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Coconut oil: what do we really know about it so far?

Coconut oil: what do we really know about it so far? In recent years, coconut oil has emerged as a potential ‘miracle’ food. Some media vehicles and health specialists assure that this fat is capable of promoting health benefits, such as weight reduction, cholesterol lowering, prevention of cardiovascular diseases, and anti-inflammatory effect, among others. These claims are used to market the product and boost its sales by coconut oil companies. However, governmental regulatory agencies in many countries are still sceptical about the benefits obtained by the consumption of coconut oil due to its high-saturated fatty acid content. In light of such controversy, this review focused on analysing the published literature on the alleged health claims, in order to investigate if there is enough scientific evidence to support them. It was verified that the metabolism of lauric acid, the major fatty acid in coconut oil, remains unclear. Many studies reported that the product was not efficient in weight loss. Also, it has been reported that the consumption of coconut oil increased low-density lipoprotein cholesterol, consequently increasing the risk of cardiovascular diseases. In general, the studies present conflicting results and there is a lack of long-term human-based clinical trials. Therefore, as a saturated fat, coconut oil should be consumed with moderation and the health allegations should not be used to market the product, once they are not scientifically proven so far. Key words: lauric acid; saturated fatty acids; medium-chain triglycerides; LDL cholesterol; cardiovascular diseases. In recent years, coconut oil (CO), the main coconut product, Introduction has attracted the attention of the media and the population world- Coconut is one of the most important foods in some tropical and wide, especially in Europe and North America. Celebrities, digital subtropical countries, with the coconut tree being referred as the influencers, and even doctors have endorsed the use of this oil as ‘tree of life’. In such places, coconut and its products (milk and oil, a cooking media in substitution to other vegetable oils and as a among others) are used in daily life by the general population for sev- supplementary ingredient to be consumed with coffee and vitamin eral purposes, such as cooking, hair and skin treatment, food ingre- shakes. Blogs, internet videos, and articles are promoting the con- dient, and folk medicine (DebMandal and Mandal, 2011). This plant sumption of CO based on allegations that this product is capable of is cultivated in more than 90 countries, yielding a total production bringing several health benefits. These benefits include cholesterol- of 59 million tons in the year of 2016. The production of coconut is lowering effect, reduction of the risk of cardiovascular diseases heavily located in Asia, which was responsible for 83.8 per cent of (CVDs), weight loss, improvement of cognitive functions, action the world’s coconut production in 2016. In this same year, Indonesia was the largest coconut producer with 16.6 million tons, followed as an antimicrobial agent, and others (BBC News, 2018; Medical by the Philippines (14.1 million tons), India (9.8 million tons), Brazil News Today, 2018; New Straits Times, 2018; SBS, 2018; The Indian (2.5 million tons), and Sri Lanka (2.2 million tons) (Statista, 2018a). Weekender, 2018). © The Author(s) 2019. Published by Oxford University Press on behalf of Zhejiang University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by- nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Downloaded from https://academic.oup.com/fqs/article-abstract/3/2/61/5475954 by Ed 'DeepDyve' Gillespie user on 11 June 2019 62 R. da S. Lima and J. M. Block, 2019, Vol. 3, No. 2 Following this modern trend, the sales of this product have grown. medium-chain fatty acids (MCFAs) as a weight reduction agent. According to Statista (2018b), the consumption of CO in the USA MCFAs account for 62 per cent of CO’s fatty acid composition. The increased by 34 per cent from 2004 to 2014. Many of the CO brands EFSA panel concluded that there is not enough evidence in human market their product based on the supposed health benefits promoted intervention studies to support that MCFAs show a positive effect in by its consumption. In their labels, we can find allegations such as ‘good weight management. The statement concludes that this specific alle- for cooking’ (iHerb, 2018a, iHerb, 2018d, eVitamins, 2018; Piping gation is weak and not convincing (EFSA, 2011). Rock, 2018; Lucky Vitamin, 2018a), ‘one of nature’s healthiest cooking In Brazil, the fourth largest CO producer, the Brazilian Society oils’ (iHerb, 2018b), and ‘easy digestion, generating quick energy, of endocrinology and metabolism (SBEM) and the Brazilian helping the protection and equilibrium of our organism’ (Americanas, Association for the Study of Obesity and Metabolic Syndrome 2018; Natumesa, 2018; Lucky Vitamin, 2018b; Lucky Vitamin, 2018c; (ABESO) have also issued a position on the use of CO as a weight iHerb, 2018c). Some labels may even suggest the consumption of loss agent. Both health agencies support that there is not conclusive one tablespoon once to three times a day with a meal (iHerb, 2018b; scientific evidence about this topic. Therefore, the use of CO should iHerb, 2018c); others affirm that the consumption of CO is capable be restricted. SBEM and ABESO also do not recommend CO as a of reducing cholesterol levels and the risk of a heart attack, besides of cooking media due to its high-saturated fatty acid composition. On aiding in weight reduction (QualiCôco, 2018; iHerb, 2018c). the other hand, unsaturated vegetable oils such as soybean oil, olive At the same time, CO has also been attracting attention from the oil, and canola oil are recommended to diminish the risk of CVDs scientific community with an exponential growth of scientific articles (SBEM and ABESO, 2015). on CO through the years (Figure 1). The scientific evidence on the supposed benefits of CO should However, the health-promoting effects of CO are far from be examined and more information should reach the population. In reaching a consensus. This may be attributed to the product’s this review, the chemistry and the processing, as well as the published majorly saturated nature, with about 90 per cent of saturated data on the major and minor health claims attributed to CO by the fatty acids in its composition. The excessive ingestion of saturated media, the general public, and the manufacturing companies are fatty acids has been positively correlated with the increase of low- presented and discussed. density lipoprotein (LDL) cholesterol, with consequent development of CVDs (Eyres et  al., 2016). The US Department of Agriculture History of CO (USDA) recommends that the daily intake of saturated fat should not surpass 10 per cent of the total calories (USDA, 2015). Likewise, the In the late 19th century, the demand for edible oils was increasing World Health Organization (WHO) also recommends limiting the in Europe and in the USA. At the same time, in tropical countries intake of saturated fat to a maximum of 10 per cent of the daily total such as India, the Philippines, and Malaysia, among others, CO had calories (World Health Organization, 2018). On the other hand, the already encountered many uses in folk medicine and as a cooking European Food Safety Authority (EFSA), which does not specify a oil. Once Europeans became aware of the utilization of CO and its limit for the ingestion of saturated fat, recommends that the intake several applications, they started establishing coconut plantations in of saturated fat should be as low as possible (EFSA, 2017). the Caribbean, Southeast Asia, and the South Pacific from the 1890s The American Heart Association, specifically for coconut fat, to the 1920s. After that, CO became an edible oil very popular in does not recommend its consumption above the limit established by European countries and in the USA (Cassiday, 2015). the USDA for saturated fat intake (Sacks et al., 2017; USDA, 2015). The first CO boom lasted until the World War II started Considering that the fatty acid profile of CO is majorly composed of (around 1940), when the supply of the product was cut off to the saturated fatty acids, the consumption of this fat at the established 10 West countries and a CO shortage took place. As a result, its price per cent limit in a 2000 kcal diet means that the subject would ingest skyrocketed while the soy industry began to expand and develop, an amount of approximately 24 g of saturated fat on a daily basis. which was made possible by the modern technology employed in As the USDA and the American Heart Association, the EFSA these oils’ processing (Oils and Fats International, 2018). Once the also have issued a scientific opinion on the specific claims about war was over, even though countries with high-coconut production Figure 1. Number of scientific papers about coconut oil through the years. (Scopus, 2018). Downloaded from https://academic.oup.com/fqs/article-abstract/3/2/61/5475954 by Ed 'DeepDyve' Gillespie user on 11 June 2019 Effects of coconut oil, 2019, Vol. 3, No. 2 63 tried to reintroduce its product in Western countries, CO was rejected Mesocarp and endocarp (husk and shell, respectively) are brown, this time due to its high-saturated fat content (AOCS, 2016). This re- fibrous, and thick (3–5 mm), whereas the testa is the thin brown layer jection was associated with the findings of epidemiological studies separating the kernel from the shell (Pradeepkumar et al., 2008). conducted by the American physiologist Ancel Keys, who, based The kernel is also known as the ‘meat’ of the coconut. It generates on such data, formulated a hypothesis of the association between most of the products such as milk, oil, and dried coconut, among the consumption of high-saturated fat with a high-blood choles- others. The kernel has a moisture content of approximately 50 per terol level and an increased development of CVDs (Cassiday, 2015). cent and it is frequently dried to a moisture content of 6%–8% for Keys formulated his scientific hypothesis based on the observation oil extraction purposes, with the dried kernel being denominated that well-fed American businessmen presented high rates of CVDs, as copra (Canapi et  al., 2005). There are basically two types of whereas people in post-war European countries facing shortage of CO—refined, bleached, and deodorized copra oil (RBDCO) and food showed decreased rates of CVDs. His hypothesis led to the de- virgin (VCO). Both RBDCO and VCO have similar fatty acids velopment of what would become one of Keys’ most relevant work: and triglycerides profile. On the other hand, virgin CO presents a The Seven Countries Study. This study described the lifestyle of the higher content of bioactive compounds such as vitamin E, sterols, population living in southern Italy, where the incidence of CVDs and polyphenols as refining removes a portion of these compounds was very low. This fact was attributed by Keys to the decreased in- (Marina et al., 2009). gestion of animal fat, which presents high level of saturated fat and The extraction of the CO is preceded by the drying step which cholesterol, and both factors were associated with the incidence of can be performed either by sun drying, direct-fire drying, or hot-air coronary heart diseases (Keys et al., 1984). drying. In the sun drying method, the kernels are placed under the The American Heart Association started in 1956, in parallel to sun for 6 to 8 days. In the direct-fire drying method, nuts are placed Key’s research, informing the population that large consumption of in a bamboo grill platform where heat is provided by the burning high-saturated fat foods, such as butter, lard, eggs, and beef could of coconut shells and husks. Finally, in hot-air drying, husks and increase the risk for CVDs. In addition, the American government shells are used as fuel. The process is conducted in a drying device launched a recommendation stating that adopting a low-fat diet was equipped with a steel plate bottom to isolate the kernels from getting necessary to prevent these diseases. in contact with the smoke generated by the fuel. After the drying In the following decades, an increased number of researches process, the kernel shrinks and separates from the shells (Canapi correlated CO with the raise in total serum cholesterol. However, et al., 2005). in most of these studies, subjects were exclusively fed with CO as a The obtained copra is flaked to increase the surface area and the fat source, whereas a control group would be fed with a vegetable flakes are cooked at 115°C for 20 min. Then, the material (with a oil such as soybean or corn. These studies were criticized because moisture content adjusted to 3%–4%) is fed to an expeller, for the CO lacks ω-3 fatty acids in its composition, and it could be another oil extraction. The copra cake usually presents an oil content of ap- possible explanation for the reported results (Heek and Zilversmit, proximately 7 per cent and an extraction using hexane as solvent 1991; Cox et  al., 1995). On the other hand, studies that used is performed, reducing the oil content of the cake to 3.5 per cent hydrogenated CO contained trans fatty acid as another possible (O’Brien, 2004). factor that could explain the negative results associated with the The oil extraction may also be performed using the fresh kernel. consumption of CO (Frantz and