The prevalence of obesity tripled worldwide between 1975 and 2016, and it is projected that half of the US population will be overweight by 2030. The obesity pandemic is attributed, in part, to the increasing consumption of the high-fat, high-carbohydrate Western diet, which predisposes to the development of the metabolic
syndrome and correlates with decreased cognitive performance. In contrast, the
high-fat, low-carbohydrate ketogenic diet has potential therapeutic roles and has
been used to manage intractable seizures since the early 1920s. The brain accounts
for 25% of total body glucose metabolism and, as a result, is especially susceptible
to changes in the types of nutrients consumed. Here, we discuss the principles of
brain metabolism with a focus on the distinct effects of the Western and ketogenic
diets on the progression of neurological diseases such as epilepsy, Parkinson’s disease, Alzheimer’s disease, and traumatic brain injury, highlighting the need to further explore the potential therapeutic effects of the ketogenic diet and the importance of standardizing dietary formulations to assure the reproducibility of clinical
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