Parkinson’s and Exogenous Ketone Esters

(Eric - The patient needs to be patient!) #22

Paul this is a great point. We just don’t know. I’m learning so much from this thread and others for topics that don’t directly apply to me. Thanks, @PaulL @carolT @atomicspacebunny and others for your science perspective.

#23

Hmmm… exogenous ketones bypass the regulatory effect of insulin on their production, not that it’s an issue since he’s not producing any of his own. Ketones still have an inhibitory effect on lipolysis through the HCA2 receptor in adipose tissue, but also play an anti-inflammatory role in the body.

As to any dangers of combining ketones and insulin… I can’t think of any off hand. It would be glucose or acidosis to worry about more?

(Eric - The patient needs to be patient!) #24

@PaulL

Two people that might have an answer are https://twitter.com/DominicDAgosti2 Dom D’Agostino and Geoffrey Woo https://twitter.com/hvmn

Both sell exogenous ketones but I think both would give you links to research. I probably trust Dom D’Agostino more since he started out just as a researcher. Is in follow the money.

#25

Found some data on insulin reducing ketones directly compared to just lowering production. So the faster clearance could be partially due to higher insulin.

The sodium acetoacetate infusion rate required during the clamp was 55 % higher during hyperinsulinaemia than in controls. This was due to increased total ketone body clearance (8.4 vs 6.7 ml. kg -1.min -1) and to enhanced suppression of ketone body production.
…
Since the plasma insulin concentrations were within those observed in patients treated for diabetic ketoacidosis, the data suggest that the antiketotic effect of insulin therapy results in part from an increase in peripheral ketone body disposal. http://www.springerlink.com/index/V548062016529563.pdf

P.S.
Frankly, I’d be way more worried about giving high dose exogenous ketones to someone with LOW insulin.

(Cancer Fighting Ketovore :)) #26

Why? And how high is “high dose”?

I’m trying to keep my ketones up with MCT oil, and I’m trying to find the right balance of how much MCT oil at a time and how frequently to take it. I’ve wondered if ketone salts or esters would be better.

#27

I’ll define high dose as using more than what’s instructed on the label (for esters) that gives you an increase beyond physiological normal ranges for fasting. So, if bumping the dose puts you at like 5 or 6 mmol, then that’s fine. By low insulin, I mean like not producing enough, or borderline T1. One of those in-between diagnoses you don’t hear much about.

I think the decrease in glucose seen with esters is waranted for cancer therapy as well, but it’s only part of the treatment.

As you can see from the chart I posted above, salts don’t give you much different levels than MCT.

(Cancer Fighting Ketovore :)) #28

I’m just trying to find what will work best. Sometimes it feels so hit-and-miss. I may try to just regularly take ½ tablespoon of MCT oil several times a day.

I’m also hoping that glucose levels will go down more once the kids go back to school.

#29

MCT is certainly cheaper. How much can you tolerate without the dreaded “gastric distress”? I can take up to 2 tbsp and be ok as long as I don’t take any more for about 6 hours.

(Cancer Fighting Ketovore :)) #30

I’m not sure. I haven’t really tried. But it might be 2-3tbsp. I may try it one day when I’ll be home all day :slightly_smiling_face:

(Bacon is a many-splendoured thing) #31

I can’t either, as it happens, but that doesn’t mean there aren’t any. If I were a researcher, my hypothesis would be that exogenous ketones cause no harm, but I’d want to do a large, well-funded study, just to make sure! :grin:

#32

Are you asking about taking exogenous ketones with exogenous insulin? I don’t recall seeing any studies like that either. Most of the studies using ketone esters are for people who can’t or won’t do a keto diet, so have normal (for SAD) insulin. Or rats.

(Ian) #33

I cant express how much I appreciate all these very interesting and informative discussions. Thanks.

My friend tends to cook everything from whole foods and eats very little processed foods. His blood work indicates that he is not pre-diabetic or diabetic, so I anticipate his insulin levels will be relatively normal, whatever that is defined as these days .

As Carol points out, I am hoping that he feels enough improvement with exogenous ketones to encourage him to consider trying a ketogenic diet or even therapeutic ketosis to help mitigate symptoms or disease progression.

Considering how much my blood glucose level was reduced with the consumption of a single dose of exogenous ketones (down to 3.4 mmol/L), is there a potential concern that inducing a higher level of exogenous ketones over a longer period of time (such as by repeated dosing through the day), would result in dangerously low blood glucose post treatment, i.e. after the ketone wore off?

I am speculating that for me it would probably not be an issue because my body is already producing endogenous ketones to compensate from reduced blood sugar, but for my friend who is not adapted to fat burning, it might be an issue?

(Bacon is a many-splendoured thing) #34

No, but we need data on that, too, come to think of it. I was more focused on endogenous insulin from a high-carbohydrate diet.

(Bacon is a many-splendoured thing) #35

That would be one of the safety concerns that I’d like to see studied. I would not actually expect this to be a concern, but the point is that we don’t know.

My supposition is that glucose drops because it is not needed in the presence of circulating ketones—this would be a drop caused by the inhibition of gluconeogenesis, not necessarily the action of insulin, if my hypothesis resembles reality in any way. Whether the liver could ramp up gluconeogenesis quickly enough to make up for the dwindling supply of serum ketones is a good question. I suspect the level would drop slowly enough for the liver to be able to pick up the slack in a timely fashion, but we have no idea whether that is really true or not. Until we do know, one way or the other, you are right to be concerned about the potential for hypoglycemic episodes.

(Cancer Fighting Ketovore :)) #36

What was it before taking the exogenous ketones? How much, and what, did you take? I’m trying to find ways to drop my glucose and raise ketones, so I’m curious.

I’m eventually going to get a CGM, so I’ll try to gather some data for you. I know my situation isn’t normal because of the cancer treatments and how it effects blood cells. Still, there are many times my glucose is higher than I’d like it to be when I’m fasting (between my OMADs).

(Ian) #37

With the morning effect my blood sugar is usually around 5.9 to 6.1, then it drops steadily through the day. On the day of testing it was 5.4 mmol/L immediately prior to consumption of a single one time dose of 25 mg of ketone ester. Four (4) hours after consumption my blood sugar had dropped to 3.4 mmol/L.

HTH

(Cancer Fighting Ketovore :)) #38

OK. Did you do any testing in the 4 hours in between the two tests?

(Ian) #39

Sorry no.

(Cancer Fighting Ketovore :)) #40

Ok. Just curious. I was hoping to see more of a trend.

(BuckRimfire) #41

Or maybe your ketone production rose a bit during the test period? A few weeks ago, I tested before and after an egg-and-cheese-rich breakfast (including a big mug of tea with quite a bit of heavy cream and coconut oil, so plenty of MCT substrates) on two mornings, and my KetoMojo reading went from just under 1.0 to just over 2.5 mM both times.
Had you been on a similar trajectory without the exogenous supplement, adding your putative endogenous rise to his curve would give your curve.