Would you be able to advise the common foods that a person with MCADD should avoid consuming? My understanding is that coconut and palm kernel oil are the big ones, but some sources seem to interchange palm oil and palm kernel oil; however, I believe their fatty acid profiles are quite different (palm oil having trace amounts of medium chain fats but palm kernel oil having quite a large proportion). That said, I might be best placed to discuss with a dietician so if you could recommend one I’d appreciate it. We have talked to some in our area but I haven’t come across one who really seems to understand the MCADD condition well. Assuming a person follows a heart healthy diet, do you see a scenario where you don’t have to avoid any specific fats? Or would you still avoid the ones note above?
Where my questions are really stemming from is that I have a daughter (5 years old) with MCADD and to date we’ve actively avoided coconut and palm/palm kernel oil (I do believe palm oil is ok but I worry about a potential mislabeling risk between palm and palm kernel oil). She’s at a point where she understands the condition she has but can get frustrated or feel left out when we say she can’t eat certain things. Do you think I am right to approach it this way? Would I be ok to stop doing this and instead place more focus on the heart healthy balance of macronutrients?
I just don’t want to cause her anymore stress than MCADD might give her growing up and so if I can give her this freedom of choice, with a healthy nutritional balance, I think it could help ease the burden of the disease she is starting to feel.
Thanks very much!
This is a good question. The short answer is we do not know; the studies have not been done, especially in MCADD.
However, lets look at what we do know. I could not find the fatty acid break down of palm kernel oil but coconut oil is 6.26 gm medium chain fatty acids of 11.5 gm total fatty acids in a 1 tbsp. Or about 55% of the fat in coconut oil is medium chain fatty acids. I think you can safely assume that other tropical oils are similar – palm or palm kernel oil. So yes – it contains oils that she cannot readily metabolize. The goal in restricting medium chain fatty acids is to keep her medium chain fatty acid product – the C8, C10 or C12 acylcarnitine low or closer towards normal. We do not know if eating a little medium chain fats raises C8 acylcarnitine or if elevated C8 acylcarnitine has any negative health consequences. Elevated C8 acylcarnitine is not associated with increased risk of hypoglycemia.
Clear here to read a paper that looks at changes in acylcarnitines with overnight fasting and moderate exercise of patients with long-chain disorders. By far, the biggest thing that drives a rise in acylcarnitines is prolonged fasting and the best way to suppress acylcarnitines is small frequent meals. I believe that total energy, consumed in small frequent meals is probably far more important than restricting the medium chain fat intake by a few grams (what she might consume in a few products that contain tropical oils). I would say focus on healthy small frequent meals and don’t worry about small amounts of tropical oils. That may be contrary to the advice you get from other RDs. I base that on the data we and other have collected in other FAODs. There is no study that has looked at the impact of small amounts of tropical oil intake on biochemical or clinical outcomes in patients with MCADD.
Melanie Gillingham, PhD,RD
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