Diet war veterans last stand. Recent saturated fat attack a blast from the past

By Jerome Burne

Last week a ‘Presidential Advisory Statement’ about saturated fat from the American Heart Association (AHA) produced a ‘you cannot be serious’ reaction from anyone who has looked at the evidence for the theory that saturated fat raises the risk of heart disease.

‘In summary,’ the abstract read ‘randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ≈30%, similar to the reduction achieved by statin treatment.’ A message from the zombie theory that facts can’t kill.

But few of us non-professionals would feel confident about delving into the biostatistics behind a paper stamped with such academic authority.

We smell a rat but we can’t locate it

So a round of applause for American journalist Gary Taubes who is not only comfortable with the statistics but as a result of his amazingly thorough books investigating the origins of this tenacious belief – Good Calories; Bad Calories, Why We Get Fat – is effectively its historian. And to really understand why the Presidential Statement is so deluded you have to know the history. Taubes rushed out a post on it that makes it clear that this is the final flourish of defiance from the old team that built and then protected this undead theory for decades. You can read it here but is such a fascinating demolition job I couldn’t resist writing about it. 

Undead evidence from the 60’s resurrected

The first fact that brings you up short is that all four – yes just four – of the papers wheeled out to defend the claim were published in the 1960’s!! And this was from a Presidential Paper which claimed to discuss:’ the scientific evidence, including the most recent studies’.

So immediately there is a strong smell of very elderly rat or what Taubes describes as ‘the most egregious example of Bing Crosby epidemiology’– a reference to one of the numbers from White Christmas; ‘Accentuate the positive and eliminate the negative.’

A dozen senior cardiologists could only find four trials worth considering. Those excluded included the Minnesota Coronary Survey, The Sydney Heart Study and the largest and most expensive clinical trial ever done – the Women’s Health Initiative. Possibly because all came up negative.

The reliability and conclusions of the many negative trials of the effects of removing saturated fats are still hotly debated but what is of interest here is that the AHA supports the notion that the evidence contained in these four ancient papers is strong enough to defend the hypothesis against anything published subsequently.

Taubes dissects one of them – the Oslo Diet-Heart study – and shows how it fails even the most basic standards of evidence based medicine, making it highly unreliable. No journal would publish it today.

Study was unblinded and had no placebo control

There is just one investigator – Paul Leren – who asks local doctors to recommend which of their patients could be enrolled in the trial. Half get a diet low in saturated fats and high in polyunsaturated oils, along with intensive counselling for years. The rest get a standard Norwegian diet and no counselling.

Already it is looking very dodgy. Not only does the control group get no counselling – known to be an effective way of ensuring patients stick to a diet – but the doctors who continue to oversee their patients know which are in which group. So it’s unblinded and without a proper placebo control.

But there’s more and this is where Taubes’ gift for obsessive research bears fruit. It turns out that there was a separate account of how the trial was run written by Leren, published in 1966 and containing information not available in the medical journal article. As it happened Taubes had bought a copy a few weeks ago. ‘That’s how curious I was’, he writes.

This monograph reveals another crucial detail. Those on the low fat diet also got very little sugar – about half what would be in a regular Norwegian diet which Taubes estimates at about 100 grams a day. So could the fact that the control group were eating a hell of a lot more sugar have contributed to the favourable result, he asks.

‘I don’t know if it did,’ he writes, ‘but the point is that neither did Leren and neither do our AHA authorities.’

Then they make the same mistake again

He finds a similar example of the AHA team’s lax standards of what counts as evidence in their approval of the recent Predimed trial of the Mediterranean diet. The trial was not one of the original favoured four but it was discussed in the paper as the kind of diet the team thought people should follow and put forward Predimed as having good evidence for its effectiveness.

Taubes, however has found that Predimed also involved the same sort of playing fast and loose with the placebo group that totally discredited the Oslo study. The details also emerged from a separate supplement. Once again those getting the diet (there were actually three versions of it being tested) also got regular counselling while those eating non-Mediterranean got no support and advice. Again this made it a trial without a proper placebo.

