Clearly Keto: For Healthy Brain Aging and Alzheimer’s Prevention

By Mary T. Newport

A #1 AMAZON HOT NEW RELEASE

Finally, an in-depth look at the things you can do—and the things you should avoid—to delay, slow down, or possibly prevent Alzheimer’s disease and other disorders of the aging brain

Billions of dollars and decades of Alzheimer’s research targeting the hallmark plaques and tangles in the brain have failed to produce a meaningful treatment for people with the disease. Drawing from the extensive research into ketogenic dietary intervention that dramatically improved her husband’s early onset Alzheimer’s disease, Mary T. Newport offers new and practical approaches to taking control of the lifestyle risk factors in our everyday lives that threaten healthy brain aging.

Clearly Keto for Healthy Brain Aging and Alzheimer’s Prevention provides the rationale and a detailed plan for adopting a whole food ketogenic Mediterranean-style diet to overcome insulin resistance and provide ketones as an alternative fuel to the brain. 

• Language: English
• Publisher: Turner Publishing Company
• Release date: Nov 29, 2022
• ISBN: 9781684428366

Mary T. Newport

MARY T. NEWPORT, M.D., grew up in Cincinnati, Ohio, and was educated at Xavier University and University of Cincinnati College of Medicine. She is board certified in pediatrics and neonatology, and she completed her training at Children’s Hospital Medical Center in Cincinnati and Medical University Hospital in Charleston, South Carolina. She practiced neonatology in Florida for thirty years and was the founding medical director of two newborn intensive care units in the Tampa Bay area. More recently, Dr. Newport has practiced at the opposite end of the spectrum, providing care for hospice patients in the Tampa Bay area for nearly three years and in-home health risk assessments thereafter. She writes and speaks in the United States and around the world on ketones as an alternative fuel for the brain for Alzheimer’s and other disorders.

Book preview

Cover: Clearly Keto, For Healthy Brain Aging and Alzheimer’s Prevention by Mary T. Newport

Also by Mary T. Newport

The Complete Book of Ketones: A Practical Guide to Ketogenic Diets and Ketone Supplements

The Coconut Oil and Low Carb Solution for Alzheimer’s, Parkinson’s, and Other Diseases: A Guide to Using Diet and a High-Energy Food to Protect and Nourish the Brain

Alzheimer’s Disease: What If There Was a Cure? The Story of Ketones

Logo: Turner Publishing Company

BASIC HEALTH

AN IMPRINT OF TURNER PUBLISHING COMPANY

Nashville, Tennessee

www.turnerpublishing.com

Clearly Keto: For Healthy Brain Aging and Alzheimer’s Prevention

Copyright © 2022 by Mary T. Newport. All rights reserved.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Sections 107 or 108 of the 1976 United States Copyright Act, without either the written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923. Requests to the Publisher for permission should be addressed to the Turner Publishing Company, email: [e-mail].

Limit of Liability/Disclaimer of Warranty: While the publisher and the author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents, and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Neither the publisher nor the author shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

Text and cover design by William Ruoto

Charts and images drawn by Joanna Newport

Library of Congress Cataloging-in-Publication Data

Names: Newport, Mary T., 1952- author.

Title: Clearly keto : for healthy brain aging and Alzheimer’s prevention / Mary T. Newport, M.D.

Description: Nashville, Tennessee : Basic Health, an imprint of Turner Publishing Company [2022] | Includes bibliographical references and index.

Identifiers: LCCN 2022008317 (print) | LCCN 2022008318 (ebook) | ISBN 9781684428342 (paperback) | ISBN 9781684428359 (hardcover) | ISBN 9781684428366 (epub)

Subjects: LCSH: Alzheimer’s disease—Diet therapy. | Ketones. | Ketogenic diet. | Fatty acids—Therapeutic use.

Classification: LCC RC523 .N5357 2022 (print) | LCC RC523 (ebook) | DDC 616.8/310654—dc23/eng/20220401

LC record available at https://lccn.loc.gov/2022008317

LC ebook record available at https://lccn.loc.gov/2022008318

Printed in Canada

Steven Jerry Newport, my husband, my best friend, and a wonderful father to our children, 1950 to 2016.

This book is dedicated to my husband and best friend, Steven Jerry Newport, who fought with all his might against early-onset Alzheimer’s disease but lost the battle on January 2, 2016.

This book is also dedicated to the memories of Richard L. Veech, MD, D.Phil., Theodore B. VanItallie, MD, and George Cahill, Jr., MD: three extraordinary ketone researchers whose studies and writings were instrumental in Steve’s recovery and better life.

