The 1984 Cholesterol Consensus Conference final report was a whitewash, containing no mention of the large body of e thence that conflicted with the lipid hypothesis. One of the blanks was filled in with the number '200'. The document defined all those with cholesterol levels above 200 mg/dL as "at risk" and called for mass cholesterol screening, even though the most ardent supporters of the lipid hypothesis had surmised in print that 240 should be the magic cut-off point. Such screening would in fact need to be carried out on a massive scale, as the federal medical bureaucracy, by picking the number 200, had defined the vast majority of the American adult population as "at risk". The report resurrected the ghost of Norman Jolliffe and his Prudent Diet by suggesting the avoidance of saturated fat and cholesterol for all Americans now defined as "at risk", and specifically advised the replacement of butter with margarine.
The Consensus Conference also provided a launching pad for the nationwide National Cholesterol Education Program (NCEP) which had the stated goal of "changing physicians' attitudes". NHLBI-funded studies had determined that while the general population had bought into the lipid hypothesis and was dutifully using margarine and buying low-cholesterol foods, the medical profession remained skeptical. A large "Physicians Kit" was sent to all doctors in America, compiled in part by the American Pharmaceutical Association whose representatives served on the NCEP coordinating committee. Doctors were taught the importance of cholesterol screening, the advantages of cholesterol-lowering drugs and the unique benefits of the Prudent Diet. NCEP materials told every doctor in America to recommend the use of margarine rather than butter.
In November of 1986, the Journal of the American Medical Association published a series on the Lipid Research Clinics trials, including "Cholesterol and Coronary Heart Disease: A New Era" by long-time American Heart Association member Scott Grundy, MD, PhD. The article is a disturbing combination of euphoria and agony - euphoria at the forward movement of the lipid hypothesis juggernaut, and agony over the elusive nature of real proof. "The recent Consensus Conference on Cholesterol...implied that levels between 200 and 240...carry at least a mild increase in risk, which they obviously do...," said Grundy, directly contradicting an earlier statement: "Evidence relating plasma cholesterol levels to atherosclerosis and CHD has become so strong as to leave little doubt of the etiologic connection." Grundy called for "the simple step of measuring the plasma cholesterol level in all adults" and said, "...those found to have elevated cholesterol levels can be designated as at high risk and thereby can enter the medical care system ... an enormous number of patients will be included.." Who benefits from "the simple step of measuring the plasma cholesterol level in all adults"? Why, hospitals, laboratories, pharmaceutical companies, the vegetable oil industry, margarine manufacturers, food processors and, of course, medical doctors.
"Many physicians will see the advantages of using drugs for cholesterol lowering...," said Grundy, even though "a positive benefit/risk ratio for cholesterol-lowering drugs will be difficult to prove". In the US alone, the cost of cholesterol screening and cholesterol-lowering drugs now stands at $60 billion per year, even though a positive risk/benefit ratio for such treatment has never been established.
Grundy was equally schizophrenic about the benefits of dietary modification.. "Whether diet has a long-term effect on cholesterol remains to be proved," he stated, but "Public health advocates furthermore can play an important role by urging the food industry to provide palatable choices of foods that are low in cholesterol, saturated fatty acids and total calories." Such foods, almost by definition, contain partially hydrogenated vegetable oils that imitate the advantages of animal fats.
Grundy knew that the trans fats were a problem, that they raised serum cholesterol and contributed to the etiology of many diseases. He knew, because a year earlier, at his request, Mary Enig had sent him a package of data detailing numerous studies that gave reason for concern, which he acknowledged in a signed letter as an important contribution to the ongoing debate.
Other mouthpieces of the medical establishment fell in line after the Consensus Conference. In 1987, the National Academy of Sciences published an overview in the form of a handout booklet, containing a whitewash of the trans problem and a pejorative description of palm oil - a natural fat high in beneficial saturates and mono-unsaturates that, like butter, has nourished healthy population groups for thousands of years, and, also like butter, competes with hydrogenated fats because it can be used as a shortening.
