Boost Your Brain: Unlocking The Power Of Ketosis

Mary Newport, MD

Oh, thank you so much, Dr. Sandison, for having me on this exciting summit.

Heather Sandison, ND

As I mentioned to our audience, if not very familiar with you, many people have heard your story. It’s part of where a lot of this started and where people started hearing this viral story of what happened with your husband, Steve. Would you mind just sharing your path of caring for him and finding out that he had dementia and what that was like for you?

Mary Newport, MD

I’m a newborn specialist neonatologist, and I practiced for 30 years in newborn intensive care units. My husband, Steve, happened to be an accountant, which worked beautifully for our family since I only worked in the hospital. I didn’t have an office. He was able to work from home and take care of our children. He made it possible for me to be a mother and a physician, which were my dreams. I owe so much to him, and so he was working at home, and when he was 51, he started having some strange memory issues, misplacing his keys constantly and his wallet. Then he started having problems remembering if he’d been to the post office and the bank, and at 51, that wasn’t normal. He saw a neuropsychiatrist, a psychologist, and I’m sorry, a neuropsychiatrist, at that time, and he mentioned dementia. The doctor mentioned dementia, but he thought it was more likely that Steve was depressed, which was one of his symptoms. That was probably his earliest obvious symptom, which put him on antidepressants. But he continued to get worse. About three years after that, when he was 54, we moved about an hour away so I could open a new newborn intensive care unit. He was completely confused about how to get around this very small town. He would spend endless hours in the garage looking for something, and he sometimes would forget what it was or what he was looking for, and he would keep looking for hours. I knew that that wasn’t normal behavior. We had him see a neurologist who didn’t diagnose dementia at that time.

He had a mini mental status exam that had 30 points, and he scored 23 at that point. He already had dementia, and he waited another six months for the doctor to retest him. He said he was progressing, and I believe it’s Alzheimer’s disease. He was officially diagnosed with it at age 54 and started taking Alzheimer’s medications. At that time, we didn’t see any improvement with the medications, but we were told not to ever stop them and that he could decline more quickly if we did. He stayed on those. By the time he was 58, he had already had to stop driving for a couple of years. He couldn’t even turn on a computer, much less do all the work he used to do on a computer as an accountant. It was very worrisome. We’re not going to get to retire together and live out that old age that most of our grandparents did. In May of 2008, two clinical trials came to our area for two different drugs. One was oral medication, and the other was a vaccine that would remove beta-amyloid plaque from the brain or keep it from further accumulating.

We were told we would have to choose between those two drugs. He was scheduled for screenings two days in a row, in two different centers and two different towns. The night before, I thought, I’m going to look for the risks and benefits of the two drugs. I just heard about a press release about medical food. It was called AC-1202. At that point, They had done two trials. They had done a pilot study of about 20 people who, on one day, took a large amount of MCT oil and Medium-Chain Triglyceride Oil, and the other day they got a placebo, and nearly half of them improved. Their score improved after just a single dose of MCT oil. I thought, well, that’s interesting. I learned a lot of this from their patent application because they didn’t say in the press release what it was or how it worked. Then they did a longer study for 90 days, and then some people extended it to six months, and that held up so well that almost half of the people had improvement in their memory and cognition.

None of the drugs claimed to improve cognition or memory. They say that they may slow the decline, but they don’t ever make claims because they aren’t showing any significant improvement in memory and cognition in these studies. I read in the patent application that several things. One is that MCT oil was extracted from coconut oil, which I didn’t know before, and I was familiar with MCT oil because I’m a newborn specialist. We used to add it to the bodies of our tiniest preemies back in the 1980s to help them gain weight, and they’d go home faster. Then they started putting it into infant formulas for premature newborns and for babies that didn’t tolerate other formulas. I knew what MCT oil was. I didn’t know it was available online, which it was at the time, and in some health food stores. But I knew what coconut oil was. The other thing I learned was that Alzheimer’s is a type of diabetes of the brain. There’s a problem. It starts happening 10 to 20 years before you even have symptoms. It’s a problem. It’s insulin resistance in the brain, a problem of getting glucose into brain cells. All the cells in the body need fuel to operate.

Most of the time, that’s glucose. If you’re on a typical diet that’s usually higher in carbs and a little lower in fat, an Alzheimer’s source is the problem with insulin resistance and getting glucose into brain cells, so they start malfunctioning, they may go dormant, and eventually, they may die if they don’t get adequate fuel. What happens when you consume MCT oil or the medium-chain fats that are in coconut oil? Is it true that your liver converts part of it to ketones? Ketones are an alternative fuel for the brain. This was discovered in the 1960s. There were studies of starvation. They found that during prolonged starvation, your fat starts breaking down after you use up the glucose that’s stored in your body, which happens after about 36 or 48 hours. then the ketones and the fatty acids from them can provide fuel to most of the organs, but they don’t cross the blood-brain barrier. They don’t cross into the brain very well. The brain needs another source of fuel. However, some of the fatty acids are converted in the liver to ketones, and ketones are very tiny molecules smaller than glucose that easily cross into the brain, and brain cells can instantly switch over from using glucose to ketones.

