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JOURNAL OF MEDICINAL FOOD
J Med Food 7 (2) 2004, 136–140
© Mary Ann Liebert, Inc. and Korean Society of Food Science and Nutrition
The Cholesterol-Lowering Effect of Coconut Flakes in Humans with Moderately
Raised Serum Cholesterol
Trinidad P. Trinidad,
1
Anacleta S. Loyola,
1
Aida C. Mallillin,
1
Divinagracia H. Valdez,
1
Faridah C. Askali,
1
Joan C. Castillo,
1
Rosario L. Resaba,
1
and Dina B. Masa
2
1
Department of Science and Technology, Food and Nutrition Research Institute, Bicutan, Taguig; and
2
Philippine Coconut Authority, Diliman, Quezon City, Metro Manila, Philippines
ABSTRACT This study investigated the effect of coconut flakes on serum cholesterol levels of humans with moderately
raised serum cholesterol in 21 subjects. The serum total cholesterol of subjects differed and ranged from 259 to 283 mg/dL.
The study was conducted in a double-blind randomized crossover design on a 14-week period, consisting of four 2-week ex-
perimental periods, with each experimental period separated by a 2-week washout period. The test foods were as follows:
corn flakes as the control food, oat bran flakes as the reference food, and corn flakes with 15% and 25% dietary fiber from
coconut flakes (made from coconut flour production). Results showed a significant percent reduction in serum total and low-
density lipoprotein (LDL) cholesterol (in mg/dL) for all test foods, except for corn flakes, as follows: oat bran flakes, 8.4
1.4 and 8.8 6.0, respectively; 15% coconut flakes, 6.9 1.1 and 11.0 4.0, respectively; and 25% coconut flakes, 10.8
1.3 and 9.2 5.4, respectively. Serum triglycerides were significantly reduced for all test foods: corn flakes, 14.5 6.3%;
oat bran flakes, 22.7 2.9%; 15% coconut flakes, 19.3 5.7%; and 25% coconut flakes, 21.8 6.0%. Only 60% of the sub-
jects were considered for serum triglycerides reduction (serum triglycerides 170 mg/dL). In conclusion, both 15% and 25%
coconut flakes reduced serum total and LDL cholesterol and serum triglycerides of humans with moderately raised serum cho-
lesterol levels. Coconut flour is a good source of both soluble and insoluble dietary fiber, and both types of fiber may have
significant role in the reduction of the above lipid biomarker. To our knowledge, this is the first study conducted to show a
relationship between dietary fiber from a coconut by-product and a lipid biomarker. Results from this study serves as a good
basis in the development of coconut flakes/flour as a functional food, justifying the increased production of coconut and co-
conut by-products.
KEY WORDS:
•
coconut flakes/flour
•
dietary fiber
•
serum cholesterol
INTRODUCTION
S
OLUBLE DIETARY FIBER SOURCES
, including oat prod-
ucts,
1–8
dried beans,
4,5,7,9,10
psyllium,
11,12
soy polysac-
charides,
13,14
guar gum,
15–17
and pectin,
15–18
have been
shown to produce a significant lowering of serum choles-
terol in humans. The principle behind the cholesterol-low-
ering effect of dietary fiber is the prevention of the re-ab-
sorption of bile acids via the enterohepatic circulation. Once
the bile acid is re-absorbed, it can form cholesterol and cir-
culate in the blood. Because of the viscosity of dietary fiber,
bile acids can bind with dietary fiber and be excreted in the
feces.
19
On the other hand, fermentable soluble fiber pro-
duced short-chain fatty acids in the large intestine and may
reduce serum cholesterol through the inhibition of choles-
terol synthesis in the liver.
11,20
Moreover, viscous fiber
slows down the absorption of carbohydrates
21,22
and may
diminish the insulin response. Insulin has been shown to
stimulate cholesterol synthesis, and a reduced concentration
of insulin may affect plasma cholesterol concentrations
23
and further offer protection against coronary heart disease.
24
Coconut flakes are produced from coconut residue, a by-
product of the coconut milk industry. When pulverized into
flour they contain 60% dietary fiber: 56% insoluble and 4%
soluble.
