The Nutrition Debate #325: Supplemental Ketones, a Prophylactic Strategy

In the introduction to this series (#322 here), I say, “I have become newly motivated…to introduce ketones to my body every day…as a prophylactic and perhaps therapeutic practice.” And that after I said I was motivated to continue “…to be very low carb/keto-adapted in my dietary practices.” For the new reader, I have been a Type 2 Diabetic for 30 years and an advocate of Very Low Carb eating for almost 14. With this WOE (Way of Eating), I have achieved 1) weight loss (170 lbs.), without hunger, 2) infinitely better blood sugar control, and 3) blockbuster improvements in blood lipids, specifically much higher HDL-C and much lower serum triglycerides.

This latest motivation comes from having attended the 3-day Nutritional Ketosis and Metabolic Therapeutics Conference in Tampa, FL, January 28-30. The sold-out meeting was presented by and intended for academics and clinicians (PhDs and MDs), and included many icons and luminaries in the field. As one of very few lay people attending, it was both eye opening and inspirational and a privilege to be present in this rarefied atmosphere.

My biggest takeaway was the very strong association shown in several presentations between the metabolic diseases whose incipient cause is insulin resistance at the cellular level both in the body and the brain, i.e. Type 2 Diabetes, and Alzheimer’s Disease (AD), the latter characterized by insulin resistance and glucose disregulation in specific regions of the brain. This similarity is explored in depth (for the serious reader) here in this 2008 peer- reviewed article (cited 68 times in PubMed), “Alzheimer’s Disease is Type 3 Diabetes – Evidence Reviewed,” by Suzanne M. de la Monte, M.D. I found this link on the website of Dr. Mary Newport, a conference presenter.

For the layman, Mark Bittman, former food writer at The New York Times, in 2012 wrote this opinion piece, “Is Alzheimer’s Type 3 Diabetes?” He must have seen Suzanne de la Monte on The Oz Show, where she appeared and then wrote this “fantastic and detailed summary” (Bittman), “Alzheimer’s: Diabetes of the Brain?” The best précis of the de la Monte piece, however, was in Bittman’s NYT piece. Here are selected excerpts:

“Let’s connect the dots: We know that the American diet is a fast track not only to obesity but to Type 2 diabetes and other preventable, non-communicable diseases, which now account for more deaths worldwide than all other causes combined. We also already know that people with diabetes are at least twice as likely to get Alzheimer’s, and that obesity alone increases the risk of impaired brain function. What’s new is the thought that while diabetes doesn’t ‘cause’ Alzheimer’s, they have the same root: an over consumption of those foods that mess with insulin’s many roles.”

Bittman, never one of my favorite food writers, especially after writing “VB6, Vegan before 6:00,” concluded,

“The link between diet and dementia negates our notion of Alzheimer’s as a condition that befalls us by chance. Adopting a sane diet, a diet contrary to the standard American diet (which I like to refer to as SAD), would appear to give you a far better shot at avoiding diabetes in all of its forms, along with its dreaded complications” [my emphasis on 'all'].

So far these points only make an argument for what I am already doing personally and cajoling my readers to do. However, the evidence presented at this conference, and in follow-up reading, has persuaded me to introduce ketones to my body every day as a prophylactic and/or therapeutic practice. Why? To avoid damage to the brain that evidence suggests occurs long before mild cognitive impairment (MCI) begins or is detectable. What is the rationale for this reliance on the daily availability of ketones?

“Ketone bodies are an alternative fuel for brain cells when glucose availability is insufficient,” Richard L. Veech says in this academic article in the Neurobiology of Aging: “A ketone ester diet exhibits anxiolytic and cognition-sparing properties, and lessens amyloid and tau pathologies in a mouse model of Alzheimer’s disease.” Dr. Veech is one of my (and Dr. Newport’s) favorite researchers. I quoted him in #322 and in four other blog posts going back 5 years. His 2013 piece above has already been cited in PubMed 30 times. Dr. Leech concludes:

“The present findings show that long-term feeding of ketone esters not only improved behavioral cognitive function but also decreased Aβ and pTau pathologic changes. The increase in blood ketone bodies, by either a ketogenic diet or by feeding a ketone ester, would be expected to alleviate the impaired brain glucose metabolism that precedes the onset of AD. Ketone bodies can bypass the block in glycolysis resulting from impairment of insulin function (Kashiwaya et al., 1997). Our preclinical findings suggest that a ketone ester-containing diet has the potential to retard the disease process and improve cognitive function of patients with AD.”

