Awakening From Alzheimer's Series

This is a very helpful and informative FREE web series currently in progress with a new episode each 24 hours. The entire series will be repeated on October 6 through 9. I am one of the speakers. Other featured speakers are Dr. Dale Bredesen, who has a studied protocol for Alzheimer's that has put some people in the earlier stages back to work, Dr. David Perlmutter, a neurologist whose neurosurgeon father suffered from Alzheimer's, and has written excellent books on the microbiome and effect of gluten on Alzheimer's and other disorders.  Dr. Dominic D'Agostino and Dr. Angela Poff, who study many aspect of ketones including cancer, and many more...

Watch as the world’s leading experts in Alzheimer’s and dementia share their most effective breakthroughs and discoveries after decades of grueling research in this groundbreaking series.

Join hundreds of thousands of people and watch the series trailer here ► https://wr374.isrefer.com/go/trailerfba/marynewport

DO KETONES HAVE ANTI-AGING EFFECTS?

There is a tiny worm that may tell us a big story about ketones. Called Caenorhabditis elegans, or C. elegans for short, this is a transparent free-living nematode (roundworm) less than 1/8 inch long (1 mm) that moves like a snake. The worm lives only about 2 to 3 weeks and emits a blue fluorescence when it dies.  It is one of the simplest organisms that has a nervous system, consisting of 302 neurons (brain cells) and has been used extensively since 1963 in medical research.  Every type of cell in this worm has been thoroughly studied and its entire genome has been mapped out.  C.elegans is a regular passenger on space flights and on the space station and actually survived the space shuttle Columbia disaster in 2003.  It has been used to study conditions like nicotine addiction, effects of zero gravity on muscle atrophy, sleep and aging. 

            

So, what does this have to do with ketones?  A recent research study using C.elegans strongly suggests that ketones extend lifespan and have anti-aging effects.  As we age, our cells deteriorate, often leading to chronic medical conditions and brain diseases like Alzheimer’s and Parkinson’s. Dietary restriction of calories slows the process of aging down and increases the lifespan of many organisms including primates and C.elegans. Dietary restriction is known to increase ketone levels and this could at least partly explain its effects on prolonging life.  Researchers in the anti-aging field look for substances that mimic dietary restriction and lead to longer lifespan and delay the onset of diseases of aging.  It turns out that the ketone betahydroxybutyrate, found in ketone salts (marketed by the Pruvit company), is one of those anti-aging substances. Medium-chain triglycerides (MCT) found in coconut oil, palm kernel oil and MCT oil, partly convert to betahydroxybutyrate as well.

            

In 2015, researchers at the University of South Florida published their study in which they found that high levels of D-betahydroxybutyrate extended the lifespan of C.elegans by 26% and that this effect was likely due, at least in part, to suppressing certain enzymes involved in inflammation and damage from reactive oxygen species. They then studied the effects of betahydroxybutyrate on models of the worm that were engineered to represent Alzheimer’s disease and Parkinson’s disease.  They further found that betahydroxybutyrate delayed the onset of signs of Alzheimer’s in the worm by 15% and also delayed the formation of clumps of the abnormal protein found in Parkinson’s disease by 35%.    The bottom line here is that betahydroxybutyrate prolonged the lifespan and was found to protect brain cells in the worm.

            

In an article published in 2017, Dr. Richard L. Veech and his associates at the National Institutes of Health further explain how these findings in C.elegans might be translated to prolonging human lifespan and delaying effects of aging on the brain.  The likely ketone effects involved include anti-inflammatory effects, reduction of damage from reactive oxygen species, and reducing levels of glucose and insulin.  My summary here is just a simple explanation for the very technical, complicated biochemistry involved.

            

We gigantic humans share many of the same chemical pathways as C. elegans, including those studied in the University of South Florida experiments. Do ketones have anti-aging effects?  Based on the latest information from studying this little worm, the answer to this question appears to be yes!

References:

Edwards C, J Canfield, N Copes, et al. D-beta-hydroxybutyrate extends lifespan in C. elegans. Aging Vol. 6 No. 8 (2014):1-24.

Edwards C, N Copes, PC Bradshaw. D-beta-hydroxybutyrate: an anti-aging ketone body. Oncotarget Vol. 6 No. 6 (2015): 3477-8.

