Doesn’t it seem that nearly every time we’re told by dietary experts that something is really healthy for us, eventually we find out that it’s really not?
Or something we thought was harmful actually turns out to be quite healthy?
Back in the early 80s, I was working at a hospital where several staff members were reducing their coffee intake because of a new report that suggested coffee caused pancreatic cancer.
I imagine the interns who relied on extra caffeine to make it through their rotations completely ignored the report.
In fact, today researchers suspect that there may actually be an inverse relationship between coffee drinking and risk of pancreatic cancer.
Well, here’s a new health scare.
A few weeks back, experts from the American Heart Association (AHA) advised us to beware of the dangers of coconut oil.
They told us that the consumption of coconut oil could kill us.
Well, they didn’t actually say it that crassly, but they did suggest that coconut oil will increase your chance of heart disease.
But since heart disease is the number one cause of deaths in the U.S., anything that contributes to it is a potential killer.
Initially, I was concerned about the news.
As one of the millions of people who have embraced a low-carb healthy fat diet, I consume coconut oil as an important source of healthy fat.
I’m also one of those people who really love the taste of coconut.
I don’t gorge on coconut oil, but I do add it to my green tea at the start of every day, and I enjoy it.
Now the AHA is telling me that it could be damaging my heart.
What are we coconut oil consumers to do?
Do we have to give up coconut oil?
OK, let’s take a deep breath and see what’s behind the AHA’s advisory.
The AHA Advisory
The recent AHA Presidential Advisory targeting the dangers of coconut oil was part of an overall call for the restriction of the consumption of saturated fats (SFA) and the replacement of them with mono and polyunsaturated fats (PUFA).
The AHA contends that SFAs (coconut oil) raises your bad cholesterol (LDL).
In the AHA’s view, this is dangerous because high levels of LDL have been linked to heart disease.
In fact, they say that there is evidence that if you replace your SFAs with PUFA vegetable oils, you could reduce your chance of heart disease by approximately 30%.
Whoa! That means I have to stop consuming coconut oil, eliminate those slabs of Kerry Gold butter on my veggies, trash the grass fed beef, and replace them with corn, soybean and canola oil.
Well, I don’t think that’s going to happen anytime soon.
I’ve seen these kinds of reports for at least 30 years and I’ve learned to be suspicious of them.
You should be suspicious too because the devil is usually in the details.
Beware Of Expert Advice
Some of the most esteemed experts on heart disease in the world authored the AHA Presidential Advisory.
However, when dietary experts speak, we should pause for a second and ask, what kind of track record do they have?
For decades we were told to fear dietary cholesterol because it could raise blood cholesterol which in turn could clog our arteries.
A whole generation was told that eggs could kill you.
We now know that it’s not true.
For decades we were told that sugar consumption was healthier for us than consuming dreaded SFAs.
We now know that two Harvard scientists were paid to skew research data in order to minimize the effect of sugar on heart disease and maximize the effect of SFAs.
Concerning this scandal, the New York Times states,
For many decades, health officials encouraged Americans to reduce their fat intake, which led many people to consume low-fat, high-sugar foods that some experts now blame for fueling the obesity crisis.
We were told and are still being told that a high-carb low-fat diet is a good way to eat.
After 50 years of this advice, the incidence of prediabetes, type 2 diabetes, obesity, metabolic syndrome, heart disease, and cancer has skyrocketed.
Of course, none of this means that the AHA advisory concerning their advice to reduce SFAs in your diet and increase PUFAs is wrong.
It does mean, though, that when experts tell you that if you don’t eat the way they recommend you might face certain calamity, we should pause and remember their past history of failed warnings.
Then, we should determine if their advice is a result of good science.
Don’t take the AHA at their word. Your health is at stake.
Let’s examine the AHA report and see if their advice to replace SFAs with PUFAs is supported by good science.
The AHA States That They Have Considered The Totality Of Evidence
The basic conclusion of the AHA report is this,
In summary, randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ≈30%.
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 CVD.
It sounds like the AHA really did their homework.
You teachers out there get ready to grade them.
The Totality Of Scientific Evidence
The AHA stated that they considered the totality of the scientific evidence.
If by that they mean the totality of all scientific evidence, that would be an impressive undertaking.
Maybe they actually mean they’ve considered the totality of the scientific evidence they examined?
Doctors these days are starting to sound like lawyers.
Let’s see what they really mean.
In reviewing all the evidence, the AHA based their crucial advice for our health on the analysis of only four core studies.
