Maybe the whole brouhaha wouldn’t have spiraled out of control had they just stuck with the broad, somewhat vague saturated fat category. But no: In a recent review published in Circulation, the American Heart Association (AHA) specifically called out coconut oil as a culprit for heart disease, and the internet went crazy.
For years, experts spoke glowingly about this oil, recommending we slather it on our skin and cook our vegetables liberally in it.
Among its benefits, coconut oil provides fat-burning medium-chain triglycerides (MCTs), which behave differently than other fatty acids because your body prefers to use rather than store them. Coconut oil also provides immune-boosting lauric acid and anti-fungal caprylic acid.
So why did the AHA attack this oil, which seemingly had its health halo firmly intact? Why would they want to take away our coconut oil?
Can the AHA be trusted?
According to their website:
The American Heart Association [AHA] is devoted to saving people from heart disease and stroke — the two leading causes of death in the world. We team with millions of volunteers to fund innovative research, fight for stronger public health policies, and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke.” (1)
They certainly sound noble and well-intended, and they’re absolutely correct to be concerned about heart disease. According to the Centers for Disease Control and Prevention (CDC), about 610,000 people die of heart disease in the United States every year. In other words, one out of every four deaths is from a heart attack. (2)
Unfortunately, the AHA isn’t always altruistic (more on that in a minute), and sometimes get a little antiquated in their thinking, as this coconut oil thing shows.
After all, the AHA subscribes to the idea that saturated fat raises cholesterol, which contributes to heart disease. Coconut oil – which is about 82 percent saturated fat – would be a prime contender to raise cholesterol, which would increase your risk for heart disease.
From that perspective, reducing saturated fat – or replacing that saturated fat with unsaturated fats like those in vegetable oils – will improve cholesterol and lower your heart disease risk.
“Replacement of saturated with unsaturated fats lowers low-density lipoprotein cholesterol, a cause of atherosclerosis,” the AHA writes in this review. “Taking into consideration the totality of the scientific evidence, satisfying rigorous criteria for causality, we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of [cardiovascular disease].” (3)
In other words, if you want to prevent or reduce your risk for heart disease, replace that saturated fat-rich coconut oil with polyunsaturated fat-rich vegetable oils like canola oil.
There you have it, right? Well, not really, as many critics were quick to prove about this review.
Not everyone, though. Obviously determined to create clickbait, USA Today put out a column evaluating the AHA’s paper entitled “Coconut oil isn’t healthy. It’s never been healthy.”
Catchy title for sure. Unfortunately, most people didn’t bother to look beyond its headlines to the actual article, where writer Ashley May’s rhetoric was slightly less hyperbolic.
Among the people May quotes is Frank Sacks, lead author on that AHA report, who “said he has no idea why people think coconut oil is healthy. It’s almost 100% fat,” May writes.
But so is vegetable oil, which the AHA adamantly recommends; any oil is pure fat.
May later lets up in her article. She acknowledges that “saturated fat is a loaded term” and mentions a 2015 British Medical Journal (BMJ) review that suggested people who cut saturated fat might not necessarily lower their heart disease risk. (4)
But other journalists and many experts weren’t so quick to hop on the AHA’s bandwagon. Among them was Emily Maguire in the UK version of Huffington Post.
“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,” Magnuire writes, who also questions why the AHA calls out coconut oil specifically.
From her review, Maguire concludes “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.” (5)
Why the confusion? How could the AHA – certainly a group of smart, well-intended folks – provide misleading or downright incorrect information?
“The history of science is littered with failed hypotheses based on selective interpretation of the evidence,” science writer Gary Taubes says. “Regrettably the AHA experts simply don’t believe that what’s true of far better scientists then themselves, could possibly be true of them as well.” (6)
Dig a little deeper than stuck-in-antiquated-science theory and you’ll find money plays a huge role in the AHA’s controversial stance. Among their sponsors include canola oil, which might help explain why they’re more prone to recommend vegetable oils than coconut oil.
Then there’s the nonsensical seal of approval – the Heart-Check mark – that gives high-sugar foods like yogurt a “heart healthy” label because they’re low in fat.
“The Heart-Check mark makes it easy to spot heart-healthy foods in the grocery store or when dining out,” the AHA says on their website. “Simply look for the name of the American Heart Association along with our familiar red heart with a white check mark on the package or menu…When you spot the American Heart Association’s Heart-Check mark, you’ll instantly know the food has been certified to meet our nutrition requirements.” (7)
“The AHA’s policies are shaped in part by the source of their funding,” writes Dr. Mark Hyman in Eat Fat, Get Thin. “They get millions of dollars a year for giving their seal of approval to highly processed industrial foods like low-fat, high-fiber oat cereals, despite the fact that they often contain six different kinds of sugar.”
