You are looking at the cover from a March 1984 issue of TIME magazine that helped to ignite the low-fat diet craze in America. The article inside began with the headline: Sorry, It’s True. Cholesterol Really Is A Killer.
I remember reading that article. At the time, I found it convincing. (Cut me some slack; I was only 25 and hadn’t yet nurtured my inner skeptic. I still believed researchers were objective and journalists who wrote for major media outlets were critical thinkers.)
So, like millions of other Americans, I began trying to live on a low-fat diet. I stopped buying meat and butter at the grocery store and started eating pasta, Egg Beaters and margarine. You know how much good that did me.
I’m 51 now, and my inner skeptic is fully developed. Re-reading the article 26 years later, I’m surprised it convinced anyone, especially doctors, who should’ve seen through the nonsense. You can read the full version online, but we’ll deal with bits of it here, starting with the sub-headline:
Cholesterol is proved deadly, and our diet may never be the same
The writer got it half right. Our diets were never the same. Within a couple of years, grocery stores looked as if they’d been the scene of a tagging contest between two gangs named LOW-FAT and CHOLESTEROL FREE. As for cholesterol being proved deadly, we’ll get to that.
This year began with the announcement by the Federal Government of the results of the broadest and most expensive research project in medical history. Its subject was cholesterol, the vital yet dangerous yellowish substance whose level in the bloodstream is directly affected by the richness of the diet.
Yup, that’s how stupid Mother Nature is … she designed the body to require all kinds of substances that happen to be deadly.
Anybody who takes the results seriously may never be able to look at an egg or a steak the same way again.
Well, that’s the problem: we took the results seriously. I remember reading a funny column by Bill Granger, a Chicago Tribune writer whose work I enjoyed. He described living on his new low-fat diet, and how his wife kept taking away his bacon and eggs and making him eat cereal so his heart wouldn’t get fat. Granger suffered a debilitating stroke in 2000 at the age of 59. Maybe it would’ve happened anyway … but the guy could’ve been enjoying bacon and eggs the whole time.
For what the study found, after ten years of research costing $150 million, promises to have a profound impact on how Americans eat and watch their health. Among the conclusions:
- Heart disease is directly linked to the level of cholesterol in the blood.
- Lowering cholesterol levels markedly reduces the incidence of fatal heart attacks.
Basil Rifkind, project director of the study, believes that research “strongly indicates that the more you lower cholesterol and fat in your diet, the more you reduce your risk of heart disease.”
Lock that quote about the diet in your brain. You’ll see why in a moment. But first, notice the “Ornish logic” in this paragraph:
Everybody knows George Ford. Or somebody like George Ford. There he was, 52, the energetic president of a small Ohio electronics firm who “wouldn’t eat an egg unless it was fried in bacon grease” His lunches were executive size. He matched his business cronies drink for drink. He smoked “pretty heavily” and exercised with a knife and fork. In the winter of 1981 doctors informed Ford that his cholesterol levels were dangerously high; by April he required a quadruple coronary bypass operation. He emerged from the hospital determined to revise his ways radically. Today he does not smoke, he exercises four or five days a week, and he sticks scrupulously to a diet high in fiber and low in cholesterol and fat. “I haven’t had a slice of bacon in three years,” he says. He is proud and relieved that his cholesterol level is normal.
Okay, so we’ve got a guy who smoked, drank heavily, never exercised and, by the way, ate bacon and eggs. Now he doesn’t smoke, exercises, probably drinks a lot less, and lives on a low-fat diet. So if his health is better now, it therefore proves — drum roll, please — low-fat diets are good for you!
Brilliant. Tell ya what: Give me a heavy-smoking, hard-drinking, fat-gobbling couch potato and let me convince him to stop smoking, stop drinking, start exercising, and take up chewing tobacco. When his health improves — and it would — I will therefore conclude that chewing tobacco prevents heart disease.
For decades, researchers have been trying to prove conclusively that cholesterol is a major villain in this epidemic. It has not been easy.
No kidding it wasn’t easy. That’s because all the previous attempts to lower heart disease through low-fat diets failed. So did the major clinical trial conducted in the 1970s to test the first big cholesterol-lowering drug, clofibrate. The subjects who took clofibrate ended up with lower cholesterol, all right … but they had a 47% higher death rate than the placebo group. Whoops.
In 1913, Russian Pathologist Nikolai Anitschkow showed that he could produce similar deposits, or plaques, in the arteries of rabbits just by feeding them a diet rich in cholesterol.
