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Augustin K et al. reviewed the effectiveness of the ketogenic diet and found the mechanism behind the diet effectiveness is less related to ketone bodies as was originally thought but is related to medium-chain triglycerides (MCTs). Decanoic acid (C10) accumulates to 150 µM during treatment and quickly enters the brain where it noncompetitively inhibits AMPA-type glutamate receptors within minutes; inhibition of AMPA receptors increases the seizure threshold in hippocampal brain slices as well as in 6 Hz and maximal electroshock models. Octanoic acid (C8), despite being present in high concentrations, does not inhibit AMPA receptors but is able to suppress seizures indirectly during hypoglycaemia via activation of adenosine A1 receptors. These fatty acids are poorly uncoupled agents compared to long chain fatty acids and decanoic acid also activates the peroxisome-proliferator-activated receptor-γ leading to increased mitochondrial biogenesis and ATP production in neurons. Together these direct and indirect effects may explain the previously observed lack of correlation between blood ketone levels and efficacy.
Fig. 1 Breakdown and circulation of dietary medium-chain triglycerides. (Augustin K.; et al. 2018)
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