If there is an antithesis to the principles of science-based medicine, it’s probably the Dr. Oz show. In this daytime television parallel universe, anecdotes are evidence. There are no incremental advances in knowledge — only medical miracles. And every episode neatly offers up three or four takeaway health nuggets that, more often than not, seem to leave the audience more ill-informed about health and medicine than they were 30 minutes earlier.

After I completed my post on Dr. Oz’s prolonged embrace of the “miracle” that is green coffee bean extract, a number of readers brought me up to speed. Green coffee beans are yesterday’s miracle. The new weight loss miracle for 2013 is red palm oil. This constant drive for miracles must keep the producers in a perpetual panic. They need at least five miracles per week. Having now watched a few episodes, I’m reminded of the classic “That Mitchell and Webb Look” skit where two nutritionists pick a new superfood. It could be just a matter of time until we see white veal profiled as a superfood in a future Dr. Oz episode.

If there is a common characteristic of complementary and alternative medicine (CAM) proponents who believe themselves to be scientific (and I include Dr. Oz in this group), it is that they extrapolate from weak clinical evidence to grandiose claims by cherry picking the most supportive strands of evidence to give the impression of being evidence-based. They have the belief, and then they look for the supporting evidence to bolster the claim. In short, to paraphrase a quote attributed to Hahns Kuhn, they use scientific evidence like a drunkard uses a light post: for support, not for illumination. As I noted with green coffee bean extract, Dr. Oz extrapolated from ambiguous, preliminary data to recommendations to consume green coffee bean extract as a weight loss strategy. Frankly, the evidence isn’t there, so I didn’t have high expectations with the latest miracle. All I knew going in about palm oil is that it’s used in most industrial food production and the demand for it is linked to massive destruction of tropical rainforests and the slaughter of orangutans. But who doesn’t want the longevity that Dr. Oz promises? So I sat down and watched another episode.

Dr. Oz’s first miracle solution of 2013 is red palm oil, an amazing fat that helps stop the signs of aging inside and out! — DoctorOz.com

Let’s look at the claims made on the show, and then consider the evidence supporting them. I’m quoting liberally from the show so it’s completely clear exactly what Dr. Oz said, but I recommend you watch both clips for the full effect. This show needs to be seen to be believed. Keep in mind that Dr. Oz is no ordinary daytime television host: he is an accomplished and still active cardiac surgeon, an academic, and a research scientist. He has hundreds of scientific publications to his name. His show has been broadcast since 2009 and he reaches millions every day. He is perceived as a credible authority, because he’s a real health professional. Unfortunately Dr. Oz has a persistent history of giving dubious health advice that doesn’t hold up when it’s checked against the evidence.

This episode is all about miracles for 2013 and the segment features Canadian homeopath Bryce Wylde, introduced by Dr. Oz as a “miracle worker and alternative medicine expert”). Oz introduces red palm oil with an argument from antiquity:

That red color is perfect because I think of it as a stop sign for aging, inside and out. Did you know that palm trees contain an ancient remedy that can slow down the aging process, fight belly fat, and combat heart disease? There’s a secret inside the flesh of this fruit, extending the warranty of nearly every organ in your body. This mega-oil may very well be the most the most miraculous find of 2013.

The purported benefits Wylde mentions include carotene, described as a “a super-powerful antioxidant” and tocotrienols, “a special form of vitamin E, very, very cardioprotective”. Oz is impressed:

I think this will actually help protect us against Alzheimer’s…

Wylde continues from there, showing a sliced apple that has browned (emphasis added):

This apple is just like our brain. When…oxygen from the environment, stress hits it, it will ultimately denature, it will become rotten. We all know the culinary trick…of putting lemon juice juice or lime juice on our fruit salad or apple. That protects it, keeps it white. Well red palm oil does the exact same thing in our brains, protecting it….That special form of tocotrienols we’re talking about, that special form of vitamin E, is actually going to increase blood circulation, it’s going to reduce incidence of dementia and Alzheimer’s, so it’s going to protect our most important organ.

