The complex nature of glaucoma demands ongoing research to discover more effective therapeutic strategies. A promising new approach involves the use of a specific type of energy source for nerve cells, often referred to as a "neuronal bioenergetic substrate."
Current evidence suggests that supplying a bioenergetic substrate can help rescue optic nerves in glaucoma and may provide neuroprotection. The first such bioenergetic substrate that researchers explored was pyruvate (a metabolite of glucose). However, Beta-Hydroxybutyrate (BHB) is viewed by some researchers as a superior alternative. A number of reasons for BHB's superiority are discussed in this article: The Best Neuronal Bioenergetic Substrate for Glaucoma - Pyruvate or BHB? | Ask FitEyes. This article will summarize some of those points. (For full details see the linked article, which is about a 30 minute read.)
BHB and Ketogenic Diets
BHB, a ketone body produced naturally by the liver during periods of low glucose availability, is widely recognized for its neuroprotective properties.
Ketogenic diets, which naturally boost βHB levels, have been proposed to be neuroprotective in glaucoma [Zarnowski et al., 2012]. They have been shown to protect retinal ganglion cell structure and function [Harun-Or-Rashid 2018-11] and were able to rescue optic nerves in a mouse model of glaucoma.
Recently, BHB has become available as a dietary supplement, making it accessible to anyone without the need to follow a specific diet.
BHB as a Neuronal Energy Substrate
βHB easily crosses the blood-brain-barrier and can provide the CNS (brain, optic nerve) with the majority of its energy needs [Laird 2013]. This is crucial in neurodegenerative diseases, including glaucoma, where neuronal energy metabolism is compromised.
BHB and Mitochondrial Biogenesis
One of the remarkable properties of BHB is its ability to stimulate mitochondrial biogenesis (the growth of new mitochondria). Mitochondria, often referred to as the powerhouses of the cell, are crucial for cellular energy production. In neurodegenerative diseases like glaucoma, the functionality of these mitochondria can be compromised, leading to an energy deficit in neuronal cells.
This not only increases the cell's overall energy capacity but also enhances the efficiency of energy production. By boosting mitochondrial biogenesis, BHB can help to address the energy crisis in retinal ganglion cells, potentially slowing or even halting the progression of glaucomatous neurodegeneration.
BHB's Anti-inflammatory and Anti-oxidative Properties
BHB has been shown to reduce oxidative stress, a major contributor to neurodegenerative diseases. By decreasing the production of reactive oxygen species (ROS) and enhancing the body's antioxidant defenses, BHB can help protect RGCs from oxidative damage.
Complex I within the mitochondria is a significant source of reactive oxygen species (ROS) production. While typical antioxidants have minimal impact on ROS production at this critical site, BHB demonstrates a unique efficacy. This makes BHB an exceptionally important antioxidant in neuroprotection, specifically targeting and mitigating ROS production where it's most prevalent. This is relevant not only for glaucoma but also for other chronic diseases and aging.
In addition, BHB has demonstrated anti-inflammatory properties. Given that inflammation is a key player in glaucomatous neurodegeneration, BHB's ability to modulate inflammatory responses could further contribute to its therapeutic potential.
BHB and Neuroprotection
In the context of glaucoma, BHB could potentially help preserve RGCs and their axons. By providing an alternative energy source and reducing oxidative stress, BHB could help alleviate the energy crisis faced by RGCs and protect them from further damage.
Current Practices
While the potential of BHB as a therapeutic agent for glaucoma is promising, further research is needed to fully understand its effects and to establish optimal dosing and administration strategies.
Outside the field of neuroprotection, manufacturers of BHB supplements generally recommend up to three servings per day.
In the FitEyes community, our current investigative approach to using BHB is to consume it in low doses at regular intervals throughout the day, such as between meals and at bedtime. In this approach, it's important to consume BHB whenever a meal is skipped or delayed. It can also be used before and after demanding exercise, if desired.
WebMD mentions that BHB is considered safe when taken as a single dose of 380 mg/kg. For a person weighing 70kg, this would equate to 26.6 grams of BHB in a single serving. Indeed, many fitness enthusiasts and dieters routinely consume multiple 30 gram servings per day. On a ketogenic diet, the human body produces between 140 grams and 240 grams of BHB per day.
Our community's current focus is on using low to moderate doses of BHB to supplement neuronal energy requirements, rather than completely replacing all other energy sources.
As these figures indicate, a total BHB dose of up to 15 grams per day is considered a low dose. As a supplement to other energy sources from our normal diet, any amount of BHB (even as little as 1 capsule 3 times a day) should theoretically be helpful.
Example Dosing Guidelines
BHB capsule supplements are available which contain 1 to 1.3 grams of BHB per serving (generally 2 capsules). One approach to using BHB for neuroprotection could involve consuming one serving between breakfast and lunch, a second serving between lunch and dinner, and a third serving at bedtime. This results in a total BHB intake of at least 3 grams/day time to supply a steady supply of energy to nerve cells.
BHB powder supplements are also available, making it easier to consume more suitable doses. As an example, one forthcoming option provides 3 grams of BHB per serving and can easily be mixed with water. BHB powder could be taken at the same times described above for capsules, resulting in a more robust BHB intake of 9 grams/day.
Skipping Meals
With the above approaches, if any meal is skipped, be sure to add extra doses of BHB. In the case of skipping a meal, a minimum dose of BHB could be at least 6 grams (e.g., 2 servings of a BHB powder), for example.
For more on this topic, see: Intermittent Fasting, Skipping Meals and Glaucoma Risk | Ask FitEyes
Seek Advice When In Doubt
All of these doses are relatively low, and some individuals may wish to try more "normal" doses. As mentioned above, BHB is considered safe for most people at much higher doses. However, if you wish to use more than about 15 to 20 grams per day, and you are new to using BHB, please seek out guidance from qualified experts. As the dose increases above this level, other considerations beyond BHB, such as electrolytes, are important to consider.
As previously mentioned, further research is needed to establish optimal dosing strategies. If you are part of the FitEyes community, we encourage you to share your feedback and experiences with BHB.
References
For all references, please visit https://ask.fiteyes.com/p/9934/