Fat is fuel. It’s a common saying within the keto community. Let’s focus on this in regards to the brain.

Fat cannot directly be used by the brain, but the ketones that become converted from a fat source can. If a brain can no longer effectively use glucose, which is an observation of many neurodegenerative diseases, can we look at ketones as an alternative fuel source?

This is the genesis of Dr. Mary Newport’s story.

Dr. Newport’s husband, Steve Newport, battled with Alzheimer’s disease until 2016, the time of his passing. During Steve’s battle, his condition responded dramatically upon the consumption of exogenous ketones - particularly from coconut oils & ketone esters. Dr. Newport often described this response as “seeing the light coming back on in his eyes”.

Host Geoffrey Woo & Dr. Newport discuss the proposed mechanisms of action behind her husband’s treatment with exogenous ketones, what to look for in coconut & MCT oils, & what the root causes of the rise of Alzheimer’s might be.

Geoff Doctor Mary Newport, thank you so much for taking the time to come on to our program.

Mary N. Oh, you're welcome. It's nice to see you, Geoff.

Geoff Yes. Great to actually see each other. I know we've spoken on the phone a number of times, so great to actually connect live.

Mary N. Right.

Geoff You play a very interesting, important role within the whole exogenous ketones space. I think one specific highlight is you are one of the seminal ketone ester case studies on the application towards an Alzheimer's patient: Your husband. That might be the first entry point that we should kick off the conversation. I know you are a doctor by background, but not necessarily a ketone expert per se. How'd you get into the ketogenic space and your story there?

Mary N. My story in that regard goes back to 2008. So I'm a neonatologist, so that's a physician that takes care of sick and premature newborns, and I practiced in newborn intensive care units for 30 years in Florida. So far a field from Alzheimer's. But my husband, Steve, developed early onset Alzheimer's with symptom starting when he was only 51 years old, and it just continued to snowball. And we got to 2008, so seven years later, and he was really on a downward spiral and we were pretty desperate. There were very few clinical trials available and he wasn't qualifying. But then two drugs came along that he could try out for, and he was scheduled two days in a row. And it happened on a press release about a medical food that was going to come out in about a year, that turned out... now it's called Axona. But it was still being studied and it said that it improved the memories and cognition of nearly half the people with Alzheimer's who took it and didn't say what it was, what it did. So I found their patent application online and I learned all of this really interesting research about Alzheimer's as a type of diabetes of the brain, that there's a problem of insulin resistance into getting glucose into brain cells, and if you could provide ketones as an alternative fuel to the brain, that that could potentially improve people with Alzheimer's disease. So I was fascinated and I knew what MCT oil was. This product was MCT oil, medium chain triglyceride oil, because I had used it in the newborn intensive care unit. In the late '70s, early '80s, we used to add it to the feedings of our tiniest preemies, and then they started adding it directly to the infant formulas and they still do today. Medium chain triglycerides are in human breast milk, babies go into ketosis when they're born, if they're strictly breastfed, and ketones help build the brain. They become building blocks of the brain for the newborn of the lipids and cholesterol in the brain and also provide fuel. They need an amazing amount of fuel to fuel that very big brain. The newborn does, so very important in the newborn. And so I thought, "Okay, well, this is something I could do for him." And I didn't know I could get MCT oil over the counter. And I learned that it was extracted from coconut oil. So the first thing we did was actually use coconut oil, which is the richest natural source of medium chain triglycerides. So it just happened that he had a day before and a day after we started coconut oil, because he was scheduled for these two clinical studies testing, and they were in two different cities. And he had a dramatic improvement in his score from the day before to the day after he took coconut oil, and it was really fascinating. And I thought, "Well, this is for real, or did we just get lucky that he had a better score?" But decided to keep it going. And it was very obvious over the next four to five days. For him, he was what we would now call a dramatic responder. He's somebody that... he became much more alert, more talkative, the animation came back and his face. He said it was like a light switch came on in his head the day he started coconut oil, and he said that over and over. And then we started eventually adding MCT oil to try to get as ketone levels higher. And I was reluctant to give up coconut oil because it has many health benefits, [inaudible 00:05:59] and it kills bacteria, viruses, other things that could possibly contribute to Alzheimer's. I just didn't know and I didn't want to take a chance of stopping that, so I started mixing it and he actually improved quite substantially over the first year. He improved so much that he was able to work as a volunteer in the hospital where I worked in the supply warehouse. He helped deliver supplies, he would put stickers on supplies. And then he leveled off for another year after that. And so we're at the two year mark and he did get into a clinical trial. He was on the placebo for the first 12 to 14 months. So he had a whole bunch of testing. He improved quite a bit on cognitive testing, on functional testing during that year, and then he did level off. And then we think he was actually on the medication. It was a crossover study, and he was probably on it for five to seven months. And he started declining after about two years, and just some new things that we were seeing, and he was having side effects that, from what we learned later, was that he was actually on the medication, and I actually took him out of the study because there were very significant side effects. And that it turned out that drug accelerated worsening of Alzheimer's. Yeah, we found out-

Geoff That's terrible.

Mary N. ... a few months later. Terrible. So this is the point where the ketone ester comes in. That's as fast as I can tell that story by the way.

Geoff No, I don't want to rush the story because I think that it's pretty incredible that you saw this... I guess the data around Axona, this food, and you reverse engineered to the pattern to realize that this was medium chain triglycerides. Just stepping back, obviously, your passion and your love for your husband, I guess, sparked that, but I'm curious, anything else that sparked... anything else that you tried? What zeroed you on specifically on ketones as an intervention versus... there's a number of things that people say could help you, or could help someone with Alzheimer's.

Mary N. We were trying all different things. For one thing, we had already two years earlier, started... We swapped over from what I call the conventional diet, or the convenience food diet because we were very much into easy foods, packaged, frozen foods, eating fast food. They don't teach you about nutrition in medical school, so I didn't really know anything about that. And I read a study about Alzheimer's and that the people who ate the most Mediterranean-like diet lived four years longer on average than people that ate the least Mediterranean-like diet. And then I thought, "Wow, nutrition could have something to do with this?" So we actually switched over, both of us, to a Mediterranean whole food, whole grain diet in 2006, so about two years before we started before we started the coconut oil. And another thing too was DHA. There was about to be a study of grams a day, very important omega fat for the brain. And I thought, "Why would we be in a clinical trial while we can get this over the counter and risk that he would get placebo for an essential fatty acid?" So I put them on 900 milligrams a day. So he was probably... for about two years, we were doing all of that and I was keeping my eyes open. There are other supplements you hear about, phosphatidylserine. Over time, even before and after the coconut oil, there were a number of things we tried, and the only other one that I ever saw any difference that I thought I could attribute to the supplement was d'ribose, which is a very interesting... it's a sugar that you make from glucose within cells. You don't make it outside. It's not made outside of cells, it's made within cells from glucose and it's part of the ATP molecule. And I thought, "Okay, well, that makes sense to me." His flow of conversation improved very substantially after a couple of days of taking that. That's the only other supplement I ever had tried for him that seemed to help.

Geoff Also, just stepping back into that era, this is over 10 years ago. I think today, the term keto is essentially viral. It's everywhere, the Google search trends are growing exponentially. But 10 plus years ago-

Mary N. Nobody knew about it.