Thus, absent strict, daily adherence to a ketogenic diet, which is an onerous task, my “insurance” to assure the prophylactic and/or therapeutic benefit of ketone bodies on my brain metabolism is to supplement with ketones.

The Nutrition Debate #324: Supplemental Ketones: “A Case Study by Dr. Mary Newport”

In her very well received presentation at the 1^ST Nutritional Ketosis and Metabolic Therapeutics Conference in Tampa recently, Dr. Mary Newport told the story of her husband’s progressive neurodegeneration starting 13 years earlier. It is a story she had told before, and written about in 2008 here, but she still wonders, “WHAT IF THERE WAS A CURE FOR ALZHEIMER’S DISEASE AND NO ONE KNEW”? She says, “I plan to tell everyone I can…” She also encourages readers of the article cited above to, “Feel free to make copies and pass this write-up on.”

Dr. Newport’s frustration is palpable. After relating the prediction “that 15,000,000 people in the United States alone will have Alzheimer’s Disease by the year 2050,” she cites research done by the NIH’s Dr. Richard Veech:

“In 2001, Dr. Richard L. Veech of the NIH, and others, published an article entitled, ‘Ketone bodies, potential therapeutic uses.’ In 2003, George F. Cahill, Jr. and Richard Veech authored, ‘Ketoacids? Good Medicine?’ and in 2004, Richard Veech published a review of “The therapeutic implications of ketone bodies....” These articles are not found in journals that the average physician would read, much less the lay public. Unless you are researching the topic, it is unlikely that you would ever randomly come across this information.”

When Dr. Newport’s husband Steve started to show signs of progressive dementia, she thought, “Strange to have no short term memory, and yet the information was filed somewhere in his brain.” “My gut feeling is that diet has something to do with the fluctuation, but what?” Then, 8 years ago, while researching new drugs his doctors were proposing, she learned (in another drug maker’s patent application!) that “the promising ‘ingredient’ in [that “other” drug] was simply MCT oil.” “In a pilot study,” they said, “some people improved on memory testing with the very first dose.” So, Dr. Newport decided to try it for Steve. What did they have to lose, she reasoned?

The results of Dr. Newport’s beginning a therapeutic dose of coconut oil (60% MCT) for Steve are best described by these three drawings of a clock (a specific test for Alzheimer’s Disease). They are indeed pretty compelling.

  

Dr. Newport was advised that the “clock” on the left indicated Steve was “leaning more towards severe than moderate AD.” In clocks #2 and #3 there is an obvious marked improvement. Extraordinary, don’t you think? 

Dr. Newport used coconut oil with Steve “because I didn’t know at that point that I could easily buy MCT oil online.” Steve took 7 teaspoons of coconut oil twice a day, which was twice the dose in the patent-application, and sometimes more, “to make sure that there were no periods without ketone bodies circulating,” she wrote.

“As an alternative, one could take 4 teaspoons of MCT oil once or twice a day, or more often as tolerated,” Dr. Newport says. “Some people may experience a sense of ‘fullness’ or even have diarrhea after taking this much to start, but this problem can be reduced by starting with one or two teaspoons and increasing over a week or so to the full amount.” Since writing her article, MCT oil is now on the market from various manufacturers in liquid and powdered form, and will soon be available in the U.S. as a gel. I intend to use the gel, prophylactically.

Dr. Newport’s hope is that “Dr. Veech and other MCT oil and ketone body researchers get the funding they need.” As MCT oil is not patentable, Big Pharma (and the Alzheimer’s Association partly funded by Big Pharma), can’t profit by it, so why should they spend on the RCTs to prove efficacy? But you don’t have to wait to try this “treatment,” either as a therapeutic or prophylactic practice. What have you got to lose?

