The possible causes of Alzheimer that might be managed by Keto Diet:

Alzheimer's Disease (AD) is a neurodegenerative disorder that affects the brain and is characterized by the gradual loss of cognitive and neurological abilities.

The disease is progressive. Over time, it slowly destroys memory, thinking and social skills, and limits the patient’s ability to conduct a basic conversation. Eventually, patients lose the ability to conduct the simplest daily tasks.

As Alzheimer progresses, some of these complications can affect other physical functions of the body, such as swallowing, balance, and bladder control.

There can be several causes for Alzheimer including aging, environmental factors, lifestyle, and genetics.

However, one of the main causes for Alzheimer from the Keto diet perspective is due to glucose and glucose metabolism.

Glucose is the main source of energy and nutrition for the brain as it allows it to preserve its main functions such as thinking, memory, and learning. The brain is the most energy-demanding organ that uses almost half of the sugar energy required by the body because it is so rich in nerve cells.

When glucose levels are too low or the brain is unable to process glucose efficiently, the brain will go hungry, and cells will start starving. As a result, neurotransmitters will not be produced and communication between neurons starts breaking down leading to their death.

Accordingly, people will start losing their capacity to remember and think properly. These Alzheimer symptoms can be due to several reasons:

1-    Excess glucose: when glucose levels in the blood become high, it can affect the brain’s functional connectivity and cause brain atrophy or shrinkage. This can lead to small-vessel disease, thus restricting the blood flow in the brain which might cause cognitive difficulties and impairment of brain functions. 
In some severe cases, it can even spur the development of vascular dementia.

2-    Insulin resistance: the main role of insulin is to help control the blood glucose levels in the body by signaling to the organs, tissues, and muscles to take in the glucose from the blood. As a result, insulin will be able to maintain two important functions in the brain: 1- control food intake; 2- regulate the cognitive functions, particularly the memory. 

For people suffering from insulin resistance, this means that cells have diminished ability to respond to the action of insulin in transporting glucose from the bloodstream into the muscles, brain, organs, and other tissues.

Accordingly, brain cells would not be able to uptake glucose properly which will deprive the brain from the main nutrients. Hence, cells will start starving and will eventually die. This process is known as cell degeneration.

This defect in insulin signaling in the brain may contribute to neurodegenerative disorders. It may also damage the cognitive system and lead to dementia states.

A study titled “"Evidence for brain glucose dysregulation in Alzheimer’s disease" demonstrated that abnormalities in brain glucose homeostasis are intrinsic to Alzheimer’s diseases development. These can begin several years prior to the onset of clinical symptoms.

3-    Excess fructose: fructose is commonly consumed in the Western diet, and it has been found that excess fructose can damage hundreds of genes in the brain. Hence, this would lead to several diseases including Alzheimer’s.

Why Keto diet helps treat and prevent Alzheimer's disease?

Keto diet helps prevent and reduce Alzheimer because it provides the brain with an alternative source of energy and nutrition called ketones, instead of glucose. These ketones are considered to be a better source of energy and nutrition for the brain and helps it maintain its main functions.

Accordingly, keto diet can help for Alzheimer by resolving the following problems that lead to its development:

1-    Insulin resistance: glucose is normally used as the primary source of energy and nutrition for the brain and body cells. However, in the case of insulin resistance, the brain cells are unable to process this glucose anymore. This leads to cells degeneration and cause brain functions to start deteriorate.

Following a keto diet triggers a metabolic shift in the body in which the liver starts producing ketones instead of glucose. The good thing about these ketones is that the brain is able to process them. Hence, it can get adequate energy and nutrition to keep functioning properly.

Research and studies confirm that ketones can supply up to 70% of the brain energy supply more efficiently than glucose. 

Recent studies also suggest that a major ketone known as beta-hydroxybutyrate (BHB), may be a more efficient fuel than glucose as it can provide more energy per unit oxygen used.

It is also suggested that the keto diet can increase the number of mitochondria, so called “energy factories” in brain cells which can additionally help in overcoming the Alzheimer’s disease.

2-    Excess glucose: a high carbs diet can produce excess glucose in the blood. This can affect the brain and lead to small vessel disease in the brain. Hence, the blood flow can’t properly reach the brain. 

Given that the keto diet restricts the consumption of carbohydrates, it reduces drastically the glucose level in the blood. Accordingly, this can help in stopping Alzheimer’s progression and even possibly reverse the disease. 