It’s a neat idea. When I read this, I thought, this is profound. I thought I was going to use this idea to help my husband, but at this point, he’s getting a screening at 9 a.m., and it’s about 1 a.m. when I’m reading all of this. I just kept reading and reading and reading and learning as much as I could, so we didn’t have time to do anything about it that day. We ended up having a day before and the day after we started our coconut oil study. Actual studies were done, and it was, so we went for the first screening. It was about 9 a.m. that he was scheduled, and he did not do well. He scored only 14 out of the 30 points on the mental status tests, and he needed to get 16 to qualify. We were bitterly disappointed because we’d been waiting for years for any new clinical trials in our area, and he drew a clock. The doctor asked him to draw a clock. I have a picture of it here. Let’s see if we can show it there. As you can see, that’s just a few little circles and a few numbers.

Heather Sandison, ND

There’s no big circle for the clock. He has just 11 and 12, not one through ten on there. The circles that he’s drawn are ones that you wouldn’t associate at all with the clock. He’s spatially very disorganized.

Mary Newport, MD

Very disorganized. The doctor told us that he was on the verge of severe Alzheimer’s. Functionally, that’s what I was seeing, too. I was surprised, yet not surprised. I thought I was going to pick up some coconut oil on the way home. I had seen it in health food sources.  I was taught medical school; it had artery-clogging fat. I thought, Why is it in health food stores? But we went and bought some. When we got home, I looked up again and saw reminders about what our medium-chain triglycerides, MCT oil, are. I was able to find the fatty acid composition of coconut oil. I learned that it was about 66.0% medium-chain triglycerides. I did a calculation, and I arrived trying to figure out how much to give him that would be equivalent to what was in the medical food, which was 20 grams of MCT oil. It was a specific medium-chain triglyceride called C8. But coconut oil has several different medium-chain triglycerides, and I arrived at 35 ml, which is a little over two tablespoons of coconut oil to try to equal this medical food.

So the next day, he was going to be screened again, but not until one in the afternoon. The timing was also fortunate. The way it came together was just unbelievable. But I gave him a little over two tablespoons of coconut oil with breakfast, and it’s semi-solid at room temperature. I put it in some oatmeal. mixed it in. I took some because I thought I wasn’t going to make him take anything I wouldn’t eat. I had indigestion; I have no gallbladder. I’ve adjusted to that since then. But he did fine with it, and we went for the screening, and about four hours after he ate that, he improved by four points. The points that he gained were that we were in a different location on a different day, he knew the day of the week, and he knew the city we were in and the floor in the facility were in during the season. Those were the fourth points that he did not get the day before, which was remarkable. He qualified for the study, and, at the time, Is this for real? Was it just good luck? It could have just been good luck.

Heather Sandison, ND

Good days and bad days.

Mary Newport, MD

Was it prayer? Was it this? I thought, well, I’m going to assume that it could be this idea of using medium-chain triglycerides for ketones and keep doing it. I’ve just found every cookbook we went to health food stores, got more cookbooks on coconut oil and online recipes, and just tried to learn everything I could about ketones and this whole idea of ketones as an alternative fuel for the brain. He got better every day, and we saw pretty dramatic improvements, just over the first four or five days. He would be in the morning he had been before this very sluggish. He couldn’t finish a sentence and was not talking very much. He couldn’t pick out the utensil from a drawer. If he was going for a spoon, he’d come back with a knife and that type of thing. And all of that improved. He had tremors like his hand when he would eat. He has a tremor in his job—a tremor in what he taught. That stopped very quickly. He started whistling again and telling jokes again. and he had been very depressed all through this. He knew he had Alzheimer’s. He was one of those people who knew it. He accepted that something was wrong. He told me that he felt like a light bulb came on in his head the day he started the coconut oil, and his mood lifted. He started expressing that he had hope for a future and that maybe he wasn’t going to die soon after all. It was just remarkable.

Over the next couple of months, by two months, he could tie shoes again, which I had to do for him. He started walking normally. He had a stiff, shuffling gait. It turned out he also had Lewy bodies. Lewy body dementia. His gait completely normalized. He could pick up a seat and run again after about two months. Then, at about three and a half to four months, he announced one day that he could read again. He hadn’t been able to read for about a year and a half. I said, Why couldn’t you read? He said that when he would look at a page, the words he described to us going into pixels like satellites would break up. He said he could tell me satellite radio at that point and that it would move around on the page and that that had stopped and he could read the words again. A few months after that, he could comprehend what he was reading better. Then he could tell me a few hours later in the day that this is around nine or ten months. He could tell me details from things he had read earlier in the day. It was dramatic, and it was a very steady improvement for the first nine or ten months.

