Can very-low-carb diets impair your mental faculties?

I wanna tell you a story...

In 2006, I had a test done on my pituitary gland*, called an Insulin Shock Test. It was pretty much what it said on the tin. I laid on a hospital bed, I was injected with an overdose of insulin and I was monitored for blood glucose and growth hormone levels every 30 minutes.

My blood glucose fell and fell and fell and fell until it reached ~1.5mmol/L (~27mg/dL). What happened was interesting. I came out in a cold sweat and developed a tremor. Apart from that, I felt fine. The consultant in charge was chatting to me and I was chatting to him. Eventually, I was given a sandwich, a yoghurt and a banana to eat.

Some time later, when I had stopped sweating and shaking, the consultant returned and told me that I had become confused. My brain had ceased to function correctly due to a lack of blood glucose (the insulin had totally suppressed serum FFAs and ketones, so there were no other brain fuels available), but I was too mentally-impaired to know that I was mentally-impaired. As far as I was concerned, everything was fine & dandy. This is like the Dunning-Kruger effect.

Referring to Blood Glucose, Insulin & Diabetes, as blood glucose falls due to either starvation or a lack of dietary carbohydrate, insulin falls and glucagon rises, stimulating the liver to convert liver glycogen into glucose for export to the blood. Eventually, liver glycogen becomes depleted and blood glucose falls again. The pituitary gland notices this and secretes AdrenoCorticoTropic Hormone (ACTH) which stimulates the adrenal cortex to secrete cortisol. The adrenal glands are also stimulated to secrete adrenaline (a.k.a. epinephrine). Cortisol increases the conversion of amino acids and other substrates into glucose by the liver and kidneys. If blood glucose continues to fall, the pituitary gland secretes growth hormone (GH), which has an anti-insulin effect.

From https://anthonycolpo.com/boosting-growth-hormone-with-diet-training-fact-or-fiction-part-2/:-
"after the zero-carb phase, subjects reported symptoms of hypoglycemia that included weakness, irritability, mental confusion, nausea, hunger, cold sweating and disturbed co-ordination. GH levels were higher during exercise after the low-carb phase, but so too were levels of other fuel mobilizing hormones such as epinephrine, glucagon, and cortisol." Epinephrine, glucagon, and cortisol are stress hormones. Chronically-high blood levels of stress hormones disrupt sleep and cause irritable, aggressive behaviour.

Ethanol inhibits gluconeogenesis in the liver (possibly also in the kidneys) resulting in worse hypoglycaemia. Worse hypoglycaemia results in more ACTH & adrenaline secretion and worse hypercortisolaemia, which can adversely affect the hippocampus, impairing memory.

In conclusion, if you want to eat a very-low-carb diet, long-term:-1) Don't do much high-intensity exercise. See "Funny turns": What they aren't and what they might be.
2) Don't drink much (if any) booze.

*My pituitary gland failed the test by secreting only 40% the amount of GH that it was supposed to. For six months, I was given GH to inject using a special pen with a 8mm x 0.3mm needle. By the end of the six month trial, I had perfected the art of painless injection. The trial was discontinued due to lack of any noticeable benefit (17 days supply of GH @0.3mg/day cost £120!).

At first I was afraid, I was petrified...

My titles are becoming increasingly blatantly song-orientated. No YouTube video, this time.

I just read Hans Wu's latest post Alzheimer's and Dementia and had a few thoughts.

1) In the early stages of mental decline, there is still self-awareness and the process is frightening. Constant reassurance is the best thing for somebody in this state. As self-awareness fades, one becomes happy. An example of this is HAL-9000 as his memory modules were being unplugged in the film "2001 a space odyssey". My mum is in this state, thank goodness.

I entered this state temporarily during an Insulin Shock Test on my pituitary gland, when my serum glucose fell to 1.5mmol/L (27mg/dL) under medical supervision. I was blissfully unaware of my confusion. Too much alcohol in the blood also causes loss of self-awareness. I entered this state last week while socialising with a friend. After half a bottle of White Zinfandel, I was blissfully unaware of my merriness!

2) When I see "arterial stiffness", I think "inappropriate calcification" and "Vitamin K2".