Geoff Right. And ketosis was probably a term for ketoacidosis where-

Mary N. Oh, yeah.

Geoff ... people would say, "This is poisoned state of the physiology. Don't do that. This is dangerous." I'm curious to rewind the clock here and get a sense of when you were putting your husband on a ketogenic diet, supplementing with coconut oil, which is saturated fat, all this stuff, did you get any push back? What were your considerations? Did you think that you were doing something wrong? I'm curious to go through your analytical process as you decided to go on coconut oil, MCT oil, and then eventually try out this ketone ester.

Mary N. I was aware a little bit of the ketogenic diet from medical school. They mentioned it for epilepsy, that it was a last resort for epilepsy, but that it was unpalatable, it was very hard to follow, and that was really all I knew about it. And I did have one patient while I was a resident that was on a keto diet for epilepsy. This was in the 1970s. But other than that, I hadn't heard, really, much about it, other than Atkins diet or something like that. When I first read that this is extracted from coconut oil and I'm thinking about going out to get coconut oil, I thought, "Well, it's in health food stores, but I always thought it was supposed to be the artery-clogging fat." But I thought, "On the other hand, his brain is dying. His brain is dying from Alzheimer's. And what are the chances that starting coconut oil would cause a heart attack before he would die from Alzheimer's?" That was my thinking at the time, risk versus benefit, which every doctor does. With every medication they start, they have to consider both. And I thought, in this case, if ketones could help revive some of those cells in his brain and get them functioning better again or maybe keep them from getting worse, it's worth trying. So that's where I was at. And I bought it, and I started reading everything I could about coconut oil and I learned very quickly about the health benefits. I've heard if it was in health food stores, there must be some health benefit. And there are, there're numerous health benefits, and it's... this whole thing about saturated fat is really completely blown out of proportion. It's based on really flawed science. In, I think, all three of my books, I have a chapter dedicated to that, discussing the real studies, not the pretend... There were cherry picked studies that they used to come up with this from the 1950s and '60s.

Geoff Right. The epidemiological studies that a lot of people have criticism on?

Mary N. Yes. So nobody knew about ketones. When I would talk to doctors about it, their first reaction, like you said, was diabetic ketoacidosis. And their many medical textbooks just out-and-out said ketones are harmful. When I've gone to Asia, they say, "But our medical textbooks say ketones are harmful." Well, if you're in the range of diabetic ketoacidosis, you got there because you had no insulin, very high blood sugar. That's a very abnormal state. And this is usually a type 1 diabetic. It can be somebody with type 2 diabetes. It's often when they become diabetic and they don't know it yet that this happens. It can happen in other situations, but very abnormal. And the ketone levels become many times higher than what you could possibly get from coconut oil or MCT oil. We're talking 0.5 millimoles versus 10, 15, 20, 25 millimoles, vastly higher levels. So fats breaking down very quickly, the body's unable to buffer it in levels that high. But your body can buffer a normal nutritional Ketosis in the physiologic range.

Geoff I would say my analogy for why ketones are there is that it's like the ambulance for your energy, because in a type 1 diabetic, there's no instant production, the body cannot use sugar for energy. So therefore, the body is forced to use fat to then produce ketones for energy. But because there's no insulin to backstop that ketone production, then ketone rates escalate. But really the purpose of ketones in that system is the ambulance. It's trying to repair and fuel the cells, and it just happens to be that there's no sort of a kickback loop. So the ketones themselves are more of the ambulance. You're not blaming when there's an accident. The ambulance, obviously, is going to be there, but you're not blaming the ambulance for causing the accident. The ambulance is there to try to rescue the situation. And I think in early science where people didn't understand the physiology, the ambulance there, the ketones there, I think, were blamed before understanding of what's actually going on there.

Mary N. I agree with you on that. And some type 1 diabetics are even using ketogenetic diet to control their blood sugar, which seems ironic because diabetics do think they're the ones that need to worry the most. But there's doctor... well, he's Andrew Kutnick, he's at University of South Florida, he's given presentations on this and he's been able to amazingly control the fluctuations in his blood sugar and keep him really fairly close to the normal range with 75% insulin by going on a ketogenic diet.

Geoff That's why it's interesting for... Typically, as you mentioned, type 1 diabetics are deathly scared of having high ketone levels. And it sounds intuitive that, okay, we'll put someone on a ketogenic diet. But if you can manage it well, then that might be an interesting solution, where you don't need to be just jamming insulin all the time anymore, which is an interesting trade off.

Mary N. Right. Diabetes is a sugar problem and if you don't eat sugar, you don't have to. It's not that big of a problem.

Geoff Yeah. So going back to Steven's story, so you tried coconut oils, you tried MCT oils and that, I imagine, would bring up his blood ketone levels to around 0.5, 1.0 millimole, that sort of range, right?

Mary N. Yeah. Probably in that territory. And he was getting a lot of it. Medical food was going to be 20 grams of MCT once a day. And when we measured Steve's ketones, his level peaked at 90 minutes and the ketones were gone at three hours. And I thought, "Well, what does his brain do the other 21 hours?" So that's why I started measuring. With coconut oil, the level peaks around three hours and it's lower, but it'll last longer. And so I thought if you mix the two together and give it three or four times a day, he could have ketones available 24/7, and then just started pushing up how much we were giving him. So he was getting a huge amount, nine, 10, 11 tablespoons a day of-

Geoff Wow.

Mary N. ... coconut and MCT. And then he stopped eating so much carbohydrate. He put away the fruit, and he wasn't eating the bread and the pasta and the rice. I think, effectively, he was on a ketogenic diet. His levels could have been higher, but we just... I don't think the device was out yet to measure them. The other measurements we had were done at the NIH by Doctor Veech. We mailed them samples and he measured his levels at that point.

Geoff Wow. One of the things that strikes me, and I think a lot of people that have used MCT oils or cooking oils would... one of the common mishaps is having too much and causing GI distress. It sounds like, obviously, Steve built up quite a bit of tolerance to have that much MCT oil, but I'm curious to hear your perspective on the tolerance and how do you find the balance between having enough of the ketogenic fat to produce ketones versus upsetting someone's stomach?

Mary N. That's been a very common problem with the medical foods. Since it's come out, they find about one in four people have trouble tolerating the 20 gram dose that they have. And we were fortunate that Steve tolerated... it was over two tablespoons of coconut oil I was trying to give him. I calculated how much coconut oil he would need to equal the dose of the medical food and I came up with 35 grams, which is a little over two tablespoons. And he tolerated that the first time, but some people take one teaspoon and they have diarrhea. So we were fortunate because that would have been the end of it, if he hadn't tolerated it. And we found with the MCT and coconut, we had to go up slowly. If we did go up too fast, he would get diarrhea and we'd have to back off for a while, wait a couple more weeks and then inch it up even slower. And over time, we were able to get the dose up quite high. But some people struggle with that. Even a quarter teaspoon of MCT oil is enough, for some people, to send them into the bathroom for like a couple of hours. It's incredible.

