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1. TBI THERAPY WEBINAR: KETOGENIC DIET FOR TBI By Dr. John Hughes February 13th, 2018

2. DR. JOHN HUGHES, DO Doctor of Osteopathy Arizona College of Osteopathic Medicine From Georgia

3. LEARNING OBJECTIVE • What is a Traumatic Brain Injury (TBI)? • What are Ketones? • What is the Ketogenic Diet? • How Does the Ketogenic Diet Help TBI?

4. WHAT IS A TBI? • A sudden, violent blow or jolt to the head • Brain collides with the inside of the skull • Bruising of the brain • Tearing of nerve fibers and bleeding

5. WHAT HAPPENS AFTER A TBI? • During brain swelling, glucose uptake that surges to the injured area to provide energy for healing and repair is blocked • The brain is flooded with disproportional responses

6. TBI = METABOLIC CRISIS “The brain is in a metabolic crisis in a concussion, potassium ion from inside the cell going extracellular, calcium ions going intracellular, neurotransmitters widely released in a chaotic manner. It takes energy to pump that potassium back, put the neurotransmitters back on so the cell can function.”

7. BIOCHEMICAL AND PHYSIOLOGICAL RESPONSES AFTER TBI • Disproportional proinflammatory cytokine production and release → Small proteins that are important in cell signaling • Increased counterregulatory hormones → Work against the action of insulin • Hypermetabolic and catabolic states • Severely impairing nitrogen homeostasis

8. OXIDATIVE STRESS FROM TBI A disturbance in the balance between the production of reactive oxygen species (free radicals) and antioxidant defenses

9. OXIDATIVE STRESS FROM TBI • Impairs cerebral vascular function • Impairs circulation • Impairs the energy metabolism • Damages mitochondria and DNA

10. • Fatigue • Disturbances in sleep • Memory loss and/or brain fog • Decreased eye sight • Headaches and sensitivity to noise • Cognitive impairment • Changes in mood • Insulin resistance • Hormone abnormalities SYMPTOMS FROM OXIDATIVE STRESS

11. HOW TO DECREASE OXIDATIVE STRESS? “Ketones decrease oxidative stress, increase antioxidants and scavenge free radicals.” (Greco, Glenn, Hovda, & Prins, 2016)

12. WHAT ARE KETONES? The result of breaking down fat for energy when carbohydrate intake is low HOW DOES THIS WORK?

13. HOW DOES THE BODY CREATE ENERGY? Glucose Glycogen/Blood Sugar/Insulin Decreases Body uses fat for energy If we cut out carbohydrates and sugar =Beta-oxidation / Ketosis / Decrease Oxidative Stress

14. Glucose/Carbohydrates = Kindling Ketones/Fats = Logs Which burns more even?

15. KETONES BURN EVENLY • Stabilizes the nervous system • Reduces seizure threshold • Enhances brain organization • Corrects the metabolic crisis • Balances hormones

16. KETONES ARE LIKE DIESEL FUEL (GLUCOSE IS LIKE GASOLINE) • Diesel fuel has a high flash point than gasoline • Harder to oxidize – Less flammable (excitable) • The brain works like a diesel engine • Burns more efficiently – lasts longer Video

17. WHAT ELSE DO KETONES DO? Increases GABA Decreases Depression, Fear, Anxiety Decreases Glutamate Decreases Oxidative Stress Increases Neuroprotection Increases Calming

18. NEUROPROTECTIVE ACTIONS OF THE KETOGENIC DIET • Increases resistance to metabolic stress • Increases resilience to neuronal loss • Upregulates energy metabolism genes • Stimulates of mitochondrial biogenesis • Enhances alternative energy substrates • Promotes synthesis of adenosine triphosphate (ATP) • Interferes with glutamate toxicity • Bypasses the inhibition of complex I in the mitochondrial respiratory chain (Pillsbury, Oria, & Erdman, 2011)

19. THE KETOGENIC DIET • High-fat • Adequate-protein • Low-carbohydrate

20. DOEAT Meats – fish, beef, lamb, poultry, eggs, etc. Leafy Greens – spinach, kale, etc. Above ground vegetables – broccoli, cauliflower, etc. High Fat Dairy – hard cheeses, high fat cream, butter, etc. Nuts and seeds – macadamias, walnuts, sunflower seeds, etc. Avocado and berries – raspberries, blackberries, and other low glycemic impact berries Sweeteners – stevia, erythritol, monk fruit, and other low-carb sweeteners Other fats – avocado oil, coconut oil, grass-fed ghee, high-fat salad dressing, saturated fats, etc. DONOTEAT Grains – wheat, corn, rice, cereal, etc. Sugar – honey, agave, maple syrup, etc. Fruit – apples, bananas, oranges, etc. Tubers – potato, yams, etc.

21. TBI THERAPY PROTOCOL 3 MONTHS 1. Begin ketogenic diet at beginning of TBI Therapy treatments 2. Read Fat for Fuel by Dr. Joseph Mercola 3. Consider intermittent fasting 4. Brain Octane (MCT Oils) = 16x more ketones than coconut oil

22. • Reduces oxidative stress • Decreases neuroexcitatory glutamate • Increases GABA – the calming neurotransmitter • Overall improvements in cognitive and motor functioning • Proven treatment for patients suffering from epileptic seizures – since 1921 KETOGENIC DIET AND TBI

23. Q&A Learn more at or call 303-447-1257 Video