1. If it was not a quantum biologic effect what was it then?
2. If you have a problem remember what should you consider?
3. How does low cholesterol make your brain soft?
4. Why carbs are not helping you either?
5. What is a Prostaglandin and does a ketogenic diet help that too?
6. How should I eat as I age?

The scene is set in a bad brain or an aging brain is as follows:

My last post dealt with the origins of the ketogenic diet and how it has tremendous beneficial affects on neurodegenerative conditions and many psychiatric conditions with origins in the brain. Today we are going to explore the biochemistry of why this is the case. We talked about a possible quantum effect but today we will deal with some biochemical reasons. We also have seen that the ketogenic diet also allows neurons to uncouple cerebral blood flow from cerebral metabolic rates of oxygen consumption. This affords a huge metabolic advantage for disease neurons. All diseased neurons tend to exhibit huge increased “leakiness” from the first cytochrome in their mitochondria. If you remember from my series on mitochondria, leakiness of this electron transport increases the inefficiency of ATP generation for neurons. This inefficiency in neurons is signaled clinically by an increased CMRO2 in the brain. Cerebral autoregulation mandates that CMRO2 and CBF remain coupled through most mean arterial blood pressures (MAP) from 50 ~160. In neurodegeneration, we see increased inflammation due to the mitochondrial leakiness but with a decrease in CBF. This is why we see hypo-perfusion in parts of the brain with damage on PET scans and fMRI’s. This is the direct cause of neurologic and cognitive decline we see clinically. It means the damaged neurons need a higher cerebral blood pressure to maintain perfusion and cognition. This is why the early stages of most neurodegenerative diseases we see elevated blood pressures due to carotid atherosclerosis. As neurons die with time via apoptosis the need for the higher CBF is reduced because metabolic demand is reduced from a shrinking brain.

We will use Alzheimer’s disease (AD) as a model from here on out to discuss why the ketogenic diet offers huge protective advantage in most cases we may see clinically. A ketogenic diet is very high in fat content and in cholesterol. Animal cells exploit this property to great advantage in orchestrating ion transport, which is essential for both mobility and nerve signal transport. For many years it was believed that the blood brain barrier blocked lipid transport into the brain. This is why many believed that the brain had to run predominantly on glucose. (Listen up vegans!) We now know this is completely false and, in fact, the brain runs much more efficiently on ketone bodies. Why does it? Special astrocytes (CNS neurons) have an LDL receptor that allows them to absorb cholesterol directly from the blood stream for use in the brain. The brain is made up predominantly from lipids to begin with. It has also been shown that when blood cholesterol is low, the astrocytes even have the capability to upregulate transcytosis in their membranes to get enough LDL for the brain. Hence, astrocytes are capable of obtaining cholesterol, fats, and antioxidants directly from LDL in the blood- stream. The ApoE4 allele has been associated with the development of AD. This allele has been shown to be associated with reduced cholesterol uptake by astrocytes in the hippocampus (memory center of the brain). ApoE4 /LDL is recognized by astrocytic receptors and transported intact across the endothelium of the blood brain barrier. The ApoE4/LDL molecules that are glycated by high levels of blood glucose, however, will not undergo transcytosis and be left in the blood and have to be deposited in arterial walls and in adipocytes (fat). This is why ApoE4 is heavily associated with atherosclerosis and heart disease progression some believe. I discussed this briefly in Dr. Williams Davis blog on July 31, 2011. Read the comments section and look for my response. This also explains why people with this allele have higher levels of LDL in the blood. The liver responds in kind, with increased production of LDL, to meet the metabolic demands of the brain for lipid. This is a compensatory mechanism that the body is using to offset the depletion of cholesterol in the brain due to glycation (AGE’s or ALE’s). Clearly, use of a high dietary carbohydrate and PUFA’s load stresses this system. This stress is magnified in the mitochondria. The reason for this is found in lipid biochemistry. I know your head is starting to hurt but you will really understand why cholesterol is needed badly in the brain soon.

The most important role of cholesterol in humans is its unique ability to allow freedom of movement to ions in cell membranes because of its chemical composition. It has both a lipid and polar component that allow it to have diversity of chemical benefits in animal cells. This allows the molecule of cholesterol to have both fat and water soluble abilities in our bodies. This allows for the formation of” lipid rafts” in tissue that allow for ion transfers. In fact, insulin is taken up into muscle cells because of the presence of these cholesterol lipid rafts in the membranes! Plants contain no cholesterol at all. Moreover, all of our hormones in the human body are also made form cholesterol. Hormones are the manner in which the brain is able to control the 20 trillion cells in our body. Its importance cannot be more apparent. Our liver is designed to make the LDL our brains need to thrive.

