Ketosis and Alzheimer's: A Metabolic Neuroscience Journey With Dr. Stephen Cunnane

welcome back to metabolic mind a non-profit initiative a bazooki group where we're focusing on the intersection of metabolic health and mental health and metabolic therapies like ketogenic therapies for mental illness I'm your host Dr Brett Shure today we're going to continue our discussion on metabolic therapies ketogenic therapies for neurodegenerative diseases such as Alzheimer's disease we're fortunate enough to be joined by Dr Stephen cunane Dr Kinane is a professor in the department of medicine at the University of Sherbrooke and he's also the chair in keto Therapeutics which is a recently new position and very exciting which we're going to hear him talk about he's published over 350 articles in peer-reviewed journals he's been the author on five different books and he's a researcher on in the center of aging and and Dr CUNY and it's really interesting because he truly is a Pioneer in this field and sort of stumbled upon it by accident so we hear about his origin story what got him interested in studying ketones ketones in the brain and then how that sort of transitioned to ketones ketogenic therapy for neurodegenerative diseases and since he's been there in the beginning and he's still there now he can give us sort of the perspective on how the field is changed but in two different ways how the research field has changed and then maybe how the clinical field hasn't changed nearly as quickly and has been very slow to adopt and why that is what he thinks needs to change plus we hear about some exciting new projects he's working on so I think this is a really interesting exploration of of Stephen and and his journey through this and what it means sort of for the field of Keto Therapeutics so I hope you enjoyed this interview with Dr Stephen Kinane well Dr cunane I'd love to start by hearing what got you interested in in exploring ketones as a potential treatment for neurodegenerative diseases because this is a you know a huge field with lots of research going on but when you look back over the past 10 20 years probably not so much about ketones it's definitely sort of an alternative approach so what got you interested in that alternative so-called approach well I guess there's two parts to the answer Brett one is serendipity and the other was that I'd heard roughly at the same time that I made the serendipitous uh observation in a research project which I'll come to in a sec I heard about the ketogenic diet in the film first Do no harm which was sort of the first uh widely publicized way of seeing the treatment of epilepsy with with the ketogenic diet with Meryl Streep and so on and I thought that was the craziest thing I'd ever heard about because you know like most people uh in the early 90s and perhaps many people today I thought low fat was was important and and the high fat was gonna sort of kill people and all the rest of it pretty naive view but that's where my I was at and and so to be honest that there weren't that many people working on even on the ketogenic diet and epilepsy in the early 90s the serendipitous observation that really made me pay more attention to the ketogenic diet in epilepsy was that we by mistake discovered that polyunsaturated fatty acids that are in our diet like alpha linolenic acid and linoleic acid or actually moderately ketogenic and more more interesting than that during early development at least in the animal model we were studying they were quite important sources of carbon to help build the lipids in the brain which completely blew me away I was working on omega-3 fatty acids and the uptake of DHA into the brain and here I was seeing one of the precursors of DHA that was being incorporated into cholesterol and saturated fatty acids in the brain at about 10 to 20 times the amount that was going into DHA it seemed completely implausible and then I I learned that the ketones were underlying that process that the fatty acids are broken down by beta oxidation and some of the carbon is lost to carbon dioxide but some is recaptured and used in in lipid synthesis and so this got me interested in brain development and you know neurodegenerative diseases came along in my in my career um at least 10 years later but it was the early development thing that that struck me and you know some of the Pioneers in the 1960s that were looking at ketones and early brain development have all been forgotten about now but that's in fact to me what was started this whole thing is that if ketones are important for early brain development maybe that explains in part why they're beneficial for child in childhood epilepsy yeah and when I got the opportunity to move to Sherbrooke because at the time I was in Toronto uh I had the opportunity to start doing brain Imaging and uh the Pet Imaging that we started here was is was something they they were quite prepared to try and make the Ketone Tracer and to me that was really an important step forward to look inside this black box and and see what was going on we still didn't have Alzheimer's disease on the radar at the time but as we though but there was no opportunity to study ketones in early development for me so and and since I was affiliated with the research center on Aging I said well you know if they're important for brain development perhaps they're important for the for brain function as we age and uh maybe there's something we can learn about the way the brain is using these two fuels that that would be relevant to healthy brain aging and uh you know it's turned out very to be very interesting but uh at the beginning we had no idea where this was