ON COCONUT OIL AND THE AHA: RESPONSE BY MARY NEWPORT MD TO THE AHA  ADVISORY COMMITTEE ON DIETARY FATS AND CARDIOVASCULAR DISEASE

The media has irresponsibly taken viral a fragment of information purporting that coconut oil may be bad for your heart from an article published in the medical journal "Circulation" 2017, 135:e1-24, as a presidential advisory committee report from the AHA, "Dietary Fats and Cardiovascular Disease". The coconut oil industry on the other side of the world, mainly comprised of small farmers who grow and sell their coconuts, is reeling from the effects of this latest careless media campaign. They have only recently been recovering from the previous advisory put forth by the AHA.

There are some serious problems with the conclusions of the advisory committee. The four "core studies" this committee relied on were all conducted in the 1950s, were relatively small groups of "men only" in three of the four studies, were conducted in populations that almost certainly were not consuming coconut oil on any regular basis, and were studies comparing diets with ANIMAL saturated fats to diets with polyunsaturated fats. Animal and human fat is well known to store hormones, pesticides, antibiotics and other environmental substances, which could be factors in heart disease, whereas vegetable fats such as coconut oil would not be so likely to contain these potentially harmful substances.

The authors do not mention whether age and smoking were controlled for in these studies; smoking, which was very prevalent in the 1950s compared to the 2010's is a major contributor to heart disease. The raw numbers of how many people in each group had cardiac events was not presented, making the summaries difficult to evaluate. The clincher in this article is that they state on page e13, under the section on coconut oil, "Clinical trials that compared direct effects on CVD [cardiovascular disease] of coconut oil and other dietary oils have not been reported." They rely on studies of individual saturated fatty acids that show a miniscule increase in LDL (so called "bad") cholesterol but rationalize away a similar small increase in HDL (so called "good") cholesterol and an improved LDL to HDL ratio. For example, lauric acid (50% of coconut oil) resulted in a less than 1 mg/dl point increase in both LDL and HDL cholesterol, with typical LDL values ranging from less than 100 to 160 mg/dl. Could a change of less than 1 mg/dl really have that much impact?

In addition, the problem here is that natural fats such as coconut oil and even lard do not come as individual fatty acids but rather as combinations of many fatty acids with different properties, which may balance each other out. Completely ignored in this report are the saturated fats in coconut oil known as medium chain triglycerides that could balance out the longer chain fats. Coconut oil also contains some mono- and polyunsaturated fats, tauted as healthy by this committee. One of the most important details that the AHA is missing here is that 70% of the saturated fats in coconut oil are medium chain triglycerides (C6 through C12) which are either converted to ketones or burned immediately as fuel by muscle and other organs and not stored as fat. Lauric acid has some properties of medium chain and longer chain fatty acids. Ketones come from breakdown of fat and provide an alternative fuel to the brain and most other organs during starvation or fasting or to cells that are insulin resistant. In a recent study conducted in Japan, lauric acid was found to potently stimulate ketone production in astrocytes in cultures; astrocytes are brain cells that nourish other brain cells. By comparison, butter, lard and animal fat contain minimal medium chain triglycerides and medium chains are not found in soybean, olive, corn, safflower and most other oils. There are hundreds of studies of potential benefits of coconut oil; for example, lauric acid, which makes up about 50% of coconut oil, is antimicrobial - there are numerous studies showing that lauric acid kills many bacteria, viruses, fungi like candida and protozoa. Lauric acid is not found in any significant amount in soybean, corn, canola and olive oils.

A few small cholesterol studies looking at coconut oil were conducted decades ago in animals or a few men over short term and used hydrogenated coconut oil - any hydrogenated oil will increase cholesterol. Also, the diets were deficient in omega-3 fatty acids which can also increase cholesterol levels. There are studies of entire populations for whom coconut oil provides 1/3 to 2/3 of the diet showing that they were of normal height and weight, had normal blood pressure, triglycerides and cholesterol levels at all ages.

The committee surmises that people who eat saturated fats likely have other bad eating habits without any proof. These days, many, if not most, of the people who embrace coconut oil are likely embracing healthier foods as well and a healthier lifestyle in general and eating fish and/or taking omega-3 fats, which weren’t on the radar in the 1950s when the so-called “core studies” for this report were conducted.

The folks in the AHA and other organizations who perpetuate these myths about coconut oil need to really do their homework and learn more about medium chain triglycerides and study the other beneficial effects of coconut oil, which they choose to ignore. The point that some people may benefit from eating more polyunsaturated fat in place of animal fat may be very valid. However, coconut oil is not animal fat and, nevertheless, the bottom line that came out of their lengthy report is that “coconut oil is bad for your heart”, which has now been perpetuated by media who jumped on this conclusion that is not even based on direct research of coconut oil and heart disease. This message has gone viral worldwide. The impact of this could take a devastating toll on the economies of countries that produce coconut oil, mostly made up of individual farmers and their families trying to make a living. These economies were devastated in the 1960s and have been slowly recovering from the initial similar AHA statement on saturated fats in 1961 based on the same four “core studies". It is irresponsible and unconscionable for this advisory committee to make such sweeping claims without direct proof that coconut oil causes heart disease.

