Tag Archives: keto

cheering woman open arms at sunrise mountain peak wellness concept[This article discusses health improvements based, at least in part, on a ketogenic diet. Professor Loren Cordain and many others, including The Paleo Diet editorial review board, don’t recommend or endorse long-term ketogenic dieting for the general public. They do acknowledge that it can be effective if used short-term or as a therapeutic measure for multiple sclerosis, Alzheimer’s, and other diseases.]

 

The title of Dr. Terry Wahls’ book, The Wahls Protocol: A radical new way to treat all chronic autoimmune conditions using Paleo principles, [1] highlights issues vital to retirees or anyone facing autoimmune conditions. But it also modestly avoids the book’s central revelation: Wahls’ own personal experience dramatically improving severe multiple sclerosis symptoms.

An avid martial artist and cyclist when first diagnosed with MS, Wahls became progressively debilitated despite the best conventional medical care—including drugs and chemotherapy. Within seven years she was wheelchair-bound, only able to walk short distances using two canes.

A firmly committed conventional physician herself, she realized she needed to look beyond Western medicine and began her own research. This resulted in a carefully crafted, rigorous diet-and-lifestyle intervention that improved her health so dramatically she could walk without canes or assistance at four months and ride a bicycle (for the first time in 10 years) at five months. She remains fully active today, devoted to both widening awareness of health problems caused by the standard Western diet and to clinical research on replicating her personal results.

 

“How did I not know any of this?” (from The Wahls Protocol, p. 5)

Many hours on Google and PubMed eventually led Wahls to the Paleolithic or Ancestral diet, which became integral to her own protocol and recovery. She credits Professor Loren Cordain as a strong early influence in her research, including his book The Paleo Diet: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat. [2] Wahls gradually abandoned her conventional Western (vegetarian) diet, and designed from scratch, by trial and error, an intensively micro- and phytonutrient-rich whole-food regimen. Her goal was not just to remove western staples like processed foods, grains, and legumes, but to add optimal levels of all vitamins and minerals needed to promote brain health—using food, not supplements.

The balance of macronutrients—heavy on vegetables, some fruit and healthy fats—that appears to have improved Wahls’ MS symptoms result in “mild ketosis.” Her protocol also includes regular exercise, toxin reduction, e-stim, whole body vibration, and decreasing stress. Some supplements may be used, but the bulk of nutrients are derived from whole foods. Her well-known TED talk [3] concisely introduces her protocol—and describes her remarkable personal resurgence. It is just as timely today as it was when it was recorded in 2011. It has been viewed (as of this writing) over 3 million times.

 

Many conditions, one etiology

Wahls views most chronic health issues, and specifically autoimmune conditions like MS, as essentially the same disease [4]:

“The primary driver of disease is biochemical dysfunction/accelerated aging due to mitochondrial dysfunction and cell membrane dysfunction. Fix those two things—cells begin to repair organs, organs function well, aging slows and often reverses, and the need for pharmacologic interventions decline and we need to steadily reduce and often eliminate prescription drugs…” [5]

In an email interview, Wahls reports success using her protocol “across a large swath of disease states across multiple specialties,” both helping patients and causing previously skeptical colleagues to reconsider her approach. [5] She emphasizes cellular nutrition, multiplying and strengthening mitochondria (the “engines” or energy-producing substructures in each cell) and the importance of treating the whole person to restore optimal biochemical processes.

Wahls, who added functional medicine to her own medical practice during her MS research, also notes that the basic whole-food, whole-person protocol can be at least as effective as a costly test- and supplement-intensive functional approaches. As many patients find, good functional practitioners are scarce—and typically not covered by health insurance. Extended functional treatment may cost thousands of dollars, including exotic lab work, versus a modest increase in the household food budget, with some funds earmarked for stress-reduction, natural detox and exercise.

Despite the success of her protocol, Wahls cautions that medical supervision is still important, especially for MS and other autoimmune patients taking medication. Each individual responds differently. Wahls recommends monitoring the protocol based on standard indicators including lipid profile, homocysteine, insulin and A1C levels. If adjustments are necessary, they typical involve changes in ratios of various vegetables, targeted supplements, or possibly the amount of dietary fat consumed.

 

Paleo vs. Keto in the protocol

The Wahls Protocol offers three versions or levels of the diet, all of which are built on six to nine cups of vegetables (and some fruit) each day. Wahls recognizes the initial difficulty of eliminating classic Western diet stressors, like sugar, grains, potatoes and dairy. These are first de-emphasized, then restricted, and finally eliminated in the third level, called “Wahls Paleo Plus.” This level targets “mild” ketosis and is credited by Wahls for reversing her MS symptoms.

Wahls includes exercise, e-stim, detox, and stress reduction in all levels.

“Wahls Paleo Plus” is unusually nutrient-dense compared to other ketogenic plans, and includes at least six cups of greens, sulfur-rich and colorful vegetables, along with coconut milk, seaweed, organ meats, and grass-fed or other carefully sourced protein. Ketosis should be consistent (but may be intermittent.)

