- Ketogenic Diet as Brain Therapy Aid
- Neurological Conditions the Ketogenic Diet Can Help
- The Science of the Ketogenic Diet and Brain Therapy
- Modifying the Ketogenic Diet for Brain Therapy
- Additional Diet/Lifestyle Changes
- Controversies and Considerations
- Top Tips for Starting the Ketogenic Diet
The ketogenic diet is helpful for those with neurological conditions, like brain neurodegenerative disease, as well as those going through brain therapy due to illness or injury. In fact, prior to the development of pharmaceutical interventions for epilepsy, the ketogenic diet was the primary treatment for epileptic patients. For those with neurological conditions, the ketogenic diet helps in similar ways as it did for patients with epilepsy.
This article examines the use of the ketogenic diet for traumatic brain injury (TBI) and other neurological conditions.
Ketogenic Diet as Brain Therapy Aid
Brain therapy is occupational and/or physical therapy designed to help people with neurological conditions or brain injuries. The therapies are used to help patients regain function or to slow the progression of degeneration. In the case of a traumatic brain injury, brain therapy is used to help a patient regain function that existed prior to the injury. In the case of Alzheimer’s or other neurological conditions, like brain neurodegenerative disease, brain therapy is intended to promote the cognitive abilities of the patient to maintain function as long as possible.
In its own way, the ketogenic diet is a form of brain therapy. It can slow degeneration in the brain after a Traumatic Brain Injury. It has also been shown to be neuroprotective, therefore preventing more damage in the brain. Plus, the ketogenic diet promotes ways of helping the brain regrow and relearn. In several ways, it aids a patient in repairing their brain.
Let's take a brief look at some of the neurological conditions or brain injuries that the ketogenic diet has been shown to help.
Neurological Conditions the Ketogenic Diet Can Help
Traumatic Brain Injury
TBI occurs when an external force causes brain injury. The injury is the result of an acceleration and deceleration inside the patient’s cranium, which comes from the sudden impact after movement. When TBI occurs, it can result in a number of symptoms affecting the patient’s cognitive, physical, behavioral, emotional, and social capabilities. These symptoms are a result of the damage that occurs to the brain and its ability to communicate with the body.
Encephalitis-Induced Brain Injury
Encephalitis is inflammation that occurs in the brain. When the inflammation occurs, nerve cells or the brain’s white matter is damaged. This can result in brain injury which behaves similarly to TBI. As with TBI, the brain injury that results from encephalitis can have a number of symptoms that affect the patient’s capabilities due to the damage to the brain.
Epilepsy is a neurological disorder. The most well-known symptom of epilepsy is seizures, but there are other symptoms, as well, including muscle spasms and fainting. Epilepsy occurs when the brain’s nerve cell activity is disturbed, which leads to the seizures. Since the nerve cells are disturbed, the brain is unable to communicate with the body correctly, which causes problems.
Alzheimer’s is a progressive neurological disorder marked by memory loss, confusion, and the destruction of mental functions. While patients may function well in the early stages of the disease, symptoms worsen as it progresses, impacting patients’ ability to complete daily living tasks independently. Some of the symptoms of Alzheimer’s may also include changes in behavior, mood, and personality because of the way the brain is affected by the disease.
Lou Gehrig’s Disease (ALS)
ALS (amyotrophic lateral sclerosis), also called Lou Gehrig’s disease, is a progressive neurological condition that impacts the nervous system. The condition causes damage to the nervous system so the brain and body cannot communicate properly. As a result, the condition leads to muscle weakness that results in limitations in physical functioning in patients.
Parkinson’s disease is a progressive neurological disease marked by an impact on a patient’s movement, including muscular tremors in the body. The symptoms come on slowly, usually beginning with a tremor in the hand of the patient. As the symptoms progress, the damage to the nervous system is more widespread, moving beyond the motor system to other functions of the body.
The Science of the Ketogenic Diet and Brain Therapy
The Ketogenic Diet
The keto diet is a diet plan that focuses on high fat intake, appropriate protein intake, and low carbohydrate intake. On a typical diet, carbohydrates are converted to glucose in the body, which is then used for energy. However, on the ketogenic diet, the lack of carbohydrates forces the body to burn fat due to an absence of glucose.
Ketosis, the metabolizing of fat for energy, naturally occurs in the body in times of starvation - when the body does not have enough glucose to run its biological processes. The ketogenic diet brings ketosis on purposefully and by the foods eaten, not by starvation. The process is purposefully changing your metabolic processes to nutritional ketosis.
