More fuss over fat!
The world of nutrition is fickle taking little for a food to go from friend to foe and recent headlines have done just that as coconut oil puts fat back in the firing line. During a recent presentation given by Dr Karin Michels of Harvard University she described coconut oil as “pure poison” continuing to say that it was “one of the worst foods you can eat” (1). These comments were made in reference to the fact that the type of fat found in coconut oil, mostly saturated fat, raises levels of LDL (bad) cholesterol, which is a risk factor for heart disease.
Dr. Michels received a fair amount of media attention from her comments but set in the right context of her presentation these were part of a wider opinion of the health food industry, questioning the marketing and attitudes towards so called ‘superfoods’. During her presentation, Dr. Michels deemed them “unnecessary” and pointed out that we can get the same nutritional benefits from everyday foods such as carrots.
I agree. We can all get sucked in by the hype and this recent story in the press does give rise to important issues surrounding the marketing of foods and how they’re perceived by consumers. However, the fact that coconut oil became the focus of the headline illustrates how our current approach to health and nutrition has become more focused on individual foods and nutrients rather than overall diet quality.
What is a balanced diet?
A balanced diet includes plenty of vegetables alongside lean proteins, high-fibre starchy foods (brown rice, oats, wholemeal bread and pasta, wholegrains) and healthy fats (olive oil, oily fish, nuts, seeds). Within the context of this diet there’s plenty of room for the odd sweet treat and if you want to add in a few ‘on-trend’ foods then that’s cool too but you should focus on getting the basics right first
Is fat that bad?
It was over 50 years ago that fat became a key focus of public health, mostly in relation to its impact on heart health. Heart health is the leading cause of premature death and in the decades that followed, nutrition advice was defined by the message that we should all be following a low-fat diet. In response to this we all turned to choosing margarine, sunflower oil and ‘low fat’ foods to keep our health in check. Fast forward to the present day and sugar has become a greater health concern. Findings from the UK National Diet and Nutrition Survey (2) have revealed that the average intake of fat amongst adults is within the recommended guidelines but that our intake of sugar is twice the recommended amount. It also became quickly apparent that many of the popular ‘low-fat’ foods people were choosing to eat were in fact high in sugar.
It’s taken a while for the nation to adapt to the message that fat isn’t all that bad and research has broadened our understanding of the role this nutrient plays in the diet and its impact on disease. Studies have shown that certain fats such as monounsaturated (MUFA’s) and polyunsaturated (PUFA’s) are better for our health, especially with respect to heart disease (3)(4). Foods rich in these fats include extra virgin olive oil, oily fish, nuts and seeds, which are key components of the Mediterranean diet, considered by many to be the ‘gold standard’ (5).
Fat is just one component of the diet and any type should be eaten in moderation as they’re the most calorific component of the diet. Putting ketogenic diets (high fat, low carb) to one side, a diet high in fat has the potential to cause overweight, which in itself a risk factor for many diet related diseases.
The average adult still eats too much saturated fat but the impact of this on heart health has come under scrutiny. A landmark scientific review published in the British Medical Journal found no association between saturated fat consumption and all-cause mortality, coronary heart disease, stroke or type 2 diabetes (6). This study sparked the saturated fat debate and further studies have contributed to a growing body of evidence that has changed the dialogue on saturated fats.
The impact this study had on the topic of saturated fat in the diet and the relevance of current dietary guidance led to the publication of a report carried out by the Scientific Advisory Committee on Nutrition (SACN). The Saturated Fats and Health report was published in May (2018) after an extensive review of data from high quality cohort studies and clinical trials (7). Their findings strongly support the current dietary guidance of limiting saturated fat intake to no more than 10% of the total energy from the diet. This is translated in dietary guidelines as no more than 30g per day for men and 20g per day for women.
SACN found that there were significant limitations in the available data, which may have helped to be fuel the debate on saturated fat. They also said that lowering saturated fat in the diet was needed to improve serum lipid profiles and events related to cardiovascular disease and coronary heart disease.
Fat intake in the UK
The latest NDNS survey (2) showed that the average daily total fat intake in adults is 33.2% of total energy, which is below the guidance of 35%. It was also shown that the average daily intake of saturated fat in adults is 11.9% of total energy, which is above the 10% guidance. The Scientific Advisory Committee on Nutrition also agreed that we should be choosing foods rich in ‘healthier fats’ such as nuts, seeds, olive oil and avocados over those containing high amounts of saturated fat. Given total fat intake in the UK is within the guidance it was suggested that the focus should still be on reducing saturated fat to achieve a better balance of fats in the diet.
So, what does all of this actually look like in practice?
I get that this issue needed to be resolved in order to support the current recommendations about saturated fat intake, but in practice it’s not that complicated. I’m a fan of whole foods and I choose to eat full fat Greek yoghurt over low fat, spread butter on my toast, and enjoy the odd bit of cheese, but they make up a small part of my diet. According to the NDNS, they make up 27% of the nation’s diet (2).
