Once again, dietary fat is making headlines, and all is not as it seems.
And, once again, the mainstream media is distorting the findings of a study, and is directing a misguided witch-hunt.
This time, they dared to target a dietary-fat-darling: coconut oil.
In the last two weeks or so, you might have noticed headlines like these…
Coconut Oil Isn’t Healthy. It’s Never Been Healthy
WTF – Coconut Oil Isn’t Healthy? Scientists Say No
Stop eating coconut oil! It’s only good as a moisturizer, study says
It sounds like some groundbreaking research on coconut oil was conducted, doesn’t it?
But, that’s not what happened.
All of this hysteria was caused by a study the American Heart Association published on June 15 titled Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association.
Let’s take a look at what the study actually SAYS vs. what the media is saying about it.
First, here’s a brief history that may help you understand why there is so much controversy over fat in the diet and its impact on health. The myth that dietary fat is bad for health just won’t die.
The Demonization of Dietary Fat
The idea that dietary fat is one of the worst things a person could possibly ingest began in the 1940s, when some scientists and physicians started to suspect that diets high in saturated fats and cholesterol were linked to heart disease. This was based on their interpretation of some controversial research.
Some experts (including John Yudkin) were skeptical and didn’t jump on the “fat is bad” bandwagon, but despite being based on flawed studies (Ancel Keys, I am looking at you), the theory gained momentum.
By the 1950s, doctors were recommending low-fat diets to patients who were considered at risk for cardiovascular disease.
Even though some studies did not support what came to be known as the “diet-heart hypothesis”, and there was no proof of a link between dietary fat and cardiovascular disease, the ideology continued to pick up speed.
Political bias, clever marketing, and heavily influence by the sugar industry sparked a decades-long low-fat craze – a trend that we are still paying for dearly.
While the “fat is evil” myth has been in a death spiral for a few years, misleading stories still pop up that confuse people about what to eat and to avoid.
The latest story is about saturated fat, and many major news outlets – perhaps in an attempt to gain clicks – distorted the information in the report.
Back to the “new” study…
Despite what the media would like you to believe, the 25-page AHA report barely mentions coconut oil. There is a short section in the report about it, and two blurbs stick out:
“A recent survey reported that 72 percent of the American public rated coconut oil as a ‘healthy food’ compared with 37 percent of nutritionists. This disconnect between lay and expert opinion can be attributed to the marketing of coconut oil in the popular press.”
“Because coconut oil increases LDL cholesterol, a cause of CVD, and has no known offsetting favorable effects, we advise against the use of coconut oil.”
While I don’t disagree that some people over-hype coconut oil – presenting it as a panacea for all that ails humanity – this is hardly a damning finding, and doesn’t come close to telling the whole story about the oil.
We will get back to that, though – for now, let’s look at the “conclusions and recommendations” section of the AHA study, which ends with:
Evidence has accumulated during the past several years that strengthens long-standing AHA recommendations to replace saturated fat with polyunsaturated and monounsaturated fat to lower the incidence of CVD. Reduction in total dietary fat or a goal for total fat intake is not recommended.
Let’s look at the first line of that blurb again, because it is very telling, (emphasis mine):
Evidence has accumulated during the past several years that strengthens long-standing AHA recommendations to replace saturated fat with polyunsaturated and monounsaturated fat to lower the incidence of CVD.
In other words, this study doesn’t tell us anything that we haven’t heard from Big Nutrition before:
- Reducing saturated fat reduces cardiovascular risk
- Replacing saturated fats with polyunsaturated fat reduces cardiovascular risk
- Replacing saturated fats with refined grains and sugars raises risk
- Replacing saturated fats with unrefined grains reduces risk
It is refreshing to see the AHA finally admit that refined grains and sugars can be harmful to heart health, but the claim that replacing saturated fats with unrefined grains reduces risk is vague at best.
I read the entire study – three times – because I couldn’t believe some of the claims made, and the basis for some of the claims also baffled me.
First, the report is based on four old studies…the publication dates were 1969, 1970, 1968, and 1979.
Why did the researchers base their advisory on the findings of those studies? As Chris Kresser points out, “There have been at least 17 systematic reviews and meta-analyses conducted in recent years that have not found a clear link between saturated fat consumption and heart disease.”