The following year, the Surgeon General's Report on Nutrition and Health emphasised the importance of making low-fat foods more widely available. Project LEAN (Low-fat Eating for America Now) - sponsored by the J. Kaiser Family Foundation and a host of establishment groups such as the American Heart Association, the American Dietetic Association, the American Medical Association, the USDA, the National Cancer Institute, the Centers for Disease Control and the National Heart, Lung and Blood Institute - announced a publicity campaign to "aggressively promote foods low in saturated fat and cholesterol in order to reduce the risk of heart disease and cancer".
The next year, Enig joined Frank McLaughlin, Director of the Center for Business and Public Policy at the University of Maryland, in testimony before the National Food Processors Association (NFPA). It was a closed conference for NFPA members only. Enig and McLaughlin had been invited to give "a view from academia". Enig presented a number of slides and warned against singling out classes of fats and oils for special pejorative labeling. A representative from Frito-Lay took umbrage at Enig's slides which listed amounts of trans fats in Frito-Lay products. Enig offered to re-do the analyses if Frito-Lay were willing to fund the research. "If you'd talk different, you'd get money," he said.
Enig urged the association to endorse accurate labeling of trans fats in all food items, but conference participants - including representatives from most of the major food processing giants - preferred a policy of "voluntary labeling" that did not unnecessarily alert the public to the presence of trans fats in their foods. To date, they have prevailed in preventing the inclusion of trans fats on nutrition labels.
Enig's cat-and-mouse game with Hunter and Applewhite of the ISEO continued throughout the later years of the 1980s. Their modus operandi was to pepper the literature with articles that downplayed the dangers of trans fats, to use their influence to prevent opposing points of view from appearing in print, and to follow up the few alarmist articles that did squeak through with "definitive rebuttals".
In 1987 Enig submitted a paper on trans fatty acids in the US diet to the American Journal of Clinical Nutrition, as a reply to the erroneous 1985 FASEB report as well as to Hunter and Applewhite's influential 1986 article - which by even the most conservative analysis underestimated the average American consumption of partially hydrogenated fats. Editor-in-chief Albert Mendeloff, MD, rejected Enig's rebuttal as "inappropriate for the journal's readership". His rejection letter invited her to resubmit her paper if she could come up with "new evidence". In 1991, her article finally came out in a less prestigious publication, the Journal of the American College of Nutrition, although Applewhite did his best to coerce editor Mildred Seelig into removing it at the last minute.
Hunter and Applewhite on oitted letters and then anergyicle of rebuttal to the American Journal of Clinical Nutrition, which were published shortly thereafter. In their article, "Reassessment of Trans Fatty Acid Availability in the US Diet", Hunter and Applewhite argued that the amount of trans in the American diet had actually declined since 1984 due to the introduction of soft margarines and tub spreads. The media fell in line with their pronouncements, with numerous articles by food writers recommending low-trans tub spreads, made from polyunsaturated vegetable oils, as the sensible alternative to saturated fat from animal sources. This was not surprising, as most newspapers rely on the International Food Information Council, an arm of the food processing industry, for their nutrition information.
Enig and the University of Maryland group were not alone in their efforts to bring their concerns about the effect of partially hydrogenated fats before the public.
Kummerow at the University of Illinois, blessed with independent funding and an abundance of patience, carried out a number of studies that indicated that trans fats increased the risk factors associated with heart disease and that vegetable-oil-based fabricated foods such as Egg Beaters cannot support life.
George Mann, formerly with the Framingham project, possessed neither funding nor patience and in fact was very angry with what he called the "Diet/Heart scam". His independent studies of the Masai in Africa, whose diet is extremely rich in cholesterol and saturated fat and who are virtually free of heart disease, had convinced him that the lipid hypothesis was "the public health diversion of this century...the greatest scam in the history of medicine".
