After 17 hours fast, only mild ketosis

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ShepR
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After 17 hours fast, only mild ketosis

Post by ShepR »

We started the Bredesen Protocol around July 2019. We have the support of a FM Doctor who happens also to be an MD.

My role has been to take the book, and other inputs and interpret where we are in the process while being the best caretaker I can. It's my wife who has the cognitive decline. She is 72, an RN who was in practice in a hospital PACU up until Nov 2017. She has tested with 23&Me, and her status is 3/4, and some positives for MTHFR, although I don't understand it that well.

We first noticed the problems when she could no longer balance the checkbook (late 2018). She now has word finding difficulties, and anything that has to be calculated in time, such as "do this AFTER doing this". And her processing speed is very slow.

We have done extensive testing, worked on gut dysbiosis, detox (25 day intensive sauna with mega doses of niacin), bio-identical hormone therapy, thyroid supplementation, 40hz light therapy, sleep improvement, lowered stress levels, and have done a pretty fair job with the keto-flex diet. Sadly, the keto-flex diet took her from a stable 125-128 weight to a low of 103, and now hovers around 109, with a height of 5'5". The two things that stand out as not accomplished are - ketosis, and intense exercise. I bought a professional grade treadmill, but walking the treadmill in my opinion, is not intense enough to improve blood flow.

The first problem we encountered was that I could get into ketosis but she could not. Even with 17 hours without food, she would only get .1 on the keto-mojo blood strip. This goes back to 2020, and just tried again last week. Nothing has changed.

Or FM doctor had no idea why that could be. (All we got was "of course you can, you're a man!"). I have listened to so many lectures by functional medicine prefessionals, and as the story goes, "we look for the 'why' not the 'what'...", but I have become discouraged with that and I sometimes wonder if they really mean it.

At this stage, I am writing to this group for ideas. I think her brain is literally starving. She has had a very slow decline, so perhaps some of our interventions have kept her for declining faster, but I feel that there must be something we can do, starting with solving the mystery of - why no ketosis.

And then seeing of there is something I can do about the exercise. She was a member (and regularly went) of a local Spa/Health Club, but it closed because of the lockdown, then they went out of business. It was the only club around here that catered to folks our age. We recently visited 2 local Gyms, and they were just not suitable for our purpose. I have contacted her yoga coach from the old club and it is my intention to try personal workouts 1 on 1 (but by zoom, since she lives in another state), for strength training and squats and cardio workout. But I don't know if this can be done successfully via zoom.

Please share your experiences. If you have had this problem (not being able to get into ketosis after 17 hour fast), how did you solve it?
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Re: After 17 hours fast, only mild ketosis

Post by NF52 »

ShepR wrote: Tue Jun 28, 2022 1:30 am We started the Bredesen Protocol around July 2019. We have the support of a FM Doctor who happens also to be an MD.

My role has been to take the book, and other inputs and interpret where we are in the process while being the best caretaker I can. It's my wife who has the cognitive decline. She is 72, an RN who was in practice in a hospital PACU up until Nov 2017. She has tested with 23&Me, and her status is 3/4, and some positives for MTHFR, although I don't understand it that well.

We first noticed the problems when she could no longer balance the checkbook (late 2018). She now has word finding difficulties, and anything that has to be calculated in time, such as "do this AFTER doing this". And her processing speed is very slow....The first problem we encountered was that I could get into ketosis but she could not. Even with 17 hours without food, she would only get .1 on the keto-mojo blood strip. This goes back to 2020, and just tried again last week. Nothing has changed.

Or FM doctor had no idea why that could be. (All we got was "of course you can, you're a man!"). I have listened to so many lectures by functional medicine prefessionals, and as the story goes, "we look for the 'why' not the 'what'...", but I have become discouraged with that and I sometimes wonder if they really mean it.

At this stage, I am writing to this group for ideas. I think her brain is literally starving. She has had a very slow decline, so perhaps some of our interventions have kept her for declining faster, but I feel that there must be something we can do, starting with solving the mystery of - why no ketosis. ...
Hi ShepR,

As a 70 year old woman who knows first-hand and from family members' surgeries the importance of skilled nursing from post-anesthesia care units (PACU), I want to recognize the breadth and depth of love, supports and efforts you are providing your wife. I also want to say that I imagine her highly skilled brain is working overtime to martial all her resources to keep going. Outsiders often forget to realize the workarounds that intelligent people have made while their brains are under assault.

Others are the experts on ketosis here, so I'll let them offer advice on that. But my non-expert opinion is that you are right: her brain is not able to translate the food provided into ketosis and is taking valuable muscle and protein away from everywhere.