going to take us yeah really interesting that started with that just the scientific curiosity of ketones in the brains and the interaction and and I like that you mentioned Imaging though because like you said the brain's a black box how do we know what fuel the brain is using how can we tell if it's using glucose or ketones so you had to sort of help develop this technology to differentiate that so give us you know the the the the one minute Layman's version of how can you tell what the brain cells the neurons are using for fuel to create energy so Imaging PET Imaging specifically um positron emission tomorrow fee you can follow different isotopes different molecules as they're being used by the brain what you get is an image of the activity of the utilization of those molecules in different parts of the brain and what we've known since the 1980s since the dawn of of PET Imaging uh in human studies is that that glucose is is the main fuel that was known already but you can see the pattern and you can see that the gray matter is using twice as much glucose as the white matter for instance but the white matter is not inert it's not just an insulated wire it's actually actively metabolizing making uh myelin making the insulation for the nerves and there's an active process that's involved there now we knew we also know that ketones are used by the brain and we've known that since the 60s with um uh George Cahill for instance um and that during starvation ketones become a dominant fuel but little was known about the process in relation to aging and the big surprise for us was that we knew that there was this problem when getting glucose into the parietal cortex and Alzheimer's disease that that had been known since the 80s as well even on the crudest pet images that were available 40 years ago you can still see that that area of the brain is simply not metabolizing glucose very well and the interpretation always was that those cells are dying or have died and hence they don't they're not going to use much fuel of course because a dying cell doesn't have any energy requirements so it was interpreted as a consequence of the disease and we said well two points one is um that problem seems to be present the metabolic problem seems to be present before people are clinically diagnosed with Alzheimer's disease so maybe it's not just a consequence but there are two fuels anyway and under the right circumstances the brain is quite happy to use ketones and lo and behold when you look at the image for for fdg and the and for ketones you don't see any deficit in Ketone utilization in the parietal cortex at all observation that was novel at the time it's confirmed by four different techniques now in in labs around the world so I'm I'm quite confident it's a very robust observation yeah so just a quick summary so fdg meaning the glucose uptake so in these in these cells glucose uptake goes down but Ketone uptake does not they can still use ketones for fuel therefore they're not dead cells like you were saying because they're still using energy they're just using ketones they probably will be in in the course of the next couple of years to come if they're starving and if you give them the right fuel they can use it so the question then is how how do you preserve that them keep them alive and keep their communications alive so that they can keep the brain function alive the memory and the executive function and language and and these cognitive parameters that decline in Alzheimer's disease and so but that Pet Imaging gives you a window on that process and it shows you where the problem is if you've just had a stroke it's probably going to show you that that area of the brain has gotten uh anatomically is is different but also has a problem with the glucose uptake but it also if you do it correctly it can show you the magnitude of the problem how much glucose is missing is it two percent of what the brain would normally want to see or is it more like 25 which is the case in Alzheimer's disease it's a huge number it's like trying to run an eight-cylinder car on on five cylinders or six cylinders I mean you know that's all technology when you think of uh today about being ethologically more responsible for the electric cars and so on but it's a the analogy is that in fact the brain is a hybrid car and what we're getting it to do is to run on the electricity and the battery and and the electrical motor and bypass problems with the the gasoline engine uh which is what's happening with glucose yeah you know it's so interesting that the terminology is frequently that ketones are an alternative fuel for the brain and I always thought that that's so interesting that it's alternative it's only alternative basically because we've made it alternative through our our lifestyle but when you when you see the way ketones are used would you say it's a it's a primary fuel or a preferred fuel or it runs better like can you use I don't know why I say sort of like judgmental terms like that to say that the brain is the brain is meant to run on ketones more than glucose perhaps well in the infant there's not enough glucose getting to the brain to meet the infant spring energy requirements when it's born so they're an essential fuel for about 25 percent uh ketones are supplying about 25 of the energy requirements of the newborn infant so they're they're essential for that purpose essential meaning you cannot survive without that's right and the fact that we're born with fat babies our species if they're born a term if they're born normal and healthy they've got fat they've got five to six hundred grams of fat and that is helping to generate the