1. COCONUT OIL & ALZHEIMER’S DISEASE
Ketones as Fuel for Neurons
Dr. Mary Newport
November 2009

2. Steve Newport 2009

3. Steve Newport
BSBA in Accounting from Xavier University, Cincinnati, Ohio
Worked for 9 years as accountant/office manager for mental health centers until 1980
1980’s to Worked from home for medical practice – accounting, management, billing, while caring for our children
Computer wiz
Loves landscaping, cooking, reading novels, kayaking
Can fix anything, invents tools

4. Onset Of Alzheimer’s Disease
Early clues (retrospective):
Grade School:
Couldn’t remember rules of football
“Fired” as altar boy – couldn’t remember flow of the service
Early adult:
Couldn’t catch on to card games
Did not feel he was functioning as well in accounting/ office manager position by late 20’s
30’s and 40’s
Hoarding – amasses garage full of “stuff”

5. Onset Of Alzheimer’s Disease
Age 50-51:
Frequently forgets appointments even with 30 minute reminders
Often loses wallet and keys
Age 51-52:
Payroll errors
Procrastinates with tax reports
Misses deadlines
Can’t remember going to bank and post office
Misplaces important mail
Psychiatrist believes it is depression rather than dementia - starts anti-depressants and counseling

6. Mild to Moderate Alzheimer’s Disease
Age 56:
Can no longer follow map – gets lost in New Port Richey
Misses turn and ends up in Jacksonville
Can’t remember how to turn on windshield wiper
Confusion at tollbooth
Gives up driving
Stops reading – can’t explain why
Often walks around house and yard with one shoe
No matching pairs of shoes in the house!

7. Moderate Alzheimer’s Disease
Age 57:
Doesn’t recognize some relatives at family reunion – lost and confused
Loses 10 pounds in 3 weeks – no longer preparing meals for himself
Develops intention tremor and problem with keeping food on fork
Develops jaw tremor when talking
Gait becomes slow, can no longer run
Forgets that he “sired” older daughter
Personality and sense of humor fading
Takes lawn tractor and vacuum cleaner apart
difficulty spelling simple written words, such as “out” and “put,” and trouble recalling many common words when speaking

8. Clinical Trials Age 58 (May 2008):
Participates in ADRC annual evaluation and screens for vaccine trial at Johnnie Byrd
MRI: “Diffuse involutional change of frontal and parietal lobes and moderate left-sided and severe right-sided amygdala and hippocampal atrophy with no ischemic change, which would support a clinical diagnosis of Alzheimer’s disease.”
Scores only 12 of 30 on MMSE
Doesn’t qualify for study – told to try again in a couple of weeks

9. Clinical Trials
Scheduled for screenings for 2 different clinical trials May 20 and 21, 2008
Late night internet research “risks and benefits”
Learn about Accera product, Ketasyn, now called Axona – read patent application
Active ingredient is medium chain triglyceride oil – derived from coconut oil
47% in pilot study had significant improvement in memory (ADAS-COG,) the rest declined minimally

10. Glucose is the usual source of energy for neurons (brain cells).
Glucose as Energy
Glucose is the usual source of energy for neurons (brain cells).

11. Glucose as Energy
In certain diseases, neurons and/or other brain and nerve cells have a problem with transporting glucose into the cell and essentially starve and die.

12. “Diabetes of the Brain”

13. PET SCANS FOR GLUCOSE UPTAKE
NORMAL BRAIN
ALZHEIMER’S BRAIN

14. ALZHEIMER’S VS. NORMAL BRAIN

15. Medium chain triglycerides converted in liver to Ketones

16. Ketone Bodies

17. Ketones: Metabolism’s Ugly Duckling
Theodore B. VanItallie, M.D., and Thomas H. Nufert, B.A. Nutrition Reviews , Vol. 61, No. 10

18. Ketones can be taken up by neurons that cannot use glucose
KETONES AS FUEL
Ketones can be taken up by neurons that cannot use glucose

19. KETONES CONVERT TO ENERGY IN NEURON= +

20. Neuron Can Function And Stay Alive

21. Theodore B. VanItallie, Metabolism Clinical and Experimental
Diagram from: Parkinson disease: primacy of age as a risk factor for mitochondrial dysfunction
Theodore B. VanItallie, Metabolism Clinical and Experimental
57 (Suppl 2) (2008) S50–S55

22. Normal neurons can use glucose or ketones
but usually use glucose if available

23. For neurons that cannot use glucose, Ketones can serve as an “alternate fuel.”

24. DAY BEFORE COCONUT OIL INTERVENTION
Steve screens for clinical trial in St. Pete
Scores only 14 of 30 on MMSE, needs 16 to qualify
Doctor asks him to draw a clock – consistent with moderately severe Alzheimer’s
We pick up coconut oil on the way home
More internet research, learn about medium chain triglycerides, ketones

