Got ketones drdebbrain

Ketones are the preferred fuel source for our brains

What is Ketosis?

Like most people, I did not know what ketosis was or whether having ketones in the body was a good thing or not. Ketosis by definition is the just the state of having ketones in our body. Since most of us have always eaten a carbohydrate-based diet, which uses glucose as the main fuel for our brains to run on, we did not know there was anything different. However, recently I have done a lot of research and found a huge body literature supporting the multiple benefits of having ketones in our bodies and using it for fuel instead of glucose.

I recently had the honor to listen to Dr. Stephen Cunnane, one of the leading researchers on nutrition and brain development, speak on his research about ketones as fuel for the brain. I have a few take-aways from that talk and from his recent article, published in Frontiers in Molecular Neuroscience that I would like to share to, hopefully, help show that having ketones in our bodies is indeed a good thing

Ketones are the preferred fuel source for the brain

It has been known since the 1960s, that ketones are the alternative fuel source, instead of glucose, for the brain. Dr Cahill at that time showed that the liver would produces ketones when glucose levels were low, as a way of survival during times of fasting or starvation.

The amount of ketones that are taken up into the cells of the brain is directly related to the amount of ketones that are present in the blood. Such that, the more ketones that are present in the blood, the more ketones will be taken up into the brain to be used. This is different than glucose, which is pulled into the brain cells based on the brain’s energy needs. Glucose also requires the presence of insulin to open the door for glucose to get into the cells (which is an issue in some neurological disorders such as Alzheimer’s Dementia).

In adults, the liver only produces ketones when glucose supplies are low, so ketones and glucose have not been available at the same time. Now that exogenous therapeutic ketones have been developed, your body can actually have ketones present even when glucose is also around. Thus, the body potentially now can have two different fuel sources in the body at the same time. So which one does the brain prefer? Dr Cunnane researched just that question, and with the use of PET scans to show the amount uptake of glucose and ketones in the brain. He found that that amount of glucose utilization in the brain decreases as the availability of ketones to the brain increases. I.e. if the energy needs of the brain are being meet by ketones, glucose uptake decreases. Thus when ketones are around, they are actually the preferred energy substrate for the brain.

Ketones are essential to the developing infant’s brain

Ketones are essential to the developing infant. In the neonatal brain, there is insufficient glucose available to meet the very high-energy needs of the growing brain thus; it must rely heavily on ketones for fuel. Ketones are not only needed as a fuel but they are also the main substrate needed for brain lipid synthesis (brain development). Even after the infant is born the infant’s brain relies on ketones for fuel. Thus, the infant remains in a sustained state of ketosis. This ketosis is not a function of food restriction (or low glucose levels) but is due to the medium chain fatty acids (MCFAs) that are supplied from the breast milk (and some formulas). The MCFAs are then stored in the infant’s adipose tissue. After breast-feeding ends, the adipose tissues provide will enough fats for ketones to be produced for many months.

So, in summary, being in ketosis is very natural. It is the body’s way to be protective of our brain during times of starvation or fasting. It is also probably also the diet of our ancestors. It is also a very natural state, since we are born in ketosis and with breast milk stay in ketosis through out infancy. Lastly, our brain actually prefers ketones over glucose. Are you ready to see how good your brain feels with it is fueled with ketones?

Got ketones drdebbrain

Bibliography

Cunnane, S. C. (2016). Can Ketones Help Rescue Brain Fuel Supply in Later life? Implications for Cognitive Health during Aging and the Treatment of Alzheimer’s Disease. Frontiers in Molecular Neuroscience , 9, 1-21.
The medical information on this site is provided as an information resource only. This information does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.
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Treating Concussions with Ketones

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What is a Concussion?

Head injury, whether it is from a concussion or a severe traumatic brain injury, can have long term and serious consequences. Concussions are typically described as mild traumatic brain injury. Concussions are most commonly occur from sports related injuries, such as from being tackled in football, to hitting a soccer ball off of head, or falling off a bicycle. In the US, there is estimated between 1.6 to 3.8 million sports related concussions that occur every year. The rates for concussion are highest in pediatric and adolescent age ranges. Even though concussions often do not cause structural damage to the brain, they still can causes significant symptoms. Headaches are the most common symptom seen with a concussion, but other post concussion symptoms include problems sleeping, impaired memory, dizziness, balance problems, attention problems and depression. These symptoms can last from weeks to months and in some cases even longer. (Giza, 2014)

Concussions have come to the forefront of pubic awareness with the recently discovered disease, chronic traumatic encephalopathy, which was the topic of the movie ‘Concussion’. Chronic traumatic encephalopathy (CTE) is the neurodegenerative changes that occur in the brains of individuals who have sustain multiple concussions earlier in their lives. CTE results in long-term neurological symptoms including behavioral, cognitive and motor symptoms.   The behavioral symptoms include depression, mood swings, aggression and possibly suicide. The cognitive deficits can range from memory problems to dementia. The motor symptoms vary from parkinsonian tremors to ataxia and even possibly a motor neuron disease. (Jordan, 2014)

What is the treatment of concussion?