The authors themselves state this in the introduction:
In the past few years, meta-analyses of observational studies and randomized clinical trials have come to discordant conclusions about the relationship between dietary saturated fat and risk of CVD.
Not only are the studies decades old, they are filled with problems of their own, as cardiologist Dr. William Davis explains:
What is astounding about this document is that many of the old, tired arguments and bad science are still being held up as proof of, for instance, saturated fats as a cause for heart disease. The same twisted and misrepresented data, most from the 1950s and 1960s, that was originally used to prop up the arguments are once again offered as proof, such as the 1960s Los Angeles VA Study in which 850 elderly men living in a VA home had consumption of a saturated fat-rich diet compared with a polyunsaturated oil-rich diet (soybean, safflower, cottonseed, corn). There were 70 deaths among the saturated fat group compared to 48 in the polyunsaturated group–small numbers, but concerning . . . but the original study failed to factor in that there were twice as many smokers among the saturated fat group. Also, the number of cancers in the polyunsaturated group was twice that of the saturated fat group. In other words, there may have been a reduction in heart disease deaths, but the total effect was nil, suggesting the apparent heart benefit was illusory, a statistical anomaly and due to mismatched groups with regards to smoking.
There are several problems that plague nutrition research, and one of them is observational epidemiological studies, the sorts of studies that rely largely on questionnaires on what participants ate, a study design that is widely accepted to almost never establish cause-effect relationships, only potential associations or hypotheses. Some of the research the AHA used in this analysis was based on those kinds of studies.
The truth is, there is very little evidence to support the claim that a diet low in saturated fat and cholesterol actually reduces death from heart disease or in any way increases one’s life span.
So, IS saturated fat bad for health?
Saturated fat, as a broad category, has not yet been shown to beneficially or adversely affect heart health.
In 2015, researchers at McMaster University analysed the results of 50 observational studies assessing the association between saturated and/or trans fats and health outcomes in adults. Their findings, which were published in the BMJ, revealed no clear association between higher intake of saturated fats and death for any reason, coronary heart disease (CHD), cardiovascular disease (CVD), ischemic stroke, or type 2 diabetes. However, consumption of trans fats was associated with a 34 percent increase in death for any reason, a 28 percent increased risk of CHD mortality, and a 21 percent increase in the risk of CHD.
While it is true that some studies show that saturated fat intake raises blood cholesterol levels, but those studies are almost always short-term – lasting only a few weeks. “Longer-term studies have not shown an association between saturated fat intake and blood cholesterol levels. In fact, of all of the long-term studies examining this issue, only one of them showed a clear association between saturated fat intake and cholesterol levels, and even that association was weak,” explains Kresser.
Studies on low carbohydrate diets (which are usually high in saturated fat) suggest that they do not raise cholesterol, and they have beneficial impacts on cardiovascular disease markers.
If you’re wondering whether saturated fat may contribute to heart disease in some way that isn’t related to cholesterol, a large meta-analysis of prospective studies involving close to 350,000 participants found no association between saturated fat and heart disease. (8) A Japanese prospective study that followed 58,000 men for an average of 14 years found no association between saturated fat intake and heart disease, and an inverse association between saturated fat and stroke (i.e. those who ate more saturated fat had a lower risk of stroke). (9)
Polyunsaturated fats, however, have been linked to cancer and other health problems. More on that in a bit.
What is cholesterol?
Cholesterol is a waxy, fat-like substance that’s found in all cells of the body. We need some cholesterol to make hormones including testosterone, estrogen, and cortisol, and to make the active form of vitamin D. The body produces all the cholesterol it needs – in fact, every cell can make it – but it also is found in some foods.
Cholesterol travels through your bloodstream in small packages called lipoproteins. These packages are made of fat (lipid) on the inside and proteins on the outside.
For a detailed explanation of cholesterol and what it does in the body, check out Diet, Cholesterol and Lipoproteins Explained in Human Terms.
The reason the AHA is advising against coconut oil consumption is because the organization claims LDL cholesterol increases the risk of heart disease.
Coconut oil can raise LDL levels. But what the AHA report (conveniently, perhaps) does not mention is that coconut oil can raise HDL (“good” cholesterol) levels, too.