3-    Excess fructose: it was found that excess fructose in the diet can damage hundreds of genes in the brain. Given that the keto diet restricts fructose consumption, it can help in protecting the genes in the brain. This would help in stopping the progression of Alzheimer’s disease, and even treating it. 

How the Keto diet works for Alzheimer’s disease:

A standard modern diet AMDR (Acceptable Macronutrients Distribution Ranges) allows for a daily caloric intake of carbs: 45% - 65%, fat: 25% - 35%, and proteins: 10% - 35%. Accordingly, our diet is considered very rich in carbs and produces high amounts of glucose in the blood.

The keto diet is a special regimen that restricts carbohydrates and limits protein, while focusing on fat intake. The diet consists of 75% fat, 20% proteins, and only 5% carbohydrates. 

By following the keto diet, the body gets depleted from its carbohydrates reserves within three to four days. Hence, it is unable to produce enough glucose anymore. As a result, the body needs to start looking for other sources of energy to survive.

 Since fat is the only remaining nutrient available in abundance, the body will need to start burning it to use it for energy.  

This metabolic shift is known under the name of “ketosis”. This is a normal metabolic process in which the body starts burning fat for energy instead of carbohydrates because it doesn’t have enough carbs available anymore. 

Accordingly, the liver starts producing ketones that are used by the body and brain as an alternative source of energy instead of glucose that is not available anymore. 

These ketones are sent into the blood stream so that the body and brain can use them now for fuel. Subsequently, the brain will start metabolizing these ketones, and use them as a main source of energy to keep functioning. This would hence help the brain protect and preserve its functions, and prolong the development of Alzheimer’s disease.

In addition, since the keto diet restricts carbs and less glucose is produced, the blood vessels blockage in the brain would be contained. Hence, this would lead to proper blood flow that can reach the brain and improve cognitive abilities. 

Furthermore, because the diet restricts fructose, the genes in the brain that are usually damaged by fructose consumption become more protected, and this enhances cognition functions as well.

Keto diet for Alzheimer's disease: diet guidelines

The ketogenic diet suggests consuming 70% to 80% of fat, 10% to 20% of protein and around 5% of carbohydrates only (less than 50 grams per day). 

There are no specific guidelines about the duration of the diet. However, it is generally recommended to follow it for at least three months. 

Currently, there’s not enough data related to the long-term effects of the keto diet. Accordingly, it is not agreed yet whether this diet can be adapted as a lifelong eating plan or it should be applied only for specific durations.

It is recommended also to consume enough proteins to preserve the tissues and muscles. However, it is important to maintain the protein amounts within moderate limits of 20%. Any excess of protein can be converted into glucose in the body. Hence, this would push the body out of ketosis.

What are macros?

It is very common to encounter the word “macros” while reading about the ketogenic diet. This term is short for macronutrients that include carbohydrates, fat and protein. These three substances provide our body with energy (calories) when we eat. 

Accordingly, if you wish to follow a ketogenic diet and make sure to maintain the “state of ketosis”, it is imperative for you to understand what are these macronutrients, and what you should do to balance them properly. 

Below is a brief explanation about each macronutrient and its main functions:

Carbohydrates:

Carbohydrates are made up of sugar and starches, and they are the body’s first source of energy. However, it is possible to survive on minimal quantities since fat and protein become the sources of energy when carbohydrates are not available. 
It is important to count net carbs as the total carbohydrate intake. Net carbs or impact carbs are common terms used in the ketogenic diet. It is the amount of carbs directly absorbed by the body that will contribute to calories, while indigestible (unabsorbed) carbohydrates that we know as dietary fiber, are subtracted from this amount.  In other words, the amount of net carbs is the total amount of carbohydrates minus the dietary fiber.

1 g of carbohydrates = 4 calories

Protein: 

Proteins have many important functions in the body since they play different roles as antibodies, enzymes and hormones. They are needed for immunity, growth, tissue repair and to preserve lean body mass.

Amino acids are what makes proteins and they are known to be the building blocks of proteins. There are twenty amino acids, nine out of them are considered to be the essential ones. These are not produced by the body, instead they come from the food we eat. 

Any deficiency in proteins intake may lead to several health conditions. That’s why the ketogenic diet requires to consume enough protein in order to preserve lean body mass. 