Carey, 1961; Huang et al., 1984). The advantage of the wet extraction is a superior quality of the Further studies on CO’s metabolism indicated that CO, like obtained oil, as well as the recovery of nutrients such as protein, other saturated fats, increases both high-density lipoprotein (HDL) carbohydrates, and vitamins. RBDCO is obtained by physical or and LDL cholesterol, also known as the ‘good and bad cholesterol’, chemical refining of the crude CO. This process is intended to remove respectively. However, the LDL particles raised by the consumption impurities that would make the product not suitable for human con- of these fats are large and buoyant, which are less related to coronary sumption and/or decrease its quality and shelf life. The substances diseases when compared with small and dense LDL particles (Katan removed in the refining process are free fatty acids, phosphatides, et al., 1994). metal irons, colour bodies, oxidation products, solid particles, and In the last decade, CO started to be massively advertized as a volatiles that cause undesirable flavours. After refining, the oil is healthier cooking oil alternative, changing the perception of the bleached and deodorized at 204–245°C (O’Brien, 2004). consumers. However, this notion was motived by a miscellany of As for VCO, in the wet extraction, the oil can be extracted dir- non-scientific information available on the internet. In addition, ectly from coconut milk. For this purpose, the oil-in-water emulsion countries with major production of coconut also have a participa- needs to be broken, which can be achieved by mechanical force (cen- tion in positively promoting CO due to economic reasons. Therefore, trifugation), fermentation, or even enzymatic extraction (Marina it is necessary to carefully analyse the chemical profile of CO and et  al., 2009). Regardless of the use of refining or not to obtain scientific evidence about its effects on health. the product, CO has a high concentration of saturated fatty acids compared with most of the vegetable oils and fats present in the diet. Table 1 shows the lipid profile of CO and some of the major oils and Processing and Lipid Profile of CO fats consumed in the diet. Although conventionally named as an oil, CO is actually a fat, The coconut tree (Cocos nucifera) belongs to the family Arecaceae once it is majorly composed by saturated fatty acids (92 per cent), and it is a tall palm typical of tropical and subtropical areas, growing from which 62 per cent corresponds to fatty acids with carbon up to 30 m, yielding up to 75 fruits per year with proper practices number between 8 and 12 (Eyres et  al., 2016). The proportion of and growing conditions. The origin of this plant is still a subject of saturated, monounsaturated, and polyunsaturated fatty acids in the debate, but the most accepted hypothesis is that the coconut tree was major oils and fats consumed in the diet can be observed in Figure 2. originated in the India–Indonesia region. Botanically, the coconut CO belongs to a unique group of fats named lauric oils, once fruit is considered a drupe, where the exocarp and endocarp surround lauric acid (12:0) is the major fatty acid present in its composition. a single shell of hardened endocarp containing a kernel inside. Downloaded from https://academic.oup.com/fqs/article-abstract/3/2/61/5475954 by Ed 'DeepDyve' Gillespie user on 11 June 2019 64 R. da S. Lima and J. M. Block, 2019, Vol. 3, No. 2 Table 1. Fatty acid profile and minor components of major vegetable oils. Fatty acid (%) CO* PKO* BPO* Butter SO* CNO* SFO* OO* Butyric C4:0 – – – 3.5 – – – – Caproic C6:0 0.5 – 0.3 1.4 – – – – Caprylic C8:0 7.8 3.3 4.9 1.7 – – – – Capric C10:0 6.7 3.4 4.6 2.6 – – – – Lauric C12:0 47.5 48.2 47.5 4.5 – – – – Myristic C14:0 18.1 16.2 19.0 14.6 – – – – Palmitic C16:0 8.8 8.4 8.0 30.2 10 4 5 16.5 Stearic C18:0 2.6 2.5 4.6 10.5 4 2 6 2.3 Palmitoleic C16:1 – – – 4 – – – 1.8 Oleic C18:1 6.2 15.3 14.5 23 23 61 30 66.4 Linoleic C18:2 1.6 2.3 5.4 3 51 21 59 16.4 α-Linolenic C18:3 – – – 1 7 11 – 1.6 C20:0 0.1 – 0.05 – – – – 0.43 C22:0 0.15 C20:1 traces – – – – – 0.3 Other – – – 5 1 – – Sterol composition (%) Cholesterol 1.8 4.6 1.4 98.8 1.0 – 0.35 0.25 Brassicasterol 0.45 – 0.15 – 0.15 12.5 0.1 0.05 Campesterol 7.2 23.1 18.2 – 20.0 31.5 10 2.0 Stigmasterol 10.5 11.2 8.9 – 17.5 0.5 9.5 2.0 β-sitosterol 35.2 56.1 51.1 – 54.6 52.0 60.5 77.5 D5-Avenasterol 27.8 1.4 18.6 – 2.8 1.5 4.2 9.0 D7-Stigmasterol 1.5 1.3 – – 3.3 – 15.5 0.25 D7-Avenasterol 1.5 2.5 0.7 – 2.8 – 4.7 – Other 14.1 – 0.95 1.2 – 2.0 – 8.9 Total sterols (ppm) 805 494.5 668 2150 2965 881 3495 100 Tocopherol and tocotrienol composition (ppm) α-tocopherol 8.5 98.5 – 16.5 180.5 148 675 99.0 β-tocopherol 5.5 117 – – 20 34.0 25.0 6.0 γ-tocopherol 7.0 263 – – 1244.5 538.5 25.0 11.0 δ-tocopherol – 61.5 – – 541 275 5.0 – α-tocotrienol 22.0 170 35.5 – 34.5 – – – β-tocotrienol – – – – – – – – γ-tocotrienol – 362 56.0 – 51.5 – – – δ-tocotrienol – 188.5 9.5 – – – – – (Adapted from Firestone, 2013; Sankararaman and Sferra, 2018; Derewiaka et al., 2011). * CO = coconut oil; PKO = palm kernel oil; BPO = babassu palm oil; SO = soybean oil; CNO = canola oil; SFO = sunflower oil; OO = olive oil. Palm kernel oil and babassu oil are also part of this group. Some of saturated fatty acids (93%–100%); therefore, this dosage researchers believe that lauric oils have unique properties, once they surpasses the recommended daily intake of saturated fat (around behave very differently in the metabolism compared with fats ma- 24–22 g). jorly composed by LCFA (Dayrit, 2014). Such differences will be A portion size of 100 g of CO contains 890 kcal and 82.5 g of addressed in the CO and weight loss section. saturated fat. Butter, lard, and palm oil present a much lower con- There is an ongoing debate whether the lauric acid should be centration of this type of fatty acid (51.2, 39, and 49  g, respect- classified as a MCFA or not. Some specialists classify MCFAs as ively) and fewer calories (717, 900, and 884 kcal, respectively) for having a chain length of 8 to 12 carbon atoms, whereas others de- the same portion size. In addition, CO lacks essential fatty acids, fine MCFAs as having 6 to 10 carbon atoms (Sankararaman and which are present in other vegetable oils used in cooking, such as Sferra, 2018). According to Scrimgeour (2005), fatty acids with a soybean oil (7 per cent linolenic acid and 51 per cent linoleic acid), chain length below 16 carbons are characterized as short-chain fatty flaxseed oil (53 per cent linolenic acid and 13 per cent linoleic acid), acids (SCFA) or MCFA. and canola oil (9.1 per cent linolenic acid and 18.6 per cent linoleic Commercial medium-chain triglyceride (MCT) oil is predomin- acid) (Mansor et  al., 2012). Also, compared with palm oil, CO is antly composed of caprylic acid, C8:0 (50%–80%) and capric acid, low on bioactive compounds. Crude palm oil contains a total ca- C6:0 (20%–50%). However, other combinations are also common. rotenoid content of 500–700  mg/l (Posada et  al., 2007), which is This product can be synthesized either by the hydrolyzation not present in virgin CO. Regarding vitamin E, virgin CO contains of MCFAs from coconut/palm kernel oil or by lipid structuring around 38 mg/kg (Mansor et al., 2012), whereas palm oil has 600– (Babayan, 1987). MCT oil is usually marketed as a supplement for 1260 mg/kg. However, α-tocopherol, which is the most biologically weight reduction, with a recommended daily dosage of 50–100 g active form of vitamin E, is higher in CO (40%–44% of total toc- (4–6 tablespoons) for improved gastrointestinal tolerance (Shah opherol content) than in palm oil (18%–21% of total tocopherol and Limketkai, 2017). However, this product is majorly composed content) (Posada et al., 2007; Mansor et al., 2012). Downloaded from https://academic.oup.com/fqs/article-abstract/3/2/61/5475954 by Ed 'DeepDyve' Gillespie user on 11 June 2019 Effects of coconut oil, 2019, Vol. 3, No. 2 65 Figure 2. Proportion of saturated, monounsaturated, and polyunsaturated fatty acids in the main fats and oil. From a biochemical standpoint, virgin CO is preferable to (Clegg, 2017). To elucidate the mechanisms involved in the absorp- RBDCO once it contains a higher amount of substances with anti- tion, digestion, and metabolism of fatty acids from CO, it is neces- oxidant properties. However, a diet based on CO as the major fat sary to review the different metabolic fates between long-, medium-, source would not contain fatty acids that are essential for humans and short-chain saturated fatty acids. In fats and oils, more than (linoleic and linolenic fatty acids). The lack of such fatty acids in the 95 per cent of fatty acids are present in the form of triglycerides diet can cause innumerous health problems such as skin conditions, (TAGs). However, they cannot be absorbed by the intestine in such dermartitis, poor wound healing, impaired growth, and increased state; therefore, they are partially hydrolysed by the action of acid- susceptibility to infections (Simopoulos, 2002). CO, due to its high stable gastric lipases in the stomach, providing diglycerides and free content of saturated fatty acids, is more resistant to oxidation and fatty acids. polymerization than unsaturated oils such as sunflower oil and olive The regiospecificity of the distribution of fatty acids are correlated oil. However, despite its saturated nature, the use of CO as a cooking with the form that each fatty acid will be absorbed. The hydrolysis oil should not be encouraged, once it exhibits a low smoking point promoted by lipases (especially pancreatic lipases) preferentially (171°C) and its use in continuous deep-frying leads to the pro- takes place at the sn-3 and sn-1 positions, respectively (Bracco, duction of carcinogenic substances, such as polycyclic aromatic 1994). This is due to the fact that the pancreatic lipase exhibits a hydrocarbons and aromatic amines. Oils with higher smoking points high affinity for short-chain saturated fatty acids (lower than 10 are preferred for deep drying, such as canola oil (238°C), corn oil carbons) located at the sn-3 and sn-1 positions, which accounts for (232°C), and soybean oil (238°C) (Srivastava et al., 2010). a higher activity of the enzyme and, consequently, better absorption Another problem with the continuous use of CO emerges from of such fatty acids. On the other hand, long-chain unsaturated fatty the fact that a large proportion of its fatty acid profile is made up acids (LCUFAs) have an increased bioavailability when located at of SCFA. Therefore, CO is more susceptible to undergo hydro- sn-2, which is also due to a higher activity of the pancreatic lipases. lytic rancidification than other fats. The liberation of free SCFAs In fact, this characteristic can be used as a strategy for structuration in the medium catalyses the reaction, accelerating the formation of lipids, where essential fatty acids, such as linoleic and linolenic of rancidity products, such as aldehydes and ketones, consequently acids, can be located at the sn-2 position in order to intensify their lowering the quality of the product (Oseni et al., 2017). bioavailability (Carnielli et al., 1995; Haumann, 1997). The products generated by the hydrolysis process enter the duo- denum, where the pancreatic lipases bind to the surface of remaining Health Claims: What Is Scientifically Proven TAGs along with co-lipases (a constituent of pancreatic juice) to con- and What Is Not tinue carrying out the digestion process. The continuous breaking Major claims down of TAGs results in sn-2-monoacylglycerols and free fatty CO and weight loss acids. The conversion of sn-2 to sn-1(3)-monoacylglycerols can CO has been heavily promoted as a weight reduction agent. The di- also take place, with further hydrolysis, resulting in glycerol and gestion mechanism of medium-chain saturated fatty acids (MCSFAs) free fatty acids. From this point on, the metabolic pathways in di- is the argument used to support this claim. According to this theory, gestion and absorption greatly differ between short- and medium- MCTs induces satiety, preventing the individual from overeating chain triglycerides, and LCT. This is due to the greater affinity that Downloaded from https://academic.oup.com/fqs/article-abstract/3/2/61/5475954 by Ed 'DeepDyve' Gillespie user on 11 June 2019 66 R. da S. Lima and J. M. Block, 2019, Vol. 3, No. 2 pancreatic lipases exhibit for SCFAs and MCFAs. Therefore, they are HDL-c, and LDL-c) of the subjects did not alter significantly during more likely to be broken into three fatty acids and glycerol (Mu and the experiment. However, the study was conducted for only 4 weeks; Høy, 2004). As for LCFAs, they are usually reesterified into LCTs therefore, it is not possible to draw a conclusion regarding the long- and, along with fat-soluble molecules, such as vitamins and choles- term effect of CO on such parameters. terol, are mixed with bile salts forming micelles. The contents present Valente et  al. (2018) evaluated the effects of the consumption in the micelles enter the enterocytes, where they are rearranged into of virgin coconut oil (VCO) on energy metabolism, serum triglycerides and packaged into chylomicrons (Mu and Høy, 2004). cardiometabolic risk markers, and subjective appetitive responses in Then, chylomicrons are transported through the blood plasma, 17 women aged between 19 and 42 years old with excess body fat and by the action of lipoprotein lipases (LLP), are partially digested, (>32 per cent). Subjects were given 25 ml of CO during breakfast, resulting in glycerol, free fatty acids, and chylomicron