The Nutrition Debate #323: Supplemental Ketones, a Therapeutic Strategy

One of the distinct highlights of the 1^st Annual Nutritional Ketosis and Metabolic Therapeutics Conference in Tampa, FL, January 28-30, 2016, was a presentation, “Hyperketonemia for Alzheimer’s Disease – A Case Report,” by Dr. Mary Newport. I was privileged, by chance, to have had supper with Dr. Newport two days earlier.

Dr. Newport’s presentation was both professional and very personal. It was the story of the 13-year travail supporting the course of treatment of her husband’s Alzheimer’s disease (AD) and how she learned about supplemental ketones as an adjunctive therapy. Her talk received a sustained standing ovation. The story is documented in Dr. Newport's article, “What If There Was a Cure for Alzheimer’s Disease, and No One Knew?”

“Brain cells, specifically neurons,” Dr. Newport wrote, “are very limited – more limited than other cells – in what kinds of fuel they can use to function and stay alive. Normally, they require glucose (sugar), but they can also use ketone bodies.” “In Alzheimer’s disease,” she continues, “the neurons in certain areas of the brain are unable to take in glucose due to insulin resistance [IR] and slowly die off, a process that appears to happen one or two decades before the symptoms become apparent”(my emphasis). Note the similarity here to IR in Type 2 Diabetes.

“If these cells had access to ketone bodies, they could potentially stay alive and continue to function,” she reasoned. However, she noted, “Humans do not normally have ketone bodies circulating and available to the brain unless they have been starving for a couple of days or longer, or are consuming a ketogenic (very low carbohydrate) diet, such as Atkins.” Ergo, unless we’re starving, or strictly dieting such that we are in ketosis, or fasting, as we age everyone is at risk. This then, for me, constitutes a rationale to supplement with ketones.

So, what are ketones, aka ketone bodies and ketoacids? They are products of the metabolism of medium chain triglycerides (MCTs), which break down to fatty acids and ketone bodies. MCTs are saturated fats, available commercially in oil form and composed of caproic and caprylic acid (6 and 8 carbon chain compounds). What is unique about MCTs is that they are metabolized differently from other saturated fats. They go immediately to the liver, and are there utilized directly for energy. The other saturated fats, the long chain fatty acids (LCFAs) are absorbed by the lymph system and circulate throughout the body, with some being used to fill your fat cells!

The most common food product containing MCTs is coconut oil, now widely available in grocery stores. Refined coconut oil is about 60% medium chain fatty acids (MCFAs), 30% LCFAs, 8% MUFAs and <2% PUFAs, but all of them omega 6s. It “contains no cholesterol and also contains omega-6 fatty acids [but virtually no omega-3s]…,” So, Dr. Newport says, if you plan to get your supplemental ketones with coconut oil, she stresses that since “it contains no omega-3 fatty acids, it is very important to eat salmon twice a week or get enough omega-3 fatty acid from other rich sources such as fish oil capsules…” for ω-6:ω-3 balance!

Another source of MCTs is palm kernel oil. Dr. Newport relates, that“…after coconut and palm kernel oil, the food that medium chain triglycerides are most concentrated in is human breast milk.” So it must be good for us, right?

Products comprising 100% MCT oil are also available in some health food stores and are easily obtainable online.

But who knew? As Dr. Newport laments, the benefits of MCTs as a therapeutic protocol for the treatment of impaired cognition, or decades earlier as a prophylactic strategy, are little known and less recognized and/or appreciated. Dr. Newport herself unearthed it while researching drugs prescribed for her husband. She found another drug in which in a pilot study some subjects “improved on memory testing with the very first test.”

And she found that “the promising ‘ingredient’ in [that drug] was simply MCT oil, and that a dose of 20 grams (about 20 ml or 4 teaspoons) was used to produce these results.” Translated to coconut oil (60% MCTs), Dr. Newport estimated that her husband “would need to take 35 grams or just over two tablespoons (about 35 ml or 7 level teaspoons) of coconut oil.” How did this all work out? The results will be the subject of the next column. 

