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Ethics in Biology, Engineering and Medicine: An International Journal
Ethics in Medical Research and the Low-Fat Diet-Heart Hypothesis
Richard David Feinman
SUNY Downstate Medical Center, Brooklyn, New York
Sara M. Keough
Maryland University of Integrative Health, Laurel, Maryland
The diet-heart hypothesis holds that circulating cholesterol is a causal factor in cardiovascular disease (CVD) and that high-fat diets lead to high cholesterol. The idea has been the major philosophy in medicine and nutrition for 40 years; most government and private health agencies have counseled reduction in dietary fat, especially saturated fat and, as a corollary, have generally opposed the use of diets based on carbohydrate restriction. Despite its pervasive presence, most experimental tests of the diet-heart hypothesis, including large expensive clinical trials, have failed to show any significant benefit for CVD or for most other health problems, and theory and practice related to diet-heart have been the target of many critiques. At the same time, low-carbohydrate diets have shown consistent benefit for obesity, diabetes, and metabolic syndrome. It is argued that adherence to low-fat has caused demonstrable harm, to scientific principles, to the scientific literature, to medical education and, most important, has failed to offer effective options to the patient. Motivation for persistence in the face of contradictory evidence is unknown but, as it becomes increasingly clear that harm has been done, continuation on our current path will constitute an ethical problem.
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