diet and lifestyle is offering far more hope.
What is Alzheimer’s?
Alzheimer’s disease is an extremely unpleasant, some say irreversible, brain problem that slowly decimates the memory and cognition of the victim over an extended period of time. The neurons quite literally are starved of nutrients in the form needed and effectively starve to death. Its effects are terrifying, in fact, it is perhaps the single most feared disease of our time. At the end of its course, the person who has it has all but disappeared as a unique entity and will find it next to impossible to carry out even the simplest and most mundane tasks.
Previously, it was often referred to as ‘old timer’s’ disease as it appeared only to attack those of relatively advanced years. In recent times though, it has been observed in much younger populations. Even people in their 20’s are now quite commonly reporting the early symptoms of MCI (Mild Cognitive Impairment). ‘
Many of the pharmaceutical interventions have been based around the idea that the problem is the presence of increased amounts of amyloid plaques. From this point of view, Alzheimer’s disease is believed to occur when abnormal amounts of these plaques or tau proteins are created in the brain. It is then hypothesized that these formations start to interfere with the normal function of the neurons.
Many of the attempted pharmaceutical approaches based on this theory have been spectacularly unsuccessful. One study using a drug that reduced these plaques had to be abandoned after a short period when it became clear that the control group, who had only been given a placebo, were drastically outperforming the group who had received the intervention. This was just one in a long list of failed trials.
There has been some speculation in recent times that much the same thing has happened in cases of cognitive decline from Alzheimer’s as happened with the cholesterol theory of heart disease. The presence of the plaques has been taken as the primary cause of the problem when this may well not be the case. It is entirely possible that they are simply a part of the body’s protective response. Much the same type of thinking was applied to the presence of cholesterol in blocked arteries. It now seems likely that the cholesterol was merely attempting to play a protective role in trying to solve the problem. The cholesterol was not causal but a physical response. This may well be one of the reasons for the relative ineffectiveness of statins in fighting heart disease.
To draw a simple analogy: it’s a little like observing the presence of the fire trucks at the scenes of fires and concluding that therefore they must have caused the fire in the first place.
Energy Systems in the Brain
The human brain only represents about 2% of the body’s weight yet it consumes something like 20% of its energy. It is a huge energy hog. For the most part, the brain uses glucose to power itself. This is not the only possibility, however. If glucose is not directly accessible the brain can mostly run on ketones. In fact, not only can it run but it actually does rather well on them.
If glucose is unavailable or unusable, ketones can and do serve as an alternative energy source so the neurons can maintain normal brain cell metabolism. It seems that the ketone beta hydroxybutyrate (as created on a ketogenic diet) may actually be a more efficient fuel than glucose. To function adequately it needs far less oxygen. It also causes much less oxidative stress in the brain.
Is Alzheimer’s Type 3 Diabetes?
‘But…’ you may well ask, ‘why would the brain not be able to access glucose?’ Glucose itself is often present in abundance in cerebral spinal fluid, the liquid that surrounds and infuses the brain. In fact, glucose is usually found there in much greater concentrations than in the bloodstream. The glucose has no problem whatsoever crossing the blood-brain barrier either. It may even easily enter the cells themselves. So, given that there is no shortage of glucose in the brain, why are the cells themselves not responding appropriately to its presence?
The answer lies in our old ‘friend’; insulin resistance. As insulin levels rise (often as the result of our body’s reaction to carbohydrate-rich diets), it finds it increasingly difficult to enter the brain. The receptors that are responsible for bringing the insulin across the blood-brain barrier become resistant in themselves. Because of this, the amount of insulin that enters the brain diminishes more and more over time.
This may lead to a situation where although the cells may be soaked in glucose they still cannot function normally because they require the insulin to process said glucose. In this parlous scenario, the cells will be unable to transform the plentiful glucose into the cellular components needed because of the lack of insulin needed for that process. A case of ‘water, water everywhere, but not a drop to drink’ it seems.