Well, there’s a reason for that: rabbits don’t eat eggs. They also they don’t form packs of vicious hunter-rabbits to run down pigs and devour them. If you force a lion to live on carrots, by the way, it will get sick and die, thus proving that carrots are deadly.
Subsequent research further supported the connection between diet and cardio-vascular disease. Epidemiologist Ancel Keys conducted a landmark study in seven nations beginning in 1947. He discovered direct correlations between a country’s incidence of heart disease, the level of cholesterol in the blood and the amount of animal fat in the national diet.
If you’ve seen Fat Head, you know how honest Ancel Keys was. He cherry-picked seven countries out of 22. As Uffe Ravnskov demonstrated in his books, you could cherry-pick seven other countries from the same 22 and show an inverse correlation between fat and heart disease; the more fat, the less heart disease.
The experts were still not quite able to pin the blame on cholesterol, however. Explains Fred Mattson, a leading researcher at the University of California at San Diego, “We were missing a key piece of evidence: no one had ever shown that reducing the level of cholesterol in the blood did any good.”
You speak the truth, Dr. Mattson — but it wasn’t for a lack of trying. Cholesterol was successfully lowered in research studies several times. It just didn’t do any good.
Now, remember when I said to lock that quote from Dr. Rifkind about fatty diets into your brain? This is the study that prompted the TIME article:
The elaborate, ten-year program recruited 3,806 men between the ages of 35 and 59, all of whom had cholesterol levels above 265 mg per deciliter of blood (the average for U.S. adults is 215 to 220). Half the men were put on daily doses of cholestyramine, an unpleasant, cholesterol-lowering drug that was mixed with orange juice and taken six times a day. One participant likened taking it to swallowing “orange-flavored sand.” Among its side effects: constipation, bloating, nausea and gas. The other half received a similarly gritty placebo. Researchers had decided to use a drug rather than diet to lower cholesterol, because it would have been virtually impossible to control or measure the diet of so many men over so long a period. By the end of the study, the cholestyramine group had achieved an average cholesterol level 8.5% lower than that of the control group and had suffered 19% fewer heart attacks. Their cardiac death rate was a remarkable 24% lower than that of the placebo group.
So, let’s think this one through: a group of study subjects who took a cholesterol-lowering drug ended up with a slightly lower rate of heart attacks, and therefore … THIS FINALLY PROVES THAT A FATTY DIET WILL GIVE YOU HEART DISEASE!
Here’s the proper response to that leap in logic: ARRRRRRGGGGHHHHHHH!!!!!
I can’t believe I didn’t recognize this load of bologna for what it was even at the tender age of 25. First off, that “remarkable” reduction in the cardiac death rate wasn’t so remarkable if you look at the actual numbers — which, in my defense, didn’t appear in TIME. Remember, we’re talking about 3,806 men with abnormally high cholesterol. With that in mind, here are the study results:
Heart Attacks: 158 Heart-Attack Deaths: 38 Total Deaths: 71
Heart Attacks: 130 Heart-Attack Deaths: 30 Total Deaths: 68
With a little Excel magic, I determined that 30 deaths versus 38 is a 24% lower death rate if you put 1940 men in the drug group and 1866 in the placebo group, which in turn gave me the actual heart-attack death rates as a percentage in each group:
Compare those figures using the magic of division, and you’ll get a 24% reduction in the rate: (2.04-1.55) /2.04 = .24. This is exactly what the statin-makers do with their data today. They use division to get impressive-sounding reductions.
But to calculate the actual difference, you use simple subtraction: 2.04% – 1.55% — which means the difference in the rate of heart-attack deaths between the two groups was (wait for it) … 0.49%. That’s right, less than one half of one percent. Put two hundred men on this drug, and you would in theory prevent (almost) one heart-attack death.
So from this miniscule difference, Rafkind came up with an astounding conclusion: Since fatty foods raise cholesterol levels in some people, and since a cholesterol lowering-drug produced a very slight drop in the heart-disease rate, fat and cholesterol in the diet must cause heart disease. Or as he put it, “The more you lower cholesterol and fat in your diet, the more you reduce your risk of heart disease.”
Dr. Malcolm Kendrick has a lovely explanation of this type of logic in his book The Great Cholesterol Con. Researchers even gave it a fancy-sounding name to make it sound legitimate: teleoanalysis. Basically, the idea is this: We can’t prove (despite years of trying) that A causes C. But if we can prove A is linked to B, and B is linked to C, then we can conclude that A causes C, despite the lack of any actual evidence.
