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

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), non-tropical 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.