In nutritional ketosis, the body can use fat from food, or body fat as its source of energy. When the body uses fat instead of glucose, ketones are produced and pass into the brain (and the rest of the body) to be used as energy.
Initially, the keto diet was developed in healthcare to help treat epilepsy. The increased production of ketones reduced seizure rates in patients.
In fact, some of the mechanisms of the ketogenic diet that helped epilepsy patients are the same ones that will help other brain neurological conditions.
The Brain's Use of Ketones for Energy
Though the primary source of energy for the brain is glucose, the body can adapt to the use of ketones, also known as ketone bodies (KBs), as a major source of energy in the case of starvation. This ensures the brain has the energy it needs to survive in case glucose is not being provided appropriately.[i]
It should be noted that the metabolism of ketones in the brain varies by region. This suggests that the brain prioritizes functions when KBs are used to supply energy. It should also be noted that, in the total absence of glucose, KBs alone cannot meet the needs of all the brain’s functions. However, your body is capable of creating glucose by breaking down protein to provide for the few process where glucose is vital.
In addition to being a source of energy, ketones have neuroprotective effects. Some ketone bodies, specifically beta hydroxybutyrate (BHB), are more energy efficient than glucose and can stimulate mitochondrial biogenesis. The stimulation of mitochondrial biogenesis can help stabilize synaptic function in the brain. The synapses allow communication between nerve cells by means of neurotransmitters.
Ketones protect against glutamate-mediated apoptosis and necrosis and decrease the formation of mitochondrial free radicals. Ketones also increase cerebral blood flow.[ii]
In the case of TBI's, there is an immediate problem after injury in the brain of energy metabolism. The cells are not able to obtain the appropriate amount of energy from glucose to aid the injured brain cells, so brain cells become damaged. If a person was to immediately change to a ketogenic diet after
Finally, KBs reduce glycolytic flux. Reducing glucose in the body, through the increase of KBs, has been shown to reduce the occurrences of seizures.
Ketones As An Alternative Energy Source for Neurological Conditions
When the brain suffers an injury, such as TBI, or a patient develops a neurological condition like brain neurodegenerative disease, mitochondrial cells are damaged. The damage makes it difficult for the cells in the brain to process glucose for it to be used as a source of energy.
This results from oxidative stress, which can compromise the brain’s ability to utilize glucose for metabolic activities. Immediately following a TBI, for example, this can lead to further damage since the brain does not have access to the energy it needs to prevent further damage. As a result, the initial damage has an impact on the patient because the inability to repair the damage or prevent further damage can make the patient’s condition worse than it would otherwise have been.[iii]
Though this effect can be seen in many neurological disorders, it is highly prevalent in the cases of traumatic brain injury (TBI) and Alzheimer’s disease. This effect is more notable in these conditions because of the way the brain is damaged. Since the brain cannot process glucose the right way because of these conditions, the ketogenic diet may be an effective approach to fueling the body and brain.[iv]
In neurological conditions like brain neurodegenerative disease, mitochondrial dysfunction usually plays a major part in symptoms. However, ketones can be used to provide energy to the brain regardless of mitochondrial dysfunction. As a result, the brain gets the energy needed as well as potential promotion of mitochondrial biogenesis. It is within this context that ketosis, as promoted through diet, is beneficial for patients with traumatic brain injury or certain neurological conditions.
Mechanisms of Neuroprotection of Keto Diet
When the keto diet is followed correctly, it results in greater quantities of omega-3s, EPA, and DHA in the brain. This results in a reduction of inflammation. By reducing inflammation, the negative symptoms of the neurological conditions can be alleviated and, in some cases, reversed to slow progression and result in improved health. [v]
Omega-3s are beneficial in those with neurological disorders because of their neuroprotective effects and their potential as a treatment. Since the ketogenic diet increases omega-3 in the body when followed correctly, it supports these neuroprotective effects. Omega-3's DHA and EPA come from salmon and other fatty fish, so these must be included as a fat source on the keto diet.[vi]
Along similar lines, DPA, EPA, and DHA, individually and in combination, have beneficial effects on neurodegenerative and neurological conditions. Since following a ketogenic style of eating increases long-chain fatty acids, including DPA, EPA, and DHA, the keto diet can have a positive impact on the conditions and its effects on the body.[vii]
The ketogenic diet, when followed correctly, can reduce reactive oxygen species (ROS). ROS can have a negative impact on cell metabolism. Since those with traumatic brain injury or brain neurodegenerative disease already experience problems with cell metabolism, reducing ROS can help offset this damage, thereby improving health. One way of decreasing the amount of ROS is decreasing the amount of protein in ones diet.
