Coconut water - good or evil?
December 17, 2010 1:39 PM   Subscribe

Coconut water and other "cholesterol-lowering" wonder foods. How to separate out the wacko health-food claims from any legitimate ones?

3 days ago my doctor's assistant calls me, tells me I have high LDL and total cholesterol and he's going to put me on a statin. I say HELL NO and what about diet & exercise? To which she pauses, sounds flummoxed, and says she'll check. A day later she calls me back and says OK, that's fine - do it for three months.

So, aside from the complete WTF of this situation (get your secretary to call me and tell me you're writing a script for a drug you're not going to bother to discuss with me?? no thanks), now I'm looking for ways to help out the "diet" part of the equation. I already eat oat bran porridge for breakfast, blueberries and walnuts. Am trying to like red wine. I'm quitting chips (my big downfall) and don't drink soda or eat meat (much). I tried niacin a while back and it gave me terrible stomach problems, so no go on that.

So now I'm looking out for more foods to add to the repertoire, in part to keep myself from being bored to tears by steamed vegetables. And I keep coming across coconut water being touted as some kind of miracle cholesterol-lowering agent, based on (as far as I can tell) one rat study. I'm confused by this, since I'd always thought coconut was Terribly Evil. So, what now? How do I separate out reputable claims for food & cholesterol reduction from cheesy new age claims?
posted by media_itoku to Health & Fitness (21 answers total) 10 users marked this as a favorite
The short answer is there aren't that many clinically proven claims for cholesterol reduction and that various things including red wine and nuts *may* have an effect.

In fact, in Europe, we're undergoing a process where a lot of these sorts of claims are being evaluated. Very, very, very few are being passed at the moment.

Plant sterols/stanols (e.g. products like Benecol) are one way to go. But even then, by "hard" standards, the data is still not that strong.

If you are interested in reading up, meta-analyses would be a good place to look.


"No conclusions can be made about the effectiveness of a cholesterol-lowering diet, or any of the other dietary interventions suggested for familial hypercholesterolaemia, due to the lack of adequate data. Large, parallel, randomised controlled trials are needed to investigate the effectiveness of a cholesterol-lowering diet and the addition of omega-3 fatty acids, plant sterols or stanols, soya protein to a cholesterol-lowering diet."
posted by MuffinMan at 1:54 PM on December 17, 2010 [2 favorites]

I Am Not a Nutritionist, but high cholesterol runs rampant in my family, and I have learned a few key things:
1. Eating cholesterol-containing things like eggs and meat does not, in itself, give you high cholesterol. My cholesterol was the highest when I was a vegan. This is probably because of #2:

2. A high-carb diet (even one focused on whole grains) can have a negative effect on your cholesterol score. My understanding is that eating lots of carbs increases the amount of glucose in your body, which increases triglyceride levels, which leads to high LDL counts.

3. How is your HDL? This is "good" cholesterol and you want this number to be high. Eat things rich in essential fatty acids like salmon and avocado.

It sucks that your doctor didn't give you any sort of nutritional direction, but you can/should talk to a nutritionist on your own.
posted by joan_holloway at 2:00 PM on December 17, 2010 [1 favorite]

You can't go wrong with this list, either because of real cholesterol benefits, or other ancillary, general good-eating advice.

Moreover, "oat porridge" may not have the same kind of fiber benefits as, say, full-on steel-cut oats. YMMV.

But ...

(get your secretary to call me and tell me you're writing a script for a drug you're not going to bother to discuss with me?? no thanks)

I've had this happen to me. Consider that your doctor may be completely right, medically, and just have bad manners.
posted by Cool Papa Bell at 2:01 PM on December 17, 2010

Per this visualization, green tea.
posted by gingerbeer at 2:52 PM on December 17, 2010

Something NOT to eat are trans fats...
Not just the ones that show up in the nutrition labels, but the ingredients themselves (because they only have to show it on the label if it is 0.5g per serving, and many companies have since adjusted serving sizes so as to be under that amount). So anything with partially hydrogenated oils should be eliminated. If you eat a lot of processed foods, you are probably getting quite a bit of trans fat in your diet without realizing it.
posted by smalls at 2:56 PM on December 17, 2010

