Coconut Oil Chews by Healthy delights

POSSIBLY EFFECTIVE

• Atopic dermatitis (eczema). Topical coconut oil has been evaluated for the management of atopic dermatitis in children, with promising results. Details: One clinical trial in children with atopic dermatitis shows that topical application of virgin coconut oil 5 mL twice daily for 8 weeks results in moderate or excellent improvements in almost two-fold more patients and reduces symptom severity about 30% when compared with mineral oil (90614).
• Prematurity. Topical coconut oil may reduce the risk for hypothermia and apnea and improve body weight, length, and skin integrity in premature infants. Details: A large clinical study in premature infants shows that applying coconut oil 5 mL topically four times daily for 28 days reduces the incidence of hypothermia and apnea by 67% and 76%, respectively, when compared with body massage without oil. There were also improvements in the level of vitamin D3 and the overall neurodevelopmental score over 12 months (101873). Clinical studies in premature infants also show that oil massage using coconut oil reduces weight loss in the first few days after birth and improves weight gain and length when compared with mineral oil or no application (17937,90616,101873). Preterm infants are at increased risk for infection due to the inadequate protective barrier provided by immature skin. Clinical studies in preterm or very preterm infants show that topical application of virgin coconut oil 2-4 times daily for 21-28 days as part of routine neonatal care helps maintain skin integrity, but does not reduce the risk for infections such as sepsis, when compared with routine neonatal care alone (96204,101873). Another clinical study in preterm infants shows that topical application of coconut oil 5 mL/kg twice daily for 28 days reduces the incidence of hospital-acquired infections from 21% to 7% when compared with control, but does not reduce overall mortality (90616).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Alzheimer disease. Although there has been interest in using oral coconut oil for Alzheimer disease, there is insufficient reliable information about the clinical effects of coconut oil for this purpose.
• Athletic performance. It is unclear if oral coconut oil is beneficial for improving athletic performance. Details: A small clinical trial in recreational runners shows that taking virgin coconut oil (Copra Alimentos, Maceio) 15 grams, with or without caffeine 6 mL/kg, 60 minutes prior to a 1600 meter running trial does not improve running performance or ratings of exertion when compared with a warm water control (101874).
• Breast cancer. It is unclear if oral coconut oil is beneficial in patients with breast cancer. Details: A small clinical study in patients with invasive or advanced breast cancer shows that taking virgin coconut oil 10 mL twice daily starting one week after chemotherapy from the third to the sixth cycle improves quality of life based on some but not all measurement scales when compared with control (90615).
• Coronary heart disease (CHD). Small clinical studies suggest that oral coconut oil does not alter the risk of CHD or prevent cardiovascular events in patients with CHD. Details: One small observational study in India has found that coconut or coconut oil consumption is not associated with a decreased or increased risk of myocardial infarction or angina (14407). A small clinical trial in patients with CHD from India shows that cooking with coconut oil does not alter cardiovascular outcomes or risk factors at 6 months, 1 year, or 2 years when compared with cooking with sunflower oil (96205).
• Coronavirus disease 2019 (COVID-19). Although there has been interest in using oral coconut oil for COVID-19, there is insufficient reliable information about the clinical effects of coconut oil for this purpose.
• Crohn disease. Although there has been interest in using oral coconut oil for Crohn disease, there is insufficient reliable information about the clinical effects of coconut oil for this purpose.
• Dental plaque. Small clinical studies suggest that pulling coconut oil through the teeth may modestly reduce dental plaque. Details: A small clinical study shows that pulling coconut oil 10 mL through the teeth for 15-20 minutes twice daily for 4 days is as effective as using a mouth rinse containing chlorhexidine gluconate-0.2% as 10 mL twice daily for 30 seconds in the prevention of plaque regrowth in posterior, but not anterior, surfaces of the teeth (101878). Another small clinical study in patients with plaque-induced gingivitis shows that pulling coconut oil 10 mL through the teeth for 5-10 minutes nightly for 30 days improves plaque scores when compared with standard dental hygiene with no mouth rinse (106491).
