Letters to the Editor
View(s):Our lifestyles and other factors probably more harmful to our hearts than coconut oil
I was tempted to add my thoughts to the informative article by Kumudini Hettiarachchi in the Sunday Times of October 25 – ‘Now; coconut oil is bad for your heart’, wherein she has succinctly reviewed a comprehensive, recent research paper on coconut and coronary heart disease (CHD) by a team of medical researchers led by Prof. Ranil Jayawardena of the Colombo Medical Faculty.
As KH states coconut oil and its impact on health has been ‘swirled and twirled’ over the last six decades. From the 1960s for about 50 years it was treated virtually as a ‘poison’ in that it was labelled as contributing to cardio-vascular diseases (heart disease and strokes).
Before the Second World War, coconut oil was the main dietary vegetable oil in the west. However, war disrupted the coconut oil supply and alternative oils such as soya and corn took its place. When coconut and palm oils supplies were resumed, the soya lobby together with the American Heart Association went on a malicious campaign urging even the US Federal government to ban importation of tropical oils. The U.S people then had less than 1 % energy from coconut in their diet!
By then the lipid hypothesis promulgated by Ancel Keys (1965) et al and Hegsted et al (1965) had taken root. The hypothesis is that saturated fats (SFA) in coconut, palm oil and animal fats increase cholesterol and hence the risk of heart disease whereas polyunsaturated fats (PUFA) in soya and corn oils decrease cholesterol and monounsaturated fats (MUFA) have a neutral or beneficial effect. Cholesterol was blamed as the villain, and coconut and palm oils were labelled “artery clogging tropical oils”.
Consequently, over the next two decades, butter (a saturated fat) consumption in the US dropped from 18 pounds per capita per year to10, and margarine filled the gap; vegetable oil, mostly soya oil and corn oil consumption increased threefold from 3 pounds to about 10 per capita per year, but heart attack rates did not decline! It was even said that Americans feared saturated fat more than they feared witches!
With the lipid hypothesis taking a strong foothold, cardiologists locally and elsewhere, strongly advised their patients to refrain from coconut oil consumption if their lipid levels were high. In fact an oft cracked joke was that the chief cardiologist in Peradeniya in the 1980s allowed only a tablespoon of ‘pol sambol’ per day for her husband, and no coconut oil at all!
However, over the years from 1975 the heart disease rate exponentially shot up whereas the per capita consumption of coconut dropped substantially, questioning whether coconut consumption is a serious risk factor in CHD.
The bad label on coconut oil is a consequence of it having 74% saturated fatty acids of which 64% comprising lauric (48%) myristic (17%) and palmetic ( 9%) are cholesterol- elevating. The dilemma is that lauric acid, on the other hand though cholesterol elevating, has a major health benefit. It is a component in mothers’ milk and gives immunity against microbial diseases together with capric acid (7%). Coconut oil has other health benefits too and regrettably there is no mention of them in the review referred to above. In fact it has now become the ‘darling vegetable oil of the west’.
However, coconut elevates HDL or the good cholesterol far more than LDL, the bad cholesterol which is said to form plaques that block blood vessels leading to angina and heart attacks. By contrast, HDL scavenges excess cholesterol from the blood and returns to the liver thus reducing plaque formation. In one study conducted in Sri Lanka by Shanthi Mendis et al (1989) coconut raised HDLC and LDLC by 69% and 32% respectively implying that the former should be negating substantially the bad effects of LDLC. The question then is whether coconut is a cardio-vascular health risk given especially the average per capita daily consumption of about one third to one fourth of a coconut which implies the energy intake via coconut is well below the WHO’s recommended saturated fat intake of 10% assuming a total per capita energy intake of 2500Kcal per day.
All evidence points to the fact that CHD is multi-factorial and lipid status in just one of them. This fact is brought home by the famous Faringham study cited even in medical texts. William P. Castelli, M.D (1992) in an editorial in the journal Internal Medicine states that “In Faringham, Mass, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, lower the person’s serum cholesterol,… the opposite of what the equation provided by Hegsted, et all(1965) and Keys et al (1957) would predict”. The fact was that people of the Faringham village did a lot of physical work. Then Walter Willett, M.D (1990) in an editorial in the American Journal of Public Health states: Even though “the focus of dietary recommendation is usually a reduction of saturated fat intake, no relation between saturated fat intake and the risk of CHD was observed in the most informative prospective study to date”. Furthermore, an exhaustive study by researchers from the University of South Florida, the Japanese Institute of Pharmacovigilance and several other reputed international institutions, and published in BMJ, a peer-reviewed journal, in 2016 concluded an inverse relationship between all-cause or cardio-vascular mortality and LDL; and that over 60s lived longer with high bad cholesterol!
