Assessing the Impact of Factors that Influence the Ketogenic Response to Varying Doses of Medium Chain Triglyceride (MCT) Oil.

Objectives, Design, Setting: The ketogenic effect of medium chain triglyceride (MCT) oil offers potential for Alzheimer's disease prevention and treatment. Limited literature suggests a linear B-hyroxybutyrate (BHB) response to increasing MCT doses. This pharmacokinetic study evaluates factors affecting BHB response in three subject groups. PARTICIPANTS: Healthy subjects without cognitive deficits <65years, similarly healthy subjects >=65years, and those with Alzheimer's Disease were assessed. INTERVENTION: Different doses (0g,14g, 28g, 42g) of MCT oil (99.3% C8:0) were administered, followed by fasting during the study period. MEASUREMENTS: BHB measured by finger prick sampling hourly for 5 hours after ingestion. Each subject attended four different days for each ascending dose. Data was also collected on body composition, BMI, waist/hip ratio, grip strength, gait speed, nutrient content of pre-study breakfast and side effects. RESULTS: Twenty-five participants: eight healthy; average age of 44yr (25-61), nine healthy; 79yr (65-90) and eight with AD; 78.6yr (57-86) respectively. Compiled data showed the expected linear dose response relationship. No group differences, with baseline corrected area under the blood vs. time curve (r2=0.98) and maximum concentrations (r2=0.97). However, there was notable individual variability in maximum BHB response (42g dose: 0.4 -2.1mM), and time to reach maximum BHB response both, within and between individuals. Variability was unrelated to age, sex, sarcopenic or AD status. Visceral fat, BMI, waist/hip ratio and pretest meal CHO and protein content all affected the BHB response (p<0.001). CONCLUSION: There was a large inter-individual variability, with phenotype effects identified. This highlights challenges in interpreting clinical responses to MCT intake.

Clinical challenges in thyroid disease: Time for a new approach?

Thyroid disease is common, and the prevalence is rising. Traditional diagnosis and monitoring relies on thyroid stimulating hormone (TSH) levels. This does not always result in symptomatic improvement in hypothyroid symptoms, to the disappointment of both patients and physicians. A non-traditional therapeutic approach would include evaluation of GI function as well as a dietary history and micronutrient evaluation. This approach also includes assessment of thyroid peroxidase (TPO) antibodies, T3, T4, and reverse T3 levels, and in some cases may require specific T3 supplementation in addition to standard T4 therapy. Both high and low TSH levels on treatment are associated with particular medical risks. In the case of high TSH this is primarily cardiac, whereas for low TSH it is predominantly bone health. This article discusses these important clinical issues in more detail, with some practical tips especially for an approach to the "non-responders" to the current traditional therapeutic approach.

A prospective evaluation of the awareness, knowledge, risk factors and current treatment of osteoporosis in a cohort of elderly subjects.

This was a prospective cohort study of 145 seniors attending a senior's clinic and social day program using a self-administered questionnaire. Its objective was to evaluate the awareness, knowledge, risk factors and current treatment of osteoporosis in our two patient groups. A secondary objective was to determine differences between the two cohorts, and between men and women. Participants included 39 men and 106 women, with an average age of 76 years. Of these, 89% were aware of osteoporosis and 61% gave the correct definition. Awareness and accurate definition were less in men compared with women (p < 0.01, and p < 0.05) and clinic compared to day program groups (p < 0.01). Only 54% of men knew osteoporosis could affect them. Television, newspapers and friends were identified as the main source of information. Physicians ranked as fifth as a source of information. In all, 84% knew diet was important. Prevalence of risk factors other than age were < 20%, except for senescence (38%) and alcohol use (40%). Utilization of specific therapies for osteoporosis was only 18% overall with a rate of 3% in men (p < 0.01). In women, 50% and were taking calcium supplements compared with 15% men (p < 0.001) and for multivitamins the figures were 57% and 33% respectively (p < 0.05). These results show a high level of awareness and correct definition of osteoporosis in this cohort of patients. Specific therapy for prevention or treatment of osteoporosis was inappropriately low in the face of high risk. This study highlights the care gap in osteoporosis in seniors and the need for increased physician involvement in patient education and treatment. Proactive treatment requests from patients need to be encouraged, especially with the future demographic shift.