As we all know, neuronal cell membranes are very excitable due to their ion channel chemistry. This allows them transmit signals. A depletion of cholesterol in neurons directly affects the ion channels in their cell membranes. The less cholesterol that is present the more small ions like (sodium) Na and (potassium) K leak out and decrease efficiency of the neurons function to signal. This stressor is directly tied to the mitochondria because of the potential change in the membrane voltage. It directly depletes the neurons ability to generate energy. A decrease in energy or metabolism is directly coupled to cerebral blood flow. Remember the brain is the ultimate energy hog. Cholesterol, therefore is, a fabulous insulator of the excitable membranes like neurons! It confers huge advantages in transmission of nerve signals. Much like an insulator of an electrical wire functions in your house, cholesterol is an insulator that saves the neuron tremendous energy. The covering reduces energy loss. With reduced cholesterol, the neurons energy expenditure rises quickly. We see this clinically on EEG studies of AD patients where they lose voltage on the EEG and the signal shrinks. Moreover, this is transmitted to the synaptic cleft and we see a resultant drop the neurotransmitter Acetylcholine. Not only that, at nerve synapses cholesterol is used in the neurotransmitter vesicle to release the neurotransmitter into the synaptic cleft to signal other neurons. This reduces nerve to nerve communication further causing declines in cognition.

The energy requirement is born directly by the inner membrane of the mitochondria where electrons must be constantly fed to oxygen to generate ATP (electrons come from food)…….if this breaks down it becomes a major cellular stressor and will use up cellular antioxidants (glutathione, SAMe melatonin, progesterone, oxytocin) to offset the damage. For a time it can hold up (4-5 minutes), by using the antioxidant systems, but it eventually fails, and this failure induces cellular protein folding events that make insoluble protein fragments more prominent in neurons (tangles). Those fragments lead to cell death. As neurons die, CBF is reduced because of the tight coupling to CMRO2 in neurons. I think you can see that a ketogenic diet offers another way to offset the energy inefficiency of cholesterol loss in the brain. It provides a steady supply of fats to insulate nerves and decrease energy drain. This is a key reason why ketones offer the brain a way out of this energy nightmare. Since it uncouples CBF from metabolism it can boost CBF to increase ATP production even as diseased neurons are dying at high rates. That is precisely how a ketogenic diet helps the diseased brain.

Another metabolic advantage of the ketogenic diet is at the astrocyte footplate. Since the body is now using ketones to generate energy over carbohydrates there is much less glycated LDL (diabetes) present in the blood. These unglycated LDL molecules are readily taken up by the “cholesterol starving brain” and used to reassemble the neurons architecture and lipid rafts and ion channels to restore optimal energy balance. It has been shown by Haines in 2001 that in vitro studies a loss of cholesterol in the cell membranes increase its permeability to potassium ion loss by 19 fold compared to normal cells. Eventually this ion loss increases and begins to affect other cell membrane transporters like calcium and magnesium which are larger ions. When this occurs more massive damage occurs in the cell and we see wide spread neuron death due to apoptosis since influx of intracellular calcium is a major signaling event for apoptosis. So as AD progresses its progression increases much faster than it first began. This biologic affect follows its clinical progression and why AD is progressive with time.

To further support the metabolic decline in neurodegenerative disorders, we have this interesting finding. In normal brain aging we see increase dolichol production and a decrease in the antioxidant ubiquinone (reduced form of CoEnzQ10) In AD, the situation is completely reversed, with decreased levels of dolichol and increased levels of ubiquinone. The reason is clear now. Dolichol is produced directly from high levels of cholesterol production in the aging brain for cellular division and maturation during stem cell activation to replace senescent cells. This occurs at the ependymal surface of the ventricles in the human brain with progesterone, oxytocin, melatonin and brain derived growth factor (BDNF) act as co-factors. The stem cells in the brain are microglia whose footplates are positioned into the cerebrospinal fluid (CSF). The CSF is used as a conduit to allow hormones to signal the microglia to divide to replenish brain cells. Often this occurs during sleep during autophagy. Those chemicals penetrate the blood brain barrier at the circumventricular organs of the brain we learned about in a previous blog. Ubiquinone (reduced form of the antioxidant) is decreased in the aging brain because there is no high stress signaling coming from the mitochondria. Dolichols are the major lipid component (14% by mass) of human substantia nigra (SN) and are important in Parkinson’s disease development. A ketogenic diet also increases the amount of BDNF and hormones in the CSF of the brain as well to help replace damaged cells. This finding is why longevity is conferred to those with the higher cholesterol levels found in ALS, heart failure (Framingham study), AD and in PD. It has never made any sense to me why cardiologists do not exam the brain data closely about longevity because it is clear higher LDL levels are protective of life and don’t confer a shortened lifespan even from heart disease. It also follows, with this evidence why higher cancer rates are associated with LOWER cholesterol levels. Cancer is a disease of cellular stress hence it is associated with lower cholesterol levels. This result has been found in numerous studies in the literature’s well.

