What Are Ketones? - with Dr. Mary Newport | The Empowering Neurologist EP. 11

Hello everyone, welcome to The Empowering Neurologist. I'm Dr. David Perlmutter. What if there was a cure for Alzheimer's disease and nobody was talking about it? Well, today we're going to talk to Mary Newport. Mary Newport is a medical doctor. She's board certified in pediatrics and neonatology, the study of newborns. She practiced neonatology here in Florida for 30 years and was the founding medical director of 2 newborn intensive care units in the Tampa Bay area. Now she's providing care to patients at the opposite end of the spectrum. She visits patients who are receiving what's called end-of-life care. She's also a caregiver for her husband of 43 years, Steve, who suffers from early onset Alzheimer's disease, is the subject of her work. She's the author of this book, Alzheimer's Disease: What If There Was a Cure? And also the story of ketones, and what ketones are, we're going to explore today. She has been an invited speaker on this subject for symposia really around the world, in the United States, of course, Canada, France, Greece, Germany, and even Japan. And she's also been a speaker at the MCT Symposium, the Medium Chain Triglyceride Symposium, that again focuses on powering the brain and the body with, with fat as opposed to carbohydrates. She is a member of the Institute for Human-Machine Cognition, and she has completed her fellowship in anti-aging medicine as well as regenerative medicine and has been an active member in the Weston Price Foundation as well as multiple other organizations. She's given numerous lectures for university students and for the public. She maintains a website and a blog, so we'll give out that information because it's really full of great information understanding human physiology, really focused on this important role of ketones as a fuel for the brain. She— her website we will post, but it's coconutketones.com. And I just spoke with Dr. Newport at a recent symposium, the American College of Nutrition. So today we're going to explore this book with a very compelling title again, Alzheimer's disease, what if there was a cure? So here we go. So again, it's really my pleasure today to get to talk with Dr. Mary Newport. Welcome to our program, Mary.

Thank you very much. Thank you for inviting me.

And again, we're going to be looking at this incredible book because right off the bat, you challenge the mainstream. I mean, the mainstream would like us to believe that we should sort of sit back and hope for that magic pill. But you are very challenging of that notion. Maybe we could start and take a step back and talk about how things changed with your husband and what it was like to try to explore the various options.

Right, right. Yeah, my husband, he was an accountant that worked at home for my practice for many years. He could do the most detailed forms. He was very active physically. But then when he was about 51 years old, In 2001, he started having problems with making payroll mistakes, missing tax deadlines, and then he would forget if he had been to the bank and the post office. So that was very serious. I knew that that wasn't normal. And he was also depressed at that time, and initially his doctors attributed that to depression. However, things continued to get worse. He started having problems finding his way around. He would spend hours in the garage looking for something that— and then he couldn't remember what it was, but he'd still be looking for it. Very odd behaviors. And around 2004, when he was 54 years old, he was officially diagnosed with dementia. And then about 6 months later, his physician felt, based on various tests and the progression of the disease, that he most likely had Alzheimer's disease.

At age 54, he's diagnosed with Alzheimer's disease. 54.

Yeah, this was a shock.

And what were you told back then? In 2004, what were you told you needed to do? What was the therapy? What was the course of action recommended?

Yeah, at that point, the only medication that had been approved for use in Alzheimer's was Aricept. And so when he was diagnosed with Alzheimer's, he was placed on Aricept. I was told that it might slow the progress of the disease a little bit by perhaps 6 months. But that ultimately it, you know, would not benefit him. We could not really expect improvement.

So you were given— you were given a prescription for the so-called Alzheimer's pill, but even then recognizing that it basically didn't work.

Right. And we were told that this was a lifelong commitment, that if once he started this medication, he needed to stay on it for life. If we took him off, we could expect that he would deteriorate more quickly. So, you know, that was one reason his physician hesitated initially to even put him on the drug because of the lifelong commitment that we expected. But, you know, we were not expecting to really see improvement and we didn't. We didn't— I didn't really notice anything, any change in him, but we did keep him on it because of the concerns, well, and that perhaps it would slow down the course of the disease. There

was no way to know really if it was happening or not.

And it's something your doctor said you should do.

But obviously that wasn't good enough for you, was it?

No, it wasn't. It didn't really give us hope. We wanted, you know, we would like to see him improve or at least stabilize. And there were so many times we thought if we could just freeze where we're at right now, we can live with this. But that's not the way the disease works. It just continues to cause a person to deteriorate. The memory gets worse and behaviors, odd behaviors start appearing. So this really didn't give us any hope with using Aricept.