Veech RL, PC Bradshaw, K Clarke, et al. Ketone bodies mimic the life span extending properties of caloric restriction. IUBMB Life Vol. 69 No. 5 (2017):305-314.

ON COCONUT OIL AND THE AHA: RESPONSE BY MARY NEWPORT MD TO THE AHA  ADVISORY COMMITTEE ON DIETARY FATS AND CARDIOVASCULAR DISEASE

The media has irresponsibly taken viral a fragment of information purporting that coconut oil may be bad for your heart from an article published in the medical journal "Circulation" 2017, 135:e1-24, as a presidential advisory committee report from the AHA, "Dietary Fats and Cardiovascular Disease". The coconut oil industry on the other side of the world, mainly comprised of small farmers who grow and sell their coconuts, is reeling from the effects of this latest careless media campaign. They have only recently been recovering from the previous advisory put forth by the AHA.

There are some serious problems with the conclusions of the advisory committee. The four "core studies" this committee relied on were all conducted in the 1950s, were relatively small groups of "men only" in three of the four studies, were conducted in populations that almost certainly were not consuming coconut oil on any regular basis, and were studies comparing diets with ANIMAL saturated fats to diets with polyunsaturated fats. Animal and human fat is well known to store hormones, pesticides, antibiotics and other environmental substances, which could be factors in heart disease, whereas vegetable fats such as coconut oil would not be so likely to contain these potentially harmful substances.

The authors do not mention whether age and smoking were controlled for in these studies; smoking, which was very prevalent in the 1950s compared to the 2010's is a major contributor to heart disease. The raw numbers of how many people in each group had cardiac events was not presented, making the summaries difficult to evaluate. The clincher in this article is that they state on page e13, under the section on coconut oil, "Clinical trials that compared direct effects on CVD [cardiovascular disease] of coconut oil and other dietary oils have not been reported." They rely on studies of individual saturated fatty acids that show a miniscule increase in LDL (so called "bad") cholesterol but rationalize away a similar small increase in HDL (so called "good") cholesterol and an improved LDL to HDL ratio. For example, lauric acid (50% of coconut oil) resulted in a less than 1 mg/dl point increase in both LDL and HDL cholesterol, with typical LDL values ranging from less than 100 to 160 mg/dl. Could a change of less than 1 mg/dl really have that much impact?

In addition, the problem here is that natural fats such as coconut oil and even lard do not come as individual fatty acids but rather as combinations of many fatty acids with different properties, which may balance each other out. Completely ignored in this report are the saturated fats in coconut oil known as medium chain triglycerides that could balance out the longer chain fats. Coconut oil also contains some mono- and polyunsaturated fats, tauted as healthy by this committee. One of the most important details that the AHA is missing here is that 70% of the saturated fats in coconut oil are medium chain triglycerides (C6 through C12) which are either converted to ketones or burned immediately as fuel by muscle and other organs and not stored as fat. Lauric acid has some properties of medium chain and longer chain fatty acids. Ketones come from breakdown of fat and provide an alternative fuel to the brain and most other organs during starvation or fasting or to cells that are insulin resistant. In a recent study conducted in Japan, lauric acid was found to potently stimulate ketone production in astrocytes in cultures; astrocytes are brain cells that nourish other brain cells. By comparison, butter, lard and animal fat contain minimal medium chain triglycerides and medium chains are not found in soybean, olive, corn, safflower and most other oils. There are hundreds of studies of potential benefits of coconut oil; for example, lauric acid, which makes up about 50% of coconut oil, is antimicrobial - there are numerous studies showing that lauric acid kills many bacteria, viruses, fungi like candida and protozoa. Lauric acid is not found in any significant amount in soybean, corn, canola and olive oils.

A few small cholesterol studies looking at coconut oil were conducted decades ago in animals or a few men over short term and used hydrogenated coconut oil - any hydrogenated oil will increase cholesterol. Also, the diets were deficient in omega-3 fatty acids which can also increase cholesterol levels. There are studies of entire populations for whom coconut oil provides 1/3 to 2/3 of the diet showing that they were of normal height and weight, had normal blood pressure, triglycerides and cholesterol levels at all ages.

The committee surmises that people who eat saturated fats likely have other bad eating habits without any proof. These days, many, if not most, of the people who embrace coconut oil are likely embracing healthier foods as well and a healthier lifestyle in general and eating fish and/or taking omega-3 fats, which weren’t on the radar in the 1950s when the so-called “core studies” for this report were conducted.

