by Dr./Professor Alvin Berger
We must nurture our brain at all life stages, but particularly as seniors. The brain is the largest user of glucose in the body. But with aging, it’s harder to utilize glucose for energy due to insulin resistance and other factors (Nugent et al. 2016). Medium chain triglycerides (MCT), particularly C8-MCT, provide a non-insulin-dependent brain energy source via conversion to beneficial ketone bodies (KBs; Courchesne-Loyer et al. 2017). KBs are also produced during periods of low food intake (fasting), carbohydrate restrictive ketogenic diets, starvation, and prolonged exercise. A 20-70 gram daily MCT dose improved various cognitive outcomes in persons with mild-to-moderate Alzheimer's disease (AD; Cunnane et al. 2016a).
This is a hugely important finding as there are more than 5 million Americans living with AD; by 2050, this number may reach 16 million (https://www.alz.org/facts/). But can MCTs improve cognitive functioning in cognitively normal persons? In 19-non-demented Japanese elderly men and women over 60 year’s age given 20 g MCTs (75% C8 and 25% C10), plasma KBs were elevated leading to positive effects on working memory, visual attention, and task switching (Ota et al. 2016). Exogenous ketones themselves, given as ketone body esters, lessened the decline in executive function after exhausting exercise, a key finding for competitive endurance athletes in particular (Evans et al. 2018).
Overall, there is growing evidence dietary MCTs and exogenous ketones can improve and possibly maintain and prolong healthy cognitive function in persons with and without cognitive disease, and provide benefit to endurance athletes and other populations.
In our practice, we find MCTs taken in coffee and on empty stomachs tend to cause more gastrointestinal discomfort in sensitive individuals; and this is largely remedied by taking MCTs with solid food or in smoothies and gradually acclimating to the optimal dose of 16-32 grams per day (1-2 tbsp). Also, taking MCTs in powdered and emulsified forms can benefit those with a sensitive gut (choose a dairy-free brand if you have dairy sensitivity).
Elderly persons tend to have sensitive guts, sometimes due to a life time of consuming foods they are sensitive to (like gluten); and also due to intake of concurrent medications. If the above practical guidelines are observed, elderly should be able to consume MCTs without gastrointestinal issues. Exogenous BHBs are usually sold as salt concentrates, and ketone body esters are prohibitively expensive, so at this time, MCTs may be the better choice for the elderly.
For weight maintenance, sustained energy, and the aforementioned cognitive benefits, I am a major proponent of MCTs. If I had my way, for the cognitive benefits alone, MCTs would be a staple at nursing homes and retirement homes; and part of every athlete’s arsenal.