The Coconut Oil Dilemma: Is it “healthy” or not?

coconut fruit sliced into two

Photo by Pixabay on Pexels.com

There has been a recent craze circulating among the media centered on the idea that coconut oil, an oil that was once praised for being “healthy” for consumption, is actually extremely bad for people’s health. The claims are that it increases the risk of heart disease because its high saturated fat content raises LDL cholesterol. An article published on USA Today titled “Coconut oil isn’t healthy. It’s never been healthy.” seems to have been what got the ball rolling on the coconut oil controversy. These ideas stem from a report published by the highly-esteemed American Heart Association that concluded that coconut oil poses a threat to a person’s well-being by increasing the risk of heart disease. These conclusions are, in my opinion, flawed for numerous reasons, which I discuss below.

Most of the information that led to the AHA’s above conclusions regarding coconut oil were based on a meta-analysis of 4 core clinical trials that focused on comparing the effects of replacing dietary saturated fat with unsaturated fat on cardiovascular disease risk. This brings me to the first problem with the AHA’s statements against coconut oil. They are based on studies that focused on saturated fats, not limited to coconut oil itself. So the AHA bases its claims about coconut oil on studies that were conducted on saturated fat in general, as opposed to specifically on coconut oil. While coconut oil is made up of about 86% saturated fat, it is both unfair and unwise to assume that all saturated fats have the same physiological effect on a person’s blood markers without studying each fat individually.

Dr. Chris Masterjohn does a wonderful job at breaking down this issue (listen to it here), and I’d like to simplify and summarize what he has shared regarding the specific studies and conclusions about saturated fat consumption that led to the AHA’s coconut oil statements. Let’s go!

FINNISH MENTAL HOSPITAL STUDY

This trail was conducted on two hospitals and included the largest group of people from the 4 core trails; it consisted of 1222 participants out of 2783 when you add up the participants of all 4 studies. It also indicated a 41% decrease in CVD when polyunsaturated fat replaced saturated fat consumption (the other groups indicated decreases of 20%, 29%, and 18%), over a 6 year dietary intervention. This makes the Finnish Mental Hospital Study the most significant study, bearing the most weight on the AHA’s conclusions on saturated fat. As Dr. Masterjohn points out, one flaw within this trial is that, according to Christopher Ramsden, the people in the hospitals were being treated with a medication that was later proven to cause cardiovascular disease. And it so happens that the incidents of heart disease occurred mostly during the time at which that medication was being administered. So this is a variable that was not controlled for in the trial. Because of this, we cannot conclude that saturated fat consumption caused more heart disease because the medication most likely played a significant role in the development of the illness. So this already compromises the validity of the most significant of the 4 core trials that led the AHA to conclude that saturated fat causes CVD, and that thus coconut oil causes CVD.

OSLO DIET-HEART STUDY

This study included 412 men, some of whom were assigned a diet that replaced saturated fat with polyunsaturated fat (experimental group), while the control group was left to consume their typical high saturated fat diet. After 5 years, the results indicated a 29% reduction in the development of CVD-related incidents. BUT, according to Dr. Chris Masterjohn, the polyunsaturated fat group was also instructed to include some additional dietary changes, which included removing margarine containing TRANS FATS, increasing the intake of fruits and vegetables, increasing the intake of fish, and they were given sardines canned in cod liver oil. Conversely, the control group was not given any dietary guidelines apart from instruction to continue their typical diet. This poses a problem because all the additional dietary instructions are things that are recognized to improve a person’s health and therefore reduce heart disease risk, especially the consumption of sardines and cod liver oil, which both contain nutrients that are protective of the heart. It’s important to mention that the AHA decided to exclude certain trials because they replaced saturated fat with polyunsaturated fat plus carbohydrates. They felt that the inclusion of the carbohydrates might interfere with the results, so they thought it was important to only include studies that replaced saturated fat with ONLY polyunsaturated fat. Despite this seemingly careful approach to controlling for all variables, they still included the Oslo-Diet Heart Study in spite of the fact that the experimental group were not only replacing the saturated fat with polyunsaturated fat, but were also including additional heart healthy foods. It therefore seems as though the AHA is perfectly content with including studies that do not control for all variables as long as the study supports their hypothesis that polyunsaturated fat is better for heart health.  Another shortcoming of this particular trial is that by the end of the trial, the saturated fat group consisted of more smokers (which increases the risk of CVD), and they were also initially older and more overweight than those of the polyunsaturated fat group. This, for me, is enough to invalidate the conclusions drawn from the Oslo Diet-Heart Study.

