Assignment 4: Literature Review Paper

The Effects of Coconut Oil on

Cognitive Function in Adults with Alzheimers Disease

Johanna Coutinho
N# N00929411
November 21, 2014
HUN3800, Section 81525

Introduction
Alzheimers Disease is a progressive form of dementia that involves memory loss and
serious cognitive decline. It affects more than five million Americans and is the sixth leading
cause of death in the United States, with no cure currently available.1 The prevalence of the
disease is higher in women than in men. While most people are familiar with the issue of breast
cancer in women, with its widely publicized push for research and awareness, it is not generally
known that a woman in her 60s is twice as likely to develop Alzheimers Disease as breast
cancer.1
Several pharmaceutical drugs have been developed to help relieve some of the symptoms
and improve quality of life for patients with Alzheimers Disease (AD), but they often lose their
efficacy over time.2 Two different types of medications are currently available: cholinesterase
inhibitorsfor mild to moderate ADor N-methyl D-aspartate (NMDA) antagonistsfor
moderate to severe AD.2 Cholinesterase inhibitors block the activity of a neurotransmitter that is
produced in lesser quantities as we age, acetylcholine. Acetylcholine handles the communication
between the central nervous system and the muscles in our body; it is also associated with
learning and memory.3 The NMDA antagonists help regulate glutamate, the most abundant
neurotransmitter in the nervous system.2,3 Glutamate is also associated with learning and
memory, and imbalances of this neurotransmitter can result in other disorders, such as
schizophrenia and Lou Gehrigs Disease.
Because AD is a progressive disease and the efficacy of the medication depends on
individual levels of either neurotransmitter in the patient, sometimes the medication can only
have a short term effect, and families grow frustrated as the patients symptoms return and
cognitive function declines. Increased dosages also result in increased incidence of side effects

from the medication, ranging from gastrointestinal disruptions to further cognitive effects like
dizziness, headaches, or confusion.2 A recent observational study conducted in Italy, however,
suggests that switching from an oral cholinesterase inhibitor to a transdermal patch, such as
Exelon (rivastigmine), can improve symptoms once more because of a continuous release of the
active compound, thus avoiding fluctuations in plasma levels that are typical of the oral
formulation, moreover it limits the typical side effects of oral ChEIs and increases patient
compliance.4
As with most chronic disease conditions, the search continues for natural remedies that
can help relieve the symptoms of AD while promoting health, rather than producing new
challenges for the patient. Coconut oil has long been used in Ayurvedic medicine in many forms,
and in World War II, it was even used in times of emergencies as an intravenous saline solution
for its electrolyte content; it is high in potassium, sodium, calcium, magnesium, and phosphorus,
and the concentration of these inorganic ions creates an osmotic pressure similar to that found in
our blood.5
The coconut itself is a nut from the palm tree, and the kernel contains 65-75% oil.5 It is
made up of several fatty acids: caprylic acid, capric acid, caproic acid, myristic acid, palmitic
acid, stearic acid, oleaic acid, linoleic acid, and lauric acid. Of these, it is most abundant (4952%) in lauric acid. Coconut oil is made up of medium-chain fatty acids (MCFAs), with most of
its fatty acid components recognized as saturated. Figure 1 below expresses the fatty acid profile
of the oil.
Fatty Acid
Caproic
Linoleic
Stearic
Oleic

% in Oil

Type

# Carbon
Atoms

0.5
1.6
2.6
6.2

Saturated
Polyunsaturated
Saturated
Monounsaturated

6
18
18
18

Capric
Caprylic
Palmitic
Myristic
Lauric

6.7
7.8
8.8
18.1
47.5

Saturated
Saturated
Saturated
Saturated
Saturated

10
8
16
14
12

Fig. 1: Fatty Acid Profile in Virgin Coconut Oil

Virgin coconut oil has been associated with a myriad of health benefits: it has an
anticholecystitic effect and has been found to help with the dissolution of gallstones; it has
antibacterial, antifungal, antiviral, and antiprotozoal properties; and it can have an
antiatherosclerotic effect by inhibiting the activity of several viruses, whose infections are
associated with increased risk for atherosclerosis.5 The potential for this natural oil seems vast,
with various opportunities for further investigation.

Body
Coconut oil has gotten a lot of attention in the United States as a healthy oil. It received
particular attention in Florida when Dr. Mary Newport, a neonatologist at Spring Hill Regional
Hospital, claimed to have successfully improve the cognitive function in her own husband, who
was so hindered by early onset Alzheimers Disease that he could not even qualify for any
clinical trials of developing pharmaceuticals.6 Dr. Newport added two tablespoons of coconut oil
to her husbands breakfast and gradually increased the dose to four times daily; with favorable
results, she has since then pushed for further research on the oils effects on patients with
Alzheimers Disease, leading to a randomized, double-blind cross over study at the University of
South Florida that is estimated to be completed in the fall of 2015.7 The Byrd study, taking place
at USF Health Byrd Alzheimers Institute, will compare coconut oil to a MCT oil mixture
against a placebo to compare the results over six months.

