Traumatic Brain Injury (TBI) results from sudden trauma to the brain - typically caused by a concussion due to a fall, an automobile collision, or a contact sport such as football or soccer. After sustaining a TBI the ability of the brain to metabolize glucose, which is its primary fuel source, can become impaired. Ketone bodies, which are water soluble fat molecules produced in the liver provide an alternate fuel source for the brain. Nutritional ketosis, which is achieved by consuming carbohydrates below a certain threshold is different from ketoacidosis which can occur in Type 1 diabetes.

The original ketogenic diet was designed in the early 1920s at the Mayo Clinic to help children with untreatable epilepsy. The "Medical Ketosis" diet macros were about 80% of calories from fat, 15% from protein and 5% from carbohydrates. The development of more effective anti-seizure drugs has reduced the number of people on the medical ketosis diet although it is still used in extreme cases. There have been some negative side effects of this diet but those risks are outweighed by the reduction of seizures. 

Now the ketogenic diet is being rediscovered by athletes, nutritionists and doctors as a way to lose body fat, increase endurance performance and treat diseases linked to insulin including diabetes, Alzheimer's, Parkinson's disease, and traumatic brain injuries. 

It is not clear from the research how effective nutritional ketosis is for people with long term TBI but the approach has a lot of potential. If the brain tissue has become insulin resistant because of the diminished ability to process glucose, then providing an alternate fuel source should be beneficial. Ketosis has been shown to reduce inflammation which would benefit the repair of brain tissue. If the mitochondria become efficient at burning ketones for fuel there will be less oxidative stress on the mitochondria and fewer antioxidants produced. 

Implementation

If you are interested in experimenting with the benefits of nutritional ketosis check out the overview of the post on ketosis for body recomposition. You do not need to worry about calories or losing weight, just focus on getting your body adapted to burning fat and producing ketones. Once you have achieved basic nutritional ketosis, you would then experiment with increasing the amount of ketones you produce. This can easily be achieved by adding MCT oil (Medium Chain Triglycerides) which is derived from coconut oil. MCT oil is easily digested and can increase the production of ketones. Too much MCT oil can have negative consequences in the GI tract, so start slowly with a teaspoon and build up to whatever you can tolerate. Another option is to use exogenous ketones as a supplement to instantly boost your blood ketone levels. Exogenous ketones are typically made from a salt and can also be disruptive to the GI. It might be a good idea to consult with a doctor before taking exogenous ketones, especially if you have high blood pressure. A nutritionist that specializes in nutritional ketosis will be able to help guide you through the process. Mark Sisson's latest book The Keto Reset provides a blueprint for adopting the ketogenic diet and provides a 21 day on-ramp complete with menus and meal plans. 

Resources

• Ketosis Aids in Protecting Against Traumatic Brain Injury by Dr. Maleah Holland

• Clinical Review: Ketones and Brain Injury 

• The Collective Therapeutic Potential of Cerebral Ketone Metabolism in TBI

• Effects of beta-hydroxybutyrate on cognition in memory-impaired adults.

• Dietary ketosis enhances memory in mild cognitive impairment

• Robb Wolf case study for 22 year old male post-TBI improvements with Ketogenic diet

• Overview of different types of ketosis

Disclaimer: I am not a doctor or a nutritionist. This information is based on my own experiences and research. Consult your doctor or nutritionist!