Critically evaluate the idea that a ketogenic diet might be a beneficial treatment for

neurodegenerative disorders.

For a very long time, carbohydrate heavy diets were considered the pinnacle of human health.
Recent ketone research has put this to debate. It was argued that the metabolism of ketones can
yield positive cognitive effects as well as slow down neurodegeneration. Ketones are primarily
formed in the liver due to insufficient glucose breakdown, however, supplementation or a ketogenic
diet can also begin ketosis. In a standard diet oxidation of carbohydrates forms oxaloacetate which is
a key molecule in the production of the energy storing molecule Adin triphosphate. The lack of
carbohydrates in ketogenic diets, means that oxaloacetate is not formed and therefore the brain
uses a different method for energy creation. Most Fatty acids are too large to enter the brain, in turn
they are broken down forming acetylcholine which is then used in the production of ketones. With
the help of albumin and ketones, fatty acids cross the blood brain barrier where enzymes break
them down, producing energy (DiabetesEducation).

Glucose can be replaced by ketones as the primary fuel for the brain without decreasing energy
output. Studies have shown that pumping ketones into the blood will result in even energy
distribution from ketones and the glucose reserves. No preferences are made by the brain
suggesting both molecules transfer similar levels of energy. For this reason, ketogenic diets are often
recommended to patients suffering from glucose related illnesses such as diabetes (Veneman, 1994).
Limiting glucose can help treat type 1 diabetes, which is a known neurodegenerative pathway to
Alzheimer’s. PET scans have shown that prior to developing Alzheimer’s there are severe reductions
in the rate of glucose metabolism in certain areas of the brain. No neuronal loss was noted meaning
that the glucose energy reserves are insufficient in activating the brains full capacity (Cunnane,
2016). This explains why studies have demonstrated that 81 percent of Alzheimer’s patients either
suffer from diabetes or a pre diabetic form of the disease (Janson, 2004). Introducing a ketogenic
diet would mean more ketones will be available for energy production and therefore glucose levels
can be kept at a suitable rate. Evidence shows that individuals who suffer from mild cognitive
impairment due to the eventual onset of diabetes have demonstrated increased cognitive
functioning. In fact, a positive correlation was found between ketone levels in blood and memory
performance (Kirkorian, 2012). These results look promising however they have been criticised by
sceptics. Following a ketone diet is a difficult process which can lead to many side effects including
“the ketone flu”. Critics claim that it would be far too gruelling to use a ketogenic diet to treat
patients, especially considering their physical health. Furthermore, this study only featured 23
participants and the diet was only followed for 6 weeks. It could be argued that much longer sample
times or follow up trials are necessary to justify using ketogenic diets as a successful treatment for
Alzheimer’s. Results from this study would be more convincing if supplementation was used instead.
It is unrealistic for a medical professional to recommend such a drastic diet change to already
suffering patients.

Whilst most fatty acids cannot be absorbed into the brain bloodstream, medium length lipids with
smaller carbon chains are capable. Providing participants with products containing medium chain
triglycerides resulted in a 750 percent increase in the number of ketones in the blood (Croteau,
2018). This means that the fatty acids were broken down into molecules which can in turn be used
for energy. Again, glucose metabolism is left unaltered meaning a diet doesn’t have to be closely
followed as long as regular supplementation is ensured. When examining patient TP’s (suffers from
sporadic Alzheimer’s) case report it was shown that these ketones reduced neurodegeneration and
enhanced cognitive ability (Newport el al, 2015). It is easy however to argue the validity of case
study reports, due to individual differences. Generalising that a similar effect will be present in all
Alzheimer’s patients is a huge leap of faith without the presence of empirical evidence. The Benefic
trial had a relatively larger sample size and focused on randomised controlled trials on sufferers of
Critically evaluate the idea that a ketogenic diet might be a beneficial treatment for
neurodegenerative disorders.

mild cognitive impairment. It was found that episodic memory and executive functioning did
improve, 2 areas which are known to be weaker in Alzheimer’s patients. Even when controlling for
extraneous variables such as age and gender a significant effect was still noted. Using
supplementation meant that it was free of the criticisms given to the TP case report. However, its
nature as an industry-based study means that positive results are of direct economic benefit to the
parent company. Furthermore, the study does not measure any markers for Alzheimer’s, making it
relevant but non-specific towards evaluating the treatment of neurodegenerative disorder. A
common issue in this topic is the lack of randomised controlled studies, which use a sufficient
sample size. Most results for other neurodegenerative disorders are case studies or animal studies
and therefore validity will be questioned. Despite this, evidence of a positive effect in patients with
schizophrenia, depression and other neurodegenerative disorders makes this topic worth future
research.

The evidence that the brain can use ketones as an energy source is concrete, the arguments arise in
their usefulness in treating disorders. It seems that following a close ketone diet is an unnecessary
burden, instead the usage of supplementation is a more effective way of encouraging ketosis. As
medium chain try glyceride tablets are readily available and do not affect glucose metabolism, it
would seem logical to implement them into the diet, alongside regular exercise, and occasional
fasting. The positive effect ketones have on memory functions would make them advisable for
sufferers of Alzheimer’s. Ketone diets also yield major benefits for diabetic individuals and could
slow down the onset of Alzheimer’s in the first place.