Van Horn, a member of the Subcommittee, said she preferred the 7% limit on saturated fats promoted by the American Heart Association (AHA), but this group addresses only those people at risk for heart disease, not the entire population. Moreover, the AHA has long been questioned for the 20%-plus funding it receives from food and drug companies, many with a direct financial interest in maintaining caps on saturated fats.

Big Pharma, for interest, is heavily invested in drugs that lower LDL-C. Thus, it’s extremely important to note that the cardiovascular benefits reported from cholesterol-lowering via drugs have never been replicated in trials that lower cholesterol via diet. In fact, in nearly a dozen large trials[1] on diet, researchers found that lowering one’s cholesterol by restricting saturated fats had a minimal effect on cardiovascular deaths--while at the same time reliably raising the risk of death from cancer.

Despite this, the 2020 Subcommittee stated that it found the link between saturated fat and heart disease to be “strong,” for both adults and children.

In addition to the issues noted above, we find these reviews by the Subcommittee to be flawed in numerous ways:

The analysis on adults used, as its starting point, the review on saturated fats from 2015, which has been criticized by the National Academies of Sciences, Engineering and Medicine, for being non-systematic. A separate peer-reviewed analysis I authored in The BMJ found that this review relied heavily on outside organizations that receive major contributions from food-and-drug companies and also that the conclusions from this review did not accurately reflect the evidence.

The review on children relied only on two trials, “DISC” and “STRIP,” both from the 1990s, which are deeply flawed as a basis for population-wide recommendations, because (1) DISC subjects had been selected for their unusually high cholesterol levels, suggesting that many of them had a genetic disorder that could not be extrapolated to a general population and (2) STRIP subjects were all Finnish, under the age of three. These unusual study groups cannot be used as a basis for population-wide recommendations to all American children.

Moreover, the DISC children consuming a low-fat diet, failed to meet basic nutritional standards—and this has also been found in other studies on children when fed diets low in fat.

Finally, there has never been evidence to show that cholesterol-lowering in children translates into better heart-disease outcomes later in life. Indeed, there is ample evidence to show that children need more fat and more naturally occurring proteins then do adults and that their growth and development is harmed when these foods are reduced during childhood[2].

(Note: it is problematic that DGAC member Van Horn, who was a lead author of the DISC study, did not recuse herself from discussions of the study’s merits in the committee proceedings. On the contrary, she was the most vocal proponent of this data and used it to push for further lowering of caps on saturated fats.)

Finally, the subcommittee noted “limitations” of the studies used to support its conclusions, namely that “[t]he majority of studies did not control for all key confounders, and many studies did not have CVD [cardiovascular disease]as a primary outcome.” These limitations are significant enough to raise serious questions about the legitimacy of the entire reviews.

In the discussion period that followed the Subcommittee’s presentation, DGAC Vice Chair, Ronald Kleinman, brought up the findings from the international expert panel, mentioned above, noting that it had reached the “opposite conclusion, that saturated fat in the diet doesn’t impact heart disease or stroke.” (starting at approx. 2:06)

Van Horn and others on the subcommittee rejected these findings, based mostly on vague terms.

Subcommittee member Joan Sabaté said that the clinical trials on saturated fats were complicated by refined carbohydrates, but all the major clinical trials on these fats kept carbohydrates constant, swapping out only saturated fats for polyunsaturated vegetable oils—implying that Sabaté’s comment was in error.

DGAC Committee chair Barbara Schneeman also emphasized that these trials lowered LDL-cholesterol (an “intermediary outcome”). However, the far more definitive “hard outcome” data—heart attacks, strokes and death—show that saturated-fat restriction had no positive benefit.

Focusing on intermediary outcomes rather than long-term “hard” outcomes is like judging the performance of a marathoner at the half-way mark rather than the finish line. As mentioned, any intermediary LDL-lowering effects do not matter when it comes to the more definitive outcomes of heart attacks and death. The latter data is more reliable—and ultimately what one wants to know. Does reducing saturated fats limit one’s chance of having a heart attack or dying from heart disease? The clinical trial data does not support this idea.

It is deeply concerning that not a single member of the Subcommittee on Dietary Fats raised any objection to its “strong” conclusions, despite the obvious, widespread scientific debate in the field. This suggests that the committee is unbalanced and one-sided. The National Academies of Sciences, Engineering, and Medicine, in its critique of the DGA process, suggested that biases be managed within the committee, but on the subject of saturated fats, this kind of management has clearly not taken place.

Transcripts and videos of this meeting are available here. (See Meeting Five, Friday morning)