The Ketogenic Diet: A Neurologist’s Warning

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The Ketogenic Diet: A Neurologist’s Warning

Postby Plumster » Thu Dec 26, 2019 6:50 am

Here's an article by neurologists working on Alzheimers prevention, Drs Ayesha and Dean Sherzai, in which they argue that ketones cause inflammation in cells and create waste by-products (in animal keto only?), the very things one should try to avoid. They leave an open door for plant-based keto, rather than animal, provided more evidence emerges through research. But the part of the article that I found most interesting is their claim that the brain doesn't need fat; it needs Omega 3s. This is contrary to what I've read on this forum where it is generally assumed the brain needs fat. Their major concern with the keto is vascular.

It is our belief that the ketogenic fad has a short-term benefit, but potential for significant long-term harm. Fat-based diets have been studied extensively and have been proven to damage vasculature. Even for those people who believe that the brain needs fat (which it actually doesn’t, it only needs omega 3’s) the brain has 400 miles of micro-vasculature – aka arteries – that are incredibly sensitive to fat and the damaging inflammation it causes. This we know.

While we know that a fat predominant diet has potential for significant damage for any system in the body, and especially the most metabolically active and most vascular organ in the body, we still believe that there is room for research into a plant based ketogenic diet to at least better understand the role of ketosis in brain function.

https://plantd.co/the-ketogenic-diet-a- ... s-warning/

Drs Sherzai have work forthcoming on omega 3 and the brain, which I look forward to reading.
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Re: The Ketogenic Diet: A Neurologist’s Warning

Postby Brainz » Thu Dec 26, 2019 4:10 pm

No sources cited. No evidence presented. Just an opinion on a plant based website. I'm unswayed.

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Re: The Ketogenic Diet: A Neurologist’s Warning

Postby Plumster » Thu Dec 26, 2019 4:19 pm

No sources cited. No evidence presented. Just an opinion on a plant based website. I'm unswayed.


Brainz, You are right that they do not provide sources for this particular claim, but they do have work forthcoming on omega 3s and the brain, which should be extremely interesting.

There are indeed sources in the linked article, just not to their assertion that the brain only needs omega 3s when it comes to fat. I look forward to hearing more about this.

P.s. check out their book The Alzheimer's Solution.
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Re: The Ketogenic Diet: A Neurologist’s Warning

Postby DaleBru » Fri Dec 27, 2019 5:28 am

The article says "A Neurologist's Warning" but IMHO it is a science-free repetition of ketogenic diet misinformation. The key statement in the article is "It is our belief..."

By coincidence I happened on this really good and recent science-based lecture from CrossFit/Virta/IUHealth. The lecture was October 13, 2019 and the video was posted on Dec. 5. It's by Doctor/Professor Jim McCarter and the title is "Debunking Common Keto Myths," For those of you still considering the evolving science of nutrition...

https://youtu.be/GJZaEYkfCHs

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Re: The Ketogenic Diet: A Neurologist’s Warning

Postby Plumster » Fri Dec 27, 2019 7:20 am

Thanks, DaleBru, I can't listen to the video at the moment, but will return to it.

But It's not the keto warning that interested me in the Sherzai article, it was their statement regarding fat and the brain. I do find it to be an apparent dilemma that the brain supposedly needs fat, yet fat harms its vasculature. No fat for the brain may cause AD; fat clogging arteries in the brain may cause AD. How do we reconcile these two statements? What kind of fat does the brain need? Just omega 3 or more than that? I know that there are distinct schools of thought on this matter, each with their own science to back it up. I deliberately posted the Sherzai article here rather than in our science thread because it is an opinionated article, by well-respected researchers, and not a study.
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Re: The Ketogenic Diet: A Neurologist’s Warning

Postby Julie G » Fri Dec 27, 2019 8:16 am

What kind of fat does the brain need? Just omega 3 or more than that?

DHA is extraordinarily important for our brains, which are comprised of more than 60% fat. DHA makes up 90% of omega-3 fatty acids in the brain. The brain is unable to manufacture DHA locally and maintains these high DHA levels primarily through the uptake of DHA from lipids in circulating blood that cross the blood-brain barrier. Additionally, we're building strong evidence that E4 carriers need additional amounts of omega-3 fatty acids to reach the same levels as other APOE genotypes.

Another nutrient that is vital for brain health is choline, found in large amounts in foods with relatively high levels of fat like eggs and liver. Choline stimulates the production of acetylcholine, a neurotransmitter responsible for synaptic connections essential to memory. Phosphatidylcholine, a phospholipid (a class of lipids that represents a major component of all cell membranes) of which choline is one component, is reduced in the brains of Alzheimer’s patients; whereas higher levels are associated with memory performance and resistance to cognitive decline. Choline has also been found to aid in the reduction of homocysteine, implicated in both dementia and cardiovascular disease as mentioned earlier. A recent study demonstrated that choline not only improved spatial memory in pregnant mice, but it did so for several generations, without further supplementation, underscoring its neuroprotective importance.

