Keto Diet for Alzheimer’s? Critics Disagree on Whether it’s Healthy and Effective

For the past year, similar to many of us, Meredith has stayed in her home and worked in her home office. She spent little time outdoors or doing the active things she used to love, such as swimming, because the pools at the rec centers were closed. She was often bored of being inside and therefore spent lots of time on the sofa or at her desk snacking on junk food.

A couple of months ago, during her annual physical, Meredith was surprised to learn that she gained 25 lbs. over the past year! She needed to do something, so she started walking again and has been following a ketogenic (keto) diet. Over the past two months, she lost ten pounds and she feels much more energetic and healthier. She often wonders whether the keto diet would be beneficial for her mother, who has Alzheimer’s. She has heard mixed reviews about it from prominent doctors and she’s not sure what to believe.

What is a Keto Diet?

The keto diet is very high in fats, low in carbs, and moderate in protein. A keto meal might involve eggs, avocado, many kinds of meat, fish, and vegetables, and sometimes low-carb bread. While the total amount varies from person to person, the ketogenic diet aims to limit total carbs to about 20 grams a day, while also eating a moderate amount of protein and lots of fats. The objective is getting your body to a state of ketosis, where your body burns fat rather than glucose for fuel.

The goal of a keto diet is to force your body to make and rely on ketone bodies (also called ketones), which come from the breakdown of fat when there are not enough carbohydrates to keep the blood glucose within normal limits. In other words, the body manufactures ketones when we are severely deprived of calories or we are on a diet that is high in fat and low in carbohydrates.

Some believe that Alzheimer’s stems from trouble processing glucose, which is typically the brain’s preferred source of fuel. It is known that as we age, less glucose is able to cross the blood-brain barrier in order to fuel the brain. The ketogenic diet provides a way for ketones to take up the energy slack.

Are Keto Diets Good for Alzheimer’s Patients?

Dr. David Perlmutter, a Board-Certified Neurologist and five-time New York Times bestselling author, recently published an article on the effectiveness of keto diets for Alzheimer’s patients.

Currently, by using PET scans, Dr. Perlmutter says we can see how the brain is able to utilize ketone bodies. According to Dr. Perlmutter, “(i)f the brain is able to utilize ketones as an alternative fuel when it is having difficulties utilizing glucose, one might think that a ketogenic diet would perhaps prove helpful in individuals with Alzheimer’s disease.”

In his blog, Dr. Perlmutter discusses how his colleague, Dr. Matthew Phillips, designed a trial to determine whether a 12-week modified ketogenic diet would have any effect on various parameters that are typically measured in Alzheimer’s disease such as cognition, daily function, or quality of life. The study was conducted in a hospital clinic for Alzheimer’s disease patients and it involved 26 patients, of whom 21 completed the keto diet. During the 12-week trial, blood was evaluated for beta-hydroxybutyrate, an important ketone, especially as it relates to the brain. The study revealed the following:

  • In the keto group, blood glucose levels remained lower than the non-keto group. Measurement of blood ketone (beta-hydroxybutyrate) showed that ketones were higher in the intervention group.
  • Compared with the standard diet, patients on the keto diet showed a small trend towards improved cognition.
  • A significant change was seen on the scale measuring activities of daily living. This was described as being a meaningful benefit that “rarely occurs with medication.” Generally, Alzheimer’s patients decline as it relates to activities of daily living and self-care.
  • Compared to the usual diet, patients had a fairly dramatic improvement in measurements of quality of life. Again, no medications have any effect on quality of life outcome, so this was seen as a substantial benefit of the keto diet.

Dr. Phillips concluded that keto diets may hold promise as viable and effective treatment strategies for Alzheimer’s patients, but larger and longer studies are needed before this can be stated with confidence.

What Is the Potential Problem with a Keto Diet for Alzheimer’s?

Some disagree with Dr. Phillips’ findings, and believe that while a keto diet can provide a non-glucose source of energy for the brain and may have potential to affect the pathogenesis of Alzheimer’s disease, there are metabolic costs and nutrient sacrifices associated with this method. According to Dr. Ed Blonz, assistant clinical professor in the Department of Clinical Pharmacy at the University of California, San Francisco, sticking to a keto diet might provide your body with a needed alternate source of energy, but doing so could deprive the body and brain of many other essential nutrients that play a role in your overall vascular health—a key issue associated with the overall risk of Alzheimer’s disease.

According to Dr. Blonz, with a keto diet, the body cranks out a lot of ketones, which affect the pH balance of the blood. We normally have a higher (less acidic) pH, but ketones are acidic, and if present at elevated levels, they can lower blood pH, which can seriously mess with our metabolism. The condition called ketoacidosis, which occurs in out-of-control diabetes, can also occur in a poorly composed and monitored ketogenic diet, and this can be serious — even fatal.

Are Keto Diets Good for the Heart and the Brain?

Dr. Blonz describes how one of the accepted tenets in the battle against Alzheimer’s is that we need to focus on the health of the heart and vascular system to help prevent Alzheimer’s, or at least slow its progression. He believes that the MIND diet —a diet high in fruits and vegetables, fish and poultry, and olive oil — is a better option than a keto diet for the long term. According to Dr. Blonz, “(p)reliminary studies have shown that adhering to the Mediterranean-based, heart and brain healthy diet may lower the risk of Alzheimer’s by as much as 53%, and is not unhealthy for those with Alzheimer’s either. If you opt, instead, for a keto diet to provide ketones, you are thwarting the healthful eating element of the equation and missing out on a lot of nutrients. Relying on a keto diet might provide some short-term benefits, but it would likely mess things up in the long run.”

The following have been found to be some of the long-term effects of keto diets:

  • Cardiovascular problems – cardiomyopathy, arrythmias;
  • GI effects – nausea / bowel problems;
  • Increased risk of pancreatitis;
  • Increased risk of fatty infiltration of liver;
  • Increased risk of renal calculi;
  • Increased risk of osteoporosis / osteopenia, and most importantly;
  • Higher rate of all-cause mortality.

Whether you are considering a keto diet, a Mediterranean diet, or any new diet at all, be sure to follow the direction of a healthcare provider who has experience with these dietary interventions.

Medicaid Asset Protection for Alzheimer’s or Other Forms of Dementia

Do you have a loved one who is suffering from Alzheimer’s or another form of dementia? Persons with dementia and their families face special legal and financial needs. At the Farr Law Firm, we are dedicated to easing the financial and emotional burden on those suffering from dementia and their loved ones. We help protect the family’s hard-earned assets while maintaining your loved one’s comfort, dignity, and quality of life by ensuring eligibility for critical government benefits such as Medicaid and Veterans Aid and Attendance. Please call us when you are ready to make an appointment for an initial consultation:

Fairfax Alzheimer’s Planning: 703-691-1888
Fredericksburg Alzheimer’s Planning: 540-479-1435
Rockville Alzheimer’s Planning: 301-519-8041
DC Alzheimer’s Planning: 202-587-2797
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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.