On June 15, 2017, the American Heart Association released a “Presidential Advisory” (linked here) concerning Dietary Fats and Cardiovascular Disease. In the advisory summary, the AHA states:
“…we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD [Cardiovascular Disease].”
This statement wouldn’t be such a huge deal by itself, but also, in the text of the actual advisory, the AHA specifically advises AGAINST the use of coconut oil altogether! They basically say that coconut oil raises LDL cholesterol and has no known benefits so we should just stop using it. Whoa!
Now, most of the population probably doesn’t read AHA advisories on a regular basis, but USA Today put out a piece the day after the AHA advisory was issued titled “Coconut oil isn’t healthy. It’s never been healthy.” The article latches on to the recommendation to discontinue the use of coconut oil completely.
The Health Community In Uproar
Of course, many in the health community have not only been fine with using coconut oil but have even touted it as a superfood. So, the USA Today article and the AHA advisory sent many into an uproar. Paleo and Primal communities, keto communities, general clean eating communities, naturopaths, nutritionists, and dieticians started responding everywhere.
The article was posted in our member community simply with the caption of “Thoughts?” I was proud that our community was able to have a discussion and not get too worked up, but I wanted to put a more formal response out on our blog so everyone knows our position on the great coconut oil debate.
Coconut Oil and the 90/10 Guidelines
We’ve always had coconut oil listed on our GREEN TIER. If you don’t follow 90/10, the green tier is a list of the foods we aim to eat at least 90% of the time. The yellow tier would be the foods we aim to eat no more than 10% of the time. The red tier is a list of the foods we aim to stay away from completely with the exception of special occasions (treats). You can learn more in our Academy (it’s pretty simple).
Based on the information in the AHA advisory, we aren’t going to be removing coconut oil from the green tier. It will remain on the green tier as an acceptable fat to use. Below, I’ll list some of the reasons why we won’t be removing coconut oil from our green tier.
Coconut Oil is still Green Tier and here's why
Reason 1 - The data source
In my reading of the AHA advisory, one of their main data points is that replacing carbs with individual fatty acids has been shown to increase LDL cholesterol (the bad type that has been associated with CVD…sort of).
The research that this data comes from is this study which you can find here. The objective of this study is as follows:
“The aim of this review and meta-regression analysis was to assess the effect of modifying TFA intake on blood lipid and lipoprotein levels by exchanging TFA with cis-monounsaturated fatty acids (cis-MUFA), cis-polyunsaturated fatty acids (cis-PUFA), saturated fatty acids (SFA) or carbohydrates, in order to inform and contribute to the development of updated WHO recommendations on TFA intake.”
What does this mean in English? Well, you have probably heard of “trans fat”, right? It’s pretty much been banned in most places and has to be at least labeled in the US. Pretty much everyone agrees that TFAs (trans fats) are bad. Most of them are “industrial” and not found that way in nature and we know they are bad for us.
This study that the AHA cites was done to see what happens when you replace TFA intake with a few other types of fats and also carbs as indicated in the objective statement.
Coconut oil would fall under SFA (saturated fatty acids) but it is a makeup of several different SFAs. The study doesn’t even actually say that they used coconut oil in the tests. In fact, the data suggests that they were using component parts such as lauric acid, stearic acid, and palmatic acid, all of which are in coconut oil TOGETHER.
In addition, the study controls cholesterol intake as a constant. So, if they replaced TFAs with something lower in the cholesterol, they would add cholesterol in other ways like using egg yolks or even crystalline cholesterol. Their reasoning for this is:
“(otherwise it would be difficult to reliably identify the independent effects of fatty acids or dietary cholesterol because, generally, animal fats high in SFA are high in dietary cholesterol, and vegetable oils high in unsaturated fatty acids are low in cholesterol)”
Interestingly, coconut oil is both high in saturated fat AND low in cholesterol and doesn’t meet this assumption at all. This is enough for me to say that this data is inconclusive in regards to coconut oil at best.