This presidential paper was entirely pointless – more vanity publishing than proper research, elderly dietary soldiers rehashing ancient battles to prove that they really had won after all. ‘The only reason to publish it’ writes Taubes ‘ is because the AHA has been taking the heat lately from folks like me and Nina Teicholz and a host of others who point out that we are dealing with pseudoscience here and the public deserves far better.’

Another researcher who has been delivering heat lately to those holding on to the low fat faith is the nutritionist Dr Zoe Harcombe who runs a very active blog at which needs a small subscription. I don’t know if she has responded to the AHA paper specifically but her research is directly relevant. Her position, set out in a recent post ‘Replacing saturated with polyunsaturated fat’, is very clear and based on research done for her PhD thesis.

Officials know low fat advice is wrong

‘The total fat guideline really is completely indefensible,’ she writes. ‘It is interesting that public health officials have largely stopped trying to justify this one (although they haven’t dropped it and/or announced that they have been wrong for 40 years).’

She then goes on to dissect a Cochrane review of saturate fat first published in 2011 which has been used by her critics to support the low fat position. It begins with a blizzard of references, which I’ve kept in the quote here to demonstrate that her research is all done by the book. The fact that her prose is very accessible might mislead you into thinking she was a lightweight. Slide over it if it is too much information.

‘The powers-that-be continue to try to justify the saturated fat guideline and the one paper that they think supports their view is a Cochrane study, by Lee Hooper et al. This was first published in 2011 (Hooper L, Summerbell CD, Thompson R, et al. Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane database of systematic reviews. 2011) and then revised in 2015 (Hooper L, Martin N, Abdelhamid A, Davey Smith G. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database of Systematic Reviews 2015), which was done to counter the impact of my paper in February 2015 (Harcombe Z, Baker JS, Cooper SM, et al. Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis. Open Heart 2015).’

The Cochrane report was about the effectiveness of lowering saturated fat in general but I’m only going to include Harcombe’s reasons for rejecting it as evidence for polyunsaturate replacement because that was what the AHA paper claimed. (In fact, it said that the switch was as effective as a statin. No distinction made between types of polyunsaturates or whether patients were primary or secondary. But hey, I imagine them saying, we didn’t worry about that fancy nit-picking stuff in the 60’s.)

Arithmetical failure with polyunsaturates

Harcombe makes three points about how unconvincing was the evidence Hooper claimed showed the benefits of the switch. ‘The paper claimed that replacing energy from saturated fat with polyunsaturated fat “appears to be a useful strategy”, she writes. ‘Yet, of the 11 studies she (Hooper) used for this conclusion only 1 actually replaced saturated fat with polyunsaturated fat!

‘Secondly no distinction was made between the types of polyunsaturated fats: omega-3 (n-3) – likely having health benefit – and omega-6 (n-6) likely not. Thirdly there were no studies included by Hooper of healthy people of both genders and hence none of the findings can be applied to the general population.’

For more details on why replacing saturated fats with industrially produced polyunsaturated oils is not a good idea and what the benefit of saturated fats are see the latest posting on the AHA paper from the excellent Alliance of Natural Health site:

You will also find there a post of mine on cancer and CAM. It’s about how there are faint signs of a thaw on another of those fiercely contested frozen medical boundaries between standard cancer treatments and options for patients based on a functional medicine approach.

The ability of bodies charged with protecting public health attack their critics on the ground that their views aren’t backed up by good evidence, while at the same time sticking to recommendations based on the most deeply flawed evidence, still continues to amaze, although I suppose it shouldn’t.

So rather than exchanges salvoes of references we need to ask age old question which has suddenly become horribly relevant about power and people: Quis custodiet ipsos custodes? Who will guard the guards themselves? We really do need to employ a new set of guards.

Jerome Burne

Jerome Burne

Jerome Burne is the editor of HealthInsightUK. He is an award-winning journalist who has been specialising in medicine and health for the last 10 years and now works mainly for the Daily Mail. His most recent book “10 Secrets of Healthy Ageing” was written with nutritionist Patrick Holford. He blogs at “Body of Evidence” – jeromeburne.com. 2015: Finalist for 'Blogger of the Year' award from Medical Journalists' Association.

12 Comments

  • Excellent article!
    Thank you.

  • What is the AHA for? It keeps its sponsors happy and defends the money-generating cholesterol theory. I’m sure its members have nice houses with swimming pools, but this discredited organisation clearly has nothing to do with public health.