25
Coconut flakes have been shown to produce short-
chain fatty acids such as acetate, propionate, and butyrate.
A previous study has shown that bakery products supple-
mented with 15%–25% coconut flour have a low glycemic
index.
26
Low glycemic index foods have been shown to
lower serum cholesterol levels in humans.
21
This study was conducted to investigate the effect of co-
conut flakes on the serum cholesterol levels of human sub-
jects with moderately raised serum cholesterol.
Manuscript received 31 July 2003. Revision accepted 29 November 2003.
Address reprint requests to: Trinidad P. Trinidad, Department of Science and Technol-
ogy, Food and Nutrition Research Institute, Bicutan, Taguig, Metro Manila, 1631 Philip-
pines, E-mail: tpt@fnri.dost.gov.ph
136
MATERIALS AND METHODS
Subjects
Forty subjects were recruited for the study. The subjects
were physically examined by a medical doctor and selected
based on the following criteria: moderately raised cholesterol
level (250–300 mg of cholesterol/100 g of serum); 30–55
years old; no cholesterol-lowering drug intake; and no com-
plications. They were interviewed to obtain data on their
usual 3-day food intake, physical activity, and smoking
habits. Twenty-two human subjects, four men and 18 women,
met the inclusion criteria. However, three female subjects
dropped out because they could not withstand eating 25% di-
etary fiber from coconut flakes. Another two female subjects
were recruited and passed the inclusion criteria. The total
number of subjects in the study was 21. One of the subjects
was not able to consume one test food (15% coconut flakes).
The study was conducted upon approval of the National Hu-
man Ethics Committee, Philippine Council for Health Re-
search and Development, Department of Science and Tech-
nology. All subjects signed an informed consent form.
Test foods
The test foods containing 50 g of available carbohydrates
were as follows: corn flakes (Nestle, Pasig City, Philippines)
with 15% or 25% dietary fiber from coconut flakes; corn
flakes as the control food; and organic oat bran flakes
(Health Valley, A Hain Food Group Company, Irwindale,
CA) as the reference food.
Coconut flakes were obtained from coconut flour pro-
duction (Philippine Coconut Authority/Sirawan Industries,
Davao City, Philippines). The flakes were made from the
by-product of the coconut milk industry, the coconut residue
or “sapal” left after extraction of coconut milk, dried, and
placed in an expeller to produce the flakes. Flakes were pul-
verized into flour. The fat content of the flakes/flour was
controlled to 10%. For every 12,000 kg of coconut, 400 kg
of flakes/flour is produced.
Study design
The study was conducted in a double-blind randomized
crossover design on a 14-week period (3.5 months), con-
sisting of four 2-week experimental periods with each ex-
perimental period separated by a 2-week washout period for
a total of three washout periods. The subjects fasted
overnight (10–12 hours of fasting) prior to the study. They
were weighed, their blood pressure was measured, and a
sample of blood from their forearm vein was taken. The sub-
jects were given the test foods to consume every day to en-
sure compliance of the subjects, except on Fridays when
three test foods were given to include Saturday and Sunday
intakes. The subjects recorded their respective food intakes
for the duration of the experimental study. On day 15, blood
was drawn from the subjects after an overnight fast. Blood
samples were taken into plain glass tubes from the forearm
vein, left to clot at room temperature, and centrifuged, and
the serum was separated. Total cholesterol, high-density
lipoprotein (HDL) cholesterol, and triglycerides were mea-
sured in a clinical chemistry analyzer (ARTAX, Menarini
Diagnostic, Florence, Italy) against standards (all from Sen-
tinel CH, Milan, Italy: cholesterol, Cholesterol Standard,
200 mg/dL; HDL cholesterol, Cholesterol Standard, 50
mg/dL; and triglycerides, Glycerol Standard, 200 mg/dL).
The amount of low-density liporotein (LDL) was estimated
from the formula used by Wolever et al.
27
as follows:
LDL (total cholesterol HDL) (triglycerides/2.2)
Subjects served as their own control.
