You may ask, “But wait, certainly there was some other research contradicting the low fat hypothesis and its relationship to heart health. Isn’t there anyone out there whose research supported the way our ancestors ate for thousands of years? Does dietary saturated fat & cholesterol really cause heart disease?”
The short answer to these two questions is yes(es) & no.
Yes. Professor John Yudkin, a British professor and founder of the nutrition department at the University of London's Queen Elizabeth College, wrote Pure, White and Deadly (1972), was the one voice who stood out in opposition to Keys, questioning whether there was any causal link at all between fat and heart disease.
Instead of laying the blame at the door of fat, he claimed there was a much clearer correlation between the rise in heart disease and a rise in the consumption of sugar. Rodents, chickens, rabbits, pigs and students fed sugar and carbohydrates, he said, invariably showed raised blood levels of triglycerides (a technical term for fat), which was then, as now, considered a risk factor for heart disease. [He believed] Sugar also raised insulin levels, linking it directly to type 2 diabetes….[questioning] whether there was any causal link at all between fat and heart disease. After all, he said, we had been eating substances like butter for centuries, while sugar, had, up until the 1850s, been something of a rare treat for most people. ‘If only a small fraction of what we know about the effects of sugar were to be revealed in relation to any other material used as a food additive,’ he wrote, ‘that material would promptly be banned.’
Additionally, and very important to the booming processed food industry, this was NOT the message that would help food manufacturers make profits.
This was not what the food industry wanted to hear. When devising their low-fat products, manufacturers had needed a fat substitute to stop the food tasting like cardboard, and they had plumped for sugar. The new "healthy" foods were low-fat but had sugar by the spoonful and Yudkin's findings threatened to disrupt a very profitable business.
With the combined message of sugar as the culprit to heart health, in opposition to Key’s message, along with food manufacturers not being able to bank on Key's anti-fat message, a full-on bullying campaign against Yudkin began in earnest.
Yudkin was ‘uninvited’ to international conferences. Others he organized were cancelled at the last minute, after pressure from sponsors, including, on one occasion, Coca-Cola. When he did contribute, papers he gave attacking sugar were omitted from publications….By the end of the Seventies, he had been so discredited that few scientists dared publish anything negative about sugar for fear of being similarly attacked. As a result, the low-fat industry, with its products laden with sugar, boomed.
But wasn’t there any other research out there that anyone with half a brain (and guts) could use to refute Key’s work?
Yes. Also in the 1960’s the Framingham Diet Study was set up to specifically look for a connection between dietary fat and cholesterol. The results of this study yet again clashed with the prevailing wisdom/popular thought of the time, and so they were suppressed and never published in a major journal. What happened to them? The results were tabulated - - but forgotten because the findings of this study showed no correlation between dietary fat and cholesterol to heart disease whatsoever.
All these findings should have buried the diet-heart hypothesis. But no amount of data could dissuade the diehards that dietary fat caused heart disease. Researchers saw what they wanted to see. Instead, researchers saved the [diet-heart] hypothesis and buried the results. Despite the massive effort and expense, the Framingham Diet Study was never published in a peer-reviewed journal. Instead, results were tabulated and quietly put away in a dusty corner—which condemned us to fifty years of a low-fat future that included an epidemic of diabetes and obesity.
Fung, J. (2016). The Obesity Code: Unlocking the Secrets of Weight Loss (p. 208).
And Yes. Unfortunately, the final nail in the coffin sealing the fate of the type of fat used in our diets came with the Minnesota Coronary Survey (1968-1973), a RCT (randomized control trials – the gold standard for proving or disproving a hypothesis) study, BUT was also completely suppressed at the time because the director of the study did not agree with its outcome, and as such, remained hidden for almost 30 years. The irony is that the researchers were hopeful their largest-ever clinical trial of the heart-lipid hypothesis would support the claim that Keys was right. Instead, the trial proved the exact opposite.
[emphasis mine]
There has been a lot of selective reporting and ignoring of the methodological problems over the years. But probably the most astonishing example of selection bias was the near-complete suppression of the Minnesota Coronary Survey, which was an outgrowth of the National Diet Heart Study. Also funded by NIH [National Institute of Health], the Minnesota Coronary Survey is the largest-ever clinical trial of the diet-heart hypothesis and therefore certainly belongs on the list along with Oslo, the Finnish Mental Hospital Study, and the LA Veterans Trial [both also ignored], but it is rarely included, undoubtedly because it didn’t turn out the way nutrition experts had hoped.
After four-and-a-half years [of trials]…the researchers were unable to find any differences between the treatment and control groups for cardiovascular events, cardiovascular deaths, or total mortality. Cancer was higher in the low-saturated-fat group... [And] The diet low in saturated fat had failed to show any advantage at all. Frantz, [a research colleague] who worked in Keys’ university department, did not publish the study for sixteen years, until after he retired, and then he placed his results in the journal “Arteriosclerosis, Thrombosis, and Vascular Biology,” which [was] unlikely to be read by anyone outside the field of cardiology. When asked why he did not publish the results earlier, Frantz replied that he didn’t think he’d done anything wrong in the study. “We were just disappointed in the way it came out,” he said. In other words, the study was selectively ignored by its own director. It was another inconvenient data point that needed to be dismissed.