The folks in the AHA and other organizations who perpetuate these myths about coconut oil need to really do their homework and learn more about medium chain triglycerides and study the other beneficial effects of coconut oil, which they choose to ignore. The point that some people may benefit from eating more polyunsaturated fat in place of animal fat may be very valid. However, coconut oil is not animal fat and, nevertheless, the bottom line that came out of their lengthy report is that “coconut oil is bad for your heart”, which has now been perpetuated by media who jumped on this conclusion that is not even based on direct research of coconut oil and heart disease. This message has gone viral worldwide. The impact of this could take a devastating toll on the economies of countries that produce coconut oil, mostly made up of individual farmers and their families trying to make a living. These economies were devastated in the 1960s and have been slowly recovering from the initial similar AHA statement on saturated fats in 1961 based on the same four “core studies". It is irresponsible and unconscionable for this advisory committee to make such sweeping claims without direct proof that coconut oil causes heart disease.

The AHA advisory committee should consider the negative impact their report has already had on the communities on the other side of the world, and issue a clarification that there is no direct proof that coconut oil has a negative effect on the heart. Then the committee needs to figure out how to make the clarification statement go viral.

USING PRUVIT KETONE SALTS IN THE ELDERLY AND PEOPLE WITH MEDICAL CONDITIONS

by Mary T. Newport, M.D.

I receive emails and Facebook messages from many people who are using or want to use ketone salts for themselves or their loved ones, many of whom are elderly or may have medical conditions and want to make their life better.  Here is some guidance for how to get started with ketone salts:

HOW KETONES COULD HELP

Pruvit ketone salts are nutritional supplements and have not been evaluated or approved by the FDA to treat any medical condition.  On the other hand, there is plenty of scientific evidence that raising ketones can provide alternative fuel to the brain, reduce inflammation, and burn fat.  Many people report increased energy, endurance, focus and mental clarity, improved mood and sleep, fewer aches and pains, and fat loss.

TALK WITH YOUR DOCTOR

As with any nutritional supplement, it is important for elderly people and people with medical conditions to consult with their physician before using ketone salts.  The doctor could monitor your blood pressure and check blood levels of electrolytes, glucose and minerals (calcium, phosphorus, magnesium) before you get started and after 3 to 6 weeks or so.  Pruvit ketone salts are the first product marketed widely to the public that contains the actual ketone body betahydroxybutyrate attached to the mineral salts sodium, potassium, magnesium and calcium.  Many people need to watch their sodium intake, may be on diuretics that may cause loss of minerals from the body, and/or may be taking potassium.  Keto//OS 2.1 and 3.0 have 1400 mg to 1600 mg per serving packet (or full scoop if you have a can of product).  Keto//OS 3.0 (chocolate swirl) also has 490 mg of potassium, compared to just 47 mg in Keto//OS 2.1 (orange dream). 

                

Another option to reduce sodium and potassium intake with ketone salts is to use KetoMax, which contains much less sodium per full serving at 925 mg and minimal potassium at 75 mg.  Another great reason to use KetoMax is that it contains a higher percentage of the circulating form of betahydroxybutyrate and may be even more effective than Keto//OS.  I recommend KetoMax especially for people with medical and neurologic conditions such as Parkinson’s, dementia, and Alzheimer’s. It costs more but the value is there. Your doctor or a dietician can help you factor the mineral salts into your diet and adjust, for example, your potassium supplement to account for the amounts in ketone salts.

                

People with diabetes taking medications and/or insulin need to be aware that raising ketone levels with ketone salts may result in a significantly lower blood sugar along with a drop in the amount of insulin the body produces. To avoid abnormally low blood sugar, I recommend that you monitor your blood sugar closely and work with your doctor to make changes in your medications.  Many diabetics report that they are able to reduce their medications, including insulin, rather quickly over days to several weeks, especially if using ketone salts is combined with a low carbohydrate diet. Pruvit ketone salts contain minimal sugar and are sweetened with stevia and/or erithritol, a sugar alcohol.

