Over the last few years, coconut products – in particular coconut oil – have become very trendy. Celebrities such as Gwyneth Paltrow and Angelina Jolie are enthusiastic consumers of the oil and one in 10 UK 16–24 year-olds currently buys it. Sales rose from around £1 million to £16.4 million in the three years up to 2016, according to the consumer research group Kantar Worldpanel.
The main driver? The popular belief that coconut oil or fat* is more nutritious than other types of fats.
But do the alleged health benefits stand up to scrutiny?
A summary of our assessment
Around 87% of coconut oil is saturated fat – more than in lard or butter. Despite what advocates of a ‘low carb, high fat’ diet suggest, scientific reviews and respected health organisations including the NHS and the British Nutrition Foundation concur that consuming too much saturated fat overall is bad for us.
As a result, the growing consumption of coconut products – especially coconut oil – is of great concern to those who work with scientific evidence-based nutrition. Coconut’s popularity is likely to add to the burden of obesity and heart disease, not reduce it.
So coconut products should be sold as an indulgent product, not a health food. Manufacturers, retailers and the media need to stop exploiting any health associations.
The scientific evidence on coconut oil
Coconut is bursting with cholesterol-raising saturated fats. Some companies marketing coconut products over-simplify what is a very complex topic. They assert that medium-chain length saturated fatty acids (MCTs) in coconut oil can actively protect heart health.
However, while some studies suggest some MCTs in isolation might have benefits, coconut oil contains a mix of fatty acids. Focusing on any benefits of a few MCTs while ignoring the detriments of the other fatty acids is at the least misleading and at worst very damaging for consumer health.
Saturated fats – a complex story
There are over 30 different types of saturated fatty acids. While there’s good evidence that some will have little, if any, effect on cholesterol, three in particular have been proven beyond a doubt to elevate cholesterol levels and are all contained in coconut oil in high amounts.
- Lauric acid, an MCT, makes up 14% of coconut oil (and is also found in palm kernel oil and cow’s and goat’s milk).
- Myristic acid, a long chain fatty acid (LCT), makes up 20% of coconut oil, and is in palm kernel oil and butter.
- Palmitic acid, an LCT, is found mainly in palm kernel oil, meat and full cream dairy milk and products, but also makes up 8% of coconut oil.
Clinical studies have consistently demonstrated that coconut oil increases total and LDL cholesterol – directly linked to higher cardiovascular disease risk. Despite some (not all) studies also demonstrating an increase in HDL (‘good’) cholesterol through the consumption of coconut oil, this is common with other saturated fats and does not negate the effect on LDL cholesterol.
Coconut products – putting statistics into context**
- Highest of all are the coconut oils and coconut butter, which are higher in saturated fat than any other commonly eaten food. Most coconut oils contain just short of nearly 90% saturated fat, compared with butter at 52%. Just 1½ tablespoons will provide the entire recommended daily intake of saturated fat.
- Four 100% natural coconut yogurt alternatives are currently on the market as ‘healthy alternatives’. Three of these provide between 17% and 20.5% saturated fat; the other a more modest 4.2% – which is still higher than full cream dairy yogurt. So an average 125g serving of three out of the four coconut yogurts will provide 21.3g to 25.6g saturated fat. That’s up to 128% of the maximum saturated fat daily recommendation. Other yogurt alternatives with coconut added to ingredients such as soya may not be high in saturated fat. It’s important to check the label.
- Creamed coconut (the block sort added to dishes like curries) is on average 58% saturated fat (some almost 70% saturated fats), which is more than butter (52%) and lard (44%)
- Canned coconut milk (made with coconut extract and water) averages 14.6% saturated fat, with reduced fat coconut milk weighing in at a somewhat lower 6.3% (three times greater than full cream dairy milk).
- Desiccated coconut is over 50% saturated fat and crops up increasingly in energy balls and similar products.