The keto diet also promotes brain-derived neurotrophic factor (BDNF). BDNF is a protein that aids in nerve growth in the brain. Since neurological conditions and traumatic brain injury result in the damage of nerve cells in the brain, promoting BDNF can combat the negative effects of the damage, improving health.
The Effects of Neurotoxicity of Excessive Glutamate
The chemical glutamate is a neurotransmitter in the brain. Normally, in a healthy brain in the right quantities, glutamate is helpful and plays a part in learning in the brain. However, when found in high concentrations, glutamate can be toxic to neurons, which regulate the communication between the brain and the body. In cases of neurological conditions, like Alzheimer’s, ALS, and Parkinson’s, the brain has too much glutamate. This is part of what causes damage to the brain and the symptoms experienced by patients.
Another neurotransmitter found in the brain is gamma-aminobutyric acid (GABA). While glutamate excites the brain, GABA works to calm it down and results in relaxation. GABA works throughout the body. When there is not enough GABA in the system, it can result in symptoms like anxiety, aggression, and other problems in thinking and behavior.
In order to be healthy, it is important that glutamate and GABA are in balance in the body. Since neurological conditions can result in an excess of glutamate, the ketogenic diet can be an effective lifestyle change to balance the glutamate with GABA in the body. The keto diet promotes the production of GABA in the body, which counters the effects of the glutamate.[viii]
By promoting the production of GABA, the keto diet can combat the symptoms of these neurological conditions as well as reduce feelings of anxiety, stress, and aggression. These symptoms may be present along with neurological conditions due to the change in the way the brain works.[ix]
Modifying the Ketogenic Diet for Brain Therapy
For patients with neurological conditions or traumatic brain injury, the ketogenic diet can be used to alleviate symptoms and promote improved health and prognosis. However, due to the way these conditions affect the brain, the diet may need to be modified to be most effective.
One change that would need to be made to the keto diet would be a reduction in the amount of protein consumed. Excessive protein consumption can result in the generation of ROS via the mTOR pathway.[x] ROS can have a negative impact on cell metabolism. Neurological conditions already have problems in cell metabolism due to the damage to the brain.
Excessive protein would simply exacerbate the problems but reducing protein on the keto diet would reduce the generation of ROS. In the keto diet, the normal protein consumption is approximately 1.2 g/kg bodyweight. However, to reduce ROS generation, patients with brain injuries are recommended to consume approximately 0.6 g/kg bodyweight.
Increase fat/Proper Fat Intake
The increased fat intake in the diet contributes to ketosis, particularly in the absence of carbohydrate consumption. However, when the diet is used as a treatment for brain injury, such as TBI, and other neurological conditions, the ketones need to be even higher than normal in ketosis for the neuroprotective abilities, such as mitochondrial biogenesis and increased cerebral blood flow. To increase the ketones to the required level, it is necessary to increase the fat intake on the diet, or to use specific ketone producing fat sources - like MCT oil or exogenous ketones.
Avoid MSG and artificial sweeteners
MSG is a form of glutamate. For patients with traumatic brain injury or neurological conditions, glutamate levels are already too high. Avoiding MSG can help avoid glutamate toxicity and keep GABA and glutamate in better balance to promote better brain functioning.
Along with MSG, artificial sweeteners should be avoided. Many artificial sweeteners include aspartame and other artificial ingredients that can result in overexcited toxicity in the body. This toxicity can contribute to worsening symptoms in the brain and body.
Increase fatty fish consumption
Fatty fish, like salmon, contain omega-3s in the form of DHA and EPA. Consuming omega-3s, especially DHA and EPA, can reduce inflammation. Reducing inflammation can help alleviate negative symptoms of brain injury, like TBI, and neurological conditions and, in some cases, even slow progression of degenerative diseases. You can read more about omega-3's and their role in reducing inflammation here.
Eat organic foods
When possible, eat organic foods, especially when eating butter and meat. Organic foods have better omega-3/6 ratios, which help reduce inflammation. In addition, they won't have been treated with pesticides or GMO's.
Reduce inflammatory foods
Inflammation is often a problem for patients with brain injury, such as TBI. In order to help reduce inflammation, certain foods should be avoided. This includes nightshade vegetables, dairy, sugar, refined flour, and processed meats, among others. Avoiding foods known to exacerbate inflammation may not reduce inflammation but can keep it from getting worse.
