Impact of Eating a Carbohydrate-Restricted Diet on Cortical Atrophy in a Cross-Section of Amyloid Positive Patients with Alzheimer's Disease: A Small Sample Study

Jennifer E. Bramen, Prabha Siddarth, Emily S. Popa, Gavin T. Kress, Molly K. Rapozo, John F. Hodes, Aarthi S. Ganapathi, Colby B. Slyapich, Ryan M. Glatt, Kyron Pierce, Verna R. Porter, Claudia Wong, Mihae Kim, Richelin V. Dye, Stella Panos, Tess Bookheimer, Tori Togashi, Spencer Loong, Cyrus A. Raji, Susan Y. BookheimerJared C. Roach, David A. Merrill

Research output: Contribution to journalArticlepeer-review

Abstract

Background: A carbohydrate-restricted diet aimed at lowering insulin levels has the potential to slow Alzheimer's disease (AD). Restricting carbohydrate consumption reduces insulin resistance, which could improve glucose uptake and neural health. A hallmark feature of AD is widespread cortical thinning; however, no study has demonstrated that lower net carbohydrate (nCHO) intake is linked to attenuated cortical atrophy in patients with AD and confirmed amyloidosis. Objective: We tested the hypothesis that individuals with AD and confirmed amyloid burden eating a carbohydrate-restricted diet have thicker cortex than those eating a moderate-to-high carbohydrate diet. Methods: A total of 31 patients (mean age 71.4±7.0 years) with AD and confirmed amyloid burden were divided into two groups based on a 130 g/day nCHO cutoff. Cortical thickness was estimated from T1-weighted MRI using FreeSurfer. Cortical surface analyses were corrected for multiple comparisons using cluster-wise probability. We assessed group differences using a two-tailed two-independent sample t-test. Linear regression analyses using nCHO as a continuous variable, accounting for confounders, were also conducted. Results: The lower nCHO group had significantly thicker cortex within somatomotor and visual networks. Linear regression analysis revealed that lower nCHO intake levels had a significant association with cortical thickness within the frontoparietal, cingulo-opercular, and visual networks. Conclusions: Restricting carbohydrates may be associated with reduced atrophy in patients with AD. Lowering nCHO to under 130 g/day would allow patients to follow the well-validated MIND diet while benefiting from lower insulin levels.

Original languageEnglish
Pages (from-to)329-342
Number of pages14
JournalJournal of Alzheimer's Disease
Volume96
Issue number1
DOIs
StatePublished - Oct 24 2023

Keywords

  • Alzheimer's disease
  • amyloid
  • atrophy
  • carbohydrate-restricted
  • carbohydrates
  • cerebral cortical thinning
  • cognitive dysfunction
  • diet
  • magnetic resonance imaging

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