Statistical analysis
The sample size was chosen to achieve 80% power at 5%
level of significance. The data were tested for normal dis-
tribution using the one-way Kolmogorov–Smirnov test prior
to analysis of variance, and the data followed normal dis-
tribution. Differences between test foods and between bio-
markers were determined by two-way analysis of variance
and Duncan’s Multiple Range Test using the Statistical
Analysis System Program (SAS Institute Inc., Cary, NC).
RESULTS
Table 1 shows the characteristics of the subjects. There
were four men and 17 women for a total of 21 subjects. The
initial serum total cholesterol for all subjects ranged from 259
to 283 mg/dL. The serum LDL cholesterol was significantly
higher in females than in males (P .05), while serum
triglycerides were significantly higher in males than in fe-
COCONUT FLAKES AND CHOLESTEROL 137
T
ABLE
1. C
HARACTERISTICS OF
S
UBJECTS
Age Body mass
Subjects Number (years) index Total LDL HDL Triglycerides
Male 4 50 325 2 271 12 120 7
b
45 6 277 24
a
Female 17 48 125 1 270 40 156 6
a
48 5 174 16
b
Data are mean SEM values.
a,b
Significant differences between males and females at P .05.
Cholesterol
males (P .05; Table 1). All other parameters were similar
in both males and females. All subjects did not drink alcohol.
Table 2 shows the composition of the test foods. The 25%
coconut flakes had the highest dietary fiber, fat, protein, and
ash content. Oat bran flakes had the highest moisture con-
tent. The mean energy intake of the subjects for the dura-
tion of the experimental study as estimated from the food
record collected for 14 days for each test food fed was
1,413.0 38.5 kilocalories/day. Protein, fat, and carbohy-
drate intake, estimated as percentages of total calories, were
12.1 0.2%, 18.4 1.7%, and 70.5 1.4%, respectively.
Protein and fat sources were beef, pork, and chicken. The
type of fat consumed by the subjects was mostly saturated
fat. Only one subject ate fish frequently, while the others
had very low intake of fish. Carbohydrate sources came
mainly from rice, bread, and noodles. Vegetables and fruits
were only eaten once or not even once a day.
Table 3 shows the serum total, LDL, and HDL choles-
terol and triglycerides of subjects before and after feeding
of the different test foods. Serum total cholesterol was sig-
nificantly lower after consumption of oat bran, 15% coconut
flakes, and 25% coconut flakes for 14 days (P .05; Table
3). Similar results were also observed for LDL cholesterol.
For all test foods there was a significant reduction in serum
triglycerides (P .05; Table 3). There was no increase in
HDL cholesterol observed in the study (Table 3).
Table 4 shows the percent reduction in serum total cho-
lesterol, LDL cholesterol, and triglycerides of subjects fed
with the different test foods. After feeding the subjects with
15% and 25% dietary fiber from coconut flakes for 14 con-
secutive days, 6.9% and 10.8% reductions, respectively,
were observed in serum total cholesterol (P .05; Table
4). These were comparable with that of oat bran flakes,
with an 8.4% reduction in serum total cholesterol. The per-
cent reduction of serum total cholesterol for the 25% di-
etary fiber coconut flakes was significantly greater than
that for the 15% dietary fiber coconut flakes (P .05;
Table 4). However, values after both 15% and 25% co-
conut flakes did not differ significantly from that after oat
bran flakes (Table 4). Similar results were also observed
in the percent reduction of LDL cholesterol from all foods,
except for corn flakes (Table 4). Although corn flakes did
not lower serum total and LDL cholesterol, it caused a
14.5% reduction in serum triglycerides and was compara-
ble to oat bran and 15% and 25% coconut flakes (Table
4). Only 60% of the subjects had serum triglycerides
greater than 170 mg/dL (normal is 60–170 mg/dL) and
were included in the analysis.
