The release of the American Heart Association (AHA) advisory on dietary fats and cardiovascular disease is a call to action, but exactly what that action should be is debatable
The AHA recommends replacing dietary saturated fat with unsaturated fat, especially polyunsaturated fat (in an overall healthful dietary plan) as a strategy to lower the risk of cardiovascular disease. The panel offers a one-size-fits-all recommendation, specifically the goal of lowering LDL, AKA "bad" cholesterol, as the primary, actionable risk-reducing measure. Their controversial comment that got health partisans in an uproar was: "we advise against the use of coconut oil." Reactions ran the gamut from support to outrage, and as expected, resulted in sensational clickbait:
"Coconut oil isn't healthy. It's never been healthy." Ashley May / USA Today
The internet is rife with opinion, so what's a health-conscious consumer to do? The AHA based their recommendations on a review of population studies and randomized trials but those do not speak to any one individual's personal risk. Regardless of your dietary bias, laboratory testing is an objective way to get a handle on cardiovascular risk and the potential need for dietary intervention.
Traditional cholesterol testing is not the most accurate way to assess cardiovascular risk. A quick screen that only checks total cholesterol can be very misleading. Total cholesterol measures the aggregate of HDL ("good" cholesterol) and LDL ("bad" cholesterol) in your bloodstream, but that doesn't tell the whole story. For example, a high cholesterol superficially suggests an elevated risk for cardiovascular disease, but in fact, the risk is low if a very high amount of HDL ("good" cholesterol) is responsible for upping the total number. On the other hand, a normal total cholesterol may be falsely reassuring, if LDL makes up most of the value. Including a more complete "lipid profile" in annual medical testing is the minimum required for actionable information, but even that isn't enough.
The generally accepted recommendations for cholesterol values come from the National Heart, Lung and Blood Institute. Triglycerides, one of the very low-density lipoproteins (VLDL) are a risk factor for cardiovascular disease fully independent of cholesterol levels. Excess calories are converted to triglycerides and stored in fat cells. VLDL are precursors in the production of LDL cholesterol. Risk assessment based on cholesterol and triglycerides is far more accurate than basing it on either of those values alone. It should be noted that cardiovascular disease also rises when total cholesterol is too low; there is a sweet spot.
To dig deeper and uncover even more valuable cardiovascular risk information, it's necessary to fractionate LDL and HDL into their respective subtypes. Both particle number and size influence risk. Large, fluffy, buoyant HDL particles are cardio-protective. The bad guys, the ones that increase the risk of cardiovascular disease as much as threefold, are the small, dense, sticky LDL particles which promote inflammation, and increase blood clotting and plaque formation. As many as one third of those with low LDL levels, which seem superficially favorable, actually have increased risk because of elevated levels of hazardous, small LDL particles. Interestingly, low-carbohydrate diets selectively lower small particle LDL more than overall LDL, thus lowering cardiovascular risk. The NMR LipoProfile test evaluates lipoprotein particle size and number along with markers of insulin resistance to derive a more comprehensive view of cardiovascular risk.
The VAP (Vertical Auto Profile) test goes even further in assessing cardiovascular risk by breaking down LDL into four measurable risk sub-factors: total LDL cholesterol, real LDL cholesterol, lipoprotein-a and intermediate density lipoproteins. The results generate very different dietary and supplement/pharmaceutical interventions that can be tailored into a treatment program targeting each individual's specific results. Generic recommendations including low carb intake or a low fat diet, omega-3 supplements, niacin, statins and exercise do not optimize individual risk reduction.
"After reading the AHA report in its entirety, I have no intention of reducing my daily dietary intake of coconut oil and ghee." Jennie Ann Freiman MD
The AHA recommendations for dietary actions to reduce cardiovascular risk are flawed:
- The AHA advises against the dietary use of coconut oil while simultaneously admitting, "clinical trials that compare direct effects on CVD (cardiovascular disease) of coconut oil and other dietary oils have not been reported."
- All of the studies supporting the AHA conclusions were performed in North America and Europe, on populations whose diet is not based on coconut oil.
- Avoiding a more nuanced look at cardiovascular risk factors is simplistic and reductive, in no way reflecting the best interest of consumers serious about improving health.
- The 2015-2020 US Dietary Guidelines no longer recommend lowering cholesterol and place no limit on dietary fat or cholesterol intake.
When deciding whether or not to include coconut oil, which is about 90% saturated fat, as part of a heart healthy diet, consider these facts:
- Coconut oil raises total and HDL cholesterol.
- Coconut oil lowers triglycerides and central, abdominal fat, both independent risk factors for cardiovascular disease.
- Coconut oil reduces insulin resistance, another independent cardiovascular risk factor.
- Countries with highest dietary intake of coconut oil are among those with lowest incidence of cardiovascular disease. Cardiovascular risk rises when refined vegetable oils, specifically those recommended by the AHA, are introduced to these populations.
For those choosing to incorporate coconut oil in an overall health plan, stick to organic, unrefined, virgin coconut oil.
Health can't possibly be promoted by any one-size-fits-all recommendation because those don't take into account the infinite variety in our diet and lifestyle. To find out what's right for you, a good start is to assess cardiovascular risk based on laboratory results, but don't forget those values are only one part of an overall cardiovascular risk-reducing lifestyle that should include exercise, sleep hygiene and stress management.
Before dismissing coconut oil as risky, remember current AHA recommendations come from the same group who previously endorsed the now-disavowed low-fat-high-carb diet approach and failed to recognize the risks of trans fats in a timely manner. The rate of cardiovascular disease in Western populations has skyrocketed over the last fifty years or so, in tandem with what the AHA, governmental and other health professional organizations told us to do.