Thursday, March 20, 2014

Coconut Miracle? Anti-Arthritis Effects of Virgin Coconut Oil Confirmed - Plus: 10 Additional Benefits of "White Gold" From "A" in 'Alzheimer's' to "W" as 'Waist Circumference'

Coconut Wonder, Coconut science or Both?
As a seasoned SuppVersity veteran, you will remember that I have been mocking the incredible hype around (virgin) coconut oil for years; not because there wasn't something "magic" to coconut oil, but rather because of the bazillions of incredible web-reports and recommendations and dozens of e-"books" on which the hype was / is built.

If you turn your head away from hype and hearsay and take a look at the coconut-science that's out there, the wonder begins to appear "wondrous", but does not disappear.

A recent study from the St. Thomas College in Kualalumpur, for example, does confirm the part where coconut oil made a lame person walk again (any similarities to biblical wonders are obviously mere coincidence ;-)

The said study was published in the International Immunopharmacology and its abstract says that the results of the corresponding rodent experiment confirm the "potential beneficiary effect of PV [virgin coconut oil] on adjuvant induced arthritis in rats" (Vysakh. 2014) - an effect, of which you as a SuppVersity reader already suspected that it was a direct results of the antioxidant and anti-inflammatory effects of virgin coconut oil.
The beneficial effects on blood lipids are more or less absent with refined coconut oil (Nevin. 2004)
Refined or not refined, this is not a question: There is a reason the virgin in the last sentence of the previous paragraph is printed in italics. Chances that the (meanwhile similarly glorified) medium chain fatty acids in coconut oil are - in one way or another - involved in the anti-arthritic effects are slim to zero. It's thus unlikely to expect similar benefits from the consumption of industrially "cleaned" zero-polyphenol refined coconut oil and - at least for rodents, a study by Nevin from 2004 did already confirm that (see figure to the left).
Now the obvious question is: What exactly have the scientists done? And how representative are their results for a human being suffering from one of the 100 different forms of this debilitating and painful joint disorder?

Basically, the researchers immunized the right hind paw of animals was immunized by injecting 0.1 mL of complete Freund's adjuvant containing heat killed mycobacteria in paraffin oil. This is a treatment that has been used quite successful for decades (Bendele. 2001) and results from previous trials would suggest that there is a satisfactory match between the effects scientists observe in the rodent model and those that occur in follow up human studies. There were three groups of rodents: The "non-arthritic" (=no injection of Freund's adjuvant) control (NC), the "arthritic" rats (AA), and two groups with arthritic rats who received
  • 80mg/kg virgin coconut oil orally (HED: 1-1.25g/day for a human being)
  • 3mg/kg indomethacin, a std. NSAID (HED: 35-40mg/day for a human)
over the course of a 30-day experiment, at the end of which the (poor) critters were were sacrificed by euthanasia.
Figure 1: Comparison of histopatho-logies of the paws (Vysakh. 2014)
"For histological analysis, paw tissues were dissected,fixed in 10% buffered formalin and then decalcified for 7 days in 20% EDTA.

The tissues were then processed and embedded in paraffin. Synovialfluid was obtained by injecting 100μL of normal saline into the knee joints followed by gentle aspiration.

Paw tissue and blood were also collected for various biochemical estimations." (Vysakh. 2014)
If you take a look at the results of this process, even you as laymen (and -women ;-) should be able to see the difference between the paw of the AA-rats (B - top right) and the relatively "mild" changes you can see in the histopathologies from the coconut oil treated group (D - bottom right, Figure 1).
If you take a look at the inflammatory markers in Figure 2, as well, it's actually not surprising to see that this relatively low amount of virgin coconut oil ameliorated the tissue damage. And even the fact that it did just that better than the standard NSAID idometacine, which commonly used as a prescription medication to reduce fever, pain, stiffness, and swelling and works by inhibiting the production of prostaglandins, cannot come as a total surprise - the "coconut miracle" did after all do a much better job as a IL-6, TNF-alpha and even COX-2 inhibitor (see Figure 2).
Fat alternatives: It's quite telling that fats, not holy... ah, I mean "hole grains" are the #1 nutritional anti-arthritic agents: Fish and Krill oil (Ierna. 2010; Lopez. 2012)!
Of the former, a group of UK researchers has reported only recently that their proven (albeit nor earthshatteringly potent) anti-arthritis effects are mediated not by DHA and EPA directly, but by so-called resolvins, molecules that enzymatically produced from the LC-N3-PUFAs which are log-orders more potent than their precursors (see figure above; cf. Norling. 2013).
And while the use of resolvins is still being explored by various researchers, we do already know that adding another virgin, in this case virgin olive oil (~10g/day) to the fish oil equation will yield more "precocious and accen-tuated improvement[s]" (Berbert. 2005) than fish oil alone.
And if even this does not work, there is still albeit anecdotal evidence of the usefulness of low-dose naltrexone treatments (Brown. 2009).
So what more can you ask for? Well, aside fro the fact that even the "coconut rodents" suffered significant tissue damage, you could ask for (a) a study to confirm these results in human arthritis sufferers, you could (b) ask for alternatives (see box on the right) and you could (c) ask me about the scientific evidence in favor / against other effects that are said to be brought about by the regular consumption of virgin coconut oil.

