debatable position among researchers. After the press conference, as Hegsted recalled, “all hell broke loose…. Practically nobody was in favor of the McGovern recommendations.”
Having held one set of hearings before publishing the Dietary Goals, McGovern responded to the ensuing uproar with eight follow-up hearings. Among those testifying was Robert Levy, director of the National Heart, Lung, and Blood Institute, who said that no one knew whether lowering cholesterol would prevent heart attacks, which was why the NHLBI was spending several hundred million dollars to study the question. (“Arguments for lowering cholesterol through diet,” Levy had written just a year earlier, even in those patients who were what physicians would call coronary-prone, “remain primarily circumstantial.”)
Other prominent investigators, including Pete Ahrens and the University of London cardiologist Sir John McMichael, also testified that the guidelines were premature, if not irresponsible. The American Medical Association argued against the recommendations, saying in a letter to the committee that “there is a potential for harmful effects for a radical long term dietary change as would occur through adoption of the proposed national goals.” These experts were sandwiched between representatives from the dairy, egg, and cattle industries, who also vigorously opposed the guidelines, for obvious reasons. This juxtaposition served to taint the legitimacy of the scientific criticisms.
The committee published a revised edition of Dietary Goals later that year, but with only minor revisions. Now the first recommendation was to avoid being overweight. The committee also succumbed to pressure from the livestock industry and changed the recommendation that Americans “decrease consumption of meat” to one that said to “decrease consumption of animal fat, and choose meats, poultry, and fish which will reduce saturated fat intake.”
The revised edition also included a ten-page preface that attempted to justify the committee’s dietary recommendations in light of the uproar that had followed. It included a caveat that “some witnesses have claimed that physical harm could result from the diet modifications recommended in this report….” But McGovern and his colleagues considered that unlikely: “After further review, the Select Committee still finds that no physical or mental harm could result from the dietary guidelines recommended for the general public.” The preface also included a list of five “important questions, which are currently being investigated.” The first was a familiar one: “Does lowering the plasma cholesterol level through dietary modification prevent or delay heart disease in man?”
This question would never be answered, but it no longer seemed to matter. McGovern’s Dietary Goals had turned the dietary-fat controversy into a political issue rather than a scientific one, and Keys and his hypothesis were the beneficiaries. Now administrators at the Department of Agriculture and the National Academy of Sciences felt it imperative to get on the record.
At the USDA, Carol Foreman was the driving force. Before her appointment in March 1977 as an assistant secretary of agriculture, Foreman had been a consumer advocate, executive director of the Consumer Federation of America. Her instructions from President Jimmy Carter at her swearing-in ceremony were to give consumers a “strong, forceful, competent” spokeswoman within the USDA. Foreman believed McGovern’s Dietary Goals supported her conviction that “people were getting sick and dying because we ate too much,” and she believed it was incumbent on the USDA to turn McGovern’s recommendations into official government policy. Like Mottern and Hegsted, Foreman was undeterred by the scientific controversy. She believed that scientists had an obligation to take their best guess about the diet-disease relationship, and then the public had to decide. “Tell us what you know, and tell us it’s not the final answer,” she would tell scientists. “I have to eat three times a day and feed my children three times a day, and I want you to tell me what your best sense of the data is right now.”
The “best sense of the data,” however, depends on whom you ask. The obvious candidate in this case was the Food and Nutrition Board of the National Academy of Sciences, which determines Recommended Dietary Allowances, the minimal amount of vitamins and minerals required in a healthy diet, and was established in 1940 to advise the government on nutrition issues. The NAS and USDA drafted a contract for the Food and Nutrition Board to evaluate the recommendations in the Dietary Goals, according to Science, but Foreman and her USDA colleagues “got wind” of a speech that Food and Nutrition Board Chairman Gilbert Leveille had made to the American Farm Bureau Federation and pulled back. “The American diet,” Leveille had said, “has been referred to as…‘disastrous’…. I submit that such a conclusion is erroneous and misleading. The American diet today is, in my opinion, better than ever before and is one of the best, if not the best, in the world today.” NAS President Philip Handler, an expert on human and animal metabolism, had also told Foreman that McGovern’s Dietary Goals were “nonsense,” and so Foreman turned instead to the NIH and the Food and Drug Administration, but the relevant administrators rejected her overtures. They considered the Dietary Goals a “political document rather than a scientific document,” Foreman recalled; NIH Director Donald Fredrickson told her “we shouldn’t touch it with a ten-foot pole; we should let the crazies on the hill say what they wanted.”
Finally, it was agreed that the USDA and the Surgeon General’s Office would draft official dietary guidelines. The USDA would be represented by Mark Hegsted, whom Foreman had hired to be the first head of the USDA’s Human Nutrition Center and to shepherd its dietary guidelines into existence.
Hegsted and J. Michael McGinnis from the Surgeon General’s Office relied almost exclusively on a report by a committee of the American Society of Clinical Nutrition that had assessed the state of the relevant science, although with the expressed charge “not to draw up a set of recommendations.” Pete Ahrens chaired the committee, along with William Connors of the University of Oregon Health Sciences Center, and it included nine scientists covering a “full range of convictions” in the various dietary controversies. The ASCN committee concluded that saturated-fat consumption was probably related to the formation of atherosclerotic plaques, but the evidence that disease could be prevented by dietary modification was still unconvincing.*15 The report described the spread of opinions on these issues as “considerable.” “But the clear majority supported something like the McGovern committee report,” according to Hegsted. On that basis, Hegsted and McGinnis produced the USDA Dietary Guidelines for Americans, which was released to the public in February 1980.
The Dietary Guidelines also acknowledged the existence of a controversy, suggesting that a single dietary recommendation might not be appropriate for an entire diverse population. But it still declared in bold letters on its cover that Americans should “Avoid Too Much Fat, Saturated Fat, and Cholesterol.” (The Dietary Guidelines did not define what was meant by “too much.”)
Three months later, Philip Handler’s Food and Nutrition Board released its own version of the guidelines— Toward Healthful Diets. It concluded that the only reliable dietary advice that could be given to healthy Americans was to watch their weight and that everything else, dietary fat included, would take care of itself. The Food and Nutrition Board promptly got “excoriated in the press,” as one board member described it. The first criticisms attacked the board for publishing recommendations that ran counter to those of the USDA, McGovern’s committee, and the American Heart Association, and so were seen to be irresponsible. They were followed by suggestions that the board members, in the words of Jane Brody, who covered the story for the New York Times, “were all in the pocket of the industries being hurt.” The board director, Alfred Harper, chairman of the University of Wisconsin nutrition department, consulted for the meat industry. The Washington University nutritionist Robert Olson, who had worked on fat and cholesterol metabolism since the 1940s, consulted for the Egg Board, which itself was a USDA creation to sponsor research, among other things, on the nutritional consequences of eating eggs. Funding for the Food and Nutrition Board came from industry donations to the National Academy of Sciences. These industry connections were first leaked to the press from the USDA,
