Xanth Myst by Twist & Myst

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Diabetes. Although there is interest in using oral coconut for diabetes, there is insufficient reliable information about the clinical effects of coconut for this condition.
• Hypercholesterolemia. It is unclear if oral coconut is beneficial for lowering cholesterol levels; the available research is conflicting. Details: Preliminary clinical research in patients with moderately elevated serum cholesterol levels shows that consuming corn flakes with 15% or 25% dietary fiber from coconut flakes (prepared with coconut flour) for 2 weeks reduces total cholesterol by about 7% to 11% and low-density lipoprotein (LDL) cholesterol by about 9% to 11% when compared with baseline (26295). However, population research suggests that people who consume large amounts of coconut have higher cholesterol levels when compared with those who do not (26558). These conflicting results may be due to the type of coconut being consumed. For example, coconut contains coconut oil, which has been associated with increased cholesterol levels in some research (12361,17940). On the other hand, coconut flour is prepared from coconut residue after extraction of milk; this byproduct residue is defatted and contains a high percentage of water-soluble dietary fiber (26197).
• Lichen Planus. There is limited evidence on the use of topical coconut cream in adults with oral lichen planus. Details: Preliminary clinical research findings suggest that topical coconut 50% cream may reduce lesion size, burning sensation, and pain level over a time period of 60 days when compared with baseline. Coconut cream appears to be similarly effective to the standard treatment clobetasol propionate 0.05% ointment in the treatment of oral lichen planus. The study is limited by unclear statistical analysis, small sample size, and a short follow-up period (110713).
• Obesity. Although there is interest in using oral coconut for weight loss, there is insufficient reliable information about the clinical effects of coconut for this condition. More evidence is needed to rate coconut for these uses.

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LIKELY INEFFECTIVE

• Alzheimer disease. Lecithin does not improve daily functioning in patients with Alzheimer disease. Details: In patients with Alzheimer disease, taking various types of lecithin, 1.2-45 grams daily for up to 6 months, alone or in combination with various conventional medications, does not improve cognitive function or other measures of disease progression (5149,5151,5152,5156,14817,14823,14825,14837,14838).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Age-related cognitive decline. It is unclear if oral lecithin can slow age-related cognitive decline. Details: A small clinical crossover study in healthy adults aged 64 years and older shows that taking lecithin 26 grams orally daily, alone or in combination with physostigmine, for 5 weeks does not seem to improve memory when compared with placebo (19204).
• Anxiety. Although there is interest in using oral lecithin for anxiety, there is insufficient reliable information about the clinical effects of lecithin for this condition.
• Atopic dermatitis (eczema). Although there is interest in using oral lecithin for atopic dermatitis, there is insufficient reliable information about the clinical effects of lecithin for this condition.
• Bipolar disorder. It is unclear if oral lecithin is beneficial in patients with bipolar disorder. Details: A clinical study in six patients with mania shows that taking lecithin 10 mg three times daily improves symptoms of delusions, incoherent speech, and hallucinations when compared with placebo (14839).
• Dry skin. Although there is interest in using topical lecithin for dry skin, there is insufficient reliable information about the clinical effects of lecithin for this condition.
• Friedreich ataxia. Small clinical studies suggest that oral lecithin is not beneficial in people with Friedreich ataxia. Details: Preliminary clinical research shows that taking lecithin 25 grams orally daily for 1 month does not have any benefit in people with Friedreich ataxia (59298). Other preliminary clinical research shows that taking lecithin for a longer period of 6 months also does not improve performance (19211).
• Hyperlipidemia. Although lecithin may lower cholesterol in healthy people, it does not seem to improve cholesterol levels in people with hyperlipidemia. Details: Some clinical research shows that taking lecithin 20-30 grams daily for up to 11 months decreases cholesterol in healthy people (5147,14820). However, other clinical research shows that lecithin has no effect on low-density lipoprotein cholesterol or total cholesterol levels in people with hyperlipidemia (5148,14820).
• Parkinson disease. It is unclear if oral lecithin is beneficial in patients with Parkinson disease. Details: Preliminary clinical research in patients with Parkinson disease shows that taking lecithin 32 grams daily for 8 weeks does not improve symptoms when compared with placebo (19212).
• Postoperative pain. It is unclear if oral lecithin is beneficial for reducing postoperative pain. Details: Preliminary clinical research shows that taking lecithin 20 grams prior to surgery increases choline levels, but does not reduce postoperative pain after gynecological surgery, when compared with placebo (91231).
• Tardive dyskinesia. It is unclear if oral lecithin is beneficial in patients with tardive dyskinesia. Details: Two small clinical studies in patients with tardive dyskinesia shows that taking lecithin orally for 2 months, alone or in combination with lithium, does not improve symptoms when compared with placebo (14822,14824).
• TPN-associated hepatic steatosis. It is unclear if oral lecithin is beneficial in patients with hepatic steatosis associated with long-term total parenteral nutrition (TPN). Details: A small clinical study in patients on long-term TPN with low choline levels suggests that taking lecithin 20 grams orally twice daily for 6 weeks reduces the degree of hepatic steatosis, compared with no significant changes in those taking placebo (5140).
• Ulcerative colitis. Oral lecithin has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that taking a disease-specific medical food (Profermin, Nordisk Rebalance) containing lecithin, fermented oats, barley malt, and lactobacillus plantarum, as 250 mL twice daily for 24 weeks, decreases disease activity by over 56% when compared with baseline and leads to remission in 46% of patients with mild-to-moderate ulcerative colitis (91228). Other preliminary clinical research in this population shows that taking Profermin 250 mL twice daily for 8 weeks improves disease activity and remission rate when compared with another medical food (Fresubin Original, Fresenius Kabi) (90271). The effects of lecithin alone are unclear. More evidence is needed to rate lecithin for these uses.

