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FAT in food is bad for everyone, not just people with a high level of
cholesterol – and we should all consume less of it. This view, from a coalition
of medical experts in the US, is an attempt to remove the confusion that
has surrounded the question of cholesterol levels in recent years.

Last week the National Cholesterol Education Programme (NCEP) advised
the public that all children and adults should adjust their diets to lower
their blood cholesterol. Previously, medical groups have recommended radical
changes in diet mainly for people at higher-than-average risk of heart disease.

Thirty-eight groups, including the American Heart Association, the American
Medical Association, and the American Public Health Association, endorsed
the NCEP’s report. The government’s Food and Drug Administration also lent
its support. The NCEP was formed in 1985 by the National Institutes of Health
to help to reduce the nation’s rate of coronary heart disease.

‘You are finally seeing everyone saying, ‘Let’s not confuse, let’s coalesce,
let’s speak with the same voice’,’ says Richard Carleton, a physician and
chairman of the panel that wrote the report.

The NCEP’s panel on population stated that a nationwide shift in diet
to reduce average blood cholesterol by 10 per cent would cut coronary heart
disease by 20 per cent. About six million Americans suffer coronary heart
disease, the nation’s top killer and disabler. Some 1.2 million people suffer
a heart attack each year.

The NCEP argues that the scientific evidence shows clearly that lowering
cholesterol will reduce the risk of coronary disease. Avoiding food that
is high in cholesterol or saturated fat can even stop deposits of fatty
material from becoming embedded in the artery wall.

No single ‘monolithic’ diet has been agreed, points out James Cleeman,
the coordinator of the NCEP. But the NCEP report suggests that no more than
10 per cent of calories in a person’s diet should come from saturated fatty
acids, which are believed to be the most harmful forms of fat. The amount
of calories from saturated fat in the average American’s diet is now 13.2
per cent. Furthermore, no more than 30 per cent of one’s calories should
come from all forms of fat, the panel stated. (One gram of fat contains
9 calories.) The NCEP also ruled that no one should consume more than 300
milligrams of cholesterol daily. This is equal to the current average among
women, but would be a steep plunge from the 435 mg a man consumes.

As evidence of the relationship between saturated fats and cholesterol
has grown, the food industry has responded with a barrage of alternatives.
Labels on packaged products now promote their lack of cholesterol, and breads
and cereals are fortified with oat bran because fibre is considered healthy.
Carleton warns that many such claims can be misleading. ‘Examples include
the words ‘no cholesterol’ on foods that are high in saturated fatty acids,’
he says.

The latest twist in the fat saga came last month from the NutraSweet
company. The Food and Drug Administration has approved the company’s product,
Simplesse, a fat substitute designed to imitate the taste and feel of fat
in food. Simplesse consists of blended protein from egg whites and low-fat
milk. Ice cream made with the product contains one-fifteenth of the amount
of fat contained by the real thing.

Although Carleton urged scientists to speak with one voice on fat and
cholesterol, not all agree with the NCEP. Paul Meier, a statistician at
the University of Chicago and an expert on clinical trials, says the NCEP
has ‘overinterpreted the science’. He criticised the NCEP for turning its
data into a reason for sharp reductions in dietary fat that will be very
difficult for people to achieve, and that could encourage physicians to
prescribe more drugs for lowering cholesterol.

Moreover, data from clinical trials on fat and heart disease among children
and older people are almost nonexistent, says Meier. Recommending strict
diets for these groups is ‘playing a game where we have no evidence’.