Until a commercial ketone ester is available to us, the next best strategy we can undertake is to incorporate medium-chain fatty acids into our diet. Medium-chain fatty acids are taken up directly from the intestine into the liver, where they are partially converted to ketones. These ketones are then taken up quickly by cells that can use them, including those in the brain, and can serve as an alternative fuel for cells that are unable to use glucose effectively. In addition, medium-chain fatty acids can be used directly as fuel by mitochondria, the tiny organelles inside of cells that generate ATP.
There are several ways to incorporate medium-chain fatty acids into the diet: with coconut oil, medium-chain triglyceride (MCT) oil, and foods and products rich in these medium-chain fatty acids. This chapter focuses mainly on answering frequently asked questions about coconut oil and coconut oil in foods. The following chapter will answer questions concerning MCT oil and products that contain MCT oil.
People who have a neurodegenerative disease that involves decreased glucose uptake in neurons may benefit from taking higher amounts of coconut and/or MCT oil to produce ketones, which may be used by brain cells and other organs as energy. These diseases include Alzheimer’s and other dementias, Parkinson’s, Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS), multiple sclerosis, Duchenne muscular dystrophy, autism, Down syndrome, and Huntington’s chorea. There are a number of uncommon conditions that also involve decreased glucose uptake in the brain or other organs that could respond (for a list of the conditions, see page 262). Your physician should be able to help you learn if this dietary intervention is appropriate for you or your loved one.
If you are at risk for one of these diseases due to family history, you might consider making this dietary change to try to prevent or at least delay the onset and lessen the effects of the disease.
Some rare conditions involve a problem of fat metabolism in which the use of coconut oil and/or MCT oil may not be appropriate and may even worsen the condition. Therefore, consultation with your physician is very important.
Coconut oil is easily absorbed by the body and increases absorption of certain vitamins and minerals and other important nutrients. This also holds true for coconut milk and coconut meat, whether wet or dry, such as flaked or grated coconut. The fiber in coconut meat may be especially beneficial for people with Crohn’s disease, other types of inflammatory bowel disease or other malabsorption syndromes, and for people who have diarrhea from coconut or MCT oil.
All cell membranes and about 60 to 70 percent of the brain are largely made up of fats. Many cell functions take place within the cell membrane. The majority of the fats most of us consume today are vegetable oils, usually soybean or canola oil. These oils often contain hydrogenated and partially hydrogenated polyunsaturated fats and trans fats, which can carry potentially damaging oxygen free radicals into cell membranes. Even nonhydrogenated polyunsaturated fatty acids can become oxidized (rancid) and pick up oxygen free radicals. If you begin to substitute coconut and other natural oils, such as olive oil and even butter, along with omega-3 fatty acids in your meals, you may be able to undo some of the damage. Most of the cells in the body turn over within three to six months, and you may notice a nicer texture to your skin and a decrease in certain problems such as yeast and fungal infections.
Coconut oil is a wonderful moisturizer and is used in tanning lotions and other skin care products. In the tropics and areas where coconut oil is readily available, it is often applied to the skin before going out in the sun. Some people use coconut oil in their hair as a natural conditioner. Coconut oil feels soothing, is not sticky, and is absorbed readily into the skin. For dry skin, it can be applied while still damp after showering; then the skin can be blotted dry.
For a lengthy discussion of the many other benefits of coconut oil, I highly recommend the book Coconut Cures (2005) by Bruce Fife, N.D.
Yes! In the Accera studies (the makers of Axona, the prescription powdered form of MCT oil), even though the ApoE4+ people as a group did not show improvement, many of the individuals with that genetic make-up did have improved scores on cognitive testing. This was not noted in the article in which the study results were published, but I learned this in conversation with one of the authors. In addition, Steve is ApoE4+ and responded to treatment with medium-chain fatty acids.
If you take too much oil too fast, you may experience indigestion, cramping, or diarrhea. To avoid these symptoms, take coconut oil with food and start with one teaspoon per meal, increasing slowly as tolerated over a week or longer.
If diarrhea develops, drop back to the previous level and stay at that level for at least a few days before trying to increase again. See more ideas for reducing the problem of diarrhea later in this chapter.
For most people, the goal is to increase gradually to four to six tablespoons a day, depending on the size of the person, spread over two to four meals. Not everyone will be able to tolerate this much oil.
