Today, on 10 February, 2010 I received this e-mail from a reader who had interesting reflections concerning Omega-6 lipid acid and its harmful effects to the human body. The reflections were so relevant that I publish them on my blog:
"Hello Elizabeth,
By way of introduction, I am a carpenter residing in Kalispell, Montana. I like being healthy so I analyze nutritional issues and controversies. Given the quality of our modern food environment and the debate over what constitutes healthy eating, I think it wise not to trust to luck. Your blog came to my attention because you mentioned Gary Taubes in your most recent blog post. I have on Google Alert for that name.
As you know, the idea that saturated fats clog arteries has been relentlessly hammered into the public mind for decades. At the same time, there's seldom been mention of the omega-6 hazard. So, when you've got about 37 minutes available, I urge you to watch this videocast: http://videocast.nih.gov/summary.asp?live=8108 Biochemist William Lands explains in plain language why excessive omega-6 fat intake is to be avoided. He says we could have been preventing a lot of chronic inflammatory disease these past forty years if scientists hadn't gotten so distracted with bio markers such as cholesterol levels and obesity. His presentation starts at minute 12. Just move the time control button at the bottom slightly to the right to skip the preliminaries.
I'm so pleased I got to listen to this lecture because, despite what I thought was a healthy diet, I've been slowly losing muscular strength for a number of years. I'm only 63 and shouldn't have deteriorated this quickly. It turns out I've been consuming too much omega-6 fat in the form of peanut butter sandwiches. I've been eating them for lunch 5 to 6 times a week for most of my adult life. About 8 or 9 weeks after I switched to eating meat or cheese for lunch, the pain in my shoulders and legs has subsided and strength is returning to my limbs. Once again, I can get up out of a chair without thinking about it.
For a short historical sketch delineating the technological events that led up to the insertion of omega-6 into our food supply: http://180degreehealth.blogspot.com/2010/01/david-brown-on-omega-6-fats.html
Regards,
David Brown
1925 Belmar Dr
Kalispell, MT 59901
Ph/406-257-5123
Nutrition Education Project"
2010-02-10
2010-02-09
The history of the lipid fear.
Elisabeth: This post from Annika Dahlqvist´s Swedish blog is not her own composition. Instead the text comes from literary references by G Taubes on the lipid issue and is about the history of the lipid fear.
"Dietary Goals for the United States in 1977.
"After World War II lipids were suspected to cause heart diseases."
"Politicians suggested that fewer lipids would result in less obesity."
"Media mixed this together – the advice turned out to be this – Eat fewer lipids, live longer."
Below the background for today’s nourishing recommendations, which at first were formulated in USA, is discussed. The content is brought from the science journalist Gary Taubes´s article “The soft science of dietary lipids” in the journal Science from 2001.
The reasons for the lipid fear:
Cardiovascular diseases. In the beginning of the 19th century the nourishment matters concerned undernourishment rather than over intake. After World War II, however, the mortality in heart attack increased in USA in an alarming manner. ”Middle-aged men, apparently completely healthy, suddenly fell down dead”, the American bio chemist Ancel Keys noticed. He indicated, among the first that the fat in the diet could be the reason, and in 1952 suggested the Americans to reduce their lipid intake to less than 30 %. However he noticed that among evidences which the diet evoked, arteriosclerosis was missing and couldn’t be brought out during the near future.
Cholesterol. In the famous Seven Countries study Keys and collaborators noted that the quantity of lipids in the diet seemed to be the most obvious difference between countries like Japan and Crete where cardiovascular diseases were uncommon, and Finland where they were very common. The Framingham study which surveyed the inhabitants in a little town in USA succeeded in 1961 to connect cholesterol with cardiovascular diseases.
Keys became famous and American Heart Association, AHA, recommended due to his advice a diet low on lipids to men with high cholesterol levels. Moreover, Keys was one of the first Americans who adopted this type of diet himself, the TIME journal wrote. He and his wife did not eat pure meat (steaks, chops, beefs and similar of the kind) more than three times a week.
In spite of certain research the position in 1969 be summarized in a one and only sentence by National Heart, Lung, and Blood Institute, NHLBI: "It is not made clear yet whether changes of diet has any effect on coronary heart disease".
Studies are needed. The chairman in the panel which analysed the question was E.H. Ahrens from Rockefeller University in New York. While spokesmen for low fat diets where mostly bent on the cholesterol’s effect on heart diseases , Ahrens and collaborators engaged themselves in the question whether a reduced fat intake could impair other bodily functions. The brain consists of about 70 % of lipids which principal task is to isolate the nerve cells. A changed fat intake could at worst change the cell membrane’s properties and disturb the transports of glucose, hormones and protection against bacteria, virus, tumour evoking substances and similar of the kind.
Whether the possible benefits due to a low fat diet could exceed the possible disadvantages could of course be determined by a scientific study by investigating whether a low fat diet really prolonged one’s life, but such a study in that case would be enormous. The cholesterol level has in the real life a very small significance to the most people, so ten thousands of experimental subjects tin that case will have to change over to a low fat diet and be compared with approximately just as many who have been on an ordinary diet. All these people have to be followed up for a number of years, until many death cases enough have occurred in order to get a statistically valid material. Ahrens did not consider such a big and expensive study would be possible to realize.
