My Book

I am very pleased to announce that my book is now available. The title is Alzheimer's Disease: What If There Was a Cure? The Story of Ketones. The book contains three parts: Our story; the science of ketones; and how to incorporate medium chain fatty acids into the diet.

To order, you can call the publisher directly at 1-800-575-8890, or you can order at a discount through www.amazon.com or www.barnesandnoble.com. There will also be electronic versions available soon.

Dr. Suzanne de la Monte and Dr. Oz Show: Nitrites and nitrates in food may cause Alzheimer's

On April 7, 2011, a former surgeon general and Dr. Suzanne de la Monte appeared on the Dr. Oz Show entitled, "A Revolutionary Breakthrough in Alzheimer's Disease," (can be watched on his website) where she presented her important research. She is the doctor who coined the term "type 3 diabetes" in reference to Alzheimer's disease.She found by accident that giving a nitrosamine compound called streptozotocin, used to deliberately produce diabetes, caused Alzheimer's in her lab mice. She learned that the brain produces its own insulin. She further found that this compound causes production of toxic lipids in the liver that cross the blood brain barrier and damage certain cells such that the brain develops insulin deficiency and insulin resistance. Nitrites and nitrates, found in very many processed foods, are nitrosamine compounds and could very well explain the epidemics of Alzheimer's, autism, diabetes, MS, Parkinson's and ALS, along with other neurodegenerative diseases that have insulin resistance, decreased glucose uptake as part of the process. These diseases have all been on the increase as processed foods have taken over our diets. I will add Dr. de la Monte's references to the website http://www.coconutketones.com/, in the very near future. These nitrites and nitrates are in most bacon, ham and other meats, deli meats, whether pre-packaged or cut at the counter, processed cheeses, cereals, breads, pretzels, crackers, white flour and anything that contains white flour, certain beers, scotch and some other whiskeys. Now something that has caught my attention for newborns and children: I found one of these offending compounds, thiamine mononitrate, in the Carnation infant formulas, some of the jarred baby foods, especially the junior combinations, cereals and other infant prepared foods such as macaroni and cheese. The government requires that certain vitamins such as thiamine are added to enrich foods that have been stripped of these nutrients by processing, most notably white flour and other grains. Thiamine mononitrate is a synthetic source of vitamin B1, rather than a naturally occurring vitamin, and is added to very many foods. Just look at the ingredients labels. Most people eat something with thiamine mononitrate in it for nearly every meal. Naturally occurring Vitamin B1 (thiamine) is usually water soluble, meaning that if you eat an excess of it, you will pass it out in the urine; however, thiamine mononitrate is fat soluble and the excess accumulates in the liver and fat cells. The FDA regulations (21 CFR 184.1878) say that thiamine mononitrate may be used in food "with no limitation other than good manufacturing practice" and that it "may be used in infant formula". These compounds could slowly kill off insulin producing cells in the brain and other organs, and when enough cells have been effected symptoms will begin to emerge. This could explain the classic development of autism in children at 1 1/2 to 2 years of age who were previously thought to be normal. And in Alzheimers' it is believed that the disease process begins at least 10-20 years before symptoms appear. Animal studies need to be done to determine if thiamine mononitrate produces Alzheimer's disease, autism, type 2 diabetes and the other diseases mentioned above. In the meantime, it would behoove us to read the labels and eliminate anything from the diet that includes nitrosamines, nitrites, nitrates; look for these words alone or in combination with other words, such as thiamine mononitrate. What is left for us to eat? Stay away from packaged and other processed foods and eat whole foods: organic whenever possible, vegetables, fruits, eggs, dairy, goat milk and cheeses, nuts, legumes, whole grains (without added nitrates) grass fed beef, free range chicken, "natural" deli meats that have nothing added (they can be frozen to prolong use). I thought we were adhering very closely to a whole food diet until learning that many of the foods we were eating, such as deli meats and some "whole grain" breads and cereals, contain nitrites or nitrates. this could explain some of the deterioration we have seen in spite of everything else we are doing. Most important to our newest generation, mothers can avoid this problem by breastfeeding their babies for as long as possible. Nitrites and nitrates are just one group of compounds we need to worry about for our newborns and toddlers. Also, consuming foods with medium chain fatty acids, such as coconut oil and MCT oil, can at least partly bypass the problem of insulin resistance by providing an alternative fuel to glucose for brain cells. And how could this possibly be related to the herpes simplex issue that I have written about? I found a 1977 article from the lab of Dr. George Cahill, Jr. ("Studies of Streptozotocin-induced insulitis and diabetes", Proc Natl Acad Sci USA, 74(6): 2485-2489, June 1977), in which he used streptozotocin to produce diabetes in mice by destroying the beta cells of the pancreas-- an unexpected finding was an increased production of a type C virus in the beta cells that survived. Could it be that the virus is involved as part of the process that destroys the cell after exposure to nitrosamines, or is an opportunistic infection that takes over the damaged cells, which further complicates the Alzheimer’s disease process? The bottom line is to avoid any foods that contain nitrites or nitrates or any ingredient in which one of the words appears.