Then he leveled off after that. A lot of things happened in between. There. He did get into both clinical trials. He went back, and when he tested for the other one again, he got 20 points. It went up even more, and he did get into a clinical trial, and then we found out that he was on the placebo. Later, we found out that for 18 months, he was on a placebo. The testing that he had done during that time reflected the only other difference we had made, which was this dietary intervention with these oils. I started adding MCT oil after about six weeks, and I kept the coconut oil because I thought there might be something in it that was important. It turns out that there are things in it that are important. About two years later, he got that I had made a connection with Dr. Richard Beech at the NIH, who was developing a ketone ester. He was a world expert on ketones at the time. I talked to him often, and he would send me papers. He was interested. He became especially interested after Steve drew his second clock. This was two weeks later. I’ll show you.

Heather Sandison, ND

Now there’s a full circle. There are more numbers in there.

Mary Newport, MD

It’s messy, but.

Heather Sandison, ND

They’re in order. He’s starting to put his hands on the clock or try to put the numbers in the correct position.

Mary Newport, MD

This is about 37 days later.

Heather Sandison, ND

It gets a little cleaner. It’s a little bit cleaner.

Mary Newport, MD

Then he told me later the lines. I thought they were hands with the clock, and he said no; he was trying to line up the numbers across from each other. Those were guiding them. Dr. Beach, when he saw that clock at two weeks compared to the first, started taking it very seriously. He told me he thought it would require much higher levels of ketones to have any improvement in somebody with Alzheimer’s. He measured Steve’s ketone levels, and they were quite low. But for the ketone ester, many people won’t know what this measurement is, but you can get a measurement of beta-hydroxybutyrate, one of the ketones of five millimoles. With coconut oil, it’s about 0.3 millimoles, so much less.

Heather Sandison, ND

Dr. Newport, there are so many directions I want to go now. You get a unique experience. The people down here give her a doctor, and this investigator’s just a description of that night where you were diving into what could potentially help and understanding these two clinical trials. You went and read the packet.

Mary Newport, MD

Yeah.

Heather Sandison, ND

Not many people would do that. You’ve taken this entire experience with Steve to dive very deep into the research into what people are understanding so that you can understand the biochemistry and what’s going on. What I want for our listeners today is to understand the takeaways. What you just mentioned is that coconut oil has important components that you don’t want to separate from the MCTs. Let’s just go there. Let’s start with that question. What would you recommend to people who are noticing cognitive decline? How many Millimoles per liter do you want people to get their ketones at, and what is effective and how do they get them? With what do we take? What do we eat? What are we taking?

Mary Newport, MD

There were all kinds of things that you could do. starting with coconut oil, because that’s what we started with. I suggest people start with a teaspoon two or three times a day with food, because not everybody is as lucky as we were and some people are so sensitive to these oils that they will end up in the bathroom with diarrhea, and it could be explosive. if you take too much, too fast. It’s even more likely with MCT oil there for people who aren’t accustomed to it. but then try to work up to at least four, maybe four to six tablespoons a day, if you’re somebody who has cognitive impairment. For prevention, there aren’t studies yet because you need studies from last year to be able to say that something might prevent cognitive decline, but it’s reasonable to think of what might help somebody who has cognitive issues, whether it may potentially prevent it or maybe slow down the delay at the onset.

Heather Sandison, ND

Do you think that for someone who is looking to optimize cognitive function, it could help them?

Mary Newport, MD

There’s a study in Australia, that used an oil that’s a combination of the main fatty acid in coconut oil, which is lauric acid. It’s about half coconut oil combined with the other MCTs. They did this for healthy people. They were planning; they were getting ready to do an Alzheimer’s study, but they did a pilot with people who were older but cognitively normal. Even those people improved cognitively when they took it. It could help optimize your cognitive abilities, memory, and that type of thing.

Heather Sandison, ND

You said four to six tablespoons per day of coconut oil. It was a cognitive impairment. Then, for things like prevention and optimization, what are we thinking?

Mary Newport, MD

What’s the dose of two to three tablespoons a day? It could be just coconut oil, just MCT oil, or a mixture of the two. My husband worked up, and in the beginning, I thought, Is one dose enough? When I read this patent application, the ketone levels peaked at about 90 minutes on average, and they were back to baseline at three hours. I thought, Well, what does a brain do the other 21 hours? Because the brain is so active, it constantly needs fuel. Even when we’re sleeping, it’s very, very active. I started giving it to him for lunch and dinner, and then eventually a fourth amount before, in the evening, before he would go to bed, and he started sleeping better.

He started remembering dreams, and he would tell me about that type of thing. He worked up to, usually, between nine and 11 tablespoons a day. This is a lot. He had also reduced the carbohydrates. He started gaining a few pounds. that well, if you just add that much oil to your diet, don’t subtract anything. You’re going to have a problem. We started substituting it for other oils and fats, and we were already doing a Mediterranean diet for a couple of years at that point. a little less olive oil and a little more of the coconut oil, that type of thing. then he just started cutting out a lot of carbohydrates. He would very voluntarily. He just leaves at first the rice, the bread, and the pasta. Then he wasn’t eating nearly as much fruit. We started focusing more on berries, which are lower in sugar. They’ve got a lot of potential health benefits themselves. He was effectively on a ketogenic diet, and we didn’t have the whole meters which wasn’t available to be able to measure ketones at that time.