I think the preceding posts summed up many of the issues. Diet, exercise and weight management have benefits/limitations depending on hereditary factors and genetic disposition. Dietary intervention appears to have only minimal effect. You do need to discuss this with a (your) physician to find out specific hdl/ldl levels and evaluate other cardiovascular risks and options. Remember, if you google "statins" or the specific drug your physician recommended many of the first 13,000,000 hits will be all the problems, complaints, lawsuits, etc. For a significant number of people statins are quite beneficial, produce minimal (if any) side effects, and have other salutary effects. This is not a WTF situation, hell no I won't go, or crisis but does suggest the need to seriously explore options and implement a plan.
posted by rmhsinc at 3:04 PM on December 17, 2010 [3 favorites]

I came across this blog while looking for more info on a low carb/paleo diet. It is written by a cardiologist who goes into great detail about lowering plaque and controlling cholesterol. The information seems completely contrary (no wheat products period) based on the diet information we have all been brought up on but, well he is a cardiologist. He is good about responding to comments on posts and about replying to email.
posted by WickedPissah at 3:11 PM on December 17, 2010

I don't have high cholesterol and I am not a nutritionist or a doctor. However, anecdotally, a good friend of mine found out he had high cholesterol. He and his doctor chose the diet and exercise route to start. He was already somewhat fit, but committed to a regular exercise plan. He also went on Atkins diet (including the latter stage where you re-introduce low-glycemic carbs) and his cholesterol levels dropped dramatically. I don't think Atkins is really the best diet, but I do think there is something to this whole carb/cholesterol relationship. Something to think about.

Oh and read up on CRPs (C-reactive protein) + cholesterol if you want to know more.
posted by getmetoSF at 4:27 PM on December 17, 2010

Plant sterols are bad news - the body has a mechanism to filter them out, and the few people who don't have that mechanism (sitosterolemia) have very poor heart health.

Total cholesterol is not even bad for you. In fact, statistically countries with average TC around 210-230 have the lowest age-adjusted mortality numbers. But even then, note how weak the correlation is. The beliefs we have on cholesterol now are based on really shoddy research from decades ago, or misinterpretations of decent research. For example, Ancel Keys cherry-picked data for his Seven Countries study; Russian studies showing that rabbits (herbivores!) who are fed cholesterol develop atherosclerosis. Sure, they shouldn't be eating steak, but when was the last time you saw a pack of rabbits bring down a cow? We, on the other hand, have mechanisms for dealing with it. Our livers make about as much cholesterol every day as you would get from food if you ate only steak.

The cholesterol-carrying lipoproteins you need to watch out for are oxidized LDL, VLDL, and small-particle LDL. Large-particle LDL is neutral and HDL is indicative of good cardiovascular health.

Excess carbs, especially sugars, contribute to the formation of those bad particles. On the other hand, saturated fats weakly help produce the neutral and good particles.

Coconut is a fantastic food in general, and coconut water is a wonderful drink, but be careful that you're not getting too much sugar from it. Aim for less than 100g of sugars every day, with most days under 50g unless you exercise.

I have summarized my several-months obsession on nutrition here, if you care to take a look. So much of what we believe is healthy is unsupported or just plain wrong.
posted by Earl the Polliwog at 5:07 PM on December 17, 2010 [1 favorite]

I posted this in a previous question, but I'll repeat it here:

I, too, thought it was crazy that I had high cholesterol, because I didn't eat a lot of meat and I exercised quite a bit. However, I had pretty high numbers for several years (283 total; 166 L). I managed to bring it down by 50 points (25 points of LDL) over four months, but I did it through basically trying to get my saturated fats as close to zero as I possibly could. (Realistically, I was aiming for 10g/day.) That meant no full-fat dairy at all, no butter, no chocolate, no coconut, and no snack foods with any saturated fat in them. (I figured that I'd save any saturated fat intake for meals where it was unavoidable.) I also ate oat bran for breakfast and took fish oil supplements. My nutritionist was particularly adamant about no butter, zero, ever.

I thought I was eating pretty well before, but clearly eliminating those things -- especially butter and chocolate -- made a huge difference. I think the key was that I was really strict about it -- I'm not sure how critical it was to be so strict, and I'm probably going to relax it a bit going forward, but that's what worked for me.
posted by cider at 5:15 PM on December 17, 2010 [1 favorite]

If you drink coffee, make sure it is paper-filtered, because coffee contains cholesterol-raising compounds. A simple paper filter removes them. Forgo espresso drinks, because those are not filtered.
posted by Knowyournuts at 6:10 PM on December 17, 2010

Oh, and I should add that I am not a doctor and I don't know anything about cholesterol except for through my personal experience -- I know some people say the numbers aren't that important and that a low-fat diet isn't a lot better for your heart, as it turns out, but I don't know anything about that.
posted by cider at 6:31 PM on December 17, 2010

You'll be glad to know that there is a dietary intervention that will drastically lower your LDL cholesterol. More importantly, it will lower your odds of cardiovascular disease and arteriosclerosis. It will also reduce your risk of stroke, diabetes and several other diseases. It is a diet that has been tested in humans - not rats, mice or other animals. And it will not cost you a penny.

