Thirty-one of the men eating Dayton’s experimental cholesterol-lowering diet, however, died of cancer, compared with only seventeen of the controls. The risk of death was effectively equal on the two diets. “Was it not possible,” Dayton asked, “that a diet high in unsaturated fat…might have noxious effects when consumed over a period of many years? Such diets are, after all, rarities among the self-selected diets of human population groups.” Because the cholesterol-lowering diet failed to increase longevity, he added, it could not provide a “final answer concerning dietary prevention of heart disease.”

If these trials had demonstrated that people actually lived longer on cholesterol-lowering diets, there would have been little controversy. But almost four decades later, only one trial, the Helsinki Mental Hospital Study, seemed to demonstrate such a benefit—albeit not from a low-fat diet but from a high-polyunsaturated, low-saturated-fat diet.

The Helsinki Study was a strange and imaginative experiment. The Finnish investigators used two mental hospitals for their trial, dubbed Hospital K (Kellokoski Hospital) and Hospital N (Nikkilä Hospital). Between 1959 and 1965, the inmates at Hospital N were fed a special cholesterol-lowering diet,†9 and the inmates of K ate their usual fare; from 1965 to 1971, those in Hospital K ate the special diet and the Hospital N inmates ate the usual fare. The effect of this diet was measured on whoever happened to be in the hospitals during those periods; “in mental hospitals turnover is usually rather slow,” the Finnish investigators noted.

The diet seemed to reduce heart-disease deaths by half. More important to the acceptance of Keys’s hypothesis, the men in the hospitals lived a little longer on the cholesterol-lowering diet. (The women did not.)

Proponents of Keys’s hypothesis will still cite the Helsinki Study as among the definitive evidence that manipulating dietary fats prevents heart disease and saves lives. But if the lower death rates in the Helsinki trial were considered compelling evidence that the diet worked, why weren’t the higher death rates in the Anti-Coronary Club Trial considered evidence that it did not?

The Minnesota Coronary Survey was, by far, the largest diet-heart trial carried out in the United States, yet it played no role in the evolution of the dietary-fat hypothesis. Indeed, the results of the study went unpublished for sixteen years, by which time the controversy had been publicly settled. The principal investigator on the trial was Ivan Frantz, Jr., who worked in Keys’s department at the University of Minnesota. Frantz retired in 1988 and published the results a year later in a journal called Arteriosclerosis, which is unlikely to be read by anyone outside the field of cardiology.*10