Teicholz, N. (2014). The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet Simon & Schuster, (pp. 95-96).
Had Yudkin’s study been supported, along with the results from the Minnesota Coronary Survey & Framingham Diet Study been blazoned all over Time Magazine like Ancel Keys’ Seven Countries Study was, today’s nutritional guidelines might look quite different than they do now, with a more evidence based recommendation for the inclusion of animal-sourced proteins and saturated fats.
So all told, in the end, No. Without the mass publication of Yudkin’s findings, the Framingham Diet Study AND the results from the Minnesota Coronary Survey trials in the major journals of the time, our country would soon be entrenched with the idea that saturated fat caused heart disease and should therefore be removed or at minimum significantly reduced, with sugar, grains and vegetable oils getting a free pass.
The rest as they say is history.
With our country’s nutritional guidelines (and it’s war on meat) not backed by hard science, aka, evidence, and the suppression of the key studies noted above (among many not listed here), the McGovern Commission established the Food Pyramid Guidelines in 1977 based on the lone observational data from Keys’ heart-lipid hypothesis study - and - the persistence of Keys self-promotion with the newly established American Heart Association (in which Keys was by then a board member).
Low-fat foods and polyunsaturated oils are now promoted by the newly organized American Heart Association, replacing centuries-old food selection, cooking and baking practices.
The food guidelines establish a diet with up to 60% carbohydrates (foods that are naturally metabolized as sugar once they are consumed), and recommend minimal saturated fat and protein as a ‘logical’ way to minimize the nutrient density calories of these foods.
The American Dietetic Association* (ADA) becomes accredited in 1957, with Nutritionists and Registered Dietitians becoming certified with high carb/low fat, calories in/calories out mentality. By 1977 the Food Pyramid has established the national food guidelines based on the ADA recommendations for all major (government) organizations including hospitals, nursing homes, schools, and the military as the go-to for our food recommendations, including the guidelines for heart disease and type 2 diabetes, including snacking throughout the day.
Big Food companies become established and capitalize with special interest funding and backing with the Food Pyramid’s foundation that our diet should be based on carbohydrates, followed with some vegetables & fruits, limited lean meat, eggs & low fat dairy (little to no saturated fats), and polyunstaturated fats. This validates the inclusion and consumption of processed foods laden with sugar and polyunsaturated seed oils (which are very cost effective because they are inexpensive to produce and transport because they don’t spoil). Big Food promotes the massive production of processed foods, which include the increased use of sugar to compensate for the lack of flavor because saturated fat is either gone, replaced with polyunsaturated fats.
Big Pharma rushes in as the saviors (who market their drugs to us on TV, and most alarmingly to our medical schools) in response to the rise of metabolic diseases and cash in big time because people are becoming sicker with skyrocketing medical costs.
And now, several decades later, we have epidemics of obesity, Type II diabetes, mental health issues, cancer and heart disease that were almost unheard of a century ago. Unfortunately, in the years that followed, the roots of the obesity epidemic were firmly established contributing to our present day metabolic problems, aka, metabolic syndrome* that more than half our population suffers.
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*Metabolic syndrome is classified as having 3 or more of the conditions listed – all of which are exacerbated with increasing carbohydrate consumption:
Obesity
High Triglycerides
Low HDL
High Blood Pressure
High Blood Sugar
Metabolic syndrome increases the risk of many/most chronic diseases including cancer and dementia, and is a top predictor of cardiovascular disease and death. One of the best ways to improve metabolic syndrome is to reduce carbohydrates.
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*The American Dietetic Association (ADA) was co-founded in 1917 by Lenna Francis Cooper, a devout Seventh Day Adventist (SDA), serving as the first lead dietitian at the Battle Creek Sanitarium in Michigan supporting and promoting Kellogg’s Cereal. Kathleen Zolber, PhD, nutrition professor at Loma Linda University, became the first SDA president of the ADA in 1982–1983. She was instrumental in establishing the SDA Evidence Analysis Library, a source for promoting the SDA doctrine about food information for RDs, and the SDA publication Food For All, authored by SDA Lydia Sonnenberg, MS, RD. This SDA publication led the way promoting vegetarian diets by virtually all nutrition professionals. [By] 1988 the ADA governed and supported by the SDA, issued a position statement favoring vegetarian diets, and have reaffirmed that position every four or five years since then, usually expanding the length of the position each time - all in the absence of RCTs - but based on solely on epidemiology and church doctrine. (The Global Influence of the Seventh-Day Adventist Church on Diet)