Are you eager to learn what this miracle diet is? Now the bad news: odds are, you will not adopt this diet.


"Calorie restriction reduces risk of heart attack, stroke and diabetes":

"People who severely restrict their caloric intake drastically reduce their risk of developing diabetes or clogged arteries, the precursor to a heart attack or stroke.

According to University researchers, some risk factors were so low they were comparable to those of people decades younger.

The study, led by John O. Holloszy, M.D., professor of medicine, will appear in the April 27 issue of the Proceedings of the National Academy of Sciences.

The first author is Luigi Fontana, M.D., Ph.D., research instructor in medicine.

"It's very clear from these findings that calorie restriction has a powerful, protective effect against diseases associated with aging," Holloszy said. "We don't know how long each individual actually will end up living, but they certainly have a much longer life expectancy than average because they're most likely not going to die from a heart attack, stroke or diabetes."

Research on mice and rats has shown that stringent and consistent calorie restriction increases the animals' maximum lifespan by about 30 percent and protects them against cancer.

This study is the first to examine individuals who have been on calorie restriction diets for a long period of time.

The researchers recruited participants through a national organization called the Caloric Restriction Optimal Nutrition Society.

By eating small amounts of nutrient-dense foods, members of this group try to consume between 10 percent and 25 percent fewer calories than the average American while still attempting to maintain proper nutrition."

"The researchers measured multiple indications of early or impending atherosclerosis, including blood pressure and levels of several biological markers in the blood, including cholesterol and triglycerides.

They also measured the levels of glucose and insulin in the blood to gauge diabetes risk, another major health concern for Americans.

People in the calorie restriction group had total and low-density lipoprotein — known as LDL or "bad" cholesterol — levels comparable to the lowest 10 percent of the population in their respective age groups.

Their high-density lipoprotein — known as HDL or "good" cholesterol — levels were in the 85th percentile to 90th percentile for middle-aged men.

That finding was a surprise because HDL levels typically decrease when individuals follow low-fat diets to lose weight.

Triglyceride levels — which, when elevated, can lead to atherosclerosis — were even more impressive in the calorie restriction group: They were lower than more than 95 percent of Americans in their 20s, despite the fact that the study participants' ages ranged from 35-82.

In contrast, cholesterol and triglyceride levels in the comparison group were in the 50th percentile for average middle-aged Americans. Moreover, 12 of the individuals in the calorie restriction group provided medical records from before and during the diet.

Their cholesterol and triglyceride scores also were close to the 50th percentile for middle-aged Americans before the diet, and levels fell the most dramatically during their first year of calorie restriction.

Blood pressure scores in the restricted group also were equivalent to those of much younger individuals. The average blood pressure in the normal diet group was about 130/80, which is standard for a typical American.

In comparison, the calorie restriction group's average was about 100/60, akin to the blood pressure of an average 10-year-old.

Fasting glucose and insulin — both markers of the risk of developing diabetes — also were significantly lower in the calorie restriction group, with insulin concentrations as much as 65 percent lower.

All other risk factors measured also were significantly better in the calorie-restriction group.

They included body mass index, body fat mass, C-reactive protein and the thickness of the carotid artery, the main blood vessel that runs from the heart to the brain.

"These effects are all pretty dramatic," Fontana said. "For the first time, we've shown that calorie restriction is feasible and has a tremendous effect on the risk for atherosclerosis and diabetes."

The team is conducting a controlled, prospective study comparing calorie restriction to the average American diet."

posted by VikingSword at 6:52 PM on December 17, 2010

It may be that the benefits of caloric restriction are due at least in part to the reduction of eating modern "foods" such as grains, sugars, and vegetable oils. Adoption of a non-calorically-restricted paleolithic diet, which does eliminate those items, improves the same measures of health.
posted by Earl the Polliwog at 7:03 PM on December 17, 2010 [1 favorite]

IANAD, IANANutritionist, but I am someone who has a long crazy history of strange medical issues, many of which turned out to controllable via diet.