CONTENTS

FOREWORD by Dominic D’Agostino, PhD, and Milene Brownlow, PhD

PREFACE

INTRODUCTION: Steve’s Reprieve from Alzheimer’s Disease

PART ONE: How a Mediterranean-Style Diet and Ketogenic Strategies Could Change Your Life and Health Span

• Get Ready to Change Your Life and Your Brain

• Why Go Keto? Fuel, Energy, and the Aging Brain

• Diabetes and Alzheimers

• Clearly Keto: A Reasonable Whole-Food Mediterranean-Style Ketogenic Diet

• Other Ketogenic Strategies and Ketone Supplements

• Other Supplements That Make Sense

• Putting Your Personal Plan Together to Fight Brain Aging

PART TWO: Other Things to Do and Things to Avoid for Healthy Brain Aging

• Lifestyle Choices That Can Impact Healthy Aging and Risk of Dementia

• Avoid These Things to Prevent Dementia and Enjoy Healthier Brain Aging

PART THREE: What Happens to the Brain in Aging and Diseases Like Alzheimer’s: How Ketogenic Strategies Can Help Overcome Insulin Resistance and Inflammation

• What Goes Wrong in Alzheimer’s and Other Brain Diseases: How Diet, Ketones, MCT Oil, and Coconut Oil Can Help

Conclusions and Final Words

Keto-Friendly Recipes

Resources

Acknowledgments

References

Index

FOREWORD

By Dominic D’Agostino, PhD, and Milene Brownlow, PhD

Left to right, Mary Newport, MD, Dominic D’Agostino, PhD, Milene Brownlow, PhD, enjoying the Metabolic Health Summit, January 2020.

Alzheimer’s disease is considered the sixth-leading cause of death in the United States (second in the United Kingdom), currently affecting 6.2 million Americans. This number is projected to reach 12.7 million by 2050 as the population of Americans aged 65 and older is projected to continue growing (Alzheimer’s Association 2021). These numbers, coupled with decades of pharmaceutical research that has resulted in few treatments, which merely address symptoms, highlight an urgent need for better approaches to optimize brain health and preserve cognitive function with age.

For well over a decade, Dr. Newport has played an instrumental role in advancing the field of Nutritional Neuroscience by expanding the use of ketogenic diets and supplementation beyond their traditional use as metabolic therapies for epilepsy. Her personal story and educational outreach have inspired researchers and brought hope for many families and caregivers, empowering them to be their own health advocates and taking steps to improve their own prognosis. She was, after all, that caregiver, faced with an impossible situation when her husband Steve, at age fifty-one, started developing early-onset Alzheimer’s and Lewy body dementia. As Steve’s cognition deteriorated with alarming speed, Dr. Newport began a desperate search for anything that could bring her husband back. Through her tireless efforts, she stumbled upon research indicating that a hallmark of Alzheimer’s disease is impaired brain energy (glucose) metabolism. Further investigation led her to early research conducted by Dr. George Cahill (Harvard), Dr. Richard L. Veech (NIH) (Veech 2001), and Dr. Samuel Henderson. Collectively, their research suggested that ketone bodies (β-hydroxybutyrate and acetoacetate) could function as an alternative fuel to preserve and enhance brain-energy metabolism. Dr. Newport tested this hypothesis on her husband by administering coconut oil, a source of medium-chain triglycerides which convert to ketones when ingested and induce hyperketonemia, more commonly known as ketosis. Remarkably, this relatively modest elevation in ketone levels resulted in positive changes in Steve’s mood and objective measures, including the Mini-Mental Status Exam and clock-drawing test. Dr. Newport’s observations garnered local media attention, including a 2008 St. Petersburg Times article about their experience using this nutritional therapy (Hosley-Moore 2008).

As a faculty member at the University of South Florida Morsani College of Medicine, Dr. Newport’s story about ketones piqued my interest from a personal and research perspective. I (D’Agostino) had personally witnessed Steve’s positive response to acute ketogenic supplementation, and it greatly inspired my interest in this topic. We had gone out to lunch after Dr. Newport guest-lectured at USF, and Steve joined us. Just prior to eating, Steve consumed a small vial of coconut/medium-chain triglyceride oil mixture. Shortly after, he became more engaged and talkative, and his fine tremors stopped. From a research perspective, I had previously proposed using a ketogenic diet as a strategy to prevent central nervous system oxygen toxicity seizures, a limitation for Navy SEAL divers breathing high concentrations of oxygen; however, the Office of Naval Research was concerned about the safety, efficacy, and logistics of feeding divers this type of diet under operational constraints. Therefore, the possibility of using supplemental ketosis (without dietary restriction) as a neuroprotective strategy was appealing to me and later became a major focus of several research projects. Shortly after I became aware of this story, another article highlighting Dr. Newport’s success with ketone supplementation surfaced in 2009, and Dr. Dave Morgan, PhD, the CEO of the University of South Florida Byrd Alzheimer’s Institute, organized a meeting. This collaborative meeting was organized to discuss investigating the efficacy and mechanism of ketogenesis for Alzheimer’s disease.

