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

neurodegenerative disorders.

Ketogenic diet: limits carbs severely, usually less than 10 percent

Flips food pyramid on its head

Many different types, classical = 90 f, 6p,4c MCT=73 f, 10p, 17c MAD 65F, 35P

Used to increase ketosis

Ways of increasing ketosis, prolonged fasting >24 hours, 90 mins of intense exercise, med chain fatty
acids, exogenus ketone=esters and salts

Epilepsy, nice, ketogenic diet, 1920, epilepsy plus fasting reduces effects, due to increase in ketosis

Deplete body carb store= go into fat burning.

3 main ketones, acetoacetate- created from breakdown of fatty acid,converted into

hydroxybuttyrate or acetone

Oxidatition of carbs- glycolysis, produces acetylcholine, goes into krebs cycle for creation of atp,
Oxaloacetate combines with acetyl coa

Oxidation of fatty acid, produces acetylcholine, limit of carbs means oxaloacetate wont combine
with acetyl, gets converted back to glucose instead, acetyl coa goes into different cycle, forming
ketones

Fatty acids are large, attached to albumin in blood, don’t cross blood brain barrier without ketones,

Most ketones produced in liver and transferred to brain

Fatty acids cant get in brain, brain contains enzymes which can break down bhb into acetyl coa,

Acetyl coa into krebs cycle for energy

Recent evidence says smaller fatty acids can cross into brain

Brain usually metabolise glucose, increased plasma ketone bodies lead to usage of them instead

Clamp experiment in type 1 diabetes patients, hypoglycemia unawareness, change amount of

glucose in blood incrementally , lower it to an uncomfortable level (trembling,pounding heart etc),
when infusing ketones into diet, preserve cognitive functioning, Veneman et al. Effect of
Hyperketonemia and Hyperlacticacidemia on Symptoms, Cognitive Dysfunction, and
Counterregulatory Hormone Responses During Hypoglycemia in Normal Humans. Diabetes 1994, 43,
1311–1317. BRAIN WILL USE KETONES IF REQUIRED

PET scans- study on overweighet individuals, very low calorie diet, 60 fay fasting, 10mmol ketones
floating in blood, in extreme circumstances ketones can replace glucose, 100 percent of metabolism
goes down to ketones if no carbs in diet. Front. Mol. Neurosci., 08 July 2016
| https://doi.org/10.3389/fnmol.2016.00053

Even if carbs still available, glucose can be be displaced for ketones, if ketones pumped into
bloodstream, shows glucose isn’t preferred by brain, ketones and glucose used to similar degree,
glucose main fuel due to lack of ketosis on daily basis. Ketones is an alternative fuel for brain
Critically evaluate the idea that a ketogenic diet might be a beneficial treatment for
neurodegenerative disorders.

Dementia

Pet scans show marked reductions in glucose metabolism around brain, e.g temporal lobe

Glucose energy deficit in brain usually proceeds onset of dementia, not a consequence of neuronal
loss, only specific to glucose, acetoacetate metabolism is preserved, therefore energy deficit can be
reserved by supplying with ketogenic diet

Very low carb diet, individuals with mild cognitive impairment, career ethics, hard to ask them to
supply ill patients with a difficult to follow diet, low carb diet, increased memory performance,
ketone levels were positively correlated with memory performance

Med chain triglycerides,8-10 carbons, absorb quicker into bloodstream, converted to ketones,
palatable

Give participants c8 fatty acids, 750 percent increase in ketones in bloodstream

When given med chain try, Glucose metabolism not altered, ketone intake in brain increases, more
available energy,

Ageing causes brain energy gap, less glucose being metabolised, ketone diet can help close the
gap/med chain trygleceride

Case report, TP, sporadic Alzheimer’s disease, apoe4 positive, 20 month on c8 triglyceride, scored
higher on Adas cog, sowed down neurodegeneration. Greater cog performance at highest ketone
level, issue with case studies provides insight for further research, lack of ability to generalise,
publication bias

Benefic trial: supplement med chain try through drinks, in participants with mild cog impairment,
phase 1 see if changes in brain met occurred, phase 2 increased power, 2 groups, placebo vs twice a
day med chain try, 6 months,

Consuming med chain try, increase in ketones, no changes In diet necessary, cognitive function
assessed, episodic memory, executive function and language did improve, outliers were present,
individual differences could be cause of effect, second study controlled for individual differences
such as age gender etc, no changes in effect, small sample size, 5 th participants dropped out, didn’t
mention any brain markers? industry funded, abit dodgy

Strengths, controlled for a number of compounds, used supplement rather than ketodiet

Benefits in cognition correlated with number of ketones in blood stream

Keto side effects, keto flu, insomnia, fatigue, nausea, vomiting, headaches, constipation,

Vitamin or mineral deficiencies

Kidney stones, hepatic setosis, bad breath,

Other disorders have been researched, not randomised controlled trial, schizophrenia, depression,
binge eating, bipolar,

Gaba inhibitory neurotransmitter in brain, linked to many psychiatric problems , oxaloacetate reacts
with glutamate, glutamate not reacting with oxaloacetate, more glutamate means more gaba,

High energy exercise requires carbs

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

Intro- what are ketones, what is a ketogenic diet, how does it work, how can diet be achieved
(fasting etc, supplements),

Brain doesn’t prefer glucose, study, diabetes,