From Low GL to Ketogenic
At Food for the Brain, one of the key messages we enforce is the importance of eating a diet that’s low in glycemic load, which in other words means avoiding refined sugars and flours, and swapping them for wholegrains, fibre-rich legumes and starchy vegetables. These sources of carbohydrates release their sugars gradually instead of all at once, which not only helps to sustain energy levels throughout the day, but also positively impacts the brain, which is sensitive to fluctuating blood sugar levels. Research in the last 10 years has exploded on the role that insulin resistance and insulin deficiency (caused by diets high in refined sugars) plays in cognitive decline and the development of Alzheimer’s disease, so much so that scientists have begun to label Alzheimer’s as a type 3 diabetes or diabetes of the brain. Switching to a low GL diet is relatively easy, but what about those diets that go as far to say that eliminating carbohydrates almost completely from the diet, such as in the ketogenic approach, is more efficient in improving brain health?
What is the Ketogenic Diet?
The ketogenic diet was first introduced by physicians in the 1920s for the treatment of childhood epilepsy, after scientists discovered that during periods of fasting the body begins to use fat as a source of energy instead of glucose, which resulted in less seizures in patients. Two specific compounds were found to be produced in the body during fasts – acetone and beta‐hydroxybutyric acid – now known as ketones, which are a byproduct of fat breakdown in the liver and are used by the body as energy when there is no more glucose available. During this research study, scientists discovered that following a diet with moderate protein, minimal carbohydrate and high fat (roughly 60%-80% fat,15%-35% protein, 5% or less carbohydrates of total daily caloric intake) could also lead to the production of ‘ketosis’, where the body begins to use ketones as energy instead of glucose. Improvements in behaviour and cognition were also reported, which set the tone for future trialling of the ketogenic diet to improve brain health for a variety of conditions.
Why is ketosis good for the brain?
Research on the ketogenic diet in the past few years has increased, in particular its therapeutic application in symptoms related to neurological disorders and mental health, as well as in treating conditions such as type 2 diabetes. Whilst the exact mechanism of how ketones improve brain health is still unclear, ketones used as fuel for the body have shown to increase neuronal growth factors (meaning neurons are able to regenerate and proliferate), reduce brain inflammation and oxidative stress, strengthen signals between synapses and enhance mitochondrial respiration (a process of energy production that takes place in our cells).
Human studies are, however, minimal in researching the value of the ketogenic diet in improving brain health, with most scientific studies still being focussed on animals. In addition, many studies use supplements such as MCT (medium-chain triglycerides) capsules to induce the production of ketones in the body, which may be due to the fact that following a ketogenic diet and monitoring large groups of people is difficult. MCTs are fatty acids that do not require bile to be digested, instead they go directly into the liver and are able to feed into the mitochondria of the cells without needing L-carnitine to shuttle them across the mitochondrial membrane, unlike other fatty acids. This translates as an immediate energy source, functioning much like simple carbohydrates do but without the impact on blood sugar levels.
There has been some positive results using supplements such as MCT. For example, in a 90-day randomized, double-blind, placebo-controlled, parallel study of 152 people with mild to moderate Alzheimer’s Disease, a daily MCT supplement was given. Participants were asked to take a cognitive test at 45 and 90 days using the ADAS-Cog scale and patients taking the MCT supplements showed significant improvement in the cognitive test, unless they carried a gene called ApoE4, which is associated with a higher risk for developing Alzheimer’s disease.
Can the ketogenic diet help with mental health symptoms?
The majority of studies are animal-based, which despite demonstrating positive results, there is still a long way to go with regards to understanding the direct mechanism of how the ketogenic approach alters brain chemistry and its value in long term improvements to mental health. One interesting study in children with medication resistant epilepsy, showed how following the diet had a significant impact on the neurotransmitters, dopamine and serotonin, both of which are implicated in depression and anxiety. The children followed the diet for a period of 3 months, neurotransmitters were measured before and after in their CSF (cerebrospinal fluid). Metabolites of both serotonin and dopamine had significantly reduced after following the ketogenic diet, demonstrating that these neurotransmitters were being utilised more efficiently in the brain.