But does measuring cholesterol mean much when evaluating risks for heart disease anyway? For decades, we’ve been led to believe cholesterol plays a major role in the development of heart disease – but is that true?
When cholesterol intake in the diet goes up, the body makes less, Kresser explains:
This explains why well-designed cholesterol feeding studies (where they feed volunteers 2-4 eggs a day and measure their cholesterol) show that dietary cholesterol has very little impact on blood cholesterol levels in about 75% of the population. The remaining 25% of the population are referred to as “hyper-responders”. In this group, dietary cholesterol does modestly increase both LDL (“bad cholesterol” and HDL (“good cholesterol”), but it does not affect the ratio of LDL to HDL or increase the risk of heart disease. (2)
Additionally, Kresser explains, AHA report only discusses LDL cholesterol (LDL-C):
One study found that of 136,905 coronary artery disease hospitalizations, almost half of patients presented with normal LDL-C (11). The number of LDL particles (LDL-P) is a much stronger predictor of cardiovascular disease risk than LDL cholesterol, and it’s possible to have normal LDL-C and high LDL-P (12, 13, 14). Preliminary studies comparing lipid profiles after subjects followed a low-carb, high-fat diet and a high-carb, low-fat diet suggest that saturated fat does not increase LDL-P (15).
One study of more than 12,000 people found that low cholesterol — not high —actually increased a person’s risk of dying prematurely.
And, there is little evidence that cholesterol is a cause of atherosclerosis, heart disease or stroke. In fact, there is more evidence available that suggests cholesterol protects us from atherosclerosis, heart disease and stroke, as Dr. Josh Axe explains in Low Cholesterol Levels Are Worse Than High.
What about polyunsaturated fats?
The AHA report recommends replacing saturated fat with polyunsaturated fat – a type of fat that is also surrounded in controversy.
Polyunsaturated fatty acids (PUFAs) are found in some foods, including walnuts, sunflower seeds, flax seeds, flaxseed oil, and salmon. They are also found in vegetable oils (which tend to be highly refined and processed), including corn, soybean, canola, safflower, and sunflower.
The structure of PUFAs makes them unstable – they are vulnerable to damage from heat, light, and oxygen, which means they can become oxidized. Consuming oxidized PUFAs is dangerous because they are inflammatory, and inflammation has been linked to just about every disease a person can develop…including heart disease.
There are two main types of PUFA: Omega-3 and Omega-6. Both are essential fatty acids that cannot be produced by our bodies – we have to get them from food and supplements.
Omega-3 fats are found in fish, seafood, flaxseeds, walnuts, and chia seeds. Omega-6 fats are found in industrial oils, including corn, “vegetable” oil, peanut oil, and soybean oil, and in foods including beef, chicken, eggs, and nuts.
Balancing intake of Omega-3 and Omega-6 PUFAs is important, as Paleo Leap explains:
Today, we don’t just have a simple problem of too much PUFA. We have a complicated problem: too much PUFA in total, and way too much Omega-6, but actually a deficiency of Omega-3s. Our ancestral diets, the ones we evolved to live on, contained Omega-6 and Omega-3 PUFA in a ratio between 4:1 and 1:1. Our modern diets have Omega-6 and Omega-3 PUFA in a ratio closer to 10:1, or even higher.
In general, a high ratio of Omega-6 to Omega-3 is pro-inflammatory, just like too much total PUFA. An imbalance of Omega-6 to Omega-3 harms gut health and may be involved in problems as apparently unrelated as depression, chronic stress, chronic pain, autism spectrum disorders, inflammatory bowel disease, rheumatoid arthritis, and liver disease…
…and, of course, cardiovascular disease.
Confusion regarding health risks and benefits of PUFAs and saturated fats is common, even among experts.
Dr. Mark Hyman provides one striking example:
In a 2010 review at Tufts University, Dr. Dariush Mozaffarian concluded there is a clear benefit from cutting out saturated fats and increasing our intake of PUFAs. However in 2014, the very same scientist reviewed all of the literature again. This meta-analysis, which reviewed 72 studies, found no benefit to reducing saturated fats or increasing PUFAs, except for omega 3 fats.
