More than 5 million Americans are believed to have Alzheimer’s disease, a degenerative brain disease. The number of people with Alzheimer’s doubles roughly for each five-year interval over age sixty-five, so that people who live beyond eighty-five years of age have a nearly fifty-fifty chance of developing the disease. As the generation of Baby Boomers reaches their mid-sixties and beyond, unless a medical breakthrough identifies ways to prevent or treat the disease, by 2050, the number of Alzheimer’s victims is predicted to triple to a staggering 15 million people in the United States alone and over 100 million worldwide.
According to the national office of the Alzheimer’s Association, this disease is the sixth leading cause of death overall in the United States and the fifth leading cause for people over age sixty-five. The National Center for Health Statistics reported that, while the rates of deaths related to stroke, heart disease, and certain cancers declined between 2000 and 2006, deaths from Alzheimer’s disease increased by 47.1 percent. In addition, at least 30 percent of people with Alzheimer’s die of other causes, so the actual number of people with the disease may be grossly underestimated.
The annual costs of caring for people with Alzheimer’s to Medicare, Medicaid, and U.S. businesses are currently estimated at an astounding $148 billion. In addition, the Alzheimer’s Association estimates that 9.9 million people provide unpaid caregiving for people with Alzheimer’s and other dementias that is equivalent to about $94 billion if such care was provided by paid attendants. Eighty-seven percent of caregivers are relatives of the person with dementia, so many people caring for their loved ones must watch them slowly and painfully deteriorate, at first forgetting little things such as where they placed their wallet or keys and, ultimately, forgetting how to do the simplest things they have done for a lifetime, such as getting out of bed, and worst of all, failing to recognize the people who love and care for them, the child they gave birth to, the spouse they married many years earlier.
Alzheimer’s is a progressive brain disease that is considered to be irreversible, a mysterious process that causes brain cells to lose their connections with one another and subsequently die. In spite of intense worldwide research since the early 1970s, the exact cause of the disease is still unknown in 2011. The first case was described by Alois Alzheimer (1864–1915), a German psychiatrist and neuropathologist, during a lecture in 1906 and published in detail in 1911. His patient was a fifty-one-year-old lady, Auguste Deter, who presented with symptoms of “impaired memory, aphasia (difficulty speaking), disorientation, and psycho social incompetence” and died at age fifty-five after gradual worsening of the disease, including loss of other cognitive functions and hallucinations. After her death, when Dr. Alzheimer performed an autopsy on her brain, he found that nearly one-third of the cells of her cerebral cortex (portions of the brain related to higher functions) had died off and, in their place, were large numbers of what are now called amyloid plaques and neurofibrillary tangles, the hallmarks of the disease that bears his name. He called this disease “presenile dementia” because of her age; now she would be considered to have early onset Alzheimer’s disease.
When someone younger than sixty-five develops this type of dementia, it is called “early onset Alzheimer’s disease,” and an estimated 200,000 people, about 3.8 percent of the 5.3 million affected in the United States, fall into this category. Alzheimer’s disease has even been described in people in their thirties and forties. People sixty-five and older are considered to have “later onset Alzheimer’s disease” and represent the vast majority of cases. Dr. Alzheimer’s first patient also had signs of hardening of the arteries at the time of her autopsy, indicative of the overlap with other conditions that is often seen with the disease. Alzheimer’s is the most common form of dementia, representing 50 to 80 percent of cases, with vascular dementia the next most common. Many people have evidence of both of these types of dementia.
Recent advances in imaging technologies have made it possible to detect subtle changes in the brain a decade or more before a person develops obvious symptoms of the disease. Such advances will make it possible for people who are known to be at risk to take preventive measures, such as stopping smoking, controlling blood pressure, increasing exercise, treating sleep apnea, adopting a healthier diet, and taking measures to prevent or reverse the effects of impaired insulin-related conditions. While the cause of Alzheimer’s is not known, such lifestyle changes, particularly if adopted sooner than later, could potentially prevent, delay the onset, or otherwise alter the course of the disease.
