Good Calories, Bad Calories Part 46

I am deeply indebted to Jon Segal at Knopf for an extraordinary job of editing and for being, quite simply, everything I could ever hope for in an editor. I'd also like to thank Knopf editorial a.s.sistant Kyle McCarthy and copyeditor Terry Zaroff. I am grateful, as ever, to my agent at ICM, Kris Dahl, for two decades of unwavering support.

I would like to thank Alexis Bramos-Hantman, Jeanna Bryner, Jasmin Chua, Susan England, Emily Hager, Jeanne Lenzer, David Mahfouda, Tariq Malik, Chung Pak, Gaia Remerowski, Sandra Neufeldt, Rochel e Thomas, and Dori Zook for helping with the research and providing the legwork for this book. I can't thank Richard Ahrens enough for his translation of Bahner's 1955 discussion of lipophilia. I'm grateful to Stefan Hagen for his German connections.

I'd like to thank Barry Gla.s.sner for his camaraderie, Charles Mann for his friends.h.i.+p and his guidance, and Marion Roach Smith, as ever, for her sisterly wisdom. I'm grateful to Ned Tanen, Kitty Hawks, and Lawrence Lederman for their unconditional support and encouragement. Final y, I'd like to thank the late, great Louie Va.s.silakis (19492004) for making one otherwise cold and cacophonous corner of Manhattan feel like home.

ILl.u.s.tRATION CREDITS.

Chapter 4 Charts showing data from MRFIT trial. Reprinted from The Lancet, 328, Browner, Hul ey, Kul er, Martin, and Wentworth. "Serum Cholesterol, Blood Pressure, and Mortality: Implications from a Cohort of 361,662 Men," pages 933936. Copyright October 1986, with permission from Elsevier.

Chapter 14 "Fat Louisa" photograph. Reprinted from The Pima Indians, Russel , page 67. Copyright 1908.

Chapter 14 Photographs from Nigeria. Reprinted from Obesity Symposium, Adadevoh. "Obesity in the African." 6073. 1974, with permission from Elsevier.

Chapter 21 Photographs of lipodystrophy with lower-body obesity. Die Krankheiten des Stoffwechsels und ihre Behandlung. Copyright 1931, page 186, Die Magersucht, Grafe, Figure 20 (Photograph of O. B. Meyer). With kind permission of Springer Science and Business Media.

A NOTE ABOUT THE AUTHOR.

Gary Taubes is a correspondent for Science magazine. His articles about science, medicine, and health have appeared in Discover, The Atlantic Monthly, and The New York Times Magazine, among other publications. He has won three Science-in-Society Journalism Awards given by the National a.s.sociation of Science Writers-the only print journalist so recognized-as wel as awards from the Pan American Health Organization, the American Inst.i.tute of Physics, and the American Physical Society. His writing was selected for The Best American Science Writing 2002 and The Best American Science and Nature Writing 2000 and 2003. He is the author of Bad Science: The Short Life and Weird Times of Cold Fusion, a finalist for the Los Angeles Times Book Award, and n.o.bel Dreams: Power, Deceit and the Ultimate Experiment. He was educated at Harvard, Stanford, and Columbia. He lives in Manhattan with his wife and their son.

ALSO BY GARY TAUBES.

Bad Science: The Short Life and Weird Times of Cold Fusion n.o.bel Dreams: Power, Deceit and the Ultimate Experiment *1 When the first American edition of The Physiology of Taste was published in 1865, it was ent.i.tled The Handbook of Dining, or Corpulence and Leanness Scientifically Considered, perhaps to capitalize on the Banting craze.

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*2 Endocrinology is the study of the glands that secrete hormones and the hormones themselves.

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*3 By 1973, there had been six major conferences or symposiums dedicated solely to research on obesity: at Harvard and at Iowa State University in the early 1950s; in Falsterbo, Sweden, in 1963, hosted by the Swedish Nutrition Foundation; at the University of San Francisco in 1967; the inaugural meeting of the British Obesity a.s.sociation in London in 1968; and an international meeting in Paris in 1971. In al six, carbohydrate-restricted diets were portrayed as uniquely effective at inducing weight loss.

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*4 Arteriosclerosis is the condition in which atheroma acc.u.mulates in arteries throughout the body. The term was often used interchangeably with "atherosclerosis."

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*5 Decreasing cholesterol consumption from four hundred mil igrams a day, the average American intake in the 1990s, to the three hundred mil igrams a day recommended by the National Cholesterol Education Program would be expected to reduce cholesterol levels by 1 to 2 mg/dl, or a decrease of perhaps 1 percent.

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*6 It did include a half-page of "recent scientific references on dietary fat and atherosclerosis," many of which contradicted the conclusions of the report.

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*7 Another of the seven was a rea.n.a.lysis of a 1964 study that had compared the health and diet of Dubliners with those of their siblings who had immigrated to Boston. The 1964 incarnation of the study concluded that the Boston Irish consumed six hundred calories a day less than their Dublin siblings and 10 percent less animal fat, but weighed more and had higher cholesterol. Heart-disease rates were similar, but the Irish brothers lived longer.

