Keys helped popularise the Mediterranean diet.
This is the first in the series of 6 articles on how the effect of nutrition on health became politicised, and has remained so since.
The Roots of the Cholesterol Theory
In Unhealthy Betrayal, I reported on how Ancel Keys, a biologist and physiologist, introduced the theory that heart disease was caused by dietary factors that raised our cholesterol levels, and that these raised levels were caused by high levels of dietary fat—specifically the saturated fats that were found in animal products, such as butter, cheese, and the flesh of red meats. [i]
Originally, in 1957, the American Heart Association (AHA) opposed Ancel Keys on the diet-heart issue and produced a fifteen-page report that castigated researchers, including Keys, for taking “uncompromising stands based on evidence that does not stand up under critical examination.” They further suggested, “There is not enough evidence available to permit a rigid stand on what the relationship is between nutrition, particularly the fat content of the diet, and atherosclerosis and coronary heart disease.”[ii]
Keys had already embarked on his landmark study, the Seven Countries Study, which he launched in 1956, with an annual grant of $200,000, which was a phenomenal sum in those days, that he was able to obtain from the U.S. Public Health Service. Keys and his collaborators studied more than 13,000 middle-aged men from mostly rural populations in Italy, Yugoslavia, Greece, Finland, the Netherlands, Japan and the United States. Results were published every five years (it was an ongoing study). Deaths varied from 992 (deaths per decade) for every ten thousand men in the lumberjacks and farmers of North Karelia, Finland, to just 66 in Japan (the US figure was 570 per ten thousand). Keys maintained the results predicted that cholesterol levels predicted heart disease risk, and the amount of saturated fat predicted cholesterol levels and heart disease with remarkable accuracy. [iii]
By the turn of the 1960s, the AHA was to change its position regarding diet and heart disease. At the time, they criticised Keys; the group was a scientific society of cardiologists, but in 1948 they became recipients of largesse from Procter & Gamble (PG), which launched them into the big time. By 1960, it had more than three hundred chapters and brought in more than $30 million annually from PG, other food giants, and other donors. It became the largest not-for-profit group in the USA. In this period, Keys had succeeded in manoeuvring himself and his chief ally, Jeremiah Stampler, a doctor from Chicago, onto the AHA Nutrition Committee. This resulted in the AHA report in 1961, which argued that the best scientific evidence at the time suggested Americans could reduce their risk of heart attacks and strokes by cutting the saturated fat and cholesterol in their diets. The report suggested the “reasonable substitution” of saturated fats with polyunsaturated fats such as corn oil or soybean oil as being part of a “prudent diet”. [iv]
Another important study that would affect the debate about cholesterol was the Framingham Heart Study. Framingham is a small town near Boston, Massachusetts, where researchers studied more than 5,000 middle-aged men and women to identify factors that could predict heart disease. In 1961, after six years of study, the Framingham investigators announced that high total cholesterol was a reliable predictor of heart disease.[v]
It wasn’t until the Nurses Health Study, led by the Harvard Epidemiologist Walter Willett, that people started to question the soundness of the advice to undertake a low-fat diet. This study tracked the diets, lifestyles, and diseases of nearly eighty-nine thousand nurses in the USA from 1982. They published their first report on fat and health in 1987 and revealed that over six hundred cases of breast cancer had appeared in the first four years of the study, and found that if anything, the less fat the women confessed to eating, the more likely they were to get breast cancer. This was supported by a further study undertaken by the National Cancer Institute (NCI) which found eating more fat, particularly saturated fat, correlated with less breast cancer. Willet produced a further report in 1992, publishing eight years of observations, which, once again, corroborated that those who seemed to eat the least fat had the highest levels of breast cancer, which included copious amounts of saturated fat. [vi]
The Politicising of heart disease
As I mention in Unhealthy Betrayal, further studies were done, but none achieved results supporting Keys’ hypothesis. There was, however, a big campaign by the margarine and vegetable oil industries, supported by the American Medical Association (AMA) to win support for Keys’ theory. The case for condemning saturated fats reached new heights with the publication announced by Senator George McGovern, the first Dietary Goals for the United States, the first Federal attempt to promote dietary guidelines for US citizens.
- The first dietary goal was to raise carbohydrate consumption to 50-60 per cent of calories consumed.
- The second goal was to decrease fat consumption to 30 per cent of all calories, with less than 33 per cent being supplied by saturated fats.
