Good Calories, Bad Calories

ONCE THE NATIONAL INSTITUTES OF HEALTH had declared the existence of a consensus, the controversy over dietary fat appeared to be over. A series of official government reports and guidelines that followed served to confirm it. In 1986, the NIH established the National Cholesterol Education Program (NCEP), which released its first guidelines for cholesterol reduction in October 1987. “The edict has been handed down,” as the Washington Post reported: “total blood cholesterol should be below 200…. If it’s above that threshold physicians must put their patients on cholesterol-lowering diets or use some of the new cholesterol-combating drugs to bring down the levels.” Surgeon General C. Everett Koop’s seven-hundred-page Report on Nutrition and Health, released in July 1988, “exhorts Americans to cut out the fat,” Time reported. The “disproportionate consumption of food high in fats,” according to the Report on Nutrition and Health, could be held responsible for two-thirds of the 2.1 million deaths in the United States in 1988. “The depth of the science base…is even more impressive than that for tobacco and health in 1964,” explained Koop in the introduction, which was certainly not the case. In March 1989, the National Academy of Sciences released its version of the surgeon general’s report, thirteen hundred pages long, entitled Diet and Health: Implications for Reducing Chronic Disease Risk. “Highest priority is given to reducing fat intake,” the NAS report stated, “because the scientific evidence concerning dietary fats and other lipids and human health is strongest and the likely impact on public health the greatest.”

These authoritative reports implied without foundation that yet more independent expert committees had weighed the evidence and agreed that dietary fat was a killer. But the surgeon general’s report had been overseen by J. Michael McGinnis, who had been Mark Hegsted’s liaison at the Surgeon General’s Office when the first USDA Dietary Guidelines had been drafted a decade earlier. The chapter linking dietary fat to heart disease had been contracted out to the same administrators at the National Heart, Lung, and Blood Institute who had organized the NIH Consensus Conference and founded the National Cholesterol Education Program. In Diet and Health, the chapter assessing the hazards of fat had been drafted by three old hands in the dietary-fat controversy: Henry Blackburn, a protégé of Ancel Keys at Minnesota; Richard Shekelle, who had co-authored more than forty papers with Jeremiah Stamler; and DeWitt Goodman, who had chaired the National Cholesterol Education Program panel that had drafted the 1987 guidelines.^*18

In the media coverage that followed, those investigators skeptical of the underlying science seemed to have vanished from the public debate. New on the scene were public-interest groups—most notably, the Center for Science in the Public Interest and its director, Michael Jacobson—arguing that neither the NAS nor the surgeon general had gone far enough in pushing a national low-fat diet plan. Both the Washington Post and the New York Times quoted Jacobson scolding the authors of Diet and Health for lacking “the courage” to tell Americans straight out that a healthy lifestyle required much “greater reductions” in total fat, saturated fat, and cholesterol. In the Post article, Arno Motulsky, chairman of the NAS committee that compiled the report, acknowledged that one intention of Diet and Health was to convince Americans further of the existence of a scientific consensus on the benefits of reducing fat in the diet. “Many people may be confused by the vast amount of advice about what to eat,” he said. “Some may have delayed making changes in their diets until they are more convinced that scientists have reached consensus. We hope our report will help these individuals move from inaction and complacency to action.” The public face of the controversy had now shifted entirely. It was no longer about the validity of the underlying science, which was no less ambiguous than ever, but about whether Americans should be eating low-fat diets or very low-fat diets.

One striking fact about this evolution is that the low-fat diets now being recommended for the entire nation had only been tested twice, as I’ve said, once in Hungary and once in Britain, and in only a few hundred middle-aged men who had already suffered heart attacks. The results of those trials had been contradictory. The diets tested since then had been exclusively cholesterol-lowering diets that replaced saturated fats with unsaturated fats.