Ketogenic drink improved cognition in MCI

Insights and discussion from the cutting edge with reference to journal articles and other research papers.
Post Reply
Creekside
Contributor
Contributor
Posts: 44
Joined: Fri Feb 22, 2019 7:42 am

Ketogenic drink improved cognition in MCI

Post by Creekside »

https://www.ncbi.nlm.nih.gov/pubmed/31027873

(Note, from what I can see, the patients were not following a ketogenic diet overall -- just consuming a drink with around 2 tablespoons of MCT oil.)

Abstract:
INTRODUCTION:
Unlike for glucose, uptake of the brain's main alternative fuel, ketones, remains normal in mild cognitive impairment (MCI). Ketogenic medium chain triglycerides (kMCTs) could improve cognition in MCI by providing the brain with more fuel.

METHODS:
Fifty-two subjects with MCI were blindly randomized to 30 g/day of kMCT or matching placebo. Brain ketone and glucose metabolism (quantified by positron emission tomography; primary outcome) and cognitive performance (secondary outcome) were assessed at baseline and 6 months later.

RESULTS:
Brain ketone metabolism increased by 230% for subjects on the kMCT (P < .001) whereas brain glucose uptake remained unchanged. Measures of episodic memory, language, executive function, and processing speed improved on the kMCT versus baseline. Increased brain ketone uptake was positively related to several cognitive measures. Seventy-five percent of participants completed the intervention.

DISCUSSION:
A dose of 30 g/day of kMCT taken for 6 months bypasses a significant part of the brain glucose deficit and improves several cognitive outcomes in MCI.
User avatar
TheresaB
Mod
Mod
Posts: 1607
Joined: Wed Feb 03, 2016 9:46 am
Location: Front Range, CO

Re: Ketogenic drink improved cognition in MCI

Post by TheresaB »

Too bad it costs money to access the full article, typically in such protocols such as this, after the MCTs are withdrawn, the subjects go back to where they started since this is only giving the brain an energy boost but not really healing everything.
-Theresa
ApoE 4/4
mike
Senior Contributor
Senior Contributor
Posts: 849
Joined: Fri Mar 09, 2018 4:55 pm
Location: CA - Sonoma County

Re: Ketogenic drink improved cognition in MCI

Post by mike »

TheresaB wrote:Too bad it costs money to access the full article, typically in such protocols such as this, after the MCTs are withdrawn, the subjects go back to where they started since this is only giving the brain an energy boost but not really healing everything.
If someone is starving, and you give them food, and they get better, then take the food away and they are starving again. How is this different? While this may not heal the broken glucose energy metabolism in the brain, it seems like a pretty good crutch in the meantime...
Sonoma Mike
4/4
Creekside
Contributor
Contributor
Posts: 44
Joined: Fri Feb 22, 2019 7:42 am

Re: Ketogenic drink improved cognition in MCI

Post by Creekside »

TheresaB wrote:Too bad it costs money to access the full article, typically in such protocols such as this, after the MCTs are withdrawn, the subjects go back to where they started since this is only giving the brain an energy boost but not really healing everything.
Moderator note - I deleted a link to the paper (doi: 10.1016/j.jalz.2018.12.017) because our copyright infringement policy prohibits it. Members in jurisdictions for which access to Sci-Hub is legal may want to search for the paper there.

If the only measure of success is a cure, this doesn't count.

I think of this as more like childhood leukemia, where the gains were slowly incremental...but eventually, very successful. It might also lead to further nutritionally-based research, which could be another good thing.
ncrocker
Contributor
Contributor
Posts: 35
Joined: Sun Apr 01, 2018 8:49 pm

Re: Ketogenic drink improved cognition in MCI

Post by ncrocker »

I am quoting below from an article I recently tried to read. I don't have a biochemistry background, so it was hard for me to read. It seems to be saying that the authors created a "pure" keto drink. I would appreciate it if someone could take a look at this and see if it is important. Is such a ketone ester available? If it is, why aren't we all taking it? Thanks. I found it through pubmed.

Here is the full citation:
FASEB J. 2016 Dec; 30(12): 4021–4032.
Published online 2016 Aug 15. doi: 10.1096/fj.201600773R
PMCID: PMC5102124
PMID: 27528626
Novel ketone diet enhances physical and cognitive performance
First author is Andrew J. Murray.

"The challenge, therefore, has been to elevate circulating ketone levels by using a palatable diet without altering lipid levels and thereby negating many of the desirable effects of ketone metabolism (6). Consequently, we made an orally absorbable form of ketone body by transesterifying ethyl (R)-3-hydroxybutyrate with (R)-1,3-butanediol by using a solid-supported lipase. The rationale behind our development of a ketone ester was the desire to feed an orally absorbable form of ketone without administering the cation load or acidosis that would accompany the feeding of a ketone salt (e.g., Na-hydroxybutyrate) or free acid (β-hydroxybutyric acid). (R)-1,3-Butanediol was chosen because it is converted to acetoacetate and d-β-hydroxybutyrate in the liver (18); therefore, (R)-3-hydroxybutyl (R)-3-hydroxybutyrate would yield only ketone bodies upon hydrolysis and oxidation (Fig. 1A). (R)-3-Hydroxybutyl (R)-3-hydroxybutyrate is palatable and nontoxic in rats (19) and humans (20)."
NF52
Support Team
Support Team
Posts: 2772
Joined: Tue Oct 25, 2016 9:41 am
Location: Eastern U.S.