There's a great quote that Robert Kennedy paraphrased, I think, from George Bernard Shaw, and it goes, some people see things as they are and ask why. Others see things as they could be and ask why not. So that's who you are, I guess, in this whole story. And then you began to develop an idea In recognizing the important role of brain energetics. How did that evolve for you?

Yeah, so, um, so many changes happened from 2004 when he was diagnosed now to 2008. At that point, he really— by 2006, he could no longer do any accounting, use a calculator, turn on a computer, even do simple math. And this was a man who was on a computer all day long, you know, doing accounting and And when he wasn't working on his computer, he was playing on his computer. So to see this happen in just such a few years was devastating to us. And by 2008, he also had some physical symptoms as well. He really couldn't finish sentences, and his jaw would tremor when he tried to talk. His hand would tremor when he was eating, and he had difficulty getting certain types of food up to his mouth. In the morning, he would come out very sluggish. He could not find a spoon or get water out of the refrigerator without numerous reminders being talked through it. So he was very much on a downward spiral. And up to that point, I had always been looking out for clinical trials. We thought he would be possibly maybe one of the first beneficiaries of the drug that would come along And that

was 8 years ago, and just to

be

clear, that still hasn't happened. So good thing you did what you ended up doing.

Yeah. So along came 2 new clinical trials, and he tried for one of them. This was May, early May of 2012— 2008, I'm sorry. But he needed to qualify for the study, and one of the tests was the Mini Mental Status Exam, which is a 30-point test, and if you're normal, you will get 30 points, maybe 29. However, he scored only 12 on the test, and he needed at least 16 points to qualify because they want to study people with mild to moderate Alzheimer's.

Well, just for our viewers, I just want to say that his score on that test is an indication of severe involvement, severe brain dysfunction. So Here he is, not even qualified, so bad off that he can't even qualify for this trial.

Right, and that was a shock. I really did not expect his Mini Mental Status to be so low at that point. So we were told to come back in a couple weeks and try again, and in the meantime, another medication, a clinical trial was starting for that, and I happened to have 2 days off in a row, and we scheduled screenings for him 2 days in a row. So the night before the first screening, I started thinking, what if it gets accepted into both trials? You can't be in 2 clinical trials. So I was online looking for the risks and the benefits of the 2 drugs, and I just happened purely by chance upon a press release for a medical food that was working towards recognition by the FDA. It was not available yet, but it claimed that in their studies of people, their clinical trials, that it had improved the memory of nearly half the people who had taken it, improved memory and cognition. And that's not something you ever hear about any of the Alzheimer's drugs.

So again, just for our viewers, this is not a prescription drug, but it is an FDA-approved medical food that Dr. Newport discovered that was subsequently approved and is available. And how does that medical food actually work? What's the, the mechanism?

Okay, so, you know, I came across this and it didn't say what it was or what it did, so I was able to find their patent application. And the interesting thing was it discussed an entire area or aspect of Alzheimer's disease that I was not aware of before. We always hear of plaques and tangles with Alzheimer's, but this was— talked about diabetes of the brain, a problem in which there is insulin resistance and insulin deficiency in the brain. That basically prevents cells from being able to take up glucose in certain areas of the brain, that this is something that occurs possibly decades before the person begins having symptoms, that it becomes progressive and extends eventually throughout the brain with each worsening stage of the disease. It was a term that was coined It was coined by Dr. Suzanne DeLamonti and her group at Brown University. They basically looked at brains of people who had died with severe Alzheimer's that did not have type 1 or type 2 diabetes and found this insulin deficiency and insulin resistance. And so they coined the term type 3 diabetes to indicate Alzheimer's disease.

You know, you said something I think I don't want to have our viewers miss, and that is that the actual process begins decades decades before clinical manifestation.

Mm-hmm.

And that the initial event seems to be a metabolic event, seems to be an event of energy production from the brain cells, which is exactly what was targeted, or what is targeted, by this medical food that was approved for treatment of people already who have the disease diagnosed. But I think the point is, for those individuals with family histories, Or who may already be type 2 diabetic, or who think they're going to be living to 85 years, that this is information they need to understand as we develop what you're about to tell us.

Yeah. One of the things that you can look at in someone with Alzheimer's is an FDG PET scan to look at glucose uptake in the brain, and studies have been done in people in their 20s who are at risk for Alzheimer's already showing that there is a problem with glucose uptake in the brain.

Well, we've all been told that the brain has to have glucose because that's its primary fuel.

Right.