Mixing MCT oil and coconut oil could provide higher levels and a steady level of ketones. One formula is to mix 16 ounces MCT oil plus 12 ounces coconut oil in a quart jar and increase slowly as tolerated, starting with one teaspoon. This mixture will stay liquid at room temperature. See more about MCT oil in Chapter 24.
Coconut oil can be substituted for any solid or liquid oil, lard, butter, or margarine in baking or cooking on the stove, and it can be mixed directly into foods already prepared. Some people take it straight with a spoon, but many people may find it hard to swallow this way and more pleasant to take with food.
Use coconut oil instead of butter on toast, English muffins, bagels, grits, corn on the cob, potatoes, sweet potatoes, rice, vegetables, noodles, and pasta. When stir-frying or sautéing on the stove, coconut oil smokes if heated to more than 350°F or medium heat. You can avoid this by adding a little olive or peanut oil. Coconut oil can be used at any temperature in the oven when mixed in foods. Mix coconut oil into your favorite soup, chili, or sauce. It can also be basted onto foods such as fish as long as the oven temperature is 350°F or below.
Coconut oil tends to become hard when exposed to cold foods. For example, if used as a salad dressing, it will turn into hard little chunks if the vegetables in the salad come straight out of the refrigerator. Some people actually like this effect and call them “crunchies.” If not, try adding equal amounts of coconut oil to another favorite salad dressing that has been warmed slightly. Also, the mixture of MCT and coconut oil tends to stay liquid and works well in this situation. This also enables you to add it to smoothies, yogurt, or kefir.
For those who cannot handle coconut oil, grated or flaked coconut, coconut milk, and fresh coconut may be good substitutes, as they are digested much more slowly. Ideas for incorporating these foods into the diet are discussed later in the chapter. Caregivers have found very creative ways to get coconut oil into the diet of their loved ones. Two of my favorite recipes are for coconut macaroons (page 361) and coconut fudge (page 362). Also check the Resources section for cookbooks containing many more great ideas and recipes.
Coconut oil has about 117 to 120 calories per tablespoon, about the same as other oils. It contains 57 to 60 percent medium-chain fatty acids, which are absorbed directly from the intestine without the need for digestive enzymes. This portion of the coconut oil is not stored as fat. Coconut oil is about 86 percent saturated fats, most of which are the medium-chain fats that are metabolized differently than animal saturated fats. The oil contains no cholesterol and no trans fat as long as it is nonhydrogenated. An advantage of a saturated fat is that there is nowhere on the molecule for free radicals or oxidants to attach. About 6 percent of coconut oil is monounsaturated fats and 2 percent polyunsaturated fats. Coconut oil also contains a small amount of phytosterols, which are one of the components of the statins used for lowering cholesterol.
Coconut oil contains a small amount of omega-6 fatty acids but no omega-3 fatty acid, so this must be taken in addition to coconut oil. You can obtain all the essential fatty acids required by using just coconut oil and omega-3 fatty acids. If you were to use coconut oil as your primary oil, the only other oil you would need is one that contains omega-3 fatty acids. You can get this by eating salmon twice a week; taking liquid fish oil or cod liver oil, which also contains significant amounts of vitamins A, D, and E; or taking fish oil or flax oil capsules, at least two to three per day. Some other good sources of omega-3 fatty acids are ground flax meal, chia (a fine grain), walnuts and walnut oil, lingonberry, and purslane. Soybeans, soybean oil, and canola oil contain small amounts of omega-3 fatty acids. It is important to note here that the basic omega-3 fats found in vegetable sources, alpha-linolenic acid (ALA), may not readily convert to the very important docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) omega-3 fatty acids that are also essential. DHA makes up 50 percent of the neuron’s plasma membrane, and low levels of DHA have been associated with Alzheimer’s disease as well as many other conditions. DHA is so important that very strong consideration should be given to getting this fatty acid directly from a marine source.
Lauric acid is a medium-chain fatty acid that makes up almost half of coconut oil and is a saturated fat. Scientific studies show that lauric acid has antimicrobial properties and may inhibit growth of certain bacteria, fungi/yeast, viruses, and protozoa. It is one of the components of human breast milk that prevents infection in a newborn. Coconut oil and/or palm kernel oil, which have a similar composition of fats, are added to nearly every infant formula to try to duplicate the important fatty acids, such as lauric acid, found in human breast milk. It is quite remarkable that coconut oil is considered so very safe and even important for the human newborn and yet considered by many to be dangerous for the adult human. The inconsistency here is mind-boggling.
