Thursday 24 Jul 2014

Information and opinions presented here do not always represent the views of the American Heart Association.

Chief Science Officer ‘sets record straight’ about diet, science, AHA

Published: 6:18 pm CDT, May 23, 2014

At the American Heart Association, everything we do is based on science. Simply put, we examine the evidence that comes from scientific studies and use it to provide advice to help people get healthier and prevent heart disease and stroke.

That’s why I was so alarmed by the many inaccuracies and misrepresentations of scientific facts in a recent article about our dietary recommendations – and why as the American Heart Association’s Chief Science and Medical Officer I need to set the record straight.

I want to do this to honor my organization’s good name, but most importantly out of concern for the health of the public, all the people we work hard every day to protect. The article published May 22 on The Daily Beast and picked up elsewhere attempted to show that the science linking saturated fats to heart disease is questionable – and it included many statements that are false or inaccurate and that could lead people to ignore the good advice that their healthcare providers are giving them.

Before I take a closer look at the author’s claims, let me make it perfectly clear who we are. The American Heart Association is a nonprofit organization devoted to saving and improving lives. We are here to help people. We do that by finding ways to prevent and treat heart disease and stroke using the best science available.

We began 90 years ago with a meeting of six scientists, and we have proudly remained rooted in science. As such, we fully understand there is room for disagreement among experts and researchers. The science world is full of ongoing debates. The friction that sometimes arises in search of the truth generally advances scientific knowledge. (As a cardiologist who has devoted a career to research and to serving the public health, I actually find scientific debate not only appropriate, but exciting and energizing.)

Now, in hopes of clearing up any confusion, here’s a look at some facts pertaining to the claims made in The Daily Beast article:

Their Story: The headline accuses the AHA of clinging to “junk science” about the potential dangers of saturated fats.

The Facts: Our guidance is based on the best available clinical research. That research has repeatedly shown a very clear link between saturated fat intake and the well-documented risk factor of LDL cholesterol for heart disease. This finding has been upheld by studies done over many years by many scientists, using the best tools and the most meticulous methods available: studying what people ate, in some cases by providing their food, measuring changes in specific risk factors like LDL (and in some cases HDL and triglycerides) and in some studies monitoring their health over years.

We feel strongly that we should use the most accurately executed science, and put less weight on less-reliable methods. And our conclusions are not just ours. The link between saturated and trans fat intake and LDL cholesterol levels is irrefutable, as is the link between LDL levels and coronary artery disease, although no one would argue that it is the only important factor.

In addition, an overwhelming number of studies in which LDL was lowered showed a fall in heart disease events like heart attacks. More than 10 national and international organizations have independently concluded from this combination of facts that a healthy diet should limit saturated fats, including the World Health Organization, the United States government, the Institute of Medicine and the European Food Safety Authority.

 

Their Story: The sub-headline says money is behind our scientific stance.

The Facts: Most of the money we take in is poured into scientific research, education and programs to help more people. We are a nonprofit and therefore we spend money on our mission, building lives free of heart disease and stroke. (About 79 percent of our spending in the most recent fiscal year was spent on research, education and community service.) In fact, we have used donor dollars to fund more heart disease and stroke research than any organization outside of the federal government.

 

Their Story: The article leads off by citing a Cambridge University analysis of several studies that questioned the link between saturated fats and heart disease.

The Facts: This refers to a paper that was published in the Annals of Internal Medicine in March and was immediately criticized in the scientific community because it included poor studies, excluded good studies and reached questionable conclusions. The study authors actually made several corrections after publication. In fact, Walter Willett, chair of the nutrition department at the Harvard School of Public Health in Boston, said afterward that the authors “have done a huge amount of damage” and called for a retraction. In short, this research is not very helpful when it comes to the question of saturated fats and heart disease. The article also claims the Cambridge study was a review of 76 previous studies. In fact, only 20 of the papers studied pertained to saturated fats.

 

Their Story: The article states that the American Heart Association recommends low-fat diets for optimal heart health.

The Facts: The article mischaracterized our dietary guidelines by saying we advise low-fat diets for optimal heart health. In the past we suggested that those who needed to lose weight, a high proportion of the American public, might benefit from cutting back on the most calorie-dense foods, including fats. But we do not currently recommend low-fat diets, and we certainly don’t recommend eating plans that replace fats with refined, simple carbohydrates like white flour and sugar. The AHA recommends a healthy eating plan that emphasizes fruits, vegetables and whole grains, includes low-fat dairy products, poultry, fish, legumes (e.g., peas, beans, lentils, soybeans), nontropical oils and nuts and restricts trans fats, saturated fats, and sodium. You can achieve this pattern by following plans such as the DASH dietary pattern, the USDA Food Pattern, or the AHA Diet. You should also balance your calorie intake with the energy you expend to maintain a healthy weight.