The American Health and Welfare Authority (National Institutes of Health, NIH) estimated in 1971 that such a study would cost about one billion dollar. This amount they were not willing to spend. Instead they suggested a number of smaller studies of which two would cost about 255 million dollar. But of greater importance was that these would take abort ten years to accomplish. Neither the public media nor the American Congress were willing to wait that long.
THE DIETARY ADVICE OF USA IN 1977.
Anti-lipid forces and politics. Simultaneously with a flourishing interest of alternative medicine in the USA an”alternative” anti-lipid movement was developed during the 1960ies. It was nourished by distrust against the establishment and the food industry – and by a backlash against mass consumption. The distrust was severe independent whether it concerned gasoline consuming cars or the classic American cookery with bacon, eggs and marbled steaks. And while the science disputed about the fat and the health the deadlock was solved. Not by new scientific results but by politicians. It was the Senator George McGoverns and some of his employees who in a committee almost all by them changed the nourishment recommendations in the country, and turned all assumptions about fat into dogmas.
McGovern’s´ Committee was founded in 1968 with the task of overcoming malnutrition in the USA and instituted a number of political programmes. But when the programs began to take effect in the middle of the 1970s, the committee was not dissolved. Instead two of the Committee’s lawyers, Marshall Matz and Alan Stone, recommended the Committee to take up the case concerning the “over nutrition”, that is the Americans gormandizing of food. “It was a rather haphazard approach”, Matz said. “We really were totally naïve, a bunch of kids, who just thought, 'Hell, we should say something on this subject before we go out of business.” And McGovern and his colleagues in the Senate, middle-age men who began to worry about the growing waistlines and declining health, subscribed.
McGovern and his wife had previously acceded to the dietary guru Nathan Pritikin´s low fat diet and exercise programme. McGovern quit the programme early, but Pritikin affected his way of thinking for a long time. Mottern, who had no scientific background and had no experience of writing abort science, nutrition and health, imagined that his dietary guide lines would start a revolution in diet and agriculture in the country.
He avoided the scientific and medical controversies by almost exclusively using the nutrition researcher Mark Hegsted, Harvard School of Public Health as an expert. Hegsted had studied lipids and cholesterol during the early 1961s and believed unconditionally in the benefits of reducing lipid intake, although he later said he was aware that this was an extreme view.
With Hegsted as a beacon Mottern began considering lipids as nutritional equivalent of cigarettes, and food industry as akin to the tobacco industry with the same eagerness to conceal the research findings in its pursuit of profit. For Mottern, were scientists who spoke against lipids, scientists who were willing to embark on the industry.
“It took back bones”, said Mottern, “to talk about that, in account of the economic interests in stake”. Mottern´s report recommended that Americans reduced their lipid intake to 30 % of energy, and intake of saturated lipids to 10 %. Everything was according to AHAs recommendations for men at high risk for cardiovascular disease. The report acknowledged that there was a controversy, but insisted that the Americans didn’t have anything to lose by following the advice. “The question is not why we should change our eating habits, but why not? Hegsted said in the introduction. “No known risks, but many important benefits to achieve.”
Controversies. This was an optimistic but still debatable position. When the dietary recommendations were released in January 1977, “crashed hell loose”, remembered Hegsted. “Virtually no one supported the McGovern recommendations.” McGovern responded with three follow-up seminars, which clearly foreshadowed the controversies to come. Among those who objected was Robert Levy, the head of NHLBI.
He explained that nobody knew about a reduction in lipid intake and decreased cholesterol levels actually resulted in fewer heart attacks, and it was by just this very reason that NHLBI had received 300 million US dollars to study the issue.
Levy’s position was precarious, he remembered. “The good gentlemen of the Senate went first out with the guidelines, and then we were called in to give good advice.” He was supported by many prominent scientists, including Ahrens, who testified that a piece of advice to all Americans to eat less lipids, based on such weak evidence, which was pushing ahead with experiments with the entire US population as guinea pigs.
Although American Medical Association, AMA, commented that the guidelines could provide potentially damaging side effects. Along with the scientist’s statement, strong protests came from the dairy, egg and meat industry for obvious reasons. In this mode, however, eroded the common position of Science and Industry, the scientific credibility – the scientists who objected to the Committee of guidelines were either (according to Hegsted) hopelessly retarded or (according to Mottern) or industry prophets.
Although the Committee published a revised version of the dietary recommendations later that year, the message remained unchanged. As a concession to the industry a reduction of the recommendation was discussed, to eat less meat. Mottern said that he thought this would be a disservice to the American public, refused to revise the test and then ended his work on the Committee. Mottern was in the process of dietary advice vegetarian and devoted his time to food trade in New York.
Nutritional recommendations become policy: Nutritional recommendations would have been able to die a quiet death in 1977 When McGovern COMMITTEE dissolved, had it not been for that two federal agencies had felt compelled to respond to them. Although they took opposing positions, it was one of the messages and – with the media’s help – were looking into the American consciousness.
