Axona, MCT & Coconut Oil: Differences & Benefits
Print
Email
This is the 2nd article in our new "Keto-dementia Diet" series.
Keto-dementia dieting adds ketones to a brain, compensating for a shortage of glucose.
MCTs are a popular ingredient that boosts ketone levels. Three products rich in MCTs are:
- Axona®
- MCT Oil
- Coconut Oil
There are a lot of similarities and differences between these three products. They have different costs, a variety of side-effects and different mixes of MCT types. These distinctions have led to many questions from our readers, such as:
“Dear Nurse Dina,
“I have been hearing about coconut oil being effective in the treatment of Alzheimer’s and understand that it is the main ingredient of Axona®. Would using a lower cost coconut oil be as effective as the higher priced Axona®? Thanks,
Linda”
To begin answering this question, we put together the following two charts.
The first chart shows the difference formulations of various MCTs in Axona®, MCT oil and coconut oil.
The second compares the daily cost to use each product.
These charts assume a serving size that includes 20 grams of MCT, which is the amount of MCTs in one packet of Axona®. For reference, there are 5 grams in a teaspoon and 15 grams in a tablespoon.
|
What Type of MCT is in Each Product? |
|
||
|
|
Three Products |
||
|
Type of MCT |
Axona® |
MCT Oil |
Coconut Oil |
|
Caprylidene [C8] |
47.5% |
|
|
|
Caprylic Acid [C8] |
|
33% |
8% |
|
Capric Acid [C10] |
|
67% |
7% |
|
Lauric Acid [C12] |
|
|
48% |
|
Total amount of the product made out of MCTs |
47.50% |
100% |
63% |
|
|
|
|
|
|
What do 20 Grams of MCTs Cost? |
|||
|
Amount needed to get 20gm |
40 gm |
22 ml |
39 ml |
|
Typical daily cost |
$ 3.00 |
$ 0.84 |
$ 0.22 |
To get the most out of this article, understand ketogenic diet basics. We recommend, “The Keto-Dementia Diet.” (These articles are for informational purposes only. Ask your doctor before using these ingredients or products.)
MCT is the Common Denominator
The common denominator in the three products above is a compound called MCT, which stands for Medium Chain Triglycerides. MCTs are quickly converted by the liver into ketones, which serve as a backup fuel for our bodies as well as our brains.
In most dementias, the system that metabolizes glucose (the preferred fuel) in the brain steadily loses its effectiveness. It seems that by raising the level of the backup fuel, or ketones, in the brain, one may compensate for this loss of primary fuel for quite some time. This seems to be achievable by consuming MCTs.
Four Types of MCTs
For the purposes of this discussion, there are four types of MCTs. Each one is commonly referred to by the number of carbon atoms in the medium-sized chain that holds it together. They are:
- C6
- C8
- C10
- C12
Look at the chart above and you can see how Axona®, MCT oil and coconut oil are similar in that their active ingredients for treating dementia are MCTs. At the same time, the types and mix of MCTs in each are different.
Facts
With this understanding, let’s take a look at a few facts.
- The Keto-dementia Diet article references three respected studies showing the effectiveness of a ketogenic diet in improving symptoms of dementia.
- A key component of a ketogenic diet is consuming MCTs and converting them to ketones.
- The active ingredient in Axona® is an MCT called caprylidene, which is powdered caprylic acid.
- Axona® has passed clinical trials demonstrating it to be an effective ketone therapy.
Questions & Answers
Now we can run through some questions and answers which should clear up the picture.
- Is there an active ingredient in coconut oil that can provide the brain with ketones? Yes.
- Is coconut oil’s active ingredient the same as the active ingredient in Axona®? No.
- Would using a lower cost coconut oil be as effective as the higher priced Axona®?
The best way to answer this last question may be with an analogy. If my daughter turned 18, had to have a car and money were no object, I would buy her a Volvo. Why? It’s not the best car in the world and in certain situations it may not even be the safest. But as far as what we DO know about safety, Volvo has studied the subject and their car addresses the issue of safety more thoroughly than any other car.
