Retrospective #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, just two years later (in 1974), The Framingham Study reported that there was no association between high cholesterol and sudden death, but men with low cholesterol had a strong association with colon cancer and premature death. The water was muddy, but nobody outside the research community paid attention to the research findings and nuanced data.

Enter Senator George McGovern, chairman of a U. S. Senate Select Committee on Nutrition and Human Needs (“the McGovern Committee”). He had been a staunch supporter of agriculture since beginning his Congressional career. He was also 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,” aka “The McGovern Report.” The first “Dietary Guidelines for Americans,” published jointly by HHS and USDA, followed soon after in 1980. It has since been revised and reissued, with only incremental changes, every 5 years. The die had been cast. There was now no going back, in spite of mounting evidence. Government appointed scientists and processed food industry representatives would henceforth decide what to recommend we eat. What we eat had become Big Government’s business, and the province of Agri Business and Big Pharma.

In that same year as The McGovern Report (1977), the National Institutes of Health (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. 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. This old link from 2009 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-C 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 advertising 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. A recent AMA editorial suggested that world-wide sales of statins may approach $1 trillion by 2020.; they are the most successful drug of all time. However, there is no evidence that statins help women or anyone over 65.

Meanwhile, Ancel Keys, father of the lipid hypothesis, retired to Southern Italy, coming home to die in 2004 at age 100. 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 ask? Is it then possible that dietary cholesterol does not have to be limited at all? That Total Cholesterol is irrelevant? That high LDL-C is not a critical metric, and that high HDL-C and lower triglycerides are more important for heart health? And finally, that higher HDL-C and lower triglycerides are achievable, with weight loss, by eating low-carb, with fish oil supplementation (to lower triglycerides), and without taking statins?

Yes, it is, and when my doctor saw my most recent blood tests, including my lipid panel, he called me to tell me the results. He concluded, exultant: “You’re going to live to be 105!” Hmmm, I thought, that’s longer than Ancel Keys.