Ministry of Agriculture’s dietary guidelines. First came the U.S. Department of Agriculture (USDA) in where the Consumer Ombudsman Carol Tucker Foreman recently had received a post. Foreman experienced a very heavy obligation of the Ministry of Agriculture to convert McGovern’s recommendations into official policy. Like Mottern, she was not particularly disturbed that the dietary advice was scientifically controversial. “Tell me what you know, and say that this is not the final answer,” she would say to the scientists. "I have to give my children food three times a day, and I want your best image of current research”.
As the science area was controversial, “the best image of research” depended of course on who was asked among the researchers. The Board of nutrition issues at the National Academy of Sciences (NAS), which decided the recommended daily rations, should have been the natural choice. NAS President Philip Handler, an expert on metabolism, however, expressed to Foreman that he considered Mottern´s dietary recommendations to be pure nonsense.
Foreman then turned to the McGovern group for advice. They recommended her to turn to Hegsted, which she did. Hegsted in turn, relied on a report on the stat of science published by a committee of experts from the American Society for Clinical Nutrition, a Committee which however, had very scattered opinions. “They were not even close to anything resembling a consensus,” said Hegsted, “but most of them supported well something like McGovern’s Committee report. The resulting document became the first edition of “Using the Dietary Guidelines for Americans”. Although the report was open to it was controversial, and stressed that a single nutrient recommendation might not suit everyone in a population with so much diversity, so was the advice to avoid lipids and saturated lipids, substantially identical to McGovern’s dietary recommendations.
Academy of Science’s dietary guidelines. Three months later, the National Academy of Science’s Board on Food and Nutrition Policy, which released its own recommendations: “Towards Healthful Diets?” The Board, consisting of a dozen nutrition experts, concluded that the only reliable advice to support American’s health was to keep an eye on the weight. Everything else, including lipids in the diet, were matters of secondary importance.
This advice was not very favourable, at least not by the media. The first of them commented – “rather suspiciously”, said Handler – which the National Acedemy of Science’s dietary guide lines created a conflict with the Ministry of Acriculture and the McGovern dietary guide lines, and this was seen as irresponsible. Subsequent comments insinuated (with Jane Brady’s words, who wrote the article for New York Times) that the board members were sitting in the lap of the industry affected. To be precise it was the President and one of the members who had been consulting for the food industry, while the financing of the board itself came from industry donations. Hints to the press abort their ties to industry were leaked from the Ministry of Agriculture.
Hegsted later defended Academy of Science’s board, which, however, he did first, and called the conflict”an issue of hell”. "Some complained that the industry did not do anything abort food, but all who were involved were frozen out because their approach was influenced by the industry." Hegsted went back to Harvard in 1981 and his research was funded by Frito-Lay (company that manufactures chips, snacks, cookies, etc).
The press had mixed feelings, and argued that that the bonds had soiled the Academy’s reputation for”considerate and careful scientific advice” (Washington Post) and that the Board’s objectivity and skill that went into question” (New York Times). Anyway, Academy of Science Board had been publically discredited.
Hegsteds Dietary Guidelines for Americans became the official U.S. policy with regard to dietary content of lipids: Eat fewer lipids. Live longer.
Building consensus:
The studies. Now when the politicians, the media and the public agreed on a policy about content of lipids in the diet, it was only the science that needed to catch up. During the 1970s, when NIH opted out of the study of one billion dollars, which would give a definite answer, and instead chose half-dozen small studies for one third of the cost, all hoped that the results would provide sufficient basis to conclude that low lipid diets prolonged life.
The results were published between 1980 and 1984. Four of these studies – which compared the incidence of cardiovascular disease between Honolulu, Puerto Rico, Chicago, and Framingham – gave no evidence that men who ate fewer lipids lived longer or had fewer heart attacks.
A fifth study, The Multiple Risk Factor Intervention Trial (MRFIT), cost 115 million dollars and tried to strengthen diets modest impact on health by persuading subjects to avoid lipids while simultaneously quit smoking and took medication for high blood pressure. The study indicated if anything, to decrease lipid intake decreased length of life.
In each survey, however, the researchers concluded that the reason for the negative results were due to methodological error. The never came to a conclusion, at least not publically, that the results were due to that the bad lipids were not quite as bad as believed.
The link between cholesterol and heart attacks. The sixth study was the Clinics (LRC) Coronary Primary Prevention Trial which cost 140 million dollars. It was headed by an administrator on NHLBI named Rifkind, and biochemist Daniel Steinberg from University of California, San Diego.
LRC study was a drug study and not a dietary study, but the NHLBI felt that the results could presage the end of the debate about lipids in the diet. In January 1984 LRCs researchers reported that a preparation called Cholestyramine and which decreased cholesterol levels in men with abnormally high cholesterol levels also resulted in a modest reduction in heart disease. The probability of getting a heart attack during the more than seven years of the study decreased from 8, 6 % to 7, 0 % in the experimental group. The risk of dying from heart attacks decreased from 2, 0 % to 1, 6 %.
The researchers then concluded, without having used the dietary data, the utility of Cholestyramine also covered the diet. Although the study only included middle-age men with cholesterol levels higher than 95 % of the population had, the researchers concluded that the benefits “could and should include other age groups and women… and other more modestly elevated cholesterol levels.”
