This week's nutrition world has been awash with the new report from the American Heart Association that coconut oil is extremely bad for you and everyone should avoid it if you want to prevent yourself from getting any form of heart disease. The statement was picked up by USA Today, with one of the lead authors stating that:
"coconut oil is worse for your heart than butter and beef, a new study claims."
On first reading it and having received many emails asking for my opinion on it, I was going to respond with my usual statement on why just focusing on factors such as total cholesterol means nothing much for heart disease and context must be taken, I decided to take a step back to look at the bigger picture with this.
Only a few months ago, the nutrition sphere was flooded with articles touting the amazing benefits of coconut oil and how a spoonful a day would be protective for the heart. Now we appear to be being told the exact opposite. No wonder the general population are getting more and more confused with what constitutes good nutrition when we are having conflicting headlines seemingly every other week.
What is the statement actually about?
Firstly, the paper is a position statement that is based on a panel of experts and their conclusion on previous studies that have been conducted since the 1950s until today.
They focus majorly on both total cholesterol and LDL cholesterol as the markers of heart disease. Total cholesterol markers are what many people take to give indications of if you are at risk of CVD or not but in fact it doesn't really tell us that much. Cholesterol is made up of a lot of different factors, some good, some bad and some downright ugly. One of these markers that is often stated to be the "bad" cholesterol is that of LDL.
LDL stands for Low Density Lipoprotein and it is believed that a higher level of this cholesterol is one of the main predictors of heart disease. This however is only one small part of the picture, there is in fact different types of LDL cholesterol which unfortunately isn't routinely tested within the UK. Pattern A is classed as large and buoyant particles being more heart protective and Pattern B is classed as small and dense and so being more detrimental to the heart.
To really determine your true risk to heart disease, other markers that need to be considered are that of your HDL (generally thought of as the "good" cholesterol) and your triglyceride level. The AHA statement even states that:
" the plasma levels of triglycerides is a well-established independent biomarker for CVD".
My first question then is why is most of the position statement simply focusing on the total cholesterol and the LDL level when triglycerides in themselves are probably a greater indicator on if you will experience any form of heart disease or not?
This may be because a lot of evidence is now pointing to the effect that refined carbohydrates can independently have on raising triglyceride levels.
Let's look at the primary source
In the world of science and research, one thing that is taught to you very early on, is to always remain critical of any work published and where possible, go to the primary source.
When someone references a certain study or article, they may have interpreted it completely differently from someone else.
The authors of the article focus on coconut oil because it contains 82% of its fat as saturated fat. Mainly consisting of lauric acid and the rest from myristic, palmitic, stearic and short chain fatty acids. They state the recommendation that is should be avoided is because it's supposed effects on LDL cholesterol, no mention of its effects on HDL or triglyceride levels.
To back up their claim that coconut oil should be avoided they predominantly used the evidence from one systematic review that looked at coconut oil and risk of cardiovascular disease in humans (a total of 7 studies were analysed).
Whilst the authors of this paper did conclude that coconut oil does significantly raise LDL cholesterol, they also had some other significant insights that were left out by the advisory panel.
Other findings by the systematic analysis were:
•They found no difference in the ratio of total cholesterol to HDL cholesterol (the "good" cholesterol) which is a strong predictor of coronary heart disease
•Of the studies that reported on triglyceride levels, the majority showed that the coconut oil groups reduced the levels- an independent risk factor for CVD.
•Again, of the studies that reported it, they generally showed a significant increase in the HDL level of participants.
•When data from 5 trials that directly compared coconut oil with other saturated fats were examined, the results were inconclusive. That's to say that the effect that coconut oil had, was no different than say that of butter. Why therefore was coconut oil highlighted?
•They were unable to exclude for cofounding factors such as smoking and sugar consumptions, making it unclear whether coconut oil in the diet had any positive or negative effects on CVD and its risk factors.
•Observational data from indigenous populations (who consume a large amount of coconut products) was analysed and showed that although they had a high coconut intake, their level of heart disease was much lower
•This was put further into context with their whole diet being looked at- these populations generally have a low sugar, high fish and fibrous veggie intake, as well as a high fat intake, all of which could contribute to the lower heart disease rate.
In summary, the AHA statement that coconut oil is worse for you than butter or beef is not actually what the evidence had stated based on the paper they used. In fact, it stated the opposite of this by concluding inconclusive results on this.
Is this to say that it can be exclusively concluded that coconut is heart protective, well not exactly either. But this conclusive headline that coconut oil is worse than butter or beef is unsubstantiated and completely taken out of context.
Hidden truths in the report
Whilst a lot of the blog postings on this article has been based upon the rebuttal to the coconut oil, I found some statements way more news worthy that appear to have been "conveniently" missed.
Nestled in this report was this specific conclusion:
"Finally, we note that a trial has never been conducted to test the effect on CHD (Coronary Heart Disease) outcomes of a low fat diet that increases intake of healthful nutrient dense carbohydrates and fibre-rich foods such as wholegrains, vegetables, fruits and legumes that are now recommended in dietary guidelines".
The bigger story here, I believe, isn't whether we should be eating coconut oil or not, but that the American Heart Association are stating that the low-fat guidelines that we have had within our food system for the past 30-40 years, has never actually been tested!
So the true story should actually have been, why have the guidelines been allowed to promote that specific type of diet?
Summary
In conclusion, is this to say that you should lather everything in coconut oil and not worry? Well really it needs to be taken into context. If you are someone that eats a diet that is mostly based on that of real foods, low in sugar and processed products, then having coconut oil, along with other fats (such as olive oil, nuts and seeds, avocado etc) will probably be of benefit. If you are someone that has a diet high in high sugary, fat and processed foods, then adding coconut oil on top of this would not be advisable and probably would contribute to heart disease.
The take away piece from this article should be to always question what is being printed, try and get to the primary source if possible and be extremely wary when conclusive statements are made in nutrition. Nutrition is still a field of science which is constantly evolving and new discoveries being made all the time.
My final piece of advice is when a nutrition headline hits, think like a scientist and always remain critical. Your nutrition intake should always fit you and your body not just what a nutrition headline or government guideline is saying.