Let’s talk about coconut oil for a moment, shall we?
Actually, it seems like everyone is already talking about coconut oil. With the recently issued Presidential Advisory from the American Heart Association denouncing its use, many people are feeling confused and exhausted by conflicting information all over the damn place. The decision fatigue is real right now.
This advisory has not changed how I feel about saturated fats or coconut oil at all.
Right off the bat, I want to say that it's important to understand this is not new information, just a review of old information. Literally nothing has changed. I still don't believe coconut oil is the solution to all health problems (sorry!). I also still believe saturated fat (including coconut oil) has a valuable place in a healthy diet... but, more on that later.
Why the AHA Hates Coconut Oil
I think the major beef that the AHA has with coconut oil is its perceived status as a magical, health-elevating food. They said "A recent survey reported that 72% of the American public rated coconut oil as a “healthy food” compared with 37% of nutritionists."
It's true that in recent years coconut oil has become super trendy, because of nutritionists like myself and others recommending it over "vegetable" oils (like canola, soy, and safflower... aka. not vegetables). There's also some research that MCTs can help with weight loss, and since coconut oil contains MCTs (kind of) it's been praised for that.
Then things got blown out of context (as tends to happen when weight loss claims get involved), and a lot of people began going above and beyond to add coconut oil into their diets without considering overall diet quality. Supplement companies started selling coconut oil "chews" and other weird things, to help you "get your daily dose coconut oil."
Suddenly coconut oil was being touted as a necessary supplement, instead of just a heat stable cooking oil. It became a classic case of, if a little is good... a lot must be GREAT!
Let's be very clear - adding coconut oil to a poor diet is not protective in the same way that adding an extra serving of vegetables or fruits would be. If we are going to inspire people to make dietary changes, they should be changes that actually help them.
There was never really science to support this level of consumption.
The AHA very strongly believes that saturated fat = bad, and vegetable oil = good, so I can only imagine how distressing this was for them (thinking of a parent watching their teenaged child rebel... because that's probably how they feel about us).
Finally the AHA actually denounces coconut oil as a healthy food. They're not telling us anything new at all but this is a pretty big deal, because usually individual foods are left alone while nutrients are labelled "good" or "bad."
Even though we know that the AHA always believed saturated fats kill hearts, this is still a huge deal for most people... because most people don't read scientific studies, they read headlines. To many, this is the first they've heard of coconut oil being anything less than a miracle cure.
I’d like to take a moment to quote one of my absolute favourite food journalists, Michael Pollan who does a really good job of explaining why plain language isn't usually used in these recommendations:
“MP: In 1977, Sen. McGovern, who had convened this select committee on nutrition, was looking at why there was so much heart disease post-WWII. The thinking then was that people were eating too much animal protein. So his initial recommendation, quite plain-spoken, was to eat less red meat. Turns out the industry would not let the government say “eat less” of any particular food, so there was a firestorm of criticism. He was forced to compromise on that language. He changed it in a way that would prove quite fateful in many ways. He changed “eat less red meat” to “choose meats that will reduce your saturated fat intake.”
“There are a couple noteworthy things about that. One is it’s a lot less clear and a lot of people aren’t going to understand it, which certainly suits the food industry. The other is, it’s affirmative. It’s saying “choose meats.” In other words, eat more of something that will have less of the bad nutrient — saturated fat. We’re no longer talking about eating more or less of a particular food; we’re saying eat more or less of a particular nutrient. That became the acceptable way for everyone to talk about food. It didn’t offend the food industry because they could always change their products to have more of the good nutrient, less of the bad. And I think it was very confusing to people: Foods are not merely the sum of their nutrient parts.”
Yet the AHA stated point blank in their Presidential Advisory: "However, because coconut oil increases LDL cholesterol, a cause of CVD, and has no known offsetting favourable effects, we advise against the use of coconut oil.”