Wahls observes, however, that no modern (or ancestral) hunter-gatherer populations maintain a year-round ketogenic diet, and that it may not be practical or even desirable, as we’ve pointed out on this website, to stay in ketosis indefinitely. She has come to favor cycling through periodic fasting (or a fasting-mimicking diet), other caloric restriction, and matching a ketogenic diet to the winter season of an individual’s ethnic background. [5]

This fosters therapeutic ketosis for a generous stretch of time each year, takes advantage of occasional controlled fasting to promote autophagy and detoxification, and allows “three-seasons” use of the less restrictive ancestral food choices in “Wahls Paleo” (the second level of the protocol.)

 

“Wahls Paleo” study results

Wahls estimates [6] that most of her patients choose the second level of the diet or “Wahls Paleo.” It follows many common Paleo guidelines, with the nine cups of vegetables as a foundation. No gluten-bearing food is permitted, and starches like legumes, brown rice, or potatoes are severely limited (two servings per week at most.)

Anecdotal evidence of patient success in her books (and on the internet) is strong, but Wahls has gone beyond word of mouth. Her intervention, typically at the “Wahls Paleo” level [5], has shown improvement or reversal of MS symptoms in multiple studies.

One study, first published in 2019 in PloS One, tracked changes in lipid profiles and the associated improvements in fatigue scoring. The intervention (diet plus e-stim, exercise, and stress-reduction) measurably reduced fatigue, a primary symptom of progressive MS, over 12 months. [7]

The same intervention was shown to improve gait and balance, primarily in mild-to-moderate progressive MS patients in a 2017 study first published in Degenerative Neurological and Neuromuscular Disease. [8] Wahls shared a related YouTube video showing some very marked improvements. [5,9]

Another important 2017 study, which first appeared in The Journal of the American College of Nutrition, showed that progressive MS patient scores for mood, cognitive and executive function, and anxiety were measurably improved by the Wahls intervention [10]. The authors noted, in particular, that the Paleolithic dietary component specifically improved mood and cognition more directly than the exercise or stress management. Fatigue, anxiety, and depression scores increased more gradually, but showed significant improvement after several months.

Finally, a 2019 study first published in Nutrients compared “Wahls Paleo” to a standard American “healthy diet.” Conventional nutritional bias is carefully balanced against Wahls’ recommendations and concluded that nutrient density was comparable in both diets (specifically that the Wahls diet is “safe” to follow.) [11]

Dr. Wahls’ work has important implications for treatment of all autoimmune conditions. Her success in reversing symptoms of a long-standing, progressive debilitating disease like MS, deserves much wider recognition.

 

REFERENCES

  1. Wahls, Terry, M. D., and Eve Adamson. The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles. Reprint edition, Avery, 2014. (hereafter “Wahls”)
  2. Cordain, Loren. The Paleo Diet: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat. Revised edition, John Wiley & Sons, 2010.
  3. Wahls, Terry. YouTube. 30 Nov. 2011, https://www.youtube.com/watch?v=KLjgBLwH3Wc.
  4. Wahls P. 47
  5. Wahls, Terry, M.D., email to the author, 9/3/2019
  6. Wahls P. 149
  7. Fellows Maxwell, Kelly, et al. “Lipid Profile Is Associated with Decreased Fatigue in Individuals with Progressive Multiple Sclerosis Following a Diet-Based Intervention: Results from a Pilot Study.” PloS One, vol. 14, no. 6, 2019, p. e0218075. PubMed, doi:10.1371/journal.pone.0218075.
  8. Bisht, Babita, et al. “Effects of a Multimodal Intervention on Gait and Balance of Subjects with Progressive Multiple Sclerosis: A Prospective Longitudinal Pilot Study.” Degenerative Neurological and Neuromuscular Disease, vol. 7, 2017, pp. 79–93. PubMed, doi:10.2147/DNND.S128872.
  9. Bisht, Babita et al. YouTube. 26 Nov. 2017, https://www.youtube.com/watch?v=tsOMPBS277Q.
  10. Lee, Jennifer E., et al. “A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis.” Journal of the American College of Nutrition, vol. 36, no. 3, Apr. 2017, pp. 150–68. PubMed, doi:10.1080/07315724.2016.1255160.
  11. Chenard, Catherine A., et al. “Nutrient Composition Comparison between a Modified Paleolithic Diet for Multiple Sclerosis and the Recommended Healthy U.S.-Style Eating Pattern.” Nutrients, vol. 11, no. 3, Mar. 2019. PubMed, doi:10.3390/nu11030537.

 

The Paleo Diet Digest

The Ketogenic Diet - Shutterstock

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Every January, The Metabolic Health Symposium takes place over three days in Los Angeles. Originally the symposium was focused on The Paleo Diet®—both the current science and how to live a Paleo lifestyle.

But a few years back, a new concept started making a showing at the symposium: the ketogenic diet. It was exciting! More and more people were talking about it, and by 2019 the Metabolic Health Symposium had gone full keto.