- Coconut drinks are not of concern in terms of saturated fat. On average a 200ml glass of coconut drink contains only 1.5g saturated fat (7.5% of the Reference Intake). Coconut water contains no saturates at all, or only a tiny trace.***
What needs to be done differently?
We think more responsibility is needed
Chefs, celebrities, manufacturers, retailers and the media all share a responsibility in how coconut products are positioned and portrayed. In some cases, there is a genuine ignorance and misunderstanding of the science, which could perhaps be addressed through more public health messaging.
HEART UK, the British Heart Foundation and Department of Health already advise that coconut oil should be consumed only in small quantities and the Change4Life website lists coconut oil within a category of foods labelled ‘leave these on the shelf!’
But these messages need more reinforcement. Manufacturers see that the market for coconut products is a lucrative one, so they are harder to influence. However, given that the majority of coconut products are excessively high in saturated fat (with the exception of waters and drinks), we believe that responsible manufacturers should position the products of concern as an indulgence rather than something that provides any health benefits.
The products should have clear nutrition labels, ideally using the traffic light system. Consumers should look out to see which are classified as high, medium or low, to help them cut down on their intake. The classifications are:
High: More than 5g saturates per 100g. May be colour-coded red.
Medium: Between 1.5g and 5g saturates per 100g. May be colour-coded amber.
Low: 1.5g saturates or less per 100g. May be colour-coded green.
*’Coconut oil’ and ‘coconut fat’ are synonymous. A fat is usually called an oil when it’s liquid at room temperature.
**Using data from Forestfield Software Ltd. Dietplan7 (2017)
***On-pack labelling of current leading brands on the market (October 2017)
A new policy paper from the European Public Health Association (EUPHA) calls upon all European States to establish a statutory Sustainable Nutrition Task force to drive better integration of nutrition and sustainability food issues. This follows a report from the Food and Agriculture Organisation and the Food Climate Research Network in 2016, Plates, Pyramids, Planet that found very limited integration of these issues thus far, in the development of food-based dietary guidelines.
As an umbrella group for over 70 public health associations and institutions across Europe, EUPHA are calling upon public health professionals to advocate for healthy diets that are also sustainable in a wider sense – incorporating the three pillars of economy, society and environment.
This new paper from the leading Not-For-Profit public health group in Europe adds further weight and drives momentum towards sustainable nutrition, which is already high on the global political agenda – recently reflected in the 2030 Agenda for Sustainable Development resolution, accepted by the UN General Assembly in 2015.
The report defines sustainable diets as those that “diets are nutritionally adequate, safe, and healthy, while having low environmental impact. They are also culturally acceptable, accessible, equitable, economically fair and affordable, contributing to food and nutrition security and to healthy lifestyles for present and future generations”.
In a practical sense this means a shift towards more plant-based diets and a concomitant reduction in the consumption of animal-origin foods. As well as the avoidance of processed foods with added fats (particularly saturated and trans fats), sugar and salt.
Sustainable Nutrition Taskforce
To achieve their policy aim, EUPHA would like to see the establishment of Sustainable Nutrition Taskforces with national agendas to reframe policies, strategies and implementation programmes towards sustainable diets, away from the current food system, which is described as “low cost food at high cost to the environment”.
EUPHA prefers that through appropriate regulation, “the food industry would be required to produce healthy, nutritious (minimally processed) foods in a sustainable manner, which contain low contents of sugars, salt and additives that could adversely affect health; production and marketing should be honest and transparent, with consumer-friendly food labelling, and with restrictions on the marketing of junk food and sweet beverages, especially to children”.
Key Take Outs
– Sustainable nutrition is moving ever-further up the global political and policy agendas
– Expect to see more alignment of the dual issues of nutrition and sustainability in Government dietary guidelines, policies and programmes
– Food businesses should be actively reviewing their product portfolios and marketing strategies to align with the core tenets of sustainable nutrition
EUPHA’s report – Healthy and Sustainable Diets for European Countries is available here: https://eupha.org/repository/advocacy/EUPHA_report_on_healthy_and_sustainable_diets_20-05-2017.pdf
The latest NDNS survey is out today! The new survey (Years 5 and 6 – 2012/13-2013/14) will be met with disappointment and possibly frustration by many public health campaigners.