Just like we know that any car can get us to the supermarket, we know that any of the products addressed in this article will get ketones to our brains. That seems to be a good thing. But there can be side-effects, interactions and other unknowns. Like the Volvo, Axona® may be costly, but it is the best-studied MCT treatment for dementia. We simply have far more scientific research regarding its safety and benefits than any other MCT treatment.
Coconut oil is common in health food stores and needs no prescription. It sounds safe. Notwithstanding, when using it as a ketogenic therapy for dementia, do not take its safety for granted. That’s not coconut oil’s normal use and it calls for professional supervision. It is the reason why Axona® DOES need a prescription. It is safe to say that medical supervision is needed when using any MCT to treat a dementia such as Alzheimer’s.
Conclusions:
- There is plenty of science backing the use of MCTs for many types of dementia.
- Prior to treating dementia with a ketogenic diet, MCT oil or coconut oil, be certain to ask your doctor.
Related Videos & Articles
More Information
.
Why isn't any one talking about Goat butter, cheese or milk.
It is an easy way to transition to MCT
There is a lot of information on this site -- http://www.coconutketones.com/
A woman medical doctor worked to get her husband into Axona clinicial trials, but was unable. Instead she gave him coconut oil and watched him recover.
I couldn't afford a Volvo, and so only used MCT oil only briefly for my husband. He has had coconut oil from Tropical Traditions for over a year--probably 2 tablespoons a day. I put it in his food. I have more information on http://plantcityladyandfriends.blogspot.com/ .
What I do know is that according to the Johnny Byrd ALZ Institute in Tampa my husband should not be dressing himself according to his MRI. He does. They also weren't sure he should be driving, ordered a driving test and he passed his DriveABLE test at the Morton Plant in Clearwater, Florida. He uses a GPS in the car. This is not very scientific, but I do feel that coconut oil plus his Exelon and Namenda have helped him.
The documentary, and the reviews, discuss the potentially harmful effects of four saturated fats -- lauric, myristic, palmitic, and stearic. Saturated fats do not magically become something else just because they're in a different foodstuff.
These four unhealthy saturated fats constitute ~72% of coconut oil.
It is entirely possible that there is enough caprylic and capric acids in coconut oil for it to be of some benefit to Alzheimer's patients over the short term. What I question is touting a food that is 72% unhealthy saturated fats when there are much better alternatives available -- alternatives that contain little or none of these unhealthy saturated fats.
What I said -- quite clearly, I believe -- was that many of the studies which led the FDA and AMA to conclude that consumption of high levels of these four saturated fats pose serious health risks were done with humans consuming coconut oil. And if one delves into the references that are cited by these reviews -- and into the papers that cite these reviews -- one finds quite a few studies done with coconut oil. Coconut oil has often been used in studies to determine the health impact of saturated fats since it is so very high in them. Note, also, that the FDA has repeatedly been requested by the coconut oil industry to declare coconut oil to be a "healthy" exception to their conclusions about saturated fats, and the experts at the FDA have repeatedly declined the request.
One does indeed have to consider the overall diet when evaluating health impact of saturated fats, not just a single constituent. The ratio of mono- and polyunsaturated fats to saturated fats is important -- a higher ratio helps minimize the adverse impact of saturated fats (as long as total fat consumption is within reasonable boundaries). Also, dietary fiber is very important for overall health (how often are caregivers warned that high levels of fiber are important for avoiding/treating diarrhea and constipation?), and one reason is that it helps mitigate the adverse impact of saturated fats.
One of the more fascinating studies on the impact of overall diet, which launched a whole, new field of investigation, concluded that the cardioprotective effects of high-density lipoprotein (HDL) may depend not only on HDL levels, but also on its behavior in the body in response to meals. In other words, the quality of HDL can be changed by what you eat. It's not just the amount of HDL, it's how active it is, or how good it is. And its 'goodness' can be profoundly influenced by either a diet high in polyunsaturated fat, or in saturated fat. Oh -- and the "saturated fat" which was shown to have a profoundly adverse impact on the "quality" of HDL? Coconut oil.
http://cme.medscape.com/viewarticle/542397
http://content.onlinejacc.org/cgi/content/full/48/4/715
This landmark study has led to quite a bit of research into the different types of HDL, as one might imagine. One of the better review articles I've found:
http://www.ncbi.nlm.nih.gov/pubmed/17941290
When reading this, remember that Alzheimer's is a chronic inflammatory disorder.