I can't offer you (a), i.e. the randomized controlled human study that would confirm these results. In view of the fact that most of you are hopefully still arthritis-free, it may yet be more interesting to hear that Ian Prior reports in his 1981 paper that the higher coconut oil intake of the Pukapuka, inhabitants of one of the atolls near the equator had significantly lower prevalence of arthritis, as well as heart disease, cancer, diabetes than their cousins, the Tokelau from the atoll next door, whose diet contained only 34%, instead of 63% coconut oil (Prior. 1983).

Looking back at our list, the observations Prior made, when he analyzed the diets and health of the inhabitants of Polynesian atoll dwellers, we have actually already breached issue (c) and the question for other 'non-anti-arthritic miracles' - and yes, a reduced heart disease risk, as well as lower cancer and diabetes rates are on the list of scientifically supported (yet not necessarily verified) benefits of virgin coconut oil (Amarasiri. 2006). There are also case reports to support the anti-Alzheimer's (Newport. 2010) and rodent studies to support bone, liver and testes protection, lipid lowering effects (Nevin. 2009, Zakaria. 2011; Abujazia. 2012; Dosumu. 2012), and beneficial effects on blood pressure and wound healing (topical application; Nevin. 2010; Nurul-Iman. 2013) and, last but not least, there are even (methodologically questionable) human trials which support the often-touted fat loss effects (-1% waist circumference in obese men - Assunção. 2009; Liau. 2011).

Miracle or not, the notion that virgin coconut oil is among the healthiest sources of dietary fats you can chose from appears to be more or less undeniable. The same is yet also true for the fact that this does not mean that you have to chose between virgin olive and coconut oil. On the contrary! If you read my recent article on the pro-/anti-diabetic effects of dietary fat, you will be aware that only a balanced mix will provide you with all the good fats and their unique "extras".
  • Abujazia, Mouna Abdelrahman, et al. "The effects of virgin coconut oil on bone oxidative status in ovariectomised rat." Evidence-Based Complementary and Alternative Medicine 2012 (2012).
  • Amarasiri, W. A. D. L. "Coconut fats." Ceylon Medical Journal 51.2 (2006): 47-51.
  • Assunção, Monica L., et al. "Effects of dietary coconut oil on the biochemical and anthropometric profiles of women presenting abdominal obesity." Lipids 44.7 (2009): 593-601.
  • Bendele, Alison M. "Animal models of rheumatoid arthritis." J Musculoskelet Neuronal Interact 1.4 (2001): 377-385.
  • Berbert, Alair Alfredo, et al. "Supplementation of fish oil and olive oil in patients with rheumatoid arthritis." Nutrition 21.2 (2005): 131-136. 
  • Brown, Norman, and Jaak Panksepp. "Low-dose naltrexone for disease prevention and quality of life." Medical hypotheses 72.3 (2009): 333-337.
  • Ierna, Michelle, et al. "Supplementation of diet with krill oil protects against experimental rheumatoid arthritis." BMC musculoskeletal disorders 11.1 (2010): 136. 
  • Liau, Kai Ming, et al. "An open-label pilot study to assess the efficacy and safety of virgin coconut oil in reducing visceral adiposity." ISRN pharmacology 2011 (2011).
  • Lopez, Hector L. "Nutritional interventions to prevent and treat osteoarthritis. Part I: focus on fatty acids and macronutrients." PM&R 4.5 (2012): S145-S154. 
  • Nevin, K. G., and T. Rajamohan. "Beneficial effects of virgin coconut oil on lipid parameters and in vitro LDL oxidation." Clinical biochemistry 37.9 (2004): 830-835.
  • Nevin, K. Govindan, and Thankappan Rajamohan. "Wet and dry extraction of coconut oil: impact on lipid metabolic and antioxidant status in cholesterol coadministered rats." Canadian journal of physiology and pharmacology 87.8 (2009): 610-616.
  • Nevin, K. G., and T. Rajamohan. "Effect of topical application of virgin coconut oil on skin components and antioxidant status during dermal wound healing in young rats." Skin pharmacology and physiology 23.6 (2010): 290-297.
  • Newport, M. "Case study: dietary intervention using coconut oil to produce mild ketosis in a 58 year old APOE4+ male with early onset Alzheimer’s disease." 25th International Conference of Alzheimer’s Disease International (ADI). 2010.
  • Norling, Lucy V., and Mauro Perretti. "The role of omega-3 derived resolvins in arthritis." Current opinion in pharmacology 13.3 (2013): 476-481. 
  • Nurul-Iman, Badlishah Sham, et al. "Virgin coconut oil prevents blood pressure elevation and improves endothelial functions in rats fed with repeatedly heated palm oil." Evidence-Based Complementary and Alternative Medicine 2013 (2013).
  • Prior, Ian A., et al. "Cholesterol, coconuts, and diet on Polynesian atolls: a natural experiment: the Pukapuka and Tokelau island studies." The American journal of clinical nutrition 34.8 (1981): 1552-1561.
  • Zakaria, Z. A., et al. "Hepatoprotective activity of dried-and fermented-processed virgin coconut oil." Evidence-Based Complementary and Alternative Medicine 2011 (2011).