Tuesday, May 28, 2013

Science-Base Medicine: Is Coconut Oil Science-Based?

From the Science-Based Medicine blog, a blog run by as conventional a bunch of doctors as it is possible to find, a “take-down” of coconut oil:
“…Alzheimer’s Disease 
“The Wellness Mama website provides a link to a reference for Alzheimer’s disease but it is only a case study showing that the writer’s husband improved and was able to draw a more accurate picture of a clock after adding coconut oil to his diet. Natural News says coconut oil can prevent and reverse Alzheimer’s. Naturopath Bruce Fife has several books touting the benefits of coconut oil and coconut water. One title claims you can “Stop Alzheimer’s Now!” 
A clinical query search for “Alzheimer’s coconut oil” on PubMed yielded no results. Snopes has evaluated the claims for coconut oil and agrees that “there are no peer-reviewed articles addressing research on coconut oil as a treatment for Alzheimer’s disease.” Even the Alzheimer’s Association says: “A few people have reported that coconut oil helped the person with Alzheimer’s, but there’s never been any clinical testing of coconut oil for Alzheimer’s, and there’s no scientific evidence that it helps.”…  
“…"There is no justification for adding it to the diet on top of the usual consumption of other fats. There is no credible evidence to support any of the many health benefits claimed for using it as a supplement."”

Search terms are everything.  Understanding an issue is essential in order to find useful information on the ‘Net.

The active ingredient in coconut oil that is hypothesized to affect Alzheimer's disease are the medium-chain triglycerides (MCT).

"Coconut oil is composed of approximately 66% medium-chain triglycerides."

They've been used for quite some time in the construction of ketogenic diets for the treatment of epilepsy.

"Medium-chain triglyceride (MCT) ketogenic therapy."

"Medium-chain triglyceride ketogenic diet, an effective treatment for drug-resistant epilepsy and a comparison with other ketogenic diets."

[P.S. Oh, and it’s well-demonstrated that coconut oil has the same effect on blood ketone levels as MCTs; replacing one with the other is common in medical interventions.

Coconut oil is acceptable in replacing medium chain triglycerides for ketogenic diet therapy in childhood epilepsy.

MCT can be given in the diet as oil, as coconut oil, or as an emulsion (Liquigen, SHS, Liverpool, U.K.)”]

Ketogenic diets have been found to be protective against various neurological conditions, including in models of Alzheimer's:

"d-β-Hydroxybutyrate protects neurons in models of Alzheimer's and Parkinson's disease."

MCTs are metabolized differently from other fats.  They're metabolized directly into ketones, regardless of the other components of the diet.  This means that you don't have to practice the extreme carbohydrate restriction typical of a ketogenic diet.

"Insulin and Ketone Responses to Ingestion of Medium and Long-chain Triglycerides in Man."

Based on those results, a MCT-oil-based ketogenic diet was proposed as a potential treatment for Alzheimer's:

"Ketone Bodies, Potential Therapeutic Uses."

A company was founded, and it formulated a medical food based on MCTs (coconut oil, purified), and it tested the hypothesis:
"Higher ketone values were associated with greater improvement in paragraph recall with MCT treatment relative to placebo across all subjects (P=0.02). Additional research is warranted to determine the therapeutic benefits of MCTs for patients with AD [Alzheimer's Disease] and how APOE-4 status may mediate beta-OHB efficacy."
"Effects of beta-hydroxybutyrate on cognition in memory-impaired adults."
"In the second phase 2 trial, 152 patients with mild-to-moderate AD received AC-1202 (containing 20 g MCT) or placebo for 90 days in a double-blind, randomized design [52]. Results from this study were consistent with those of the earlier phase 2a study; AC-1202 produced a rapid onset of significant improvements in cognition, as measured using AD Assessment Scale-cognitive subscale (ADAS-cog), which were maintained throughout the study, correlated with blood levels of BHB, and were most apparent in ApoE4-negative patients."
"Hypometabolism as a therapeutic target in Alzheimer's disease."
Testing continues, based on early successes:
"As a result of several positive research findings, in March 2009, the U.S. Food and Drug Administration (FDA) decided to regulate Axona® as a medical food available by prescription for the “dietary clinical management of the metabolic processes associated with mild to moderate Alzheimer’s disease”."
"Coconut Oil for Alzheimer’s Disease?"

"AC-1204 26-Week Long Term Efficacy Response Trial With Optional Open-label Ext (NOURISH AD)."

Meanwhile, a substance that increases ketone uptake also seems to have benefits:

"Sodium butyrate improves memory function in an Alzheimer's disease mouse model when administered at an advanced stage of disease progression."

Butyrate is the chemical root of the ketones produced by the MCT-oil-based ketogenic diet.

But, as Alzheimer's doesn't wait for clinical confirmation, many people are using coconut oil directly, without waiting for the trial results.  Given that the downside is merely the possibility of diarrhea, one can hardly blame them; MCTs are generally recognized as safe, and have been used for decades in treating neurological dysfunction.

Back to the Science-Based Medicine blog, the above is not "no evidence", or "no justification".

That's reasonable behavior based on emerging scientific evidence.

Is ignorance of evidence evidence of absence of evidence?  I don’t think so.

I'll be interested to see how Dr. Hall incorporates this new evidence into her post, as a this post is a modified version of a comment I posted on her blog.

Unfortunately, this is a standard viewpoint in the medical community.  From the Mayo clinic:
“…Axona is marketed as a medical food. Medical foods are dietary supplements that help manage a disease or condition that causes nutritional deficiencies. The Alzheimer's Association, however, disputes the notion that Alzheimer's disease causes nutritional deficiencies and requires a medical food….”
Er, that’s wrong. Axona is not addressing a “nutritional deficiency”, as perusing the links above (the medical literature, in other words) makes abundantly clear.

P.S. Axona is “fractionated coconut oil”.  According to the FDA, a “medical food”:
“…is a specially formulated and processed product (as opposed to a naturally occurring foodstuff used in its natural state) for the partial or exclusive feeding of a patient…”
If you want a doctor to prescribe it (and to charge a premium for it), you have to “process” it.  Efficacy is irrelevant.  Must protect the guild at all costs!

More evidence of the effectiveness of ketones on Alzheimer's:

"Ketone esters increase brown fat in mice and overcome insulin resistance in other tissues in the rat."