by Mary Enig, PhD, and Sally Fallon
First published in Nexus Magazine,
Dec ’98-Jan ’99 and Feb ’99-Mar ’99
Cholesterol screening for everyone
In November of 1986, the Journal of the American Medical Association published a series on the Lipid Research Clinics trials, including “Cholesterol and Coronary Heart Disease: A New Era” by longtime American Heart Association member Scott Grundy, MD, PhD.35 The article is a disturbing combination of euphoria and agony—euphoria at the forward movement of the lipid hypothesis juggernaut, and agony over the elusive nature of real proof. “The recent consensus conference on cholesterol. . . implied that levels between 200 and 240. . carry at least a mild increase in risk, which they obviously do. . .” said Grundy, directly contradicting an earlier statement that “Evidence relating plasma cholesterol levels to atherosclerosis and CHD has become so strong as to leave little doubt of the etiologic connection.” Grundy called for “. . . the simple step of measuring the plasma cholesterol level in all adults. . . those found to have elevated cholesterol levels can be designated as at high risk and thereby can enter the medical care system. . . an enormous number of patients will be included.” Who benefits from “the simple step of measuring the plasma cholesterol level in all adults?” Why, hospitals, laboratories, pharmaceutical companies, the vegetable oil industry, margarine manufacturers, food processors and, of course, medical doctors. “Many physicians will see the advantages of using drugs for cholesterol lowering. . .” said Grundy, even though “a positive benefit/risk ratio for cholesterol-lowering drugs will be difficult to prove.” The cost in the US of cholesterol screening and cholesterol-lowering drugs alone now stands at sixty billion dollars per year, even though a positive risk/benefit ratio for such treatment has never been established. Physicians, however, have “seen the advantages of using drugs for cholesterol lowering” as a way of creating patients out of healthy people.
Grundy was equally schizophrenic about the benefits of dietary modification. “Whether diet has a long term effect on cholesterol remains to be proved,” he stated, but “Public health advocates furthermore can play an important role by urging the food industry to provide palatable choices of foods that are low in cholesterol, saturated fatty acids and total calories.” Such foods, almost by definition, contain partially hydrogenated vegetable oils that imitate the advantages of animal fats. Grundy knew that the trans fats were a problem, that they raised serum cholesterol and contributed to the etiology of many diseases—he knew because a year earlier, at his request, Mary Enig had sent him a package of data detailing numerous studies that gave reason for concern, which he acknowledged in a signed letter as “an important contribution to the ongoing debate.”
Other mouthpieces of the medical establishment fell in line after the Consensus Conference. In 1987 the National Academy of Science (NAS) published an overview in the form of a handout booklet containing a whitewash of the trans problem and a pejorative description of palm oil—a natural fat high in beneficial saturates and monounsaturates that, like butter, has nourished healthy population groups for thousands of years, and, also like butter, competes with hydrogenated fats because it can be used as a shortening. The following year the Surgeon General’s Report on Nutrition and Health emphasized the importance of making low-fat foods more widely available. Project LEAN (Low-Fat Eating for America Now) sponsored by the J. Kaiser Family Foundation and a host of establishment groups such as the America Heart Association, the American Dietetic Association, the American Medical Association, the USDA, the National Cancer Institute, Centers for Disease Control and the National Heart, Lung and Blood Institute announced a publicity campaign to “aggressively promote foods low in saturated fat and cholesterol in order to reduce the risk of heart disease and cancer.”
National Food Processors Association Conference
The following year, Enig joined Frank McLaughlin, Director of the Center for Business and Public Policy at the University of Maryland, in testimony before the National Food Processors Association. It was a closed conference, for NFPA members only. Enig and McLaughlin had been invited to give “a view from academia.” Enig presented a number of slides and warned against singling out classes of fats and oils for special pejorative labeling. A representative from Frito-Lay took umbrage at Enig’s slides, which listed amounts of trans fats in Frito-Lay products. Enig offered to redo the analyses if Frito-Lay would to fund the research. “If you’d talk different, you’d get money,” he said.
Enig urged the association to endorse accurate labeling of trans fats in all food items but conference participants—including representatives from most of the major food processing giants—preferred a policy of “voluntary labeling” that did not unnecessarily alert the public to the presence of trans fats in their foods. To date they have prevailed in preventing the inclusion of trans fats on nutrition labels.