Add coconut or MCT oil
Coconut oil and MCT (medium-chain triglycerides) oil are fatty acids that help to stabilize blood sugar and enhance the production of ketones in the body, which helps achieve ketosis. By adding these oils to the keto diet, immediate ketones can be developed, prompting ketosis to be achieved or maintained. This produces a more rapid reaction in the brain.
Additional Diet/Lifestyle Changes
Along with the modifications of the ketogenic diet recommended for people with brain injury, TBI or other neurological conditions, there are additional dietary and lifestyle changes that can be beneficial. These changes can help combat the negative effects of the brain injury and help prevent further problems from arising.
Intermittent Fasting/Calorie Restriction
While it is important to get all nutrition required to be healthy, there are instances that support intermittent fasting and calorie restriction to improve health. Intermittent fasting and calorie restriction can be effective to reduce the mTOR pathway. The reduction of this pathway can help prevent the generation of ROS, which has a negative impact on cell metabolism. It is important that intermittent fasting and calorie restriction be under the supervision of a licensed medical professional. To read more about intermittent fasting, check out our guide to fasting.
Exercise is almost always healthy for people regardless of any injuries or diagnoses. For people with brain injuries or neurological conditions, exercise can be especially beneficial. Exercise helps promote BDNF, which promotes nerve cell growth. Since neurological conditions and brain injury like TBI result in the damage of nerve cells in the brain, promoting BDNF can combat the negative effects of the damage, improving health.
In addition, exercise can help reduce stress, depression, and anxiety. Exercising regularly can help improve emotional health and wellbeing, which can suffer after a diagnosis.
Try starting slow with exercise. Even a slow walk can help, and once you get used to that, you can slowly increase your exercise time and intensity.
Meditation is often recommended for people who experience emotional or behavioral symptoms associated with a diagnosis. Meditation helps ease stress and promote calmness and feelings of wellbeing. For people with brain injury like TBI or neurological conditions, a major benefit of meditation is the production of GABA, which combats elevated levels of glutamate. As with exercise, meditation can also help combat negative emotional side effects of a brain injury or neurological condition.
Relearning Programs and Therapies
Relearning programs and therapies not only help people with TBI re-learn how to do certain tasks but they are helpful to combat further damage. When patients learn to complete tasks through the therapies and programs, they use parts of the brain that have been damaged. Using these parts of the brain help promote new cell growth and slow any further deterioration.
Supplements are often used to add to the benefits of dietary and lifestyle changes or fill nutritional gaps caused by diet or lifestyle. There are also supplements that aid in the body’s functions.
- Mitochondrial supplements can be used to help combat the damage to the mitochondrial cells. These include supplements like PQQ, coenzyme q10 and acetyl-L-carnitine.
- Anti-inflammation supplements, like turmeric and antioxidants, reduce inflammation to help alleviate symptoms of a brain injury.
- Exogenous ketones supplements provide immediate ketones, which help keep the ketone levels high in the body.
Controversies and Considerations
One of the primary concerns associated with the keto diet is the elimination of an entire food group (carbohydrates). Many argue that this is not healthy because all food groups are needed for health. However, the ketogenic diet uses the body’s natural processes to address damage to the brain.
Because of the potential benefit of the keto diet for treating brain injury, brain neurodegenerative disease, and other neurological conditions, patients should address the potential of the diet with their doctors. The sooner the diet is implemented after traumatic brain injury, the more effective it can be in preventing further damage to the brain.
Though the keto diet has seen success in improving health for early-stage Alzheimer’s patients, the diet may be less successful for late-stage patients. For these patients, the damage to the brain may be too advanced for the diet to improve the brain’s functions. This should be discussed with the patient’s doctor to determine whether it should be implemented or not.
Top Tips for Starting the Ketogenic Diet
To increase the likelihood of success in the keto diet, the following tips can be used.
- Drink plenty of water.
- Exercise regularly.
- Be mindful of what carbs are consumed.
- Keep your stress levels under control.
- Use MCT oil to achieve and maintain ketosis.
- Watch out for constipation.
For more details on these tips, check out our Beginner's Guide to the Ketogenic Diet.
When people experience brain injuries, a lot changes in their lives. Treatment is designed to help patients regain some of what was lost due to the injury. Through the ketogenic diet, patients can combat the negative effects of injuries and neurological conditions, which helps them return to who they once were, moving toward greater health. The ketogenic diet can help patients through neuroprotective mechanisms, alternative energy sources, anti-inflammatory properties and more. There are additional lifestyle changes that can be made to enhance rehabilitation - and there's no one size fits all solution.