ketones to meet their brain's energy requirements so it's essential now it's still not the main fuel in the neonate and that and if that baby's being breastfed then that's sort of the ideal situation so now we progress towards adolescence and adulthood and we're on a typical Western diet whatever that means and obviously it's predominantly carb um and the Ketone contribution goes down to around three to five percent the only way you can get it back up is to really suppress carbohydrate uh intake and when if you're if you're on a ketogenic diet which is as you know well it's probably under five percent uh carbohydrates in the diet ketones will be supplying on the order of 40 plus percent of of the brain's energy requirements still not the majority but what's very interesting is that when you are on a ketogenic diet and you have no problem with spraying glucose or Ketone utilization such as in a young healthy adult for instance glucose uptake will be suppressed when the ketones are available so when you provide ketones they are in fact the preferred fuel it's it's a term that I I I know rubs some people the wrong way but I think it's it's the correct term that ketones when they're available and both fuels are available and there's no limit to utilizing both of them ketones will go in and will suppress utilization of glucose and that's been shown by two different techniques totally different techniques as well so I think that's a robust observation but for the majority of of people uh unless you're on a very strict ketogenic diet glucose will still be the main fuel and and I think that's normal and that's okay but underlying your question is are ketones doing something that glucose cannot do um are they complementing in some important way and that's something we still don't know but when you're born they are actually the main fuel to make not the main fuel but the main substrate to make brain lipids cholesterol is quite an important component of the brain saturated fats are very important in the brain to make the myelin but also in the gray matter and so they are the dominant source of carbon when you're born to make the brain lipids yeah so interesting to think about how it is from birth throughout and then changes throughout life but then again at in diseases of Aging like Alzheimer's disease neurocognitive diseases that it becomes important again and and so let's fast forward then to when your research turn towards Alzheimer's disease where so much of the focus has been on the the you know the amyloid plaques and the neurofibrillary tangles and like that's been the predominant Focus for decades and decades and decades and here you come and say well let's why don't we start looking at energy utilization and change energy utilization I mean there was what did that seem just completely revolutionary at the time and completely crazy to some some neurologists and researches at the time well we've always had trouble convincing the neurologists that that it was relevant because they they're all looking for uh sort of the Magic Bullet treatment to these sorts of disorders and the amyloid seemed to be the obvious choice I mean it is present it's a present not in all people with Alzheimer's disease as you may know so it's not a guarantee that having high amyloid May in fact be associated with Alzheimer's but it may not and you can you can have Alzheimer's disease clinically without a large amyloid load um but so yes it's always been sort of um the orphan approach to um to to alzheimer's Therapeutics but we came to it honestly in the sense that we were never intending to to treat Alzheimer's disease we were simply looking at the metabolic state of the brain in a healthy older person in fact we spent a lot of time trying to Define what is a healthy how do we Define a healthy aging anyway and what is the state the energy state of the brain in that that the person that we've defined as cognitive as healthy and we ended up dividing based on on cognitive norms for for uh for normal cognitive performance at certain ages and we always found that there was a five around five to seven percent lower glucose uptake in the brain in even in the healthiest elderly people that we could identify and we said well what's happening in mild cognitive impairment which is the early stage of Alzheimer's disease and Alzheimer's disease and there's a gradual progression towards a lowering of of glucose uptake with with a steady uptake of ketones so we kind of said wow that's interesting uh if if the cells are not dead and they're able to metabolize ketones maybe this can help support brain function so what are we going to give people to supply them with more ketones this is around 2012 or so um I knew about the ketogenic diet of course at this point and I was I was doubtful the Ethics Committee was going to let me put 75 year olds on a ketogenic diet for uh six months and even if they were going to permit me to do it I knew enough about Alzheimer's disease at that point to realize that their their fragile population uh and it's maybe capricious sounds like a little maybe not fair but but they're likely to change their mind and they might say oh yeah I'm willing to do this project but a week later they might change their mind so we need something that's more likely to take over an extended period of time and we ended up settling on MCT medium chain triglyceride as a supplement knowing that once you give the dose you're going to get a rise in blood levels and it's going to go down and if you get another another dose later on it'll rise and go down so it's kind of um you're making a compromise either way they're on a ketogenic diet for