Now for some other biochemistry tied to the PUFA’s or omega 6 biology and prostaglandins and linking it to the ketogenic diet. Rub your head right here and put Pandora on listen to Fragile by Sting.

Prostaglandins vary somewhat from one another based upon subtle differences in their chemical structures. These small variations are believed to be responsible for the immense diversity of effects they have on the body. Prostaglandins act in a manner similar to that of hormones, by stimulating target cells into action. Where they differ from hormones in that they act locally, near their site of synthesis, and they are metabolized very rapidly to non functional compounds. Interestingly, the same prostaglandins can act differently in different tissue and organs.

Since prostaglandins are only active for a short period of time before they are modified into a non-functional form, tissues cannot store prostaglandins. They are made locally on an as needed basis. Also, many prostaglandins induce inflammation and the constriction of muscle tissue, while certain prostaglandins are believed to be involved in the inhibition or promotion of activities such as ion transport, cell growth, temperature regulation, and immune system response. Prostaglandins are described in series. There are three series.
Series 1 reduce inflammation, dilate blood vessels, and inhibit blood clotting. The strong anti-inflammatory properties help the body recover from injury by reducing pain, swelling and redness.
The Series 2 prostaglandins play a role in swelling and inflammation at sites of damage or injury. They also play a role in inducing birth, in regulating temperature, lowering blood pressure, and in the regulation of platelet forming and clotting. The role of Series 2 Prostaglandins does serve a vital role for the body for without it you would bleed to death from the slightest cut. However, in excess (think high omega 6 content of the diet), these prostaglandins are harmful and many diseases are directly linked to excessive inflammation and blood clotting.
The Series 3 group has a modulating effect of the stress response in the local organ. This brings the local reaction to an end.

More recent research has focused on the balance between Series 2 and Series 3 prostaglandins. The Series 2 group is involved in intense urgent actions , often in response to some emergency such as injury or stress. Now to tie the ketogenic diet to these chemicals…

The organic chemistry of the success of the ketogenic diet is based upon the following. Dietary fasting or the use of high dietary MCT’s (coconut oil), stimulates the beta oxidation (fat breakdown in mitochondria) of very long chain fatty acids that occurs in most neurodegenerative disorders and some disorders with developmental delay like autism. This action immediately depletes the brain of its lipid supply and causes the prostagladins to be unregulated. Moreover, the use of simultaneous dietary carbohydrate ingestion increases the release of insulin peripherally which depresses delta 6 de-saturase enzyme and stimulates the production inflammatory prostaglandin series two chemicals which destroy the brains stores of DHA and EPA and this slowly erodes the brain’s lipid content. This can be offset by increasing transcytosis at the astrocytes if there is enough dietary LDL made by the liver. Restricting dietary fat by choice or using statins exacerbates this problem and will cause further cognitive decline. We should encourage the liberal use of cholesterol laden foods and foods high in MCT in these cases. Any excess of dietary PUFA (polyunsaturated fats) made from omega 6 fats worsen the situation further. These are the series two prostaglandins from excess dietary omega 6 fats. This is why I advocate checking a patients omega 6/omega 3 level ratio on the blood test often. I check mine quarterly. Ideally we want this number 2/1 to 6/1 for optimal human health. I personally shoot for a 1/1 ratio. Moreover, as we saw with cholesterol transport and the LDL receptor, blood glucose from dietary carbs also compromises the production of the good prostaglandins for lipid synthesis in the brain. So when you order your O6/O3 ratio you should also want your fasting insulin level as close to zero as possible. Below 3 is acceptable for most but if you have a neurologic disease you really need very tight control of your insulin to restock the brain with lipids.

The Series 3 prostaglandins are formed at a slower rate and work to deal with excessive Series 2 prostaglandin production. They act to turn off the inflammatory cascade that the series two PG’s cause. Series 2 prostaglandins are often called antagonistic prostaglandins because they counter balance PG series one. All antagonistic prostaglandins are made from a fatty acid called arachidonic acid (AA). Series 1, or beneficial prostaglandins are made from a fatty acid found mostly in marine plants and fish known (grass fed beef) as EPA. EPA is the most important member of an exclusive group of three fatty acids called the “omega-3 fatty acids” that include ALA, EPA and DHA. These fats are critical building blocks in lipids for the brain.