One of the problems I have with Newport's coconut oil regimen is that she has been known to recommend cutting key sources of fiber (e.g., breads and cereals) and the "healthy" unsaturated fats from a loved one's diet in order to be able to consume the huge amounts of coconut oil and MCT oil without the loved one gaining weight. (I would note, since we're discussing "case histories" here, that many caregivers have been reporting their loved ones developing severe diarrhea on her regimen.)
Axona has been shown to be beneficial to Alzheimer's patients in double-blind, placebo-controlled clinical trials ... without making such drastic changes to the patients' diets.
No one questioned why other supplements should not be taken as well. I questioned how one can point to a single supplement as the cause of all the benefits. Most caregivers are aware that symptoms bounce around all over the place, and one cannot conclude that a particular supplement or drug is beneficial until the loved one has been monitored on it for a reasonable period of time. Newport's husband has been on massive doses of MCT oil for nearly as long as he's been on coconut oil. I believe it is important to point this out, since there is every reason to believe the MCT oil is much more beneficial (especially calorie for calorie) than the coconut oil.
I would also note that some caregivers have reported their loved ones declined when switched from MCT oil to coconut oil, and improved again when put back on MCT oil. And some found that their loved ones were developing behavioral problems on coconut oil, which were resolved when put on MCT oil instead.
One of the reasons I pointed out that Newport's husband takes quite a few supplements that are thought to have potential for treating Alzheimer's is that few, if any, other caregivers have reported the same kind of response to coconut oil that Newport reports for her husband. It seems logical that there may be some other supplements in the brew she uses that make the caprylic triglyceride in the coconut and MCT oils more effective. Perhaps it's something she hasn't even mentioned yet.
I would also question her statement that coconut oil and MCT oil hold GRAS (FDA's "Generally Recognized as Safe") status. Caprylic acid holds GRAS status as a food additive. Coconut oil holds GRAS status as it is used in manufacturing paper and cotton materials used for packaging food -- not as a foodstuff. MCT oil does not hold GRAS status, nor does capric acid. (I haven't bothered to look at all of them, but I seriously doubt that any of the other supplements Dr Newport gives her husband hold GRAS status, either. The ones I did look up -- D-ribose, curcumin, folic acid, L-carnitine, Coenzyme Q -- don't.)
Where to begin...! For those who don't know, my husband Steve has early onset Alzheimer's disease and while he was screening for clinical trials I came across information about AC-1202, now called Axona, and learned that consuming medium chain triglycerides, derived from coconut oil, resulted in improved cognition in about half of the persons with AD or MCI in their studies. I gave him the equivalent amount of medium chain triglycerides as coconut oil and he had a dramatic response (see www.coconutketones.com website for the original July 2008 article and my blog that details what happened thereafter).
Since Axona was still far off from becoming available to the general public, I felt obliged to make others aware that over the counter coconut oil and/or MCT oil could potentially help their loved ones as well. Thus, two months later, as he continued to improve and others (testing and family) confirmed that it was not my imagination, I wrote an article detailing what happened in order to get the message out. I also asked important persons and groups such as Justice Sandra Day O'Connor, the Alzheimer Study Group and Alzheimer's Association to have their scientific/medical committees investigate AC-1202 and their positive studies and make the Alzheimer caregiver community aware of this.
After studying Steve's ketone levels with both coconut oil and MCT oil, I began mixing MCT and coconut oil together to try to get higher peak levels from the MCT oil and also longer duration of ketone levels from the coconut oil, so that he would have ketones circulating 24/7. Axona can only recommend taking one 20 gram MCT dose a day because that it what they studied. The ketones levels from one dose peak between 60 and 90 minutes and are virtually gone within 3 hours. Hopefully they will continue their studies and look at two and three doses a day.
