A review came out doing its best to investigate the effects of Ketogenic Diets on vitamin D. Being a huge fan of both; I thought it would make an interesting blog post and contribute to my goal of you knowing all the ways you can feel better.
Table of Contents
Introduction
In this scientific review, published in Dec 2022, some experts dug deep into intervention studies and other factors that could effect the connection between Ketogenic Diets and vitamin D. They even took a look at gene-nutrient interactions! So I am going to unpack what they found so you can better understand how a ketogenic diet may influence your Vitamin D status.
The researchers found five studies done in healthy adults, one in subjects with type 2 diabetes, and seven in subjects with epilepsy that assessed the levels of vitamin D pre-and post-intervention. What did they find? Here is a summary for your convenience! ⬇️
Ketones
First, we need to introduce some of the terms used in this part of the authors’ review. Let me introduce you to 25(OH)D and 1,25(OH)2D. It will make reading this part easier to understand.
25(OH)D is the abbreviation for 25-hydroxyvitamin D. It is a blood test used to measure the level of vitamin D in your body. When vitamin D is absorbed by the body, it is converted into 25-hydroxyvitamin D (25(OH)D), which is the main circulating form of vitamin D in the blood. Measuring the level of 25(OH)D in the blood is considered the best way to assess a person’s vitamin D status.
1,25(OH)2D is the abbreviation for 1,25-dihydroxyvitamin D. It is the active form of vitamin D that is produced in the body through a series of metabolic reactions that involve the liver and kidneys. 1,25(OH)2D is a hormone that helps regulate the levels of calcium and phosphorus in the body, which are important for maintaining healthy bones.
Unlike 25(OH)D, which is considered the best marker for overall vitamin D status, 1,25(OH)2D levels are usually measured to evaluate certain medical conditions that affect calcium and bone metabolism, such as renal failure, hyperparathyroidism, and some rare genetic disorders.
What they found was that initially, low levels of vitamin D are often observed in Ketogenic Diet patients, but supplementation can increase vitamin D levels. The production of ketone bodies by the Ketogenic Diet creates an acidic environment that can inactivate liver and kidney hydroxylase, preventing the conversion of vitamin D to its active form. A hydroxylase is an enzyme that adds a hydroxyl group (-OH) to a substrate molecule, which is an important step in many biological processes, like Vitamin D conversion.
The authors discuss acidosis resulting from the production of ketone bodies that can decrease the vitamin D binding protein, reducing the amount of circulating active vitamin D. One of the evaluated studies cited showed that following a KD, 25(OH)D was increased, while 1,25(OH)2D was decreased, suggesting an effect of the KD on hydroxylase. But it was noted that 1,25(OH)2D has a short half-life and may not be a reliable index of vitamin D status.
And please note that a properly done ketogenic diet does not produce a chronic state of acidosis.
Macronutrients
Individuals on ketogenic diets tend to consume more high-fat foods, which can lead to an increased dietary intake of vitamin D and higher levels of circulating vitamin D. One observational study they evaluated found that subjects following a low-carbohydrate/high-fat diet had significantly higher levels of 25(OH)D compared to those on an eastern European diet.
Fatty acids in the diet can also interact with cholecalciferol in intestinal absorption, and vitamin D supplementation is more effective when given with high-fat meals. Bile acids, increased after fat consumption, have been reported to activate vitamin D receptors.
Dietary intake of other macronutrients, such as protein, may also affect key metabolic enzymes of vitamin D. However, no data currently exist for the effects of Ketogenic Diets on these key metabolic enzymes.
Weight Loss
In all studies that have assessed the effects of Ketogenic Diets (KDs) on vitamin D in healthy subjects, weight loss was present, which may have obscured the net effects of the Ketogenic Diets.
They found only one study that compared the effects of a KD versus another weight-loss diet (Mediterranean diet) on circulating 25(OH)D. And in that study, after weight loss via a very-low-carbohydrate Ketogenic Diet (VLCKD), the serum 25(OH)D concentrations increased significantly, while after the Mediterranean diet, the increase in vitamin D was not statistically significant.
Hormonal
This part is interesting and deserves some context because I don’t think it gets discussed enough. So I am going to do some explaining in a step-by-step manner. You won’t want to miss understanding this cool part!
The ketogenic diet (KD) is known to improve insulin sensitivity.
Insulin is a hormone that regulates blood sugar levels and has been reported to have effects on bone health and vitamin D metabolism.
Insulin has been shown to downregulate fibroblast growth factor 23 (FGF23), which is produced by bone cells and plays a key role in renal phosphate and vitamin D metabolism.
FGF23 is a hormone that physiologically inhibits α-hydroxylase, an enzyme responsible for converting vitamin D into its active form. It decreases the formation of active vitamin D.
Therefore, higher levels of FGF23 can lead to lower levels of active vitamin D.
Given that insulin can downregulate FGF23, increasing insulin sensitivity through a Ketogenic Diet could lead to reduced levels of FGF23 and potential increases in hydroxylated (active form) vitamin D.
This would suggest that Ketogenic Diets may actually have a positive impact on vitamin D metabolism.
Gut Microbiome
Ketogenic diets have been proposed to modulate the gut microbiota by decreasing the abundance of Firmicutes and increasing the abundance of Bacteroidetes and microbial diversity.
This can have implications for vitamin D metabolism, as there is evidence that probiotics can increase circulating vitamin D levels and affect protein levels of vitamin D transporters, thereby promoting its absorption.
The authors reported that there really isn’t enough evidence on how gut microbiome changes on the ketogenic diet might affect Vitamin D levels.
Somebody get on that! I want to know! And in the meantime, we are going to continue to learn all the ways we can feel better. Let’s continue learning what we can from this excellent review!
Genes
Along with environmental factors, genetic variations in genes implicated in cholesterol synthesis, hydroxylation, and vitamin D transport can affect vitamin D levels.
A genetic SNP (single nucleotide polymorphism) is a common type of genetic variation that involves a single nucleotide change in the DNA sequence of a gene. It can influence how well we store, transport, or convert micronutrients into bioavailable forms.
Their review of the research identified 35 genes and several SNPs associated with vitamin D levels, suggesting that genetic variations can alter individual responses to ketogenic diets.
It’s part of why in my Brain Fog Recovery Program, I teach people how to do a nutrigenomics analysis so they can personalize their supplementation of Vitamin D and other important nutrients needed for optimal brain health.
So that was a LOT of information. Would you like to know the bottom line? Here it is. In the majority of studies, increases in circulating vitamin D were reported.
Check it out yourself in the references if you are interested!
References
Detopoulou, P., Papadopoulou, S. K., Voulgaridou, G., Dedes, V., Tsoumana, D., Gioxari, A., … & Panoutsopoulos, G. I. (2022). Ketogenic Diet and Vitamin D Metabolism: A Review of Evidence. Metabolites, 12(12), 1288. https://doi.org/10.3390/metabo12121288
We need to talk about the role of GABA in mental illness and neurological disorders. And then I am going to explain to you why ketones can help regulate this neurotransmitter.
Table of Contents
What is GABA?
GABA (gamma-aminobutyric acid) is the main inhibitory neurotransmitter in the brain, and it plays a critical role in regulating neuronal excitability and maintaining the balance between neuronal excitation and inhibition.
GABAergic dysfunction has been implicated in a wide range of psychiatric and neurological disorders, including anxiety disorders, depression, epilepsy, schizophrenia, and autism spectrum disorders.
Changes in GABA signaling can alter the balance between excitatory and inhibitory neurotransmission in the brain, leading to various symptoms depending on the affected brain regions and circuits.
What diagnoses see problems with GABA?
Lots.
Anxiety disorders and depression are often characterized by an imbalance between excitatory and inhibitory neurotransmission in brain regions such as the amygdala and prefrontal cortex. Reduced GABA signaling in these regions can lead to increased neuronal excitability and hyperarousal, which may contribute to anxiety and mood disorders.
Epilepsy is a neurological disorder characterized by recurrent seizures, and it is often associated with perturbations in GABA signaling. Reduced GABA signaling can lead to hyperexcitability and seizure activity, while increased GABA signaling can lead to sedation and anticonvulsant effects.
Schizophrenia is a complex psychiatric disorder that is associated with abnormalities in multiple neurotransmitter systems, including GABA. Reduced GABA signaling in the prefrontal cortex and other brain regions has been implicated in the cognitive deficits and positive symptoms (such as hallucinations and delusions) of schizophrenia.
Autism spectrum disorders are neurodevelopmental disorders that are characterized by impaired social communication and repetitive behaviors. GABAergic dysfunction has been implicated in the pathophysiology of autism, and alterations in GABA signaling have been observed in several brain regions in individuals with autism.
Ketones and GABA
What does all this have to do with a ketogenic diet? I am going to tell you. Because I want you to understand all the ways you can feel better. ⬇️
D-β-hydroxybutyrate (BHB; a ketone body) has been shown to enhance GABA signaling in the brain, which may have beneficial effects on cognitive function and neurological disorders.
Acetoacetate (another ketone body) has also been shown to modulate GABA signaling in the brain. We are still figuring out how, but the effect is absolutely there.
One proposed mechanism for acetoacetate’s effect on GABA signaling is that it may increase the availability of GABA by enhancing the activity of the GABA-synthesizing enzyme glutamic acid decarboxylase (GAD).
GAD (enzyme) requires the cofactor pyridoxal 5′-phosphate (PLP) for its activity, and acetoacetate (a ketone body) has been shown to increase the availability of PLP in the brain. This may result in increased GABA synthesis and release, leading to enhanced GABA signaling. For those that don’t know, PLP is the active form of B6. Vitamin B6 is involved in the metabolism of amino acids, the synthesis of neurotransmitters such as serotonin and dopamine, and the regulation of gene expression.
Note: This is why I like to combine ketogenic diets with increased nutrient intake during healing. There are synergistic effects!
Another proposed mechanism is that acetoacetate may modulate GABA receptors, which are the proteins that mediate the effects of GABA on neuronal excitability.
Acetoacetate has been shown to enhance the activity of GABA-A receptors in the brain. GABA is a neurotransmitter in the brain that helps control brain activity. There are two types of receptors that GABA can bind to, called GABA-A and GABA-B receptors. GABA-A receptors act quickly to stop neurons from firing, while GABA-B receptors work more slowly to reduce activity in the brain. Both types of receptors are important for maintaining a balance between brain activity and relaxation.
Conclusion
So there you have it. Now you understand more about how a ketogenic diet helps balance the neurotransmitter GABA and the implications this has for the treatment of many neurological disorders and mental illnesses.
Go forth and make a better-informed decision in your recovery from mental illness and neurological disorder!
If you do a search on this blog (bottom of page) on your diagnosis, you will likely find an article that talks about disturbed GABA as it applies to your particular diagnosis. Here are some of those you might be interested in!
And if you need help learning how to implement a ketogenic diet and personalizing your supplementation and lifestyle changes toward a better brain, you are welcome to check out my Brain Fog Recovery Program.