25. HOW MUCH? Coconut Oil is 60% MCT oil
4 teaspoons MCT Oil or 7 teaspoons Coconut oil provide same amount of
medium chain triglycerides

26. 1st DAY OF COCONUT OIL INTERVENTION
Receives at least 35 grams coconut oil with breakfast
Screens at Johnnie Byrd Center for vaccine clinical trial
Scores 18 of 30 on MMSE
Qualifies for study

27. First Days after Coconut Oil Intervention
Begins daily consumption of coconut oil
Measured dose at breakfast, cooking and other coconut containing foods for dinner
More alert - Personality and sense of humor resurface
Steve says the “light switch came back on” and the “fog lifted”
Facial tremor disappears
Intention tremor infrequent

28. 14 Days After Starting Coconut Oil

29. 37 Days After Starting Coconut Oil

30. Steve’s Clocks DAY BEFORE COCONUT OIL 14 DAYS ON COCONUT OIL

31. More Research
Ketones, medium chain triglycerides, fatty acids, coconut oil
Dr. Richard Veech/NIH – Ketone expert
Ketone ester (beta-hydroxybutyrate)
Suggested ketone levels

32. Ketone Ester Dr. Richard Veech – NIH-Rockville, MD
Became interested in studying ketones in early 1990’s
Developed an ester of ketone body beta-hydroxybutyrate – oral or IV
Can achieve levels comparable to starvation – 10 x coconut oil or MCT oil levels
No adverse effects in recent human toxicity testing
Needs funding to mass produce for testing in AD and other diseases

33. 35 grams (7 teaspoons) coconut oil with breakfast and with dinner

34. 20 grams (4 teaspoons) medium chain triglyceride oil (C:8)

35. Expanded Coconut Oil Intake
As a result of levels with coconut oil also used measured amounts at lunch and dinner
Mixing coconut oil and MCT oil
Substituting foods with MCTs for others:
Goat’s milk and cheese for cow’s milk and cheese
Coconut milk for other liquids in cooking

36. Between 2 - 4 months after Intervention
Visual disturbance resolves
Normalization of gait – able to run again
Completes household and gardening tasks with minimal to no supervision and without distraction
Wears both shoes and keeps pairs together
His ability to initiate and continue a course of conversation improves
Recognizes family members that he couldn’t recall one year earlier
Family says he no longer looks lost, conversation makes sense

37. Between 4 -10 Months After Intervention
Conversational skills continue to improve
Reading comprehension improves
Short term and recent memory improves
Stops having episodes of near syncope
No longer depressed – Says, “I have my life back.”
Wants to do more with his life - volunteers in hospital warehouse
Vacuums, cuts grass and weeds gardens again (instead of taking equipment apart!)

38. Getting the Message Out
Family confirms Steve has improved
Article: “What If There Was a Cure for Alzheimer’s Disease and No One Knew?” July 2008
Sent letters to high profile persons to investigate MCT oil studies and make public aware
Chicago ICAD conference
Grass roots method/internet
St Petersburg Times article October 2008
Website:
Legislators March 2009

39. Diseases With Decreased Glucose Uptake into Brain/Nerve Cells
Alzheimer’s disease
Parkinson’s disease
Multiple sclerosis
Huntington’s chorea
ALS/Lou Gehrig’s disease
Duchenne muscular dystrophy
Some forms of autism
Down’s syndrome –develop Alzheimer’s disease by ages 30-40
Acute brain injury, accompanied by lack of oxygen
Type I and Type II diabetes

41. Other Reported Improvements
Parkinson’s disease
Multiple sclerosis
Improved blood sugars in type II diabetes
Down’s syndrome
Bipolar disorder
Glaucoma
Macular degeneration
Cognition in elderly dog

42. Foods with Short and Medium Chain Fatty Acids
Fats/Oils:
Coconut oil 59%
Palm Kernel Oil 54%
Babassu Oil 55% (Amazon palm)
Ucuhuba butter 13% (Amazon tree seed)
Butter %
Nutmeg Butter 3.1%
Sheanut Oil 1.7%

43. Foods with Short and Medium Chain Fatty Acids
Per 8 ounces:
Goat Milk grams
Whole Cow Milk grams
Human breast milk grams
Infant formula grams
Cottage Cheese grams

44. Foods with Short and Medium Chain Fatty Acids
Per ounce:
Goat cheese 2.0 grams
Feta cheese grams
Cream cheese grams
American cheese grams
Mozarella grams

45. Newborns and Ketones
Newborn develops “ketosis” at onset of breastfeeding
Ketones provide 25% of energy requirements during first weeks of life
Even with equivalent amount MCTs in formula, same degree of “ketosis” doesn’t occur – missing factor?