But I’m quite sure that he was on a pretty significant ketogenic diet with that amount of fat in his diet. But the coconut oil has some other interesting things in it. That and this is why I always kept coconut oil. The lauric acid that I mentioned is half of the fat and coconut oil. It’s a medium-chain fatty acid. It’s on the verge of a medium and a long chain in the type of properties that it has. But it has a couple of interesting properties, and one of them is that it’s highly anti-microbial. It kills so many different types of viruses, bacteria, protozoa, and fungi. It’s used if you ever got a white or a spray that says it’s antiviral, it has sodium lauryl sulfate. The lauryl is from lauric acid; they separate these fatty acids from coconut oil, and they sell them for use as surfactants and as anti-microbial compounds. The sprays and wipes contain it, and it’s active against many different organisms that have been implicated as possible causes, accelerants, or triggers of Alzheimer’s. We’re talking about the herpes simplex virus, which causes fever and blisters.

A lot of people are dealing with chlamydia and Lyme disease. There’s a spirited kid that’s in the same family as syphilis, which is known to cause dementia if it’s not treated, and fungi, candida as a common fungus, that it kills, and it kills dental pathogens. They’ve been associated with Alzheimer’s disease, so the coconut oil with the lauric acid is beneficial in that way. Most of the MCT oil products have no or minimal lauric acid in them. The other interesting thing is that a group in Japan was very interested in how my husband could improve so much with the low ketones in coconut oil, so they studied it and used cultures of astrocytes, which are, for those who don’t know, brain cells that nourish the major neurons in the brain. They studied these in cultures, and they found that lauric acid potently stimulated ketone production directly in the astrocytes. It might not be at the blood level so much. It may have a more direct action in the brain, and they still have to show this,  like mice or something else, to prove it. 

But that it’s, it could explain why my husband could improve so much, so quickly, with it from the fuel aspect of taking ketones so that those things, and then there are just a whole bunch of polyphenols and other compounds in coconut oil that are anti-inflammatory and antioxidants, and there’s a lot of neuroinflammation in the brain, and people who have Alzheimer’s disease as well as a lot of other neurological diseases, Parkinson’s, multiple sclerosis, ALS, epilepsy, psychiatric disorders, even depression and anxiety, are they’re being studied now. Many people are reporting improvement with the ketogenic diet.

Heather Sandison, ND

Seizure disorder. That’s where a lot of this came from, especially in children. 

Mary Newport, MD

Has been used for a hundred years. The ketogenic diet has been used for over 100 years to successfully stop seizures or greatly reduce seizures in children who don’t respond to drugs.

That results too.

Heather Sandison, ND

There is much potential benefit here. Now, if someone is considering doing this, the downside is pretty low. You mentioned diarrhea as one of the risk factors for cholesterol. Can we talk about someone asking? I have high cholesterol. My doctor’s worried about it. I’m even maybe on a statin. Is this a contraindication for me?

Mary Newport, MD

That’s a little bit of a complicated question, but it’s a common question that I get all the time because there is this myth that coconut oil increases cholesterol levels. A lot of the real early studies were small studies that were done with hydrogenated coconut oil. Any hydrogenated oil will increase your cholesterol level. Even polyunsaturated fats that are subjected to hydrogenation. They create all these trans fats, and they’ll increase cholesterol levels. There’s a whole collection of coconut studies that were done between about 1985 and 2018. They are a few decades old, some of them fairly recent, and they’re almost always comparing coconut oil to other oils. They use coconut oil because it’s high in saturated fat. The others they’re checking are usually olive oil, which is a monounsaturated fat or polyunsaturated fat. We always hear that we should replace saturated fat with polyunsaturated fat. They’ve been telling us this for decades. but coconut oil contains most of the saturated fat. About 70% of it is medium-chain triglycerides.

Those are not present in any of the other common oils that we know of that people eat. It’s not like soybean, corn oil, olive oil, or fish oil. These medium chains are not. these other oils and the actual saturated fats, the long-chain saturated fats, the coconut oil has about 11% of those. These other common oils also have saturated fat, and they have somewhere between 11 and 14% of these long-chain saturated fats. Coconut oils are in the same range of long-chain saturated fats as the other common vegetable oils and medium-chain triglycerides. They’re either converted to ketones or they’re used directly as fuel. They’re not stored as fat. When you just take MCT oil, most of the studies show that there is no increase, even with a six-month use of MCT oil. In a study of people with mild cognitive impairment, there was no increase in their cholesterol levels. The medium chains don’t do that, and so I got a group where there were about 16 studies that were done between 1985 and 2018. It had a total of about 525 people in these studies. In the reports, they were comparing coconut to other oils; what was the relative difference in the cholesterol levels? I wanted to see, well, what was the actual difference between the groups that took coconut oil from their baseline levels to the end of the study? When I combined these 525 people, there was almost no difference at the end of their studies for cholesterol levels. Now, where there was a difference was in the very short-term studies.

