Back in June, the American Heart Association released a Presidential Advisory Report that I covered in posts titled The American Heart Association Bravely Admits They’ve Been Right All Along, part one and part two.
The lead author of the report was Dr. Frank Sucks … er, Sacks, who is a fine example of a scientist too firmly wedded to a particular hypothesis to ever be objective. Sucks was chairman of the AHA’s Nutrition Committee back when they were releasing guidelines warning us that saturated fats will kill us and vegetable oils (and Cocoa Puffs!) will save our lives.
He was the lead researcher on the DASH trial, which concluded that restricting salt produces “major” benefits for hypertension … even though the study’s own data showed that reducing salt intake by 75% led to a measly three-point drop in blood pressure.
Sucks .. er, Sacks was also a member of the National Cholesterol Education Program (the folks who decided we should all have a total cholesterol score below 200), and a member of the Whole Grains Council, which is generously supported by the grain industry.
In other words, you’d be hard-pressed to find someone more personally invested in the arterycloggingsaturatedfat! and hearthealthywholegrains! nutrition advice than Dr. Frank Sacks … with the possible exception of The Guy From CSPI. So naturally, The Guy From CSPI (or his organization’s newsletter, to be exact) recently interviewed Dr. Sacks to explain why they’ve both been right all along.
Here are some quotes from a CSPI article titled A refresher on fats:
Q: How strong is the evidence that saturated fat in foods like meat, butter, and cheese is harmful?
A: The evidence that saturated fat causes atherosclerosis and heart disease is compelling. It’s consistent across randomized trials, large observational epidemiologic studies, and animal studies.
This is, of course, complete poppycock. Consistent across randomized trials and epidemiologic studies?! Not even close. I’ve written about the glaring inconsistencies in the evidence in this post and many others.
Q: Why have some people heard that the evidence on saturated fat has gotten weaker?
Actually, CSPI Guy, the evidence hasn’t “gotten weaker.” It was never strong to begin with. But let’s see what Sucks has to say on the matter.
A: Some of the more recent studies take a standard epidemiologic approach, which is inadequate. Saturated fat seems to be harmless in those studies because it’s being compared, by default, to the typical American diet, which is high in refined, junk-food carbohydrates. They’re also linked to a higher risk of heart disease.
Ahh, I see! Recent studies – and apparently only recent studies – took a standard and therefore inadequate epidemiological approach! Gee, it’s nice to see a Harvard researcher finally speak out against drawing conclusions from observational evidence. Too bad Harvard spent decades scaring the hell out of people based on crappy observational studies.
Q: Why inadequate?
A: Let’s say you give someone advice to reduce their saturated fat. Well, what do they eat instead? If they just reduced their saturated fat, they’d lose weight, because they’d be getting fewer calories. That’s unlikely. So what do they actually do? In many cases, people who eat less saturated fat eat more refined carbohydrates.
Yeah, that tends to happen when you tell people bacon and eggs will kill them and then put the American Heart Association seal of approval on boxes of Cocoa Puffs. And Dr. Sacks was a big muckety-muck at the AHA back when that was happening.
A: But Walter Willett and Frank Hu—my colleagues at Harvard—devised a new epidemiology based on food substitutions that would occur in real life. And that’s really innovative.
Allow me to interpret that: Willet and Hu spent lord-only-knows how much time finding a new way to crunch the numbers so they can continue believing that 1) observational studies based on food surveys tell us anything meaningful, and 2) saturated fat is the killer they’ve always said it is.
Q: Didn’t you re-examine the clinical trials from the 1960s that assigned people to diets with different fats and then measured heart disease rates?
A: Yes. We separated them into core and non-core trials, because some were superb in quality, and some were kind of dreadful. So we set out uncontroversial criteria for a good clinical trial.
Allow me to interpret that as well: we looked at all the clinical trials and decided the ones that showed higher rates of heart disease after switching to vegetable oils just HAD TO WRONG, DAMNIT! So we put those in the ‘dreadful’ category. Then, after digging like crazy, we found a whopping four trials that seemed to suggest that switching to vegetable oils reduces heart disease. We labeled those ‘superb in quality.’ And our criteria are uncontroversial because we all agreed with ourselves.
Q: Is large LDL safer than small LDL, as some people argue?
A: No. It’s basically a non-issue. If you have a lot of big LDL, it’s no better than a lot of little LDL. In fact, big LDL is probably worse, because it’s loaded up with more cholesterol.
Q: Do high triglyceride levels cause heart disease?
A: We don’t have proof with triglycerides the way we have proof that LDL cholesterol causes heart disease. But the evidence linking triglycerides to heart disease is getting stronger.
Fascinating. Dr. Sacks believes we have proof that LDL causes heart disease, but don’t yet have proof triglycerides cause heart disease. Perhaps he missed this study and its conclusion:
Stepwise higher concentrations of nonfasting triglycerides were associated with stepwise higher risk of heart failure; however, concentrations of low-density lipoprotein cholesterol were not associated with risk of heart failure in the general population.
I suppose Sacks could dismiss the study as dreadful, but that could be embarrassing since it was published by The American Heart Association.
Q: What about coconut oil?
A: Some of the short-chain saturated fatty acids in coconut oil don’t raise LDL cholesterol. But they don’t counteract the effects of the oil’s longer-chain fatty acids, which do increase LDL cholesterol. So coconut oil raises LDL cholesterol in the same way that, say, butter does.
Ah, yes, in the Presidential Advisory Report, Dr. Sacks assured us that coconut oil is even worse for our hearts than butter because it’s higher in saturated fat. But Dr. Michael Moseley recently conducted a small study in which volunteers added 50 grams of butter, olive oil or coconut oil to their diets. A BBC article describes the results:
As expected the butter eaters saw an average rise in their LDL levels of about 10%, which was almost matched by a 5% rise in their HDL levels.