The Nutrition Debate #322: Ketosis, the Ketogenic Diet and Supplemental Ketones: An Overview

The National Institutes of Health researcher, Richard L. Veech, addressing KETOSIS, said it best (to Gary Taubes):

"Doctors are scared of ketosis. They're always worried about diabetic ketoacidosis.

 But ketosis is a normal physiologic state. I would argue it is the normal state of man.”

I have been writing about Ketosis and NUTRITIONAL KETOSIS (before it had its new moniker) in various posts for about 5 years. More recently, Amy Berger, a blogger at TuitNutrition.com, put together an excellent 3-part series on the subject starting here. You need go no further than Amy’s series for all you need to know about the similarities and differences between “very low carb” and “keto-adapted.” It’s an excellent source for those who want to lose weight, including those with Metabolic Syndrome, Pre-Diabetes and Type 2 Diabetes.

The therapeutic KETOGENIC DIET has been around since 1921 when Russell Wilder developed it for the treatment of childhood epilepsy. He also developed the formula for the ketogenic/glucogenic ratio (K:G). The keto fraction in the original ratio is about 90% fat, with adequate protein and de minimis carbohydrates.

Both Nutritional Ketosis and the therapeutic Ketogenic Diet are dietary regimens with specific targets; the first is broad and the second narrow but starting to explode. The broad goal of Nutritional Ketosis is primarily 1) easy weight loss without hunger, 2) improved control of glucose metabolism for treatment of metabolic disorders like Pre-Diabetes and Type 2 Diabetes, and 3) huge improvements in lipid (cholesterol) and inflammation markers.

The narrow goal of the therapeutic Ketogenic Diet was (and is) the treatment of drug-resistant epilepsy. Today, however, there is a burgeoning interest in researching the KETOGENIC DIET as an adjunctive therapy for many other serious medical conditions including Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, multiple sclerosis, ALS (Lou Gehrig’s disease), and various types of cancer.

Years ago I heard Eugene Fine lecture on the alternative use of ketones as “brain food” in the treatment of brain cancer, specifically glioblastomas. Brain cancers “feed” on glucose, but while fatty acids (catabolized from triglycerides) can’t cross the blood-brain barrier, ketones, a byproduct of the breakdown, can.

While interesting to me at the time, glioblastomas comprise only about 15% of all brain tumors and brain tumors only about 2% of all cancers. Recently, however, I attended the 1^st Annual Nutritional Ketosis and Metabolic Therapeutics Conference in Tampa, FL, and I gained a totally new perspective on ketones. In this 4-part I will share my lay perspectives from this 3-day event with you. Spoiler alert: It has transformed my thinking. I’ve had an awakening.

But today I will just describe what I saw as the component constituencies and then give you my main takeaway. Remember, this is from the perspective of an old, type 2 diabetic; as such, what I shared in common with most people over 50 (before changing my Way of Eating), is a diet-related, genetic expression of a metabolic disorder, and related body-weight issues (obesity), high blood pressure (hypertension) and “high” (they say) cholesterol (dyslipidemia). All these things, epidemiologically speaking, put me at much greater risk of a passel of diseases.

The conference was organized by PhDs at the University of South Florida and was attended by many iconic PhDs and MDs in the field. Subject matter was diverse and included plenary and break-out sessions to accommodate the different constituencies. The two main themes in the break-out sessions were, as the name implies, 1) nutritional ketosis and SUPPLEMENTAL KETONES for performance athletes, and 2) metabolic therapies, also with SUPPLEMENTAL KETONES, for diseases including brain cancer and Alzheimer’s Disease (AD), both for the same reason: Ketone bodies are the preferred “brain food” and easily cross the blood—brain barrier.

In the following columns I will not explore supplemental ketones from the performance athlete’s perspective. I will, however, tell you how I have become newly motivated 1) to not just be very low carb/keto-adapted in my diet (but not particularly interested in how my urine scores on a keto strip – I never was), and also 2) to introduce ketones to my body every day for the rest of my life as a therapeutic and perhaps prophylactic practice.