two weeks it's not enough to learn anything about their cognitive function really if they're on MCT for six months that's long enough but you might not have high enough ketones to change anything in their lives um so that's the gamble we took and we came out ahead in the sense that uh in looking at mild cognitive impairment we actually showed you could improve cognitive performance in all the five cognitive domains in in the very early stage of Alzheimer's disease where there's only a mild deficit to start with yeah so this is fascinating it was a six-month randomized controlled trial that you did with the MCT supplement versus a placebo supplement and as you mentioned there was improved cognitive function for memory executive function language and you know one important thing when you when you're dealing with trials is what is the magnitude of improvement was it just a tiny Improvement was a clinically relevant Improvement so how would you summarize the degree of improvement that the people on the MCT supplements saw in six months so the main Improvement that we saw in terms of magnitude was in language and and it was borderline clinically relevant um so the other changes were also statistically important they're they're considered to have a decent effect size a moderate effect size which is sort of a proxy for clinical utility but remember in mild cognitive impairment they are they're fully autonomous in their daily lives they're able to get around to drive um remember their pin number for their bank account and so on so they're only starting with a very small deficit that you can Define on these objective tests so you're not expecting a dramatic change in their lives that you can see and they when they walk into the into the research center which you do see occasionally with the ketogenic diet is a colleague of mine Russell swerdlow again in Kansas city has said you know I could tell in a couple of my patients who were on the ketogenic diet when they crossed the parking lot to come into the research center I could tell how much better they were doing so that that jumps out at you because the Ketone levels are a lot higher on a ketogenic diet than they will be on a ketogenic supplement so again it's it's it's it's often a practical question and you'd like to get ketones up to a certain number but what's the way to do it and what's the chances of sustaining someone on that treatment for an extended period of time what's your Placebo going to be uh and work with the ketogenic diet but also with the ketogenic supplements faces this sort of um scrutiny that okay you've seen an effect um what was the control group on and you know for the ketogenic diet that's a tough call to set up a a controlled study we were able to use a control group uh with the MCT so you know it's a it's a question of progressing towards uh solving these sort of practical issues um that make it credible in the end and so far it's been promising for me yeah and and you know other researchers in this space we we recently interviewed um Dr Matthew Phillips who also did a study on on ketogenic intervention for Alzheimer's disease and showed improvements so it's clear that the needle is moving that direction which I think for you must be fascinating to think about when you started in this field how nascent it really was and now to the point where there are a number of different intervention studies that keep getting I guess you could say better or keep adding to the the literature and hopefully progressing and now to the point where there's even a chair in keto Therapeutics which is what you are in your new position like so do would you ever have dreamed that it would have progressed this much and and this quickly I mean you know some people could say it's been slow but by research standards I would say it's been fairly quickly so I don't know would you ever dreamed it would have happened well you feel you feel both ways about it you watch the time go by in the year years go by and you say you know no one seems to be doing this any faster than we are in terms of getting clinical results published that a randomized controlled trial so in that sense I feel good but in the end you know you spent 30 years working on this and you'd like to see it go faster and to be more accepted because there's I think there's a certain resistance if I could use that word in the medical establishment by and large the expectation is that drugs will be the solution to many of these diseases whether it's diabetes hypertension mental health in fact and they're the Mainstay For Better or For Worse they're there and they're in your face um and and so the idea for a neurologist to see to see or a psychiatrist or a geriatrician to see the disease through the lens of a metabolic problem and to reconfigure the way they think about the disease I think that's probably the the main challenge ahead now is to is to get an acceptance that there is a metabolic Foundation to many of these disorders and there's a metabolic solution and it doesn't necessarily involve drugs and their side effects but if you come back to the original disease that was um treated with the ketogenic diet that was epilepsy and every generation new generation of epileptic drug that was developed kind of set back the ketogenic treatments by another decade or so and but the side effects were often worse than than the benefits uh and and yet there's so many people were frustrated I mean uh the bazuki family went through a period of immense frustration when they realized that there was a different approach to their their sons mental health issue it's exactly the same story without in epilepsy with Jim Abrams