Mastering Nutrition With Chris Masterjohn, PhD, Episode 41: Is Coconut Oil Killing Us? A Response to the American Heart Association's 2017 Presidential Advisory on Dietary Fats and Cardiovascular Disease
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Dr. Chris Masterjohn discussion on American Heart Association's position on saturated fat and coconut oil.

In this episode, I weigh in on the American Heart Association's new Presidential Advisory and Dietary Fats and Cardiovascular Disease, and all the headlines that have been spinning on the supposed risks of coconut oil.

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Show Notes for “Is Coconut Oil Killing Us?”

In this episode, you will find all of the following and more.

03:55 The recent headlines on coconut oil.

04:52 The American Heart Association’s new Presidential Advisory, “Dietary Fats and Cardiovascular Disease” is not centrally about coconut oil, but it laments the popularity of coconut oil.

07:10 This is a position paper reinforcing the conventional view about saturated fat as the stance against it within the scientific community has begun to soften around the edges. The 2015 dietary guidelines and the 2016 Ramsden paper reflect that softening.

14:39 The inclusion and exclusion criteria of the “4 core trials” of the AHA meta-analysis.

16:38 The 4 core trials.

17:00 The Finnish Mental Hospitals Study makes the largest contribution to the AHA conclusion but was not a randomized controlled trial and doesn’t belong in this list.

23:44 The Oslo Diet-Heart Study was included and made a contribution, yet other trials were excluded on the basis of confounding that were far less confounded than Oslo.

27:38 The LA Veterans Administration Hospital Study showed that a vitamin E-deficient diet makes you vulnerable to the heart disease-promoting effects of smoking, and that vegetable oils cause more cancer than cigarettes.

36:41 The Medical Research Council study showed a trend toward a benefit of soybean oil that was not statistically significant. Lack of heat damage to the fats in the diet, coenzyme Q10, and omega-6/omega-3 balance could have played a role in the trend.

41:12 Exclusion of Rose 1965 and Minnesota Coronary Survey from the “4 core trials” was fair.

42:33 Controversy over the possible contribution of trans fats to the results of the Sydney Diet Heart Study. But this as a basis for exclusion could have excluded the LA Veterans Administration Hospital Study as well.

47:59 The impact of including or excluding MRC and Sydney shows how the conclusions are driven not by the cumulative data but on the qualitative decisions about which studies to include.

52:02 The observational studies are hopelessly confounded by popular campaigns about the heart-healthiness of replacing saturated fat with polyunsaturated fat.

56:08 The experiments in monkeys using lard, palm oil, and dietary cholesterol to bring their plasma cholesterol to 300-400 mg/dL.

58:33 The oxidation of lipoproteins drives atherosclerosis and polyunsaturated fats drive the oxidation. This is embraced by the leading conventional thinkers.

1:06:00 The AHA position on coconut oil is based on its effect on LDL-C, explicitly arguing in favor of ignoring its effects on HDL-C, and explicitly acknowledging the complete absence of clinical evidence.

1:13:12 Coconut oil has benefits unrelated to heart disease, such as the antimicrobial (antifungal and antibacterial) effects of lauric, capric, and caprylic acids, and the increased energy expenditure and decreased appetite caused by capric and caprylic acids.

1:17:00 Coconut oil could protect against heart disease due to its low polyunsaturated fat content.

1:19:32 Traditional Pacific island diets were far higher in saturated fat than the standard American diet, yet heart disease was absent.

1:22:09 The Tokelau Migrant Study showed that the freedom from heart disease on Tokelau, where coconut consumption pushed saturated fat over 50% of calories, was not due to genetics or age.

Links and Research Related to “Is Coconut Oil Killing Us?”

The American Heart Association Presidential Advisory, “Dietary Fats and Cardiovascular Disease

As the Cholesterol Consensus Crumbles, the Stance on Saturated Fat Softens (blog post, podcast)

The Scientific Report of the 2015 Dietary Guidelines Committee

The eighth edition of the actual Dietary Guidelines

The 2010 Mozaffarian meta-analysis

The 2016 Ramsden paper

The reason for randomization

Ramsden's criticism of the Finnish Mental Hospitals Study

My discussion of the Finnish Mental Hospitals Study in How to Read a Science Paper

Controversy over trans fat contribution to Sydney Diet-Heart results

Coenzyme Q10 protects against PUFA-induced aging in rodents.