The initial response to the report at its press conference produced uproar. This prompted McGovern to hold further hearings and produce a revised set of guidelines later that year. What McGovern really succeeded in doing, however, was to turn the whole discussion of cholesterol and saturated fats into a political issue instead of a question of science. [vii]
This, in itself, created a problem that would manifest in unforeseen consequences. Once the idea that saturated fats caused raised cholesterol levels that in turn led to heart disease, and strokes—was officially accepted as fact—would lead to repercussions that would impact generations to come, and not just in America. Once it became official policy to recommend cutting down on saturated fats in the world’s wealthiest country, with what was considered the most advanced healthcare facilities, other countries simply toe the line and dance to the same tune. Anyone who wished to voice opinions that conflicted with this position was simply not given space in leading journals; they found their research funding drying up, invitations to speak being withdrawn, and even their livelihoods at risk.
The trouble with stifling dialogue, particularly in science and, more specifically, in health, is that you put health at serious risk. And the consequences can spiral into a phenomenal health crisis if left unchecked. So here’s the problem: his theory was simply wrong.
Flaws started appearing from the beginning. One of the scientists who was troubled by the stampede into the idea that saturated fats caused heart disease was George Mann, the Vanderbilt biochemist, who had gone to Africa and had extensively studied the Masai. The Masai seemed to thrive on a diet of meat, blood and milk, and were found to have some of the lowest cholesterol levels in the world. They did not suffer from heart disease, nor did they from any other chronic diseases. Mann was also one of the first scientists to raise the alarm over trans fats in 1955. Several universities were disturbed by Mann’s revelations about the Masai, and they dispatched their own scientists to Kenya to look for flaws in Mann’s data, but they only succeeded in corroborating his findings. Keys himself simply dismissed Mann’s findings, and stated: “the peculiarities of those primitive nomads have no relevance.” [viii]
Presidential intervention
President Dwight D. Eisenhower succumbed to his first heart attack Friday, September 23rd 1955. It happened the day he played a game of golf, after lunching on a hamburger with onions, which seemed to give him indigestion. Later that night he awoke with severe pain. On Saturday, he was taken to hospital; by midday Sunday, Dr Paul Dudley White, the world-renowned Harvard cardiologist, had been flown in to consult. Eisenhower’s heart attack, I mention here, had a profound effect on the whole issue regarding heart disease in the USA; it seemed to focus people’s minds on the issue. Facts about his recovery and his dietary habits became part of the public record. George Mann, who worked with White at Harvard, took an interest in Eisenhower’s circumstances. It was known he exercised regularly and had given up smoking five years prior to his attack; his cholesterol was below normal, and his blood pressure was only occasionally elevated. These circumstances should not have raised concern for his health.
We know that following Eisenhower’s attack, he dieted religiously, had his cholesterol checked regularly, and ate little fat. His meals were cooked in either soybean oil or the newly developed polyunsaturated margarine which appeared on the market in 1958 (apparently as a palliative for high cholesterol). His weight increased with his new diet, which caused Eisenhower considerable anguish. In March 1969, after reading about a group of middle-aged New Yorkers who attempted to reduce their cholesterol by renouncing such things as butter, lard, and cream, and even margarine, by replacing them with corn oil, Eisenhower was influenced to switch as well. His cholesterol continued to rise, however, which caused him such consternation that his doctor would give him a lower figure for his cholesterol reading than it actually was. On Eisenhower’s final day in office, 19th January 1961, his cholesterol was 259mg/dL, which is a level that physicians would come to consider dangerously high. This reading was taken just six days after Ancel Keys made the cover of Time Magazine. [ix]
Eisenhower eventually succumbed to heart disease and died of a heart attack on 28th March 1969. Whatever dietary advice he followed had evidently not protected him from the congestive heart failure that eventually took his life.