There have also been some case studies that encourage further research into this field. In one particular study, a significant improvement in symptoms were reported. 2 women with bipolar disorder type II followed the ketogenic diet for an extended period of 2 and 3 years respectively. Only one measured their macronutrient composition, which was roughly 70% fat, 22% protein, and 8% carbohydrates, and ketones were measured in the urine. Both women reported subjective improvement in mood stabilisation as well as an overall improvement of their condition, which surpassed the effects of medication.
Is it safe to follow the ketogenic diet unsupervised?
Research to date suggests that the ketogenic diet is safe for most people, however, it has a large impact on the body and for this reason we would always advise people to seek expert guidance before trying it, especially if they are are on medication of any form. According to Dr Georgia Ede, a Harvard-trained psychiatrist and nutrition consultant, in the first couple of months of the ketogenic diet your body goes through profound shifts in chemistry, which may affect the metabolism of medication, as well as significant mood changes. Here is a list of medications related to common mental health conditions and how they can be affected by following the ketogenic diet.
Whilst the emphasis is on achieving the correct amount of macronutrients (ratio between carbohydrates, protein and fat) to encourage ketosis, the nutrient value of food should also be taken into account in order to prevent deficiencies. For example, many may be drawn away from having a significant amount of vegetables on the keto diet, due to the fact that some can be high in carbohydrate content. However, it is critical to ensure enough fresh vegetables whilst undertaking this approach to prevent falling short on micronutrients that play an important role in our cellular health and preventing oxidative stress. In addition, eating the right protein and fat sources is also very important, as processed meat and hydrogenated or refined oils can leave us more vulnerable to long-term health problems such as cardiovascular disease.
Low GL or Keto?…
Whilst research on the ketogenic diet and brain health has showed and continues to show some positive results, it’s still very much in the early stages and a lot needs to be understood about the underlying mechanism of how ketones improve biomarkers associated to poor mental health and the long term impacts of this dietary approach. Eating a diet that’s low in glycemic load may be an easier, more accessible way of switching to a way of eating that has little impact on blood sugar levels and encourages a healthy insulin response, which has shown to have a positive impact on cognitive health. If you’d like some more support on how to switch to a low GL diet, please click below for our mini guide.
Where to go for support…
We believe that following a ketogenic approach should be under the guidance of a nutrition professional, to ensure you’re still getting the right nutrients and that the diet is tailored to your individual needs. If you’d like to reach out to a qualified nutritional therapist to guide you through this process, BANT (British Association for Nutrition and Lifestyle Medicine), have a search engine for practitioners that are local to you. Our not-for-profit clinic, the Brain Bio Centre also have a team of therapists that specialise in brain health and can discuss the best approach for you individually. If you’d like to get in touch to find out more about their services, please call 0208 332 9600 or visit their website here Brain Bio Centre.
Nutrition; the Building Blocks of Health
Proper nutrition is important for all children to help them grow and develop, both physically and mentally. It stands to reason that the brain benefits from the best possible nutrition as much as the body, and the evidence-base in this area is growing. Many vitamins and minerals support brain health including magnesium, zinc, B vitamins, calcium and iron, some of which are often found to be low in tests.
Key Nutrients for Brain Health
Magnesium, in particular, supports improved focus and concentration, and supports calm and sleep. Vitamin D is a key brain nutrient and deficiency is very common in the UK. Most children would benefit from vitamin D supplementation especially those with learning, behavioural or developmental differences. Colourful plant-based foods contain a range of special nutrients known as phytonutrients which also support brain health. Omega-3 essential fats have a very important role in optimising brain function. Blood tests reveal that most children with learning, behavioural or developmental differences have low or sub-optimal levels of these important fats. These fats are found in oily fish and fish oil supplements. Specific amino acids from protein-rich foods are involved in neurotransmitter production which can have a range of effects including balanced mood, better concentration, reduced anxiety and improved sleep.
Sugar; the Brain’s Enemy
Sugar is, quite simply, bad for the brain. Most children, including those on quite ordinary diets, take in excessive sugar and refined carbohydrates which adversely affect their health including behaviour, concentration and sleep. Many sources of sugar are ‘hidden’ in foods which are marketed as ‘healthy’ or ‘low fat’, making this a minefield for parents. In fact, fat is an essential nutrient for the growing child’s brain.
