Unbalanced, One-sided Subcommittee on Dietary Fats
Do saturated fats cause heart disease? This question has once again come under consideration by the Dietary Guidelines Advisory committee, an expert group appointed every five years to update the science for the Dietary Guidelines.
By The Nutrition Coalition
Do saturated fats cause heart disease? This question has once again come under consideration by the Dietary Guidelines Advisory committee, an expert group appointed every five years to update the science for the nation’s most important nutrition policy, the Dietary Guidelines for Americans (DGA). Unfortunately, at the committee’s final meeting, in March, it became clear that the group overseeing the review of saturated fats is highly unbalanced and one-sided. Indeed, the 4-person subcommittee includes one of nutrition’s staunchest antagonists to saturated fats and another member who has strong religious beliefs that preclude a diet high in saturated fats. The other two members offered no alternative views at the public meeting.
The staunch opponent to saturated fats is Linda Van Horn, a professor at Northwestern University, who suggested, at the March meeting that the current 10% limit on saturated fats should be dropped even lower, to 7%. Only one person on the full DGAC raised an objection.
This person cited a recent consensus report, by a group of 11 leading nutrition scientists from the U.S., Canada, and Denmark, which concluded that the caps on saturated fats were no longer justified, and indeed could be causing harm. This group submitted a formal public comment to USDA and also wrote a letter to the Secretaries of the U.S. Departments of Agriculture and Health and Human Services (USDA-HHS), which co-issue the guidelines.
In the letter to the Secretaries, they wrote, “we respectfully request….that [you] give serious and immediate consideration to lifting the limits placed on saturated fat intake for the upcoming 2020 Dietary Guidelines for Americans (DGA). This request is based on a review of the most rigorous scientific data available.”
They added, “…anything but the most rigorous science available is likely to have unintended or even potentially harmful consequences to health.”
This group of prominent scientists comprised three former members of the DGAC including a member of the 2015 Subcommittee on Saturated Fats and the Chair of the entire 2005 committee. The group has said that they are working towards publishing their findings in an academic journal.
This group of scientists is notable for their stature in the field, yet in fact they represent a small sample of the growing number of experts worldwide who have concluded that the caps on saturated fats are not supported by the evidence, as seen in numerous peer review journals, over the past decade. Last year, a group of mostly European scientists came out with a statement in The BMJ that, like the U.S. group, found no strong evidence to continue saturated-fat restrictions. The accumulating evidence, as reviewed by all these scientists, strongly suggests that saturated fats have been unfairly targeted, based on weak evidence, and do not, according to more than a dozen large independent meta-analyses, have any effect on cardiovascular or total mortality.
Yet clearly none of this science nor the thousands of public comments submitted to the committee on this data, including one by the Nutrition Coalition, with a comprehensive dossier on the last decade of evidence, seem to have been considered by the tiny subcommittee of only four people who hold the awesome power of deciding the future of saturated fats.
The caps on these fats are important because they determine whether butter, eggs, and regular meat could be liberated for greater consumption. These natural foods contain many nutrients that are essential for human health. Indeed, in the limited quantities in which these foods are currently allowed due to the saturated-fat caps, the DGA fails to meet nutritional adequacy goals for “potassium, vitamin D, vitamin E, and choline.” Further, the DGA would suffer even greater shortfalls, in B Vitamins and iron, if it did not recommend 3-5 servings of refined grains per day, because these grains—and not whole grains—are enriched and fortified. However, refined grains are known to drive diabetes, obesity, and also to be worse for cardiovascular health than saturated fats, according to the peer-reviewed literature. Thus, the current limits on saturated fats are causing unnecessary nutritional deficiencies. The Dietary Guidelines have a vast influence not only over public opinion but also everything from school lunches and food for the elderly to hospital food, and military rations. The guidelines have also been the curricula for K-12 teachers, doctors, nurses, dietitians, and nutritionists across the U.S.
Whether government-funded institutional food in such places as prisons, nursing homes and schools will be allowed to serve foods that naturally contain essential nutrients will thus depend depend on this four-person subcommittee.
The danger of a committee being unbalanced over important issues is something federal regulators take seriously. Indeed, the Federal Advisory Committee Act (FACA) repeatedly mentions the importance of having “balance” on a committee as well as the need for a “divergence” of opinion. Noting that the DGACs have historically lacked such balance, the National Academies of Sciences, Engineering, and Medicine, in the first-ever outside peer-review of the DGA process, elaborated on the importance of managing bias—in other words, of having a balance of opinion on both sides of an issue.
