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The Western diet has been implicated in a number of chronic diseases, including heart disease, diabetes and cancer. Patients have eagerly sought medical guidance on the proper diet, and although certain food elements appear to increase the risk of certain diseases, offering up specific dietary advice can be a treacherous endeavor. For one thing, diet is notoriously difficult to study. The effects of diet may take years to develop, few volunteers are willing to engage in randomized trials of diet for long periods of time, and protective factors identified in cohort studies rarely stand up to randomized trials. Not surprisingly, diet advice predicated on observational studies or pathophysiological mechanisms rather than randomized trial evidence may turn out to be ineffective e. Admitting that our past advice was wrong is uncomfortable and may also make patients less inclined to trust medical recommendations in the future. This may explain why the American Heart Association AHA was slow to rescind the recommendation to limit dietary fat due to its effects on total blood cholesterol levels.
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