It wasn’t that The Paleo Diet had been upended or replaced. Many of the people on the stage advocating for the keto diet had been big names in the Paleo-sphere just a few years earlier. And many still were. They just saw the ketogenic diet as the next evolution—or refinement—of The Paleo Diet.

This has led to some confusion, and we frequently get asked the same questions: Is the ketogenic diet Paleo? Is it healthy? And, simply, what is the ketogenic diet?

Let’s start with that last question. A ketogenic diet is one that is very low in carbohydrates—in the neighborhood of 50 grams or fewer per day. This essentially starves the brain, which normally fuels itself exclusively on glucose. Since our brains need to be fuelled, our bodies look for alternate fuel sources. The solution? The body converts abundant fatty acids to ketones which the brain can use instead of glucose. This is what someone is talking about when they say, “they’ve gone into ketosis.”

Certainly, in Paleolithic times, our ancestors would necessarily have gone into ketosis at certain points of the year. Back then, the only sources of carbohydrates were vegetables, fruits, and sometimes syrup and honey. At certain times of the year—particularly the winter months for some northern hunter-gatherer societies—all of these sources of carbohydrates could be hard to find. In fact, Native Americans were known to make a snack of protein and fat, called pemmican, that they could eat all year.

But, while some hunter-gatherers were forced into ketosis for short periods, it was never a permanent or long-term lifestyle. This is why, as you’ll discover in the articles below, ketosis can have short-term health benefits, but as a long-term strategy it simply isn’t Paleo. Nor is it truly healthy.

If you’re interested in learning more about the keto diet, and The Paleo Diet’s stance on ketosis, check out our collection of articles below.

Enjoy!

— The Paleo Diet Team


Ketogenic Diets: Long-Term Nutritional and Metabolic Deficiencies

By Loren Cordain, PhD, Professor Emeritus

Dr. Cordain, the originator of The Paleo Diet, weighs in on the benefits and detriments of the ketogenic diet in this article. Using simple dietary software, he demonstrates very clearly why the ketogenic diet has nutritional deficiencies that can lead to serious health consequences over time—things like osteoporosis and heart disease. More importantly, many of the short-term benefits of the keto diet can be achieved on a Paleo Diet, but without the health consequences.


Is keto paleo?

Paleo vs. Keto: Choosing the Diet for You

By the Paleo Diet Team

If Dr. Cordain’s article goes a little too deep into the “scientific weeds” for you, this summary, written by our editorial board, explains the key differences between the two diets, and can help you choose which one you’d prefer.

Ketogenic Diet Infographic - The Paleo Diet

The Ketogenic Diet. Is it Paleo?

By Christopher James Clark, BB.A.

There are many misconceptions about ketogenic diets, and the media often doesn’t help people to understand the truth about what it is and isn’t. We get asked this question all the time: Is the ketogenic diet Paleo? To answer that question, Christopher J. Clark delves into the physiology of the ketogenic diet, giving a full primer on what it is, why it has the effects it does on our bodies, and whether it’s something you want to consider. 

Man with alzheimers

Diet Wins a Battle with Alzheimer’s

By David Whiteside

While we don’t recommend it as a long-term solution, the keto diet does have clear short-term benefits, particularly when it comes to some chronic conditions. This article, written by David Whiteside, explains how ketones have been able to help patients with Alzheimer’s disease. 

Can the ketogenic diet improve cancer therapy?

By Christopher James Clark, BB.A.

Christopher James Clark, one of our top science writers, goes into detail about how being in a state of ketosis can help fight cancer. It’s a fascinating story, but be ready for some deep science such as an explanation of the Warburg effect. Ultimately, while a keto diet can help fight cancer, it is certainly not a cure on its own. 

Does a ketogenic diet extend life span?

By Casey Thaler, B.A. NASM-CPT, FNS

Extending longevity and helping to treat cancer are some of the most recent and exciting claims from the ketogenic diet community, and novel new research is exploring these claims. Writer Casey Thaler explores the theory that periodic ketosis can extend your life, and whether the science backs these claims. Want to live a little longer? Then this may not be one to miss. 

How to achieve ketogenic gains with a Paleo Diet

By Marc Bubbs, ND, CISSN, CSCS

If you do decide you want to dive in and give a ketogenic approach a try, well, it’s not as simple as cutting back on your carbohydrates. Dr. Bubbs shares his tips on how to transition. More importantly, he explains how to put your body into a ketogenic state in a way that’s healthier and still true to your Paleo lifestyle.


More Digests to Come…

We hope you’ve been enjoying these digests we’ve put together for you this holiday season on common topics you have told us you are interested in. The ketogenic diet has certainly been popular, but we have more digests coming out over the next few weeks including our most popular recipes, tips on how to lose weight in healthy ways, and FAQs about The Paleo Diet.

If you enjoyed this digest and are interested in our upcoming themes, keep checking our website every few days—there are more to come.

