Coconut Oil, Ketones and Alzheimer's

Friday, February 4, 2011

Dr. Veech needs an angel

Coconut oil and MCT oil provide relatively low levels of ketosis, however, the ketone ester made and studied in the lab of Dr. Richard Veech can provide levels at least 10 times as high. As noted in the article that is the subject of my previous post, the amount of energy provided to the brain is directly proportional to the level of ketones in the blood. Thus his ketone ester could provide as much as 60% of the brain's energy requirement compared to perhaps 5-10% by MCT oil/coconut oil.

There have been more than 700,000 hits on my website I am pleased that very many people now know that ketones may provide an alternative fuel to glucose in the brain for people with Alzheimer's and other neurodegenerative diseases. There must be someone out there who can help provide funding for continuation of Dr. Veech's very important work. He has only enough funding from the NIH to continue the research in his lab and production of the ketone ester until June 2011. He is in need of a charitable or government source of funding to continue just this basic work. He wishes to perform a pilot study of Parkinson's and the ketone ester. This would be a 28 day study. He lacks funding to even begin this short term study. Thereafter, he wishes to study Alzheimer's and this would require $10 to 15 million to manufacture enough ketone ester and fund the clinical trial. Alzheimer's is so complex and symptoms so variable from person to person, as compared to Parkinson's, that a two year study would be required to determine that the ester is effective.

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New brain metabolism and ketone review article

I recently received this new article that discusses in great detail what is known about brain metabolism as we age and the potential for alternative fuels to glucose to prevent or stabilize the progression of Alzheimer's disease:

"Brain fuel metabolism, aging, and Alzheimer’s disease",
Stephen Cunnane Ph.D., Scott Nugent B.Sc., Maggie Roy M.Sc., and others, Nutrition, January 2011

Here are some important excerpts from this article:

"The recent development of 11C-acetoacetate as a ketone tracer for PET studies opens a new window to compare brain metabolism of glucose and ketones in the same individual. If brain
ketone metabolism is not lower in AD or is less affected than glucose metabolism, one potential strategy to improve brain fuel availability and reduce the risk of AD that has already been targeted in clinical studies would be to develop a way to safely and reliably provide the brain with ketones as an alternative fuel to glucose..."

"Whether or not mitochondrial dysfunction reflects genetic or metabolic disturbances,
clinical trials attempting to redress the energy deficit in the AD brain suggest that cognitive function can be at least transiently improved if more fuel (glucose or ketones) can be
supplied to the brain."

"In carriers of apo E4, small areas of lower brain glucose metabolism are observed at an age
as young as 30 y old, e.g., 30-40 y before clinical onset. Indeed, we see an inverse relationship between CMRg in several brain regions and fasting plasma insulin, so brain metabolism
seems to be sensitive to even mild disturbances in systemic insulin control even if no clinical symptoms of cognitive decline are observed. Compared to non-carriers of apo E4, carriers have altered u3 [omega-3] fatty acid metabolism and higher measures of oxidative stress in the brain, both of which may contribute to a higher risk of early onset of brain hypometabolism. If brain hypometabolism can be present before clinical symptoms are apparent, this does not prove that hypometabolism is the earliest event in AD. However, to the best of our knowledge, hypometabolism is currently the earliest measurable abnormality in the brain that is connected to AD so its features and the reasons for it should shed light on the etiology of AD."

"The cerebral metabolic rate of ketones (CMRk) varies directlywith their blood concentration, starting at very low ketone concentrations...Hence, at a plasma b-hydroxybutyrate [one of the primary ketone bodies] concentration of 0.3-0.5 mM, such as can be achieved during 12-24 h fasting, b-hydroxybutyrate supplies 3-5% of whole brain energy requirements. As plasma ketones rise, CMRk also rises such that at a b-hydroxybutyrate of about 1.5mM, ketones provide about 18%, and at 6 mM, they provide about 60% of brain fuel." [Dr. Richard Veech's ketone ester can provide levels this high].

