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  #1   ^
Old Thu, Jun-27-19, 08:18
Demi's Avatar
Demi Demi is offline
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Default Low-carb 'keto' diet ('Atkins-style') may modestly improve cognition in older adults

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27 June, 2019

Low-carb 'keto' diet ('Atkins-style') may modestly improve cognition in older adults

Diet that restricts glucose may help brain function

Johns Hopkins Medicine


In a pilot study of 14 older adults with mild cognitive problems suggestive of early Alzheimer's disease, Johns Hopkins Medicine researchers report that a high-fat, low-carbohydrate diet may improve brain function and memory.

Although the researchers say that finding participants willing to undertake restrictive diets for the three-month study -- or partners willing to help them stick to those diets -- was challenging, those who adhered to a modified Atkins diet (very low carbohydrates and extra fat) had small but measurable improvements on standardized tests of memory compared with those on a low-fat diet.

The short-term results, published in the April issue of the Journal of Alzheimer's Disease, are far from proof that the modified Atkins diet has the potential to stave off progression from mild cognitive impairment to Alzheimer's disease or other dementias. However, they are promising enough, the researchers say, to warrant larger, longer-term studies of dietary impact on brain function.

"Our early findings suggest that perhaps we don't need to cut carbs as strictly as we initially tried. We may eventually see the same beneficial effects by adding a ketone supplement that would make the diet easier to follow," says Jason Brandt, Ph.D., professor of psychiatry and behavioral sciences and neurology at the Johns Hopkins University School of Medicine. "Most of all, if we can confirm these preliminary findings, using dietary changes to mitigate cognitive loss in early-stage dementia would be a real game-changer. It's something that 400-plus experimental drugs haven't been able to do in clinical trials."

Brandt explains that, typically, the brain uses the sugar glucose -- a product of carbohydrate breakdown -- as a primary fuel. However, research has shown that in the early stage of Alzheimer's disease the brain isn't able to efficiently use glucose as an energy source. Some experts, he says, even refer to Alzheimer's as "type 3 diabetes."

Using brain scans that show energy use, researchers have also found that ketones -- chemicals formed during the breakdown of dietary fat -- can be used as an alternative energy source in the brains of healthy people and those with mild cognitive impairment. For example, when a person is on a ketogenic diet, consisting of lots of fat and very few sugars and starches, the brain and body use ketones as an energy source instead of carbs.

For the current study, the researchers wanted to see if people with mild cognitive impairment, often an indicator of developing Alzheimer's disease, would benefit from a diet that forced the brain to use ketones instead of carbohydrates for fuel.

After 2 1/2 years of recruitment efforts, the researchers were able to enroll 27 people in the 12-week diet study. There were a few dropouts, and so far, 14 participants have completed the study. The participants were an average age of 71. Half were women, and all but one were white.

To enroll, each participant required a study partner (typically a spouse) who was responsible for ensuring that the participant followed one of two diets for the full 12 weeks. Nine participants followed a modified Atkins diet meant to restrict carbs to 20 grams per day or less, with no restriction on calories.

The typical American consumes between 200 and 300 grams of carbs a day. The other five participants followed a National Institute of Aging diet, similar to the Mediterranean diet, that doesn't restrict carbohydrates, but favors fruits, vegetables, low- or fat-free dairy, whole grains and lean proteins such as seafood or chicken.

The participants and their partners were also asked to keep food diaries. Prior to starting the diets, those assigned to the modified Atkins diet were consuming about 158 grams of carbs per day. By week six of the diet, they had cut back to an average of 38.5 grams of carbs per day and continued dropping at nine weeks, but still short of the 20-gram target, before rising to an average of 53 grams of carbs by week 12. Participants on the National Institute of Aging diet continued to eat well over 100 grams of carbs per day.

Each participant also gave urine samples at the start of the dietary regimens and every three weeks up to the end of the study, which were used to track ketone levels. More than half of the participants on the modified Atkins diet had at least some ketones in their urine by six weeks into the diet until the end; as expected, none of the participants on the National Institute of Aging control diet had any detectable ketones.

Participants completed the Montreal Cognitive Assessment, the Mini-Mental State Examination and the Clinical Dementia Rating Scale at the start of the study. They were tested with a brief collection of neuropsychological memory tests before starting their diets and at six weeks and 12 weeks on the diet. At the six-week mark, the researchers found a significant improvement on memory tests, which coincided with the highest levels of ketones and lowest carb intakes.

When comparing the results of tests of delayed recall -- the ability to recollect something they were told or shown a few minutes earlier -- those who stuck to the modified Atkins diet improved by a couple of points on average (about 15% of the total score), whereas those who didn't follow the diet on average dropped a couple of points.