    Here is a list of AHA sponsors. Is there a major pharma company not listed? How likely is this organisation to ever accept that eating fat is fine? That would mean rejecting the diet-heart theory and that’s the goose that lays the golden statin egg.

    The AHA is stuck in the 1960s because that’s the only way it can maintain its position, relying on old, selective science to support an old and selective theory.

    Alex & Ani
    Amgen
    AstraZeneca
    BMS/Pfizer
    BonTon
    Chiesi
    CycleBar
    Daiichi Sankyo
    Edwards Lifescience
    Fitbit
    Genentech
    Grocery Manufacturers Association
    Hibbett
    Interactive Health
    Jamba Juice
    Jamberry
    Janssen
    Jewelry Television
    Macy’s
    Mazda
    Medtronic /Coviden
    Monsanto Fund
    NFL
    Novartis
    Party City
    Sanofi
    Splenda
    Subway
    Verily (Google Lifescience)
    Walgreens
    Walmart
    ZS Pharma
    Wall Street Journal

    • Loss of face is a greater threat than loss of money. But if you think that they are influenced, it might be time to go after the sponsors. I doubt that Subway or Splenda or even Mazda wants to get in a fight. We’ll see if we can form a real organization.

      • I agree that loss of face is important, but so far it hasn’t stopped the AHA publishing this type of nonsense in the face of criticism and some derision. They seem utterly detemined to defend the vegetable oil Alamo. I’m not sure what would be left of the AHA if they finally admitted the truth and abandoned the cholesterol position. The loss of face will be all the greater when the fortress finally collapses.

        Influencing and, where appropriate, criticising sponsors for supporting these harmful policies is a good strategy. They move whenever it suits them. Even FIFA found that out.

  • In the healthy fats controversy, both sides ignore this thing called The Reverse Effect. That’s the title of an 1198 page book by Walter A Heiby. The book contains a 95 page chapter on polyunsaturated fats.

    The anti-saturated fat group (AHA) can point to research that demonstrates cardio-metabolic benefits with really high polyunsaturated fat intake. Excerpt:

    “The two diets contained the same number of total calories and percent of calories from fat but differed in the types of fat included. The control diet was comprised of 7% polyunsaturated fat, 15% monounsaturated fat and 13% saturated fat, compared to the PUFA-rich diet which was 21% polyunsaturated fat, 9% monounsaturated fat, and 5% saturated fat.” https://eurekalert.org/pub_releases/2017-06/es-dri061417.php

    What I suspect is that intermediate intakes of omega-6 linoleic acid are lethal over time. High intakes seem to be less so and possibly beneficial. It may be that high intakes of linoleic acid promote the growth of beneficial gut microbes. http://jb.asm.org/content/189/6/2566.full

    Curious readers may find this interesting: http://www.doctoroz.com/article/safflower-oil-use-fat-lose-fat

    Also, Google – Calories Don’t Count Herman Taller. Read customer reviews.

  • I asked Lee Hooper at a meeting how she could explain the French paradox and suggested that if she couldn’t her contention was invalid. She shrugged her shoulders and said “Well, there’s France for you.” At the same meeting where another expert denigrated coconut oil, I pointed out that the Kitavans ate 18% saturated fat, almost all from coconut and had no heart disease and that they would have to explain that, I got a goldfish impersonation.

    We are dealing with entrenched ignorance.

    • It is difficult to attack ignorance. However, there are supposed to be gate-keepers, that is, editors and reviewers. That is why the nutritional medical literature is near worthless. Here, off course, there was presumably no peer review at all. The AHA owns the journal (and the authors).

    • Well said, Dr Lee.

      The ‘French’ paradox includes Switzerland, Sweden, Norway, Holland, Belgium, Germany, Spain and Iceland. How many paradoxes does it take to show a theory is wrong? In a genuinely scientific field, one ‘paradox’ would be enough to sound alarm bells.

  • Excellent article!
    Thank you so much.

  • Quis custodiet ipsos custodes?

    Jerome, it is people like you (round of applause, please), Dr Zoe, and Gary that fill this role when the gatekeepers should be the Journals and the Professors maintaining a very high standard of integrity for research.

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