Podcast Summary: How Ketones Help the Brain Recover From Concussions

Podcast: The Metabolic Classroom with Dr. Ben Bikman
Host: Insulin IQ
Episode Date: November 3, 2025

Episode Overview

This episode focuses on the metabolic consequences of concussions, specifically how traumatic brain injuries impair glucose metabolism in the brain and the crucial, overlooked role of ketones in supporting brain recovery. Dr. Ben Bikman breaks down the metabolic crisis triggered by concussions, the science of how ketones can bridge the energy gap, and practical strategies—ranging from ketogenic diets to exogenous ketone supplementation—for optimizing brain resilience and recovery.

Key Discussion Points and Insights

1. Concussions as a Metabolic Problem

[02:38–04:20]

• While typically considered mechanical injuries resolved by rest, concussions create a significant metabolic disturbance in the brain.
• "When the brain is injured, its ability to generate energy from glucose declines, creating a temporary but profound and relevant energy crisis." — Dr. Ben Bikman [03:15]

Key Facts:

• A concussion is a mild traumatic brain injury (TBI) caused by physical impact that temporarily disrupts brain function.
• Symptoms may include headaches, dizziness, concentration issues, and mood changes.
• Up to 30% of individuals may experience lingering symptoms—post-concussion syndrome.

2. The ‘Energy Crisis’ in the Injured Brain

[04:21–07:40]

• The brain accounts for only 2% of body mass but consumes roughly 20% of total energy expenditure.
• After a concussion, the main energy pathway—glucose metabolism—becomes impaired at multiple stages:
  • Reduced Glucose Transport: GLUT1 (on the blood-brain barrier) and GLUT3 (on neurons) decrease after injury, restricting glucose entry.
  • Enzymatic Bottlenecks: Key enzymes in glycolysis (hexokinase, PFK) and mitochondrial entry (pyruvate dehydrogenase) are inhibited by increased calcium and oxidative stress following TBI.
• This leads to reduced ATP (cellular energy) production and increased vulnerability of neurons.
• "There's a bottleneck of glycolysis, which of course is going to sharply reduce the ability of the brain cells to produce energy in the form of ATP." — Dr. Ben Bikman [06:40]

3. Knock-on Effects: Oxidative Stress and Inflammation

[07:41–09:12]

• Disrupted mitochondrial function leads to increased oxidative stress (ROS), prompting inflammation.
• Microglia (brain immune cells) are activated, escalating the inflammatory response and exacerbating injury.

4. Ketones: The Brain’s Backup Fuel

[09:13–12:30]

• The brain can adapt by shifting to ketones—specifically, beta hydroxybutyrate (BHB) and acetoacetate—produced by the liver during fasting or carbohydrate restriction.
• Ketones cross the blood-brain barrier efficiently via monocarboxylate transporters (MCTs).
• Unlike glucose pathways, ketone metabolism operates independently, bypassing glycolytic bottlenecks.
• "It's the glucose transport that's compromised, not ketone transport. It's the breakdown of that glucose that's compromised, not the breakdown of the ketones." — Dr. Ben Bikman [10:55]
• Classic fasting studies (e.g., by Dr. George Cahill) demonstrate that the brain can derive more than two-thirds of its energy from ketones when available.

Notable Insight:

• Most people on a standard, carbohydrate-heavy diet rarely generate meaningful ketone levels due to frequent eating and elevated insulin—leaving the brain unable to access this protective fuel after injury.

5. Animal and Human Evidence Supporting Ketone Therapy

[12:31–13:18]

• Animal models show that ketogenic diets or exogenous ketones can increase brain ketone uptake by ~50%, restoring ATP and aiding neuron survival post-injury.
• Human studies (e.g., Bernini et al, 2018) confirm that blood ketone levels closely track brain ketone levels following TBI, demonstrating rapid ketone availability to the injured brain.
• "Collectively, these findings and more suggest that ketones do serve as an efficient compensatory substrate when glucose metabolism is impaired." — Dr. Ben Bikman [13:10]

6. Mechanisms: How Ketones Support Brain Recovery

[14:18–17:41]

A. Energy Provision

• Ketones sustain ATP production even when glucose metabolism is disrupted.
• Animal studies: ketones reduce lesion volume by up to 50% compared to glucose-fed counterparts.