Geoff We've done a couple of pharmacokinetic studies of MCT oils in the office at H.V.M.N. and a couple... I just remember a couple of our colleagues... I think [Zoo 00:18:37] might be one of the colleagues that actually spent quite a bit of time in the toilet after that experiment. So I guess a caveat that some of the listeners who might be wanting to implement Mary's protocol here, that that might be a consideration. Start slow with a lower dose and then ramp up as you build tolerance.

Mary N. And eat it with food.

Geoff Right. Eat with food. And it's not uncommon. It's not that you are getting poisoned necessarily, it's probably a sign of your stomach not being adopted to having such high fat content all at once. But it's something that can be built up in terms of tolerance.

Mary N. Yeah.

Geoff So how did you come across Doctor Veech, The NIH, the ketone ester? Curious to get the story and how you came across the world of exogenous ketones. So instead of having to eat ketogenic fats to produce ketones endogenously, what is a story in terms of finding that you could consume these ketones exogenously?

Mary N. Dr. Veech, when Steve improved with the coconut oil, probably within a few days, I called him. I found out him on Wikipedia. For some reason, his phone number was right there, which was amazing, and he picked up the phone when I called. And I asked him, I said, "Do you think it is possible for someone with Alzheimer's to improve from just taking coconut oil?" And he was like, "Oh no, no." He said, "The levels would be much too low. You need much, much higher levels." And then he mentioned that the inventor of the Axona product had talked to him several years earlier and asked him the same question about MCT oil and he told him, no, it's not going to work. The levels aren't high enough. But I already knew that it did work at that point. For Steve, it seemed to be working. It was either it's the biggest coincidence in the world or it was doing something for him. And so I thought, "Okay", so I kept reading and reading and reading. I think he sent me a couple of his articles about the ketone ester. He mentioned the ketone ester. He said you would need much higher levels, and that he had been working on this ketone ester since the 1990s. He told me about some of the studies they had done and that he lacked funding from the NIH to mass produce it and do clinical trials for Alzheimer's. And they were mainly looking at it for the Department of Defense for the troops, to see if it could help improve their physical and mental endurance. And so we left it at that, that first conversation. And then when Steve, the day before the coconut oil, when he did not qualify for the study, the Doctor had him draw a clock, which is a test for Alzheimer's. And he drew this... it was a few random circles, not a big circle even, a few little random circles and a few numbers. And he said, "It's very disorganized. It looks like he's on the verge of severe Alzheimer's." That was scary. That really was my impetus to say, we're going to pick up coconut oil and see if we can do something, anything to help him. So two weeks later, he drew another clock and this time, full circle, all the numbers were there, and he had numerous hands of the clock, dozens of hands of the clock and it was so much more organized. It was messy, but it was just amazingly better. And I faxed the clocks. I called Doctor Veech and I faxed the clocks to him. And then he called me back and he says, "Well, this is unexpected", he said. Those were his words. "This is unexpected. I really didn't think..." He didn't really think the levels could be high enough to help somebody, so he was fascinated. And he sent me more papers, and within the next 24 hours, I got calls from three of the physicians and researchers who were interested in ketones and they had written hypothesis papers about it. And this was Doctor Theodora Van Italie, Doctor Sami Hashem and Doctor George Cahill Jr., who had discovered that during starvation, your brain is fueled off of ketones. Two thirds of the fuel supplied to the brain is from ketones. So they all called me within 24 hours and I didn't know who they were or how important they were, but it was... To me, it was just amazing. I took notes when I talked to them, I was trying to learn everything I could and-

Geoff How did they find your contact information? Was it-

Mary N. Doctor Veech gave it to them. He gave them my phone number and told them to call me and they all did.

Geoff Yeah. George Cahill's seminal papers, Starvation of Man is an interesting paper. I think just for the folks that are listening, one of the key results was starving theology students for 40 days.

Mary N. That was the second study. The first was an obese nurse. She was our first volunteer and she... it was for 41 days.

Geoff I don't know if you could pass ethics approval in the modern day to starve someone for 40 plus days. But that was one of the interesting research to show that, yes, you could fuel the brain with ketones and ketones would actually be the predominant fuel for the brain in that kind of starvation state, which is... obviously, all the underpinning framework that, yes, you can fuel the brain with ketones and glucose or sugar is not a required substrate for brain function.

Mary N. So I just stayed in touch, and I still talk to Doctor Veech once or twice a month on average, I would say, now. So then my big thing was, I have to get this message out. There're 35 million people in the world dealing with Alzheimer's and not to mention also Parkinson's and ALS and MS and diabetes. All of these people could potentially benefit from this ketone ester that Doctor Veech had before that. In the meantime, use coconut and MCT oil. So I wrote an article that... I started writing to politicians and media people, really got no response. I was trying to tell them about Steve's case study, but this is about a medical food that is going to come out in a year, but it's available on the shelf, it's coconut and MCT, but there's this ketone ester that Doctor Veech is working on, he needs funding for it, so this needs to get studied urgently. Alzheimer's Association, I went to their conference. I had written up a case study, it's available on my website from 2008, a little case report about Steve that I was going to present and try to get the researchers interested there in studying ketones. There were 5,000 people from all over the world attending this conference. And first the Alzheimer's Association approved me to have a table and then they didn't. They pulled the approval about three days before the conference. I went to Chicago anyway, I attended the conference. I snuck as many to people as I could of the article, but-

Geoff They were not going to stop you from spreading the-

Mary N. It's crazy. And I had chats with them at various times, this is just a food, the MCT and coconut. And there's this ketone ester, why aren't you funding this? And they said, "Well, why aren't you telling people about it? It's just a food." And they're like, "Well, it needs clinical trials before we can tell people about it." I said, "But you're the guys that fund the clinical trials, why don't you do a clinical trial?" And they just weren't doing it. But I think they had gotten proposals, probably, from Doctor Veech to try it, but they just hadn't done it. So that was very frustrating, and I ended up doing a grass roots approach then.

Geoff So I presume at the time, this is late 2000s, early-

Mary N. Eight.

Geoff So 2008.

Mary N. Yeah, this is still 2008. Yeah, two months after Steve.

Geoff So the Amyloid Tau Plaque thesis was-

Mary N. Oh, predominant.

Geoff ... was predominant. And as you fast forward now into 2019, all these neurological programs attacking that pathway have failed. And a lot of the big drug companies have pulled out of the neurological programs because the targets for amyloid plaque tau have not worked. So I guess this is in the heyday of when this was, I guess, a relatively new hypothesis. This is where all the funding was going to, this is where all the academics are focused on?

Mary N. Yes. And you should seen the size of their exhibits at that conference. Axona actually had an exhibit there. And I went to them, and I would say, "What is in your product?" And they would say, "Oh, it's a powder." And I'm like, "No, what is the active..." It was like pulling teeth for them to say it was MCT oil, which was interesting. And I thought, "If they're not going to tell doctors and researchers what's in their product, nobody's going to understand it, much less use it." So I just felt like they were going to have a tough time, and I think they did. They might still be struggling out there with it. But Doctor Veech and I were just constantly talking at that point, and one of the things we decided to do was to go visit my representative. Steve and I visited her locally, our representative from Congress, to talk about this needed urgent attention for funding. And so he and I, and Dr. George Cahill, we went together to Congress and visited my representative, Ginny Brown-Waite. At the time, we were standing in the hall outside of where they had just voted on something. It was one of the most amazing days of my life, and it didn't get anywhere. She was very interested. She actually had somebody in her office that had started doing that approach, a friend of one of the people that worked in her office who started talking again after not talking for almost a year.

