When cognitive impairment strikes the brain, ketones can come to the rescue.
That’s what researchers in Quebec found when they gave a ketogenic drink to people diagnosed with MCI. The participants drank the specially formulated beverage twice a day, with breakfast and dinner.
At the end of six months, they got some good news. Their brain had higher energy levels and they scored better on tests of episodic memory and other thinking skills.
And here’s even better news. The lead researcher says anyone with mild cognitive impairment has the potential to benefit from this discovery, and to do so right now.
Professor Stephen Cunnane says keto drinks similar to the one used in the Quebec study are safe and commercially available, and present a viable option for those facing cognitive decline.
“As a general principal, yes, go for it,” says Cunnane, a physiologist at the University of Sherbrooke Research Center on Aging. “There are several lines of investigation that show this is a legitimate approach and people should be thinking seriously about how they can integrate it into their own dietary habits.”
Cunnane agreed to speak with me shortly after his initial findings were published in May 19. He has validated the results with a larger, follow-up study that was just published in the journal Alzheimer’s & Dementia. In a wide-ranging interview, he explained to me the ingenuous way that ketones can act like a back-up battery for the brain.
In the studies, the subjects who received the keto drink had a level of ketones in the brain that was twofold higher than those who received a placebo.
And their scores on a whole variety of cognitive exams went up, too, and in direct proportion to the increase in ketones.
That, Cunnane says, was not a coincidence.
“Ketones seem to be able to help the brain out in general,” he says. “I’m happy our idea was confirmed, and that we could see the relationship between that twofold increase in brain ketones and the cognitive outcomes, and that the two seemed to be related.”
Cunnane is careful in how he talks about the study, and he encourages us to keep the findings in perspective. This is not a cure for cognitive impairment.
But for people with MCI, the power of ketones is something that can potentially help in a way few other things seem able to.
“This is one of the only ways anyone has been able to show you can potentially slow down the progression . . . by coming to the energetic rescue of the brain,” Cunnane says.
Now, brain energy can be a complicated thing to explain. But Cunnane has a way of making it easy to understand for the average person by using a simple analogy.
“It’s kind of like a hybrid car,” he says. “Once the gas gets too low in the tank, the computer in the car switches over to the electric battery. The analogy for the brain is that the ketones are the battery and the electric motor. Ketones are the alternative fuel (for the human brain) like the electric battery is the alternative fuel for the car.”
Continuing along with that comparison, here is what you need to know in order to understand why the study was conducted, what it means for you, and how to take advantage of what we learned from it to defend your own cognition.
In the brain, the main source of fuel — the “gasoline,” if you will — is something called glucose.
Glucose is a simple sugar, and a normal, healthy brain gets pretty much all the glucose it needs thanks to the carbohydrates we eat. Our diet typically includes plenty of carbohydrates, particularly grains and starches, such as bread or pasta or potatoes. Our body turns part of that carbohydrate into glucose and that’s what powers our brain.
But your brain can run low on glucose, just like your car can run low on gas.
That’s true of people with certain health problems, and it’s also true of all of us as we age. There may still be plenty of glucose being produced in our body, but the brain becomes less able to metabolize it, and starts to run low on energy. For people with MCI — and especially, Alzheimer’s — that’s even more true. Their ability to metabolize glucose drops precipitously and the brain suffers from that loss of power.
“It’s starving of glucose; it’s starving of energy,” Cunnane says.
In the human body, we have a natural, alternative source of energy called ketones. When glucose runs low in the brain, ketones have the potential to come to the rescue as a secondary source of power. But doesn’t work out that way if we are always eating carbs.
There are two reasons for that. First, our diet doesn’t deliver a lot of ketogenic energy to the brain. “If you are eating three meals a day, your ketones are contributing no more than 5 percent to your brain energy metabolism,” Cunnane says.
Worse yet, as we age, our body doesn’t produce ketones as well as it once did, and the medical conditions associated with MCI limit the body’s ability to produce ketones even further.
Yet, despite all of that, if you can get more ketones to your brain, “the brain is able to use those ketones,” Cunnane says. That’s true even of people who have MCI or early stage dementia.
So the key is to find a way to get a good supply of ketones to the brain, so they can serve as that back-up battery, and boost brain power.
In the Quebec study, that was done by having people take a keto drink twice a day for six months. The study involved about 50 people over the age of 55 who had been diagnosed with MCI. Half of them were given bottles of skim milk infused with a pair of ketogenic ingredients called caprylic acid and capric acid. Both are what’s known as medium-chain triglycerides, or MCTs. The other half got a placebo drink that was indistinguishable from the keto drink.
At the beginning and end of the study, the participants underwent a series of tests that included PET scans and MRIs, and a whole battery of cognitive exams. That allowed the researchers to demonstrate solid scientific evidence that the people who took the keto drink had a more than twofold increase in ketones in the brain, and that they saw improvement in a variety of cognitive skills.