The general requirements are 0.8 grams per kilogram of body weight to preserve muscle mass and 0.8-1.2 grams per kilogram of body weight in order to gain muscle mass. It is important to note 0.8 g/kg is the minimal requirement to maintain good health.

1g of protein = 4 calories

Fat:

Fats provide energy for the body and support cells growth. They help the body absorb fat-soluble vitamins (vitamin A, D, E, K) and nutrients. They also help protect the organs and keep the body warm.

Fats are made up of fatty acids and glycerol. There are two essential fatty acids called linoleic acid and linolenic acid (omega 3 and 6) that the body cannot produce. Accordingly, these should come from the food we eat. 

Consuming fats is also known to influence satiety as it gives a feeling of being full for longer.

1 g of fat = 9 calories

Keto Diet Macro Calculator:

1-    Calculate your BMR ((Basal Metabolic Rate): The Mifflin equation

The number of calories required by the body per day is called the Total Daily Energy Expenditure (TEE). This is equal to the sum of the Basal Metabolic Rate (BMR), which is the number of calories the body needs to function at rest, plus the amount of physical activity achieved daily.

To maintain your current weight, you should fulfill your TEE needs. In order to lose weight, you should subtract calories from your calculated TEE. Make sure to always check with a health professional regarding the number of calories you can reduce from your diet.

The Mifflin equation is used to calculate the BMR. It works as such:

Women

BMR (Basal Metabolic Rate) = (10 x weight in kg) + (6.25 x height in cm) – (5 x age in years) -161

Men

BMR (Basal Metabolic Rate) = (10 x weight in kg) + (6.25 x height in cm) – (5 x age in years) +5

2-    Calculate the TEE (Total Daily Energy Expenditure):

To calculate the TEE, the activity level should multiply the BMR.

3-    Calculate your macros:

Once the TEE is determined, the macronutrients can be calculated accurately.

Example of macronutrients calculation: 

TEE = 1,600 for a woman.

Fat = 75 % = 1,200 cal = 133.3 g (each gram of fat is 9 calories)

Protein = 20% = 320 cal = 80 g (each gram of protein is 4 calories)

Carbohydrate = 5% = 80 cal = 20 g (each gram of carbohydrate is 4 calories)

This is a typical example of how many grams should be consumed daily depending on the TEE and percentage requirement of each macronutrient. The goal is to be able to choose foods properly that meet these needs.

Keto diet for Alzheimer's disease: food types 

The various food types incorporated in the keto diet are high in good fat and very low in carbohydrates. Maintaining the proper proportions is critical to maintain the state of ketosis. Proportions should be done as per the macro calculation provided in the diet structure section. 

Below is a list of the various food types for Keto diet: 

- Healthy fats: incorporate healthy high fat foods daily such as some oils (coconut, olive), avocadoes, nuts (macadamia, walnuts, almonds, pecans), and seeds (sunflower, pumpkin, sesame, flax). 

- Meat: it is suggested to consume grass-fed beef instead of grain-fed, and free-range poultry because they contain higher amounts of omega-3. Pork, bacon and organ meats can be consumed in moderation.

However, it is important to avoid eating too much meat in order to maintain the protein restrictions. It is also important to note that processed meats like sausages and cold cuts contain added carbohydrates. You should avoid them.

- Dairy: some dairy products are allowed such as butter, high fat cheese, and high fat yogurt, because of their low lactose content. Low fat dairy products should not be consumed as they tend to be higher in carbohydrates.

- Fish: it is suggested to consume fatty fish like salmon, wild-caught fish being the best option. Avoid breaded fish because it contains carbohydrates. 

- Non-starchy vegetables: non-starchy vegetables (low carb) include leafy greens (kale, Swiss chard, spinach, lettuce), cauliflower, broccoli, Brussels sprouts, asparagus, bell peppers, onions, garlic, mushrooms, cucumber and celery. Mostly, all vegetables that grow above the ground are lower in carbohydrates, and hence can be consumed.

- Fruits: fruits that are low in net carbs such as berries are allowed.

- Nuts: nuts can be consumed in moderation as a snack. Avoid cashews and peanuts since they are high in carbohydrates.

- Dark chocolate: 90% dark chocolate and cocoa powder are allowed. Only higher than 70% dark chocolate can be consumed. For example, one ounce (28 grams) of unsweetened chocolate (100% cocoa) has 3 grams of net carbs.