Geoff Wow.

Mary N. It was incredible. And so then I said to Doctor Veech, "Do you think I should write a book about this? Maybe if I write a book I can get awareness out about ketones, about the ketone ester and maybe that will get funding." And he said yes. And it took me about 16 months to write it. I'm working full time, I'm taking care of my husband with Alzheimer's. I would get up really early in the morning and spend two or three hours writing before he woke up and before I get to go to work. There were so many papers. It was surprising, really, at the time, how much ketone research had taken place. But there was a lot of other stuff I had to research. Like if I would get an article from Doctor Veech, I would get the articles and read the articles related to that that were important. My first book was called Alzheimer's Disease: What If There Was a Cure?: The Story of Ketones. It took forever to get published. It took about a year and a half after I wrote it to actually come out, which was very frustrating. But it was long. It was 500 pages, I think.

Geoff Wow.

Mary N. But I just wanted to really get it right too. And it actually did pretty well. It did pretty well. And The 700 Club, which... they invited us to do a story. So they came to our house, they filmed it. It was a little five minute story about ketones. They talked to Doctor Veech, and they had an amazing little thing about how ketones work, a little video showing how ketones are taken up in the brain. And that went viral. They said they had 5 million views that year-

Geoff Wow.

Mary N. ... pretty quickly, most of them, after they aired that on their show. So that got the message out, and people are still using it. So people that sell their ketone salts constantly use that video to back the claims. There're people that haven't heard of ketone salts and what they can do. So really I was just obsessed with being a messenger and writing about it was part of that. I probably had part of the book written by the time Steve started the ketone ester and it was a secret. It was a secret at that point. Doctor Veech considered a pilot study of one person, and he could only make enough for one person in his lab. It wasn't available to anybody else at that point.

Geoff Yeah. I know it's one of Veech's lab, research scientists hand making this.

Mary N. Yes. Drop by drop by drop. Yup.

Geoff Few milliliters at a time.

Mary N. Yup. He worked on it every day. And so what happened was Steve started having those side effects that were most likely due to that clinical trial medication that failed and accelerated the disease. So he started doing some strange things that he hadn't done before. Even though in other ways he was doing pretty well, would put his clothes on backwards. One day we were standing in the mirror, this was horrible, and he said, "You know," he said "I can see that's you." And he said, "This is me from the neck down, but from the neck up, it's not me. It's somebody else."

Geoff Wow.

Mary N. And I thought, "What? That is strange." And that was the beginning of him being confused by mirrors. He would see his father when he'd look in the mirror. We actually had him grow a beard because then he didn't look like his father and it worked.

Geoff So he didn't recognize his own face basically.

Mary N. He didn't recognize his own face, and that's a common problem with Alzheimer's. It's so strange. And he started wandering from home. His brother's lived about 700 miles away, but he'd start wandering, saying he was looking for his brothers. And he deteriorated in his ability to function, and I had to start talking him through things like shaving and taking a shower. When you talk somebody through with Alzheimer's, you have to say, "Okay, now get your hair wet." They're standing in the shower. "Okay, now put some shampoo. Now rub it around. Okay, now rinse it." And step by step by step, the whole shower. And same thing with shaving. It was startling that that was happening. And so Doctor Veech and I talked about it and he said, "Well, we finished toxicity studies. They went well. People didn't have adverse affects. It was approved." The FDA, I think, recognized it maybe for use for five days or something at that point.

Geoff Right. The earliest grass status.

Mary N. Yeah.

Geoff So what year was this?

Mary N. April of 2010. So Doctor Veech said that he had taken himself to test to make sure it wouldn't kill somebody. He's such an interesting man. I love Doctor Veech. He's my hero. He really is my hero. And he said, "I'm going to send you this." And he said, "I've been wanting to send it to Steve, but I wanted to wait until the toxicity studies were done and it's the time now", he said. You can't imagine how amazing that was to us, to be the first people... somebody with Alzheimer's to get to try this ketone ester. I had been writing about it, I had been telling people, I've been trying to get funding for studies, and here we were, the first people to get to try it. And it was just incredible. And so it arrived on our doorstep in an Ocean Spray Cranberry bottle, sealed up, that Todd King had put it in, and that's how we always got it. And we had the raw material. Basically, we had the pure raw material to work with, which tasted horrible. It tasted like jet fuel. It might even taste worse than jet fuel, I don't know. It was bad. And Todd said they had tried various things there in their lab, different flavorings and things like that. So he suggested that I diluted one to four, three parts water to one part ester, and then just see what I could do with it to try to flavor it somehow. We tried so many different things.

Geoff It's come a long way since those early days of the raw ketone ester. I think it's funny that people compare it to jet fuel because my question is, have they tried to drink jet fuel? How do they compare to that?

Mary N. Well, coconut oil is actually jet fuel, and they can use 10% of the fuel as coconut oil. Did you know that? And the worst tasting thing you can possibly imagine. I had different family members, they would try just a tiny sip of it and they said, "I will never take that again." Because the aftertaste too would leave an aftertaste in your mouth. I tried full doses of it a couple times because I wanted to see what Steve might feel like, maybe, while he was taking it. And I was like, "Oh my gosh, this is really bad. It's amazing that he can drink this." And he did shutter. Every time he took it, he'd shutter. But he was such a willing participant. He knew he had Alzheimer's, he knew what he had lost, what he could do before and could no longer do, he was always aware of it, and he was a willing participant in all this. He couldn't wait to try it. I videotaped him for two hours before, and when he took it, and then the after. And I watch it every now and then to remind me because it was such an amazing day. And he was euphoric. He felt great, and he hadn't been able to say or write out the alphabet for like a few months, at least, before that. He spent 20 minutes, which in and of itself was amazing for somebody with Alzheimer's, but he tried and tried and tried for like 20 minutes. He would get partway through the alphabet. Finally he got all the way through the alphabet saying it and writing it out. He had tried numerous times to write it out, he finally wrote it out and he was so happy. He was so happy. And he talked about his abysmal penmanship. He pulled out of his hat, he said... he called his first grade teacher by her name, sister Anthony Anne, and he called her a name you wouldn't want to repeat for her abysmal penmanship. And I had never heard them even mention her before. So how he pulled her out of the hat was amazing to me, but it was incredible. And then the next day, he could take a shower automatically. He didn't need step by step instruction. He picked his clothes out, he put them on right. And just very quickly, 24 hours, there were noticeable differences. And then-

Geoff And this was off of one 25 gram bolus, one-third 25-

Mary N. Well, Todd suggested, and Doctor Veech suggested we give him 20 grams three times a day.

Geoff Okay.

Mary N. So it was a pretty hefty amount. And then we upped it, I think a couple of days later, just a little bit to 25 grams three times a day, somewhere around there. And he basically continued to improve over six weeks, where he got back to where he was before he declined again. He stopped wandering, he was able to do things out in the yard again. Just functionally, he could read a menu and choose something off a menu, which he hadn't been able to do for a while. And he just said he felt good and he felt like he could do things, and that was one of his things with Alzheimer's, "I can't do this anymore, and now I can do things again." So that was what changed.