I mean, I think what you've explained to us is that isn't necessarily true, and in fact, here you're seeing that this disease may be, in fact, a manifestation of defective neurons' ability to utilize glucose.

Right, right, and there are several other reasons. There is an enzyme deficiency. It's called pyruvate dehydrogenase that basically metabolizes glucose to pyruvate. There's a problem with that. There's a problem with what are called GLUT1 and GLUT3 transporters getting glucose into the brain and into neurons. It's almost like there's a conspiracy of getting glucose into certain areas of the brain.

And, you know, to some degree, when that happens, when we have ultimately elevated glucose in the body, That glycates proteins, and the carrier proteins then for even delivering fat into the brain as a fuel source, when they become glycated, that compromises even that pathway for utilization of fatty acids.

Right, right. So, um, one of the interesting things that is not well known is that the brain can use an alternative source of fuel called ketones, and the This happens mainly in starvation or fasting, and that's— it's basically part of our evolution. And probably one of the reasons people have been able to evolve and survive evolution is that our brains and other organs of our body can easily switch over from using glucose to ketones during starvation. This was discovered around 1967, a very interesting study in which they fasted an obese lady for 40 days, and they found that after that period of time, that ketones supplied about 2/3 of the fuel to her brain, and that was how her brain survived without damage for such a prolonged period of starvation. So it's an interesting concept that has been known for quite a while. What happens during starvation is that you start breaking down some muscle, and certain amino acids can be converted to glucose. But if you only had muscle to use, you would die probably within 7 to 10 days using up all of your muscle because the brain is very active. It requires a great amount of fuel, probably about 20 to 25% of the fuel that our body consumes. However, we have fat, and when we have periods of excess of calories, we store fat. And during starvation, when the glucose stores are used up in our body, which happens around 36 to 48 hours, we begin breaking down fat. And some of the fatty acids can be used by skeletal muscle and heart muscle and other organs, but they do not cross the blood-brain barrier. However, the liver can process some of these fatty acids to make ketones, which do cross the blood-brain barrier. They're small molecules relatively, And they're easily taken up by the brain. It's been shown by Dr. Stephen Cunnane in Canada that the higher the plasma level of ketones, the more energy is provided to the brain. So these are taken up by neurons, and the neat thing about it is they do not require insulin to get into the neurons. And we're having a problem in Alzheimer's of insulin deficiency and insulin resistance. So ketones use a different type of transporter called monocarboxylate transporters. And it basically bypasses this problem of insulin resistance and enters the same metabolic pathway that glucose enters but at a different level to end up making ATP, which is the energy molecule that fuels all of the processes of the cells, really. So it's kind of a neat trick that ketones can be used as an alternative for.

So what you're saying is, number one, you're refuting this notion that the brain The brain has to have glucose, therefore we've got to eat carbohydrates all the time, which—

Right.

I think dates back to high school biology. The reality of the situation is the brain can metabolize fat and does so, in fact, very well, and does so with great efficiency, able to make these ATP molecules that you're talking about far more efficiently burning fat than it would do when burning glucose, and with less production of damaging free Free radicals, so it kind of upends this notion that we've all been told about the brain needing sugar, therefore I'm going to eat lots of carbohydrates. Right. You aggressively treated your husband on a very ketogenic type of diet, restricted his carbs, gave him things like coconut oil, and what happened to him?

Yeah, so basically this medical food I learned was MCT oil, medium-chain triglyceride oil. Mm-hmm. It rang a bell with me because I'm a neonatologist. We used to add it to the feedings of our premature newborns because they tolerated it well and it would help them grow faster. Then they started adding it to infant formulas. It's in virtually every infant formula. One of the things I learned was that MCT oil is extracted from coconut oil. I learned that coconut oil is about 60% medium-chain fats. Yeah. So what happened was Steve was trying out for these 2 clinical trials and on the day before he started coconut oil, and this is the morning after I learned about this on the internet, he went for the screening. I didn't have time to go out and get coconut oil or MCT oil and he scored again a low score, only 14 out of 30 points on the MMSE and he did not qualify for the study, and the doctor had him draw a clock. It's in the book that you mentioned there. It was just a few little random circles and 4 numbers. It didn't look anything like a clock, very disorganized, and she told us that he was on the verge of severe Alzheimer's. So this was very devastating news, and I thought, what do we have to lose? I'm gonna go buy some coconut oil.

Coconut oil?

Yeah.