The USDA appeared to take this advice seriously and in its charter for the 2020 DGA stated that it would assemble a committee that “will be balanced fairly in its membership in terms of the points of view represented” and that “[s]teps will be taken to encourage fresh points of view…including members with varying points of view on the topics and questions to be examined by the Committee.” However, on the subject of saturated fats, these intentions were not realized.
The four members of the Subcommittee on Dietary Fats are:
Linda Van Horn, as mentioned, who is an especially vigorous detractor of saturated fats and indeed has devoted her decades-long career attempting to prove their danger. She has been a lead investigator of many of the U.S. government’s largest trials aiming to show the benefits of reducing fats, including saturated fats. These studies include the Women’s Health Initiative (WHI) on nearly 49,000 women,[1] the “DISC” study on children with abnormally elevated cholesterol (LDL-C),[2] the “DASH” studies on middle-aged adults with hypertension,[3] the “MRFIT” trial on nearly 50,000 adults, a study on hormones in menopausal women,[4] and the “COVID” study on young adults,[5] among others.
It is crucial to note that none of these trials showed health benefits from a diet reduced in fat and saturated fats, except perhaps the DASH studies, on middle-aged hypertensive adults, but while the DASH subjects saw their LDL-cholesterol drop, which is generally considered a positive sign, they also reliably saw their HDL-cholesterol go down, a sign of worsening heart-disease risk. Thus, the DASH trials had mixed results (in addition, they were all short term). Regarding the other trials: WHI, an 8-year trial, showed no benefit for the prevention of cardiovascular disease, obesity, diabetes or any kind of cancer; MRFIT, a multifactorial intervention, was considered a spectacular failure, because the men on the low-fat diet (who also quit smoking and reduced their blood pressure) died at higher rates than the controls; the DISC study resulted in the children lowering their LDL-cholesterol, yet they suffered from nutritional deficiencies; the hormone study showed that restricting saturated fat showed “modest or non-existent” benefits, and the COVID study found that “saturated fats [were] not a strong predictor of CVD risk factors.”
Such a string of large, expensive failures (WHI alone costed $700M) might cause any researcher to give pause, but Van Horn’s adherence to the hypothesis that saturated fats cause heart disease seems unshakable. Her longtime mentor is the Chicago cardiologist Jeremiah Stamler, an author of the original guidelines, by the American Heart Association in 1961, to cut back on saturated fats as a principal way to fight heart disease. Stamler, too, has remained steady in this belief, despite the vast body of evidence that has not supported his hypothesis. Van Horn has stayed close to the American Heart Association (AHA) and in 2016, as the first author of the AHA’s latest guidelines, managed to push down the caps on saturated fat ever lower—to 5-6% of calories.
Since the U.S. Dietary Guidelines nearly always follow those of the AHA, it’s highly likely that Van Horn might ultimately be aiming for the DGA to adopt this 5-6% limit as well—even though the DGA is meant to address all Americans, whereas the AHA targets only those at risk for heart disease.
Van Horn believes that children should also reduce their caps on saturated fats, based largely on her work on DISC, yet remember that the subjects in this experiment had unusually high LDL-cholesterol (suggesting that they had a genetic condition called hypercholesterolemia, which is not generalizable to the larger public) and ultimately suffered nutritional deficiencies. Also, it has never been shown that lowering cholesterol in children has any effect on cholesterol levels later in life.
Van Horn remains, firmly opposed to saturated fats. When interviewed in February of this year, Van Horn told CNBC that people should avoid saturated fat and animal foods and reportedly said she is “is a fan of plant-based meat alternatives.”[6] Last September, she also wrote an editorial in JAMA, stating that “the continued excessive intake of saturated fats…is of major concern.”[7]
Van Horn has a clear, perhaps even ideological position on saturated fats. She’s also obviously the senior-most person on the panel, with major involvement in many large, government-funded trials as well as previous, recent service as a member of the 2010 Dietary Guidelines Advisory Committee and one of only a handful of peer reviewers of the 2015 DGAC report.
