Will a Ketogenic Diet and/or Metformin Relieve Cognitive Impairment Due to Androgen Deprivation Therapy?

[MateoBeach]

As I posted previously, I have been experimenting with a ketogenic diet and intermittent fasting (IMF) as well as taking metformin (1,000 mg/day) for non-glycemic benefits for the past 3 months now. It is amazing how well I feel on this. Even while going through radiation (SBRT/IGRT for pelvic nodes) and adjuvant ADT. I easily dropped all excess fat from my body. (Back to high school and Marine Corps weight!) And have abundant steady energy with no hunger or cravings.

But what is more and unexpected is that my cognitive impairment from ADT and chemo in the past seems to be lifting. My verbal recall and expression seems to be improving substantially. I noticed this most when I was studying Sanskrit last year and I just could not learn and recall the new and very challenging vocabulary and grammar. This would have been much easier for me pre-cancer.

It is hard to be sure that I am not just manufacturing a placebo effect with hopeful thinking. So I jumping back in to my Sanskrit as a test. Indeed recalling vocabulary and some of the details of grammar, etc. are becoming increasingly accessible.

So it leads me to hypothesize that either ketogenic diets (and its variations) and/or non-glycemic / no-diabetic effects of metformin may ameliorate the cognitive impairment associated with Androgen Deprivation Therapy for PC.

Here are two well written and well referenced review articles on the application of these two modalities for other forms of cognitive impairment.

On Neuro-keto-therapeutics for Alzheimer's and Mild Cognitive Impairment:

ncbi.nlm.nih.gov/pubmed/314...

Evalluation of Metformin in Cognitive Impairment in NDVCI:

ncbi.nlm.nih.gov/pmc/articl...

[Kaliber]

I’ve been on 50 carbs -1000 calories keto diet for many years ( two decades ) and I take 250mg of metformin every day ( 1000 of metformin would probably cause my bg to plummet and go into diabetic shock ) ... I’m on Lupron Xtandi Zometa for 15 months. I have mild to moderate cognitive impairment which seems to increase the longer I stay on adt. My short term memory , sometimes, nearly doesn’t exist , it feels like . I couldn’t tell you if it would be worse or better without keto , since I’ve always been on keto before the adt .... maybe the keto - metformin is saving me some. If it is, I’d hate to see what happens without it yayahahahaya. I definitely could not say keto - metformin helps me in any noticeable way related to cognitive function . My speech is starting to slur off and on ... mostly on. Not bad but noticeable. I believe this is a result of adt as well. Adt is working extremely well for me holding the cancer at bay. The side effects of the adt , for me, are profoundly devastating tho.

This is just my experience, your mileage will probably vary. I’m old , ... younger guys seem to fare better. Even on keto my weight is wildly variable and my diabetes is DX’ed as “ drug induced “ by my adt meds. Without them I have no diabetes or high blood pressure.

👍👍👍

[MateoBeach in reply to Kaliber]

Sorry to hear of your challenges and struggles and that even with a long term keto diet you are so affected by cognitive constraints. Thank you for sharing your personal experience which certainly gives me pause about this hypothesis.

[Kaliber in reply to MateoBeach]

I like what one guy here says ... says once the horse is out of the barn, diet isn’t going to have much effect on it.

Myself I try anything I think might benefit me and push the bugs back , even a little. If it’s not going to hurt you , go for it. It’s good to feel like you are trying to fight the bugs yourself along with your medical team. Just always run it by your doctors to make sure you don’t hinder any of your mainline meds.

Peace brother ✌️

[Jimhoy in reply to Kaliber]

Like looking in a mirror except for the length of ADT.

I may have screwed up by talking my PcP out of A1C meds by explaining that that condition was likely a result of my ADT. If I understand correctly, there is a possibility that metformin may actually help with my cognitive / executive impairment!!

I been off Eligard for over a year now with NO relief from the above. My verbal agility has actually worsened to occasionally stuttering while trying to get a word out or completely loosing a word in the middle of a sentence, to using a completely wrong word (usually a rhyming word).

Anyway, I started a keto diet and exercise program last month. Keto solely for the weight gain during ADT (70#’s) and exercise to regain use of my joints and hopefully rebuild some ADT muscle loss (later). My debilitating joint pains seamed to dissipate with a slight rebound of T and as my ADT poison got out of my system.

To read this post that there is a possibility to easy my cognitive decline with this diet made my day!!!! This is really the only thing adversely effecting me now, but boy it’s a doozy!!! Would be great to remember stuff, recognize people, speak spontaneously, read at an adult level again, do math in my head, assemble kids toys never mind executive skills like schedules, budgets, spreadsheets, building schools, hospitals, treatment plants, laboratories, carpentry..............!!!!

Sorry for the vent!!!! My hunt and peck finger got away from me!!!!!