Regarding diabetic ketoacidosis, this is an abnormal condition that occurs with very elevated blood sugar and inadequate insulin.  Levels of ketones are many times (20 to 50 times higher) than the levels you would get by taking a serving or two per day of ketone salts.  The risk is extremely low, but could be a problem for someone on the brink of diabetic ketoacidosis.   Ketone levels can easily be monitored with a Precision Xtra or NovaMax glucose/ketone monitor using ketone strips, available online without a prescription.  Ketone salts usually produce betahydroxubutyrate levels in the 0.5 to 2 mmol range, compared to 10 to 25 mmol in diabetic ketoacidosis.

START SLOWLY AND INCREASE AS TOLERATED

While it is tempting to start with a whole serving in hopes of seeing maximum benefits right away, I recommend in elderly people and those with medical conditions, to start with 1 or 2 level teaspoons per day, which would be equal to about 1/8 to 1/4 of a serving, and if there is no issue, such as intestinal distress, you could increase by the same amount every few days until arriving at ½ to 1 full serving per day.  The total amount could be divided into smaller portions throughout the day.

                

Also, it is very important that the person taking ketone salts take plenty of water and other clear liquids.  Ketone salts can have a dehydrating effect in some people, especially in the beginning.

                

Ketones can suppress appetite, which is great if you need to lose weight.  If you are very thin you might consider adding more calories to your diet with calorie dense foods such as coconut oil, olive oil, butter, cream, avocado and nuts.

BRING THESE GUIDELINES TO YOUR DOCTOR

Ketone salts are so new that most doctors don’t know about them yet much less the potential of ketones to provide alternative fuel to the brain and other organs, reduce inflammation, and burn fat.  I suggest that you take a copy of these guidelines to your doctor.  Many doctors decide to pass this information on to other patients when they see improvement in just one of their patients.  Some doctors may even decide to help their patients by providing ketone salts as samples or ordering them through their office.

                

For more information see:  www.coconutketones.com and www.marynewport.pruvitnow.com. 

Fourth Anniversary of Steve's Ketone Rebirth (May 21, 2012)

Yesterday, May 21, 2012, was the fourth anniversary of the day Steve started taking coconut oil to provide ketones as an alternative fuel to glucose for his brain, with very positive results.  He is now 62 years old and in his eleventh years of symptoms related to early onset Alzheimer's disease.  Much has happened in these four years, both setbacks and recoveries. Fortunately, we are in a recovery phase.  We have surprises all of the time that lead me to believe that everything he was is still in there, but he has a problem getting access to it.
I will post a point by point update in the near future.
In the meantime, here is a little bit of my funny old Steve coming out to visit yesterday:

New brain metabolism and ketone review article

I recently received this new article that discusses in great detail what is known about brain metabolism as we age and the potential for alternative fuels to glucose to prevent or stabilize the progression of Alzheimer's disease:

"Brain fuel metabolism, aging, and Alzheimer’s disease",
Stephen Cunnane Ph.D., Scott Nugent B.Sc., Maggie Roy M.Sc., and others, Nutrition, January 2011

Here are some important excerpts from this article:

"The recent development of 11C-acetoacetate as a ketone tracer for PET studies opens a new window to compare brain metabolism of glucose and ketones in the same individual. If brain
ketone metabolism is not lower in AD or is less affected than glucose metabolism, one potential strategy to improve brain fuel availability and reduce the risk of AD that has already been targeted in clinical studies would be to develop a way to safely and reliably provide the brain with ketones as an alternative fuel to glucose..."

"Whether or not mitochondrial dysfunction reflects genetic or metabolic disturbances,
clinical trials attempting to redress the energy deficit in the AD brain suggest that cognitive function can be at least transiently improved if more fuel (glucose or ketones) can be
supplied to the brain."

"In carriers of apo E4, small areas of lower brain glucose metabolism are observed at an age
as young as 30 y old, e.g., 30-40 y before clinical onset. Indeed, we see an inverse relationship between CMRg in several brain regions and fasting plasma insulin, so brain metabolism
seems to be sensitive to even mild disturbances in systemic insulin control even if no clinical symptoms of cognitive decline are observed. Compared to non-carriers of apo E4, carriers have altered u3 [omega-3] fatty acid metabolism and higher measures of oxidative stress in the brain, both of which may contribute to a higher risk of early onset of brain hypometabolism. If brain hypometabolism can be present before clinical symptoms are apparent, this does not prove that hypometabolism is the earliest event in AD. However, to the best of our knowledge, hypometabolism is currently the earliest measurable abnormality in the brain that is connected to AD so its features and the reasons for it should shed light on the etiology of AD."

