Only two of these trials actually studied the effect of a low-fat diet on heart-disease rates—not to be confused with a cholesterol-lowering diet, which replaces saturated with polyunsaturated fats and keeps the total fat content of the diet the same. Only these two trials ever tested the benefits and risks of the kind of low-fat diet that the American Heart Association has recommended we eat since 1961, and that the USDA food pyramid recommends when it says to “use fats and oils sparingly.” One, published in a Hungarian medical journal in 1963, concluded that cutting fat consumption to only 1.5 ounces a day reduced heart-disease rates. The other, a British study, concluded that it did not. In the British trial, the investigators also restricted daily fat consumption to 1.5 ounces, a third of the fat in the typical British diet. Each day, the men assigned to this experimental diet, all of whom had previously had heart attacks, could eat only half an ounce of butter, three ounces of meat, one egg, and two ounces of cottage cheese, and drink two ounces of skim milk. After three years, average cholesterol levels dropped from 260 to 235, but the recurrence of heart disease in the control and experimental groups was effectively identical. “A low-fat diet has no place in the treatment of myocardial infarction,” the authors concluded in 1965 in The Lancet.

In all the other trials, cholesterol levels were lowered by changing the fat content of the diet, rather than the total amount of fat consumed. Polyunsaturated fats replaced saturated fats, without altering the calorie content. These diet trials had a profound influence on how the diet/heart-disease controversy played out.

The first and most highly publicized was the Anti-Coronary Club Trial, launched in the late 1950s by New York City Health Department Director Norman Jolliffe. The eleven hundred middle-aged members of Jolliffe’s Anti-Coronary Club were prescribed what he called the “prudent diet,” which included at least one ounce of polyunsaturated vegetable oil every day. The participants could eat poultry or fish anytime, but were limited to four meals a week containing beef, lamb, or pork. This made Jolliffe’s prudent diet a model for future health-conscious Americans. Corn-oil margarines, with a high ratio of polyunsaturated to saturated fat, replaced butter and hydrogenated margarines, which were high in saturated fats. In total, the prudent diet was barely 30 percent fat calories, and the proportion of polyunsaturated to saturated fat was four times greater than that of typical American diets. Overweight Anti-Coronary Club members were prescribed a sixteen-hundred-calorie diet that consisted of less than 20 percent fat. Jolliffe then recruited a control group to use as a comparison.