Coconut outtakes: what the Mail didn’t say

So you’ve read the Daily Mail story today about how it’s possible that coconut oil can help with some of the symptoms of Alzheimer’s. No one knows for sure because the idea has never been properly tested but there is a good reason why it might work – by supplying the brain with a natural source of energy called ketones that our bodies make from fat.

But inevitably some details of the story had to be dropped. Read on for the director’s cut:

  Does the Alzheimer’s brain have a glucose problem?

Several studies suggest it does. This is one of them. In April researchers at the University of Pennsylvania found that parts of the brain in Alzheimer’s patients were no longer using glucose effectively even though they didn’t have diabetes. What’s more, problems with glucose showed up in people with Mild Cognitive Impairment  (MCI) and got worse as their Alzheimer’s developed. Certainly not proof the coconut oil works but it does suggest that detecting a glucose problem in the brain could help predict who was going to develop Alzheimer’s later. It doesn’t prove that supplying an alternative source of fuel to glucose would make a difference, but it does suggest it could well be worth trying.

 Temporary improvement doesn’t prove anything.

“Many experts dismiss the changes reported after taken coconut oil down as spontaneous improvement,” says pioneer of this approach Dr Mary Newport . “But I have lived with Steve (her husband – profound apologies for calling him Harry in the article) and his Alzheimer’s for around 12 years and nothing happened that was anything like as dramatic as the changes that followed taking the coconut oil. He took the drug treatment Aricept for two years and I didn’t notice any effect at all. When we combined coconut oil with MCT (medium chain triglycerides) oil the change was even more striking.

 The significance of the patented food Axona.

The idea that coconut oil could help is frequently dismissed for lack of evidence. But a medical food  called Axona that largely consists of MCTs obtained from coconut oil has two trials supporting its use as a medical food in the States. “So it’s not at all unreasonable to suppose coconut oil should have an effect too,” says Dr Newport who is a paediatrician. “It might even have additional benefits. It also contains a saturated fat called lauric acid, found in breast milk, which has antimicrobial properties.” She dismisses the claim that the saturated fat in coconuts could put the heart at risk as “ignorant and not based on any evidence.”

Axona also raises questions about dosage. “The license for Axona is for one dose a day,” says Newport “but my experience is you need rather more than that. I give coconut oil plus MCT 4x a day. The licensing trial only involved 20 people and half improved their scores. Would more frequent dosing produce better results? We don’t know at the moment.”

 The impact of pure ketones

Dr Kieran Clarke, the Oxford University metabolism and ketone expert, who is impressed by Dr Newport’s experimenting with coconut oil has found a way to make ketones in the lab that can be used directly by the body.  They can deliver a much higher dose than MCTs or coconut oil.  Recently Dr Newport has begun giving them to her husband Steve and says the results are extraordinary.

“It’s been like turning on a switch,” she says. “When he get the pure ketone he comes alive but as they get used up it’s as if his brain goes dark again. We give him the ketones in the evening and then he is alert and very much aware of what is going on around him. But when he wakes up in the early morning he’s pretty much back in a state of Alzheimer’s confusion.

However another dose of pure ketones and he’s soon back to how he was the night before.” It is a vivid demonstration of the difference high dose ketones could well make. But yet again large scale trials are needed to definitively prove their benefits and finding the funding is a constant problem.

 Problems with the mouse model

But there is a problem with testing treatments on animals. The one researcher who is planning a human trial is Dave Morgan, professor of molecular pharmacology and physiology at an Alzheimer’s Institute in Florida. He recently ran a a trial on mice and found the oil was ineffective. But he didn’t believe that necessarily meant it wouldn’t work on humans. His reasoning is very revealing about how Alzheimer’s treatments are tested.

He points out that there are many reasons why memory and thinking decline. The two classic ones are the development of damaged proteins, known as amyloid plaques and tau tangles, but there are others such as changes linked to ageing or brain cells becoming less efficient, possibly because they can’t use glucose effectively any more.

“However because mice don’t naturally develop Alzheimer’s ,” says Morgan “they have to be genetically created to develop amyloid deposits so researchers can test drugs aimed at clearing or blocking them, which is what nearly all drugs are designed to do. What this means is that if you are testing for the benefit of say, improved energy supply via ketones,  if it doesn’t clear plaque it may well not show up as having any effect. The mice aren’t a realistic model of what happens in Alzheimer’s.”

So how could coconut oil be tested?

Running a full scale trial to test the oil properly would be expensive and could take years. Is there a simpler of finding out if some people benefit?  “Like other experts I’ve no idea if the oil is effective.” says Dr Emer MacSweeney, Medical Director and Consultant Neuroradiologist at  Re:Cognition Health, a top Centre in London, specialising in memory loss and cognitive impairment.

“But with the new automated testing techniques we could, at least, monitor a group of patients who are taking the oil anyway and record changes in their memory and thinking.  Whilst it would be difficult to attribute these changes to the sole effect of the oil, we could discover if the tests results match any benefits the carers reported.”

Are we wise to continue relying on drug companies to find a cure?

Some scientists are calling for a suspension of the private, profit-based research model in favour of a global, public-private program. “The medical-care system is going to be bankrupt by 2050 if we don’t figure out a way to delay or treat Alzheimer’s disease,” says Dr. Barry Greenberg, the director of strategy for the Toronto Dementia Research Alliance, in a recent article in the MIT Technology Review. He believes that won’t happen without a major public-private international initiative. “The competitive marketplace,” he says, “was not conceived to overcome problems of this magnitude.”