Coenzyme Q10 in foods.

Daniel Steinberg's Cholesterol Wars

Good Fats, Bad Fats: Separating Fact From Fiction

AJCN Publishes a New PUFA Study That Should Make us Long For the Old Days covers many of the trials discussed herein.

The effect of dietary fat on the total-to-HDL-cholesterol ratio

Absence of heart disease on Kitava, where coconut is the main source of fat.

Absence of heart disease in Pukapuka and Tokelau, where coconut consumption was even higher.

Stephan Guyenet's series on the Tokelau Migrant Study

MCT oil decreases hunger.

MCT oil increases energy expenditure.

Masterclass With Masterjohn: Oxidative Stress and Heart Disease

Masterclass With Masterjohn: Vegetable Oils and Heart Disease, Examining the Controversy

Episode 38: What to Do About High Cholesterol

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26 Comments

  1. Rarely is it easy to find one single point of view about anything connected with science (and what isn’t?) which isn’t soon rivaled by another. This is no exception. But, the difference is that both sides of the argument are expressed, backed up by facts or claimed facts, and dissected logically and clearly.

    So here is another source of rare insight and detail, that is a big help in making an informed and intelligent decision, coming to the best of conclusions that current knowledge in the field can enable.

    Thank you.

  2. You say “I am not a fan of soybean oil. However, when you look at soybean oil compared to all these other vegetable oils, a couple things stand out. Number one, it’s much more balanced between omega-3 and omega-6 fatty acids than most of the other vegetable oils.

    I don’t use soybean oil, and I wouldn’t recommend it as a source of omega-3 fatty acids, but the fact that it is balanced instead of being very biased towards omega-6 fatty acids, like many of the other oils, is significant and could explain why it looks better in its results than some other trials.”
    From Wikipedia Ratio of fatty acids in different foods.
    Soybean oil, (Unhydrogenated) 1 Tbsp = omega-6, 7.0g omega-3, 0.9g 6-3 ratio 7.8 : 1 .
    So i see it’s lot more omega-6? not balanced at all.
    https://en.wikipedia.org/wiki/Ratio_of_fatty_acids_in_different_foods

    1. That’s extremely well balanced compared to non-oleic varieties of sunflower and safflower oil, for example, or corn oil.

  3. I am not a fan of soybean oil. However, when you look at soybean oil compared to all these other vegetable oils, a couple things stand out. Number one, it’s much more balanced between omega-3 and omega-6 fatty acids than most of the other vegetable oils.

    I don’t use soybean oil, and I wouldn’t recommend it as a source of omega-3 fatty acids, but the fact that it is balanced instead of being very biased towards omega-6 fatty acids, like many of the other oils, is significant and could explain why it looks better in its results than some other trials. From Wikipedia Ratio of fatty acids in different foods.
    Soybean oil, (Unhydrogenated) 1 Tbsp = omega-6, 7.0g omega-3, 0.9g 6-3 ratio 7.8 : 1 . So i see it’s lot more omega 6?
    https://en.wikipedia.org/wiki/Ratio_of_fatty_acids_in_different_foods

  4. You Have an excellent information . but please explain it with more simple language , not like attorney’s in court of law . Half way through podcast I start dozing off . Great info…… thank you.

  5. Thanks for this. Could you give a brief 3 line definition of what cholesterol in & of itself is please? My understanding is that it’s an Esther of a non water soluble alcohol? I get muddled when the word cholesterol is used by some to describe to describe fat per se, or LDL. Than you so much.

  6. Hi Chris,

    Excellent podcast! I have two questions:

    1) You say that lipoprotein particle oxidation begins with the peroxidation of the PUFA(s) within those particles. Now, given that oxidation requires the presence of oxygen, how do those polyunsaturated fatty acids *inside* the lipoprotein particle get oxidised in the first place? Or do you imply that the peroxidation of these fatty acids takes place before ingestion, i.e. during storage and cooking?