Who knew? You could write a book about it. Matter of fact, for all of you, I want you to see this book because this is your foray into the world of coconut oil and coupling that with low carbohydrate. Low carbohydrate for the brain, depriving the brain of basically sugar and forcing the brain to start to burn these fats.

Right, right.

What happened to him when you put You put him on that type of diet?

Yeah. So just purely coincidentally, the next day he was screening again for a different clinical trial, really at a different location, but the same location that he had been at 2 weeks earlier when he scored a 12 on the test. So I had researched what were medium-chain triglycerides. I had to remind myself from, you know, first-year biochemistry in medical school. And I was able to find the composition of coconut oil on a USDA website and learned that it was almost 60% medium-chain. So I figured out how much coconut oil to give him that I believed was the equivalent of the medical food dose that they were going to use. And so the morning of the second clinical trial screening, I gave Steve basically 35 mL, which is a little over 2 tablespoons of coconut oil. And his testing was about 3 hours later. On the way down when we were driving, he still couldn't remember the day of the week or what the season was. He couldn't even remember or pull out the word spring. But then when he got there for the trial, they took him away, they did the Mini-Ministatus, they came back, he didn't think he had done very well, but the nurse comes in and she starts taking his blood pressure, drawing blood, and I said, well, what's happening? She says, well, didn't he tell you he scored 18, so he qualified for the the trial.

I love it.

So at that center, his Mini Mental Status went up from 12 to 18, and this was just a few hours after his very first dose of coconut oil. And I thought at the time, is it really the coconut oil, or did we just get very lucky? But in the clinical trials of the MCT oil for the medical food, their first pilot study was of 20 people who just came 2 times. One time they got placebo, and The other time they got MCT oil, and they did cognitive testing on each occasion. What they found was nearly half of the people with just one dose of MCT oil had improvement 90 minutes later in their cognitive testing. It was possible that it was the coconut oil, but at any rate, I thought we were going to—

I think the coconut has proven beyond any doubt that you are correct. Let me just, again, for our viewers, when Dr. Newport is talking about this MCT oil that you may not have heard about. 60% of the fat in coconut oil is MCT. So when she says MCT oil, you should think coconut oil. There are other— there are MCT oil products on the market, but you can just get coconut oil to make this happen.

Yeah, you can.

This is the platform for the FDA-approved medical food which goes by the name of Axona. A-X-O-N-A. You can read about that online, but So you really began to become very interested. And let me just say one other thing I think is really interesting. You were a neonatologist. You were dealing with the youngest of the young, the newborns.

Right.

And now at this point in your career, you have taken it upon yourself to explore what you can do to help your husband with an old person's situation. Right.

An old person's disease.

It wasn't really a place of comfort for you. You really had to do the homework.

Right, right. None of the adult medications are familiar to me at all, so much less adult diseases and neurodegenerative type diseases.

No one wants to be taking care of neonates, I can promise.

Right, right. So I was out of my comfort zone and I was always on the internet constantly reading and reading everything that I could. And the only thing I had ever heard about that prior to stumbling across this was that there was a problem with insulin receptors. In neurons, that they weren't— that they were somehow not on the surface of the cell membrane in the neurons. In Alzheimer's, they could see them, like, clumped with some kind of amorphous substance below the surface of the cell membranes. And I thought, wow, that's very interesting. And that was the only other time I had heard anything about it.

Well, as I'm sure you're well aware, but our viewers may not be so aware of, and that is that there are various trials that are still happening, and actually products now being formulated to to bypass that insulin receptor issue by administering nasally, intranasally insulin and actually demonstrating a small degree of success. But understand, you know, that's one small part of the story, right? And the big picture here is that brain cells are metabolically compromised. And that's what your approach seems to be overriding.

Right, right. Just trying to bypass the problem, taking advantage of the brain's metabolic flexibility, I guess you can say.

So over the years, you studied this, you— he continued to improve, you began lecturing globally on this whole notion, and, you know, there's really been a huge level of support for the work that you've done. Wow. And now, you know, the idea of being on a ketogenic diet and being in low-grade ketosis is becoming more and more accepted. Has really transcended just treating Alzheimer's. But I mean, even in your coconut oil book, you're talking about Alzheimer's, Parkinson's. We know that you know the idea of using ketones to treat epilepsy has been present since 1928. But even beyond that, we are now seeing a ketogenic diet, a strict ketogenic diet, demonstrating efficacy in treating some of the most aggressive brain tumors like glioblastoma. Textbooks are now incorporating this information. So it's really been a bit of a revelation for us to get back to how brain cells are powered.