The Brits have done little to improve their intakes of essential nutrients despite significant government and NGO campaigns. We’re still eating too much sugar and saturated fat and seem to be unable to increase our fruit and vegetable, fibre and essential vitamin and mineral intakes. On a positive, and there was only one positive, we are reducing our intakes of red and processed meats. And at least our diets have not got worse. But the question remains, with little dietary improvements over the last 10 years, what really needs to be done to help the nation change their eating behaviour and nudge them into a healthier and happier life?
- Brits still struggling to meet their 5-a-day with no improvements in consumption compared to previous years:
- Just 8% of children and less than a third (27%) adults achieving their 5-a-day.
- Children’s average intake is less than 3 portions per day, whilst adults are so close to the recommendations at 4 portions a day.
- Heart healthy omega-3 and much needed vitamin D intakes cannot be expected to improve with oil-rich fish consumption continuing to fall short of the recommended 140g per day.
- Brits are only managing 62% of the recommendations at a max of 87g per day.
- The message is getting through about red and processed meat with reductions in intakes from previous years. However, men need to make further improvements as their intakes are significantly higher than women’s and the maximum recommendations of no more than 70g per day of red meat and avoidance of processed meat.
- Could the sugar reduction public health campaigns be making some small inroads to reducing added sugar intakes in children?
- Let’s not get too excited, but 4-10 year olds have reduced their intakes by 1% compared to previous years (13.4% of total energy intake vs. 14.4%).
- Unfortunately, teens and adults continue on their sweet ways with intakes remaining unchanged at 15.2% and 12.3% contribution to total energy intakes.
- Intakes are a long way from meeting the SACN recommendations of no more than 5%! Is sugar tax really going to be the solution?
- The attack on sweetened soft drinks seems to have made an impact on 4-10 year old’s intakes with a 23% reduction in amount consumed daily compared to previous years (100g vs 130g respectively).
- Unfortunately, adults and teens refuse to be told what to do and continue to struggle with the sweet nectar!
- Could the misleading media headlines ‘butter is good for you’ be responsible for the population continuing to exceed saturated fat intake recommendations (11% of total energy intake) and in fact have higher intakes than previous years.
- The latest data shows saturated fat to contribute to 12.7% of total energy intake, whilst in previous years it has been at 12.3-12.5%. A major contributor to elevated ‘bad’ cholesterol which afflicts over half the adult population.
- Fibre – another new government dietary recommendation doomed for failure! Although less publicity has been given to fibre, the SACN carbohydrate report did not only make new recommendations on sugar intakes but also recommended a significant increase in fibre intakes to 30g AOAC (23g non-starch polysaccharides NSP).
- The nation continues to struggle to meet the previous recommendations of 18g NSP per day with adults making no improvements to previous years at 13-14g NSP intakes daily.
- It would be great to see a public campaign for us to eat MORE of something rather than to deprive ourselves!
- Is it time for mandatory vitamin D fortification? The survey found around a fifth of adults with low vitamin D status and with an average level of 42-48nnmol/L.
- Few have the optimal status as recommended by many vitamin D experts of 50-70nnmol/L.
- Fatigue and tiredness in teenage girls and young women could be explained by continued poor iron intakes, with almost half of teenage girls and over a quarter (27%) of young women having iron intake below the lower reference nutrient intake.
The latest headlines have been fueled by the ill-advised national obesity forum publication ‘Eat fat, cut the carbs and avoid Snacking to reverse obesity and type 2 diabetes” (23rd May) and the findings from diabetes.co.uk survey of its 80,000 diabetic patients undertaking a 10-week low carb programme (31st May).