Joan Sabaté is clearly on the same side of the saturated-fat issue as Van Horn:
Joan Sabaté is a professor of public health at Loma Linda University, a Seventh Day Adventist Institution whose central evangelical goal is to improve health, in large part through the promotion of the vegetarian diet.[8] Sabaté therefore has an actual ideological bias against saturated fats, since the elimination of caps on these fats would allow greater consumption of meat and dairy, foods (especially meat), which are strictly prohibited by his church. Sabaté is a devotee of the Seventh Day Adventist mission and has written extensively about the “success” of his church in converting people globally to vegetarianism. In promoting his beliefs, Sabaté chaired the vegetarian nutrition conference held every five years at Loma Linda in 1997, 2002, 2008, 2013, and again, in 2018. He has also been a longtime advisor on the vegetarian diet to Oldways, an industry-funded food group.
In at least one of his own scientific experiments testing the Seventh Day Adventist diet, the protocols call for limiting saturated fats to less than 7% of calories.
Sabaté also has significant potential financial conflicts of interest, as he has received monies from food industries that benefit when saturated fats are substituted for foods high in unsaturated fats, as the DGA currently recomments. Substitution foods high in unsaturated fats include nuts, avocados, and soy, all industries that have funded Sabaté:
California Walnut Commission, and he has authored papers promoting the benefits of walnuts:
https://www.sciencedirect.com/science/article/pii/S0261561418300748
Haas Avocado Board, and he has authored papers favorable of avocados as well as promoting avocados to the media:
Nut and Dried fruit Foundation
National Peanut Board
The Almond Board of California
The National Pecan Sheller’s Association[9]
Soya products[10]
In addition, Sabaté is on the Scientific Advisory Boards of:
Paramount Farms, a grower of pistachios and almonds,[11] and the
California Walnut Commission.[12]
In all, Sabaté has written more than 25 papers promoting the health benefits of nuts, high in unsaturated fats. Notably, Sabaté was nominated to the DGAC by the animal-rights advocacy group, the Physicians for Responsible Medicine, which advocates aggressively for the elimination of animal-food consumption. Capping saturated fats is clearly one way to do this.
Disentangling Sabaté’s religious beliefs and financial interests is likely impossible, yet in any case, one can fairly appraise him as having a strong bias in favor of unsaturated fats over saturated fats. Lowering the limits on saturated fats would serve his combined interests.
Do the other two committee members offer any balance on the issue? Unfortunately not.
Linda Snetselaar, a professor of Preventive Nutrition Education from the University of Iowa, is the Subcommittee Chair. Like Van Horn, she favors a plant-based diet, as evidenced by her participation in the proactive vegetarian advocacy group, the True Health Initiative (THI)[13] as well as her service, alongside several well-known vegetarian advocates,[14] as a Scientific Advisor for Diet ID, a company led by the same vegetarian advocate who leads THI.
Like Van Horn, Snetselaar has devoted a good portion of her career to trying to establish the health benefits of a diet low in fat and saturated fats. She participated in the DISC study follow-up, the same trial that Van Horn launched. And Snetselaar has published some 33 papers on the Women’s Health Initiative follow-up study, looking at various possible benefits of fat-restriction that could not be found in the original trial. Thus, like Van Horn, Snetselaar has worked for years trying to find support for the hypothesis that a plant-based diet, low in saturated fats, is optimal.
Regan Bailey, a nutritional epidemiologist from Purdue University, is the youngest member of the subcommittee. She could perhaps bring a fresh perspective to the group, yet Bailey’s only experience working on fats of any kind appears to be on omega-3 fatty acids. Bailey was also the officer of group that aimed to promote supplements including omega-3s, funded by the Reckitt Benckiser Group, a company that sells supplements, among other products.
Bailey did not make a single comment during the subcommittee’s report on the second day of the March meeting, nor did she comment during the discussion period.
The final ‘member’ of the subcommittee is Barbara Schneeman, who is the Chair of the full Advisory Committee (DGAC) and also sits on various subcommittees. She stated that her job is not so much to review the specific evidence of the subcommittees but rather to ensure consistency of standards across the subcommittees. In any case, she endorsed Van Horn’s idea about lowering the caps on saturated fats at the March meeting—therefore providing no counterweight to the one-sided conversation.
Schneeman is on the Advisory Board of Monsanto, [15] the agricultural giant whose primary business is crops (the basis of unsaturated-fat products), and she has worked extensively with international and U.S. government agencies, making her an unlikely person to challenge long-time government policy.
2015 DGAC on Saturated Fat Also One-sided
It is of further concern that the 2020 Subcommittee on Dietary Fats is relying, as the foundation of its work, upon the review of the same topic by the 2015 DGAC. However, this 2015 review, like all the 2015 reviews, has been deemed, by the NASEM report as falling short of “current standards of practice” and not meeting “validated, standardized processes.” Further, the 2015 report on saturated fats was found, in a peer-reviewed article published in The BMJ, to be especially non-systematic and ad-hoc.