Those consuming olive oil saw a small reduction, albeit a non-significant drop, in LDL cholesterol, and a 5% rise in HDL. So olive oil lived up to its heart-friendly reputation.
But the big surprise was the coconut oil. Not only was there no rise in LDL levels, which was what we were expecting, but there was a particularly large rise in HDL, the “good” cholesterol, up by 15%. On the face of it that would suggest that the people consuming the coconut oil had actually reduced their risk of developing heart disease or stroke.
But there I go again, digging up contrary information. Dr. Sacks and The Guy From CSPI are worried that people like me are causing confusion:
Q: How can people avoid confusion?
A: If you want to sort out what is good scientific knowledge and what is speculation or biased, look at guidelines produced by the American Heart Association, American Diabetes Association, or American Cancer Society.
Riiiight. Because organizations whose very existence depends on generous contributions from the makers of vegetable oils and grain products couldn’t possibly be biased.
So what’s going on here? Are people like Sucks … er, Sacks and the The Guy From CSPI just pathological liars? Are they intentionally dishonest?
Actually, I don’t think so. I think we’re seeing yet another example of the phenomenon described in an excellent book I haven’t mentioned in quite a while: Mistakes Were Made (but not by me). The subtitle is Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts. That pretty much captures the subject matter.
The authors give many examples of the same basic behavior:
DNA evidence exonerates someone who spent 15 years in prison for murder, but the district attorney still insists he didn’t prosecute an innocent man. The lab screwed up, or someone tainted the samples, or the guy in prison must have had an accomplice whose DNA ended up on the victim.
A doctor’s procedure kills a patient, but the doctor insists the procedure was correct. Some complication that was impossible to predict caused the death.
A therapist prods a young patient into “recovering” memories of sexual abuse that were supposedly repressed, but are later proven to be false. The therapist insists the memories are accurate and rationalizes away all evidence that the abuse couldn’t have happened.
A woman stays married to a physically abusive husband, insisting to her friends and family that he’s really a sweet guy at heart and his behavior is his employer’s fault, or his parents’ fault, or whatever.
A researcher accepts generous funding from a pharmaceutical company, then fudges a few numbers in a study concluding that the company’s newest drug is wonderful, but tells himself the drug really is wonderful and the fudged numbers simply enhance the truth.
A boy who moves to a new school district and wants to fit in somewhat reluctantly joins a pack of bullies in tormenting a fat, weak kid … and the more he participates in the bullying, the more convinced he becomes that the fat, weak kid deserves every bit of it.
As the authors explain, humans are naturally inclined to engage in self-justification as a means to reduce cognitive dissonance. Most of us believe we’re basically decent and competent, and we selectively filter information and rewrite memories to support that belief. (People with low self-esteem do likewise to confirm their negative opinion of themselves, but that’s another matter.)
The result is that once we’ve chosen a path or a position, we’re quite brilliant at convincing ourselves the path or position is correct … and the longer we’re on that path, or the more public the position, or the more consequential the action, the more we’re psychologically driven to justify it.
DNA says the guy didn’t do it? That can’t be right! I’m a good person, and a good person wouldn’t railroad an innocent man, so he had to be involved in that murder.
The patient died the family are blaming me? That can’t be right! I’m a good doctor, and a good doctor wouldn’t make a mistake that killed a patient. It wasn’t my procedure; it was something else.
Does fudging a few numbers make me a dishonest researcher? No, I’m a good scientist. Those numbers were outliers, and I had to smooth them over so this life-saving drug can be approved and help people who need it.
I picked on a weakling just to fit in? No, that would make me a bad guy, and I know I’m a good guy. The weakling is pathetic and annoying and not a good person, so he had it coming to him.
You get the idea. I’m a good and competent person, but I made a stupid or harmful decision creates cognitive dissonance. So we convince ourselves the decision wasn’t stupid or harmful. We do that largely through confirmation bias; that is, by latching onto any evidence that we were right and ignoring or dismissing evidence that we were wrong.
So imagine you’ve spent decades very publicly promoting grains and vegetable oils as the key to health while warning people away from saturated fats. Imagine you’ve also received generous donations from the makers of grains and vegetable oils – which is fine, you tell yourself, because those funds merely help you fulfill your life-saving mission.
Now imagine the science is turning against you. New (and old but recently discovered) studies suggest that vegetable oils and grains are harmful to health, while animal fats and other saturated fats are either neutral or beneficial.
You only have a couple of choices. You can look in the mirror and say to yourself, “Oh my god. I’ve spent 30 years giving out advice that helped turn countless people into fat diabetics suffering from inflammation and autoimmune diseases they didn’t need to have.” Or you can tell yourself you’re a good scientist, the advice you’ve been handing out is actually beneficial, and those new studies can be ignored because they were conducted by people who are incompetent.
As the authors point out, Americans tend to forgive and sometimes even rally to support public figures who admit to their mistakes, take the blame, and sincerely apologize. Nonetheless, most public figures and organizations don’t go that route. They can’t admit to themselves that they were wrong, so they double down. They rationalize. They attack the critics. And so the correction, whatever it is, almost always happens as the result of outside forces.
That’s why whenever I receive one of those email petitions demanding that the AHA or USDA change their dietary advice, I toss it. They’ll never announce that they were wrong because their heads would probably explode as a result. All we can do is convince more and more of the public to stop listening to them. I’m pretty sure that’s already happening — even if Dr. Sacks and The Guy From CSPI have a psychological need to convince themselves we’re just confused.
If you enjoy my posts, please consider a small donation to the Fat Head Kids GoFundMe campaign.