Currently, there is no medical treatment for concussion except supportive measures. Other than the prevention of concussion in the first place, there is no medical ways to prevent it from progressing into CTE.

What is the pathobiology of concussion?

The underlying pathobiology of concussion has been well described. The shaken brain causes a disruption of the cellular membranes. This then causes a release of chemicals; potassium to flow out of the cells and calcium to flow into the cells. This triggers a cortical spreading depression of the neurons, which then results in the release of glutamate from the cells. The brain needs energy, or ATP to reestablish a balance or homeostasis of these chemicals. ATP is produced in the mitochondria of the cell after the uptake of glucose thru the process of glycolysis.(Giza, 2014)

Immediately after the brain injury there is then a transient increase in glucose uptake, followed by a prolonged decreased in glucose uptake and decrease glycolysis. This impairment in glucose uptake and glycolysis results in an over decreased in ATP production. This time of energy crisis or metabolic dysfunction of the brain is variable, ranging from days to months, depending on severity of injury and age of the brain.(Prins, 2104) Other changes that are occurring in the brain during this time include; increased glutamate excitotoxic damage and increased free radical production. During this time of metabolic dysfunction the brain is felt to be more vulnerable to a second injury. (Giza, 2014)

Is there an alternate fuel source that can be used?

Ketones are the only known natural alternative of glucose that can be used for cerebral energy metabolism. The advantage of using ketones is that they produce ATP thru beta- oxidation not thru glycolysis. Thus ketones are able to bypass the glucose metabolic derangements that are seen associated with brain injuries. ATP supply is also increased from mitochondria biogenesis that is seen with ketones. (Streijger, 2016) In the injured brain, ATP stores have been to be restored after administration of a ketone, beta-hydroxybutyate. (Prins, 2004) Ketones may also benefit the injured brain by their antioxidant effect, ability to increase the antioxidant glutathione and reduce free radical production. (Gano, 2014) Ketones also have been shown to protect cells against glutamate-induced neurotoxicity. (Ziegler, 2003) Hence, using Ketones as an as alternate fuel source instead of glucose, as therapeutic treatment of head injury is appealing.

How does this translate clinically?

There have not been any trials, as of yet, in humans. In studies using adolescent rats, the ketogenic diet has been shown to improve outcomes both with cognitive and motor function, following traumatic brain injury.   When the rats are pretreated with ketogenic diet they were found to have 58% less cortical injury volumes and better neuronal preservation. (Streijger, 2016)

For maximum neuroprotective effects, it is best to be in a state of ketosis (a state where the body is producing ketones) prior to any brain injury. The next best is to start it as soon as possible after the injury. Typically, if you start a ketogenic diet, it may take a while, up to several days, before you will be in ketosis. Another option, which can be used either in place of, or in addition to a ketogenic diet, is to use a ketone supplement. This supplement will get your body in the state of ketosis in less than 60 minutes. This supplement is not currently FDA approved for the treatment of concussion or other diseases. However, the researchers, who are currently using this supplement in research studies for concussion and head injury, are very excited about its potential. They currently recommended it for anyone who plays contact sports and are discussing potential uses in college and profession sports.

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Bibliography

Gano, L. (2014). Ketogenic Diet, mitochondria, and neurological diesases. Journal Lipid Research, 55, 2211-2228.
Giza, C. C. (2014). An Introduction to Sports Concussions. Continuum Lifelong learning in Neurology, 20 (6), 1545-1551.
Jordan, B. (2014). Chronic Traumatic Encephalopathy and other long-term sequelae. Continuum, lifelong learning in Neurology, 20 (6)1588-1604.
Prins, M. (2004). Increased cerebral uptake and oxidation of exogenous BHB improves ATP following traumatice brain injury in adult rats. Journal of Neurochemistry, 90, 666-672.
Prins, M. M. (2014). The collective therapeutic potential of cerebralketone metabolism in traumatic brain injury. Journal of Lipid Research, 55, 2450-2457.
Streijger, F. (2016). Ketogenic Diet and Ketones for the Treatment of Traumatic Brain and Spinal Cord Injury. In S. Masino (Ed.), Ketogenic Diet and Metabolic Therapies (pp. 133-146). Oxford.
Ziegler, D. (2003). Ketogenic diet increases glutathion peroxidase activity in rat hippocampus. Neurochem Res, 28, 1793-1797.