The lipophobes, however, proved to be remarkably adept at bobbing, weaving and altering their message in the face of the challenges. The American Heart Association continued to find new ways to prosper from lipophobia. In 1988 it deleted the provision in its charter prohibiting product endorsements and began offering, for a fee, to endorse any food products that met its guidelines for fat, cholesterol and sodium. In final form, the AHA campaign sold the right to use a “Heart Check” symbol and say “Meets American Heart Association food criteria for saturated fat, cholesterol and whole grains for healthy people over age two.” For this, it charged fees ranging from the US$2,500 it cost Kellogg’s for each of the more than 50 of its products that qualified (including such nutritional dazzlers as Fruity Marshmallow Krispies) to the $200,000 that Florida citrus fruit producers paid for exclusive rights to the symbol, cutting out their competitors in California. The Florida producers now ran ads saying, “Fight Heart Disease. Drink Florida Grapefruit Juice.” In 1992–93 ConAgra, the hydra-headed giant involved in practically every stage of food production, gave $3.5-million to the AHA, ostensibly to make a television program on nutrition.
By the end of the 20th century, however, the AHA’s calls to reduce heart disease through diet were sounding rather threadbare. There was still no evidence that low-fat diets prevented heart disease. In 1996 the American College of Physicians came out against the AHA program of screening all people over 20 for high cholesterol. It said that it resulted in young people being put on low-fat diets that rarely reduced cholesterol. Others began pointing out that the AHA campaign to have people adopt low-fat, high-carbohydrate diets led to increased consumption of calorie-dense foods that contributed to obesity and diabetes, both of which were risk factors for cardiovascular disease. Then, in 2000, another fat panic gave lipophobia yet another boost. This time it was about trans fats, which were in the hydrogenated oils used in making everything from French fries to Doritos to granola bars.
Then, in late 2008 came an apparently crushing scientific blow. A new theory claimed that the main culprit in heart disease was not fat, but inflammation. Statins were effective, it said, because they reduced levels of a protein, called high-sensitivity C-reactive protein (CRP), that contributes to inflammation in the body. The crucial risk factor for heart disease was therefore not cholesterol, but elevated CRP, which has nothing to do with fat in the diet.
In July 2009 another study tried to alter this theory by reducing CRP to the role of an indicator, not a cause, of heart disease. Inflammation remained a villain, but whether it was cause or effect was unknown.
With cholesterol’s role now unclear, it seemed highly unlikely that Keys’s diet-heart theory would ever be resurrected.
In February 2010, the press reported on a meta-analysis of 21 lengthy studies, comprising 347,747 subjects, that concluded that there was no association between saturated fat consumption and the risk of heart disease.