"The cerebral metabolic rate of ketones (CMRk) varies directlywith their blood concentration, starting at very low ketone concentrations...Hence, at a plasma b-hydroxybutyrate [one of the primary ketone bodies] concentration of 0.3-0.5 mM, such as can be achieved during 12-24 h fasting, b-hydroxybutyrate supplies 3-5% of whole brain energy requirements. As plasma ketones rise, CMRk also rises such that at a b-hydroxybutyrate of about 1.5mM, ketones provide about 18%, and at 6 mM, they provide about 60% of brain fuel." [Dr. Richard Veech's ketone ester can provide levels this high].

"Acute, controlled human experiments show that ketone infusion or ketogenesis inhibits the cognitive and behavioral sequelae of acute, experimental hypoglycemia, both in healthy
adults and in type 1 diabetes. It is generally assumed that the cognitive effects of hypoglycemia can be prevented by ketones because they seamlessly replace glucose to meet the brain’s energy requirements. However, acutely raising plasma ketones also increases cerebral blood flow in humans, an effect that may contribute to their beneficial impact on cognition during hypoglycemia. Studies in humans and animal models suggest further protective effects of ketones in the brain after ischemic insult [lack of oxygen/stroke] and other treatments damaging neuronal function."

"More recent controlled clinical trials confirm that short-term improvement can occur in cognitive tests when individuals with mild to moderate AD are provided with an exogenous source of glucose, ketones, insulin, or insulin sensitizers. These clinical studies show that the
affected brain regions in AD are at least partially viable and that cognition can improve when exogenous fuel supply to the brain is increased. In two of these studies, ketogenic supplements
based on medium chain triglycerides were used, thereby permitting a relatively normal choice of meals. Medium chain triglycerides have long been known to be ketogenic because they contain medium chain fatty acids (octanoic [8:0] and decanoic [10:0] acids), which do not require activation by CoA to enter mitochondria. The mild beneficial effects on cognition and relatively good tolerance to the doses of medium chain triglyceride used are promising, notwithstanding the possibility that carriers of apo E4 with AD derive little benefit from this treatment [Dr. Newport's comment: per one of the authors of the MCT oil studies, many of the ApoE4+ individuals did experience improvement, as a group when data was combined on the average they did not]. The explanation for the beneficial effect of mild, experimental ketonemia on cognition in AD may be as simple as exchanging one brain fuel for another as occurs in
fasting or starvation. It may also be due to the observation that although glycolysis may be impaired in the AD brain, CMRk and metabolic capacity to use a fuel other than glucose may
both be relatively normal in AD."

"...two observations in particular support the notion that the neurons affected in AD are still functional: (1) in AD, brain ketone uptake is apparently normal or at least less impaired than is glucose, and (2) there is a functional response to nutritional supplements that increase brain fuel
availability, particularly ketones. Hence, if brain fuel metabolism could be optimized or even partially returned toward normal, the risk of further cognitive decline may diminish. Raising plasma ketones to 0.4-0.5 mM would contribute to 5-10% of the brain’s energy requirements, which is equivalent to the early cortical glucose deficit in those genetically at risk AD. Such a mild, safe level of ketonemia is achievable with ketogenic supplements, so if implemented before symptoms develop, it seems plausible that they could diminish the risk of further metabolic deterioration and clinical onset of cognitive decline."

Regarding Omega-3 fatty acids:

"The u3 [omega-3] polyunsaturated fatty acid, DHA, is now widely understood to have an important role in mammalian brain development...Insufficient dietary intake of DHA and low levels of DHA in the hippocampus may have a role in cognitive decline in the elderly and/or AD. Hence, the low intake of DHA now widely but not universally reported in AD may contribute to the evolution of cognitive decline because of its role in brain glucose transport and in other aspects of brain function and structure. This emerging role of DHA in brain energy metabolism could be linked to the early presymptomatic onset of brain glucose hypometabolism in AD, at least in carriers of the e4 allele of apoE4. Nevertheless, such an effect probably involves relatively subtle changes in DHA metabolism because plasma DHA appears to be higher in the healthy elderly and is widely variable in AD."