B. Oxidative Stress Reduction

• BHB inhibits Class 1 histone deacetylase, promoting antioxidant gene expression.
• Ketogenic diets attenuate post-injury oxidative stress by boosting antioxidant defenses.

C. Inflammation Control

• Ketones dampen inflammatory responses by inhibiting the NLRP3 inflammasome (pro-inflammatory master switch).
• This modulates cytokines, shifting the brain environment from pro- to anti-inflammatory.

D. Enhanced Neuroplasticity

• BHB elevates brain-derived neurotrophic factor (BDNF), supporting neurogenesis and repair.
• Animal models indicate ketogenic adaptation improves motor recovery and preserves cell health markers (telomere length).

7. Practical Strategies for Individuals at Risk

[17:42–19:47]

• Metabolic preparedness is critical, especially for those in contact sports or with recurrent concussion risk.
• Dr. Bikman advocates for maintaining a mild state of nutritional ketosis as a preventative measure, but acknowledges that strict ketogenic diets are impractical for many athletes.
• "I submit that maintaining some level of nutritional ketosis during play or during that work may offer some preventative protection." — Dr. Ben Bikman [18:16]

Exogenous Ketones:

• Exogenous ketone supplements (particularly those with BHB or GO BHB) offer a practical solution for real-time brain fuel before, during, and after potential concussions.
• Not all ketone supplements are equal—look for “GO BHB” or “straight BHB acid.”
• Clean Form Nutrition now offers NSF-certified ketone supplements suitable for athletes.

Discount Mention:

• Dr. Bikman shares a discount code: "You can use the code BEN10… and you can get a 10% discount." [19:36]

8. Takeaway Message

[20:15–21:02]

• Concussions trigger a metabolic crisis in the brain by shutting down glucose pathways, but ketones present a safe and effective backup energy source.
• Ensuring ketones are available—through diet or supplementation—can support resilience and recovery.
• "As Dr. George Cahill demonstrated decades ago, the brain is very metabolically adaptable. It will use whatever fuel is present. Our task…is to ensure that ketones are available when the brain needs it most." — Dr. Ben Bikman [20:35]

Notable Quotes & Memorable Moments

• “When the brain is injured, its ability to generate energy from glucose declines, creating a temporary but profound and relevant energy crisis.” [03:15]
• “There's a bottleneck of glycolysis, which of course is going to sharply reduce the ability of the brain cells to produce energy in the form of ATP.” [06:40]
• “It's the glucose transport that's compromised, not ketone transport. It's the breakdown of that glucose that's compromised, not the breakdown of the ketones.” [10:55]
• “Maintaining some level of nutritional ketosis during play or during that work may offer some preventative protection.” [18:16]
• “As Dr. George Cahill demonstrated decades ago, the brain is very metabolically adaptable. It will use whatever fuel is present. Our task…is to ensure that ketones are available when the brain needs it most.” [20:36]

Important Timestamps

• [03:33] – Introduction to concussion and metabolic lens
• [04:21] – Explanation of glucose transport impairment
• [07:41] – Description of oxidative stress and inflammation
• [09:13] – Introduction to ketones as alternative brain fuel
• [12:31] – Evidence for ketone therapy in brain injury
• [14:17] – Ketones, energy, oxidative stress and inflammation
• [17:42] – Practical strategies for at-risk individuals
• [19:36] – Exogenous ketone supplement recommendation
• [20:15] – Summary and core takeaway

Final Thoughts

Dr. Ben Bikman delivers a compelling scientific breakdown of why ketones are vital for brain recovery after concussion, elevating the conversation beyond rest and mechanical repair. The episode equips listeners—from athletes to health professionals and caregivers—with a clear understanding of the underlying metabolic crisis in concussion and actionable strategies to support brain resilience.

Class dismissed. Until next time—more knowledge, better health!