So what types of cognition did these people do better in?
The answer, according to Cunnane, is that the improvements were broad, across a variety of cognitive domains.
“The strongest statistical effect was on language,” Cunnane says. “We also saw beneficial effects on episodic memory. We saw a beneficial effect on what’s called processing speed, which is your reaction time, and on one test of problem-solving, or what’s called executive function.
“It doesn’t seem to be a specific effect on any one type of brain function,” he says. “It seems to be more broadly distributed.”
But what about the people in the study? Did they have a particular type of MCI, such as amnestic MCI versus non-amnestic MCI? Were these people who had a diagnosis of MCI due to Alzheimer’s?
Cunnane says all types of people who had MCI and who received the keto drink appeared to benefit.
“We took a generic MCI population; we did not select for the Alzheimer’s type MCI,” he says. “We are in a small city, so we didn’t have the choice to only study those who had amnestic MCI with those who had non-amnestic MCI. But even pooling them together, blending them, we saw this beneficial effect for all.”
Given how widely this approach benefitted people with MCI and how broad the cognitive improvements were, I asked Cunnane if the keto drink used in the study is commercially available, and if people can get their hands on it if they want to see where it could help their cognition.
He told me the ketonic MCT contained 60 percent caprylic acid and 40 percent capric acid. It was given to people with MCI in eight-ounce bottles that were about 12 percent MCT and 88 percent skim milk. Participants drank four ounces in the morning and four ounces later in the day.
Cunnane says there are plenty of commercial products available that contain medium-chain triglycerides, or MCTs and he does not discourage people with MCI from considering them.
“It’s available all over the place,” he says. “You can buy it from Amazon. You can buy it from suppliers. You can make this type of drink in your own kitchen, and flavor it the way you want to.”
MCT supplements are most commonly sold as either an oil or powder, and the person can mix them into beverages they already are drinking, such as coffee, tea, shakes or smoothies.
But it’s very important to understand that not all products marketed as containing MCTs are ketogenic.
“The issue I see right now is that MCT is a generic term, and it’s for fatty acids from 6 to 14 carbons, which in practical terms means that when you buy this stuff, often you don’t know what you’re getting,” Cunnane says.
He says MCTs with c8 or c10 are the ones producing ketones, while other MCTs with a higher carbon count, such as c12 or c14, may be less costly, but they don’t offer ketones.
For instance, coconut oil is less expensive, but it has a higher carbon count and is not ketogenic.
“It’s the shorter-chain MCTs that are most ketogenic, so the 8 and 10 numbers,” Cunnane says. “And that makes it more expensive. If you buy the c8, it’s more expensive than coconut oil and more expensive than most MCTs.
“And so, how do you know what you’re buying?” he asks rhetorically. “If they’re trying to sell a lower-priced product, they’re not going to say there’s no c8 in it. So people can ask for technical info, or they can go to suppliers that are more expensive, but they know they are getting the c8 as opposed to the c12 or c14 in coconut oil.”
It’s also possible to up the ketone energy in your brain by adopting a keto diet. But that has pros and cons, compared to a keto drink.
Eating a keto diet gives your brain a more steady supply of ketones throughout the day.
“The diet is advantageous to give you a higher and especially a more consistent level of ketones in the blood,” Cunnane says. “The disadvantage of the drink is that it doesn’t raise the ketones as much as a ketogenic diet. If you take the drink at breakfast, by lunch the ketones are back at zero. This sporadic change in ketones is helpful, but it’s not consistent.”
But he says the downside of the keto diet is that it’s hard to adhere to, and often times, people can’t adjust to it.
“Most people find it hard to adapt to a diet that has less than 50 grams of carbohydrates,” Cunnane says. “They are eliminating virtually all of their pasta, rice, potatoes, bread and sugar, and that’s a big transition that can be hard to achieve. Most people don’t achieve it very effectively.”
On the other hand, drinking a ketogenic beverage a couple of times a day is something that people find easy and convenient.
“They don’t have to think too much about it,” Cunnane says. “They say, ‘OK, I take 4 ounces of this in the morning and I take 4 ounces of this in the evening and I don’t have to change what I eat, and I’m getting this free dose of ketones, so what could be better than that?’”
As our interview wrapped up, I asked Cunnane if he had any parting words to share with my readers. Here’s what he said:
“I don’t want people to over-interpret this study and expect miraculous results,” he said. “Don’t consider this as a magic bullet in any sense.
“They should be as active as they can on several fronts because there’s no one solution,” he continued. “If you have diabetes problems, for instance, try to lose weight. And doing exercise is really important. Ketones are just one part of that package.”
(And one final reminder: Always consult with your doctor when you are thinking of trying a new vitamin, nutrient or supplement.)