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The Ketogenic Diet: A Potential Therapeutic Strategy for Parkinson’s Disease
Parkinson's disease (PD) affects 1% of people over 60 years of age, causing progressive neurological decline. While its exact causes remain elusive, the ketogenic diet, which induces nutritional ketosis, is emerging as a promising intervention. By restricting carbohydrates to use ketones as energy, this diet may help stabilise blood sugar levels, reduce insulin resistance and improve both cognitive and motor function in PD patients, offering hope for managing the challenging symptoms of the disease.
What will you learn from the article?
Parkinson’s disease (PD) is a prevalent chronic neurodegenerative disorder that affects about 1% of the global population over the age of 60. It’s characterized by the progressive deterioration of dopaminergic neurons, leading to significant mobility and cognitive impairments. Despite extensive research, the exact causes of PD remain elusive; however, factors such as mitochondrial dysfunction, abnormal brain glucose metabolism, and systemic inflammation are commonly implicated.
Cognitive Impairment and Parkinson’s Disease
Approximately 20%–33% of individuals newly diagnosed with PD exhibit mild cognitive impairments (MCI), and a distressing 60%–80% of these cases may progress to dementia within 12 years. Complicating matters further, a significant overlap exists between PD and impaired carbohydrate metabolism, affecting 50%–80% of patients. This intersection suggests that dietary interventions, particularly those influencing carbohydrate metabolism like the ketogenic diet, could be beneficial.
Nutritional Ketosis and Its Implications for PD
Nutritional ketosis involves restricting carbohydrate intake to promote the body’s production of ketones, which serve as an alternative energy source for the brain and other tissues. This metabolic state not only stabilizes blood sugar but also reduces insulin spikes, thereby potentially mitigating some neurodegenerative processes associated with insulin resistance. The liver plays a central role by converting fats into ketones, which are then utilized by the brain to support cognitive function and neuronal health.
Ketogenesis, the production of ketones for fuel, is a normal, physiologic process that occurs via hepatic beta-oxidation of free fatty acids in the mitochondria of liver cells. Energy stored as fat in adipose tissue is liberated to acetyl-CoA and converted to ketones. Extra-hepatic tissues are able to undergo ketolysis and convert ketones back to acetyl-CoA which enters the TCA cycle and is used by the mitochondria to generate ATP for energy. It is a great source of energy for the brain [2].
Image source: Gershuni, Yan, & Medici, 2018
Ketones and Parkinson’s
Current forms of therapy, such as the use of the drug L-DOPA, can prevent the onset of motor dysfunction but do not affect other cognitive functions [3]. A study published in 2022 evaluated the impact of a KD on Parkinson’s disease (PD) symptoms, depression, anxiety and biomarkers in adults with PD. At the time, 16 adults aged between 36-80 years with PD went on a KD for 12 weeks in a single-arm trial. Weight, waist circumference, HbA1c and fasting insulin improved. Anxiety and part 1 of the United Parkinson’s Disease Rating Scale (UPDRS) improved; depression [4].
Regarding other aspects associated with PD, animal studies demonstrated promising results, with improvements in locomotor activity, dopaminergic activity, redox status, and inflammatory markers [5]. Human clinical trials show heterogeneous outcomes, and we believe that timing is crucial and that adults should take care of their brains as soon as possible, not waiting for the worst to come.
Exogenous ketones and Parkinson’s disease
A study in a mice model showed that a BHB supplement is beneficial, reversing motor deficits, loss of dopaminergic neurons, and glial cell activation. BHB prevented microglia pyroptosis (a highly inflammatory form of lytic programmed cell death) via the NLRP3 inflammasome, resulting in downregulation of proinflammatory cytokines IL-1β and IL-18. You can find BeKeto exogenous ketones here.
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