Iknew for several decades that medium-chain triglyceride (MCT) oil existed, since it was in use in newborn intensive care units as early as the 1970s. I assumed it was only available to hospitals, but not long after Steve responded to coconut oil, I learned that it could easily be purchased over the counter. I was surprised to find it in several local natural food stores and to learn that it is commonly used by bodybuilders to increase lean body mass. Following are the most frequently asked questions I receive about using MCT oil.
Medium-chain triglyceride oil is derived from coconut oil or palm kernel oil. Most of the products that are readily available over the counter are a mixture of caprylic (C:8) and capric (C:10) acids, with small amounts of caproic (C:6) and lauric acids (C:12)—the four medium-chain triglycerides found in coconut oil. Coconut oil is about 60 percent medium-chain fatty acids and contains a much larger proportion of lauric acid compared to MCT oil. About 70 percent of the saturated fats in coconut oil are medium-chain fatty acids.
MCT oil can be used as an alternative to coconut oil to produce mild ketosis. The primary differences between using MCT oil and coconut oil are that a smaller volume of oil can be taken without the additional fatty acids found in coconut oil and that the levels of ketones may be slightly higher, although compared to coconut oil, they leave the circulation after a few hours.
Diarrhea is a common side effect of using MCT oil, so it is a good idea to start with a small amount, such as one-half or one teaspoon and gradually increase to an amount that is tolerated, such as one to two tablespoons two to four times a day. (More suggestions follow.) At higher levels of MCT oil, most people develop diarrhea, so when this happens, you may want to cut the dose back to the previous level.
The most common complaint with MCT oil is the problem of diarrhea, which usually occurs if too much is taken by someone who has not taken it before, or if the amount of oil is increased too quickly. MCT oil is more likely than coconut oil to produce this problem, which occurs in about 25 percent of people as they begin taking the oil.
Considering the amount of oil that one might consume in a day’s time—upwards of six to eight tablespoons—most people will find the level at which they have diarrhea, which usually occurs within an hour or so of eating the oil. An occasional person will experience diarrhea with just one teaspoon, so caution should be exercised with the first dose.
Some strategies to help decrease the likelihood of developing diarrhea are:
1. Start with a small amount of oil, such as one teaspoon once or twice a day, and increase slowly as tolerated. Increase by one teaspoon every few days until reaching the desired amount, possibly as much as two or more tablespoons three times a day.
2. Always take the oil with other foods.
3. Take the oil slowly during the course of the meal, over twenty to thirty minutes. If the oil is mixed with food, this will be easier to accomplish.
4. Mixing the oil with cottage cheese may decrease the odds that diarrhea will occur, so it might be practical to take the oil with cottage cheese one or more times per day. Cottage cheese is also an excellent source of protein and provides a relatively small amount of carbohydrate.
5. If using even small amounts of oil persists in causing diarrhea, consider trying other coconut products such as coconut milk or even grated coconut, which contains a substantial amount of oil. The oil may be released more slowly in the course of digestion and therefore be less likely to set off diarrhea.
For those who want a method prescribed by their physician, Axona, from the Accera Company, is now on the market. This is a powdered form of MCT oil mixed with some other nutrients and emulsifiers that dissolve in liquids and can be taken as a drink. Current recommendations are to take Axona once a day in the morning. More frequent dosing has not been studied as of this writing, so the company is bound by Food and Drug Administration (FDA) rules to recommend just once-a-day dosing. (For more information, go to www.about-axona.com.) A video demonstrating how ketones work as an alternative fuel is available there.
A company called True Protein (www.trueprotein.com) offers a nonprescription powdered form of MCT oil combined with some carbohydrate.
About two months after starting Steve on coconut oil, after receiving results of his ketone levels, we began experimenting with mixing MCT oil and coconut oil. After Steve took just coconut oil in the morning, his ketone levels peaked at about three hours and were nearly gone after eight to nine hours, just before dinner time. Steve’s ketone levels with just MCT oil were higher but gone within three hours. I reasoned that a mixture of MCT and coconut oil should result in higher levels and longer-lasting levels, so that some ketones are always circulating.
If you decide to take just MCT oil several times a day, the levels fluctuate up and down more than with coconut oil or with a mixture of coconut and MCT oils. Also, some fatty acids in whole coconut oil are not found in MCT oil, and I think they might contribute to the improvements seen in Steve and others. For example, the lauric acid in coconut oil kills certain types of viruses, such as those that cause fever blisters. At least one group of researchers has found evidence of the herpes simplex virus type 1 that causes fever blisters in the beta-amyloid plaques in the brains of people with Alzheimer’s, especially those with the ApoE4 gene like Steve. Taking coconut oil seems to be working for Steve in that he was regularly fighting fever blisters, sometimes for several weeks at a time, and these episodes have become much less severe and less frequent, with just four episodes over two years.
Coconut oil is also reported to support the thyroid, and many people with dementia have or develop hypothyroidism at some point in the disease process. People with Down syndrome all develop Alzheimer’s disease by the time they reach their thirties or forties, and they also have a problem with hypothyroidism. Coconut oil could have a beneficial effect in this regard.
Many people have reported to me that they have seen improvements in their loved ones with Alzheimer’s using just coconut oil. Steve had a dramatic improvement using just coconut oil for the first two months. I don’t know for certain if there is any additional benefit to adding MCT oil, so I see no problem with using just coconut oil for this dietary intervention. One of the reasons to consider adding MCT oil would be to achieve higher levels of ketones. Only part of MCT oil is converted to ketones, so the remaining medium-chain fatty acids could potentially be used by neurons as an alternative fuel. So the more medium-chain fatty acids one can tolerate, the more will be available to brain. Much more needs to be learned about exactly what medium-chain fatty acids do.
Another point to consider is that by mixing MCT and coconut oil in a four-to-three ratio, the long-chain saturated fatty acids are reduced to about 10 percent of the total fat. For those worried about the possible health issues related to saturated fats (read Chapter 21), this offers an alternative to using an equivalent amount of coconut oil. See page 355 for a recipe to make this mixture.