Dr. Newport is the reason I (Brownlow) became passionate about the topic of ketogenic diets and metabolic therapies for brain health. Back in 2009, I was a first-year doctoral student at the Byrd Alzheimer’s Institute in search for a thesis topic. My background in behavioral neuroscience had previously focused on specific brain areas that control food intake and metabolism. After joining an Alzheimer’s Research Laboratory with a strong focus on immunology, I was intent on finding a connection between brain health and metabolism, and I soon learned that type 2 diabetes is a strong risk factor for cognitive decline. As I was digging through the literature and trying to piece together a reasonable research question, Dr. Dave Morgan invited me to join in the aforementioned meeting to hear about Dr. Newport’s personal experience.

From that conversation, a collaborative research project was formed to test the hypothesis that a low-carbohydrate ketogenic diet rich in medium-chain triglycerides could slow or reverse the neuropathological and behavioral features of Alzheimer’s mouse models. Our experiments used two different transgenic mouse models that each focused on well-established hallmarks of Alzheimer’s pathology: amyloid-beta and tau proteins. As rodents do not develop dementia, these transgenic models are genetically engineered to overexpress these proteins that aggregate in the brain and are associated with disease onset and progression. We tested adult mice that already had established pathology to address the question of whether our intervention could attenuate or reverse disease once it was already underway. This way, we could mimic Steve’s experience with testing an intervention once symptoms were established.

The mice loved their new diet, promptly eating the ketogenic food provided multiple times a week. We did not restrict calories, and despite the transgenic mice eating more than their controls on a standard rodent diet, we did not see overall differences in body weight. It has since been reported that these transgenic lines tend to present hyperactivity and increased metabolic rate that, at the time, prevented us from seeing the weight loss and satiety effects that are now consistently reported in human clinical studies testing ketogenic diets for metabolic health. The most striking result reported was a greatly improved motor performance by the mice consuming the ketogenic diet (Brownlow 2013). Because we did not see improvements in memory tests or neuropathology, this finding could have easily become sidelined or gone unnoticed. However, two key points came up as we worked on data analysis and interpretation. First, as mentioned above, these transgenic mice carry mutations that replicate early-onset or autosomal dominant Alzheimer’s disease, and these represent approximately 1 percent of diagnosed cases (Alzheimer’s Association 2020), suggesting that a genetic model is likely not representative of a majority of patients or even optimal to address our central question of whether the cerebral hypometabolism can be mitigated by ketones as alternative brain fuel. Second, improvements in motor performance may immensely improve quality of life for many patients and caregivers. It could be the difference between being bedridden and getting dressed by yourself, preventing a fall, or even filling your own glass of water. As any caregiver or family member with a loved one undergoing a dementia diagnosis could probably attest, these small steps can slowly add up and amount to more good days than not.

Dr. Newport has propelled biomedical research in ketogenic diets; but, more importantly, her work has inspired many to take control of their seemingly impossible situations. While Alzheimer’s remains a neurodegenerative disease with more pharmaceutical failures than successes, Dr. Newport’s story and continued efforts encourage others to become their own health advocates by using nutrition and targeted supplementation to care for Alzheimer’s and other dementias. In times when healthy eating is viewed as costly and labor-intensive, Dr. Newport proposes that wellness and cognitive health can start at home, in your very own kitchen, and that starting earlier will pay big dividends later in life. When I was growing up, I often heard my mother say she would rather spend on food than on medicine. I am often reminded of her motto when I am contemplating healthcare costs (for my small family of three or even for the nation amid a global pandemic) and whenever I am at the grocery store.

PAST, PRESENT, AND FUTURE

After its use in treating epilepsy for over one hundred years and its resurgence in the 1990s due to the heroic efforts of Jim Abrahams and the Charlie Foundation, the ketogenic diet has rapidly expanded as a more accepted metabolic-based therapy for seizures and for managing other neurological diseases, type 2 diabetes, and even brain cancer (Clini calTrials.gov 2021). It takes many years for a new treatment to gain acceptance or to be repurposed for other medical applications. Sadly, many doctors who are accustomed to prescribing pharmaceuticals still view diet therapy as snake oil. However, diet therapy was the prevailing practice long before the ketogenic diet was shown to effectively manage (and cure, in some cases) ⅔ of epilepsy patients after they failed multiple anti-seizure drugs. The consensus today is that the ketogenic diet’s effects are multifaceted and synergistic, and work independently of any known drug mechanism. It shifts metabolic physiology and brain-energy metabolism, and it targets signaling pathways (e.g., ion channels, neurotransmitters, epigenetics) that help restore brain homeostasis. Although epilepsy patients are acutely and overtly responsive, it is becoming clear that these beneficial changes also occur in those with Alzheimer’s and other neurodegenerative and neuropsychiatric diseases. Evidence of this is demonstrated in figures 1 and 2. No doubt the science of ketogenic therapies will continue to increase for many years to come, not only as a therapy but as a preventative lifestyle approach.

FIGURE 1. Publication by year (from PubMed as of 8.6.21). Overall increasing publication count for the term: ketogenic diet, 2005 to 2020.