ALA is made in the chloroplasts of green plants from linoleic acid. In mammals, linoleic acid is converted to arachidonic acid that is used to make the antagonistic prostaglandins. BUT, in the green plants, the same linoleic acid is converted into the beneficial ALA. (Think flax) Mammals are not good converters of ALA from plants so that is why it is not optimal choice for your diet or your brain. Wild shellfish, fish, and grass fed beef are our best sources in our diet. Can you say Epi-paleo Rx anyone?

DHA and EPA are the most critical of the omega 3 fatty acids for the brain. It is the only material that our bodies use to make the beneficial prostaglandins that help reduce inflammation. DHA is another omega 3 fatty acid. It is an integral part of eye and brain tissue in collecting electrons. It is made by marine algae, plankton, fish and mammals from EPA. Fish accumulates DHA in their oily tissue, along with EPA. As I laid out in my posts about the causes of AD and PD the causes of these diseases destroy the brains lipid stores while simultaneously increasing inflammation, depleting cholesterol in the face of an elevated omega six from our diets. I believe once you understand this cascade, if you eat in such a way to avoid this cascade you can treat these diseases. If you have a family history of these diseases you can completely avoid it but eating a VLC ketogenic diet.


Here I have laid out two biochemical reasons why a ketogenic diet works in our brains to increase cognition. It also makes sense why in neurodegeneration we see brains starved of cholesterol and DHA levels. The ketogenic diet is the best and most ideal way to restore both of these key fats to the brain in this time of stress to increase cognition.

The bottom line is as you age, the evidence is accumulating, that you should be eating a more ketogenic diet with a liberal amount of saturated fat in MCT (coconut oil and pastured butter) and one that supports a substantial production of LDL from your liver via your diet…that is also devoid of glycosylation from carbohydrates. This describes the Epi-paleo Rx well. It is a version of the ketogenic diet. If one has a formal neurologic condition a more stringent version of the paleo diet should be entertained. But if you are interesting in optimizing for longevity as you age a ketogenic diet confers huge advantages. If one is a performance athlete, a ketogenic diet may not be the best diet for you long term. If you are overweight and wish to shred weight this option is an excellent choice. As always, discuss this with your doctor before deciding what to do. I recommend the book “The Epi-Paleo Rx” to my patients as a resource to get them started on what foods can lead to a disease reversal best.

So how should we consider eating as we age when neolithic diseases increase in incidence and prevalence?

1. First, eat marine fats (MCT and saturated fats, PUFA’s last to decrease inflammation) then consider moderate protein (controls mTOR pathway) and then low carbs (to decrease inflammation and glycation)
2……and those macro’s should increase as one ages for health and longevity to keep your hormones in the best balance they can be. Remember every single hormone we have are made from cholesterol!!!! If you go into aging with hormonal imbalance due to a bad diet, you will age much faster. If you eat a SAD you will age and die much faster of neolithic diseases.
3. Everyone should consider checking their omega6/3 ratio at some point with a HS CRP level to determine the amount of inflammation in their body to make good dietary adjustments.
4. I completely reject the lipid hypothesis and diet heart hypothesis as they currently stands. I think this blog makes you understand why. You may want to consider throwing your statin Rx away at some point. The data on statins for people over the age of 60 without any risk factors says no one should be on a statin based upon the data. Only those people who listen to the opinions of cholesterol panelists that have ties to big pharma will tell you its a good thing to do. The older you get, the more DHA and LDL your brain needs,  and the less carbohydrate it needs.

1. http://jcs.biologists.org/content/123/4/595.full.pdf (Tong et al. 2009)
2. http://bms.ucsf.edu/sites/ucsf-bms.ixm.ca/files/varoninjillian_04072011.pdf
3. http://onlinelibrary.wiley.com/doi/10.1111/j.1471-4159.2010.06768.x/pdf (cholesterol deficiency decrease synapse vesicle recycling)
4. http://www.sciencedirect.com/science/article/pii/S1550413110003980
5. http://www.pnas.org/content/107/17/7927.full.pdf
6. http://people.csail.mit.edu/seneff/EJIM_PUBLISHED.pdf

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  1. Jack August 12, 2011 at 3:02 pm - Reply

    http://www.lewrockwell.com/miller/miller38.1.html. I'm posting this link for my own patients to read from a heart surgeon who has seen the light as I have.

  2. Perry August 12, 2011 at 3:48 pm - Reply

    Jack, are you so sure about the safety of MCT oils? I've not used straight MCT oil, but I've eaten plenty of coconut oil. It causes me to lose weight, mostly body fat, and I'm at the point now were the weight loss is alarming.