• Diabetes. It is unclear if oral coconut oil is beneficial for diabetes. Details: A meta-analysis of clinical trials shows that a single intake of coconut oil as part of a meal modestly increases postprandial glucose levels and decreases insulin levels. However, long-term intake of coconut oil increases insulin resistance, with no effect on fasting blood glucose or insulin levels. Only two studies in these analyses included patients with diabetes (107667). Therefore, the effect of coconut oil in patients with diabetes is unclear.
• Diarrhea. It is unclear if oral coconut oil is beneficial for improving diarrhea in children. Details: One small clinical study in children with mild-to-moderate dehydration due to diarrhea shows that eating a diet consisting of coconut oil, chicken, and plantain reduces the duration of diarrhea by 20 hours when compared with a cow's milk diet (19269). However, another small clinical trial in children with acute gastroenteritis shows that total duration of diarrhea is no different in children given a milk-free formula containing coconut oil when compared with children given cow's milk formula (19270).
• Dry mouth. It is unclear if topical coconut oil is beneficial for improving dry mouth in patients receiving radiation therapy. Details: One small clinical study in patients with dry mouth caused by radiation therapy shows that coating the mouth with coconut oil prior to meals and at bedtime for 2 weeks does not improve dry mouth-related quality of life scores when compared to baseline (106490).
• Dry skin. It is unclear if topical coconut oil is beneficial for improving dry skin. Details: A small clinical study in patients with mild-to-moderate dry skin shows that applying coconut oil topically twice daily improves skin moisture and skin lipid levels when compared to baseline. Coconut oil seems to be comparable to mineral oil as a skin moisturizer (17936). Also, preliminary clinical research in individuals who apply alcohol-based sanitizers to the hands six times daily shows that applying 6-8 drops (0.1 mL/cm²) of virgin coconut oil to the hands before bed for 15 days modestly increases perceived moisture content, but not perceived appearance or sensation, when compared with not using coconut oil (107668).
• Fetal and premature infant mortality. It is unclear if topical coconut oil is beneficial for reducing mortality in premature infants. Details: One clinical study in preterm infants shows that topical application of coconut oil 5 mL/kg twice daily for 28 days reduces the incidence of hospital-acquired infections from 21% to 7% when compared with control, but does not reduce overall mortality (90616).
• Gingivitis. It is unclear if pulling coconut oil through the teeth is beneficial in patients with gingivitis. Details: A small clinical study in patients with plaque-induced gingivitis shows that pulling coconut oil 10 mL through the teeth for 5-10 minutes nightly for 30 days improves gingival bleeding scores when compared with standard dental hygiene without a mouth rinse (106491). Another small clinical study in volunteers with gingival inflammation shows that pulling extra virgin coconut oil, 5 mL, through the teeth for 8 minutes daily for 28 days does not change plaque microbial counts when compared with baseline or with palm oil pulling (110010).
• HIV/AIDS. Although there has been interest in using oral coconut oil for HIV/AIDS, there is insufficient reliable information about the clinical effects of coconut oil for this purpose.
• Hypertension. It is unclear if oral coconut oil is beneficial in patients with hypertension. Details: One small clinical study in patients with hypertension shows that taking extra virgin coconut oil 3 mL with breakfast, 4 mL with lunch, and 3 mL with dinner daily for 30 days does not reduce blood pressure when compared with placebo (106493).
• Irritable bowel syndrome (IBS). Although there has been interest in using oral coconut oil for IBS, there is insufficient reliable information about the clinical effects of coconut oil for this purpose.
• Lice. Topical coconut oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One clinical study in children with head lice shows that application of a topical spray containing coconut oil, anise oil, and ylang ylang oil (Chick-Chack) once every 5 days for three treatments eradicates lice in around 92% of infected children, a rate comparable to children treated with a spray containing permethrin, malathion, piperonyl butoxide, and isododecane (13483). It is unclear if these findings are due to coconut oil, other ingredients, or the combination.