For decades, Alzheimer’s-disease therapies and research focused on transgenic rodent models that assume the aggregation and deposition of amyloid beta and tau protein is the root cause of the disease. Although the targeting of amyloid beta and tau protein is the primary research focus, it does not address all neuropathological features and has consistently shown translational shortcomings in drug trials. The presence of amyloid plaques and tau tangles are important features of this chronic condition, but the true cause of Alzheimer’s remains largely unknown and debated. Emerging data suggest that factors such as metabolic dysregulation, insulin resistance, chronic inflammation, or a chronic infectious agent (viral or bacterial) could trigger and precede the development of amyloid beta and tau pathologies (Abbott 2020; Irwin 2019; Butterfield 2019). When viewed from this perspective, the amyloid beta, tau, and even Lewy-body pathologies may simply be a downstream reactive response to inflammation or infection (Pastore 2020). Although the cause of Alzheimer’s disease remains elusive, investigators like Dr. Stephen Cunnane, PhD and others have further validated the observations Dr. Newport saw in Steve (Fortier 2021; Broom 2019).

FIGURE 2. Publication by year (from PubMed as of 8.6.21). Increasing publication count for the terms ketogenic diet and brain, cognition, neurodegenerative disease, and Alzheimer’s disease, 2005 to 2020. KD: Ketogenic diet; NDs: neurodegenerative diseases; AD: Alzheimer’s disease.

By sharing her story and science-based, family-friendly research, Dr. Newport continues to be a beacon of hope offering a path forward to many of us. In Clearly Keto for Healthy Brain Aging and Alzheimer’s Prevention, she has compiled all the latest information on this topic and synthesized it into a user-friendly plan to treat and prevent Alzheimer’s disease and age-related cognitive decline. It is an exciting time for those of us working on the front lines of ketogenic diet research, and we are very grateful for Dr. Newport’s tireless effort to advance the science and practical application of ketogenic therapies.

PREFACE

Over the past century, the average lifespan has more than doubled worldwide, from just thirty to more than seventy years, thanks to advances in surgical techniques, medical practice, pharmaceuticals, and especially in the prevention and treatment of infection. Industrialization, urbanization, and advances in transportation have improved many aspects of our lives, but they have also polluted our air and soil, resulting in significant health threats. Humans on average are taller and stronger, thanks to an abundance of food. However, the global population explosion has required escalation of food production, and food quality has deteriorated. Over the past half century, Alzheimer’s and other dementias have become epidemic, along with diabetes and obesity. Much of this can be blamed on the very changes that have made our lives easier.

Keynote speakers at recent Alzheimer’s Association International Conferences have reported that modifiable lifestyle risk factors account for at least 30 percent of dementia cases, of which Alzheimer’s is the most common. Poor diet is the greatest risk factor for development of chronic diseases, dementia, and premature death, and may seriously impact the second half of our extended lives. In this book, we will discuss dietary and other lifestyle risk factors and changes that we can make to try to prevent age-related cognitive decline and improve symptoms in people who already have mild cognitive impairment, dementia, or other brain-related problems. People who are diabetic or prediabetic may also benefit from this approach, since diabetes accelerates brain aging and is a major risk factor for dementia.

In part 1, we will discuss the problems of insulin resistance and the brain-energy gap, how a low-carb ketogenic diet could help, and how to adopt a reasonable, healthy Mediterranean-style diet to sustain mild-to-moderate nutritional ketosis. We will also discuss other ketogenic strategies and a few supplements that make sense. Part 2 delves deeply into other lifestyle-risk factors, positive changes you can make, and some things to avoid that may cause, trigger, or accelerate Alzheimer’s and other dementias and impact healthy brain aging. Part Three provides a comprehensive review of the pathologies in the Alzheimer’s brain and how each brain cell type is affected. You will learn that insulin resistance leads to many different pathological changes in the brain, which then further worsen insulin resistance—vicious cycles that could explain the progressive downward spiral that is Alzheimer’s.

Alzheimer’s is the most studied of brain diseases, but insulin resistance with poor glucose uptake occurs in many other types of dementia and neurodegenerative diseases, diabetes, Down syndrome, migraines, and certain psychiatric disorders. The heart could also benefit from ketones as fuel for congestive heart failure and for recovery from a heart attack.

The Clearly Keto approach will not require you to spend a fortune on frequent doctor visits, prescribed supplements, and monthly newsletters. However, if you have a medical condition, I encourage you to find a doctor who recognizes the importance of good nutrition to support and monitor you. People with epilepsy or cancer could also benefit from a strict very-high-fat version of the ketogenic diet, in which case I strongly recommend working with a dietitian trained in the ketogenic diet. Of course, anyone could benefit from the help of a knowledgeable dietitian. It is never too late to make beneficial lifestyle changes, but the sooner, the better.

My previous books go into much greater detail about my husband Steve’s story and the large body of science behind this concept. A companion booklet is also available on my website (coconutketones.com) with recipes and color photos to help you plan healthy and delicious Mediterranean-style ketogenic meals.

INTRODUCTION

STEVE’S REPRIEVE FROM ALZHEIMER’S DISEASE

Physicians have long been taught to fear ketosis … This fear of ketosis may be exaggerated. Mild ketosis can have therapeutic potential in a variety of disparate disease states.

