Alzheimer’s disease and the implications for treatment.

In terms of the brain’s fuel requirements there is an interchange normally between the ketones and glucose used by the brain, which becomes faulty as we get older. If we look at the infant brain, it cannot develop normally without ketones. Ketones supply 20 to 25 percent of the infant’s brain energy requirements.

The main source of supply the ketones for the infant during lactation, is the medium chain triglycerides that are in human milk. Infants are in mild ketosis during the lactation period.

In the aging brain we can use the ketone energy the new born brain thrives on.

Need a refresher on what a Ketogenic diet is? Please refer to my Blog Comparing common diets: Ketogenic, Paleo, Mediterranean Diets

Two fuels that are used by the brain:

Blog Apr. 26 -1 glucose pull.png
  1. Glucose,(simple sugar mainly from plants) gets into the brain usinga push strategy.See the little stick person is pulling a glucose molecule into the brain, which is on the right. That process is driven by a falling glucose in the brain cell.
  1. Ketones use a push strategy. When the ketones go up in the blood on the left they are pushed into the brain and this is the way the brain works all the time if glucose goes down because you’ve been fasting for 24 hours and insulin is down and ketones are being produced and they will go into the brain.

As ketones become available in the blood, they will be used by the brain, which is an extraordinarily efficient way of providing a backup fuel for the brain in the fasted state.

Glucose is the main fuelof the brain under most circumstances except under extreme fasting but it’s not the preferred fuel.

Glucose uptake is goes down when there’s sufficient ketones around to go into the brain. This is a very useful glucose sparing effect that in fact occurs on the ketogenic diet.

See the brain scans the control, a healthy adult as compared to a person with Alzheimer’s Disease.

Blog Apr. 26 - 2 brain scans.png

The effects of aging and Alzheimer’s disease is shown by the two little arrows in the scan. In one scan where the arrows are in the scan is basically missing the orange to red color in the parietal lobes over the ears, this is a classic image of what one sees in Alzheimer’s disease.

The glucose problem precedes the cognitive deficit in Alzheimer’s disease.  There are five categories of people with pre-symptomatic brain glucose hypometabolism (decreased life-maintaining processes)that are at risk of Alzheimer’s disease:  Older people, people with insulin resistance independent of age, people with a family history of Alzheimer’s disease, people with that are ApoE4 carriers and the Presenilin-1 mutation.

 This developing glucose hypometabolism is helping with the deterioration of synapses and deterioration and brain function which is associated with cognitive decline and which is going to push down the glucose metabolism further and is going to create a vicious cycle of brain energy exhaustion and progression of the disease.

What about brain ketone uptake in people at risk or with Alzheimer’s disease?

Blog Apr. 26 - 3 glucose and ketone uptake.png

In the brain scan the capacity of the brain to use glucose is higher in the areas where the red and orange colors are shown on the brain and as you go towards Alzheimer (AD) you can see there’s a virtual disappearance of the red, orange and the green is more predominant.  The capacity of the brain to use glucose decreases in Alzheimer’s disease through CTL (normal healthy brain), to MCI (mild capacity impairment) to AD (Alzheimer’s Disease).

If we look at the ketone up taken in exactly the same individuals the capacity is lower than it is for glucose under the normal circumstances but it if anything actually increases as you get towards Alzheimer’s disease.  There is no loss of the capacity to transport ketones into the brain.

Blog Apr. 26 -4 Keto on brain scans.pngIt is encouraging to see that we could use the normal brain ketone uptake capacity to in fact bypass the glucose deficitand potentially have an impact on cognitive function.

Dr. Cunnane discussed treatment with MCT (medium chain triglyceride). Please see the original Youtube post for his findings.

Is there capacity to use ketones normal in mild cognitive impairment? The answer is yes. There is improved episodic memory, processing speed and language.

You can achieve a metabolic rescue of the brain and that the rescue is going to have a functional effect that is going to correlate with the level of ketones achieved both in the blood and in the brain.

People with mild cognitive impairment are going need 45 grams of MCT a day to improve to be between the healthy elderly and the healthy young.  We might be able to get right up to this 100% value with a ketone ester or some other supplement.

Exercise helps get glucose into the brain.It also helps get ketones into the brain without a ketogenic supplement. Being in ketosis and exercising can improve glucose and ketone up take to better than a healthy adult.

People who are on a ketogenic diet are helping to preventtheir glucose deficit in the brain. Prevention is hard to achieve with a MCT supplement but much easier to achieve with a ketogenic diet.

The Ketogenic diet is potentially a cognitive benefit in those that that are not facing aging associated cognitive decline.

Blog Apr. 26 -5 Summary.png

In Summary,in the brain scan, the losses of the red and orange color shown by the arrows, are definitely a consequence of the disease but they’re also contributing to the disease. The losses represented by the arrows are present before the disease starts and it’s a glucose specific problem. Brain energy rescue by ketones is definitely feasible in mild cognitive impairment and in Alzheimer’s disease.  We want to let the brain have the luxury of thriving in a fuel environment (ketones) that you were born into.

Dr. Stephen Cunnane obtained his PhD in Physiology from McGill University and completed post-doctoral research on nutrition and brain development. He has researched fatty acids and their effect on brain development as well as the effect of ketones and ketogenic diets on brain development. Stephen Cunnane has published over 280 peer-reviewed research papers.

This Post has been condensed from this October 2018 video Dr. Stephen Cunnane – Brain Glucose and Ketone Metabolism in Alzheimer’s Disease

For more information on Alzheimer’s please go

Then go to Full Text Articles and search by “CanKetonesHelpRescueBrainFuelSupplyin LaterLife? Implicationsfor CognitiveHealthduring Agingand the Treatmentof Alzheimer’s Disease.

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Lydia Polstra





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