The “demo” then moves on to the heart. Dr. Oz asks Wylde to explain why saturated fats protect the heart. Two fake arteries (actually what appears to be sections of bisected PVC sewer pipe) are shown. Both are coated with clumps of white goo. Oz pours some liquid down one pipe. The liquid is viscous and sticks to the goo. Then he pours some red palm oil down the other pipe. It washes the pipe clean. This new biochemical model clearly impresses Dr. Oz:

Folks who were using this lowered their bad cholesterol by nearly 40% in one month! Drugs don’t even do this!

In a statement on the Dr. Oz website, Wylde elaborates:

Over the past two decades, researchers have intensely studied red palm oil’s effect on cardiovascular health and the preliminary results initially baffled scientists. At room temperature, this semi-solid oil seems as likely as lard to clog your arteries. But what might shock you to learn, as it has equally stunned researchers, is that although red palm fruit oil is indeed high in saturated fat, it actually protects against heart disease. Saturated fats behave like a thick molasses through the cardiovascular system, eventually contributing to plaque (atherosclerosis). But studies show that adding palm oil into the diet can remove plaque build-up in arteries and, therefore, reverse the process of plaque and prevent blockages.

The demonstration finally moves a piece of fat that Dr. Oz says is our omentum. Wylde notes:

Red palm fruit oil goes straight to the liver and gets used up as calories, and might help to reduce your fat tissue concentration, because you’re not storing it, your burning it.

Then Dr. Oz ignites a candle, which he likens to other fats, and a sparkler (which explodes) which he likens to red palm oil:

There was another study done of women who ate two tablespoons of an oil that was like palm oil. And it helped turn up their metabolism and whittled away this belly fat that so many of you are frustrated by.

So at the end of the segment we are left with three distinct, testable claims about red palm oil consumption and supplementation:

Red palm oil protects against dementia and Alzheimer’s. Red palm oil reduces bad cholesterol, reduces atherosclerosis, and prevents new blood clots. Red palm oil spot reduces belly fat.

Palm Oil

If you eat any packaged or prepared foods that contain “vegetable oil”, you’re probably eating palm oil. The palm tree is the source of one of the most widely used industrial oils in the world. Raw palm oil does contain a rich source of carotenoids and vitamin E. Red palm oil is a refined version of raw red palm oil which retains a significant amount of these ingredients. For industrial purposes, however, red palm oil is not ideal. It is described as having a bitter, pronounced flavor which some describe as unpalatable. The dark colour, a consequence of the carotenoids, can discolor prepared foods. Refining raw palm oil further, with bleaching, eliminates the carotenoids and tocoperols. Refined, palm oil is very versatile: it’s stable at high heat, largely tasteless, trans-fat free, and is low cost. With the exception of the carotenoids and vitamin E, red palm oil, and refined palm oil, are essentially the same product: saturated fatty acids palmitic acid (44%), stearic acid (5%) and myristic acid (1%), and the unsaturated fatty acids oleic acid (39%) and linoleic acid (11%).

It’s the vitamin content that has driven most of the research into uses for red palm oil. Vitamin A deficiency is a significant public health issue in developing countries [PDF], as major cause of blindness as well as overall mortality. Red palm oil has been studied as a supplement and as part of food fortification to boost vitamin A levels. It seems to be effective and could serve to help fortify the food supply in nations where widespread deficiency exists. Vitamin A deficiency, however is rare in developed countries, though it can still appear in some malabsorbtion-related disease states. When used as a supplement, red palm oil seems to be a good source of the vitamin E compounds as well. Compared to vitamin A, however, vitamin E deficiency is almost unheard of — even in developing countries.