Mann resolved to bring the issue before the public by organising a conference in Washington, DC, in November of 1991. "Hundreds of millions of tax dollars are wasted by the bureaucracy and the self-interested Heart Association," 'wrote in his invitation to participants. "Segments of the food industry play the game for profits. Research on the true causes and prevention is stifled by denying funding to the 'unbelievers'. This meeting will review the data and expose the rascals."
The rascals did their best to prevent the meeting from taking place. Funding promised by the Greenwall Foundation of New York City was later withdrawn, so Mann paid most of the bills. A press release, sent as a dirty trick to speakers and participants, wrongly announced that the conference had been cancelled. Several speakers, including the prestigious Dr Roslyn Alfin-Slater and Dr Peter Nixon of London, did in fact renege at the last minute on their commitment to attend. Dr Eliot Corday of Los Angeles cancelled after being told that his attendance would jeopardise future funding.
The final pared-down roster included: Dr George Mann; Dr Mary Enig; Dr Victor Herbert; Dr Petr Skrabenek; Dr James McCormick, a physician from Dublin; Dr William Stehbens from New Zealand, who described the normal protective process of arterial thickening at points of greatest stress and pressure; and Dr Meyer Texon, an expert in the dynamics of blood flow.
Mann, in his presentation, blasted the system that had foisted the diet/heart-disease dogma on a gullible public. "You will see," he said, "that many of our contributors are senior scientists. They are so for a reason that has become painfully conspicuous as we organised this meeting. Scientists who must go before review panels for their research funding know well that to speak out, to disagree with this false dogma of Diet/Heart, is a fatal error. They must comply or go unfunded. I could show a list of scientists who said to me, in effect, when I invited them to participate, 'I believe you are right, that the Diet/Heart hypothesis is wrong, but I cannot join you because that would jeopardise my perks and funding.' For me,that kind of hypocritical response separates the scientists from the operators, the men from the boys."
By the 1990s the operators had succeeded, by slick manipulation of the press and of scientific research, in transforming America into a nation that was well and truly oiled. Consumption of butter had bottomed out at about 5 grams per person per day, down from almost 18 grams at the turn of the century. Use of lard and tallow had been reduced by two-thirds. Margarine consumption had jumped from less than 2 grams per person per day in 1909 to about 11 grams in 1960. Since then, consumption figures have changed little, remaining at about 11 grams per person per day - perhaps because knowledge of margarine's dangers has been slowly seeping out to the public.
However, most of the trans fats in the current American diet come not from margarine but from shortening used in fried and fabricated foods. American shortening consumption of 10at mas per person per day held steady until the 1960s, although the content of that shortening had changed from mostly lard, tallow and coconut oil - all natural fats - to partially hydrogenated soybean oil. Then shortening consumption shot up and by 1993 had tripled to over 30 grams per person per day. But the most dramatic overall change in the American diet was the huge increase in the consumption of liquid vegetable oils, from slightly less than 2 grams per person per day in 1909 to over 30 grams in 1993 - a fifteenfold increase.
The irony is that these trends have persisted concurrently with revelations about the dangers of polyunsaturates. Because polyunsaturates are highly subject to rancidity, they increase the body's need for vitamin E and other antioxidants.
Excess consumption of vegetable oils is especially damaging to the reproductive organs and the lungs - both of which are sites for huge increases in cancer in Americans. In test animals, diets high in polyunsaturates from vegetable oils inhibit the ability to learn, especiallyfs. er conditions of stress; they are toxic to the liver; they compromise the integrity of the immune systat; they depress the mental and physical growth of infants; they increase levels of uric acid in the blood; they cause abnormal fatty acid profiles in the adipose tissues; they have been linked to mental decline and chromosomal damage; and they accelerate ageing.
Excess consumption of polyunsaturates is associated with increasing rates of cancer, heart disease and weight gain. The excessive use of commercial vegetable oils interferes with the production of prostaglandins, leading to an array of complaints ranging from autoimmune disease to premenstrual syndrome (PMS). Disruption of prostaglandin production leads to an increased tendency to form blood clots, and hence to myocardial infarction - which has reached epidemic levels in the US.