But why were the results hard to cover these conclusions?
Rifkind told that his logic was simple: For 20 years he and his colleagues argued that lowering cholesterol levels could prevent heart attacks, and they had made off with huge sums to prove it. They had reached the realization that they actually could never come to show that low lipid diets prolonged life – that would be too expensive. Now they had at least been able to establish an important link in the chain – from reducing Cholesterol to increase cardiovascular health. With this link, they could take the”Leap of Faith” from the Cholesterol-lowering medicines and health to diet and health. After all efforts they were eager – for now not to say pressured from Congress – to formulate useful guide lines. "There comes a point when the consequences can be just as big even if they do not take a decision,” said Rifkind. "If you just allow Americans to continue eating 40 % of calories in lipids, so this will result in something.”
Media went astray. While printing presses rustled up LRCs results, NHLBI launched what Levy called a”massive public health campaign.” Media was accommodating but completely lost. TIME, for example, commented LRCs results under the heading”Sorry, it is true.” The article about a drug study began:”No standard milk. No butter. No fat meat ….”. TIME followed up three months later with a review article: "And Cholesterol, and now to the bad news. …”. Cover photograph was a grim face: a breakfast plate with two fried eggs for eyes and a bacon slice mouth. Rifkind was quoted when he said that the results”strongly suggest that the more you lower cholesterol and lipids in your diet, the more reduced the risk of heart disease”, a claim that there is still no scientific support.
Concensus Conference 1984. In December 1984, NIH effectively ended the debate with a Concensus Conference. The idea of such a conference is a panel of experts, preferably unaffected, listening to two days of requests and from this comes to a conclusion that everyone agrees on. In this case, Rifkind was chairman of the planning committee, which chose LRCs second researcher Steinberg to lead the expert panel. The twenty speakers included a handful of sceptics, including Ahrens, and cardiologist Michael Oliver from Imperial College in London, which argued that it was unscientific to equate the effects of a drug with effects of a diet. However, the members of Steinberg’s panel were, which Oliver later complained in The Lancet, selected so that they only consisted of experts who could be predicted assert that all levels of blood Cholesterol in the U.S. were too high and should be reduced. And, of course, this was exactly what was claimed.
Conference report, written by Steinberg and his panel, revealed certainly not the least absence of discord. There was”no doubt”, held on, that low-lipid diets”will offer a significant protection against coronary heart disease” for all Americans over the age of two.
Consensus Conference formally gave the impression of consensus where none exists. After all, as Steinberg put it in the journal Science,”if there had been a true consensus a consensus conference had not been necessary.
Simple relationship more convenient than the complex one.
"Wishful science?” To the outside observer, it is a great challenge to turning on such a lengthy scientific controversy. The main task is to find out if the sceptics are simply on the wrong side of the new paradigm, or whether scepticism is justified.
In other words, is the science in question, based on sound scientific thinking and unambiguous data, or is it what Sir Francis Bacon (1561-16265) would have called wishful science, based on fancies, opinions, or concealment of challenging or inconsistent results? Bacon proposed a method for distinguishing the two: They let time give the
Good science is rooted in reality, it grows and develops evidence and produces less and less room for doubts. Wishful Science blooms up shortly after the drafting of their authors, and then it goes out. So here was the example with the idea that lipids in the diet cause cancer, which was part of the concern in the late 1970.
They hade the idea that there was such a strong connection, and the NAS wrote 1982 in a report that those who did not believe in a connection between lipids and cancer ere compared with those who formerly did not believe in a connection between smoking and lung cancer.
Fifteen years and hundreds of millions of dollars later struck a thick expert report from the World Cancer Research Fund and American Institute for Cancer Research determined that that they have not found anything convincing, or even reasonable, to believe that lipids in the diet caused cancer. Time gave its answer.
Low lipid diet – Time has given the answer. With the idea that a low lipid diet is a way out of obesity, it has also gone out. The last resort for the recommendations to reduce lipid intake was based on energy balance: Lipid has nine calories per 0, 04 ounce, while carbohydrates and protein have four calories per 0, 04 ounce, so by eliminating lipids from the diet would crumble pounds. This has been regarded almost as a religious truth, says Walter Willett at Harvard. A substantial body of data suggests something else entirely. The results from well-.controlled clinical trials are consistent: People who eat a low lipid diet drop a few pounds in the beginning, as they would on any diet whatsoever, but then usually the weight goes back. After one or two years, almost none of the weight loss was maintained.
Take for example the 50 000 women who engaged in the ongoing study Women’s Health Initiative (WHI) for one hundred million U.S. dollars. Half of theses women have been fully allocated to eating only 20 % of energy from lipids. After three years of this horror diet, said sources in the WHI, every woman has lost an average of two pounds.
Also here, time has given its answer.
No simple relationship. Since Ancel Keys began advocating low lipid diets fifty years ago, the science of lipids and health has developed from an assumption to fairly simple relationship in an extremely complicated problem. The snag was that few involved were prepared to address a complex problem.