THE VETERANS ADMINISTRATION TRIAL

This study included 846 men. The experimental group replaced saturated fat with polyunsaturated fatty acids. The control group ate the same foods but consumed saturated fats in place of the polyunsaturated fats. The results indicated a 20% reduction in CVD-related incidents in the polyunsaturated fat group. A huge problem with this study is that although heart disease seemed to improve in the experimental group, total mortality rate increased in that group. This means that, in the polyunsaturated fat group, there was less heart disease but more deaths! This increase in deaths was mostly a result of rises in cancer. So this basically means that those that ate more polyunsaturated fats had less heart disease but more cancer, and more total deaths as a result. Masterjohn believes that the reason that this did not seem to happen in the other trials is that this particular trial was the only one long enough (8 years in length) to allow the development of cancer to take place. Another issue with this study is that the control group, that is the saturated fat group, consisted of 2x more heavy smokers than that of the polyunsaturated fat group. Smoking is known to contribute to heart disease, and it turns out that in this study, all the heart disease-related incidents took place in people who were heavy smokers. Now, smoking is also known to cause cancer. But there were still lower rates of cancer in the heavier-smoking/saturated fat group than there were in the lower-smoking/polyunsaturated fat group! So what I can conclude from this study is that consuming polyunsaturated fats in place of saturated fats for an extended period of time will increase my risk of developing cancer, and will also increase my risk of an earlier death, even more so than cigarette smoking will! Of course, the American Heart Association makes no mention of the mortality rate in their report of the meta-analysis.

THE BRITISH MEDICAL RESEARCH STUDY

This study included 393 men, half of which were instructed to consume 86 g of soybean oil (a polyunsaturated fat) per day. They were also instructed to reduced their saturated fat intake in order to ensure that both groups consumed about the same amount of total fat per day, which seems fair to me. The other group ate saturated animal fats instead of soybean oil. After the 4 year intervention, there was an 18% decrease in heart disease in the soybean oil group compared to the saturated fat group, which is not statistically significant in this case. This is because 62 of the 199 participants in the soybean oil group had a heart disease incident, while 74 of the 194 participants in the saturated fat group had a heart disease incident. This is what yielded the 18% difference. As you can see, the numbers are quite similar, and the sample sizes are quite small. As Chris Masterjohn notes, another problem with this study is that soybean oil contains coenzyme Q10 (a nutrient that is NOT present in other polyunsaturated fats), which is extremely important for heart health. This then poses the question, was the slight decrease in heart disease a result of polyunsaturated fat replacing saturated fat? Or was it a result of the extra coenzyme Q10?  So, in my opinion, this study does not very well support the conclusion that saturated fat raises heart disease risk.

clear glass container with coconut oil

Photo by Dana Tentis on Pexels.com

So now that we have dissected the meta-analysis that influenced the statements from the American Heart Association regarding coconut oil (which were really only based on studies about general saturated fat), I would like to share some of the reasons why I love coconut oil and eat it pretty much daily.