—Richard L. Veech, MD, D.Phil. (Veech 2001)

Steven Jerry Newport’s battle with early-onset Alzheimer’s does not have a happy ending, but there is a happy middle in this story.

My husband Steve and I grew up in Cincinnati, Ohio, and started dating when I was a high school senior. We were married after he graduated with a BS in business administration from Xavier University, while I was still in pre-medicine there. He stuck with me patiently through medical school and years of training in pediatrics and neonatology (the care of sick and premature newborns). When we decided to have children, he volunteered to work from home as the manager and accountant for my medical practice, which made it possible for me to be a mother and a doctor. I owe all of that to Steve, and he often said taking care of our two girls was the best job he ever had.

Steve was a physically active, creative man who loved gardening, kayaking, and reading Stephen King and Clive Cussler novels. He always had the latest, fastest computer for his accounting work, and when he was not working on his computer, he was playing on it. As an accountant he was a perfectionist and kept the business end of my practice flowing smoothly. Steve was not someone you would ever expect to get Alzheimer’s disease.

At age fifty-one, Steve began to show signs of a serious memory problem. He missed deadlines for simple quarterly tax returns and appointments for our children; soon he began forgetting whether he had been to the bank and post office, which was part of his daily work routine for many years. At first, his doctor thought depression explained his memory problems, which was likely exacerbated by his awareness that his brain was struggling. The memory problems steadily worsened, and he was diagnosed with early-onset Alzheimer’s disease in 2004 at age fifty-four. This was devastating news, since we fully expected to retire, travel, and live to a ripe old age together. Instead, our world was forever turned upside-down. Steve took the usual Alzheimer’s medications for years, but we did not see any difference.

By 2006, Steve could no longer read a map and stopped driving after turning up three hours away on the opposite coast of Florida; fortunately, he still remembered how to use his cell phone. By the end of that year, he could no longer do any accounting, use a calculator, do very simple math, or even remember how to turn on his computer. By mid-2007, Steve was losing weight and unable to prepare meals for himself. He was very distractible, often dismantling things like the vacuum cleaner and his lawn tractor and misplacing the parts. He had trouble finishing his sentences, could barely write a short word or two, and forgot how to tie his shoes. He had tremors in his hands and jaw when he tried to eat and speak. Steve had a slow, stiff gait and could no longer pick up his feet to run. The physical symptoms were most likely due to the further complication of Lewy Body dementia, which brain donation later confirmed.

Two clinical trials became available at the same time in our area in the spring of 2008. Steve was spiraling downhill, and we were very hopeful that one of these drugs would be the long-promised cure for Alzheimer’s. He was scheduled for screenings two days in a row on May 20 and 21, 2008. On the evening of May 19, while searching online for risks and benefits of the two drugs, semagacestat and bapineuzumab, I happened upon a press release for a medical food called AC-1202 (now Axona), which was about one year away from FDA recognition. In their studies, nearly half of the people with Alzheimer’s taking AC-1202 experienced improved memory and cognition after a single dose pilot study and during a 90-day study.

Digging deeper, in the AC-1202 patent application I learned that a key feature of Alzheimer’s is diabetes of the brain, which results in poor glucose uptake into cells in the affected brain areas. With no fuel, these brain cells malfunction and eventually die. Furthermore, ketones could bypass the problem of getting glucose into the brain and potentially help somebody with Alzheimer’s disease (see figure 1). The only active ingredient in AC-1202 was simply medium-chain triglyceride (MCT) oil, which is converted partly to ketones in the liver after it is consumed. The brain eagerly takes up ketones from the bloodstream, which enter the same chemical pathway as glucose to make the energy molecule ATP (adenosine triphosphate), which cells require to function. I also learned that MCT oil is usually extracted from coconut oil or palm-kernel oil.

This information hit me like a bolt of lightning. As a newborn specialist, I was quite familiar with MCT oil, which was added to the feedings of our tiniest premature newborns in the late 1970s to the mid-1980s to help them grow faster. Then formula manufacturers began to add MCT, coconut oil, and/or palm-kernel oil directly to infant formulas for premature and larger infants to mimic those found in human breast milk, which contains about 10 to 17 percent medium-chain triglycerides.

FIGURE 1. Ketones and glucose enter the TCA cycle to make ATP.

People consuming a typical American diet do not usually have ketones in their blood, and glucose is the main fuel to the brain and other organs. Ketosis begins naturally after about ten hours of fasting, as the glucose stored in our liver is depleted and the ketone level steadily increases thereafter. At that point, stored fat is converted to fatty acids, which provide fuel to the heart, muscles, and most other organs but do not cross easily into the brain, which then needs another source of fuel. Fortunately, fatty acids can be converted to ketones in the liver and used by the brain as fuel. If fasting or starvation is prolonged, ketone levels increase substantially and can provide up to two-thirds of the fuel required by the brain. Without fat and ketones, even with water available, we would likely die in a matter of seven to ten days. Use of our stored fat substantially increases how long we can live during starvation.