In other words, if you meet the AHA’s less-than-stringent criteria, your sugar-loaded processed food that, never fear, is low in saturated fat, can get a seal of approval that lets buyers know it’s “heart healthy.” Even if it isn’t.
Why Does the AHA Target Cholesterol?
The AHA’s underlying premise is that saturated fat raises cholesterol, leading to heart disease. Critics argue that allows them to certify sugary, processed foods as “heart healthy” if they are low in saturated fat. But is there any truth to that idea?
Saturated fat can raise cholesterol; little debate exists about that statement. But whether high cholesterol can lead to heart disease becomes a far messier, more contentious discussion.
To understand why cholesterol got a bad rep, we need to go back several decades – 1950s, in fact – and look at the research of Dr. Angel Keys. His Seven Countries Study is a little misleading. He actually looked at 22 countries and cherry-picked his data, conveniently leaving out countries that didn’t support his theory.
From his flawed research (which goes beyond just cherry-picking data), he connected blood cholesterol levels with heart disease. Because saturated fat raised cholesterol, that suddenly became public enemy number one.
Much of the AHA’s position – that saturated fat raises cholesterol, which causes heart disease – rests on this decades-old antiquated research and thinking. Most of the four studies they looked at in their recent review, in fact, dated from the 1960s. Newer studies have more or less disproved it.
Let’s go back for a minute to biochemistry class. Cholesterol is a waxy, fat-like substance in every one of your cells. Your body needs it to make things like sex hormones and vitamin D. About 25 percent of your brain is cholesterol. (9)
Cholesterol is a fat, and fat doesn’t travel well in your watery bloodstream. Instead, it hitches a ride in small packages called lipoproteins.
Lipoproteins are made of fat on the inside and proteins on the outside. There are two types of these cholesterol-carrying shuttles: Low-density lipoproteins (LDL) and high-density lipoproteins (HDL). You’ve no doubt heard the term “bad cholesterol” (referring to LDL) and “good cholesterol” (referring to HDL).
Traditional thinking goes that LDL cholesterol is bad because it leads to a buildup of cholesterol in your arteries, whereas HDL cholesterol is good because it carries cholesterol from other parts of your body back to your liver, which removes that cholesterol.
“The higher the level of LDL cholesterol in your blood, the GREATER your chance is of getting heart disease. The higher the level of HDL cholesterol in your blood, the LOWER your chance is of getting heart disease,” explains an article called “What is Cholesterol?” written by the National Heart, Lung, and Blood Institute. (10)
It isn’t nearly that simple. That HDL is “good” and LDL “bad,” end of story, has become wildly outdated. Both HDL and LDL have several subtypes or patterns. LDL has several: One is big, fluffy, and pretty innocuous. The other is like BB pellets and potentially dangerous.
Back to saturated fat, which indeed can raise total cholesterol; but what about HDL and LDL, and more importantly, the patterns of these two lipoproteins?
“Yes, saturated fat sometimes increases total cholesterol—but dig into the data a little more deeply and you’ll find that it raises the harmless sub-type of LDL (pattern A) while lowering the amount of harmful (pattern B) LDL,” write Jonny Bowden, PhD and Steven Sinatra, MD in The Great Cholesterol Myth.
Let’s look closer at LDL, the so-called bad cholesterol. Whereas LDL-a is big, fluffy, and does little if any harm, LDL-b can easily become oxidized (think of your car rusting) and create inflammation.
Especially when these BB-pellet LDL molecules (LDL-b) become oxidized or “rusty,” they stick to your arterial walls, creating plague and inflammation (more on that in a minute) that pave the pathways for heart disease.
Only about 15 percent of circulating cholesterol in your blood comes from what you eat, whereas 85 percent comes from your liver.
In other words, your liver makes the vast major of cholesterol, which again is a molecule your body needs. Food minimally impacts those cholesterol levels. (Cholesterol, by the way, only exists in animal-derived foods. Coconut oil comes from a fruit, so it would not contain cholesterol.)
Even the conservative Dietary Guidelines for Americans, which get revised every five years by the Department of Health and Human Services with the Department of Agriculture, suggested backing off cholesterol a few years ago.