The Gut Brain
Food sensitivities may contribute to symptoms too. It is best to work with a nutritional therapist to identify which foods or food additives are affecting your child before making major changes or cutting out whole food groups. The bacteria in your child’s gut (‘gut flora’) can have a significant impact on brain function too. Assessing the mix of gut flora and improving the balance can affect learning, behaviour, mood, development and supports physical health and immunity. Gut flora balance is heavily influenced by diet (the bacteria live off the food that your child eats), so whilst probiotic (good bacteria) supplementation can be very helpful, it is dietary change which is required over the long term.
The Importance of Working with a Nutritional Therapist
Nutritional therapy works well alongside other therapies including medication and other therapies, and these therapies may be even more effective in a well-nourished individual. Even children who already eat a relatively healthy diet are likely to benefit from nutritional therapy. The benefits that most parents report including better focus and concentration and improved sleep, along with reduced sugar cravings, fewer coughs and colds, and a healthier digestive system (fewer tummy aches, constipation, bloating etc).
According to Dr Vivette Glover, Director of the Foetal and Neonatal Stress and Research Centre, at any one time during pregnancy, one in every ten women will be depressed and around one in every thirty will be depressed both during pregnancy and the postnatal period (1). It is not yet understood exactly what causes the symptoms associated to depression during and after pregnancy. However, factors such as the large changes that the body undergoes due to the demands of the growing foetus, as well as breastfeeding and potential sleep deprivation, can all play a significant role in how the body deals with stress. It is during this period of time that our bodies require more nourishment from food than ever and it can also be at exactly this time when we perhaps struggle to prioritise nutrition due to lack of energy, loss of appetite or sickness.
Pre and Post-Natal Depression are both complex conditions that can have multifactorial underlying drivers, including genetic and environmental influences. These are currently poorly investigated and the gold standard of treatment is often medication to help stabilise mood. Whilst SSRIs and other types of antidepressants have proven to be helpful for many, they do not address potential causes or drivers of poor mental health and can often mask symptoms. Antidepressants are also not regularly recommended during pregnancy, which is why being more mindful of nutrition and lifestyle habits can be a safer option for you and your baby. There are some natural, evidence-based steps you can take to help support optimal mental wellbeing:
Eat Foods to Support Energy Depletion:
Common issues such as poor sleep during pregnancy and sleep deprivation following the birth can often heighten cravings for stimulants and sugary foods, which may seem like a good option for quick sources of energy, however, these foods can often cause further issues with energy and lead to fatigue and low mood. Eating foods that are high in refined sugar and refined grains such as commercial white bread, pastries, cakes and biscuits, give us an unsustainable source of energy. The brain is a very metabolically active organ; despite it only being 7% of the body’s weight, it can take up to 20% of the body’s metabolic needs (2), meaning that it is very energy hungry. This is why it is important to nourish the brain with foods that are nutrient rich, providing the body the building blocks to produce neurotransmitters, as well as a sustainable source of energy. The best options are fresh, unprocessed foods such as wholegrains (brown bread, brown rice, quinoa, rye and oats), pulses, vegetables, good quality sources of protein (meat, poultry and fish) and healthy fats such as those found in olive oil, coconut oil, avocados and oily fish.
Just like throughout pregnancy, nutritional needs after birth, especially if breastfeeding, are incredibly important. The healthier the diet, the easier it will be to sustain the energy needed to take care of a newborn. Research shows that a breastfeeding mother needs an extra 300-500 calories a day, from food that is rich in the right macro and micronutrients to nourish both mother and baby (3). For example, nutrients such as B vitamins have shown to be important in supporting the mother in ensuring she has enough energy to meet the demands of lactation (4). These nutrients can be found in green leafy vegetables, wholegrains and good sources of animal protein.