This study was then reinterpreted twenty years later by Lawrence Kus.h.i.+, who worked in Keys's department at the University of Minnesota. Kus.h.i.+ concluded that those men who reportedly ate the most saturated fat and the least polyunsaturated fat in the early 1960s had slightly higher heart-disease rates in the years that fol owed. Though "The Cholesterol Facts" described the rea.n.a.lysis as producing "particularly impressive results," Kus.h.i.+ himself had been less impressed: "These results," he wrote, "tend to support the hypothesis that diet is related, albeit weakly, to the development of coronary heart disease."

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*8 When Dayton and his col eagues autopsied the men who died, they found no difference in the amount of atherosclerosis between those on the two diets.

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9 Ordinary milk was replaced with an emulsion of soybean oil in skim milk, and b.u.t.ter and ordinary margarine were replaced with a margarine made of polyunsaturated fats. These changes alone supposedly increased the ratio of polyunsaturated to saturated fats sixfold.

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*10 The results were also presented at a conference of the American Heart a.s.sociation in 1975. A smal chart doc.u.menting the results, without explanation, was then published as an abstract in the journal Circulation, along with the other abstracts from the conference.

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*11 A second randomized double-blind control ed trial-the Heart and Estrogen/Progestin Replacement Study-tested hormone replacement in twenty-three hundred women who had already had heart disease. It also found no benefit from the hormones and suggested an increased risk of heart disease, at least for the first few years of taking hormone-replacement therapy.

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*12 Frantz's Minnesota Coronary Survey was technical y a pilot project for the National Diet-Heart Study.

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*13 The investigative reporter Wil iam Broad suggested another version of this story in Science in June 1979. He said the Dietary Goals const.i.tuted a last-ditch effort to save McGovern's Select Committee, which had required renewal every two years since its inception and was now facing a reorganization that would downgrade its status to a subcommittee of the Senate Committee on Agriculture. "They were fighting for their life," Cortez Enloe, editor of Nutrition Today, told Broad. "Their tenure was up."

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*14 As Dietary Goals explained, "Fat supplies 9 calories per gram, whereas protein and carbohydrates, the other two energy sources, supply only 4 calories per gram.... Consequently, particularly for those not involved in heavy physical activity, the consumption of a diet deriving 40 percent of its calories from fat may result in a continual struggle to lose weight."

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*15 It also affirmed the suspicion that polyunsaturated fats might be dangerous, and so further diminished the role of margarines and corn oils in dietary recommendations.

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*16 The Honolulu Heart Program offered an extreme example of this conflict in 1985. The study revealed that high-fat diets were significantly a.s.sociated with a lower risk of total mortality, cancer mortality, and stroke mortality. On the other hand, the percentage of calories as fat and dietary-cholesterol intake were both a.s.sociated with a higher risk of heart-disease death. Thus, the authors concluded that "these data provide support for the diet-heart hypothesis," albeit with a caveat: "They also suggest that men with low fat intakes have a higher total mortality rate than men with higher fat intakes."

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*17 In 1997, the MRFIT investigators also reported that the men in the treatment group subsequently had more lung cancer than the controls. This was despite the fact that 21 percent of the men had quit smoking in the treatment group, compared with 6 percent in the usual-care group. Because it was hard to believe that quitting smoking increased rates of lung cancer, the MRFIT investigators suggested the possibility that the lower cholesterol levels in the treatment group "might explain [their] higher lung cancer mortality." And, indeed, serum cholesterol showed a "marginal y significant inverse a.s.sociation" with lung-cancer mortality. Nonetheless, the MRFIT investigators concluded that this was not a likely explanation for the results.

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*18 The fourth author was Henry McGil , a pathologist who studied atherosclerosis in humans and in baboons, who says he had agreed unconditional y with the American Heart a.s.sociation position on dietary fat since the early 1960s.

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*19 Though women were clearly meant to adhere to the low-fat guidelines, they had not been included in any of the clinical trials. The evidence suggested that high cholesterol in women is not a.s.sociated with more heart disease, as it might be in men, with the possible exception of women under fifty, in whom heart disease is exceedingly rare.

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*20 Browner's a.n.a.lysis also a.s.sumed that restricting dietary fat would reduce cancer deaths, which was speculative then and is even more speculative now.

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*21 Wil iam Taylor, the Harvard physician who had done the first of the three a.n.a.lyses on the questionable benefits of eating less fat, was unimpressed with this argument. "Most patients don't come into my office saying I real y want to contribute to the public health statistics in this country," he said. "If they did, I'd know what to do for them."

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*22 Melvin Konner has doubts about the conclusions. "Boyd and I probably did underestimate the amount of meat in the Paleolithic diet based on our extrapolations for hunter-gatherers," he said. "I just don't think it's nearly as extreme as this paper claims."

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*23 They did not, however, lose any weight because of this, which is paradoxical, and an issue we wil discuss later.

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*24 This paradox could also include Switzerland. In 1979, Swiss public-health authories reported that cardiovascular mortality had undergone a "suprising decline" in Switzerland between 1951 and 1976, during a period in which the Swiss increased their consumption of animal fats by 20 percent.