Vegetable oils are more toxic when heated. One study reported that polyunsaturates turn to varnish in the intestines. A study by a plastic surgeon found that women who consumed mostly vegetable oils had far more wrinkles than those who used traditional animal fats. A 1994 study published in the Lancet showed that almost three-quarters of the fat in artery clogs is unsaturated. The 'artery-clogging' fats are not animal fats but vegetable oils.
Those who have most actively promoted the use of polyunsaturated vegetable oils as part of a Prudent Diet are well aware of their dangers. In 1971, William B. Kannel, former Director of the Framingham Study, warned against including too many polyunsaturates in the diet. A year earlier, Dr William Connor of the American Heart Association issued a similar warning, and Frederick Stare reviewed an article which reported that the use of polyunsaturated oils caused an increase in breast tumours. And Kritchevsky, way back in 1969, discovered that the use of corn oil caused an increase in atherosclerosis.
As for the trans fats produced in vegetable oils when they are partially hydrogenated, the results that are now in the literature more than justify the concerns of early investigators about the relation between trans fats and both heart disease and cancer.
The research group at the University of Maryland found that trans fatty acids not only alter enzymes that neutralise carcinogens and increase enzymes that potentiate carcinogens, but in nursing mothers they also depress milk-fat production and decrease insulin binding. In other words, trans fatty acids in the diets of new mothers interfere with their ability to nurse successfully and increase their likelihood of developing diabetes.
Unpublished work indicates that trans fats contribute to osteoporosis. Hanis, a Czechoslovakian researcher, found that trans consumption decreased testosterone, caused the production of abnormal sperm and altered gestation. Koletzko, a German paediatrics researcher, found that excess trans consumption in pregnant women predisposed them to having low-birth-weight babies. Trans consumption interferes with the body's use of omega-3 fatty acids (found in fish oils, grains and green vegetables), leading to impaired prostaglandin production. George Mann confirmed that trans consumption increases the incidence of heart disease. In 1995, European researchers found a positive correlation between breast cancer rates and trans consumption.
Until the 1993 studies, only the disturbing revelations of Dutch researchers Mensink and Katan in 1990 received front-page coverage. Mensink and Katan found that margarine consumption increased coronary heart disease risk factors. The industry - and the press - responded by promoting tub spreads, which contain reduced amounts of trans compared to stick margarine.
For the general population, these trans reductions have been more than offset by changes in the types of fat used by the fast-food industry. In the early 1980s, the Center for Science in the Public Interest campaigned against the use of beef tallow for frying potatoes. Before that, it campaigned against the use of tallow for frying chicken and fish. Most fast-food concerns switched to partially hydrogenated soybean oil for all fried foods. Some deep-fried foods have been tested at almost 50 per cent trans.
Epidemiologist Walter Willett at Harvard worked for many years with flawed databases, which did not identify trans fats as a dietary component. He found a correlation with dietary fat consumption and both heart disease and cancer. After his researchers contacted Enig about the trans data, they developed a more valid database that was used in the analysis of the massive Nurses Study. When Willett's group separated out the trans component in their analyses, they were able to confirm greater rates of cancer in those consuming margarine and vegetable shortenings - not butter, eggs, cheese and meat. The correlation between trans fat consumption and cancer was never published, but was reported at the Baltimore Data Bank Conference in 1992.
In 1993, Willett's research group at Harvard found that trans contributed to heart disease. This study was not ignored but in fact received much fanfare in the press. Willett's first reference in his report was Enig's work on the trans content of common foods.
The industry continues to argue that American trans consumption is a low 6 to 8 grams per person per day - not enough to contribute to today's epidemic of chronic disease. Total per-capita consumption of margarine and shortening hovers around 40 grams per person per day. If these products contain 30 per cent trans (many shortenings contain more), then average consumption is about 12 grams per person per day.