I choose not to eat other foods that are high in saturated fat on a regular basis. These foods include pies, pizza, pastries, sweet puddings, ice cream, cakes and chocolate, which are also high in calories, salt and refined carbohydrates such as sugar. It doesn’t take a rocket scientist to get that none of these foods are ever going to be considered as healthy, but eating them in moderation, within the context of a balanced diet is fine. The problem with redefining saturated fat is that it can easily cause confusion and if taken out of context may only contribute to unhealthy food choices that increase the risk of weight gain and disease.
What about coconut oil?
Coconut oil is sourced from the meat of mature coconuts and is mostly made up of saturated fatty acids. Whilst saturated fat is considered to be something we should be cutting down on in the diet, those found in coconut oil are different in structure and called medium chain fatty acids (MCFA’s) as opposed to the long chain variety found in food like cheese and fatty cuts of meat. It’s these MUFA’s and in particular, lauric acid, which are thought to be at the root of the many health benefits associated with coconut oil.
Medium Chain Fatty Acids are more easily digested and directed to the liver (bypassing the gut), where they’re converted into energy rather than being stored as fat. Research has suggested that coconut oil can increase levels of HDL (bad) cholesterol as well as possessing anti-inflammatory, antibacterial and antifungal properties. Coconut oil is also commonly touted as supporting weight loss, but the evidence isn’t strong enough to back this claim.
The popularity of coconut oil
It’s easy to get seduced by food and health trends given the attention and interest they generate in the media and especially when accompanied by a flurry of health benefits. The research questioning saturated fat and heart health has helped to position coconut oil as a healthy food. Coconut oil has also made its way into the mainstream like other foods trends that came before it such as quinoa and green juices. The popularity of coconut oil has been helped by its promotion amongst healthy eating chefs, social media and the ‘clean eating’ revolution. Evidence of its popularity is reflected in sales, which have grown four-fold since 2014 with predicted sales this year thought to hit £24 million.
Whilst popular, the science surrounding coconut oil doesn’t tally with its associated health benefits, and the effect of coconut oil on heart health is still not clear, which has contributed its controversy.
What oil should you be using on a daily basis?
Whilst polyunsaturated fats such as sunflower oil have always been considered to be the best choice of cooking oil, some have questioned the impact they have on our omega 6 intake, which in excess can impact on inflammation. Extra virgin olive oil is popular and even more so since becoming more widely available and cheaper to buy. Speciality oils such as those from nuts and seeds have also become more widely available but not as popular given the fact that many people are unsure how to use them.
In my opinion, extra virgin olive oil is still the best choice. Time and again, large studies have highlighted the close relationship between the Mediterranean diet and cardiovascular disease (5). Extra virgin olive oil, which is a major component of this diet, has been shown to be very relevant in lowering the incidence of heart disease and stroke. The majority of fatty acids found in extra virgin olive oil are monounsaturated that have been proven to increase HDL (good) cholesterol and lower LDL (bad) cholesterol. Compounds found in extra virgin olive oil such as a polyphenol called oleocanthal have been shown to help reduce inflammation (8), which is thought to be a risk factor for many diseases including heart disease.
Given the evidence to support the health benefits of extra virgin olive oil, it only goes to prove the power of marketing that someone would choose any other oil over this one, especially one that is wrapped in controversy.
There are many other oils on the market that offer unique flavours that can be incorporated into cooking such as nut and seed varieties (these work well in dressings and drizzling). Despite the fuss over coconut oil, likening it to poison is a bit harsh and only adds to the ‘kill or cure’ culture surrounding foods in relation to diet and health. Used in moderation, coconut oil can add a unique flavour to dishes that works particularly well with Asian and Indian cuisines.
And what about Superfoods?
Most of us have ‘wised up’ to the notion of ‘superfoods’ and understand that this is nothing more than a marketing ploy, but the word has still become commonplace and seen as a descriptor for foods that may be particularly nutritious. The idea that one food is more nutritious than another or focusing on a single food or nutrient to protect your health is never a good idea as it’s the overall diet that counts. Marketing foods as such is of course misleading and food labelling and health claims legislation has helped to create some degree of transparency.
It’s the overall quality of your diet that counts
The National Diet and Nutrition Survey (2) has shown that many people are not eating the right foods to meet their dietary needs. Only a third of people in the UK manage to eat 5-a-day and very few eat oily fish on a weekly basis. The average adult is also eating twice the recommended amount of added sugar, too much saturated fat and less than 10% are meeting the guidance for fibre.
Nutrition research tends to look at the effects of individual components of the diet, but it’s worth keeping in mind that people eat food and not nutrients. Don’t assume that a single food or nutrient is going to be a panacea or antidote to an unhealthy lifestyle, ‘superfood’ or not. These false expectations are completely redundant as it’s the overall quality of your diet that is going to have the most significant impact on your health.
And the debate on fat?
As far as the debate on fat is concerned, the consensus still seems to be that we should be eating less saturated fat in our diet, whilst focusing on foods that contain PUFA’s and MUFA’s. Regardless of this, the debate on fat is just one of many in the world of nutrition that all raise important issues. The downside is that they have the potential to cause further confusion amongst people as to what foods they should be eating, particularly as the science is often not clearly understood or the outcomes are taken out of context or misrepresented in the media. The wider issue is still how to get people to make better choices to improve the quality of their overall diet and part of this is making food the focus and not nutrients.