Scientists preferred to believe that it was a simple relationship, that the effect of a single unwholesome nutrient could be isolated fro diversity and richness of the human diet. Public health bureaucrats preferred a simple connection to serve Congress and the public. The press preferred a simple relationship - at least in each article – to give their editors and readers of a few tens of column inches.
It is now clear to many that the simple relationship never existed.
________________________________________
References.
1. Taubes G. The Soft Science of Dietary Fat. Science (2001); vol 291, issue 5513: p2536-2545. 30 March 2001.
2005-12-30
________________________________________
"Dietary Goals for the United States in 1977.
"After World War II lipids were suspected to cause heart diseases."
"Politicians suggested that fewer lipids would result in less obesity."
"Media mixed this together – the advice turned out to be this – Eat fewer lipids, live longer."
Below the background for today’s nourishing recommendations, which at first were formulated in USA, is discussed. The content is brought from the science journalist Gary Taubes´s article “The soft science of dietary lipids” in the journal Science from 2001.
The reasons for the lipid fear:
Cardiovascular diseases. In the beginning of the 19th century the nourishment matters concerned undernourishment rather than over intake. After World War II, however, the mortality in heart attack increased in USA in an alarming manner. ”Middle-aged men, apparently completely healthy, suddenly fell down dead”, the American bio chemist Ancel Keys noticed. He indicated, among the first that the fat in the diet could be the reason, and in 1952 suggested the Americans to reduce their lipid intake to less than 30 %. However he noticed that among evidences which the diet evoked, arteriosclerosis was missing and couldn’t be brought out during the near future.
Cholesterol. In the famous Seven Countries study Keys and collaborators noted that the quantity of lipids in the diet seemed to be the most obvious difference between countries like Japan and Crete where cardiovascular diseases were uncommon, and Finland where they were very common. The Framingham study which surveyed the inhabitants in a little town in USA succeeded in 1961 to connect cholesterol with cardiovascular diseases.
Keys became famous and American Heart Association, AHA, recommended due to his advice a diet low on lipids to men with high cholesterol levels. Moreover, Keys was one of the first Americans who adopted this type of diet himself, the TIME journal wrote. He and his wife did not eat pure meat (steaks, chops, beefs and similar of the kind) more than three times a week.
In spite of certain research the position in 1969 be summarized in a one and only sentence by National Heart, Lung, and Blood Institute, NHLBI: "It is not made clear yet whether changes of diet has any effect on coronary heart disease".
Studies are needed. The chairman in the panel which analysed the question was E.H. Ahrens from Rockefeller University in New York. While spokesmen for low fat diets where mostly bent on the cholesterol’s effect on heart diseases , Ahrens and collaborators engaged themselves in the question whether a reduced fat intake could impair other bodily functions. The brain consists of about 70 % of lipids which principal task is to isolate the nerve cells. A changed fat intake could at worst change the cell membrane’s properties and disturb the transports of glucose, hormones and protection against bacteria, virus, tumour evoking substances and similar of the kind.
Whether the possible benefits due to a low fat diet could exceed the possible disadvantages could of course be determined by a scientific study by investigating whether a low fat diet really prolonged one’s life, but such a study in that case would be enormous. The cholesterol level has in the real life a very small significance to the most people, so ten thousands of experimental subjects tin that case will have to change over to a low fat diet and be compared with approximately just as many who have been on an ordinary diet. All these people have to be followed up for a number of years, until many death cases enough have occurred in order to get a statistically valid material. Ahrens did not consider such a big and expensive study would be possible to realize.
The American Health and Welfare Authority (National Institutes of Health, NIH) estimated in 1971 that such a study would cost about one billion dollar. This amount they were not willing to spend. Instead they suggested a number of smaller studies of which two would cost about 255 million dollar. But of greater importance was that these would take abort ten years to accomplish. Neither the public media nor the American Congress were willing to wait that long.
THE DIETARY ADVICE OF USA IN 1977.
Anti-lipid forces and politics. Simultaneously with a flourishing interest of alternative medicine in the USA an”alternative” anti-lipid movement was developed during the 1960ies. It was nourished by distrust against the establishment and the food industry – and by a backlash against mass consumption. The distrust was severe independent whether it concerned gasoline consuming cars or the classic American cookery with bacon, eggs and marbled steaks. And while the science disputed about the fat and the health the deadlock was solved. Not by new scientific results but by politicians. It was the Senator George McGoverns and some of his employees who in a committee almost all by them changed the nourishment recommendations in the country, and turned all assumptions about fat into dogmas.
McGovern’s´ Committee was founded in 1968 with the task of overcoming malnutrition in the USA and instituted a number of political programmes. But when the programs began to take effect in the middle of the 1970s, the committee was not dissolved. Instead two of the Committee’s lawyers, Marshall Matz and Alan Stone, recommended the Committee to take up the case concerning the “over nutrition”, that is the Americans gormandizing of food. “It was a rather haphazard approach”, Matz said. “We really were totally naïve, a bunch of kids, who just thought, 'Hell, we should say something on this subject before we go out of business.” And McGovern and his colleagues in the Senate, middle-age men who began to worry about the growing waistlines and declining health, subscribed.