As always, our team appreciates your support for The Paleo Diet. We look forward to and encourage your feedback on our website and Facebook

Thank you,
– The Paleo Diet Team

Man with alzheimers

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[This article discusses health improvements based, at least in part, on a ketogenic diet. Dr. Loren Cordain and many others, including The Paleo Diet editorial review board, don’t recommend or endorse long-term ketogenic dieting for the general public. They do acknowledge that it can be effective if used short-term and as a therapeutic measure for Alzheimer’s and other diseases.]

Peter Dredge’s book Beating Alzheimer’s, the enemy at the gate: turning despair into hope and action [1], recounts his wife Ann’s early-onset Alzheimer’s diagnosis and their intense struggle with both the disease and “conventional” medical treatment. They refused to accept what most of us believe; that Alzheimer’s is unstoppable, incurable, and irreversible (at one-point Ann was offered euthanasia.) Instead, they researched every nontraditional alternative.

They discovered the work of Dr. Mary Newport [2] and Dr. Dale Bredesen [3] and using that work as a guide, they achieved both short term relief from the worst symptoms, and measurable reversal of the condition. Ann, initially given only three months to live, is sometimes referred to as “probably the first New Zealander to come back from end-stage Alzheimer’s” [4].

Diet and supplementation contributed heavily to Ann’s progress. Drs. Newport and Bredesen, among many others, have exhaustively researched how the conventional Western diet, heavy in carbs, sugar, inflammatory oils and additives, can create a “perfect storm” in the brain. While food choices are not the only Alzheimer’s culprits, dietary changes can be pivotal in slowing—and even reversing—cognitive decline.

 

Dr. Newport and coconut oil

Dr. Newport’s husband Steve also suffered early-onset Alzheimer’s. Frustrated by conventional medicine’s lack of options, she began her own internet research. As passionately and painstakingly described in her book Alzheimer’s Disease – What If There Was A Cure? The Story of Ketones, [3] she discovered research on a prototype “medical food” (Ketasyn, a forerunner of Axona [5]) for dementia patients. The food was based on medium-chain triglycerides derived from coconut and palm kernel oil. Since the food itself was not yet available, Dr. Newport calculated the available MCT’s in coconut oil and added this to Steve’s diet.

Steve responded dramatically and immediately to coconut oil, and later MCT oil, consuming both regularly. His caregivers, including Dr. Newport, all noticed that he “was back,” with improved life and coping skills (dexterity, gait, personality,) better short-term memory, and measurably improved cognitive exam scores. Two years later, “stable” MRI results showed that there had been little, if any, additional brain atrophy during this oil-supplementation phase.

Steve did not experience a miracle cure, but rather measurable, intermittent relief from the worst symptoms of Alzheimer’s over fifteen years. Average life expectancy after diagnosis is 3-11 years [6]. During this time, the family diet was gradually modified along more classic ketogenic, or at least lower-carb lines. Steve also later used prototype “ketone esters,” then being developed by Dr. Richard Veech et al. [7]

Like Steve, Ann Dredge also responded quickly to a 60/40 MCT to coconut oil mixture. Four ounces each day, caused her daily, hour-long full-body twitching episodes to disappear. The same mixture could alleviate any rare recurrence. Dressing herself became much easier, and the oil mixture would also help calm Ann during what Peter calls “more-delusional episodes” of anxiety and confusion.

Ann also follows a ketogenic diet, exercises when possible, minimizes stress, and continues to use the oil mixture to this day. Symptoms often resume or intensify if she misses a dose. [1]

 

Ketones and the brain

Dr. Newport’s original 2008 case study [8], available on her website, succinctly introduces ketones, and ketosis, in the context of Alzheimer’s and other chronic diseases. Ketosis, the body’s use of fat-derived “ketone bodies” for energy (instead of glucose) has been widely popularized in the last few years due to the ketogenic diet craze.

As most keto dieters know, our bodies (and brains) come “factory equipped” to function in the absence of exogenous glucose. While we manufacture some glucose internally, due to our ability to survive on ketones, we don’t need to consume additional glucose in order to maintain bodily function. Keto texts, including Dr. Newport’s, often refer to starvation or fasting as a normal context for ketosis, but low-enough carbohydrate dieting produces the same result.

Interestingly, full ketosis is not the only way to increase available ketones—especially for use by the brain.

High fat foods and supplements like coconut or MCT oil can provide medium-chain triglycerides, which are readily converted to ketones. These become available immediately in the bloodstream. MCT oil supplementation, in particular, has been shown to increase bioavailable ketones even without reducing dietary carbohydrates [13]. The brain will preferentially use available ketones even if glucose is also present. That is, full ketosis is not required for the brain to take advantage of ketones [9]. One reason, or perhaps the main reason, for this is that ketones freely cross the blood-brain barrier.

Glucose, on the other hand, requires a more complex chemical process (involving insulin) to be made available to the brain.