Dr. Newport's comments:

The bottom line here, to try to prevent or stabilize AD, include medium chain fatty acids (coconut oil, palm kernel oil and MCT oil are the richest sources) in the diet to provide ketones as an alternative fuel to glucose AND eat fish (especially salmon) and/or take a supplement of marine based omega-3 oil (fish oil for most of us; algae based oil for vegans found in brands that are marketed to pregnant women).

Bad news for Eli Lilly Drug Trial/ More thought about beta-amyloid and infection

The Eli Lilly drug that has been in phase III trials has been stopped due to increased risk of skin cancer and, even worse, an acceleration of deterioration of AD compared to the placebo, the opposite of what was hoped for. This is yet another sad turn of events. Steve was in this study but we stopped in the winter due to several side effects; I believe he was on the actual drug for only about a month at that point. His hair started to grow out a very light gold color (one of the known effects that didn't bother us)and when we stopped it, the darker hair grew in again. He had a half inch white stripe work its way out to the tips of his hair! I no longer have any regrets that we pulled him out of the study.

I believe the worsening of AD in people who were on this drug supports infection as at least one important cause of Alzheimer's disease. One group has found that beta-amyloid kills microbes; they tested a number of bacteria, all of which were killed by beta-amyloid, and this group is now looking at viruses, such as herpes simplex, and other microbes (Soscia "The Alzheimer’s Disease-Associated Amyloid b-Protein Isan Antimicrobial Peptide" PLOS March 2010,Volume 5, Issue 3, e9505: www.plosone.org). If a drug is used to suppress the production of beta-amyloid and it normally is part of the brain's defense against infection, then infection could spread more readily and potentially cause more extensive damage to brain tissue. Beta-amyloid may be more prevalent in people with AD because they have chronic, recurrent infections that are provoking this response. So the increase in amyloid may be the aftermath, no the cause of, the process that does cause AD.

Drs. Ruth Itzhaki and Mark Wozniak in the UK have done extensive work looking at the herpes simplex virus as a cause of AD (they have numerous papers on this from 2005 through 2009.) This virus causes fever blisters, can cause shingles (along with the chickenpox virus, a close relative), and also genital herpes. Herpes simplex lives within nerves and the nerves to the face around the mouth orignate deep in the brain. Most people carry this and other viruses by the time they reach old age, but they have found that people who are ApoE4+ are particularly likely to suffer recurrent episodes of fever blisters. these researchers have found this virus within about 90% of the beta-amyloid plaques in the autopsied brains they have looked at, which strongly suggests that beta-amyloid is there to defend the brain against it. They have also found in animals that the herpes virus increases production of beta-amyloid and also induces AD-like tau phosphorylation (production of tangles). They want to study whether suppression of herpes virus with anti-viral medication would be beneficial to people with AD, but have had trouble getting funding for this.

Acyclovir, for example, is taken daily orally by many people to suppress the genital variety of herpes simplex, including woman who are pregnant, to try to prevent spread of the nfection to the newborn. Perhaps such a treatment could decrease the number and severity of outbreaks in the brain as well. Lysine (available OTC) is used to suppress herpes infections and the lauric acid (C:12) and capric acid (C:10)found in coconut oil kill herpes family of viruses by dissolving the lipid capsule around the virus.

It could also be that, even though beta-amyloid is there to fight infection, it causes some of the damage as well; if you think about it, whenever there is inflammation, part of the body's defensive reaction to infection, there can be damage/scarring to the nearby tissue from the inflammation. The infectious agent is the cause of the whole process, but the body's defenses can also cause some collateral damage, in order to preserve the whole person.

I hope work by Itzhaki and others studying infection will be taken more seriously so that they can get the funding they need.

Powdered MCT Oil

I just learned something new for those who are using MCT oil, or want to, that there is a powdered form of it available in bulk from a company called True Protein - https://www.trueprotein.com/Product_Details.aspx?cid=24&pid=86 . The product contains 63% caprylic acid (c:8), 25% capric acid (C:10) and < 2% C:6. This would be useful for those who don't like the idea of taking oil. It has a milk protein with it that allows it to be in powder form, and apparently can be mixed easily with water or other liquids. I am ordering some to try it out. This could also be ideal for traveling by plane or taking to restaurants.

This company also has many other foods and supplements that are available in powder form, and they will even let you create a custom mix of their powders, which could make life easier for those who have trouble swallowing pills and capsules.