remnants. The whereas the control group received olive oil instead. No difference FFAs are absorbed by adipocytes, being once again restructured into in fasting metabolic rates was observed between the two groups. On triglycerides and stored. The glycerol and the chylomicron remnants the other hand, lower hunger suppression at 240  min, satiety, and are ultimately transported to the liver (Mu and Høy, 2004). total fullness were reported for the group of subjects who received On the other hand, short- and medium-chain saturated fatty VCO when compared with the group who received olive oil. Some acids, due to their smaller molecular weight, are hydrolysed faster limitations such as the fact that this was not a long-term study when compared with long-chain saturated fatty acids. Therefore, and the subjective method used to assess the research questions SCSFA and MCSFAs are not deposited in the adipose tissue, once (application of questionnaires to the subjects) were reported by the they are transported directly in the portal venous system to the liver, authors. bypassing the peripheral tissues. In addition, MCSFAs are able to Kinsella et al. (2017) also reported that CO promoted a smaller cross the mitochondrial membrane of the liver and muscle without satiety compared with the MCT oil composed of caproic (2 per the aid of the acylcarnitine transfer system, which makes them a cent), caprylic (50%–60%), capric (30%–45%), and lauric (3 per more readily available energy source (Dayrit, 2015). cent) acids. The authors administered a dosage of 25 g of the studied The problem with the assumption that CO aids to weight loss oils during breakfast to 24 men and 18 women, and assessed satiety relies on the fact that lauric acid is the major fatty acid encountered using a visual analog scale. In addition, the leftover from their lunch in CO (47.5 per cent). This fatty acid is present in much smaller meal were weighted to measure food intake. The MCT oil group amounts in MCT oil, which is used in the majority of scientific had a reduced food intake throughout the day compared with the researches. Moreover, the classification of lauric acid as a MCFA is CO group. Also, the MCT oil group reported the highest fullness still controversial, once clinical studies point out that only 20 to 30 perception as assessed by the visual analog scale. The exclusion of per cent of lauric acid is directly transported to the liver (Lockyer obese subjects, the high amount of fat administered, which does not and Stanner, 2016; Clegg, 2017; Sankararaman and Sferra, 2018). represent the reality of most of the population, and the awareness St-Onge and Jones (2003) reported that the consumption of of the participants about their food intake being measured were MCT oil by overweight men increased energy expenditure and some limitations of this study. Maher et al. (2017) reported similar decreased adiposity. The subjects were recruited based on a BMI results when studying the effect of CO in comparison with MCT between 25 and 31 kg/m , total cholesterol below 7.0 mmol/l, and oil on satiety and food intake of 15 healthy participants. MCT oil total triglyceride concentration below 3.0 mmol/l. Besides, the men showed a better response for fullness perception and food intake did not present cardiovascular disease, diabetes, hypertension, and when compared with CO. gastrointestinal disorders, nor were taking cholesterol-lowering In another similar study reported by LaBarrie and St-Onge medications. The diet consumed during the trial period consisted of (2017), corn oil and CO-enriched meals (dosage of 20  g) were 40 per cent of energy as fat, 55 per cent as carbohydrates, and 15 administrated to 15 obese adolescents aged 13–18 years old. They per cent as protein. The MCT oil used in this study was composed of observed that the thermogenesis and satiety were not increased in caproic (0.17 per cent), caprylic (36.95 per cent), capric (30.33 per the group that received CO. The authors concluded that more re- cent), lauric (3.61 per cent), myristic (1.06 per cent), palmitic (3.52 search is needed in order to investigate CO as a tool for weight man- per cent), palmitoleic (0.23 per cent), stearic (0.65 per cent), oleic agement. Clegg (2017) reviewed the existing literature linking CO (13.81 per cent), linoleic (4.62 per cent), linolenic (4.94 per cent), to weight loss and concluded that there is not enough scientific evi- and eicosanoic (0.05 per cent) fatty acids. dence to support that CO helps increase satiety and contributes to However, once the MCT oil used in the study contained only weight loss. The author also highlights the lack of long-term clinical 3.61 per cent of lauric acid, these results cannot be extrapolated to trials on this specific topic. CO, once both products are very different regarding the fatty acid Clinical trials studying the relationship between the consump- composition. Assunção et al. (2009) studied how the administration tion of CO and weight reduction are still scarce in the literature. of a daily dosage of 30  ml of either soybean oil or CO would The analysis of the existing data shows a lack of evidence that CO affect the biochemical and anthropometric profiles of 40 women may work as a weight loss agent. The few existing data are not suf- aged 20–40  years old presenting abdominal obesity. Both groups ficient to indicate that the metabolism may be accelerated through decreased energy intake and the amount of carbohydrate ingested the consumption of coconut nut. Also, due to the discrepant fatty during the 12 weeks the study was conducted. On the other hand, acid profile, MCT oil data are irrelevant to understand the digestion the consumption of protein and fibre increased while the ingestion behaviour of CO. Therefore, based on the current knowledge, the of lipids remained unaltered. The CO group exhibited a reduction allegations that CO aids to weight loss are unrealistic and unsup- in waste circumference, which was not observed for the soybean oil ported by scientific evidence. group. The benefit of CO in reducing the waste circumference was also observed by Liau et al. (2011). The authors reported that a daily CO in the reduction of cholesterol levels dosage of 30 ml of CO reduced an average of 2.86 cm in the waste Cholesterol is a lipid molecule synthesized by animal cells with the circumference of male subjects. The lipid profile (total cholesterol, primary function of structuring cell membranes, maintaining its Downloaded from https://academic.oup.com/fqs/article-abstract/3/2/61/5475954 by Ed 'DeepDyve' Gillespie user on 11 June 2019 Effects of coconut oil, 2019, Vol. 3, No. 2 67 integrity and fluidity. This substance also functions as a precursor Feranil et  al. (2011) conducted a cohort study about the rela- for the synthesis of steroid hormones, vitamin D, and bile acids. tionship between the intake of CO as a cooking oil for frying and Cholesterol is transported through the portal vein mainly by the ‘soutéing’ and the lipid profile of 1839 pre- and post-menopausal HDL and the LDL. HDL-c is often referred as ‘good cholesterol’, Filipino women aged between 35 and 69 years old. The average daily once it removes cholesterol from the peripheral vessels back intake of CO was 9.54 g. The post-menopausal women showed the to the liver for disposal, which is named reverse cholesterol highest intake level of CO and a lower HDL-c, higher total chol- transport (RCT). Additionally, it has been discussed that HDL also esterol, LDL-c, triglycerides, and total cholesterol:HDL ratio when exhibits antioxidant, anti-inflammatory endothelial/vasodilatory, compared with pre-menopausal women. Eyres et al. (2016) reported antithrombotic, and cytoprotective functions (Kosmas et al, 2018). that in the majority of the 21 studies evaluated in their review, CO is On the other hand, LDL, also known as ‘bad cholesterol’, can be more effective at increasing total cholesterol and LDL-c than unsat- a driving factor for the development of CVDs if they oxidize urated oils. On the other hand, this effect would be diminished when within the walls of arteries. Thus, maintaining higher HDL-c levels compared with butter. while keeping LDL-c low is recommended in order to avoid the The decrease in LDL-c and/or the increase in HDL-c promoted development of CVDs (Ganesan et al., 2017). by CO has also been reported. Cardoso et al. (2015) reported in a The effects of the consumption of CO on cholesterol levels vary study with 114 coronary heart disease patients a decrease of LDL-c from study to study and generate controversy, once the majority of and unaltered levels of total cholesterol and HDL-c in the blood both them are animal trials. Allan et  al. (2001) studied how the serum for the group consuming the control diet and the one consuming lipoprotein cholesterol and triglyceride concentrations of 30 pigs VCO. Chinwong et al. (2017) reported a randomized crossover trial were affected by the consumption of diets containing fish oil, milk to assess the effects of VCO consumption on the lipid profile of 32 fat, olive oil, and hydrogenated CO (at a 4 per cent concentration). healthy participants (age 18 to 25  years old). Fifteen millilitres of The study was conducted for 3 weeks and at the end of this period VCO twice a day were consumed by one of the groups, whereas the no significant difference in LDL-c levels was observed between the control group received a solution of carboxymethylcellulose 2 per groups consuming different oils. The authors reported that the cent. The VCO group showed a significant increase in the HDL-c groups of pigs consuming CO, milkfat, and olive oil showed a higher level (64.2  mg/dl) compared with the control group (59.0  mg/dl) HDL-c, with CO and milkfat also increasing the serum triglyceride after 8 weeks. The changes in total cholesterol, LDL-c, and trigly- concentration. The authors highlighted that the lipoprotein metab- ceride levels were not significant between the groups studied. olism is different between pigs and humans and for this reason the A neutral effect for CO on lipid parameters was reported by results may not be extrapolated to humans. Sabitha et al. (2009). They found that the consumption of CO and Nevin and Rajamohan (2004) found that VCO reduced total sunflower oil (13 to 20 per cent of the total calorie content in the cholesterol, triglycerides, phospholipids, LDL, and VLDL choles- diet) did not alter lipid parameters on normal and type 2-diabetic terol in Sprague–Dawley rats after 45  days when compared with subjects. Shedden (2017) reported a randomized double blind study RBDCO. On the other hand, HDL-c was increased and in vitro LDL for 8 weeks with 42 healthy adult men between 18 and 40 years old. oxidation was prevented in the group of animals fed with VCO. The results showed no changes in the levels of total, HDL, and LDL The authors concluded that the higher polyphenol content and cholesterol for supplementation either with capsules with 2 g of CO other minor components present in VCO were responsible for the or a placebo capsule of flour. observed effects. The effects of CO on reducing human cholesterol levels do not Dauqan et al. (2011) evaluated the effects of the supplementation have solid scientific support yet. The insufficient number of studies, in the diet of 15 per cent of CO, red palm olein, palm olein, and corn the small number of subjects, the short periods, and the different oil on the lipid profile of 66 Sprague Dawley male rats. The vegetable concentrations of CO in the diet in the studies performed contribute oils were supplemented for 4 and 8 weeks and a control group with for a lack of consistency among the results reported in the literature. no vegetable oil addition was also conducted. The group that was Since there is no consensus on the effects of CO intake on the health supplemented with CO and corn oil showed an increase in LDL-c of the population, the information conveyed in advertisements or and a decrease in HDL-c when compared with the control group. present in CO labels has no scientific support and may be considered After 8 weeks, total cholesterol and LDL-c levels did not present a misleading. significant difference between the diets supplemented with the vege- CO and the incidence of CVDs table oils and the control group. CVDs include a number of different conditions such as stroke, Other measurements besides the level of LDL-c may indicate hypertension, myocardial infarction, and congestive heart failure, increased risk of development of CVDs. Mangiapane et  al. (1999) among others. A combination of many factors may lead to the devel- reported the effects of CO and olive oil (150 g/kg diet) on athero- opment of these conditions, such as age, lifestyle, smoking, lacking sclerosis in Golden Syrian. The plasma LDL-c concentration and the of exercise, obesity, diabetes, and diet. Researchers and government extension of atherosclerotic lesions for the group consuming olive regulatory agencies have a special concern about CVDs once they oil were lower than the group consuming CO. After 16 weeks, lesion are responsible for over 40 per cent of deaths worldwide every year sizes doubled in rats fed with the CO diet. (Nabel, 2003). The American Heart Association estimates that in The few studies performed on human subjects also present the USA every 38  s a death occurs due to CVDs (American Heart conflicting conclusions. Cox et al. (1995) found that CO raised total Association, 2018). and LDL cholesterol compared with safflower oil in 28 individuals The development of CVDs may be heavily influenced by the with moderate