The document discusses the controversial relationship between dietary saturated fats, specifically coconut oil, and heart disease. Despite its high saturated fat content, coconut oil is suggested to have little impact on total cholesterol and may even improve cholesterol ratios beneficial for heart health. Epidemiological evidence indicates lower cardiovascular disease rates in populations consuming high amounts of coconut oil, suggesting potential protective effects despite conventional views on saturated fats.

1. FOR HEALTH PROFESSIONALS ONLY: For scientific and medical informational purposes.
Material not intended for Consumers
Coconut Oil and Heart Disease
by Dr. Alexander J. Rinehart, DC, MS, CCN, CNS
The association between dietary saturated fat and coronary heart disease has been
controversial, with reports consistently showing correlations between the two (1; 2). Dietary
saturated fats have been correlated with hypercholesterolemia, and hypercholesterolemia
has been correlated with increased cardiovascular mortality, but evidence directly linking
dietary saturated fat and mortality has been less clear (2; 3; 4; 5; 6; 7; 8; 9; 10).
For instance, total dietary fat and saturated fat intake may have a protective relationship
with stroke (11; 12); and, a 1994 article in Lancet demonstrated that the fatty acid
composition of plaque associated with arteriosclerosis is comprised of mostly unsaturated
fat (74%) (13).
Coconut oil is comprised of 64% medium chain saturated fatty acids, 28% long-chain
saturated fatty acids, 6% monounsaturated fats, and 2% polyunsaturated fats. Despite its
high saturated fat content, coconut oil has been shown to have little effecton total
cholesterol, and may improve total cholesterol (TC):high density lipoprotein (HDL) and
LDL:HDL (14; 15; 16; 17; 18). Authors attribute the positive cholesterol effectto a more
pronounced lipid-raising effecton HDLs than TC and LDL alone. Lauric acid, the primary
medium chain saturated fatty acid found in coconut oil has been proven to decrease
TC:HDL more so than other fatty acids studied (19).
While both animal and human studies have failed to find a definitive relationship between
coconut oil, saturated fats and abnormal lipids, the research suggests that the few studies
which have linked coconut oil to hyperlipidemia and hypercholesterolemia, used
hydrogenated coconut oil as the source of fat. When total fat as a percentage of diet is held
the same, higher intakes of coconut oil and saturated fats will lead to a relative deficiency in
essential fatty acids which may be the cause of high lipids and cholesterol seen in these few
studies (3; 14; 20; 21; 22). Some of the studies also used coconut oil intakes that are
unlikely to be consumed in everyday life (16; 17; 23). Additionally, the supportive effects of
short, medium, and long-chain saturated fats on HDL and key ratios such as TC:HDL have
been generally underappreciated in the research literature.
Positive changes in levels of other key risk factors for heart disease such as tissue
plasminogen activator antigen (t-PA) concentration - affecting fibrinolysis and lp(a) have
also been seen (24). Even though dietary intake of cholesterol has a small effecton
systemic levels, coconut oil contains only trace amounts of cholesterol (0-14 ppm),
compared to 3000 ppm cholesterol found in butter and lard (15).

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Ultimately, consumption of coconut oil and/or MCTs may yield a net protective effecton
overall risk of heart disease despite potential increases in total cholesterol and total LDL.
Coconut Oil Intake and Heart Disease
Sri Lanka, Polynesia, Philippines, Indonesia, and New Guinea have lower incidences of
cardiovascular disease compared to more developed countries even though they have the
highest consumption of coconut oil (1; 25; 26; 27).
While the prevalence of cardiovascular disease is rising in Sri Lanka and India (28; 29; 30),
a 1998 review in the Journal of the Indian Medical Association suggests that the increase
may be due to the recent dietary transition from ghee, coconut oil, and mustard oil to
polyunsaturated fats such as corn, sunflower, or safflower oils (4). It is estimated that while
total fat intake has remained the same in Sri Lanka, intake of fat from coconut decreased
25-30%. During this same period, deaths from cardiovascular disease increased (31). A
similar trend is occurring in Indonesia yet a correlation between dietary coconut and heart
disease has not been reported (32).
While controversy continues on the link between saturated fats (coconut-derived or
otherwise) and heart disease, the effectof lifestyle factors such intake of refined
carbohydrates (33), smoking and obesity may be more harmful and of more public concern
(5; 34; 35).
Other Proposed Cardiovascular Benefits of Coconut Oil
Due to their unique metabolism, the MCTs in coconut oil may also offer an energy source
that promotes general heart health, and may improve clinical symptoms of heart disease
such as cardiomyopathy (36).
Coconut MCTs may help improve lipids (37), oxidized LDLs (38), fat deposition (39; 40; 41),
triglycerides (42), and inflammation (43), while also raising HDLs as discussed previously
(44).
Coconut oil constituents may offer anti-microbial properties and support the immune
response to such infections. Low-grade bacterial and viral infections have also been
associated with coronary heart disease, particularly Helicobacterpylori (45), Chlamydia
pneumoniae and cytomegalovirus (46; 47) which may be inactivated by the medium chain
triglycerides and monoglycerides in coconut oil (48; 49).

3. 3
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