    2) You mention the antifungal and antimicrobial properties of capric, caprylic and lauric acids. To my best knowledge, these effects have only been observed with *free* capric, caprylic and lauric acids. Given that the amount of free fatty acids within a fat – any fat, not just coconut oil – is low (as most of the FAs are esterified to a glycerol backbone, forming triglycerides), how relevant are the results of these in-vitro experiments done with FFAs to the human consumption of coconut oil?

  7. Dr Masterjohn, I too like my potatoes cooked in coconut oil. Thank you for the clear rational explanation of the AHA report. I will continue to make coconut oil a part of my diet.

  8. The AHA Presidential Advisory is pseudoscience

    Thank you for your in depth analysis of the AHA Presidential Advisory. To me, what you report is quite shocking. Let me explain why

    I am a GP in New Zealand. As a GP I am at the coal face of primary care and one of our roles is to give advice on diet and life style. As a rule we rely on the guidelines published by various government bodies, and that is what we tell our patients. Our version was published by the New Zealand Ministry of Health in 2015
    http://www.health.govt.nz/our-work/eating-and-activity-guidelines/current-food-and-nutrition-guidelines

    This document mirrors USA advice and recommends replacement of saturated fat with polyunsaturated fat , the recommended intake for saturated fat and transfats
    together is no more than 10 percent of total energy.

    On cocnut oil:
    “The Ministry of Health recommends using unsaturated plant oils such as olive, canola or rice bran oil, rather than coconut oil, as the main dietary or cooking oil.
    The recent heavy marketing of coconut oil is based on misinformation. Much of the research used to promote coconut oil was conducted on animals or with medium-chain triglycerides (MCTs). The evidence on MCT oils cannot be applied to coconut oil as they are different substances…”

    But I have been skeptical of the low fat diet dogma for some time and have done a lot of reading around the subject. What I have come to realise is that these guidelines are not scientific and evidence based. The advice we are supposed to give is flawed and maybe actually harmful.

    The fact that the AHA Advisory lead author is Frank Sacks MD, Professor of Cardiovascular Disease Prevention at the Harvard School of Public Health make it appear to be authoritative. But is now I realise it is a blatant example of pseudoscience. It is dogma and because it is from such a prestigious source it seems unassailable.
    Pseudoscience has many definitions, but essentially it starts with a hypothesis that seems credible and is emotionally appealing. Then you only look for evidence that supports it and ignore evidence that refutes it. The supporters of the Diet Heart Hypothesis do just that. This puts them in the same league as climate deniers, intelligent design creationists, astrologers, UFOlogists, parapsychologists and practitioners of alternative medicine.

    It shocks me that the medical professions has been fed garbage guidelines for so many years by a bunch of biased and self invested “experts”. Well done Chris for exposing this sort of nonsense to the light of day.

  9. Thanks Chris … this podcast answered more than one question for me. I think it’s significant for those promoting ketogenic diets to recognize clients with high cholesterol (over 300), significant metabolic back ups, and thyroid issues should be excluded from those diets. That’s the take away for me. Did I get that right?

  10. Chris Masterjohn’s review of the recent AHA report was insightful especially regarding coconut oil. As a result I cannot take seriously the AHA’s attack on coconut oil as a saturated fat that should be avoided. In fact, Chris pretty much demolishes the AHA’s position that American eat too much saturated fat and not enough PUFFA.

  11. https://www.researchgate.net/profile/Staffan_Lindeberg/publication/14749606_Apparent_absence_of_stroke_and_ischaemic_heart_disease_in_a_traditional_Melanesian_island_A_clinical_study_in_Kitava/links/543049e50cf29bbc12771d2a/Apparent-absence-of-stroke-and-ischaemic-heart-disease-in-a-traditional-Melanesian-island-A-clinical-study-in-Kitava.pdf
    Apparent absence of stroke and ischaemic heart disease in a traditional Melanesian island : a clinical study in Kitava

    “Cultivated boiled tubers (yam, taro, sweet potato) are staples, providing an estimated 50-70% of the diet by weight, supplemented by fruits (banana, papaya, pineapple, mango, guava, watermelon, pumpkin), leaves, nuts (COCO, okari), fish, tapioca, maize and beans.”