    I bet it is blowing out the gut bacteria and causing absorption issues. Paul Jaminet points out fungi eat keytones, so someone with small intestine fungal overgrowth might be headed for real trouble by losing good gut bacteria and gaining candida!

  3. Perry August 12, 2011 at 3:51 pm - Reply

    I might add turmeric seems to do the same thing.

  4. Jack August 12, 2011 at 4:57 pm - Reply

    @perry…….remember context. Anything to an excess is problematic. But in someone with a pathological condition in the brain where their epigenetic switches are set…….MCT and turmeric are incredibly good choices……far better than a statin I might add. The weight loss can be a problem but in this country the only people I worry about high calorie intake of coconut oils or MCT's are psychiatric patients who have eating disorders. In them they need a higher protein diet and their fats to come in the small chain and long chain triglycerides variety for proper neurotransmitter construction and bioavailabilty of co factors necessary for their synthesis. I'm a firm believer in their case the gut and specifically the liver is a huge factor in their disease process and in their ultimate recovery.

    Take a look at this N-1

  5. Jack August 12, 2011 at 5:19 pm - Reply

    And ladies would also like to know that turmeric coconut oil and vitamin K 2 are the best way to get rid of cellulite paleo style because of how it shreds sub Q fats and demolishes the inflammation in the basal dermis…….stretch marks too. Topical and oral use for the coconut oil……too!

  6. Cameron House August 12, 2011 at 6:18 pm - Reply

    A couple more questions.

    First, would someone who was eating paleo and balancing their omega 3/6 see increased cognition outside of the diseases that you directly wrote about?

    Second, while doing the leptin reset would taking a spoonful of coconut oil be considered cheating? I know you tend to be a zero tolerance kind of guy but I have also seen you recommend it for its calming effect. My understanding is it wouldn't ellicit a insulin response and it would be OK.

    Thanks for an awesome blog!

  7. Jack August 12, 2011 at 7:01 pm - Reply

    @cam. Most would. Even in the fittest I see clinically the one test that humbles most is the omega six to three ratio. Once you realize how much fat is on the bone…..cognition can become razor sharp.

    Regarding the reset…..if it's done on meal timing….nope. If it's outside the meal it's cheating regardless of insulin. Leptin is not just about insulin. Just take a look at the current SG Taubes battle. The meals are about readying circadian clocks in certain organs……liver and brain being two big ones……and the gut being the other.

  8. Cameron August 13, 2011 at 8:09 am - Reply


  9. Shijin13 August 13, 2011 at 9:30 am - Reply

    DR K Read Dr. Rockwell's stuff LAST week – a friend shared it w/me! Awesome info there! I'm hoping this excerpt of you Quilt – will be the tipping point that will CONVERT my mom – make her leave her vegan spilling/ statin pushing cardiologist – and find one who understands what paleo can do!

  10. Tim August 13, 2011 at 12:51 pm - Reply

    This talk of ketogenic diets got me thinking back to my Atkins days of trying to keep 'in ketosis' by checking my ketostix several times a day. But Atkins is hardly paleo! To have a good paleo ketogenic diet, should one just shoot for a max daily carb range, say 50g, while eating plenty of CO and whole foods, and not worry if they are really 'in ketosis' a la Atkins?

    • Jack August 13, 2011 at 1:48 pm - Reply

      First you need to decide do you really need to be in ketosis? Why ? and for how long? Depends upon your goals. The older one gets the longer you should be in it. If you are insulin sensitive at the muscles like Anthony Colpo……you dont have to worry about ketosis. But most do.

  11. cancerclasses August 13, 2011 at 12:53 pm - Reply

    @Cameron House: I take half a couple grams of omega-6 hemp seed oil or evening primrose, a gram of omega-3 flax and a tablespoon of coconut oil about a half hour before reading Dr. Jack's blog posts or I'd never understand them, it definitely helps with my cognitive abilities.

    @Dr. Jack: WOW! great post, HIGHLY enlightening! RE your cellulite comment, great skin also depends on omega-6 intake as there is no omega-3 in skin, only CIS omega-6 supports skin & arterial health.

    Hate to belabor the point, but would like to see more distinction between appropriate intake levels of good organic CIS omega-6 as opposed to total avoidance of toxic, oxidized cancer causing TRANS omega-6. Outside your explanation on daily intake levels it seems readers are still confused as to how omega-6 can be both good and bad at the same time. It's a 2 part problem, intake levels *and* TRANS vs. CIS. TRANS intake is bad but too much good O-6 or any polyunsaturate is also bad.