Brownlow, M. L., Benner, B., D’Agostino, D., Gordon, M. N., & Morgan, D. (2020). Ketogenic diet improves spatial memory impairment caused by exposure to hypobaric hypoxia in male Sprague-Dawley rats. PloS one, 15(2), e0228763. DOI: 10.1371/journal.pone.0228763
Cahill, G. F. (2006). Fuel metabolism in starvation. Annual review of nutrition, 26, 1-22. DOI: 10.1146/annurev.nutr.26.061505.111258
D’Andrea Meira, I., Romão, T. T., Pires, D. O., da Silva-Maia, J. K., & de Oliveira, G. P. (2021). Ketogenic diet and epilepsy: what we know so far. Frontiers in neuroscience, 15, 684557. DOI: 10.3389/fnins.2021.684557
Lutas, A., & Yellen, G. (2021). The ketogenic diet: metabolic influences on brain excitability and epilepsy. Trends in neurosciences, 44(6), 383-394. DOI: 10.1016/j.tins.2021.02.004
Newman, J. C., & Verdin, E. (2014). Ketone bodies as signaling metabolites. Trends in endocrinology and metabolism, 25(1), 42-52. DOI: 10.1016/j.tem.2013.09.002
Sleiman, S. F., Henry, J., Al-Haddad, R., El Hayek, L., Abou Haidar, E., Stringer, T., … & Ninan, I. (2016). Exercise promotes the expression of brain derived neurotrophic factor (BDNF) through the action of the ketone body β-hydroxybutyrate. eLife, 5, e15092. DOI: 10.7554/eLife.15092
Yamanashi, T., Iwata, Y. T., & Shibata, M. (2017). Neurochemical basis underlying the enhancement of GABAergic transmission by β-hydroxybutyrate in the rat hippocampus. Neuroscience letters, 643, 35-40. DOI: 10.1016/j.neulet.2017.02.019
Yudkoff, M., Daikhin, Y., & Nissim, I. (2020). Heterogeneity in ketone body metabolism in the developing and mature brain. Journal of inherited metabolic disease, 43(1), 30-37. DOI: 10.1002/jimd.12156
Let’s explore the outcomes of a study that explored the neurobiological evidence supporting improvement in depression with a ketogenic diet and find out what underlying biological mechanisms they uncovered through in vitro and in vivo studies in the scientific literature.
Table of Contents
Shamshtein D, Liwinski T. Ketogenic Therapy for Major Depressive Disorder: A Review of Neurobiological Evidence. Recent Progress in Nutrition2022;2(1):003; doi:10.21926/rpn.2201003.
Basically, they did a literature review from August 2021 to January 2022. This means they searched peer-reviewed studies looking for data on use of the ketogenic diet for depression and trying to find possible underlying mechanisms to explain the effects.
Here’s what they found.
Impaired Glucose Metabolism
Another term for this is brain hypometabolism. People with depression may have changes in glucose metabolism in the brain. This is a condition called brain hypometabolism. The ketogenic diet boosts cellular energy metabolism by raising ketone bodies and replacing glucose as the main fuel source.
Ketones restore mitochondrial function and help maintain energy balance. The ketogenic diet, which relies on ketone bodies instead of glucose, could obviously, be a promising approach.
GABA and Glutamate Balance
The glutamate/GABA neurotransmitter system is implicated in depression. Studies have shown altered glutamate levels in depressed individuals, suggesting excessive glutamate-induced excitation in depression.
Reduced GABAergic activity accompanies depression, similar to epilepsy. Ketosis, which enhances astrocyte metabolism and increases glutamate removal, might explain the efficacy of ketosis in treating both epilepsy and depression.
Mitochondrial Dysfunction and Oxidative Stress
Mitochondria are responsible for energy metabolism in cells, and their reduced function is implicated in the pathogenesis of neurodegenerative diseases, which may contribute to depression.
Ketosis may help alleviate depression by impacting mitochondrial and oxidative processes, ultimately improving brain function.
The induction of low redox signaling molecules triggered by ketone bodies may increase the levels of antioxidants and detoxification enzymes, and it is thought that this potentially reduces oxidative stress and mitochondrial dysfunction associated with depression.
Ketosis and Inflammation
The authors found many studies suggesting a strong association between depression and inflammation and also acknowledged it is likely not a purely inflammatory condition.
Microglial alterations are thought to play a critical pathophysiological role in depression. β-hydroxybutyrate promoted microglial ramification in mice with depressive behavior. This finding, and many more outlined in their investigation of the scientific literature, provide evidence for the antidepressant effects of ketone bodies via their immunomodulatory actions. (13/36) #depression #inflammation #immunomodulation
Depression may have a causal link with the gut microbiota, as shown in animal model-based studies. Microbiome alterations seen in depressed patients are similar to those found in other chronic diseases such as metabolic syndrome.
Ketosis and Gut Microbiome
A ketogenic diet may help restore microbial balance in the gut, potentially alleviating the burden of depressive symptoms. Animal models and patients with brain disorders have shown promising results.
These findings identified in the scientific literature provide a strong rationale for studying the effects of a ketogenic diet on the gut microbiota and symptom improvement in patients with depression and animal models with depression-like behaviors.
Ketogenic Diet and Mood
Depression is a complex human phenomenon that can be difficult to study. Still, animal studies have provided valuable insights into potential pathophysiological mechanisms and clues for novel treatments for Major Depressive Disorder.
In rat models of depression-like behaviors, a ketogenic diet improved “behavioral despair”, indicating that ketosis could improve depressive symptoms. In other animal studies, feeding ketone salt and ketone salts mixed with medium-chain triglycerides improved anxiety-associated behaviors in Sprague-Dawley and WAG/Rij rats, achieving ketosis within seven days.
Interestingly, in a mice study, exposure to a gestational ketogenic diet modulated the offspring’s brain structures and protected them against anxiety and depression-associated behaviors later in adulthood, even though the offspring were fed a standard chow after birth.
Furthermore, recent animal studies demonstrated that a ketogenic diet with regular exercise decreased anxiety and depressive behaviors in mice. The reduction in depression burden was correlated with BHB levels, linking mood improvement to favorable metabolic changes.
Clinical Evidence
While the evidence for the improvement in depressive symptoms and the underlying mechanisms is limited, the existing data are encouraging and warrant further mechanistic studies on the beneficial neuromodulator effects of ketosis.
When this research article was published, there were no RCTs investigating ketogenic diets and depression! But I know of at least one going on as I write this post! So what did this study find out based on what was currently out there at the time around ketogenic diets for mood and cognition?
A randomized controlled study found that a ketogenic diet reduced anxiety and improved mood and cognition in children and adolescents with refractory epilepsy compared to a regular diet with standard care.
And in adult patients with chronic epilepsy, a ketogenic diet was associated with lesser anxiety and depression. The longer they were on the diet, the more favorable impact on their psychological state. I think that’s pretty cool.
A case study demonstrated that a ketogenic diet might act as a mood stabilizer in patients with type II bipolar disorder. Patients achieved mood stabilization superior to that accomplished using medication.
The authors who reviewed all of these studies carefully go on to say that In humans, the ketogenic diet is a safe and affordable therapy with multiple benefits. They understandably call for more research in order to understand the effects of the ketogenic diet on neurometabolic dysfunction, inflammation, and commensal microbiota alterations associated with depression. They would like to see studies demonstrating a direct correlation between the ketogenic diet and reducing symptoms of depression.
But let’s be honest. It’s going to take some time for those studies to be done. And people are suffering now.
They end their review of the literature with the following conclusion.
Nevertheless, the available evidence strongly supports the implementation of randomized controlled trials involving the use of the ketogenic diet in depressed populations.
And while these randomized controlled trials on depressed populations are being organized and going on, I don’t know about you, but I am going to make sure my clients are aware of the literature. They deserve to know that ketogenic diets show potential benefits in the typical comorbidities and pathologies seen in Major Depressive Disorder.
There isn’t a lot of funding available for dietary intervention unless you count the Baszucki Group and their partners who will change countless lives by funding the studies needed to mainstream this powerful metabolic therapy for mental illness and neurological disorders.
Despite this wish list of further research, the researchers of the study go on to say that existing data suggest potential benefits of the ketogenic diet against Major Depressive Disorder (MDD) in typical comorbidities or intersecting pathological features.
I can tell my patients it is not the standard of care after offering them the standard of care. And still remain in an ethical stance. Because not sharing this therapy showing so much promise to those suffering from Major Depressive Disorder would, in my mind, potentially do harm and not be an ethical stance.
Here is the study for your convenience in case you want more detail. So you can have the information you need to make your own ethical choice as a practitioner, Or maybe you are watching someone you love suffer. And you would like them to know all the ways they can feel better.
If you would like to learn more about the potential underlying mechanisms of action in a ketogenic diet on depression, you may enjoy these other blog articles available here on the Mental Health Keto Blog.
Some of you are searching for treatments for Autism. This is a website focused on the use of ketogenic diets as a treatment for mood and neurological disorders. So it is well past time that mentalhealthketo.com provides some of the information out there, so you can learn all the ways you (or your child) can feel better.
Table of Contents
What this article is and what it is not
Some of you identify as neurodivergent or your child as neurodivergent and are not interested in modifying these differences. That’s Ok.
You may also not want to participate in a discussion that sees these differences as pathology. If that is the case, this is not the post for you. This post is not about that philosophical discussion.
This post is for people who are experiencing distress around what they experience as symptoms or symptoms causing their children distress, and they deserve to know all the ways they can feel better.
And I am going to tell them.
To maintain the integrity of the space and intent of this post, comments will be disabled.
So with that caveat, let’s begin.👇
Pilot Prospective Follow-Up Study
This first one looked at the role of the ketogenic diet on the behavior of children with Autism. It was a pilot prospective follow-up study carried out on 30 children (ages 4-10) with autistic behavior. It was 6 months long, with continuous administration for four weeks, interrupted by 2-week diet-free intervals. 7 participants could not tolerate the diet, but five did adhere to the diet for 1-2 months and then discontinued it.
Of the 18 who adhered to the diet, improvement was seen in ALL participants in several parameters of the Childhood Autism Rating Scale.
2 participants experienced>12 units of improvement on the scale
8 participants experienced an average improvement of >8-12 units
8 other participants experienced minor improvement between 2-8 units
The data was preliminary (2005) but shows some evidence that the ketogenic diet can be used to treat autistic behavior as an additional or alternative therapy.
I don’t know if any drugs that can replicate these results. Do you?
Case-Control Study using Modified-Atkins Ketogenic
Here is another one. A case-control study in 45 children with Autism Spectrum Disorder (ASD) looked at the effect of a Modified-Atkins #ketogenic diet, a casein and gluten-free diet, and a control group. Those on the ketogenic diet improved the Childhood Autism Rating Scale scores AND Autism Treatment Evaluation Checklist scores.
The study found that the Modified Atkins #ketogenic diet was superior in Childhood Autism Rating Scale improvement compared to the gluten-free, casein-free diet. h
A small but recent (2018) clinical trial in 15 children with Autism investigated the effect of a modified gluten-free #ketogenic diet supplemented with MCT providing ketosis for 3 months.
The children significantly improved in comparison scores, total scores, and social affect categories of the Autism Diagnostic Observations Schedule. They also improved imitation and body function measured on the Childhood Autism Rating Scale after 3 months.
At 6 months, 10 of the participants maintained this improvement of scores in the Autism Diagnostic Observation Schedule. However, no difference was observed for restricted and repetitive behaviors. Caregivers reported improvement in sociability, focus, and hyperactivity. Which is a big win for these families.
There are several pathways that a ketogenic diet influences that may cause the improvements we see in this population. That would be a whole other article. But luckily, someone has already edited an amazing one, and you can find it on Amazon in a wonderful book chapter.
