The coconut oil - cholesterol relationship

Over the last decade, coconut oil has enjoyed increasingly popularity as the go-to healthy oil, with purported benefits ranging from burning belly fat, curbing appetite, decreasing inflammation, and improving glucose control. Recently, however, savvy consumers have had increasing concerns about how coconut oil increases cholesterol levels and, thus, their risk of heart disease. Let’s examine what coconut oil actually contains (is it really made up of medium-chain triglycerides?), how it affects our cholesterol levels, and if we should use it.

What fats are in coconut oil?

Coconut oil is comprised entirely of fat, about 90% of which is saturated fat.

Saturated fats are fully hydrogenated, which allows them to be tightly packed together, and thus solid at room temperature. The saturated fatty acid composition of coconut oil is about 50% lauric acid (a 12 carbon fatty acid - this will become relevant later, stick with me!), with myristic and palmitic acids (long-chain fatty acids) making up the majority of remainder fatty acids.

There are trace amounts of monounsaturated fat, polyunsaturated fat, vitamins, minerals, and plant sterols, but not in significant enough quantities to have much biological effect.

Does coconut oil raise LDL cholesterol?

Yes. A recent meta-analysis of 16 well conducted studies found that, compared with nontropical oils, coconut oil significantly increased LDL cholesterol by 10.5 mg/dl (about 8%) when used in cooking. Surprisingly, coconut oil also significantly increased LDL cholesterol compared to palm oil, another tropical oil high in saturated fat.

Only one trial compared coconut oil to butter, and interestingly, coconut oil did better than butter - so there’s that!

Elevated levels of LDL cholesterol are important because they cause heart disease by delivering cholesterol to the arteries, causing atherosclerosis. Read more about that here.

But doesn’t coconut oil have medium chain triglycerides?

This is actually really interesting.

Medium-chain fatty acids (MCTs) are processed by your body differently than long-chain fatty acids - they are rapidly absorbed by the portal circulation (going straight to your liver for energy usage) rather than being packaged into chylomicrons, which the typical delivery of fat in your intestine. Thus, true medium-chain fatty acids do not appear to have the same LDL cholesterol raising effects as other saturated fatty acids.

Medium-chain fatty acids chemically have 6 to 12 carbon atoms - caproic acid (6 carbons), caprylic acid (8 carbons), capric acid (10 carbons), and lauric acid (12 carbons). Recall that the predominant fatty acid in coconut oil is lauric acid. Lauric acid - while chemically classified as a medium-chain triglyceride - acts in our body much more like a long-chain fatty acid in that the majority gets packaged into chylomicrons and absorbed. Hence, the cholesterol raising effect seen.

It is worth nothing that MCT oil - which is what has been used in much of the prior research demonstrating possible health benefits - typically consists entirely of caprylic acid and capric acid, which are true MCTs. Not lauric acid. As such, none of that data should be extrapolated to coconut oil.

Does coconut oil reduce heart disease risk?

While LDL cholesterol is a very important, and causative risk factor for heart disease, it’s not the only risk factor for heart disease. It’s important to consider how coconut oil may reduce the risk of heart disease by affecting other pathways.

Unfortunately, we do not have any long-term randomized controlled trials looking at coconut oil ingestion and heart disease outcomes like heart attack.

There is some epidemiological data demonstrating that indigenous populations who consume coconut as part of their native diet in the Philippines and Polynesia have lower rates of heart disease. However, it is important to note that these populations do not consume coconut oil, but whole coconut or pressed coconut cream, as well as a diet that is otherwise very high in fiber (which lowers cholesterol) and low in processed foods. As a result, it’s very difficult to extrapolate how that might impact coconut oil consumption given we know that our bodies react differently to processed vs whole foods.

What about other risk factors? The same meta-analysis described above also took a look at those. They found that coconut oil consumption did not significantly affect markers of body fat, body weight, glucose control, or inflammation. Coconut oil, similar to other saturated fats, does raise “good” HDL cholesterol by 4 mg/dl - but as I discussed here, this cannot be thought of as reliably cardioprotective.

What about extra virgin or virgin coconut oil?

Extra virgin or virgin coconut oil is made by pressing fresh coconut meat. These terms are used interchangeably. It has been suggested that the polyphenols in unrefined coconut oil, like in extra virgin olive oil, may be beneficial for improving inflammation and glucose regulation.

Importantly, unlike extra virgin olive oil, use of these terms is not regulated.

What does the science say? Unfortunately, most studies do not report on the type of oil used. One small trial with virgin coconut oil found it significantly raised LDL cholesterol compared to safflower oil with no changes in body composition. Another trial of virgin coconut oil found no difference compared to extra virgin olive oil on blood lipids, blood pressure, or body composition. Studies demonstrating possible benefit are limited at this time to animal studies. As such, it’s difficult to draw a firm conclusion from these small studies, but current available evidence does not suggest it is significantly healthier.

So - is coconut oil healthy?

The purported health benefits seem to be overblown. The data is quite convincing that coconut oil, when used regularly in cooking, increasing LDL cholesterol significantly. We also do not have any other data at this time to suggest that coconut oil, not whole coconut, results in improved heart outcomes or any other major risk factors (like blood pressure, weight, inflammation, etc) to suggest that it is heart healthy. While using it occasionally for baking in the context of an otherwise healthy, plant based or plant predominant diet is unlikely to significantly alter your risk for heart disease, those with elevated cholesterol should be aware that it does increase LDL cholesterol and avoid as able. Ultimately, given there are other oils (such as extra virgin olive oil) with a wealth of data demonstrating improved heart health outcomes, it makes sense to stick to this (or no oil!) when possible. Personally, I use coconut oil when baking or reduced fat coconut milk in certain dishes, but rarely. It’s otherwise quite lovely when used topically for dry skin or diaper rash!

Interested in working with Dr Harkin on your personalized heart healthy plan?