138 TRINIDAD ET AL.
T
ABLE
2. C
OMPOSITION OF
T
EST
F
OODS
Corn flakes
Oatbran 15% DF from 25% DF from
Component Corn flakes flakes coconut flakes coconut flakes
Total amount fed to subjects/day 51.0* 59.5* 65.8 75.7
Carbohydrates 50.0* 50.0* 50.0 50.0
DF 1.0* 8.5* 16.0 1.0
b
26.0 0.9
a
Fat 0.04 0.03
d
0.86 0.06
c
2.50 0.02
b
4.16 0.02
a
Protein 3.1* 5.4* 4.8 0.1
b
6.0 0.1
a
Ash 2.03 0.00
c
1.35 0.04
d
2.42 0.00
b
2.67 0.01
a
Moisture 1.68 0.00
d
3.11 0.02
a
2.38 0.02
c
2.84 0.02
b
Data are mean values (in g). DF, dietary fiber.
*From food label.
a–d
Significant differences between test foods at P .05.
T
ABLE
3. S
ERUM
T
OTAL
, LDL,
AND
HDL C
HOLESTEROL AND
T
RIGLYCERIDES
L
EVELS
OF
S
UBJECTS
B
EFORE AND
A
FTER
F
EEDING OF THE
D
IFFERENT
T
EST
F
OODS
Cholesterol
Total LDL HDL Triglycerides
Test food Before After Before After Before After Before After
Corn flakes 276 7 280 10 144.3 7.0 145.6 6.8 47.4 4 45.3 5 277 18 236 15
a
Oat bran 296 10 271 9
a
154.0 3.7 140.4 4.9
a
50.2 5 45.2 4 233 16 180 13
a
15% coconut flakes 288 7 268 7
a
152.6 5.0 135.8 5.0
a
53.3 4 44.3 4 327 24 264 23
a
25% coconut flakes 296 10 264 10
a
168.7 4.8 153.1 3.1
a
41.7 3 38.1 2 243 19 190 16
a
Data are mean SEM values.
a
Significantly different at P .05.
DISCUSSION
Epidemiological data suggested that high intakes of di-
etary fiber reduced the risk of coronary heart disease.
24
The
Lipid Research Clinics Coronary Primary Prevention Trial
predicted that for every 1% decrease in serum cholesterol
concentration, there is a decreased risk of coronary heart dis-
ease of 2%.
28
In a previous meta-analysis of 20 trials, the
daily intake of 3 g of -glucan from oats caused a clinical
reduction of 0.13–0.16 mmol of serum cholesterol/L.
29
Results of the present study revealed that daily con-
sumption of 15% and 25% dietary fiber from coconut flakes
with the usual meal reduced serum total and LDL choles-
terol and triglycerides in humans (Table 4). Interestingly,
the greatest reduction in serum total and LDL cholesterol as
well as triglycerides was observed in subjects fed with 25%
dietary fiber from coconut flakes but did not differ signifi-
cantly from that of oat bran flakes (P .05; Table 4). Co-
conut flakes are made from the production of coconut flour
containing 60% dietary fiber: 56% insoluble and 4% solu-
ble.
25
It produced short-chain fatty acids with butyrate ac-
etate propionate after fermentation in the large intestine.
A study revealed that coconut kernel contained water-solu-
ble galactomannans.
30
The galactomannans from coconut
have been shown to be the leguminous type
30
with a man-
nose:galactose ratio of 2:1, similar to guar gum.
30
Galac-
tomannans are not digested in the small intestine but are me-
tabolized by the microflora in the large intestine and produce
short-chain fatty acids. One interesting component of co-
conut that may have also contributed to lowering serum cho-
lesterol levels is its content of uronic acid, also present in
pectin.
30
Uronic acid increases as coconut matures.
30
It is
also fermentable in the large intestine and produces short-
chain fatty acids.
30
The hypocholesterolemic property of di-
etary fiber is associated with the water-soluble fractions of
fiber, e.g., galactomannans, uronic acid, and glucomannans.
However, various water-soluble fibers may differ in their abil-
ity to reduce serum cholesterol.