They did consider 6 additional studies and 2 meta-analyses but determined that they didn’t meet their criteria for inclusion as a core study.
Interestingly, all four of the AHA’s core studies were performed in the 1960s.
That means the AHA has warned us of the dangers of SFAs based on studies done over 50 years ago.
Is that really the best they could do?
But consider what they’ve done.
They’ve whittled down the evidence to four old studies that just happen to validate the position they’ve been advocating for the last 40 years.
This is like a trial lawyer getting to hand pick a jury but with the added advantage of knowing which way the jury will vote in the future.
This is also called cherry-picking your evidence.
Of course, this fact alone doesn’t automatically make the studies unworthy of consideration.
But we can ask, “How is it even possible with all the technology and reporting advances we’ve had since the 1960s that the AHA couldn’t find more recent acceptable meta-analyses?”
The AHA Eliminated Some of the Largest Studies On Heart Disease
Unfortunately, the AHA’s criteria for determining the validity of a study eliminated some of the largest trials ever performed.
These included the Minnesota Coronary Survey, the Sydney Heart Study, and the famous Women’s Health Initiative (WHI).
The WHI is the single largest and most costly clinical trial ever done on heart disease.
Other researchers, however, have found these studies to be quite acceptable.
The Cochrane Collaboration Disagrees With The AHA’s Elimination Of Studies
The Cochrane Collaboration is an organization that reviews health information and assesses its validity.
They are considered world class experts at determining the validity of scientific studies.
They also review meta-analyses and arrive at conclusions.
In a meta-analysis they did on SFAs and PUFAs, they deemed both the Sydney Heart Study and the WHI to be acceptable studies.
Why did Cochrane deem these studies worthy of inclusion in their study and the AHA didn’t?
I’m not sure.
However, both these studies arrived at conclusions unfavorable to the AHA’s presuppositions on the dangers of SFAs.
Flaws In The AHA Selected Studies
Though the AHA was meticulous to point out errors in non-core studies, they failed to note the flaws in their own studies.
One fact they didn’t reveal was that women fared pretty poorly in those studies.
First, only one out of the four trials included women.
Ladies, don’t feel bad about this next little piece of information.
The 30% benefit gained in heart health by replacing SFAs with PUFAs was found only in men!
It seems odd that the AHA would base important health advice for women where only one of four studies included women.
Specific Flaws In The AHA’s Studies
In order for a scientific trial to be considered high quality, it has to be a randomized controlled trial.
This means that,
“The people participating in the trial are randomly allocated to either the group receiving the treatment under investigation or to a group receiving standard treatment (or placebo treatment) as the control.”
This has the effect of reducing bias in the study.
Researcher Gary Taubes has done a fine job of illustrating the deep flaws in one of the AHA’s core studies.
He points out that the Oslo Diet – Heart study, an AHA core study, didn’t contain a control group. He states,
This is technically called performance bias and it’s the equivalent of doing an unblinded drug trial without a placebo.
Another study used by the AHA was the Finnish Mental Hospital Study. Researcher Chris Masterjohn has demonstrated how it is seriously flawed. See here.
He points out that the study failed at randomizing its participants. He states,
To consider this study a “randomized, controlled trial” is to make a mockery of the very concept of randomization and to flout the scientific method and every philosophical, logical, and statistical concept incorporated therein.
The bottom line is that two of the core studies used by AHA in their presidential advisory are not very good studies.
If you’re interested in a good analysis of the deficiencies of trials associating SFAs with heart disease, see here.
The AHA Studies And Mortality
Providing data on mortality is an important part of clinical trials.
In other words, it’s important to know if a particular drug will kill you.
I’m sure you’ve seen a TV commercial for a specific medicine, and the narrator says it’ll help you with your problem, but it may also cause you to die suddenly.
That’s the kind of information you like to have before you make a choice on whether or not to take that medicine.
Of the four core studies referenced by the AHA, only one study showed that replacing SFA with PUFA increased longevity.
Unfortunately, ladies, that was only in men.
Also, simply focusing on heart disease as an endpoint is not always sufficient in a trial.
For example, it is known that PUFA consumption can cause oxidative stress on cells.
Oxidative cell stress can lead to chronic inflammation, which in turn could cause cancer and possibly death.
Did the AHA focus so much on SFAs and heart disease that they ignored the damaging nature of PUFAs?
There is good evidence that the high omega 6 fatty acid content in PUFAs can disrupt your body’s omega 6 to omega 3 fatty acid ratio.
