In this issue of our Technical Series we focus on Alzheimer’s disease and MCTs.
Currently, more than 5 million Americans are living with Alzheimer’s. By 2050, this number could rise as high as 16 million (https://www.alz.org/facts/). As we noted in our last Newsletter, there is intense interest to study the effects of medium chain triglycerides (MCTs) for Alzheimer’s disease.
Herein, we will be describing changes to endogenous (made in the body) ketone bodies. Ketone bodies are byproducts of fat metabolism and MCT metabolism. Ketone bodies are water-soluble molecules produced by the liver from fatty acids (and also acetyl coenzyme A) usually during periods of low food intake (fasting), consumption of carbohydrate restrictive ketogenic diets, starvation and prolonged intense exercise.
Ketone bodies formed from MCTs (and potentially exogenous ketone bodies) may function as an alternative fuel for cerebral neurons, and have other physiological mechanisms, to improve cognition. A neuron, also known as nerve cell is an electrically excitable cell that processes and transmits information through electrical and chemical signals. Neurons are major components of the brain and spinal cord of the central nervous system
In a recent double-blinded placebo-controlled study, scientists examined effects of Ketonformula®, a powdered water soluble emulsion, containing 20 g (5 teaspoons; or about 1 ¼ tablespoons) MCTs, on cognition in 19 non-demented Japanese elderly men and women over 60 year’s age (range, 63-69), who underwent neurocognitive tests 90 and 180 min after the meal 31. The MCT fatty acids were about 75% C8 and 25% C10. Plasma ketones (like blood ketones) increased after the meal vs. control. Participants in the placebo-control group were not given MCT oils.
Generalized descriptions of the cognitive tests employed in the study are listed below.
- Digit Span test (Wechsler Memory Scale-revised version): focuses on the ability of an individual to hold a sequence of numbers in memory. For example, the ability to memorize a phone number long enough to write it down. It’s an important cognitive test, since everyday tasks depend on remembering sequences of information.
- Trail-Making Test (Wechsler Memory Scale-revised version): a neuropsychological test of visual attention and task switching. It consists of two parts in which the subject is instructed to connect a set of 25 dots as quickly as possible while still maintaining accuracy.
- Letter-number sequencing Digital Span test (Wechsler Adult Intelligence, 3rd Edition): Examiner presents combinations of letters and numbers, from 2 to nine letter-number combinations. Examinee must repeat each series by, first, repeating the numbers in ascending order, then the letters in alphabetical order (e.g., 9-L-2-A; correct response is 2-9-A-L). Measures "working memory," the ability to simultaneously recall and organize stimuli of different, similar types. This also is a standard test on the Wechsler Memory Scale-III.
- Global Score: used to evaluate the integrative cognitive function of participants. The global cognitive score was obtained by calculating the sum of the scaled scores of the letter-number sequencing Digital Span test and the Trail-Making Test B and the average of all s scaled cores of the attention task (digit span, visual memory span, and Trail-Making Test A).
Improvements were observed in the Digit Span Test, Trail-Making Test B, and the Global Score. The change in executive functioning score was positively correlated with plasma betahydroxybutryate (BHB; a primary ketone body) level.
Cognition-enhancing effects were observed mainly for those with relatively low global scores at baseline versus those with a higher score. This finding is very exciting, because low cognitive functioning individuals in the group experienced the best improvement.
The meal containing MCTs had positive effects on working memory, visual attention, and task switching in non-demented elderly. Results demonstrate to us that MCTs can benefit cognition, even when there is no apparent dementia. With a proper adaptation to MCTs (per our guidelines), and with some caution due to possible drug interactions (elderly consuming many drugs), in the future, we expect to see vast elderly populations consuming MCT oils. It is expected that pure C8 MCT oils such as KetoMCT may be more potent than the C8:10 blend used in this study, since C8 fatty acids are more ketogenic (raising of ketone bodies) than C10 and will provide faster/more energy to the brain.
Ota, M., et al., Effect of a ketogenic meal on cognitive function in elderly adults: potential for cognitive enhancement. Psychopharmacology (Berl), 2016. 233(21-22): p. 3797-3802..