Healthwise

Coconut, coconut oil and heart disease

Dr. D. P. Atukorale

There are various misconceptions regarding coconut, coconut oil and heart disease in Sri Lanka among laymen and doctors as a result of various newspaper articles and other publications on the subject. Sri Lankans who have been using coconut and coconut oil for over 1000 years are in a dilemma regarding the use of coconut in their daily diet.

Everyone of us have cholesterol in our blood and all the organs such as the brain, kidneys and liver. Cholesterol is essential for the functioning of all the cells in our body. Only man and animals have the power of manufacturing cholesterol most of which is produced in the liver. Plants do not have the capability of manufacturing cholesterol. So all oils of plant origin have no cholesterol. 70% of our cholesterol is manufactured in the liver and the rest is derived from our diet.

Types of cholesterol

There are two major types of cholesterol, the LDL cholesterol or bad cholesterol and the HDL or good cholesterol. When too much of saturated fats are consumed, the LDL increases making the person prone to atherosclerosis (thickening of arteries) and making the person more prone to heart attacks and strokes. On the other hand if you consume polyunsaturated oils in moderation the LDL level decreases making the person less prone to heart attacks and strokes. If large quantities of polyunsaturated oils and fats are consumed, the serum triglycerides which is another blood fat, increases and the HDL (good cholesterol) level decreases, making the person prone to heart attacks as both high triglycerides and low HDL are risk factors for heart attacks.

Coconut oil although it is a saturated oil has medium chain fatty acids unlike fatty acids found in meat, butter and cheese. Coconut oil is a neutral oil i.e. it neither elevates the serum cholesterol level nor does it reduce the serum cholesterol level.

Coconut oil, unlike other oils such as soya oil or corn oil and other polyunsaturated oils is highly resistant to oxidative rancidity and does not result in the formation of dangerous aldehydes and ketones on deep frying i.e. using the same oil repeatedly for frying. Polyunsaturated oils on the other hand when used for deep frying results in the production of aldehydes and ketones which are hazardous to health. So if you use corn oil or any other polyunsaturated oil for frying purposes it is advisable to throw it away after using once.

As far as I am aware there is no scientific evidence to show that coconut oil used in moderation results in elevating serum cholesterol level or production of atheroscleroses in man. The myth that coconut oil consumption elevates serum cholesterol in man is based on the research done by Ahren in 1957 using a small group of Bantu people in South Africa. These people were fed with large unphysiological amounts (100 g) of hydrogenated coconut fat and their blood was examined after 4 days and he found that the serum cholesterol level had gone up. As you may be aware hydrogenated coconut oil is more saturated than ordinary coconut oil and the essential fatty acids get destroyed by the process of hydrogenation. Other drawbacks in this experiment are.

(i) The number of people used is very small

(ii) If coconut oil was used for a few months the body would have adapted itself to this large quantity of coconut oil used and cholesterol level may have dropped as human body has vast powers of adaptation to changes in environment.

Nobody in any coconut producing country uses such large amounts of coconut as 100 g per day. It has been found that majority of people in rural areas of Sri Lanka consume 35 g of coconut fat per day.

Animal r esearch

Majority of research on coconut oil has been done using pigs, rabbits, rats, monkeys and dogs. In some experiments the cholesterol level has increased whereas in others cholesterol level has decreased. Very small number of animals such as 4 or 5 have been used and in some experiments majority of the animals have died due to essential fatty acid deficiency as hydrogenated coconut oil has been used. These animals were killed in a few days and the research workers did not find any evidence of atherosclerosis in their arteries.

Shanthi Mendis et al fed coconut diet to 32 rats who were killed in 3 1/2 months and found that there was no evidence of atherosclerosis in their coronary arteries. Mayor fed coconut oil to a few rabbits and found thickening of aorta in these animals but the coronary arteries were not affected.

Shanthi Mendis et al fed 22 men with typical Sri Lankans diet containing coconut milk and coconut oil and measured their serum cholesterol level in 6 weeks. The serum cholesterol level was 178 mg/dl (which is normal). She also used corn oil for the same men and found that the cholesterol level has come down to 146-13.4 mg/dl at the end of 6 weeks. Their lipid profile revealed that the reduction was at the expense of HDL (good cholesterol) which has decreased from 43.13 mg/dl to 25.43 mg/dl thereby causing LDL. HDL ratio to rise from 3.0:1 to 3.9:1 making them more susceptible to heart attacks. Thus substituting polyunsaturated fats for coconut oil carries a risk from the point of view of heart attacks.

In 1994 research work was done by Kurup and Rajmohan using 64 volunteers. They found, after 6 weeks, that there was a cholesterol lowering effect of using coconut kernal and coconut oil. Sindu Ram et al (1993) using 64 human volunteers found that consumption of coconut kernel and coconut oil produced a cholesterol lowering effect.