It is always important to challenge current thinking and explore new research. It is however, highly irresponsible to debate current thinking using studies that have already been discredited for methodological flaws. Add to which, in our opinion, it’s also unhelpful and damaging to design and direct a debate around controversial research findings for the consumer arena. Unless of course, we expect consumers to be totally adept at interpreting research findings into context of public health and able to fully understand and critique statistics and methodologies. This is unlikely when we consider that not all expert health professionals are able to correctly interpret research data into context nor have the skills to grasp appropriate selection criteria, dietary methodologies and limitations of study findings.
Low saturated fat debate – based on the same bad science
It was very disappointing to see the NOF cite the same studies that have been discredited in the past for methodological flaws and study selection bias. Their conclusions that lowering saturated fat intakes has no correlation to cholesterol levels or CVD outcome does not only go against the totality of scientific evidence but demonstrates their experts lack of knowledge in the critiquing of published data. Obvious factors such as the presence of trans fats from polyunsaturated margarines, the overall macronutrient profile of diets and which macronutrient replaced saturated fat reductions in the intervention groups were completely ignored in the studies cited by the NOF. These are very basic and undisputed factors that impact on CVD and serum cholesterol outcomes. An excellent explanation has been published by Dr Nita Forouhi from the University of Cambridge and covered by Prof. Bruce Griffin from University of Surrey during the Alpro Foundation symposium in March this year.
The totality of evidence points to:
• We should be talking about foods and diet and not individual nutrients.
o I.e. saturated fat sources from dairy do not adversely affect serum cholesterol levels compared to saturated fat from processed meat. Therefore, advice to consumers should be to eat less processed meats and not to eat less saturated fats.
• Lowering saturated fat intakes is important for reducing serum cholesterol levels, however, it isn’t enough. Which macronutrient replaces the saturated fat energy is important with polyunsaturated fats proving most effective whilst refined carbohydrates will show no benefit and in some cases negative effect.
• Whole diet approach should be encouraged where higher soluble fibre wholegrains, beans and peas, fruit and veg, oil rich fish and lean proteins are encouraged. It is the nutritional profile of the whole diet that will impact on CVD outcomes.
• Meta-analysis are not full proof and their conclusions should never be taken at face value. It is important to have a full understanding of the selection criteria used and potential contraindications that have been missed.
Low carbohydrate diets and type 2 diabetes
This has been fuelled by the patient led forum at diabetes.co.uk where it encourages its subscribers (over 120,000 patients with diabetes) to embark on a low carb 10-week programme. This has been championed by Dr Unwin, a GP from Southampton, who was frustrated at the lack of weight loss and poor glycaemic control of his type 2 DM patients following traditional dietary advice. He embarked on prescribing the low carb diet and has found that his patients are sticking to the dietary regimen, losing weight and significantly improving their HbA1c readings with significant financial savings to his practice. He has published two papers, one with 19 subjects and the other based on a case study. The low carb diet recommends anything from 0-130g of carbohydrates a day – normally no more than 100g – and a higher vegetable intake with lower fruit intake. To put it into context, 100g carbohydrate equates to 5 thick slices bread, 4½ medium bananas, 4 small servings (30g) of cornflakes OR 1¾ medium jacket potatoes. Carbohydrate calories are replaced, in the main, by unsaturated fats but also from proteins. Studies published on the success of this regimen are often small in number and over a short period of approx. 3 months. However, they are promising and seem to support the high protein satiety theory and better compliance to dietary restrictions. Ultimately, individuals on these regimens do consume significantly fewer calories. Although this dietary regimen can be successful for some patients, so have other regimens been proven to be as successful including higher wholegrain and low fat diets.
The primary goal for type 2 diabetes is weight loss to help optimise glucose control, therefore, dietary regimens should be matched to the individual patient’s needs. Different approaches will work for different individuals.
Wednesday 15th March saw the nation’s health top of the government agenda with the launch of the new Eatwell Guide and more surprising, the new budget announcement declaring a tax for sweetened beverages.
We are still in the dark about the how much tax will be added, but it is thought that it will be set at the PHE recommendation of 20%, despite the National Obesity Forum recommendation to set it at 50% if any impact on behaviour change is to occur.
