*15 It also affirmed the suspicion that polyunsaturated fats might be dangerous, and so further diminished the role of margarines and corn oils in dietary recommendations.
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*16 The Honolulu Heart Program offered an extreme example of this conflict in 1985. The study revealed that high-fat diets were significantly associated with a lower risk of total mortality, cancer mortality, and stroke mortality. On the other hand, the percentage of calories as fat and dietary-cholesterol intake were both associated with a higher risk of heart-disease death. Thus, the authors concluded that “these data provide support for the diet-heart hypothesis,” albeit with a caveat: “They also suggest that men with low fat intakes have a higher total mortality rate than men with higher fat intakes.”
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*17 In 1997, the MRFIT investigators also reported that the men in the treatment group subsequently had more lung cancer than the controls. This was despite the fact that 21 percent of the men had quit smoking in the treatment group, compared with 6 percent in the usual-care group. Because it was hard to believe that quitting smoking increased rates of lung cancer, the MRFIT investigators suggested the possibility that the lower cholesterol levels in the treatment group “might explain [their] higher lung cancer mortality.” And, indeed, serum cholesterol showed a “marginally significant inverse association” with lung-cancer mortality. Nonetheless, the MRFIT investigators concluded that this was not a likely explanation for the results.
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*18 The fourth author was Henry McGill, a pathologist who studied atherosclerosis in humans and in baboons, who says he had agreed unconditionally with the American Heart Association position on dietary fat since the early 1960s.
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*19 Though women were clearly meant to adhere to the low-fat guidelines, they had not been included in any of the clinical trials. The evidence suggested that high cholesterol in women is not associated with more heart disease, as it might be in men, with the possible exception of women under fifty, in whom heart disease is exceedingly rare.
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*20 Browner’s analysis also assumed that restricting dietary fat would reduce cancer deaths, which was speculative then and is even more speculative now.
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*21 William Taylor, the Harvard physician who had done the first of the three analyses on the questionable benefits of eating less fat, was unimpressed with this argument. “Most patients don’t come into my office saying I really want to contribute to the public health statistics in this country,” he said. “If they did, I’d know what to do for them.”
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*22 Melvin Konner has doubts about the conclusions. “Boyd and I probably did underestimate the amount of meat in the Paleolithic diet based on our extrapolations for hunter-gatherers,” he said. “I just don’t think it’s nearly as extreme as this paper claims.”
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*23 They did not, however, lose any weight because of this, which is paradoxical, and an issue we will discuss later.
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