Do consumers in developed countries need to routinely supplementation with carotenoids and vitamin E? Here we get into the complexity of diet. Dietary patterns have been examined in observational studies that have suggested that foods high in antioxidants like carotene may offer protection from cardiovascular disease, cancer, and other illnesses. Randomized trials with antioxidants have not borne out the touted benefits of supplements, however, so the most pragmatic advice seems to be that eating a diet of foods that contain these factors is a better approach than using supplements. Given red palm oil is not consumed routinely in populations that have been studied in supplement trials, the overall effect of a diet that includes regular consumption of red palm oil isn’t clear. Unlike the well-studied “Mediterranean Diet” that features olive oil as the primary oil consumed, there have been no similar studies of populations that consume red palm oil routinely as part of their diet.

The rationale for specific vitamin E supplementation is even more questionable. The idea for years was “oxidation bad, antioxidant good”. Eating foods that contain sources of vitamin E seems to be beneficial to health. Yet trials with supplements haven’t been shown to protect against heart disease or stroke, and at higher doses may increase the risk of cancer and of overall mortality. On balance the best evidence seems to suggest that diets rich in fruits and vegetables may be protective of different diseases, but specific supplementation may not. What this means if you decide to consume red palm oil isn’t clear — it may be influenced by whether you add it to your existing diet, or if you substitute it for something else.

The Evidence Check

Dr. Oz’s statements were unambiguous and testable. Here is how they stack up against the evidence.

Claim 1: Red palm oil protects against dementia and Alzheimer’s

There is no direct evidence to substantiate this claim, either with refined palm oil or red palm oil. I couldn’t locate any trial that has prospectively examined this — and I’m not surprised, because studying treatments for the prevention of dementia are notoriously difficult to do, requiring hundreds of patients and years if not decades of follow-up.

Alzheimer’s disease is the most common form of dementia, but not the only cause. Antioxidants have been proposed as possible preventative treatments for dementia, given oxidative stress may be a component of the degenerative changes observed with the disease. Trials studying vitamin E supplementation for the prevention of Alzheimer’s disease have shown no effect, though it may have a role in the treatment of established disease. It’s been similarly disappointing with beta-carotene, where no clear benefit has been demonstrated.

If we look at the fatty acid components, there’s no evidence suggesting palm oil will have any meaningful effects. Rather what evidence exists suggests negative effects from saturated fats. In contrast to palm oil, the evidence is at least promising for the omega-3 fatty acids, particularly when consumed as fatty fish. The same can be said for the Mediterranean diet. But the usual biases in studying diet confound the results.

Overall, there is no convincing evidence to suggest that consuming red palm oil will have any meaningful effect at preventing dementia or Alzheimer’s disease. What limited evidence exists suggests either a neutral or possibly a negative effects from supplementation.

Claim 2: Red palm oil reduces bad cholesterol, reduces atherosclerosis, and prevents new clots

There is no convincing evidence with red palm oil to substantiate a recommendation to preferentially consume this oil. Studies with palm oil suggest that it can raise LDL and total cholesterol, but the effects are not consistently shown. None of the studies are large, nor do they clearly establish any role for red palm oil as a therapeutic treatment for reducing LDL cholesterol or preventing clots. Dr. Oz cites a 40% reduction in LDL- he may be referring to this study, which gave a palm-oil-vitamin E concentrate to a group of nine (yes, only nine) volunteers. One subject was noted to have a 37% reduction in LDL. Yet that’s not the mean – just the max. I was unable to find any relevant trials with actual product in question. Despite the impressive effects Dr. Oz showed with his PVC pipe, the effects in the real world, with real arteries, haven’t been established. If only there was a cardiac surgeon there to correct the science presented.