Which soft drinks will be hit?
Two tax levels will be set. One for soft drinks providing more than 5g sugar per 100ml and a higher levy for those providing more than 8g sugar per 100ml. The table below indicates how the current soft drinks market will be taxed.
Nutrilicious feels that single serve formats should have been taken into consideration when setting the sugar benchmarks, similarly to front of pack traffic light labelling. As an example, sports drinks are only available as a single 500ml serve bottle providing a total of 18g sugars, yet because they contain less than 5g sugar per 100ml, they will be exempt. This could be argued by other soft drinks companies as unfair. Many that will be taxed for containing over 5g or 8g sugar per 100ml, offer much small single serve formats, limiting the total serve sugar intake to the same as sports drinks and sometimes less.
Exemptions: fruit juice, milk drinks and small producers. This does muddy the waters somewhat as the government in its new sugars recommendations classified fruit juice as a ‘free sugars’ source and why are small producers exempt if they do produce high sugar drinks? Not quite an even playing field and this will not encourage innovation for lower sugar products from companies who will be exempt. Also, what does ‘milk drinks’ refer to? Will sugar laden flavoured milk drinks be exempt?
When will it be enforced? The tax will come into force in April 2018, giving manufacturers adequate time to reformulate their drinks and / or change their offerings to consumers. Many could try to reduce their sugars from the higher to the lower levy benchmark.
Will this reduce consumer purchase of higher sugar soft drinks? Possibly not, but the government is banking on this levy to add over £500 million to the economy which will be used to:
- Double the primary school PE and sport premium.
- Give 25% of secondary schools increased opportunity to extend their school day to offer a wider range of activities for pupils, including more sport.
- Expand breakfast clubs in up to 1,600 schools.
So, Jamie has won the battle to place taxes on sweetened drinks and this will be welcomed by health organisations even though many of them wanted to see a significantly higher levy. We do feel that a more even playing field should have been set and all high sugar drinks, including fruit juice and drinks from small producers, should have the levy enforced. In addition, single serve formats should be considered when assessing sugar levels. If anything, this could go a long way to help prevent consumers’ from being misled by marketing claims that a soft drink ‘is full of / provides energy’. A clever abuse by some manufacturers regarding consumer’s misunderstanding of the word ‘energy’ relating to healthiness rather than empty unnecessary calories. We look forward to more specific details.
A selection of current soft drinks on the market, their sugar content per 100ml and their single serve format or recommended serving size and which tax level they will incur in April 2018.
Sugar Drinks details
For further information on the 2016 budget: www.gov.uk/government/publications/budget-2016-documents/budget-2016
Kept under much secrecy, the government revealed the updated Eatwell Plate to the nation on Thursday 17th March following a stakeholder meeting on Wednesday 16th , which we were pleased to attend. Surprising for us, the changes to the new Eatwell Guide went beyond some simple cosmetic adaptations. In the main, the plate, based on exhaustive reviews of the scientific evidence, has embraced more of the 21st Century consumer eating trends and the growing concerns around sustainability. Will it be more effective at improving the population’s poor nutritional status and reduce obesity? As with all dietary guidelines, effective communication and behaviour change strategies that follow will be key.
Can you spot the 13 differences?
The official documentation lists 12 differences, however, we’ve added one more!
- Importance of hydration has finally been embraced! With recommendations to consumer 6-8 glasses of fluid daily: water, sugar free drinks including tea and coffee and milk.
- Front of pack labelling: possibly coming to terms that as much as we would love the nation to be keen cooks, ready meals and take-aways are by far more popular.
- High fat, salt and sugar foods removed altogether: ‘no role in a healthy balanced diet.’ At last, the group that also included healthy unsaturated fat oils and spreads has been better clarified with latter remaining within the Eatwell Guide as a much smaller section (taking up just 1%).
- Calories have been included for adult men and women – to remind consumers that all foods contribute to calories.