Before starting coconut oil, Steve was taking vitamins and fish oil for at least two years and we had changed over to a much healthier Mediterranean/whole food diet more than two years earlier. The other supplements Lizzie mentions were added anywhere from two to eighteen months later. His dramatic improvement began on the very day he began taking coconut oil and is consistent with results of the first Axona study in which nearly half of the people had improved memory scores after taking just one dose of Axona. Since we had changed nothing else in the months prior to or immediately after starting coconut oil, it is clear that this was why he improved. He says it was like the light bulb came back on that day. And why shouldn't my husband take supplements that might be beneficial to him? He has a disease that will most likely take his life within a few years, particularly if we take no intervention to stave it off. We don't have time to wait for results of large clinical trials that may come years down the road. If the scientific basis seems reasonable and the supplement is considered safe, why not use it? All of the supplements Steve takes are considered "Generally Regarded As Safe" by the FDA, including coconut oil and MCT oil.
Lizzie implies that the HBO documentary and the articles she cites address in some way the harmful effects of using coconut oil, however they do not. The HBO documentary discusses the problem of insulin deficiency and resistance in the Alzheimer brain and use of intranasal insulin. In this documentary Dr. Clark also discusses a study looking at people who ate a high fat AND high sugar diet and shows a table full of fried and processed foods with virtually no vegetables as would likely appear on the typical American table, versus a low fat, low glycemic diet; the former increases insulin resistance compared to the latter. Dr. Clark does not mention coconut oil and most people would be well aware that the typical American diet does not include coconut oil. The typical fried foods on that table are made with soybean or cannola oil.
The articles Lizzie cites look at the connection between saturated fats and cholesterol and/or coronary artery disease. None of them specifically mentions coconut oil and two of them include studies in individual fatty acids that are added to the diet in larger quantities and in different relative amounts than they are found in coconut oil or any other natural oil; of interest, in one of the articles where a large amount of lauric acid was added proportionately to the diet, the total cholesterol level only increased by a fraction of one point, and HDL and LDL increased by the same amount (each less than 0.5 points). For every study that shows negative effects of certain fatty acids, there is another study that shows the opposite. The final word isn't in on this.
70% of the saturated fats in coconut oil are medium chain triglycerides, which behave differently than the long chain saturated fats. Lauric acid, in particular, is found in abundance in human breast milk and is one of the important factors in breast milk that protect the newborn from infection. Medium chain triglycerides (C:8, C:10, and C:12) are made de novo (from scratch) in the human mammary gland and are there for a reason; otherwise we do not make medium chain fatty acids and must acquire them from foods; unfortunately the oils used by most Americans do not contain any medium chain fatty acids. Infant formulas do contain these fats in the form of MCT oil, coconut oil and/or palm kernel oil.
I have collected data from sixty caregivers who reported improvement(s) (and sometimes no improvement) in their loved ones with dementia using coconut oil, and/or MCT oil, and in some cases Axona and/or coconut oil. Some of the improvements were in the area of cognition, but others reported improvements in social interaction, behavior, mood, conversational skills, recognition of people, resumption of lost activities, relief from physical symptoms, improved sleep, vision, and/or appetite. After review by their scientific committees, I had the opportunity to present Steve's case study and results of the caregiver reports at the Alzheimer Disease International conference in Greece in March 2010 and at the Dietary Interventions for Epilepsy and Other Neurologic Diseases In Edinburgh, Scotland in October2010. The case study about Steve was presented orally at the ADI, and the other studies were poster presentations. Dr. Henderson also presented his information about Axona at the ADI conference. While my studies present anecdotal information, my intent was to promote the idea to others, who have the means of engaging in clinical research that I do not have, to formally study the responses of persons with dementia and certain other diseases to medium chain triglycerides.
If someone can afford to buy a Volvo, then by all means buy the Volvo. But if you cannot afford the Volvo, there are other good alternatives out there. You may even want to supplement the Volvo with a second vehicle.
It is incorrect to discuss lauric, caprylic, and capric triglycerides as if they are all metabolized in the same way.