First off - are you female or male? Because there is a metric shit-ton of stuff coming out right now about how statins may be more harmful than beneficial to women. If you're female and your doc is pushing these drugs, run, do not walk, and find yourself a new doctor.

Equally important to LDL are your numbers for HDL and triglycerides. I'm pointing this out because of my own experience with Hyperalphalipoproteinemia - in other words, off-the-charts high HDL. Half the time the docs don't even look at this number; they look at my LDL and start making noises about statins until I point out that my HDL is so high as to put me in the negative risk factor category.

As for diet - it really depends on what your body responds to. When I ate low-fat, whole-grain, high-fiber stuff like the government tells us to, I was 50 pounds overweight and gaining, and my total cholesterol was something like 380.

Switching to diet centered around protein and fat brought my LDL and triglycerides down to nearly nothing within a matter of weeks. I also dropped those 50 extra pounds effortlessly. I've stayed in that range for almost 8 years now. To read about this type of nutrition, Google "paleo" or "primal" diet - there are tons of sites out there with lots of good info.
posted by chez shoes at 7:04 PM on December 17, 2010 [1 favorite]

Apologies for the frequent posts, but this is what I meant to link in my last answer: Paleolithic-inspired diet improves nearly every measure of health in just 10 days.
posted by Earl the Polliwog at 7:23 PM on December 17, 2010 [1 favorite]

It may be that the benefits of caloric restriction are due at least in part to the reduction of eating modern "foods" such as grains, sugars, and vegetable oils. Adoption of a non-calorically-restricted paleolithic diet, which does eliminate those items, improves the same measures of health.

I don't believe this to be so, given the number of studies showing that it is the caloric restriction that's responsible for these effects - in animals. However, regardless of what I believe, your assertion is dramatically contradicted in the very link to the studies you linked to:

1) First study: as a result of the paleo diet the participants *voluntarily* "Decreased their caloric intake from 2,478 to 1,584 kcal" - that is an astoundingly huge restriction of calories.

2) Second study: compared to a Mediterranean diet, the Paleo diet adherents showed "Greater voluntary reduction in caloric intake (total intake paleo= 1,344 kcal; Med= 1,795)" - again a dramatic restriction of calories.

In short, the good effects of the paleo diet cannot be disentangled from the dramatic effect of restricting calories. In general, there have been many studies - in animals - which have tried to put the effects of CR down to some other factor (IGF-1, growth hormone, insulin, etc., etc.,), but it always comes out that ultimately... it was the calories that were the upstream controllers. For example EOD (Every Other Day feeding) which allowed ad libitum feeding every other day showed similar effects to CR - but when measured, it showed that EOD eaters overall consumed fewer calories than AL eaters. Again - calories, calories, calories. Of course, always understanding it's not merely restricting calories, but critically in conjunction with adequate nutrition.
posted by VikingSword at 7:28 PM on December 17, 2010


try eating some omega 3 related food, like salmon or some fish. olive oil is good too.
posted by janet bin at 7:32 PM on December 17, 2010

In short, the good effects of the paleo diet cannot be disentangled from the dramatic effect of restricting calories. In general, there have been many studies - in animals - which have tried to put the effects of CR down to some other factor (IGF-1, growth hormone, insulin, etc., etc.,), but it always comes out that ultimately... it was the calories that were the upstream controllers.

Due to the actual biochemical effects of the modern foods I mentioned, I don't fully agree with this - but assuming it is correct, any means by which calories could be restricted without constant hunger would be very beneficial. Conscious caloric restriction is not sustainable for the majority of the population, and has its share of negatives as well.
posted by Earl the Polliwog at 7:40 PM on December 17, 2010 [1 favorite]

Also, remember this: the body uses a shit-ton of cholesterol in its daily function. The liver makes something like a gram or two of the stuff every day. So dietary cholesterol, provided you aren't eating dozens of eggs a day, is a negligible risk factor.

And modern research does say that the proportion of good to bad cholesterol is the thing. That's why the Atkins diet works so well for improving cholesterol numbers: it eliminates almost all foods that create triglycerides, which causes bad cholesterol.

Calorie restriction: the truth is that we probably don't need all that many calories to live, but because we eat so many "empty" calories, we have trained ourselves to eat more. The fact that the study participants voluntarily reduced calories just because they were eating different foods sort of proves this. I think if they were offered bread and lettuce sandwiches they would not voluntarily reduce calories.
posted by gjc at 8:47 AM on December 18, 2010

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