Nutritional Ketosis and photobiomodulation remediate mitochondria warding off Alzheimer's disease in a diabetic, ApoE4+ patient with mild cognitive impairment: A case report

Alzheimer's Disease (AD) is a neurodegenerative progressive disorder for which there is currently no cure. Recent research demonstrates a robust correlation between type-2 diabetes mellitus (T2DM) and the development of MCI and AD, now referred to as type-3 diabetes. Both AD and T2DM, as metabolic pathologies, can be traced to the level of mitochondrial function. The metabolic hypothesis suggests that the cause of AD might be rooted in mitochondrial dysfunction accompanied by fuel shortage in the brain. Although glucose is known to be the deferred source of fuel for cells, ketone bodies have been observed to provide metabolically compromised brain cells with an alternative fuel source, bypassing deficiencies in GLUT transport due to increased insulin resistance. By keeping glucose and insulin levels low to allow for the production of ketones, there is evidence that mitochondrial function will be restored and cognition/memory improved. Further, visible red or near-infrared (NIR) light has been shown to heal and stimulate damaged tissue by interacting with the mitochondria to restore function. This case study evaluates the effects of a 10-week clinically prescribed ketogenic nutrition protocol combined with transcranial photobiomodulation (PBM) with a 59-year-old male, heterozygous ApoE4 carrier, with a dual diagnosis of mild AD and an 11 year history of insulin dependent type 2 diabetes (T2DM). Statistically significant results reflect an 83% reduction in HOMA-IR; 64% decrease in the triglyceride/HDL ratio; HgA1c reduction from 9.44% to 6.4%; 57% decrease in VLDL and triglycerides; and normalized cognition as measured via the MoCA (Montreal Cognitive Assessment), 26/30 post intervention.

APOE ε4, the door to insulin-resistant dyslipidemia and brain fog? A case study

For decades, scientists have known that carriers of the apolipoprotein E ε4 (APOE ε4) allele (homozygous/heterozygous) are at respectively higher risk for developing Alzheimer's disease (AD). Although previous research reveals that the APOE ε4 variant impacts the clearance capacity and degradation of β-amyloid from the brain, as compared with APOE ε3 (wild type with normal risk) and APOE ε2 (variant with accelerated clearance and reduced risk), little has been documented about APOE ε4's dual role in cholesterol transport, both peripheral and cerebral, and the effects of sluggish APOE ε4 cholesterol transport on cerebral metabolic rate. An understanding of the connection between brain metabolism and brain fat/cholesterol transport may unlock new prevention strategies for treating patients with a comorbidity of metabolic syndrome (MetS) with cognitive impairment. Recent findings suggest that the APOE ε4 carrier impedes the shuttling of lipids from neurons and circumvents the storage of fat within the glia lipid droplets. This sluggish transport of lipids to triglyceride droplets in the glia cells can lead to dangerous reactive oxygen species and hydroxyl-free radicals as lipids are prematurely oxidized. This case study evaluates the effects of a 10-week clinically prescribed ketogenic diet (KD) with a 68-year-old male, heterozygous APOE ε4 carrier, with a dual diagnosis of mild AD and type 2 diabetes (T2DM). The patient was administering both long- and short-acting injectable insulin to mediate his T2DM for 15+ years. Clinical goals of the intervention included increased hypothalamic and peripheral insulin sensitivity as measured via blood ketones with the Abbott Precision Xtra Blood Ketone Meter to confirm metabolic flexibility; controlled plasma glucose as measured via Abbott Precision Xtra Blood Glucose Meter and HgA1c via venous draw; normalization of lipid panel via venous draw and improved memory with restoration of cognitive functionality measured via the Montreal Cognitive Assessment. The Montreal Cognitive Assessment is considered to be a gold standard assessment in the diagnosis of early AD. Physiological biomarkers for T2DM/MetS and cognitive functionality were assessed before/during/after intervention. These measures included HOMA-IR, triglycerides/HDL ratio, HgA1c, fasting glucose, fasting insulin, complete fasting lipid panel and the PEAK mobile application for real-time measurement of cognitive improvement. The results were statistically significant. The patient's baseline Montreal Cognitive Assessment improved from 23/30 (mild AD) to 29/30 (normal ≥ 26). His T2DM was reversed. Pre-intervention HgA1c was 7.8% (T2DM); post intervention HgA1c measured 5.5% (normal). Likewise, the patient achieved statistically significant improvements in the other aforementioned biomarkers of MetS. The results of this case study suggest that a clinically prescribed ketogenic diet has strong potential to restore systemic insulin sensitivity and metabolic flexibility in diabetic, APOE ε4 heterozygous carriers. Mechanisms of action point to normalization of homeostatic negative feedback loops resetting/restoring lipid synthesis/utilization and glucose (insulin)/fatty acid (glucagon) utilization/production in both the body and brain, resulting in increased cerebral metabolism, improved cognition, and reversal of T2DM via renewed cellular insulin sensitivity.

Ketogenic diets potentially reverse Type II diabetes and ameliorate clinical depression: A case study

Efficacious adherence to treatment protocol predicts metabolic control among Type 2 diabetics (T2DM) [1-4]; however, few healthcare systems employ individualized strategies to mediate the comorbidity of T2DM with other chronic disease states. A clinically prescribed ketogenic diet, patient-centered nutritional education and high intensity interval training (HIIT), girded by solution-focused psychotherapy, modulate significant improvements in the clinical biomarkers associated with concurring T2DM and clinical depression [5-15]. Relevant metabolic change was noted in the following measures: HOMA-IR, triglyceride/HDL ratio, HgA1c, fasting insulin, fasting glucose, fasting triglycerides, LDL, VLDL, HDL, total cholesterol and C-reactive protein. The Patient Health Questionnaire 9 (PHQ-9) along with clinical interview and the mental status exam showed notable change in the patient's depressive symptoms; likewise, her self-efficacy score normalized, as measured by the General Self-Efficacy Questionnaire (GSE) and the Metabolic Syndrome Compliance Questionnaire (MSC). The case study highlights a 65-year old female who presented with a 26-year history of dually-diagnosed Type 2 diabetes (T2DM) and major depressive disorder (MDD). The patient was prescribed a ketogenic diet (KD), clinically formulated from her resting metabolic rate, body fat percentage and lean body mass, together with weekly nutrition education, high intensity interval training (matched to her cardiovascular conditioning), and eight 45-minute solution-focused psychotherapy sessions. Intervention goals included improved insulin sensitivity evaluated by the HOMA-IR, sustained glycemic control measured via HgA1c, reduced cardiovascular risk via the triglyceride/HDL ratio, and improved depressive symptoms with increased self-efficacy monitored by the PHQ-9 and GSE/MSC. The results of the 12-week intervention were statistically significant. The patient's HgA1c dropped out of diabetic range (8.0%) and normalized at 5.4%. Her average daily glucose measurements declined from 216 mg/dL to 96 mg/dL; the HOMA-IR and triglyceride/HDL ratios improved by 75%. Her marker for clinical depression and measurement of self-efficacy normalized. The 12-week individualized treatment intervention served to functionally reverse 26 years of T2DM, ameliorate two and half decades of chronic depressive disorder and empower/equip the patient with a new experience of hope and success.