Dietary medium chain triglycerides for management of epilepsy: New data from human, dog, and rodent studies

Abstract

Many studies show that glucose metabolism in epileptic brain areas can be impaired. Energy is crucial to maintain normal brain function, including ion and neurotransmitter balances. Energy deficits can lead to disruption of ion gradients, which can trigger neuronal depolarization and generation of seizures. Thus, perturbed metabolic processing of glucose in epileptogenic brain areas indicates a specific nutritional need for people and animals with epilepsy, as they are likely to benefit from auxiliary brain fuels other than glucose. Ketogenic diets provide the ketone bodies acetoacetate and β‐hydroxybutyrate, which can be used as auxiliary fuel by the brain. In approximately 50% children and adults with certain types of epilepsy, who can tolerate and maintain these dietary regimens, seizure frequency can be effectively reduced. More recent data demonstrate that addition of medium chain triglycerides (MCTs), which provide the medium chain fatty acids octanoic and decanoic acid, as well as ketone bodies as auxiliary brain energy, can be beneficial in rodent seizure models, and dogs and humans with epilepsy. Here, this evidence is reviewed, including tolerance in 65% of humans, efficacy studies in dogs, possible anticonvulsant mechanisms of actions of MCTs, and specifically decanoic acid as well as metabolic and antioxidant mechanisms. In conclusion, MCTs are a promising adjunct to standard pharmacological treatment for both humans and dogs with epilepsy, as they lack central nervous system side effects found with current antiepileptic drugs. There is now a need for larger clinical trials in children, adults, and dogs to find the ideal composition and doses of MCTs and the types of epilepsy that respond best.

Cross Sectional Survey of Canine Idiopathic Epilepsy Management in Primary Care in the United Kingdom

“…Participants from small animal primary care were more likely to recommend medium chain triglyceride supplements than those from mixed primary care practice. There is some evidence to support the use of medium chain triglycerides as a dietary supplement in drug resistant cases of canine IE (35)(36)(37)(38). There was a small decrease in seizure frequency of some dogs in a recent randomized controlled trial (37).…”

“…While dietary manipulation is commonplace by owners of dogs with IE (two thirds of owners changed the diet following IE diagnosis in one study (37) it is important that dogs with IE are fed a high-quality diet due to the long-term nature of management (37)(38)(39). A low-calorie diet is often necessary to maintain a healthy body weight in dogs with IE and long-term ASD treatment (38). Medium chain triglyceride oils may be high in fat and powders may be high in carbohydrates.…”

Evaluation of the Effect of Different Dietary Lipid Sources on Dogs’ Faecal Microbial Population and Activities

“…These triglycerides have been suggested for companion animals with lipid digestion problems and poor physical condition. Furthermore, Han et al [ 4 ] recently indicated medium-chain triglycerides as an auxiliary treatment for humans, rodents, and dogs with epilepsy. Indeed, these triglycerides provide additional energy in the central nervous system by compensating for the lack of energy due to current antiepileptic drugs.…”

Oral Palatability Testing of a Medium-Chain Triglyceride Oil Supplement (MCT) in a Cohort of Healthy Dogs in a Non-Clinical Setting

“…This supports its more frequent use in small animal nutrition. As MCT oil has been shown to be a useful adjunct in the nutritional management of a number of different conditions in dogs, including epilepsy [14,31] and cognitive dysfunction [17,32], MCT is still a promising nutritive component and should be further explored for its effects on other diseases in companion animals.…”