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Thank you for this thread. I see this over and over in clinical practice....MCT and insulin resistance, in addition to a degradation of LDL particle size over time.
In the first few weeks, all looks good. In the long run 6 months or more...not so much. My patients that have decided to adhere to a keto diet fare the worst as far as lipid quality. When they include small amounts of whole grain fibers and focus on Omega 3, omitting MCT, cholesterol markers improve.

Good morning Nutritionmuse,
I'd like to welcome you to our ApoE4 community and thank you for your response! We'd love to learn more about you and your practice. I'm a Functional Medicine certified health coach working with clients in the Bredesen program. Emphasizing use of PU sources certainly... Have you thought about publishing your findings?

As you've just recently joined us, we highly recommend reading our site Primer written by a member practicing physician. In addition to being a great way to learn more about our community, it's truly a wonderful source of information about this ApoE4 gene of ours and offers clearly stated, prioritized lifestyle strategies focused on mitigating its effects. You'll find our site Wiki has more in-depth discussions on topics of interest to our members. For tips on how to get the most out of our website, check out our How-To-Guide. And to search our forums for topics of interest to you, just click on the magnifying glass along the upper right of this page.

Nutritionmuse, please don't hesitate to ask questions of the group at any time as they come up. And again, welcome!
dscoachRN

FWIW, here's my LDL particle size while eating a very high amount of MCT oil:

Small LDL-P: <90 (optimal)
LDL Size: 21.7 - Large Pattern A (optimal)
LP-IR Score: <25
HDL-C: 92 mg/dL

While on a more traditional keto diet, my lipids look like:

apoB: 72 mg/dL
apoA1: 192 mg/dL
Triglycerides: 65 mg/dL
LDL-C: 79 mg/dL
HDL-C: 77 mg/dL

On a higher carb diet:

LDL Size: 21.2
LP-IR Score: 27 (lower is better)
HDL-C: 58 mg/dL

I realize that this is an older thread that got bumped up, but I have to comment. I find the original cited article to be very weak. Too small of sample size, too short of a time period, and my god, look at those error bars! This was published in 2012, and I can find no follow-up research on this topic by this group since. This paper has been cited 7 times in PubMed, but none of those papers provide any support for this conclusions to this paper.

I see this over and over in clinical practice....MCT and insulin resistance, in addition to a degradation of LDL particle size over time.
In the first few weeks, all looks good. In the long run 6 months or more...not so much. My patients that have decided to adhere to a keto diet fare the worst as far as lipid quality. When they include small amounts of whole grain fibers and focus on Omega 3, omitting MCT, cholesterol markers improve.

Welcome, nutritionmuse! Help me understand. Are you abandoning the creation of ketone bodies as a goal or rather using Omega-3 fatty acids in lieu of MCT? As E4 carriers, we have a reduced utilization of cerebral glucose that precedes and accompanies symptoms of cognitive decline. As you know, ketone bodies can serve as an alternative fuel helping us to overcome that shortfall.

I wonder if your clients could learn from our community? We've spent years tweaking a ketogenic approach to yield optimal lipid and glycemic markers. One needn't use MCT to reach a ketotic state. Many of us combine fasting and exercise with nutritional ketosis to improve our numbers. Also, replacing MCT (and SFA in general) with unsaturated fatty acids from primarily whole foods (like fatty fish, nuts, seeds, avocados and high polyphenol EVOO) is another of our top tweaks. I'm a 4/4 and have used this approach for six years with no degradation of my biomarkers. At last check, LDL-P: 890, small LDL-P: <90, A1c: 4.6, BMI: 18.9.

As I understand it, whether or not MCT is insulinogenic depends on the individual's glucose status. If one is ketongenic via low carb intake, exercise, and intermittent fasting thus maintaining low blood glucose levels and supplementing with MCT in an effort to to provide fuel to the brain and full cognitive function, that's probably not insulinogenic due to the low glucose level prior to supplementation.

However if a person maintains a typical diet with elevated glucose levels (excess energy in the bloodstream) then introduces more energy (MCT), the body is going to release insulin, thus MCT is insulinogenic in most cases. Having high levels of energy sitting around in the blood stream leads to glycation and oxidation both "bad juju" for APOEe4s.

From this Optimizing Nutrition article are ketones insulinogenic and does it matter?

So if your blood glucose levels are greater than 5.0mmol/L (or 90 mg/dL), then those expensive exogenous ketones will be working just like a quick burning insulinogenic fuel, just like a dose of carbs.