I’ll Take It with a Grain of Salt and Teaspoon of Coconut Oil

by Ashley Jordan Ferira, PhD, RDN

Heart disease is killer

Cardiovascular disease is the #1 cause of mortality globally (17.9 million deaths annually),¹ so it makes sense that researchers, clinicians, and health policymakers want to hunt down the culprit(s) of the heart disease epidemic. Recognized risk factors for heart disease include overweight and obesity, hypertension, dyslipidemia, excessive alcohol consumption, physical inactivity, and smoking.² With the exception of smoking and physical activity habits, one’s nutrition choices (i.e., diet) can mitigate the risk for all of the aforementioned heart health culprits.

But, what role do specific dietary patterns, food groups, or even certain nutritional bioactives (i.e., macro-, micro- and phytonutrients) play in heart health? That seems like a daunting query (because it is), but Harvard researcher and professor Karin Michels, PhD, ScD, MPH got rather specific in 2018, denouncing coconut oil as “pure poison” in a lecture at the University of Freiburg that was posted on YouTube.³ The video went viral and was subsequently and swiftly propagated by several media and news outlets.

Is coconut oil really “poison”?

With current widespread interest and practice (some new, some resurgent) of low-carbohydrate dietary patterns (e.g. Atkins, ketogenic, Paleo, Whole30), Dr. Michels’ anti-coconut message has some people questioning the content of their kitchen cabinets, and a few folks were mid-scoop in coconut oil…

So, let’s break it down: The basic premise of anti-coconut oil camp criticism is that coconut oil is a saturated fat, and saturated fats raise LDL cholesterol, which contributes to atherosclerosis and heart disease.³ Are the biochemical paths and clinical literature that clear cut? Before we go any further, let’s recap some fat biochemistry basics. Triglycerides (dietary fats) are made up of a glycerol backbone + 3 fatty acids. It’s the chemical structure of the majority of fatty acids (i.e., the number of double bonds, if any) in the triglyceride that dictates the classifications that humans created for them. Naturally occurring fats include saturated (think butter, solid at room temperature) and unsaturated fats (think oils, liquid at room temperature), which are further divided into monounsaturated fats (think olive or canola oils) and polyunsatured fats (think omega-3 and omega-6 fatty acids). Trans fats also exist naturally in small amounts in meat and dairy products, but most trans fats in our food supply are artificially synthesized via the process of hydrogenation.

So, where does coconut oil fit into this classification system? Its fatty acid profile is 82% saturated, but the predominant fatty acid (~%50) is lauric acid, a medium-chain triglyceride (MCT), with the rest being long-chain saturated fatty acids (myristic, palmitic, stearic) and short-chain fatty acids.⁴ It’s noteworthy that the primary fat in coconut oil is an MCT, because they do not significantly contribute to fat accumulation due to their energy efficiency in the body via rapid liver metabolism and conversion to ketone bodies.⁵

Dr. Michels holds several academic professorships and is a specialist in epigenetic epidemiology, with particular expertise in breast cancer in association with Dana-Farber/Harvard Cancer Center. Her pedigree and research contributions are impressive. I thought it would also be valuable to have researchers and clinicians with niche knowledge and experience in fat biochemistry and low-carbohydrate implementation weigh in on this coconut query. Here’s what they had to say:

Insights from Dominic D’Agostino, PhD:⁶

“Coconut oil has been wrongly demonized because of its categorization as a saturated fat. My opinion is that replacing processed carbohydrates with more quality fats like coconut oil will go a long way in improving overall health. The best studies done to date have demonstrated that higher saturated fat intake was associated with lower risk of total mortality and stroke.”⁷

Insights from Scott Bergman, DC, CTN, DAAIM:⁸

“Vilifying saturated fats goes back to the 1950s with Dr. Ancel Keys and the Seven Countries Study linking saturated fat to high cholesterol to cardiovascular disease. It is quite frankly old and inaccurate science. According to Dr. Walter Willett of Harvard Medical School and Harvard School of Public Health: coconut oil helps to increase the levels of HDL cholesterol (good cholesterol) that aid in improving heart health.”⁹

Insights from Christopher Keroack, MD, IFMCP:¹⁰

“The main concern is that the fats in coconut oil are about 80% saturated fats and there is concern about saturated fat from our diet leading to disease states, specifically heart disease and cardiometabolic disorders. However, the specific type of saturated fat in coconut oil is lauric acid, which has been shown to assist with managing HDL and LDL cholesterol levels.” Dr. Keroack went on to explain that coconut oil “needs to be considered with regards to the entire diet that person is consuming: If extra coconut oil is added into the average American diet, it may prove detrimental because of the increase in saturated fat. However, coconut oil can be a staple when it comes to the ketogenic diet and helpful when it comes to the Mediterranean diet. It is the balance of macronutrients, as well as the quality of the food, that leads to overall health.

