What are the effects of coconut oil on cardiovascular health?

Coconut Oil and Cardiovascular Health

The current evidence does not support promoting coconut oil for cardiovascular health, and it should be limited in favor of oils with established cardiovascular benefits like extra-virgin olive oil, canola oil, or soybean oil. 1

Critical Evidence Gap

Long-term investigations are urgently needed to make evidence-informed decisions about avoiding or increasing use of tropical oils like coconut oil. 1 Little investigation has been done on the long-term health effects of coconut oil specifically, despite its saturated fat content and unique medium-chain fatty acid composition that could theoretically have health benefits. 1

Effects on Lipid Parameters

LDL and Total Cholesterol

• Coconut oil consistently raises total cholesterol and LDL cholesterol compared to cis-unsaturated plant oils (such as safflower, sunflower, or canola oil), though to a lesser extent than butter. 2, 3, 4
• The isocaloric replacement of carbohydrates with lauric acid (the predominant fatty acid in coconut oil) increases total cholesterol by 0.029 mmol/L and LDL-cholesterol by 0.017 mmol/L. 4
• Coconut oil consumption increases LDL-C and thereby could increase adverse cardiovascular health. 3

HDL and Triglycerides

• Coconut oil increases HDL cholesterol by 0.019 mmol/L, though the cardiovascular significance of HDL elevation remains controversial. 4, 5
• Triglyceride levels generally decrease with coconut oil consumption. 5

Current Clinical Recommendations

For Patients with Hypertriglyceridemia

• The American Heart Association and American College of Cardiology recommend limiting coconut oil in patients with hypertriglyceridemia as it is high in saturated fats. 6
• Patients with hypertriglyceridemia should be screened for consumption of foods high in saturated fats, including coconut oil. 6
• For persistent hypertriglyceridemia, replacing coconut oil with unsaturated plant oils like olive oil may be beneficial. 6

General Population

• Sufficient evidence to support strong promotion or avoidance of tropical oils is lacking. 1
• The current evidence supports generally increased consumption of vegetable oils (soybean, extra-virgin olive, and canola oil) in place of refined grains, starches, sugars, meats, butter, and lard—not coconut oil. 1
• Replacing saturated fats (including coconut oil) with cis-unsaturated fats would alter blood lipid profiles in a manner consistent with a reduction in cardiovascular disease risk factors. 2, 4

Important Nuances and Caveats

Processing Methods Matter

• The processing methods of coconut oil significantly affect its metabolic impact, with increasing processing associated with more adverse effects on cholesterol metabolism. 6
• Virgin coconut oil may have different effects than highly processed versions, though long-term cardiovascular outcome data are lacking. 6

Context of Traditional Diets

• Observational evidence from populations consuming coconut flesh or squeezed coconut in traditional dietary patterns (such as Pacific Islanders) does not show adverse cardiovascular outcomes. 2
• However, these findings cannot be applied to a typical Western diet due to large differences in dietary and lifestyle patterns. 2

Medium-Chain Triglycerides (MCTs)

• While coconut oil is marketed as an excellent source of MCTs, the clinical benefits of commercial MCT oils cannot be generalized to coconut oil. 3
• Modern nutritional science has demonstrated the limitations of drawing conclusions about health effects of any food based solely on theories about its nutrient contents. 1

Practical Clinical Approach

Until long-term effects of coconut oil on cardiovascular health are clearly established, coconut oil should be considered as a saturated fat and its consumption should not exceed the USDA's daily recommendation of less than 10% of total calorie intake. 3

• For cooking and dietary fat choices, prioritize extra-virgin olive oil, canola oil, or soybean oil over coconut oil. 1
• For patients with elevated cardiovascular risk or dyslipidemia, actively recommend replacing coconut oil with cis-unsaturated vegetable oils. 2, 4
• No randomized controlled trials or prospective cohort studies have investigated the effect or association of coconut oil with cardiovascular disease outcomes (mortality, myocardial infarction, stroke). 4