    For the entire eicosanoid, hormone & cholesterol production systems to function properly intake of TRANS O-6 must be ZERO. National Academy of Sciences' Institute of Medicine has publicly stated that, like radiation, there is NO SAFE LEVEL of trans fat intake. In my opinion most people just do not understand how destructive & toxic trans fats are to the body's biochemical & metabolic processes, including brain function. Proof of that is found in the increasing rates of schizophrenia & other neurological problems in people maintaining a high carb trans fat laden processed "food" diet.

    Although important, EPA & DHA as omega-3 derivatives are not classified as essential fatty acids or true omega-3's because the body can and does synthesize them, also on demand and as needed, from the base substrate omega-3 which is essential, and a comparatively low physiological demand naturally limits conversion of O-3 to EPA & DHA to around just 2 to 5 percent.

    So unless a person has a disease or condition that knocks out the desaturase enzymes and the body's ability to synthesize them, the answer is not to take EPA & DHA supplements or concentrates as most people would think and do, but to take the parent omega-3 and let the body do the math & biochemical processing so as to not imbalance the systems with pharmacological overdose levels of EPA & DHA. But given the delta 6 desat depression caused by the insulin stimulated by the Standard American Diet maybe EPA & DHA supplementation for a limited time to jump start the normalization wouldn't necessarily be bad.

    • Jack August 13, 2011 at 1:52 pm - Reply

      Caprylic Acid 8 0 octanoic acid coconut oil

      Capric Acid 10 0 decanoic acid coconut oil

      Lauric Acid 12 0 dodecanoic acid coconut oil

      Those are my favorites…….caprylic acid absolutley is the shredder of sub Q fat and stretch marks on the skin when combined with Vitamin K2. Use it topically and orally.


  12. Kimberly August 17, 2011 at 4:00 am - Reply

    I've often seen the advice to take GLA or DGLA supplements. In the case of evening primrose oil, does the amount of GLA omega-6 typically found in EPO outweigh the downsides of increasing ones' total omega-6 intake from an EPO supplement?

  13. majkinetor August 17, 2011 at 8:10 am - Reply

    Hello Jack.

    How this explanation of ketogenic diet with regard to AD can be translated to epileptic people ? They don't have attenuated EEG signals but the opposite. It looks like ketosis balances out neurotransmitter levels rather then shifting them in one direction…

    What do you think about nootropic use to improve CMRO2. For instance, combination of Piracetam and Choline (eventually Hydergine) improves memory, cognition, hyphoxia response, corpus collosum communication, etc… Its even said to be generic in such way that it improves ionic channels which is similar to effects of cholesterol.

    • Jack August 17, 2011 at 10:36 am - Reply

      @majkinetor A ketogenic diet is still the best option for epilepsy if you ask me. And I do support the use of Nootropics for patients with neurologic disease. Epilepsy is a neurologic disease so I dont see any reason to change my stance on this from a biochemistry stand point. Obviously, you need to discuss this with your own physician but most docs who treat epilepsy know full well the advantages of a ketogenic diet. How it is optimally constructed, however, they know very little about and dietitians and nutritionist know even less about this issue.

  14. majkinetor August 17, 2011 at 1:39 pm - Reply

    Yes, I know that ketogenic diet is best for epilepsy I just didn't see how it helps to calm down already overexcited brain since ketones will, in your words, activate 30-100% more neurons.

    About nootropics, I am asking from maintenance perspective. It looks to good to not start using it in 30ies, given the almost non existent side effects. I am perfectly healthy and I don't have any neurological disease that I am aware of.


  15. LSSeeker August 29, 2011 at 7:49 am - Reply

    Dr. Kruse,

    I've asked a question about our son and what should he be eating. One important part I left out and now want to know if it changes your previous advice. You suggested paleo diet with 150gms and lower it by 20gms until he feels good. He was breastfed close to a year, I have two brothers with schizophrenia, and my mother was sick most of her pregnancy with me. He's ten now, but when he was three, he had three grand mal seizures in a day. He went on the lowest dose of Depakote and after a year, his EEG was normal. No problems since then. Does he have a "bad brain" and need the ketogenic diet or does the 150gm/day and lower it as necessary still apply? Thanks.

  16. Santiago September 26, 2011 at 11:27 am - Reply


    just a question about coconut oil. I see the paleo community is very enthusiastic about butter and coconut oil. However, both of them are clearly neolithic foods. In particular, from an evolutionary point of view vegetables oils are hard to justify. That is for instance the position, or sort of, of professor De Vany.

    What's your take about this?. Personally I like quite a lot coconut oil, but I'm afraid its regular use can be more harmful than good.


