Coconut Oil & the Boost in HDL “Good” Cholesterol

Coconut Oil & the Boost in HDL “Good” Cholesterol
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The effects of coconut oil are compared to butter and tallow. Even if virgin coconut oil and other saturated fats raise LDL “bad” cholesterol, isn’t that countered by the increase in HDL “good” cholesterol?

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

We’ve known for nearly a half century that, according to “200 of the country’s leading experts in cardiovascular diseases,” in a report representing 29 “national medical organizations,” including the American Heart Association and the American College of Cardiology, that “coconut oil is one of the most potent agents” for elevating the level of cholesterol in the blood. Studies showing coconut oil elevates cholesterol date back to 1955, when it was first shown experimentally that switching someone from coconut oil to something like soybean oil could drop cholesterol from like 200 down to 150.

Coconut oil can significantly raise cholesterol levels within hours of consumption: a significantly increased blood cholesterol within hours of eating a slice of cake made from coconut oil—or from cod liver oil for that matter—mmm!—but not from the same cake made from flax seed oil.

Coconut oil may even be worse than tallow, or beef fat, but not as bad as butter. The latest interventional trial was published in March of 2017, a month-long randomized, controlled, crossover study looking at “the impact of [two tablespoons a day of] virgin coconut oil,” and it elevated about 14% over control—consistent with the other seven interventional trials published to date in this 2016 review.

But wait; saturated fats can make so-called good cholesterol—HDL—go up. So, what’s the problem? The problem is that doesn’t seem to help. Having a high blood HDL level “is…no longer regarded as protective.” What? But, wait a second. Higher HDL is clearly associated with lower risk of heart disease. In fact, “HDL…levels are among the most consistent and robust predictors of [cardiovascular disease] risk.” Ah, but see, there are two types of risk factors: causal and non-causal. Association does not mean causation—meaning that just because two things are tightly linked, doesn’t mean one causes the other.

Let me give you an example. I bet that the number of ashtrays someone owns is an excellent predictor of lung cancer risk. I bet study after study would show that link, but that doesn’t mean that if you intervene and lower the number of ashtrays they have, their lung cancer risk would drop, because it’s not the ashtrays that were causing the cancer, it was the smoking. The ashtrays were just a marker of smoking, an indicator of smoking, as opposed to playing a causal role in the disease. So, just like having a high number of running shoes and gym shorts might predict a lower risk of heart attack, having a high HDL predicts a lower risk of heart attack. But, raising HDL, just like raising the number of gym shorts, wouldn’t necessarily affect disease risk.

How do you differentiate between causal and non-causal risk factors? You put it to the test. The reason we know LDL cholesterol really is bad is because people who were just born with genetically low LDL end up having a low risk of heart disease. And if you intervene and actively lower people’s LDL through diet or drugs, their heart disease risk drops. Not so with HDL.

People who live their whole lives with high HDL levels don’t appear to have a lower risk of heart attack, and if you give people a drug that increases their HDL, it doesn’t work. That’s why we used to give people high-dose niacin—to raise their HDL. But, it’s time to face the facts. “The lack of benefit of raising…HDL…seriously undermine[s] the [concept of] HDL [being] a causal risk factor.” In simple terms:  “High HDL may not protect the heart.” We should “[c]oncentrate on lowering LDL.”

And so, specifically, as this relates to coconut oil:  “The increase in HDL…is of uncertain clinical [significance], but the increase in LDL [cholesterol you get from eating coconut oil] would be expected to have an adverse effect on [atherosclerotic cardiovascular disease] risk.”

But, what about the MCTs? Proponents of coconut oil, who lament that this whole “coconut oil causes heart disease” thing “has created this bad image” for their national exports, assert that the medium chain triglycerides, the shorter saturated fats found in coconut oil, aren’t as bad as the longer chain saturated fats in meat and dairy. And, what about that study that purported to show low rates of heart disease among Pacific Islanders who ate tons of coconuts? I’ll cover both these topics, next.

Please consider volunteering to help out on the site.

Icons created by Tom Glass, Jr., Luis Prado, Catherine Please, Martin Chapman Fromm, Iconic, Hopkins, and Px icon from The Noun Project.

Image credit: Kristina DeMuth. Image has been modified.