Enig’s cat and mouse game with Hunter and Applewhite of the Institute of Shortening and Edible Oils continued throughout the later years of the 1980’s. Their modus operandi was to pepper the literature with articles that downplayed the dangers of trans fats, to use their influence to prevent opposing points of view from appearing in print and to follow-up the few alarmist articles that did squeak through with “definitive rebuttals.” In 1987 Enig submitted a paper on trans fatty acids in the US diet to the American Journal of Clinical Nutrition, as a reply to the erroneous 1985 FASEB report as well as to Hunter and Applewhite’s influential 1986 article, which by even the most conservative analysis underestimated the average American consumption of partially hydrogenated fats. Editor-in-chief Albert Mendeloff, MD rejected Enig’s rebuttal as “inappropriate for the journal’s readership.” His rejection letter invited her to resubmit her paper if she could come up with “new evidence.” In 1991, the article finally came out in a less prestigious publication, the Journal of the American College of Nutrition,36 although Applewhite did his best to coerce editor Mildred Seelig into removing it at the last minute. Hunter and Applewhite submitted letters and then an article of rebuttal to the American Journal of Clinical Nutrition,37 which were published shortly thereafter. In the article, entitled “Reassessment of trans fatty acid availability in the US diet,” Hunter and Applewhite argued that the amount of trans in the American diet had actually declined since 1984, due to the introduction of soft margarines and tub spreads. The media fell in line with their pronouncements, with numerous articles by food writers recommending low-trans tub spreads, made from polyunsaturated vegetable oils, as the sensible alternative to saturated fat from animal sources—not surprising as most newspapers rely on the International Food Information Council, an arm of the food processing industry, for their nutrition information.
Other research on trans fats
Enig and the University of Maryland group were not alone in their efforts to bring their concerns about the effect of partially hydrogenated fats before the public. Fred Kummerow at the University of Illinois, blessed with independent funding and an abundance of patience, carried out a number of studies that indicated that the trans fats increased risk factors associated with heart disease, and that vegetable-oil-based fabricated foods such as Egg Beaters cannot support life.38 George Mann, formerly with the Framingham project, possessed neither funding nor patience—he was, in fact, very angry with what he called the Diet/Heart scam. His independent studies of the Masai in Africa,39 whose diet is extremely rich in cholesterol and saturated fat, and who are virtually free of heart disease, had convinced him that the lipid hypothesis was “the public health diversion of this century. . . the greatest scam in the history of medicine.”40 He resolved to bring the issue before the public by organizing a conference in Washington DC in November of 1991.
“Hundreds of millions of tax dollars are wasted by the bureaucracy and the self-interested Heart Association,” he wrote in his invitation to participants. “Segments of the food industry play the game for profits. Research on the true causes and prevention is stifled by denying funding to the ‘unbelievers.’ This meeting will review the data and expose the rascals.”
The rascals did their best to prevent the meeting from taking place. Funding promised by the Greenwall Foundation of New York City was later withdrawn, so Mann paid most of the bills. A press release sent as a dirty trick to speakers and participants wrongly announced that the conference had been cancelled. Several speakers did in fact renege at the last minute on their commitment to attend, including the prestigious Dr. Roslyn Alfin-Slater and Dr. Peter Nixon of London. Dr. Eliot Corday of Los Angeles cancelled after being told that his attendance would jeopardize future funding.
The final pared-down roster included Dr. George Mann, Dr. Mary Enig, Dr. Victor Herbert, Dr. Petr Skrabenek, William B. Parsons, Jr., Dr. James McCormick, a physician from Dublin, Dr. William Stehbens from New Zealand, who described the normal protective process of arterial thickening at points of greatest stress and pressure, and Dr. Meyer Texon an expert in the dynamics of blood flow. Mann, in his presentation, blasted the system that had foisted the lipid hypothesis on a gullible public. “You will see,” he said, “that many of our contributors are senior scientists. They are so for a reason that has become painfully conspicuous as we organized this meeting. Scientists who must go before review panels for their research funding know well that to speak out, to disagree with this false dogma of Diet/Heart, is a fatal error. They must comply or go unfunded. I could show a list of scientists who said to me, in effect, when I invited them to participate: ‘I believe you are right, that the Diet/Heart hypothesis is wrong, but I cannot join you because that would jeopardize my perks and funding.’ For me, that kind of hypocritical response separates the scientists from the operators—the men from the boys.”
90s see the nation well oiled
By the nineties the operators had succeeded, by slick manipulation of the press and of scientific research, in transforming America into a nation that was well and truly oiled. Consumption of butter had bottomed out at about 5 grams per person per day, down from almost 18 at the turn of the century. Use of lard and tallow had been reduced by two-thirds. Margarine consumption had jumped from less than 2 grams per person per day in 1909 to about 11 in 1960. Since then consumption figures had changed little, remaining at about 11 grams per person per day—perhaps because knowledge of margarine’s dangers had been slowly seeping out to the public. However, most of the trans fats in the current American diet come not from margarine but from shortening used in fried and fabricated foods. American shortening consumption of 10 grams per person per day held steady until the 1960’s, although the content of that shortening had changed from mostly lard, tallow and coconut oil—all natural fats—to partially hydrogenated soybean oil. Then shortening consumption shot up and by 1993 had tripled to over 30 grams per person per day.
But the most dramatic overall change in the American diet was the huge increase in the consumption of liquid vegetable oils, from slightly less than 2 grams per person per day in 1909 to over 30 in 1993—a fifteen fold increase.
