Author: Beth Zupec-Kania RDN, CD Consultant for The Charlie Foundation.
Dietary fat has endured a long history of controversy in its role in health. Saturated fat, found predominately in animal products (butter, cheese, cream, meat fats), and, in coconut oil, have been villainized as “bad” fats. Newer research is turning the tide on this old way of thinking. A 2015 systematic review found no association between saturated fat consumption and risk of heart disease, stroke, diabetes, or death (1). An even more recent review of randomized controlled trials concluded that replacing saturated fats with mostly polyunsaturated fats is unlikely to reduce coronary heart disease. This 2017 review showed that inadequately controlled trials that were included in earlier meta-analyses explain the prior results (2). Despite these recent findings, the American Heart Association continues to tout the old data. It’s important, however, to understand that their reference to fat is in the context of a high-carbohydrate diet. Ketogenic and modified ketogenic diets have a completely different effect on metabolism. Emerging data from several sources reveal that low-carb, high-fat diets are effective in improving metabolic syndrome (3-5). Metabolic syndrome is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke. Coconut oil is a safe fat to include in low-carb, high-fat diets. Its shorter chain length makes it easier to digest then long chain animal and vegetable oils. It also contains antibacterial properties which is helpful for the digestive tract. While coconut and palm oils found in processed snack foods are undoubtedly unhealthy, pure coconut oil has been used for decades in epilepsy. The MCT oil diet, originated at The Mayo Clinic consists of 60% MCT oil – a concentrated form of coconut oil. Not only has this oil been helpful in treating epilepsy, it has recently shown to be beneficial for brain health (6.7).
The Charlie Foundation encourages you to have regular cholesterol and lipid testing, including particle size, during ketogenic diet therapy. The particle size is important in understanding cardiovascular risk. Ketogenic diets often increase the large-sized LDL which is thought to be protective against heart disease. We also advise including monounsaturated fats such as extra virgin olive oil and avocado oil daily in the diet. These unique monounsaturated oils contain several vitamins plus the essential omega-3 and 6 fats.
Note- This commentary was written in response to this advisory from the AHA.
1. de Souza RJ et al. (2015). “Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies”. BMJ. 351 (h3978).
2.Hamley, S. (2017). “The effect of replacing saturated fat with mostly n-6 polyunsaturated fat on coronary heart disease: a meta-analysis of randomised controlled trials”. Nutrition Journal. 16 (1): 30. PMID28526025. doi:10.1186/s12937-017-0254-5.
7. Fernando W.M.A.D et al. (2015) “The role of dietary coconut for the prevention and treatment of Alzheimer’s disease: potential mechanisms of action.“ British Journal of Nutrition. doi:10.1017/S0007114515001452.
Reviewed 6/28/2017, Dawn Martenz
Reviewed 9/11/2018, Dawn Martenz