Observational studies are inherently limited — and that’s exactly why we should be cautious when different camps start declaring specific foods as “sacred” or universally beneficial.
The same type of data is often used to support completely opposing narratives. That alone should make us pause.
Maybe the more important question isn’t which food is “good” or “bad” — but under which physiological conditions a certain food becomes helpful, neutral, or even harmful.
I very much appreciate your response. But I'm not sold on your hesitation. Of course there have been long-term studies on keto for childhood epilepsy, used for more than a century now. Keto has been safe been safe for them, and I haven't heard of adverse effects from a "stressful state." I'll add that I've been in ketosis at a moderate level (~2.0 mmol/L in blood, on average) for 4.5 years now with no adverse effects, I feel great. My Oura ring doesn't tell me I'm stressed and I certainly don't feel stressed - quite the opposite. I am not obese and I can't imagine I've ever been insulin resistance (I've had virtually no health problems in my almost 68 years, numbers always good), but I'm APOE4/4 and I know glucose wouldn't be utilized well by my brain by now, so I'm hoping ketones are a better energy source. (You also wrote that the elderly brain doesn't utilize glucose well.) I feel like it's a more natural state to be in versus the way most people eat, which includes inordinate amounts of grains (whether ultra-processed or not), which humans didn't eat in large quantities before agriculture began 10K-12K years ago, i.e., not what our brains or bodies evolved on.
Given that APOE4/4's are, by some accounts, virtually guaranteed to get AD by about my age, there seems to me to be no harm in trying this strategy - nothing to lose, much to gain, as I feel I already have.
Dear Sandy, it appears that this diet is working for you and that is great! But that does not mean it is a recommendation for everyone. As long as you monitor your health and make reasonable choices in your dietary choices, why not. There are folks who cannot do ketogenic diets and that’s the ok too.
What I've not understood, respectfully, is why not keto, in your view. If it's only because it can be challenging to do and sustain, would you recommend against it for those of us who have no problem doing and sustaining it? Might you at least believe it to be beneficial to do sometimes, on and off, for those who can more easily manage it that way?
For several reasons. First, we have no long term studies on the effect of ketogenic diets on the brain to my knowledge. Second, ketosis is an adaptive response and this is a stressful state to be in chronically. Third, we still do not know who benefits most from ketosis. I suspect it is beneficial in conditions of obesity and insulin resistance reversing or improving these conditions, but would it have the same impact in lean individuals? Finally, we still do not know effects of APOE4 and AD pathology on ketone metabolism. An intermittent ketogenic diet may be less stressful and more physiological but not a requirement.
Observational studies are inherently limited — and that’s exactly why we should be cautious when different camps start declaring specific foods as “sacred” or universally beneficial.
The same type of data is often used to support completely opposing narratives. That alone should make us pause.
Maybe the more important question isn’t which food is “good” or “bad” — but under which physiological conditions a certain food becomes helpful, neutral, or even harmful.
I very much appreciate your response. But I'm not sold on your hesitation. Of course there have been long-term studies on keto for childhood epilepsy, used for more than a century now. Keto has been safe been safe for them, and I haven't heard of adverse effects from a "stressful state." I'll add that I've been in ketosis at a moderate level (~2.0 mmol/L in blood, on average) for 4.5 years now with no adverse effects, I feel great. My Oura ring doesn't tell me I'm stressed and I certainly don't feel stressed - quite the opposite. I am not obese and I can't imagine I've ever been insulin resistance (I've had virtually no health problems in my almost 68 years, numbers always good), but I'm APOE4/4 and I know glucose wouldn't be utilized well by my brain by now, so I'm hoping ketones are a better energy source. (You also wrote that the elderly brain doesn't utilize glucose well.) I feel like it's a more natural state to be in versus the way most people eat, which includes inordinate amounts of grains (whether ultra-processed or not), which humans didn't eat in large quantities before agriculture began 10K-12K years ago, i.e., not what our brains or bodies evolved on.
Given that APOE4/4's are, by some accounts, virtually guaranteed to get AD by about my age, there seems to me to be no harm in trying this strategy - nothing to lose, much to gain, as I feel I already have.
Dear Sandy, it appears that this diet is working for you and that is great! But that does not mean it is a recommendation for everyone. As long as you monitor your health and make reasonable choices in your dietary choices, why not. There are folks who cannot do ketogenic diets and that’s the ok too.
What I've not understood, respectfully, is why not keto, in your view. If it's only because it can be challenging to do and sustain, would you recommend against it for those of us who have no problem doing and sustaining it? Might you at least believe it to be beneficial to do sometimes, on and off, for those who can more easily manage it that way?
For several reasons. First, we have no long term studies on the effect of ketogenic diets on the brain to my knowledge. Second, ketosis is an adaptive response and this is a stressful state to be in chronically. Third, we still do not know who benefits most from ketosis. I suspect it is beneficial in conditions of obesity and insulin resistance reversing or improving these conditions, but would it have the same impact in lean individuals? Finally, we still do not know effects of APOE4 and AD pathology on ketone metabolism. An intermittent ketogenic diet may be less stressful and more physiological but not a requirement.