Chapter 1  The Eisenhower Paradox

President Eisenhower was the best chronicled heart attack survivor. He kept a strict diet, yet his cholesterol kept going up. 

Ancel Keys

2 myths passed on to the present day. One was that a "great epidemic" of heart disease had ravaged the country since WWII. The other could be called the story of the changing American diet. Together they told of how a nation turned away from cereals and grains to fat and red meat and paid the price in heart disease. The facts did not support these claims, but the myths served a purpose, and so they remained unquestioned. 

The early 19th century was an anomoly. By the 1950s, deaths from infectious diseases and nutritional deficiencies had been all but eliminated in the USA, which left more Americans living long enough to die of chronic diseases - in particular, cancer and heart disease. Lengthened the life of Western man from an average life expectancy of only forty-eight years in 1900 to sixty-seven years in 1950. Also, there was an increased likelihood that a death would be classified on a death certificate as coronary heart disease. 

Changing American Diet Theory. Based on estimates and lousy data. More home-grown food, hard to keep track of what was consumed. 

Sinclair Lewis' 1906 book The Jungle (fictional expose on the meatpacking industry) caused meat sales on the US to drop by half! The effect was long-lasting, 1928 still trying to woo people back to meat. 

During the decades of the heart-disease "epidemic", vegetable consumption increased dramatically. This change was attributed to nutritionists' emphasizing the need for vitamins from the fruits and green vegetables that were conspicuously lacking in our diets in the nineteenth century. "The preponderance of meat and farinaceous foods on my grandfather's table over fresh vegetables and fruits would be most unwelcome to modern palates... I doubt if he ever ate an orange. I know he never ate grapefruit, or broccoli or cantaloup or asparagus. Spinach, carrots, lettuce, tomatoes, celery, endive, mushrooms, lima beans, corn, green beans and peas - were entirely unknown, or rarities... The staple vegetables were potatoes cabbage, onions, radishes and the fruits - apples, pears, peaches, plums and grapes and some of the berries - in season." 

From end of WWII, when USDA statistics become more reliable, the the late 1960s, while coronary heart-disease mortality rates supposedly soared, per-capita consumption of whole milk dropped steadily, and the use of cream was cut by half. We ate dramatically less lard (13 pounds, compared with 7 pounds) and less butter (8.5 pounds versus 4) and more margarine (4.5 pounds versus 9 pounds), vegetable shortening (9.5 pounds versus 18 pounds) an salad an cooking oils (7 pounds versus 18 pounds). As a result, during the worst decades of the "epidemic", vegetable-fat consumption doubled (from 28 pounds to 55 pounds) while the average consumption of ALL animal fat dropped from 84 pounds to 71. So the increase of total fat consumption, to which Ancel Keys and others attributed the "epidemic", paralleled not only incrased consumption of vegetables and citrus fruit, but of vegetable fats, which were considered heart-healthy, and a decreased consumption of animal fats. 

Atherosclerosis not tied to cholesterol, per se - heart surgeons and cardiologists were skeptical. 

Keys' scientific abilities arguable. He became convinced that the crucial difference between those with heart disease and those without it was the fat in the diet. He was not taken seriously at the time. 

He selected only 6 of 22 countries whose data was available to prove his hypothesis. 

Ironically, some of the most reliable facts about the diet-heart hypothesis have been consistently ignored because they complicated the message, and the least reliable findings were adopted because they didn't. Dietary cholesterol, for instance, has an insignificant effect on blood cholesterol. Nonetheless, the advice to eat less cholesterol - avoiding egg yolks, for instance - remains gospel. 

Saturated fat became implicated in raising cholesterol levels. Now it's taught in high school the erroneous idea that all animal fats are "bad" saturated fats, and all "good" unsaturated fats are found in vegetables and maybe fish. This accepted wisdom was probably the greatest "handicap to clear thinking" in the understanding of the relationship between diet and heart disease. The reality is that both animal and vegetable fats and oils are composed of many different kinds of fat, each with its own chain length and degree of saturation, and each with a different effect on cholesterol. Half of the fat in beef, for instance, is unsaturated, and most of that fat is the same mono-unsaturated fat as in olive oil. Lard is 60 percent unsaturated; most of the fat in chicken fat is unsaturated as well. 

In 1957 the AHA opposed Ancel Keys on the diet-heart issue. They castigated researchers - including Keys - for taking "uncompromising stands based on evidence that does not stand up under critical examination." "Not enough evidence... on the relationship between nutrition particularly the fat content of the diet and atherosclerosis and coronary heart disease." 

Less than four years later, the evidence hadn't changed, but now a six-man ad-hoc committee issued a new AHA report that reflected a change of heart. Their report was slightly over two pages long and had NO references. "The best scientific evidence of the time" strongly suggested that Americans would reduce their risk of heart disease by reducing the fat in their diet, replacing saturated fats with polyunsaturated fats.  This was the AHA's first official support of Keys's hypothesis. After that report, Time quickly enshrined Keys on its cover as the face of dietary wisdom in America. It contained only a single paragraph noting that his hypothesis was "still questioned by some researchers with conflicting ideas of what causes coronary disease."