How is this possible?! Where is Big Coconut oil to defend their product’s integrity and prevent the AHA from publishing such a harmful statement?
Well, first you should know where coconut oil actually comes from. I checked index mundi for the top 5 countries that that produce coconut oil, here they are:
4. Viet Nam
This is not a food produced in America. (Yay, finally recommendations that are not based on industry bias!) However, consider that AHA promotes the use of canola, safflower, and peanut oil instead, and that all these products are proudly Made In America. (Nevermind, I guess.)
Another American industry that really cares about maintaining the status quo for the saturated fat and cholesterol = heart disease panic? The pharmaceutical industry, with statins being the most widely prescribed drugs in the country.
The advisory didn't just address coconut oil, though. Titled Dietary Fats and Cardiovascular Disease, it's making the case for all saturated fats being bad for heart health. Coconut oil is just what made the headlines (possibly to distract from made-in-America butter a cheese from coming under fire?).
So now that's we've scraped the surface of the financial interests involved here, let's move on...
The AHA seems to exist to defend one hypothesis (which they no longer believe is a hypothesis). Saturated Fats = Heart Disease, so let's unpack that.
The Important Part: Evidence
The AHA's conclusion that dietary intake of saturated fat increases risk of heart disease is based on some very old research. The trials that are at the heart of this Presidential Advisory began in the 50’s or 60’s.
This obvious research gap is addressed in the paper, with the AHA stating that it’s simply too expensive to run a trial these days because researchers would need 20,000-30,000 participants to “achieve satisfactory statistical power.”
Yet, they haven’t they dismissed their core trials from the 50’s and 60’s despite the fact that they do not meet this requirement of satisfactory statistical power.
Perhaps because, although flawed, they confirm the AHA’s hypothesis that saturated fat should be replaced with polyunsaturated fat to reduce risk of heart disease.
A great example of this is the Oslo Diet-Heart Study providing half of the subjects (randomly chosen) intensive nutritional counselling to help them follow a “healthy” diet, while the control group received nothing at all. This means the “control group” received no placebo… making this in fact a randomized but uncontrolled trial.
During the trial, the group receiving counselling made changes beyond just replacing saturated fats with polyunsaturated fats, thanks to the performance bias created by the poorly designed study. It’s reasonable to assume that if the conclusion of the study had not been in favour of the AHA’s hypothesis, this flawed design would have been reason enough to dismiss it.
This is just one example of ways that the core trials reviewed in this advisory were flawed.
The AHA dismissed some major trials including the largest clinical trial ever preformed, the Women’s Health Initiative (the largest, most expensive trial ever run... no big deal), which actually does meet their criteria for “satisfactory statistical power.”
Did they have good reason for rejecting these larger trials from being included in the Presidential Advisory? Sure. But what matters is that they fail to describe what their criteria was for a study to be considered. Best practise in this case would have been to consider studies based on their set-up, before even looking at the outcome. The AHA doesn't seem to have done this, which is really a shame since this would have given considerably more strength to their hypothesis if the results were consistent.
Presumably they looked hard at the studies with conclusions that challenged their hypothesis, finding legitimate reasons to reject them. Meanwhile, they didn’t look quite as closely at the trials that had findings in their favour.
The thing is that with nutrition, most trials are flawed in some way. It is really hard to blind people to what they are eating for long periods of time. This makes it particularly important that scientists leave their biases at the door when attempting this kind of analysis.
Most of the newer, rejected trials found that while saturated fat does have the potential to increase total cholesterol levels, that doesn’t necessarily increase risk for heart disease. Instead, the diet as a whole should be considered.
Also, cholesterol ratios matter. Not only HDL vs. LDL levels, but also the actual type of LDL particles that make up that number. Yes, we now know that not all LDL is dangerous, but the vast majority doctors are trained to prescribe medication based on old science, rather than run a test that has the potential to reduce the sales of the most widely prescribed pharmaceuticals in America.