hypercholesterolaemia, although butter had the consumption of foods capable of increasing serum cholesterol and highest effect between the three types of lipid sources studied. The blood pressure. This can also be a leading factor in the incidence authors reported that this result was expected due to the proportion of obesity and diabetes. An excessive amount of reactive oxygen of saturated fatty acids in CO in relation to predominantly species generated by the oxidative process can lead to atherosclerosis unsaturated oils. Downloaded from https://academic.oup.com/fqs/article-abstract/3/2/61/5475954 by Ed 'DeepDyve' Gillespie user on 11 June 2019 68 R. da S. Lima and J. M. Block, 2019, Vol. 3, No. 2 and other CVDs (Heistad et al., 2009). Therefore, the ingestion of was significantly better compared with the group fed with 10 per cent substances with radical scavenging capacity, such as polyphenols, of VCO. Similar results have been reported in the literature in animal carotenoids, tocopherols, and tocotrienols present in fruits, trials associating the VCO’s polyphenols to a reduction on the risk vegetables, and some oils and fats may help prevent CVDs. of CVD (Nevin and Rajamohan, 2008; Arunima and Rajamohan, Red palm oil is a rich source of carotenoids, specifically 2013; Nurul-Iman et  al., 2013; Arunima and Rajamohan, 2014; β-carotene. Vitamin E (tocopherols and tocotrienols) is also present Subermaniam et al., 2014; Kamisah et al., 2015). in high amounts in red palm oil as well as in soybean and canola oil On the other hand, Muthuramu et al. (2017) reported a higher (Posada et al., 2007). Olive oil is rich in monounsaturated and poly- mortality by cardiomyopathy for mice fed a diet containing 10 per unsaturated fatty acids, which are linked to cholesterol-lowering and cent of CO when compared with chow-fed mice. The myocardial anti-atherogenic effects, reducing the risk of CVD. Olive oil is also capillary density was lower and the oxidative stress was higher for the main source of hydroxytyrosol, a phenolic compound with anti- CO-fed group. The authors concluded that the daily consumption of oxidant properties. Other vegetable oils such as sunflower and soy- CO aggravates pressure overload-induced cardiomyopathy in mice. bean oil are also rich in polyunsaturated fatty acids and antioxidant Vijayakumar et al. (2016) studied how the administration of CO compounds. The consumption of different oils with this chemical and sunflower oil affected the cardiovascular risk factor in humans. profile has been associated with a decreased risk of CVD (Metcalf The trial was conducted with 100 patients in each group who also et  al., 2007; Guasch-Ferré et  al., 2014; Jones et  al., 2014; Covas received the standard medication. The oil intake was calculated to et al., 2015; Valderas-Martinez et al., 2016). meet the 15 per cent of the daily calories from fat. After a period of On the other hand, fats rich in saturated fatty acids are known 2 years, their lipid profile, antioxidant mechanism, and endothelial for increasing blood cholesterol, which is one of the prevalent causes function were analysed. No significant differences between the two of atherosclerosis, associated with an increased risk for coronary groups were observed. The authors concluded that such results were heart disease (Ganesan et al., 2017). Zhong et al. (2016) analysed the due to the fact that CO is predominantly composed of MCSFAs, influence of saturated fatty acids on the risk of coronary heart disease behaving differently from fats majorly composed of LCSFA. The in American men and women in two prospective longitudinal cohort limitations of this study include the low number of subjects and the studies. The 18 years study followed 115.782 healthy people (73 147 exclusion of CVD-free from the trial. women and 42 635 men). A higher consumption of lauric acid (12:0), Palazhy et  al. (2018) also reported the effects of the consump- myristic acid (14:0), palmitic acid (16:0), and stearic acid (18:0) was tion of CO compared with sunflower oil in coronary artery disease positively correlated with an increase in the risk of coronary heart patients in Kerala, India. A  total of 150 subjects consumed one of disease. The risk was significantly decreased when saturated fatty the two oils for a period of over 2 years. The lipid parameters such acids, especially palmitic acid, were replaced with polyunsaturated as TC, LDL-c, HDL-c, and oxidized LDL were evaluated and did not fatty acids, whole grain carbohydrates, and plant protein. differ significantly between the two groups. The limitations of this In recent years, the media and CO producers have linked the study that could have interfered with the results include the small consumption of CO to the prevention of CVDs (Sankararaman and number of subjects, uncontrolled conditions, and the use of lipid- Sferra). However, due to its majorly saturated structure, composed lowering medication by the patients. mainly by lauric and myristic acids, this claim should be carefully The few studies that have reported a cardioprotective effect for analysed. Vijayakumar et  al. (2016) reported a high incidence of VCO are predominantly animal trials. There is not enough informa- CVDs in the state of Kerala (India) where the population heavily tion on this topic as well as a lack of studies using human subjects. uses CO as a cooking medium. Therefore, it is still not possible to assume that the continuous con- Nevertheless, some studies investigate if VCO has a positive sumption of this fat may have an impact on diminishing the risk of effect on lowering the incidence of CVD due to its polyphenol com- CVDs. position. Famurewa and Ejezie (2018) isolated polyphenols from Minor claims virgin CO to verify their potential action against cadmium-induced dyslipidemia and oxidative stress in rats. The polyphenol extract CO and the prevention and treatment of Alzheimer’s disease used had a total phenolic content of 57.11 mg GAE/100 g of oil. The It has been reported that the MCTs of CO have a potential for pre- subjects were treated with VCO-polyphenols (10, 20, and 50 mg/kg vention and/or treatment of Alzheimer’s disease. The MCTs are body weight) for 2 weeks prior to the administration of Cd (5 mg/kg easily absorbed and metabolized by the liver and converted into ke- body weight). The Cd-control group (no polyphenols ingestion) tone bodies. Once ketone bodies are an alternative energy source for had their total cholesterol (TC), LDL-c, and VLDL-c significantly the brain, they might help improve the cognitive function (Fernando increased, whereas the HDL-c decreased. The administration of et al., 2015). VCO-polyphenols was capable of decreasing TC, VLDL-c, and Nafar and Mearow (2014) reported the effect of 2 g of VCO on LDL-c while increasing HDL-c, with the 50 mg/kg doses being the cortical neurons treated with amyloid-β (Aβ) peptide in vitro. VCO most efficient. This study showed that polyphenols present in VCO and Aβ-treated cell cultures showed a higher survival rate, and VCO could be a great source for the development of CVD-preventing also attenuated Aβ-induced mitochondrial alterations. In a study supplements. However, as VCO was not used as a whole product conducted by Nafar et al. (2017), the addition of VCO 24 h prior in the experiment, it cannot be said if the same effect would be to the application of Aβ led to the highest survival rate of neuron observed if VCO itself was administrated. cell cultures. The results indicated that the supplementation with CO Famurewa et al. (2018) studied the effect of the supplementation may be effective on the symptoms of the neurodegeneration, since its in the diet of 10 and 15 per cent of VCO in healthy rats on the lipid polyphenol content might promote neuronal health through antioxi- profile, hepatic antioxidant status, and cardiovascular risk indices dant mechanisms. over 5 weeks. The authors reported a reduction of TC, triglycerides, Yang et  al. (2015) reported that Alzheimer’s disease patients and LDL-c levels and an increase in the HDL-c for the groups of rats treated with daily doses of 40 ml/day of extra virgin CO improved fed with 10 and 15 per cent of VCO when compared with the control their cognitive status tested by the score MEC-WOLF. The results group. The performance of the group fed with 15 per cent of VCO were higher for women without diabetes mellitus type II and for Downloaded from https://academic.oup.com/fqs/article-abstract/3/2/61/5475954 by Ed 'DeepDyve' Gillespie user on 11 June 2019 Effects of coconut oil, 2019, Vol. 3, No. 2 69 severe patients. Since the studies on this topic are very scarce, there product. This kind of promotion should not be used, once it misleads is not enough scientific support for the claims associating CO the perception of the consumers. Also, the media should not take consumption with an improvement of the symptoms of Alzheimer’s. this matter lightly, once the very high intake of saturated fat has deleterious effects on health. CO and the anti-inflammatory effects From the two types of CO available, virgin CO seems to carry The potential anti-inflammatory properties of CO and its bioactive the greatest potential, once it presents polyphenols and a higher compounds have been investigated by Vysakh et al. (2014). A VCO- amount of vitamin E compared with RBDCO. However, more re- polyphenol extract (80  mg/kg) exhibited 74 per cent inhibition on search is needed, especially human trials, in order to verify how such adjuvant induced chronic model of inflammation and the antioxi- components can affect the health, and to establish the necessary dant enzymes were also increased on adjuvant-induced arthritis rats. dosage for these effects to take place. This study showed that VCO can be a source for the extraction of polyphenolic compounds for further development of nutraceuticals. Acknowledgements However, VCO per se was not used in the study; therefore, the results obtained cannot be extrapolated. We are grateful to the National Council of Technological and Scientific Intahphuak et  al. (2010) reported that a dosage of 4  mg/20 μl Development (CNPq) for granting a scholarship to Renan da Silva Lima. We also thank Guilherme Corrêa Danielski for proof-reading this article. of VCO showed moderate anti-inflammatory effects on ethyl phenylpropiolate-induced ear oedema in rats. However, the efficacy of VCO was not higher than the standard drug Indomethacin. Zakaria et al. (2011) showed an anti-inflammatory activity in an Conflict of interest statement acute inflammation model of VCO (dried and fermented) using in None declared. vivo models (Male Balb-C and Sprague–Dawley rats). Studies on this topic are still scarce and the anti-inflammatory effects of CO do not References have a solid scientific support yet. Allan,  F.  J., et  al. (2001). Serum lipoprotein cholesterol and triglyceride concentrations in pigs fed diets containing fish oil, milkfat, olive oil and CO and the antimicrobial effects coconut oil. Nutrition Research, 21: 785–795. The antimicrobial effects of CO are attributed to monolaurin, which American Heart Association. (2018). Heart Disease and Stroke Statistics is a monoglyceride formed by glycerol and lauric acid (Lieberman 2018  – At-a-Glance. https://www.heart.org/-/media/data-import/ et al, 2006). This compound is widely used as a food emulsifier and downloadables/heart-disease-and-stroke-statistics-2018---at-a-glance- also sold as a supplement. Strandberg et al. (2009) reported an in- ucm_498848.pdf. Accessed 18 September 2018. hibitory effect of monolaurin on Staphylococcus aureus in a human- Americanas. (2018). https://www.americanas.com.br/produto/38549885/ based study. Wang et al. (2014) reported the inhibition of monolaurin linho-lev-coconut-oil-1g-60caps?WT.srch=1&epar=bp_pl_00_go_ against Hilicobacter pylori added in a mouthwash solution. Since the todos-os-produtos_geral_gmv&gclid=CjwKCAjw7vraBRBbEiwA amount of monolaurin produced biologically after the consumption 4 W BO n 4r O o N C 8g r e vn s l Xq 4 t Z bp 7 J N5 r M K 80 _ lR 9 H 3G F N A _ of CO is still unknown, these results cannot be extrapolated and the bA y6BogLshIhoCLP A QA vD_BwE&opn=Y SMESP&selle rId=22839785000123. Accessed 30 July 2018. biological effect of the in vivo-produced monolaurin would need to American Oil Chemists’ association (AOCS). (2016). Coconut oil boom. be investigated. https://www.aocs.org/stay-informed/read-inform/featured-articles/ coconut-oil-boom-may-2016. Accessed 03 May 2018. Arunima, S., Rajamohan, T. (2013). Effect of virgin coconut oil enriched diet Conclusions on the antioxidant status and paraoxonase 1 activity in ameliorating The literature on the health benefits promoted by CO is still incon- the oxidative stress in rats - a comparative study. Food & Function, 4: clusive. Some studies about the impact of CO on human health, es- 1402–1409. pecially regarding weight loss, were able to obtain positive results; Arunima, S., Rajamohan, T. (2014). Influence of virgin coconut oil-enriched diet on the transcriptional regulation of fatty acid synthesis and oxida- however, the subjects’ diets were altered during the experiments, tion in rats – a comparative study. The British Journal of Nutrition, 111: increasing the level of fibre and protein and reducing the inges- 1782–1790. tion of carbohydrates. Therefore, it is not possible to isolate CO as Assunção,  M.  L., Ferreira,  H.  S., dos  Santos,  A.  F., Cabral,  C.  R. Jr, the single factor behind the increased satiety. 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Coconut oil: what do we really know about it so far?