    • Jack September 26, 2011 at 2:43 pm - Reply

      @Santiago I somewhat agree. I think coconut oil is very paleo. I just dont think it was widespread in paleo times because it was included in SOuth PAcific HG diets in the whole form. Butter I agree is not paleo persay but pastured butter is about the only way to get Vitamin K2 in our diet nowdays. So its necessary unless you supplement. See my post today on paleo supplements. The question you raise is a good one but I have to say what we ate in paleo times is not a great optic to view things. I think we have evolved in the last 15,000 years and we are omnivores. So what we did back them may not be operational today for our biochemistry. For example in todays Western diet by relative example butter and coconut oil are extremely paleo……so the context of how you view your question must be considered. I think humans today are adept at using CO in large quanties when their carbs and PUFA's are limited. As for butter I use ghee quite a bit more because it eliminates the milk proteins that cause bigger problems. (A1 vs A2 issues and the insulinogenic nature of whey)

  17. […] In fact ketosis (the result of eating a high fat diet) is the brain’s best friend. From neurosurgeon Dr. Jack Kruse: For many years it was believed that the blood brain barrier blocked lipid transport into the […]

  18. Santiago October 16, 2011 at 3:52 pm - Reply


    I'm thinking of including Ghee on my diet (I discard Butter because of its effect on increasing insulin http://heartscanblog.blogspot.com/2010/03/butter-… and that brings me to your previous answer:

    " As for butter I use ghee quite a bit more because it eliminates the milk proteins that cause bigger problems. (A1 vs A2 issues and the insulinogenic nature of whey)"

    please, could you point me out to studies witch show that Ghee is not insulinogenic, or if it increases insulin the effect is minor?.

    I've the impression that the role of fats (vegetables or animals) is not quite well understood in the paleo community.

    Thanks a lot.

    • Jack October 16, 2011 at 6:07 pm - Reply

      @Santiago All Ghee is OK because it is essentially 100% fat with all the proteins and carbs of butter removed.

  19. Rachelle mills October 25, 2011 at 1:58 pm - Reply

    I just have a quick question, as someone who did Atkins for YEARS then on to the hcg diet (also being 17) I wad wondering how I would be able to eat MORE carbs, without gaining weight but not overdoing it? To eat a true paleo life style (75-100) carbs would be awesome :))

    • Jack October 25, 2011 at 4:20 pm - Reply

      @rachelle. With out really seeing your labs and examing your medical chart there is no way to answer that over the internet. Do i have some patients who can do this now…..yes. But not everyone can.

  20. Jack November 6, 2011 at 10:45 pm - Reply

    @Danny This is why you got the pancreatitis…. .http://www.medicalnewstoday.com/releases/237090.php

  21. Geri November 12, 2011 at 11:40 am - Reply

    Dr K, thank you so much for this thread, as well as the many others. Given the history in my family of early-onset dementia (mother, 3 aunts, maternal grandmother, all diagnosed by age 56-58) and my own age, now 58, I have a great interest in halting the already recognizeable changes in memory and cognition. Your posts give me hope, and I am aware that I need to take charge of my own health care in this regard, as my docs have basically said that there is nothing that can be done to prevent it. So I have gone ketogenic, put 2 Tbs CO into my diet every day, take turmeric, Co-Q10, K2, Mg, fish oil, Vit D3, B complex, Vit E, and Vit C supplements as well as getting as much of that in my diet as possible. I'm assuming that this is on track.

    A question I have, though, is that this is the approach to tackling the early- and late-onset varieties of AD. Will this also aid with vascular dementia? I don't know what type has been in my family, and no one was ever definitely diagnosed as far as I know. Any thoughts?

    • Jack November 12, 2011 at 3:00 pm - Reply

      @Geri yes it will. But with vascular dementia you need to be optimal on Vitamin D3 and Vitamin K2. Read my blogs on both of these nutrients.

  22. Geri December 6, 2011 at 5:02 am - Reply

    Dr. K, thanks for your reply re vascular dementia. I completely understand the need to be optimal with Vitamin D3 and K2, and your most recent blog on how to detect optimisation without blood testing was really helpful. I also do loads of VCO in my diet as well. But I have a question about other supplementation. These are the ones I do: Omega-3, PQQ, Co-Q10, Pyncnogenol, Resveretrol, Vit E, Vit C, Vit B complex, Mg, turmeric, folic acid, ALA, Acetyl L-Carnitine, Phosphatidylserine, Vinpocetine. A lot, I know, but I have a lot at stake with early onset dementia (unknown type) in my family. Is this overkill? I have regained leptin sensitivity, based on the signs you listed, but am still maintaining a lo-carb paleo diet. The UK NHS doesn't allow me much latitude with blood testing and paying privately still requires a physician request, so hard to get blood levels of anything at the moment.