Whereas previous Guidelines recommended Americans limit cholesterol to no more than 300 mg/day, the 2015 guidelines didn’t “because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum (blood) cholesterol, consistent with the AHA/ACC (American Heart Association / American College of Cardiology) report. Cholesterol is not a nutrient of concern for overconsumption.” (11)
As Christopher Masterjohn noted on Weston Price’s blog, once those cholesterol guidelines softened, so too did saturated fat. (12)
In other words, even if saturated fat did raise cholesterol, if that cholesterol wasn’t harmful, what does it matter? And – bigger picture – if cholesterol and saturated fat weren’t the heart-attack villains the AHA and other organizations make them, what is? (Much more on that in a minute.)
Interestingly, one study re-evaluated early evidence from the late 60s and early 70s to find replacing saturated fat with linoleic acid “effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes.” Interestingly, researchers found a “robust association between decreasing serum cholesterol and increased risk of death.” (13)
More specifically, among both groups combined in one review, they found a 30 mg/dL decrease in serum cholesterol created a 22 percent higher risk of death from any cause. (13)
In other words, every 30 mg you decrease cholesterol, you have a 22 percent higher chance of dying. So maybe optimizing, rather than lowering, cholesterol is the answer.
Using Coconut Oil
Although the AHA wasn’t specifically targeting coconut oil in this report, that’s what stuck as the aforementioned USA Today report mentioned and numerous critics went hysterical about. “Should we ditch our coconut oil?” became the central question.
Coconut oil is mostly saturated fat, and as you’ll remember, any saturated fat can raise total cholesterol. On the other hand, some studies show coconut oil raises HDL (your “good” cholesterol) and LDL (your “bad” cholesterol). (14) Even if it does, that tells us nothing about the type of HDL or LDL it raises.
A bigger problem becomes that we anointed coconut oil as some kind of “super food,” and as I noted in an earlier article, any super food becomes fair game to be debunked by critics and overused by devotees.
While I don’t always subscribe to the “everything in moderation” mentality – there are no moderate amounts of ingredients like high-fructose corn syrup (HFCS), trans fat, and especially if you have food intolerances, gluten and dairy – in the case of many of these healthy foods like red wine, their benefits become dependent on dose.
In other words, a glass or two of pinot noir could provide some health benefits. Start drinking more than that, and the drawbacks start outweighing its benefits.
I approach coconut oil with that same perspective. Yes, it provides some benefits, but others have been overhyped. Getting large amounts of MCTs from coconut oil, for instance, aren’t likely to provide those mesmerizing fat-burning benefits some people believe.
That especially becomes true if you’re eating a bad diet. As saturated fat and cholesterol became the villains for heart disease and many other problems, we replaced that saturated fat and cholesterol over the ensuing decades with inflammatory sugar and vegetable oils, and the consequences have been detrimental.
“The idea we need to limit saturated fat and cholesterol shifted Americans from a well-balanced diet to high-sugar diets, which made people eat more and get fatter,” Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, told CNN in 2015. (15)
Overall, more health-conscious consumers might use extra-virgin coconut oil in their, say, organic broccoli. In other words, healthy people incorporate coconut oil as a small part of their diet. They cook with a few tablespoons of coconut oil; they aren’t going through half a container every day.
These same coconut oil users generally do things like lower sugar intake, exercise more, sleep well, manage stress levels, supplement smartly, and eat nutrient-rich foods. Ultimately, those things matter far more than a few tablespoons of coconut oil.
The Real Villain of Heart Disease
If saturated fat doesn’t cause heart disease, what does? Simply put: Inflammatory foods like sugar and yes, the vegetable oils the AHA recommends to replace coconut oil.
“The primary cause of heart disease is inflammation,” writes Bowden. “Small injuries to the vascular wall that can be caused by anything from high blood pressure to toxins attract all sorts of metabolic riff-raff, from bacteria to oxidized (damaged) LDL particles; the immune system sends inflammatory cytokines to the area, and more oxidation and inflammation takes place eventually resulting in the growth of plaque and, ultimately, to an increased risk for heart disease. If there were no inflammation, the arteries would be clear.” (16)
One editorial title in the British Journal of Sports Medicine says it succinctly: “Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions.” (17)
If inflammation underlies coronary heart disease (and numerous other diseases), it makes sense to eliminate or strongly reduce any inflammatory food. So why does the AHA recommend canola and other vegetable oils, which are lower in saturated fat and higher in unsaturated fats but also inflammatory omega-6 fatty acids?
After all, when manufacturers process these vegetable oils, which often come from genetically modified (GMO) plants sprayed with pesticides and other potential toxins, they can quickly become oxidized or damaged. That’s because polyunsaturated fatty acids are unstable at higher heats and other processing methods.