• Low birth weight. It is unclear if oral coconut oil is beneficial for improving growth in infants with very low birth weight. Details: One small, open-label clinical trial in very low birth weight infants shows that giving coconut oil 1 mL four times daily in expressed breast milk until 40 weeks corrected age does not increase growth when compared with breast milk alone. The addition of coconut oil also has no effect on head circumference, length, weight, or body fat improvements (101875).
• Metabolic syndrome. It is unclear if oral coconut oil is beneficial in patients with metabolic syndrome. Details: One small clinical trial in patients with metabolic syndrome shows that using 30 mL of virgin coconut oil in place of other cooking oils daily for 4 weeks reduces levels of triglycerides, very low-density lipoprotein (VLDL) cholesterol, and fasting plasma glucose and increases high-density lipoprotein (HDL) cholesterol levels when compared with a usual diet. However, levels of total cholesterol and low-density lipoprotein (LDL) cholesterol were increased with coconut oil use. Coconut oil did not alter blood pressure or waist circumference (106494).
• Multiple sclerosis (MS). Oral coconut oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small clinical study in patients with MS shows that taking coconut oil 60 mL in combination with epigallocatechin gallate (EGCG) 800 mg daily for 4 months improves functional capacity, increases muscle mass, and reduces symptoms of anxiety and depression by a small amount when compared to baseline (101876,106492). It is unclear if these findings are due to coconut oil, EGCG, or the combination. Additionally, the validity of these findings is limited by the lack of a comparator group.
• Nipple fissures. It is unclear if topical coconut oil is beneficial for nipple fissures in breastfeeding mothers. Details: Preliminary clinical research in breastfeeding primiparous mothers with nipple fissures shows that applying 0.5 mL of virgin coconut oil to the fissures after breastfeeding three times daily for 14 days improves scores on Storr's fissure scale and on a visual analog pain scale, when compared with applying 3 to 4 drops of breastmilk to the nipples after every breastfeeding session (110407).
• Nocturnal enuresis. It is unclear if topical coconut oil is beneficial in children with primary nocturnal enuresis. Details: Preliminary clinical research in children aged 6 to 14 years with primary nocturnal enuresis shows that applying coconut oil, 6 drops to the suprapubic, sacral, and flank areas nightly for 4 weeks reduces the mean frequency of urination at 4 weeks and 8 weeks of follow-up, when compared with baseline. Complete resolution occurred in 24 patients receiving coconut oil, and 17 receiving the paraffin oil control. There was no improvement in 5 on coconut oil, and 14 on paraffin oil (110405). However, the validity of these findings is unclear since blinding was compromised by the different oil odors.
• Obesity. Although some clinical studies suggest that oral coconut oil may modestly reduce body weight or body mass index (BMI), most research is mixed. Details: A meta-analysis of clinical research shows that taking coconut oil in the diet or as a supplement daily decreases body weight, BMI, and fat mass percent by 0.75 kg, 0.28 kg/m², and 0.35%, respectively, when compared to other oils and fats, usually polyunsaturated oils. However, there was no effect on waist circumference or total fat mass, and significant changes did not occur in more than half of the individual studies (107665). These individual studies were generally small, of low to moderate quality, and utilized a wide range of dosing regimens. Doses of coconut oil used in the individual studies ranged from 7-93 mL or 14% to 15% of daily energy intake and included extra-virgin, virgin, bleached and deodorized, hydrogenated, and ordinary sources. Study durations ranged from 4 weeks to 2 years (17938,17942,99102,107665). Virgin coconut oil is associated with reduced hunger and desire to eat in normal weight subjects, but not in obese subjects, when compared with extra virgin olive oil. It is also associated with reduced energy intake at the next meal when compared with olive oil in obese subjects, but not in normal weight subjects (110406).
• Psoriasis. It is unclear if topical coconut oil is beneficial in patients with psoriasis. Details: One small clinical study in patients with psoriasis shows that applying coconut oil to the skin before treatment with ultraviolet B (UVB) or psoralen and ultraviolet A (PUVA) phototherapy does not seem to improve the clearance of psoriasis (12356). More evidence is needed to rate coconut oil for these uses.

