The Media, the AHA Advisory, and Coconut Oil: A Smoke Screen for the Need to Reduce Meat, Butter and Cheese

Since the release of the Presidential Advisory on Dietary Fats and Cardiovascular Disease on Thursday afternoon June 15, 2017, there has been a flurry of international headlines, TV segments, and social media comments praising and condemning the scientific article. For example, an article I wrote on the topic Friday had a huge reaction both positive and negative. In the past few days the conversation has been focused almost entirely on the single paragraph and 4 references on coconut oil. The conclusion of this paragraph was that “because coconut oil increases LDL cholesterol, a cause of CVD, and has no known offsetting favorable effects, we advise against the use of coconut oil”. Given the strong response of many voices in the nutrition world reacting as if breast milk had been banned for good, you might think that the use of coconut oil in your diet was the main thrust of the communication by 12 leading and respected members of the scientific community.

The reality is that the overall AHA advisory statement is actually 25 pages in length and cites a total of 139 references to published medical research. Indeed, coconut oil was just a passing comment worthy of mention but not at all the main point of the paper. Consumption of coconut oil in the USA makes up a tiny fraction of all vegetable oils. Coconut consumption per capita in the US is low by international standards and is about 0.7 kg a year. How does that compare to other common sources of dietary saturated fats that are just as atherogenic as the maligned coconut discussed endlessly in social media? Annual per capita cheese consumption in the USA is 16kg or more than 20 times that of the coconut. In 2014 in the USA, about 181 lbs (or 82 kg) of red meat, poultry, shellfish and fish were consumed per capita. This is 100 times more than coconuts by weight. Finally, dairy topped all animal products ingested per capita in the USA with 239 lbs or 108 kg a year (excluding cheese mentioned above) so 150 times the amount consumed compared with coconut.

Did the AHA Presidential Advisory have comments about the relationship between cheese and cardiovascular disease? Sure they did and they concluded that there was no data to “support the hypothesis that cheese has special protective effects compared with beef on lipid risk factors for cardiovascular disease”. Yet the headlines and bloggers were not foaming at the mouth at this slap at cheese by the AHA research team. Did the Advisory discuss other dairy products like butter and milk? They did and highlighted the experience in Finland where “a successful nationwide health project to lower the very high rate of CHD mortality, started in 1972, had as a major goal the reduction in the high intake of saturated fat. The project reduced intake of high-fat milk and butter, which lowered serum cholesterol by 13% in men and 18% in women. By 1992, CHD death rates decreased by 55% in men and 68% in women. Reduction in serum cholesterol accounted for≈ 50% of the total reduction in CHD mortality”. Surprisingly, you have not seen many headlines about diary and butter since the Advisory was published. Finally, although meat was not specifically discussed in detail by the AHA Advisory, at least 4 of the top 10 sources of dietary saturated fats are meat based dishes such as chicken and bacon and the need to reduce these foods is obvious for health yet generated little reaction by the media.

So what are we to do with the AHA Presidential Advisory whether those in medical or nutritional practices advising patients or the rest just trying to decide what to do for the next family meal. My advice is to not get lost in the jungle of discussion over coconut and its oil. Without a doubt the AHA Advisors were responsible in highlighting the lack of data for a health benefit to adding coconut oil to the diet and the likely risks. Yet coconut oil pales in significance to the larger issue the media did not want to address over these last few days. Consistent with statements by Oxford University, the USDA, the United Nations, the Harvard School of Public Health, the True Health Initiative and others, the public needs to be taught to eat less meat, butter and cheese and find replacements like beans, vegetable oil spreads free of trans fats, and nut based cheeses. The message is to pack more fruits and vegetables in to the diet of most people. Only then will the percentage of calories from dietary saturated fats drop substantially and the enormous number of preventable cases of cardiovascular disease drop significantly.