Yes. Yeah, the cancer part is very interesting. Cancer loves sugar, and their mitochondria are altered such that they cannot use ketones efficiently, but our other cells can. So We can take advantage again in cancer of greatly reducing the sugar in the bloodstream that's available to the tumor by going on a very strict ketogenic diet, which is a very high-fat diet. It's 80 to 90% of the calories is fat and very minuscule amounts of carbohydrate and just enough protein to try to maintain lean body mass, which will essentially starve or deprive the tumor of glucose. Which could allow it to shrink. If there is a tiny metastasis, potentially it could kill the metastasis. There have been some animal studies showing that this seems to occur, you know, with the strict ketogenic diet in animals and a number of human volunteers that I'm aware of that have had improvement and decrease in apparent lighting up on PET scans, you know, with their metastases. So it's very interesting work. There are several clinical trials just getting underway looking at people with the ketogenic diet as either a primary treatment or— but as an adjunct to other treatments, perhaps shrinking the tumor so it's more easily taken care of surgically, or shrinking it and then with radiation it might have better success, you know, better outcome.

So over the ensuing years, As you worked with creating this strongly ketogenic diet for your husband, how much more did he improve?

He improved very substantially during the first year. Basically, I felt like, why limit to just one dose a day, like of a medical food? When you look at levels of ketones after you take a product like Axona or A dose of MCT oil and even coconut oil, you know, the levels go up for an hour or 2 or 3 and then ketone levels are gone after several hours. Well, what do you do the rest of the 24 hours? So basically we started cooking with it right away and then eventually I added measured doses at dinner and then at lunch and then before bedtime thinking that the more ketone you could provide to the brain, the more benefit you could potentially get. So basically, we saw Steve's Mini Mental Status Exam rise even further from 18 to 20 a couple months later. And then he was actually accepted into one of the clinical trials, and we later learned he was on the placebo for about 12 to 14 months.

Always my objection to these double-blind trials. But, you know, that said, I would indicate that So, while you can certainly force ketone levels with a dose of MCT oil or coconut oil, that said, if you're really strict with carbohydrate restriction, your body's going to really open the channel for ketone production from utilizing your own body fat as well. Oh. So, you can remain in a low grade of ketosis throughout the day and not really require continued dosages of whichever source of fat. MCT, right, looking at. But right, to get jump-started, you know, coconut oil is a terrific idea.

Yeah. And, you know, basically what we saw with Steve is before he started coconut oil, he seemed to be craving sugar, and he was just eating— for him, it was tremendous amounts of fruit. We already had transitioned to a whole food diet, you know, for both of us, trying to get away from packaged foods and chemicals and all of that. But we still had a fair amount of whole grain and In our diets and fruits.

But beyond that, he was craving it, and he was seeking it out. What that, you know, what I think that represents is his brain needing a fuel source. Yeah, that you decided, you know, flex fuel, you were going to give him, come into the metabolic pathway in a different way. And you did that with great success. And I really want to commend you because it's really difficult for a lot of people to step out and challenge the standard dogma and the status quo. And you did, and you realized great success. But beyond that, I think you took it upon yourself to make the public aware of your observation. And I know, you know, likely you've taken criticism for that, as we all have. Yeah. And God bless you for doing it because— Thank you. You see now that The blanks have been filled in by other researchers, Richard Veech, Mark Mattson. There are plenty of people out there doing the work and demonstrating that this is an extremely efficient and effective way of powering the brain. Even Dr. Dale Bredesen at UCLA has his patients on a very low-carbohydrate, higher-fat diet and uses coconut oil in an attempt to really emulate what what you were able to discover. Kudos to you. I enjoyed meeting with you a couple of weeks ago at the American College of Nutrition when I invited you to participate. In closing, let me just tell our viewers, I'll give you more information about Dr. Newport in just a moment, but Mary, let me thank you for being with us today. This information is so very valuable. Thanks again.

Thank you so much for helping me to spread the message.

Absolutely, and we'll talk soon.

Okay, thank you.

Well, that was really an amazing interview. I mean, you know, we focus on the idea that we're waiting for a magic pill to cure our illnesses like Alzheimer's, and here Dr. Newport has really opened up our eyes to an incredible new view of Alzheimer's by focusing on the brain's energetics. So again, here is her book, Alzheimer's Disease: What If There Was a Cure? And I would be really remiss if I didn't tell you that this is an incredibly important book to add to your collection for yourself in terms of your day-to-day nutrition, and certainly as you consider the nutrition of, of your parents. I'm Dr. David Perlmutter. Thanks for joining us today.