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*25"Among women high blood cholesterol is not a.s.sociated with al -cause mortality nor even with cardiovascular mortality," wrote UCSF epidemiologist Steve Hul ey and his col aborators in a 1992 Circulation editorial about these data, ent.i.tled "Health Policy on Blood Cholesterol: Time to Change Directions.""We are coming to realize that the results of cardiovascular research in men, which represents the great majority of the effort thus far, may not apply to women."

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*26 Conspicuously absent from the final a.n.a.lysis, because it was not a "randomized" trial and so the results could not be trusted, was the famous Helsinki Mental Hospital Study that had been cited by three generations of investigators, including The Surgeon General's Report on Nutrition and Health and the National Academies of Science Diet and Health report, as providing the most compel ing evidence that cholesterol-lowering diets lowered mortality, not just heart disease.

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*27 In Across Australia, Baldwin Spencer and F. J. Gil en describe embarking on an expedition through central Australia in the late 1890s with eight thousand pounds of flour (forty bags, each weighing two hundred pounds) and seven hundred pounds of sugar.

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28 A typical diet of one Australian Aborigine settlement, according to a joint American/Australian expedition in 1948, "consisted of white flour, rice, tea and sugar, buffalo and beef."

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*29 In 1938, C. P. Donnison confirmed this observation in his book Civilization and Disease, using British Colonial Office yearly medical reports, which listed hospital inpatient diagnoses in al the British colonies. Many of the colonial physicians, wrote Donnison, reported that diabetes had never been seen in their local native populations. "Others say they have seen an odd case or two during many years experience." In those populations that had been more influenced by civilization, he continued, "a greater incidence is recorded."

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*30 Such as peas, beans, and lentils.

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*31 Joslin also cited a 1936 article by Himsworth in The Lancet, but this latter article, if anything, tended to implicate carbohydrates as a cause of diabetes.

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*32 Although, he noted in the 1946 edition of his textbook, "Dr. F. G. Brigham tel s me Mrs. K. with multiple sclerosis developed diabetes after starting in to eat candy to gain weight."

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*33 This close relations.h.i.+p temporarily diverged at the end of World War I, when sugar rationing was relaxed. As Cleave noted, however, this coincided with the introduction of penicil in into clinical use to treat the infections that often kil adult diabetics. Diabetes management and control also improved dramatical y with the development of the standard insulin syringe in 1944, and long-acting insulin two years later.

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*34 Although, as we noted earlier (Chapter 1), the amount of animal fat Americans ate decreased during this period, and so the increased total fat consumption was entirely due to the increased consumption of vegetable fats.

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*35 There is even a plausible biological mechanism to explain how refined carbohydrates and sugars could cause or exacerbate cancer. See Chapter 13.

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*36 John Higginson, director of the World Health Organization's International Agency on Cancer Research, later described Non-infective Diseases in Africa as a "bril iant review" that had been "regrettably ignored."

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*37"The t.i.tle Western diseases is preferred to that of the diseases of civilization," they explained, "for it proved obnoxious to teach African and Asian medical students that their communities had a low incidence of these diseases because they were uncivilized."

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*38 According to records from the local trading s.h.i.+ps, this increase was nearly tenfold between 1961 and 1980: from seven pounds per person per year to sixty-nine pounds.

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*39 Although Reaven deserves much of the credit for identifying the syndrome and compel ing the diabetes and heart-disease research communities to take notice, I wil refer to it as metabolic syndrome, because that is now the preferred public-health terminology, rather than Syndrome X, except when discussing Reaven's work in particular.

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40 The first time the Was.h.i.+ngton Post mentioned metabolic syndrome or Reaven's research was in 1999, in an article about popular weight-loss diets.

The second time was in 2001, in an article that actual y discussed metabolic syndrome as a risk factor for heart disease. By that time, the paper had published a couple of thousand articles that at least touched on the issue of cholesterol and heart disease.

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*41 A triglyceride molecule is composed of three fatty acids-hence, the "tri"-linked together by a glycerol molecule.

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*42 To be precise, Gofman's Science paper identified IDL-i.e., intermediate-density lipoproteins-as the cla.s.s a.s.sociated with heart disease. He would later decide that LDL was more important than IDL. For the sake of simplicity, I've used LDL throughout.

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*43 One notable case was Theodore Cooper, who was a.s.sistant secretary for health in 1976, when he testified about "diet and kil er diseases" to the Senate Select Committee on Nutrition and Human Needs. Cooper said that his personal dietary concern was with carbohydrates rather than fats. "If I have a problem, it is a tendency to gain weight," Cooper explained. "I am cla.s.sified Type IV. As a Type IV, my lipid levels are much more subject to elevation if I consume large amounts of carbohydrates or alcohol."

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*44 This was not because the NIH had any interest in testing the HDL/heart-disease relations.h.i.+p, according to Gordon, but only because Fredrickson, Levy, and Lees's new measurement technique required that the amount of cholesterol in HDL be known so that the amount in LDL could be calculated.