These were studies that lasted three to six weeks, and there was an adjustment period for some of these studies. They would take like a teaspoon of coconut oil. In other studies, it was several tablespoons a day. There was a real variety in the amounts people were getting. But even in the studies themselves, the individual studies, there were somewhere the average cholesterol level went up, and we’re talking LDL and total cholesterol. Sometimes it went up, and in some studies, the average was the same. They didn’t change, and others went down even in some of these short-term studies. They were all over the place. In the short-term studies, on average, there was a little bit, but it was less than 5% difference when you added all the people that were in the short-term studies together, and in the medium-term studies, which were like eight to 15 weeks, there was virtually no difference. It was within about 1% of the baseline for the total and the LDL cholesterol. for, like I said, about ten long-term studies. The interesting thing about the long-term studies is that you asked about people on statins, and they had interesting results. This was the biggest study. There were 200 people in the study.

100 of them were taking coconut oil, and it was for two years. They were people who had all had some adverse cardiac events, and they were all on statins. At three months, one year, and two years, their levels were almost identical to their baseline level. When they were taking it, they were taking about three tablespoons of coconut oil a day, and then the other group was taking sunflower oil, and at the end of the two years, the results were almost identical between the sunflower and the coconut oil. It was very interesting, so it’s hard to convince some cardiologists.

Heather Sandison, ND

It’s for people with ApoE if they have a four, three-four, four-four, and if they have one or two copies of the four, do you see that that makes a difference because of this dysregulated lipid metabolism?

Mary Newport, MD

In theory, it should. I was worried because my husband was three-four. He had ApoE4 and he responded. When they read the patent application, in these early studies of the C8 medical foods, they found that the people who were ApoE4 didn’t seem to respond on average again. But I spoke with one of the authors, and he told me, Well, that was when they added everybody up, but they did have people who ApoE4 that did respond. It’s just that when they averaged everybody together, it looked like they didn’t respond.

Heather Sandison, ND

Interesting. so they may or may not.

Mary Newport, MD

I wish they had put that in the articles—that there were people who did respond. That’s important because a lot of physicians and other people, including dieticians have seen that suggestion that people with ApoE4 might not respond and don’t recommend it. But some individuals do. My husband was one of them. Then there’s another study, too. I’m Dr. Steven Koonin. He studied 65 people with mild cognitive impairment for six months. They were taking MCT oil, and he found no difference between the people taking an ApoE4, versus those that didn’t.

Heather Sandison, ND

Published prolifically on ketogenic diets for brain health. It’s consistent with our experience too. With the clinical trial we did in my office, we had several people who were able to eat either three four, or four four, and some of them did respond. Now, some didn’t, but we had great results, and we did not tell them to avoid coconut oil or saturated fat. We encouraged all of them to get into a ketogenic diet and include those. That’s interesting. It seems like the ApoE4 status doesn’t determine whether or not your cholesterol will go up. We have found that people’s cholesterol mostly got better as they got into ketosis, especially as you mentioned when we looked at six months. It was more likely that their cholesterol had improved compared to baseline. Then, when we looked at 12 weeks.

Mary Newport, MD

With my husband, his triglycerides were always very low. While he was doing 60 or 70, his HDL went up dramatically. In this group of studies that I looked at, one of the groups had an increase in HDL cholesterol, and it was more than any change in the other group’s total or LDL cholesterol. But so he always had an HDL that would be like 60, 70, or sometimes 80, which is quite high. His total cholesterol; he was on a statin when we started this. But after reading about statins and sweating bullets, I thought he’d decline quite a lot during the five years that he was on them. They weren’t helping them, clearly, and they weren’t preventing Alzheimer’s for him. We decided to stop it. At first, as expected, his LDL cholesterol went up, but then it just slowly started coming down, and eventually, he came down to something like a total cholesterol of 200; under 200, it was 194. His LDL became normal as his HDL always stayed up, and his triglycerides were always very low despite the huge amount of fat that he was eating.

Every person is different. For people who are worried about it, it might be a good idea to monitor it. Some people might still be leery of taking coconut oil itself, but I sometimes suggest that people take a high-lauric acid MCT oil, there are a couple of them out there; several of them are available here in the U.S., and one has about 12 or 13% lauric acid as opposed to 1% and the usual MCT oils. Two brands have 32% Lauric Acid. They’re clear, colorless, and odorless. They have the other MCT C8 and C10 which are cooking oils. You can use low heat with them. But the thing about it is that they’ve taken the heavier fats out of the coconut oil; they’ve moved the heavier saturated fats, and it just stays completely clear at room temperature, and you can use it in almost any food. You can cook with it at low heat, and it won’t harm the oil as long as it doesn’t smoke. The oil would be okay. The product that they used in that study in Australia that I mentioned earlier, where even the healthy cognitively normal people improved, was that oil that was Lauric Acid, MCT oil.