back in the 90s when which got him to uh to produce the film first Do no harm why is is there is there a cultural uh resistance or a cultural obstacle in in the medical establishment um and that's something that we have to learn to deal with and try to solve yeah it's very well said and if you I mean you can imagine that the two different graphs one of the progression of research in these fields and one is the the adoption in clinical practice and with epilepsy you know the research took off and there there are you know dozens of randomized controlled trials and Cochrane reviews on ketogenic therapy for epilepsy but the clinical uptake was so slow compared to the research church and I think we're we're probably seeing something similar with ketogenic therapy for neurodegenerative diseases that we see more pockets of people doing research but the clinical adoption is still very low because of this drug-centric approach um that that you mentioned so well I think answer keys casts a long Shadow over the ketogenic Therapies in the sense that fat is the enemy and and if there's more fat in your diet we're still uh as a worldwide we're still um very much affected by that um Dogma that fat is the enemy um and and so uh that's something that we have to reconfigure and our older population on the Alzheimer's study I mean they were really concerned that MCT is a saturated fat that's going to be bad for me I'm going to gain weight so I said well these are the results and the result is that you don't you don't gain weight and so it's one study at a time uh gradually but we have Society has seen that as the enemy for the past 50 60 years and it's it's not going to change overnight yeah yeah I want to go back to something you said where you said you doubted that the um IRB and the Ethics Committee would allow you to put 75 year olds on a ketogenic diet implying that they would assume it is a dangerous diet and they should not go on it which is of course backwards thinking do you think that's changed do you think if you went to an IRB tomorrow that it would be they'd be much more accepting of it yes I think it has changed um it's changed because of the results of people the people like Verde health and and the acceptance now that type 2 diabetes can be treated and can even be put into remission and the openness I think that the American dietetic and diabetic associations have two uh a lower carb intake is is coming so I know I don't know whether the cardiologists have have turned the page on that yet um that's something you might might know better but I don't think neurologists have yet so there's still a fairly um strict view of of treatment options and you know to be fair if I was a neurologist I would have a list of options that I'd be allowed to use that my Association has approved um and and the ketogenic diet is is nowhere on that list so uh what risk is that person taking to be ostracized or to even be disciplined for introducing a treatment that is not accepted if it's not accepted it's probably because it doesn't work I mean that that's the logic and so we need to change that um when and it's still going to take time yeah and of course if the alternative is just to let them continue to eat their standard American Standard industrialized diet nobody thinks twice about that right but uh to put them on a ketogenic diet would be potentially risky or dangerous from a a medical perspective which doesn't quite fit does it that that framework no and the evidence is there um that that it is acceptable because often they they said well it might be effective uh the ketogenic diet but people won't tolerate it and even if they tolerate it it's too expensive or it's limiting in its vitamins and and there's always this search for some other reason to not try try it when when in fact those reasons aren't valid but we have this sort of internal psychological resistance that's pretty hard to overcome yeah yeah and when you I mean when you hear these personal stories of how much people have improved um with ketosis that all of a sudden it becomes the most sustainable and easiest thing to comply with because of the benefits you're seeing you don't want to see disappear so so many people will do anything they can to stick with it with that type of benefit and it's it's um anybody who says that clearly hasn't tried it or or doesn't know enough about it to to realize that it can be incredibly sustainable and easy for many people but our society is not one that that promotes it and our society is one that makes it more challenging so I guess you know it's understandable some of these hurdles so you have to figure out how do how do you change things from a research perspective so that we can get some infiltration into the clinical perspective so when you think about that and you think about connecting the dots where do you think research has to go to make it more clinically acceptable oh we need more robust results I mean my RCT had 40 people per group that's borderline uh significant in terms of the sample size um but most neurologists will say well you know it's going to take you 300 people per group normally to to be convincing of course we didn't have access to five million dollars to do it with 300 people but but more robust studies are needed we Placebo is is is a um an absolutely essential part of this process whether you're working with a supplement it's it's basically impossible to do with it with a ketogenic diet so um I I don't know whether we'll ever have the robust results for the ketogenic diet in in older in in neurodegenerative disorders um I I think the the thing that that sort of resets the the table a little