title: A new way to produce hyperketonemia: use of ketone ester in a case of Alzheimer's disease.
abstract: BACKGROUND
  Providing ketone bodies to the brain can bypass metabolic blocks to glucose utilization and improve function in energy-starved neurons. For this, plasma ketones must be elevated well above the ≤ 0.2 mM default concentrations normally prevalent. Limitations of dietary methods currently used to produce therapeutic hyperketonemia have stimulated the search for better approaches.
  
  
  METHODS
  Described herein is a new way to produce therapeutic hyperketonemia, entailing prolonged oral administration of a potent ketogenic agent--ketone monoester (KME)--to a patient with Alzheimer's disease dementia and a pretreatment Mini-Mental State Examination score of 12.
  
  
  RESULTS
  The patient improved markedly in mood, affect, self-care, and cognitive and daily activity performance. The KME was well tolerated throughout the 20-month treatment period. Cognitive performance tracked plasma β-hydroxybutyrate concentrations, with noticeable improvements in conversation and interaction at the higher levels, compared with predose levels.
  
  
  CONCLUSIONS
  KME-induced hyperketonemia is robust, convenient, and safe, and the ester can be taken as an oral supplement without changing the habitual diet.
authors.affiliation: Spring Hill Neonatology, Inc, Spring Hill, FL, USA.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Newport
authors.affiliation: Department of Medicine, St. Luke's Hospital, New York, NY, USA.
authors.forename: Theodore B
authors.initials: TB
authors.lastname: VanItallie
authors.affiliation: Division of Neurology, Tominaga Hospital, Osaka, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kashiwaya
authors.affiliation: Laboratory of Metabolic Control, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Michael Todd
authors.initials: MT
authors.lastname: King
authors.affiliation: Laboratory of Metabolic Control, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA. Electronic address: rlveech@comcast.net.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Veech
mesh_terms: D020155:3-Hydroxybutyric Acid / Q000097:blood; D000544:Alzheimer Disease / Q000188:drug therapy*; D019587:Dietary Supplements; D005947:Glucose / Q000172:deficiency / Q000378:metabolism; D006801:Humans; D006885:Hydroxybutyrates / Q000008:administration & dosage / Q000627:therapeutic use*; D007657:Ketone Bodies / Q000008:administration & dosage / Q000627:therapeutic use; D007662:Ketosis / Q000139:chemically induced; D008297:Male; D008875:Middle Aged
chemical_list: C576699:(R)-3-hydroxybutyl (R)-3-hydroxybutyrate; D006885:Hydroxybutyrates; D007657:Ketone Bodies; D005947:Glucose; D020155:3-Hydroxybutyric Acid
keywords: Brain insulin resistance; Fasting; Ketogenic diet; Ketone bodies; Ketone monoester; Medium-chain triglyceride; Pyruvate dehydrogenase; β-Hydroxybutyrate