Finding the press release and patent for AC-1202 gave me an idea to help Steve, but at this point it was about 1:00 a.m., and he was scheduled at 9:00 a.m. for his first clinical trial screening. We were very disappointed after the screening in St. Petersburg, Florida, since Steve came up two points short of the sixteen needed to qualify on the simple thirty-point Mini-Mental State Exam (MMSE). On a clock drawing, a specific test for Alzheimer’s disease, Steve drew just a few random circles and four numbers, and the doctor advised me that he was on the verge of severe Alzheimer’s (see figure 2).

Thinking What do we have to lose? we stopped at a health-food store to pick up coconut oil. In medical school, I was taught that coconut oil was an artery-clogging fat, but then wondered why it was sold in health food stores. When we arrived home, I reviewed online which fatty acids were classified as medium chains. From the USDA website, I learned that coconut oil is about 60 percent medium-chain triglycerides and calculated that about seven teaspoons (just over two tablespoons) would equal the 20-gram dose of AC-1202.

The following day, with the second screening scheduled for 1:00 p.m., Steve ate seven teaspoons of coconut oil in oatmeal for breakfast. Four hours later in Tampa, he scored eighteen out of thirty points and qualified for the study! Obviously, we were extremely happy. I wondered if this result was just good luck, prayers, or the coconut oil, but decided to continue this new dietary intervention and I set out to learn everything I could about coconut oil and cooking with it. I questioned whether one dose daily was adequate if his brain needed ketones 24/7. Thereafter, I gave Steve just over two tablespoons each morning at breakfast and added coconut oil to most other meals and snacks.

FIGURE 2. Steve’s clock drawing on May 20, 2008, the day before starting coconut oil. The doctor advised us that the disorganized pattern indicated that Steve was on the verge of severe Alzheimer’s.

Over the next few days, things changed very rapidly. Steve was no longer sluggish and could carry on a good conversation, and was back to whistling and joking. His tremors nearly stopped except in the morning before he had his coconut oil. Steve said that on the day he started coconut oil, it was like a light switch came back on in his brain. His mood improved dramatically, and he expressed hope for his future.

I began calling and emailing Richard Veech, MD, D.Phil., a world expert on ketones working at the National Institutes of Health (NIH) near Washington, D.C. Veech had spent years developing a ketone ester and needed funding for mass production to conduct clinical trials for Alzheimer’s. Two weeks after starting coconut oil, Steve drew a second clock that was remarkably improved from the day before he started consuming coconut oil (see figure 3). The clock was a single full circle with all the numbers in the correct order, though there were numerous hands on the clock. I faxed the clock to Dr. Veech, who immediately called and said this was unexpected. He thought it would take much higher levels of ketones to produce any improvement in someone with Alzheimer’s disease.

Dr. Veech encouraged us to add MCT oil to try to achieve higher ketone levels. I found MCT oil available online, began mixing coconut oil and MCT oil together, and slowly increased the amount Steve was taking to maximize his ketone levels. I soon learned that a 4:3 ratio (4 parts MCT oil to 3 parts coconut oil) stays liquid at room temperature and can be used in almost any type of food, hot or cold.

About two months after starting the coconut oil, Steve rescreened and qualified for the other clinical trial with twenty out of thirty points on the MMSE. He drew a third clock that was even better (see figure 4, clock dated July 26, 2008). The dietary intervention with coconut and MCT oil did not disqualify him, and Steve started the trial shortly after. During that first year, he improved by six of seventy-five points on more detailed cognitive testing and by fourteen of seventy-eight points on Activities of Daily Living, which, for Steve, meant he could do things better. Two months after starting coconut oil and then adding MCT oil, he was able to walk normally and run again. By four months, he could read again after a visual tremor stopped. and by ten months, he could remember details of what he’d read several hours earlier. Steve improved so much that he began to volunteer in the supply warehouse of the hospital where I worked, which made him very happy (see photo 1).

FIGURE 3. Steve’s clock drawing on June 3, 2008, 14 days after starting coconut oil. This drawing is a big improvement from fourteen days earlier.

FIGURE 4. Steve’s clock drawing on July 26, 2008, just over two months after starting coconut oil. The clock continued to improve, with better organization, and was less messy.

Unlike many people with dementia, Steve was always very aware that he had Alzheimer’s, what he once had been able to do, and what he could no longer do. Eventually, we learned that he had been receiving the placebo for at least the first twelve months of the clinical trial. So we could attribute his improvement to ketones and possibly other effects of coconut oil and MCT oil, the only other factors that had changed that year. Over several months, Steve worked up to nine to ten tablespoons of coconut and MCT oil per day, while eliminating most carbs and starchy foods, except vegetables and very small servings of berries and whole-grain rice. He was effectively on a ketogenic diet by virtue of the low-carbohydrate and high-healthy-fat content, though at-home blood ketone level testing was not yet available to prove it.