You may want to focus on supplementing with MCT (mean chain trigylcerides) along with some more high quality proteins, carbs and calories, without worrying about getting into ketosis). Here are excerpts from recent articles that may be helpful, with some parts highlighted by me. The first abstract quoted below is from a 2021 article of a study with mostly women in Quebec with a profile similar to your wife: It seems to suggest that statistically significant improvements occurred regardless of achieving changes in the metabolic profile or "ketosis": A ketogenic drink improves cognition in mild cognitive impairment: Results of a 6-month RCT
Methods: Cognition, plasma ketone response, and metabolic profile were assessed before and 6 months after supplementation with a ketogenic drink containing medium chain triglyceride (ketogenic medium chain triglyceride [kMCT]; 15 g twice/day; n = 39) or placebo (n = 44)...[The kMCT kMCT drink was a 12% emulsion of Captex 355 (60% C8, 40% C10; Abitec Corp, Columbus, Ohio, USA) in lactose-free skim milk.]
Results: Free and cued recall... verbal fluency...and the Trail-Making Test... improved significantly in the kMCT group compared to placebo Some cognitive outcomes also correlated positively with plasma ketones. Plasma metabolic profile and ketone response were unchanged.
Efficacy and Safety of Ketone Supplementation or Ketogenic Diets for Alzheimer's Disease: A Mini Review
suggests why focusing on. strict ketogenic diet (KD) may not work for women like your wife:
...weight loss due to fasting is likely to accelerate cognitive decline, whereas maintaining stable weight and nutritional status are mandatory for patients with AD (23). Despite sufficient calorie intake, extreme carbohydrate restriction due to KD can profoundly affect diet quality. Low-carbohydrate diets are often low in thiamin, folates, vitamin A, vitamin E, vitamin B6, calcium, magnesium, iron or vitamin K. KD are typically low in fiber (40)...KD or MCT supplementation may represent promising options to fight against the cognitive symptoms of AD, especially in the prodromal stage of the disease
I've personally found the following article's explanations and recommendations useful, and respect the expertise of the authors:
Precision Nutrition for Alzheimer’s Prevention in ApoE4 Carriers Tables 1 & 2, on peg 14-15 of the PDF in the attached link, provide specific dietary and supplementation ideas that you may want to discuss with your FMD.

As someone who worked with kids with traumatic brain injuries (TBI) and has been interested in what happens in the "prodromal" MCI and mild or early stages of AD, I think your wife's difficulty with "do this, then that" is a function of "working memory"--the ability to hold new information for about 30 seconds before we act on it. You may notice that she can actually hold information that long if she doesn't need to manipulate it ("can you put on your sweater?") but "take this letter and put it on the front table" is a 2-step direction. For parts of her day that do require multiple steps, it can be helpful to use a chart using visual cues: a picture of a toothbrush may come before a picture of her hairbrush, which comes before a picture of her favorite lipstick--at 70, lipstick is one of the beauty routines I haven't given up!)

Similarly, one way around word-finding is to suggest "tell me more about it, or tell me what category it is in", for example if she's trying to suggest a food to get at the store, or an article of clothing she wants. And of course, since it's frustrating for her, it's always helpful to say "sounds like that word is hiding; how about we talk about how we used to take the kids to the beach in summer." Accessing long-ago memories may allow her to use fewer specific nouns and more emotionally-happy words.

You are showing every day what love and commitment look like--never lose sight of that!
4/4 and still an optimist!
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Re: After 17 hours fast, only mild ketosis

Post by mike »

ShepR wrote: Tue Jun 28, 2022 1:30 am The first problem we encountered was that I could get into ketosis but she could not. Even with 17 hours without food, she would only get .1 on the keto-mojo blood strip. This goes back to 2020, and just tried again last week. Nothing has changed.
Shep, it could be that your wife's brain/body is using the ketones as fast as they are created. Can you describe in more detail what her diet looks like? It is likely that she needs more calories to put back on some weight. If she is eating dairy, then adding whole cream to her diet might help. As also mentioned, MCT could also help.

In regards to exercise, movement of any kind is critical. Walking gets the blood flowing. Sure, you want to try to up the level over time, but just starting is important. Adding strength training is also good = my wife uses videos. You could do with her.
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Re: After 17 hours fast, only mild ketosis

Post by JD2020 »

Re the exercise, for strength training, perhaps consider Tonal. https://www.tonal.com/

I've been going to gyms for decades. No more. I bought this during the lockdown. This device includes a gazillion workouts - upper body, lower body, core, whole programs. It makes weight lifting fun. There is also yoga, dance, mobility, etc., if you are interested.
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Re: After 17 hours fast, only mild ketosis

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ShepR wrote: Tue Jun 28, 2022 1:30 am Sadly, the keto-flex diet took her from a stable 125-128 weight to a low of 103, and now hovers around 109, with a height of 5'5". The two things that stand out as not accomplished are - ketosis, and intense exercise. I bought a professional grade treadmill, but walking the treadmill in my opinion, is not intense enough to improve blood flow.

The first problem we encountered was that I could get into ketosis but she could not. Even with 17 hours without food, she would only get .1 on the keto-mojo blood strip. This goes back to 2020, and just tried again last week. Nothing has changed.
Wonder what her glucose was when you tested BHB ketones? She genetically may not make ketones well. NF52's suggestion of MCT's makes sense. Caprylic acid (C-8) version of MCT's make would be most likely to work. You need to be cautious when starting intake of MCT's as they can cause bowel (loose stool) issues. I'd start with 1 tsp and work up to 1 TBL. The MCT elevation of ketones will last for ~3 hours. You could try & test after 90 minutes and see. As a 170# male, 1 TBL will elevate my BHB by about 0.4 mmol/L Do you have a fasting insulin level for her? Low insulin is required to make ketones.

On exercise, I'm a huge fan of long duration Zone 2 exercise. More in this link. Zone 2 isn't that strenuous, but per the linked podcasts with Iñigo San Millán, can increase mitochondrial density up to 4x. If you really want intensity, my choice is a fan bike (old style Schwinn Airdyne, Rogue Echo or Assault bike). You can do infinite amounts of intensity with low risk of pulling a muscle. The newer bikes with a belt drive rather than a chain are quieter. One routine I do is warm up at 50 watts on the bike for 3 minutes. Max it as hard as I can for 20 seconds, 3 more minutes at 50 watts, then another 20 seconds max (which I can actually hold my max output for only 3 or 4 seconds) then 3 minutes cool down at 50 watts. You can shorten the 50 watt sections. I sometimes warm up for three minutes do 20 seconds max, 10 seconds 50 watts, rinse & repeat for a total of 8 times and end with 3 minutes at 50 watts. This should be intense enough for anyone. I usually do the 3 min, 20 sec max, 3, 20, 3 not the 20:10's and then only once or twice a week.

You can make the treadmill more intense with hand weights. Dr. Leonard Schwartz developed hand weights with straps he called Heavy Hands, for this purpose (more here) I use these hand weights outside, have used them on treadmills when traveling and also with my 90's Nordic Track skier. In the Heavy Hands FB group there is a lot of info on this. There are links to PDF's of Schwartz's two books in the files section.

I think strength training is also necessary. Isometrics can be done with little equipment in a small area. I can give ideas if interested. Also calisthenics, body weight exercises, exercise bands, suspension trainer and so on. At age 67, I do all of the above, sometimes on on a vibration platform.
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Re: After 17 hours fast, only mild ketosis

Post by ShepR »

Hey Guys,

Thanks for all the great replies. And suggestions. I am new to the APOE4.info platform, and I could not figure out how to reply to each individual's comment.

I know there is a tutorial, so I will research it tonight, then try and give a full reply to each.

(I do most of my research and writing late at night. One of my handicaps as a care partner is that I have a very inconvenient circadian cycle. Waking hours 12:30pm to 4am.)

I just wanted everybody to know that I heard you and that I appreciate all your comments.

I will be back after I study up on how to use this platform.

Warm regards, Shep
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Re: After 17 hours fast, only mild ketosis

Post by Tincup »

ShepR wrote: Tue Jun 28, 2022 2:31 pm Thanks for all the great replies. And suggestions. I am new to the APOE4.info platform, and I could not figure out how to reply to each individual's comment.
Hi Shep,

Here is the quick answer to replies. Hit the large quote marks at the right top of the person's reply. This will quote that person in the reply box. You can edit or delete so that only what you are replying about show's up. Once in the reply box, you could also quote multiple parts of the reply, answering each one in succession. When your quote shows the person's name (i.e "Tincup" in my case), then they will get an email notifying them in the reply.

The quote function in the reply box puts in these arguments (I've added a space after the [ so it will show) . The quoted text then goes between the ] [
[ quote] [ /quote]

Manually quoting someone looks like this:
[ quote=ShepR] Here is the quoted text [ /quote]
and will look like this (with me removing the blanks after the [
ShepR wrote: Here is the quoted text
(I do most of my research and writing late at night. One of my handicaps as a care partner is that I have a very inconvenient circadian cycle. Waking hours 12:30pm to 4am.)
Caregiving is very difficult and kudos to you for doing it for your wife!
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Re: After 17 hours fast, only mild ketosis

Post by ShepR »

Caregiving is very difficult and kudos to you for doing it for your wife!


Just playing around with your directions. I don't think I have quite got it yet. (I think I should see your comment above in a shaded box, but did something wrong. No shaded box. Nevertheless, thanks! I can now reply individually.

Thanks for the quick start.

More later tonight.
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Re: After 17 hours fast, only mild ketosis

Post by ShepR »

Tincup wrote: Tue Jun 28, 2022 2:00 pm
ShepR wrote: Tue Jun 28, 2022 1:30 am Sadly, the keto-flex diet took her from a stable 125-128 weight to a low of 103, and now hovers around 109, with a height of 5'5". The two things that stand out as not accomplished are - ketosis, and intense exercise. I bought a professional grade treadmill, but walking the treadmill in my opinion, is not intense enough to improve blood flow.

The first problem we encountered was that I could get into ketosis but she could not. Even with 17 hours without food, she would only get .1 on the keto-mojo blood strip. This goes back to 2020, and just tried again last week. Nothing has changed.
Wonder what her glucose was when you tested BHB ketones? She genetically may not make ketones well. NF52's suggestion of MCT's makes sense. Caprylic acid (C-8) version of MCT's make would be most likely to work. You need to be cautious when starting intake of MCT's as they can cause bowel (loose stool) issues. I'd start with 1 tsp and work up to 1 TBL. The MCT elevation of ketones will last for ~3 hours. You could try & test after 90 minutes and see. As a 170# male, 1 TBL will elevate my BHB by about 0.4 mmol/L Do you have a fasting insulin level for her? Low insulin is required to make ketones.

=====
Something here is new info for me. "Low insulin is required to make ketones" - Her last (fasting) insulin from Quest was on 3/7/22, 4.3 uIU/mL. What are your thoughts? Good or Not Good?

=====

You can make the treadmill more intense with hand weights.

====
Hand weights. I will try this. The challenge is always trying to adapt any regimen to her gradient level, so that she will actually be willing to carry it out. I learned a LOT with the 25 day sauna regimen. I think I can add hand weights to her regimen without too much complaint. Needs to be some way to use the weights, w/o holding in her hands though as it may lead to off-balance and a fall. I will check out the link(s).

====

Dr. Leonard Schwartz developed hand weights with straps he called Heavy Hands, for this purpose (more here) I use these hand weights outside, have used them on treadmills when traveling and also with my 90's Nordic Track skier. In the Heavy Hands FB group there is a lot of info on this. There are links to PDF's of Schwartz's two books in the files section.

I think strength training is also necessary. Isometrics can be done with little equipment in a small area. I can give ideas if interested. Also calisthenics, body weight exercises, exercise bands, suspension trainer and so on. At age 67, I do all of the above, sometimes on on a vibration platform.
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Re: After 17 hours fast, only mild ketosis

Post by Tincup »

ShepR wrote: Tue Jun 28, 2022 4:57 pm
Something here is new info for me. "Low insulin is required to make ketones" - Her last (fasting) insulin from Quest was on 3/7/22, 4.3 uIU/mL. What are your thoughts? Good or Not Good?
4.3 uIU/mL is good. Fasting insulin is pulsatile (from a PhD friend who studies it). So can vary a bit. However 4.3 isn't 12, 15 or 20, which are not good. This is low enough, she should be making some ketones. So she genetically may not make them much OR she is using them fast. There is a relatively new breath acetone device I've not used that is supposed to be pretty reliable. Acetone is more of a real time measure while beta hydroxybutyrate is a storage form. I'd need to look up the info on the device. As people are adapted for longer periods of time, their bodies get better at using ketones, so measurements tend to be lower. I have a 10 year old model breath acetone device, but it also spikes on methane, which is a by product of all the high fiber foods I eat. This competitor is not supposed to do that.

Trying some organic caprylic acid, seeing if you can get her up to 1 tbl at a time might be useful. Dr. Mary Newport's husband had early onset AlzD (he was in his mid 50's) and she started using coconut oil & MCT and saw a good response from him (he was a 3/4). She later tried a ketone ester (very expensive) with excellent results. I haven't looked at her site in quite a while, but here is a link.
You can make the treadmill more intense with hand weights.

Hand weights. I will try this. The challenge is always trying to adapt any regimen to her gradient level, so that she will actually be willing to carry it out. I learned a LOT with the 25 day sauna regimen. I think I can add hand weights to her regimen without too much complaint. Needs to be some way to use the weights, w/o holding in her hands though as it may lead to off-balance and a fall. I will check out the link(s).
If you join the FB Heavy hands group & ask that as a question, there are some creative folks there who might have a good suggestion. I think there are wrist weights as well as weighted gloves that might fit the bill. Dr. Schwartz wasn't fond of the wrist weights, but for your application, it makes sense.
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