The dogma that saturated fat causes heart disease is crumbling.
A recent Cambridge University analysis of 76 studies involving more than 650,000 people concluded, “The current evidence does not clearly support guidelines that [recommend]… low consumption of total saturated fats.”
Yet the American Heart Association (AHA), in its most recent dietary guidelines, held fast to the idea that we must all eat low-fat diets for optimal heart health. It’s a stance that—at the very best—is controversial, and at worst is dead wrong. As a practicing cardiologist for more than three decades, I agree with the latter—it’s dead wrong.
Why does the AHA cling to recommendations that fly in the face of scientific evidence?
What I discovered was both eye-opening and disturbing. The AHA not only ignored all the other risk factors for heart disease, but it appointed someone with ties to Big Food and bizarre scientific beliefs to lead the guideline-writing panel—just the type of thing that undermines the public’s confidence in the medical community.
The AHA guidelines warrant that saturated fat make up no more than 5 to 6 percent of daily calories for adults because this will lower “bad” (LDL) cholesterol. And, for those people who need blood pressure control, the guidelines also suggest lowering sodium (salt) intake to no more than a teaspoon (2,300 mg) daily.
Despite many other known risk factors for heart disease, salt and fat were, astonishingly, the only two considered by the AHA panel writing the guidelines. There are many other recognized risk factors the AHA ignored, including blood sugar level, low “good” (HDL) cholesterol, insulin levels, and body weight—all of these are influenced by diet.
In fact, most people who have heart attacks don’t have elevations in bad cholesterol. They are much more likely to have metabolic syndrome—a condition that puts you at high risk for diabetes and heart disease. Metabolic syndrome is defined when you have three of the following: high triglycerides (blood fats), high blood sugar, high blood pressure, low “good” cholesterol (HDL-C), and a large abdomen measurement (abdominal obesity).
Interestingly enough, blood triglycerides do not go up with eating fat—they go up if you eat a diet high in processed grains, starches, and sugar. Unfortunately for the proponents of high-carbohydrate diets, high blood triglycerides are a major risk factor for heart disease. In addition, low fat/high carb diets lower protective “good” cholesterol and raise insulin. These diets are implicated in the development of diabetes, which is a potent risk factor for developing heart disease.
The writers of the 2013 statin guidelines based their recommendations on studies that looked at the reduction in the risk of events like heart attacks in people treated with statins, compared to people on a placebo. The AHA dietary guidelines do not cite any diet studies that looked at whether following a specific diet lowered the risk of developing cardiac events—yet they are giving dietary advice. Why?
There might be two plausible reasons. One is the AHA’s moneymaking “Heart Check Program.” The second is the conflict of interest (and curious beliefs) of Robert Eckel—the co-chair of the panel that wrote the guidelines.
The AHA introduced the Heart Check Program in 1995 and it has been quite the moneymaker, as the AHA sells the Heart Check stamp-of-approval to food manufacturers. Food companies shell out between $1,000 and $7,500 to be certified by the Heart Check Program—and then there are yearly renewal fees. The program currently endorses 889 foods as “heart-healthy.”
And the Heart Check Program is not the only way the AHA benefits from Big Food companies. In their annual report for 2012-2013, the AHA lists among its lifetime donors of $1 million or more Conagra, Quaker Oats, and Campbell Soups, among others.
Forty-five percent of these “heart healthy” foods—over 400 of them—are meat; 92 are processed meats—which have been shown to have either neutral or negative effects on heart health.
Even more problematic are the foods containing added sugar. The AHA recommends that women consume less than 6 teaspoons (100 calories) of sugar a day and less than 9 teaspoons (150 calories) for men. Yet there are items that get the nod of approval from the Heart Check program despite being near or at the sugar limit, like Bruce’s Yams Candied Sweet Potatoes and Healthy Choice Salisbury Steak. Indeed, until 2010, the Heart Check imprimatur was stamped on a drink called Chocolate Moose Attack, which contained more sugar per ounce than regular Pepsi.
And until this year, Heart Check approved many foods with trans-fats, which raise bad cholesterol and lower good cholesterol, among other deleterious effects on health, like increasing inflammation and the laying down of calcium in arteries.
Like the dietary guidelines, the AHA Heart Check Program appears to address only the effect of foods on cholesterol level and blood pressure. Meanwhile, since the 1970s, our yearly sugar consumption has skyrocketed along with the incidence of diabetes and obesity.
This brings us to Dr. Robert H. Eckel, the co-chair of the Working Group. He is a consultant for Foodminds, which specializes “in food, beverage, nutrition, health and wellness.” Foodminds works with more than 30 leading food, beverage, and nutrition to offer a “one stop shop of…consulting…to guide food and beverage companies in navigating the complexities around the upcoming FDA Nutrition Facts label overhaul.” In other words, Foodminds is a lobbying firm for “Big Food.”
And then there is this:
Dr. Eckel describes himself as “a scientist and professing six-day creationist and a member of the technical advisory board of the Institute for Creation Research…” Many scientists are religious. This is not to question Dr. Eckel’s religious beliefs, but to question his ability to think scientifically. He believes there is scientific proof that the world was created in six days and that evolution does not exist. This should at least raise eyebrows when the co-chair of an influential panel charged with giving scientifically sound dietary advice has a financial conflict of interest and proselytizes for beliefs that are anti-scientific.
Practice guidelines affect both public policy and medical practice. We should expect professional medical organizations—like the American Heart Association—to examine all the evidence relating to diet and heart disease risk.
The American people should be able to trust that only impartial scientists write guidelines. We should be confident that those experts are not working to advance corporate interests and that they do not espouse beliefs that are well outside the scientific mainstream. An avowed creationist who consults for a food lobby hardly seems an appropriate choice to fulfill these criteria.
For the last several decades, the AHA has promoted a low-fat high-carbohydrate diet as a cornerstone of heart health. It has taken a very public position that saturated fats are a major driver of heart disease risk and the mounting tide of evidence that this is dead wrong must put them it in a very uncomfortable position. And yet a fundamental requirement of science—as opposed to propaganda—is that when evidence that contradicts a hypothesis is replicated over and over again, that hypothesis must be abandoned.
The idea that eating high amounts of saturated fat causes hardening of the arteries—the so-called “diet-heart hypothesis”— deserves to be jettisoned along with other discredited belief systems. Creationism comes to mind. Will the AHA step up to the plate?
The American Heart Association had not returned an inquiry for comment at the time of publishing.