Studies show a massive increase in the omega-6 linoleic acid (LA) prevalent in vegetable oil consumption, specifically soybean oil. In fact, between 1909 and 1999, soybean oil consumption increased over 1,000-fold, decreasing tissue concentrations of the anti-inflammatory omega-3 fatty acids EPA and DHA in the bargain. (18)
In other words, it isn’t just that we’re eating more inflammatory fats and fewer anti-inflammatory fats these days. Those inflammatory fats are nudging out what little anti-inflammatory fat we eat.
From that perspective, reducing inflammatory vegetable oils (and other inflammatory foods) and increasing anti-inflammatory omega-3 fats becomes a smart step to reducing heart disease and other problems.
Being mostly saturated, coconut oil contains very little polyunsaturated omega-3 or omega-6 fats. And that could be a problem in itself: Some studies show saturated fat can trigger inflammation, but Dr. Mark Hyman provides an intelligent remedy for that.
“There is evidence that saturated fats cause inflammation in humans and animals, and that is not a good thing because inflammation is an underlying cause of heart disease, obesity, type 2 diabetes, cancer, and dementia,” he says in Eat Fat, Get Thin. “But there are some important caveats. It seems that saturated fats cause inflammation only in the context of two things: low levels of omega‐3 fats and high levels of carbohydrates. Take out the high-carb foods and add omega-3-rich foods or supplements, and saturated fat is not a problem.”
From that perspective, these seven strategies can help you further reduce inflammation to reduce your risk for heart attack and pretty much every other disease on the planet.
1. Get most of your food from whole sources.
Get your healthy fats from whole-food sources like wild-caught fish, nuts, seeds, and fruits like coconut and avocado. Second-best would be the least-processed oils like coconut oil, which is centuries old and seems pretty low on the “processed foods are harmful” echelon because it requires the least amount of machinery to produce.
2. Ditch problem foods.
Reduce or eliminate anything inflammatory in your diet. I’m talking about processed, sugary foods but also sneaky sugar sources (like “healthy” agave-sweetened cookies) and food intolerances like gluten and dairy. All of these can trigger or exacerbate inflammation.
3. Take the right nutrients.
“Most risk markers for cardiovascular disease have a pro-inflammatory component, which stimulates the release of a number of active molecules,” researchers in one study argue. To control atherosclerosis and lower inflammation, they recommend nutrients including:
a. Arginine – a semi-conditionally essential amino acid that improves blood flow in your arteries
b. Antioxidants like vitamins C and E, lipoic acid, glutathione
c. A B-complex multi
d. The anti-inflammatory omega-3 fatty acids DHA and EPA from fish oil and other anti-inflammatory compounds like quercetin (19)
At the very least, I recommend taking a high-quality multivitamin/ mineral, one or more grams of EPA and DHA, and extra magnesium and vitamin D3.
4. Find a better balance.
Studies show Americans eat up to 25 times more inflammatory omega 6s than anti-inflammatory omega 3s. (20) We can do better than that. Maybe you can’t achieve the 1:1 ratio your Paleolithic ancestors got, but you can come pretty darn close. Along with more leafy and cruciferous veggies, low-sugar fruits like berries and avocados, and other colorful plant foods, incorporate plenty of omega-3 rich foods like wild fish, grass-fed beef, walnuts, flaxseeds, chia seeds, and omega-3 enriched pasture-raised eggs.
5. Look for these 2 numbers on your lab work.
“The triglyceride to HDL ratio is an excellent indicator of heart health,” writes Bowden. “It’s also an excellent marker for insulin resistance (or it’s opposite, insulin sensitivity). You want your triglyceride to HDL ratio to be low—2 or under is wonderful. When it’s high, it’s cause for concern, or, even better, action.” (21)
6. Request 21st-Century tests from your doctor.
Conventionally, doctors typically look at total cholesterol, HDL, and LDL when they look for heart-risk factors. Request other tests like LDL-C that measures lipoprotein subtype as well as inflammatory measures like C-reactive protein (CRP), Phospholipase A-1 (PLA-2), and homocysteine levels. These and other tests provide a broader, more accurate perspective about your heart attack risk. I have observed that progressive medical doctors, well-schooled in nutrition, are more than happy to extend these tests to their patients.
7. Pay attention to other factors.
Diet isn’t the only culprit here. Optimal sleep, stress management, the right kind of exercise, and fostering connection and community with other people also play a significant role to reduce inflammation.