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POSSIBLY EFFECTIVE

• Periodontitis. Oral and topical mangosteen may modestly improve gum health. Details: A small clinical study in adults with chronic periodontitis shows that applying a gel containing mangosteen pericarp 4% to the periodontal pocket following scaling and root planing procedures improves pocket depth, clinical attachment, and bleeding by 56% to 63%, compared with a 33% to 42% improvement with placebo (97875). Another small clinical study in similar patients shows that applying mangosteen 4% gel to the periodontal pocket following scaling and root planning improves pocket depth and clinical attachment when compared with placebo. However, plaque and bleeding indices were not compared between groups (110126). A clinical study in patients with generalized or localized gingivitis or stage I periodontitis shows that taking 194 mg of a product containing mangosteen and propolis orally improves the modified gingival index by 31% or 40% at weeks 4 or 8, respectively, compared with 16% or 25% in those receiving placebo. No changes in probing depth, clinical attachment, plaque index, bleeding, or gingival recession were observed (106789). It is unclear if these effects are due to mangosteen, propolis, or the combination.

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Alzheimer disease. It is unclear if oral mangosteen is beneficial for patients with Alzheimer disease. Details: A small clinical study in adults with Alzheimer disease in Thailand shows that treatment with oral mangosteen pericarp extract, provided either as 220-280 mg daily for 24 weeks, or as 220-280 mg daily for 12 weeks followed by 440-560 mg daily for 12 weeks, does not consistently improve cognitive function scores to a clinically significant extent when compared with placebo. This study assessed cognitive function on the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and Thai Mental State Examination (110127). However, the validity of this study is limited by poor methodology, including inadequate power and blinding.
• Androgenic alopecia. Mangosteen has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A large clinical trial in males and females with androgenic and diffuse alopecia shows that applying a hair lotion containing fermented mangosteen 2%, fermented papaya 2%, and caffeine 0.5% to the scalp daily plus use of a shampoo containing fermented mangosteen 0.5% and fermented papaya 0.5% 3 times weekly for 14 weeks improves hair shaft and root quality, hair diameter, and the density and percentage of thick hairs compared to baseline (111719). It is unclear if these effects are due to fermented mangosteen, other ingredients, or the combination.
• Atopic dermatitis (eczema). Although there has been interest in using topical mangosteen for eczema, there is insufficient reliable information about the clinical effects of mangosteen for this purpose.
• Muscle fatigue. It is unclear if oral mangosteen is beneficial in preventing muscle fatigue during physical activity. Details: A very small clinical study in healthy, physically active adults shows that drinking 250 mL of a specific mangosteen juice product (Lord Duke Biotechnology Corporation) containing mangosteen, pomegranate, acerola, white grape, strawberry, passion fruit, and tamarind, 1 hour prior to physical activity, does not improve time to exhaustion when compared to the juice product without mangosteen (92805).
• Muscle strength. Oral mangosteen has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One small clinical study in young, resistance-trained males shows that taking a combination product (CinDura, Laila Nutraceuticals) containing mangosteen fruit rind extract and Indian cassia leaf extract 400 mg twice daily for 42 days increases muscle strength and endurance when compared with placebo. Single bench and leg presses improved by approximately 23.5 kg and 29.3 kg, respectively, compared with 3.4 kg and 5.2 kg, respectively, in those taking placebo. Also, the number of leg extension repetitions increased by 6.5, compared to an increase of 2 with placebo (101079). It is not clear if these benefits are due to mangosteen, Indian cassia, or the combination.
