Reality Check on Coconut Oil

In today's marketplace, it seems that we are constantly being presented with the next great thing - a way of eating, a food product, or a supplement, promising health benefits ranging from better skin to weight loss to a longer, healthier life.   Because marketers are so slick, it is often really tough to figure out which claims are true, and which are an inflated or completely false version of reality.

Coconut oil is an example of a very successful marketing engine that has tirelessly promoted the its benefits, to the point where it seems almost commonly accepted that coconut oil is a healthy choice.

Coconut oil is an oil that is extracted from the nut of the coconut palm tree.  Coconut oil is actually one of the least healthy oils you can eat, because it is almost purely saturated fat - it contains even more saturated fat than lard.   Overall, studies show that saturated fat consumption is associated with an increased risk of heart disease.


(Sidebar: While studies overall have suggested that saturated fat is associated with an increased risk of heart disease, this has recently come into question with recovery of data from Minnesota Coronary Experiment in the 1960s.   What is quite clear (from much more recent studies) is that replacing saturated fat with carbohydrates (ie a low fat, high carb diet) does not reduce heart risk.  In fact, eating excess carbs as a replacement for saturated fat actually increases the risk of diabetes, weight gain and metabolic syndrome. Conversely, replacing saturated fat with polyunsaturated fat in your diet can confer substantial health benefits, possibly including a reduction in cardiovascular events and mortality - read recent studies about this here and here.)



So why has coconut oil been touted as a 'healthy' fat?  Here are some of the health claims that have been made:


1. Health Claim: Medium chain fatty acids (contained in coconut oil) may not raise bad cholesterol (LDL) as much as long chain fatty acids (found in other oils) do.

Reality check:  This is highly controversial, with conflicting results in the small studies that have been done.  There is also very little study of the effect of coconut oil on heart health, which is why we we care about LDL in the first place.  Contrast this with extra virgin olive oil, which has been shown as part of a randomized clinical trial to reduce the risk of cardiovascular disease.


2.  Health Claim: Fatty acids in coconut oil (medium chain) may not be as readily stored in fat tissue as long chain fatty acids.

Reality check: Whether or not this is true, adding additional fat to your diet should be avoided - coconut oil still contains 117 calories per tablespoon (this is about 10% of the total calories for a whole day for a typical woman trying to lose weight).


3.  Health Claim: Coconut oil can improve Alzheimer's disease and/or dementia.

Reality check:  This claim started with a YouTube clip that went viral in 2012, showing a patient with Alzheimer's who dramatically improved with eating coconut oil.  This case was never confirmed or reported in any medical or scientific literature, and there is no clinical trial data to substantiate or refute this claim.


THE BOTTOM LINE:   Avoid adding extra fat to your diet.  When you do use fats or oils for cooking, monounsaturated or polyunsaturated fats are a better choice than saturated fat (eg extra virgin olive oil and canola oil).  Coconut oil is not the way to go.

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www.drsue.ca © 2016

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Risks of Overweight and Underweight Before Pregnancy

Doing one's best to achieve an appropriate amount of weight gain in pregnancy is important for best health outcomes for baby and mother.  As it turns out, mom's weight before pregnancy is an important predictor of birth outcomes as well.

A recent review summarizes available data on this issue, looking at 60 studies involving over 1.3 million women.

They found that for women with overweight or obesity before pregnancy, compared to women with normal weight, the risks were as follows:

• 45% higher risk of having a large for gestational age baby
• 24% higher risk of having a small for gestational age baby
• 29% higher risk of the newborn baby needing admission to intensive care after birth
• 27% higher risk of stillbirth

For women with underweight before pregnancy: (again, compared to women with normal weight)

• 30% higher risk of preterm birth
• 67% higher risk of having a small for gestational age baby

These data remind us of the importance of managing weight as well as possible not only during pregnancy, but also before consideration of pregnancy. 

Recommended weight gain during pregnancy is based on pre-pregnancy Body Mass Index, and can be calculated using Health Canada's handy Pregnancy Weight Gain Calculator. 