"Acute, controlled human experiments show that ketone infusion or ketogenesis inhibits the cognitive and behavioral sequelae of acute, experimental hypoglycemia, both in healthy
adults and in type 1 diabetes. It is generally assumed that the cognitive effects of hypoglycemia can be prevented by ketones because they seamlessly replace glucose to meet the brain’s energy requirements. However, acutely raising plasma ketones also increases cerebral blood flow in humans, an effect that may contribute to their beneficial impact on cognition during hypoglycemia. Studies in humans and animal models suggest further protective effects of ketones in the brain after ischemic insult [lack of oxygen/stroke] and other treatments damaging neuronal function."

"More recent controlled clinical trials confirm that short-term improvement can occur in cognitive tests when individuals with mild to moderate AD are provided with an exogenous source of glucose, ketones, insulin, or insulin sensitizers. These clinical studies show that the
affected brain regions in AD are at least partially viable and that cognition can improve when exogenous fuel supply to the brain is increased. In two of these studies, ketogenic supplements
based on medium chain triglycerides were used, thereby permitting a relatively normal choice of meals. Medium chain triglycerides have long been known to be ketogenic because they contain medium chain fatty acids (octanoic [8:0] and decanoic [10:0] acids), which do not require activation by CoA to enter mitochondria. The mild beneficial effects on cognition and relatively good tolerance to the doses of medium chain triglyceride used are promising, notwithstanding the possibility that carriers of apo E4 with AD derive little benefit from this treatment [Dr. Newport's comment: per one of the authors of the MCT oil studies, many of the ApoE4+ individuals did experience improvement, as a group when data was combined on the average they did not]. The explanation for the beneficial effect of mild, experimental ketonemia on cognition in AD may be as simple as exchanging one brain fuel for another as occurs in
fasting or starvation. It may also be due to the observation that although glycolysis may be impaired in the AD brain, CMRk and metabolic capacity to use a fuel other than glucose may
both be relatively normal in AD."

"...two observations in particular support the notion that the neurons affected in AD are still functional: (1) in AD, brain ketone uptake is apparently normal or at least less impaired than is glucose, and (2) there is a functional response to nutritional supplements that increase brain fuel
availability, particularly ketones. Hence, if brain fuel metabolism could be optimized or even partially returned toward normal, the risk of further cognitive decline may diminish. Raising plasma ketones to 0.4-0.5 mM would contribute to 5-10% of the brain’s energy requirements, which is equivalent to the early cortical glucose deficit in those genetically at risk AD. Such a mild, safe level of ketonemia is achievable with ketogenic supplements, so if implemented before symptoms develop, it seems plausible that they could diminish the risk of further metabolic deterioration and clinical onset of cognitive decline."

Regarding Omega-3 fatty acids:

"The u3 [omega-3] polyunsaturated fatty acid, DHA, is now widely understood to have an important role in mammalian brain development...Insufficient dietary intake of DHA and low levels of DHA in the hippocampus may have a role in cognitive decline in the elderly and/or AD. Hence, the low intake of DHA now widely but not universally reported in AD may contribute to the evolution of cognitive decline because of its role in brain glucose transport and in other aspects of brain function and structure. This emerging role of DHA in brain energy metabolism could be linked to the early presymptomatic onset of brain glucose hypometabolism in AD, at least in carriers of the e4 allele of apoE4. Nevertheless, such an effect probably involves relatively subtle changes in DHA metabolism because plasma DHA appears to be higher in the healthy elderly and is widely variable in AD."

Dr. Newport's comments:

The bottom line here, to try to prevent or stabilize AD, include medium chain fatty acids (coconut oil, palm kernel oil and MCT oil are the richest sources) in the diet to provide ketones as an alternative fuel to glucose AND eat fish (especially salmon) and/or take a supplement of marine based omega-3 oil (fish oil for most of us; algae based oil for vegans found in brands that are marketed to pregnant women).

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Mirrors and Windows - Temporary solutions

This post has nothing to do with coconut oil!

Many people with Alzheimer's have an interesting interaction with mirrors, windows and other reflective surfaces, sometimes pleasant and other times not so pleasant. This may be more prominent in the evening when dark windows may present disturbing images. We have seen some of this in Steve with glass doors and windows facing our courtyard that were not covered with curtains. He feels like there are a lot of people/strangers in the room when he sees reflections in a dark window.

