Is Coconut Oil Effective for Alzheimer Disease ? Article from Medscape Phamacists

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Is Coconut Oil Effective for Alzheimer Disease?

Gayle , PharmD

Authors and Disclosures

Posted: 05/30/2012

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Question:

Is coconut oil effective for treating Alzheimer disease?

Response from Gayle , PharmD

Assistant Professor, Eastern Virginia Medical School, Norfolk,

Virginia; Clinical Pharmacist, Chesapeake Regional Medical Center,

Chesapeake, Virginia

Coconut oil and a related medical food, Axona® (Accera, Inc;

Broomfield, Colorado), are being promoted as treatments for Alzheimer

disease (AD). Obtained from the kernel of the coconut palm (Cocos

nucifera),[1] coconut oil contains medium-chain fatty acids,

predominately lauric acid but also caprylic, myristic, and palmitic

acids. Medium-chain triglycerides are the esterified form of

medium-chain fatty acids; the terms are often used interchangeably.[2]

The active ingredient of Axona is caprylic triglyceride. In the

published research available, the product is called AC-1202.[3-5]

Proponents claim that coconut oil and Axona provide ketones as an

alternative to glucose for cerebral metabolic processes. Advocates of

these treatments describe AD as " diabetes of the brain " and contend

that the AD brain is better able to use ketones than glucose.[6] This

theory is not widely accepted among AD clinicians and researchers,[7]

but some speculate that ketogenesis might improve free

radical-mediated pathologies associated with AD.[8]

Normally, metabolic energy comes from glucose. When glucose

availability is reduced, the liver produces ketone bodies (primarily

acetoacetate and beta-hydroxybutyric acid [beta-OHB]) as energy

sources. Unlike the heart and skeletal muscle, the brain cannot use

fatty acids as an energy source because it requires glucose or ketone

bodies.[8]

Medium-chain triglycerides are more ketogenic than long-chain

triglycerides, such as those in animal fat. Ketogenic diets, which are

diets high in fat and low in carbohydrates and proteins, have been

used since the time of Hippocrates for treatment of epilepsy; the

mechanism is still unknown.[8] Ketogenic diets are still used in

refractory epilepsy, but poor tolerance of the gastrointestinal side

effects and dislike for the diet limit effectiveness.[9] Medium-chain

triglyceride diets are better tolerated than classic ketogenic diets,

which include more long-chain triglycerides. Because medium-chain

triglycerides are highly ketogenic, patients can consume more

carbohydrates, making the diet more palatable.[8]

Several theories have been proposed for beneficial effects of ketones

in AD, including prevention of amyloid plaques, reduction of

proinflammatory mediators associated with neurodegeneration, and a

neurotrophic effect of cerebral ketone metabolism.[10] Studies with

encouraging results using ketogenic diets in AD have been

published.[10-13] In a 6-week clinical study of 23 elderly patients

with mild cognitive dysfunction, a diet very low in carbohydrates,

which increased ketone levels, improved memory function better than a

high-carbohydrate diet.[10] In another preliminary clinical study of

20 persons with AD or mild cognitive impairment, administration of a

medium-chain triglyceride beverage was associated with improvement on

some cognitive measurements in response to acute elevation of beta-OHB

levels 90 minutes after treatment in 2 single-dose study visits, but

only in patients without the apolipoprotein E gene (n = 9).[14]

A literature search for coconut oil and AD revealed no clinical

studies. A search for the medical food Axona yielded 1

manufacturer-sponsored study and 2 substudies.[3-5] In a 90-day,

randomized, double-blind phase 2 study, 152 persons diagnosed with

mild to moderate AD received Axona10-20 g/daily or placebo. The

primary endpoint was improvement on the AD Assessment Scale-Cognitive

subscale (ADAS-Cog). At 45 days, patients receiving the study drug

showed improvement on the ADAS-Cog, as noted in company advertising.

However, scores were similar in both groups at day 90 and after a

2-week washout period on day 104. In patients without the

apolipoprotein E gene, Axona was superior to placebo at both time

points.[3]

According to the Alzheimer's Association, the manufacturer of Axona

elected to market the product as a medical food rather than conducting

phase 3 studies in a larger population to prove effectiveness. Medical

foods do not require phase 3 studies.[15]

Both coconut oil and Axona are high in calories and saturated fat, but

some research suggests that coconut oil neither increases weight nor

adversely affects lipid levels.[2,16,17] Gastrointestinal adverse

effects, particularly diarrhea, were frequent causes of

discontinuation in the phase 2 study.[3] Coconut oil costs about $12

for 16 oz. Axona costs about $85 per month.

Currently, neither coconut oil nor Axona can be recommended for AD due

to lack of credible effectiveness research. For patients or family

members who insist on these products, suggest starting with a low dose

and gradually increasing the dose to avoid adverse gastrointestinal

effects. Healthcare providers should monitor for adverse effects and

effectiveness and possibly increased lipid levels.