Only a handful of drugs have been approved by the U.S. Food and Drug Administration to treat Alzheimer’s disease, and none of them stop or reverse the course of the disease. They have been shown to slow the worsening of the disease, but only for about six to twelve months on average, and only in about half the people who take them. Hundreds of drugs are currently in development for Alzheimer’s, but it takes many millions of dollars and an average of thirteen years to bring a single drug from the concept stage to the market.
Even though the exact cause, or causes, of Alzheimer’s is unknown, many details of the pathology have been worked out. The brain that allows us to breathe and move and think, and defines who we are as individuals, is an incredibly complex machine, made up of a vast network of cells that interconnect with one another as well as to the other types of cells in the body. Hundreds of chemical reactions take place within each cell and cell membrane and in the spaces between the cells where they connect and communicate with one another. These reactions are in delicate balance, and an excess or deficiency of one substance can upset this balance in such a way that the entire organ is affected. Insulin is one of those substances for which either an excess or deficiency can have profoundly negative effects on the organ or organs involved.
One of the prominent known features of Alzheimer’s disease is the problem of insulin deficiency and insulin resistance in the brain. Just six years ago, in 2005, the term “type 3 diabetes” to describe Alzheimer’s disease was coined by Suzanne de la Monte, M.D., of Brown University. Glucose is the primary fuel for our cells, including the cells of the brain, and insulin is required to allow glucose to enter our cells. As the ability to make insulin and use insulin becomes defective in the brain, cells malfunction and die off as the connections between these cells disintegrate, a process that appears to begin one or more decades before symptoms, such as memory loss and poor judgment, become apparent.
Glucose is in rather short supply in our bodies and should we go without food for more than a day, there is a backup plan to ensure we will not quickly die. Our brains and most other organs have the ability to use certain alternative fuels if glucose is not available. Without this capability, we would not exist today as a species. During starvation, we begin to tap into our stores of fat and release fatty acids, some of which are converted to ketone bodies that can cross the blood/brain barrier and provide an alternative fuel for our brain cells. Short of starving ourselves, there are other ways to provide ketone bodies. One way is to adhere to a strict ketogenic diet, a diet that is high in fat and relatively low in carbohydrate and protein. Another less challenging way to provide ketones is to consume foods that contain medium-chain fatty acids, which are easily absorbed from the intestine during digestion and are partially converted to ketone bodies in the liver. Even better, a doctor at the National Institutes of Health has developed a ketone ester that, when available, will make it simple to provide this precious fuel.
What all of this means for someone with Alzheimer’s disease, or any number of other diseases that involve insulin deficiency and insulin resistance, is that a simple dietary intervention could bypass this fundamental problem and provide fuel to energy-starved cells, thereby keeping the brain alive and functioning.
My husband, Steve Newport, has early onset Alzheimer’s disease. We were living with this disease for nearly seven years, and hope was fading when everything turned around. Since our lives changed for the better in May 2008 when Steve began consuming medium-chain fatty acids, I have communicated with a multitude of people dealing with Alzheimer’s and other neurodegenerative diseases. One of the most distressing comments I have heard is that, upon relaying a diagnosis of probable Alzheimer’s disease, some physicians will tell the person and his or her family that nothing can be done, that they should “go home and have a good life.” Too many people take this kind of advice at face value and truly believe that there is nothing they can do. So they go home and cope the best they can with what appears to be a hopeless situation—a situation that is anything but good.
At the opposite extreme, knowing that doctors are human and don’t have all the answers—I can say this because I am a doctor—there are people who refuse to accept a course of action that involves giving up. I am one of those people. The Internet makes it possible to look for answers to this complex disease, and I know of many people, some with no previous background in the sciences, who spend hours on the Internet nearly every day trying to learn whatever they can to help their loved one.
Were it not for the Internet, I wouldn’t be writing this book. It was the “perfect storm” of my background as a physician, specifically one who cares for premature infants, having a husband with Alzheimer’s, and a chance encounter with a press release on the Internet that led me to the discovery that changed our lives. This is our story and the story of ketones.