 

Their Story: The article says our recommendations “fly in the face of scientific evidence.”

The Facts: The basis for the AHA’s advice about nutrition has always been a thorough review of the best available scientific information. Our most recent dietary guideline in this area in particular, released in November 2013, is based on a rigorous systematic evidence review supported and overseen by the National Heart, Lung, and Blood Institute. It was written by individuals from many different fields and organizations. In fact, because this was such a balanced and thorough review of the scientific literature, the federal government will consider the evidence review in developing the 2015 Dietary Guidelines for Americans. And of course, our scientific volunteers continue to review all additional studies that might cause us to change our advice to keep up with the latest and best science.  Not everything that is published falls into that category.

 

Their Story: The author says she was disturbed to find the AHA focused on saturated fats and sodium and “ignored all other risk factors for heart disease” in the guidelines.

The Facts: The prevention guidelines we released in November 2013 considered numerous risk factors, including smoking, uncontrolled blood pressure, high cholesterol, elevated blood sugar, physical inactivity, an overall healthy diet and healthy body weight. In fact, the American Heart Association published one guideline focused entirely on obesity. Further, an overarching message of our guidelines and the supporting consumer information we wrote to explain them, was the importance of treating the patient in a holistic way – and the importance of starting all treatment with meaningful doctor-patient conversations.  For our most recent review of the role of triglycerides (TG), including discussion of the role of diabetes and the multiple other conditions affecting TG levels, see our scientific statement in 2011.

 

Their Story: The author references the guideline writing group as “the AHA panel” and calls the cholesterol guideline the “statin guideline.”

The Facts: The Expert Work Groups for all the prevention guidelines we published in November were made up of individual expert scientists impaneled by the government specifically for this project.  Some of them were members of the AHA or the American College of Cardiology but many belonged to other groups.  None were representing any organization.  And what is referred to as the “statin guideline” was actually the Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. This might sound like nitpicking, but within the medical/scientific community these wording errors indicate a lack of understanding of the guideline process.

 

Their Story: The author says there “might be two plausible reasons” for the AHA’s dietary recommendations: the moneymaking Heart Check Program and the “conflict of interest (and curious beliefs)” of Robert Eckel, M.D., co-chair of the panel that wrote the guidelines.

The Facts on Heart-Check: The Heart-Check program takes account of multiple ingredient values, such as saturated fat and cholesterol levels, along with sodium. The program’s criteria are based on sound science, food categories, specific product ingredients and nutrient values, and FDA and USDA regulations. No food product can receive the Heart-Check certification that has not met FDA’s strict regulatory requirements for a making a coronary heart disease health claim. These factors alone, determine our Heart Check certification of products.

Participants in the Heart-Check program pay the American Heart Association administrative fees to cover the costs of running the program. Fees are used only to cover the expenses related to the program which include product review, testing and certification, program management and oversight, program marketing and staff resources. These fees are NOT used for any purposes beyond the support of the program. The Food Certification program is designed as a consumer resource. NO donor dollars are used to underwrite this valuable service.

 

The Facts on Dr. Eckel: Dr. Robert Eckel is a renowned, award-winning scientist who is highly respected in his field. He is a former AHA president who has also worked with the Western Society for Clinical Investigation, the North American Association for the Study of Obesity, and served as president of the Association for Patient-Oriented Research. Like many doctors who understand nutrition and the Food and Drug Administration, Dr. Eckel at one time, after the completion of the Guideline and referred to in the publication for the sake of transparency, consulted with a company to help them understand what complying with FDA regulations in food labeling would mean. This kind of consultation has moved many food companies to improve their products in terms of health.  He received a consulting payment of $1,000. This work had no bearing on his work with the Lifestyle guideline writing committee.  

As for the “curious beliefs” the author cites, Dr. Eckel is a Christian. These are his personal beliefs and are completely unrelated to his professional scientific studies on changes in metabolism in various dietary situations. To hint otherwise is offensive to anyone, including many scientists, with religious beliefs. That’s the beauty of good science: Your work stands on its own and has to be verifiable. Dr. Eckel’s scientific work is highly regarded and stands on its own merit. The conclusions he reaches are scientifically sound, regardless of what belief system he has accepted, what hobbies he has, what his favorite TV shows are, what kind of ties he wears, etc. It’s all about the science.