Be sure to examine the label on the back of the jar or container. Look for coconut oils that are nonhydrogenated with no trans fat. Avoid coconut oils that are partially hydrogenated or super-heated because these processes change the chemical structure of the fats. In the United States, food manufacturers are required to state on the product label if there are hydrogenated or partially hydrogenated oils and trans fats. One caution is that they can state on labels that there are no trans fats if a serving contains less than 0.5 grams. This can be deceptive, since the serving size is often adjusted accordingly.
Two types of coconut oil are on the market: unrefined and refined. The label for unrefined coconut oil normally reads “virgin” or “extra virgin,” may read “raw,” and most often also reads “organic.” These unrefined oils are generally pressed from freshly harvested coconuts and are rarely exposed to high levels of heat. As a result, they are more flavorful and nutritious than refined coconut oils, and tend to be more expensive, largely because the nature of the equipment and the process used in removing the oils from the meat are more costly to the manufacturer.
There are quality differences with more than six different ways of making virgin coconut oil. Generally, some type of mechanical process, such as a press or a centrifuge is used rather than chemicals to separate the oil from the coconut meat; one example is the process called direct micro-expelling (DME) developed by Dan Etherington of Kokonut Pacific in Australia. DME is a cold (low-heat) process of pressing the oil from the fresh meat within one hour of opening the coconut.
Refined coconut oil is made from copra (dried coconut flesh), which, in the drying process and transit time to the oil mills often picks up mold and off-flavors, thus it needs to be refined to be palatable. The label usually reads “regular,” “all natural,” or “RBD” (refined, bleached, and deodorized). The dried coconut is soaked in bleach and solvents are used to leech out the oils, which are subjected to high temperatures to further purify and liquefy the oils. Refined coconut oils have virtually no coconut taste or aroma.
Coconut oil can be found at your local health food stores and natural food markets, most Asian markets, some traditional grocery stores, as well as large department stores with grocery sections. You can also use the Internet to find other quality brands of coconut oil and at a wide range of prices not available at your local retailers, however, the quality can vary enormously; don’t expect the highest quality for the lowest price.
Check the Resources section for a listing of websites offering coconut oil and coconut oil products.
Using coconut oil capsules is not an efficient way to give the oil since the capsules are relatively expensive and nearly all contain only 1 gram of oil per capsule, whereas there are 14 grams in one tablespoon of oil. Some products state there are 4 grams per serving; however, the serving size is four capsules. It would require taking about fourteen capsules to equal one tablespoon of coconut oil, so it may not be practical and could be expensive to use capsules. On the other hand, for people who will not use the oil in liquid form and have no problem with swallowing capsules, this may offer an alternative. (See the Resources section.)
Coconut oil is a clear or slightly yellow liquid above 76°F but becomes solid at 76°F and below. If your house is kept right around 76°F, you may even see partly liquid oil with solid clouds floating in it. If your home is generally kept at 75°F or below, the oil will tend to be a white or slightly yellow, and soft to semi-solid.
• Coconut milk is a combination of the oil and the water from the coconut, and most of the calories are from the oil. Look for brands with 10 to 13 grams of fat in 2 ounces. Coconut milk also contains some protein and a small amount of carbohydrate, which gives it a slightly sweet taste. Coconut milk can generally be found in natural foods stores, Asian stores, and the Asian and/or Hispanic sections of traditional grocery stores. Look at the fat content closely on the label, and be aware that some less expensive brands are considerably diluted with water. You can dilute condensed coconut milk yourself with water, or even better, with coconut water, which is loaded with vitamins and other nutrients. Organic coconut milk products are also available. Some coconut milks are also labeled “light” or “lite.” Much of the oil has been removed, and using these lower fat products defeats our purpose of including coconut oil in the diet. Coconut milk blends very well into smoothies and is a tasty substitute for cow’s milk on cereal or right out of the glass. Coconut milk can be substituted for some or all of the milk in many recipes.
