The ketogenic diet first became known as a therapeutic treatment in the 1920s, when it showed positive effects for children suffering from pediatric epilepsy. But does the diet help treat other neurological disorders, too? Studies continue to explore the extent of which the ketogenic diet can be used as therapy regarding neurological disorders.
What are Neurological Disorders?
Neurological disorders are a class of diseases that impact the brain, spine, and nerves. There are over 600 different diseases of the nervous system, many of which are increasing in frequency and lacking in effective treatment modalities.
Brain Diseases and Glucose
While every disease of the brain has its own characteristics, one theme that most have in common is impaired cerebral glucose metabolism, or the inability for the brain to get enough energy from glucose.
There are several key contributors to impaired cerebral glucose metabolism, but aging is one of the biggest.
However, glucose is not the only fuel source that can be used by the brain. Ketones, created via carbohydrate restriction or severe calorie restriction, can also be used by the brain. In fact, research shows that ketone bodies are the preferred fuel source of the human brain, meaning that when both glucose and ketones are present, the brain will preferentially take in ketones. Additionally, ketones can provide more fuel for the brain compared to glucose, and they are considered a “cleaner” fuel source because they produce less oxidative stress when they are metabolized compared to glucose. Finally, research has demonstrated that brain ketone uptake does not diminish with age, meaning this superior fuel source can still provide energy to the brain when glucose cannot.
While leveraging ketones for energy is not the only way that keto can impact brain diseases, it’s a huge mechanism that makes a compelling case for considering the use of the ketogenic diet in several different neurological disorders.
Keto and Epilepsy
Many people don’t realize that the ketogenic diet was created for its ability to treat pediatric epilepsy.
Epilepsy is one of the most common serious neurological conditions in the world and is characterized by abnormal brain cell activity resulting in recurrent seizures.
Interestingly, fasting recommendations for health were first recorded back in 500 BC and eventually became the primary therapeutic approach for epilepsy. But in the 1920s, it was found that a diet high in fat and low in carbs was able to mimic the effects of fasting on seizure control, only with the ability to still eat food. Just like that, the ketogenic diet was born.
However, as the creation and use of anti-epileptic drugs increased, the ketogenic diet became a forgotten option. Now the most popular treatment options for epilepsy are pharmaceutical medications, surgery, and vagal nerve stimulation, two of which are more medically invasive.
But using such treatments, especially medication, comes at a cost, specifically the side effects that accompany their use such as dizziness, nausea, vertigo, and fatigue among many others. Additionally, 25 percent of children do not respond to antiepileptic drugs, and those who do typically build up resistance to the drug, requiring frequent switching of medication, only to develop resistance and have to switch again.
This begs the question, how successful is the ketogenic diet for epilepsy? Medical literature suggests a nearly 60 percent success rate in patients utilizing the keto for seizure control. This is especially good news considering the ketogenic diet is not met with the same side effects and resistances to anti-epileptic drugs.
It’s not completely understood why the ketogenic diet helps prevent seizures, but the belief is that the change in metabolism that occurs on the diet plays a big role in the anti-convulsant effect. Additionally, along with creating more available energy for the brain, the keto diet has demonstrated the ability to increase the synthesis of GABA, a neurotransmitter in the brain that reduces excitability of brain cells thus reducing seizure risk.
As a result, it’s believed that keto may also help manage other conditions that result in seizures such as Rett syndrome, infantile spasms, Dravet syndrome, and tuberous sclerosis complex, GLUT1 deficiency syndrome, and Doose syndrome; however, much more research is needed in these specific cases.
Keto and Alzheimer’s Disease
An estimated 5.8 million Americans currently have Alzheimer’s disease (AD). Alzheimer’s disease is a progressive neurodegenerative disorder that is characterized by a decline in memory and language. Those suffering from AD demonstrate an accumulation of amyloid plaques (clumps of beta-amyloids, which destroy connections between nerve cells) and tau protein tangles (a neurofibrillary tangle and common AD marker) within the brain; together, they play a big role in the progression and symptoms of the disease. It’s currently thought that AD can be a result of environmental, lifestyle, and genetic factors. It’s also believed that a ketogenic diet can have positive effects on AD patients.