Protect yourself from Oxidative Stress:
Oxidative stress refers to a biochemical process that occurs as a result of an accumulative everyday exposure to toxic burdens such as chemicals in cosmetics, furniture, paints, cars, and pollution. Our body has its own way of armouring itself from the damage that exposure to toxins can create through its production of endogenous antioxidants, which is nature’s way of neutralising oxidative stress. Although we have our own production of these wonder molecules, when we are continuously overloaded with toxins in our environment and have problems detoxifying, the liver can become overwhelmed. Research shows that over time oxidative stress can lead to an increase in inflammatory molecules such as cytokines, which have been shown to correlate with depression (5).This is why it is important to have a high intake of nutrients that support the liver in metabolising and removing toxins from the body, as well as regulating the inflammatory response. There are a few things we can change in our diet to support this area, for example eating foods such as the cruciferous family of vegetables which includes kale, cauliflower, broccoli and cabbage. These are particularly effective at supporting the liver in ushering out toxins as they all share an antioxidant compound called indole-3 Carbinol, which plays an important role in liver health (6). In addition, bitter greens such as collard greens, rocket, chicory and swiss chard are also great for supporting the liver’s own antioxidant defence system.
Increase intake of Omega-3 Fatty Acids:
During pregnancy and after pregnancy there is often a concern for the potential depletion of the maternal nutrient reservoir due to the needs of the growing foetus. A nutrient that is particularly important for mental wellbeing and is also essential for the growth of the foetus’s brain, is DHA. This is an omega 3 fatty acid that is found in oily fish and is the primary structural component of brain tissue, as well as playing a crucial role in the maintenance of brain cells and neurotransmitter metabolism (our body can also convert plant sources of omegas 3’s into DHA, such as those found in flaxseeds or chia seeds into DHA, but the conversion can often very poor). Deficiency in this nutrient during pregnancy is common, namely because of lack of seafood intake (the most bioavailable source of DHA) due to poor eating habits and concerns of mercury levels in fish during pregnancy, as well as higher requirements during foetal growth, which can lead to depletion. Due to the role that DHA plays in neurotransmitter metabolism, deficiency in this nutrient has been correlated to symptoms of depression during pregnancy (7). In order, to support your intake of omega 3, aim to have 3 portions of oily fish a week from sources that are low in mercury. These are mainly small fish that have a short life-span such as sardines, mackerel and herring. If you are vegetarian or vegan, although omega 3 is less readily available, it is still possible to get this nutrient from your diet through flax seeds, chia seeds, walnuts and seaweed. If you feel you may not be getting enough through your diet, you may want to consider using a good quality fish oil supplement (or algae based supplement if vegan) as an option. With fish oils, aim to choose a supplement that has been filtered for heavy metals and other pollutants to make sure you’re getting the full benefits of the omega 3 oils.
Exercise and Personalised Nutritional Therapy:
In addition to diet, there are many other things you can also do related to lifestyle, such as stress management through mindfulness (8) or gentle movement such as pre or post natal yoga (9), which have both shown to be incredibly helpful in encouraging mental wellbeing. If you feel you need extra support, personalised nutritional therapy can be very helpful as there can often be other drivers such as nutrient deficiencies and digestive complaints that can play a significant role in mental health and will need to be addressed in a way that is tailored to the individual.
At the Brain Bio Centre, our nutritional therapy clinic, our therapists specialise in mental health and biochemical testing that can provide in-depth information about your own specific needs, so we can create a personalised plan to support your health. For more information, please visit our website: www.brainbiocentre.com. Alternatively, BANT (British Association for Applied Nutrition and Nutritional Therapy), have a large network of therapists you can use to find a therapist suitable for you.
For wider help and information, you might want to contact the PANDAS Foundation, a charity who offer pre and post natal advice and support. They also have a helpline, 0843 28 98 401, open 9am-8pm, 7 days a week.
(3) American Academy of Pediatrics. Policy Statement. Breastfeeding and the use of human milk. Pediatrics, March 2012 Sneed SM, Zane C, Thomas MR.
(4) The effects of ascorbic acid, vitamin B6, vitamin B12, and folic acid supplementation on the breast milk and maternal nutritional status of low socioeconomic lactating women. Am J Clin Nutr. 1981 Jul;34(7):1338-46.