Alzheimer’s is often characterized by insulin insensitivity in the brain and has been called “Type 3 Diabetes” by some researchers [10]. They theorize that the brain atrophies over time as glucose provides less and less available energy—even if ingested in prodigious amounts. They also note that the brain can develop this insensitivity even if the patient is not clinically “diabetic” [11].

 

Strong anecdotal evidence

Steve and Ann’s quick reactions to ingesting medium- and long-change triglycerides, metabolized into ketone bodies, appears to show that energy deprivation in the brain could be a major contributor to Alzheimer’s.

Dr. Newport carefully gathered numerous testimonials in her books, which she received during heroic efforts to raise awareness of Steve’s progress, both within and outside of the medical community. Not everyone responds as quickly or easily as Steve, or Ann Dredge, but even the slightest improvement can be welcome to the afflicted, as well as desperate family members or caregivers.

It should be noted that this “oil therapy” is not a cure but appears to slow, arrest and mitigate—sometime even reverse—multiple gross Alzheimer’s symptoms.

According to Dr. Dale Bredesen (a neurologist specializing in Alzheimer’s research,) insulin resistance is only one of several possible contributing co-factors to Alzheimer’s and other dementias. Nevertheless, his own protocol is also based on a ketogenic diet, including supplemental MCT or coconut oil. [3] His book also contains many corroborative case studies and testimonials.

Dr. Bredesen’s protocol will be examined in a subsequent article.

 

Lack of mainstream acceptance

The Dredges, Newports, and Dr. Bredesen have all experienced resistance on many levels as they explored or tried to promote awareness of these ideas.

Peter Dredge recounts repeated instances of vigorous opposition to the idea that Alzheimer’s could be treated. He has often been treated very negatively and was even threatened with legal proceedings to remove Ann from his care. His courageous refusal to accept conventional medicine’s death sentence on his beloved wife is a strong theme throughout his book. Ann is still with us.

Dr. Newport similarly describes being repeatedly stymied as she tried to follow conventional pathways to raise awareness of Steve’s modest recovery. Attempts to exhibit or speak at Alzheimer’s Association-sponsored events were denied or shut down, once with a public announcement that the Association “did not support” coconut oil research. She was also privately told that “extensive clinical trials” would be needed before her ideas could be publicly discussed.

As Dr. Bredesen’s book [3] shows, money for “extensive clinical trials” is controlled by various institutional review boards and hard to come by. His own protocol was denied funding as “too complicated,” despite many successful case studies [12].

Conventional medicine’s intransigence, especially when faced with effective but non-traditional methodologies, is well known to Paleo readers—many of whom have resolved serious health conditions by abandoning conventional dietary advice.

The stories of Peter and Ann Dredge, and the work of Drs. Newport and Bredesen, deserve much wider awareness.

 

REFERENCES:

  1. Beating Alzheimer’s, The Enemy at the Gate: Turning Despair into Hope and Action EBook: Peter Dredge: Gateway. https://www.amazon.com/Beating-Alzheimers-Enemy-Gate-Turning-ebook/dp/B07HH67GV3/ref=sr_1_4 crid=1OL2PXR69Y6EO&keywords=beating+alzheimers&qid=1560174789&s=gateway&sprefix=beating+al%2Caps%2C187&sr=8-4.
  2. Newport, Mary T. Alzheimer’s Disease: What If There Was a Cure?: The Story of Ketones. Second edition, Basic Health Publications, Inc, 2013.
  3. Bredesen, Dale E. The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline. Avery, an imprint of Penguin Random House, 2017.
  4. “Beating Alzheimer’s Disease? Anne Dredge’s ‘huge Improvements’ with Dale Bredesen Treatment.” RNZ, 21 Sept. 2018, https://www.rnz.co.nz/national/programmes/afternoons/audio/2018663546/beating-alzheimer-s-disease-anne-dredge-s-huge-improvements-with-dale-bredesen-treatment.
  5. Henderson, Samuel T., et al. “Study of the Ketogenic Agent AC-1202 in Mild to Moderate Alzheimer’s Disease: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial.” Nutrition & Metabolism, vol. 6, 2009, p. 31. www.ncbi.nlm.nih.gov, doi:10.1186/1743-7075-6-31.
  6. “What to Know about the Stages of Alzheimer’s.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers-stages/art-20048448.
  7. Kashiwaya, Yoshihiro, et al. “A Ketone Ester Diet Exhibits Anxiolytic and Cognition-Sparing Properties, and Lessens Amyloid and Tau Pathologies in a Mouse Model of Alzheimer’s Disease.” Neurobiology of Aging, vol. 34, no. 6, June 2013, pp. 1530–39. PubMed, doi:10.1016/j.neurobiolaging.2012.11.023.
  8. Newport, Mary. “What If There Was a Cure for Alzheimer’s Disease and No One Knew?  A Case Study by Dr. Mary Newport.” www.CoconutKetones.Com , Mary Newport, MD, 22 July 2008, http://coconutketones.com/wp-content/uploads/2016/09/whatifcure.pdf.
  9. Reger, Mark A., et al. “Effects of β-Hydroxybutyrate on Cognition in Memory-Impaired Adults.” Neurobiology of Aging, vol. 25, no. 3, Mar. 2004, pp. 311–14. DOI.org (Crossref), doi:10.1016/S0197-4580(03)00087-3.
  10. de la Monte, Suzanne M., and Jack R. Wands. “Alzheimer’s Disease Is Type 3 Diabetes–Evidence Reviewed.” Journal of Diabetes Science and Technology (Online), vol. 2, no. 6, Nov. 2008, pp. 1101–13.
  11. Schilling, Melissa A. “Unraveling Alzheimer’s: Making Sense of the Relationship between Diabetes and Alzheimer’s Disease 1.” Journal of Alzheimer’s Disease, vol. 51, no. 4, Jan. 2016, pp. 961–77. content.iospress.com, doi:10.3233/JAD-150980.
  12. Bredesen, Dale E. “Reversal of Cognitive Decline: A Novel Therapeutic Program.” Aging, vol. 6, no. 9, Sept. 2014, pp. 707–17. PubMed, doi:10.18632/aging.100690.
  13. Courchesne-Loyer, Alexandre, et al. “Stimulation of Mild, Sustained Ketonemia by Medium-Chain Triacylglycerols in Healthy Humans: Estimated Potential Contribution to Brain Energy Metabolism.” Nutrition, vol. 29, no. 4, Apr. 2013, pp. 635–40. ScienceDirect, doi:10.1016/j.nut.2012.09.009.