Dr. Veech needs an angel

Coconut oil and MCT oil provide relatively low levels of ketosis, however, the ketone ester made and studied in the lab of Dr. Richard Veech can provide levels at least 10 times as high. As noted in the article that is the subject of my previous post, the amount of energy provided to the brain is directly proportional to the level of ketones in the blood. Thus his ketone ester could provide as much as 60% of the brain's energy requirement compared to perhaps 5-10% by MCT oil/coconut oil.

There have been more than 700,000 hits on my website www.coconutketones.com. I am pleased that very many people now know that ketones may provide an alternative fuel to glucose in the brain for people with Alzheimer's and other neurodegenerative diseases. There must be someone out there who can help provide funding for continuation of Dr. Veech's very important work. He has only enough funding from the NIH to continue the research in his lab and production of the ketone ester until June 2011. He is in need of a charitable or government source of funding to continue just this basic work. He wishes to perform a pilot study of Parkinson's and the ketone ester. This would be a 28 day study. He lacks funding to even begin this short term study. Thereafter, he wishes to study Alzheimer's and this would require $10 to 15 million to manufacture enough ketone ester and fund the clinical trial. Alzheimer's is so complex and symptoms so variable from person to person, as compared to Parkinson's, that a two year study would be required to determine that the ester is effective.

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).

Mirrors and Windows - Temporary solutions

This post has nothing to do with coconut oil!

Many people with Alzheimer's have an interesting interaction with mirrors, windows and other reflective surfaces, sometimes pleasant and other times not so pleasant. This may be more prominent in the evening when dark windows may present disturbing images. We have seen some of this in Steve with glass doors and windows facing our courtyard that were not covered with curtains. He feels like there are a lot of people/strangers in the room when he sees reflections in a dark window.

In our kitchen, we put up sheer cafe curtains with a spring rod that can easily be readjusted to any height. The curtains are positioned so that the top is just above his eye level. For the glass doors I also put up sheers that are positioned to allow light to come in above and below, but again reach to just above eye level to eliminate the reflection.

There is also privacy film that can be placed on mirrors or windows as an easier solution than taking down the mirrors. We used some of this on the sidelights to our doors. I have found this at stores such as Home Depot, and Bed Bath and Beyond. There are two types - one is very much like holiday window decorations, that sticks easily to the surface and peels right off. There is another type, much harder to install, that requires spraying the surfaces with water then burnishing out the bubbles with a squeegy; this is much more difficult to use and would probably be a nightmare to remove as well. Both types have a number of different patterns available.

In restaurants, the person may be more comfortable if facing away from any dark reflective windows, if at all possible. If you are in a restaurant and your loved one becomes unsettled, consider the possibility that window reflections could be the issue.

More on herpes simplex virus and Alzheimer's

On a previous post, I discussed the research conducted by Dr. Ruth Itzhaki in England providing very strong evidence that recurrent infection with herpes simplex in the brain may be the cause of Alzheimer's in certain people, those who are ApoeE4+. Please look back for the details.