It has been found that in countries where people use coconut oil consumption of coconut oil has no relationship to occurrence of heart attacks. In Sri Lanka according to 1978 UN Demographic Year Book, coconut oil is the predominant dietary fat, the death rate due to ischaemic heart disease (IHD) is only 1 per 100,000 as against 16-187 per 100,000 in other countries with little coconut consumption.

The National Nutrition Survey carried on in Philippines showed that cardiovascular morality is not related to coconut consumption. Bicol region which has the highest coconut oil consumption in Philippines is the lowest in terms of IHD whereas Metro Manila where the consumption of coconut oil is the lowest in Philippines has the highest heart attack morality.

People in Kerala State which had the highest coconut oil consumption in India in 1979 had the lowest incidence of heart attacks k(2.3 per 1000). As a result of sustained campaign against coconut oil, coconut oil was substituted by various vegetable oils including palm oil, and coconut oil consumption was reduced and heart attack rate showed a three fold increase during 1993 showing that coconut oil increase could not have been the cause of increased incidence of heart attacks.

The incidence of heart attacks among Nicobar Islanders in India is very low in spite of the fact that their staple food comprised mainly raw coconut and coconut products (Thampan 1975). Coconut and coconut oil is the main fat consumed by majority of Sri Lankans especially the rural people who comprise 70% of our population who derive a significant portion of their calories from coconut fat. It has been shown that rural folk get about 35g of fat from coconut and oil. These people do not consume much animal fat such as beef, mutton, pork, eggs, butter and cheese and their heart attack rate is very low compared to that of people in urban areas.

Vitamin A

For absorption of vitamin A, you need fats in your diet. IF we advise our rural people to give up coconut and coconut oil, there will be an epidemic of vitamin A deficiency among rural people as they cannot afford to buy corn oil and other polyunsaturated oils.

From our clinical experience we know that cholesterol level of rural people is low and their incidence of heart attacks is low in spite of coconut and coconut oil consumption. Coconut and coconut oil has been used by Sri Lankans for over 1000 years and our admission rate for heart attacks was 57.3 in 1970 and this has gone up to 213.9 in 1992 in spite of reduction in our consumption of coconuts. Coconut consumption has come down from 132 nuts per person per year in 1952 to 90 nuts per person in 1991 according to central bank statistics. Thus the present epidemic of heart attacks does not appear to be due to coconut and coconut oil consumption.

Then what are the causes of the recent epidemic of heart attacks in Sri Lanka, in spite of reduced consumption of coconut. The important risk factors for the recent increase in incidence of heart attacks in Sri Lanka are heavy smoking, hypertension, diabetes, stress, lack of exercise and consumption of high fat diet consisting of meat, eggs and dairy products.

There does not appear to be any relationship between coconut oil and cholesterol or coconut oil and heart disease.

Extensive training a must for medical practitioners

Suharshi PERERA

Mental health is an integrated component of the health services. Sri Lanka can improve and deal with mental disorders at the early stage by integrating mental health into the general healthcare system, says Director of Institute for Research and Development Consultant Psychiatrist Dr. Athula Sumathipala.

In Sri Lanka, mental disorders are mostly prevalent among elders and the prime reason being mental health is associated with other chronic diseases like diabetes which pop up later in life. Therefore, it is important that medical practitioners are well trained in the aspect of detecting mental disorders, he observed.

"They are already trained but the healthcare system should pay attention to provide extensive training to them so that patients of chronic diseases with mental disorders can be detected and treated promptly," he said.

Life issues, retirement could be some of other reasons why mental disorders are more prevalent among the elderly population. Due to social stigma, the cases of mental disorder go unrecognized. That's why general and specialized medical doctors should be trained to detect patients with symptoms of mental disorders. So that they can be treated at the early stage, he added.According to the Islandwide Mental Health Survey commissioned by the Health Ministry in 2007, Moneragala and Puttalam districts recorded the maximum number of cases of mental disorders. The survey included 6,000 community samples and 4,000 schoolchildren. However, North and East provinces were not included in the survey.

Among the findings of the survey, major depression is 2.1 percent, mild and moderate depression is eight percent, medically unexpected symptoms three percent, anxiety eg disorder is one percent and post-somatic stress disorder 1.7 percent.

Though the reasons for the high prevalence of mental disorders in the two districts are not yet analyzed, trauma could be a prominent cause, he said.Most of these people do not come into contact with psychiatrists. That is why mental health should be integrated to the other health services. Increased awareness among the public is vital to remedy the present predicament, the psychiatrist observed.

Community mental health services should be expanded. Public awareness on mental health is also important to reduce stigma, he added.Institute for Research and Development is an academic organization and a network working towards creating a new strategic alliance among academics, scholars, professionals and the public. My aim is to build a new research culture in Sri Lanka.

Dr. Athula Sumathipala is a Consultant Psychiatrist and the Director of the Institute for Research and Development and Sri Lankan Twin Registry. He is also a senior lecturer at the Department of Health Service Research, Institute of Psychiatry, Kings College, University of London.