 

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When it comes to brain fuel – glucose is king.[1] Glucose is the brain’s primary source of fuel and it is quite narrowly regulated inside our body as a result. This is referred to as glucose homeostasis.[2] There are two key players in this process – insulin and glucagon.[3] These two hormones are kept in balance so that our blood sugar remains stable. When we eat, the ratio of insulin to glucagon is high – which helps to facilitate many postprandial (after meal) processes in the body.[4]

The standard American diet is very high in glucose – meaning it’s high in carbohydrates like bread, pasta, baked goods, and juices.[5] While glucose is the king of brain (and body) fuel, we do also have the ability to fuel our brains with ketone bodies, which is part of why low carb diets are currently exploding in popularity.[6] Heck, even I got in on the action, and wrote a low carb cookbook. (Note that while the Paleo Diet is lower carbohydrate than the standard American diet, at www.thepaleodiet.com, Dr. Loren Cordain and the Editorial Board do not support extreme low-carbohydrate diets like the Ketogenic diet.)

 

How the Body Manages Glucose

The nuts and bolts of how our brain handles glucose is actually very fascinating. To easily explain a very complex situation, it is best to start by describing the various different metabolic states which bring about different activity in the body and brain. For example, when we lack carbohydrates, our liver glycogen stores are rapidly used and fatty acids are then shuttled (from stored fat,) to provide energy via a process called oxidation.[7] These changes rapidly makes the body less reliant on glucose as it addresses the shortage.

Fatty acid oxidation allows the limited supply of glucose to be conserved for the brain – likely a mechanism developed to prevent starvation in our ancestors, during times of food scarcity.[8]

Think of this as a backup fuel system. Our body knows when one fuel is running low or not available, and switches to another energy supply. Taken to an extreme, when carbohydrates are low enough, for long enough, we go into ketosis.[9] The ‘keto flu’ – where we don’t feel very good after removing carbohydrates from our diet – is directly related to this switch in fuel systems.

On the flip side, if we have plenty of carbohydrates, our bodies will choose to store fat and rely on glucose for fuel since our ability to store carbohydrates is limited. This is also why marathon runners carb-load. They want to maximize this limited store and make sure more glucose is available for their bodies to draw upon as they step outside of a normal human activity range. Glycogen stores can be increased temporarily this way, but if you do this repeatedly – without burning the energy – you are very likely to gain weight instead.[10]

But when we really get into the details; how exactly does our brain sense glucose? and why is this important?

Essentially, there are neurons which detect the presence of glucose, and send signals to our brain, alerting the brain to its presence.[11] Since our brain controls our energy balance (as well as our hunger and satiety signaling processes) – the neurons which detect glucose are critically important.[12] But interestingly, these neurons are located outside the blood-brain barrier – not where you might expect.

 

What Happens to the Brain when Glucose Balance is Disrupted?

When glucose gets out of balance, diseases, obesity, and other conditions develop. But how does this happen, if we have glucose sensing neurons? In some cases, cells such as these neurons, can die and this is tightly related to brain disorders and degenerative brain conditions.[13] Also, neurotransmitter synthesis requires glucose, and our brain will simply have extreme issues if glucose levels (or regulation of glucose sensing) is disrupted.[14]

Glucose is actually shuttled from the blood to the brain through GLUT1 transporters on the surface of the brain which allows glucose to cross the blood-brain barrier.[15] This transport is carefully regulated and can be disrupted if the glucose-sensing neurons aren’t functioning appropriately. This can lead to serious issues.