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www.drsue.ca © 2016

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Could Diet Drinks Be Sabotaging Your Weight Loss Efforts?

We know that consumption of beverages containing sugar increases the risk of obesity, metabolic syndrome, and type 2 diabetes, so it is often advised to consume diet drinks instead.  However, it has been suggested that even diet beverages may be associated with an increased risk of type 2 diabetes.  As such, a recent study studied the effect of diet beverages vs water as part of a weight management program in women with overweight or obesity and type 2 diabetes.

The study, published in Diabetes, Obesity & Metabolism, randomized 81 women who were habitual consumers of diet beverages, to consume either water after lunch five times per week instead of her usual diet drink, or to continue to drink diet beverages after lunch, during a 6 month weight loss program which consisted of dietary modifications and exercise.

They found that women who switched up diet drinks to water had a 1.2kg greater decrease in body weight compared to women who continued to drink diet beverages, as well as greater improvements in fasting blood sugar, fasting insulin levels, and post meal blood sugars.

While the differences in the study were small, it is interesting to consider how diet drinks could be detrimental to weight loss efforts.  It has been proposed that artificial sweeteners may raise the hedonic desire for sweet, energy dense foods. The women drinking diet beverages did consume a few more calories per day than those drinking water, so this may be a plausible mechanism of the differences seen in this study.  There may also be an effect of sweeteners on gut bacteria, which we are learning have an important impact on energy balance and metabolic homeostasis.

It should also be noted that there is conflict in the research in this area, with other studies showing no effect on weight between water vs diet beverages or even a benefit of diet beverages over water.

However, based on the current study, it seems that water may be best.

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www.drsue.ca © 2016

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Do Calcium Supplements Increase The Risk Of Heart Disease?

Calcium is a nutrient that is essential for bone health.  While adequate calcium intake is recommended for maintaining bone health, some studies have suggested that calcium supplements may increase the risk of heart attack.  It seems that these fears may not have been warranted after all: the most recent review of existing literature suggests that recommended levels of calcium intake are NOT associated with cardiovascular risk in generally healthy adults.

The data on calcium supplements and heart disease risk was recently assessed in systematic review and meta-analysis done by the American National Osteoporosis Foundation, and published as a joint position statement with the American Society for Preventive Cardiology.  Published in the Annals of Internal Medicine, they found that calcium intake from either food or supplement sources at levels within the recommended tolerable upper intake range in USA of 2000-2500 mg/day are not associated with cardiovascular disease risk in generally healthy adults.

They do recommend that wherever possible, recommended intake of calcium should be obtained through natural food sources rather than supplements, but that supplements can be used safely when food sources do not meet goals.  One of the theories behind the benefits of getting calcium through real food is that absorption of calcium occurs more gradually from the intestinal tract, whereas absorption of calcium from supplements may be faster, resulting in more of a ‘spike’ of calcium in the blood.

The authors note that the available data to answer this question about calcium supplements and cardiovascular health is not the best, as none of the studies looked at cardiovascular endpoints are the primary outcome.  This type of study is unlikely ever to be done, as it would be very costly and likely need to be very large to detect small differences.  In the absence of such data, the currently available data suggests that calcium supplements are a safe approach to reach recommended calcium intake, in situations where calcium intake from real food is insufficient.

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www.drsue.ca © 2016

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Pregnancy After Bariatric Surgery - How Long Should You Wait?

After bariatric surgery, it is recommended to wait at least 12-18 months (with some guidelines recommending to wait two full years) before considering pregnancy.  This is because rapid weight loss and a higher risk for nutritional deficiencies occurs during this phase, which may be a poor environment for fetal development. However, a recent study suggests that waiting two years may not be enough.

The study, published in JAMA Surgery, looked at data from women and their infants in Washington state who had had bariatric surgery (n=1859), and compared them to women and their infants who had not had bariatric surgery (n=8437).  They found that babies who were born to mothers who had had bariatric surgery had a 57% higher risk of prematurity, 25% higher risk of needing to be admitted to the NICU, 93% higher risk of being small for gestational age.