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LIKELY EFFECTIVE

• Cystic fibrosis. Long-term nebulized hypertonic sodium chloride improves lung function and reduces pulmonary exacerbations in patients with cystic fibrosis. Details: Meta-analyses of clinical research in adults with cystic fibrosis show that, when taken along with a bronchodilator and other standard therapies, nebulized hypertonic sodium chloride in concentrations of 3% to 7%, up to 10 mL twice daily for 4 weeks, increases forced expiratory volume at one second (FEV1) when compared with isotonic saline (sodium chloride 0.9%) (26230,26230). This benefit was not seen at 48 weeks. Other clinical research in adults with cystic fibrosis shows that inhaling sodium chloride 7%, 4 mL twice daily for 48 weeks, does not improve FEV1 when compared with isotonic saline. However, chronic treatment with hypertonic saline does reduce the number of pulmonary exacerbations and increase the number of patients without pulmonary exacerbations when compared with isotonic saline (29402). It is not clear if this benefit occurs in children with cystic fibrosis. The Pulmonary Clinical Practice Guidelines Committee of the Cystic Fibrosis Foundation recommends that individuals with cystic fibrosis aged 6 years or older use nebulized hypertonic saline long-term to improve lung function, reduce the number of exacerbations, and improve quality of life (29403).

POSSIBLY EFFECTIVE

• Amphotericin B nephrotoxicity. Oral sodium chloride seems to prevent nephrotoxicity associated with use of amphotericin B. Details: Clinical research shows that administering oral or intravenous sodium chloride 150 mEq daily during treatment with amphotericin B can attenuate the rise in serum creatinine levels and preserve renal function when compared to treatment with amphotericin B alone (26226).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Bipolar disorder. It is unclear if oral sodium is beneficial in preventing lithium level fluctuations in patients with bipolar disorder. Details: A moderate-sized open-label clinical study in adults with type I bipolar disorder receiving lithium carbonate shows that taking sodium chloride 1 gram daily for 12 weeks along with dietary salt restriction of 1 gram daily reduces the percentage of patients with lithium level fluctuations above 0.8 mEq/L, but does not significantly affect serum sodium, potassium, aldosterone, or creatinine levels when compared with controls who were not salt restricted, but were advised not to consume additional salt at the table (112909). However, the interpretation of these findings is limited by missing data in both groups.
• Canker sores. Although there is interest in using topical sodium chloride for canker sores, there is insufficient reliable information about the clinical effects of sodium chloride for this condition.
• Congestive heart failure. It is unclear if oral sodium is beneficial in patients with acute decompensated heart failure requiring decongestive therapy with diuretics. Details: A moderate-sized clinical study in adults hospitalized with acute decompensated heart failure requiring high-dose intravenous furosemide shows that taking sodium chloride 2 grams three times daily for up to 96 hours does not affect patient weight or serum creatinine levels when compared with placebo (112911). However, the clinical relevance of this study is unclear and it may have been inadequately powered to detect a difference between groups.
• Conjunctivitis. Although there is interest in using ophthalmic sodium chloride for conjunctivitis, there is insufficient reliable information about the clinical effects of sodium chloride for this condition.
• Hyponatremia. Although there is interest in using oral sodium chloride for hyponatremia, there is insufficient reliable information about the clinical effects of oral sodium chloride for this condition.
• Pharyngitis. Although there is interest in using topical sodium chloride for pharyngitis, there is insufficient reliable information about the clinical effects of sodium chloride for this condition.
• Prematurity. It is unclear if oral sodium is beneficial for premature infants. Details: Preliminary clinical research in infants born at less than 32 weeks' gestation shows that adding sodium 4 mEq/kg daily to enteral feedings, starting from the 7th day after birth and continuing through the 35th day, reduces the risk of developing hyponatremia and improves weight gain when compared with adding water (98180). A small, open-label clinical study in newborns less than 35 weeks gestation shows that high sodium intake, defined as an average of 0.25% sodium in maintenance fluids, for 48 hours on day 2 and 3 after birth results in less weight loss within the first 72 hours of life when compared with control, but does not improve mortality, length of hospital stay, or complications from prematurity (112908). However, interpretation of these findings is limited by varied concentrations of sodium as an intervention. More evidence is needed to rate sodium for these uses.

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LIKELY SAFE ...when used orally in food amounts. Coconut oil can be safely consumed as a component of the diet (12361,17935,94452,106494). However, coconut oil should not be considered a healthy alternative to other saturated fats (94453,94643). Coconut oil contains more saturated fat than animal based fats, including lard and butter (94643). Therefore, like all saturated fats, coconut oil should be used in moderation (94453,94643). ...when used topically and appropriately. Commercial products containing coconut oil in concentrations up to 100% have been used with apparent safety. However, most research has used commercial products with concentrations up to 70% (12356,17936,17941).

POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts, short-term. Taking coconut oil up to 10 mL orally two or three times daily for up to 12 weeks has been used with apparent safety in clinical research (17938,17942,90615,106493).