46. Newborn MCFAs Equivalent in Adult
10 pound breastfeeding baby gets about 3.12 grams MCFAs per quart breast milk =
47 grams MCFAs for 150 pound adult =
5.5 tablespoons of coconut oil

47. Coconut Oil Equivalents
Coconut oil - 1 tablespoon =
Coconut Milk (undiluted) – 4 ½ tablespoons
Coconut meat – 2” x 2” x ½” piece
Coconut grated – 1/3 cup
Coconut oil capsules (1 gm) – 14 capsules

48. Use only NON-HYDROGENATED Coconut Oil

49. START SLOW Common effect – Diarrhea
Begin with 1 teaspoon and increase slowly
Start on a day when you don’t have to go somewhere immediately!
Take with other food
Can take it slowly during meal over minutes
Some foods may help retain oil – cottage cheese
Try grated coconut or coconut milk as alternative for part of “dose”

50. Food Ideas
Use coconut oil instead of butter on toast, English muffins, bagels, grits, corn on the cob, potatoes or sweet potatoes.
Add coconut oil or coconut milk to your favorite smoothie recipe.
Mix coconut oil into:
Oatmeal or other hot cereal.
Rice, vegetables, noodles, pasta.
Half and half with salad dressings.
Soup, chili or spaghetti sauce.

51. Food Ideas
Use a measured amount of coconut oil to stir fry or sauté any of your favorite dishes.
Purchase or make coconut macaroons made from all natural products.
Make Coconut oil “fudge”
Eat a 2” x 2” square of raw coconut for a snack to provide 15 grams of oil.
Add flaked or grated coconut to hot or cold cereal, yogurt, fruit or vegetable salads

52. Mixing MCT and Coconut Oil
Reason: to achieve higher and continuous levels of ketones
One combination:
MCT Oil 16 ounces + Coconut oil 12 ounces
Can emulsify with soy lethicin (about ½ teaspoon)
Start low and increase as tolerated
Take with each meal

53. Mixing MCT and Coconut Oil
Advantages:
Stays liquid when mixed
Mixes more easily into many foods
Takes advantage of properties of each oil
More portable for eating away from home

54. Do Eat Foods with Omega-3 Fatty Acids

55. Eat Whole Foods

56. Don’t Eat Foods with Transfats and Hydrogenated or Partially Hydrogenated Oils

57. Why not use just MCT oil?
Many other fatty acids of all chain lengths in coconut oil that may serve special purpose:
Supports thyroid
Anti-microbial properties – kills certain viruses and bacteria that some research implicates in Alzheimer’s and Parkinson’s
Herpes viruses
Helicobacter pylori
May be other factors in the “whole” oil that benefit Alzheimer’s and other diseases

58. Why not use just Coconut Oil?
Ketone levels higher with MCT oil
Recent evidence that medium chains cross blood brain barrier and appear to also be used by neurons as fuel

59. Cholesterol Issue
Proponents of each side of issue can find studies to support their beliefs
Large scale study with men and women of all ages needs be done to lay the issue to rest
Consider risks vs. benefits in making decision to try this intervention in Alzheimer’s and other diseases

60. Expectations
Most people will not have immediate or dramatic response and some “stabilize”
Keep a journal
Must be consistent and persistent
Cannot miss a day
If no fuel in the tank the car won’t run
Strongly suggest at least three month trial
Monitor closely if stopping this intervention
Some don’t realize how much it was helping until they stop it

61. Is there a relationship between lack of MCFAs AND AUTISM?
A Mother’s Observation: Child developed neurologic symptoms of autism after discontinuing infant formula at 18 months
Lack of MCFAs the culprit?
Do MCFAs delay onset of neuro symptoms?
Onset of autism often during second year
Parental Survey:
Most autistic children not breastfed

62. www.coconutketones.com Website for information only
Copies of article, “What If…?
Diet guidelines and FAQs
Complete articles - scientific references related to ketones that can be printed out
Interviews
Can me with questions
Updates
Blog

63. Drs. George Cahill, Mary Newport & Richard Veech
in Capitol Building – March 2009

66. KETOGENIC DIET History
Fasting used as treatment for seizures and epilepsy in biblical times and middle ages
Early 1900’s - NY Pediatrician Rawle Geyelin successfully fasted children to control seizures (15 day fast) – 18% were helped
1921 – Wilder proposed that benefits of fasting (increase in ketone bodies) could be produced by diet rich in fats and low in carbohydrates - - “ketogenic diet”