• Some wonderful ice creams are now available in a variety of flavors made with coconut milk as the first ingredient. Coconut milk ice creams are available at Asian markets, many natural food stores, and some traditional grocery stores. There are even some ice cream products labeled “gluten free.” Coconut ice cream may be one way to encourage coconut oil intake for someone with a sweet tooth or for an otherwise uncooperative loved one.
• Coconut cream is mostly coconut milk, often has added sugar, and comes in liquid and powdered forms.
• Flaked or grated coconut can be purchased unsweetened or sweetened and is a very good source of coconut oil and fiber. Grated coconut has about 15 grams of oil and 3 grams of fiber in one-fourth cup; in fact, about 70 percent of the carbohydrate content is fiber. The oil in grated coconut can help with absorption of certain vitamins and other nutrients as well. Flaked or grated coconut can be bought in bulk, usually for less than three dollars per pound, at many natural food stores, and can be added to cold or hot cereals, smoothies, soup, ricotta or cottage cheese, and used as a topper for ice cream. Flaked coconut is often found in trail mix, and some people snack on unsweetened flaked coconut. Homemade or store-bought macaroons are a delicious source of coconut.
• Frozen or canned coconut meat often has a lot of added sugar and not much oil per serving. Coconut meat can also be found in jars as coconut balls and “coconut sport,” which is large strands of coconut. These products are especially nice for adding to fruit salads.
• A fresh coconut can be cut up into pieces and eaten raw. A 2-inch square piece has about 160 calories with 15 grams of oil (equivalent to about one tablespoon oil) and 4 grams of fiber. Removing the meat from the coconut can be quite a challenge, however. In Bruce Fife’s The Coconut Lover’s Cookbook (2008), he suggests heating the whole coconut in an oven for twenty minutes at 400°F after poking two holes in the eyes of the coconut and draining the coconut water. I like to strain off the coconut water, and then Steve and I share it, since it has significant nutrients as well. After the coconut cools down, it can be opened with a hammer or whatever tool you can think of. To avoid shattering anything important, we take the coconut outside and crack it open on newspapers covering the garage floor. The meat can usually be pried from the shell with a blunt knife. This is quite a process and can be time consuming, but some consider it well worth it. Pieces of coconut meat can be saved for a week or longer in the freezer.
• Coconut water does not usually contain coconut oil, but does contain many other nutrients and has other health benefits. The electrolyte composition is similar to human plasma and is useful to prevent or treat dehydration. Coconut water has been used as intravenous fluid in Asia and was even used by our American troops when supplies of standard intravenous fluids were low. Coconut water is coming into its own now as a sports drink.
• MCT oil is part of the coconut oil and can also be purchased in some natural food stores or on the Internet. (Check the Resources section for listings.) This may be useful for people who are on the go and do not have much time to cook. MCT oil can also be mixed with coconut oil as described in the next chapter. MCT oil is used as energy and not stored as fat, so it may be useful for someone who wants to lose weight if it is substituted for some other fats in the diet.
The following coconut foods contain the equivalent of 1 tablespoon of coconut oil:
• Coconut milk (undiluted): 41/2 tablespoons
• Coconut meat: 2- x 2- x 1/2-inch piece
• Coconut grated: 1/3 cup
• Coconut oil capsules (1 gram): 14 capsules
Coconut oil is extremely stable with a shelf life of at least two years when stored at room temperature. The container should have an expiration date on it. In the refrigerator, coconut oil becomes quite hard, so you may need a chisel to get it out of the jar! If you wish to keep it in the refrigerator, you can measure out one or two tablespoons into each section of a plastic ice cube tray. The coconut oil pops easily out of the tray. Refrigeration is not necessary, but some people may be more comfortable storing it this way.
Coconut milk is mostly coconut oil and can be substituted for the oil in many ways. Coconut milk must be refrigerated after opening, and should be used within a few days or tossed out.
Grated or flaked coconut can be stored at room temperature, but may last longer if stored in a refrigerator.
A freshly cut coconut can be stored in the refrigerator for a few days or freezer for a couple of weeks.
Some other foods contain short- and medium-chain fatty acids that are worth mentioning, including whole cow’s milk, goat’s milk, and cheeses. Table 23.1 shows the content (in grams per ounce) of short- and medium-chain fatty acids contained in these and other foods. Short-chain fatty acids behave similarly to medium-chain fatty acids in that they are also converted to ketones in the liver. In general, the amounts are considerably less than in coconut oil. However, using these foods may contribute to the overall production of ketones. In other parts of the world, certain oils listed in Table 23.1 may be more available than in the United States.
