It is impossible to grow up in modern society without being bombarded with information about fats. Usually fats are portrayed as either “good fats” or “bad fats” and that changes according to any number of factors. Most people can tick off “saturated, unsaturated or polyunsaturated, trans,” and maybe even “monosaturated” as types of fat and may even have some idea of whether they fall in the “good” or “bad” column, according to the latest news on the topic. “Essential fatty acids” or EFAs have made their way into popular parlance as these are touted for optimum health. What any of this means to a person depends largely on their state of health, the emphasis their doctor places on nutrition, and frankly, on what each person wants to eat.
Eggs and butter are usually held up as examples of how medical opinion can change drastically. Once considered heart-killers and responsible for many health woes, new research indicates that as part of a healthy diet both eggs and butter can not only be OK for the body, but preferable to some substitutes. Some people are still told to avoid these due to their bodies’ over-production of cholesterol, but on the whole such fats have been vindicated when used in moderation.
No matter how knowledgeable one is on this topic, when the subject veers into the area of chain length, people are left scratching their heads. Nutrition labels list the kinds of fat in a product, but never the chain length. So, families with both medium-chain disorders and long-chain disorders may feel like they have hit a brick wall concerning nutritional information.
Long-chain fats are most common. From butter to solid shortening to dairy products to nearly every commercially produced and packaged item such as cookies or even frozen foods, long-chain fatty acids predominate. For someone with a long-chain FAOD the grocery store is a minefield. Those with medium-chain disorders are similarly challenged because as coconut and palm oils (the predominant sources for medium-chain fats) are stable at room temperatures, they are often used in many snack foods and even in health foods. Many products feature both types of fats.
The FAOD patient, or his or her family, must begin to think of fats in a new way. No longer can they ask themselves simply, “Is this a good monosaturated fat?” Now they must consider chain length as well as how much of any particular fat is in an item. While long-chain disorder patients are typically cautioned against consuming any of these fats, they are encouraged to consume coconut oil, usually in the form of medium-chain triglycerides, or MCT oil, a purified product made from coconut oil. Other foods have some medium-chain fat in them, notably walnuts and avocados, but these are paired with long-chain fats as well, making them off-limits for almost all FAOD patients.
Those with MCAD are usually told to keep their diets low in all fats but to avoid any MCTs. Those with long-chain disorders are usually told to supplement with MCTs to make up for the fats they are missing. So, a new way of thinking about fats is required.
Most FAOD families will have a genetic nutritionist as part of their medical team so little detail will be given here regarding specific diets for any FAOD. However, all must keep in mind that both the type of fat and the amount will matter. A good practice is to read all of every label on any processed food. Some helpful nutrition websites are listed in Part III that can provide information on specific foods.