A recent March 2020 article published in Circulation, a journal of the American Heart Association, evaluated 16 clinical studies that had compared the effects of coconut oil consumption with other fats, evaluating their impact on cholesterol, inflammation, and blood sugar control.
My goal for this blog is to summarize this recent article, share my thoughts on how coconut oil may impact your risk for a future heart disease, and look at other health claims regarding coconut oil, as well.
Epidemiological studies that have compared cultures that used coconut products have shown very low rates of heart disease, yet much of the coconut consumed in these studies was from coconut meat (which includes fiber) or coconut milk, not just the extracted coconut oil itself. These populations also happen to be far more physically active and eat less sugar than most other cultures, so it would be very challenging to say with conviction that coconut oil consumption might prevent heart disease based upon this epidemiological evidence.
Impact of Coconut Oil on Cholesterol
Although cholesterol is not the most important risk factor for heart disease (blood sugar levels and blood pressure control are likely more important) it remains one of the many factors we consider when evaluating the long-term risk for heart disease.
In the past, studies have shown that consuming coconut oil raises both your LDL cholesterol (less healthy) and HDL cholesterol (healthier) similarly. Rather than focusing on either total cholesterol, LDL cholesterol, or HDL cholesterol by themselves, the best predictor for your risk for future heart disease has been your LDL to HDL ratio (LDL/HDL, in essence the ratio of garbage to garbage trucks in your streets), that determines how clean your arteries might be.
In contrast to reports from individual studies performed in the past, combining the results from all 16 studies showed that LDL cholesterol increased twice as much as HDL cholesterol, worsening the LDL/HDL ratio. The authors concluded that regular use of coconut oil and the cholesterol changes that follow would increase the risk for heart disease and future cardiovascular events by about 5-6 percent.
Unfortunately, this meta-analysis did not review studies sharing more advanced cholesterol profiles that consider particle size, as the size of LDL and HDL particle size in the blood stream is likely more important than just the cholesterol numbers. Coconut oil appears to increase large, fluffy (healthier particles) than small, denser (less healthy particles.) Past studies that compared particle sizes would suggest that coconut oil´s impact on cholesterol is more neutral than bad. Although we have never had any studies to confirm that the beneficial impact of coconut oil on particle size may result in true cardiac benefits.
Impact of Coconut Oil on Inflammation and Blood Sugar Control
Despite past claims that coconut oil may help blood sugar control and inflammation, in this recent analysis of 16 studies, there was no difference in blood sugar or inflammation levels between coconut oil and other oils.
In contrast, several other previously published studies have shown that extra-virgin olive oil will enhance blood sugar control and decrease inflammation.
How About the Impact of Coconut Oil on Artery Function?
Several years ago, a study in subjects with established heart disease analysed the impact of coconut oil versus other fats on artery wall function. When people were fed coconut oil, their arteries tended to constrict and show a decrease in blood flow (called endothelial dysfunction) more than the other oils studied. This study also showed that use of coconut oil increased oxidation of HDL cholesterol and inflammation within the artery wall. At least for people with established heart disease, this would make using coconut oil relatively contraindicated.
How About the Impact of Coconut Oil on Brain Function?
Past studies have shown that for people with established memory loss, adding medium chain fats (specifically caprylic acid and capric acid) could improve cognitive function and show promise short term for stopping the progression of dementia. There are no studies using only coconut oil that show this same benefit. However, coconut oil is only 12% caprylic and capric acid, with 50% lauric acid, plus other longer saturated fats. Coconut oil has been marketed as a good source of medium chain fatty acids, but in truth if you really wanted to treat memory loss, I would strongly suggest using only caprylic and capric acid formulations and skipping the coconut oil.
Important Specifics for Cooking with Coconut Oil
The smoke point of virgin coconut oil is only 300° F, meaning that it will be damaged if heated past medium heat. There has been a rumor that coconut oil is a good choice for high heat cooking, yet this is simply not the case. You can use it at low or medium heat, but from a health perspective, do not use it for high heat cooking.