bit is is um the internet and at the families and and patients are able to access the information and judge it for themselves and either push their doctors to to agree or or to say that I'm going to do it despite your misgivings sort of thing um but you know there are companies making money off ketogenic products uh uh a lot a lot of money in some cases and I think there's a question of social responsibility to to produce uh Placebo so the research can go forward to engage at some percentage of their profits in in research uh that can be independently vetted by some sort of uh advice scientific Advisory Board uh and and to to make this treatment more credible because at the moment it looks like the wild west out there and it's only feeding the concern that some clinicians will have that this is simply profiteering and there's nothing really scientifically valid underneath this and so I I think the companies are going to gonna burn they're burning the candle at both ends and at some point they're missing the opportunity to be more responsible and to have longer term view of of the profits they could make because it has a more it's a more credible treatment for for serious chronic diseases yeah that's a great point I mean as as we know from medicine that anytime industry and profits get intertwined with medicine it becomes quite complicated and uh you never know what to trust and what to believe when profits get in the way which is one thing that's so great about about a diet when we're talking about food you know if we're not talking about products and we're just talking about eating in a certain way you know nobody is going to have a patent on that and uh and and it folk the focus is more on helping people improve than really helping the bottom line so hopefully that that Purity can help people understand these results better than than industry sponsored results but maybe that's naive I don't know is this a challenging process I mean if you need to stop not need to anyone who smokes needs to stop smoking but if smoke is not something you need to do except because of the addiction it's not you don't need it for it's not life-giving it's it's life sapping alcohol is not something you need but food is something you need so people will have to have to make choices and they may prefer at some point to have eaten more sugar in their diets or more dessert or more pop or whatever it is and they have to learn to consume less but and consume differently and that's that's a psychological uh and an appetite adaptation that is is slower in an older population it's not easy to get that commitment that motivation how does a 75 year old in a residence where everyone's getting dessert twice a day uh decide not to eat dessert for instance as a starting in to reduce their carb intake without changing whether the Corn Flakes without changing whether to eat rice or potatoes just trying to reduce their desserts for instance it's it's a challenging process I'm doing it in a residence right now we started with a 10-day project and and we got we got uh some very encouraging results and we're going on to a two-month project now but there's a lot of resistance like I don't I don't want to have to eat you know this is I'm finding a stage in my life where people are taking care of me I can afford to be in this nice residence why why would I change what I'm going to eat well you're taking medication for diabetes wouldn't you like to stop that some do some don't I'm sure people with mental health issues it's the same problem how do you motivate them to to make that change when perhaps the only pleasure they're getting out of the day is the bag of chips or two Donuts or whatever it is um so there's a there's quite a challenge and I'm by no means I'm not a behavioral psychologist so I'm not sure the best way to approach these these issues but one approach is with the ketogenic supplements which allows people to eat what they're eating ideally they would change towards a lower carb but they can still get the ketones because the Ketone production from medium chain triglyceride or from a ketone salt for that matter is independent of insulin whereas if you're depending on the body to make the ketones without the supplement you have to get insulin down so you have to get that motivation level to reduce your carbs and so on so there are different strategies and they're not they're not mutually exclusive they can be combined and that's what we're starting in in the in the trial in in the resonance uh this fall is is a combination of MCT plus a 50 reduction in carbon team oh that's wonderful I I think we need programs like that especially in in a controlled setting like that like in a residence that that can really control what people are eating and really see the impact because like you said when you're getting dessert twice a day and every meal is high carb and that's just the way it is you don't question it and so it takes someone like you to come along and and question it and change it and and you mentioned that you're not a behavioral psychologist but you brought up some very important issues which you clearly understand that if you're if all you're doing is taking taking taking it feels like deprivation but if you can substitute if you can take away the pleasure from the donut and substitute it with something else whatever that something else may be then you're on the more on the road to accomplishing you know a longer term success with that and the hope is for people with cognitive impairment or with mental illness us that improved brain function improves psychiatric and mental health is one of those carrots that you feel better and then