He goes on to explain that historically, humans consumed much more Omega-3 fats and much less Omega-6 fats than we currently do, and that the shift is causing us harm:
Introducing refined oils into our diet and moving away from grass-fed and wild animals increased our omega 6 fat intake. Corn, soy, cottonseed, and canola oils skyrocketed, while omega 3 fats have dramatically declined. In that surge, many Americans sadly became deficient in these essential omega 3 fats.
Omega 6 fats not only fuel your body’s inflammatory pathways, but also reduce availability of anti-inflammatory omega 3 fats in your tissues, resulting in more inflammation.
In other words, omega 6 fats undo any benefit eating omega 3s would normally give you.
Coconut oil, butter, and olive oil are low-PUFA.
Avocados, grass-fed meats, almonds, walnuts, pecans, and macadamia nuts are good sources of fat. So are fatty fish that are rich in Omega-3 fats, including sardines, mackerel, herring, and wild salmon.
And, what about monounsaturated fats?
Monounsaturated fats (MUFAs) are not the subject of much controversy – and therefore do not get starring roles in sensational media headlines about dietary fat. Foods that contain MUFAs are generally healthful ones.
The most common MUFA found in food is oleic acid, a fatty acid that occurs naturally in vegetable and animal oils, especially olive oil. Monounsaturated fats are also found in foods like nuts, avocados, egg yolks, grass-fed beef, and whole milk.
A bit more about the AHA report…
The AHA has issued questionable dietary guidelines in the past (including consuming a low-fat diet and whole grains, for example). In this case, as with past ones, they are making blanket statements and do not appear to be factoring in all relevant information.
Nutrition science is tricky; it is riddled with challenges and problems, including pharmaceutical company and industry influence.
This “study” is no exception.
It is worth noting that two AHA panel members who participated in this study disclosed relationships that may be perceived as actual or reasonably perceived conflicts of interest. One received research grants from eleven pharmaceutical companies and listed seven pharmaceutical companies under “consultant/advisory board” disclosures. Another reported research grants from the California Walnut Association, Ag Canada and Canola Oil Council, and National Cattlemen’s Beef Association, and under “consultant/advisory board” disclosures, that panel member listed Seafood Nutrition Partnership, California Walnut Commission, TerraVia (a biotechnology company that creates oils out of algae, among other things), and Avocado Nutrition Science Advisors.
Findings can be misinterpreted and/or miscommunicated, and dramatic headlines can be misleading. All of this causes even more confusion.
In Coconut Oil Is Still Fine — Not Great, But Fine, Susie Neilson wrote,
Still, thanks to the dietary industrial complex — a $20 billion industry whose members are bent on protecting their revenue and reputations — science often gets twisted, oversimplified, or lost in translation as it makes its way to the consumer. One overarching trend over the last few decades, for example, has been to demonize whole categories of nutrient, known to scientists as “macromolecules.” First, the trend was to shun fats in favor of a high-carb diet; then, as research came out showing that refined carbohydrates were probably contributing to the obesity epidemic, industry players pivoted to shun sugar and carbs in favor of certain fats — like, yes, coconut oil. Who knows? Perhaps proteins are next.
We need saturated fat and cholesterol in our diets. Remember when eggs were demonized? Some studies have focused on egg consumption (eggs are high in dietary cholesterol), and found that eating them was not associated with the risk of incident coronary heart disease. It’s a shame that so many people avoided eggs for so long, because they contain nutrients that may help lower the risk for heart disease, including protein, vitamins B12 and D, riboflavin, and folate. The yolks are abundant in nutrients.
As I wrote in Myths, Misconceptions, and Outright Lies About Nutrition Are Keeping People Fat and Sick, the following are generally accepted as true.
Butter, once believed to be terrible for health, is filled with vitamins, minerals, and beneficial fatty acids, and has anti-inflammatory properties. Raw, unpasteurized butter and cream contain a unique substance called the Wulzen factor, a hormone-like substance that prevents arthritis and joint stiffness.
Sugary beverages (sodas and juices) can damage health and are linked to excess body fat and type 2 diabetes.
Processed food package labels can be misleading and should be viewed with skepticism. Avoiding processed “foods” as much as possible is a good idea, speaking of that. Studies show we eat far too much of them, and we are paying for it dearly.
Bottom line? Coconut oil is fine, in moderation, as part of an overall healthful diet. It isn’t a miracle food as some would like you to believe, but it also isn’t dangerous to health.
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