In this sense, cognitive decline from Alzheimer’s can be thought of as another manifestation of insulin resistance. Indeed, it has been suggested that it should be called Type 3 Diabetes. Whereas Type 2 Diabetes is insulin resistance in the body, Type 3 is insulin resistance in the brain. Interestingly, somewhere in the region of 80% of Alzheimer’s sufferers already have Type 2 Diabetes or insulin resistance.
The next question is how do we turn on the supply of ketones in order to displace the compromised glucose absorption in Alzheimer’s? Regular readers of this blog may have already guessed the answer: a ketogenic diet.
Adopting a ketogenic diet will, in relatively short order, allow the body to produce the ketones required. Although this way forward is fairly obvious it is not always so easy to apply in practice. Many victims of cognitive decline from Alzheimer’s can be quite resistant to this drastic change in diet and lifestyle. For such folks, there is an alternative: exogenous ketones.
In the field, researchers often differentiate between endogenous ketones, those that come from within the body, and exogenous ketones, those introduced artificially from outside. Exogenous ketones can be used to at least arrest the progress of the disease. If the patients can see for themselves the positive influence of the ketones they may then be more open to the drastic dietary changes required. It’s not easy for a person so compromised to change a lifetime of destructive dietary habits, but a glimpse of the possible benefits may well help.
There have been studies that demonstrate the compensatory benefits of ketones in cases of impaired glucose uptake. Other studies show the benefits for cognition that such a diet brings. Ketones also offer a degree of neuronal protection as they tend to favour the calming effects of GABA neurotransmitters over the more excitatory Glutamate. These profound benefits apply not just to those suffering from Alzheimer’s but anyone utilizing a truly ketogenic diet.
The Way Forward
Although much of the research into ketone’s effects on brain function is looking very positive, it should be stressed that we are still at a very early stage in understanding the process. Unfortunately, it would seem that not every patient can be helped to the extent that we would desire by these interventions. On the other hand, the vast majority will show some improvement at least.
More research clearly needs to be done in the coming years into ketones and their effect on cognitive decline from Alzheimer’s. As ever though, there is resistance to such radical ideas. The Amyloid plaque theory is probably, at the time of writing at least, the dominant theory in the field. The times they are a-changing though. The weight of evidence is increasingly pointing to the effectiveness of dietary and lifestyle interventions. The ongoing problems with using pharmaceutical interventions, the sheer lack of clinical success, would seem to indicate that a change of direction is much needed.
Culturally, we live in a time that seeks to solve every health problem via ingesting pharmaceuticals. We tend to want the answer to be in the form of a pill we can pop. I think that the flaws in such an attitude have become more and more apparent over the last few decades. Lifestyle interventions, particularly in the areas of diet, and to a lesser extent exercise, are proving to be far more profound. It is no longer good enough to outsource responsibility for your health to the local MD. As in so many areas in life, each of us needs to take responsibility for what we do and who we are. Health is no exception to this.
It seems clear now that these profound approaches to treating Alzheimer’s are set to revolutionize the field in the years to come. Research is ongoing, but more and more of those working in the field are realizing the benefits of ketones both in malfunctioning and even normal brains. Research takes time though. It may be decades before enough evidence is in to definitively say that this is the most effective way of treating Alzheimer’s.
We do know already that the brain clearly benefits from the use of the alternative energy substrate known as ketones. It may be some time before the evidence is definitive that these help to protect the brain from the cognitive decline from Alzheimer’s. For those of us already of an age where we may be vulnerable to such problems, the question becomes: can we afford to wait?
Given that this whole subject is sufficiently complex and challenging as to be a long way ‘beyond my pay grade’, I thought I would add a few links as a springboard for further research for those who are interested:
- The first is to the Alzheimer’s page of Amy Berger’s site.
- The second will be to the blog section of the much esteemed Dom D’Agostino’s, who is considered something of an authority on all things keto.
- And the third will be to the psychiatrist and nutrition researcher Dr. Georgia Ede and her various blogs on Alzheimer’s.