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Oxford University Press
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© The Author(s) 2019. Published by Oxford University Press on behalf of Zhejiang University Press.
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2399-1399
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2399-1402
DOI
10.1093/fqsafe/fyz004
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Abstract

In recent years, coconut oil has emerged as a potential ‘miracle’ food. Some media vehicles and health specialists assure that this fat is capable of promoting health benefits, such as weight reduction, cholesterol lowering, prevention of cardiovascular diseases, and anti-inflammatory effect, among others. These claims are used to market the product and boost its sales by coconut oil companies. However, governmental regulatory agencies in many countries are still sceptical about the benefits obtained by the consumption of coconut oil due to its high-saturated fatty acid content. In light of such controversy, this review focused on analysing the published literature on the alleged health claims, in order to investigate if there is enough scientific evidence to support them. It was verified that the metabolism of lauric acid, the major fatty acid in coconut oil, remains unclear. Many studies reported that the product was not efficient in weight loss. Also, it has been reported that the consumption of coconut oil increased low-density lipoprotein cholesterol, consequently increasing the risk of cardiovascular diseases. In general, the studies present conflicting results and there is a lack of long-term human-based clinical trials. Therefore, as a saturated fat, coconut oil should be consumed with moderation and the health allegations should not be used to market the product, once they are not scientifically proven so far. Key words: lauric acid; saturated fatty acids; medium-chain triglycerides; LDL cholesterol; cardiovascular diseases. In recent years, coconut oil (CO), the main coconut product, Introduction has attracted the attention of the media and the population world- Coconut is one of the most important foods in some tropical and wide, especially in Europe and North America. Celebrities, digital subtropical countries, with the coconut tree being referred as the influencers, and even doctors have endorsed the use of this oil as ‘tree of life’. In such places, coconut and its products (milk and oil, a cooking media in substitution to other vegetable oils and as a among others) are used in daily life by the general population for sev- supplementary ingredient to be consumed with coffee and vitamin eral purposes, such as cooking, hair and skin treatment, food ingre- shakes. Blogs, internet videos, and articles are promoting the con- dient, and folk medicine (DebMandal and Mandal, 2011). This plant sumption of CO based on allegations that this product is capable of is cultivated in more than 90 countries, yielding a total production bringing several health benefits. These benefits include cholesterol- of 59 million tons in the year of 2016. The production of coconut is lowering effect, reduction of the risk of cardiovascular diseases heavily located in Asia, which was responsible for 83.8 per cent of (CVDs), weight loss, improvement of cognitive functions, action the world’s coconut production in 2016. In this same year, Indonesia was the largest coconut producer with 16.6 million tons, followed as an antimicrobial agent, and others (BBC News, 2018; Medical by the Philippines (14.1 million tons), India (9.8 million tons), Brazil News Today, 2018; New Straits Times, 2018; SBS, 2018; The Indian (2.5 million tons), and Sri Lanka (2.2 million tons) (Statista, 2018a). Weekender, 2018). © The Author(s) 2019. Published by Oxford University Press on behalf of Zhejiang University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by- nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Downloaded from https://academic.oup.com/fqs/article-abstract/3/2/61/5475954 by Ed 'DeepDyve' Gillespie user on 11 June 2019 62 R. da S. Lima and J. M. Block, 2019, Vol. 3, No. 2 Following this modern trend, the sales of this product have grown. medium-chain fatty acids (MCFAs) as a weight reduction agent. According to Statista (2018b), the consumption of CO in the USA MCFAs account for 62 per cent of CO’s fatty acid composition. The increased by 34 per cent from 2004 to 2014. Many of the CO brands EFSA panel concluded that there is not enough evidence in human market their product based on the supposed health benefits promoted intervention studies to support that MCFAs show a positive effect in by its consumption. In their labels, we can find allegations such as ‘good weight management. The statement concludes that this specific alle- for cooking’ (iHerb, 2018a, iHerb, 2018d, eVitamins, 2018; Piping gation is weak and not convincing (EFSA, 2011). Rock, 2018; Lucky Vitamin, 2018a), ‘one of nature’s healthiest cooking In Brazil, the fourth largest CO producer, the Brazilian Society oils’ (iHerb, 2018b), and ‘easy digestion, generating quick energy, of endocrinology and metabolism (SBEM) and the Brazilian helping the protection and equilibrium of our organism’ (Americanas, Association for the Study of Obesity and Metabolic Syndrome 2018; Natumesa, 2018; Lucky Vitamin, 2018b; Lucky Vitamin, 2018c; (ABESO) have also issued a position on the use of CO as a weight iHerb, 2018c). Some labels may even suggest the consumption of loss agent. Both health agencies support that there is not conclusive one tablespoon once to three times a day with a meal (iHerb, 2018b; scientific evidence about this topic. Therefore, the use of CO should iHerb, 2018c); others affirm that the consumption of CO is capable be restricted. SBEM and ABESO also do not recommend CO as a of reducing cholesterol levels and the risk of a heart attack, besides of cooking media due to its high-saturated fatty acid composition. On aiding in weight reduction (QualiCôco, 2018; iHerb, 2018c). the other hand, unsaturated vegetable oils such as soybean oil, olive At the same time, CO has also been attracting attention from the oil, and canola oil are recommended to diminish the risk of CVDs scientific community with an exponential growth of scientific articles (SBEM and ABESO, 2015). on CO through the years (Figure 1). The scientific evidence on the supposed benefits of CO should However, the health-promoting effects of CO are far from be examined and more information should reach the population. In reaching a consensus. This may be attributed to the product’s this review, the chemistry and the processing, as well as the published majorly saturated nature, with about 90 per cent of saturated data on the major and minor health claims attributed to CO by the fatty acids in its composition. The excessive ingestion of saturated media, the general public, and the manufacturing companies are fatty acids has been positively correlated with the increase of low- presented and discussed. density lipoprotein (LDL) cholesterol, with consequent development of CVDs (Eyres et  al., 2016). The US Department of Agriculture History of CO (USDA) recommends that the daily intake of saturated fat should not surpass 10 per cent of the total calories (USDA, 2015). Likewise, the In the late 19th century, the demand for edible oils was increasing World Health Organization (WHO) also recommends limiting the in Europe and in the USA. At the same time, in tropical countries intake of saturated fat to a maximum of 10 per cent of the daily total such as India, the Philippines, and Malaysia, among others, CO had calories (World Health Organization, 2018). On the other hand, the already encountered many uses in folk medicine and as a cooking European Food Safety Authority (EFSA), which does not specify a oil. Once Europeans became aware of the utilization of CO and its limit for the ingestion of saturated fat, recommends that the intake several applications, they started establishing coconut plantations in of saturated fat should be as low as possible (EFSA, 2017). the Caribbean, Southeast Asia, and the South Pacific from the 1890s The American Heart Association, specifically for coconut fat, to the 1920s. After that, CO became an edible oil very popular in does not recommend its consumption above the limit established by European countries and in the USA (Cassiday, 2015). the USDA for saturated fat intake (Sacks et al., 2017; USDA, 2015). The first CO boom lasted until the World War II started Considering that the fatty acid profile of CO is majorly composed of (around 1940), when the supply of the product was cut off to the saturated fatty acids, the consumption of this fat at the established 10 West countries and a CO shortage took place. As a result, its price per cent limit in a 2000 kcal diet means that the subject would ingest skyrocketed while the soy industry began to expand and develop, an amount of approximately 24 g of saturated fat on a daily basis. which was made possible by the modern technology employed in As the USDA and the American Heart Association, the EFSA these oils’ processing (Oils and Fats International, 2018). Once the also have issued a scientific opinion on the specific claims about war was over, even though countries with high-coconut production Figure 1. Number of scientific papers about coconut oil through the years. (Scopus, 2018). Downloaded from https://academic.oup.com/fqs/article-abstract/3/2/61/5475954 by Ed 'DeepDyve' Gillespie user on 11 June 2019 Effects of coconut oil, 2019, Vol. 3, No. 2 63 tried to reintroduce its product in Western countries, CO was rejected Mesocarp and endocarp (husk and shell, respectively) are brown, this time due to its high-saturated fat content (AOCS, 2016). This re- fibrous, and thick (3–5 mm), whereas the testa is the thin brown layer jection was associated with the findings of epidemiological studies separating the kernel from the shell (Pradeepkumar et al., 2008). conducted by the American physiologist Ancel Keys, who, based The kernel is also known as the ‘meat’ of the coconut. It generates on such data, formulated a hypothesis of the association between most of the products such as milk, oil, and dried coconut, among the consumption of high-saturated fat with a high-blood choles- others. The kernel has a moisture content of approximately 50 per terol level and an increased development of CVDs (Cassiday, 2015). cent and it is frequently dried to a moisture content of 6%–8% for Keys formulated his scientific hypothesis based on the observation oil extraction purposes, with the dried kernel being denominated that well-fed American businessmen presented high rates of CVDs, as copra (Canapi et  al., 2005). There are basically two types of whereas people in post-war European countries facing shortage of CO—refined, bleached, and deodorized copra oil (RBDCO) and food showed decreased rates of CVDs. His hypothesis led to the de- virgin (VCO). Both RBDCO and VCO have similar fatty acids velopment of what would become one of Keys’ most relevant work: and triglycerides profile. On the other hand, virgin CO presents a The Seven Countries Study. This study described the lifestyle of the higher content of bioactive compounds such as vitamin E, sterols, population living in southern Italy, where the incidence of CVDs and polyphenols as refining removes a portion of these compounds was very low. This fact was attributed by Keys to the decreased in- (Marina et al., 2009). gestion of animal fat, which presents high level of saturated fat and The extraction of the CO is preceded by the drying step which cholesterol, and both factors were associated with the incidence of can be performed either by sun drying, direct-fire drying, or hot-air coronary heart diseases (Keys et al., 1984). drying. In the sun drying method, the kernels are placed under the The American Heart Association started in 1956, in parallel to sun for 6 to 8 days. In the direct-fire drying method, nuts are placed Key’s research, informing the population that large consumption of in a bamboo grill platform where heat is provided by the burning high-saturated fat foods, such as butter, lard, eggs, and beef could of coconut shells and husks. Finally, in hot-air drying, husks and increase the risk for CVDs. In addition, the American government shells are used as fuel. The process is conducted in a drying device launched a recommendation stating that adopting a low-fat diet was equipped with a steel plate bottom to isolate the kernels from getting necessary to prevent these diseases. in contact with the smoke generated by the fuel. After the drying In the following decades, an increased number of researches process, the kernel shrinks and separates from the shells (Canapi correlated CO with the raise in total serum cholesterol. However, et al., 2005). in most of these studies, subjects were exclusively fed with CO as a The obtained copra is flaked to increase the surface area and the fat source, whereas a control group would be fed with a vegetable flakes are cooked at 115°C for 20 min. Then, the material (with a oil such as soybean or corn. These studies were criticized because moisture content adjusted to 3%–4%) is fed to an expeller, for the CO lacks ω-3 fatty acids in its composition, and it could be another oil extraction. The copra cake usually presents an oil content of ap- possible explanation for the reported results (Heek and Zilversmit, proximately 7 per cent and an extraction using hexane as solvent 1991; Cox et  al., 1995). On the other hand, studies that used is performed, reducing the oil content of the cake to 3.5 per cent hydrogenated CO