PHOTO 1. Steve Newport working as a volunteer in a hospital supply warehouse in fall 2009.

Steve was quite stable for another year, but then had a setback in early 2010. At that point, we believed he had crossed over to the clinical trial drug, because his hair was growing out lighter, a known side effect. He also had other alarming side effects, such as wounds that would not heal and a fainting episode, and some dementia symptoms returned, like requiring supervision with bathing, shaving, and picking out clothes. Imagine how difficult this setback was after two very hopeful years. We decided to withdraw from the study and were advised a few months later that the entire clinical trial had been stopped because the drug (semagacestat) was found to accelerate Alzheimer’s disease. The irony was that Steve’s improvement from consuming coconut oil led to his qualifying for a study drug that likely harmed him.

In April 2010, due to this serious setback, Dr. Veech proposed that Steve become the sole participant in a pilot study of his ketone ester. Since I am a physician, he felt comfortable allowing me to conduct this study with Steve. Dr. Veech sent the raw material, which, I can attest, tasted very much like jet fuel, and left it to me to make it drinkable. Steve took the ester willingly and with great excitement, but he shuddered every time, despite trying various flavors and sweeteners to hide the taste. During the first two hours after the first dose of ester, Steve recited and wrote out the entire alphabet for the first time in months, after trying repeatedly for twenty minutes. Within twenty-four hours, he took a shower, shaved, brushed his teeth, and picked out clothes, which he put on correctly without step-by-step instructions. Nearly all the new symptoms he’d experienced with this setback reversed over about six weeks. The ketone ester kept Steve stable for another twenty months before the next serious setback. Between the coconut oil, MCT oil, and ketone ester, Steve gained nearly four years of better quality of life than he had experienced the year before he started the coconut oil.

Eventually, Steve lost his battle with Alzheimer’s and Lewy Body dementia on January 2, 2016. This began with a head injury that occurred when he fell back during his first-ever seizure, a common occurrence in the later stages of Alzheimer’s and Lewy body dementia. During that first twenty-minute seizure, he stopped breathing and turned blue. This was too much for his already-fragile brain. He did not recover well, was totally dependent, and most of his speech was gone. We continued the ketone ester, coconut oil, MCT oil, and the healthy Mediterranean diet. Steve ate well and maintained a healthy weight. He always knew my voice, and he would hold my hand whenever we sat together. Steve was in home hospice care for about one and a half years and passed away peacefully at home while listening to a playlist of his favorite music that our daughter Joanna prepared for that moment.

In May 2008, when Steve improved so dramatically from simply adding coconut oil to his diet, I knew others would improve as well, and there were 35 million other people in the world and their families dealing with dementia. I became a messenger for ketones at that point and now dedicate my life to carrying on Steve’s legacy. It is gratifying that so many others are now spreading the message of ketones. Since 2008, ketone research has grown exponentially for Alzheimer’s and many other conditions that share the problem of insulin resistance with poor glucose uptake into the brain and other organs.

PART ONE

How a Mediterranean-Style Diet and Ketogenic Strategies Could Change Your Life and Health Span

CHAPTER ONE

GET READY TO CHANGE YOUR LIFE AND YOUR BRAIN

Let food be thy medicine, and let medicine be thy food.

—Attributed to Hippocrates, c. 400 B.C.

LET FOOD BE THY MEDICINE

Soon after starting medical school in 1974, I realized that science had barely uncovered what causes disease and how to treat it. Given how rapidly medical science was (and still is) advancing, I cringed upon reading about treatments for newborns in a decades-old medical textbook with modern in the title, then laughed at the far superior information in a slightly newer contemporary textbook. In the 1970s, words like neuroinflammation and microbiome were not yet part of the medical vernacular. Like other medical students, I took the Hippocratic Oath to first do no harm. Despite his teachings, the typical medical curriculum, then and now, focuses on pharmaceuticals, which do save many lives, but the curriculum seriously neglects nutrition, which could prevent disease altogether, reduce disability, and save many more lives. During four years of medical school, my total education on how diet affects health and disease consisted of just three hours on a single afternoon.

While rotating through the basic medical fields, I learned that many diseases could not be treated effectively and seemed hopeless—invasive cancers, many psychiatric disorders, and all neurodegenerative diseases. I chose a satisfying field of great hope, neonatology, the care of sick and premature newborns. As a neonatal doctor or nurse, you save lives and usher many families from utter fear to hope and promise. My pediatrics and neonatology nutrition training centered much more on what infant formula to prescribe than why, without much critical consideration of the evidence that led to the formulations. As a neonatologist, I encouraged breastfeeding, worked to maximize oral feedings, and wrote out formulas for intravenous nutrition daily. Breast milk is incredibly complex, with thousands of different nutrients, and infant formulas contain only a fraction of these nutrients. I came to recognize that, if a natural substance is consistently present in breast milk, it is likely an important building block for cells or has another important biological function in the developing human. This is relevant here, because breast milk contains significant amounts of medium-chain triglycerides, an important part of the Clearly Keto diet.