McGovern and his wife had previously acceded to the dietary guru Nathan Pritikin´s low fat diet and exercise programme. McGovern quit the programme early, but Pritikin affected his way of thinking for a long time. Mottern, who had no scientific background and had no experience of writing abort science, nutrition and health, imagined that his dietary guide lines would start a revolution in diet and agriculture in the country.
He avoided the scientific and medical controversies by almost exclusively using the nutrition researcher Mark Hegsted, Harvard School of Public Health as an expert. Hegsted had studied lipids and cholesterol during the early 1961s and believed unconditionally in the benefits of reducing lipid intake, although he later said he was aware that this was an extreme view.
With Hegsted as a beacon Mottern began considering lipids as nutritional equivalent of cigarettes, and food industry as akin to the tobacco industry with the same eagerness to conceal the research findings in its pursuit of profit. For Mottern, were scientists who spoke against lipids, scientists who were willing to embark on the industry.
“It took back bones”, said Mottern, “to talk about that, in account of the economic interests in stake”. Mottern´s report recommended that Americans reduced their lipid intake to 30 % of energy, and intake of saturated lipids to 10 %. Everything was according to AHAs recommendations for men at high risk for cardiovascular disease. The report acknowledged that there was a controversy, but insisted that the Americans didn’t have anything to lose by following the advice. “The question is not why we should change our eating habits, but why not? Hegsted said in the introduction. “No known risks, but many important benefits to achieve.”
Controversies. This was an optimistic but still debatable position. When the dietary recommendations were released in January 1977, “crashed hell loose”, remembered Hegsted. “Virtually no one supported the McGovern recommendations.” McGovern responded with three follow-up seminars, which clearly foreshadowed the controversies to come. Among those who objected was Robert Levy, the head of NHLBI.
He explained that nobody knew about a reduction in lipid intake and decreased cholesterol levels actually resulted in fewer heart attacks, and it was by just this very reason that NHLBI had received 300 million US dollars to study the issue.
Levy’s position was precarious, he remembered. “The good gentlemen of the Senate went first out with the guidelines, and then we were called in to give good advice.” He was supported by many prominent scientists, including Ahrens, who testified that a piece of advice to all Americans to eat less lipids, based on such weak evidence, which was pushing ahead with experiments with the entire US population as guinea pigs.
Although American Medical Association, AMA, commented that the guidelines could provide potentially damaging side effects. Along with the scientist’s statement, strong protests came from the dairy, egg and meat industry for obvious reasons. In this mode, however, eroded the common position of Science and Industry, the scientific credibility – the scientists who objected to the Committee of guidelines were either (according to Hegsted) hopelessly retarded or (according to Mottern) or industry prophets.
Although the Committee published a revised version of the dietary recommendations later that year, the message remained unchanged. As a concession to the industry a reduction of the recommendation was discussed, to eat less meat. Mottern said that he thought this would be a disservice to the American public, refused to revise the test and then ended his work on the Committee. Mottern was in the process of dietary advice vegetarian and devoted his time to food trade in New York.
Nutritional recommendations become policy: Nutritional recommendations would have been able to die a quiet death in 1977 When McGovern COMMITTEE dissolved, had it not been for that two federal agencies had felt compelled to respond to them. Although they took opposing positions, it was one of the messages and – with the media’s help – were looking into the American consciousness.
Ministry of Agriculture’s dietary guidelines. First came the U.S. Department of Agriculture (USDA) in where the Consumer Ombudsman Carol Tucker Foreman recently had received a post. Foreman experienced a very heavy obligation of the Ministry of Agriculture to convert McGovern’s recommendations into official policy. Like Mottern, she was not particularly disturbed that the dietary advice was scientifically controversial. “Tell me what you know, and say that this is not the final answer,” she would say to the scientists. "I have to give my children food three times a day, and I want your best image of current research”.
As the science area was controversial, “the best image of research” depended of course on who was asked among the researchers. The Board of nutrition issues at the National Academy of Sciences (NAS), which decided the recommended daily rations, should have been the natural choice. NAS President Philip Handler, an expert on metabolism, however, expressed to Foreman that he considered Mottern´s dietary recommendations to be pure nonsense.
Foreman then turned to the McGovern group for advice. They recommended her to turn to Hegsted, which she did. Hegsted in turn, relied on a report on the stat of science published by a committee of experts from the American Society for Clinical Nutrition, a Committee which however, had very scattered opinions. “They were not even close to anything resembling a consensus,” said Hegsted, “but most of them supported well something like McGovern’s Committee report. The resulting document became the first edition of “Using the Dietary Guidelines for Americans”. Although the report was open to it was controversial, and stressed that a single nutrient recommendation might not suit everyone in a population with so much diversity, so was the advice to avoid lipids and saturated lipids, substantially identical to McGovern’s dietary recommendations.
Academy of Science’s dietary guidelines. Three months later, the National Academy of Science’s Board on Food and Nutrition Policy, which released its own recommendations: “Towards Healthful Diets?” The Board, consisting of a dozen nutrition experts, concluded that the only reliable advice to support American’s health was to keep an eye on the weight. Everything else, including lipids in the diet, were matters of secondary importance.