• Obesity. Oral mangosteen has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in healthy adults who were overweight shows that taking a specific combination product containing a mixture of mangosteen and Sphaeranthus indicus (Meratrim, Laila Nutraceuticals) 400 mg twice daily for 16 weeks results in weight loss of 6.7%, compared with weight loss of 1.4% with placebo (97876). In adults with obesity, taking the same dose of this product for 8 weeks results in an additional reduction in body weight of 4.6% when compared with placebo (97878,97879). This product also seems to improve body mass index (BMI), waist and hip measurements, and blood lipids in some patients (97876,97878,97879). It is not clear if these benefits are due to mangosteen, Sphaeranthus indicus, or the combination.
• Osteoarthritis. Topical mangosteen has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A large, single-blind clinical study in adults with knee osteoarthritis causing moderate pain shows that applying a specific cream (TMP-4) containing extracts of mangosteen peel, sesame seed, soybean, and gotu kola leaf four times daily for 4 weeks provides similar improvement in pain scores when compared with diclofenac 1% gel. Topical TMP-4 cream also seems to improve knee stiffness, stair climbing, and mobility similarly to diclofenac gel. However, patient impression of overall improvement was higher with diclofenac (110128). The validity of this study is limited by inadequate blinding.
• Schizophrenia. It is unclear if oral mangosteen is beneficial in schizophrenia. Details: A clinical study in adults with schizophrenia or schizoaffective disorder shows that taking mangosteen pericarp 1000 mg daily for 24 weeks does not improve total symptom severity when compared with placebo (106787). A secondary analysis of cognitive outcomes also did not demonstrate any differences (106790). More evidence is needed to rate mangosteen for these uses.

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LIKELY SAFE ...when used orally in food amounts. Coconut is recognized as safe for human consumption by the US Food and Drug Administration (95809).

POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts, short-term. Corn flakes supplemented with 15% or 25% dietary fiber from coconut flakes prepared with coconut flour have been used with apparent safety (26295).

PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in food amounts (95809). There is insufficient reliable information available about the safety of coconut when used in medicinal amounts during pregnancy and lactation; avoid use.

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LIKELY SAFE ...when used orally in amounts commonly found in foods. Lecithin has Generally Recognized As Safe (GRAS) status in the US (2619,105544). ...when used orally and appropriately in medicinal amounts. Lecithin has been used safely in doses of up to 30 grams daily for up to 6 weeks (5140,5149,5152,5156,14817,14822,14838,19212). ...when used topically (4914).

PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in food amounts. Lecithin has Generally Recognized As Safe (GRAS) status in the US (105544). There is insufficient reliable information available about the safety of medicinal amounts of lecithin during pregnancy or lactation; avoid using.

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POSSIBLY SAFE ...when used orally. Mangosteen has been used with apparent safety at a dose of up to 560 mg daily for 12 weeks (110127). It has also been used with apparent safety in combination with Sphaeranthus indicus (Meratrim, Laila Nutraceuticals) or Indian cassia (Cindura, Laila Nutraceuticals), for a total dose of 800 mg daily for up to 16 weeks (97876,97878,97879,101079). ...when used topically as a single dose. Mangosteen pericarp 4% gel has been applied once along the gum line with apparent safety (97875).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

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ANTIDIABETES DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, taking coconut with antidiabetes drugs might increase the risk of hypoglycemia.  Details Animal research suggests that coconut milk might increase insulin levels and/or decrease blood glucose levels (107671).

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of mangosteen with anticoagulant or antiplatelet drugs may increase the risk of bleeding.  Details In vitro and animal research shows that gamma-mangostin, a constituent of mangosteen, is a potent and competitive antagonist of the serotonin 2A (5-HT2A) receptor. Antagonism of the 5-HT2A receptor is believed to reduce platelet aggregation (12017,61685,61686).

