DEAR DR. ROACH: Please write about the increasing use of “fashionable” coconut oil and coconut milk. I am on a plant-based diet, approaching vegan, and I see more products with high amounts of saturated fat, which seems to be due to increased use of coconut. I see this used in yogurts (where soy used to be more common), frozen vegan meals (where I would have expected olive oil), etc. One vegan slice of cake (which I did not buy) contained 113 percent of the daily allotment of saturated fat — made with coconut oil. — G.W.

ANSWER: It sounds like you have made up your mind about coconut oil, but the science isn’t entirely settled. Most authorities have recommended avoiding tropical oils, including palm oil and coconut oil, but feel they are not as unhealthy as meat-based saturated fats. I also recommend against large amounts of coconut and palm oil. In my opinion, vegetable oils, olive and canola oils and nut oils are better choices for health.

DEAR DR. ROACH: I would very much like to stop using warfarin. I underwent a successful ablation surgery (maze procedure) to correct my atrial fibrillation, and my valve replacement surgeries also were successful (mitral and aortic). At that time, they also did a closure of the left atrial appendage where the blood pools and possibly clots. It’s been a year on the blood thinner, but I would like to stop. Do you think that would be safe? — G.M.

ANSWER: You have had a lot done. Let me explain what you went through before answering the question. The combination of atrial fibrillation with both mitral and aortic valve repair makes me concerned that you may have had rheumatic fever as the underlying cause.

Atrial fibrillation is a common rhythm disturbance, where the normal, regular rhythm of the heart is disrupted by chaotic electrical activity in the upper chambers of the heart. This leads to an irregular, sometimes too fast, heartbeat. The chaotic rhythm lessens the ventricles’ ability to fill up with blood, which can lead to decreased output and an increase in the risk of blood clotting. This, in turn, increases the risk of stroke. It’s the stroke risk that should concern you most.

The electrical abnormalities of atrial fibrillation can be treated with anti-arrhythmic drugs or with surgery. The maze procedure is about 60 percent effective in restoring normal heart rhythm. At the time of the maze procedure, the left atrial appendage (where clots are most likely to form) is normally closed. In people who have been successfully treated and have remained in normal heart rhythm for at least three months, with no recurrence of atrial fibrillation, and who have had the left atrial appendage closed, anticoagulation can be stopped, particularly in people who are not good candidates for long-term oral anticoagulants, such as warfarin, due to bleeding risk or some other reason. So, it’s entirely reasonable to ask your cardiologist about it. Your cardiologist knows you much better than I do.

The valve replacements may or not be an issue. Most valve replacements now are biomechanical valves, which do not need warfarin or a newer agent. However, people with mechanical valves usually are treated with long-term aspirin.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

Dr. Roach

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