Editor’s note: This post is a collaborative effort between Grant Ritchey, a Science-Based Medicine semi-regular, and Stephanie Tornberg-Belanger, a co-author of the research paper discussed below and who brought the study to Grant’s attention. We are pleased to welcome Stephanie as a guest contributor to SBM.
In his last SBM post, Grant reported on a systematic review of the literature that undermined just about everything dentists had been taught in dental school and have been preaching to patients since The Olden Times: flossing, as it turns out, is not the be-all, end-all that we’ve been led to believe with regard to cavity and gum disease prevention. While the message itself was interesting and relevant, the meta-message in that piece is that we all must be willing to slay our own sacred cows when the evidence demands it, even if it requires shedding long-held, cherished beliefs. This is difficult for any human being to do, and skeptics who are presumably open minded are no different (and can sometimes be worse, because we are often overconfidently convinced of our “rightness”).
So with that in mind, gather ’round children, because we have another meta-message for you. This one deals with coconut oil.
(Pause for gasps.)
If you just had a visceral negative reaction at the mention of coconut oil within the venerable halls of SBM headquarters as we did, then we hope you’ll stick around for the entire blog post. Coconut oil is pervasive in the alt-med world, a virtual panacea, ostensibly showing benefits against heart disease, helping with weight loss, “boosting” the immune system (see figure above), and in dentistry, pulling out dreaded toxins, among many, many other maladies – the CAM counterpoint to the cause of all disease. It even raises your body temperature! (Isn’t that called a “fever?”) So naturally (pun intended) many of us tend to summarily reject any health claims involving coconut oil, because after all, they have to be ineffective treatments if they are recommended by the likes of woomeisters such as Oz and Mercola, right?
Well, not so fast there.
A recently published research paper of which Stephanie is among the co-authors demonstrates the effectiveness of coconut oil in the treatment gastrointestinal candidiasis (a fungal or “yeast” infection) in mice. Whether this will eventually translate into a safe and effective treatment for humans remains to be seen, but the research – even if it does contain the words “coconut oil” – is worth considering and not dismissing it out of hand. And the lessons we learn from it can serve us well into the future.
A fungus among us
Candida albicans is a microscopic fungus which is part of normal human flora. However, given the opportunity (such as in premature infants, uncontrolled diabetics, long term antibiotic use, immunocompromised persons, etc.), C. albicans infection is capable of causing pathologies ranging from mild oral thrush to systematic disseminated candidiasis, which is why it is labeled an “opportunistic pathogen.” Fungal infections are difficult to treat, and because C. albicans can be fatal, there has been interest in reducing the fungus through dietary means rather than resorting to pharmaceutical antifungals as a first line of treatment. (It’s also a favorite fake disease among CAM purveyors and supplement salespeople.)
A recent publication from a collaborative research effort (including Stephanie) at Tufts University, investigated the effect of coconut oil on gastrointestinal candidiasis in a mouse model. The research team found a significant reduction in the gut colonization of C. albicans in mice fed a diet high in coconut oil versus diets high in soybean oil or beef fat. To look into this effect further, they fed mice diets high in beef tallow then changed to the high coconut oil diet after two weeks, and a reduction in C. albicans was still observed. Even when feeding mice a diet with an equal combination of coconut oil and beef tallow there was a reduction of gastrointestinal candidiasis in the mice. This demonstrated that something in the coconut oil had an anti-fungal effect; it wasn’t a function of the other dietary components and could still be effective in the presence of other dietary components.
Looking into the molecular biology of the coconut oil’s mechanism of action, there is good explanatory plausibility for the results they obtained that has nothing to do with some magic natural essence of coconut oil. The expression of genes used to break down fatty acids in C. albicans exposed to coconut oil versus those exposed to beef tallow was lower, which supports the findings seen from the gut colonization in the mice. C. albicans is able to utilize fatty acids as a carbon source for fuel; decreased ability to metabolize fatty acids not only reduces its ability to obtain nourishment to grow and reproduce, it can also reduce its virulence. In addition, medium chain fatty acids such as lauric acid and decanoic acid, which are present in relatively high concentrations in coconut oil, have previously been shown to have fungicidal effects in vitro. All of these results put together show an exciting potential for using coconut oil as a dietary intervention to inhibit C. albicans. It should be emphasized that these effects must be replicated in humans; just because Minnie and Mickey’s candidiasis can be managed with coconut oil doesn’t necessarily mean Grandma and Grandpa’s can. This point cannot be emphasized enough. To take the next step in this line of inquiry, two of the authors have joined with a neonatologist in proposing a clinical trial looking at the reproducibility of reducing gastrointestinal candidiasis in premature newborns, a population at increased risk of severe fungal infections. In addition to the limitations presented using animal models or in vitro studies, the diets the authors fed the mice accounted for more calories from fat than recommended by the USDA. Though populations at high risk for C. albicans infections may not run a risk of long term heart disease problems when using coconut oil as a short term prophylactic intervention, there may be a cardiovascular risk to people who choose to consume a lifetime diet high in fat to prevent conditions which they may not be at risk for. Therefore, should this research pan out for humans, the active ingredients (possibly the aforementioned lauric acid and/or decanoic acid, but that remains to be confirmed) theoretically could be isolated and developed into a medicinal form for use in patients.