Most glucose in the brain is used for ‘thinking’ and ‘processing’. These are broad terms, but essentially mean that without enough glucose in the brain, we can’t think properly, or process information. This disruption is similar to what is seen when alcohol is consumed, for example.

These processes (and glucose) are very critical for both learning and memory, and one can quickly see how glucose disruption and cell malfunction or cell death can greatly impair our brain’s critical processes.[16]

Glucose is in fact even more critical for other functions. For example, glucose can be used to synthesize glutamate, glycine, aspartate, and other important compounds. This is critical, as these compounds normally cannot easily gain entry directly into the brain, without glucose being used to synthesize them.[17] Another example of the importance of glucose, is autophagy. Autophagy is a greatly important process that “cleans out” dying or misfunctioning cells. It can be disrupted by poor glucose metabolism. In the simplest terms, think of it as recycling – but for the body.[18] Just as we recycle to provide better results for the earth – our body has internal mechanisms of recycling, for our own well-being. Glucose is also critical for metabolic coupling – where compounds made in one cell, can be used by a neighboring cell.[19] Think of it as similar to your neighbor borrowing a cup of sugar from you (though hopefully as a Paleo Dieter, you’re not keeping big bags of sugar in your kitchen.)

About 50 percent of all glucose in the body is used by the brain – which helps explain the ‘hangry’ state that we all experience.[20] If there isn’t glucose in the brain – neurotransmitters are not produced. This means neurons can’t talk to each other and helps explain our confusion and foul mood when our blood sugar gets very low.

Interestingly, research has also shown a direct link between too much sugar (specifically fructose) – and premature aging. Other studies have shown that too much glucose can be linked to cognitive decline and memory issues.[21] This research is the most frequently cited when articles claim that ‘sugar can kill us’, or ‘sugar can cause Alzheimer’s’. Type 2 diabetes is of course known as the disease where our bodies simply become resistant to insulin – truly scary.

Glucose sensing in the brain is critically important, and a Paleo Diet® will keep glucose levels at normal, healthy levels – leading to much better brain health and a healthier life overall.

 

References

  1. Mergenthaler P, Lindauer U, Dienel GA, Meisel A. Sugar for the brain: the role of glucose in physiological and pathological brain function. Trends Neurosci. 2013;36(10):587-97.
  2. Tups A, Benzler J, Sergi D, Ladyman SR, Williams LM. Central Regulation of Glucose Homeostasis. Compr Physiol. 2017;7(2):741-764.
  3. Kalra S, Gupta Y. The Insulin:Glucagon Ratio and the Choice of Glucose-Lowering Drugs. Diabetes Ther. 2016;7(1):1-9.
  4. Kalra S, Gupta Y. The Insulin:Glucagon Ratio and the Choice of Glucose-Lowering Drugs. Diabetes Ther. 2016;7(1):1-9.
  5. Sartorius K, Sartorius B, Madiba TE, Stefan C. Does high-carbohydrate intake lead to increased risk of obesity? A systematic review and meta-analysis. BMJ Open. 2018;8(2):e018449.
  6. Laffel L. Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev. 1999;15(6):412-26.
  7. Purdom T, Kravitz L, Dokladny K, Mermier C. Understanding the factors that effect maximal fat oxidation. J Int Soc Sports Nutr. 2018;15:3.
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  16. Mergenthaler P, Lindauer U, Dienel GA, Meisel A. Sugar for the brain: the role of glucose in physiological and pathological brain function. Trends Neurosci. 2013;36(10):587-97.
  17. Hertz L, Rothman DL. Glucose, Lactate, β-Hydroxybutyrate, Acetate, GABA, and Succinate as Substrates for Synthesis of Glutamate and GABA in the Glutamine-Glutamate/GABA Cycle. Adv Neurobiol. 2016;13:9-42.
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  20. Mergenthaler P, Lindauer U, Dienel GA, Meisel A. Sugar for the brain: the role of glucose in physiological and pathological brain function. Trends Neurosci. 2013;36(10):587-97.
  21. Calsolaro V, Edison P. Alterations in Glucose Metabolism in Alzheimer’s Disease. Recent Pat Endocr Metab Immune Drug Discov. 2016;10(1):31-39.

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Ketogenic diets are one of the hottest trends in wellness right now. This past year, I even wrote a keto cookbook. In fact, they have become so popular, that many variations of low carb diets are currently spearheading their way into the mainstream. While any focus on a healthier way of eating should be viewed as a positive, rather than a negative – the question remains: are carbohydrates really so bad? There is, of course – a complex scientific answer to this question.

First, we must look at the research. What does it say, what does it not say, and were the methods used to extract these conclusions properly conducted? Secondly – is there conclusive scientific evidence that the type of carbohydrates ingested, makes a difference? Third – is it possible that there is significant sensationalism around keto diets, which may tend to cloud the actual scientific data. Which in turn may be used to support their popularity? Lastly, is a Paleo Diet® actually worse for weight loss than a keto diet – or are there significant benefits to both approaches

To answer these questions, we must do a deep dive into the research of low carbohydrate diets. The newest study to gain widespread attention, focused only on 164 adults – not exactly a large enough sample pool, to say the least. While the media is quick to write attention grabbing headlines (i.e. “new study shows that low carb diets are better for weight loss”) the data rarely – if ever – supports these dramatic conclusions (1, 2, 3, 4, 5, 6, 7, 8, 9, 10).