In our kitchen, we put up sheer cafe curtains with a spring rod that can easily be readjusted to any height. The curtains are positioned so that the top is just above his eye level. For the glass doors I also put up sheers that are positioned to allow light to come in above and below, but again reach to just above eye level to eliminate the reflection.

There is also privacy film that can be placed on mirrors or windows as an easier solution than taking down the mirrors. We used some of this on the sidelights to our doors. I have found this at stores such as Home Depot, and Bed Bath and Beyond. There are two types - one is very much like holiday window decorations, that sticks easily to the surface and peels right off. There is another type, much harder to install, that requires spraying the surfaces with water then burnishing out the bubbles with a squeegy; this is much more difficult to use and would probably be a nightmare to remove as well. Both types have a number of different patterns available.

In restaurants, the person may be more comfortable if facing away from any dark reflective windows, if at all possible. If you are in a restaurant and your loved one becomes unsettled, consider the possibility that window reflections could be the issue.

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ALS and Coconut Oil - A one year experience

I was very pleased to receive this email from a person with ALS who wanted to share his experience with coconut oil of more than a year duration. This person gave me permission to post about this so that it may benefit others:

"ALS started in early 2007, and officially diagnosed with FALS September 2008.

My age is 62. I started taking 4 tablespoons of coconut oil daily on November 4th, 2009. I increased it to 6 tablespoons on December 4th, 2009, and increase that to 8 tablespoons per day the first of January, 2010. I have also been taking 3 ounces (2 shot glasses) of a magnesium/water solution each day, which I started on Sept. 15th, 2009, which was before I found information about coconut oil and ketones. Following are the details of my current and previous status before taking coconut oil.

A. Current symptoms:
1. Weakness in my right leg, primarily in the gluteus maximus and related muscles affecting the knee.
2. Slight twitching in upper right leg and buttocks.
3. Excessive pain in leg knee. But, this is due to the increased workload caused by the weakness in the right one. In my younger days both knees were injured by some accidents, since then both have given me problems.
4. Poor circulation in my right leg and foot at least during these months
5. With my toes on the floor I cannot raise the rear of the right foot and leg upward.

B. Current physical limitations:
1. Walking without pain and the use of two canes.
2. Unable to pivot the right foot as far outward as with the left.
3. When sitting, am unable to raise my right upper leg up off the chair as much as the left
4. When laying face down on my stomach and my legs outstretched, am unable to bend my right knee to raise my foot upwards.

C. Changes since taking coconut oil:
1. Have normal feelings back in my right leg much like the left one.
2. Have increased muscles strength and size in the upper right leg. Also the muscles in the left leg have increased in size and strength.
3. If I place my right foot flat on the floor I can now raise my toes and the front of my foot upward. I can now tap my right foot to the music
4. When sitting I can now pull my right foot and calf backwards.
5. When sitting, am able to raise my right leg upward.
6. There is reduced bruising in my right ankle.
7. I can pivot my right foot inward and outward.
8. I can stand on my right leg a little more because it has more strength.
9. I can roll over in bed with a minimum of difficulty.
10. I can push downward with my right leg.
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D. Before taking coconut oil: (Nov. 4, 2009)
1. Difficulty walking due to weakness in my right leg.
2. My right leg felt asleep and non-responsive when walking or trying to move it
3. The muscles in the upper right leg had reduced in size to the point I could reach upward on the underside of my leg and easily feel the leg bones.
4. I had “drop-foot,” and could not pivot my right foot side to side nor raise it at all.
5. When sitting I could not raise my right leg off the chair.
6. My right ankle was very purple and bruised
7. I had extreme difficulty rolling over in bed because my right leg would not move on its own.
8. I could not push downward with my right leg at all.
9. Had very thick saliva at night.
10. Muscle vibrations in the left leg, some in the upper right arm.

In conclusion:
So far I have only experienced improvements taking the coconut oil and magnesium chloride solution. I plan to continue with both, and track my progress monthly with more detail just in case it could be of value to someone later."

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