In this solo presentation, Dr. David Perlmutter explains that Parkinson's disease is fundamentally an energetic disorder caused by mitochondrial dysfunction. He introduces the ketogenic diet—high‑fat, low‑carbohydrate—as a way to provide ketone bodies that can bypass the defective complex 1 pathway and improve cellular energetics. Perlmutter reviews a small feasibility study (five patients) in which participants were placed on a strict ketogenic regimen, achieved nutritional ketosis, and were evaluated with the Unified Parkinson’s Disease Rating Scale (UPDRS). Across the four UPDRS domains—mentation/mood, activities of daily living, motor function, and medication complications—most patients showed marked improvements, with total score reductions of 46‑81 %. He emphasizes the study’s limited size, advises consultation with healthcare providers (especially for those on diabetes medication), and suggests that dietary intervention may be a viable adjunct or alternative to pharmacologic symptom management in Parkinson’s disease.
Chapters
Hello, I'm Dr. David Perlmutter. Today I'd like to talk about Parkinson's disease. You know, we're hearing so much more about that situation these days, and the reason being is because we're seeing more and more cases of Parkinson's. This is a fairly common disease affecting 2 to 4% of people in America over the age of 60, 50% more likely if It is a disease which is— has environmental factors, it has genetic factors, but what we understand is at its core it's an energetic issue. It is a disease that is characterized by failure of mitochondrial activity, which means energy production within the cell. That specific defect, in fact, has been looked at, and that discussion kind of paves the way for what we're going to be talking about today. But I would like to say that Parkinson's does not have any treatment, at least for the disease. There are certainly symptomatic treatments available to help manage the tremor, help manage the rigidity, but it— when it comes to actually treating the disease itself, Parkinson's, there is really nothing as yet available, though research continues. Now, we've heard a lot recently about the so-called ketogenic diet. I've blogged about it quite extensively. And what does that mean? It means a diet that is higher in fat, much higher in fat, and also at the same time restricts sugar and carbohydrates so that the metabolism shifts away from burning carbs, burning sugar, to using fat molecules, really what are called ketone bodies, to power the cell. And the reason that's really interesting as it relates to Parkinson's disease is again When you power the cell with a more efficient fuel, in this case fat or ketones, it helps the mitochondria, it helps the cellular energetics improve. So the question was asked, could putting Parkinson's patients on a ketogenic diet, in other words, higher fat, lower carb diet, lead to any improvement in their functionality and in their symptoms? Well, that's exactly what was done in this study. So let's take a look at a really fascinating study. This study is called Treatment of Parkinson Disease with Diet-Induced Hyperketonemia: A Feasibility Study. And again, the reason that the researchers wanted to look at putting these patients on a higher level of ketones, restricting their carbs, giving them more fat, is that they, they stated that ketones can bypass the defect in complex 1 activity in Parkinson's. And what does it mean? It means that ketones are able to bypass that defect in energy production at the level of the mitochondria that has been defined in Parkinson's disease. This is a way around that energy issue and allowing the brain to virtually power itself up. The study involved just 5 Parkinson's patients, so I agree it isn't a robust study, but nonetheless, I think when we look at the results, we'll see that it is pretty profound. The study had a dietitian to estimate that patient's— how compliant they were, but also beyond just looking at their diets, they did measure the blood levels of the ketones to make sure they were on— they were in ketosis, and they also did evaluations during the study and after. Using what's called the UPDRS evaluation. That is the Unified Parkinson's Disease Rating Scale. The lower you are on that scale, the more functional you are, the better off you are. And it looks at 4 parameters: mentation and mood, activities of daily living like personal hygiene, feeding yourself, dressing yourself, etc., motor function, and complications from medications. You get a total And we're going to look at that in just a moment. So first, let's look at mentation and mood both before and after going on the diet. What did they find? That really almost across the board there was improvement significantly in the case of patient number 2 and patient number 5 in terms of mood and mentation when they changed their diet and started using fat as a fuel source. What about activities of daily living, living before and after getting into ketosis? Pretty much across the board an improvement. No real change in patient 1, but really the rest of them showed significant improvements in their ability to carry out their day-to-day tasks of taking care of themselves. What about motor function? Really something that's very compromised in Parkinson's disease, and we see that every patient demonstrated improvement. In other words, lowering of their dysfunction. Uh-huh. In going on this hyperketonic diet, improvement in motor function. And what about treatment complications? That was also improved pretty much across the board. Patient 3, interestingly, had some increase in complications from his or her medication, which sometimes you see in Parkinson's when patients get too much medication, they begin to get complications. And It might just be that, you know, the hyperketogenic diet coupled with the medications was just too much in that one case. But when you look at the total score, everybody improves. And in the cases of patient 2, 3, and 5, those improvements are dramatic. Patients 2 and 3 have a 46% improvement. Patient number 5 has an 81% improvement. Wow. In other words, a decrease in their disability score. So again, this is a powerful study in terms of its implication. Only 5 patients, not a robust study, but that said, it really, I think, characterizes the importance of looking at dietary and lifestyle interventions as a treatment for some of our most pernicious issues, in this case, Parkinson's disease, and I think these results are powerful. I think that there may be a role that we should consider with respect to using a more ketogenic diet in Parkinson's. So what did we learn? We learned that there was a dramatic change in these subjects who were placed on a very aggressive ketogenic diet with very strict restriction of their carbohydrates and sugars, eating fat, became in what we call ketosis. And that said, look at the significant improvement in a variety of parameters that were measured in this study. Now, again, this was a relatively small study, 5 people, but they all had varying degrees of significant improvement. So, Should all Parkinson's patients go on a ketogenic diet? Obviously can't say that, but I think it is at least worthwhile to consider that there are other options for improving symptoms aside from medications that may have potential side effects. If you're thinking about, you know, engaging in this type of diet, very worthwhile to discuss it ahead of time with your healthcare practitioner Especially, for example, if you're on diabetic medication, in which case your blood sugar might really get too low because of the medication. But nonetheless, maybe the ketogenic diet is all a Parkinson's patient might need. Maybe it can be used in conjunction with medication. The point is that, you know, the answer to symptom management at this case— in this case, in Parkinson's, Mm-hmm. Might not always necessarily be in the form of a drug. Really interesting information, and I hope it opened up your minds a bit in terms of the power of dietary intervention in a neurological problem. Thanks for joining me. I'm Dr. David Perlmutter.