In other words, I have no confidence in the conclusions that they have drawn from that data after reading the data and reports myself. There are far too many extrapolations and the objective of the study they are using as a main part of their data is too different.
Reason 2 - There are no direct studies
In the AHA advisory, they actually say this right before they recommend not using coconut oil:
“Clinical trials that compared direct effects on CVD of coconut oil and other dietary oils have not been reported.”
Reason 3 - What about dairy?
The AHA advisory also has a section on dairy. The numbers, direct studies, and links to CVD and LDL are more substantiated in the report, yet they do not in any way recommend discontinuing dairy consumption specifically.
This is a red flag, in my opinion. Why would they single out coconut oil and specifically say not to consume it but not make that statement about dairy or butter in particular?
Reason 4 - Lumping all saturated fats
In addition to using research aimed at TRANS FAT, they also lump all saturated fats together regardless of how much of the fat is long-chain or medium-chain. This changes how the fat is digested, whether it can be stored as fat, and how it is used in the body.
Coconut oil has more than twice the amount of medium-chain triglycerides (MCTs) as dairy and meat. MCTs act differently in the body. To lump these all together is surprising at best.
Reason 5 - Increase in LDL is made the enemy
In the advisory, LDL is called specifically “a cause of CVD”. This seems to be a generally accepted medical “truth” these days. If your LDL is high, you get put on statins via prescription to lower your LDL.
Interestingly, though, UCLA reports (among others) that “75 percent of patients hospitalized for a heart attack had cholesterol levels that would indicate they were not at high risk for a cardiovascular event, based on current national cholesterol guidelines.” (read the article here)
Dr. Mark Hyman also writes in his blog extensively about the link between cholesterol and heart disease. He says it is much more complex than just lowering LDL. Read his thoughts here.
With the research I’ve done, I do not believe that it is a simple as “if LDL goes up when you eat it, then you should not eat it”.
Reason 6 - Conflicts of interest
The cool thing about these AHA advisories is that they put the list of contributors and how their research was funded. Unfortunately, if you just read the USA Today article, you don’t get that information.
What you’ll find when you look at the list of financial contributors to the research for that advisory is a list of companies that benefit greatly from the sale of the fat sources recommended OR from the sale of pharmaceuticals to lower cholesterol. The Ag Canada and Canola Oil Council, Takeda Pharmaceuticals, AstraZeneca, Pfizer, and more.
Reason 7 - Personal Experience and Evidence
You can easily google reports from various doctors, nutritionists, dieticians, and naturopaths that report some of the best cholesterol profiles in patients who also consume saturated fats including coconut oil.
Here is a direct reply from Dr. Tania Dempsey on the coconut oil debate in which she writes, “My patients who eat more saturated fat in general but lower carbohydrates have the best cholesterol profiles of all my patients.”
Now, that doesn’t mean that you should go replace all your carbs with saturated fat necessarily, but it doesn’t support the idea that we should get rid of coconut oil based on the AHA advisory.
Reason 8 - We already knew the rest of what they said
The only thing in the AHA advisory that seems like a pretty solid conclusion and takeaway based on data is that replacing saturated fat intake with unsaturated fats can help lower LDL cholesterol. This isn’t new information though. The health community has been saying that for years with the idea that we should eat less butter, meat, and other saturated animal fats and more olive oil, fish, and avocados. This is pretty good advice. It just doesn’t mean that we shouldn’t eat coconut oil any more than it means that we shouldn’t eat meat ever again.
How should we use coconut oil?
Our stance remains that same. We will use coconut oil as part of a balanced diet. Don’t spoon it into your mouth in mass quantities as if it is a miracle cure, but don’t shun it. We’ll also still use olive oil for unsaturated fats.
In summary, I don’t trust the AHA report after thoroughly reading it and several of the cited data sources. There are too many conflicts of interest, the data doesn’t fit, and it seems biased.
If you’re still worried about it, I recommend you do your own research on it and come to your own conclusion based on information from a wide range of sources.