Dr. Melanie Tidman is an Adjunct Professor at A.T. Still University where she researches the effects of the Ketogenic Diet (KD) or Low-Carb-High-Fat (LCHF) nutrition on health, specifically in patients with neurodegenerative diseases like Parkinson’s and Alzheimer’s.
Tell us about your personal journey to learning about the ketogenic diet.
I have been in healthcare for many years and always advised my patients to eat a low-fat, high-carb diet, avoid red meat, and exercise a minimum of three times per week. I too followed this advice for most of my life. In 2013, I ended up with five major medical conditions and was on five medications. I had chronic fibromyalgia preventing me from doing many tasks, as well as severe obstructive sleep apnea which had me on CPAP for over eight years. I was on three medications for hypertension, chronic supraventricular tachycardia (SVT) and heart arrhythmias. I also had occasional asthma, osteoarthritis, pre-diabetes, and was chronically overweight. My ability to exercise was declining and even simple tasks became increasingly difficult. I finally came to the end of my rope and ended up at the Mayo Clinic. It was there that the revelation of the ketogenic diet came to me.
I then googled the ketogenic diet during the 2014 World Low Carb Summit from Cape Town, South Africa and I tuned in. As I listened to all the talks, frankly, I became very angry at the advice I had followed and had given my patients about diet for many years! I had followed the advice, and look what it got me: five chronic health conditions.
Being the 110% personality that I am, I returned home from the Mayo Clinic visit and went “cold turkey” onto a ketogenic diet (70% fat/25% protein /5% carbs) and went off all sugar and almost all carbohydrates, except for an occasional salad. Within six months I was off all medications. Within one year I had no medical conditions and began daily exercise. Today, I am mostly a carnivore after almost 10 years of strict adherence to this lifestyle. I teach dance aerobics classes three times per week and power lift heavy weights two times per week. I teach for four university doctoral programs, and am a Clinical Researcher for the Colorado Parkinson Foundation. Since 2014 I have read almost every book written on the ketogenic/low-carb approach, listened to almost every podcast, and read dozens of research studies. At 65, I feel I am in the best shape of my life.
How did that impact and guide you as an Occupational Therapist working with patients who have Parkinson’s Disease?
For over 40 years, I have witnessed the devastation caused by Parkinson’s Disease (PD) including the tremors, rigidity, and gradual loss of independence. By viewing lectures through the Nutrition Network, Kostholdslege, og Low Carb USA and participating in various low-carb conferences, I have learned a great deal about the science of inflammation and its effects on the biochemical and mitochondrial processes in the body and brain. I have seen the use of therapeutic carbohydrate restriction (TCR) and the ketogenic diet produce a reduction in inflammation and bring about vast changes in symptoms of PD in my patients including greater control over tremors and improved independence in activities of daily living.
In addition, due to the improvement in brain energy through the production and usage of blood ketones, I have seen improvements in symptoms of anxiety and depression in my patients with PD. Depression and anxiety are common problems in PD due to the deficits seen in dopamine production which I call the “feel good” neurochemical.
Additionally, patients with PD develop chronic metabolic conditions as they seek pleasure from sweet food items and junk foods to compensate for the loss of dopamine-producing neurochemicals that help them to feel good. By increasing the production of blood ketones (specifically BHB), patients report they feel better and have better brain function, cognition and memory with fewer cravings for sweet foods and junk foods.
What lead you to become a Certified Metabolic Health Practitioner?
I was so excited to see the formation of the Society of Metabolic Health Practitioners. Finally, an organization where those of us practicing TCR with our patients can have a “home.” We can receive ongoing support, training, and recognition as we seek to support each other along with encouraging ongoing research endeavors addressing the need to fill the gaps in research and add to the body of evidence for the use of TCR in chronic disease.
What inspired you to start research using a LCHF diet for Parkinson’s Disease patients?
This is an interesting story. I was camping with some friends who are on the board of the Colorado Parkinson Foundation (CPF). They were talking about some of their medical conditions and how as they grew older, they were experiencing more and more chronic health concerns. I taught them about LCHF/KD and worked with them over the course of a year. Their health improvements were impressive. As a result, they asked me to present the approach to the entire Board of CPF. Many of the board members were so impressed, that they too adopted the LCHF approach and witnessed vast improvements in their health.
I approached the Board about the possibility of conducting research on the LCHF/KD and TCR on Parkinson’s Disease. They were overwhelmingly enthusiastic! They provided the funding needed and we recruited our study participants from their membership rolls.
How do you educate patients with Parkinson’s to adopt a LCHF diet? What has been your biggest challenge?
I have not found a website with more educational materials and videos for my patients and participants needing to adopt the TCR lifestyle than the Keto-Mojo website. I use the videos on the website for training on blood glucose and ketone testing to teach my participants and patients how to use the Keto-Mojo meter. I find the resources to be incredible and direct my patients to the site to answer any questions they might have.
My biggest challenge in PD is the apathy associated with reductions in dopamine levels as the disease progresses. It is difficult to encourage patients with PD to initiate and follow-through, especially on dietary changes that reduce the sugar, something they use to “self-medicate,” if you get my meaning. Many persons with PD struggle with sugar in their diet. So little in their experience gives them the “highs” they crave and sugar often fits the bill.
