Coconut milk is often a staple fat source for those following a Paleo diet. From a nutritional perspective, it’s an excellent choice. It’s high in saturated fatty acids and medium-chain triglycerides (MCT), which are both easily burned as fuel by the body. MCTs are particularly beneficial in that they don’t require bile acids for digestion, and they’re directly shunted to the liver via the portal vein.

Coconut milk and fruit can be a great snack for Paleo folks, and coconut milk smoothies make a great Paleo breakfast choice – especially in the summer.

So what could be wrong with coconut milk? Here are three things to consider.

Bisphenol-A

Bisphenol-A (BPA) is a chemical that has been used in consumer goods since the 50s. It’s found in reusable drink containers, DVDs, cell phones, eyeglass lenses, automobile parts and sports equipment. While the research on BPA is still mixed (some studies indicating harm and others not), given the uncertainty I think it makes sense to avoid it whenever possible.

BPA is used in the lining of certain canned foods. BPA especially leaches into canned foods that are acidic, salty or fatty, such as coconut milk, tomatoes, soup, and vegetables.

So what’s the solution here? In short, if you want to be on the safe side and reduce your exposure to BPA, you have to reduce your consumption of canned foods (including coconut milk) as much as possible. I made this recommendation in 9 Steps for Perfect Health-#3: Eat Real Food. A study published in Environmental Health Perspectives found that families who ate fresh food for three days with no canned food, and using only glass storage containers, experienced a 60% reduction of BPA in their urine. The reductions were even higher (75%) for those with the highest BPA levels at the beginning of the study.

The good news, however, is that there are brands of coconut milk with BPA-free cans or carton packaging. One is Native Forest, which you can purchase on Amazon if it’s not available at your local store.

Coconut milk can also be made quite easily at home, with coconut flakes, a blender and cheesecloth. Here’s a video to show you how (get a load of the soundtrack). I find that blanching the coconut flakes prior to blending improves the results.

Guar gum

The other potential problem with canned coconut milk is guar gum. Guar gum is a galactomannan, which is a polysaccharide consisting of a mannose backbone with a galactose side group.

It’s primarily the endosperm of guar beans.

Beans and legumes have a variety of compounds in them that make them difficult to digest, especially for people with digestive problems (1 in 3 Americans, from the latest statistics). In my clinical experience, many patients with gut issues improve when they remove guar gum from their diet—including canned coconut milk.

There’s no evidence that guar gum may cause serious harm. So, if you’re able to tolerate guar gum, there’s no reason to avoid it. If it does give you digestive trouble, look for a brand that’s free from guar gum. The other option, of course, is making coconut milk at home.

Fructose malabsorption

Fructose malabsorption (FM) is a digestive disorder characterized by impaired transport of fructose across the small intestine. This results in increased levels of undigested fructose in the gut, which in turn causes overgrowth of bacteria in the small intestine. Undigested fructose also reduces the absorption of water into the intestine.

The clinical effects of FM include: intestinal dysbiosis, changes in motility, promotion of mucosal biofilm, and decreased levels of tryptophan, folates and zinc in the blood.

Symptoms produced include bloating, gas, pain, constipation or diarrhea, vomiting and fatigue (to name a few). Recent research has also tied fructose malabsorption to depression.

Lest you think this isn’t a common problem, studies have shown that up to 30% of people in Western countries suffer from fructose malabsorption.

Even in healthy people without fructose malabsorption, however, only about 20-25g of fructose can be properly absorbed at one sitting. Glucose assists in transport of fructose across the intestine, so in general foods with equal amounts of glucose and fructose will be better absorbed than foods with excess amounts of fructose (in relation to glucose).

While fructose malabsorption can cause symptoms in anyone, those with Irritable Bowel Syndrome (IBS) or Inflammatory Bowel Disease (IBD) are particularly affected. While the prevalence of FM is the same in healthy populations and those with IBS & IBD, the experience of FM appears to be more intense in the latter group. This is probably due to the increased visceral sensitivity common in IBS and IBD patients.

In fact, one of the most promising clinical approaches to managing IBS & IBD right now is the low-FODMAP diet. FODMAP stands for Fermentable Oligo-, Di- and Mono-saccharides And Polyols. These include:

fructose (fruits, honey, HFCS)

fructans (wheat, onions)

lactose (milk sugar)

polyols (sugar alcohols like sorbitol, xylitol & mannitol, along with fruits like apples, pears and plums)

galactooligosaccharides (legumes & beans, brussel sprouts, onions)

other sweeteners like polydextrose and isomalt

Studies have found that restricting FODMAPs can significantly improve the symptoms associated with IBS, IBD and fructose malabsorption.

What does this have to do with coconut milk, you ask? According to Drs. Gibson & Barrett, experts in fructose malabsorption, coconut milk is a FODMAP and should be avoided by people with digestive conditions like IBS & IBD.

According to NutritionData.com, coconut milk has very little sugar of any kind – including fructose. Nevertheless, I do have patients that cannot even tolerate homemade coconut milk (which has no guar gum in it), even though they are fine with coconut oil. I assume that they are reacting to the fructose in the coconut milk – but I can’t be sure. According to Monash University, small quantities (up to 1/3 of a cup or 80g) of coconut milk may be tolerable for those who are sensitive to FODMAPs.

Recommendations

Let’s bring this together into recommendations for three different groups of people:

Women who are trying to get pregnant, pregnant or breastfeeding, children and other vulnerable populations (chronically ill) : should avoid canned coconut milk products except for those that are BPA-free, like Native Forest and Arroy-D. Note: Native Forest is organic, but Arroy-D is not.

: should avoid canned coconut milk products except for those that are BPA-free, like Native Forest and Arroy-D. Note: Native Forest is organic, but Arroy-D is not. People with digestive problems (IBS, IBD, GERD, etc.) : may want to avoid coconut products entirely, except for coconut oil

: may want to avoid coconut products entirely, except for coconut oil Healthy people: may be fine with canned coconut milk, provided they don’t react to the guar gum, and provided they’re willing to take the side of industry scientists that claim BPA doesn’t cause harm in humans

Want organic coconut milk – but without the BPA and guar gum?

There are available options to buy organic, guar-gum-free coconut milk in a BPA-free container. Or, with a little extra effort, you can easily make this at home yourself.

Purchase coconut cream (Let’s Do Organic and Artisana are good choices) and blend with water to make coconut milk.

Purchase shredded coconut (again, Let’s Do Organic is a good choice), and follow the instructions below for making homemade coconut milk.

Homemade coconut milk instructions

Ingredients

4 cups water

1.5 – 2 cups unsweetened coconut flakes

Instructions