- Four of the five food segments renamed: changing the emphasis to embrace more wholegrains and plant foods whilst keeping saturated fat down.
• Bread, rice, potatoes pasta and other starchy foods is now ‘Potatoes, bread, rice, pasta and other starchy carbohydrates’ with an overarching sub-line ‘Choose wholegrain or higher fibre versions with less added fat, salt and sugar.’
• Milk & dairy foods is now ‘Dairy & alternatives’ with the sub-line ‘Choose lower fat and lower sugar options.’
• Meat, fish, eggs, beans and other non-dairy sources of protein is now ‘Beans, pulses, fish, eggs, meat and other proteins’ with the sub-line ‘Eat more beans and pulses, 2 portions of sustainably sourced fish per week, one of which is oily. Eat less red and processed meat.’
• Food and drinks high in fat, sugar and/or salt has now been removed and instead replaced with ‘Oil & spreads’.
- The five food segments re-sized:
• Fruit and vegetables – go up by 7%, now making up 40% of the plate.
• A bigger push for wholegrain carbs – and up by 5% to 38% of the plate. We hope this will help towards the fight against the ‘anti-carb-based on dodgy and misinterpreted science’ brigade. – As well as wholegrain, there is more emphasis (we feel within the full guidance notes) that it’s not carbs that are fattening but what we choose to add to them.
• Dairy and alternatives – almost halving the recommendations from 15% down to just 8% of the plate. We are pleased to see calcium fortified and unsweetened dairy alternatives making a bigger noise here. And interestingly, 1% dairy milks are recommended over semi-skimmed.
• Protein segment making up the same proportion as previously, has significantly been revamped to embrace sustainability and the need for more plant-based protein consumption. With ‘other proteins’ including soya and Mycoproteins. Single portions of meat to be 70g and fish to be sustainably sourced.
- Fruit juice removed from the Eatwell Guide fruit and vegetable visual in this sector, but highlighted in the hydration section with a significant emphasis that no more than 150ml daily consumption.
- Smoothies have lost their halo: previously, smoothies were permitted to count as 2 of our 5-a-day at 125ml per portion. With both smoothies and fruit juice now classified as ‘free sugars’ the consumption of either has been clearly limited to no more than 150ml per day as part of hydration and contributing to just one of our 5-a-day.
- Oils and spreads: now making just 1% of the Eatwell Guide and thankfully no longer considered as part of the high fat, salt and sugar foods. There is good emphasis within the guidance that all fats however add cals and should be limited.
- Additional messages for further guidance – helping consumers better understand the visuals including 8 tips for healthy eating.
Some changes based on qualitative stakeholder and consumer insights, but considered more cosmetic by us:
- No fork and knife
- Change of name from Eatwell Plate to Eatwell Guide
• Both the above changes based on insights that they little reflect how consumers see meals / consume foods.
- Drawn food images rather than photography. Interesting insight that although stakeholders prefer the latter, consumers prefer the former.
Great strides – but will it be enough?
We are disappointed that there continues to be no offer of practical and household portion guides particularly for the carbohydrate and some foods from the protein groups. This will make it difficult for both the consumers and health advisors to provide the real practical much needed approach. We appreciate that it is a challenging task but believe it to be achievable. As Dietitian communicators in public health we are aware of how much the public needs to be shown how to put these guidelines into practice and how much a consistent approach is needed. PHE at the stakeholder meeting mentioned that they have done some preliminary work on this internally but such things like meal plans will not currently feature in the tools and communications, due largely to lack of funding. We were also surprised that no quantitative survey work representative of the population and health advisers using the tool had not been undertaken prior to the focus group work. Perhaps if this had been done these needs would have been prioritised and addressed.
Will this change the health of the nation?
It will all depend on how and who it’s communicated to and what behaviour change strategies will be put into place which as we all know, means funding. With Cameron’s Obesity Strategy expected to be announced in 2016, how much funding is put behind such campaigns will be the true sign of how seriously they are about tackling the health of the nation.