The 2015 Subcommittee was also small and unbalanced. It consisted of only three people: Alice Lichtenstein, Frank Hu, and Tom Brenna, in addition to Barbara Millen, 2015 DGAC Chair who was on all the subcommittees to ensure consistency. Of the three subcommittee members proper, Alice Lichtenstein, of Tufts University, has often argued for reducing consumption of saturated-fat and was responsible, as head of the nutrition committee at the American Heart Association, for lowering that group’s caps on saturated fats down to 8%. Despite that, she has acknowledged that any percentage limit on saturated fats is not based on any rigorous data and wrote, in an email to members of the 2015 DGAC: “Giving the matter more thought I wonder whether we can give a range of recommended SFA [saturated fat] intake. There is no magic/data for the 10% number or 7% number that has been used previously.”
In debates and in the media, Lichtenstein has also consistently argued for keeping saturated-fat consumption very low. [16] [17]
A second member of the 2015 subcommittee, with whom Lichtenstein worked closely, was Frank Hu, a professor at the Chan Harvard School of Public Health. Hu has arguably published more papers promoting the putative dangers of saturated fats and of animal foods containing these fats than any other researcher in the country. His work relies entirely upon epidemiological findings, a weak type of science that can demonstrate association but not cause-and-effect. As reported in The BMJ, Hu, before his service on the 2015 DGAC, had also received funds from companies that were potential conflicts of interest, including the California Walnut Commission and the Tree Nut Council, as well as vegetable oil giants Bunge and Unilever. All of these companies produce foods high in unsaturated fats, which benefit from an official recommendation to use these fats as substitutes for saturated fats.
The third member of the 2015 subcommittee, Tom Brenna, then at Cornell University, did not proffer strong views on the subject, and he was sometimes omitted from important subcommittee correspondence, according to emails obtained through the Freedom of Information Act. Importantly, he later became convinced that on the subject of saturated fats, he had been wrong and in fact, joined the group of 11 scientists described above.
DGAC members from years past have told the Nutrition Coalition that the DGA process offers no opportunity for conversations among the different subcommittees. Thus, this four-person subcommittee on Dietary Fats has made its decision in isolation. With so much at stake, it was imperative for this group to be balanced, with a variety of viewpoints. The clear, strong biases on this subcommittee should have been managed by the inclusion of members of equally strong, opposite viewpoints. Yet biases were clearly not managed, and as a result, the DGA is not only in danger of having violated FACA regulations but also of repeating its serious non-evidence-based mistakes of the past on the subject of saturated fats.
[1] https://www.ncbi.nlm.nih.gov/pubmed/29859758
https://www.sciencedirect.com/science/article/abs/pii/S1877782117301728
https://www.ncbi.nlm.nih.gov/pubmed/28515068
[2] https://www.ncbi.nlm.nih.gov/pubmed?term=11158455
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657306/pdf/main.pdf
https://www.sciencedirect.com/science/article/abs/pii/S0749379718320257
[4] https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/cncr.11735
[5] https://pubmed.ncbi.nlm.nih.gov/10546693/?from_term=Van+Horn+L+CARDIA+%22saturated+fat%22&from_pos=2
[6] https://www.cnbc.com/2020/02/14/what-joe-rogan-learned-from-eating-a-carnivore-diet-for-30-days.html
[7] JAMA. 2019;322(12):1150-1151. doi:10.1001/jama.2019.13976
[8] Sabate writes, “Most of the Adventist idiosyncrasies on dietary patterns have been summarized in the book Counsels on Diet and Foods (White, 1938) SDA [The Seventh Day Adventist Church] recommends: fruits, vegetables, cereals, legumes, and nuts; to avoid meats.” Religions 2018, 9(9), 251; doi:10.3390/rel9090251
[9] https://www.ncbi.nlm.nih.gov/pubmed/18716180
[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232985/
[11] https://vegetarian.procon.org/source-biographies/joan-sabate/
[12] Ibid.
[13] https://www.truehealthinitiative.org/council_member/linda-snetselaar/ (Accessed, April 6, 2020)
[14] https://www.dietid.com/advisors (Accessed April 6, 2020)
[15] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415710/
[16]https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000510
[17] https://jandonline.org/article/S0002-8223
Note: Article corrected on Nov 3, 2020 to remove an inaccurate financial connection related to L. Van Horn.