Summary Regarding Coconut Oil Use
In the past I have been on the fence about using coconut oil, thinking there might be some mild heart risk and some modest brain benefit, although for people with known heart disease I have said that it should be avoided.
Yet, as time moves forward and more studies become available, the benefits of coconut have always been a bit sketchy. In reality, if you want brain benefit you would be better off taking formulations with caprylic and capric acid and not cooking with coconut oil. Multiple previous studies have shown that extra virgin olive oil helps to improve cognitive function and to prevent memory loss.
For a young healthy adult, using coconut oil on occasion would be fine, just cook with it at low heat. In a curry, better would be to use coconut milk instead of coconut oil.
From a heart perspective, especially people at high risk for a cardiovascular event, it is best avoided. Better choices would be extra-virgin olive oil for salads dressings and low-heat cooking, and avocado or almond oil for medium-high or high heat cooking.
I wish you the best of health!
Steven Masley, MD, FAHA, FACN, CNS
 Neelakantan N, Hoong Seah JY, Van Dam RM. The Effect of Coconut Oil Consumption on Cardiovascular Risk Factors A Systematic Review and Meta-Analysis of Clinical Trials. Circulation. 2020;141:803–814. DOI: 10.1161/CIRCULATIONAHA
 Nichols SJ et al. Consumption of saturated fat impairs the anti-inflammatory properties of HDL lipoproteins and endothelial function. J Am Coll Cardiol. 2006;48:715-20.
Thank you for condensing and clarifying the information.
Thank you very much for clarifying this issue and for your summary !!
I so appreciate your comments. As a 77 yr old I am always looking for the elixir of youth, and soak up lots of claims that may not be true.
I have found that coconut oil did not make me feel so good, and am now using it very sparingly. I do like the flavour however. How about use on the skin to prevent dryness?
Yes I think it is a healthy oil for your skin, and I like to use it with massage. I also use it on occasion when cooking curries for the flavor; I typically do most of the cooking with avocado oil at first, and then add coconut milk or coconut oil at the end at lower heat when I simmer the dish at the end. Steven Masley, MD
It seems the coconut oil controversy continues.
I have always followed Dr Masley’s advice to be cautious with this oil. Except that having decided I must do something about my recent weight gain I am now following the Keto Green 16 plan. Dr Anna is quite a fan of coconut oil … I since I do have some mild heart issues I am reluctantly (having spent money buying the oil) I will return to using olive oil and avocado oil. Her book also recommends the coconut oil for high heat cooking. I became aware of Dr Anna through Dr Masley so am left wondering if Dr M endorsed Dr A’s work?
I think the controversy of coconut oil will continue long term. I am not aware of any large clinical studies being conducted that would answer some of these important questions. Dr Anna Cabeca and I are colleagues and friends. Of all the keto diets on the market, her’s is one of the few that I would recommend. I have reviewed close to 100 books and written blurbs for them, including all of Anna’s books. Yet, in every book there are typically a few things that I might disagree with, but if I can find 80-90% agreement, and the book has other strong points, that is as good as it gets. I actually spoke to Anna today, and for a short term keto diet for weight loss some authors overlook smoke points, to keep it simple. I am looking at how you might use oils long term, and I feel that the evidence strongly supports my recommendation not to use it at high heat. I think you are wise to stick with extra-virgin olive oil and avocado oil, and for long term use Dr Anna would agree, although she would also include ghee, which does tolerate high heat cooking. To Your Health! Steven Masley, MD
Thanks for your reply. Glad to know you do recommend the diet – I am very pleased with the results. The virus has played havoc with many of our diets and this is a great “quick fix” to get back on track with my all time best choice : Dr Masley’s recommendations!
Thanks for this clear explanation. Previous information has been so inclear
Could you give examples of caprylic and capric acid?
Hi Shelle, MCT oil is typically made of caprylic and capric acid, but not intended for cooking. Best, Steven Masley, MD
This blog contained valuable information and sensible reasoning, which is why I trust your advice very much. Thank you!
very good article. I love your pieces. Short, succinct, to the point, educational. I read a TON of these and yours is tops. Also, your recipes are wonderful. Thank you for all you do to educate us about vibrant health.