PERSONAL THOUGHTS ON THE KETOGENIC DIET IN PARKINSON’S DISEASE

PERSONAL THOUGHTS ON THE KETOGENIC DIET IN PARKINSON’S DISEASE

by

Nutritional Therapist:  Lucille Leader Dip ION MBANT CNHC Reg

Editor: Dr Geoffrey Leader MB ChB FRCA Dip ION 

To understand the basis of the Ketogenic Diet, it is essential to appreciate the vital need for all cells in the body to make sufficient energy to carry out their functions. This takes place in the powerhouses of the cells, known as the mitochondria.  In Parkinson’s disease, this process may be compromised due to Parkinson’s Disease (Ref 1), other illnesses,

stress (Ref 2), or as a side effect of medication (Ref 3).

The primary fuel needed by cells to produce this energy is glucose.  Glucose is derived mainly from carbohydrates - fruit and vegetables - in the diet.   In the cells of the body, it combines with specific vitamins and minerals from the diet, as well as oxygen that we breathe, to produce this vital energy (Ref 4). In Parkinson’s disease, research has suggested that the process of absorption of glucose by the cells, can be compromised. 

However, the brilliance of the human body is that its energy can be produced in an emergency by other cellular techniques. These include the use by cells of their specific fat stores which were derived from the diet, which produces ketones.  This then provides interest in the so-called Ketogenic Diet! 

Applying this, so-called, dietary approach, the body is encouraged to produce ketones as an alternative to the complete reliance on glucose as an effective fuel source for energy production. 

During periods of fasting for some hours or overnight, when glucose may be in short supply, body cells release their fats. They are then taken by the circulation to the liver, where ketones are produced.

The cells, therefore, acquire the ability to make energy without the basic fuel of glucose, and this is then helpful to those with a compromised ability to metabolize glucose for cell energy production, as may be the case in Parkinson’s disease as well as other illnesses.

However, “ONE SIZE DOES NOT FIT ALL!”

Firstly, it is important for people with Parkinson’s not to embark upon any specialized form of a diet without having undergone a thorough health assessment. This would include basic routine medical tests as well as those for metabolic and nutritional status.  These tests are available at medical and biochemical laboratories and can be authorized by your doctor. They will point the appropriate way forward for diet considerations and choices.

This establishment of the individual’s basic health potential is vital! 

• In normal health, the liver controls a balanced level of ketones produced. However, if a person has some metabolic difficulty, there can be an overproduction of ketones which can lead to a dangerous condition known as ketoacidosis. 

• The sudden change to a predominantly fat-based diet (ketogenic) may be unsuitable if a person has an insufficiency of fat-digesting Enzymes (pancreatic enzymes) and also of an imbalance of Essential Fatty Acids and Cholesterol.  

• Saturated fats may be unsuitable if a person has an illness, in addition to Parkinson’s disease, where a predominance of fats may be medically and therefore biochemically (nutritionally) contraindicated.  

• Increasing Protein relative to Carbohydrates would be unsuitable if people have high uric acid levels and gout. 

       Abnormally high protein intake would produce an acidic environment in cells that could engender negative conditions for other serious diseases.

• Additionally, if a person is reliant on L-dopa and other dopaminergic medication, it may be necessary to correlate food with the timing of drug administration for better tolerance of the pharmaceutical.  In some cases where drug doses are close together, then intermittent fasting would be difficult.

There have been very encouraging independent reports on the Internet by people who have benefited from adopting the Ketogenic approach.  But for safe and best health practice, it must be realized that the diet that each has adopted has fortunately been suitable for their specific biochemical individuality.  

Clinical research of the high fat, high protein, and lower carbohydrate diet is being undertaken and published.  It would seem that some people with Parkinson’s disease do benefit, and some do not – it obviously depends on the specific metabolic needs and health status of each individual. 

Ideally and logically, the appropriate diet for each person needs to be medically and biochemically assessed, and responses monitored.  A logical approach to the type of fats taken in the diet might include the use of specific Essential Fatty Acids which are vital fats necessary for the healthy membranes surrounding brain cells (neurons) and which control inflammation,  as well as fats which do produce ketones, such as are found in the medium-chain triglycerides (MCTs) in coconut oil.

Dietary Saturated Fats, Medium Chain Triglycerides which form Ketones, Other classes of Fat, Essential Fatty Acids, Protein, Carbohydrates, Vitamins, and Minerals all need to be combined to form a working balance for the body to obtain all the nutrients required for Optimum Functional Health, within the confines of its particular disease. 

Conclusion  

Although results in research have been inconclusive (Ref 5) for the routine application of a ketogenic diet in Parkinson’s Disease, it is nonetheless of special consideration for those who have difficulty with glucose metabolism.  Ketones do offer a dynamic fuel source to cells.

Research has suggested that there is a need to assess the value of a ketogenic diet further.  However, an overall supportive diet that takes into account a logical ratio of ketogenic fats to protein and carbohydrates might well be of general benefit in Parkinson’s Disease

(Ref 5).                                                                                                                                                                                                                                                                                                                                                                                                                                                          

References

1. Biochemica et Biophysica Acta (BBA): Vol 1802: Issue 1: pps 29-44: Jan 2010

  Molecular Basis of Disease: Mitochondrial dysfunction in Parkinson’s disease.

Winklhofer KF, Haass C

2. Psychosom Med: Feb-Mar; 80(2): pps 141–153 2018

Psychological Stress and Mitochondria: A Systematic Review

Martin Picard, Bruce S. McEwen

3. Ann Neurol: 34:5. pps. 715-723: 1993 

Chronic Levodopa Administration alters Cerebral Mitochondrial 

Respiratory Chain Activity. 

Przedborski S, Jackson-Lewis V, Muthane U:

4. Parkinson’s Disease: Reducing Symptoms with Nutrition and Drugs 

Cellular Energy Production pps 12–14: 2017

ISBN 978 0 9526056 4 5 Denor Press 

  Dr Geoffrey Leader, Lucille Leader, Professor Leslie Findley

5. Mov Disord. 33(8): pps 1306 –1314: August 2018

  Low-fat versus ketogenic diet in Parkinson’s disease: A pilot randomized 

  controlled trial 

  Matthew C.L. Phillips, Deborah K.J. Murtagh,  Linda J. Gilbertson,  

Fredrik J.S. Asztely, Christopher D.P. Lynch

Bibliography

PARKINSON’S DISEASE Reducing Symptoms with Nutrition and Drugs

Dr Geoffrey Leader, Lucille Leader, Professor Leslie Findley

Third Edition ISBN 978 0 9526056 4 5 Denor Press

Dr. Geoffrey and Lucille Leader have been loyal and committed supporters of Parkinson’s Resource Organization since 2001. They lectured at the PRO Symposium “Meeting of the Minds” in 2003 and are on standby for PRO’s 2020 Symposium.