This advice was not very favourable, at least not by the media. The first of them commented – “rather suspiciously”, said Handler – which the National Acedemy of Science’s dietary guide lines created a conflict with the Ministry of Acriculture and the McGovern dietary guide lines, and this was seen as irresponsible. Subsequent comments insinuated (with Jane Brady’s words, who wrote the article for New York Times) that the board members were sitting in the lap of the industry affected. To be precise it was the President and one of the members who had been consulting for the food industry, while the financing of the board itself came from industry donations. Hints to the press abort their ties to industry were leaked from the Ministry of Agriculture.
Hegsted later defended Academy of Science’s board, which, however, he did first, and called the conflict”an issue of hell”. "Some complained that the industry did not do anything abort food, but all who were involved were frozen out because their approach was influenced by the industry." Hegsted went back to Harvard in 1981 and his research was funded by Frito-Lay (company that manufactures chips, snacks, cookies, etc).
The press had mixed feelings, and argued that that the bonds had soiled the Academy’s reputation for”considerate and careful scientific advice” (Washington Post) and that the Board’s objectivity and skill that went into question” (New York Times). Anyway, Academy of Science Board had been publically discredited.
Hegsteds Dietary Guidelines for Americans became the official U.S. policy with regard to dietary content of lipids: Eat fewer lipids. Live longer.
Building consensus:
The studies. Now when the politicians, the media and the public agreed on a policy about content of lipids in the diet, it was only the science that needed to catch up. During the 1970s, when NIH opted out of the study of one billion dollars, which would give a definite answer, and instead chose half-dozen small studies for one third of the cost, all hoped that the results would provide sufficient basis to conclude that low lipid diets prolonged life.
The results were published between 1980 and 1984. Four of these studies – which compared the incidence of cardiovascular disease between Honolulu, Puerto Rico, Chicago, and Framingham – gave no evidence that men who ate fewer lipids lived longer or had fewer heart attacks.
A fifth study, The Multiple Risk Factor Intervention Trial (MRFIT), cost 115 million dollars and tried to strengthen diets modest impact on health by persuading subjects to avoid lipids while simultaneously quit smoking and took medication for high blood pressure. The study indicated if anything, to decrease lipid intake decreased length of life.
In each survey, however, the researchers concluded that the reason for the negative results were due to methodological error. The never came to a conclusion, at least not publically, that the results were due to that the bad lipids were not quite as bad as believed.
The link between cholesterol and heart attacks. The sixth study was the Clinics (LRC) Coronary Primary Prevention Trial which cost 140 million dollars. It was headed by an administrator on NHLBI named Rifkind, and biochemist Daniel Steinberg from University of California, San Diego.
LRC study was a drug study and not a dietary study, but the NHLBI felt that the results could presage the end of the debate about lipids in the diet. In January 1984 LRCs researchers reported that a preparation called Cholestyramine and which decreased cholesterol levels in men with abnormally high cholesterol levels also resulted in a modest reduction in heart disease. The probability of getting a heart attack during the more than seven years of the study decreased from 8, 6 % to 7, 0 % in the experimental group. The risk of dying from heart attacks decreased from 2, 0 % to 1, 6 %.
The researchers then concluded, without having used the dietary data, the utility of Cholestyramine also covered the diet. Although the study only included middle-age men with cholesterol levels higher than 95 % of the population had, the researchers concluded that the benefits “could and should include other age groups and women… and other more modestly elevated cholesterol levels.”
But why were the results hard to cover these conclusions?
Rifkind told that his logic was simple: For 20 years he and his colleagues argued that lowering cholesterol levels could prevent heart attacks, and they had made off with huge sums to prove it. They had reached the realization that they actually could never come to show that low lipid diets prolonged life – that would be too expensive. Now they had at least been able to establish an important link in the chain – from reducing Cholesterol to increase cardiovascular health. With this link, they could take the”Leap of Faith” from the Cholesterol-lowering medicines and health to diet and health. After all efforts they were eager – for now not to say pressured from Congress – to formulate useful guide lines. "There comes a point when the consequences can be just as big even if they do not take a decision,” said Rifkind. "If you just allow Americans to continue eating 40 % of calories in lipids, so this will result in something.”
Media went astray. While printing presses rustled up LRCs results, NHLBI launched what Levy called a”massive public health campaign.” Media was accommodating but completely lost. TIME, for example, commented LRCs results under the heading”Sorry, it is true.” The article about a drug study began:”No standard milk. No butter. No fat meat ….”. TIME followed up three months later with a review article: "And Cholesterol, and now to the bad news. …”. Cover photograph was a grim face: a breakfast plate with two fried eggs for eyes and a bacon slice mouth. Rifkind was quoted when he said that the results”strongly suggest that the more you lower cholesterol and lipids in your diet, the more reduced the risk of heart disease”, a claim that there is still no scientific support.