In reality, consumption figures can be dramatically higher for some individuals. A 1989 Washington Post article documented the diet of a teenage girl who ate 12 doughnuts and 24 cookies over a three-day period; her total trans intake worked out to at least 30 grams per day, and possibly much more. The fat in the chips that teenagers consume in abundance may contain up to 48 per cent trans, which translates into 45.6 grams of trans fat in a small, 10-ounce (284-gram) bag of snack chips which a hungry teenager can gobble up in a few minutes. High school sex education classes do not teach American teenagers that the altered fats in their snack foods may severely compromise their ability to have normal sex, to conceive, to give birth to healthy babies and successfully nurse their infants.
Foods containing trans fat sell because the American public is afraid of the alternative: saturated fats found in tallow, lard, butter, palm oil and coconut oil - fats traditionally used for frying and baking. Yet the scientific literature delineates a number of vital roles for dietary saturated fats: they enhance the immune system, are necessary for healthy bones, provide energy and structural integrity to the cells, protect the liver, and enhance the body's use of essential fatty acids. Stearic acid, found in beef tallow and butter, has cholesterol-lowering properties and is a preferred food for the heart. As saturated fats are stable, they do not become rancid easily, they do not call upon the body's reserves of antioxidants, they do not initiate cancer, and they do not irritate the artery walls.
Your body makes saturated fats, and your body makes cholesterol - about 2,000 mg per day. In general, cholesterol that the average American absorbs from food amounts to about 100 mg per day. So, in theory, even reducing animal foods to zero will result in only a five per cent decrease in the total amount of cholesterol available to the blood and tissues. In practice, such a diet is likely to deprive the body of the substrates it needs to manufacture enough of this vital substance.
Cholesterol, like saturated fats, stands unfairly accused. It acts as a precursor to vital corticosteroids (hormones that help us deal with stress and protect the body against heart disease and cancer) and to the sex hormones like androgen, testosterone, estrogen and progesterone. It is a precursor to vitamin D, a very important fat-soluble vitamin needed for healthy bones and nervous system, proper growth, mineral metabolism, muscle tone, insulin production, reproduction and immune system function. And it is the precursor to bile salts which are vital for digestion and assimilation of fats in the diet.
Recent research shows that cholesterol acts as an antioxidant. This is the likely explanation for the fact that cholesterol levels go up with age. As an antioxidant, cholesterol protects us against free-radical damage that leads to heart disease and cancer. Cholesterol is the body's repair substance, manufactured in large amounts when the arteries are irritated or weak. Blaming heart disease on high serum cholesterol levels is like blaming firemen, who have come to put out a fire, for starting the blaze,
Cholesterol is needed for proper function of serotonin receptors in the brain. Serotonin is the body's natural 'feel-good' chemical. This explains why low cholesterol levels have been linked to aggressive and violent behaviour, depression and suicidal tendencies. Mother's milk is particularly rich in cholesterol and contains a special enzyme that helps the baby utilise this nutrient. Babies and children need cholesterol-rich foods throughout their growing years to ensure proper development of the brain and nervous system. Dietary cholesterol plays an important role in maintaining the health of the intestinal wall, which is why low-cholesterol vegetarian diets can lead to leaky gut syndrome and other intestinal disorders.
Animal foods containing saturated fat and cholesterol provide vital nutrients necessary for growth, energy and protection from degenerative disease. Like sex, animal fats are necessary for reproduction. Suppression of natural appetites leads to weird nocturnal habits, fantasies, fetishes, bingeing and splurging. Animal fats are nutritious and satisfying and they taste good.
"Whatever is the cause of heart disease," said the eminent biochemist Michael Gurr in a recent article, "it is not primarily the consumption of saturated fats." And yet the high priests of the lipid hypothesis continue to lay their curse on the fairest of culinary pleasures: butter and Béarnaise, whipped cream, soufflés and omelettes, full-bodied cheeses, juicy steaks and pork sausages.