Heather Sandison, ND

Do you mind sharing the brand because people are going to be asking.

Mary Newport, MD

If I’m allowed to do that, I will certainly do that. The one that has about 11 to 13% Lauric Acid is called Carrington Farms, it’s liquid coconut and cooking oil. Then two brands have 32% Lauric Acid, and they’re on it, ONNIT, and the other one is Sports Research MCT. Sports Research has a C8, C10, and then they have C8, C10, and C12. You want to look for the one that says C8-C10 and C12. I just happened to be looking at those yesterday. They have a 128-ounce jug of it that is relatively inexpensive. It’s 256 tablespoons of it, which is $88.

Heather Sandison, ND

That Sports Research, when it’s organic as well.

Mary Newport, MD

It is. It’s a classic.

Heather Sandison, ND

That’s great. Many people will start going in this direction, and if it’s their first time getting into ketosis, especially their testing, we always aim for one minimal and at least some point in 24 hours. Many people struggle there, and they get 0.4 or 0.6, and they’re frustrated that they’re not getting higher. Are there other factors when it comes to getting those blood ketone levels up and different lifestyle strategies that can be used to increase that number?

Mary Newport, MD

Number one, trying to reduce the carbohydrates in the diet, and there’s a study that going to come out fairly soon. They reduced the carbohydrate in half. People who are residents in an assisted-living facility found that it reduced their total blood glucose area under the curve of blood glucose by about 40%, just cutting their carbohydrates in half. This was about 130 grams of carbohydrate a day. I’m aware of this and that it will hopefully get published this year. But if you eat carbohydrates and MCT oil, it’s not as ketogenic. It doesn’t increase ketone levels as much as if you eat a low-fat, low-carbohydrate meal, which can make a big difference in whether or not you can get a higher ketone level.

Heather Sandison, ND

Do you think there’s a risk of raising your fat without reducing your carbohydrates?

Mary Newport, MD

Probably not, except that if you think about it,  we’re dealing with insulin resistance in the brain. The longer you keep eating a higher-carb diet, a lot of simple sugars, and ultra-processed foods, the more likely it is that the process is going to continue getting worse insulin resistance. So chances are it may continue to progress. reducing the sugar and eating more complex carbohydrates—what they call low-glycemic carbohydrates, whole grain instead of refined flour, whole grain rice instead of white rice, and things like that can make a difference because your blood sugar doesn’t go up as much and your insulin levels don’t have to come up as much. That seems to be the problem over time: you’re constantly spiking your blood sugar up and your insulin levels up. that seems to be associated with developing insulin resistance over time. I do think it’s important to encourage people to eat a whole-food diet as much as possible. Whole foods: stay away from ultra-processed foods and try to reduce, take, and get rid of the sugary beverages completely. They’ve been shown to accelerate atrophy of the brain, and this is just in regular people; this is in people who have Alzheimer’s already. Age affects memory much sooner, so your brain, age, and memory-wise, maybe 13 years older than you are if you’re drinking, say, two or more sugary beverages a day, or three or more beverages a day.

Heather Sandison, ND

What about the diet versions?

Mary Newport, MD

The diet didn’t have that effect on the person’s diet, but with the sugary drinks, they were even talking about 100% fruit juice.

Heather Sandison, ND

Not just soda and juice

Mary Newport, MD

Sodas, soda pop, or whatever you call it, wherever you live.

Heather Sandison, ND

Perhaps on intermittent fasting or fasting generally.

Mary Newport, MD

That’s a perfect strategy, too. That’s another good one. Like people who have had some of the best long-term success,  a lot of them started with coconut oil and added MCT oil. Then they thought, I’m doing better. What else can I do? Then reducing the carbohydrate. That’s the next step a lot of times. But another easy thing to do that’s easy is doing overnight fasting. If you do this for at least 10 to 12 hours, your liver is depleted of glucose, the stores in your liver are depleted, and you do start breaking down some fat, and you will start making some ketones at that point. You can start the morning in ketosis. You stop eating at 8 p.m. and you don’t eat till at least 8 a.m. That’s 12 hours, so you’ll wake up in a little bit of ketosis. That might be a level of point three or point four, or something like that. then what a lot of people do is have their morning coffee or tea with coconut oil or MCT oil in it, and that’s further, it doesn’t stop your ketosis; it enhances it.

You’re ketone levels will keep going up, and then that is often enough to keep you from getting hungry for another few hours. A lot of people extend that to 14 and even 16 hours and then have their first meal around lunchtime, say around noon or so. They’ll have their first solid meal. and then just limiting the portions of carbohydrates. I don’t think you have to; I don’t know. It’s unreasonable to think that somebody, for their lifetime, is going to be able to eliminate bread, rice, pasta, and all that. I suggest to people that an easy way to cut it down is to take your usual portion and cut it in half. Then, when you get used to that, cut it in half again, and you still have a few bites, at least. It might be a quarter cup of whole-grain rice, but to me, the first few bites are the best. If you like that food, just have a little bit of it.

