Op-Ed: Reclaiming the Brain: How Ketones Could Combat Early Alzheimer’s

A growing body of evidence suggests that early-stage cognitive decline—particularly when tied to insulin resistance in the brain—might be significantly slowed, or even partially reversed, through a ketogenic diet and supplemental ketones like beta-hydroxybutyrate (BHB). While not a cure, this metabolic therapy could offer a powerful, low-risk intervention for those teetering on the edge of neurodegeneration.

But it must be approached with care—and a clear understanding of both its promise and its limitations.

What Is “Type 3 Diabetes,” Anyway?
“Type 3 diabetes” isn’t an official diagnosis—it’s a term used to describe Alzheimer’s-like brain changes caused by insulin resistance. In these early stages, the neurons haven’t died yet. They’re just not getting enough glucose—the brain’s primary fuel—because insulin, the hormone that helps shuttle glucose into cells, has stopped working properly in the brain.

The result? A slow-motion energy crisis. FDG-PET scans show reduced glucose uptake. Mitochondria—our cellular power plants—start to falter. Inflammation rises. Amyloid plaques and tau tangles begin to form. And the earliest cognitive symptoms—brain fog, forgetfulness, difficulty concentrating—creep in.

It’s here, in this preclinical or early clinical window, that a metabolic intervention could change the trajectory.

Why Ketones Help—and How to Use Them Safely
Ketones like BHB offer a remarkable workaround: they fuel the brain without needing insulin. When the body is in ketosis—whether from fasting, a ketogenic diet, or supplements—it generates these molecules, which neurons can use almost immediately. For someone whose brain can’t effectively metabolize glucose, ketones are like a backup generator kicking in just before the lights go out.

But that’s not all. BHB also enhances mitochondrial efficiency, reduces oxidative stress, calms inflammation, and even activates genes linked to brain repair and resilience. In other words, it’s not just a fuel substitute—it’s a molecular multitool for neuroprotection.

So what would a responsible, medically-informed version of “self-treatment” look like?

1. Get Baseline Labs: Before making any changes, test fasting glucose and insulin, A1C, lipid profile, inflammatory markers (like hs-CRP), and your current BHB levels.
2. Start a Ketogenic Diet: This typically means fewer than 30 grams of net carbs per day, moderate protein, and a high intake of healthy fats (think olive oil, avocados, nuts, and fatty fish).
3. Consider Supplemental BHB: Exogenous ketones—BHB salts or esters—can help you enter ketosis more quickly or provide a boost when needed. Target a therapeutic BHB range of 1.0–3.0 mmol/L.
4. Monitor and Adapt: Track your progress with cognitive tests, ketone levels, and lab work. Adjust as needed. This isn’t a one-size-fits-all protocol.

Caveats and Counterpoints
Of course, this approach isn’t without risks. Cutting carbs can cause temporary fatigue, electrolyte imbalance, and shifts in cholesterol levels. BHB supplements can lead to digestive upset. And for anyone on glucose-lowering medications, the risk of hypoglycemia is real. That’s why medical supervision is essential—especially if you’re managing diabetes, cardiovascular disease, or other chronic conditions.

There’s also the issue of long-term adherence. Strict keto isn’t for everyone. But modified or cyclical ketogenic diets—paired with regular exercise, quality sleep, and stress reduction—can often deliver similar benefits in a more sustainable way.

The Bigger Picture: Prevention, Not Just Treatment
If this sounds radical, it shouldn’t. In fact, it’s remarkably consistent with what we already know about lifestyle medicine. Exercise improves insulin sensitivity. Sleep deprivation worsens brain inflammation. Chronic stress elevates blood sugar. Nutrients like magnesium, B vitamins, and omega-3s support mitochondrial function. None of this is fringe science. But what’s new—and urgent—is applying this knowledge early, before irreversible damage sets in.

Here’s the truth: By the time Alzheimer’s is formally diagnosed, much of the damage is already done. If we wait for symptoms to escalate before intervening, we’re playing catch-up. But if we act when the first signs of metabolic dysfunction appear—brain fog, prediabetes, a family history of cognitive decline—we might be able to rewrite the script.

Conclusion: The Promise of a Metabolic Revolution
We are entering a new era in brain health—one where metabolism matters as much as memory. And for people in the early stages of cognitive decline, that shift offers hope.

Ketosis and BHB aren’t magic bullets. But when used thoughtfully—alongside other lifestyle interventions—they may offer the brain a second chance at clarity, connection, and resilience.
So instead of asking, “What pill will fix this?” perhaps the better question is: “What if food is the medicine?”