One of the most common and earliest signs of AD is an energy deficit in the brain. Those suffering from AD have insulin resistance of the brain, which causes impaired glucose metabolism, leading to that energy deficit. This characteristic of AD has led many to refer to the disease as “type III diabetes.”
This characteristic of AD is also one of the biggest reasons why a ketogenic diet should be considered for people with Alzheimer’s. As mentioned above, ketones are able to provide energy for the brain through pathways that are independent of insulin’s action. That means these ketones can provide fuel even to the insulin-resistant brain.
However, the power of a ketogenic diet for AD is not just a result of mitigating the energy deficit. Animal research has demonstrated that the ketogenic diet can reduce levels of the aforementioned amyloid plaques that also characterize AD; however, much more research is needed to determine if this occurs in humans. We also know that ketones are neuroprotective, meaning they can help reduce inflammation, which is important for preventing or slowing mental deterioration over time.
Keto first gained traction for the treatment of Alzheimer’s thanks to Dr. Mary Newport, author of The Complete Book of Ketones, who found that inducing ketosis through a keto diet and the use of coconut oil, MCT oil, and exogenous ketones, all drastically improved her husband’s AD symptoms.
Since then, the ketogenic diet has been used in research much more frequently and has demonstrated a strong correlation between levels of ketosis and improvements in cognitive performance in individuals suffering from AD.
It’s important to note that we need much more human research to determine the best use of the keto diet and ketogenic compounds for reducing the risk of and/or treating Alzheimer’s disease. It’s also not fully understood if the ketogenic diet can demonstrate improvements for all individuals since research hasn’t produced the same results in AD subjects who have the ApoE4 gene, which is associated with the greatest risk for Alzheimer’s.
Keto and Parkinson’s Disease
Parkinson’s disease (PD) is another neurodegenerative disease that manifests through impaired movement and affects 1 to 2 percent of people over the age of 65.
PD is caused by the death of neurons in the substantia nigra (a layer of midbrain gray matter) and creates immense motor problems affecting daily life, including slow jittery movement and disruption to the basal ganglia (thalamus-linked structures in the base of the brain involved in movement coordination).
Early symptoms of PD include rigid motions, trembling or shaking, and slow movement. Advanced symptoms include dementia, depression, and impaired walking and talking.
The basal ganglia control the “autopilot” functions of the brain, such as walking or basic motor tasks, thus explaining many of the symptoms of PD. The death of neurons in the substantia nigra is caused by the impairment of mitochondrial complex 1 activity, which compromises mitochondrial activity and results in an energy deficit.
Impaired mitochondrial activity and lack of brain energy allow the ketogenic diet to again be considered as a viable treatment option.
While the research is still limited, a study published in 2005 demonstrated that the subjects who were able to adhere to the ketogenic diet for 28 days experienced significant improvements on the unified Parkinson’s disease rating scale.
While the study shows a very small sample size, it offers promising hope in the treatment of Parkinson’s disease and gives reason to further explore the use of the ketogenic diet.
Keto and Amyotrophic Lateral Sclerosis
Amyotrophic Lateral Sclerosis (ALS), also referred to as Lou Gehrig’s disease, is a progressive neurodegenerative disease affecting motor neurons and ultimately leading to paralysis and death.
Death from ALS typically occurs 2 to 5 years from symptom onset and currently, the only FDA approved therapy for ALS extends survival by a measly 2 to 3 months.
About 6,000 people in the U.S. are diagnosed with ALS each year, and so far, no cure has been found. Symptoms of ALS include loss of motor function, impaired breathing, loss of or difficulty speaking, trouble eating, and muscle wasting.
While researchers are still working to determine the exact cause of ALS, it appears that like epilepsy, Alzheimer’s, and Parkinson’s disease, dysfunctional brain metabolism plays a big role.
While the available research here is also slim, keto’s ability to reduce inflammation and improve energy balance in the brain gives reason to consider its use in the treatment of ALS.
One animal study investigated the effects of a ketogenic diet on ALS. The results demonstrated an improvement in physical performance, mitochondrial function and ATP production, however it did not increase survival time. For this reason, a great deal of research is needed to see if there are adjustments that can be made to the diet to help improve survival time.