67. KETOGENIC DIET History (continued):
1924 – Peterman reports effectiveness of diet from Mayo Clinic – 51% seizure free after 2 ½ years on diet
1 gram protein per kg body weight
10-15 grams/day carbohydrate
Remainder of calories as fat
Total calories Basal Metabolic Rate + 50%
Identical to ketogenic diet used today – some variations exist – including MCT oil version – half of calories are MCT oil

68. KETOGENIC DIET Reported positive effects of ketogenic diet: Epilepsy
Alzheimer’s disease
Parkinson’s disease
Lou Gehrig’s disease (ALS)
Traumatic brain injury and stroke
Oxygen toxicity
Glioblastoma and other cancerous tumors
Weight loss

69. Brain Metabolism during Fasting
0. E. OWEN, A. P. MORGAN, H. G. KEMP, J. M. SULLIVAN, M. G. HERRERA, AND
G. F. CAHILL, JR.
The Journal of Clinical Investigation
Vol. 46, No. 10, 1967
First report of ability of brain to use ketones as fuel

70. Overnight in normal people: glucose 100% of fuel
Starvation: Ketones about 2/3 of fuel
Diagram from: Ketone Bodies as a Fuel for the Brain during Starvation - Oliver E. Owen‡ BIOCHEMISTRY AND MOLECULAR BIOLOGY EDUCATION Vol. 33, No. 4, pp. 246–251, 2005

71. FIG. 3. Concentrations of ketone bodies and free fatty acids during starvation in humans. Values are shown as the means
S.E. Ketone bodies undergo the greatest changes of all fuels during total starvation.
Diagram from: Ketone Bodies as a Fuel for the Brain during Starvation Oliver E. Owen‡ BIOCHEMISTRY AND MOLECULAR BIOLOGY EDUCATION Printed in U.S.A. Vol. 33, No. 4, pp. 246–251, 2005

72. Ketone Effects
Presence of ketone in circulation, even at low levels increases cerebral blood flow by as much as 40%
Ketones used within mitochondria to drive the chain reaction that produces ATP
Reduces generation of free radicals and at same time increases the scavengers of free radicals linked to the NADP system, such as glutathione.
Activates anti-inflammatory mechanisms

73. Ketone Effects
Presence of ketone in circulation, even at low levels increases cerebral blood flow by as much as 40%
Rectify cerebral energy metabolism (provide alternative fuel)
Protect cerebral function
Suppress cerebral edema and reduce extent of cerebral infarction in brain injury
Treat diseases involving free radical damage such as occurs in coronary reperfusion, diabetic angiopathy, inflammatory bowel disease, pancreatitis

74. Ketone Effects
“Utilizing the nerve growth/ stimulatory effects of the ketone bodies…cells that are still viable can be caused to improve beyond the state to which they have degenerated and accordingly some improvement of function will be seen in patients.”
Veech has shown in mice receiving 30% ketone ester diet, significant increase in brain peptides BDNF and NGF, compared to high CHO or high fat diet.

75. Potential Effects of Ketones
Would allow diabetics to maintain better control of blood sugars without fear of hypoglycemic consequences and thereby prevent the vascular changes in eye and kidney
May treat refractory epilepsy and other seizure related disorders currently treatable with ketogenic diet

76. D,L-3-hydroxybutyrate treatment of multiple acyl-CoA dehydrogenase
deficiency (MADD,) Johan L K Van Hove, et.al., Lancet 2003; 361: 1433–35
After a 150 mg/kg dose
of D,L-3-hydroxybutyrate, plasma physiological ketone body concentrations peaked between 0·19 mmol/L and 0·36 mmol/L after 30 min to 1 h, and remained above pre-treatment concentrations for 4 h.
Brain MRI scans were obtained before (A and D), after 2 months (B and E), and after 9 months of treatment (C and F). There is diffuse involvement of the supratentorial white matter both centrally and peripherally and in the corpus callosum (A, D). On the posttreatment scans there is a progressive change in the central white matter with a decrease in signal intensity. Cavitation can occasionally be seen (F)

78. CELL BASICS – SIMPLE DIAGRAM

79. CELL

80. Electron micrograph of cell membrane

82. CELL MEMBRANE

83. FATTY ACIDS

84. Hydrogenation produces abnormally shaped molecules called transfats
FATTY ACIDS
Hydrogenation produces abnormally shaped molecules called transfats

85. Different vehicles use different fuels
FUEL ANALOGY
Different vehicles use different fuels

86. NEURONS

87. NEUROTRANSMITTERS