Nearly all of us acquire herpes simplex virus at some point and then carry it. When we are young most of us can apparently control these infections more so than when we age. Some people, though, have recurrent outbreaks, usually as fever blisters, or for some, genital lesions. Some people with active virus show no outward symptoms at all. Reactivation of the virus produces inflammation in the brain. Most of the episodes are mild, but over time the effects could be cumulative. An infection such as this could explain why Alzheimer's begins in certain parts of the brain and eventually spreads to other areas. It could also explain the fluctuations that we often see in symptoms - when the virus is latent the person may do a little better, when there is a reactivation and greater inflammation, the person may get worse, a sort of two steps forward (worsening) and one step back (improvement) kind of process.

Steve has a long time history of lengthy outbreaks of fever blisters on his mouth, and had an outbreak around his eye and was quite sick at age 29. I strongly believe that, at least in his case, herpes simplex may be the cause of his Alzheimer's disease and this particularly bad episode could explain why he became symptomatic so early.

Now another group led by Dr. Nancy Sawtell at Cincinnati Children's Medical Center is providing more proof that herpes simplex may be the culprit for some people. She was inspired to do this work after Dr. Ruth Itzhaki visited her lab a few years ago. They have been working with mice in which the Apoe4 allele has been "knocked in" and infected them with the virus. They found that a lot more virus got into the brains of the Apoe4 mice than the non-Apoe4 mice. They are now trying to learn what makes some people more susceptible to the virus. She has found that the viral protein VP 16 is essential in triggering the virus's reactivation. So now they are trying to find substances that may inhibit VP 16 and therefore keep the virus from reactivating.

Dr. Itzhaki, in the meantime, is having difficulty getting funding for continuing her vital research. One skeptic on a review board can keep the board from approving a grant. I believe she and Dr. Sawtell are on the right path - their work needs to continue.

GPS Shoes, Ketone Meter and Coconut Milk Orange Soda

There was article in USA Weekend about some new shoes for people with Alzheimers that have a GPS imbedded in them. They cost $250-300 plus a monthly fee, but could mean peace of mind for many. They are called The GPS Shoe by Aetrex and can be purchased online at Foot.com or GPSShoe.com. They expect to stores to carry them next year.

There is a new at home glucose and ketone meter by Abbott called Precision Xtra. The meter costs less than $20, but the test strips for ketones run $51 for ten strips; glucose strips are much less expensive. Might be useful for someone who wants to see what their ketone response. I suggest checking the level either 90 minutes after MCT oil or about 3 hours after taking coconut oil or the mixture of MCT and coconut oil which should tell you what your peak level is. This woudl also be very helpful for someone on a ketogenic diet. I found the meter and test strips on www.amazon.com.

Dr. VanItallie suggested that I give Steve diet orange soda since it contains potassium citrate which could help prevent kidney stones in someone who is prone to them. We usually stay away from these types of drinks but Steve does have a history of stones in the past, so we decided to try this. We soon found that coconut milk tastes very, very good with the orange soda. The best way to mix it is to put the coconut milk in first then carefully pour in the soda - it can froth over easily if you pour it too fast! This could be a great way to get some coconut oil (by way of coconut milk) into someone who doesn't care for the oil.