Another challenge with the ketogenic diet is the abundance of meat in the diet. Many persons with PD have issues with chewing and swallowing so adjustments need to be made to be able to keep the high fats and moderate proteins without sacrificing safety when eating.
What were the most surprising results from the pilot study?
To tell the truth, I anticipated a few of the variables improving, but I never imagined that every single variable we tested would improve significantly over 12 weeks! Every one! This, in my experience, is rather unheard of, even for a small, short-term study like this one.
All biomarkers, and I mean all of them, improved significantly (Triglycerides, HDL, Fasting Insulin, C-Reactive Protein, Waist Measurements, Weight, HgA1C). Of course, I knew these would improve somewhat but did not expect them to show statistically significant changes in 12 weeks.
More surprisingly were the changes in the UPDRS scores. The UPDRS is a scale used to assess symptoms of PD. There were significant improvements in Behavior, Mentation, and Mood scores in 12 weeks. Additionally, improvements in scores on the Depression and Anxiety scales were also seen in 12 weeks, even in the midst of COVID isolation. This was surprising.
Many of my 16 participants reported improvements in quality of life including increased willingness to socialize with others. Persons with PD often isolate themselves due to feelings of embarrassment over their symptoms or speech difficulties. Many said they were more willing to get out into society and participate (once the COVID restrictions were eased). They reported improvements in cognition and a reduction in brain fog, which is a common complaint in PD.
Based on your experience, how are the current protocols for treating Parkinson’s Disease symptoms missing the mark in terms of improving anxiety and depression symptoms?
Well, I could really write a book here! The most common treatment we have for PD is the administration of a Carbo-Levodopa medication to replace the missing dopamine neurochemical. Unfortunately, this medication has many side effects, a short half-life, variability with interference from dietary ingredients, and the schedule for dosing vary from day to day. I also feel the treatment of anxiety and depression in PD uses all the common medications used for patients who do not have PD but have depression or anxiety diagnoses. Therefore, these medications often exacerbate the symptoms and cause severe side effects like lethargy, suicidal ideation, loss of appetite, etc. There has to be a better way!
Why do you think there isn’t much evidence yet with using KD for neurodegenerative diseases? What else needs to happen for other practitioners to adopt this treatment modality?
This is a really good question and one that baffles me. With PD and Alzheimer’s Disease on the rise in our world, why are there very few research studies or talks online regarding the effects of TCR and KD on persons with neurodegenerative diseases? This, in my opinion, is a large gap. I have kept track, and for all the conferences on the LCHF/KD lifestyle I have attended in the past five years, there has not been one talk on the management of neurodegenerative diseases using this approach. Why is this? It seems the focus has been largely on diabetes and cardiovascular diseases, which is good to establish the benefits. However, Pringsheim (2014) estimates that 50 million people worldwide suffer from neurodegenerative diseases (NDDS), and that by 2050 this figure will increase to 115 million people (para.6). This is in comparison with type 2 diabetes where according to an article by Khan (2020), the author estimates that “Globally, an estimated 462 million individuals are affected by Type 2 diabetes (T2D), corresponding to 6.28% of the world’s population” (para.7).
So 115 million are affected with NDDS versus 462 million affected by T2D….maybe this is why? Nonetheless, NDDS are a significant problem and they are on the rise, especially as the population lives longer. However, longevity is not the only factor. I had one participant in my study with Young Onset Parkinson’s Diseases (YOPD). She developed PD in her early 30’s. Perhaps NDDS like T2D will become increasingly an issue in the young due to our poor diet and lifestyle starting at such a young age.
I sincerely appreciate the work of Dr. Matthew Phillips in New Zealand who encouraged me in the design of my study and allowed me to use some of his patient materials with my participants. His work in PD is ongoing and I consider him to be one of the few experts on the use of TCR and KD with PD.
You used a similar approach to a continuous remote care model with your subjects; specifically measuring dietary compliance through ketone tracking. Do you think checking blood ketones was a helpful measure for adherence to the prescribed diet?
I sincerely appreciated the ability to Zoom with my participants as much as they needed for support and education and to encourage them to monitor their blood glucose and ketones. I only wish, in retrospect, I had had them test daily. Some of them did, but the study requirement was once a week just to monitor nutritional ketosis. This was probably not as accurate as daily testing would have been. My next study, already in the works, will use daily testing. The Institutional Review Board (IRB) felt that daily testing could possibly be “too invasive or arduous” so I had to change this to once a week. Now that I know the importance of daily testing, I will push to include daily testing in my next study.
My next study will test the effects of the ketogenic diet on cognition, various types of memory, and also include biomarkers of health. I will add the variable of the use of MCT oil. I hope to make this a randomized controlled trial (RCT) with a control group and an intervention group. I hope to once again collaborate with Keto-Mojo on securing blood glucose and ketone meters for my participants and have them test daily. Exploring more of the research resources available through Keto-Mojo will be helpful as well. I am thankful for their continued focus on supporting research on this highly effective nutritional approach.