Lifestyle choices have been examined to determine whether a change in diet and/or
physical activity can have any impact on the risk of Alzheimers Disease. Studies have produced
mixed results when patients followed a Mediterranean diet rich in monounsaturated fats like
olive oil.8 Meanwhile, studies on coconut oil are just beginning to emerge. One recent study
published earlier this year tested 31 patients with moderate to severe AD and discovered a
significant improvement in cognitive function as early as two weeks, with more prominent
changes by four and six weeks: It was further observed that most of the caregivers observed
improvements in the mental/cognitive domains of alertness, expression of language and overall
activity.9 The high density lipoprotein (HDL) values of the subjects also increased over the
duration of the study, presenting a favorable outcome against cardiovascular disease risk.
One possible explanation for the positive response of patients to coconut oil is what is
known as the ketogenic effect. A double-blind, placebo controlled study examined the effects of
the ketone body, beta-hydroxybutyrate (-OHB) on cognition, by administering an oral dose of
MCTs and using the Alzheimers Disease Assessment Scale-Cognitive Subscale (ADAS-cog) for
assessment.10 As glucose metabolism may become impaired with older age, ketone bodies such
as -OHB were associated with rapid improvements in mental status. The previous six-week
study, however, suggests a distinction between just any MCT oil mixture that can produce a
ketogenic effect and coconut oil, suggesting coconut oil by virtue of its variable composition,
with similar beneficial effects and limited sustained effects...might be acting by its unique
properties beyond the induction of ketosis.9
Researchers do continue to question the need for concern over the saturated fat content
found in coconut oil, particularly when ingesting it on a daily basis. Animal research studies
have produced mixed results with this medium-chain triacylglycerol. In 2008, a study using

middle-aged rats looked at the influence of a diet high in saturated fat and cholesterol on brain
function and morphology, finding a significant increase in working memory errors, reduced
Map 2 staining and increased microglial markers in the hippocampal formation in the group fed
the diet concentrated in saturated fat.11 In 2009, however, a study using senior dogs found a
striking correlation between the ingestion of medium-chain triacylglycerols and increased brain
n-3 polyunsaturated fatty acid (PUFA) levels, which are associated with improved cognitive
performance.12 The metabolism of the MCTs seemed to promote increased n-3 PUFA
concentrations in the brain, and the dogs all received adequate carbohydrate and protein sources;
so, they were not studied under the influence of a ketogenic diet.
Multiple clinical trials have demonstrated n-3 PUFAs have a profound effect on cerebral
blood flow, inflammation, and cognitive activity. A randomized, double-blind, parallel-group,
comparative study involving krill oil, sardine oil, and a MCT as the placebo showed that memory
function improves with long term ingestion of krill and sardine oils, both of which contain n-3
PUFAs.13

Discussion
Coconut oil is just starting to emerge in clinical research trials with some positive
outcomes in the treatment of cognitive decline for patients of Alzheimers Disease. Some of the
sample sizes of the studies are small, however, as many of the studies require participants to
score within a certain range on the ADAS-cog assessment. Once the disease has progressed too
far, reversing the symptoms of AD prove too difficult, and subjectivity can disrupt a study that
should actually be unbiased. Research should include both male and female participants, but

perhaps the need is greater for female subjects, given the greater prevalence of the disease in
women, compared to men.
There is an open case for a clinical trial to follow up on the findings of the animal
research study involving the senior dogs from 2009. If such a strong correlation should exist
between coconut oil and n-3 polyunsaturated acids, it would be an important area to explore in
nutrition and even neurobiological medicine. Dogs and humans are not terribly different on a
biochemical level, but we might metabolize certain nutrients in different ways. So, it would be
very interesting to find out if medium-chain triacylglycerols do promote n-3 PUFA
concentrations in the human brain, as they did in the dog. One could also argue the patient could
just go directly to the source and take an omega-3 supplement. It may, therefore, be worth
examining the outcomes of both supplements within the same trial, perhaps in a double-blind,
cross over design.
Saturated fat intake is still a topic we deal with on a daily basis in the United States. The
Academy of Nutrition and Dietetics has not established a Recommended Dietary Allowance for
saturated fat but reports that the American Heart Association suggests less than seven percent of
our daily calories be consumed in the form of saturated fat for reduced risk of cardiovascular
disease.14 Further research could be done to determine if there is a difference between saturated
fat sourced from animals, versus plant sources. Right now, all saturated fats are addressed the
same, regardless of any other health-promoting properties they contain because of their
connection to plaque formation, which can lead to endothelial dysfunction and atherosclerosis.
The studies produced in this review, however, found little to no deleterious effects on blood lipid
profiles.