contained trans fatty acid as another possible (O’Brien, 2004). factor that could explain the negative results associated with the The oil extraction may also be performed using the fresh kernel. consumption of CO (Frantz and Carey, 1961; Huang et al., 1984). The advantage of the wet extraction is a superior quality of the Further studies on CO’s metabolism indicated that CO, like obtained oil, as well as the recovery of nutrients such as protein, other saturated fats, increases both high-density lipoprotein (HDL) carbohydrates, and vitamins. RBDCO is obtained by physical or and LDL cholesterol, also known as the ‘good and bad cholesterol’, chemical refining of the crude CO. This process is intended to remove respectively. However, the LDL particles raised by the consumption impurities that would make the product not suitable for human con- of these fats are large and buoyant, which are less related to coronary sumption and/or decrease its quality and shelf life. The substances diseases when compared with small and dense LDL particles (Katan removed in the refining process are free fatty acids, phosphatides, et al., 1994). metal irons, colour bodies, oxidation products, solid particles, and In the last decade, CO started to be massively advertized as a volatiles that cause undesirable flavours. After refining, the oil is healthier cooking oil alternative, changing the perception of the bleached and deodorized at 204–245°C (O’Brien, 2004). consumers. However, this notion was motived by a miscellany of As for VCO, in the wet extraction, the oil can be extracted dir- non-scientific information available on the internet. In addition, ectly from coconut milk. For this purpose, the oil-in-water emulsion countries with major production of coconut also have a participa- needs to be broken, which can be achieved by mechanical force (cen- tion in positively promoting CO due to economic reasons. Therefore, trifugation), fermentation, or even enzymatic extraction (Marina it is necessary to carefully analyse the chemical profile of CO and et  al., 2009). Regardless of the use of refining or not to obtain scientific evidence about its effects on health. the product, CO has a high concentration of saturated fatty acids compared with most of the vegetable oils and fats present in the diet. Table 1 shows the lipid profile of CO and some of the major oils and Processing and Lipid Profile of CO fats consumed in the diet. Although conventionally named as an oil, CO is actually a fat, The coconut tree (Cocos nucifera) belongs to the family Arecaceae once it is majorly composed by saturated fatty acids (92 per cent), and it is a tall palm typical of tropical and subtropical areas, growing from which 62 per cent corresponds to fatty acids with carbon up to 30 m, yielding up to 75 fruits per year with proper practices number between 8 and 12 (Eyres et  al., 2016). The proportion of and growing conditions. The origin of this plant is still a subject of saturated, monounsaturated, and polyunsaturated fatty acids in the debate, but the most accepted hypothesis is that the coconut tree was major oils and fats consumed in the diet can be observed in Figure 2. originated in the India–Indonesia region. Botanically, the coconut CO belongs to a unique group of fats named lauric oils, once fruit is considered a drupe, where the exocarp and endocarp surround lauric acid (12:0) is the major fatty acid present in its composition. a single shell of hardened endocarp containing a kernel inside. Downloaded from https://academic.oup.com/fqs/article-abstract/3/2/61/5475954 by Ed 'DeepDyve' Gillespie user on 11 June 2019 64 R. da S. Lima and J. M. Block, 2019, Vol. 3, No. 2 Table 1. Fatty acid profile and minor components of major vegetable oils. Fatty acid (%) CO* PKO* BPO* Butter SO* CNO* SFO* OO* Butyric C4:0 – – – 3.5 – – – – Caproic C6:0 0.5 – 0.3 1.4 – – – – Caprylic C8:0 7.8 3.3 4.9 1.7 – – – – Capric C10:0 6.7 3.4 4.6 2.6 – – – – Lauric C12:0 47.5 48.2 47.5 4.5 – – – – Myristic C14:0 18.1 16.2 19.0 14.6 – – – – Palmitic C16:0 8.8 8.4 8.0 30.2 10 4 5 16.5 Stearic C18:0 2.6 2.5 4.6 10.5 4 2 6 2.3 Palmitoleic C16:1 – – – 4 – – – 1.8 Oleic C18:1 6.2 15.3 14.5 23 23 61 30 66.4 Linoleic C18:2 1.6 2.3 5.4 3 51 21 59 16.4 α-Linolenic C18:3 – – – 1 7 11 – 1.6 C20:0 0.1 – 0.05 – – – – 0.43 C22:0 0.15 C20:1 traces – – – – – 0.3 Other – – – 5 1 – – Sterol composition (%) Cholesterol 1.8 4.6 1.4 98.8 1.0 – 0.35 0.25 Brassicasterol 0.45 – 0.15 – 0.15 12.5 0.1 0.05 Campesterol 7.2 23.1 18.2 – 20.0 31.5 10 2.0 Stigmasterol 10.5 11.2 8.9 – 17.5 0.5 9.5 2.0 β-sitosterol 35.2 56.1 51.1 – 54.6 52.0 60.5 77.5 D5-Avenasterol 27.8 1.4 18.6 – 2.8 1.5 4.2 9.0 D7-Stigmasterol 1.5 1.3 – – 3.3 – 15.5 0.25 D7-Avenasterol 1.5 2.5 0.7 – 2.8 – 4.7 – Other 14.1 – 0.95 1.2 – 2.0 – 8.9 Total sterols (ppm) 805 494.5 668 2150 2965 881 3495 100 Tocopherol and tocotrienol composition (ppm) α-tocopherol 8.5 98.5 – 16.5 180.5 148 675 99.0 β-tocopherol 5.5 117 – – 20 34.0 25.0 6.0 γ-tocopherol 7.0 263 – – 1244.5 538.5 25.0 11.0 δ-tocopherol – 61.5 – – 541 275 5.0 – α-tocotrienol 22.0 170 35.5 – 34.5 – – – β-tocotrienol – – – – – – – – γ-tocotrienol – 362 56.0 – 51.5 – – – δ-tocotrienol – 188.5 9.5 – – – – – (Adapted from Firestone, 2013; Sankararaman and Sferra, 2018; Derewiaka et al., 2011). * CO = coconut oil; PKO = palm kernel oil; BPO = babassu palm oil; SO = soybean oil; CNO = canola oil; SFO = sunflower oil; OO = olive oil. Palm kernel oil and babassu oil are also part of this group. Some of saturated fatty acids (93%–100%); therefore, this dosage researchers believe that lauric oils have unique properties, once they surpasses the recommended daily intake of saturated fat (around behave very differently in the metabolism compared with fats ma- 24–22 g). jorly composed by LCFA (Dayrit, 2014). Such differences will be A portion size of 100 g of CO contains 890 kcal and 82.5 g of addressed in the CO and weight loss section. saturated fat. Butter, lard, and palm oil present a much lower con- There is an ongoing debate whether the lauric acid should be centration of this type of fatty acid (51.2, 39, and 49  g, respect- classified as a MCFA or not. Some specialists classify MCFAs as ively) and fewer calories (717, 900, and 884 kcal, respectively) for having a chain length of 8 to 12 carbon atoms, whereas others de- the same portion size. In addition, CO lacks essential fatty acids, fine MCFAs as having 6 to 10 carbon atoms (Sankararaman and which are present in other vegetable oils used in cooking, such as Sferra, 2018). According to Scrimgeour (2005), fatty acids with a soybean oil (7 per cent linolenic acid and 51 per cent linoleic acid), chain length below 16 carbons are characterized as short-chain fatty flaxseed oil (53 per cent linolenic acid and 13 per cent linoleic acid), acids (SCFA) or MCFA. and canola oil (9.1 per cent linolenic acid and 18.6 per cent linoleic Commercial medium-chain triglyceride (MCT) oil is predomin- acid) (Mansor et  al., 2012). Also, compared with palm oil, CO is antly composed of caprylic acid, C8:0 (50%–80%) and capric acid, low on bioactive compounds. Crude palm oil contains a total ca- C6:0 (20%–50%). However, other combinations are also common. rotenoid content of 500–700  mg/l (Posada et  al., 2007), which is This product can be synthesized either by the hydrolyzation not present in virgin CO. Regarding vitamin E, virgin CO contains of MCFAs from coconut/palm kernel oil or by lipid structuring around 38 mg/kg (Mansor et al., 2012), whereas palm oil has 600– (Babayan, 1987). MCT oil is usually marketed as a supplement for 1260 mg/kg. However, α-tocopherol, which is the most biologically weight reduction, with a recommended daily dosage of 50–100 g active form of vitamin E, is higher in CO (40%–44% of total toc- (4–6 tablespoons) for improved gastrointestinal tolerance (Shah opherol content) than in palm oil (18%–21% of total tocopherol and Limketkai, 2017). However, this product is majorly composed content) (Posada et al., 2007; Mansor et al., 2012). Downloaded from https://academic.oup.com/fqs/article-abstract/3/2/61/5475954 by Ed 'DeepDyve' Gillespie user on 11 June 2019 Effects of coconut oil, 2019, Vol. 3, No. 2 65 Figure 2. Proportion of saturated, monounsaturated, and polyunsaturated fatty acids in the main fats and oil. From a biochemical standpoint, virgin CO is preferable to (Clegg, 2017). To elucidate the mechanisms involved in the absorp- RBDCO once it contains a higher amount of substances with anti- tion, digestion, and metabolism of fatty acids from CO, it is neces- oxidant properties. However, a diet based on CO as the major fat sary to review the different metabolic fates between long-, medium-, source would not contain fatty acids that are essential for humans and short-chain saturated fatty acids. In fats and oils, more than (linoleic and linolenic fatty acids). The lack of such fatty acids in the 95 per cent of fatty acids are present in the form of triglycerides diet can cause innumerous health problems such as skin conditions, (TAGs). However, they cannot be absorbed by the intestine in such dermartitis, poor wound healing, impaired growth, and increased state; therefore, they are partially hydrolysed by the action of acid- susceptibility to infections (Simopoulos, 2002). CO, due to its high stable gastric lipases in the stomach, providing diglycerides and free content of saturated fatty acids, is more resistant to oxidation and fatty acids. polymerization than unsaturated oils such as sunflower oil and olive The regiospecificity of the distribution of fatty acids are correlated oil. However, despite its saturated nature, the use of CO as a cooking with the form that each fatty acid will be absorbed. The hydrolysis oil should not be encouraged, once it exhibits a low smoking point promoted by lipases (especially pancreatic lipases) preferentially (171°C) and its use in continuous deep-frying leads to the pro- takes place at the sn-3 and sn-1 positions, respectively (Bracco, duction of carcinogenic substances, such as polycyclic aromatic 1994). This is due to the fact that the pancreatic lipase exhibits a hydrocarbons and aromatic amines. Oils with higher smoking points high affinity for short-chain saturated fatty acids (lower than 10 are preferred for deep drying, such as canola oil (238°C), corn oil carbons) located at the sn-3 and sn-1 positions, which accounts for (232°C), and soybean oil (238°C) (Srivastava et al., 2010). a higher activity of the enzyme and, consequently, better absorption Another problem with the continuous use of CO emerges from of such fatty acids. On the other hand, long-chain unsaturated fatty the fact that a large proportion of its fatty acid profile is made up acids (LCUFAs) have an increased bioavailability when located at of SCFA. Therefore, CO is more susceptible to undergo hydro- sn-2, which is also due to a higher activity of the pancreatic lipases. lytic rancidification than other fats. The liberation of free SCFAs In fact, this characteristic can be used as a strategy for structuration in the medium catalyses the reaction, accelerating the formation of lipids, where essential fatty acids, such as linoleic and linolenic of rancidity products, such as aldehydes and ketones, consequently acids, can be located at the sn-2 position in order to intensify their lowering the quality of the product (Oseni et al., 2017). bioavailability (Carnielli et al., 1995; Haumann, 1997). The products generated by the hydrolysis process enter the duo- denum, where the pancreatic lipases bind to the surface of remaining Health Claims: What Is Scientifically Proven TAGs along with co-lipases (a constituent of pancreatic juice) to con- and What Is Not tinue carrying out the digestion process. The continuous breaking Major claims down of TAGs results in sn-2-monoacylglycerols and free fatty CO and weight loss acids. The conversion of sn-2 to sn-1(3)-monoacylglycerols can CO has been heavily promoted as a weight reduction agent. The di- also take place, with further hydrolysis, resulting in glycerol and gestion mechanism of medium-chain saturated fatty acids (MCSFAs) free fatty acids. From this point on, the metabolic pathways in di- is the argument used to support this claim. According to this theory, gestion and absorption greatly differ between short- and medium- MCTs induces satiety, preventing the individual from overeating chain triglycerides, and LCT. This is due to the greater affinity that Downloaded from https://academic.oup.com/fqs/article-abstract/3/2/61/5475954 by Ed 'DeepDyve' Gillespie user on 11 June 2019 66 R. da S. Lima and J. M. Block, 2019, Vol. 3, No. 2 pancreatic lipases exhibit for SCFAs and MCFAs. Therefore, they are HDL-c, and LDL-c) of the subjects did not alter significantly during more likely to be broken into three fatty acids and glycerol (Mu and the experiment. However, the study was conducted for only 4 weeks; Høy, 2004). As for LCFAs, they are usually reesterified into LCTs therefore, it is not possible to draw a conclusion regarding the long- and, along with fat-soluble molecules, such as vitamins and choles- term effect of CO on such parameters. terol, are mixed with bile salts forming micelles. The contents present Valente et  al. (2018) evaluated the effects of the consumption in the micelles enter the enterocytes, where they are rearranged into of virgin coconut oil (VCO) on energy metabolism, serum triglycerides and packaged into chylomicrons (Mu and Høy, 2004). cardiometabolic risk markers, and subjective appetitive responses in Then, chylomicrons are transported through the blood plasma, 17 women aged between 19 and 42 years old with excess body fat and by the action of