So there should be no risk in consuming coconut the way we do now! What matters is your total dietary composition and quantity, and of course, your lifestyle. Over the years, people have become more and more sedentary. Housewives are glued to the television. A high proportion of children, apart from their parents are obese and hardly take part in sports. Education has become highly competitive. The mothers virtually drag the children from school to the tuition class, stopping only at the pastry shop for a hurried lunch of pastries. The risk of coconut fat in cardio-vascular diseases, if at all, should be negligible compared to lifestyle and other factors!
Dr Parakrama Waidyanatha
Via email
Some concerns in the interest of doctors and patients
I write, both as a senior citizen and an elderly patient, about a well known chain of hospitals in Colombo.
It is with great concern and absolutely no malice towards the management, but totally in the interest of the public who flock to these hospitals, be it for laboratory testing, consultation of visiting consultants, as well as the patients who are admitted to the hospital that I make these observations. I and many others wish these hospitals to continue their services, but it is my duty to bring some failings I have noticed, to the management for early rectification, so that we could visit these hospitals without any fear especially during these trying times.
Two elderly patients I knew, who were discharged, as well enough to go home, developed very bad chest infections the very next day and had to be treated again at home. The doctors who saw these two patients concluded that both of them picked up the new infections in the hospital wards.
The nursing care has deteriorated visibly to a point that the nurses have become lax in their daily routine in the care of their patients. Also it was noticed that student nurses were used to administer medicines without the supervision by an accompanying qualified nurse.
In these days of a very virulent strain of the COVID-19 virus spreading very rapidly within the community, my own concerns have increased a hundredfold. It is well known that a number of consultants have contracted the disease and have had to be quarantined. One wonders if there is a certain laxity in the screening of the patients who come to see the consultants. Also, the facilities that are available to the doctors both in the interest of the patients’ safety as well as their own wellbeing, are not inspected and rectified as and when necessary.
Also, it is a well known “secret”, that over 60 nurses have had to go for quarantine, for suspected exposure to the virus. The serious issue is that the doctors have not been informed of the potential risk to themselves as well as their own patients. The doctors should be warned so that their own patients could be informed of a potential risk, so that they could make their own risk assessments, and still come if absolutely essential.
Transparency is vital at this critical moment.
Concerned citizen
Via email
Saner counsel need of the hour regarding to bury or not to bury COVID-19 victims
The decision to cremate obviously was taken as we didn’t know anything much about this new coronavirus at the time of its appearance. Today we are more knowledgeable about it. One argument that was put forward was that the water tables in the cemeteries are quite high and there is a great chance that the body fluids can get mixed with the ground water which would slowly seep into the drinking water resources.
The water table being high is known to me as I was the Chief Medical Officer of Health in Colombo and the cemeteries were under my administration. The Madampitiya cemetery had this issue when it rained as the water table rose and pushed up the coffins and sometimes bodies. In one area it is almost impossible to bury even now as the water gets collected and we had to re-allocate space in other areas for these bodies. The Borella Kanatte is a filled marshy land and even now a few acres near the Golf Links need filling if we ever plan to use that area.
So why are we worried about the body fluids getting mixed with the ground water? Even before China confirmed the first known case of COVID-19, the virus has been in the water in many countries. Water samples taken in Milan and Turin had shown genetic virus traces of the novel coronavirus on December 18, 2019. Chinese officials confirmed the first cases at the end of December. Italy’s first case was found only in mid-February although the virus had been in the water months before. French scientists carrying out investigations showed that a patient treated for suspected pneumonia near Paris on December 27, 2019 actually had the coronavirus. But the first recognized patient was found much later.
Sewage water samples from the state of Santa Catarina, Brazil had been found to contain traces of the virus, the Federal University of Santa Catarina (UFSC) of Brazil had announced. This finding was two months earlier than the first official confirmed case of COVID-19 in the Americas and much earlier than the first reported case in Brazil at the end of February 2020.
Professor Davey Jones of Bangor University in the UK has gone on record saying that wastewater can tell us where the next outbreak will be. PCR tests were done to find traces of SARS-CoV-2 in untreated wastewater for disease surveillance. Similar research is being conducted in Barcelona, Spain at the university. They reported the presence of the virus in samples taken as early as January 15, 2020, 41 days before Barcelona’s first known case was reported on February 25, 2020. Most surprisingly, they reported the presence of two genetic fragments of COVID-19 virus in a sample taken on March 12, 2019 and that is eight months before the first human infections in Wuhan, China, in November to December of 2019!
All these reports show that the virus could be in the waters and may survive too. Newer studies show that the virus can survive on surfaces for up to 30 days. If we bury the bodies of COVID-19 victims there is a chance that our water table will get contaminated by the virus especially during the rains. Who knows the virus could get mutated or change its structure and come out as an entirely different virus and cause another type of pandemic. Let saner counsel prevail.
Dr. Pradeep Kariyawasam
Former CMOH/CMC