Coconut Oil Nutrient Ups Risk for Ulcerative Colitis Flares

Caroline Helwick

May 22, 2016

SAN DIEGO — Patients with ulcerative colitis could be more likely to experience a flare if they eat a diet high in coconut oil, according to a prospective multicenter study presented here at Digestive Disease Week 2016.

"We identified multiple nutritional factors associated with increased odds of an ulcerative colitis flare, including myristic acid, found in coconut oil, which was a novel finding," said lead investigator Edward Barnes, MD, from Brigham and Women's Hospital in Boston.

On univariate analysis, Dr Barnes and his colleague found that multiple nutritional components were culprits, especially when consumed in high quantities. But on multivariable analysis, only a couple of factors remained: the high intake of myristic acid, which is found in coconut oil and dairy fat; and the medium intake of alpha-linolenic acid.

The investigators conducted their observational study of 412 patients with ulcerative colitis from 49 academic and community centers to assess the role of diet in disease flares.

Participants enrolled in the study were being treated with mesalamine monotherapy and were in remission. They could have had a flare in the previous 18 months, but not in the previous 3 months.

During the 12-month study period, the investigators contacted the patients every 3 months to assess disease activity. A flare was defined as a score of at least 5 on the Simple Clinical Colitis Activity Index or a change in disease activity requiring new or additional therapy.

At study entry, all participants completed a 131-item food frequency questionnaire that was linked to a validated nutritional database. The investigators analyzed the relation between food intake and disease status, and they categorized intake tertiles as low, medium, and high. The low tertile served as the reference group for comparison.

Foods Associated With Flares

Of the 412 patients, 45 (11%) experienced a relapse of disease during the 12-month study period.

On univariate analysis, the high intake of many nutrients was associated with the increased odds of relapse. In fact, for several groups of fatty acids, dairy protein, lysine, and alanine, the risk was more than doubled.

The median intake of some nutrients also more than doubled risk, including dairy protein, alpha linolenic acid, linolenic acid, and lactose. Interestingly, the highest intake of lactose did not increase risk.

"In our univariate analysis, one trend was the apparent dose–response relationship for the intake of multiple fatty acids," Dr Barnes said.

"Oleic acid is an n-3 polyunsaturated fatty acid that, in previous studies, has been associated with a decreased risk of ulcerative colitis. However, in our univariate analysis, it was associated with an increased chance of flare, especially in the high-intake tertile," he reported.

"Myristic acid is a saturated fatty acid found in coconut oil, and while it has not previously been associated with an increased risk for developing ulcerative colitis or for flare among patients with established ulcerative colitis, it has been previously linked to proinflammatory states, such as obesity," Dr Barnes explained.

On multivariable analysis, only a few associations remained statistically significant. The high intake of myristic acid was strongly associated with the increased odds of a disease flare. Unlike in previous reports, alpha-linolenic acid was not shown to be protective; in fact, the medium but not high intake of this nutrient was associated with increased flares, he reported.

Table. Odds of Ulcerative Colitis Flare After Nutrient Intake on Multivariable Analysis (n = 412)

Nutrient Medium Intake High Intake
Myristic acid 1.71 3.89
Alpha-linolenic acid 7.03 1.45
Total omega-3 fatty acid without supplementation 0.23 1.41
Lactose 3.02 1.20
processed meats 0.22 0.49
Dietary insulin index 0.34 1.07

 

The study showed no association between increased flares after protein, meats, alcohol, or sulfur consumption, in contrast to previous studies.

"Processed meat was actually associated with a decreased risk of fare in the medium-intake tertile," Dr Barnes said.

Total omega-3 fatty acids, which are thought to be protective against the development of ulcerative colitis, were protective against flares in the medium- but not the high-intake tertile, he noted.

 
I just texted this to my wife; she puts coconut oil on popcorn.
 

Dr Barnes acknowledged that the overall number of flares in this population was small, which could have limited both the ability to detect weaker signals and the total number of variables that could be evaluated. In addition, he noted, flares were not endoscopically documented, and patients were not on standardized doses of mesalamine.

"But it has many strengths," he added. The study used a prospective, validated approach to nutritional analysis, the population was homogenous and therefore presumed to have a similar risk for flares, and patients were drawn from across academic and community facilities, "which may lend to the increased generalizability of the results," he explained.

This study adds to a growing body of evidence on the association between diet and ulcerative colitis, an area of self-management that is particularly important, said Thomas Ullman, MD, from Mount Sinai Hospital in New York City.

"My patients are telling me they are simplifying their diets, and that helps," he said. "I would like to be able to come back to them and tell them we are investigating whether food preparation matters."

We change the chemical structure of certain foods when we cook them, Dr Ullman told Medscape Medical News. "It would be interesting to know whether types of preparation (such as searing, broiling, slow cooking) are proinflammatory or not."

This study provides "supporting evidence that certain kinds of fatty acids, like myristic acid in coconut oil, may be associated with a greater incidence of flare," Dr Ullman said, noting the popularity of coconut oil as a substitution for other oils. "I just texted this to my wife; she puts coconut oil on popcorn."

The study also shows the evolution in ulcerative colitis research toward methodical, prospective investigations of diet and outcomes, he pointed out. "This is becoming possible. And it's very cool."

Dr Barnes and Dr Ullman have disclosed no relevant financial relationships.

Digestive Disease Week (DDW) 2016: Abstract 17. Presented May 21, 2016.

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