3) Transient Ischaemic Attacks (TIAs a.k.a. mini-strokes) cause loss of blood flow to parts of the brain, resulting in amnesia. There may be some permanent brain damage, depending on how long the TIAs last. TIAs can be caused by spasms in arteries within the brain. Ditto migraines.

When I see "spasm", I think "magnesium".

Get in! Parts 2 & 3.

In Get in!, I described how I persuaded mum's GP to let mum have Vitamin D3 5,000iu/day.

Well...

Today, I persuaded mum's GP to let mum have Epsom Salts 2.5g/day (provided by me) dissolved in fruit juice and Seven Seas Fish Oil 10ml/day (provided by me). There's only one possible reaction:-


P.S. The doctor didn't even ask for supporting evidence. He just said "Yeah, other relatives do that. No problem. He just wanted to check for contraindications, which is fine by me. I have plans to ask him to allow mum to have one more supplement that may help her bones & brain. Any ideas as to what that might be, O.K.?

P.P.S. Another lady that's been at the care home since day one died Wednesday night/Thursday morning. She died from terminal cancer, but she had been physically crippled by Parkinson's Disease. R.I.P.

Mum's Proposed Ketogenic Diet for Dementia.

The following diet is not intended to induce deep ketosis. It's intended to be a trade-off between ketosis, palatability & simplicity.



Feedback from the nurse on duty:- "Eggs shouldn't be in the "unlimited" list. You're not supposed to eat more than two eggs a week because of the cholesterol". God Bless the NHS! The British Heart Foundation doesn't impose a restriction on egg consumption.

Eggs can be eaten as part of a balanced diet.

Mum's currently eating two eggs a day in her cooked breakfasts.

Effect of dietary egg on human serum cholesterol and triglycerides.

Old people have the lowest mortality when their serum cholesterol is higher than average.

Total cholesterol and risk of mortality in the oldest old.
Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study.
Low total cholesterol and increased risk of dying: are low levels clinical warning signs in the elderly? Results from the Italian Longitudinal Study on Aging.
Higher total serum cholesterol levels are associated with less severe strokes and lower all-cause mortality: ten-year follow-up of ischemic strokes in the Copenhagen Stroke Study.
Serum total cholesterol levels and all-cause mortality in a home-dwelling elderly population: a six-year follow-up.
Lipid-lowering treatment to the end? A review of observational studies and RCTs on cholesterol and mortality in 80+-year olds.

Paul Jaminet has done a series on ketogenic diets.
Ketogenic Diets, I: Ways to Make a Diet Ketogenic
Ketogenic Diets 2: Preventing Muscle and Bone Loss on Ketogenic Diets

Also: See Branched chain amino acids as adjunctive therapy to ketogenic diet in epilepsy: pilot study and hypothesis.

Dementia: A review of the evidence.

To make my discussions with Health Professionals a.k.a. "experts" more effective, I need to know what they know. To help me with this task, I have been rummaging through The Cochrane Library. The results for Dementia NOT "Down Syndrome" NOT Vascular NOT Aids NOT carer and Reviews only produced 44 results. Some weren't relevant. The following are relevant and I have added the plain language summary:-

