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Coconut Oil – Duct Tape for the Broken Metabolism

Coconut oil can be found in just about every grocery store, health food store and coffee shop near you.  It was made popular in the last few years by the highly advertised Bullet Proof Coffee claims of health and taste over the last few years.  But in the last few days, the news outlets through video and print have made it clear that the American Heart Association (AHA) isn’t happy with our use of this “duct tape for one’s metabolism.” The AHA has long been a proponent of education against activities increasing the risk of heart disease.  Since 1961 the AHA has decried the use of saturated fat, based on their support of Ansel Key’s diet heart hypothesis, and leading to over 60 years of preaching against the use of saturated fats from the pulpits of science.  The claim is that 85% of coconut oil is saturated fat (this is the fat deemed “evil” by those “disciples of the low-fat cloth”).   Yes, coconut oil is predominantly a saturated fat.  And approximately 75% of that is medium chain triglycerides, the form that converts most efficiently into ketones, for those of us using ketogenic nutritional approaches to health.  But is coconut oil really bad for your heart health?

Those of us using ketogenic diets know that LDL-C will commonly rise with increased saturated fat intake.  And, we’ve know this for over twenty years. This is to be expected, because LDL-C is really comprised of three different LDL sub-particles (big fluffy, medium, and small dense).  We’ve known for the last twenty years that increased saturated fat actually causes a shift in these particles to bigger “fluffier” particles.  We also know that it’s the small dense LDL particles are the atherogenic/inflammatory particles participating in the formation of vascular disease (arterial blockage) and their presence in the blood is directly correlated with the level of triglyceride, and that the big “fluffy” particles actually reduce the risk of vascular disease. Those of us following ketogenic lifestyles and treating disease with these protocols also know that triglycerides levels are increased directly by increasing levels of insulin.

The 2015 British Medical Journal published a study reviewing the relevant 19 peer reviewed medical articles that included over 68,000 participants.  This review showed that there is no association of high LDL-C (a calculated value of all the LDL sub-particles) with mortality (meaning that an elevated LDL-C does not lead to an increased risk of death from heart disease).  In stark contrast to this landmark review, The American Heart Association’s Presidential Advisory published this week in the June 20, 2017 issue of Circulation states that saturated fat is the cause of increased LDL-C and elevated LDL-C is associated with an increase in death by cardiovascular disease.  This boldfaced claim is based on a single small 4 year (2009-2013) literature review completed by the World Health Organization with a whopping 2353 participants, most of these studies only lasting 3-5 weeks (not nearly long enough to see fully effective cholesterol changes) and none of which had any focus on carbohydrate intake, insulin levels or LDL sub-particle measurement.  From this singular study, the AHA concludes that elevated LDL-C is an indicator of increased cardiovascular mortality.  That’s the equivalent of saying, “you know cars drive on the roads and cause pot holes, so we should all STOP driving cars because it is causing our freeway system to have increased pot holes.”

You can’t extrapolate mortality risk based on a single small study that doesn’t actually identify correlation or causation.  But the AHA did exactly that in 1961, and they are trying to do it again today.   The MR-FIT study, largest study ever completed, is incessantly quoted as the study that demonstrates reduction in cholesterol leads to reduction in cardiovascular disease, but this trial was actually a failure and did not demonstrate improved risk by lowering cholesterol.  In fact, the Director of the study, Dr. William Castelli actually stated, “. . . the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol…”

“We found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories weighed the least and were the most physically active,” he said.

Isn’t that interesting?

So, is coconut oil, or any other food high in saturated fat to blame?  Absolutely not!  There is no solid evidence to support these facts and there hasn’t been in over 65 years.   In fact, clinically, I find that the addition of coconut oil lowers triglycerides, decreases appetite, improves energy, improves skin tone, and plays a huge role in shifting the Omega 3/6 ratios to a more normal 2:1 level.

Is coconut oil, or any other food high in saturated fat to blame? Absolutely not! There is no solid evidence to support these facts and there hasn't been in over 65 years. #docmusclesClick To Tweet

So, how does coconut oil help the broken metabolism?  The majority of people I see in my office have insulin resistance to some degree.  Insulin resistance is an over production of insulin in response to any form of carbohydrate or starch.  Increasing your saturated fat, does two things.  It provides a fantastic form of fuel, one your body can use very easily.  And second, it will decrease your craving for starches and carbohydrates, naturally decreasing production of insulin and helping to improve insulin resistance over time.

If you want to learn more about using fat and improving insulin resistance, see my previous blog post here.

You can learn more about how our acceptance of bad science has lead to an obesity and diabetes epidemic in our country over the last 65 years by reading these books below:


Atherosclerosis: The Stuff Heart Attacks & Strokes are Made Of. . .

Watch as we talk for a few minutes about how insulin affects atherosclerosis and increases the risk of heart disease.  The higher your insulin, the more plaque you make . . . yes, it is that simple.

Risk for atherosclerosis can be determined by checking your cholesterol and specifically an NMR Lipoprofile with lipids through LabCorp or a CardioIQ with Lipid Panel through Quest Labs.  Additionally, ultrasound testing of the carotid arteries, which we do in my office, or through the cardiology offices, checks risk of vascular disease in the arteries of the neck and a stress test can be completed by the cardiologist to assess risk in the arteries of the heart.