CHENG, N., MASINO, S. A., & RHO, J. M. (2022). Ketogenic Diet, Social Behavior, and Autism. Ketogenic Diet and Metabolic Therapies: Expanded Roles in Health and Disease, 154.
Conclusion
I hope this article helps you on your journey to know all the ways you and/or your child can feel better! If you are a healthcare practitioner helping these families, now you know about this treatment, and you can offer it to your patients. A win-win for all involved. #autism#ketogenic#research#brainhealthmatters#ASD
I do not work with or specialize in Autism Spectrum Disorders. But I want you to know that you can find an experienced dietician for this purpose through a wonderful organization called The Charlie Foundation
In this post, we will not be going into the underlying mechanisms involved in the pathology seen in Parkinson’s disease or how the ketogenic diet can modify them. But I will briefly outline research showing that a ketogenic diet can be an excellent treatment for Parkinson’s Disease.
Table of Contents
An early study showed the benefit.
In 2005 there was this study that, although very small, showed benefits. “Unified Parkinson’s Disease Rating Scale scores improved in all five during hyperketonemia”
Patients with mild cognitive impairment associated with Parkinson’s disease in an eight-week nutritional intervention with random assignment to either ⬆️carb consumption typical of the Western dietary pattern (n=7) or to a ⬇️carb, keto regimen (n=7) for 8-weeks.
Cognitive performance, motor function, anthropometrics, and metabolic parameters were assessed.
Relative to the high-carb group, the low-carb group demonstrated improvements in lexical access (word finding; p=0.02), memory (p=0.01), and a trend towards reduced interference in memory (p=0.6).
The changes in body weight were strongly associated with memory performance (p=0.001).
Motor function was not affected by the intervention. Remember, though, it was only 8-weeks. There could have been further benefits seen in time. Let’s give those brains some time to heal!
Ok. Maybe a little bit about underlying mechanisms.
Even though these studies are small, it is important to know that we have a pretty darn good understanding of the likely mechanisms by which a ketogenic diet may improve the multiple cellular pathologies of Parkinson’s disease.
Ketogenic diets have biological mechanisms that help normalize energetic abnormalities, reduce oxidative stress and neuroinflammation and provide neuroprotection in Parkinson’s disease. Don’t believe all this is possible?
Then you should check in with these researchers who literally wrote a paper all about it in 2019. I keep telling you all. I am not making this stuff up.
Finally, a pilot randomized controlled trial occurred.
Still need more convincing? How about a pilot randomized controlled trial #RCT to compare the plausibility, safety, and efficacy of an 8-week, low-fat, high-carb diet vs. a ketogenic diet in a hospital clinic of Parkinson’s patients?
This study had an 88% completion rate, with 38 participants completing the study. Ketosis was measured and maintained.
On measures of daily living experiences (non-motor) they hit a home run.
Both groups significantly decreased their symptoms., but the ketogenic group decreased more in this area, representing a 41% improvement compared to just an 11% improvement in the low-fat group.
These are the symptoms that people with Parkinson’s report as being the most upsetting to live with, and they are the symptoms that medications simply offer no help with.
Large between-group decreases were also observed for urinary problems, pain and other sensations, fatigue, daytime sleepiness, and cognitive impairment.
All huge quality of life factors for people with Parkinson’s disease.
I love that we have this treatment for Parkinson’s disease. But imagine how helpful it could be when people show the earliest signs even before a formal diagnosis.
You know, when people begin to show less facial expression, stop swinging their arms when they walk, talking very quietly or slurring their speech, or at the first sign of even the slightest tremor.
The bottom line is this.
I think people have a right to know all the ways they can feel better. And for people with Parkinson’s Disease, it is clear that a #ketogenic diet is one of them.
Someone out there is suffering a lot more than they need to. You may want to consider sharing this post.
#parkinsons #tremor #neurology
Are you interested in learning how to use a ketogenic diet to address neurological symptoms like those seen in Parkinson’s disease? If so, please check out my online program to learn more!
When I tell people they can learn how to treat their cognitive and mood symptoms (also experienced as Brain Fog), I ultimately mean it.
Let’s learn about ketogenic diets and Multiple Sclerosis. There has actually been quite a bit of research done on low-carb diets and MS
Table of Contents
Research Study on Relapsing-Remitting MS and Ketogenic diets
A randomized, parallel-group, 3-arm pilot trial was done to assess the safety and feasibility of a fasting-mimicking diet (FMD) or Ketogenic on health-related quality of life measurements (HRQOL) in Relapsing-remitting MS.
60 patients were randomly assigned to a control diet (n=20), KD for 6 months (n=20), or a single cycle of a modified FMD for 7 days (n=20) followed by a Mediterranean diet for 6 months.
The FMD and KD cohorts displayed clinically meaningful improvements on the HRQOL summary scales at 3 months, which included: Overall Quality of Life Change in Health Physical Health Composite Mental Health
Tons of info about the plausible mechanisms of these changes are available in the article here:
Pilot study using Keto in Relapsing-Remitting Multiple Sclerosis
Another 2019 study, titled “Pilot study of a ketogenic diet in relapsing-remitting MS” found that a modified-Atkins style #ketogenic diet was safe, feasible to study, and well-tolerated in people suffering from this type of MS.
The authors reported that it improved fatigue and depression, promoted weight loss, and reduced serologic proinflammatory adipokines. If you know anything about brain immunology, you know that’s a pretty big deal! Because chronic body inflammation drives neuroinflammation, which then drives neurodegeneration. So this is a relevant and impressive finding and shows great treatment benefit.
Intention-to-treat KD intervention for Multiple Sclerosis
The same authors reproduced the finding in 2022 in this study, finding the ketogenic diet specifically was safe and tolerable over 6 months, yielding statistically significant improvements in body comp, depression (p<0.001), neuro disability (p<0.001), fatigue (p<0.001), quality of life (p<0.001) and adipose-related inflammatory markers (p<0.001;p<0.002).
Seriously people. Go back to that paragraph and look at the power of those findings! Statistically significant minimums are p<0.05, and the p<0.001 findings are nothing short of stunning and full of hope for people with MS! Let’s take a moment to celebrate those!
Ketogenic diet and immunology markers in Multiple Sclerosis
If you still aren’t convinced, maybe this next one will impress you. It found that at 6 months, a #ketogenic diet used to complement current therapies reduced sNfL levels, suggesting potential neuroprotective effects in MS
This is EPIC, considering in MS we are trying to protect from autoimmune destruction of the myelin sheaths in the brain, right?
Seems like an important therapeutic effect to me 🤷
But what about Terry Wahls and the Wahls Protocol for Multiple Sclerosis?
And yes, I am very aware of Terry Wahl’s work! For those of you who are not familiar, she is a physician who was diagnosed with MS in 2000 & developed her own personalized keto-Paleo diet called the Wahls Protocol and has successfully managed her Multiple Sclerosis with it!
Here is a 2014 study she (Wahls) is an author on that was a small, uncontrolled pilot study that found significant improvement in #fatigue in those with secondary progressive MS
Group average fatigue severity decreased from 5.7 at baseline to 3.32 (p=0.0008) at 12 months. Look at that p value, people!
My understanding is that Wahls does a modified-paleolithic diet in which ketone production may be a part, and she has not seen a benefit from simply adding MCT oil to increase ketone production. If you have MS you may want to explore both options.
If you have done the Wahls protocol and it hasn’t quite worked well for you, I want you to know there is research specific to the ketogenic diet being helpful, in case you would like to try that out.
The bottom line regarding Ketogenic Diets and the Treatment of Multiple Sclerosis
I don’t care if you do a #ketogenic diet for your MS. I just sincerely want you to know there is an evidence-base using diet to treat this disorder. I want you to know that a ketogenic diet is a multiple sclerosis treatment. I want you to know all the ways you can feel better! #MS #autoimmune #neurology #ketogenic
If your brain fog comes from Multiple Sclerosis and you would like to work with me on learning how to use the ketogenic diet and other powerful nutritional supports as a treatment, you can learn more about my online program. Lots of 1:1 interaction, support, and personalization to help you learn all the ways you can feel better!
Mitochondria do much more than just provide power to cells.
Don’t get me wrong. They have everything to do with energy. And because they are so important to energy production, they play a key role in metabolism. And as a result, are center stage in the field of Metabolic Psychiatry.
We hear that mitochondria are the powerhouses of the cell absolutely everywhere. Or at least I do in the circles I hang out in. And you will see it stated all through the blog posts on this website. Communicating that mitochondria are the powerhouses of your cells is really the easiest and most simplistic way to get across to you that you need them for neuronal energy. It’s easy to understand. If we don’t have working batteries in a flashlight, the flashlight won’t work. And if our batteries are going dead, it will kind of work, but not very well. And that goes for our brain when we have mitochondrial dysfunction going on. Cells cannot do the multitude of work they need to do to keep you humming along properly.
But for those of you who want to know more, it’s important to know that mitochondria are SO MUCH MORE than the powerhouses of your cells. So in the interest of a slightly more complete understanding of what these magical little organelles do I have written this blog post!
Note: I do not use the word magical lightly. If you don’t like the word magical, by all means, substitute the word quantum. Because that is also accurate and pretty darn cool. But beyond the scope of this small article (I am no physicist).
Mitochondria translate between the quantum and macroscopic worlds and utilize quantum tunneling of electrons to reduce activation energy barriers to electron flow. Electron tunneling has been extensively characterized in Complex I of the electron transport chain.
Bennett, J. P. (2019). Medical hypothesis: Neurodegenerative diseases arise from oxidative damage to electron tunneling proteins in mitochondria. Medical hypotheses, 127, 1-4.
So let’s get into the other things that mitochondria play crucial roles in other than just amazing energy production.
Table of Contents
Stress response
There are physical stressors and psychological stressors. And your body’s ability to handle stressors of any sort comes down to mitochondrial function. Have you been exposed to a virus or bacteria that is stressing your immune system? Mitochondria regulate your immune system function. Are you dealing with a psychological stressor that is challenging you in your life? Mitochondria are in charge of your cell’s ability to adapt, survive and become more resilient by initiating changes in both gene expression and metabolism. If you don’t have healthy and abundant mitochondria to support cells then more cells die, or worse. They turn into zombies (senescence) that pump out some nasty inflammatory signals that increase your oxidative stress and worsen your symptoms.
Hormone production
If it is a cell that makes hormones, it is a cell that requires more energy than most and that means your mitochondria are basically in charge of hormone synthesis. That’s right. Sterol hormones such as estrogen, testosterone, and cortisol. Mitochondria hold the key. Right down to providing the enzymes needed to initiate hormone production.
This is why your functional medicine treatment for adrenal fatigue is not working. Giving you plant sterols to replace your own cortisol does not address the mitochondrial dysfunction that is going on. This is why going on hormone replacement therapy is not actually a “root cause” intervention. If your hormones are out of whack, it is a sign of mitochondrial dysfunction. The point of intervention is to improve your mitochondrial function.
Tell your friends.
Cleaning up messes
Almost every article on this website talks about the role of oxidative stress in mental illness and neurological disorders. Oxidative stress is what we call the burden of trying to repair the damage that occurs due to Reactive Oxygen Species (ROS). When your mitochondria are abundant and healthy you generally have all the help you need in order to repair the normal levels of damage that happen from being alive and moving through the world.