If that sounds like decent logic to you, try applying it elsewhere. Here, I’ll get you started: Drinking a lot of water causes frequent urination. Frequent urination is linked to diabetes. Therefore, drinking too much water can lead to diabetes.
Or for a more relevant example: Adopting a low-fat diet reduces cholesterol in some people. In the clofibrate trial, the group that took a cholesterol-lowering drug had a 47% higher death rate. Therefore, low-fat diets cause premature death.
That makes just as much sense as Rifkind’s logic. All we can actually conclude about bacon and eggs from his study is that you can put them on a plate and make a reasonable facsimile of an unhappy face. But that’s not how TIME, or most doctors, or most of the scientific world saw it. At least there were few skeptics:
Other doctors are not so sure, and urge a stricter interpretation of the study. Says Dr. Edward Ahrens, a veteran cholesterol researcher at Rockefeller University: “Since this was basically a drug study, we can conclude nothing about diet; such extrapolation is unwarranted, unscientific and wishful thinking.”
Spot-on, Dr. Ahrens. Unfortunately, wishful thinking became confused with settled science.
The American Heart Association has been urging people for years to take this preventive approach. Specifically, A.H.A. experts recommend that American men limit themselves to 300 mg of cholesterol a day, and women to 225 mg, roughly the amount in a single egg. They insist that fat should make up no more than 30% (rather than its current 40%) of the diet, and no more than one-third of this should be saturated.
Yup, I really should trade my eggs for a nice, big bowl of Cocoa Puffs. The AHA says so, and they’re staffed by experts.
Because atherosclerosis develops slowly throughout life, Gotto believes that children should be started on a low-fat and low-cholesterol regimen at about the age of two.
Definitely. That way they can be taking drugs for ADD by the age of eight.
Many Americans have already heeded the A.H.A. gospel. Over the past 20 years, the nation’s consumption of butter has dropped 30%, egg consumption has declined 14%, and the average intake of animal fat has plummeted 60%.
I guess that explains the remarkable improvements in the nation’s health we’ve seen since 1984.
Over the same two decades, deaths from heart disease have declined 30%.
For Pete’s sake, lady! Smoking dropped by nearly 50% over the same period! Think maybe those two are related in some way?
Even so, not everyone agrees with the A.H.A. on dietary reform. The drop in mortality, some scientists point out, is partly due to better treatment for heart disease and to a decline in smoking among middle-aged men.
Sorry. My bad.
“I have an aversion to this cholesterolphobia,” scoffs Purdue Cardiologist Story. “Why treat everybody? We don’t give everybody insulin out of fear of diabetes.” According to Rockefeller University’s Ahrens, who has spent nearly 40 years studying cholesterol metabolism, individuals differ greatly in their response to dietary fat and cholesterol. “To deny everyone red meat could mean taking away the joy of life unnecessarily,” he says. “And as an inexpensive source of good nutrition, there is nothing more glorious than the egg.”
Thank you, Dr. Story. I wish more people had listened to your scoffing.
The food manufacturers who oppose the Heart Association’s dietary recommendations have come in for widespread criticism. “Instead of making excuses, they ought to be adopting the long-range goal of making better products,” says Dr. John LaRosa, an internist at George Washington University Medical School.
Don’t worry, Dr. LaRosa, they heard you. They stopped making excuses and started making Snackwells, which became a $490 million business by the early 1990s. Eat all the sugary treats you want — they’re fat-free!
Saturated fat, usually in the form of coconut oil, lurks in most commercially baked breads and cakes, in nondairy creamers, on the oiled surface of frozen French fries, and even in wholesome granola.
Coconut oil: lurking in our food. Granola: wholesome. American Heart Association: experts, giving us the gospel. People who don’t agree with the AHA: scoffers, coming in for widespread criticism. Man, it’s inspiring to watch an unbiased journalist at work. At least the good folks at CSPI managed to get all that lurking coconut oil replaced with hydrogenated soybean oil.
The trends of the past two decades give cause for optimism. Medical researchers generally believe that Americans will become increasingly willing to change to a healthier diet and a more sensible lifestyle. By the year 2000, they say, heart disease could cease to be the leading cause of death in America.
Yeah, I’d say that’s about how it all worked out.