Motion graphics by Avocado Video

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

We’ve known for nearly a half century that, according to “200 of the country’s leading experts in cardiovascular diseases,” in a report representing 29 “national medical organizations,” including the American Heart Association and the American College of Cardiology, that “coconut oil is one of the most potent agents” for elevating the level of cholesterol in the blood. Studies showing coconut oil elevates cholesterol date back to 1955, when it was first shown experimentally that switching someone from coconut oil to something like soybean oil could drop cholesterol from like 200 down to 150.

Coconut oil can significantly raise cholesterol levels within hours of consumption: a significantly increased blood cholesterol within hours of eating a slice of cake made from coconut oil—or from cod liver oil for that matter—mmm!—but not from the same cake made from flax seed oil.

Coconut oil may even be worse than tallow, or beef fat, but not as bad as butter. The latest interventional trial was published in March of 2017, a month-long randomized, controlled, crossover study looking at “the impact of [two tablespoons a day of] virgin coconut oil,” and it elevated about 14% over control—consistent with the other seven interventional trials published to date in this 2016 review.

But wait; saturated fats can make so-called good cholesterol—HDL—go up. So, what’s the problem? The problem is that doesn’t seem to help. Having a high blood HDL level “is…no longer regarded as protective.” What? But, wait a second. Higher HDL is clearly associated with lower risk of heart disease. In fact, “HDL…levels are among the most consistent and robust predictors of [cardiovascular disease] risk.” Ah, but see, there are two types of risk factors: causal and non-causal. Association does not mean causation—meaning that just because two things are tightly linked, doesn’t mean one causes the other.

Let me give you an example. I bet that the number of ashtrays someone owns is an excellent predictor of lung cancer risk. I bet study after study would show that link, but that doesn’t mean that if you intervene and lower the number of ashtrays they have, their lung cancer risk would drop, because it’s not the ashtrays that were causing the cancer, it was the smoking. The ashtrays were just a marker of smoking, an indicator of smoking, as opposed to playing a causal role in the disease. So, just like having a high number of running shoes and gym shorts might predict a lower risk of heart attack, having a high HDL predicts a lower risk of heart attack. But, raising HDL, just like raising the number of gym shorts, wouldn’t necessarily affect disease risk.

How do you differentiate between causal and non-causal risk factors? You put it to the test. The reason we know LDL cholesterol really is bad is because people who were just born with genetically low LDL end up having a low risk of heart disease. And if you intervene and actively lower people’s LDL through diet or drugs, their heart disease risk drops. Not so with HDL.

People who live their whole lives with high HDL levels don’t appear to have a lower risk of heart attack, and if you give people a drug that increases their HDL, it doesn’t work. That’s why we used to give people high-dose niacin—to raise their HDL. But, it’s time to face the facts. “The lack of benefit of raising…HDL…seriously undermine[s] the [concept of] HDL [being] a causal risk factor.” In simple terms:  “High HDL may not protect the heart.” We should “[c]oncentrate on lowering LDL.”

And so, specifically, as this relates to coconut oil:  “The increase in HDL…is of uncertain clinical [significance], but the increase in LDL [cholesterol you get from eating coconut oil] would be expected to have an adverse effect on [atherosclerotic cardiovascular disease] risk.”

But, what about the MCTs? Proponents of coconut oil, who lament that this whole “coconut oil causes heart disease” thing “has created this bad image” for their national exports, assert that the medium chain triglycerides, the shorter saturated fats found in coconut oil, aren’t as bad as the longer chain saturated fats in meat and dairy. And, what about that study that purported to show low rates of heart disease among Pacific Islanders who ate tons of coconuts? I’ll cover both these topics, next.

Please consider volunteering to help out on the site.

Icons created by Tom Glass, Jr., Luis Prado, Catherine Please, Martin Chapman Fromm, Iconic, Hopkins, and Px icon from The Noun Project.

Image credit: Kristina DeMuth. Image has been modified.

Motion graphics by Avocado Video

Doctor's Note

I love topics that give me an excuse to talk about scientific concepts more generally, like various study designs in my video Prostate Cancer and Organic Milk vs. Almond Milk or my discussion of direct versus indirect risk factors in this one. Surprised that raising HDL levels may not matter? I’m going to delve into that much deeper in an upcoming video series since it is such a revolution in our thinking. How do we know LDL is really bad, though? Check out How Do We Know That Cholesterol Causes Heart Disease?.

But, wait. Isn’t the whole saturated fat thing bunk? No. See my videos:

Up next? The thrilling conclusion in What About Coconuts, Coconut Milk, and Coconut Oil MCTs?.

What about swishing it around in your mouth? See:

Finally, you may want to check out Coconut Oil and Abdominal Fat.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

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