- Drinks: water is the best choice in order to stay hydrated since it has no carbohydrates. Unsweetened coffee and tea can also be consumed. It is critical not to add any sugar. For example, 1 teaspoon of sugar is equivalent to 4 grams of carbohydrates. Hence, this will make it so difficult to remain within the recommended carbohydrates amount if you add any sugar.

Keto diet for Alzheimer's Disease: recommendations to follow

- Always check food labels: some hidden carbs may be present in spices, vegetables, and drinks. Always read food labels carefully before you buy any product.

- Always stay hydrated: make sure you always drink enough water to stay hydrated. Carbohydrates retain water in the body, so a low-carb diet can lead to dehydration and constipation.

- Consume enough salt, electrolytes, and magnesium: minerals can be lost along with water while following a keto diet. It is important to consume enough salt and take electrolytes or magnesium if necessary.

- Restrict your calories consumption: always restrict your diet within the allowed daily calories requirements. Do not exceed the recommended calories, otherwise this will result in weight gain.

Keto diet for Alzheimer's disease: what you should avoid

- Limit grains and starches: avoid wheat-based products like rice, pasta and cereals since they are high carbohydrate sources. 

- Limit sugary foods: avoid soda, beverages and juices with added sugars, smoothies, cake, and candies.

- Limit fruits: avoid fruits that are not considered low net carbs and all fruit juices because they are high carbohydrate sources.

- Limit beans and legumes: avoid eating beans, lentils and peanuts because they have high carbohydrate content.

- Limit root vegetables: avoid potatoes, sweet potatoes, carrots and parsnips because they are high in carbohydrates.

- Limit high lactose dairy: while dairy can be high in fat, most are also high in lactose sugar. Be aware of the amounts of carbohydrates present in the dairy products consumed.

Avoid highly processed dairy such as ice cream because they are higher in sugar content.

- Avoid low fat or diet products: pay attention to low fat products because they are usually high in carbohydrates.

- Limit unhealthy fats: while a high fat diet is recommended, avoid consuming too much bad fat found in processed vegetable oils and mayonnaise.

- Limit alcohol: avoid full carbohydrates wine, beers, and cocktails with added sugars.

- Avoid processed food: processed foods should be avoided even if they are low in carbohydrates. They are composed of bad fats and increase the risk of several diseases.

- Be aware of sweeteners and sugar: sugar is naturally present in fruits and dairy, and hence these should be consumed in limited amounts. Watch out for sweeteners as well, and go instead for keto-friendly sweeteners or Stevia.  

- Avoid eating farmed fish: While eating fish is great for keto but you should avoid eating farmed fish because of the fewer benefits they might have and the chemical additives they might contain. Check out this video about farmed fish.

Keto diet benefits:

The ketogenic diet includes many benefits besides its ability to treat Alzheimer’s disease. For instance, the diet is known for its ability to control blood sugar, increase mental performance, increase energy, reduce blood pressure, reduce weight, and reduce cholesterol. The diet can also help in epilepsy treatment, heart disease, type 2 diabetes, and solving acne problems. 

Below is a list of the keto diet various benefits:

- Weight loss: the diet is quite effective for reducing weight as it increases the amount of fat burned in the body which contributes to weight loss. Plus, the diet triggers satiety much quicker. Hence, fewer calories are consumed, resulting in additional weight loss.

- Improve physical performance: the body has large amounts of fat stores that are not used effectively. However, when the body starts burning fat efficiently for energy instead of carbs, it can benefit from large fat fuel reserves available. Hence, a long-lasting energy burning process. Accordingly, this diet can sustain improved energy and physical performance. 

- Diabetes: the diet is beneficial for diabetes because it reduces carbohydrate intake and control levels of glucose in the blood.

- Heart disease: the diet can protect against heart diseases by reducing the risks factors associated with heart diseases such as overweight, triglycerides, hypertension, and blood sugar levels. The diet can also increase the good cholesterol (HDL) in the body and lower the bad cholesterol level (LDL). This would balance the cholesterol ratio in the body and help further in reducing the risks of heart disease. 

- Triglycerides: the diet reduces drastically the triglyceride levels found in the blood. High levels of triglycerides are associated with heart disease.

- Cholesterol: the diet increases the level of good cholesterol called HDL and reduces bad cholesterol. High levels of HDL cholesterol lower the risk of heart diseases, because it helps in balancing the cholesterol ratio. 