When it comes to the antioxidants in red palm oil, there is no convincing data from prospective trials that vitamin E or the carotenoids have any benefit for the primary prevention of cardiovascular disease. Again, the usual recommendations (lots of fruit and vegetables, using monounsaturated and polyunsaturated fats instead of trans fats and saturated fats, and eating omega-3 fatty acid-rich foods) have much better evidence behind them. Like claim 1, there is actually some promising evidence with other oils — particular fish oils and the consumption of fatty fish. And again, it’s really not clear that if you want to reduce bad cholesterol, that palm oil is your best choice. Some data suggests palm oil raises total cholesterol and LDL, compared to olive oils. It also may be inferior to sunflower oil. The data are preliminary and no clear effects on lipids have been established.

Claim 3: Red palm oil spot reduces belly fat

Finally, let’s look at the claim that red palm oil won’t cause belly fat gain and will “melt away” existing belly fat. Spot reduction of fat is a huge red flag for bogus claims. The idea comes from the thought that red palm oil-rich fatty acids are metabolized by the body, and not deposited as fat. Spot reduction is a persistent but unfounded dietary myth that can give unrealistic expectations about weight loss and what constitutes a healthy diet. While weight loss can result in fat loss in different areas of the body at different rates, this is due to genetic effects — not due to any specific treatment. Not surprisingly, there is no direct evidence suggesting red palm oil, or refined palm oil, contributes to a loss of belly fat. Oz may be extrapolating the idea the medium-chain triglyceride oil, when used instead of other oils, can cause weight loss. But MCT oil isn’t red palm oil. There’s been a trial in coconut oil that was unimpressive, showing a 1.4cm difference versus soy oil after 12 weeks. In aggregate, the evidence isn’t impressive, even when coconut oil is used as a substitute for other oils. Whether any of the studies with other oils are relevant to the consumption of red palm oil isn’t known — it hasn’t been directly studied. Certainly if net calorie intake goes up because of specific supplementation, all things being equal, we should not expect any meaningful changes in weight or waist size. On balance, supplementing with or switching oils probably has a trivial effect compared to the big drivers of obesity, like overall energy intake and expenditure. Calories clearly still matter. Substituting oils may not.

Other considerations

If environmental impact is a factor in your oil selection, palm oil may not be the best option. Orangutan protection advocates are outraged Dr. Oz has endorsed red palm oil, and have launched a campaign to shame him. Says Orangutan outreach:

Dr. Oz Declares war on Orangutans

Dr Oz and his staff should have done more research before recommending palm oil. In doing so, he has inadvertently declared war on orangutans– along with every other living creature in the jungles of Borneo and Sumatra.

While originally from West Africa, today 90% of the global supply of palm oil actually comes from Indonesia & Malaysia. This has come at a tremendous environmental cost. Indonesian and Malaysian forests are being burned to the ground– releasing so much carbon into the atmosphere that Indonesia now ranks 3rd behind China and US in carbon emissions– and it is barely industrialized. The UNEP estimates that the forests of Indonesia are being cleared at a rate of 6 football fields per minute every minute of every day.

While this may be the case, it’s unlikely that even Dr. Oz-driven demand for red palm oil is meaningful compared to the current worldwide use of palm oil. With use predicted at 42.6 million tons this year, I’d be surprise if even the Dr. Oz effect will have a big effect on what appears to be a consequence of our already massive consumption of palm oil.

Conclusion

If there is one thing that really frustrates me about the Dr. Oz show is that he ignores the boring-but-factual and always hypes the gimmicks. Red palm oil is no exception. It’s foolish and short-sighted to declare red palm oil as healthy or beneficial based on the limited data that exists. The history of dietetics and nutrition is replete with cases of extrapolating preliminary data into supplement and dietary advice, only to see population-level data, and good clinical trials later refute it. There is no clearly established need for the routine supplementary consumption of the carotenoids and vitamin E in red palm oil. And you may already have palm oil as a routine part of your diet — perhaps unwittingly. The impact of red palm oil consumption on your health is likely to be insignificant, compared to the big drivers of health. But none of this matters on the Dr. Oz show. Because just as quickly as this post is published, Oz will have moved on to the next dietary fad, leaving consumers who watch his show more confused than ever about what constitutes good health and nutrition.