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MEDIUM CHAIN TRIGLYCERIDES: COGNITIVE & OTHER BENEFITS

 

 

Frankly, I had not paid much attention to the details of medium chain triglycerides (MCT’S) until I read the story of a doctor whose husband had dementia. His cognitive function was poor.  However, when she gave him MCT'S, he improved significantly  …. as long as he ate a low carbohydrate diet. If he did not eat a low carbohydrate diet, the effects were not as dramatic. I became intrigued, and of course set about to investigate.

 

Although the normally functioning brain relies primarily on glucose for its fuel, in Alzheimer’s Disease there are early & region specific pathological declines in the brains ability to use glucose. Luckily, the brain is capable of using alternative fuels. This ability of the brain to adapt toward using other fuels is augmented by a low carbohydrate diet (10-20 grams of carbohydrates daily), such as the famous Dr Atkins’ Diet . The low carbohydrate diet causes the body to burn its own fat for fuel. When body fat is burned , the process creates what are called ketone bodies (beta hydroxyl butyrate), or a state of “ketosis” in the body. The ketones can function as an alternate fuel for the brain.  Though unable to adequately use glucose, the Alzheimer’s brain can use ketones.

 

The above mentioned low carbohydrate diet is called a ketogenic diet. A low carbohydrate intake forces your body to burn it’s own fat to produce energy. Your body fat is then broken down to form ketones. This forces a ketone-based rather than glucose based cellular metabolism throughout your body and in your brain. This shift in fuels influences the major inhibitory and excitatory neurotransmitter systems in the brain. This type of diet has been extensively researched for use in various medical conditions. The ketogenic diet has long been used to manage intractable epilepsy in children when medications have failed. When the brain is switched away from glucose and toward the ketones & fatty acids for fuel, it seems to quiet overactive processes & modulate a malfunctioning brain.

 

I sure started thinking about how this might work with obsessive-compulsive disorder to quiet the repetitive thought processes and brain over activity. So I looked for research on that subject but didn't find much. It’s certainly worth exploring, and even worth a trial in those with this problem.  Throughout my career I have noted sugar or junk carbohydrate intake worsened symptoms in my patients with OCD. I have asked them to avoid all sugar & white flour as unwanted triggers. But we did not use a ketogenic diet to actually produce alternative brain fuels.

 

Besides epilepsy, ketogenic diets have been used to help cancer (especially brain cancer), traumatic brain injuries, chronic pain, obesity, Parkinson’s, any neurodegenerative process, Type II diabetes, & inherited disorders called glycogen storage diseases. The glycogen storage disease includes severe brain malfunction , which is treated with the ketogenic diet.  

 

Many studies support the efficacy of the ketogenic diet in altering brain function. Here are a couple of interesting ones and their subsequent outcomes re developing a new prescription treatment for cognitive dysfunction.

 

An oral ketogenic compound called  AC-1202 was made into a milkshake called Ketasyn.  This was  used in subjects diagnosed with mild to moderate Alzheimer’s in a 90 day randomized double-blind placebo controlled study. There was a significant improvement in the Alzheimer's Disease Assessment Scale, (ADAS-Cognitive) scores at days 45 and 90 in those on the AC-1202. This worked well in the 50% of the subjects not carrying the ApoE4 Alzheimer’s gene, but not as well in those with the gene. There were a couple of clinical trials with this.

 

Ketasyn worked well enough in the clinical trials to be subsequently launched as a prescription medical food for managing Alzheimer’s. In 2009 it became available under the name Axona, created and distributed by the drug company Accera.  Medscape also commented on this at the time.

 

What is the therapeutic food in Axona? The main ingredient is Caprylic acid  , a medium chain triglyceride produced by processing coconut oil and palm kernel oil. Medium chain triglycerides provide a readily available alternate fuel source for the brain and body, besides the ketones discussed above.  MCT’S are rapidly absorbed & metabolized into medium chain fatty acids. Medium chain fatty acids readily cross the blood brain barrier & are metabolized by the brain as fuel. Also they are absorbed & oxidized in the liver to rapidly produce ketones, as does the ketogenic diet mentioned above. So the MCT'S actually provide two alternative fuels, the medium chain fatty acids & the ketones. In fact, using MCT'S augments the ketone forming activity of the ketogenic diet.

 

Another ketogenic compound called, 2-deoxy-D-glucose was used to induce ketones in mice that had been given experimental Alzheimer’s. The ketones decreased the beta amyloid burden in the brain and delayed the progression of brain deficits. Beta-amyloid deposits are part of what induces brain malfunction in Alzheimer’s. Other studies have also suggested a down regulation of the genetic apolipoprotein E caspase-3 messenger RNA expression for Alzheimer's & an improved brain oxidative stress response when brain ketones are increased. Nutr Metab (London) Aug 2009.

 

Thus we see that MCT’S not only provide their own fatty acid fuel but also help to induce a more reliable ketogenic state, augmenting the Atkins’ diet or other ketone producing diets toward obtaining quicker more reliable ketosis and all the benefits which come with achieving ketosis. 

