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Ketogenic Diets for AD Prevention: a "Large [and Unwise] Bet"

Alzheimer's, cardiovascular, and other chronic diseases; biomarkers, lifestyle, supplements, drugs, and health care.
GenePoole0304
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Re: Ketogenic Diets for AD Prevention: a "Large [and Unwise] Bet"

Postby GenePoole0304 » Mon May 04, 2015 4:14 pm

I'm with cycling ketosis without going to full K which I read can be impaired even getting there in some E4\s

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Juliegee
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Re: Ketogenic Diets for AD Prevention: a "Large [and Unwise] Bet"

Postby Juliegee » Mon May 04, 2015 4:50 pm

I think a lot of what we need to focus on when there is so little human research to guide us is to look at what has the least probability of harm and greatest potential for other benefits.


I couldn’t agree more and very much appreciate your cautions. Several of them (protein restriction/sarcopenia & effect on immune function) have resonated with me, but I’ll address them in a separate post so as to not convolute my message.

I think we DO have mounting evidence that the degree of ketosis necessary to compensate for impaired cerebral hypometabolism (depending on what stage we are intervening) may be MUCH less than that which is required for addressing epilepsy. To suggest that lower levels may have reduced benefit is probably quite accurate when a patient is already experiencing symptoms. That notion may not hold up, however, when applying the strategy earlier in high risk patients. Everything I have learned suggests a continuum may apply here with Dr. Cunnane’s 0.3 - 0.5 mmol/L for high risk patients practicing prevention (E4 carriers; with homozygotes being more severely impacted) ranging to 3.0+ mmol/L (?) for AD patients.

ApropoE4, Richard can better speak to the very high levels of beta-hydroxybutyrate needed to suppress epilepsy; 4.0+ mmol/L(?) They are MUCH higher than the levels we are discussing for preventing or even addressing the initial signs of Alzheimer's. I'm hopeful that the negative side effects for our population will be proportionately less.

For anyone struggling to wrap their heads around this topic, I highly recommend this Medscape article. It’s worth continuing education if you happen to be a neurologist or neurosurgeon ;) but it’s perfectly suited to our audience as well. (You may need to register to access. It’s free & well worth it.)

Brain Glucose Hypometabolism, Ketosis, and Alzheimer Disease: From Controversy to Consensus
http://www.medscape.org/viewarticle/809725_transcript

The research is very clear that our population experiences a reduction in cerebral metabolism in the same brain regions as Alzheimer’s patients decades before the first symptom shows. To simply ignore this because we don’t have enough evidence of the efficacy of utilizing ketone bodies (whether derived via exercise, CR, IF, starchy carb reduction, MUFAs, etc.) could be missing a window of opportunity to prevent the neuronal death that may precede Alzheimer’s pathology.

Dr Isaacson: I try to take a realistic approach with my patients and their families. I tell them we do not have proof, we do not yet have an FDA-approved drug for the prevention of AD. Perhaps one day we will, but until that time, using a combination of these approaches is the best defense we have.


For a better understanding of the mechanism involved and why lower levels of beta-hydroxybutyrate may be enough for us- depending on where we fall on the continuum of affectedness, I highly recommend Dr. Cunnane’s paper:

BRAIN FUEL METABOLISM, AGING AND ALZHEIMER’S DISEASE
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3478067/

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Re: Ketogenic Diets for AD Prevention: a "Large [and Unwise] Bet"

Postby LAC1965 » Mon May 04, 2015 7:32 pm

Thanks Julie, and to others who posted on this topic. I’m still working on finding my optimal diet and this synthesis of information is extremely helpful.

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Re: Ketogenic Diets for AD Prevention: a "Large [and Unwise] Bet"

Postby GeorgeN » Mon May 04, 2015 8:55 pm


Yep, the 14% is in the right ballpark...
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Re: Ketogenic Diets for AD Prevention: a "Large [and Unwise] Bet"

Postby MarcR » Mon May 04, 2015 9:46 pm

Thanks for the leptin post, George. Interesting disconnect with Dr. Rosedale's information. Your interpretation in light of the LabCorp table seems right.
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Re: Ketogenic Diets for AD Prevention: a "Large [and Unwise] Bet"

Postby Juliegee » Wed May 06, 2015 1:20 pm

I just wanted to follow-up on some of the keto warnings that have been outlined here. The one from Dr. Ballantyne re. the possible effect on the immune system really caught my eye. In the podcast linked by Richard, she suggests that a full-blown keto diet can depress the innate immune system and fire-up the adaptive. That feels important to me as we have multiple clues for E4 carriers that our immune systems may play a part in the pathogenesis of AD.

The fact that Gamma Guard-IVIG therapy, improved cognition ONLY in E4 carriers leads me to think strengthening our immune systems should be of primary importance:
http://www.medpagetoday.com/MeetingCoverage/AAIC/40493

Secondly, we have evidence that the viral infection, HSV-1 linked to Alzheimer's, is more prominent in E4 carriers perhaps suggesting that our immune systems are more vulnerable: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4019841/

I’m an interesting n=1 as I’ve been DXed with an incidental immune disorder prior to beginning my mildly ketogenic diet, called hypogammaglubulinemia. I have low levels of IgG. I’m basically asymptomatic, but I'm closely followed by a hematologist; who's periodically considered IVIG therapy. When I followed Dr. Perlmutter’s recommendations for much higher protein: 20%; my IgG levels almost normalized. I’ve since dropped down much lower and my IgG levels have also dropped. My immune function (as measured by immunoglobulins) appears to follow my protein intake. For me, at least, a little more protein may play a part in bolstering my immune system. And, as Richard has pointed out, higher protein will help with muscle loss and help off-set sarcopenia. I’ve added glycine to try to balance the methionine as I work on increasng levels- work-in-progress :?

Gene & ApropoE4 had a few other cautions…I do check minerals and electrolytes. My magnesium was low prior to beginning my current diet. I now supplement a lot, 1,500 mg a day, and levels are mid/high range. I also liberally use salt or else sodium levels are low/normal. My potassium and calcium has always been perfectly regulated, mid range. No kidney stones, my GI function is much improved (after a lifetime of issues,) and my osteopenia has reversed. My T-score actually IMPROVED by 1.5 points- unheard of. I attribute that to paying very close attention to Vitamins D, A, K.

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Re: Ketogenic Diets for AD Prevention: a "Large [and Unwise] Bet"

Postby GenePoole0304 » Wed May 06, 2015 4:12 pm

"Keifer (the interviewer in the above podcast) suggests a reason for his "Carb Nite" and "Carb Backloading" approach is to reset the hormones so the body doesn't think it is always in a starvation mode. "

the reason is to up-regulate the thyroid which I think he intended to say. so ketosis down regulates!

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Re: Ketogenic Diets for AD Prevention: a "Large [and Unwise] Bet"

Postby Russ » Thu May 07, 2015 9:50 am

RichardS wrote:For an interesting take on the potential downsides of a ketogenic diet, keep an eye out for Dr. Sarah Ballantyne's follow-up to her Paleo f(x) talk. http://www.thepaleomom.com/2015/04/tpv- ... diets.html She promises a very detailed blog post to include all the scientific reference used for her talk. I've been following her for years and have been impressed with her scientific background and intellectual integrity. The podcast is worth a listen, but it is over an hour long.


Richard, I finally got a chance to listen to the full podcast (including the 30 min rant) yesterday while driving. I was really looking forward to hearing a strong, scientifically grounded argument, but that is not the impression I am left with honestly.

Although I am maybe contaminated by the long very emotional rant, whereas she did have an interesting point worth thinking about re ketogenic diet effect on balance on the innate and adaptive parts of the immune system, pretty much all of her evidence was anchored in the therapeutic ketogenic diets used in clinical settings for treatment of childhood epilepsy. I would concur that such diets, rich in only a few bland and non-nutrient dense foods, could indeed be problematic (and hard to adhere to) on a long-term basis, but I haven't heard anyone in or out of this forum advocating such things when they talk about 'ketogenic.' A strong clue was their shared rant about how you couldn't possibly get all necessary micronutrients if you don't eat your leafy green vegetables, and then positively ascribed a brief comment to the Wahl's diet, which is largely intended to be a ketogenic protocol.

I kept waiting to hear Emily Litella pop out and say 'never mind' when Chevy Chase noted that he hadn't said 'meatogenic' diet ;-)

Am I off base?
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Re: Ketogenic Diets for AD Prevention: a "Large [and Unwise] Bet"

Postby RichardS » Thu May 14, 2015 5:24 pm

Two quick points before I leave for 2 weeks of travel:

(1) As mentioned earlier, I did not truly get that so many references on the board to "ketogenic" really were much more mild that what is routinely discussed in the scientific literature and some other forums I have visited. There are a wide variety of ways in which people are using the term "ketogenic". So my cautions appear to be a bit overblown.

(2) As promised Sarah Ballantyne posted the blog that she referenced during that podcast. I have not had a chance to read it due to travel in the past week, but I will. I just wanted to make sure others interested in it have the link.

http://www.thepaleomom.com/2015/05/adve ... vised.html

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Re: Ketogenic Diets for AD Prevention: a "Large [and Unwise] Bet"

Postby LillyBritches » Thu May 14, 2015 8:58 pm

Hi, all. *hanging head in abject shame* *truly*

I'm so incredibly sorry that I literally posted that slumber cry for help and then bolted. No excuse...just negligent stupidity. I did read your caring and intelligent responses, took them to heart, and implemented a few. THANK YOU, THANK YOU. I shall answer this weekend (not that anyone is holding her/his breath...).

But, this! Julie, I know you've always advocated ketosis for 4s. I've got to agree. Purely subjectively, my numbers have NEVER been as amazing as when I was in mild ketosis - I mean, Jesus - it was night and day. Annnddd...I'm almost there (ketosis) again. But my personal travails with diet/exercise/discipline are ultimately pretty boring. So, thanks, Julie and all, for all this great ketoformation.

MichaelR - you never answered my initial query to you. I think we've all disclosed what our involvement with an ApoE4 forum is...what's yours? Are you ApoE4? If not - and this is blunt - what's your angle? Why are you posting here? Are you researching ApoE4? AD? Family member?

You've absolutely nothing to prove to me personally, but, as an e4 x 2, I'd like to place credence in your fairly detailed opinions.

So I'd like to know your gig.
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