It is worth mentioning that the animal research study involving the middle-aged rats,
which produced adverse results in the group fed MCTs, used refined, hydrogenated coconut oil,
whereas human clinical trials with affirmative outcomes used virgin coconut oil. Hydrogenation
of the coconut oil breaks more bonds and ususally involves the addition of either heat or hexane,
compromising the natural structure of the oil and, ultimately, changing the way it is metabolized.

Implications for Practice

Coconut oil may provide a valuable, low-cost treatment option for the symptoms of AD
related to memory loss. While there are existing studies in place recognizing positive correlations
between coconut oil and improved cognitive function with no harmful side effects, the findings
are relatively new and should be considered carefully in practice while further research is
conducted. Coconut oil should be treated as a nutraceutical if used in the treatment of
Alzheimers Disease, whether in conjunction with pharmaceutical treatment or as a standalone
option. While current studies suggest coconut oil may have an antiatherosclerotic effect, plasma
lipid values of the patient should probably still be monitored due to the saturated fat content of
the oil, as results may vary in individuals. Quality of the oil also needs to be considered, as most
clinical trials implement virgin or extra virgin coconut oil. Highly refined coconut oil will differ
in nutrient composition, as the fatty acid profiles can change if the oil is overprocessed or heated,
rather than expeller pressed.

References
1. Alzheimers Association. What is Alzheimers?
http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp. Accessed October 7,
2014.
2. National Institute on Aging (National Institute of Health). Alzheimers Disease
Medication Fact Sheet. http://www.nia.nih.gov/alzheimers/publication/alzheimersdisease-medications-fact-sheet. Accessed October 7, 2014.
3. Timberlake Karen C. Amines and Amides. Organic and Biological Chemistry, Structures
of Life: Fourth Edition. Upper Saddle River, NJ: Pearson; 2013: 662
4. Spalletta G, Caltagirone C, Padovani A, et al. Cognitive and Affective Changes in Mild
to Moderate Alzheimers Disease Patients Undergoing Switch of Cholinesterase
Inhibitors: A 6-Month Observational Study. PLOS One.February 2014; 9(2): e89216.
5. DebMandal Manisha and Mandal Shyamapada. Coconut (Cocos nucifera L.: Arecaceae):
In health promotion and disease prevention. Asian Pacific Journal of Tropical Medicine.
2011; 241-247.
6. USF Health Byrd Alzheimers Institute. Coconut Oil: A boost for faltering brain cells?
Brain Research Discoveries. Fall/Winter 2013; 3-9.
7. ClinicalTrials.gov. Study to Evaluate Coconut Oil for Alzheimers Disease.
http://clinicaltrials.gov/show/NCT01883648. Accessed October 8, 2014.
8. Arab Lana and Sabbagh Marwan N. Are Certain Lifestyle Habits Associated with Lower
Alzheimers Disease Risk? Journal of Alzheimers Disease. 2010; 785-794.
9. Gandotra S, Kour J, and Van der Waag A. Efficacy of Adjunctive Extra Virgin Coconut
Oil Use in Moderate to Severe Alzheimers Disease. International Journal of School and
Cognitive Psychology. June 2014; 1:2
10. Reger Mark A, Henderson Samuel T., Hale Cathy, et al. Effects of beta-hydroxybutyrate
on cognition in memory-impaired adults. Neurobiology of Aging. 2004; 311-314.
11. Granholm A, Bimonte-Nelson H, Morre A., et al. Effects of a Saturated Fat and High
Cholesterol Diet on Memory and Hippocampal Morphology in the Middle-Aged Rat.

12. Taha A., Henderson S., and Burnham W.M. Dietary Enrichment with Medium Chain
Triglycerides (AC-1203) Elevates Polyunsaturated Fatty Acids in the Parietal Cortex of
Aged Dogs: Implications for Treating Age-Related Cognitive Decline. Neurochemical
Research. 2009; 34:1619-1625.
13. Konagai C., Yanagimoto K., Hayamizu K, et al. Effects of krill oil containing n-3
polyunsaturated fatty acids in a phospholipid form on human brain function: a
randomized controlled trial in healthy elderly volunteers. Clinical Interventions in Aging.
2013; 8:1247-1257.
14. Academy of Nutrition and Dietetics. Position of the Academy of Nutrition and Dietetics:
Dietary Fatty Acids for Healthy Adults. Journal of the Academy of Nutrition and
Dietetics. January 2014; 114:1.