 

 Ketones also have specific neuroprotective properties making the ketogenic diet and MCT’S useful natural alternatives for modifying the progression of any  degenerative processes in the brain.

 

So, after all this explanation, we now can understand what this wife and doctor was noting with her husband & why he functioned best when he followed the correct diet as well as supplementing the MCT’S.

 

In fact, Dr Bruce FIFE, who has devoted his career to writing multiple books about MCT’S, as in coconut oil, has written a book titled, Stop Alzheimer’s Now! How to Prevent & Reverse Dementia, Parkinson’s, ALS, Multiple Sclerosis, & other Neurodegenerative Disorders

 

WHERE DO YOU FIND MEDIUM CHAIN TRIGLYCERIDES?

 

You can obtain commercial MCT oil as a liquid, as capsules, or in drinks. You can also  get your MCT’S from extra virgin coconut oil.

 

Coconut oil has been classified as a “Functional Food”, which is defined as a “food that provides health benefits over and above the basic nutrients.” It is used in the traditional medicine of Asian and Pacific populations. Pacific islanders refer to the coconut as the Tree of Life. It is a primary food source in half the world. Those parts of the world using more coconut oil have less cardiovascular disease. Coconut oil comprises 50% of the dietary fat in Sri Lanka where they have a low incidence of cardiovascular problems.

 

Coconut oil is solid at temperatures below 76 and liquid above those temps. It is heat stable and good to use for cooking. Fried foods are even not so bad for you if fried in coconut oil. I have certainly enjoyed the coconut oil as a salad dressing, added to various drinks, rubbed on baked chicken before baking (yum, yum), added to vegetable dishes, straight from the spoon, and so on.

 

Medium chain triglycerides comprise 2/3 of the fat in coconut, and 15% of the fat in palm kernel oils and butter. A smaller amount is found in milk fat, and breast milk. The fatty acid components add to the overall health benefits. The fatty acids  are a family of triglycerides containing mostly lauric (50%) , capric (7-10%), caprylic, caproic, myristic, palmitic, oleic, linoleic, linolenic, and stearic fatty acids.

 

These various fatty acids provide additional health benefits, as they have the capacity to kill viruses, bacteria, and fungi, to expel or kill tapeworms, giardia, and other parasites, and to generally aid the immune system. For instance lauric acid converts to monolaurin in the body, where it then confers  antiviral, antibacterial, and anti protozoal properties. Monolaurins are derived only from coconut oil and mother’s milk and are the best fat that mother’s milk has. The monolaurin supports the newborn’s immune system development & the capacity to withstand infection. When mother’s milk is not available, the best alternative food fat for the baby is coconut oil. Nursing mothers also need ample amounts of MCT’S in their diets.

 

 WHEN ARE MEDIUM CHAIN TRIGLYCERIDES PARTICULARLY USEFUL?

 

Commercial MCT'S were originally formulated in the 50’s for those too ill to properly digest normal fats and oils & to also be used in intravenous nutrition or with tube feeding. MCT’S are  used and preferred in those with malabsorption, chronic diarrhea, inflammatory bowel disease, obstructive jaundice, biliary cirrhosis, pancreatitis, cystic fibrosis, celiac disease, Whipples disease, Crohn’s disease, regional enteritis, pancreatic insufficiency, gallbladder disease, and those with tissue wasting. MCT’S are also used in the feeding of newborns and premature babies. MCT’S are essentially nontoxic in acute toxicity tests.

 

Interestingly, a publication by the US Department of Health and Human Services & National Institute on Alcohol Abuse and Alcoholism lists the following treatment suggestions for Alcoholic Liver Disease:

For more information on specific uses of coconut oil,  see the book "Coconut Cures: Preventing and Treating Common Health Problems with Coconut by Bruce Fife and Conrado S Dayrit.

 

 WHAT FATS DO WE USUALLY EAT?

 

The terms medium chain and long chain refer to the number of carbon with hydrogen chains making up a fat. Long chain fatty acids ( 11-24 carbon atoms) comprise 98-100% of the fats in our diets. These are in meat, fish, milk, eggs, vegetable and olive oils. The long chain fatty acids include essential fatty acids such as the omega-3 and omega-6 oils. Omega-9 may be essential under certain conditions.

 

Omega-3 fatty acids are commonly deficient in the American diet. The main sources of omega-3 are fish oil, krill oil, flaxseed oil,green-lipped mussel, perilla oil,  and chia seeds. The non-fish oils contain much less of the DHA and EPA than is in fish or krill oil. See my newsletter Benefits of the Omega-3 Fatty Acids for more information.

 

Major food sources for the omega-6 fatty acids are most vegetable oils, borage oil, evening primrose oil, black currant oil, nuts, seeds, eggs, poultry, whole grains, avocados.  Make sure any  oil you eat is cold processed, expeller-processed, or naturally pressed.

 

The best food sources for omega- 9 are extra virgin olive oil, avocados, and nuts. The best oils for cooking are extra virgin olive oil, grapeseed oil, and coconut oil.  But you can also cook with peanut oil, avocado oil, sesame oil, canola oil, and the high oleic forms of safflower & sunflower oil. 