…mitochondria serve as ROS janitors.
(Palmer, 2022, p. 126)
Abundant and well-functioning mitochondria are required in order to keep oxidative stress in check. And keeping oxidative stress in check is required to have a working brain. Oxidative stress that is not kept in check leads to neurodegenerative processes that affect mood and cognitive functioning. Mitochondria are instrumental in the functioning and maintenance of your body’s own internal antioxidant systems. And as I have stated repeatedly throughout all the blog articles, you are not going to Vitamin C, turmeric or curcumin your way out of an oxidative stress burden coming from poorly functioning or inadequate numbers of mitochondria.
Ask any number of people taking giant doses of antioxidants per their functional medicine practitioner’s recommendation that are still struggling to feel well.
Tell your friends about that part, too.
But mitochondria are way more than the cleanup crew when mayhem ensues. They help maintain cells in all kinds of ways. They regulate the number of cells created, help control what connections get pruned away and which ones stay, and are instrumental in the recycling process that is a part of healthy cell functioning (autophagy, cell apoptosis – the good kind of cell death). It’s not just about cleaning up the messes after they have happened. Mitochondria are ensuring healthy gene expression and cell functioning to reduce the likelihood that a big mess is going to occur in the first place.
Gene expression
The bottom line here is your genes won’t express themselves right without healthy functioning mitochondria. About 20 years ago they figured out that mitochondria were needed to transport a protein that helped regulate gene expression. Mitochondria have their own DNA and that DNA codes for proteins that regulate gene expression. And that gene expression has effects on stress responses, metabolism, and antioxidant function. When researchers play with mitochondria by essentially breaking them (reducing their functional capacity) they find that more epigenetic problems occur.
What does that mean?
It means if you don’t want your genes expressing themselves in funky ways that cause problems and symptoms and make you (and your brain) age faster, you better put your focus on learning how to have kick-ass healthy, and happy mitochondria.
Neurotransmitter Synthesis
Mitochondria like to hang out at synapses. If your mitochondria are sparse in number or something gets in the way of their ability to travel where they are needed, then you don’t make your neurotransmitters. And if your mitochondria are sparse in number or inefficient or sick then neurotransmitters can become imbalanced.
And imbalanced neurotransmitters lead not only to mood problems but cognitive problems, too. You need healthy and abundant mitochondria to synthesize, release, and reuptake your neurotransmitters and then produce the enzymes that break them down. I know we all think that the idea is to have your neurotransmitters hanging out in the synapses longer, but that can cause its own set of problems when they can’t be broken down.
It’s a feedback loop. The neurotransmitters produced and utilized then give mitochondria important messages that are used to optimize your brain functioning. Nobody is rooting for your brain function success like your powerful, little mitochondrial friends. Who is cheering on your stable mood attainment? Who is wanting you to feel smart, present, and capable?
It’s your mitochondria.
To psychiatrists using primarily medications to try to increase or decrease certain neurotransmitters without considering mitochondrial health, I encourage you to explore some of the Metabolic Psychiatry training opportunities provided on the page below.
If you focused on no other area of improved function in your recovery than mitochondrial function, you would be doing yourself a fantastic service. There are excellent ways to improve mitochondrial function, and one of the most powerful interventions for increased mitochondrial number and improved mitochondrial function consists of a ketogenic diet.
Why? Because ketogenic diets increase the number of mitochondria and improve the health and functioning of mitochondria. The ketogenic diet is a mitochondrial intervention that affects metabolism and all the other important activities so important to brain function that were outlined in this short article.
Below are some articles that talk about why ketogenic diets, and the subsequent upregulation of mitochondria that results, are wonderful treatments for various diagnoses.
If you don’t see the diagnosis you are interested in reading about, just scroll down to the search bar at the bottom of the page!
Now that you have a better idea of some of the functions mitochondria provide, you are in a much better position to enjoy the blog posts on this website.
If you would like to explore an online program in your journey to learn all the ways you can feel better, I encourage you to learn more about my Brain Fog Recovery Program.
Anderson, A. J., Jackson, T. D., Stroud, D. A., & Stojanovski, D. (2019). Mitochondria—hubs for regulating cellular biochemistry: emerging concepts and networks. Open biology, 9(8), 190126. https://doi.org/10.1098/rsob.190126
Bennett, J. P. (2019). Medical hypothesis: Neurodegenerative diseases arise from oxidative damage to electron tunneling proteins in mitochondria. Medical Hypotheses, 127, 1–4. https://doi.org/10.1016/j.mehy.2019.03.034
Bennett, J. P., & Onyango, I. G. (2021). Energy, Entropy and Quantum Tunneling of Protons and Electrons in Brain Mitochondria: Relation to Mitochondrial Impairment in Aging-Related Human Brain Diseases and Therapeutic Measures. Biomedicines, 9(2), Article 2. https://doi.org/10.3390/biomedicines9020225
Dzeja, P. P., Bortolon, R., Perez-Terzic, C., Holmuhamedov, E. L., & Terzic, A. (2002). Energetic communication between mitochondria and nucleus directed by catalyzed phosphotransfer. Proceedings of the National Academy of Sciences, 99(15), 10156–10161. https://doi.org/10.1073/pnas.152259999
Kanellopoulos, A. K., Mariano, V., Spinazzi, M., Woo, Y. J., McLean, C., Pech, U., Li, K. W., Armstrong, J. D., Giangrande, A., Callaerts, P., Smit, A. B., Abrahams, B. S., Fiala, A., Achsel, T., & Bagni, C. (2020). Aralar Sequesters GABA into Hyperactive Mitochondria, Causing Social Behavior Deficits. Cell, 180(6), 1178-1197.e20. https://doi.org/10.1016/j.cell.2020.02.044
Picard, M., Zhang, J., Hancock, S., Derbeneva, O., Golhar, R., Golik, P., O’Hearn, S., Levy, S., Potluri, P., Lvova, M., Davila, A., Lin, C. S., Perin, J. C., Rappaport, E. F., Hakonarson, H., Trounce, I. A., Procaccio, V., & Wallace, D. C. (2014). Progressive increase in mtDNA 3243A>G heteroplasmy causes abrupt transcriptional reprogramming. Proceedings of the National Academy of Sciences, 111(38), E4033–E4042. https://doi.org/10.1073/pnas.1414028111
Safiulina, D., & Kaasik, A. (2013). Energetic and Dynamic: How Mitochondria Meet Neuronal Energy Demands. PLOS Biology, 11(12), e1001755. https://doi.org/10.1371/journal.pbio.1001755
Spinelli, J. B., & Haigis, M. C. (2018). The Multifaceted Contributions of Mitochondria to Cellular Metabolism. Nature Cell Biology, 20(7), 745–754. https://doi.org/10.1038/s41556-018-0124-1
West, A. P., Shadel, G. S., & Ghosh, S. (2011). Mitochondria in innate immune responses. Nature Reviews Immunology, 11(6), Article 6. https://doi.org/10.1038/nri2975
Zhu, X.-H., Qiao, H., Du, F., Xiong, Q., Liu, X., Zhang, X., Ugurbil, K., & Chen, W. (2012). Quantitative imaging of energy expenditure in human brain. NeuroImage, 60(4), 2107–2117. https://doi.org/10.1016/j.neuroimage.2012.02.013
Some new research has come out evaluating the occurrence of neurological symptoms in people who were infected with COVID. They found that in those infected with COVID (the original, not the variants), there was a 42% increased chance of developing neurological issues.
And one of those identified is brain fog. And some of you are suffering from brain fog that you suspect comes from past COVID infection (variant or not). And you are wondering what you can do about it, how you can decrease your brain fog symptoms, and facilitate healing.
If you have been suffering from recurrent or persistent brain fog since your Covid infection, I want you to know you are not alone.
A lack of cognitive acuity has increasingly been described in the literature as “brain fog” … Although there is not yet consensus on how to define this term, memory loss, poor focus, reduced concentration, increased word-finding latency, difficulty tracking complex information, and decreased executive functions have all been associated with the term.
And because I am all about you knowing all of the ways you can feel better, I will devote this post to showing you why a ketogenic diet is an evidence-based first step in providing a powerful treatment for your COVID-related brain fog symptoms.
The studies I looked at (see references at end of article) discussed that most of the data came from people over 60 and that those hospitalized generally had more severe neurological problems after. But as someone who helps people with their brains and is active in various forums, I can assure you that plenty of post-COVID brain fog is experienced in all age groups. And that is what they are finding in these papers evaluating the numbers. Even people with mild infections can go on to develop neurological problems. No hospitalization experience indicative of severity seems to be required.
The most frequent neurological manifestations of ‘long-COVID’ encompass fatigue; ‘brain fog’; headache; cognitive impairment; sleep, mood, smell, or taste disorders; myalgias; sensorimotor deficits; and dysautonomia.
The most frequent neurological manifestations of ‘long-COVID’ encompass fatigue; ‘brain fog’; headache; cognitive impairment; sleep, mood, smell, or taste disorders; myalgias; sensorimotor deficits; and dysautonomia. https://doi.org/10.1177/20406223221076890
And for those suffering, it is a scary and debilitating experience, with minimal support available in the form of prescriptions or medical treatments to alleviate symptoms.
And while that may change in the future, many of you are suffering now. And I want you to know that effective treatments exist using metabolic brain therapies like the ketogenic diet.
What kinds of neurological problems do we see with long COVID that are directly relevant to brain fog or that we often find co-occurring with brain fog symptoms?
Cognition and memory disorders
Episodic headaches and even migraines
Mental health – stress and adjustment disorders, anxiety disorders, major depressive disorder, and psychotic disorders
So how would a ketogenic diet assist with these serious neurological issues brought on by Covid infection?
Ketogenic diets allow the body to produce ketones. And ketones are molecular signaling bodies that influence gene expression. And the gene expression it provides can improve the expression of brain energy in hypometabolic (low energy use) structures, reduce neuroinflammation and oxidative stress, and improve neurotransmitter balance.
What do these things have to do with long Covid? Everything. We see problems with these four factors in long Covid, and particularly with neurological symptoms that manifest as a result of prior Covid infection.
Let’s explore the literature.
Table of Contents
Brain Hypometabolism and Covid Brain Fog
Areas of brain hypometabolism occur and can persist after Covid infection. Hypometabolism is a term used to describe an inability or impaired ability to produce energy (hypo=low, metabolism=energy creation). Individuals suffering from long Covid symptoms have been seen to have persistent areas of hypometabolism in the frontoparietal and temporal lobes, which was seen to be improved after 6 months from the onset of symptoms.
Which is good. It’s great that the hypometabolism seen post-Covid is thought to be eventually resolved. But here is the thing. A bout of long-term brain hypometabolism is a disaster. While your brain struggles to use energy in those areas, oxidative stress goes up, and if severe enough, structures will shrink. There is a risk of losing grey matter (brain). It is not in your best interest to “wait it out” for those brain parts to turn back on and be able to use energy well again. You need to rescue brain energy NOW!
Further consistent changes included functional and structural abnormalities in the insula and parahippocampus.
Najt, P., Richards, H. L., & Fortune, D. G. (2021). Brain imaging in patients with COVID-19: A systematic review. Brain, behavior, & immunity-health, 16, 100290.
This is a problem. While the most persistent changes were seen in the olfactory areas of the brain, we cannot ignore the persistent changes seen in the insula and the parahippocampus. Both are important structures in cognition and memory.
An additional area of more persistent hypometabolism is the fronto-insular cortex. This area of the brain consists of important networks of connections that are integral to cognitive control ability. This looks like the ability to switch attention, hold attention, bring attention back to a task, and generally be able to focus. These are complaints we hear people with long-COVID brain fog complain of regularly. And therefore, I would suggest that the brain hypometabolism that is experienced should be a primary point of intervention.
There is a crisis in brain energy after a Covid infection. It is well documented that SARS-COV2 induces mitochondrial dysfunction and underlies the persistent neuropathology seen in some people with long-Covid symptoms.
Luckily, science has an intervention that rescues brain energy. Both by providing an alternative fuel source and improving mitochondrial number and function.
Ketogenic diets for brain hypometabolism and mitochondrial dysfunction seen in Covid brain fog
Ketogenic diets are used specifically to improve brain hypometabolism in various populations. The most common use is with Alzheimer’s disease, in which important brain structures can no longer utilize glucose for fuel effectively. This causes areas of the brain to starve literally and increases oxidative stress, which causes further deterioration. How do ketogenic diets rescue brain energy? By providing an alternative fuel source. Ketogenic diets produce ketones, which are a preferred fuel source for the brain. They can bypass broken machinery needed to shuttle glucose in and are directly absorbed into the cell and used by cell batteries (mitochondria), a superior fuel source.
I don’t call them a superior fuel source lightly. Because ketones are not only a fuel source, they are molecular signaling bodies that have powerful, multi-faceted effects to promote brain energy. Ketones will effect changes that will increase the number, health, and efficiency of existing mitochondria (aka cell powerhouses) providing energy.
So just like in people with mild to moderate Alzheimer’s disease, ketogenic diets can rescue areas of brain hypometabolism and increase brain energy through improved mitochondrial function. And there is absolutely no reason to believe that they would not accomplish the same service for areas of brain hypometabolism due to Covid. Nor is there a reason to believe that a ketogenic diet would be unable to ameliorate the mitochondrial dysfunction well-documented in the scientific literature attributed to Covid. In fact, without improved brain energy, those cells cannot do the work to repair those structures and rebuild.
The decrease in brain energy that comes from poor mitochondrial function and areas of brain hypometabolism cause a ton of oxidative stress. So it doesn’t surprise me that oxidative stress is also consistently seen to be a problem with long-Covid.
This brings us to our next section.
Oxidative Stress and Covid brain fog
There is simply no question or debate about whether we see oxidative stress in long-Covid patients.
neuroinflammatory and oxidative stress processes are thought to prevail in propagating neurological ‘long-COVID’ sequelae
Stefanou, M. I., Palaiodimou, L., Bakola, E., Smyrnis, N., Papadopoulou, M., Paraskevas, G. P., … & Tsivgoulis, G. (2022). Neurological manifestations of long-COVID syndrome: A narrative review. Therapeutic advances in chronic disease, 13, 20406223221076890.
Oxidative stress is the term used to describe an imbalance between the amount of damage going on in a cell and the body’s ability to combat it and be able to keep up with repairs. It is thought that oxidative stress may be responsible for the endothelial and vascular dysfunction we see occur after infection up to 4 months after (and many of you will have experienced this even longer). Oxidative stress is like a clean-up crew that is too few in number and not enough cleaning supplies to go around. They can’t do the work. And your brain doesn’t repair. And this causes a cycle of additional damage that cannot be repaired. And I think you get the idea.
Addressing the oxidative stress that is part of long-Covid brain fog needs to be a primary area of focus.
Oxidative stress in Covid brain fog and ketogenic diets
So how does a ketogenic diet help reduce oxidative stress? A lot of ways. Burning ketones for fuel provides cleaner energy with fewer byproducts to clean up. But mostly, I think the sweet spot is in its ability to upregulate the production of endogenous antioxidant systems. In particular, the production of more glutathione.
Glutathione production is crucial. And the signaling molecule properties of ketones help your body make more of it. And if you have brain fog symptoms, regardless of reason, glutathione is really your best friend and cooperative component in your recovery.
If you have long-Covid that has manifested as brain fog symptoms, it is likely you have developed a leaky blood-brain barrier. That means things are getting close to your brain that are not supposed to be up in there, causing your brain’s immune system to freak out and contribute to neuroinflammation through the production of inflammatory cytokines.
You were supposed to have a healthy blood-brain barrier to keep them out. But your Covid infection may have made that not possible, and it could still be desperately trying to repair (but lacking brain energy, sufficient micronutrients, and a nonstop oxidative stress assault, simply cannot).
Luckily, ketogenic diets are great for blood-brain barrier integrity. Glutathione is used to help repair this barrier, and it is also used to help repair the damage. And I just cannot think of a scenario in which the upregulation in the production of glutathione would not be of astronomical importance and benefit for someone struggling with long-Covid brain fog symptoms.
Neuroinflammation and Covid Brain Fog
You don’t have to contract Covid to know how inflammatory cytokines feel in your brain. Anyone who has come down with a particularly bad cold or even the flu knows how tired you get. You just sit or lie down, and you pretty much do not get up again until you a feeling better. Your brain doesn’t work well, and you don’t dare go near anything in which accuracy or focus is required. And quite frankly, you don’t have the motivation to even try! You turn on your favorite movie and nap with your cat until you feel better (Ok, that’s me, but you probably do something similar). These are sickness behaviors initiated by inflammatory cytokines in your brain.
Inflammatory cytokines in the brain are a necessary part of recovery. But there are definitely conditions where an inflammatory process gets started and cannot calm itself down and just continues out of control. Traumatic Brain Injury (TBI) is a great example of this, as are certain infections. This can also happen if your immune system is not balanced and working well.
So if you tell me that you are still experiencing sickness behaviors post-Covid infection, I believe you.
And so does the research literature.
The inflammatory cytokine storm we have all heard about increases neuroinflammation, which then in turn produces enormous oxidative stress. Remember, after inflammation there needs to be a clean-up crew. This leads to a widespread neuroinflammatory process.
And many people who endured a Covid infection were coming into it already with untreated neuroinflammation due to lifestyle disease, poor or insufficient nutrient status, or some other disadvantage that would make it difficult to calm the neuroinflammatory process back down.
You didn’t need to have a “storm” to create a neuroinflammatory process that is having trouble calming back down on its own. Plenty of people with cases considered to be of mild Covid are suffering from brain fog.
So you need a powerful intervention to reduce inflammation. And the most powerful intervention to reduce inflammation (and neuroinflammation in particular) that I know is the ketogenic diet. Let me tell you how it works.
Ketogenic diets and Covid brain fog neuroinflammation
Ketogenic diets create ketone bodies. One of those ketone bodies is called beta-hydroxybutyrate (BHB). BHB is a molecular signaling molecule, and this means that it is powerful enough to turn gene expression off and on. One of the magical properties of BHB is its ability to turn down chronic inflammatory gene expression. You still get a well-functioning acute inflammatory response, like you would need if you hit your shin on the bed frame or cut yourself while preparing dinner. But it shuts down and dampens the genes that turn on and facilitate and maintain a chronic inflammatory response.
And if you are dealing the brain fog post-Covid, you really need that.
Normally, when I write about ketogenic diets and neurotransmitter balance, I write about their effects on serotonin, dopamine, norepinephrine, GABA, and glutamate. There are really a lot of blog posts on this site about the effects of those neurotransmitters. You can do a search on any of them on the search bar at the very bottom of this article and learn more!
But because this post is about Covid specifically, we will dive more into Nitric Oxide (NO), which can be conceptualized as a retrograde neurotransmitter.
Nitric Oxide (NO) and the associated enzyme that produces it (Nitric Oxide Synthase) are super important and do so many things that are important to help regulate the very symptoms that people with long-Covid often complain about. It helps regulate pain, neuroendocrine function, and the HHP Axis (hypothalamus-hypophysis axis) that regulates stress response, immune system, mood, sleep, and hippocampal (memory) function.
And perhaps most striking and potentially relevant is that Nitric Oxide (NO) impairs platelet aggregation. Platelet aggregation is the process by which platelets stick to one another at sites of vascular injury.
This could be helpful when we talk about reducing the incidence of stroke.
In fact, after an acute Covid infection, your body tries to produce more nitric oxide to help heal the damage.
Following SARS-CoV-2 infection, blood-borne competent mitochondria provide a novel source of restorative ATP and constitutive nitric oxide synthase (cNOS) to stimulate the release of nitric oxide (NO), which is anti-inflammatory
Stefano, G. B., Büttiker, P., Weissenberger, S., Martin, A., Ptacek, R., & Kream, R. M. (2021). The pathogenesis of long-term neuropsychiatric COVID-19 and the role of microglia, mitochondria, and persistent neuroinflammation: a hypothesis. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 27, e933015-1.
…we propose that some of the neurological signs in patients with COVID‐19 are associated with the virus‐induced decrease in NO levels in the brain.
Annweiler, C., Bourgeais, A., Faucon, E., Cao, Z., Wu, Y., & Sabatier, J. M. (2020). Neurological, Cognitive, and Behavioral Disorders during COVID‐19: The Nitric Oxide Track. Journal of the American Geriatrics Society. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361837/
Wouldn’t it be great if there was a way to enhance your production of nitric oxide so you could help heal your brain?
Exercise increases nitric oxide, but I know some of you are suffering from exercise intolerance either due to chronic fatigue that has developed or you get shortness of breath easily as part of your long-Covid symptoms. So I will not tell you just to get out there and exercise because some of you can’t.
Luckily, there is another powerful way to increase Nitric Oxide (NO) production. You guessed it. It’s the ketogenic diet!
Ketogenic diets and neurotransmitter balance – effects on Nitric Oxide and likely treatment for Covid brain fog
Ketogenic diets enhance neurovascular function, particularly by facilitating increased Nitric Oxide (NO) production. In fact, researchers talk about how implementing a ketogenic diet early in cognitive decline can reduce the risk of Alzheimer’s disease, in part because of the pronounced enhanced brain vascular function that is observed. And there is also research to suggest that the ketogenic diet specifically increases NO production in important structures needed for memory, like the hippocampus. And I don’t know anyone who complains of brain fog that does not also complain to some degree about decreased memory function.
But my symptoms are mostly anxiety and depression!
That’s ok. A healthy brain is a healthy brain. If you believe your brain fog symptoms coming from long Covid are mostly due to a mood disorder that came on as a result, a ketogenic diet will still be a powerful treatment for the underlying mechanisms involved.
You can learn more about how a ketogenic diet can be a primary treatment for mood disorders like anxiety and depression, you can explore these articles below:
If you are fearful of using a ketogenic diet because you are afraid of saturated fat, I really need you to get over that. It’s not considered an evidenced-based stance. Nobody who has been keeping up with the research on this topic believes that anymore. And the failure of that information to disseminate down to the public is getting in the way of people using powerful evidence-based therapies like the ketogenic diet to heal chronic diseases.
Don’t take my word for it. I am just a licensed mental health therapist with additional training in using metabolic, nutritional, and functional psychiatry methods. I am not a cardiologist or anything.
So if you are suffering from recurrent and chronic brain fog because of Covid, please consider a ketogenic diet. And don’t let unsubstantiated and poorly researched fear-mongering get in your way.