The researchers say the biggest hurdle for researchers was finding people willing to make drastic changes to their eating habits and partners willing to enforce the diets. The increase in carbohydrate intake later in the study period, they said, suggests that the diet becomes unpalatable over long periods.

"Many people would rather take a pill that causes them all kinds of nasty side effects than change their diet," says Brandt. "Older people often say that eating the foods they love is one of the few pleasures they still enjoy in life, and they aren't willing to give that up."

But, because Brandt's team observed promising results even in those lax with the diet, they believe that a milder version of the high-fat/low-carb diet, perhaps in conjunction with ketone supplement drinks, is worth further study. As this study also depended on caregivers/partners to do most of the work preparing and implementing the diet, the group also wants to see if participants with less severe mild cognitive impairment can make their own dietary choices and be more apt to stick to a ketogenic diet.

A standardized modified Atkins diet was created and tested at Johns Hopkins Medicine in 2002, initially to treat some seizure disorders. It's still used very successfully for this purpose.

According to the Alzheimer's Association, about 5.8 million Americans have Alzheimer's disease, and by 2050 the number is projected to increase to 14 million people.



https://eurekalert.org/pub_releases...hm-ld062619.php
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  #2   ^
Old Thu, Jun-27-19, 08:52
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GRB5111 GRB5111 is offline
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Yes, many in my generation have or are in the process of developing Alzheimer's or T3D. It's not hard to correlate the dramatic increase in these cases to the Food Pyramid and the misinformed recommendations with ample availability of Franken Foods masquerading as reasonable food choices. The result, carb addiction and deteriorating health.
Quote:
The researchers say the biggest hurdle for researchers was finding people willing to make drastic changes to their eating habits and partners willing to enforce the diets. The increase in carbohydrate intake later in the study period, they said, suggests that the diet becomes unpalatable over long periods.

"Many people would rather take a pill that causes them all kinds of nasty side effects than change their diet," says Brandt. "Older people often say that eating the foods they love is one of the few pleasures they still enjoy in life, and they aren't willing to give that up."

But, because Brandt's team observed promising results even in those lax with the diet, they believe that a milder version of the high-fat/low-carb diet, perhaps in conjunction with ketone supplement drinks, is worth further study. As this study also depended on caregivers/partners to do most of the work preparing and implementing the diet, the group also wants to see if participants with less severe mild cognitive impairment can make their own dietary choices and be more apt to stick to a ketogenic diet.


Yes, the "one of the few pleasures" comment indicates a dependency on hyper-palatable foods that weren't available in the early 1900s. Cravings have resulted that people cannot control, but they're rationalized as "pleasures." Pure denial due to a very distorted definition of "pleasure."

The recommended solution of a milder version of the diet is fine and works for many except for the very metabolically damaged. The suggestion that exogenous ketones can provide benefit is typical of the "pill for every ill" mentality. Doing this naturally without any further help other than the correct functioning of our metabolisms would be my preference, as some will achieve a redefinition of food "pleasures" that would be the healthy choices that also provide metabolic relief.
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Old Thu, Jun-27-19, 09:30
CityGirl8 CityGirl8 is offline
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Quote:
Originally Posted by GRB5111
Yes, the "one of the few pleasures" comment indicates a dependency on hyper-palatable foods that weren't available in the early 1900s. Cravings have resulted that people cannot control, but they're rationalized as "pleasures."
I remember my grandfather saying this very thing when doctors put him on a low fat diet in the early 80s and told him he couldn't eat bacon and eggs for breakfast anymore. I don't think bacon and eggs was a "craving that he couldn't control." It was food he enjoyed eating.
Quote:
Originally Posted by GRB5111
The suggestion that exogenous ketones can provide benefit is typical of the "pill for every ill" mentality.
I think doing it by just eating the right food is a better option, but even Amy Berger who is an expert on ketogenic diets for Alzheimer's says that she sees a potential use for exogenous ketones in Alzheimer's. And she doesn't see them really useful otherwise.
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Old Thu, Jun-27-19, 09:36
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WereBear WereBear is offline
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"Many people would rather take a pill that causes them all kinds of nasty side effects than change their diet," says Brandt. "Older people often say that eating the foods they love is one of the few pleasures they still enjoy in life, and they aren't willing to give that up."


And yet, these same people, losing toes, facing dialysis, in constant pain of neuropathy; THEN the change is a tiny price to pay for health.
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  #5   ^
Old Thu, Jun-27-19, 12:52
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GRB5111 GRB5111 is offline
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Originally Posted by CityGirl8
I think doing it by just eating the right food is a better option, but even Amy Berger who is an expert on ketogenic diets for Alzheimer's says that she sees a potential use for exogenous ketones in Alzheimer's. And she doesn't see them really useful otherwise.

