Coconut Oil, MCT oil, and other Ketone/Cognition Boosters (salts, esters)
Ketones, also known as ketone bodies, are a source of fuel for the body, especially the brain. With today’s diet most individuals burn glucose as a source of fuel, but ketones can also be made by the body for energy (endogenous ketones). Making ketones in the body for fuel was something our ancestors did with great regularity given the unpredictable/seasonal availability of food with no refrigerators or grocery stores. Today there are products that can be consumed for rapid conversion to ketones (exogenous ketones): coconut oil, MCT oil, salts, esters etc.
While glucose is typically an individual’s primary fuel, those with Alzheimer’s Disease have glucose uptake impairment in the brain. This is a condition that starts decades before cognitive impairment is evident and especially so in ApoE ε4s (Brain Glucose Hypometabolism and Oxidative Stress in Preclinical Alzheimer’s Disease, Mosconi, et al 2008). But the brain is a fuel “hybrid” it can also burn ketones even if glucose uptake is impaired. In fact, there are many who argue the brain prefers ketones even though it’s not the main fuel(glucose) of the brain . Because ketones offer a source of energy for the brain, they are often advocated for ApoE ε4s. For more information, see Ketosis_and_Ketogenic_Diet
In the presentation Can Ketones Slow Down Alzheimer’s? Dr Stephen Cunnane, who has researched omega-3 fatty acids and ketones in human brain development and function for over 30 years, posits two possibilities for Alzheimer’s. (1) That the brain’s cells are alive but glucose uptake is impaired, so unless ketones are available, they are starved for fuel. (2) That the brain’s cells are dead/dying and thus unable to uptake any form of fuel either glucose or ketones. He has found the first scenario to be more accurate: those with Alzheimer’s are able to use ketones even though they are unable to use glucose. Thus the rationale for providing ketones to enhance cognitive function. This of course is only accurate when intervention to provide ketones occurs early enough that the brain cells haven’t died due to a lack of an energy source and exposure to oxidizing agents.
Coconut oil and MCT oil
Coconut oil and MCT oil help boost ketones/brain function because, unlike other oils/foods, they are high in Medium Chain Triglycerides. In fact that’s what the MCT stands for: Medium Chain Triglyceride. The name just refers to the way the carbon atoms are arranged in their chemical structure, the important quality is in how they are metabolized. The fat in most food consists of long chain triglycerides. When you eat fat in the form of long chain triglycerides it is broken down in the small intestine. But medium-chain triglycerides, bypass that process, they go to the liver where they are quickly converted into ketones, which are then released back into your bloodstream and transported throughout the body, including the brain, to be used as fuel.
While both Coconut oil and MCT oil can boost brain function, ApoE ε4s are often advised to use them judiciously with the preferred source of ketones coming endogenously, i.e. made in the body by the liver through a process called ketogenesis. See Ketosis and Ketogenic Diet. In his book The End of Alzheimer’s Dr Dale Bredesen , internationally recognized expert in the mechanisms of neurodegenerative diseases, refers to coconut oil and MCT oil by saying, ”But both may also have drawbacks for ApoE4-positive individuals …If you are ApoE4 positive, think of MCT and coconut oil as temporary crutches to ease your segue into fat burning mode.”
What Dr Bredesen is referring to when he says “segue into fat burning mode” is the keto adaptation process. When we are born, we are efficient ketone burners but as we approach adulthood, and especially with eating a mostly carbohydrate diet, our ability to produce/burn ketones goes into “sleep mode.” When reawakening this ability to burn fat for fuel in the body, the brain has to be weaned off the glucose and a person can feel bad (keto flu) during this adaptation process. Adding MCT or coconut oil can ease the transition.
Coconut oil or MCT oil does seem to be particularly useful for anyone with cognitive issues and insulin resistance. (A person can be insulin resistant without being Type 2 Diabetic (T2D), but if Type 2 Diabetic, a person is by definition insulin resistant. If not diabetic but insulin resistant, a person is on the path to Type 2 Diabetes and other significant health concerns whether or not diabetes develops. Intervention can reverse insulin resistance/Type 2 Diabetes. Unfortunately, insulin resistance often goes undiagnosed. For more info Insulin Resistance. Studies show a strong association between insulin resistance and/or diabetes with dementia and Alzheimer’s. If an ApoE ε4 carrier with insulin resistance or diabetes, this association with dementia and Alzheimer’s is particularly strong. At about the 33 minute point of this lecture, Can Ketones Slow Down Alzheimer’s?, Dr Cunnane discusses insulin resistance. He notes that if on a ketogenic diet but insulin resistant, the insulin resistance prevents the body’s fat tissue from releasing the fatty acids that are used to make ketones, thus preventing ketones from getting into the brain. But coconut oil and MCT bypass the glucose and Long Chain Fatty acid metabolism (that requires insulin) by going directly to the liver thereby providing ketones for the brain.
However, there are areas of concern for ApoE ε4s when it comes to relying solely on supplementation of ketones to aid cognition versus addressing insulin resistance and using ketones produced by the body.
- Providing fuel to the brain in the form of exogenous ketones can be considered a “band-aid” approach. It works around the problem but does not resolve the fuel impairment issue nor the insulin resistance. Insulin resistance/diabetes is associated with a number of other health concerns besides Alzheimer’s including vascular dementia and cardiovascular disease to which ApoE ε4s also have a greater predisposition.
- For ApoE ε4 carriers, coconut oil and MCT worsens lipid profiles, particularly LDL-P and ApoB. LDL and ApoB, used as markers for cardiovascular health, also appear to correlate with cognitive impairment Ratio of apoB/LDL: a potential clinical index for vascular cognitive impairment, Cheng Qian and Fei Tan, 2016. It may be better for ApoE ε4s to use other unsaturated fats (such as olive oil), to resolve insulin resistance, and become ketogenic in order to produce and use their own ketones.
- Oils high in medium chain triglycerides are also high in saturated fats. Granted, saturated fats have been demonized more than they’ve deserved, see the subheading write-up A short history regarding contemporary attitudes about fat Fats, Omega -3(ω-3) & -6(ω-6), DHA and More. But there are studies that indicate saturated fats do have a more pronounced negative effect on ApoE ε4s, see the subheading Deeper Dive into the Science Fats, Omega -3(ω-3) & -6(ω-6), DHA and More
- Oils high in medium chain triglycerides are also high in Omega-6s. Omega-6s are inflammatory when overconsumed, something to which ApoE ε4s are already highly susceptible. On the other hand, Omega-3s, found predominantly in unsaturated fats are critical contributors to cell structure and function in the central nervous system suggesting supplementation may slow early memory decline in ε4 carriers. For further discussion see the Omega -3s and Omega -6s subheading Fats, Omega -3(ω-3) & -6(ω-6), DHA and More.In balance, Omega-3s and Omega-6s work well together. In the Primer: An introduction to ApoE4, biochemistry, and possible prevention strategies a 3:1 ratio of Omega-6s to Omega 3-s is recommended, but most modern diets don’t support that. Coconut oil has a poor Omega -6 to -3 ratio of 88:1. Palm kernel oil is even worse with no Omega-3s whatsoever. Trying to counterbalance the Omega-6s by supplementing with Omega-3s won’t work since Omega-3s and Omega-6s compete for the same conversion enzymes and the Omega-6s will “crowd out” the beneficial Omega-3s making the Omega-3 supplementation a waste of money.