lipoprotein lipases (LLP), are partially digested, (>32 per cent). Subjects were given 25 ml of CO during breakfast, resulting in glycerol, free fatty acids, and chylomicron remnants. The whereas the control group received olive oil instead. No difference FFAs are absorbed by adipocytes, being once again restructured into in fasting metabolic rates was observed between the two groups. On triglycerides and stored. The glycerol and the chylomicron remnants the other hand, lower hunger suppression at 240  min, satiety, and are ultimately transported to the liver (Mu and Høy, 2004). total fullness were reported for the group of subjects who received On the other hand, short- and medium-chain saturated fatty VCO when compared with the group who received olive oil. Some acids, due to their smaller molecular weight, are hydrolysed faster limitations such as the fact that this was not a long-term study when compared with long-chain saturated fatty acids. Therefore, and the subjective method used to assess the research questions SCSFA and MCSFAs are not deposited in the adipose tissue, once (application of questionnaires to the subjects) were reported by the they are transported directly in the portal venous system to the liver, authors. bypassing the peripheral tissues. In addition, MCSFAs are able to Kinsella et al. (2017) also reported that CO promoted a smaller cross the mitochondrial membrane of the liver and muscle without satiety compared with the MCT oil composed of caproic (2 per the aid of the acylcarnitine transfer system, which makes them a cent), caprylic (50%–60%), capric (30%–45%), and lauric (3 per more readily available energy source (Dayrit, 2015). cent) acids. The authors administered a dosage of 25 g of the studied The problem with the assumption that CO aids to weight loss oils during breakfast to 24 men and 18 women, and assessed satiety relies on the fact that lauric acid is the major fatty acid encountered using a visual analog scale. In addition, the leftover from their lunch in CO (47.5 per cent). This fatty acid is present in much smaller meal were weighted to measure food intake. The MCT oil group amounts in MCT oil, which is used in the majority of scientific had a reduced food intake throughout the day compared with the researches. Moreover, the classification of lauric acid as a MCFA is CO group. Also, the MCT oil group reported the highest fullness still controversial, once clinical studies point out that only 20 to 30 perception as assessed by the visual analog scale. The exclusion of per cent of lauric acid is directly transported to the liver (Lockyer obese subjects, the high amount of fat administered, which does not and Stanner, 2016; Clegg, 2017; Sankararaman and Sferra, 2018). represent the reality of most of the population, and the awareness St-Onge and Jones (2003) reported that the consumption of of the participants about their food intake being measured were MCT oil by overweight men increased energy expenditure and some limitations of this study. Maher et al. (2017) reported similar decreased adiposity. The subjects were recruited based on a BMI results when studying the effect of CO in comparison with MCT between 25 and 31 kg/m , total cholesterol below 7.0 mmol/l, and oil on satiety and food intake of 15 healthy participants. MCT oil total triglyceride concentration below 3.0 mmol/l. Besides, the men showed a better response for fullness perception and food intake did not present cardiovascular disease, diabetes, hypertension, and when compared with CO. gastrointestinal disorders, nor were taking cholesterol-lowering In another similar study reported by LaBarrie and St-Onge medications. The diet consumed during the trial period consisted of (2017), corn oil and CO-enriched meals (dosage of 20  g) were 40 per cent of energy as fat, 55 per cent as carbohydrates, and 15 administrated to 15 obese adolescents aged 13–18 years old. They per cent as protein. The MCT oil used in this study was composed of observed that the thermogenesis and satiety were not increased in caproic (0.17 per cent), caprylic (36.95 per cent), capric (30.33 per the group that received CO. The authors concluded that more re- cent), lauric (3.61 per cent), myristic (1.06 per cent), palmitic (3.52 search is needed in order to investigate CO as a tool for weight man- per cent), palmitoleic (0.23 per cent), stearic (0.65 per cent), oleic agement. Clegg (2017) reviewed the existing literature linking CO (13.81 per cent), linoleic (4.62 per cent), linolenic (4.94 per cent), to weight loss and concluded that there is not enough scientific evi- and eicosanoic (0.05 per cent) fatty acids. dence to support that CO helps increase satiety and contributes to However, once the MCT oil used in the study contained only weight loss. The author also highlights the lack of long-term clinical 3.61 per cent of lauric acid, these results cannot be extrapolated to trials on this specific topic. CO, once both products are very different regarding the fatty acid Clinical trials studying the relationship between the consump- composition. Assunção et al. (2009) studied how the administration tion of CO and weight reduction are still scarce in the literature. of a daily dosage of 30  ml of either soybean oil or CO would The analysis of the existing data shows a lack of evidence that CO affect the biochemical and anthropometric profiles of 40 women may work as a weight loss agent. The few existing data are not suf- aged 20–40  years old presenting abdominal obesity. Both groups ficient to indicate that the metabolism may be accelerated through decreased energy intake and the amount of carbohydrate ingested the consumption of coconut nut. Also, due to the discrepant fatty during the 12 weeks the study was conducted. On the other hand, acid profile, MCT oil data are irrelevant to understand the digestion the consumption of protein and fibre increased while the ingestion behaviour of CO. Therefore, based on the current knowledge, the of lipids remained unaltered. The CO group exhibited a reduction allegations that CO aids to weight loss are unrealistic and unsup- in waste circumference, which was not observed for the soybean oil ported by scientific evidence. group. The benefit of CO in reducing the waste circumference was also observed by Liau et al. (2011). The authors reported that a daily CO in the reduction of cholesterol levels dosage of 30 ml of CO reduced an average of 2.86 cm in the waste Cholesterol is a lipid molecule synthesized by animal cells with the circumference of male subjects. The lipid profile (total cholesterol, primary function of structuring cell membranes, maintaining its Downloaded from https://academic.oup.com/fqs/article-abstract/3/2/61/5475954 by Ed 'DeepDyve' Gillespie user on 11 June 2019 Effects of coconut oil, 2019, Vol. 3, No. 2 67 integrity and fluidity. This substance also functions as a precursor Feranil et  al. (2011) conducted a cohort study about the rela- for the synthesis of steroid hormones, vitamin D, and bile acids. tionship between the intake of CO as a cooking oil for frying and Cholesterol is transported through the portal vein mainly by the ‘soutéing’ and the lipid profile of 1839 pre- and post-menopausal HDL and the LDL. HDL-c is often referred as ‘good cholesterol’, Filipino women aged between 35 and 69 years old. The average daily once it removes cholesterol from the peripheral vessels back intake of CO was 9.54 g. The post-menopausal women showed the to the liver for disposal, which is named reverse cholesterol highest intake level of CO and a lower HDL-c, higher total chol- transport (RCT). Additionally, it has been discussed that HDL also esterol, LDL-c, triglycerides, and total cholesterol:HDL ratio when exhibits antioxidant, anti-inflammatory endothelial/vasodilatory, compared with pre-menopausal women. Eyres et al. (2016) reported antithrombotic, and cytoprotective functions (Kosmas et al, 2018). that in the majority of the 21 studies evaluated in their review, CO is On the other hand, LDL, also known as ‘bad cholesterol’, can be more effective at increasing total cholesterol and LDL-c than unsat- a driving factor for the development of CVDs if they oxidize urated oils. On the other hand, this effect would be diminished when within the walls of arteries. Thus, maintaining higher HDL-c levels compared with butter. while keeping LDL-c low is recommended in order to avoid the The decrease in LDL-c and/or the increase in HDL-c promoted development of CVDs (Ganesan et al., 2017). by CO has also been reported. Cardoso et al. (2015) reported in a The effects of the consumption of CO on cholesterol levels vary study with 114 coronary heart disease patients a decrease of LDL-c from study to study and generate controversy, once the majority of and unaltered levels of total cholesterol and HDL-c in the blood both them are animal trials. Allan et  al. (2001) studied how the serum for the group consuming the control diet and the one consuming lipoprotein cholesterol and triglyceride concentrations of 30 pigs VCO. Chinwong et al. (2017) reported a randomized crossover trial were affected by the consumption of diets containing fish oil, milk to assess the effects of VCO consumption on the lipid profile of 32 fat, olive oil, and hydrogenated CO (at a 4 per cent concentration). healthy participants (age 18 to 25  years old). Fifteen millilitres of The study was conducted for 3 weeks and at the end of this period VCO twice a day were consumed by one of the groups, whereas the no significant difference in LDL-c levels was observed between the control group received a solution of carboxymethylcellulose 2 per groups consuming different oils. The authors reported that the cent. The VCO group showed a significant increase in the HDL-c groups of pigs consuming CO, milkfat, and olive oil showed a higher level (64.2  mg/dl) compared with the control group (59.0  mg/dl) HDL-c, with CO and milkfat also increasing the serum triglyceride after 8 weeks. The changes in total cholesterol, LDL-c, and trigly- concentration. The authors highlighted that the lipoprotein metab- ceride levels were not significant between the groups studied. olism is different between pigs and humans and for this reason the A neutral effect for CO on lipid parameters was reported by results may not be extrapolated to humans. Sabitha et al. (2009). They found that the consumption of CO and Nevin and Rajamohan (2004) found that VCO reduced total sunflower oil (13 to 20 per cent of the total calorie content in the cholesterol, triglycerides, phospholipids, LDL, and VLDL choles- diet) did not alter lipid parameters on normal and type 2-diabetic terol in Sprague–Dawley rats after 45  days when compared with subjects. Shedden (2017) reported a randomized double blind study RBDCO. On the other hand, HDL-c was increased and in vitro LDL for 8 weeks with 42 healthy adult men between 18 and 40 years old. oxidation was prevented in the group of animals fed with VCO. The results showed no changes in the levels of total, HDL, and LDL The authors concluded that the higher polyphenol content and cholesterol for supplementation either with capsules with 2 g of CO other minor components present in VCO were responsible for the or a placebo capsule of flour. observed effects. The effects of CO on reducing human cholesterol levels do not Dauqan et al. (2011) evaluated the effects of the supplementation have solid scientific support yet. The insufficient number of studies, in the diet of 15 per cent of CO, red palm olein, palm olein, and corn the small number of subjects, the short periods, and the different oil on the lipid profile of 66 Sprague Dawley male rats. The vegetable concentrations of CO in the diet in the studies performed contribute oils were supplemented for 4 and 8 weeks and a control group with for a lack of consistency among the results reported in the literature. no vegetable oil addition was also conducted. The group that was Since there is no consensus on the effects of CO intake on the health supplemented with CO and corn oil showed an increase in LDL-c of the population, the information conveyed in advertisements or and a decrease in HDL-c when compared with the control group. present in CO labels has no scientific support and may be considered After 8 weeks, total cholesterol and LDL-c levels did not present a misleading. significant difference between the diets supplemented with the vege- CO and the incidence of CVDs table oils and the control group. CVDs include a number of different conditions such as stroke, Other measurements besides the level of LDL-c may indicate hypertension, myocardial infarction, and congestive heart failure, increased risk of development of CVDs. Mangiapane et  al. (1999) among others. A combination of many factors may lead to the devel- reported the effects of CO and olive oil (150 g/kg diet) on athero- opment of these conditions, such as age, lifestyle, smoking, lacking sclerosis in Golden Syrian. The plasma LDL-c concentration and the of exercise, obesity, diabetes, and diet. Researchers and government extension of atherosclerotic lesions for the group consuming olive regulatory agencies have a special concern about CVDs once they oil were lower than the group consuming CO. After 16 weeks, lesion are responsible for over 40 per cent of deaths worldwide every year sizes doubled in rats fed with the CO diet. (Nabel, 2003). The American Heart Association estimates that in The few studies performed on human subjects also present the USA every 38  s a death occurs due to CVDs (American Heart conflicting conclusions. Cox et al. (1995) found that CO raised total Association, 2018). and LDL cholesterol compared