Best of luck and health.

Jc

[Kaliber in reply to Jimhoy]

Yayahahahaya. Well theres many people here that think metformin beats back the bugs. I wouldn’t disagree, heck I’m taking it myself for different reasons. If I had to guess, I’d probably say the benefit isn’t dramatic, perhaps even noticeable, but different people are different.

Keto s the only diet that works for me and it’s very effective, but even keto has its own downsides. It don’t personally know if my brain will snap back if I quit adt ... odds are I’m gonna be on it for the duration unless it quits on me. I hope it does. Lucky you to be off adt.

If you’re stage 4 M1 like I am, as long as you aren’t hurting yourself or impeding your meds ... I say have at it big time. I think your cognitive functions will improve over time.

It’s known that adt takes months and months to clear your system. 6 months to a year or more isn’t unusual. Who knows if you’ll hit the lucky medical lottery and at the least add some days, weeks or months to your life. Doesn’t hurt to keep fighting any way possible brother. That’s a fact Jack yayahahahaya

Peace ✌️✌️✌️✌️

[LearnAll]

Thank you for sharing this useful information.

"Sarve Bhavantu Sukhine...Sarve Santu Niramaye"

[cesces]

Occam's razor would assign causation to the weight loss.

[Jimhoy]

Well isn’t that some good news!!!

Was Keto and metformin both 3 months?

Jc

[Break60]

Imho the keto diet is dangerous. I lost 50 lbs just reducing intake of mostly plant based foods and religiously tracking calories. It ain’t rocket science!

[MateoBeach in reply to Break60]

There is a large and growing body of evidence that it is not dangerous in non- type 1 diabetics. And very beneficial in prediabetics, Type 1 diabetics, seizure disorders, dementias, endurance and other athletes. Some of this is presented in these two review articles.

Many physicians have a strong bias against keto diets stemming from harrowing experiences caring for diabetics in the very dangerous, lethal condition of diabetic ketoacidosis in insulin-dependent diabetics. The two are very different states. One a natural evolved system for fueling the body's and brain's energy needs from fat. The other is a true emergency disease state.

BTW metformin, a very useful medication in Type 2 diabetes/prediabetes is a naturally ocurring substance first found in the French Lilly. Among other (beneficial) effects it overcomes insulin resistance. In non-diabetics who do not have insulin resistance it does not cause hypoglycemia.

[Break60 in reply to MateoBeach]

I’ve been taking metformin 500 mg twice daily for five years as recommended by dr Meyers .

[Break60 in reply to MateoBeach]

I’m just saying that a diet with low carbs and high fats is not normal and is unsustainable.

[PhilipSZacarias]

Very good report. I have found that intermittent low dose THC (4-5 mg) at bed time also helped with cognitive function and secondarily obtaining a good nights rest. Cheers, Phil

[PhilipSZacarias]

I should have mentioned that intermittent fasting, that is eating only within a 6 to 8 hour window, also resulted in losing 10 lbs and feeling more alert. Cheers, Phil

[MJCA]

I guess I am the exception to the rule.

I believe I am on my sixth round of Lupron now with Erleada and Xgeva (I refer to it as the holy trinity). Over the years, I gained a lot of weight. Had gastric sleeve 4.5 years ago. Lost 206 pounds.

So, my diet is basically Keto (hi protein/low carb). The trinity causes lots of nausea and gastric upset. I am mainly a pescatarian.

I have lost another 20 pounds. I now wear Boy’s size 18 pants 🤪. Cognitive function sucks, but I smoked a lot of 🍁. I have quit. Don’t feel as foggy. I will see if that assists with cognitive function.

Hell, I am young. Diagnosed age 45, just turned 60.

[MateoBeach]

Thanks all for the feedback and perspectives.

My most recent ADT was from degarelix with estradiol patches. As for duration, at 3 months after last injection my T was still 11. Now at 4 months it is 48, so that is the washout period.

I am not staying off of ADT long term because I am metastatic (N1 at least).

At 3 months after RT for pelvic nodes seen on PSMA scan I hit PSA nadir of .138. This month it rose to .185 indicating 1) the RT did not cure my oligometastatic PC and that I have other non-identified sites of metastasis.

I am interrupting my ADT to allow for T recovery to maximize PSMA expression for my first round of Lu-PSMA treatment in April. I will also get a repeat Ga-PSMA scan at that time in Australia.

And most interesting: I have received approval for compassionate use of Veyonda in conjunction with the Lu-PSMA treatment similar to the LuPIN Trial of Noxopharm. Hoping, not expecting it is a home-run for me.

I will resume ADT after the first treatment cycle in April.

Yes I have been on both the metformin and keto diet with intermittent fasting (one meal a day) for the three months. Now that I am (happily) back at ideal weight I will back off the intensity to a maintenance program.