Acetyl-l-carnitine for dementia. No evidence of benefit of Acetyl-l-carnitine for dementia.
Alpha lipoic acid for dementia. No evidence of efficacy of alpha lipoic acid for dementia.
Antidepressants for treating depression in dementia. Insufficient evidence for the efficacy and safety of antidepressants for depression in dementia.
Aroma therapy for dementia. The one small trial published is insufficient evidence for the efficacy of aroma therapy for dementia.
Cannabinoids for the treatment of dementia. No evidence that cannabinoids are effective in the improvement of disturbed behaviour in dementia or in the treatment of other symptoms of dementia.
Cholinesterase inhibitors for dementia with Lewy bodies. No convincing evidence from one trial of the efficacy of cholinesterase inhibitors for dementia with Lewy bodies.
Cholinesterase inhibitors for Parkinson's disease dementia. Rivastigmine appears to moderately improve cognition and to a lesser extent activities of daily living in patients with PDD.
Donepezil for dementia due to Alzheimer's disease. Donepezil is beneficial for people with mild, moderate and severe dementia due to Alzheimer's disease.
Ginkgo biloba for cognitive impairment and dementia. There is no convincing evidence that Ginkgo biloba is efficacious for dementia and cognitive impairment.
Haloperidol for agitation in dementia. No evidence has been found of any significant general improvement in manifestations of agitation, other than aggression, among demented patients treated with haloperidol, compared with controls.
Homeopathy for dementia. No evidence that homeopathy is effective in treating dementia.
Hormone replacement therapy to maintain cognitive function in women with dementia. There is no evidence of a positive effect that oestrogen replacement therapy can maintain cognitive function for a longer period of time (> five months) in women with Alzheimer's disease.
Hydergine for dementia. Uncertainty about the efficacy of hydergine in dementia.
Lecithin for dementia and cognitive impairment. Doubtful effect of lecithin as a treatment for dementia.
Light therapy for managing cognitive, sleep, functional, behavioural, or psychiatric disturbances in dementia. There is insufficient evidence to determine whether light therapy is effective in the management of cognitive, sleep, functional, behavioural or psychiatric disturbances in dementia.
Massage and touch for dementia. Insufficient evidence to draw conclusions about the possibility that massage and touch interventions are effective for dementia or associated problems.
Memantine for dementia. Some evidence of efficacy of memantine for dementia.
Music therapy for people with dementia. There is no substantial evidence to support nor discourage the use of music therapy in the care of older people with dementia.
Nicergoline for dementia and other age associated forms of cognitive impairment. Nicergoline may improve cognition and behavioural function of people with mild to moderate dementia.
Omega 3 fatty acid for the prevention of dementia. There is no evidence that dietary or supplemental omega 3 polyunsaturated fatty acid (PUFA) reduces the risk of cognitive impairment or dementia in healthy elderly persons without pre-existing dementia. This review yielded no clinical trials that could confirm or refute the utility of omega 3 PUFA in preventing cognitive impairment or dementia. This is an important area that is in pressing need of further research.
Physical activity programs for persons with dementia. There is insufficient evidence to determine the effectiveness of physical activity programs in managing or improving cognition, function, behaviour, depression, and mortality in people with dementia.
Physostigmine for dementia due to Alzheimer's disease. Limited evidence of effectiveness of physostigmine for the symptomatic treatment of Alzheimer's disease.
Piracetam for dementia or cognitive impairment. Evidence for the efficacy of piracetam for dementia or cognitive impairment is inadequate for clinical use but sufficient to justify further research.
Procaine treatments for cognition and dementia. In analysing the effect of procaine and its preparations, there was no evidence for benefit in the prevention or treatment of dementia or cognitive impairment.
Propentofylline for dementia. Limited evidence that propentofylline benefits cognition, global function and activities of daily living in people with Alzheimer's disease and/or vascular dementia.
Reminiscence therapy for dementia. Inconclusive evidence of the efficacy of reminiscence therapy for dementia.
Snoezelen for dementia. No evidence of the efficacy of snoezelen or multi-sensory stimulation programmes for people with dementia.
Statins for the prevention of dementia. There (is) good evidence that statins given in late life to individuals at risk of vascular disease have no effect in preventing dementia.
Thioridazine for dementia. No evidence to support the use of thioridazine for dementia.
Transcutaneous Electrical Nerve Stimulation (TENS) for dementia. Insufficient data to determine the efficacy of transcutaneous electrical nerve stimulation for dementia.
Trazodone for agitation in dementia. Insufficient evidence from randomized, placebo-controlled studies to support a recommendation that trazodone should be prescribed, or not prescribed, for BPSD.
Validation therapy for dementia. No new evidence of the efficacy of validation therapy for people with dementia or cognitive impairment has been identified.
Valproate preparations for agitation in dementia. No evidence of efficacy of valproate preparations for treatment of agitation in people with dementia.
Vinpocetine for cognitive impairment and dementia. Insufficient evidence of benefits of vinpocetine for people with dementia.

So there you have it. Virtually everything that's been thoroughly tested is ineffective for the treatment of dementia.
There are a whole load of things that haven't been properly tested yet e.g. Omega-3, Vitamin D3, Vitamin K2, Curcumin, Berberine, Trans-dermal Progesterone, Sub-lingual B12, S-Adeno-Methionine and The Ketogenic Diet. What is The Alzheimer's Society doing with all of the money that they get?

