Alzheimer's & Dementia: Translational Research & Clinical Interventions
Volume 4, 2018, Pages 28-36
Feasibility and efficacy data from a ketogenic diet intervention in Alzheimer's disease
Matthew K. Taylor, Debra K. Sullivan, Jonathan D. Mahnken, Jeffrey M. Burns, Russell H. Swerdlow
https://doi.org/10.1016/j.trci.2017.11.002
Highlights
• The medium-chain triglyceride–supplemented KD was feasible in very mild (clinical dementia rating [CDR] 0.5) and mild (CDR 1) Alzheimer's disease participants, as 10 of 11 participants adhered to the dietary protocol.
• The medium chain triglyceride-supplemented KD was not feasible in moderate (CDR 2) Alzheimer's disease participants as all four of these participants withdrew from the study.
• Dietary compliant participants had a 4.1-point mean improvement on Alzheimer's Disease Assessment Scale-cognitive subscale scores from baseline to the end of the diet. Alzheimer's Disease Assessment Scale-cognitive subscale improvements diminished after a 1-month diet washout period.
Abstract
... The Ketogenic Diet Retention and Feasibility Trial featured a 3-month, medium-chain triglyceride–supplemented KD followed by a 1-month washout in
clinical dementia rating (CDR) 0.5, 1, and 2 participants. We obtained urine acetoacetate, serum β-hydroxybutyrate, food record, and safety data. We administered the Alzheimer's Disease Assessment Scale-cognitive subscale and Mini–Mental State Examination before the KD, and following the intervention and washout.
We enrolled seven CDR 0.5 [so-called very mild dementia], four CDR 1 [so-called mild dementia], and four CDR 2 [so-called moderate dementia] participants. ...
Targeted macronutrient composition for the dietary intervention included approximately
70% of energy as fat (including the MCT),
20% of energy as protein, and restriction of
carbohydrate to less than 10% of energy; we sought a ketogenic ratio of 1:1 (ratio of lipid consumption in grams to nonlipid consumption in grams) or better. Energy intake requirement and targeted daily MCT dosage was estimated using the Mifflin-St. Jeor equation [24]. A monthly supply of MCT oil (Now Foods, USA), which contained a combination of C8:0 and C10:0 fatty acids, was provided at each study visit. In general, the
MCT dosage provided approximately 10% of total energy from fat during the first week and increased by increments of 10% during each successive week until reaching 40% ... We provided daily multivitamin, vitamin D, calcium, and phosphorus supplements to help prevent micronutrient deficiencies.
One CDR 0.5 and all CDR 2 participants withdrew citing caregiver burden. The 10 completers achieved ketosis. Most adverse events were medium-chain triglyceride–related. ...
[In practice], During the intervention, total fat intake increased (fat: 90.6 g vs. 166.7 g; P < .001), and total carbohydrate intake was significantly reduced (209.8 g vs. 46.0 g; P < .001).
The mean macronutrient proportion during the VHF-KD intervention was 73.4% fat, 9% carbohydrate, and 17.6% protein as energy.
Among the completers, the mean of the Alzheimer's Disease Assessment Scale-cognitive subscale score improved by 4.1 points during the diet (P = .02) and reverted to baseline after the washout.
. I've only barely skimmed it, but a few caveats largely from the abstract: it's of course a very small study; there were no controls; the "completers" (AKA "per protocol") analysis is generally considered to be bad scientific form; this comes against a background of several studies finding no effect; there was no information about apoE variant (in past studies, where there has been a hint of an effect, it's been in APOEε4 non-carriers].
