A ketogenic drink improves brain energy and some measures of cognition in mild cognitive impairment

Abstract

IntroductionUnlike 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.MethodsFifty‐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.ResultsBrain 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.DiscussionA 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.

Ketosis After Intake of Coconut Oil and Caprylic Acid—With and Without Glucose: A Cross-Over Study in Healthy Older Adults

“…In a previous 90-day trial (27), 23% of the participants receiving an MCT-supplement discontinued the study due to tolerance problems, mainly gastrointestinal symptoms. A similar dropout rate was reported in a 6-months trial (19), and both these studies targeted patients with mild cognitive impairment. Daily MCT doses were 20 g and 2 × 15 g respectively, and intake was recommended to be with food.…”

“…In combination with the observed signaling functions of BHB (9), the hypothesis that ketones could compensate for glucose hypometabolism in Alzheimer's disease and normal aging (3) provides a theoretical framework to motivate ketogenic interventions in the field of cognitive health. As small ketogenic diet interventions (34,35), as well as interventions with MCTsupplements (19,27), have shown promising results, the next step to advance the field would be to conduct larger clinical trials in the range of 3-6 months. Combining different ketogenic mechanisms like carbohydrate restriction, scheduled eating windows and MCT-supplementation, could be a strategy to enhance flexibility and adherence.…”

“…At the given dose we expect cream to have a negligible effect on ketosis. Sunflower oil is not assumed to be an active substance of arm 2 & 3 (19), but is added to balance caloric content, and potential competition in uptake of MCFA by LCFA. Therefore, the labeling will be just C8.…”

Are ketogenic diets promising for Alzheimer’s disease? A translational review

“…One can notice that the use of Aβ or tau biomarkers, highly recommended for increasing diagnostic accuracy, was not mentioned in these studies. APOE genotyping was performed in four studies only [28,30,37,38].…”

The use of sodium DL-3-Hydroxybutyrate in severe acute neuro-metabolic compromise in patients with inherited ketone body synthetic disorders

“…Ketogenic diets have become more prevalent in the general community and in specific situations to improve cerebral health such as in pyruvate dehydrogenase complex and GLUT 1 deficiencies as well as generalised epilepsy and Alzheimer's disease [37][38][39][40][41]. The conditions in this paper are all inherited hypoketotic disorders and hence would deteriorate with a standard ketogenic diet.…”