However, when 4 years or more had elapsed since bariatric surgery, the risk of these outcomes was lower when compared to women where 2 years or less had elapsed.  Specifically, the risk for babies born less than 2 years after bariatric surgery was 48% higher for prematurity and 54% higher for NICU admission, compared to babies born to mothers where 4 years or more had elapsed (the difference for being small for gestational age was not significant). For babies born in the 2-4 year window after bariatric surgery, the authors note that the prevalence of prematurity and NICU admission was not meaningfully different from babies born to women who had not had bariatric surgery.

So how do we interpret these data? Well, we already knew that the risks identified in this study exist for babies born to mothers after bariatric surgery, but we need to remember that there are benefits to pregnancy outcomes after bariatric surgery as well - for example, less babies born large for gestational age, less labor and delivery complications, lower risk of C section birth, lower risk of gestational diabetes and high blood pressure in pregnancy.  However, based on these data, it may be better to wait even longer than two years after bariatric surgery before conceiving.

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www.drsue.ca © 2016

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Poke Free Blood Sugar Monitor Helps Prevent Lows

On behalf of my patients who struggle with the discomfort of having to poke their fingers to check their blood sugars every day, I am super excited about a new poke-free technology that will hopefully be approved in Canada soon – the Freestyle Libre.  With this glucose monitoring system, a small patch is applied to the upper arm with a tiny filament underneath which inserts under the skin.  Wave your glucose monitor over the patch and voilà! – the last 8 hours of blood sugars, including current blood sugar, are transmitted to your monitor for evaluation.  Not only that, but it tells you the current trend in sugar (ie if your blood sugar is on its way up, down, or stable).

In the first randomized controlled trial of this device, it has now been show that monitoring with the Libre helps patients with type 1 diabetes prevent hypoglycemia (low blood sugars).  The study, published in The Lancet, randomized 241 patients with good blood sugar control to the Libre vs usual monitoring with finger pokes.  They found that over 6 months, people using the Libre spent 38% less time with low blood sugars than people using standard finger pokes.  (Despite this benefit, people using the Libre still spent a shocking 2 hours per day with low blood sugar, compared to 3.3 hours per day for people taking finger pokes - so clearly a better monitoring approach is only part of the solution.)

Ten patients reported concerns related to the sensor, primarily itching, allergic reaction, or redness at the site (not out of keeping of the usual risk of reactions to medical devices that stick to the skin).  Some aspects of quality of life were reported to be improved as well – not surprising,  since studies have shown that people with diabetes who have had severe low blood sugar in the past fear this occurring again as much as they fear blindness as a complication of their diabetes.

It would be interesting for this study to be repeated in people with type 2 diabetes, and also to compare the Libre to the continuous glucose monitoring system.

Bottom Line: The Libre would be a strong addition to our blood glucose monitoring options for diabetes in Canada.

Disclaimer: I have received honoraria as a continuing medical education speaker and consultant from the makers of the Freestyle Libre (Abbott). 

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016

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Want A Lower Calorie Meal To Go?

For those days when you know you're going to need to eat on the run, it can be especially hard to resist the temptations of the take-out restaurant or deli that you hit up for your lunch.  A great way to cut calories on those days was proven in a recent study - order well ahead!

The study, published in the Journal of Marketing Research, found that longer delays between placing a lunch order and eating lunch was associated with a reduction in calorie content of the order, with 38 calories less ordered per hour of delay between the order and lunchtime.  They also found that people who ordered lunch immediately before eating had the highest calorie content of their order - about 100 calories more than someone ordering earlier in the day.

Ordering lunch soon after breakfast may be the best time to order, perhaps because of fullness from breakfast, or perhaps because it's easier to think about exerting self control over our future selves than our present selves.  Perhaps the stress of the day hasn't yet taken hold in the earlier morning, allowing us to make healthier lunch choices (stress can cause us to eat more and crave unhealthy foods).  Whatever the reason, try ordering lunch when you get to the office in the morning, and let me know how it goes via comments to this post!

Thanks to my friend Bob for the heads' up on this study!

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016

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