Friday, December 31, 2010

The Nutrition Debate #4: Big Government, Big Pharma, and Poor Little Dr. Atkins

In 1972 Dr. Robert Atkins published his “Diet Revolution” advocating a very low carbohydrate diet. In response the AMA attacked Atkins calling his “high fat” diet a “dangerous fraud.” When Atkins was called before a congressional committee to defend himself, he was publically ridiculed and humiliated. Meanwhile, two years later (in 1974), The Framingham Study again reported that men with low cholesterol have a strong association with colon cancer and premature death, but that there was no association between high cholesterol and sudden death. The water was getting muddied, but nobody outside the research community paid attention to the newly nuanced data and findings.

Enter Senator George McGovern, chairman of a U. S. Senate Select Committee on Nutrition and Human Needs (“the McGovern Commission”) and staunch supporter of agriculture since beginning his Congressional career in 1956. He was convinced that fat made us fat and was responsible for “killer diseases” like cancer and heart disease. In 1977, after only two days of very contentious hearings, his committee published the “Dietary Goals for the United States” (The McGovern Report). That was followed in 1980 by “Dietary Guidelines for Americans,” published jointly by HHS and USDA then and now every 5 years including the present iteration, published July 13, 2010. Again, the die was cast. There was no going back, in spite of mounting and persistent evidence. Government appointed scientists and processed food industry representatives would henceforth decide what to recommend we eat. What we eat had become the government’s business, and the business of big business.

In that same year as the McGovern Report (1977), the NIH reported on five diet-heart studies suggesting that a depressed level of HDL was the most reliable predictor of heart disease for men and women at all ages, but this went virtually unnoticed at the time. This finding was studied further by the NIH, but only after a substantial delay. It wasn’t until 1999 that a large scale, long term study confirmed that increasing HDL lowers CVD risk. Recent research indicates that it also lowers cancer risk, approximately 36% with every rise of 10 mg/dl. (

In the meantime, NIH’s MRFIT study (1982, 13,000 men followed for 6 years) studied a low-fat, high carbohydrate diet with a focus on vegetable fat, which effectively lowered total cholesterol. Participants had more heart disease deaths than their “usual care” cohort. In addition, the lowest cholesterol levels were associated with mortality levels equivalent to the highest cholesterol levels. They were also associated with significantly more strokes, digestive diseases and cancers. This study was also ignored, but the focus did shift to lowering LDL instead of total cholesterol, perhaps due to the desire for a simple public health message. (

Now, enter Big Pharma. By the late 1980’s sales of the first LDL cholesterol lowering statin drug had begun. As a result of public campaigns, people became familiar with their cholesterol numbers, and the difference between “good” and “bad” cholesterol entered the public consciousness. These campaigns were very effective. World-wide sales of statins in 2010 should top $20 billion; they are the most commonly prescribed drug of all time. However, 30 years later, there is no evidence that statins help women or anyone over the age of 65. (

Meanwhile, Ancel Keys, father of the lipid hypothesis, lived on in Southern Italy to age 100, before coming home to die in 2004. Years earlier, however, according to Malcolm Kendrick, author of “The Great Cholesterol Myth,” Keys admitted (in 1997) that cholesterol in the diet has no effect on cholesterol levels in the blood. Keys is said to have said, “There's no connection whatsoever between cholesterol in food and cholesterol in blood. And we've known that all along.”

What is that he said, you say? Is it then possible that: dietary cholesterol does not have to be limited at all? that Total (blood) Cholesterol is irrelevant? that high LDL is not a critical metric, and that high HDL and lower triglycerides are more important for heart health? And finally, that those two goals are achievable, with weight loss by low-carb eating alone, with fish oil supplementation, and without statins?

When my doctor, an internist/cardiologist, looked at my blood tests, including my lipid panel, after a recent visit, he called to tell me the results. He concluded, exultant: “You’re going to live to be 105!” Hmmm… that’s longer than Keys.

© Dan Brown 12/12/10

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