Dangers of polyunsaturates
The irony is that these trends have persisted concurrently with revelations about the dangers of polyunsaturates. Because polyunsaturates are highly subject to rancidity, they increase the body’s need for vitamin E and other antioxidants. Excess consumption of vegetable oils is especially damaging to the reproductive organs and the lungs—both of which are sites for huge increases in cancer in the US. In test animals, diets high in polyunsaturates from vegetable oils inhibit the ability to learn, especially under conditions of stress; they are toxic to the liver; they compromise the integrity of the immune system; they depress the mental and physical growth of infants; they increase levels of uric acid in the blood; they cause abnormal fatty acid profiles in the adipose tissues; they have been linked to mental decline and chromosomal damage; they accelerate aging. Excess consumption of polyunsaturates is associated with increasing rates of cancer, heart disease and weight gain; excess use of commercial vegetable oils interferes with the production of prostaglandins leading to an array of complaints ranging from autoimmune disease to PMS. Disruption of prostaglandin production leads to an increased tendency to form blood clots, and hence myocardial infarction, which has reached epidemic levels in America.41
Vegetable oils are more toxic when heated. One study reported that polyunsaturates turn to varnish in the intestines. A study by a plastic surgeon found that women who consumed mostly vegetable oils had far more wrinkles than those who used traditional animal fats. A 1994 study appearing in the Lancet showed that almost three quarters of the fat in artery clogs is unsaturated. The “artery clogging” fats are not animal fats but vegetable oils.42
Those who have most actively promoted the use of polyunsaturated vegetable oils as part of a Prudent Diet are well aware of their dangers. In 1971, William B. Kannel, former director of the Framingham study, warned against including too many polyunsaturates in the diet. A year earlier, Dr. William Connor of the American Heart Association issued a similar warning, and Frederick Stare reviewed an article which reported that the use of polyunsaturated oils caused an increase in breast tumors. And Kritchevsky, way back in 1969, discovered that the use of corn oil caused an increase in atherosclerosis.43
As for the trans fats, produced in vegetable oils when they are partially hydrogenated, the results that are now in the literature more than justify concerns of early investigators about the relation between trans fats and both heart disease and cancer. The research group at the University of Maryland found that trans fatty acids not only alter enzymes that neutralize carcinogens, and increase enzymes that potentiate carcinogens, but also depress milk fat production in nursing mothers and decrease insulin binding.44 In other words, trans fatty acids in the diet interfere with the ability of new mothers to nurse successfully and increase the likelihood of developing diabetes. Unpublished work indicates that trans fats contribute to osteoporosis. Hanis, a Czechoslovakian researcher, found that trans consumption decreased testosterone, caused the production of abnormal sperm and altered gestation.45 Koletzko, a German pediatric researcher found that excess trans consumption in pregnant mothers predisposed them to low birth weight babies.46 Trans consumption interferes with the body’s use of omega-3 fatty acids found in fish oils, grains and green vegetables, leading to impaired prostaglandin production.47 George Mann confirmed that trans consumption increases the incidence of heart disease.48 In 1995, European researchers found a positive correlation between breast cancer rates and trans consumption.49
Until the 1995 study, only the disturbing revelations of Dutch researchers Mensink and Katan, in 1990, received front page coverage. Mensink and Katan found that margarine consumption increased coronary heart disease risk factors.50 The industry—and the press—responded by promoting tub spreads, which contain reduced amounts of trans compared to stick margarine. For the general population, these trans reductions have been more than offset by changes in the types of fat used by the fast food industry. In the early 1980’s, Center for Science in the Public Interest campaigned against the use of beef tallow for frying potatoes. Before that they campaigned against the use of tallow for frying chicken and fish. Most fast food concerns switched to partially hydrogenated soybean oil for all fried foods. Some deep fried foods have been tested at almost 50% trans.51
Epidemiologist Walter Willett at Harvard worked for many years with flawed data bases which did not identify trans fats as a dietary component. He found a correlation with dietary fat consumption and both heart disease and cancer. After his researchers contacted Enig about the trans data, they developed a more valid data base that was used in the analysis of the massive Nurses Study. When Willett’s group separated out the trans component in their analyses, they were able to confirm greater rates of cancer in those consuming margarine and vegetable shortenings—not butter, eggs, cheese and meat.52 The correlation of trans fat consumption and cancer was never published, but was reported at the Baltimore Data Bank Conference in 1992.
In 1993 Willett’s research group at Harvard found that trans contributed to heart disease,53 and this study was not ignored, but received much fanfare in the press. Willett’s first reference in his report was Enig’s work on the trans content of common foods.
The industry continues to argue that American trans consumption is a low six to eight grams per person per day, not enough to contribute to today’s epidemic of chronic disease. Total per capita consumption of margarine and shortening hovers around 40 grams per person per day. If these products contain 30% trans (many shortenings contain more) then average consumption is about 12 grams per person per day. In reality, consumption figures can be dramatically higher for some individuals. A 1989 Washington Post article documented the diet of a teenage girl who ate 12 donuts and 24 cookies over a three day period. Total trans worked out to at least 30 grams per day, and possibly much more. The fat in the chips that teenagers consume in abundance may contain up to 48% trans which translates into 45.6 grams of trans fat in a small ten-ounce bag of snack chips—which a hungry teenager can gobble up in a few minutes. High school sex education classes do not teach American teenagers that the altered fats in their snack foods may severely compromise their ability to have normal sex, conceive, give birth to healthy babies and successfully nurse their infants.