DONEPEZIL (Aricept) Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of mangosteen with donepezil might increase the effects of donepezil.  Details Animal research shows that concomitant use of an aqueous extract of mangosteen pericarp with donepezil increases brain concentrations of donepezil at 4 hours by 64% without associated effects on systemic exposure (106791).

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General ...Orally, coconut is generally well tolerated.
Most Common Adverse Effects:
Orally and topically: Allergic reactions, including anaphylaxis and hives.

Dermatologic ...Orally or topically, coconut and coconut palm pollen may cause allergic skin reactions such as urticaria and hives (12359,26561,26572,95806).

Immunologic ...Although coconut is a stone fruit, in the US, coconut is grouped with tree nuts for allergen declaration purposes (107673). Orally or topically, coconut can cause allergic reactions ranging from hives to anaphylaxis in those with hypersensitivity to coconut or its pollen (12359,26561,95806,95807,95808,107673,107674). Based on a review of hospital records in the US, most reactions to coconut are due to oral exposure, including through breastfeeding, with about 50% of reactions associated with anaphylaxis (107673). In addition, there have been numerous case reports of anaphylaxis from coconut in the literature, with most cases presenting in infancy or early childhood (95808,107674). In one case report, a 12-year-old child with asthma and allergic rhinitis experienced anaphylaxis with difficulty breathing, wheezing and vomiting, from eating a piece of coconut for the first time (95808). In another case report, a 6-year-old child who had previously had urticaria and hives from applying coconut oil experienced throat swelling and anaphylaxis after eating food containing coconut (95806). Coconut may also play a role in cross-sensitization. In a case report, a 17-year-old male who experienced prickling in the mouth after ingesting coconut soon after experienced an anaphylactic reaction to buckwheat. The child was found to be sensitized to both coconut and buckwheat (95807).

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General ...Orally, lecithin is well tolerated.
Most Common Adverse Effects:
Orally: Abdominal pain, diarrhea, fullness, and nausea.

Dermatologic ...Orally, lecithin can cause allergic skin reactions in people with egg or soy allergies (15705).

Gastrointestinal ...Orally, lecithin may cause abdominal pain, diarrhea, fullness, and nausea (5140,6243,14817,14822,14838,19204,59281).

Neurologic/CNS ...Orally, lecithin caused CNS complaints and agitation in one patient in a clinical trial (59261).

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General ...Orally, mangosteen is generally well tolerated. Topically, no adverse effects have been reported. However, a thorough evaluation of safety outcomes has not been conducted.
Serious Adverse Effects (Rare):
Orally: Lactic acidosis.

Dermatologic ...Orally, mangosteen extract up to 560 mg daily has been reported to cause skin rash. It is not known if this side effect was related to mangosteen (97877).

Gastrointestinal ...Orally, mangosteen extract up to 560 mg daily has been reported to cause constipation, abnormal stool, abdominal discomfort, abdominal bloating, salivation, nausea and vomiting, and diarrhea. It is not known if these side effects were related to mangosteen (97877).

Neurologic/CNS ...Orally, mangosteen extract up to 560 mg daily has been reported to cause mild tiredness, headache, dizziness, and malaise. It is not known if these side effects were related to mangosteen (97877).

Pulmonary/Respiratory ...Orally, mangosteen extract up to 560 mg daily has been reported to cause dry throat, flu-like symptoms, cough, and nasal congestion. It is not known if these side effects were related to mangosteen (97877).

Renal ...Orally, mangosteen extract up to 560 mg daily has been reported to cause abnormal urination. It is not known if this side effect was related to mangosteen (97877). In one case report, a patient with chronic kidney disease and metabolic syndrome consumed mangosteen juice daily for 12 months and later presented with severe lactic acidosis. The juice was reported to contain 250 mg of mangosteen with 25 mg alpha-mangostin per ounce. Alpha-mangostin appears to inhibit mitochondrial function, disrupting the electron transport chain and adenosine triphosphate (ATP) production, causing accumulation of reactive oxygen species and inducing apoptosis. Researchers speculate that these effects might have led to lactic acidosis in this patient (16399).

Other ...Orally, mangosteen extract up to 560 mg daily has been reported to cause weight loss. It is not known if this side effect was related to mangosteen (97877).

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