On July 9, a Johns Hopkins feasibility trial found a modified Atkins diet beat a control diet on memory in older adults with mild cognitive impairment due to Alzheimer’s disease, even though only two participants met ketosis-based adherence criteria. The 12-week parallel-group trial screened 839 people to randomize 38, with 20 assigned to the modified Atkins plan and 18 to control. By the primary endpoint, only 13 in the keto arm and nine in the control arm were still in the analysis, yet the modified Atkins group still posted a 1.37-point higher change in Memory Composite Score, with a moderate effect size of Cohen’s d = 0.57.
It found significant shifts in 13 metabolites and 10 lipids, including acetoacetate, several triacylglycerols and sphingomyelins. A 2019 pilot in the Journal of Alzheimer’s Disease followed 14 older adults with mild cognitive problems suggestive of early Alzheimer’s disease, and recruitment was difficult because the broader phase I/II trial required both patients and study partners to stick with a restrictive diet for three months. During the first 2.5 years of active recruitment, only 27 eligible and willing patients enrolled. Adherence to both the modified Atkins diet and the National Institute on Aging diet was only fair, but the participants on the ketogenic side who produced at least trace urinary ketones showed a statistically significant increase in Memory Composite Score and reported more energy. Jason Brandt said ketone supplements might eventually make the approach easier to follow than a strict ketogenic diet.
A 2023 University of Michigan systematic review included 10 Alzheimer’s ketogenic trials, three mild cognitive impairment trials and five Parkinson’s disease trials, and concluded that the strongest evidence so far was for cognitive improvement in mild cognitive impairment and in mild-to-moderate Alzheimer’s patients negative for APOE 4. The Alzheimer’s Association estimated 7.4 million Americans age 65 and older were living with clinical Alzheimer’s dementia, projected that total could reach 13.8 million by 2060 without medical breakthroughs, and said Alzheimer’s was the sixth-leading cause of death in the United States in 2024.
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