    • Jack December 6, 2011 at 6:46 am - Reply

      @Geri I like all the supplements you are on for the vascular dementia. I also believe that the more you try to do the better off you are. But make sure K2 and coconut oil are your staples. There is much we can do to change our epigenetic switches and alter our futures if we wish too.

  23. Geri December 6, 2011 at 7:55 am - Reply

    Thank you Dr.K. I could weep with hope for myself and my siblings.

  24. […] of obtaining cholesterol, fats, and antioxidants directly from LDL in the blood- stream. " – WHY YOUR BRAIN NEEDS PALEO STAT! – Jack Kruse The body is also able to produce glucose, if needed, from proteins. […]

  25. […] of obtaining cholesterol, fats, and antioxidants directly from LDL in the blood- stream. " – WHY YOUR BRAIN NEEDS PALEO STAT! – Jack Kruse As you noted, the body is also able to produce glucose, if needed, from proteins. Also […]

  26. Jack February 13, 2012 at 9:10 pm - Reply

    @Lianda There are many reason for it…….but few want to really explore the nature of the beast because simple testing and thinking would solve it.

  27. Lianda February 22, 2012 at 2:01 pm - Reply

    Can you make any suggestions about where one could read to find out about the effects of thyroid disease on weight management in people eating the Paleo plan? I haven't been able to find any sources of in-depth science based answers, like yours. Thanks again for your help.

  28. Tim Jaeger May 5, 2012 at 9:09 am - Reply

    All this information is a god send.
    My father (75) has severe AD, but is also type 2 diabetic (for the last 40 years) I have been carefully trying put back into balance as many physiological/biochemical factors as possible and rule out influences from fungal, bacterial or heavy metals. He has been taking a small medicine cabinet of supplements many mentioned above. It seems some of my last avenues left are limiting glycation from glucose excess (go close to ketogenic), support of mitochrondria (PQQ, Q-10, resveratol) and preventing further damage (specifically at present using Glutathione(& NAC) and Theanine, but also a host of many free radical scavengers too and support with omega 3, phosphatidyl serine, MCT etc). My concern is being diabetic will we have issues severely restricting carbohydrates ??

    • Jack May 6, 2012 at 7:09 am - Reply

      @Tim he needs to change his diet to a keto template stat. Make sure there is a lot of coconut oil in there.

  29. Tim May 6, 2012 at 8:54 pm - Reply

    I’m so very grateful for you spending the time to reply!!
    I have been given “medical” advice that dad will not be able to cope with a ketogenic diet, along the lines of his liver not being able to process enough ketone bodies. I suppose this is partially countered by the coconut/ MCT. Having said that I believe, from general liver test results, his liver is within normal ranges, but I believe under stress (I wonder why!) Just to clarify ‘keto template’ means completely ketogenic (meaning, by my understanding, using ketone bodies as the primary/ sole energy source for the body by restricting to < 25g cabs) or merely approaching ketogenic ie very low in carbs??
    Disappointingly I recently spoke to an experienced functional medicine specialist and she told means in her 35 years of practice she has never treated Alzheimer's successfully but I still refuse to give in!! Nothing to lose (except a bit of time) and so much to gain, life, knowledge and a challenge!!
    Once again thank you, if you are ever in Adelaide Australia or visiting Australia I would like to extend the warmest of invitations to you and your family to be my guest.

  30. Lauren Porter May 31, 2012 at 1:20 am - Reply

    Dr K, I have been eating a ketogenic, paleo, seasonal diet for 6 months now (after decades of vegetarianism and a breast ca diagnosis)… I have been feeling great, losing weight, am trending my hsCRP and clearing the brain fog/low energy of many years. In the past few weeks I’ve had increasing allergy symptoms (sinus as well as joint swelling) despite not changing my diet. I realise from what you told me that ‘immune system reorganisation’ can cause this, but I am re-reading these posts trying to figure out if this means I need to alter my diet or change something else. Should I be assisting this reorganisation somehow? Trying to stop it? I’m questioning everything I’m doing and it’s making my head spin.

    • Jack May 31, 2012 at 5:53 am - Reply

      @Lauren If you have an HLA status that increases your innate immunity potential to make IgE on mast cells or basophils this could be the other answer. You too could add a supplement called Quercetin which is an natural antihistamine

  31. Lauren Porter May 31, 2012 at 3:10 pm - Reply

    Thanks, as always, for taking the time to answer so thoughtfully. Amazingly, I went to the local health shop yesterday and asked myself ‘do I need something from here?” and, for the first time, bought quercetin! Nice to know I can channel my inner Dr K 🙂

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