The AHA advisory committee should consider the negative impact their report has already had on the communities on the other side of the world, and issue a clarification that there is no direct proof that coconut oil has a negative effect on the heart. Then the committee needs to figure out how to make the clarification statement go viral.

Glioblastoma and Ketogenic Diet

"Sunny Lee" recently posted a comment under my previous post. His wife has glioblastoma and I hope he will see this.

There are at least two articles by Dr. Thomas Seyfried and associates on use of the ketogenic diet and caloric restriction to treat glioblastoma. This information was presented at the "Ketogenic Diet for Epilepsy and other Neurologic Disorders" conference we attended in Scotland October 2010. They have found that this type of diet shrinks glioblastoma tumors by as much as 80% in lab animals and they have published a case study of a woman whose tumor virtually disappeared after six weeks on this diet. When she reverted back to a higher carbohydrate diet the tumor returned.

The concept here is that many cancerous tumors can only use glucose as a fuel and cannot use ketones. On a strict ketogenic diet, carbohydrate as well as protein (which can be converted to glucose) are minimized and the diet is high in fat, usually 80% or more of calories as fat. Using coconut oil and/or MCT oil in this type of diet helps maintain constant ketone levels. The brain and other organs can continue to thrive using ketones as fuel, whereas the tumor will shrink due to low availability of glucose. Dr. Seyfried believes radiation may not even be necessary thereby sparing the horrendous side effects of this treatment. In many cases, after the tumor is reduced in size, it could be more readily removed surgically. This could significantly lengthen the person's life.

Dr. Seyfried believes that man other types of cancers would respond to ketogenic diet an dmroe so if there is also caloric restriction.

For anyone who needs help with the ketogenic diet there are two websites to look at: In the USA www.charliefoundation.org and in the UK www.matthewsfriends.org. Both websites were created by parents of children with severe drug resistant epilepsy that responded remarkably to the ketogenic diet and have dieticians available to help. They also have a tool called the ketocalculator to help create ketogenic meals. Also, there is help available with ketogenic diet and ketone research ongoing at the John Hopkins Hospital in the USA.

2nd Ketone Conference in Edinburgh, Scotland

Steve, our daughter Joanna, and I travelled to Edinburgh, Scotland in early October 2010 to attend the 2nd symposium on ketones called “Dietary Interventions for Epilepsy and Other Neurologic Diseases,” where I presented two abstracts on posters. One was Steve’s case study and the other was caregiver reports of responses of persons with dementia to medium chain fatty acids. I hope to get the chart up on the website very soon. Dr. Veech’s work and/or his ketone ester were discussed in several of the presentations. About 150 people attended, mostly pediatric neurologists, PhD researchers, and dieticians, who are interested in and involved in ketogenic diet and other ketone research. Several of the presenters were from John Hopkins University, where the ketogenic diet has been used for many decades for childhood epilepsy. This diet is used primarily in children who do not respond to anti-convulsant medication, but recently has been used in adults as well. We met a man named Mike from England who had resistant epilepsy who became seizure free on this diet and has remained so for about three years ago. The diet has even been tried as a first line (before medication) at John Hopkins with success in some infants with infantile spasms. About 18-20% of children with drug resistant epilepsy become seizure free and another 35-40% have a reduction in their seizures by at least 50%. They do not know exactly why it works and also why it works in some people and not in others. This is the same thing that we see in our friends with Alzheimer's that some respond to the ketones from coconut oil and/or MCT oil and some do not.
The strictest form of the diet calls for about 75-80% of the total calories to be consumed as fat and the rest as a combination of carbohydrate and protein. The protein is calculated to allow the child to grow, or the adult to maintain lean body mass. Some of the presenters have done research showing that less strict forms of the diet may work for some people. There is an MCT oil modification of the diet, using 60% of the calories as MCT oil, a modified Atkins diet, and the Low Glycemic Index Diet. Any of these diets could be tried with the help of a dietician in someone with Alzheimer’s, Parkinson’s, ALS, traumatic brain injury and potentially some other neurologic diseases. There are some small studies and case studies suggesting that this could be beneficial. One study showed that following stroke, the ketogenic diet can help preserve brain volume.
Another section of the conference focused on cancer and the ketogenic diet with caloric restriction (20-40% less than maintenance calories). Dr. Tom Seyfried presented his research showing that glioblastomas shrink by as much as 80% in response to this type of diet. He believes that at least 80% of cancerous tumors would shrink with this approach, since most cancers can use only glucose as fuel and cannot use ketones. On this type of diet as the blood sugar becomes low, the blood supply and energy to the tumor dwindles as well as the tumor(s), even in the case of metastatic tumors. He has some human case studies as well as plenty of animal studies to support this.
The organizers for this conference were www.matthewsfriends.org and for the previous conference in 2008 www.charliefoundation.org. Both of these organizations were founded by parents of children with epilepsy who responded to the ketogenic diet, and either of these can provide information and dietician help with these diets. The next conference will be in 2012 and they are seriously considering including a section on Alzheimer’s disease.
We had a wonderful time in Edinburgh, although the travelling back and forth is not much fun. Steve did amazingly well, although there was some confusion when we were out after dark. The hardest part was trying to figure out the best times to give him his oil since we were five hours ahead there. It is always good to get back home - much less confusion there!