Finally, I accept that mum is on her last legs and won't be around for much longer, so here's a song. I normally hate raps, but the Pinky & Perky backing vocals are kinda quirky and the lyrics are poignant. So here's Stay with Me by DJ Ironik. Listen to the words!

Look after your brain.

"One in three people over 65 will die with dementia..." said Dr Susanne Sorensen, head of research at the Alzheimer's Society. I read this in a recent BBC News article Vitamin D 'is mental health aid' which referred to the study Serum 25-Hydroxyvitamin D Concentration and Cognitive Impairment.
The article contained the usual phrase "...more work was needed..."

The above article also led to Parkinson's linked to vitamin D which referred to the study Prevalence of vitamin d insufficiency in patients with Parkinson disease and Alzheimer disease. "However, the Emory University researchers do not yet know if the vitamin deficiency is a cause or the result of having Parkinson's". "Further research is required...." yet again.

It's like someone standing by their broken-down car wondering whether it's the empty fuel tank that's made the car stop or whether it's the car stopping that's made the fuel tank empty. Does it matter? Just put some fuel in the tank and see what happens! See also Higher serum vitamin D3 levels are associated with better cognitive test performance in patients with Alzheimer's disease.

Severe Mental Impairment blights the lives of many old people and their loved ones. My mum developed Parkinson's Disease a few years ago. I didn't know anything about the condition at the time, but it's caused by the formation of Lewy Bodies (blobs of abnormally-folded alpha-synuclein protein) in the substantia nigra part of the brain, which controls movement. This part of the brain has high levels of the Vitamin D receptor. I don't know why the brain contains Vitamin D receptors, but I think that they'd like to receive some Vitamin D!

As Lewy Bodies form in other parts of the brain, mental faculties decline. The hippocampus is involved with short-term memory. The neocortex is involved with concious thought.

Mum started showing obvious signs of mental impairment in August 2007. She was assessed by a Community Psychiatric Nurse (CPN) in January 2008 when she scored 14/30 in a MMSE. She was unable to remember 3 words or follow 2 simple instructions in a row (e.g. fold this piece of paper in half and put it on the floor). I started her on 5,000iu/day of Vitamin D3, as it was having a positive effect on my mental function. She was prescribed Aricept, starting at 5mg/day for a month then increasing to 10mg/day. In May 2008 she was re-assessed and scored 26/30 in a MMSE. EDIT: In 2010, Mum's consultant told me that Aricept increases MMSE score by 3 points on average.

Unfortunately, Aricept has side-effects including severe diarrhoea and worsening of the symptoms of Parkinson's Disease, which she complained about, so her Aricept dose was reduced back down to 5mg/day.

Unsurprisingly, this resulted in a slight decline in mum's mental faculties. In November 2008, I increased her intake of smoked salmon to about 400g/week, as the consumption of long-chain omega-3 pufas have benefits. See
Low Plasma N-3 Fatty Acids and Dementia in Older Persons: The InCHIANTI Study.

After about four weeks, this had a noticeable (by myself and mum's friend) positive effect on her mental faculties so, inspired by Dr Art Ayers, I started her on Turmeric (curcumin) extract and Goldenseal (berberine) extract. See
Curcumin inhibits aggregation of alpha-synuclein
Neuroprotective effects of curcumin
Alpha-synuclein assembly as a therapeutic target of Parkinson's disease and related disorders
Curcumin labels amyloid pathology in vivo, disrupts existing plaques, and partially restores distorted neurites in an Alzheimer mouse model
Influence of piperine on the pharmacokinetics of curcumin in animals and human volunteers
Research on the mechanism of neuronal apoptosis in Alzheimer's disease and the effects of tetrohydroberberine on the apoptosis... and
Berberine chloride can ameliorate the spatial memory impairment and increase the expression of interleukin-1beta and inducible nitric oxide synthase in the rat model of Alzheimer's disease.

On January 12th 2009, mum was re-assessed and still scored 26/30 in a MMSE. I thought that this was impressive considering that 1) she was taking half the dose of Aricept, compared to when she previously got that score, 2) she had no adverse effects from any of the supplements and 3) she was eight months older and degenerative brain diseases always worsen with increasing age.