For decades, I followed the AHA and USDA low-fat dogma—no eggs, butter, or cream. I was shocked and overjoyed when the first USDA Food Pyramid was published in 1992 (see figure 1.1), which encouraged six to eleven servings per day of grains at its base, with a tiny point of fat and sweets at the top with advice to use sparingly. I was on a diet, counting calories every day and always hungry. I drank skim milk and ate low-fat everything, like heart-healthy cereals, margarine, and overly processed packaged foods that typically contained trans fat, high-fructose corn syrup, and synthetic chemicals. I repeatedly lost, then slowly regained, very large amounts of weight. At age fifty-four in 2006, my BMI was just above the cutoff for morbid obesity, my fasting blood sugar was elevated, and my heart was enlarged. I was on the pathway to diabetes.

With Steve’s symptoms progressing rapidly, I came across a study of improved survival for people with Alzheimer’s who consumed a Mediterranean-style diet (Scarmeas 2007). I read every book and scientific study I could to devise a plan using this new information. Up until then, we had eaten a convenience-food diet. We dined out often, including fast-food restaurants, and were fond of easy frozen family meals. As a physician, I am embarrassed at how poorly we fed our growing daughters and ourselves and that we were so far off-track from a healthy diet. We quickly transitioned to a whole-food Mediterranean-style diet with much fewer carbohydrates and more healthy fat intake, mainly as olive oil, and began to take fish oil. We removed the sweets and refined grains from our house. We ate a variety of colors of fresh vegetables and fruit, much more fish, and whole-grain rice, pasta, and breads in small servings.

FIGURE 1.1. USDA Food Pyramid, 1992.

Over the next two years, coupling the diet with more intense exercise, I lost ninety-four pounds and easily got my fasting blood sugar back to normal. However, Steve’s Alzheimer’s symptoms steadily worsened, and it is impossible to know whether the diet slowed the disease progression. Then, in 2008, armed with new information about Alzheimer’s as diabetes of the brain and ketones as an alternative fuel to glucose, we incorporated ketogenic oils (coconut oil and MCT oil), followed by a dramatic steady improvement in Steve’s symptoms. Within the year, we transitioned further to a lower-carb ketogenic diet. We maintained a ketogenic whole-food Mediterranean-style diet throughout Steve’s life, and I have continued thereafter.

THE MEDITERRANEAN-STYLE DIET

The specific foods in the Mediterranean diet differ greatly among populations of Europe and are far from exclusive to Europe. Therefore, I refer to it as a Mediterranean-style diet, which includes daily consumption of vegetables, fruits, whole grains, and adequate protein as poultry, legumes, eggs, moderate portions of whole-fat dairy or goat-milk products, intake of fatty fish at least weekly, and limited intake of red meat. Healthy fat is a mainstay of the diet, emphasizing olive oil, and I also include coconut oil and MCT oil on the healthy fats list. Eating this way can substantially lower the amount of carbohydrates in the diet. We will discuss the specifics of the Mediterranean-style ketogenic diet in much more detail in chapter 4 and coconut and MCT oil in chapter 5.

The whole-food Mediterranean-style diet is easily adaptable to a reasonable low-carb, ketogenic diet, as are the Paleo, vegetarian, vegan, and traditional diets of many cultures. It is even possible to eat a junk-food ketogenic diet if there is too much reliance on overly processed packaged foods, and I strongly discourage that for obvious reasons.

First Steps to Go Keto and Clean Up Your Diet

To help kick-start nutritional ketosis and clean up your diet, I suggest the following:

Consult with your physician before making any radical change in your diet, especially if you have medical conditions, if you are taking medications, or if you are elderly, pregnant, breastfeeding, or helping a child with the diet.

Consider this as dietary advice to discuss with your physician, and not as medical advice.

Do not stop or change any medications without consulting your physician. If you are diabetic, you need to know that a low-carb diet can drop your blood sugar quickly. Monitor your blood sugar more often, and discuss medication changes with your doctor to avoid hypoglycemia.

If you are taking warfarin (an anti-blood-clotting medication), you should be aware of foods and supplements that could throw off your INR test. Consult with your doctor before instituting dietary changes or adding supplements suggested in the book.

A very high-fat diet is not for you if you have severe liver disease or liver failure, or certain rare enzyme defects involving fat metabolism.

If you are allergic to coconut oil, do not eat it … or any other food you are allergic to, for that matter.

First Steps to Kick-Start Nutritional Ketosis

Add virgin organic coconut oil and MCT oil (which is extracted from coconut oil) to your diet.

Since MCT oil is more ketogenic, I suggest starting with coconut oil and then consider combining MCT oil with virgin coconut oil to smooth out the ups and downs of ketone levels that may occur when taking just MCT oil. You can make your own mixture or look at my website (see Resources) for commercial options.

To avoid diarrhea, which can happen if you are not used to larger amounts of oils, start with one teaspoon of coconut oil two or three times a day with food, and increase by this amount every few days