CHILDREN: POSSIBLY SAFE
when used topically and appropriately, short-term. Coconut oil has been used with apparent safety in children and neonates for about one month (13483,17937,90614,90616,96204,101873). There is insufficient reliable information available about the safety of coconut oil when taken orally in children.

PREGNANCY AND LACTATION:
There is insufficient reliable information available about the safety of using coconut oil in medicinal amounts during pregnancy or lactation. Coconut oil ingestion increases the amount of lauric acid in breast milk within 10 hours. This indicates that fatty acids from coconut oil are rapidly transferred into human breast milk following oral intake (14086). The impact of this increase in lauric acid on nursing infants is not known.

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LIKELY SAFE ...when used orally and appropriately. Sodium is safe in amounts that do not exceed the Chronic Disease Risk Reduction (CDRR) intake level of 2.3 grams daily (100310). Higher doses can be safely used therapeutically with appropriate medical monitoring (26226,26227).

POSSIBLY UNSAFE ...when used orally in high doses. Tell patients to avoid exceeding the CDRR intake level of 2.3 grams daily (100310). Higher intake can cause hypertension and increase the risk of cardiovascular disease (26229,98176,98177,98178,98181,98183,98184,100310,109395,109396,109398,109399). There is insufficient reliable information available about the safety of sodium when used topically.

CHILDREN: LIKELY SAFE
when used orally and appropriately (26229,100310). Sodium is safe in amounts that do not exceed the CDRR intake level of 1.2 grams daily for children 1 to 3 years, 1.5 grams daily for children 4 to 8 years, 1.8 grams daily for children 9 to 13 years, and 2.3 grams daily for adolescents (100310).

CHILDREN: POSSIBLY UNSAFE
when used orally in high doses. Tell patients to avoid prolonged use of doses exceeding the CDRR intake level of 1.2 grams daily for children 1 to 3 years, 1.5 grams daily for children 4 to 8 years, 1.8 grams daily for children 9 to 13 years, and 2.3 grams daily for adolescents (100310). Higher intake can cause hypertension (26229).

PREGNANCY AND LACTATION: LIKELY SAFE
when used orally and appropriately. Sodium is safe in amounts that do not exceed the CDRR intake level of 2.3 grams daily (100310).

PREGNANCY AND LACTATION: POSSIBLY UNSAFE
when used orally in higher doses. Higher intake can cause hypertension (100310). Also, both the highest and the lowest pre-pregnancy sodium quintile intakes are associated with an increased risk of hypertensive disorders of pregnancy, including gestational hypertension and pre-eclampsia, and the delivery of small for gestational age (SGA) infants when compared to the middle intake quintile (106264).

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ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = A Theoretically, a high intake of dietary sodium might reduce the effectiveness of antihypertensive drugs.  Details High intake of dietary sodium can increase systolic and diastolic blood pressure (26222). Also, high intake of sodium may necessitate increased use of antihypertensive medications to achieve blood pressure control in some patients, such as those with chronic kidney disease (26223).

CORTICOSTEROIDS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Concomitant use of mineralocorticoids and some glucocorticoids with sodium supplements might increase the risk of hypernatremia.  Details Mineralocorticoids and some glucocorticoids (corticosteroids) cause sodium retention. This effect is dose-related and depends on mineralocorticoid potency. It is most common with hydrocortisone, cortisone, and fludrocortisone, followed by prednisone and prednisolone (4425).

LITHIUM Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = B Altering dietary intake of sodium might alter the levels and clinical effects of lithium.  Details High sodium intake can reduce plasma concentrations of lithium by increasing lithium excretion (26225). Reducing sodium intake can significantly increase plasma concentrations of lithium and cause lithium toxicity in patients being treated with lithium carbonate (26224,26225). Stabilizing sodium intake is shown to reduce the percentage of patients with lithium level fluctuations above 0.8 mEq/L (112909). Patients taking lithium should avoid significant alterations in their dietary intake of sodium.

SODIUM-CONTAINING DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Concomitant use of sodium-containing drugs with additional sodium from dietary or supplemental sources may increase the risk of hypernatremia and long-term sodium-related complications.  Details The Chronic Disease Risk Reduction (CDRR) intake level of 2.3 grams of sodium daily indicates the intake at which it is believed that chronic disease risk increases for the apparently healthy population (100310). Some medications contain high quantities of sodium. When used in conjunction with sodium supplements or high-sodium diets, the CDRR may be exceeded. Additionally, concomitant use may increase the risk for hypernatremia; this risk is highest in the elderly and people with other risk factors for electrolyte disturbances.

