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American Heart Association Paradox

The American Heart Association this week urged that "health care professionals downplay the popular but unproven supposition that drinking red wine can help ward off heart attacks."

But "unproven suppositions" don't stop the AHA from promoting other foods and beverages as "heart healthy." Some "unproven suppositions," as it turns out, are more lucrative and politically correct than others. 

The AHA is referring to the so-called "French paradox," the hypothesis that drinking wine, particularly red wine, helps counteract alleged harmful effects of dietary cholesterol and saturated fats on the heart and vascular system. Many population surveys report lower rates of heart disease among Europeans who, despite a relatively high-fat, high-cholesterol diet, consume wine regularly. 

It's been suggested that moderate alcohol consumption may increase blood levels of the "good" high-density lipoprotein (HDL) cholesterol. Another suggestion is that certain "phenolic" compounds in wine act as platelet inhibitors and antioxidants to reduce heart disease risk. 

Nevertheless, wine consumption isn't proven to reduce heart disease risk. The population surveys only look at population, not individual characteristics. Unexplored factors like genetics and lifestyle are not fully considered in the population surveys and could explain the French paradox. 

The French paradox remains controversial, and the AHA is correct to point out that there is no firm scientific basis for advocating alcohol consumption to reduce heart disease risk. 

It's too bad the AHA doesn't apply similar scrutiny to its Food Certification Program, established in 1995 "to provide consumers a quick, easy way to identify heart-healthy foods that can be part of a [heart] healthful eating plan." Grocery stores are filled with brands displaying the AHA's "heart-check" mark. 

Foods and beverages qualifying for the heart-check mark include those that are considered low fat, low saturated fat, low cholesterol and low sodium, and have at least 10 percent of the recommended daily value of one or more of vitamin A, vitamin C, calcium, iron or dietary fiber. 

The problem is that the theories underlying the Food Certification Program are like the French paradox — unproven. Conventional wisdom may be that the AHA's recommended diet, which it says it comes up with after perusing a wide array of studies, is "heart smart." But the science isn't quite there. 

In November 1997, Harvard University researchers noted in a New England Journal of Medicine study, "The results of [studies] between dietary fat and coronary disease have been inconsistent." Their own study of more than 80,000 women over 14 years reported no statistically significant associations between total fat, animal fat, saturated fat, cholesterol and risk of heart disease. 

A recent article in the journal Science summarized the state of the knowledge about dietary salt and high blood pressure: "After decades of intensive research, the apparent benefits of avoiding salt have only diminished." 

"This suggests either that the true benefit has now been revealed and is indeed small, or that it is nonexistent," the article said, "and researchers believing they have detected such benefits have been deluded by the confounding influences of ... genetic variability; socioeconomic status; obesity; level of physical exercise; intake of alcohol, fruits and vegetables, or dairy products; or any number of other factors." 

Harvard researchers stated in January 2000 that "data do not support a strong role for vitamin C in reducing risk of coronary disease." University of Colorado researchers reported in November 1999, "Evidence that supplementation with vitamin A or C reduces the risk of coronary heart disease is inadequate." 

Heart disease is complex. Lifestyle factors, including diet, may play a role in some people. But scientific uncertainty abounds. The evidence behind the AHA's Food Certification Program is weak — just like evidence of the French paradox. Why then trumpet the program and disparage the paradox? 

Money and politics. 

The AHA sells its "heart check" logo to companies who want to sell their food products by exploiting the AHA's good name. For a first-year fee of $7,500 per product, and subsequent renewals priced at $4,500, companies are permitted to market qualifying products as "heart healthy." Several hundred products now carry the heart-check logo. You do the math. 

Even if the French paradox were true, wine makers would probably face another barrier to the Food Certification Program: the requirement of social responsibility. Political correctness is why General Mills' Frosted Wheaties, but not Post's Frosted Shredded Wheat, is heart-healthy. The Post brands are owned by tobacco giant Philip Morris, and tobacco company affiliates are barred from the Food Certification Program. 

So here's the drill for the AHA's program: Pass the political correctness check, pony up a bank check and then get the heart check. Don't worry that the science doesn't check. 

The Food Certification Program deceives consumers by implying that certain brands are proven to help prevent heart disease. Adding insult to injury, consumers pay up for the more expensive brands that can afford to dance with the AHA. Pricey Tropicana grapefruit juice is "heart healthy," but supermarket bargain brand grapefruit juice isn't? 

It's swell that the AHA is cautioning the public about the unproven French paradox. But the AHA should try some much-needed introspection. 

— Steven Milloy is a biostatistician, lawyer and adjunct scholar at the Cato Institute and publisher of Junkscience.com.