 

The problem is most people do not eat a diet which is properly balanced with the appropriate fatty acids in the right ratios. They end up getting too much omega-6 relative to omega-3, or omega-9. The omega-6 oils are high in  polyunsaturated fats. This imbalance adds to general inflammatory conditions in the body, as well as other health problems such as cancer.

 

One of the reasons we end up with this imbalance is that these worse kinds of fats are in almost every processed food we eat and we eat too many processed foods. Polyunsaturated vegetable fats have been artificially created and added everywhere to our processed, packaged, baked, and fried food supply. The initial powerful lobbying campaign, which allowed this to happen, promoted these oils as healthy and low fat. Subsequently they have been shown to be dangerous, adding to the episode of obesity and cardiovascular disease. The longer shelf life for these processed oils was a major selling point. A process called hydrogenation created a longer shelf life for these oils, but also created fragile, unstable, unhealthy molecules, some of which are called “trans fats”. These fats are easily oxidized and create unhealthy free radicals. You want to avoid any substance having the words trans fats, partially hydrogenated, or hydrogenated on the label.

 

One reason Medium chain triglycerides (6-10 carbon atoms) are so desirable is they do not deplete the body of antioxidant reserves as do other oils because they do not oxidize and create free radicals. Also they do not form harmful by products when heated to normal cooking temperatures, as many other oils.

 

 

 

 Since MCT’S do not contain the essential fatty acids required for optimum nutrition, they cannot be the only source of dietary fat.  MCT'S can be substituted for part of other fat consumption rather than added to increase overall dietary fat.  A 50/50 ratio works well except for those with medical conditions requiring even more MCT’S and less LCT’S.

 

Some Studies:

 

A number of studies support the benefits of using MCT’S in weight loss programs, to boost energy levels, to increase fatty acid metabolism, and to reduce fat deposits in the body.

 

The research is mixed re the MCT’S improving athletic performance.  But some athletes believe it does & some studies suggest it does. Athletes use drinks combining MCT’S with carbohydrates, the drink CLIP 2  is an example of this. 

 

1-In a clinical trial of 40 women ages 20-40 with over 88 centimeters abdominal obesity.  Half were given 30 ml/d of soy bean oil and half the same amount of coconut oil.  They were to walk 50 minutes daily and eat a balanced low calorie diet.  After 12 weeks, both groups had reduced body mass index (BMI), but only the coconut oil group had a significantly reduced waist circumference.  The soy bean oil group had increased cholesterol and LDL and decreased HDL (all not good).  The coconut oil group had increased HDL only (good).  The researchers concluded, “It appears that dietetic supplementation with coconut oil does not cause dyslipidemia, and seems to promote a reduction in abdominal obesity.” LIPIDS 2009 vol 44 #7

 

2-In a double-blind placebo-controlled study 78 healthy men and women were divided with half being given MCT’S and the other half LCT’S over 3 months and with both groups consuming the same number of calories daily.  The body weight and fat decreased in both groups, but in the heavier subjects the extent of decreased weight and loss of body fat and decrease in areas of subcutaneous fat was greater in the MCT than in the LCT group. J. Nutrition 2001, Nov

 

3- Another 27 day study comparing MCT’S to LCT’S in overweight women found increased energy expenditure and increased fat oxidation in the MCT group, but no overall change in body composition.

 

These are examples of some of the conflicting studies re weight loss and change in body composition with MCT’S, but the operative issue may be it needs to be taken at least 3 months, with strict comparison re the rest of the diet and exercise.

 

4-In another study consumption of 40 gm/d of MCT’S for 1 month “did not cause liver fat accumulation or liver dysfunction”.

 

5-A study compared the fat burning effect of a 40% MCT diet to a 40% LCT diet.  The fat burning effect of the MCT”S was double, 120cal vs. 60 cal.

 

6-Another study compared the immediate fat burning effect of a single meal of MCT’S vs. LCT’S.  After the meal the MCT group had 3 times the fat burning effect than the LCT group.

 

7-Diabetics often have episodes of hypoglycemia (sounds strange doesn’t it?)  But they often overshoot on their blood sugar lowering regimens.  Since MCT’s are an alternative brain fuel they have been frequently studied in diabetics.  Ingestion of MCT’s reversed the hypoglycemia impaired cognitive performance in tests of verbal memory, digit symbol coding, digit span backwards, & map searching.  They concluded the MCT’S preserved brain function under hypoglycemic conditions without causing hyperglycemia.

 

8-Rat studies showed MCT’S improved decreased heart functioning in rats with enlarged hearts.

 

9-Experimental animals given MCT’s vs. only LCT’S lived longer and healthier lives.

 

10-Rats fed virgin coconut oil for 45 days compared to rats fed copra oil “demonstrated the potential beneficiary effect of virgin coconut oil in lowering lipid levels in serum and tissues & LDL oxidation by physiological oxidants.”  Clin Biochem 2004 Sept

 

 

Books by Dr. Bruce Fife: