The day after my article lambasting the American Heart Association’s 2013 dietary guidelines came out in The Daily Beast, Dr. Rose Marie Robertson posted a response on blog.heart.org titled: Chief Science Officer ‘sets record straight’ about diet, science, AHA.
I don’t know Dr. Robertson personally, but there are interesting parallels between our careers. We’re about the same age and went into cardiology at a time, when female cardiologists were rare. We have both headed up centers devoted to treating heart disease in women. Since 2003 Dr. Robertson has been the AHA’s Chief Science and Medical Officer (receiving more than $500,000 a year in salary and benefits) while I have continued seeing patients and engaging in clinical research and teaching. In other words, in the war against heart disease, you might say that Dr. Robertson is an officer and I am a foot soldier. But it is often in the trenches that the truth is most apparent.
Dr. Robertson employs a “Their Story” vs. “The Facts” method for the post, in which she purports to show how The Daily Beast’s arguments were “based on falsehoods, questionable allegations and personal attacks.” In part to “honor” the American Heart Association’s “good name,” Dr. Robertson says she’s also writing it “out of concern for the health of the public, all the people we work hard every day to protect.”
Her rebuttal begins by bashing the Cambridge University study that questioned the link between saturated fat intake and heart disease. While there was criticism of this study, and minor corrections posted by the authors, the fundamental findings stand: Saturated fat intake and the risk of heart disease do not appear to be related.
In fact, the correction of the Cambridge study had to do with polyunsaturated fats—not saturated fats. The correction means that the meta-analysis now says people who report eating lots of this particular fat have significantly less heart disease; previously, it said there was no significant effect. The lack of correlation between saturated fat intake and heart disease risk still stands.
Dr. Robertson writes that “research has repeatedly shown a very clear link between saturated fat intake and the well-documented risk factor of LDL cholesterol for heart disease.” But this is a gross oversimplification. In truth, we have known for years that the same level of LDL-cholesterol (so-called “bad” cholestrol) will cause heart disease in some people but not in others. In fact, half of the people who have cardiac events have “ideal” levels of LDL cholesterol.
With more sophisticated testing, we’ve been able to look at both LDL particle size and particle number. LDL particles come in various sizes, with small, dense LDL being more harmful than light, fluffy LDL. And it is precisely the light, fluffy LDL that is increased by saturated fat intake, while substituting carbohydrates for saturated fat causes an increase in the small, dense LDL, along with a decrease in the protective HDL-cholesterol.
We’ve also seen that in some populations, LDL-particle number appears to be an even more important predictor of heart disease. Indeed, many cutting-edge physicians are manipulating the diet to lower particle number. And how does particle number go down? You guessed it—low-carbohydrate diets.
Dr. Robertson writes that “our guidance is based on the best available clinical research.” But when that clinical research does not jibe with AHA dogma, it is ignored. A classic example is the Lyon Diet Heart Study, which compared what happened to nearly 600 survivors of a heart attack, half of whom followed a Mediterranean Diet and half of whom followed the low-fat “prudent” diet advocated by the AHA. After almost four years of follow-up, those on the Mediterranean Diet had a 56 percent relative risk reduction in death from any cause, a 65 percent reduction in the risk of dying of heart disease and a 70 percent reduction in the risk of having another heart attack, compared to those who followed the prudent low-fat diet.
And at the end of the study there was no difference in the LDL-cholesterol levels between the two groups! So you can reduce your risk of heart disease, by a lot, without lowering your LDL. I wonder how long it will take for the AHA to admit that.
Yet another important barrier to addressing this issue is the implication for statin sales. If we admit that diets that raise some forms of LDL are actually healthier, would this mean that we don’t need statin medicines at all? In other words, to reverse itself on dietary policy would threaten the AHA’s fiduciary arrangements with not only “Big Food” but also “Big Pharma.”
In defense of the AHA’s Heart Check Program, Dr. Robertson writes that the participating food companies pay the AHA “administrative fees to cover the costs of running the program.” She states that the Food Certification is only designed as a consumer resource. But the AHA’s own website notes, “We learned that this brand awareness translates to increased sales…”
Dr. Robertson also twists the facts when she comes to the defense of Dr. Robert Eckel. “As for the ‘curious beliefs’ the author cites, Dr. Eckel is a Christian. These are his personal beliefs and are completely unrelated to his professional scientific studies,” she writes. “To hint otherwise is offensive to anyone, including many scientists, with religious beliefs…”
My article specifically noted that many scientists are religious: “This is not to question Dr. Eckel’s religious beliefs, but to question his ability to think scientifically.” Indeed, I know many scientists who are Christian, Jewish, Muslim, and Hindu. What I have not encountered is another scientist who claims that there is scientific proof of the Bible’s accuracy.
At the end of my original article I pointed out that the diet-heart hypothesis (eating saturated fat causes hardening of the arteries) has been disproven and deserved to be jettisoned along with other discredited belief systems like Creationism. I asked “Will the AHA step up to the plate?”
The AHA stepped up to the plate, but instead of an out-of-the-ballpark home run, it fouled out.
I feel sorry for the AHA. I really do. But they are wrong, and people have been hurt by following their dietary guidelines.
That is “My Story” and those are “The Facts.”