Insights from Ryan Lazarus, DC, MSc, CNS, IFMCP:¹¹

“Unfortunately, nowadays there are more attention-grabbing headlines rather than evidence-based, high-quality science reporting. A perfect example is the lecture ‘Coconut Oil and Other Nutritional Errors,’ which provides a radical opinion and fearmongering statement that ‘coconut oil is pure poison.’ According to Dr. Michels: ‘There’s no study showing significant health benefits to coconut oil consumption.’ This is inaccurate, as the scientific research has clearly indicated with multiple meta-analyses that saturated fat does not cause heart disease. Moreover, additional scientific literature has indicated various immunomodulatory, cognitive, and metabolic health benefits regarding coconut oil consumption. I believe this is yet another attempt to ignore quality scientific findings in the interest of creating sensational headlines to confuse the general public. I’ll take it with a grain of salt and teaspoon of coconut oil.”

So, what’s the upshot on coconut oil?

Coconuts and their oil are not menacing and can certainly fit into a healthful dietary pattern. Coconut oil should not be considered in isolation from the rest of the diet, nor should coconut oil (or other fats) be consumed in excess. Neither “poison” nor “miracle”, coconut oil can be incorporated into one’s diet in the right context- a nutrient-dense dietary pattern that does not exceed the individual’s metabolic/caloric needs. Furthermore, in people already following a low-carbohydrate or ketogenic diet whose metabolism is already adapted to use fat efficiently, incorporation of coconut oil, MCTs, or saturated fats can support long-term adherence to the dietary pattern.

A knowledgeable healthcare practitioner (HCP) can help their patients create and implement dietary patterns that are personalized and sustainable, and the nutritional approach can pivot based on the patient’s health goals, quality of life, and objective measures (e.g. anthropometrics, lab biomarkers, etc.).

Coconut oil has been consumed for thousands of years in many cultures. Interestingly, some of those cultures are now advocating for the return of the coconut oil consumption patterns of their native, local diet in lieu of imported vegetable and seed oils.¹² In addition to antioxidant and anti-bacterial, viral, and fungal properties, there is a growing body of literature demonstrating the benefits of coconut oil and/or MCTs in many health areas, including but not limited to cardiovascular health, weight loss, epilepsy, and Alzheimer’s disease. This research will be explored in a future blog!

The field of nutrition is young and complex

Sensationalism and histrionics sell. We all eat food, so dramatic stories on nutritional topics have wide-reaching readership. Nutrition, albeit fascinating, is not as emotionally charged as the news stories would have you believe. Considering the totality and nuance of the research literature (which is dynamic, with discoveries still to be had) in most areas of science and medicine, nutrition included, is the better approach. Nutrition is a relatively young field of science. Interestingly, the husband-and-wife team George and Mildred Burr discovered the existence and importance of essential fatty acids in humans in 1930;¹³ that’s less than 100 years ago.

Definitive answers are satisfying, but nutrition science and health queries are not usually binary, as much as we would like for them to be. There are a lot more gray areas in science and medicine than some would like to admit. Dietary patterns don’t exist in isolation when it comes to health outcomes (consider genetics, environmental inputs, microbiome effects, and other lifestyle choices), and the foods in those diets contain numerous, diverse bioactives (some are still being discovered) with pleiotropic effects in the complex human body. Instead of condemning one food, it seems more prudent to take a holistic approach, considering overall dietary patterns, which can be personalized and optimized via partnership with a HCP. 

Citations

1. WHO. Cardiovascular Disease. http://www.who.int/cardiovascular_diseases/en/. Accessed August 20, 2018.
2. CDC. Heart Disease Facts. https://www.cdc.gov/heartdisease/facts.htm. Accessed August 20, 2018.
3. YouTube. Coconut Oils and Other Nutritional Errors. https://www.youtube.com/watch?v=Mnc_aoN7lMM&feature=youtu.be. Accessed August 20, 2018.
4. Sacks F et al. Dietary fats and cardiovascular disease, a Presidential Advisory from the American Heart Association. Circulation. 2017;136:e1-e23.
5. Dayrit FM. The properties of lauric acid and their significance in coconut oil. J Am Oil Chem Soc. 2015;92(1):1-15.
6. Interview. Dr. Dominic D’Agostino. August 21, 2018.
7. Dehghan M et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet. 2017;390:2050-2062.
8. Interview. Dr. Scott Bergman. August 21, 2018.
9. Harvard Health Publishing. Ask the doctor: Coconut oil and health. https://www.health.harvard.edu/staying-healthy/coconut-oil?&utm_medium=53. Accessed August 22, 2018.
10. Interview. Dr. Christopher Keroack. August 21, 2018.
11. Interview. Dr. Ryan Lazarus. August 21, 2018.
12. Boateng L et al. Coconut oil and palm oil’s role in nutrition, health and national development: a review. Ghana Med J. 2016;50(3):189-196.
13. Burr GO et al. The nature and role of the fatty acids essential in nutrition. J Biol Chem. 1930;86:587-621.

Ashley Jordan Ferira, PhD, RDN completed her bachelor’s degree at the University of Pennsylvania and PhD in Foods & Nutrition at The University of Georgia, where she researched the role of vitamin D in pediatric cardiometabolic disease risk. Dr. Ferira is a Registered Dietitian Nutritionist (RDN) and has served in leadership roles across local and statewide dietetics, academic, industry, and nonprofit sectors.