In this group, the shorter the carbon chain, the more ketogenic the fat (i.e., the greater the percentage that is turned into ketone bodies). Caprylic triglyceride (C8) is strongly ketogenic, and capric triglyceride (C10) is similar in the way it's digested, but not as ketogenic. By the time you get to lauric triglyceride (C12), only a small amount is processed via the liver into ketone bodies -- most is processed via the lymph system and stored as fat. (Adipose tissue collected from people who consume high levels of coconut products contain very high levels of lauric fatty acids -- even those who eat what would be considered a ketogenic diet.) By the time you get to myristic triglyceride (C14), all of it is processed via lymph.
The way in which the various triglycerides have been grouped depends on who was doing the grouping, and when, and why, and it has changed over time. Some researchers lump "short chain triglycerides" (C4 and C6) in with MCTs, but most no longer do. Lauric was often lumped in with caprylic and capric in the past, but as our understanding of fat metabolism has become more sophisticated, it has become much more common to include it with the other long-chain triglycerides (LCTs), due to the now well-established health risks of the lauric triglyceride that is processed via the lymph system.
Given that a high percentage of lauric triglyceride is processed for storage as fat rather than metabolized into ketone bodies, it is inappropriate to claim that all of the lauric in coconut oil is equivalent to the caprylic and capric triglycerides in the other products.
Moreover, simply looking at the percentage of these triglycerides in each product, rather than considering the overall composition of the products, tells only a small part of the story.
Lauric acid is considered by the medical community -- including the FDA and AMA -- to be one of the four "unhealthy" saturated fats (along with myristic, palmitic, and stearic acids) that pose serious health risks when consumed in high amounts. Numerous studies have shown that these four saturated fats are strong risk factors for cardiovascular disease, insulin resistance, diabetes, metabolic syndrome, and obesity -- all of which have strong links to, and share many of the same underlying pathologies as, Alzheimer's -- and have also been directly linked to cognitive decline. Many of the studies on which these conclusions are based were done on humans consuming "virgin" coconut oil. Coconut oil was frequently used for such studies simply because it is the richest source of these four saturated fats.
"The Connection Between Insulin and Alzheimer's", a supplementary film from the HBO "The Alzheimer's Project", gives a nice, readily understood discussion on the the relationship between insulin, the saturated fats found in such high amounts in coconut oil, and Alzheimer's:
http://www.hbo.com/alzheimers/supplementary-the-connection-between-insul...
For a few reviews on the health impacts of saturated fats, see, e.g.:
http://www.jacn.org/cgi/content/full/20/1/5
http://jn.nutrition.org/content/135/9/2075.full
http://jn.nutrition.org/content/139/1/1.full
Finally, please note that Dr Newport gives her husband very high levels of MCT oil as well as coconut oil, and has been giving the MCT oil to him all along. (When doing a cost analysis, it might be more representative to look at the cost of the recommended daily dose, not the cost per 20g [hypothetical] MCTs. Newport gives her husband so much MCT oil and coconut oil that they account for roughly half of his daily caloric intake.)
Newport also gives her husband numerous supplements, including omega-3 fatty acids, cinnamon, turmeric (curcumin), folic acid, vitamin B complex, L-carnitine, Coenzyme Q, Memory XL, liquid vitamin E with tocopherols, magnesium, D-ribose, and a multivitamins and minerals supplement. Most of these supplements have been talked about on discussion forums as possible treatments for Alzheimer's, and some of them have been or are in clinical trials. When a patient is receiving a plethora of treatments, it is impossible to conclude which ones or which combinations may have been beneficial.
It would be very nice if articles about Newport's husband gave credit to the full dosing regimen he's been on, not solely and exclusively to coconut oil. And since we don't know which ones have been beneficial to him, it might be more appropriate to include them in any cost analysis, too.
In the tables accompanying the article, I have a problem with stated MCT C8/C10 values. They appear to be reversed. I have been studying this for some time and I talked personally to people at Nestle and NOW; makers of MCT Oil, during my initial work. They gave me 67% and 56 % respectively for C8 and 27% and 44% for C10. Nestle's product also contains not less than 6% C6 nor more than 4% of C12.
Also, the price quoted for Axona must be some sort of retail pharmacy price which may not be applicable to many folks. MedcoHealth fill scripts for millions of people and under my plan the cost is 56 cents per packet. i assume many others may have similar pricing.