Re: Ketogenic drink improved cognition in MCI

Post by NF52 »

ncrocker wrote:I am quoting below from an article I recently tried to read. I don't have a biochemistry background, so it was hard for me to read. It seems to be saying that the authors created a "pure" keto drink. I would appreciate it if someone could take a look at this and see if it is important. Is such a ketone ester available? If it is, why aren't we all taking it? Thanks.
HI ncrocker,
Like you, I feel like a foreign traveler without Google translate when I try to decipher many articles!
I'm adding a link to the article so others can check it out if they want: Novel ketone diet enhances physical and cognitive performance

One of my strategies when reading an dense article, especially one that has been out for a few years, is to look at the "Cited by" column on the right hand side of the NIH's PMC webite (where I found your article) to see who has cited and maybe expanded on the topic. I tried that here and came up with this 2019 article. Role of Ketogenic Diets in Neurodegenerative Diseases (Alzheimer’s Disease and Parkinson’s Disease) It suggests that multiple U.S., Canadian (Quebec) and U.K. funded research in ketogenic diets is comparing the effectiveness of various formulations. I found the article was a good overview for me of the current state of the field. And they offered this "Coming Soon" preview of research currently underway:
More evidence regarding the influence of the KD on AD will be available after publication of reports from ongoing registered randomized clinical trials sponsored by Johns Hopkins University (NCT02521818), Wake Forest University (NCT03130036, NCT03472664 and NCT02984540), Universite de Sherbrooke (NCT02709356), and the University of British Columbia (NCT02912936) [39]. In these studies, participating patients with subjective memory impairment, mild AD, and/or healthy controls were used to evaluate the impact of 6–18 weeks of the modified Ketogenic-Mediterranean diet to a low-fat diet; 12 weeks of the modified Atkins diet compared to the recommended diet for seniors to achieve a healthy eating index; 1 month treatment with the two different medium-chain triglycerides oil emulsions (40–60 oil or C8 oil), or 10 days, twice a day, and supplementation with a lactose-free skim milk drink containing either 10–50 g/day of MCT oil or 10–50 g/day of placebo (high-oleic sunflower oil).
I trust that forum users who are wise in ketogenic diets will offer their thoughts also on your question.
4/4 and still an optimist!
ncrocker
Contributor
Contributor
Posts: 35
Joined: Sun Apr 01, 2018 8:49 pm

Re: Ketogenic drink improved cognition in MCI

Post by ncrocker »

Thanks!
mike
Senior Contributor
Senior Contributor
Posts: 849
Joined: Fri Mar 09, 2018 4:55 pm
Location: CA - Sonoma County

Re: Ketogenic drink improved cognition in MCI

Post by mike »

ncrocker wrote:I am quoting below from an article I recently tried to read. I don't have a biochemistry background, so it was hard for me to read. It seems to be saying that the authors created a "pure" keto drink. I would appreciate it if someone could take a look at this and see if it is important. Is such a ketone ester available? If it is, why aren't we all taking it? Thanks. I found it through pubmed.
Ketone Esters are currently unaffordable for most folks and are mostly used in research. It does sound like it may be a solution in the future. Ketone Salts are more affordable, but have some side effects as discussed. MCT oil is another option to increase ketones, but goes through a bit more processing in the body than the salts and ketones. If you are going to use any ketone, it should probably be micro-dosed throughout the day to minimize glucose/insulin disruption. There is debate here about whether exogenous ketones in any form should be used by ApoE4s - there is old research out there that says cognitive scores did not improve for 4 carriers. Most here on the forum would say that creating ketones endogenously is better. This means that you need to eat a bunch of fat like olive oil and avocado.

This particular research broke the mice into 3 groups - but they all had high carbohydrates, so I'm not a huge fan. The one group with the ketone esters did do better than the others, but so what. Maybe down the road, you can give someone ketone esters without making them cut carbs, but it seems rather counter-productive. We need to see what someone on a keto-low carb diet to begin with does with exogenous ketones (and it sounds like from the article that NF52 provided that we will be seeing some of that research soon!).

While I have had biochem at one time, I often skip the gory details on research like this and just read the abstract, intro, discussion and conclusions. I trust that the authors or the peer reviewers got the biochem part correct, so I don't need to review...
Sonoma Mike
4/4
ncrocker
Contributor
Contributor
Posts: 35
Joined: Sun Apr 01, 2018 8:49 pm

Re: Ketogenic drink improved cognition in MCI

Post by ncrocker »

Thank you!
Post Reply