you can exercise more and then you can engage in in more creative activities or that those are the carrots I use carrot but those are the the benefits to the low carb carrots the low garbage those are the benefits to replace which are quote unquote taking away so I mean you clearly understand the concept and um and and that has to be part of it you mentioned talking to Matthew Phillips and and I I know of Matthew have corresponded with him but I haven't actually spoken to him but uh he's worked with both Parkinson patients on a ketogenic diet and Alzheimer's patients and I'd be very interested to to know whether he had the same experience as us which is that the Parkinson patients are easier to recruit and easier to maintain their retention on the study is easier than it is with the Alzheimer's patients they're basically the same age so it's not age alone but I think the difference is that the Parkinson patients if they're improving can actually see that the Tremor is going down or that they're actually able to write something or hold their spoon for their soup or whatever it is I I I'm not sure and I'm sure that's a motivating factor because the quality of life is they can feel the difference whereas with Alzheimer's disease is the Improvement that may be occurring may be perceptible to the patient themselves probably more likely to their their loved one or the their caregiver who can see improvements that the per the patient themselves doesn't even notice so how do you motivate the person who doesn't actually perceive the benefit yet yeah great question great question yeah really interesting that's where that's where having a care team and having loved ones and a family and a support system can be can be so important so it's not it's not just change what you eat is change what you eat have behavioral modifications in place have a support system it's all part of it which is a lot harder than just popping a pill right it's it's more involved than just taking a drug so we can see why there's a higher a steeper on-ramp maybe to adopt it but in the long run probably so much more important than the than this taking medication so I think this has been a wonderful journey to hear about you and your big beginnings and and how you progress through this field and how the field has progressed and we heard about your project that you're working on in the residence so so what else are you working on what can we expect from you in in the near future as As you move on with your research uh two things really um one is that we learned Again by accident that exercise helps get ketones into the brain in in Alzheimer's patients I presume that's also true in healthy individuals but we don't know that for sure so we were struck immediately by the opportunity to combine the supplement or the ketogenic diet plus exercise again this is not a a a single Silo approach to the to the disease that ketones can be generated by one technique but their uptake can be improved by another technique which would be the exercise so combining the two so we're doing a pilot study and Parkinson patients with a ketogenic supplement plus exercise and the same thing in Alzheimer's patients we're going to be analyzing the preliminary data uh later this summer and hopefully we'll have something to to say about that this fall so again multimodal I guess is the term we would use and these things are ketones can't do it all and they shouldn't be seen as something that um is is sufficient by itself it should be combined with with other approaches to your health uh because even if there was no problem getting ketones uh or energy into the brain exercise of course is beneficial for for for health anyway and so it's it's not just one or the other two together the other thing we we're impressed to learn again a little bit by accident is that when you have a tracer for ketones you can look at it where it's used in the body so uh we had been focused on the brain pretty much above the neck as we say we decided to look below the neck one day and found that the heart is extremely actively metabolizing ketones as is the kidney uh and so we're sort of ruminating about what kind of projects we can do to study heart failure and there's already Publications out there uh suggesting that ketones could be beneficial in in uh diabetic heart cardiac failure um and so is this a question of fuel utilization and fuel strategies fuel-based strategies metabolic strategies uh as as for the brain is it is it actually a similar situation to that in the brain the difference being of course that the heart prefers to use fatty acids as fuel in the brain does not the brain essentially cannot use fatty acids for all intents and purposes doesn't use fatty acids specifically so we're looking below the neck and there may be some interesting things that we can learn it's still a bit physiological a bit exploratory but there could be some opportunities there as well wow very interesting I love to hear all that so hopefully uh hopefully we can have you back when some of this research starts to to play out and you get some results we'll have you back on at metabolic Minds here to discuss the results and see be a pleasure uh Brett yeah absolutely well great well thank you for taking the time really appreciate you sharing your journey with us you're welcome thanks

Channel: Metabolic Mind

Views: 36,358

Keywords: metabolic psychiatry, keto, ketogenic diet, keto for mental health, nutritional psychiatry, mental health, mental illness, bipolar, schizophrenia, depression, alternative psychiatry, metabolic health

Id: I0N0W4y-KLM

Length: 40min 11sec (2411 seconds)

Published: Wed Aug 30 2023