Conclusion
Here is the thing. If you are post-Covid and still suffering from brain fog, whether it’s a month later or even years later, I’m not sure your doctor or neurologist is up to being able to help you treat it. If they were, you wouldn’t be here reading this article. And you cannot wait around for them to catch up on what effective root-cause treatments are going to help. Doctors and neurologists specifically are steeped in pharma as the primary, and quite frankly, only, intervention for what you are experiencing.
But we don’t have a pill that fixes brain hypometabolism, oxidative stress, and neuroinflammation. And while pharma would attempt to argue that there are prescriptions for neurotransmitter imbalances, those medications do not and will not address brain hypometabolism, oxidative stress, and chronic neuroinflammation.
Pharma has attempted prescriptions to fix these things without success. And that does not surprise me. You are a complicated and beautiful system. You deserve a balanced and pleiotropic intervention. Which is exactly what a ketogenic diet is. And a ketogenic diet is available to you right now.
Ketogenic diets, and the ketones they produce, have additional benefits for people suffering from long-Covid that are beyond the scope of this article. They include powerful immune system balancing effects, positive microbiome changes, and even improved blood-brain barrier repair and function.
It’s time to take your neuro-cognitive functioning back and use a powerful, evidence-based intervention for the underlying mechanisms of pathology we see going on in long-Covid brain fog.
You can absolutely learn how to do a ketogenic diet to treat mood and cognitive problems with resources here on this blog! This post below is a wonderful place to start.
If you would like help moving towards a ketogenic diet and would like to implement additional powerful nutritional therapies as part of your recovery, I encourage you to check out my Brain Fog Recovery Program. It has been my joy and pleasure to help many people suffering from long-Covid “get their brain back” so they can live their best life and thrive!
But most importantly, I just really want you to know that evidence-based treatment for impaired neurocognitive function, even after a virus like Covid, absolutely exist. And that if your doctor doesn’t know enough about them to suggest them to you, that doesn’t mean you have to continue to suffer while they catch up to the literature. I want you to know all the ways you can feel better. And this is one of them.
References
Achanta, L. B., & Rae, C. D. (2017). β-Hydroxybutyrate in the Brain: One Molecule, Multiple Mechanisms. Neurochemical Research, 42(1), 35–49. https://doi.org/10.1007/s11064-016-2099-2
Annweiler, C., Bourgeais, A., Faucon, E., Cao, Z., Wu, Y., & Sabatier, J. (2020). Neurological, Cognitive, and Behavioral Disorders during COVID‐19: The Nitric Oxide Track. Journal of the American Geriatrics Society, 68(9), 1922–1923. https://doi.org/10.1111/jgs.16671
Cascella, M., & De Blasio, E. (2022). Features and Management of Acute and Chronic Neuro-Covid. Springer International Publishing. https://doi.org/10.1007/978-3-030-86705-8
Clough, E., Inigo, J., Chandra, D., Chaves, L., Reynolds, J. L., Aalinkeel, R., Schwartz, S. A., Khmaladze, A., & Mahajan, S. D. (2021). Mitochondrial Dynamics in SARS-COV2 Spike Protein Treated Human Microglia: Implications for Neuro-COVID. Journal of Neuroimmune Pharmacology, 16(4), 770–784. https://doi.org/10.1007/s11481-021-10015-6
Förstermann, U., & Sessa, W. C. (2012). Nitric oxide synthases: Regulation and function. European Heart Journal, 33(7), 829–837. https://doi.org/10.1093/eurheartj/ehr304
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How can a ketogenic diet help heal a leaky brain and make the blood-brain barrier stronger and more resilient?
That’s a really good question. So I am going to answer it. In this blog post, we are going to discuss what the blood-brain barrier is, what symptoms we can expect to take place if it becomes damaged and leaky, and even lab tests that can be used to try to evaluate if it’s leaky.
Your blood-brain barrier (BBB) is super important
First, just a little bit of anatomy and function. Just enough so you understand what’s involved.
The BBB separates the blood from the extracellular cerebrospinal fluid and protects the brain from bloodborne pathogens and toxins while allowing the diffusion of oxygen, carbon dioxide, and small lipophilic molecules/ethanol. Maintenance of the BBB is essential for a tight control of the chemical composition of the brain’s interstitial fluid (ISF) essential for synaptic function as well as offering a form of protection against bloodborne pathogens
Kakaroubas, N., Brennan, S., Keon, M., & Saksena, N. K. (2019). Pathomechanisms of blood-brain barrier disruption in ALS. Neuroscience journal, 2019. https://doi.org/10.1155/2019/2537698
The BBB is a collection of blood vessels and astrocytes that together keep things out of the brain from systemic circulation. It has different transporters that allow some things to pass through.
But just like a leaky gut as the BBB declines in health it cannot maintain its integrity and things get into the brain that should not. These might include:
Chemicals and Environmental Toxins
Pathogens (bacteria and viruses)
Food proteins (e.g., gluten)
Various inflammatory mediators in the bloodstream (e.g., lipopolysaccharide)
Circulating anti-bodies
Hormone imbalances (true hypothyroidism)
When these things get through a leaky blood-brain barrier they activate the brain’s immune system to try to protect the brain. Specifically, microglial cells become activated. If you have a leaky BBB, it means things are getting up there all the time that do not belong. And this means the microglial activation is happening constantly. That’s not good. That sets the stage for chronic neuroinflammation. And if your brain cannot repair itself fast enough to keep up with the damage going on from chronic neuroinflammation, it’s going to set you up for a neurodegenerative process.
Brains need micronutrients to repair the damage, make neurotransmitters and important enzymes, and to generate energy. Do you know how your brain gets the majority of the vitamins it needs for those processes? Your BBB. Yep, that’s right! Most of the essential water-soluble vitamins (e.g., B vitamins) and other important metabolites are transported into the brain using specific transporters in the BBB.
Some of these transporters are used to pass glucose into the brain. As we have discussed in previous articles, this does not have to be glucose you eat. Your body is more than happy to make the glucose substrate you need for certain parts of your brain to work. But if your BBB is damaged and the transporters used for that purpose are damaged or not working (BBB can become insulin resistant) then you are not going to get to use that glucose for energy. And in this way, BBB deterioration can happen and its deterioration can perpetuate energy crises in the brain.
If your BBB is damaged, that can cause a problem for all of those transporters, whose job is to get nutrients and fuel into your brain.
This means your brain ages MUCH faster than it is supposed to. And it doesn’t matter if you are 15 or 27 or 34 or in your 40s or 50s or 60s. Neurodegenerative processes happen at any age. A leaky BBB is not an old person’s problem. It is an “every person of any age sort of problem.” And it needs to be considered and addressed.
Don’t get me wrong. I am glad to see leaky GUT get a lot of airtime and concern. I am relieved it is finally on people’s radars in a real way. Healing a leaky gut is important because you need to keep the body’s immune system quiet to keep the brain’s immune system from becoming overactive. You need healthy digestive tracts to be able to break down and absorb your nutrients through your gut and you need a healthy microbiome for probably a billion reasons.
You can learn more about healthy microbiomes here.
But there is a whole other barrier that needs to be promoted and understood by the general public and people who are struggling with brains that do not work as well as they would like. And that’s why this post is being written. A leaky brain is a thing.
When the BBB is broken down the major thing that happens is that you get neuroinflammation. When there is a neuroinflammatory process, people begin to complain about having symptoms of brain fog.
When you have brain fog, it means something is interfering with normal synapse function.
Synapses constitute a highly specialized and vital part of neuronal cells. They are the primary sites of communication between neuronal cells, and therefore, they are involved in all aspects of neuronal physiology. Proper synaptic function is a prerequisite for normal brain function, and even minor disturbances may lead to neurological disorders.
Xylaki, M., Atzler, B., & Outeiro, T. F. (2019). Epigenetics of the Synapse in Neurodegeneration. Current neurology and neuroscience reports, 19(10), 1-10. https://doi.org/10.1007/s11910-019-0995-y
Neuroinflammation interferes with nerve conduction speed and you may notice that thinking and motor tasks become less efficient or come less easily. Neuroinflammation also “uncouples” mitochondria. Mitochondria are your cell powerhouses. They provide the energy your cell needs to function. From firing those synapses to keeping the cell healthy with the energy to do basic cell housekeeping. What do uncoupled mitochondria feel like? It feels like brain fatigue. Your brain gets tired faster. Maybe you cannot drive in heavy traffic anymore, withstand long social interactions or read as much as you used to. Your ability to do tasks and pay attention is diminished.
Neuroinflammation can wax and wane. Some weeks there are mood and cognitive disturbances, and other weeks you will experience less of those symptoms. This simply means that the brain is having some success, some of the time, managing the inflammatory process and repairing neurodegeneration as it is happening.
But as you can imagine, the root causes that create a leaky BBB should not be ignored, and at some point the brain fog may become chronic, as the immune system becomes chronically overactive and the rate at which damage is done outstrips the body’s antioxidant systems, creating oxidative stress and setting off significant neurodegenerative processes.
Growing evidence shows that oxidative stress (OS) plays a critical role in the induction of BBB changes.
Kadry, H., Noorani, B., Bickel, U., Abbruscato, T. J., & Cucullo, L. (2021). Comparative assessment of in vitro BBB tight junction integrity following exposure to cigarette smoke and e-cigarette vapor: A quantitative evaluation of the protective effects of metformin using small-molecular-weight paracellular markers. Fluids and Barriers of the CNS, 18(1), 1-15. https://doi.org/10.1186/s12987-021-00261-4
I keep mentioning these neurodegenerative “processes” because while occasional neurodegeneration happens, once it escalates into something chronic (aka a process) the neurodegeneration feeds itself, creating a loop of constant damage, nutrient depletion, additional neuroinflammation, and other factors that can make it much more difficult to turn it around after a certain point of damage. If allowed to go unchecked it can in fact cause a level of damage that cannot be remediated. And that is why this blog sounds the alarm that brain fog needs to be taken seriously and treated with powerful nutritional and functional psychiatry treatments that halt the root causes of neurodegenerative processes. Regardless of reason or diagnosis.
How do I know if I have a leaky brain?
There are different antibody markers associated with BBB permeability. These include S100B, aquaporin 4, glial fibrillary acidic protein, and zonulin antibodies. Your functional medicine practitioner can order tests like these through Cyrus Laboratory.
You can get tested, but here is the thing. If you know you have a leaky gut, or you have been diagnosed with a leaky gut, then there is a very good chance that you have a leaky BBB. Because a leaky gut allows things to enter the bloodstream that should not. And some of those things are direct assaults on the BBB. The correlation between leaky gut and leaky BBB is super high. They go together.
For example, the antibodies produced against gluten, that are not stopped by the BBB can bind to astrocytes and neurofilament proteins in the cerebellum and cause a condition called Gluten Ataxia. The neurodegenerative process leading up to this diagnosis can look like brain fog symptoms that include trouble speaking, odd tingling sensations in the extremities, poor coordination and balance, and maybe problems using your arms and legs or your fingers and hands (e.g., you begin to notice more problems getting your fingers to work while you crochet).
Maybe you have toxins in your body, whether through exposure to a chemical from a typical household product or something you inhaled from your environment walking down the street (this happens constantly). If your BBB is healthy, these are not going to cross into the brain. But if it isn’t healthy, whatever the substance it will cross into the brain, activating microglia that release inflammatory cytokines.