TOLVAPTAN (Samsca) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = C Theoretically, concomitant use of tolvaptan with sodium might increase the risk of hypernatremia.  Details Tolvaptan is a vasopressin receptor 2 antagonist that is used to increase sodium levels in patients with hyponatremia (29406). Patients taking tolvaptan should use caution with the use of sodium salts such as sodium chloride.

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General ...Orally and topically, coconut oil is generally well tolerated.
Most Common Adverse Effects:
Orally: Increased cholesterol levels.
Serious Adverse Effects (Rare):
All routes of administration: Allergic reactions, including anaphylaxis, in sensitive individuals.

Cardiovascular ...Due to its high saturated fat content, there has been some speculation that consuming coconut oil might increase cholesterol levels and the risk of cardiovascular disease. Several population and clinical studies have found that consuming coconut oil increases total cholesterol, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol in some patients (12361,14407,17935,17940,94451,94452,99103,101877,101879,106489,106494). In patients with normal to high cholesterol levels, consuming a daily diet providing 30% to 36% of calories from fat, of which 46% to 66% is from coconut oil, for 4-12 weeks increases total cholesterol by about 12-15 mg/dL, low-density lipoprotein (LDL) cholesterol by about 9-12 mg/dL, and HDL cholesterol by 3-6 mg/dL when compared to a diet containing vegetable oils, especially those rich in polyunsaturated fatty acids (17935,94451,94452,101877,106489). In some cases, these cholesterol effects are similar to those seen in patients consuming a similar diet containing butter or beef fat (12361,17935,94451,99103,101879). Despite the potential effects of coconut oil on cholesterol levels, population research has not found an association with coconut oil consumption and risk of adverse cardiovascular events such as myocardial infarction or angina (14407,96205). Advise patients not to rely on coconut oil as a "healthy" alternative to other saturated fats.

Dermatologic ...In one case report, a 6-year-old child developed urticaria and hives from applying coconut oil to the skin. The child had been exposed to coconut oil consistently since 2 weeks of age, indicating sensitization over the course of regular exposure (95806). In clinical research, one patient reported localized pruritus immediately after applying a combination of coconut oil, anise oil, and ylang ylang (13483). It is unclear if this event was due to coconut oil, other ingredients, or the combination. Also, it is possible that this was an idiosyncratic event.

Gastrointestinal ...Orally, diarrhea and gastroenteritis have been reported rarely (101877).

Hepatic ...Orally, taking virgin coconut oil in the diet for 28 days modestly increased levels of liver enzymes in patients with coronavirus disease 2019 (COVID-19). However, it is unclear if this was due to the coconut oil or to the illness (107664).

Immunologic ...Several cases of allergic reactions have been reported for patients who consumed coconut fruit. In some of the cases, the patients were previously diagnosed with sensitivity to other tree nuts, including peanuts, so cross-sensitivity is suspected. In a separate case report, a 17-year-old male was found to be sensitized to both coconut and buckwheat, indicating a possible cross-sensitivity between the two allergens (95808). In other cases, the patients did not show sensitivity to any other allergens, so the patients were considered to have a single allergy to coconut fruit (12359,12360).
Because coconut oil is derived from coconut fruit, ingestion of coconut oil may theoretically cause allergic reactions in patients with confirmed allergy to coconut fruit. In one case report, a 6-year-old child who had previously experienced urticaria and hives from applying coconut oil to the skin experienced throat swelling and anaphylaxis after eating food containing coconut, indicating a sensitivity to both the fruit and the oil via both topical application and ingestion (95806). However, allergic reactions to coconut appear to occur significantly less often than allergies to other food items such as wheat, milk, soy, or peanut (14408).

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General ...Orally, sodium is well tolerated when used in moderation at intakes up to the Chronic Disease Risk Reduction (CDRR) intake level. Topically, a thorough evaluation of safety outcomes has not been conducted.
Serious Adverse Effects (Rare):
Orally: Worsened cardiovascular disease, hypertension, kidney disease.