Concensus Conference 1984. In December 1984, NIH effectively ended the debate with a Concensus Conference. The idea of such a conference is a panel of experts, preferably unaffected, listening to two days of requests and from this comes to a conclusion that everyone agrees on. In this case, Rifkind was chairman of the planning committee, which chose LRCs second researcher Steinberg to lead the expert panel. The twenty speakers included a handful of sceptics, including Ahrens, and cardiologist Michael Oliver from Imperial College in London, which argued that it was unscientific to equate the effects of a drug with effects of a diet. However, the members of Steinberg’s panel were, which Oliver later complained in The Lancet, selected so that they only consisted of experts who could be predicted assert that all levels of blood Cholesterol in the U.S. were too high and should be reduced. And, of course, this was exactly what was claimed.
Conference report, written by Steinberg and his panel, revealed certainly not the least absence of discord. There was”no doubt”, held on, that low-lipid diets”will offer a significant protection against coronary heart disease” for all Americans over the age of two.
Consensus Conference formally gave the impression of consensus where none exists. After all, as Steinberg put it in the journal Science,”if there had been a true consensus a consensus conference had not been necessary.
Simple relationship more convenient than the complex one.
"Wishful science?” To the outside observer, it is a great challenge to turning on such a lengthy scientific controversy. The main task is to find out if the sceptics are simply on the wrong side of the new paradigm, or whether scepticism is justified.
In other words, is the science in question, based on sound scientific thinking and unambiguous data, or is it what Sir Francis Bacon (1561-16265) would have called wishful science, based on fancies, opinions, or concealment of challenging or inconsistent results? Bacon proposed a method for distinguishing the two: They let time give the
Good science is rooted in reality, it grows and develops evidence and produces less and less room for doubts. Wishful Science blooms up shortly after the drafting of their authors, and then it goes out. So here was the example with the idea that lipids in the diet cause cancer, which was part of the concern in the late 1970.
They hade the idea that there was such a strong connection, and the NAS wrote 1982 in a report that those who did not believe in a connection between lipids and cancer ere compared with those who formerly did not believe in a connection between smoking and lung cancer.
Fifteen years and hundreds of millions of dollars later struck a thick expert report from the World Cancer Research Fund and American Institute for Cancer Research determined that that they have not found anything convincing, or even reasonable, to believe that lipids in the diet caused cancer. Time gave its answer.
Low lipid diet – Time has given the answer. With the idea that a low lipid diet is a way out of obesity, it has also gone out. The last resort for the recommendations to reduce lipid intake was based on energy balance: Lipid has nine calories per 0, 04 ounce, while carbohydrates and protein have four calories per 0, 04 ounce, so by eliminating lipids from the diet would crumble pounds. This has been regarded almost as a religious truth, says Walter Willett at Harvard. A substantial body of data suggests something else entirely. The results from well-.controlled clinical trials are consistent: People who eat a low lipid diet drop a few pounds in the beginning, as they would on any diet whatsoever, but then usually the weight goes back. After one or two years, almost none of the weight loss was maintained.
Take for example the 50 000 women who engaged in the ongoing study Women’s Health Initiative (WHI) for one hundred million U.S. dollars. Half of theses women have been fully allocated to eating only 20 % of energy from lipids. After three years of this horror diet, said sources in the WHI, every woman has lost an average of two pounds.
Also here, time has given its answer.
No simple relationship. Since Ancel Keys began advocating low lipid diets fifty years ago, the science of lipids and health has developed from an assumption to fairly simple relationship in an extremely complicated problem. The snag was that few involved were prepared to address a complex problem.
Scientists preferred to believe that it was a simple relationship, that the effect of a single unwholesome nutrient could be isolated fro diversity and richness of the human diet. Public health bureaucrats preferred a simple connection to serve Congress and the public. The press preferred a simple relationship - at least in each article – to give their editors and readers of a few tens of column inches.
It is now clear to many that the simple relationship never existed.
________________________________________
References.
1. Taubes G. The Soft Science of Dietary Fat. Science (2001); vol 291, issue 5513: p2536-2545. 30 March 2001.
2005-12-30
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2010-02-03
www.Brejka.se
Elisabeth: Today on 03 February, 2010 I received a mail from Peter Gestrup. He is PR Manager for a web service named Brejka.se . He asked me if I could spread information about his web page on my blog. A short summarizing description follows below:
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Brejka.se is a free service offering people help to quit smoking, stop using snuff, take a white period or consume less sweets. At the service, use your social network to get assistance with your personal challenge.
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Please return if you have any questions about the service.
Your sincerely,
Peter
Peter Gestrup
Web: www.Brejka.se
Email: peter@brejka.se
Cell: +46 707 53 72 52
----------------------------------
Your friends will help you!”
“Brejka helps you breaking an unhealthy habit!
Brejka.se is a free service offering people help to quit smoking, stop using snuff, take a white period or consume less sweets. At the service, use your social network to get assistance with your personal challenge.
The point of Brejka is that you put social pressure on your ambition to lead a better life. The friends you invited get a chance to give their support and rewards, with functions as both carrot and stick.
Brejka´s ambition is taking a holistic approach to the galloping health problem. Too often health problems are considered equal with weight problems. Not as often they highlight the dangers of nicotine and alcohol. Therefore we have decided to launch Brejka.
Please return if you have any questions about the service.
Your sincerely,
Peter
Peter Gestrup
Web: www.Brejka.se
Email: peter@brejka.se
Cell: +46 707 53 72 52
----------------------------------
Your friends will help you!”
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