I hope this analysis of the facts in this story have been helpful. And I hope it has added a bit of science back into this important discussion we should all be having about the best ways to keep our hearts healthy.

Enlightened scientific discourse can improve our world. But arguments based in falsehoods, questionable allegations and personal attacks serve no purpose but to confuse people. And that is irresponsible.

Editor’s Note: Dr. Rose Marie Robertson has been the AHA’s Chief Science and Medical Officer since 2003. She is professor of medicine at Vanderbilt University Medical Center, where she created and directed the Vanderbilt Women’s Heart Institute.  Dr. Robertson has served on numerous review and advisory committees for the National Institutes of Health, the Veterans Administration, the Robert Wood Johnson Foundation, the American College of Cardiology and the European Society of Cardiology. In 2001, she was honored by the CDC with their Partner in Public Health Award. Dr. Robertson does not have conflicts of interest or ties to industry. 

 

13 Comments

  1. Pat Morgan says:

    Thank you Dr. Robertson for clearing up this issue! I am a cardiology nurse who has been interested in nutrition for many years and appreciate the AHA guidelines for myself and my patients.
    Pat Morgan, RN, CCRN

    Reply
  2. IdiocyAbounds says:

    Based on whose science? Big Ag or Big Pharma? Your latest report is total hooey and is chocked full of people with a conflict of interest that is is almost laughable if it were not so dangerously disgusting. Shame on you for hurting people.

    Anyone who cares for accuracy, do your research and ignore any that has a financial interest in pushing their “science”

    Reply
  3. doctorsh says:

    The problem the AHA has is lack of trust. With the advent of the internet and studies galore there will be many varying opinions. Unfortunately the AHA has gone “corporate” and the public is expected to believe that donations from other corporations do not cloud the AHA’s recommendations. This is no difference between the AHA’s donors and political donors wanting payback, at least in the minds of many.
    Whether that is true or false does not matter, as what matters is that the AHA is beginning to lose the battle of ideas.

    Large corporations have a tough time reversing course. When they do it takes a long long time. Saturated fats do NOT cause disease. So what if they raise LDL cholesterol, what do they do to the particles of LDL, do they raise inflammation, do they cause an autoimmune attack, do they directly cause heart disease, what is the NNT for statins that lower LDL..

    There are so many points about heart disease prevention that the AHA seems to behind the eight ball on that I am afraid it may be too late for your organization to be anything but a non-profit advocacy group followed by less and less each year.

    Reply
  4. Faxon says:

    Dr.
    Robertson, the AHA is on the defensive, as it should be. Dr SH below is
    accurate when he suggests that non-scientists such as myself will not trust
    your rejoinders as long as the AHA takes money from Big Food corporations. Further,
    your statement “many doctors who understand nutrition and the Food and
    Drug Administration… consulted with a company to help them understand”
    etc, would make me weep if I were not so angry. So many of us see elected and
    non-elected public “servants” in a revolving door with private corporations and
    lobbyists. We think too much of the government has been hijacked by big money,
    and serves them, not the citizens. Finally, a person who believes that
    evolution is not true and the universe was created in 6 days should be
    challenged for such views if they wish to sit on influential science-based
    panels and organizations. Such beliefs are not harmless and purely personal.
    Evolution and its teaching in public schools is a huge lightening rod issue and
    its opponents are negatively impacting the education of the next generation. A
    person in a high profile position who has such beliefs cannot hide behind
    religious preference: it is appropriate for these beliefs to be challenged.

    Reply
  5. Dorothygreen says:

    Your campaign since its inception in 1948 has most likely contributed to the obesity epidemic. Who understood lipoproteins or why cholesterol (a very important nutrient) ended up in plaque? Who knew about addiction to sugar and refined grains? Now we know. And now we know about sdLDL, apo A and B,
    calcification, oxidation, advanced glycation end products and inflammation (the
    general public can understand inflammation), and still cholesterol – a very
    important nutrient – and healthy saturated fats –– get a bad rap. Pasture eggs, avocados, chicken livers, coconut oil, grass fed animals are real food; food that has been with the human race since before agriculture, but the AHA doesn’t think so.