It might be ten or 12 grams of carbs. If you stay under 50 or 60 grams of carbs a day, most people can be in ketosis at that point. The more fat you eat and the fewer carbs you eat, the deeper into ketosis you will go and the higher your ketone level will go. That seems to hold up pretty well for the people who are struggling to get to one millimole at some point in the day. If they just cut their portions of carbohydrates even in half, and then maybe in a quarter again, they might find that they’re getting better results.

Heather Sandison, ND

We also find that logistically, people travel; they have birthdays, weddings, celebrations, and holidays. I often will recommend it, and I am wondering what you think about the benefits of the metabolic flexibility of going back and forth between burning carbs for fuel and burning fat for fuel, being in ketosis, and maybe even planning for that and saying that I’m going to be on a trip, I’m going to eat mostly whole foods, be in glycolysis, be burning sugar for fuel, and then I’ll go back to ketosis. Do you think there’s even more potential benefit from that, or is it better to stay in ketosis?

Mary Newport, MD

I don’t think it hurts in the long run. There could be benefits. There are a couple of papers about metabolic flexibility and the advantages of going between primarily fat burning and glucose burning, so there could be benefits to doing that. I take a break here and there. I’ve been on, I guess, a very low-carb diet, but we started the Mediterranean diet in 2006, and that already reduced the carbohydrates a lot. It cut out all the simple sugars and promoted a low-glycemic diet. I lost a whole lot of weight. My husband, I don’t know, kept it progressing, and Alzheimer’s, did it slow it down? I have no idea. You can’t tell just from one person’s experience. But I had tremendous benefits from it. I quit craving carbs all the time. I was always thinking about my next meal, and that went away after about three days. so I’ve had a lot of benefit from it. I felt like it too.

Then, when we had the coconut and MCT oil, I felt like I had better mental endurance. I could read and read and I was writing to people constantly, trying to get this out—politicians and media people and everything—early on, trying to get this information out to increase awareness, but combining those two things, you can take a break, here and there; it doesn’t have to be for the rest of your life. During the holidays, it’s hard. You go to parties and you want to enjoy some of the other foods that people are having. Just try to keep the other meals and just get back to them. Keep your other meals low-carb and high-fat, and then just get back to them as soon as you can.

It’s surprising like in there at the beginning. A lot of people, though, have gone through a period of a few weeks where they don’t feel good when they first go on a ketogenic diet, especially if they try to go low-carb, like under 20 grams of carbs a day. They’ll feel lethargic, and their muscles will ache. It’s almost like they have the flu. They call it the keto flu, even though it’s not an infection. But that feeling passes after a little bit. But you can ease into it, too, by just reducing the carbs, like we talked about, to half-size servings and then quarter-sized servings just to get into it, and then maybe aim for staying under 50 or 60 carbs a day. that turns into a reasonable diet that people can sustain nearly every day for the rest of their lives.

Heather Sandison, ND

We find that, as you well know, Alzheimer’s is a disease that affects women more than men. They’re two-thirds of Alzheimer’s patients. When they’re not the patient, they’re the caregiver. As women age, we worry about frailty. If someone is concerned about losing too much weight, what advice do you give them?

Mary Newport, MD

I advise them that when I talk about planning a ketogenic diet or a low-carb diet, I talk about paying attention first to how much protein you’re consuming to make sure you get adequate protein. I did for a while. I did hospice care and I did home health visits, and some of the very frail elderly women that I would meet were eating only a little bit of soup at their meals. They were not getting enough protein. They were, and you could just see the muscle wasting and frailty there. It’s important at any age to get adequate protein, and this will help maintain your muscle mass over time. When combined with exercise, the kinds of exercise—aerobic exercise doesn’t build up muscles so much, but resistance-type exercises do. Then, in the one book that I have to do, keto, that you mentioned, I have a set of exercises. My sister was the model for it. I do this every single day. because of one type. It’s just simple exercises. One is squats, which might not be so simple when you first start.

If somebody has balance issues, you can stand next to your kitchen counter or have a chair behind you in case you’re worried about losing your balance. But you just, you just well put your arms out, and you just slowly come down a bend at the knees like you’re going to sit in a chair, and then you come back up again. You’re just up and down. Some people might only be able to do three or four in the beginning but try to work up to maybe ten or twelve at a time. I do three sets of 12 for every single warning. For the last couple of years, I’ve been doing this, and then, regular pushups are hard, but pushups against a wall can be effective in maintaining the strength and your arm muscles. In something called pushups, you stand a couple of feet away from the wall and then just come toward the wall. It uses all the muscles in your arms and shoulders to do that. Another one is a wall plank where you go towards the wall like you’re going to do a push-up against the wall, but then you freeze, and you just try to stay that way for as long as you can.

