Editorial: The Ketogenic Diet for Cognitive and Behavioral Function

Neurodegenerative diseases are a broad set of pathologies based on the progressive death of neurons in different regions of the nervous system. Given the complexity of the nervous system, the symptoms, depending on the affected area, are numerous and diverse. Among them, potential impairment of movement, memory, language, cognition and learning stand out, causing a deterioration in the quality of life and autonomy of patients.

However, despite the fact that these are incurable diseases, in recent years the importance of diet in improving the prognosis of these pathologies has been highlighted. Among them, ketogenic diets stand out, because they are able to counteract the pathogenic processes that characterize neurodegeneration, such as high oxidative stress, inflammation and energy abnormalities at the mitochondrial level. Therefore, they are increasingly used as a complement to treatment, especially due to the benefits proven at the cognitive and emotional level.

In this sense, this Research Topic aims to present some of the latest scientific works that provide information on different aspects of ketogenic diets. In particular, four research articles were included, three of which are reviews and a mini-review (Kong et al.; Cecchi et al.; de la Rubia Ortí et al.), and one is an original study (Wiers et al.).

In the first article included in this research topic, Kong et al., through a review, examine the effects of ketogenic diets on substance use disorders (SUD) using a review. Reducing carbohydrate intake through a ketogenic diet may have a positive effect. To delve into this potential benefit, it is hypothesized that ketone bodies may compensate for the impaired glucose metabolism caused by alcohol consumption by increasing ketone metabolism. Thus, the goal was to reduce withdrawal symptoms. It is also worth noting that SUD is particularly associated with mitochondrial damage, oxidative stress, inflammation, glial dysfunction, and gut microbial dysfunction, which are pathogenic mechanisms that can be reversed with ketogenic diets. Therefore, this study delves into these benefits while taking into account the side effects that have been associated with the consumption of these diets, such as metabolic abnormalities, increased risk of malnutrition, and gastrointestinal symptoms.

Similarly, Wiers et al. have addressed in a very interesting way how the ketogenic diet can modify the desire to drink alcohol in people with alcohol use disorders (AUD) undergoing abstinence for more than 3 weeks. To do this, they rely on the aspects already considered in the review by Kong et al., and in particular on the fact that acute alcohol consumption changes the brain energy from glucose to acetate (alcohol metabolite), and this change persists for a period after quitting the habit. In this sense, the authors propose that promoting the production of ketone bodies through a diet that is structurally very similar to acetate can suppress the signs and symptoms of alcohol withdrawal, the desire for alcohol and the possibility of relapse, which occur precisely as a result of the low availability of acetate. After the study, it was observed that, comparing the effect during this period of consumption of the ketogenic diet with the standard American diet, the desire to drink alcohol decreased during the 3 weeks of abstinence only in the group of patients who followed the ketogenic diet.

Another interesting study in this research topic was conducted by Cecchi et al. In their review, the benefits of pharmaconutrics are brilliantly analyzed, combining personalized pharmacological treatment with a designed diet to synchronize the effects of drugs in the treatment of childhood gliomas. It should be noted that childhood gliomas represent the most common brain tumor in children, which gives greater importance to the results and evidence provided by the authors regarding the benefits of these diets.

Finally, the research topic presents a mini review by de la Rubia Ortí et al. on the possible role of ketogenic diets in multiple sclerosis (MS), which is the most devastating neurodegenerative disease in young people. This work aims to update the topic and discuss the potential effect of ketogenic diets on anxiety and depression through the modulation of glutamate activity. After analyzing the main findings, ketogenic diets seem to represent an alternative source of ketone bodies in the blood to improve glutamate activity. According to the authors, this benefit is mediated by a reduction in obesity, which is associated with insulin resistance and dyslipidemia, and finally with central inflammation. This would improve synaptic glutamate activity and reduce extrasynaptic activity, which in excess has been associated with functional disability and the presence of anxiety and depression.

Author’s Contributions

JR: Conceptualization, Data collection, Formal analysis, Funding acquisition, Research, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – draft, Writing – review & editing. MG-P: Conceptualization, Data collection, Formal analysis, Funding acquisition, Research, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – draft, Writing – review & editing. MC-B: Conceptualization, Data collection, Formal analysis, Funding acquisition, Research, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – draft, Writing – review & editing. GC-E: Conceptualization, Data collection, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – draft, Writing – review & editing. MB: Conceptualization, Data collection, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – draft, Writing – review & editing.

Financing

The authors declare that they received no financial support for the research, authorship, and/or publication of this article.

Thanks

We would like to express our sincere thanks to all authors and reviewers who participated in this research topic.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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