This is a valid point, another use of exogenous ketones would be with adolescents with seizures, and I know they're experimenting with that now. I'm still trying to determine if the presence of ketones due to dietary protocols (in other words, the natural production of ketones) is simply a marker for the potential of health improvements or is it the ketones themselves. According to Bikman, research is focusing on this very question.

Last edited by GRB5111 : Fri, Jun-28-19 at 09:40.
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  #6   ^
Old Fri, Jun-28-19, 09:15
CityGirl8 CityGirl8 is offline
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Quote:
Originally Posted by GRB5111
I'm still trying to determine if the presence of ketones due to dietary protocols (another words, the natural production of ketones) is simply a marker for the potential of health improvements or is it the ketones themselves. According to Bikman, research is focusing on this very question.
I've wondered this myself. I've always thought it was just a marker, but it does look like for certain conditions--especially those that are brain related--that the ketones themselves may cross the brain barrier and provide benefit.

I also think that in the case of Alzheimer's there are two issues: How it develops and how it's treated. It's development has a lot to do with over-consumption of seed oils apparently. Avoiding those can happen without switching to a ketogenic diet. It's how people ate before 1900, when those oils weren't so available. Once it's developed, low carb can contribute to improvement (along with getting off the seed oils).
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  #7   ^
Old Fri, Jun-28-19, 11:12
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WereBear WereBear is offline
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Perhaps if a person is already sick the exogenous ketones are needed.
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  #8   ^
Old Fri, Jun-28-19, 14:03
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bevangel bevangel is offline
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I definitely noticed an improvement in my step-mother (alzheimer's) whenever I would take care of her for an extended time and give her MCT oil while cutting off her sugar and starch intake. It usually took about 2 days for the changed diet to kick in but then she would become quite noticeably more alert and capable of holding an extended, reasonably rational conversation again. Unfortunately her son was her primary guardian and he was completely unwilling to depart from her doctor's orders re her meds and diet. During the last 5 years of her life, I only saw MIL about 2 or 3 times a year for about a week or two at a time when I would take my Dad (who had major health issues of his own) across the country to visit her. (Dad's lung issues made it impossible for him to continue caring for her and her sons were unwilling to allow her to come to Texas where I could care for the both of them, or to spend any of her savings to allow the two of them to live together in assisted living.) But during our visits, she would come stay with us at whatever AirBNB I had rented and, by the end of our visit, the change in her would be so noticeable that even her fellow church members would remark on it. They all always assumed that she perked up because of Dad's visit. I think it was the diet.

I'm also convinced that going on a low carb diet very definitely improved my father's health. When he first came to live with me, I asked his doctor to give Dad a Mini-mental status exam because I could see that he wasn't functioning at full capacity mentally. Dad scored 26/31 which, given that he was a college grad, indicated "mild cognitive impairment." The doctor didn't know if it was very early alzheimer's or something else. Given that his lung condition required him to be on supplemental oxygen 24 hrs a day, I rather figured it could be caused by intermittent periods of low oxygen. Whatever. I certainly didn't expect it would get better.

But, amazingly less than a year on a low carb diet while living with me, it was obvious to me that he WAS better. I asked the doctor to retest him and he scored a perfect 31/31 AND he'd come off of his diabetes medication (glimepiride).

With his mental capacity restored, Dad was able to move into a small house nearby and was able to take care of himself (with a bit of house-keeping and driving assistance) right up until he died. Once he started cooking for himself again, Dad didn't stay quite as low-carb as I would have liked b/c he LOVED to bake...but he acknowledged that when he indulged in too many sweets, he got "foggy-headed" so he kept the indulgences low enough that even without diabetes meds, he kept his HbA1c's in the low 7s.

It's great to see that scientists are running studies on keto/low carb and cognitive function. But based on my personal experience, I'm already convinced.
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Old Sat, Jun-29-19, 02:51
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WereBear WereBear is offline
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Quote:
Originally Posted by bevangel
With his mental capacity restored, Dad was able to move into a small house nearby and was able to take care of himself (with a bit of house-keeping and driving assistance) right up until he died. Once he started cooking for himself again, Dad didn't stay quite as low-carb as I would have liked b/c he LOVED to bake...but he acknowledged that when he indulged in too many sweets, he got "foggy-headed" so he kept the indulgences low enough that even without diabetes meds, he kept his HbA1c's in the low 7s.

It's great to see that scientists are running studies on keto/low carb and cognitive function. But based on my personal experience, I'm already convinced.


So am I!

It has reached the point where I wonder where we could have gotten without agriculture We might have built an entirely different, and even smarter, system
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  #10   ^
Old Sun, Jun-30-19, 11:09
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bevangel bevangel is offline
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Quote:
Werebear wrote: It has reached the point where I wonder where we could have gotten without agriculture...
You might find this article from the May 1987 issue of Discover magazine interesting.
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