294 CHAPTER 19 | Nutrition Management of Neurological Disorders


mode of action for the ketogenic diet is unclear; how- ever, metabolic changes in the blood and cerebro- spinal fluid, including decreased glucose levels and increased ketone bodies, are proposed to be factors in controlling seizures. The most restrictive ketogenic diet used may be 60% medium-chain triglycerides, 10% other fats, 10% protein, and 20% carbohy- drates. In other instances, the ketogenic diet may be more liberalized but remains low in carbohydrate and high in protein and fat. This diet provides only small amounts of fruits, vegetables, grains, milk, and cheese, so supplementation with vitamins and min- erals, especially calcium, folate, and vitamins D, B6, and B12, is necessary. Stimulants, such as tea, coffee, colas, and alcohol, should be avoided. The side effects of following a ketogenic diet include hypoglycemia, weight loss, high levels of low-density lipoprotein, and elevated total cholesterol; therefore, health care practitioners should monitor lipids.97


Sev-


eral modifications to the ketogenic diet that are more palatable can be followed, including the modified Atkins diet and the low glycemic diet.


The nutrition practitioner should instruct the older adult to restrict use of cough syrups, laxa- tives, toothpaste, and over-the-counter medications


REFERENCES


1. U.S. burden of Alzheimer’s disease, related dementias to double by 2060. Centers for Disease Control and Prevention. 2019. Accessed March 3, 2023. www. cdc . gov / media / releases / 2018 / p0920 - alzheimers - burden - double - 2060 . html


2. Types of dementia. Dementia Australia. 2022. Accessed November 27, 2023. www. dementia . org . au / information / about - dementia / types - of - dementia


3. Mixed dementia. Alzheimer’s Association. December 2022. Accessed March 3, 2023. www. alz . org / media / Documents / alzheimers - dementia - mixed _ dementia - ts . pdf


4. Chronic traumatic encephalopathy (CTE). Alzheimer’s Association. 2023. Accessed March 3, 2023. www. alz . org / alzheimers - dementia / what - is - dementia / related _ conditions / chronic - traumatic - encephalopathy - (cte)


5. Types of dementia. Alzheimer’s Association. 2023. Accessed March 3, 2023. www. alz . org / alzheimers - dementia / what - is - dementia / types - of - dementia


6. Facts and figures. Alzheimer’s Association. 2023. Accessed March 3, 2023. www. alz . org / alzheimers - dementia / facts - figures


7. Zanetti O, Solerte SB, Cantoni F. Life expectancy in Alzheimer’s disease (AD). Arch Gerontol Geriatr. 2009;49(suppl 1):237-243. doi:10 . 1016 / j . archger . 2009 . 09 . 035


8. Rusanen M, Kivipelto M, Levälahti E, et al. Heart diseases and long-term risk of dementia and Alzheimer’s disease: a population-based CAIDE study. J Alzheimers Dis. 2014;42(1):183-191. doi:10 . 3233 / jad - 132363


9. Causes and risk factors. Alzheimer’s Association. 2023. Accessed March 3, 2023. www. alz . org / alzheimers - dementia / what - is - alzheimers / causes - and - risk - factors


10. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet. 2020;396(10248):413- 446. doi:10 . 1016 / S0140 - 6736(20)30367 - 6


11. Rakesh G, Szabo ST, Alexopoulos GS, Zannas AS. Strategies for dementia prevention: latest evidence and implications. Ther Adv Chronic Dis. 2017;8(8-9):121-136. doi:10 . 1177 / 2040622317712442


or other agents that may have high carbohydrate content and may interfere with the ketogenic diet. Potential drug–drug interactions may also occur with the use of antipsychotic agents, selective sero- tonin reuptake inhibitors, and statins. The nutri- tion practitioner should also investigate the use of supplements, herbs, and botanicals, as these may inhibit drug absorption. Refer to Chapter 7 for more information on the implications of drug–nutrient interactions and pharmacology.


Summary


Nutrition interventions can be effective at addressing some symptoms of the neurological diseases reviewed in this chapter. Although these interventions may not change the ultimate disease course, they can aid in improving nutritional status, at least for a period, and help promote improved quality of life. The nutrition practitioner is an integral part of the health care team for individuals with neurological diseases and, along with other team members, may identify solutions that aid in disease management.


12. S´ liwin´ska S, Jeziorek M. The role of nutrition in Alzheimer’s disease. Rocz Panstw Zakl Hig. 2021;72(1):29- 39. doi:10 . 32394 / rpzh . 2021 . 0154


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