By Marika Sboros
Heart associations worldwide tend instantly to raise researchers’ blood pressure into the stratosphere. The latest “Presidential Advisory” from the American Heart Association (AHA) is no exception.
The BBC reported it as branding coconut oil “as bad for you as beef lard and butter”. USA Today reported it as that coconut oil was “even worse than beef lard and butter”.
The 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 brilliant post on her Sustainable Dish blog, saying just that. At heart, it’s because the AHA, like heart foundations globally, is heavily conflicted.
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” 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. It is 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 AHA regularly bases advisories on out-dated thinking on cholesterol, says British food scientist Dr Verner Wheelock. It based this advisory once again on the currently unproven diet-heart hypothesis that saturated fat causes heart disease. Thus, critics say it’s not surprising that the Harvard authors come to some remarkably unscientific conclusions.
Thus, the Harvard authors come to some 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”. Thus, they advise against its use.
They also punt vegetable oils as healthy with an unscientific passion that borders on the pathological.
US science journalist Nina Teicholz is author of the seminal work on the murky world of nutrition science. It is: The Big Fat Surprise, Why Butter, Meat And Cheese Belong In A Healthy Diet. In it, she explains 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, Teicholz says. “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, she says. And AHA advisories have always promoted these industries’ products.
British consultant cardiologist Dr Aseem Malhotra gave a talk at the annual Public Health Collaboration (PHC) conference in Manchester at the weekend. Both Malhotra and another speaker, Australian cricket team physician, Dr Peter Brukner, told of why they are often ashamed of their profession. Malhora spoke movingly of his despair at the state of the medical profession today.
Vested interests have so corrupted it that “honest doctors can no longer practise honest medicine”, Malhotra said. On social media, he 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?
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 of how coronary artery disease develops and best treatment for it.
On social media, British researcher Dr Zoë Harcombe has called the AHA “evil”. Harcombe, who has a Ph D in public health, also spoke at the PHC conference. She said that food and drug companies are not the real enemies of public health.
These companies are in the business of making profits, not making people healthier, Harcombe said. The real enemies are public health bodies, such as Public Health England, and the nutrition “experts” who head them. They should be dragged into court, she said.
Are Malhotra and Harcombe being a bit harsh? Not when you look at the totality of scientific evidence. And not when you look at the AHA’s slavish support for sponsors’ interests and the influential, unscientific US dietary guidelines.
Harcombe is author of compelling research in the BMJ Open Heart in 2015. She showed that evidence from RCTs (randomised controlled trials) did not support the introduction of dietary fat guidelines in the US in 1977 and the UK in 1983. In the BJSM in 2016, Harcombe showed that there was no epidemiological evidence either.
There is progress, painfully slow though it is – and confusing. Those responsible for the guidelines have dropped their “low-fat” dietary recommendation but quietly and without any public announcement, says Teicholz. They still model their “dietary patterns” as low in fat and high in carbs. They were also very quiet about cholesterol as “no longer a nutrient of concern”. Thus, their advice is conflicting.
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 the 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.
Click here to read: Noakes trial: Who really dishes up dangerous advice?
South African scientist Prof Tim Noakes says that the AHA advisory is “all wrong”. “The RCT evidence is clear,” says Noakes, a University of Cape Town emeritus professor of sports science. “If you swop saturated fat for vegetable oils you don’t reduce your risk of heart disease.”
How has the AHA got away with declaring the opposite for so long? Simple. Noakes says it’s because of funding that Prof Walter Willett and his “Harvard crew” receive from vegetable oil and grain industries.
It all harks back to the Minnesota Coronary Experiment by Ancel Keys way back in the 1970s, Noakes says.
Keys suppressed the evidence because it showed no benefit from replacing saturated fat with vegetable oils, he says. If Keys had published his data, he would never have been able to promote the diet-heart hypothesis.
The Heart and Stroke Foundation of South Africa (HSFSA) is just as culpable, Noakes says. It promoted margarine as healthy when it was full of trans fats. Heart foundations globally only started acknowledging the link between trans fats and heart disease rates in 2007, he says.
The production process of margarine has changed dramatically to reduce the trans fats, but it’s still an industrial product. Yet the HSFSA still promotes margarine as healthy because it contains polyunsaturated fats.
However, no one knows the effects of the chemicals created in the process of vegetable oil production, Noakes says. One of those is aldehyde, a known carcinogen.
Click here to read: Obesity? Forget fat – it’s the carbs, stupid!
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.”
Furthermore, saturated fatty acids are a heterogeneous group. “Some may have adverse metabolic effects whereas other 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 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 is not sufficient to 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 LDL as opposed to raising LDL”.
Coconut oil has “clear-cut benefits for hair and skin so you can safely use it topically”, Goodman says.
That’s all very well and not every statement or idea in the AHA document is false. As Schofield and Henderson point out, it’s just 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. 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.