142 : c h a p t e r t e n
that dietary cholesterol caused heart disease. The obstacles to accurately measuring and comparing the food intakes and health outcomes of such disparate groups of people were simply insurmountable. Only “prospec-tive” studies, using strictly supervised control groups who were fed on diff erent diets and followed over many years, could hope to achieve this.
However, a large NIH-funded study aiming to do this foundered, mainly because only about one-quarter of the men on low-fat diets could stick to them for more than a year.¹²
143 : Creating a National Eating Disorder
“no cholesterol,” “low cholesterol,” and “unsaturated.” Soon polyunsatu-rated oil was being touted as a health food in its own right. The Harvard nutritionist Frederick Stare advised swallowing three tablespoons of it each day as a “medication.” Jean Mayer, his counterpart at Tuft s, said that consuming one cup of corn oil a day would prevent heart disease, but that it did not have to be in raw form.¹⁵
This blitz—particularly ads such as Saff ola’s saying that it recom-mended using vegetable oil to cut heart disease—alarmed the AMA.
It tried to scotch this notion that people could prevent heart disease without the help of their doctors by issuing a statement saying, “The antifat, anticholesterol fad is not just foolish and futile; it carries some risk. . . . Dieters who believe they can cut down their blood cholesterol without medical supervision are in for a rude awakening. It can’t be done. It could even be dangerous to try.”¹⁶ Yet when people did consult their doctors, they were almost inevitably told to go on low-fat diets. As a leading medical scientist later wrote, “Physicians were overwhelmed by this assault, both from their waiting rooms and their professional jour-nals. A low fat, low cholesterol diet became as automatic in their treat-ment advice as a polite goodbye.”¹⁷
“Should an Eight-Year-Old Worry about Cholesterol?”
The AMA’s opposition to selling food for therapeutic purposes once again lined it up with the Food and Drug Administration, its erstwhile ally in the batt le against vitamin supplements. In late 1959, the FDA had warned food producers that any claims that unsaturated fats would re-duce blood cholesterol were “false and misleading.” It had been shown, said its commissioner, that the human body produced its own choles-terol and was “aff ected very litt le by the amount present in our foods.”¹⁸ But this did litt le to stifl e the dubious claims. Finally, in September 1964, the FDA seized a shipment of Nabisco Shredded Wheat on the grounds that the packages carried “false health claims,” namely that eat-ing a bowl of it each morneat-ing would lower blood cholesterol and pre-vent heart disease and stroke.¹⁹ For the rest of the decade, the agency repeatedly said that there was no proof of a relationship between dietary cholesterol and heart disease, and warned food processors against claim-ing that the polyunsaturated fats in their products might prevent heart disease.²⁰
However, the Food and Drug Administration only controlled drug ad-vertising. It was the Federal Trade Commission (FTC) that oversaw food
144 : c h a p t e r t e n
advertising, and under its benign gaze, food processors ran all kinds of ads strongly implying that their products would prevent heart att acks.
The secretary of the American Medical Association’s Council on Foods complained that “we are all tired now of the unending advertisements for oils and margarines that promise to clean one’s arteries in much the same way a drain cleaner works,” but the AMA’s journal itself carried such advertisements. The one for Fleischmann’s margarine featured a photograph of a boy blowing out eight birthday candles. In medical jour-nals, the caption said, “Is there a heart att ack in his future?” and the text below recommended low-saturated-fat diets to prevent heart disease “for people of all age groups.” In popular magazines, the company’s ads advis-ing parents to feed their children its margarine carried the same picture with the caption, “Should an 8-year-old worry about cholesterol?”²¹
In 1971, when the Federal Trade Commission fi nally stepped in to tell Fleischmann’s to “tone down” its ads, it was hard to tell whether to laugh or cry. The commission forbade the company from directly claiming that its margarine prevented heart disease, but it did allow it to say that it “can be used as part of a diet to reduce serum cholesterol which can contribute to the prevention and mitigation of heart and artery disease.” In justifying this, the FTC said that although these claims “have not been established by competent and reliable scientifi c evidence,” heart disease was such a serious problem that it was good to “acquaint the consumer . . . with some of the steps recommended for its avoidance.” Moreover, the order applied only to Fleischmann’s and did not stop others from advertis-ing, as did Saff ola, that their foods “will do your heart good.” Nor did it stop Fleischmann’s from giving mothers a litt le booklet about its mar-garine called “The Prevention of Heart Disease Begins in Childhood.”²² In fudging the issue, the FTC was simply going along with the Ameri-can Heart Association, which routinely blamed dietary cholesterol for heart att acks while admitt ing, in the fi ne print, that there was no proof of this. In 1971, aft er the FTC reported that a majority of experts it consulted supported the diet-heart hypothesis, one of the dissenting scientists said bitt erly, “The dietary dogma was a money-maker for segments of the food industry, a fund raiser for the Heart Association and busy work for thousands of fat chemists. . . . To be a dissenter is to be unfunded because the peer-review system rewards conformity and excludes criticism.”²³
The next year saw the AMA return to the lipophobe fold. This may not have been unconnected with the new role that had emerged for doc-tors—doing regular cholesterol checks. It now warned that most
Ameri-145 : Creating a National Eating Disorder
cans had elevated cholesterol levels and that doctors should begin check-ing their cholesterol levels in early adulthood. Those found to be “at risk”
should cut down on saturated fats—under their doctor’s supervision, of course.²⁴
Finally, in January 1973, the FDA caved in. It began allowing food labels to carry their cholesterol and saturated fat content and to say that eating foods low in cholesterol and saturated fats and high in poly unsaturated fats would help lower cholesterol levels.²⁵ Although they could still not say directly that this would prevent heart att acks, there was no need to do so. As Edward Pinckney, a disgusted preventative medicine physician, wrote:
The consumer’s understandable fear of heart disease and impending death is being exploited by certain health groups as well as by an industry whose profi ts have more than doubled as a direct result of its implied promise that heart disease can be forestalled through use of its products. The very word
“polyunsaturated” has become synonymous with protection against heart disease just as “cholesterol” and “saturated fat” have been made to intimate doom.
Yet, he said, there was no proof at all that cholesterol in the blood caused heart disease and especially that dietary change would make any diff erence.²⁶
However, naysayers like him were drowned out by the lipophobic cho-rus. The AHA soon raised the ante by telling all Americans to double their consumption of polyunsaturated fats and reduce their meat con-sumption by one-third.²⁷