I mentioned to the CPN who did the MMSE that I was starting mum on 15mg/week Vitamin K2 as there were benefits. See
Menaquinone-4 concentration is correlated with sphingolipid concentrations in rat brain ,
Vitamin K status influences brain sulfatide metabolism in young mice and rats ,
Substantial sulfatide deficiency and ceramide elevation in very early Alzheimer's disease: potential role in disease pathogenesis and
The possible role of vitamin K deficiency in the pathogenesis of Alzheimer's disease and in augmenting brain damage associated with cardiovascular disease
New Vitamin K, an emerging nutrient in brain function
New The Science of Brain Health and Cognitive Decline | Eric Kandel
New Vitamin K2, Intelligence and the Aging Brain

I don't anything about sphingolipids, but sulfatides are good and ceramides are bad.

Around the time that mum collapsed, I received a copy of a letter from the CPN to mum's GP which stated "I have informed him (i.e. me) that I am unaware of any robust evidence that these substances are of any benefit." However, there is no evidence that these substances are of any harm.

And finally......
What started the cascade of confusion and collapse leading to hospitalisation and discharge to a nursing home was a simple Urinary Tract Infection UTI) of e. coli. I don't know why UTIs cause so much confusion in elderly people, but elderly females are at a high risk of developing UTIs because a) elderly people don't drink enough so they don't pass enough urine, b) females have insufficient spacing between anus & urethra and c) elderly females who have any urinary/faecal leakage wear a Tena disposable "nappy/diaper", which increases the likelihood of faeces entering the urethra.

To reduce the risk of further UTIs, I have supplied the nursing home with a pot of D-mannose Plus, which contains D-mannose and cranberry extract, with instructions to add a heaped teaspoonful to a glass of juice once a week. See Intervening with urinary tract infections using anti-adhesives based on the crystal structure of the FimH-oligomannose-3 complex,
Natural approaches to prevention and treatment of infections of the lower urinary tract and
Vitamin D Induction of the Human Antimicrobial Peptide Cathelicidin in the Urinary Bladder.


EDIT: Thanks to Galina L for bringing the following study to my attention.
Magnesium supplementation in the treatment of dementia patients.
It's probably of no help to Lewy Body Dementia sufferers, as they already have high Mg levels in their CSF. See CSF Mg and Ca as diagnostic markers for dementia with Lewy bodies.

Continued on Look after your brain, Part 2.

So, when & where did it all go wrong?

No, I'm not talking about Demand Five! I'm talking about us, modern man & woman. We have improved hygiene, clean water & food, modern medicine, antibiotics, antivirals etc. We should be enjoying good health and vitality into our nineties. We're not, though. Degenerative diseases like Type 2 Diabetes, Coronary Heart Disease, Cancer, Dementia, IBS etc are afflicting increasing numbers of people (including youngsters) and are even starting to reduce our longevity statistics. Why?

On one side of the fence are the anti-animal fat brigade who claim that animal fats are the cause of all our health problems and that we should all be eating more vegetable fats and reducing our cholesterol.

On the other side of the fence are the anti-carb brigade who claim that carbohydrates are the cause of all our health problems and that we should all be eating less carbohydrates and increasing our fat consumption.

I'm sure you can guess where I am. I have the splinters to prove it!

In 1911, hydrogenated vegetable oil (Crisco) entered the marketplace. So, in 1911, fat turned bad! See The rise and fall of Crisco.

Interestingly, rates of Coronary Heart Disease started to rise from 1920, 9 years later. Co-incidence?

Our genes may have not changed much in the last few hundred thousand years, but our lifestyles certainly have. We now live mostly sedentary lives (which makes our muscles less sensitive to insulin). We now live and work mostly indoors (which makes us deficient in Vitamin D).

We now don't eat much oily fish. Our vegetables contain much less omega-3 fat than they used to (to make them stay fresh for longer). Our meat now contains much more omega-6 and much less omega-3 fat than it used to (due to feeding animals on grains). These changes make us deficient in omega-3 fat (which makes our muscles less sensitive to insulin).

We now eat loads of refined carbohydrate (which causes unstable blood glucose & insulin levels) and loads of processed foods (which makes us deficient in Magnesium and fibre/fiber).

As a result of all of the above changes, we have many modern diseases.