An increased omega 6 to omega 3 ratio is associated with nonalcoholic fatty liver disease, cardiovascular disease, obesity, inflammatory bowel disease, rheumatoid arthritis, and Alzheimer’s disease.
Considering the lack of reliability in the AHA’s core studies, recommending PUFAs as a replacement to SFAs seems quite risky from a health standpoint.
The AHA Agrees That It Is Difficult To Obtain A High-Quality Study
The AHA does acknowledge that the trials they’ve selected contain weaknesses.
A good trial, they point out, should be more recent, contain 20,000 – 30,000 participants, last for at least 5 years, and be better controlled.
Unfortunately, they say this kind of trial is cost prohibitive.
Since the AHA’s core studies didn’t even approach these standards, why then did they even bother making a conclusion?
Interestingly, the WHI did include numbers in the tens of thousands. It didn’t, however, reach a conclusion that was favorable to the AHA.
As we’ve seen so far the AHA’s advisory was hardly based on good science.
What’s The Story With Coconut Oil?
When this advisory came out, media outlets focused on the AHA’s criticism of Coconut Oil.
This headline is from the BBC:
Coconut oil ‘as unhealthy as beef fat and butter’
Here’s one from USA Today:
Coconut oil isn’t healthy. It’s never been healthy.
The above headlines were prompted by the AHA advisory targeting coconut oil as an unhealthy fat.
However, what the experts failed to mention is the evidence that exists that works against their hypothesis.
While coconut oil may raise LDL, it is probably not the danger it’s made out to be.
There is good evidence to suggest that SFAs increase the number of large LDL molecules.
It is the smaller LDL particles that are connected to heart disease.
So it’s possible that coconut oil may actually improve your LDL profile.
Also, evidence suggests that coconut oil raises your HDL (good cholesterol).
This is significant because the ratio of good cholesterol to bad is more important than your total cholesterol level.
The AHA did say this about coconut oil,
Clinical trials that compared direct effects on CVD of coconut oil and other dietary oils have not been reported.
There is no evidence that directly connects coconut oil to heart disease.
Studies On SFAs That Don’t Agree With The AHA
In the last ten years, there has been a constant flow of data refuting the hypotheses that SFAs cause heart disease.
Last April the British Medical Journal released a “landmark systematic review and meta-analysis of observational studies showed no association between saturated fat consumption and all-cause mortality, coronary heart disease (CHD), CHD mortality, ischemic stroke or type 2 diabetes in healthy adults.”
The experts who performed the review stated,
Despite popular belief among doctors and the public, the conceptual model of dietary saturated fat clogging a pipe is just plain wrong… selective reporting may partly explain this misconception.
It certainly does appear that the AHA is guilty of selective reporting.
Does The AHA Have Another Agenda?
Everbody’s heard of the pharmaceutical company Bayer.
Besides making aspirin, Bayer also happens to produce soybeans.
This past March, Bayer announced its support for the AHA,
For each bag of LibertyLink® soybean seed sold for the 2017 season, Bayer will contribute 5 cents to the AHA’s Healthy for Good movement for a total maximum donation of $500,000.
Now I’m not saying that the AHA would put forth a favorable report on PUFAs just because Bayer is giving them $500,000.
But wouldn’t it be a little difficult to criticize soybean oil after receiving big bucks from a soybean producer?
Ideas have consequences. So does advice.
I’m afraid that if people heed the advice of the AHA, we’ll see a resurgence of people increasing their intake of PUFAs.
This could have a serious negative health impact for millions.
As I mentioned before, PUFAs are known to be pro-inflammatory which could lead to a host of medical problems.
Interestingly, the Sydney Heart Study (one of the studies left out of the AHA advisory) showed that PUFAs were problematic.
One group reduced their SFA intake and the other increased their intake of omega-6 linoleic acid (safflower oil).
These were the results,
- The omega-6 linoleic acid group had a 17 percent higher risk of dying from heart disease during the study period, compared with 11 percent among the control group.
- The omega-6 group also had a higher risk of all-cause mortality.
Is this why the AHA did not use this study for consideration?
The Bottom Line
If I were a teacher and the AHA submitted this report to me, I would give it a failing grade.
I don’t buy their advice.
This won’t give me license to go out and consume pints of coconut oil.
I consume way more extra virgin olive oil (monounsaturated fat) than coconut oil.
See my post on healthy cooking fats here.
But coconut oil and butter definitely make up a portion of my healthy fats.
I think it’s time we bury the “SFAs will kill you” mantra.
How would you grade their report?
We’d love to hear from you.
To learn more about coconut oil watch this video.
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