We can only guess the effect Eisenhower’s circumstances had on Mann. He was an associate director on the Framingham Heart Study. He would, however, have been aware of the evidence revealed by the Framingham follow-up study 30 years after the initial study began, when it was found that total cholesterol was not a reliable predictor of heart disease after all. The new study revealed that for men aged 48-57, those with cholesterol in the mid-range (183-222mg/dL) had a greater risk of heart attack and death than those with higher cholesterol levels (222-261mg/dL). They found that for every 1 mg/dL drop in overall cholesterol, coronary mortality increased. According to Nina Teicholz, Mann’s research that supported the idea that saturated fat was not related to heart disease was so abhorrent to his funders, the National Institutes of Health (NIH), that he was not permitted to publish the data he had accumulated, and as a result it lay in an NIH basement for almost a decade. She reports Mann’s comments in a report he wrote in 1977, which begins: “A generation of research on the diet-heart question has ended in disarray,” and he further condemned it as “a misguided and fruitless preoccupation.” [x]
In Unhealthy Betrayal, I discuss the cholesterol controversy and offer a number of studies that showed the flaws in Keys theory. But suffice it to use the evidence of the major studies themselves, such as the landmark Framingham study itself, and here is a quote by Dr William Castelli, Director of the Framingham Study, in 1992:
In Framingham, Massachusetts, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol.[xi]
Dr Malcolm Kendrick, author of The Great Cholesterol Con—The Truth about What Really Causes Heart Disease, and How to Avoid It, discusses many of the flaws in Keys’ theory. One criticism of Keys was that he manipulated the Seven Countries Study to serve his theory, simply by carefully choosing the countries for the study. Kendrick illustrates this point by choosing the following countries: Finland, Israel, the Netherlands, Germany, Switzerland, France and Sweden. Simply choosing these countries for the study at that time would have proved no link between cholesterol levels and heart disease.[xii]
Whilst we are on the subject of the Framingham study, Nina Teicholz draws our attention to the Crete survey, which fell during the forty-eight-day fasting period of Lent. This was a strict Greek Orthodox fast, when the population abstained from all foods of animal origin, including fish, cheese, eggs and butter. She points to a study undertaken in Crete in 200 and 2001 which showed saturated fat halved during Lent. This would, of course, skew any results, particularly if it was not revealed or accounted for, which it was not.[xiii]
Another critic of the whole cholesterol controversy, Dr Uffe Ravnskov, wrote an excellent volume, titled Fat and Cholesterol are Good for You! In this volume, he discusses why cholesterol is good for you, and declares, ‘The cholesterol Campaign is medical quackery of the first order.’ He also quotes George Mann, one of the leading Framingham researchers who we have already mentioned: ‘In fact, the eminent American physician and scientist George Mann called it “the greatest scientific deception of this century, perhaps of any century.” Ravnskov. He also mentions how, since his first publication on the cholesterol controversy, The Cholesterol Myths, in 1991, the evidence continues to go contrary to Keys’ original hypothesis:
Much has happened in this area since then, but nothing that has changed my mind. On the contrary, many more studies have appeared that contradict the current view. What is particularly interesting and surprising is that a steadily increasing number of studies have found that high cholesterol is beneficial.[xiv]
Well, are you all confused now? Not only is cholesterol not bad for us, but it is also actually good for us? What is going on here? This is interesting. This raises a number of important questions (a number I have discussed in Unhealthy Betrayal). If cholesterol is not the bad guy here, what is actually happening here? There is now talk of the so-called ‘good’ and ‘bad’ cholesterol (a subject we will discuss in a following article in this series), and the goalposts have now been moved.
For me, one important question is: if saturated fats are not the cause of heart disease, then what is? Another important question is: what effect has following what appears to be totally erroneous diet advice had? And what effect has it had on our health? These are the important questions we discuss in the accompanying articles.
Andrew Burgoyne
This was initially posted on October 20th,2018. Following an attack on my site, this article was lost. It has now been reposted.
[i] Andrew Burgoyne, Unhealthy Betrayal, Fundamental Press, 2015, p.14.
[ii] Gary Taubes, The Diet Delusion, Ebury Publishing, 2007, p. 20.
[iii] Ibid.
[iv] Nina Teicholz, The Big Fat Surprise—Why butter, meat and cheese belong in a healthy diet, Scriba Publications, 2014.
[v] Ibid.
[vi] Gary Taubes, The Diet Delusion, Ebury Publishing, 2007, p. 73.
[vii] Andrew Burgoyne, Unhealthy Betrayal, Fundamental Press, 2015, p. 17.
[viii] Nina Teicholz, The Big Fat Surprise, Scriba Publications, 2014, p. 62.
[ix] Gary Taubes, The Diet Delusion, Ebury Publishing, 2007, p. 4.
[x] Nina Teicholz, The Big Fat Surprise, Scriba Publications, 2014, p. 71.
[xi] Dr Malcolm Kendrick, The Great Cholesterol Con—The Truth about what really Causes Heart Disease, and How to Avoid it, John Blake Publishing Ltd. London, 2007, p. 35.
[xii] Ibid.
[xiii] Nina Teicholz, The Big Fat Surprise, Scriba Publications, 2014, p. 41.
[xiv] Dr Uffe Ravnskov, Fat and Cholesterol are Good for You! GB Publishing, Sweden, 2009.
What do you think?