It’s surprising at first; it might be ten or 15 seconds, and you can’t stand it. I do like 30 seconds three times. I do this little series of exercises with the squats, the wall, push-ups, and the wall planks. Every time, it takes maybe six or seven minutes. I just decided I’m going to make a habit. It started with the pandemic because I was going to the gym, taking advantage of the SilverSneakers, pulling the weights, and all of this. Then we couldn’t; they were closed, and we couldn’t do it. This was a routine I got into to replace that. And now I do try to go to the gym and use the machines a couple or even once a week can help maintain muscle mass. So resistance exercise combined with getting enough protein and, like, enough protein, if you have a way to look up the grams of protein in the foods that you eat, it helps to write them down. Aiming for like a half gram, what I suggest is a half gram per pound that you weigh per day; if you say you weigh 150 pounds, that would be 75 grams a day of protein that you would aim for. A few easy-farming cottage cheeses are a really easy way to get a good amount of protein, like a snack or maybe a lunch or something. Greek yogurt is loaded with protein. That height that I do, full fat, full-fat cottage cheese, or Greek yogurt doesn’t mess with the fat, free or reduced fat.

Heather Sandison, ND

There was a study of, like, the earliest processed foods. As I hear you talking about, even just how they set this study up, we tend to overcomplicate things. Your story is a great illustration of trusting your own experience. But yes, look at the science, and you have done these incredible deep dives into the science, understanding the biochemistry, and all of that. And yet you double-checked it with this direct experience that you had with your husband, and then, seeing that that led to this incredible improvement, you double-clicked on it over again and continued to go back to that. It’s just such a gift to all of us, and I’m so inspired that your doctor knows just how you’ve taken this tragedy, this personal tragedy, and created this very meaningful and passionate career around it.  You were presenting at the Alzheimer’s Association meetings this year, and I got to meet you in Las Vegas at the forum meeting where you were presenting. Your passion and dedication, I don’t know how you keep up with it all. It’s so impressive.

Mary Newport, MD

It’s tiring. There isn’t a day that goes by that I am not thinking about Alzheimer’s and working on this, reading and writing, pretty much every day. But my alternative is that I’m starting 72 in a couple of weeks, and I could just enjoy the rest of my life and watch television. I still go out with my friends here and there, and I watch some television in the evening, but I just fill up my day with this thing. It’s just a compulsive experience that first day. When Steve started having, he had an improved score; after expecting, it hasn’t stopped. At the time, I felt like if he improved, other people would improve. At that point, they were saying there were 35 million people in the world with dementia. that was a lot of people to try. 

Heather Sandison, ND

To get the message out too.

Mary Newport, MD

That’s where it started. It’s the message that’s getting out, but it’s not out there wide enough, and it’s not recognized yet by the Alzheimer’s Association; They’ve sponsored studies now. I couldn’t get through to them then. I couldn’t convince them that they should even ever mention this to anybody. It’s only food. It’s not a harmful drug with a lot of potential toxicities that we’re talking about. But when they talked with their medical directors, they just weren’t interested in acknowledging it at all. They wanted it to be studied first. I told them that you’re the people who are funding the studies, but eventually, they did. Starting around 2017, there have been several sessions on ketones, sometimes more than one each year, at their international conference, which has about 5000 people, physicians, and researchers from all over the world attend. They’ve had the results of the studies presented at their conference. If you look at their website and look up coconut or MCT oil, the last entry they have is from about 2014, and it says, Well, this hasn’t been studied yet, so we can’t advise it. It’s like, Wait a minute, you funded it, and you let people present the good results at your conference. Why aren’t you making people more aware of this? I don’t know; I just can get the people, but so I’ve been taking the grassroots approach for a long time.

Heather Sandison, ND

Giving people the information that they need to potentially make some changes that are safe and effective at home. Dr. Newport, thank you so much for all that you do. We all benefit, and I have certainly heard from patients who have heard about you and then started using the coconut oil. As we mentioned, there’s this layering effect. They get into the coconut oil or the MCT oil, and then they start cutting out carbs, and then they end up reading Doctor Bredesen’s book. Then they come into my office to do the testing, and they get better and better. Sometimes people plateau, but I am sure that in many cases, we’re reducing the suffering associated with dementia by delaying or stabilizing. then hopefully, with many people even reversing, as Steve did, it’s just such a privilege to be here with you today. Thank you so much.

Mary Newport, MD

I appreciate you allowing me to come on and help spread this message to more people.

Heather Sandison, ND

If people want to learn more about you, I do. You have a website where they can get your books or learn more about where you’ll be speaking next.

Mary Newport, MD

I sure do. They’re all available on Amazon and a whole lot of other bookstores. If you look up my name, you’ll find them all. Those are a couple of other Mary Newports on there, so mine are about Alzheimer’s or ketones, but my website is coconutketones.com. That’s  COCONUTKETONES.com There’s no Y in ketones.

Heather Sandison, ND

Thank you so much again.

Mary Newport, MD

You’re welcome. I appreciate it. Thank you so much.