Ketosis, mental health and cognition Nutritional ketosis can serve as an efficacious treatment for mental disorders. It can drastically impact brain processes that govern pathology, mood, behaviour, and cognition. - treatment resistant depression patients demonstrated improvements in both somatic and psychiatric symptoms and it is proposed as a dietary regimen to maintain euthymia [1,2] - In schizophrenia, it has been proposed as leading to possible better outcome of the disease regarding symptomatology [3] and help to correct the abnormal cerebral glucose and energy metabolism - it treats metabolic syndromes, cognitive deficits and neurological disorders. Ketone levels were positively correlated with memory performance in cognitively impaired populations [4] - Studies have observed mental, emotional, and behavioural benefits. Documented effects are improved energy in the long-term, decreased negative affect, improvement in social functioning improvement in mental components of quality of life and improvement in working memory [5] 1 Source: https://doi.org/10.3390/ijms21228767 Observations point towards a synergistic effect between the various interventions (aerobic exercise, ketogenic interventions, other nutritional factors/diet) that may alleviate cognitive impairment [6, 7] - increased ketones improves white matter energy supply and processing speed - attention improved as a function of ketone uptake - Uptake of ketones by the brain as a whole was directly related to improved episodic memory, verbal fluency and language Potential for diet to prevent and remediate cognitive deficits in neurological disorders A ketogenic diet may improve neurological function in conditions such as multiple sclerosis, traumatic brain injury, and Alzheimer’s disease because these conditions demonstrate increased oxidative stress, neuroinflammation, and impaired glucose metabolism in the brain. Similarly, the ketogenic diet has been suggested as an additional therapy for individuals with autism in light of observed disturbances in mitochondrial energy production in this condition. These diets are typically for reducing pathology in these conditions (eg, demyelinating lesions in multiple sclerosis or axonal cell death in traumatic brain injury) and resultant effects on level of physical disability. There are no human studies to our knowledge that investigate ketogenic diet and cognition in traumatic brain injury. 6 months ketogenic diet improved self-rated mental and cognitive health in MS. Improvement on the Childhood Autism Rating Scale was noted in all 18 patients who were able to adhere to the diet. In 20 older adults with Alzheimer’s disease or mild cognitive impairment, consumption of a drink containing medium-chain triglycerides to elevate serum 2 ketone body levels improved performance on a brief screening tool covering several cognitive domains, including attention, memory, language, and praxis. However, this effect was observed only for those individuals without the Apolipoprotein-E (APOE) e4 allele. In 23 older adults with mild cognitive impairment, ketosis was induced using a very low carbohydrate diet (5%–10%) and was shown to improve verbal memory performance compared with a high carbohydrate diet (50%), with improved memory positively correlated with ketone levels. One other RCT in 152 individuals with Alzheimer’s disease administered an agent to increase serum ketone bodies, finding improved performance on cognitive screening (Alzheimer’s Disease Assessment Scale–Cognitive Subscale) compared with placebo. Although this is a pharmacologic intervention, it lends further support for increasing ketone bodies via dietary means to improve cognition in Alzheimer’s disease In sum, the findings regarding the effect of ketogenic diet on cognition in neurological conditions are limited but interestingly suggestive at this stage. In sum, the findings regarding the effect of ketogenic diet on cognition in neurological conditions are limited but interestingly suggestive at this stage. Source: https://doi.org/10.1093/nutrit/nux073 References: [1] https://pubmed.ncbi.nlm.nih.gov/31568812/ [2] https://pubmed.ncbi.nlm.nih.gov/33497756/ [3] https://pubmed.ncbi.nlm.nih.gov/30037619/ [4] https://pubmed.ncbi.nlm.nih.gov/21130529/ [5] https://pubmed.ncbi.nlm.nih.gov/32305355/ [6] https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/eci.13806 [7] https://doi.org/10.1002/trc2.12217 3