- Blood pressure: the diet may also decrease blood pressure levels. Hypertension is associated with many diseases such as heart disease and kidney failure.

- Blood sugar: the diet lowers the level of sugar found in the blood. This is especially useful in patients with diabetes. 

- Epilepsy: the diet reduces significantly seizures in epileptic patients, especially children. Studies have shown that a keto diet can reduce epilepsy, 50% among adults, and 90% among children.

Other conditions: following a keto diet has also shown to have beneficial effects for other conditions such as cancer, Parkinson’s disease, acne, and polycystic ovary syndrome (PCOS). However, more research and findings are needed in order to support these statements further.

Keto diet for Alzheimer's disease: precautions

Before you start your keto diet, it is important to take some precautions in case you are taking some medication or if you have any medical condition. Always consult with a health expert especially if you have any of the following conditions or you are taking any medication.

- Blood-pressure: a combination of blood pressure medication and a low carb diet is risky because there’s a possibility of decreased blood pressure from the diet. Low blood pressure may occur within the first days and sometimes might take months to happen. If low blow pressure occurs, it is important to contact a doctor.

- Diabetes: the keto diet will reduce blood sugar levels due to the reduced carbohydrate intake. If you are taking any diabetes medication such as insulin to reduce blood sugar levels as well, it is important to discuss this with your doctor before starting the diet to avoid any possible complications.

- Pregnancy / breast feeding: it is not advised to restrict any food groups if you are pregnant or breast feeding. A balanced diet is highly required for developing babies. Since the keto diet eliminates completely some food groups, this can be risky for them. Always make sure to discuss this with a specialized nutritionist before starting any diet to make sure you avoid any sort of nutrient deficiencies. 

- Nutritional deficiencies: it is important to watch out for any possible nutritional deficiencies since the keto diet does not include all food groups. Other reasons that may lead to deficiencies are fewer calories that are consumed because they are subtracted from the TEE in order to promote weight loss or because less food is consumed due to increased satiety. Always make sure to follow up with a nutrition expert before starting this diet.

Keto diet for Alzheimer's disease: side effects

The ketogenic diet is mainly safe, however there are some side effects that need to be taken into consideration:

- Keto flu: the keto flu is a series of symptoms such as fatigue, headache, nausea and cramps that are experienced by some people following the keto diet. These symptoms are quite common especially at the beginning of the diet. However, this problem will be resolved in few days by the time the body starts adapting to lower carbohydrate intake and starts burning fat properly. To avoid these symptoms, it is recommended to reduce carbohydrates gradually out of the diet so that the body gets used to this gradually.

- Cramps:  leg cramps are common with the keto diet. It’s an indication of mineral deficiency, mainly magnesium. This is because carbohydrates retain water in the body. Hence, less carbs mean less water retention, resulting in fewer electrolytes as well. It is important to stay hydrated and consume enough salt as this helps retain magnesium in the body.

- Constipation:  the main cause behind constipation is dehydration, due to less water retention from the reduced carbohydrates intake. It is important to drink enough water while making sure the vegetables consumed contain some fiber.

- Heart palpitations:  during the transition period, the heart may beat faster and harder. This is quite common especially because of dehydration and lack of salt. Accordingly, you should always make sure to have enough water and salt. This should usually solve this problem. However, if this situation continues, you should immediately seek medical assistance. 

- Fatigue: at the initial stages of ketosis while the body is shifting to using fat for energy instead of carbohydrates, people would feel tired. Their physical performance might be affected as well. However, this should be resolved once the body adapts to the new process and starts burning fat properly to produce the required energy.

- Ketoacidosis: this happens when the buildup of ketones results in higher levels of acids in the blood (byproduct of burning ketones). Ketoacidosis can affect the livers, kidneys, and the brain.

Ketoacidosis can occur for people following a low carbohydrates diet, though it is very rare. However, this can be a more common problem for people that suffer from diabetes. Accordingly, if you have diabetes, it is important to contact your doctor before starting the keto diet.

- Hypoglycemia: this is when glucose levels become very low in the blood. Accordingly, people might experience blurred vision, headaches, and confusion. This might become dangerous if left untreated as it can cause seizures. In some cases, it can even be fatal. Hypoglycemia happens mainly because our bodies are not used to run on ketones from fat instead of glucose from carbohydrates, this might lead in some cases to hypoglycemia.