    You are the organization who gets it right about sugar. The AHA is referenced in FED UP. So why are you not out there showing what Big Food is pushing and promote a tax on sugar – not just soda but all added and processed sugar at say $.003/gram. Why are you not lobbying to take sugar ads off TV or to help folks like Alice Cooper develop not only healthy but tasty lunch programs. And, why not go all the way to the USDA, lobby to get the corn subsidies used for HFCS and industrial cattle fed transferred to growing vegetables, Your marketing is superb but in the wrong place.

    Reply
  6. Novatar Services LLC says:

    Having had almost four decades of experience working in the medical
    field, I have seen a number of alarming trends: The tendency to isolate
    the effects of a treatment or medication to the organ or specialty
    studied, instead of the entire body; the tendency to oversimplify ideas
    and concepts to the point of virtually complete inaccuracy and then
    expound them as fact; the tendency to arrange studies to prove a prior
    decided on conclusion; and the tendency of big pharma and big agri to
    arrange for their products to be considered healthy and/or needed by the
    media, health care providers, etc.

    The Science Officer of the
    AHA appears to have good motivation…however, she needs to
    independently study ALL the materials. She needs to go out among
    society and look at the people who are obese and fat. She needs to go
    to the grocery store and study what these people are buying. She needs
    to go to their homes and see the results of her well meaning but
    problematic recommendations. She needs to see how they are affecting
    Americans who think they are doing the healthy thing, but paying the
    price: Alzheimers, ASHD, diabetes, immune disorders, cancer, dvts, ms,
    and etc. I personally know how the AHA’s recommendations are
    affecting Americans, because I have done all this. There are many valid scientific studies that link the equivalent of the AHA’s recommendations to these diseases. Let’s propagate health, not disease.

    Nutrition is a
    relatively new field. It is OK to admit that recommendations need to be
    tweeked. No field can be static….If the AHA wants to stay up with
    the times, they need to get out of their comfortable box. They need to
    welcome new ideas and study them in a manner that the results will be
    accurate. Instead of trying to stay on top of the hill, remember that
    it is the people who count….not you. Healthcare providers need to
    get back to putting the patient/client first and treating the whole
    body…not a body part.

    Reply
    • DrJKH says:

      Ohhhhh… You were doing so good until you said “big pharma.” Saying that instantly removes any credibility you might have had. So let me add one to your list:

      The tendency to imagine a multifaceted and diverse entity such as the pharmaceutical industry as a monolithic, singularly acting boogeyman that is the source of all our problems. Perhaps with a few more decades of experience you’ll grow up. Perhaps.

      Reply
  7. DrJKH says:

    Methinks thou doth protest too much, AHA. You like to claim your unfounded opinions are based on science, but reality says otherwise. And you ARE all about money. Don’t give us that nonsense about most of your revenue going to research. We all know otherwise. You all are quick to denounce any and all research that doesn’t fit into your unchanging mantra that is based on the pseudoscientific Puritanism of SW Graham and J Kellogg. Meanwhile, you don’t understand that LDL isn’t actually cholesterol and levels of LDL aren’t affected by diet, but by inflammation. Heart disease is an inflammatory disease, not a dietary disease. YOU are setting treatment of cardiovascular disease decades back by your usurpation of all the oxygen in the room.

    Reply
    • Faxon says:

      Dr, does it make sense to separate diet and inflammation? Doesn’t cigarette smoking, diet, exercise, air pollution where you live, all impact the levels of inflammation? I have read other physicians who believe that “lifestyle changes” impact your level of inflammation.

      Reply
      • DrJKH says:

        With the exception of lack of omega-3 fat in our diet, it is not affected by diet at all. And medical science isn’t about belief. It’s about facts. Doctors can believe what they want, as anyone can. But belief without fact is irrelevant in medical science. In this case, those beliefs are counterfactual beliefs. Counterfactual beliefs are also known as delusions.

        The other factors you mentioned do have some impact. Most of all smoking ANYTHING, on the negative side, and exercise, on the positive side. But that’s not the root of the issue.

        Reply
        • Faxon says:

          So what causes inflammation?

          Reply
          • DrJKH says:

            It’s more complicated than the oversimplifications by groups such as the AHA make it. It’s too complicated to cover in a post, likely over your head, and definitely over the heads of others reading this. Get an education in science and then read the primary literature to figure it out. And no, medical journals are not primary literature, despite what they think of themselves. They are too filled with beliefs (a priori conclusions) and not enough real science.

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