2nd Ketone Conference in Edinburgh, Scotland

Steve, our daughter Joanna, and I travelled to Edinburgh, Scotland in early October 2010 to attend the 2nd symposium on ketones called “Dietary Interventions for Epilepsy and Other Neurologic Diseases,” where I presented two abstracts on posters. One was Steve’s case study and the other was caregiver reports of responses of persons with dementia to medium chain fatty acids. I hope to get the chart up on the website very soon. Dr. Veech’s work and/or his ketone ester were discussed in several of the presentations. About 150 people attended, mostly pediatric neurologists, PhD researchers, and dieticians, who are interested in and involved in ketogenic diet and other ketone research. Several of the presenters were from John Hopkins University, where the ketogenic diet has been used for many decades for childhood epilepsy. This diet is used primarily in children who do not respond to anti-convulsant medication, but recently has been used in adults as well. We met a man named Mike from England who had resistant epilepsy who became seizure free on this diet and has remained so for about three years ago. The diet has even been tried as a first line (before medication) at John Hopkins with success in some infants with infantile spasms. About 18-20% of children with drug resistant epilepsy become seizure free and another 35-40% have a reduction in their seizures by at least 50%. They do not know exactly why it works and also why it works in some people and not in others. This is the same thing that we see in our friends with Alzheimer's that some respond to the ketones from coconut oil and/or MCT oil and some do not.
The strictest form of the diet calls for about 75-80% of the total calories to be consumed as fat and the rest as a combination of carbohydrate and protein. The protein is calculated to allow the child to grow, or the adult to maintain lean body mass. Some of the presenters have done research showing that less strict forms of the diet may work for some people. There is an MCT oil modification of the diet, using 60% of the calories as MCT oil, a modified Atkins diet, and the Low Glycemic Index Diet. Any of these diets could be tried with the help of a dietician in someone with Alzheimer’s, Parkinson’s, ALS, traumatic brain injury and potentially some other neurologic diseases. There are some small studies and case studies suggesting that this could be beneficial. One study showed that following stroke, the ketogenic diet can help preserve brain volume.
Another section of the conference focused on cancer and the ketogenic diet with caloric restriction (20-40% less than maintenance calories). Dr. Tom Seyfried presented his research showing that glioblastomas shrink by as much as 80% in response to this type of diet. He believes that at least 80% of cancerous tumors would shrink with this approach, since most cancers can use only glucose as fuel and cannot use ketones. On this type of diet as the blood sugar becomes low, the blood supply and energy to the tumor dwindles as well as the tumor(s), even in the case of metastatic tumors. He has some human case studies as well as plenty of animal studies to support this.
The organizers for this conference were www.matthewsfriends.org and for the previous conference in 2008 www.charliefoundation.org. Both of these organizations were founded by parents of children with epilepsy who responded to the ketogenic diet, and either of these can provide information and dietician help with these diets. The next conference will be in 2012 and they are seriously considering including a section on Alzheimer’s disease.
We had a wonderful time in Edinburgh, although the travelling back and forth is not much fun. Steve did amazingly well, although there was some confusion when we were out after dark. The hardest part was trying to figure out the best times to give him his oil since we were five hours ahead there. It is always good to get back home - much less confusion there!

New animal studies with ketones and coconut oil

I have learned of two new studies that have received funding.

One is at University of Maryland, conducted by Dr. Beverly Teter, in which she will look at whether coconut oil improves the outcome for "Alzheimer" mice. The second is a study of ketones at Univesity of South Florida, Byrd Alzheimer Institute.

They will be looking at ketogenic diet, ketone ester, caloric deprivation and their effect on abnormal amyloid and tau production compared to the "normal" diet in mice.

If these studies have the outcome we hope for, this may spur further human research.

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.

Steve's MRI - Two years later

Steve had an MRI at the end of April 2010. His previous MRI was nearly two years ago, just about the time we started using the coconut oil, in June 2008. I am very pleased to report that Steve's MRI was reported as "stable" compared to the previous study. In contrast, his MRI went from normal in 2004 to having significant atrophy by 2008. Normally with Alzheimer's disease, the brain would continue to atrophy over such a two year period. This is quite encouraging, to think that medium chain triglycerides might be responsible for heading off the process of brain atrophy.

Great New Book for Caregivers

I want to recommend a wonderful new book for caregivers of people who have AD or other forms of dementia. The book is called Staying Afloat in a Sea of Forgetfulness: Common Sense Caregiving. It is written by Gary LeBlanc who lived with and cared for his father 24/7 for more than 3000 days until he finally passed away. Gary writes a column with tips for caregivers that appears in the Hernando Today section of the Tampa Tribune. This is a very practical book, written from caregiver to caregiver in a very down to earth style and injected with humor when appropriate. He addresses a variety of problems that arise on a day to day basis and ways that he found to deal with them. This is very helpful in that people who are newer to caregiving won't have to reinvent the wheel. I can totally relate to so many of the issues he discusses in this book and find his advice very useful. Between each section there is a short piece called "Dear Caregiver," usually a meaningful or humorous quote from a famous person that we will all appreciate.

If you want to learn more about this wonderful new book the website is: www.stayingafloatbook.com .

Direct link to 6 part interview series

Instead of going to YouTube, the six part series of Steve and I with Ken Lightburn can now be viewed at http://www.youtube.com/watch?v=iScs0uzQZFk