Lauric Acid: The history of an apparently essential saturated fat.

What Is the Current Use of Lauric-rich Diets as Antiviral Modalities for Adjunct Nutrition Support in HIV?

Except for the use of commercially available enteral feeding supplements (e.g., Ensure-type liquids) that utilize medium-chain triglyceride (MCT) oils, and one enteral product (Impact®, Sandoz Nutrition) that contains palm kernel oil as part of its structured lipid, novel or unusual dietary treatments related to fats in the diet appear not to have been systematically investigated for HIV adjunct treatment, although there is a substantial research supporting their potential. At least one of the commercial lipid formulas (High MCT Supplement®, Corpak, Inc.) is based on coconut oil. This product is listed as an incomplete medical food in tables of enteral formulas and does not appear to have been utilized in treatment of AIDS patients.

The American Foundation for AIDS Research (AMFAR) did a preliminary review of the antiviral lipid monolaurin in 1987 but did not pursue this adjunct treatment modality (AMFAR office, personal communication 1994). Also in 1987, an alternative medical journal published an extensive discussion of the properties and clinical use of monolaurin. However, as noted above, the review by Raiten(6) did not indicate use of or knowledge of monolaurin.
Most dietary recommendations published for HIV+/AIDS patients are directed at prevention of weight loss. All the diets currently being formally recommended by the professional dietetic groups, government agencies, or organizations involved in support for individuals with AIDS are structured from foods that are missing lauric acid. Thus any benefit that might accrue to an individual who is HIV+ or has AIDS, from the substantial utilization of lauric acid-rich foods, is missing.

The potential benefits that can be derived from feeding antimicrobial lipids need to be investigated in humans on a systematic basis, the lauric oils need to be made more readily available in the general food supply, and the rationale for use of these lipids needs to be explained to the food and nutrition professionals as well as the medical and lay community.
Loss of lauric acid from the American diet
Increasingly, over the past 40 years, the American diet has undergone major changes. Many of these changes involve changes of fats and oils. There has been an increasing supply of the partially hydrogenated trans-containing vegetable oils and a decreasing amount of the lauric acid-containing fats and oils. As a result of these shifts in fats usage, there has been an increased consumption of trans fatty acids and linoleic acid and a decrease in the consumption of lauric acid. There has also been a decrease in some of the other antimicrobial fatty acids. This type of change in the diet has an important effect on the fatty acids the body has available for its metabolic activities.

The lipid coated (envelop) viruses are dependent on host lipids for their lipid constituents. Given this fact, it becomes important to evaluate the variability of the fatty acids in an individual patient’s diet, since such variability is reflected in the changes in the lipid membrane of the virus envelop, leads to the variability of glycoprotein expression, and plays a role in the aspects of mutation that interfere with successful vaccine development.
Lauric Acid Intake in Selected Asian Countries

Based on the per capita intake of coconut oil in 1985 as reported by Kaunitz, the per capita daily intake of lauric acid can be approximated. For those major producing countries such as the Philippines, Indonesia, and Sri Lanka, and consuming countries such as Singapore, the daily intakes of lauric acid were approximately 7.3 grams (Philippines), 4.9 grams (Sri Lanka), 4.7 grams (Indonesia), and 2.8 grams (Singapore). In India, intake of lauric acid from coconut oil in the coconut growing areas (e.g., Kerala) range from about 12 to 20 grams per day , whereas the average for the rest of the country is less than half a gram. An average high of approximately 68 grams of lauric acid is calculated from the coconut oil intake previously reported by Prior et al in 1981 for the Tokelau Islands. Other coconut producing countries may also have intakes of lauric acid in the same range.
Lauric Acid Intake in the U.S.

In the United States today, there is very little lauric acid in most of the foods. During the early part of the 20th Century and up until the late 1950s many people consumed heavy cream and high fat milk. These foods could have provided approximately 3 grams of lauric acid per day to many individuals. In addition, desiccated coconut was a popular food in homemade cakes, pies and cookies, as well as in commercial baked goods, and 1-2 tablespoons of desiccated coconut would have supplied 1-2 grams of lauric acid. Those foods made with the coconut oil based shortenings would have provided additional amounts. Until two years ago, some of the commercially sold popcorn, at least in movie theaters, had coconut oil as the oil. This means that for those people lucky enough to consume this type of popcorn the possible lauric acid intake was 6 grams or more in a three(3) cup order.
Some infant formulas (but not all) have been good sources of lauric acid for infants. However, in the past 3-4 years there has been reformulation with a loss of a portion of coconut oil in these formulas, and a subsequent lowering of the lauric acid levels. Only one U.S. manufactured enteral formula contains lauric acid (e.g., Impact®); this is normally used in hospitals for enteral tube feeding; it is reported to be very effective in reversing severe weight loss in AIDS patients , but it is discontinued when the patients leave the hospital because it is not sufficiently palatable for continued oral use (D.P. Kotler, private communication, 1995) The more widely promoted enteral formulas (e.g., Ensure®, Nutren®) are not made with lauric oils, and, in fact, many are made with partially hydrogenated oils.
There are currently some candies sold in the US that are made with palm kernel oil, and a few specialty candies made with coconut oil and desiccated coconut. These can supply small amounts of lauric acid. Cookies such as macaroons, if made with desiccated coconut, are good sources of lauric acid, supplying as much as 6 grams of lauric acid per macaroon (Red Mill Farm's Jennies Macaroons is apparently the only brand in the U.S. that supplies this amount). However, these cookies make up a small portion of the cookie market. Most cookies in the United States are no longer made with coconut oil shortenings; however, there was a time when many U.S. cookies (e.g., Pepperidge Farm) were about 25% lauric acid.
Originally, one of the largest manufacturers of cream soups used coconut oil in the soup formulations. Many popular cracker manufacturers also used coconut oil as a spray coating. These products supplied a small amount of lauric acid on a daily basis for some people.
Probable Levels of Lauric Acid Required For Antimicrobial Effect
Based on the amount of lauric acid found in human milk, which is known to be effective in its role as an antimicrobial component for the infant, the percent of calories that would be appropriate can be determined. For example, human milk provides at least 3.5% of calories as lauric acid for the human infant. Mature human milk has been noted to have up to 12% of the total fat as lauric acid (approximately 6.6% of calories. The upper end of this range represents approximately twice the amount of calories as lauric acid (i.e., 7% of calories) as does the minimum.

When developing lauric-rich diets for adults, one can use this range as the starting point for calculating the amount of lauric fat to be consumed. Based on the upper end of the range, we see that this would entail providing an adult consuming 3000 kilocalories a day with 52 grams of coconut oil (approximately 24 grams of lauric acid). This could be accomplished by use, for example, of two 250 ml cans of a calorically dense enteral formula (e.g., Carnation Nutren 2.0) if that product was made with full coconut oil. As it is, that product is made with MCT oil and corn oil and provides no lauric acid.
Lauric acid-rich diets can be developed readily for infants and children. For infants, a formula made with coconut oil that supplies at least 7% of the calories as lauric acid would be needed. When infants progress to solid food, these foods can be enriched with added coconut oil. Cereals and strained baby foods make ideal bases for 2-5 gram additions coconut oil (0.5-1.0 teaspoons). This would add approximately 1-2 grams of lauric acid. Children can utilize the same protocol as outlined for adults with alterations in the portions of food depending on the caloric needs of the child.