  1. It makes for a great cooking oil.
    • Because coconut oil consists mostly of saturated fat, it has a high smoke point and is less likely to become oxidized (damaged) through heat and light exposure. This makes it a great oil to use for cooking, as opposed to using other oils. For example, avocado oil and olive oil are both nutrient-dense healthy oils, but I would not recommend  using them for cooking because their high unsaturated fat content makes them more susceptible to heat damage. Consuming oxidized oils is a good way to increase cardiovascular disease risk.
  2. It improves cognitive function, and can improve/prevent symptoms of Alzheimer’s Disease.
    • Coconut oil contains medium-chain triglycerides (MCTs), which come with many health benefits. MCTs encourage the production of ketones, which are a more accessible form of energy for the brain compared to glucose. This allows them to boost cognitive function, especially in the presence of insulin resistance. Because Alzheimer’s is influenced by insulin resistance and the brain’s inability to use glucose for energy, MCTs can offer a better source of fuel and thus improve cognitive function in people with the illness.
  3. It has anti-inflammatory and antioxidant effects.
    • The MCTs in coconut oil have an anti-inflammatory effect that has been shown to improve symptoms of arthritis. Coconut oil has also been shown to help prevent and reduce osteoporosis symptoms because of its high antioxidant content and because it aids the gut’s absorption of calcium, a mineral that is extremely important for maintaining healthy bones.
  4. It is antimicrobial, antiviral, and antifungal.
    • The capric acid and lauric acid found in coconut oil has been shown to have antimicrobial effects and can potentially reduce candida overgrowth, which has been linked to chronic and strong sugar cravings. They can also help treat urinary tract infections (UTIs) by killing off harmful bacteria. Coconut oil can also boost general immunity by reducing allergies and histamine intolerance.
  5. It can improve heart health.
    • Coconut oil has been shown to decrease triglycerides (a marker for heart disease risk) and increase HDL (“good”) cholesterol and reduce LDL (“bad”) cholesterol, which can decrease the risk of heart disease.
  6. It improves digestion.
    • The MCTs in coconut oil do not have to be processed with bile salts, which makes them easy to digest even for people without a gallbladder. These MCTs also help to build and repair the gut barrier wall. All of this coupled with the antibacterial effects that help remove harmful bacteria from the digestive tract make coconut oil a wonderful tool in aiding and improving healthy digestion, and in preventing illnesses like ulcerative colitis and stomach ulcers.
  7. It helps maintain stable and long-lasting energy.
    • Because the MCTs found in coconut oil are easily converted by the liver into ketones, as opposed to glucose, they can provide a stable and reliable source of energy that lasts for longer periods of time compared to that of sugar and other carbohydrates. This has even led some endurance athletes to use coconut oil as their preferred source of energy when training or competing.
  8. It helps reduce insulin resistance.
    • Coconut oil does not have the same effect on blood sugar and insulin levels as sugar and carbohydrates do. Consuming it in place of sugary foods can help manage insulin and blood sugar surges, which can help improve insulin resistance. This is important because insulin resistance can lead to the development of type 2 diabetes and Alzheimer’s Disease. The absence of blood sugar spikes also helps reduce sugar cravings and general appetite by stabilizing energy, which can aid in healthy weight loss.

In addition to all of this, coconut oil also has some wonderful topical uses, which I will not mention here because I simply want to focus on the issue of its consumption. So overall, while coconut oil does have a high fat content, and therefore a high calorie content, this does not necessarily negate the health benefits that it can provide for individuals looking to improve their well-being. I hope you find this information useful when deciding whether or not eating coconut oil is a healthy option for you. As for me, I consume coconut oil almost daily, and I do not foresee myself changing this any time soon.

Feel free to add any other health benefits that I might have left out in the comments below!

References
Axe, J., DC, DMN, CNS. (2018, May 21). 20 Coconut Oil Benefits for Your Brain, Heart, Joints More! Retrieved December 05, 2018, from https://draxe.com/coconut-oil-benefits/
Ballantyne, S., PhD. (2018, August 27). Coconut Oil: Any Truth to the “Pure Poison” Claims? Retrieved December 5, 2018, from https://www.thepaleomom.com/coconut-oil-any-truth-to-the-pure-poison-claims/
Masterjohn, C., PhD. (2017, January 24). Is Coconut Oil Killing Us? [Audio blog post]. Retrieved December 5, 2018, from https://chrismasterjohnphd.com/2017/06/24/coconut-oil-killing-us
May, A. (2017, June 16). Coconut oil isn’t healthy. It’s never been healthy. Retrieved December 5, 2018, from https://www.usatoday.com/story/news/nation-now/2017/06/16/coconut-oil-isnt-healthy-its-never-been-healthy/402719001/
Sacks, F. M., MD, Chair, Lichtenstein, A. H., DSc, FAHA, Wu, J. H., PhD, MSc, Appel, L. J., PhD, MPH, FAHA, Creager, M. A., MD, FAHA, Kris-Etherton, P. M., PhD, RD, FAHA, . . . Van Horn, L. V., PhD, RD, FAHA, Vice Chair. (2017). Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation, 136(3), E1-E23. doi:10.1161/CIR.0000000000000510

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