This study is no different. While the results did show good outcomes for people following a low carbohydrate diet – the study did not come close to proving that all carbohydrate intake is bad. It also did not show that a diet filled with healthy carbohydrates cannot be just as good (if not better) for sustained weight loss. As has been shown in numerous scientific studies, higher carbohydrate diets consistently have better long-term success in terms of compliance (11, 12, 13, 14, 15, 16, 17, 18, 19, 20). In simpler terms, this means that those eating more carbohydrates have a much easier time adhering to a dietary protocol, over the course of years of eating.

This should not be shocking. While keto (and other low carb diets) do typically result in some short-term weight loss – this is sometimes just water weight. Secondly, almost without fail, people do eventually return to consuming carbohydrates (though sometimes it is in a diminished volume). Subsequently, they often do gain back the weight they may have lost (21, 22, 23, 24, 25, 26, 27, 28, 29, 30). Gary Taubes did an excellent job of analyzing and synthesizing nearly a century’s worth of research on this very topic, in his scientific tome Good Calories, Bad Calories.

A different study from earlier this year, showed that a low-carb diet and a low-fat diet both provided nearly identical results for dieters. This study followed 600 people over the course of a year and showed predictable results. The main takeaway from the sum of these studies is the conclusion that limiting sugar and eating high quality nutrient dense foods – a central tenant of The Paleo Diet – is the best strategy for long term weight loss (31, 32, 33, 34, 35, 36, 37, 38, 39, 40).

This means vegetables are the best foods to eat, along with high quality proteins, and anti-inflammatory fats. When it comes to a healthy diet (and especially fat loss) – the body’s delicate biochemistry and neurology must be prioritized. What foods provide the best hormonal response, along with limiting cravings and supporting brain health? Over and over again – the scientific research has pointed to the foods consumed when following a Paleo Diet (41, 42, 43, 44, 45, 46, 47, 48, 49, 50).

Another interesting aspect of these studies – they have highly variable results. For example, in the aforementioned study – one person lost a miraculous 60 pounds – while another gained 20. This shows the genetic variability inherent in all populations. It also illustrates that one specific diet is never going to be the solution for the entire population (51, 52, 53, 54, 55, 56, 57, 58, 59, 60).

Controlling leptin, ghrelin, blood sugar, and limiting consumption of empty calories – are all cornerstones of any healthy dietary approach. This is because scientific data has shown that these elements all quickly lead to rapid weight gain, if not properly controlled (61, 62, 63, 64, 65, 66, 67, 68, 69, 70). One fascinating study even showed that by modulating actual dopamine receptors (in this case, specifically the D2 receptors) – binge eating could be almost completely eliminated. This links in with other fascinating studies, which show that processed foods (like cookies) – may be as psychologically rewarding as hard drugs, like cocaine. It may appear shocking at first, but once the underlying neuronal circuitry is understood, there is truthfully very little difference between how the brain responds to these over-powering stimuli (71, 72, 73, 74, 75, 76, 77, 78, 79, 80).

So, is a high carb/low fat diet the holy grail to weight loss, or is the answer consuming no carbohydrates at all? As with most things, the truth lies somewhere in the middle. Moderate carbohydrate consumption (like the amount consumed in a healthy, properly implemented Paleo Diet) – seems to have the best long-term results (81, 82, 83, 84, 85, 86, 87, 88, 89, 90). This is not to say that low carbohydrate diets do not have their benefits – they do. But as Dr. Cordain has rightly pointed out, there can also be significant issues that may arise in long term implementations of ketogenic diets (91, 92, 93, 94, 95, 96, 97, 98, 99, 100).

In summary – neither approach is wrong, but carbohydrates (especially natural, low sugar forms) – are not bad. In fact, you will usually become very deficient in potassium, very quickly, if you do not consume at least some healthy carbohydrates. Of course, common sense wisdom like this (backed by strong science) – does not sell nearly as well as headlines like ‘lose 20 pounds quickly with the keto diet!’.

High quality protein, healthy fats, and low sugar carbohydrate consumption is really all you need to prioritize, to have a perfectly healthy diet. This is a simple, easy-to-remember paradigm, and it is applicable to anyone – no matter your age or gender. As always – don’t believe the hype. Carbohydrates won’t kill you, or absolutely cause you to gain weight. Sticking to whole, natural carbohydrates (which are low in sugar) is the best approach to a healthy diet. You can certainly experiment with a ketogenic diet, but it is not the only option for sustainable weight loss. For more reading on the fascinating topic of ketogenic diets, please read Dr. Cordain’s excellent piece.

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