15,31,32
In this study, oat bran
flakes was given at 8.5 g of dietary fiber, while 15% and 25%
dietary fiber coconut flakes were given at 15.0 and 25.0 g of
dietary fiber, respectively, with percent serum cholesterol re-
ductions of 8.4%, 6.9%, and 10.8%, respectively. There were
no significant differences among the three dietary fiber
sources (P .05; Table 4). The amount of dietary fiber pre-
sent in the 25% coconut flakes (25 g) was more than twice
that of oat bran flakes (8.5 g). Results of the present study re-
vealed that for every gram of dietary fiber from oat bran, 2–3
g of dietary fiber from coconut flakes is needed to obtain a
serum total cholesterol reduction of 6–12%. The present study
also confirmed the U.S. Food and Drug Administration’s
health claim for oat bran’s role in reducing serum cholesterol
level in humans. Oat bran has been shown to decrease serum
total cholesterol in humans in many studies and is preventive
of cardiovascular disease.
1–8
Coconut flakes/flour contained greater proportions of in-
soluble fiber than soluble fiber. The fibrous structure of co-
conut flakes/flour may have entrapped, if not bound, the bile
acids and prevented their re-absorption in the liver in the en-
terohepatic circulation and thus caused their excretion in the
feces.
There was no significant increase or decrease in HDL
cholesterol levels of all subjects. The concentration of serum
HDL cholesterol is affected by alcohol intake and body mass
index.
33
However, none of the subjects drank alcohol, and
the body mass indices were not significantly different be-
tween subjects in the duration of the experimental period.
In conclusion, 15% and 25% dietary fiber from coconut
flakes reduced serum total cholesterol, LDL cholesterol, and
triglycerides of humans with moderately raised serum cho-
lesterol levels. Coconut flakes/flour is a good source of both
soluble and insoluble fiber, and both types of dietary fiber
may have played an important role in the significant reduc-
tion of the above lipid biomarkers. To our knowledge, this
is the first study that showed the relationship of dietary fiber
from a coconut by-product and lipid biomarkers. The results
of this study serve as a basis in the development of coconut
flakes/flour as a functional food, thus justifying the in-
creased production of coconut and coconut by-products.
ACKNOWLEDGMENTS
The authors wish to thank Nestle Philippines for provid-
ing us the corn flakes; the Philippine Coconut Authority,
Department of Agriculture through Ms. Divinia Bawalan for
the preparation of the coconut flakes; and the Department
of Science and Technology, Philippine Council for Health
Research and Development for financial support. The au-
thors also wish to thank Ms. Josefina A. Desnacido and Mr.
Zoilo B. Villanueva for their technical assistance and Ms.
Ma. Isabel Z. Cabrera, Supervising Science Research Spe-
COCONUT FLAKES AND CHOLESTEROL 139
T
ABLE
4. P
ERCENT
R
EDUCTION IN
S
ERUM
T
OTAL
C
HOLESTEROL
, LDL C
HOLESTEROL
,
AND
T
RIGLYCERIDES
L
EVELS OF
S
UBJECTS
F
ED WITH
D
IFFERENT
T
EST
F
OODS
Test food Total cholesterol LDL cholesterol Triglycerides*
Cornflakes 1.3 1.8
c,y
0.9 6.3
b,y
14.5 6.3
a,x
Oat bran flakes 8.4 1.4
a,b,y
8.8 6.7
a,y
22.7 2.9
a,x
15% coconut flakes 6.9 1.1
b,y
11.0 4.0
a,x,y
19.3 5.7
a,x
25% coconut flakes 10.8 1.3
a,y
9.2 5.4
a,x,y
21.8 6.0
a,x
Data are mean SEM values.
*Only 60% of subjects were considered for percent reduction (serum triglycerides 170 mg/dL).
a–c
Significant differences between test foods at P .05.
x–z
Significant differences between serum total cholesterol, LDL cholesterol, and triglycerides at P .05.
cialist, Nutritional Biochemistry Group, Nutrition Science
and Technology Division, Food and Nutrition Research In-
stitute (FNRI), Ms. Celeste C. Tanchoco, Chief, Nutrition
Science and Technology Division, FNRI, Dr. Aida R.
Aguinaldo, FNRI Deputy Director, and Dr. Corazon V.C.
Barba, FNRI Director, for their support.
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