On April 30, 1996, senior researcher David Kritchevsky received the American Oil Chemists' Society's Research Award in recognition of his accomplishments as a "researcher on cancer and atherosclerosis as well as cholesterol metabolism". His accomplishments include co-authorship of more than 370 research papers, one of which appeared a month later in the American Journal of Clinical Nutrition. "Position Paper on Trans Fatty Acids" continued the debate on trans fats that began in the same journal with Hunter and Applewhite's 1986 attack on Enig's research. "A controversy has arisen about the potential health hazards of trans unsaturated fatty acids in the American diet," wrote Kritchevsky and his co-authors.
Actually, the controversy dates back to 1954. In the rabbit studies that launched Kritchevsky on his career, the researcher actually found that cholesterol fed with Wesson oil "markedly accelerated" the development of cholesterol-containing low-density lipoproteins; and cholesterol fed with shortening gave cholesterol levels twice as high as cholesterol fed alone. Enig's work - and that of Kummerow and Mann and several others - merely confirmed what Kritchevsky ascertained decades ago but declined to publicise: that vegetable oils, and particularly partially hydrogenated vegetable oils, are bad news.
However, "Position Paper on Trans Fatty Acids" took no position at all. Studies have given contradictory results, said the authors, and the amount of trans in the average American diet is very difficult to determine. As for labelling, the authors said: "There is no clear choice of how to include trans fatty acids on the nutrition label. The database is insufficient to establish a classification scheme for these fats." There may be problems with trans, says the senior researcher, but their use "...helps to reduce the intake of dietary fats higher in saturated fatty acids. Also, vegetable fats are not a source of dietary cholesterol, unlike saturated animal fats."
As a footnote, early in 1998 a symposium entitled "Evolution of Ideas about the Nutritional Value of Dietary Fat" reviewed the many flaws in the lipid hypothesis and highlighted a study in which mice fed on purified diets died within 20 days, but mice fed on whole milk stayed alive for several months. One of the symposium participants was David Kritchevsky. He noted that the use of low-fat diets and drugs in intervention trials "did not affect overall CHD mortality". Ever with a finger in the wind, this influential founding father of the lipid hypothesis concluded thus: "Research continues apace and, as new findings appear, it may be necessary to re-evaluate our conclusions and preventive medicine policies."
About the Authors:
Mary G. Enig, PhD, is an expert of international renown in the field of lipid biochemistry. She has headed a number of studies, in America and Israel, on the content and effects of trans fatty acids, and has successfully challenged government assertions that dietary animal fat causes cancer and heart disease. Recent scientific and media attention on the possible adverse health effects of trans fatty acids has brought increased attention to her work. She is a licensed nutritionist, certified by the Certification Board for Nutrition Specialists, a qualified expert witness, a nutrition consultant to individuals, industry, and state and federal governments, a contributing editor to a number of scientific publications, a Fellow of the American College of Nutrition, and President of the Maryland Nutritionists Association. She is the author of over 60 technical papers and presentations, as well as a popular lecturer. Dr Enig is currently working on the exploratory development of an adjunct therapy for AIDS using complete medium-chain saturated fatty acids from whole foods. She is the mother of three healthy children brought up on whole foods including butter, cream, eggs and meat.
Sally Fallon is the author of Nourishing Traditions: The Cookbook that Challenges Politically Correct Nutrition and the Diet Dictocrats (with Pat Connolly, Executive Director of the Price-Pottenger Nutrition Foundation, and Mary G. Enig, PhD), as well as of numerous articles on the subject of diet and health. She is Vice President of the Price-Pottenger Nutrition Foundation and editor of the Foundation's quarterly journal. She is the mother of four healthy children raised on whole foods including butter, cream, eggs and meat. Her publications may by obtained by contacting the Price-Pottenger Nutrition Foundation in San Diego, California, USA, on (619) 574 7763.