Tuesday, April 12, 2016

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

One of the distinct highlights of the 1st 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. 

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