The Fatty Diet Under Attack

By Claudia Wallis

A panel tells many Americans to lower their cholesterol levels

After nearly 30 years of warnings from health officials, most Americans are well aware of the perils of too much cholesterol. The problem is, how much is too much? What level of cholesterol in the blood should be considered acceptable, and at what point does treatment become necessary to reduce the risk of heart disease? For three days last week the National Institutes of Health in Bethesda, Md., convened a panel of 14 experts to try to answer these questions. The group reviewed the extensive scientific evidence linking high levels of cholesterol and fatty diet to heart disease, the leading cause of death in the U.S. They heard testimony from dozens of people and then retired to draft a report, working into the early hours of the morning. The result is the most far-reaching recommendation yet made on the subject of cholesterol and heart disease.

For the first time ever, American physicians were offered specific, numerical guidelines to help them identify and treat the one-quarter of the population that is considered to have a moderate to high risk of developing heart disease because of their cholesterol levels. In addition, to end the confusion about what levels should be considered normal, the panel issued specific targets for all adults: those under 30 should have cholesterol levels no higher than 180 mg per deciliter of blood; those over 30, not above 200 mg. These targets are below what many doctors had previously considered acceptable and below the average reading for middle-aged Americans. "By specifying numbers, we hope to make things happen," said Panel Chairman Daniel Steinberg, professor of medicine at the University of California at San Diego.

The panel urged immediate and "intensive" treatment of those at risk, beginning with a lowfat, low-cholesterol diet. Such a regimen usually emphasizes fruits and vegetables, substitutes chicken, fish and lean meats for fatty ones, and encourages the use of polyunsaturated oil for cooking. For patients who fail to respond to diet, cholesterol-lowering drugs are advised. Further cautions: Do not smoke, exercise regularly and control your weight.

In a more sweeping recommendation, the experts urged that all Americans over age two adopt a diet that would reduce total fat intake from its current national level of about 40% of total calories to just 30%. Saturated fat--the type found mainly in meat and dairy products--should constitute no more than 10% of a person's daily diet, the panel said. The suggested regimen would limit cholesterol consumption to 250 to 300 mg a day (one large egg yolk contains 270 mg).

While such a diet has been advocated by the American Heart Association for years, some scientists believe it is wrong to try to impose it on the entire U.S. public. "We are holding out the promise that the whole population will benefit from this, and that is unrealistic," says Dr. Edward Ahrens, a leading cholesterol researcher at Rockefeller University. But Steinberg argues that the diet can do no harm and hardly poses a hardship: "There is no reason a person can't follow it and still have a sundae at Haagen-Dazs every Saturday."

The NIH panel acknowledged that a number of obstacles must be removed if its recommendations are to have an impact on American health. First, cholesterol testing must be standardized across the country. At present, results from one laboratory to the next may vary by as much as 10% to 15%, and some laboratories continue to regard readings of up to 300 mg as within the normal range. The panel called on the food industry to provide better labeling of the fat content in processed foods, and it urged restaurants to offer lower-fat items on their menus. Public education was seen as vital so that high-risk people can quickly be identified and treated. Said Steinberg: "We hope that five years from now people will say, 'I better go get my cholesterol checked.' " --By Claudia Wallis.

Reported by Patricia Delaney/Washington and Melissa Ludtke/Los Angeles

With reporting by Patricia Delaney, Melissa Ludtke