Decrease your plaque risk through the use of a ketogenic diet.  How do you do that?  You can learn the basic principles here:


Many people have asked me over the last few weeks how to jump-start this process and get the most effective approach as they apply the principles above.  You can jump-start your ketogenic journey by incorporating Dr. Nally’s favorite ketogenic products below.




The Conundrum of Cholesterol & Ketones

Watch as Dr. Nally discusses how eating more fat actually lowers your cholesterol and your risk for heart disease.  Is a ketogenic lifestyle more effective than cholesterol medication?  Find out as we discuss this an many fascinating cholesterol questions from Dr. Nally’s Periscope watchers from around the world.  He also answers questions about his KetoEssentials Multi-Vitamin, Exogenous Ketones, and Pork Rinds (his favorite are the Pork Clouds brand).

So, mix up a bowel of fluff and grab a spoon while you listen and lower your cholesterol.


Vascular Plaque Reduction with Ketogenic Diet – A Case Study

Does your diet really reverse vascular disease?  I mean, will the diet you’re following ACTUALLY reverse the plaque burden that has occurred over the years of eating the SAD diet (Standard American Diet)?

It appears that the ketogenic diet does.  At least that’s what research is showing, and that’s what I am seeing clinically.  Let me give you an example.  Reversal of vascular disease is what I saw last week in this patient case study in my office.

Meet “Mrs. Plaque” (name has been changed to protect her identity).  She is a very pleasant 78 year old female who has been seeing me as a patient for the last 10 years.  We identified worsening cholesterol and hyperinsulinemia in this patient a few years ago, and last year, she finally decided to go on a ketogenic diet after we noted slight worsening blood sugar (HbA1c increased to 6.1%), worsening cholesterol and a recent TIA (transient ischemic attack or “mini stroke”).  We identified a 44% blockage in her left internal carotid artery and a 21% blockage in the right internal carotid artery putting her at risk for further cerebral ischemic events like a stroke and/or other vascular events like a possible heart attack down the road. She refused STATIN therapy as she had previous myalgia and side effects with their use in the past.

Past Medical History:  Hyperlipidemia, Impaired Fasting Glucose (Pre-Diabetes),.Asthma, GERD, Irritable Bowel, Generalized Anxiety, Idiopathic Peripheral Neuropathy, Surgical Menopause (Hysterectomy) with Secondary Atrophic Vaginitis, Recent TIA, Cataracts, Appendectomy

Medications: Plavix 75mg one daily, Premarin Cream 0.635mg every other day, Xanax 0.5mg at bedtime for anxiety, Lyrica 50mg one nightly for neuropathy, Vitamin D 2000 IU daily , TUMS 750mg twice a day.

Her carotid ultrasound and carotid medial intimal thickness (CIMT) study completed April 1, 2015 is present below.  You can see that her intimal thickness is only slightly higher than the average female her age, however, she has notable internal carotid artery blockage in both the right and the left sides.


The “mini stroke” and the report above, convinced her that she needed to tighten up her diet.  The patient’s husband was also a diabetic and the patient had been “partially” restricting sugar in her diet up to this point in time, however, she had not fully jumped on the ketogenic band wagon.    At this point she decided to change her diet.

She was placed on a ketogenic diet, restricting her carbohydrates to no more than 20 grams per day and increasing total fat to >50-60% of her total calories.  Nothing else changed including her medications.  She followed this program for the next year and this is the blood work that she had while following this program:

4/2/2015 8/4/2015 11/6/2015 5/12/2016
HbA1c (%) 6.1 5.8 5.2
Tot Chol (mg/dL) 224 156 230 233
HDL (mg/dL) 76 76 87 96
LDL-C (mg/dL) 134 65 128 123
Small Dense LDL-P (nmol/L) 481 150 222 217
Triglycerides (mg/dL) 72 76 74 68
Fasting  Insulin (uIU/mL) 12
Glucose (mg/dL) 91 95 92 85

Because she was already partially restricting her sugar intake, her triglycerides and small dense LDL particle number was not bad, however, her average blood sugars were still significantly elevated. Weight decreased from 127 lbs to 119 lbs in August. She admits to slightly increased protein intake over the holidays and her weight increased back up to 125 lbs as of her last visit.

These labs also demonstrate that Total Cholesterol and LDL-C don’t appear to correlate with regression of plaque.

The image below is the patient’s repeat CIMT and carotid ultrasound 13 months later through the same lab.  What is dramatic is that she has had over 10% regression in the plaque in both internal carotid arteries and a return of her carotid intimal thickness to the average female in her age bracket.


This case study is consistent with the findings of Dr.Shai and his group when they did a two year comparative dietary intervention study of Low Fat – Group 1, Mediterranean Diet – Group 2, and a Ketogenic Diet – Group 3 on vessel wall volume and CIMT.


Carotid IMT changed by −1.1% from 0.816 mm at baseline to 0.808 mm after 2 years (P=0.18), with no significant difference between diet groups (P=0.91). There was a trend toward significant correlation between the 2-year changes in carotid IMT and VWV (r=0.173, P=0.056).

So, does your diet reverse vascular disease?  Evidence is pointing to the fact that the ketogenic diet does.  I return to the statement Hippocrates made over 2000 years ago, “Let food be thy medicine, and let medicine be thy food.”

Oh, and pass the bacon.