Lol Bulletproof Coffee

LAS VEGAS -- Spiking coffee with butter and coconut oil -- a concoction known as "bulletproof coffee" -- may be boosting hyperlipidemia in otherwise healthy patients, researchers said here.

In a case report, a 39-year-old male with no previous cardiovascular risk factors developed elevated and at-risk levels of LDL cholesterol (198) and apolipoprotein B (133), Karl Nadolsky, DO, of Walter Reed Medical Center in Washington, and colleagues reported during a poster session at the American Association of Clinical Endocrinologists meeting.

"This is like a bomb of butter, which is a longer-chain fatty acid and palmitic acid, which is not so good for your lipids," Nadolsky told MedPage Today.

As more recent data have run contrary to thinking that all saturated fats increase cardiovascular risk, some dietitians have recommended high-fat diets, such as the paleo diet, along with specific nutrients such as medium-chain saturated fatty acids. Patients have been told to replace carbohydrates and long-chain fatty acids with these nutrients.

But the science on medium-chain fatty acids -- such as coconut oil -- is still unclear, Nadolsky said. And it's especially unclear if adding medium-chain fatty acids without a compensatory hypocaloric diet improves lipoprotein profile and cardiovascular risk or adversely effects them.

Still, some entrepreneurs have tried to capitalize on the craze, including the inventor of the "bulletproof coffee," Dave Asprey. He prescribes mixing 2 tablespoons of butter and 2 tablespoons of coconut oil into two cups of coffee with the promise of burning fat and losing weight. It's meant to replace breakfast.

Nadolsky said there is some evidence that dairy fat and medium-chain fatty acids may have some benefit, especially when derived from whole-food sources, but the literature is far from settled.

Also, some of the long-chain saturated fatty acids in butter, including palmitic and myristic acids, may have more hypercholesterolemic effects, he said, adding that some cases have indeed reported increased atherogenic lipidemia in otherwise healthy patients who have added butter and medium-chain fatty acids to their baseline diets.

In the case reported here, the 39-year-old male was referred to Nadolsky for hyperlipidemia but was otherwise healthy. He had no previous cardiovascular risks but his lipids had recently changed significantly.

He wasn't taking any medications -- although he took fish oil, vitamin D, and creatinine -- and exercised regularly at a high level of intensity. He'd adopted the "paleo" diet over a year-long period, increasing his intake of meat, cheese, and vegetables, mixed with a bit of nuts, low-carb ice cream, and dark chocolate.

After beginning the diet, his lipid panel revealed some increases in all cholesterol but a decline in triglycerides.

But over the preceding few months he'd also started drinking "bulletproof coffee" every morning, which contained 456 calories and 46 grams of fat (42 grams of which were saturated).

The patient had requested a lipid panel from his primary care provider, which included a scan of apolipoprotein B. The PCP referred him to endocrinology when he saw that all cholesterol parameters and triglycerides had increased beyond that seen with the "paleo" diet.

For instance, his total cholesterol jumped from 248 to 282, HDL from 59 to 66, LDL from 180 to 198, and triglycerides from 41 to 73. The apolipoprotein scan revealed a level of 133, which was high-risk, Nadolsky said. He attributed it to the bulletproof coffee intake.

Nadolsky believes similar patterns will be seen with more patients as the bulletproof coffee trend -- and other saturated fatty acid diets -- gains even more popularity. He's planning a follow-up study to determine the wider effects of the trend.

"If people drink this and don't change the rest of their diet, they're getting extra calories," Nadolsky said. "I think they're giving themselves a bomb of not-so-great long chain saturated fatty acids."

He said he'd instead advise patients to eat whole foods: "I'd rather people eat coconut than put 2 tablespoons of coconut oil into their food. We should be looking at whole foods instead of specific saturated fats."