Total cholesterol may not be as big of a risk factor as once thought. In fact, less than half of people who suffer from heart attacks even had cholesterol in the "danger zone." Most heart attack patients have "normal" cholesterol. So why are we still talking about this??
What you need to know: saturated fat probably isn't as bad for us as the AHA thinks. They've got something to prove... maybe because of the fact that statin drugs are the most widely prescribed and therefore a massive industry to mess with, maybe just because these scientists don't want to see their life's work disproven. Either way is spells bias. But that doesn't mean we need to start eating it in insane quantities.
The Health Benefits of Coconut Oil Were Already Inflated
There always seems to be a disconnect between what the science says, what the media says, and what people actually do with nutrition information. Coconut oil is a great example of this.
Science says: coconut oil has benefits including a small amount of medium-chain-triglycerides that might aid in weight loss, antimicrobial properties, and since new research shows that saturated fat intake alone is not responsible for heart disease, consuming some coconut oil may be beneficial but it probably depends on a lot of factors so don’t go crazy.
Media says: Coconut Oil – New MIRACLE Weight Loss Solution!!!!! 10 Reasons to Eat Coconut Oil With Every Meal! Baptize Your Baby In Coconut Oil!
What people actually do: cook french fries in coconut oil instead of canola oil, make boxed mac 'n cheese with coconut oil instead of margarine, eat an extra 400 calories from coconut oil per day in an attempt to lose weight.
Nothing has really changed in terms of evidence (again, the AHA isn't presenting anything new), but now coconut oil is being specifically labelled as a "bad food" while is was previously labelled as an "amazing miracle food."
This is why I cannot stress enough: no food will magically save you, and no food will magically kill you. It's just food. Really.
What You Need to Do With This Information
Here’s what I believe given the available information: we should moderate our consumption of all isolated macronutrients, and eat a diet high in minimally processed foods.
Refined macronutrients: protein powder, sugar/syrup (of ANY origin), and oils. These represent the processing of foods down to their basic components: protein, sugar, and fat.
I’m not saying these foods are bad (because I don’t believe foods are “good” or “bad”), I’m simply observing that there seems to be a lot of controversy constantly surrounding them. In the interest of looking at “what has been truest, longest” I like to consider the fact that all these foods are relatively new to our species, and choose whole foods instead.
The foundation of your diet should be whole, minimally processed foods. At least half of your plate should belong to vegetables and fruits. Get most of your protein from fish, eggs, meats, legumes, nuts and seeds. Get most of you sugar from whole fruit and choose raw honey as an occasional sweetener. As for fats, try to choose whole fats like nuts and seeds, avocado, whole coconut, eggs, fatty fish, and grass-fed meats.
The idea that we should displace a whole food to make room for a refined one is completely ridiculous to me. Every time someone tells me they add 2 tablespoons of coconut oil to their smoothie, but avoid fruit "because of the sugar" I die a little inside.
Of course, if this strategy makes you feel amazing and your blood work looks amazing, it's obviously working for you. But please be sure to actually take the time to check on your personal health, instead of blindly believing in some health guru, or e-news headline. Don't just guess and stress.
When it comes to oils (including coconut oil), my stance remains the same as always:
A couple tablespoons of oil per day can be healthy addition to your diet, which should be based on whole foods in the first place.
My top picks for cold use(ie. salad dressing): olive oil, flax oil, walnut oil, virgin avocado oil.
My top pick for cooking: avocado oil, coconut oil, ghee, and sometimes olive oil.
In general, it's better to consider your diet as a whole than to focus on one tiny area, such as the oil you use. If you're eating mostly Kraft Dinner, ramen, takeout food and cereal, having some coconut oil is not going to save you. If you're eating a diet high in plant foods and getting exercise, having some coconut oil is not going to kill you.
It doesn't have to be this confusing.
To quote Pollan once more: "Eat food. Not too much. Mostly plants."