The potential lack off these two key nutrients is one (of many) reasons that a low fat vegan diet is especially risky for our genotype.
But It's not the keto warning that interested me in the Sherzai article, it was their statement regarding fat and the brain. I do find it to be an apparent dilemma that the brain supposedly needs fat, yet fat harms its vasculature. No fat for the brain may cause AD; fat clogging arteries in the brain may cause AD. How do we reconcile these two statements?

I think we can pretty easily reconcile those statements by simply avoiding insulin resistance and by choosing high quality fats in the context of an otherwise nutrient dense, clean diet. FWIW, I suspect your claim is based on studies like this which presume a high fat diet leads to obesity and metabolic syndrome. Sadly, there's almost no research that separates an examination of dietary fat without concurrent high level of carbohydrates, which we all know is a formula for disaster- especially for our genotype. The other thing to take into consideration when thinking about dietary fat, is the role it plays in addressing our significant reduction in neural fuel that precedes and accompanies cognitive decline. Higher levels of healthy fat (especially when combined with a long daily fast and exercise) can safely help create ketones that have been shown to offset our cerebral fuel reduction.

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Re: The Ketogenic Diet: A Neurologist’s Warning

Postby Plumster » Fri Dec 27, 2019 12:00 pm

I think we can pretty easily reconcile those statements by simply avoiding insulin resistance and by choosing high quality fats in the context of an otherwise nutrient dense, clean diet. FWIW, I suspect your claim is based on studies like this which presume a high fat diet leads to obesity and metabolic syndrome.


Thanks, Julie. No, my concern is not about insulin or weight but, rather, the arteries in the brain. How can we sustain high fat and keep our brain vasculature safe and healthy? Aren't saunas recommended for us primarily because they expand the arteries in the brain and keep them resilient, in addition to the benefits of heat shock proteins and elimination of toxins?
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Re: The Ketogenic Diet: A Neurologist’s Warning

Postby Julie G » Fri Dec 27, 2019 1:17 pm

Thanks, Julie. No, my concern is not about insulin or weight but, rather, the arteries in the brain. How can we sustain high fat and keep our brain vasculature safe and healthy?

I've never heard that fat clogs the arteries of the brain. That sounds like a hypothesis that has yet to be proven or maybe you have a paper? There is a condition called intracranial artery stenosis or transient ischemic attack (TIA) which can be a precursor to stroke. Risk factors include metabolic syndrome; insulin resistance, high blood pressure, etc.
Aren't saunas recommended for us primarily because they expand the arteries in the brain and keep them resilient, in addition to the benefits of heat shock proteins and elimination of toxins?

Yes, sauna bathing may improve the function of blood vessels walls reducing the risk of dementia and heart disease although not because it breaks up clogged fat in the vasculature of the brain or anywhere else in the body. Many people think of sauna use as an exercise mimetic. Both are also really good for detoxifying water soluble toxins. As you mentioned, adapting to high levels of heat also induces heat shock proteins through hormesis. We were designed to be uncomfortable; a concept foreign to most folks outside of our community. ;)

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Re: The Ketogenic Diet: A Neurologist’s Warning

Postby slacker » Fri Dec 27, 2019 3:25 pm

Just as saturated fats are thought by some to cause arteriosclerosis of heart arteries, SF is also associated with stroke. The process of arteriosclerosis, regardless of cause, gradually restricts the blood flow to the heart, brain, muscles, etc.

There have been lively debates elsewhere on our website concerning causality of saturated fat intake and coronary heart disease. These debates are also relevant to arterial blood flow anywhere in the body.

edited 12/28/19: thanks Julie G for catching my error as you posted below! (note to self: slow down....) Too bad that the entire article is behind a paywall.
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Re: The Ketogenic Diet: A Neurologist’s Warning

Postby Julie G » Fri Dec 27, 2019 6:41 pm

Just as saturated fats are thought by some to cause arteriosclerosis of heart arteries, SF is also associated with stroke. The process of arteriosclerosis, regardless of cause, gradually restricts the blood flow to the heart, brain, muscles, etc.

There have been lively debates elsewhere on our website concerning causality of saturated fat intake and coronary heart disease. These debates are also relevant to arterial blood flow anywhere in the body.

Thanks for sharing, slacker. It's refreshing to see that these associations are being re-examined. The study you linked actually found higher SF to reduce the risk of stroke.
Highlights
•Higher dietary saturated fat intake is associated with a decreased overall risk of stroke.

•There is a linear dose–response relation between dietary saturated fat intake and the risk of stroke.

•It is necessary to re-evaluate the restrictions on saturated fat intake for future dietary guidelines.


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