By Marika Sboros
The American Heart Association (AHA) is raising researchers’ blood pressure into the stratosphere.
The BBC reported the AHA latest “presidential advisory ” as branding coconut oil “as bad for you as beef lard and butter”. USA Today reported its view as that coconut oil is “even worse than beef lard and butter”.
The AHA advisory doesn’t actually say that. It does say that replacing saturated fat with “healthier fat” lowers cardiovascular disease (CVD) risk. By healthier fat, the authors mostly mean polyunsaturated fats (PUFAs) in refined, processed vegetable oils. They also say that coconut oil’s high saturated-fat content makes it a potential killer.
Should you believe the AHA just because it says so? You’re better off not believing the AHA precisely because it says so, say critics. They say that coconut oil won’t kill you but listening to the AHA might.
US dietitian and nutrition therapy practitioner Diana Rodgers has written a post on her Sustainable Dish blog, saying just that. At heart, she says, it’s because the AHA, like heart foundations globally, is heavily conflicted.
Presidential dietary bluster
It’s true that there is little new in this advisory, including that coconut oil is high in saturated fat (around 80%).
So, just how “presidential” is this advisory really? Not at all, say New Zealand public health professor Grant Schofield and researcher George Henderson. Most people associate the word “presidential” with a lot of bluster, they say in a post on their Science of Human Potential blog. That tends to disguise real problems and do more harm than good. It is also “a partisan approach to any question”.
Click here to read this: Alzheimer’s – fat path to prevention and ‘cure’
And in the US at least, being “presidential” often means a “pathological inability to admit error”, Schofield and Henderson say. It also means “a cavalier approach to the evidence and the scientific method”. These vices are on “full display” in the AHA’s advisory.
Certainly, the AHA’s shameless habit of cherry-picking to come up with findings its wants is nothing new. It’s called confirmation bias in the medical trade.
US science writer and author Gary Taubes calls it “pseudoscientific methodology”.Taubes is author of Good Calories, Bad Calories and most recently, The Case Against Sugar. He has written a biting post on the CardioBrief blog, titled Vegetable Oils, (Francis) Bacon, Bing Crosby, And The American Heart Association. It does a thorough demolition job of the advisory. It would be funny were it not meant seriously.
Taubes says that a Scottish cardiologist and epidemiologist once described cherry-picking as “Bing Crosby epidemiology”. By that was meant a methodology that “accentuates the positive and eliminates the negative”. Taubes considers the AHA advisory as possibly “the most egregious example of Bing Crosby epidemiology” yet.
The Harvard authors have come to what some believe are remarkably “unscientific conclusions” including about coconut oil.
Leading the pack is Dr Frank Sacks, a Harvard professor of cardiovascular disease prevention and professor of medicine at Harvard Medical School. The authors state as fact that coconut oil increases LDL cholesterol and that this is a “cause” of CVD. They also say that coconut oil has “no known offsetting favorable effects”. Therefore, they advise against its use and the punt vegetable oils as healthy.
US science journalist Nina Teicholz is author of a seminal work on the murky world of nutrition science, The Big Fat Surprise, Why Butter, Meat And Cheese Belong In A Healthy Diet. In it, she explains what she sees as the pathology behind some of the AHA’s utterings.
The AHA was the first authority globally to recommend lowering cholesterol by eating a diet high in vegetable oils and low in saturated fats, as Teicholz shows. “Coincidentally, the AHA has long received major financial support from the vegetable oil industry,” she says.
In fact, since its inception as a national powerhouse in 1948, the vegetable oil industry has heavily supported the AHA, Teicholz says. Pharmaceutical companies that sell cholesterol-lowering drugs known as statins have also always heavily supported the AHA. And AHA advisories have always promoted these industries’ products.
British consultant cardiologist Dr Aseem Malhotra has called the AHA advisory “unscientific nonsense” and media reporting of it “criminal”. The AHA’s conflicts mean you cannot trust its advice, Malhotra has said.
Click here to read: Malhotra sounds statins death knell?
‘Fat doesn’t clog arteries’
In an editorial in the BJSM in April 2017, Malhotra and co-authors said that saturated fat does not clog arteries. The conceptual model of dietary saturated fat clogging a pipe “is just plain wrong”, they say.
They call for an urgent paradigm shift in understanding how coronary artery disease develops and best treatment.
There are other examples of the AHA’s habit of dishing out conflicted advice like chocolates. Statins are but one. The AHA endorses population-wide prescriptions of cholesterol-lowering drugs even for low-risk groups. That’s despite significant evidence of serious side effects that outweigh benefit even for at-risk groups.
Icelandic cardiologist Dr Axel Sigurdsson is more muted in criticism. Considering all the evidence that has emerged in recent years, the advisory comes as a “surprise”. Sigurdsson says.
“Today, most of us acknowledge that using macronutrient composition to address the long-term benefits or harms of foods is unreasonable,” he says. “It‘s an approach known to push us into paradoxical food choices.”
Good and bad carbs
Furthermore, saturated fatty acids are a heterogeneous group. “Some may have adverse metabolic effects whereas others may have benefits,” Sigurdsson says.
Interestingly, the AHA now claims that “good carbohydrates”, such as whole grains and whole fruits, are other appropriate foods to substitute for saturated fats.
“In the era of metabolic syndrome and diabetes, such a recommendation is controversial,” Sigurdsson says. “Reducing carbohydrate consumption may have several metabolic benefits for people who suffer from these disorders.”
There’s also the not-so-small matter of where the AHA publishes its advisory: in Circulation. The AHA owns the journal, says US biochemistry professor Richard Feinman. He is a professor of biochemistry and medical researcher at SUNY (State University of New York) Health Science Centre. The AHA can, therefore, write what it likes in its own journal, says Feinman. And it does.
I did find a voice to speak up for the AHA: cardiologist Dr Dennis Goodman. Goodman is director of integrative medicine at NYU Langone Medical Centre. He says that there are no robust studies showing that coconut oil reduces CVD risk.
“It is clearly better to use monounsaturated and polyunsaturated fats that do not raise LDL and can actually lower it,” he says. These include olive, canola, peanut, corn, nuts, seeds and avocado oils.
Coconut oil has medium-chain fatty acids that can raise HDL (so-called “good cholesterol). However, this benefit does not offset the detrimental effect of raising LDL, Goodman believes.
The AHA has always taken a strong stand against saturated fats, says Goodman. It recommends only 5-6% of calories coming from saturated fat if the goal is to lower cholesterol in a patient.
“(The advisory) is really to clarify that coconut nut oil is full of saturated fat. It has 80% saturated fat compared with only 14 % for olive oil,” he says.
In Goodman’s opinion, it’s “a no-brainer to choose an oil that raises HDL and lowers rather than raises LDL”. Coconut oil has “clear-cut benefits for hair and skin so you can safely use it topically”.
But Schofield and Henderson that half the story is “hidden in darkness”. That darkness fails to hide the authors’ submissive promotion of sponsors’ interests.
The AHA has an ethical duty to balance all the evidence wisely, not just the bits that suit its beliefs, they say. Schofield and Henderson also say that the AHA should step “well beyond the bias of defending their previous assumptions that a high-carb, low-fat diet, low in saturated fat, is best for all”.
In other words, the advisory authors should break the habit of a lifetime and slip their sponsors’ yokes from around their neck. If not, the real killer really will be the AHA.
- Click here to subscribe for email notifications of Foodmed.net postings
- Like my Facebook Page
- Follow me on Twitter @MarikaSboros