Geoff So his lights came back on, he was lucid.

Mary N. Yes.

Geoff So you felt like you had your husband back for that-

Mary N. Yes.

Geoff ... time.

Mary N. And that was another 20 months that he was stable, that he improved, and then he leveled off and he was stable again for another 20 months, which was really quite amazing. At various times, he ended up taking it. My husband, many people might not know this, but he did pass away from Alzheimer's in 2016, so this was about six years after he started the ketone ester. He started having seizures and 2013 and he felt... the very first time he fell back and hit his head and he stopped breathing.

Geoff Yikes.

Mary N. He turned blue for about 20 minutes. It was a 20 minute seizure. I had just left home. I was at the hospital. His care giver called me and said she had called 911 and was waiting for them and that he was blue. And I got home, he was still blue when I got home. It was-

Geoff Yikes.

Mary N. ... horrible. And he was unconscious when I got home and they said he had another seizure on the way to the hospital. And Alzheimer's, that happens in Alzheimer's and he happened to be standing and he hit a hard surface with his head and he never was the same after that. So he was dependent after that. We had to feed him, and he was in a wheelchair much of the time and we kept giving them the ketone ester. We had times when we couldn't get it, the supply would run out. They would run out of money to make it, literally. And so we had a couple of months where he didn't get it and saw a pretty big decline where he really couldn't lift his head up, and that Doctor Veech, when he was able to get it to us again within a matter of a day or two, he was lifting his head up again, which was incredible. So even in the late stages, people ask me that all the time, could it help somebody in the late stages? And I have numerous stories about that, where people have improved with coconut, MCT oil and now with these exogenous ketones, people that weren't talking, that are talking and are smiling again, making eye contact, things like that. So it's really dramatic what this could potentially do for people with Alzheimer's.

Geoff That's an incredible story, and I think we've seen some of our customers send in videos and I think... obviously, very, very late stages. It's not a magical liquid that will bring someone from very, very late stages Alzheimer's back to normal.

Mary N. Right.

Geoff I think there's the caveat and certain expectations, but some of the videos have people... the caretakers will see that they can lift their heads up straight. They can actually look people in the eye again, which for a very, very late stage dementia is definitely an improvement.But at a certain point, there is damage, chronic damage built up over time that you're not reversing all of that, but you can rescue some of that brain energy deficit. I think during that early, early phase, it would have cost thousands of dollars per dose of ketone esters, so-

Mary N. I think the cost was $600 a kilo that they were making it. So that's... Let's see, a kilo is two pounds, about, roughly. And you would need that much. The amount that Doctor Veech felt people needed, you would need that every 10 days. So it was expensive, the raw material. But one question I have, and you might be able to tell me this, we didn't know if we were giving Steve... if he needed as much as he was taking. We did ketone levels, by then there was a ketone meter we could use to check his ketone levels. So we experimented with dosing anywhere from 20, 25 grams up to 50 grams. And 50 grams got his ketone levels up to seven millimoles in an hour, somewhere around 45 minutes or an hour. So we ended up settling on, usually, 25 grams a dose. And after his seizures, Doctor Veech said, "Let's push it," and we actually had him up to, I think, 150 grams a day for a little while to see if it would make a difference. He did get to the point where he was up, walking about again. It's just most of the time, he had to be on a wheelchair. He just needed a lot more help after that. He did improve after that seizure. But I hear of people today who are taking five or 10 grams even once a day, that are reporting improvements and their memory may be functioning somewhat better, so I just wonder what you've heard about that.

Geoff So I think in terms of dosing, there's the body weight components. Obviously, the bigger the mass someone has, the more ketone ester is needed to elevate the blood levels to a substantial portion of your brain. Energy deficit is partially recovered in a brain with some glucose uptake dysfunction. So we've seen folks report in with around five or 10 grams of ketone ester getting their blood ketone levels to surround one, one and a half millimole ketones-

Mary N. Yup, that's what I've heard too.

Geoff ... which is consistent to your experience with MCT oils and coconut oil. If you've seen benefit from having a mild elevation ketone levels to a 0.5 or a 1.0, then a micro dose, if you will, of ketone ester could get you that equivalent level. So I think this is where it's cutting edge research, where we're working with folks like Steven Koonin up in Canada, looking at, well, what is exactly the level of depth that you would need? Is it more of a millimole? What is the minimum millimole of ketones in the blood that would enable the brain to use a substantial portion of the brain, to use ketones as a fuel? I think that's where science is yet to be done, but we're excited to contribute to a part of that.

Mary N. I think he's going to do a step wise study, start maybe at 10 grams two or three times a day and increase from there. I've got to chat with him a bit about that. But the amazing thing to me is the Alzheimer's Association didn't want to have anything to do with this idea in 2008. And then about two years ago, they actually came around a funding, a study of MCT oil with Doctor Kunane for a mild cognitive impairment to see if it could prevent advancement to Alzheimer's. And that study is... they're halfway through, and it's about to be published. And the results actually look good, with about 30 grams a day, which is two tablespoons of MCT oil. And they felt that probably 45 grams would be even better. But now, The Alzheimer's Association is going to fund the study of the ketone ester, which here we are, let's see, 11 years after I tried to get attention for this. But they're going to fund the study, and he has an opportunity. Like you say, you can start people on a lower dose. And I do think they may be able to determine, maybe per kilo, what dose will a person achieve the minimum benefits and the maximum benefit, above which more ketone won't help possibly. So I think it's just going to be an amazing study. I'm sure it'll take a year and a half, two years. He seems to do a great job of recruiting people quickly to his studies. He gets his studies done quite well and just keeps at it. And what he learns from it is just incredible. They're going to do cognitive testing, and they do ketones and glucose pet scans. They can see how much ketone is taken up by the brain, which is amazing.

Geoff Yeah. He's one of the first folks that really hasn't [inaudible 00:45:29]. Yeah. Is it vindicating for you to see the [inaudible 00:45:34] turn around to what you proposed and realized 10 plus years ago? It must feel rewarding. Walk me through the feeling. And what were some of the title shifts that I made this change happen?

Mary N. Well, Kunane's work, I think... It's proof of concept when you can show you take MCT oil and it does increase ketone uptake in the brain. And his other landmark study, I feel is... when he was able to show that ketone up take is normal in the Alzheimer brain, that the very same areas that have decreased glucose uptake, take up ketones normally. And ketones don't need insulin, they go in by a different pathway, the apparatus is still there in Alzheimer's. So this is a proof of concept, doctor Veech's idea, that it could help Alzheimer's. This is proof that yes, there's every reason to believe that it can. And then now he's done studies showing that they do have cognitive improvement, and this is with lower levels, 0.5 millimoles from MCT oil. So now he has the opportunity to look with the ketone ester. So when I first heard about Doctor Kunane and what he was doing... and it was before he published the study about Alzheimer's, the ketone uptake being normal, I was following him, in contact with him and telling people about him everywhere, trying to get his message out too, because I felt it was really important and, I would say, so that that was really a landmark thing. Doctor Veech published a paper about... it was a transgenic mouse model of Alzheimer's. And so this is a mouse that makes amyloid plaque tangles and has cognitive deficits that they studied. And they used the ketone ester and they found compared to the controls, that they did have less plaque in the brain, I believe also less a tangle the brain, and they had less anxiety, and they did have some cognitive benefit from it in the mouse study.