As a point of reference about how important medium-chain fatty acids are to humans, a ten-pound breastfeeding baby gets about 3.12 grams medium-chain fatty acids per quart of breast milk. Extrapolated to a 150-pound adult, that would be the equivalent of 47 grams of medium-chain fatty acids and would require eating five and a half tablespoons of coconut oil.
To try to duplicate what is in human breast milk, infant formulas contain medium-chain triglyceride oil as well as coconut and/or palm kernel oil. When children are weaned from the breast and from infant formulas, the usual next step in the United States is to transition to cow’s milk. In recent years, there has been a push to encourage feeding even small children low-fat or fat-free milk and milk products, which would eliminate virtually every potential source of medium-chain fatty acids from the diet of the average child.
TABLE 23.1. FOODS WITH SHORT- AND MEDIUM-CHAIN FATTY ACIDS
| FATS AND OILS | GRAMS PER 0.5 OUNCE (approximately 3 tsp/15 ml) |
| Coconut oil | 8.3 |
| Babassu oil | 7.7 |
| Palm kernel oil | 7.5 |
| Goat butter | 2.4 |
| Ucuhuba butter | 1.8 |
| Cow butter | 1.6 |
| Nutmeg butter | 0.4 |
| Shea nut butter | 0.24 |
| Lard | 0.04 |
| CREAM AND CHEESE | GRAMS PER OUNCE (approximately 6 tsp/30 ml) |
| Goat cheese | 2.0 |
| Feta cheese | 1.4 |
| Cream (heavy) | 1.3 |
| Cream cheese | 1.0 |
| American cheese | 0.85 |
| Mozzarella | 0.78 |
| MILKS AND COTTAGE CHEESE | GRAMS PER 8 OUNCES (approximately 1 cup/240 ml) |
| Goat milk | 1.7 |
| Infant formula | 1.0 |
| Cow milk (full-fat) | 0.9 |
| Human breast milk | 0.78 |
| Cottage cheese | 0.78 |
Note: The following commonly eaten fats and oils contain no short- and medium-chain fatty acids: canola, cod liver, corn, fish, flaxseed, olive, peanut, safflower, soybean and sunflower oils, as well as margarine.
Source: USDA National Nutrient Database for Standard Reference, Release 23. Agricultural Research Service (www.ars.usda.gov/nutrientdata), 2010.
It may interest some readers to know that the mother of a child with autism contacted me because she had observed that the seizures and other neurologic symptoms related to her disease began to occur shortly after she was weaned off infant formula. After she read my July 2008 article, it occurred to her that perhaps the medium-chain fatty acids in the formula had delayed the onset of the disease. Some parents of children with autism believe that a vaccine triggers the disease. Many children receive a “junior” formula until fifteen to eighteen months of age, at which point they are weaned to cow’s milk. It just so happens that certain vaccines are given at the same visits at which the pediatrician suggests it is time to come off formula. Could there be a relationship between the lack of medium-chain fatty acids in the diet and autism?
At this point, I must repeat that medium-chain fatty acids may be essential fatty acids, not only for adults but also for children. Many people with Alzheimer’s have a life-long history of memory problems. Could consuming these fatty acids beginning in childhood lessen this problem? I also believe there is an autism/Alzheimer’s connection.
In its natural state at room temperature, coconut oil is usually solid and, as mentioned earlier, can be challenging to measure and mix with other foods. By the time this book is published, new products may be on the market to make the process of incorporating coconut oil in the diet considerably easier.
One such product under development is called Cocomul from Cognate Nutritionals, a company for which I serve as an advisor. It is a liquid nutritional supplement that is easily taken “as is” in measured amounts or can be mixed with other liquids or foods. Cocomul contains both coconut oil and MCT oil and therefore provides a large measure of medium-chain fatty acids in a delicious, convenient, and consistent formula that is very low in sodium and lactose and contains no artificial sweeteners. This product is composed exclusively of ingredients classified by the Food and Drug Administration (FDA) and the U.S. Department of Agriculture (USDA) as “generally recognized as safe” (GRAS). The availability of Cocomul will be particularly useful to anyone needing assistance, as well as those who want an easy, convenient way to add coconut oil and MCT oil to the diet. For more information, see www.cognatenutritionals.com.