Cardiovascular ...Orally, intake of sodium above the CDRR intake level can exacerbate hypertension and hypertension-related cardiovascular disease (CVD) (26229,98176,100310,106263). A meta-analysis of observational research has found a linear association between increased sodium intake and increased hypertension risk (109398). Observational research has also found an association between increased sodium salt intake and increased risk of CVD, mortality, and cardiovascular mortality (98177,98178,98181,98183,98184,109395,109396,109399). However, the existing research is unable to confirm a causal relationship between sodium intake and increased cardiovascular morbidity and mortality; high-quality, prospective research is needed to clarify this relationship (100312). As there is no known benefit with increased salt intake that would outweigh the potential increased risk of CVD, advise patients to limit salt intake to no more than the CDRR intake level (100310).
A reduction in sodium intake can lower systolic blood pressure by a small amount in most individuals, and diastolic blood pressure in patients with hypertension (100310,100311,106261). However, post hoc analysis of a small crossover clinical study in White patients suggests that 24-hour blood pressure variability is not affected by high-salt intake compared with low-salt intake (112910). Additionally, the available research is insufficient to confirm that a further reduction in sodium intake below the CDRR intake level will lower the risk for chronic disease (100310,100311). A meta-analysis of clinical research shows that reducing sodium intake increases levels of total cholesterol and triglycerides, but not low-density lipoprotein (LDL) cholesterol, by a small amount (106261).
It is unclear whether there are safety concerns when sodium is consumed in amounts lower than the adequate intake (AI) levels. Some observational research has found that the lowest levels of sodium intake might be associated with increased risk of death and cardiovascular events (98181,98183). However, this finding has been criticized because some of the studies used inaccurate measures of sodium intake, such as the Kawasaki formula (98177,98178,101259). Some observational research has found that sodium intake based on a single 24-hour urinary measurement is inversely correlated with all-cause mortality (106260). The National Academies Consensus Study Report states that there is insufficient evidence from observational studies to conclude that there are harmful effects from low sodium intake (100310).

Endocrine ...Orally, a meta-analysis of observational research has found that higher sodium intake is associated with an average increase in body mass index (BMI) of 1. 24 kg/m2 and an approximate 5 cm increase in waist circumference (98182). It has been hypothesized that the increase in BMI is related to an increased thirst, resulting in an increased intake of sugary beverages and/or consumption of foods that are high in salt and also high in fat and energy (98182). One large observational study has found that the highest sodium intake is not associated with overweight or obesity when compared to the lowest intake in adolescents aged 12-19 years when intake of energy and sugar-sweetened beverages are considered (106265). However, in children aged 6-11 years, usual sodium intake is positively associated with increased weight and central obesity independently of the intake of energy and/or sugar-sweetened beverages (106265).

Gastrointestinal ...In one case report, severe gastritis and a deep antral ulcer occurred in a patient who consumed 16 grams of sodium chloride in one sitting (25759). Chronic use of high to moderately high amounts of sodium chloride has been associated with an increased risk of gastric cancer (29405).

Musculoskeletal ...Observational research has found that low sodium levels can increase the risk for osteoporosis. One study has found that low plasma sodium levels are associated with an increased risk for osteoporosis. Low levels, which are typically caused by certain disease states or chronic medications, are associated with a more than 2-fold increased odds for osteoporosis and bone fractures (101260).
Conversely, in healthy males on forced bed rest, a high intake of sodium chloride (7.7 mEq/kg daily) seems to exacerbate disuse-induced bone and muscle loss (25760,25761).

Oncologic ...Population research has found that high or moderately high intake of sodium chloride is associated with an increased risk of gastric cancer when compared with low sodium chloride intake (29405). Other population research in patients with gastric cancer has found that a high intake of sodium is associated with an approximate 65% increased risk of gastric cancer mortality when compared with a low intake. When zinc intake is taken into consideration, the increased risk of mortality only occurred in those with low zinc intake, but the risk was increased to approximately 2-fold in this sub-population (109400).

Pulmonary/Respiratory ...In patients with hypertension, population research has found that sodium excretion is modestly and positively associated with having moderate or severe obstructive sleep apnea. This association was not found in normotensive patients (106262).

Renal ...Increased sodium intake has been associated with impaired kidney function in healthy adults. This effect seems to be independent of blood pressure. Observational research has found that a high salt intake over approximately 5 years is associated with a 29% increased risk of developing impaired kidney function when compared with a lower salt intake. In this study, high salt intake was about 2-fold higher than low salt intake (101261).

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