with safflower oil in 28 individuals The development of CVDs may be heavily influenced by the with moderate hypercholesterolaemia, although butter had the consumption of foods capable of increasing serum cholesterol and highest effect between the three types of lipid sources studied. The blood pressure. This can also be a leading factor in the incidence authors reported that this result was expected due to the proportion of obesity and diabetes. An excessive amount of reactive oxygen of saturated fatty acids in CO in relation to predominantly species generated by the oxidative process can lead to atherosclerosis unsaturated oils. Downloaded from https://academic.oup.com/fqs/article-abstract/3/2/61/5475954 by Ed 'DeepDyve' Gillespie user on 11 June 2019 68 R. da S. Lima and J. M. Block, 2019, Vol. 3, No. 2 and other CVDs (Heistad et al., 2009). Therefore, the ingestion of was significantly better compared with the group fed with 10 per cent substances with radical scavenging capacity, such as polyphenols, of VCO. Similar results have been reported in the literature in animal carotenoids, tocopherols, and tocotrienols present in fruits, trials associating the VCO’s polyphenols to a reduction on the risk vegetables, and some oils and fats may help prevent CVDs. of CVD (Nevin and Rajamohan, 2008; Arunima and Rajamohan, Red palm oil is a rich source of carotenoids, specifically 2013; Nurul-Iman et  al., 2013; Arunima and Rajamohan, 2014; β-carotene. Vitamin E (tocopherols and tocotrienols) is also present Subermaniam et al., 2014; Kamisah et al., 2015). in high amounts in red palm oil as well as in soybean and canola oil On the other hand, Muthuramu et al. (2017) reported a higher (Posada et al., 2007). Olive oil is rich in monounsaturated and poly- mortality by cardiomyopathy for mice fed a diet containing 10 per unsaturated fatty acids, which are linked to cholesterol-lowering and cent of CO when compared with chow-fed mice. The myocardial anti-atherogenic effects, reducing the risk of CVD. Olive oil is also capillary density was lower and the oxidative stress was higher for the main source of hydroxytyrosol, a phenolic compound with anti- CO-fed group. The authors concluded that the daily consumption of oxidant properties. Other vegetable oils such as sunflower and soy- CO aggravates pressure overload-induced cardiomyopathy in mice. bean oil are also rich in polyunsaturated fatty acids and antioxidant Vijayakumar et al. (2016) studied how the administration of CO compounds. The consumption of different oils with this chemical and sunflower oil affected the cardiovascular risk factor in humans. profile has been associated with a decreased risk of CVD (Metcalf The trial was conducted with 100 patients in each group who also et  al., 2007; Guasch-Ferré et  al., 2014; Jones et  al., 2014; Covas received the standard medication. The oil intake was calculated to et al., 2015; Valderas-Martinez et al., 2016). meet the 15 per cent of the daily calories from fat. After a period of On the other hand, fats rich in saturated fatty acids are known 2 years, their lipid profile, antioxidant mechanism, and endothelial for increasing blood cholesterol, which is one of the prevalent causes function were analysed. No significant differences between the two of atherosclerosis, associated with an increased risk for coronary groups were observed. The authors concluded that such results were heart disease (Ganesan et al., 2017). Zhong et al. (2016) analysed the due to the fact that CO is predominantly composed of MCSFAs, influence of saturated fatty acids on the risk of coronary heart disease behaving differently from fats majorly composed of LCSFA. The in American men and women in two prospective longitudinal cohort limitations of this study include the low number of subjects and the studies. The 18 years study followed 115.782 healthy people (73 147 exclusion of CVD-free from the trial. women and 42 635 men). A higher consumption of lauric acid (12:0), Palazhy et  al. (2018) also reported the effects of the consump- myristic acid (14:0), palmitic acid (16:0), and stearic acid (18:0) was tion of CO compared with sunflower oil in coronary artery disease positively correlated with an increase in the risk of coronary heart patients in Kerala, India. A  total of 150 subjects consumed one of disease. The risk was significantly decreased when saturated fatty the two oils for a period of over 2 years. The lipid parameters such acids, especially palmitic acid, were replaced with polyunsaturated as TC, LDL-c, HDL-c, and oxidized LDL were evaluated and did not fatty acids, whole grain carbohydrates, and plant protein. differ significantly between the two groups. The limitations of this In recent years, the media and CO producers have linked the study that could have interfered with the results include the small consumption of CO to the prevention of CVDs (Sankararaman and number of subjects, uncontrolled conditions, and the use of lipid- Sferra). However, due to its majorly saturated structure, composed lowering medication by the patients. mainly by lauric and myristic acids, this claim should be carefully The few studies that have reported a cardioprotective effect for analysed. Vijayakumar et  al. (2016) reported a high incidence of VCO are predominantly animal trials. There is not enough informa- CVDs in the state of Kerala (India) where the population heavily tion on this topic as well as a lack of studies using human subjects. uses CO as a cooking medium. Therefore, it is still not possible to assume that the continuous con- Nevertheless, some studies investigate if VCO has a positive sumption of this fat may have an impact on diminishing the risk of effect on lowering the incidence of CVD due to its polyphenol com- CVDs. position. Famurewa and Ejezie (2018) isolated polyphenols from Minor claims virgin CO to verify their potential action against cadmium-induced dyslipidemia and oxidative stress in rats. The polyphenol extract CO and the prevention and treatment of Alzheimer’s disease used had a total phenolic content of 57.11 mg GAE/100 g of oil. The It has been reported that the MCTs of CO have a potential for pre- subjects were treated with VCO-polyphenols (10, 20, and 50 mg/kg vention and/or treatment of Alzheimer’s disease. The MCTs are body weight) for 2 weeks prior to the administration of Cd (5 mg/kg easily absorbed and metabolized by the liver and converted into ke- body weight). The Cd-control group (no polyphenols ingestion) tone bodies. Once ketone bodies are an alternative energy source for had their total cholesterol (TC), LDL-c, and VLDL-c significantly the brain, they might help improve the cognitive function (Fernando increased, whereas the HDL-c decreased. The administration of et al., 2015). VCO-polyphenols was capable of decreasing TC, VLDL-c, and Nafar and Mearow (2014) reported the effect of 2 g of VCO on LDL-c while increasing HDL-c, with the 50 mg/kg doses being the cortical neurons treated with amyloid-β (Aβ) peptide in vitro. VCO most efficient. This study showed that polyphenols present in VCO and Aβ-treated cell cultures showed a higher survival rate, and VCO could be a great source for the development of CVD-preventing also attenuated Aβ-induced mitochondrial alterations. In a study supplements. However, as VCO was not used as a whole product conducted by Nafar et al. (2017), the addition of VCO 24 h prior in the experiment, it cannot be said if the same effect would be to the application of Aβ led to the highest survival rate of neuron observed if VCO itself was administrated. cell cultures. The results indicated that the supplementation with CO Famurewa et al. (2018) studied the effect of the supplementation may be effective on the symptoms of the neurodegeneration, since its in the diet of 10 and 15 per cent of VCO in healthy rats on the lipid polyphenol content might promote neuronal health through antioxi- profile, hepatic antioxidant status, and cardiovascular risk indices dant mechanisms. over 5 weeks. The authors reported a reduction of TC, triglycerides, Yang et  al. (2015) reported that Alzheimer’s disease patients and LDL-c levels and an increase in the HDL-c for the groups of rats treated with daily doses of 40 ml/day of extra virgin CO improved fed with 10 and 15 per cent of VCO when compared with the control their cognitive status tested by the score MEC-WOLF. The results group. The performance of the group fed with 15 per cent of VCO were higher for women without diabetes mellitus type II and for Downloaded from https://academic.oup.com/fqs/article-abstract/3/2/61/5475954 by Ed 'DeepDyve' Gillespie user on 11 June 2019 Effects of coconut oil, 2019, Vol. 3, No. 2 69 severe patients. Since the studies on this topic are very scarce, there product. This kind of promotion should not be used, once it misleads is not enough scientific support for the claims associating CO the perception of the consumers. Also, the media should not take consumption with an improvement of the symptoms of Alzheimer’s. this matter lightly, once the very high intake of saturated fat has deleterious effects on health. CO and the anti-inflammatory effects From the two types of CO available, virgin CO seems to carry The potential anti-inflammatory properties of CO and its bioactive the greatest potential, once it presents polyphenols and a higher compounds have been investigated by Vysakh et al. (2014). A VCO- amount of vitamin E compared with RBDCO. However, more re- polyphenol extract (80  mg/kg) exhibited 74 per cent inhibition on search is needed, especially human trials, in order to verify how such adjuvant induced chronic model of inflammation and the antioxi- components can affect the health, and to establish the necessary dant enzymes were also increased on adjuvant-induced arthritis rats. dosage for these effects to take place. This study showed that VCO can be a source for the extraction of polyphenolic compounds for further development of nutraceuticals. Acknowledgements However, VCO per se was not used in the study; therefore, the results obtained cannot be extrapolated. We are grateful to the National Council of Technological and Scientific Intahphuak et  al. (2010) reported that a dosage of 4  mg/20 μl Development (CNPq) for granting a scholarship to Renan da Silva Lima. We also thank Guilherme Corrêa Danielski for proof-reading this article. of VCO showed moderate anti-inflammatory effects on ethyl phenylpropiolate-induced ear oedema in rats. However, the efficacy of VCO was not higher than the standard drug Indomethacin. Zakaria et al. (2011) showed an anti-inflammatory activity in an Conflict of interest statement acute inflammation model of VCO (dried and fermented) using in None declared. vivo models (Male Balb-C and Sprague–Dawley rats). Studies on this topic are still scarce and the anti-inflammatory effects of CO do not References have a solid scientific support yet. Allan,  F.  J., et  al. (2001). Serum lipoprotein cholesterol and triglyceride concentrations in pigs fed diets containing fish oil, milkfat, olive oil and CO and the antimicrobial effects coconut oil. Nutrition Research, 21: 785–795. The antimicrobial effects of CO are attributed to monolaurin, which American Heart Association. (2018). Heart Disease and Stroke Statistics is a monoglyceride formed by glycerol and lauric acid (Lieberman 2018  – At-a-Glance. https://www.heart.org/-/media/data-import/ et al, 2006). This compound is widely used as a food emulsifier and downloadables/heart-disease-and-stroke-statistics-2018---at-a-glance- also sold as a supplement. Strandberg et al. (2009) reported an in- ucm_498848.pdf. Accessed 18 September 2018. hibitory effect of monolaurin on Staphylococcus aureus in a human- Americanas. (2018). https://www.americanas.com.br/produto/38549885/ based study. Wang et al. (2014) reported the inhibition of monolaurin linho-lev-coconut-oil-1g-60caps?WT.srch=1&epar=bp_pl_00_go_ against Hilicobacter pylori added in a mouthwash solution. Since the todos-os-produtos_geral_gmv&gclid=CjwKCAjw7vraBRBbEiwA amount of monolaurin produced biologically after the consumption 4 W BO n 4r O o N C 8g r e vn s l Xq 4 t Z bp 7 J N5 r M K 80 _ lR 9 H 3G F N A _ of CO is still unknown, these results cannot be extrapolated and the bA y6BogLshIhoCLP A QA vD_BwE&opn=Y SMESP&selle rId=22839785000123. Accessed 30 July 2018. biological effect of the in vivo-produced monolaurin would need to American Oil Chemists’ association (AOCS). (2016). Coconut oil boom. be investigated. https://www.aocs.org/stay-informed/read-inform/featured-articles/ coconut-oil-boom-may-2016. Accessed 03 May 2018. Arunima, S., Rajamohan, T. (2013). Effect of virgin coconut oil enriched diet Conclusions on the antioxidant status and paraoxonase 1 activity in ameliorating The literature on the health benefits promoted by CO is still incon- the oxidative stress in rats - a comparative study. Food & Function, 4: clusive. Some studies about the impact of CO on human health, es- 1402–1409. pecially regarding weight loss, were able to obtain positive results; Arunima, S., Rajamohan, T. (2014). Influence of virgin coconut oil-enriched diet on the transcriptional regulation of fatty acid synthesis and oxida- however, the subjects’ diets were altered during the experiments, tion in rats – a comparative study. The British Journal of Nutrition, 111: increasing the level of fibre and protein and reducing the inges- 1782–1790. tion of carbohydrates. Therefore, it is not possible to isolate CO as Assunção,  M.  L., Ferreira,  H.  S., dos  Santos,  A.  F., Cabral,  C.  R. Jr, the single factor behind the increased satiety. 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