Geoff I would also call it... the paper you wrote and you coauthored with Richard Veech, that, I think, was very exciting for me as a reader and a follower of this space because this is a human. Like you can say, "We are not mice."

Mary N. Right. This was the first person. Yeah.

Geoff There's a lot of mouse studies that have shown potential for a number of diseases that don't pan out in humans, so it was exciting to see the actual very, very strong results from your work.

Mary N. Right. And I got to do part one and part two, the medium chain triglyceride response and then the ketone ester response, how it really brought him back around again to be able to get higher levels of ketones. So I thought that was an important part of that. And yeah, for me to have my name as first author on a paper with Doctor Veech and Doctor Van Italie, oh my gosh. That was just so amazing. Incredible. Doctor Van Italie recently said, "We should write another paper." I'm like, "Okay, I'm ready." So it's just been an extraordinary experience. I never imagined. I started talking in health food stores locally and a podcast here or there after my book came out and after had got on The 700 Club. So it took a while for that information to get out there, but now, I get to travel everywhere. There's interest all around the world. Alzheimer's is an epidemic. It's been increasing everywhere. For example, Singapore, beautiful place, clean, modern, beautiful place, and they have had a... it's a 300% increase in early onset Alzheimer's in the last five years. 300% in five years, and so-

Geoff Wow.

Mary N. ... they are worried about this. And so when somebody hears about this possibility, that ketones could provide fuel and could help, I'll get an invitation to come and speak, and I have an opportunity to get this message out in a new place, a new country, to people that may not have heard about this before. And now that's very gratifying to me and it's just been incredible.

Geoff So we've talked around the mechanism a little bit, but it might just be helpful for our audience to just make that very, very explicit. So obviously, we've seen in a number of case studies... [inaudible 00:50:01] of Steven, all the supporting work, that ketones can rescue brain function in Alzheimer's patients. So why is that? What is the mechanism of action here?

Mary N. Well, the immediate action is fuel, that it provides an alternative fuel to the brain, to glucose. And the brain, instantaneously, can switch from using glucose to ketones. The apparatus is there, they've looked as early as 12 week fetus. The enzymes, everything is in place to be able to use ketones and it's still there in people with Alzheimer's. And I think the immediate response we saw with Steve was probably related to fuel. But he continued to improve steadily and very much over a year. Another thing that has been learned since then is that it's an anti-inflammatory. Ketones are anti-inflammatory. Doctor Veech said that, but there's much more proof. They've been able to identify where, how it affects the inflammasome-

Geoff Right. NRLP 3 inflammasome.

Mary N. Right. And it increases the scavengers of free radicals, it suppresses the production of free radicals. So there're several different anti-inflammatory mechanisms. And a disease like Alzheimer's and virtually all of the neurodegenerative diseases, autism, diabetes, arthritis, lung... so many diseases have, as a feature, inflammation. Like in Alzheimer's, they have found recently that you can have a bunch of plaque in your brain, but you don't have Alzheimer's unless you also have inflammation in the brain, which is interesting. So I think that the anti inflammatory factor very likely played a role, also, for Steve in the gradual improvement that we saw over time. Yeah, coconut oil has other factors. Lauric acid, half of coconut oil is lauric acid, and it's anti microbial. It kills numerous viruses, bacteria, fungus.

Geoff So this is C10 lauric acid?

Mary N. C12.

Geoff Right.

Mary N. And C10 is also antimicrobial, just not quite as much as C12. And there are hundreds of papers looking at various microorganisms, more than a hundred about herpes simplex virus that causes fever blisters on the mouth. And people, they have found these organisms in the plaques in the brain, and various studies where they've infected animals with herpes simplex, and they've developed plaques and tangles and cognitive deficits, all kinds of studies. The story about ketones, all of that's been suppressed. I went to the last Alzheimer's Association Conference, six day conference, not a single session about infections and Alzheimer's. They talked a lot about the microbiome, that's a new thing and how the gut microbiome affects the brain, although they're not even looking. They're looking at the bacteria in the gut, but they're not looking at the changes in the brain. There are microorganisms in our brain as we get older. And so lauric acid may have helped suppress an infection in his brain. Steve, he had an infection around his eye with herpes simplex when he was 29 and he never felt the same after that, and I thought... I always felt like that was a trigger, why he got Alzheimer's so early in somebody that was so young and healthy and physically active and a novel reader and on a computer all day. It didn't make sense to me that... What triggers that? An infection is a very likely possibility.

Geoff Right. So does your experience with Alzheimer's suggest a different understanding of the ideology of Alzheimer's? I think through a lot of my conversations, I guess, the status quo definition of Alzheimer's is some sort of amyloid or tau cause phenomenon. But I think within the conversations around the low carb ketogenic space, is this a glucose uptake dysfunction problem with neurons, brain, so this is more of the type 3 diabetes explanation of why Alzheimer's happens? But there seems to be just a subset of possible forms of Alzheimer's. Would you say that Alzheimer's is more of an umbrella term for multiple-

Mary N. Multiple triggers, yes.

Geoff ... of dementia or cognitive dysfunction versus one unified disease? Curious to unpack that story a little bit here.

Mary N. Doctor Veech and I talked about this forever, but even at the very beginning, we talked a lot about this, that the plaque may be a downstream effect. The metabolic changes, the problem with glucose uptake starts 10, 20 years before a person even develops symptoms. And they have done MRIs of people in their mid 20s who are at risk because of their family history for Alzheimer's and already they have decreased glucose uptake in the brain at that point. So it's a very early phenomenon, these metabolic changes, and the plaque seems to come later. It comes much later. Now they can do amyloid scans to look for plaque, and they can do tau scans to look for tau. They don't see Alzheimer's even with a large amount of plaque in the brain until tau appears and then it goes very quickly after that. Tau is a protein that... it's the structure inside the axons and dendrites that connect neurons. It's like the skeleton of the neurons. And this tau protein seems to be attacked in Alzheimer and it wads up inside of the nucleus of the neuron. You don't have Alzheimer's until the tau appears. They learned this probably in the last two or three years. And the inflammation is another important component. So when they look at these amyloid plaques... People have talked for years about heavy metals possibly causing it, like mercury, lead, cadmium, aluminum, you may have heard of that, and then infections. And when they analyze these plaques, they have these bacteria, viruses, they have heavy metals in it, they have things like calcium carbonate, which is in TOMS calcium supplements that so many people take. And they have also learned that amyloid plaque is an antimicrobial substance. It seems to be secreted in response to a microorganism in the brain, and they have found heavy metals in these plaques. So it seems like it's part of the primitive immune system. So it seems like there's some trigger that the plaque is responding to, and not the other way around.

Geoff I'm glad that you brought that up. I think that's, again, potentially... I think this is early, I don't want to over speculate here, but similar to how ketones are demonized early, is amyloid more of an ambulance situation, where it is a response-

Mary N. At the scene of the crime.

