Cholesterol - Irresponsible Advice

Beware of Pseudoscientific Nonsense 

I became very concerned this week reading the advice of gym owners, personal trainers, and unqualified nutritional "experts" spouting their unqualified nonsensical advice on how to die young.  Or, as they term it, how to reduce your cholesterol.

These people generally do not have access to evidence-based science - access to this type of literature costs a pretty penny.  Although, I am not sure they would let facts get in the way of a good story, and an expensive product sale.

One of the products I saw recommended for reducing cholesterol is coconut oil!  

Coconut Oil - Good or Bad?

Some people will have you believe that coconut oil is a total health panacea.  A cure-all for ails such as alzheimer's to high cholesterol.  There is no evidence to support this.

Whilst one study does suggest that males may be able to reduce their waist circumference measurements by taking virgin coconut oil (reference) there is no evidence that it boosts the good cholesterol (High Density Lipoproteins) or reduces the bad cholesterol (Low density lipoproteins).  Actually, research from Liverpool Hope University has shown that coconut oil has no statistically significant impact on HDL cholesterol, Total cholesterol, waist circumference, fat %, fat density, total body weight, hip to weight ratio, or BMI (reference).​

The Mayo clinic states that there is no evidence that coconut oil increases HDL cholesterol as it is high in saturated fats.  There is better evidence for fish oils although these can increase HDL and LDL cholesterol similarly (reference)

"Coconut oil is full of unhealthy saturated fat, which raises bad cholesterol levels, clogs the arteries and increases the risk of heart disease"
​- Professor David Colquhoun 

Professor David Colquhoun from the University of Queensland's School of Medicine has stated "there have been bizarre claims that coconut oil lowers cholesterol, cures alzheimer's disease, and even prevents heart disease, however the research does not support this... in fact, coconut oil is full of unhealthy saturated fat, which raises bad cholesterol levels, clogs the arteries and increases the risk of heart disease".

According to Dr Jay Kenney coconut oil is higher in long-chain saturated fatty acids than animal fats.  Many of the positive claims surrounding coconut oil depend on the medium-chain fatty acids that the body does not absorb.  According to Dr Kenney coconut oil is 92% saturated fat, the vast majority is the worst type of fat for you - a higher proportion than animal fats (reference).

There are some minor disputes over coconut oil but there is no concrete evidence to support the claims made by unqualified people, who happen to sell coconut oil in their shops.  Coconut oil likely increases your risk of heart disease and therefore it's advisable to take the advice of unqualified self-labelled nutritional experts with a pinch of salt and wait for scientists to come up with a wholly conclusive answer.

Ways to reduce cholesterol, the healthy way

Obviously, some need statins and the GP will prescribe these if needed.  There are scaremongering stores amongst some regarding statins but when people believe such scaremongering techniques they are more likely to experience side-effects (as discussed by Dr Ben Goldacre).  This nocebo effect has had further evidence lately with people taking a generic ibuprofen based drug reporting side-effects as they deem the branded version to have less side-effects.  The active drugs were actually identical but similarly to the placebo effect where we experience positive benefits through psychological beliefs, we can also experience negative benefits, illnesses, through psychological beliefs (reference).  Statins are very effective at reducing LDL cholesterol (reference) and unqualified advice from non-medically trained individuals should be ignored.

It has been shown that through dietary interventions cholesterol levels can be significantly reduced, although its worth noting that individual differences mean that some are affected differently.  One piece of advice that some give relates to the eating of nuts.  Specifically walnuts and almonds.  It has been demonstrated recently that eating almonds and walnuts can reduce cholesterol but it is not that simple.  There is a spectrum of impact.  Some people can reduce their cholesterol by 10-15% by just introducing nuts into their diet.  Others experience no reduction.  Others experience an increase.  

In a recent BBC documentary Dr Michael Mosley demonstrated a diet as effective as statins in reducing cholesterol.  The portfolio diet included eating nuts high in plant sterols (almonds, hazelnuts, and walnuts), reducing the intake of dairy, substituting with soya alternatives, cutting out bacon, sausages, eggs, and chicken skin, and eating 75g or oats a day.  Dr Mosley reduced his LDL cholesterol by 42%.  The simple introduction of 75g of porridge oats into the diet reduced cholesterol by an average of 13%.  Simple interventions can be extremely effective (reference).

Disclaimer:  If you do have high cholesterol please do not just stop your statin medication without proper medical advice from a qualified physician.  Should you adopt a dietary plan to reduce cholesterol please ensure you regularly visit your GP to assess your LDL levels.  It is important that LDL cholesterol is monitored to ensure it does not become dangerously high.