Keto and Multiple Sclerosis
Multiple Sclerosis (MS) has traditionally been viewed as an autoimmune-mediated inflammatory disease resulting in damage to the myelin (protective sheaths that cover nerve cells) of neurons. Myelin damage is thought to be a primary contributor to the symptoms of MS, which are numbness, impaired muscle function and coordination, impaired speech, poor vision, and severe fatigue.
Those suffering from MS typically experience symptoms in cycles, meaning the symptoms appear, disappear, then come back, usually getting a little worse each time they return.
Researchers have identified that mitochondrial dysfunction plays a role in the progression of MS. Unfortunately, there’s a lack of data assessing the effects of the ketogenic diet on MS. However, there is now ongoing research by Dr. Terry Wahls, and a recent review article highlighted several theoretical mechanisms by which the ketogenic diet can improve symptoms of MS, including limiting neurodegeneration, improving mitochondrial function, promoting mitochondrial biogenesis, increasing ATP production, and reducing oxidative damage.
Keto and Autism
Autism is a developmental disorder that affects the nervous system. While there is a spectrum of symptoms for autism, the disorder is most notably characterized by repetitive and compulsive behaviors. Additionally, people with autism display impaired mitochondrial function and glucose metabolism. This again gives reason to consider the ketogenic diet as an effective treatment.
A 2002 study examining the effects of a ketogenic diet on 30 children with autism, ages 4 to 10, displayed very promising results. While 7 of the children had difficulties tolerating the diet and 5 were only able to adhere for 2 months, 18 children were able to follow the ketogenic diet for 6 months. This study found that 2 of the patients experienced significant improvements on the childhood autism rating scale, 8 patients experienced average improvements, and 8 patients experienced mild improvements.
Despite the study’s small sample size, the results indicate that we should conduct more research on the use of keto for autism, especially since keto can improve gut health, which is also often impaired in children with autism.
Keto and Traumatic Brain Injury
Traumatic brain injuries (TBI) are common in contact sports as well as car and workplace accidents. TBI is associated with impaired cerebral energy production as well as with increased free radical production. As with the other conditions listed in this article, TBI, too, can be positively treated with a ketogenic diet.
When head trauma occurs, it creates a major energy deficit in the brain. To compensate for the loss, the brain upregulates glycolysis and metabolizes glucose at an accelerated rate. This eventually leads to insulin resistance in the brain, which creates both an energy deficit and stimulates inflammation.
But research has demonstrated that ketone transporters are elevated after a TBI, almost as if the brain is requesting ketones during this time. While research around the subject has only been conducted in animals, there’s good reason to believe the keto diet and the use of ketone supplements could be beneficial here, especially since ketones can meet the energy demand of the brain during this time, prevent insulin resistance, and reduce neuroinflammation.
Keto and Migraines
Migraines are characterized by recurrent neurovascular pain attacks triggered by genetic or environmental factors or both. While the exact cause of migraines is not known, it is believed that over excited neurons, lack of adequate energy, and an imbalance in brain chemicals all play a role.
Most of the evidence for the use of the ketogenic diet to combat migraines is anecdotal, but there are a few mechanisms that give this evidence credibility: Besides improving energy to the brain, keto can help calm over excited neurons and block neurotransmitters like glutamate, which is found in high amounts in those suffering from migraines and is often targeted by medications prescribed to those suffering from migraines.
Recently, one review analyzed 7 studies examining the effects of a ketogenic diet on migraines in over 150 patients and found that 6 out of the 7 studies demonstrated the ketogenic diet was effective at reducing the frequency and intensity of migraines. The researchers involved suggested that more research is needed but that preliminary data suggests that the stabilizing effects of the ketogenic diet may improve migraine-related symptoms.
While the research is still in its infancy, there are some individuals who are not waiting to start making an impact with the ketogenic diet, including Dr. Angela Stanton, who has developed her own migraine protocol that includes a modified ketogenic diet.
The Final Word
There’s a lot of evidence that suggests the ketogenic diet could be promising in the treatment of neurological disease, but we need a lot more research before it becomes part of the standard of care or adjuvant therapy.
The mechanisms by which keto can insert its benefits into the many conditions we mentioned in this article are great for getting the conversation started; however, it will take many more clinical trials before physicians will start prescribing the diet for these various disorders. We look forward to more research and results to better spread awareness on the increasingly popular topic of the ketogenic diet for neurological disorders.