    ” Fish is eaten 2-4 times a week (roughly 100-300 g per person: some 1300 varieties). Chicken, eggs, sea-eels. octopus, shellfish, turtles, flying foxes, pork, gwadila (a fruit), breadfruit, sugarcane, pandanus nuts, pomelo, mushrooms and some other items are each eaten less than once a week. Coconuts and fish provide most of the fat, but total fat intake is low by western standards. Irrespective of the proportions of the different foodstuffs, the intake of soluble fibre, minerals and vitamins is high, while sodium, fat and phytate intakes are low, compared to western populations. Food shortage is practically unknown. No evidence of malnutrition was observed. Alcohol intake is insignificant. ”

    SO – total fat intake is low by western standards!

    Your thoughts

    1. I agree that there are so many factors not taken into in RCT s; especially though the AHA s). There are far too many variables for the AHA to consider (e.g. Endocrine Distruptors added to processed foods) for this body to demonise 1 food over another. Before any RCT s are acceptable all variables need to be acturised.

    2. Charles,
      We’ve always known that Kitavans ate a high-carb (~70%), low(ish)-fat (~20%) diet. However, the fatty acids within that 20% are mostly saturated. And Chris explicitly says so in this podcast: “On the island of Kitava, they eat a low-fat diet. Twenty percent of their calories are fat, compared to 30-40% in the United States. Even in their low-fat diet, because the fat is mostly from coconut, they’re eating 17% of their total calories as saturated fat. That is way more than the Americans are consuming.”

  12. I am just amazed how everybody is posturing about different fats are beneficial vs not….no one talks about that you have to have a pretty well operating liver and pancreas to digest any of these fats……It wouldn’t be far fetched to guess that most ordinary people don’t have a excellent fat digestion…..one study I saw about a northern region in India where more fats were consumed like ghee compared to other regions of the country, they had a higher incidence of adenomas of their gall bladder….I just think we are over thinking one or the other…..diversify consumption of various fats…..don’t go crazy on any of them…

    Carl

    1. Here’s that ghee/gallbladder cancer study. It is not causing me to change the fats I use.
      https://www.ncbi.nlm.nih.gov/pubmed/14727332
      It is a case-control study and refers to the risk of

      “using repeatedly boiled or improperly stored ghee or oil (OR:2.6).”
      Ghee in Pakistan and India during this period was largely “vegetable ghee” which was a partially hydrogenated oil very high in trans fats. The largest risk factor seems to be fasting and time between meals, in other words these are poor people on inadequate diets, so it’s very likely they’re reusing the cheapest oils, ghee, and ghee substitutes.

      In Nepal there was no association with fats, just
      “History of gallstone disease, cigarette smoking and early menarche were associated with increased risk of gallbladder cancer while high consumption of fruits was found to have a protective effect.”
      http://apocpcontrol.com/paper_file/issue_abs/Volume17_No7/3447-3453%205.23%20D%20Tamrakar.pdf

      This paper says
      “Studies from India where GC has the highest incidence have also reported positive correlation of life style with GC and suggested high carbohydrate diet, low protein and low fiber diet in a low socioeconomic class have strong relation with gallstone and GC (odds ratio 1.4-30)”
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256117/

  13. Thank you for another informative, inspiring, and entertaining podcast. You consistently translate what I have considered to be, sometimes intimidating topics, in a way that allows me to better understand the science of food in our bodies.
    And as is in the case of good food, you leave me craving for more.
    PS, I too think their braunsweiger is the best I’ve had so far, be well…

  14. Dr. Jack Wolfson wrote a good article the other day about the AHA’s latest ignorant press release on saturated fat. You can read it here: http://www.naturalnews.com/2017-06-18-the-conspiracy-against-saturated-fat-dr-jack-wolfson-responds-to-the-aha-attack-on-coconut-oil.html#
    Basically, the AHA is a lobbyist group for Big Pharma and Big Agriculture. As such, they have no interest in promoting whole foods (like coconut oil) to keep people healthy, because that doesn’t make them any money. All you need to do is follow the money to figure out why AHA and similar organizations promote the agenda that they do.

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