These unwelcome substances that made it through your BBB, and should not be anywhere near the brain, will bind and attach to different proteins and break things. What do I mean by “break things” exactly? I mean they will bind to places other things were supposed to bind to, and not allow something to function properly. They will get in the way and inhibit important mechanisms your brain needs to function and keep your brain healthy.
How your BBB got leaky
Your BBB is basically endothelial cells and astrocytes (astroglia). Both of these are easily damaged in environments of chronic inflammation. Chronic diseases that increase inflammation in the body (which is probably all of them) can play a role in breaking down the BBB. Some of the medications that mainstream medicine uses to treat the chronic disease can cause a breakdown of the BBB (e.g., corticosteroids). It can also happen as a result of a traumatic brain injury (TBI) (e.g., car accidents, falls) because the BBB may not sufficiently heal after such an assault. Chronic inflammatory gut problems can create a state of systemic inflammation because of leaky gut (permeability) releasing more zonulin or lipopolysaccharides (LPS) into the bloodstream, which then impairs the health of the BBB directly.
What else causes problems for my BBB?
If you have high levels of homocysteine on your blood tests, you have a higher likelihood that your BBB is leaky. If you have genetic SNIPS such as MTHFR, you are at higher risk of problems keeping your BBB intact and healthy. You can improve the odds by taking a methylated B-complex.
Other factors that create BBB permeability include the following:
Sedentary lifestyle
Alcohol consumption
Chronic sleep deprivation
You would probably like to know what can be done to fix it.
How ketogenic diets might help heal a leaky brain
Most of our information about how ketones affect the BBB comes from animal studies. Personally, I am relieved by that. I don’t want anyone cutting into anyone’s head trying to figure out what’s going on in there. So don’t get hung up on the idea that because these come from animal studies somehow the findings are not legit for your BBB. There is a lot of the same machinery going on.
Improved brain and BBB metabolism
When your body is making ketones on a ketogenic diet, it can provide an alternative energy source for the damaged BBB. They just happen to be THE preferred fuel source for the brain. They get into the brain without the fuss or muss of needing a happy or working transporter (e.g., simple diffusion or facilitated diffusion). Monocarboxylate transporters mediate ketone body entry into the brain, and they are in abundance all through the BBB, including the plasma membrane of the choroid plexus, the endothelial and epithelial cells, glia, and neurons. Literally, oodles of ways to get those ketones on up in there to fuel your brain. Those ketones get used in the mitochondrial matrix (a membrane in your cell batteries) that makes energy.
And here is what I need you to get also. The BBB uses energy from ketones also. Those little cells that make up the BBB try to make their own ketone-based energy all the time. And if you are on a ketogenic diet those cells are going to be replete with the energy they need to tighten up the junctions needed to keep the BBB strong and intact.
Did I mention brains need a lot of energy? Pretty cool that there is a way to get it the energy it needs that doesn’t require more effort. Right? It’s kind of like a passive income stream instead of buying into hustle culture. I mean, we can get those GLUT receptors working again eventually as our healing progresses. But we are never going to progress in our healing if we starve the brain in the meantime. It’s just going to perpetuate the neurodegenerative processes going on. As a bonus, ketone bodies also directly enhance GLUT1 activity, and GLUT1 is a transporter that helps that glucose get where it belongs.
Ketones are anti-inflammatory
We just don’t have a medication that provides the same level of anti-inflammatory effects as safely or effectively as the ketogenic diet.
The therapeutic efficacy of large-spectrum anti-neuroinflammatory drugs is limited by their side effects after even transient immunosuppression.
JANIGRO, D. (2022). Effects of the Ketogenic Diet on the Blood–Brain Barrier. Ketogenic Diet and Metabolic Therapies: Expanded Roles in Health and Disease, 346. P.355
When there is chronic immune activation there is damage that is done in the brain and to the BBB. This causes inflammation and additional stress for the body in trying to maintain the tight junctions in the BBB. This inflammation can damage those important vascular structures that are a part of the BBB. It can damage the glial and astrocytes. Ketogenic diets turn down inflammation. The ketones produced on a ketogenic diet behave as signaling molecules, literally telling genes involved in chronic inflammation to turn themselves off. Pretty useful for helping that little BBB catch up on repairs, maintain its integrity and function, and perpetuate its own healing if you ask me.
Now back to those vascular structures. There are a lot of dementias that have vascular disease components. Ketones increase cerebral blood flow uptake and this increased blood flow and use of oxygen is thought to contribute to the well-documented neuroprotective effects of ketone bodies. A leaky BBB is an etiological factor in some dementias (e.g., Alzheimer’s) and it is thought that benefits seen in with ketogenic diets in these populations may in part be due to improved BBB function. The hypothesis that ketones improve neurovascular function in dementias is a current area of research study.
As if all this were not reasoning enough for using a ketogenic diet to help heal the leaky brain, ketones help create more of the very proteins the BBB uses to heal those gap junctions that got leaky, to begin with.
Supplement Options
Because I believe you have the right to know all the ways you can feel better, I am going to list some of the supplements that are used that have varying levels of evidence of improving the BBB. But let me be perfectly clear in that I don’t think this is anywhere near as cool or as effective for healing the BBB as a well-formulated ketogenic diet. None of these heal insulin resistance. None of these are alternative fuel sources for the brain. Some of these can improve the function and blood flow to the epithelial and endothelial cells, and some can provide some improved antioxidant action so you can try to play catch up with oxidative stress.
Will you get some BBB healing from these supplements? Yes, you might. As long as the neurodegenerative cascade you have going on doesn’t have too much momentum. But if your BBB permeability is from a stroke or TBI, or early dementia processes, these do not provide the correct fuel source your brain needs to combat brain hypometabolism. These supplements do not provide improved micronutrients or even macronutrients for maintenance and repair towards optimized brain and BBB function.
If you are serious about healing your brain, don’t be afraid to do the thing you are imagining is really hard. I promise you, that learning how to implement and sustain a ketogenic diet is not nearly as hard as having a brain that doesn’t work. A brain that keeps you from enjoying life fully.
A brain that is in constant distress with mood issues and memory problems?
THAT IS HARD. Every. Single. Day.
A ketogenic diet is a learning curve and you deserve support in implementing it. But I promise you, as someone who has recovered my own brain, it is not nearly as hard as you are imagining. You are already going through one of the hardest things. Ketogenic diets are easy in comparison.
Supplements that can assist with BBB repair include fish oils, Ginko Bilboa, vinpocetine, alpha-lipoic acid, and glutathione (get liposomal, learn why here LINK), and resveratrol.
I will sometimes use some of these in addition to a ketogenic diet as adjunctive therapy, but I do not use them by themselves to heal BBBs or other parts of the brain. And so I do not know the exact dosages that people use if they are using these as primary therapy for this purpose. But again, you will be able to research those variables for your own healing.
Conclusion
In the Brain Fog Recovery Program I teach, we use ketogenic diets, personally optimized nutritional supplementation, and coaching towards functional medicine interventions that help treat a leaky BBB and help people live their very best life. Because let’s be honest. How do you experience life? Through your brain. You don’t have to live with brain fog symptoms, regardless of reason or diagnosis. Just because your doctor ignored your complaints about your inability to focus, remember things, or maintain your mood doesn’t mean there are no effective treatments.
I am happy to help you learn all the ways you can feel better!
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You may be wondering, why your brain fog experience is different from that of others. Why does one person have problems finding words while another cannot remember why they entered a room? And another finds having a conversation to be exhausting?
Table of Contents
Introduction
I am often on Reddit forums, talking about brain function and helping people figure out what might be going on with their brains. The questions in the TBI, dementia, and stroke forums reflect an understanding that their brain function is directly involved. Sometimes the diagnosis they are asking about would appear to not necessarily be neurological. People are asking about brain fog symptoms for all kinds of things:
Post-Viral or Active viral (Post-COVID, Epstein-Barr, CMV)
And this is not surprising. Because anytime you have a disease process or an imbalance that is causing an inflammatory response, we know that neurodegenerative processes in the brain can be triggered.
Other times the people in the forums are well aware there are neurodegenerative processes going on, but they just do not know what to do about it or how to help it, and they are not getting sufficient help from their doctor. They get told it’s just normal aging and they go off and try to come to terms with the idea their brain fog symptoms are just a part of life and will get progressively worse. And that might be the case when no effective intervention is offered by their doctor. But the level of brain fog that happens that causes a person to seek out help in the first place is quite unlikely to be normal levels of cognitive symptoms with aging. People who are older can have thriving brains and can continue to learn, remember, focus and live a high quality of life. Especially when we use interventions to slow, stop or even reverse neurodegenerative processes.
The flavor of nonstop questions I see come up is basically one type with hundreds of variations:
Is this a brain fog symptom?
Do other people have this symptom?
Is this thinking, perceiving, and remembering symptom a part of this or that diagnosis?
What becomes strikingly apparent in following these forums, on Reddit and on other social media platforms, is the wide diversity of experiences in brain fog symptoms. Brain fog is an umbrella term we use when we are trying to say our brain is not working well and that our ability to function has decreased to noticeable levels. And every person who is suffering from recurrent or chronic brain fog knows that these symptoms become intolerable and steal a lot of the enjoyment out of life by interfering with our ability to be present in our lives and relationships.
If you have occasional brain fog, you may not be having a neurodegenerative process. You may have intermittent brain inflammation. But be aware that repeated neuroinflammation can set the stage for a neurodegenerative process if you can’t get it under control. If your brain fog is recurrent or chronic, it is really time to listen to what your brain is trying to tell you.
And this article is part of facilitating your improved ability to listen to your symptoms and validate your experience, even when your doctor does not. In doing this you can begin to take the necessary steps for yourself (or a loved one) to begin to make powerful dietary and lifestyle choices to improve these symptoms.
The TYPE of brain fog symptoms you are having can help you identify what part of your brain is being impaired by neurodegenerative processes.
Brain anatomy. Human brain lateral view. Illustration isolated on white background.
Let’s begin to learn what struggling brain structures may likely be involved in your own personal brain fog symptoms. As I discuss neurodegenerative processes I need you to understand that this is not an old person’s problem. I need you to understand that even a teenager can have a neurodegenerative process triggered. That it can begin to occur in your 20s and 30s.
Neurodegenerative processes happen all across the age ranges for a variety of reasons such as diet, nutritional insufficiencies, exposure to toxins, and illnesses. Don’t let the associations you have made with the term “neurodegenerative” keep you from understanding that this is an underlying factor in the creation and continuation of your brain fog symptoms.
Frontal Lobe
In the front of your brain, you have a big section called the frontal lobe. It’s involved in something called executive functioning and is involved with the ability to plan, organize, and follow-through. It is also very critical in working memory. Working memory allows you to hear information, hold it long enough to analyze it, and the ability to recall it a few minutes later.
Vector Illustration ,Flat Frontal lobe of human brain anatomy side view flat of human brain anatomy Side view on white background
When your frontal lobe is not working well you can’t think well. You have trouble initiating tasks or finishing anything. You will find that you are losing your desire to want to do new things and you have a real loss of motivation. This does not mean you are lazy. It’s a brain fog symptom that you beat yourself up about. With frontal lobe dysfunction, you are going to see your performance go down in your profession, regardless of what it is. You may assume you are depressed or that you have ADHD. And you might. But knowing your diagnosis or resonating with a diagnosis is not the same as treating the underlying causes of a diagnosis. What you really need to do is figure out how to fix your brain.