When worlds collide
This blog post is a bit different than most found in SBM, because the story really isn’t the story. I hope we’ve made it abundantly clear that this is preliminary research that, while interesting and promising, may or may not apply to humans. A lot more research has to take place before that can even be considered. But that’s beside the point. Our goal was not to tout the potential benefits of coconut oil. Rather, our take home message here is two-fold:
- Primary research is just that – primary. Its aim is to show proof of concept, generate new questions and hypotheses, and to lay the fundamental groundwork for later studies. Scientific medicine knows this and acts accordingly; alternative practitioners often tout primary research as definitive, often basing treatment recommendations upon it. They stretch the data well beyond what it’s qualified to show, inferring what shouldn’t be inferred. Mice aren’t people; sometimes murine models translate to humans, sometimes they don’t.
- Next, just because you are a science-based individual, do not automatically and summarily reject research just because it has alt med “trigger words” such as coconut oil, herb, or plectum as the object of study. Of course, biological plausibility must be taken into consideration first; don’t waste your time seeing if something will work until you know if it can work. Do your due diligence to see if the research was well done and if the data support the conclusions the authors make instead of the authors trying to use the data to support an agenda or worldview. The best way to arm yourself in this area is to learn how to read and understand a scientific paper if you don’t already know how to do so. Accept legitimate findings tentatively, contingent upon further confirmatory and expansionary research.
“Be skeptical. But when you get proof, accept proof.” ~Michael Specter
And lest we are misinterpreted, misquoted, or in any other way misrepresented, we also want to go on record as to what we don’t mean to say or imply:
- We are not saying to give every woo therapy “equal time” in the marketplace of ideas. Most ineffective alt-med therapies have been marginalized for good reason.
“The weight of evidence for an extraordinary claim must be proportioned to its strangeness.” ~ LaPlace
However, one must be intellectually nimble enough to give oneself cognitive wiggle room to entertain plausible possibilities and if the evidence warrants, one must accept the finding, no matter how unpalatable it might seem.
- We are not saying that coconut oil can treat candidiasis in humans. The research Stephanie was part of shows plausibility and justifies future study into the matter, possibly leading to research and clinical trials in humans. If those trials pass rigorous standards, there could even be a product developed for use in people, one that has gone through the proper channels to demonstrate safety and efficacy. And we can be relatively certain that should said product come to marketplace, it will not be just a matter of slamming down a few shots of coconut oil. Just as we take aspirin instead of chewing on willow bark and we take penicillin tablets instead of slurping down a petri dish full of mold, the active ingredient(s) in the coconut oil could be identified, purified, and standardized for maximum efficacy, safety, and quality control in manufacturing. But we’re getting way ahead of ourselves and we’ll cross that bridge if and when we get to it. In the meantime, if you read a report that claims that it is effective in humans, you can be assured that you are being quack’D.
With great power…
Sadly, but not surprisingly, the alt-medders have already seized this paper and are using it to tout it as a “natural” cure for “Candida overgrowth,” an alt-med term for the cause of almost all human ailments (including cancer). When they cite “a Tufts University study,” it adds unearned and undeserved legitimacy to their claims, which can deceive the non-SBM layperson. They are likely also using it to help sell their products on their woobsites. Unfortunately for Stephanie and her co-authors, their names will forever be cited in the alt-mediverse. Do not hold this against them.
Sometimes worlds do collide. There can be quite a bit of overlap between the “natural” medicine world and the “conventional” medicine one. However, all of it has to be vetted the same way and if it works, it’s medicine; if it doesn’t, it isn’t. It’s that simple. The easy thing for a person to do is to prejudge and to decide what is woo and what isn’t based upon preconceived notions, not evidence. We need to avoid that fallacy.
Stephanie Tornberg-Belanger has an educational and working background in animal sciences and health. Following years of nursing pets back to health, she entered research in a molecular microbiology lab to investigate the pathology of candidiasis in animal models. More recently, Stephanie completed an M.S. in microbiology focusing on detection of enteroviruses in surface waters and an M.P.H. at the University of New Hampshire. When not in the lab, Stephanie can be found working with undergraduate students as an adjunct lecturer or laboratory instructor/assistant.