Alpha Health Products is developing another new product in Canada called MCT Gourmet Salad Oil that combines MCT oil with DME virgin coconut oil in the 4:3 ratio that Steve and I have used. Unrefined chia seed oil is also added to provide omega-3 fatty acids, as well as vitamin E. This oil mixture is liquid and very stable at room temperature due to the high MCT content and will easily combine with lemon or vinegar to make salad dressing. It has a pleasant nutty taste and is a superior healthy oil for daily use. For more information, see www.alphahealth.ca.
If your loved one is in assisted living, the doctor may be willing to prescribe coconut oil to be given at each meal and can order the oils to be increased gradually as tolerated. A number of people have reported success in this regard.
I know of one assisted living facility in which the cook was preparing some foods with coconut oil. She said the residents with Alzheimer’s seemed more talkative and to have more energy. Hopefully, over time the directors of these facilities will consider allowing staff to cook with coconut oil.
If no such options are possible, another alternative is to ask the person’s physician for a prescription for Axona (www.about-axona.com), a powdered form of MCT oil, manufactured by Accera. Also, a company called True Protein (www.trueprotein.com) offers a nonprescription powdered form of MCT oil combined with some carbohydrate that can be added to liquids or pureed foods.
This dietary intervention may not be appropriate for someone with liver disease. A healthy liver is required to convert medium-chain fatty acids to ketones.
Partially hydrogenated oils, including partially hydrogenated coconut oil, can result in a fatty liver. Therefore, it is important to always use nonhydrogenated coconut oil or any other oil, for that matter.
No and yes! Some studies show that substitution of coconut oil for other fats in the diet can actually result in weight loss of ten to twelve pounds over the course of a year, because the medium-chain fatty acids are converted directly to energy and not stored as fat. However, if the fat is simply added to the diet and nothing subtracted, you can expect to gain weight. In general, if you consume more calories than you burn in the course of a day, the net result will be weight gain.
The best way to avoid gaining weight is to substitute coconut oil for most other fats and oils in the diet, and if that isn’t enough, eliminate or cut back on portion sizes of carbohydrates, such as breads, rice, potatoes, cereals, and other grains. In general, it is a good idea to use whole-milk products, but if weight gain is a problem, you can compensate for some of the new fat in the diet by changing from full-fat to lower-fat dairy products, such as milk, cheese, cottage cheese, and yogurts, as well as to low-fat or fat-free salad dressings, to which you can add coconut oil. By the same token, if you decide to go with low-fat dairy, be aware that you may not absorb as much calcium and vitamin D through the intestine, compared to absorption when using full-fat dairy.
Also, some people overestimate portions substantially by dipping into the coconut oil jar with a kitchen tablespoon. You can avoid this problem by using a measuring spoon and removing the excess by leveling it off with a knife. This can make a big difference in the number of calories consumed.
Tiny glass measuring cups are available at grocery stores with markings for teaspoons, tablespoons, and milliliters. These little measuring cups are especially useful for combining salad dressing with coconut oil and for measuring out the liquid MCT/coconut oil mixture discussed elsewhere.
One of the most unexpected emails I received was from a lady who wanted to know if coconut oil might improve cognition in her thirteen-year-old Welsh terrier. It is completely understandable that someone wouldn’t want to see their beloved elderly pet suffer with dementia any more than another family member. It turns out that one of the Accera MCT oil studies involved elderly dogs, and they did in fact show improved cognition in response to consuming the oil (Studzinski, 2008; Taha, 2009). I relayed this information to her and suggested that she follow the guidelines for children: give one-quarter teaspoon for each ten pounds the dog weighed two or three times a day. Her dog weighed twenty pounds, so she decided to give her one-half teaspoon in her food twice a day. Several weeks later, she reported that her dog was getting up and around more and finding her way to her food bowl, which she was not able to do prior to consuming the oil.
Dogs can also get diarrhea from coconut oil. The lady reported that one of her friends decided to use twice the recommended amount, and her dog developed diarrhea. Apparently, it is a good idea to start with caution and increase gradually with animals as well as people.