Another area that is part of the frontal lobe is the Supplementary Motor Area (SMA) and it is involved in the planning and carrying out of complex movements in your arms and legs. When this area of the brain begins to suffer from neurodegeneration people have a tendency to have tightness and heaviness in one or more limbs, especially after cognitive fatigue. This is not a common brain fog symptom that people complain about but I include it here you may recognize it in yourself along with other symptoms of frontal lobe dysfunction. It may be a clue that this part of your frontal lobe is beginning to suffer from neurodegeneration.
Another area of the frontal lobe is Broca’s area and it involves speech. It’s a motor speech area. It controls your muscular ability with your lips, tongue, and voice box. The motor parts of speaking, not the cognitive parts. You might start to mispronounce words and your speech fluency may go down, resulting in some slurring of words.
You may also notice that when you speak, you are not doing so anymore with proper grammar and syntax. Meaning to say things plural but it comes out singular or perhaps reversing the word order in a sentence, may actually be a very early form of agrammatism.
Agrammatism is difficulty with using basic grammar and syntax, or word order and sentence structure.
Are you having more and more difficulty reading long passages? Even though you used to be an avid reader? This can be because this part of the brain is not working as well as it should (it may also show that your Weirneke’s area). If one of your brain fog symptoms is that you find it hard to speak or that speaking feels really tiring to you, it could be that neurodegenerative processes are occurring in this part of the brain.
Parietal lobe
Your parietal lobe is farther back from the frontal lobe and is considered a different structure. One important area of the parietal lobe is the somatosensory cortex. This brain area is responsible for having sensations and perceiving sensations. It helps you perceive with your arms and legs. Although people don’t often see this as a brain fog symptom, it’s still an area that is at risk of neurodegenerative processes.
Vector Illustration ,Flat Parietal lobe of human brain anatomy Side view on white background
You might just experience this as clumsiness. As knocking things over often or easily, and slamming into your bed or running into doors. Maybe you have had a streak of getting injured more often. It’s just a sensation of not quite knowing that your body was there or less awareness of where your limb was in relation to something else. You may have this symptom on your own or you may notice that you have it along with brain fog symptoms. I include it here to help you validate yourself and your experiences.
Your parietal lobe has a section called the inferior parietal lobule. You may have brain fog in which you notice you are not remembering new faces very well, and this is different than your abilities in the past. Or you get clues that you are not reading emotion in others as well as you used to.
While neural activation elicited by imitating and being imitated were distinct with little overlap, on-line imitative interaction enhanced inter-brain synchronization in the right inferior parietal lobule that correlated with the similarity in facial movement kinematic profile.
Miyata, K., Koike, T., Nakagawa, E., Harada, T., Sumiya, M., Yamamoto, T., & Sadato, N. (2021). Neural substrates for sharing intention in action during face-to-face imitation. NeuroImage, 233, 117916. https://doi.org/10.1016/j.neuroimage.2021.117916
If you have brain fog, you may not only find conversing very fatiguing, but you may also be less adept at mirroring those you interact with and not be able to participate in interactions of emotional intimacy in important friendships and relationships. As a therapist, I know what a big deal this is for people and how it can affect oneself and one’s loved ones.
Perhaps more commonly parietal lobe dysfunction looks like a confusion between right and left, difficulty with basic math calculation, or finding words as you speak or recalling numbers (e.g., phone number, address). If these are your brain fog symptoms it is a clue that the inferior parietal lobule section of your brain may be struggling to function.
I see posts with people complaining about these particular brain fog symptoms all the time. And I just really want to tell them all that these are not normal, normal aging, or something they should let their doctor dismiss. I want to tell them that there are good solid, evidence-based, and powerful interventions available to treat this. And sometimes I do. But often people will argue with me and tell me that these symptoms are just unavoidable parts of their illnesses or that they have already been told that it’s just normal aging. And when that happens I just go back to writing this blog and working with the people in my Brain Fog Recovery Program, where I see these symptoms improve and even reverse every single day. And that makes me feel better.
Temporal Lobe
The auditory cortex is in the temporal lobe and it helps you perceive sounds. When this area is not working well you get brain fog symptoms that look like having difficulty with sounds in environments with a lot of background noise. You really can’t understand what you are assaying and you will try to rely on lip-reading. As this area degenerates further you will start to get rhythms out of your head. Getting a song stuck in your head once in a while is normal. But if it’s often or somewhat chronic (weekly or daily), it can be a sign of possible neurodegenerative processes in this part of the brain.
You may also develop tinnitus. Usually, tinnitus is due to the damage of auditory nerves from accident, injury, or more often in our society, high blood sugars. There is a very high correlation between tinnitus and insulin resistance. But tinnitus can also be a sign of neurodegeneration occurring in the temporal lobe.
Deep within the temporal lobe is the medial temporal lobe and it is a major area of degeneration in Alzheimer’s disease and dementia. When the medial temporal lobe is going through a degenerative process you are going to get brain fog symptoms that look like problems with memory recall of slightly longer-term events. What did you eat for lunch two days ago? Can you access that memory? That’s the medial temporal lobe. Can’t remember an event two weeks ago, or a memory you had five years ago that was truly an event? That’s a problem in this area.
Vector Illustration ,Flat Temporal lobe of human brain anatomy Side view on white background
Has your sense of direction been getting confused? Your ability to map where you have been or how to get somewhere? Beginning to rely on a navigation system in your car to go places and make it back home? That indicates problems with your right medial temporal lobe.
Has your ability to play trivia games gone down? And recall facts you once had access to in conversation? Have problems remembering (recall) numbers that have been always known in the past (e.g., the PIN number you have used for many months or years, your address at the one house you grew up in)? That is potentially neurodegenerative processes in the left medial temporal lobe.
People describe brain fog symptoms such as continually walking into a room and forgetting what you needed to do there or you can’t remember events you signed up for or you have 1000 sticky notes trying to keep track of things it is a sign of neurodegenerative processes. Whether this is early signs of Mild Cognitive Decline (MCI) and early dementia or just a neurodegenerative process going on you haven’t gotten a handle on, IT DOESN’T MATTER. Pay attention to it and prioritize the work you need to do to fix your brain.
Occipital Lobe
Vector Illustration ,Flat Occipital lobe of human brain anatomy Side view on white background
This lobe is in the back of the brain. It helps you perceive colors. I don’t hear brain fog symptoms around problems perceiving colors but I include it here in case this is part of your experience. There are many people with traumatic brain injuries (TBI) that have symptoms of occipital lobe degeneration. TBI can set up a cascade of neurodegeneration that needs to be quieted and quelled long after the initial brain injury.
Early signs of degeneration in this lobe are likely not caught very quickly. If it is a brain fog symptom you may find you have trouble tracking moving objects, have odd little subtle visual hallucinations, and/or problems recognizing written words. These may be some of the more perplexing brain fog symptoms I see people ask about in the forums, but they are often come up much less often.
Cerebellum
This area of the brain is important in balance, coordinated movement, and motor learning. Are you having more trouble with balancing? If you close your eyes and stand with your feet together, do you sway and wabble a bit? Whether it is at your yoga class trying to do the tree pose or finding you want to hold onto the stair rail more often, feeling more unsteady is an indicator that this part of the brain is not as healthy as it could be and that a neurodegenerative process may be going on. Did you have a lot of trouble learning simple Tik Tok dance or a truly impossible time following along at Zumba (and you used to be better at that kind of thing)? Didn’t do too well at that free ballroom dancing lesson you signed up for?
It could be that your ability to coordinate and remember movements is impaired. You may conceptualize this as a brain fog symptom, that you just “can’t learn new things” lately and lump it all together, but it signifies a distinct area of dysfunction that deserves your acknowledgment and attention.
Will brain games help?
Yes and no. The idea that you can rehabilitate these areas of the brain by doing the very thing you are struggling with is legit. Yes, absolutely, exercise those areas of the brain where you are experiencing neurodegeneration. But as someone who had very severe brain fog and neurodegenerative processes and got their brain back, I don’t think that should be everyone’s go-to fix-it strategy.
When my cognitive symptoms were severe, I attempted to do brain games in the form of apps and activities. And I was terrible at them. I made no progress and it was scary and very demoralizing. It made me want to give up on trying to get better. Sometimes I would find them to be cognitively exhausting, and my symptoms would be worse the next day.
After a certain point of recurrent and chronic brain fog, it does not make sense to focus on brain games and exercises to strengthen the brain without fixing underlying issues of brain hypometabolism, neuroinflammation, oxidative stress, and neurotransmitter imbalances. The ketogenic diet is an important piece in that recovery.
Having someone with really bad brain fog do brain games is the equivalent of telling someone with Chronic Fatigue Syndrome (CFS) to go to a Crossfit class. Yeah, it is great if they managed to get dressed and make it to the parking lot and inside, but it’s not an appropriate intervention for where they are at. Theoretically, it’s going to make them stronger and increase their energy in the long run, but it doesn’t make sense for where they are at and how they are functioning. It is safe to say it may even worsen underlying issues causing their fatigue and symptoms. There are better and more important things to work on before we sign them up for Crossfit.
And that’s the kind of work I do with people every day.
But I have had a brain scan and they told me everything was normal!
It is really important that you understand that problems with neurodegeneration do not show up on brain scans until the damage reaches a certain level of severity. If you are relying on a scan to tell you if your brain is healthy or not this is a false premise. Unchecked neurodegeneration will EVENTUALLY shrink brain structures enough that someone will point out there might be a pathology going on, but by then you have done a lot of damage that could be avoided and have lived in an impaired state unnecessarily for far too long.
Some scans are better at picking up some factors in neurodegeneration, like brain hypometabolism, but those scans are NOT going to be ordered on you until your symptoms are quite severe. They are expensive. And no insurance company in the US is going to authorize that in an exploratory way for you to figure out if you need to change diet and lifestyle factors.
Conclusion
These symptoms do not get better on their own if you continue to do what you are currently doing. I would say that you know your brain, and you know if it isn’t working well anymore. And you need to listen to that. And you need to stop telling yourself stories that come from the medical establishment’s complete inability to conceptualize, treat and manage chronic, early neurodegenerative processes. That story you tell yourself that you are just getting old? And that a drop in brain function that you experience as impairing your life is a normal part of that? That’s a story. That’s not real. And it doesn’t have to be real for you.
That is why I created an online version to teach you what I do with people every day in my individual practice to help slow, stop and even reverse these symptoms. This online program is called the Brain Fog Recovery Program, and you can learn more about it below:
If you have a friend or loved one with brain fog, please discuss this article with them. They very likely do not have the brain energy to read and comprehend this big blog post. Sometimes they need it lovingly broken down so they can feel validated and seen. They have been getting distressing symptoms, for maybe a long time, and feeling broken and abandoned by the medical system. Helping them advocate for themselves as best they can or assisting them in advocating for effective treatments is an important part of the person you care about learning all the ways they can feel better.
You may also find the following past blog posts helpful in your journey to recover your health and cognitive function.
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Catani, M. (2019). Chapter 6—The anatomy of the human frontal lobe. In M. D’Esposito & J. H. Grafman (Eds.), Handbook of Clinical Neurology (Vol. 163, pp. 95–122). Elsevier. https://doi.org/10.1016/B978-0-12-804281-6.00006-9
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