Geoff Right. It's a response to some of these infection, and that's why all these drugs, these failed drugs that have been trying to target amyloid have failed?

Mary N. Yeah. They've removed it. They remove amyloid from the brain. The one Steve took was an oral medication that was supposed to help prevent further accumulation of plaque and possibly dissolve it. There was just another antibody trial. It was a vaccine that they could see that it removed all the plaque from the brain and there was no cognitive improvement whatsoever or removing the plaque. So it appears that... and now all the big companies, Pfizer, I think Merck and Lilly have all gotten out of the Alzheimer drug business. They've spent millions and millions of dollars-

Geoff Billions.

Mary N. ... going towards this dead end, and they're now out of the business, so they're giving up, basically. So they need to look another way. The last few years, The Alzheimer Association has started to stress prevention. They have been trying to fix it after the fact by attacking plaque and getting rid of plaque. It hasn't worked, and so what they need to do really, is prevention. So that's where the ketogenic strategies come in. If you can keep those neurons functioning by providing fuel, the neurons are there. Like Doctor Koonin, one of the big questions was, when you look at an MRI of somebody that has Alzheimer's and a pet scan of somebody... there's these big areas were there appears to be no brain tissue, there's atrophy or shrinkage of the brain. And also these areas of poor glucose uptake. And they thought the areas of poor glucose uptake were there because the neurons were dead, that they simply just weren't there to take up the glucose anymore. But he said the fact that the neurons can take up ketones, they are there. They're like cars that are parked that don't have fuel. They just need fuel in the tank and then they can function. And no doubt, many of them have died, but we have trillions of neurons, so we have a big backup system in our brain. And it is possible, even, to grow more neurons. Doctors used to think that you got what you got when you were a child and that you kept those same neurons forever, and now they're learning that it is possible to grow new neurons, like in the hippocampus where memory starts. It's just very intriguing that the neurons really are there. They're just... the brain has shrunk.

Geoff So if we follow the direction that, okay, there's some sort of glucose uptake dysfunction, do we have an understanding of whether this is an insulin resistance of neurons or is it happening within the cell, for example, [inaudible 00:59:57] is somehow being inhibited, do we have-

Mary N. There's several factors.

Geoff Or maybe to open up a little bit, what are the contributing factors that's preventing glucose from fueling these cells and why are ketones able to shortcut or run in a parallel process into fueling this brain? And then when we... And I think it would be worth to define for our listeners here that when we define fuel, we define it as a substrate for the Krebs cycle.

Mary N. Right. To make ATP.

Geoff Yeah. So this is in the Mitochondria. This is the power plant of all of life. And you can either fuel the Krebs cycle with... well, you can feel it for a number of substrates, but the two that we're primarily talking about right now, glucose, which turns into pyruvate or ketones, beta hydroxybutyrate into Acetyl-CoA and they feed into the Krebs cycle.

Mary N. Right. One easy way to think of ATP is when you flex your muscle, every single muscle fiber needs ATP to do that and to relax it again, every single muscle fiber needs more ATP. So you're constantly needing to make ATP for virtually every cell in your body. And so there's this Krebs cycle that is a biochemical pathway that results in production of ATP, but it has to be fueled. So it's fueled by glucose, ketones. Fatty acids can fuel it, but they don't cross very well into the brain, so they're not a good source of fuel for the brain. So basically for the brain, the main sources would be glucose or ketones. So several things happen in Alzheimer's that they've been able to document. One is insulin deficiency and insulin resistance in the brain. Another, it's the insulin receptors into... There's one group that has been able to show that the insulin receptors, which should be on the surface of the cell, aren't. There's some kind of a morphous substance that seems to be trapping or preventing the insulin receptors from getting to the surface of the cell, which is really interesting. So that could explain some of this problem with insulin resistance, that the insulin receptors aren't where they're supposed to be in the cell. Pyruvate dehydrogenase deficiency, so this is one of the enzymes involved in breaking down glucose so that it can enter the Krebs cycle, that's deficient. And then there are these GLUT transporters, glucose transporters called GLUT1 and GLUT3 that are deficient in the Alzheimer brain. And GLUT1 one helps get glucose into the brain to help cross the blood-brain barrier and GLUT3 helps get glucose into neurons. So those are deficient. So to me, it's like there's a conspiracy of getting glucose into the brain. But ketones don't need any of that to get into the Krebs cycle to produce ATP.

Geoff Right. The transporters are just completely different. Glucose transporters, they go through what's called the monocarboxylate transporter, which is completely separate from glucose uptake.

Mary N. Right.

Geoff So do we have any speculation on what is causing downregulation of glute transporters, PDH, pyruvate dehydrogenase, insulin receptors are down regulated? And I think that's an interesting observation in the broader context of increased rates of metabolic syndrome, diabetes, all of these things. Can we speak towards the broader... I don't know if I want to say conspiracy, but the broader context of why all these things are accelerating?

Mary N. I don't know for sure the answer to that, but a very large suspicion of mine is that it has something to do with what we're eating. For the last 50 or 60 years, obesity's been on the rise, diabetes has been escalating. If you get to be 75 in the US, three quarters of the people either have diabetes or prediabetes. It's astounding. It's happening in very young children. And we've been on this very high carb diet, a huge amount of sugar we're eating. There's some statistics showing back in 1820s, people were eating on average six pounds a year of added sugar, which sounds like a lot. Six pounds a year, jeez. Well, now it's over 130 pounds a year of added sugar in the US. It's incredible. And trans fats, they're now in the process of being phased out in the US. They've been banned, basically, by the FDA. And in 2002, they started requiring food manufacturers to label whether there were trans fats in the food. So trans fats are these fats that are produced from subjecting oils to very high heat and pressure. And the structure, it actually saturates the fat, but it also twists... I think of it as twisting the molecule. It's an abnormal shape, and yet these become part of cell membranes. They don't fit normally into the nice, fluid cell membrane. They make the cell membrane stiffer, they shorten the life of the cells. So trans fats have been out there. Most of us alive the day were eating a whole lot of trans fat most of our life if we were eating out, eating at fast food places ever-

Geoff Margarine, all that stuff.

Mary N. Margarine, Crisco. Crisco was used constantly. I have a lipid researcher friend at University of Maryland, and she said they used to measure in a medium serving of McDonald's fries before 2000 to 35 grams of trans fats.

Geoff Whoa.

Mary N. Massive amount of trans fat.

Geoff Yikes.

