Previous studies have shown the brain loses its ability to use glucose to produce energy in Alzheimer’s disease. Researchers are now conducting studies to determine if ketones could replace glucose as an energy source for the brain and ultimately restore cognitive ability.
Learn more about ketones and their role in brain health and combating Alzheimer’s.
The Alzheimer’s Association International Conference (AAIC) 2017 featured a session focused on the impact of brain ketone metabolism and ketogenic interventions in Alzheimer’s. Ketones are molecules produced by the liver from fatty acids, usually during periods of low food intake or carbohydrate restrictive diets and an energy source for the body.
Stephen Cunnane, Ph.D., from the University of Sherbrooke in Quebec, explains, “We know that in Alzheimer’s disease, the brain loses its ability to use glucose to produce energy. Some areas of the brain are down by 40% in terms of glucose metabolism. We believe that this energy gap increases the risk of neuronal dysfunction and cognitive decline.”
Dr. Cunnane also notes that glucose uptake into the brain frontal cortex has shown to be 14% lower in healthy seniors than in healthy young adults. Additionally, people with early Alzheimer’s have 20-30% less glucose uptake than cognitively healthy seniors. “Anybody trying to function with 20% less brain glucose long term will suffer from brain exhaustion,” he said.
Early studies show that the brain is able to use ketones instead of glucose and is prompting researchers to delve further into the relationship between ketones and the brain to see if ketones can delay cognitive decline in seniors.
Two preliminary studies have shown that increasing the uptake of ketones in the brain can have a positive impact on cognitive health.
There are two major ways of increasing ketones in the blood, thus increasing the uptake of ketones to the brain:
The first way of increasing ketone concentration in the blood is through a ketogenic diet. A ketogenic diet requires extremely low carbohydrate intake, nearly bringing the body to starvation conditions. Dr. Russell H. Swerdlow from the University of Kansas Alzheimer’s Disease Center explains:
“The ketogenic diet has been used in epilepsy for almost 100 years and has been shown to reduce intractable seizures. Our results suggest it could also be useful in other forms of neurological disease like Alzheimer’s, but it is not an easy diet to follow,” he added. “The point of our study is that it helps to establish a principle that brain metabolism can be rescued by a fuel other than glucose.”
His small study involved 15 people diagnosed with mild Alzheimer’s disease. They were placed on a ketogenic diet and given a triglyceride supplement for 3 months. Daily urine tests and monthly measurements of plasma betahydroxybutyrate levels showed the degree of ketosis for each participant. Cognitive function was assessed at the beginning, at the end of the three-month study, and then a month after the study when participants were eating normally again.
Of the 15 participants, 10 stuck to the diet and all 10 showed a significant improvement on the Alzheimer’s Disease Assessment Scale-Cog. All scores returned to normal when the participants returned to their normal diets. Dr. Swerdlow says, “This is just a pilot study – I wouldn’t go so far as to say it worked. But we can say we saw a potential therapeutic signal that warrants further studies to confirm whether there is a real effect. That is definitely exciting.”
Because the diet has such a low carbohydrate intake, it is not recommended for routine use, treatment or prevention of Alzheimer’s. “This is not a diet that people will enjoy being on,” Dr Swerdlow said. “The ultimate goal is not to recommend a ketogenic diet in their daily lives – it will be too difficult. We are just trying to show proof of principle that manipulating brain energy metabolism can impact the symptoms of Alzheimer’s. If we can establish that then we can try and develop other ways to simulate the effects of a ketogenic diet that would hopefully be more palatable.
Because of the difficulty in keeping with a ketogenic diet, triglyceride supplements may be an easier way to increase ketone concentration in the blood without sending the body into starvation mode.
While this study is still ongoing, early results are promising. The 50 participants in the study take a triglyceride supplement twice a day and will for a six month period. There are 12 participants who have completed the supplements and preliminary results showed a direct correlation between ketone levels and cognitive function.
Results are still being analyzed and released, but Dr. Cunnane is encouraged by the results thus far. “We are evaluating whether the brain can use the ketones in the supplement, and the answer is definitely yes. That was a critical step. We also saw some signs of cognitive benefits, but it is too small a study to say anything definitive.”
Final results will be available next spring.
What do you think about the relationship between brain health and ketones? Would you put your loved one on a ketogenic diet to improve cognitive health? We’d like to hear your thoughts in the comments below.
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