Mary N. And these are not normal fats, they're... So I think that could have played a role. I think it could be the sugar. I wonder what feeds microorganisms. Why do people get infections in their brain? Is this a fuel? We know it's a fuel for [inaudible 01:05:37]. That's one of the culprits that has been looked at. I need to research more the different microorganisms and what fuels that you use. The inflammation in the brain... Sugar, just really high, chronic high levels of sugar produces what are called advanced glycation end products and they're sticky substances. This happens when sugar combines with either fat or protein, and diabetics are very prone to getting damage to many different tissues from having chronically high levels of glucose. So the inflammation in the brain as well can be attributed to that. And I think it could be a setup for infection. If you have inflammation in any tissue, there's a reasonable chance that a micro organism will find that and try to grow on it, produce an infection. So I do think the biggest culprits are probably sugar, very possibly trans fat and just getting away from eating that natural whole food which our ancestors ate. They didn't have all these convenience foods that we have today. So many chemicals in our foods, they've been genetically modified. We don't know how that factors in yet, if it's important or not. It very possibly is. The micronutrients. Say you take a vitamin supplement. A lot of those supplements are a synthetic vitamins. They're not the naturally occurring forms of the vitamins. When we do that instead of eating vegetables, are we doing the right thing? There's white flour, it's really pure sugar, almost pure sugar, and they've had to fortify it with B vitamins. The vitamin that they're using is called biomin mononitrate, and it's not a naturally occurring form of biomin. The nitrate part of it, it's partly fat soluble, which B vitamins usually aren't, so it could be stored in fat, it could be accumulated in fat. And when you think about the diet of the average American, probably almost every meal and snack, they have white flour. Almost every single meal and snack, many, many people in the US. So where does this vitamin go if it's fat-soluble? Does it accumulate in the brain? I have so many questions I think about this stuff. I can't sleep some nights because I think all about this.

Geoff I think you're just unpacking it. I think that this is complicated.

Mary N. It is complicated.

Geoff I think modern processed foods have saved a lot of lives in the sense that famine used to be one of the biggest killers and for better, for worse, we resolved that problem. But now, have we unpacked another can of worms here, which is that all these processed foods which prevented people from starving to death, which is a good thing, but now are causing these chronic diseases that are now coming home to roost? And that's where, I think, folks like yourself, folks like ourselves, folks in the bio community are trying to change the paradigm, where I don't think we blame processed foods for taking us from starvation, famine prone species and society-

Mary N. Being able to feed everybody.

Geoff Which is good. But that's just step one. Now that everyone is fed, the problem is being overly fed and fed with non-optimal nutrition that is causing these chronic diseases. Can we now take the next step to evolve our food supply and an education there to a place that doesn't let us starve to death, but also does not give us chronic diseases, potentially? And hopefully, that is what we all work on together here. So you've written the first book, which kicked off this interest into ketogenic diets, Ketones Into Alzheimer's. I know you just recently published The Complete Book of Ketones, which is over our shoulders. I've had a chance to read through some of the key areas there, and I think it is one of the most comprehensive historical overviews on the history of the space here. And I think that a lot of this knowledge is hidden in different podcasts or conversations like this, in the scientific circles. But it's a very cool to see all this, I would say oral tradition, this knowledge of ketones and ketone research in one specific area. So I know, obviously, you're out getting the awareness out for The Complete Book of Ketones, but what else is on your docket? What other projects do you have in the works?

Mary N. I have three or four more books I would like to write.

Geoff Great.

Mary N. ... for one thing. I think just continuing to get the message out there. It's great to be able to do a podcast like this because it's that many more people that this information gets out to. But diabetes is such a big, big area. It's such a big problem. And people can reverse... Diabetes type 2 can be reversed with a ketogenic diet. People can get off insulin in a matter of days and off medications in a matter of two or three weeks with a ketogenic diet. Doctor Eric Westman, I've heard him speak several times, but at the last conference he... He's had over 4,000 patients now, type 2 diabetics that he's gotten into remission. They've lost 76,000 pounds with a keto diet. And now the ketone supplements having exogenous ketones to boost ketone levels even higher than the average person is capable of doing with the ketogenic diet is really incredible. I've been a messenger for ketones since 2008, including the ketone ester. And to me, it's just extraordinary that it's finally here. It's available. People can actually buy it and they can try it and there is actually going to be a clinical trial starting soon for Alzheimer's for this ketone ester. I just look forward to sit, watching all of that unfold. I encourage people who are thinking about using it for Alzheimer's or any other medical condition to get their doctor involved. There's some things about the ketone ester... for example, whenever we checked Steve's ketone level, we also checked his blood sugar level and consistently, we saw his blood sugar level go down. And I do that same thing with myself, and I see my blood sugar go down. So people who are diabetic taking insulin need to know that. They need to monitor their blood sugar closely so that they don't bottom out and get hypoglycemic if they're doing something like this. There can be changes in electrolytes and things like that. One of the big things I want to do is go out and educate doctors about this. Doctors still, I'd say 98% of them still don't know a thing about this. They don't know much about ketogenic diet. Like I said, even today, they're not really taught much about nutrition in school, much less about the ketogenic diet and its benefits. Hopefully, that will happen soon.

Geoff I think talking to a lot of doctor friends, they've gotten four hours of nutritional lecture over the course of medical school.

Mary N. Exactly. And I had it one afternoon, one afternoon for about three hours was the extent of my nutrition training, which is why we were eating the convenience food diet for so many years. But just trying to get out there and educate doctors about food and how to use exogenous ketones with their patients, what they need to monitor, what they need to watch for, how much to use, what can ketones do, what are the possible indications or applications of it? And they're going to want clinical trials. Doctors like to see clinical trials-

Geoff And rightly so. If we believe in the science, then it should have the results. So I have absolutely no problems helping make that happen. If we think this works, then it should actually work in an RCT.

Mary N. It should. The other thing too, it is a food substance. It's considered a food, it's not a drug. It's not a harmful toxic drug. Beta-hydroxybutyrate, the ketone that's used in the ketone esters is our beta-hydroxybutyrate. It's the naturally occurring form of beta-hydroxybutyrate that we make from our own fat. So it's a natural substance, it's not a synthetic chemical that's produced in a lab and then has numerous potential adverse effects because it's synthetic and it's not a normal substance that we would have. So those are the kinds of things I want to be able to educate physicians about so that they understand it and so that they may have patience. People with Alzheimer's, like I said before, their brain is dying. There is no option. When you look at risks and benefits, perhaps it may be worth trying if the patient wants to try it. Doctors are allowed to use medications off label. They can use a ketone esters off label, but they should become educated about it and just use it with caution, I think.

Geoff 100%. And we'd love to support your work there. So how do folks follow along with your work? I know you have a website that has a lot of resources there.

Mary N. Oh yeah.

Geoff Where do our listeners continue to learn about your efforts here?

Mary N. So my website is coconutketones.com. I put that together at the end of 2008. After Steve responded, I thought, "Okay, websites are getting popular now." It was a pretty messy website for a long time, but I've really worked a lot on it the last few months. And so it's C-O-C-O-N-U-T-K-E-T-O-N-E-S.com. And I have a Facebook page called Coconut Oil Helps Alzheimer's, Dementia, ALS. And so people can tune in there. I'm going to probably have a new page soon that has a more keto title. Dementia prevention should begin in our 30s, and going the keto route is one way to do that. A one important way. And I'm talking about food and possibly exogenous ketones for people that are at risk. I want to have a page that I'll hopefully have up soon in Facebook. And I'm doing a series Facebook Live on Mondays. Through April and May, we're talking about my book chapter by chapter, sort of like a book club online, and the times will be posted on my Coconut Oil Helps Ketones and on my Coconut Ketones website. And I have a lot of articles I've written about the various types of exogenous ketones and using in the elderly and people with medical conditions. I have that written up that people can actually read about it, doctors can read about it, nutritionists can read about it.