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Category: Health/Fitness
Description: In this groundbreaking book, the result of seven years of research in every science connected with the impact of nutrition on health, award-winning science writer Gary Taubes shows us that almost everything we believe about the nature of a healthy diet is wrong. For decades we have been taught that fat is bad for us, carbohydrates better, and that the key to a healthy weight is eating less and exercising more. Yet with more and more people acting on this advice, we have seen unprecedented epidemics of obesity and diabetes. Taubes argues persuasively that the problem lies in refined carbohydrates (white flour, sugar, easily digested starches) and sugars--via their dramatic and longterm effects on insulin, the hormone that regulates fat accumulation--and that the key to good health is the kind of calories we take in, not the number. There are good calories, and bad ones.
eBook Publisher: Random House, Inc./Knopf,
MemoWare PDA Bookstore Release Date: October 2007

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In medicine, we are often confronted with poorly observed and indefinite facts which form actual obstacles to science, in that men always bring them up, saying: it is a fact, it must be accepted.
CLAUDE BERNARD, An Introduction to the Study of Experimental Medicine, 1865

PRESIDENT DWIGHT D. EISENHOWER SUFFERED his first heart attack at the age of sixty-four. It took place in Denver, Colorado, where he kept a second home. It may have started on Friday, September 23, 1955. Eisenhower had spent that morning playing golf and lunched on a hamburger with onions, which gave him what appeared to be indigestion. He was asleep by nine-thirty at night but awoke five hours later with "increasingly severe low substernal nonradiating pain," as described by Dr. Howard Snyder, his personal physician, who arrived on the scene and injected Eisenhower with two doses of morphine. When it was clear by Saturday afternoon that his condition hadn't improved, he was taken to the hospital. By midday Sunday, Dr. Paul Dudley White, the world-renowned Harvard cardiologist, had been flown in to consult.

For most Americans, Eisenhower's heart attack constituted a learning experience on coronary heart disease. At a press conference that Monday morning, Dr. White gave a lucid and authoritative description of the disease itself. Over the next six weeks, twice-daily press conferences were held on the president's condition. By the time Eisenhower's health had returned, Americans, particularly middle-aged men, had learned to attend to their cholesterol and the fat in their diets. Eisenhower had learned the same lesson, albeit with counterintuitive results.

Eisenhower was assuredly among the best-chronicled heart-attack survivors in history. We know that he had no family history of heart disease, and no obvious risk factors after he quit smoking in 1949. He exercised regularly; his weight remained close to the 172 pounds considered optimal for his height. His blood pressure was only occasionally elevated. His cholesterol was below normal: his last measurement before the attack, according to George Mann, who worked with White at Harvard, was 165 mg/dl (milligrams/deciliter), a level that heart-disease specialists today consider safe.

After his heart attack, Eisenhower dieted religiously and had his cholesterol measured ten times a year. He ate little fat and less cholesterol; his meals were cooked in either soybean oil or a newly developed polyunsaturated margarine, which appeared on the market in 1958 as a nutritional palliative for high cholesterol.

The more Eisenhower dieted, however, the greater his frustration (meticulously documented by Dr. Snyder). In November 1958, when the president's weight had floated upward to 176, he renounced his breakfast of oatmeal and skimmed milk and switched to melba toast and fruit. When his weight remained high, he renounced breakfast altogether. Snyder was mystified how a man could eat so little, exercise regularly, and not lose weight. In March 1959, Eisenhower read about a group of middle-aged New Yorkers attempting to lower their cholesterol by renouncing butter, margarine, lard, and cream and replacing them with corn oil. Eisenhower did the same. His cholesterol continued to rise. Eisenhower managed to stabilize his weight, but not happily. "He eats nothing for breakfast, nothing for lunch, and therefore is irritable during the noon hour," Snyder wrote in February 1960.

By April 1960, Snyder was lying to Eisenhower about his cholesterol. "He was fussing like the devil about cholesterol," Snyder wrote. "I told him it was 217 on yesterday's [test] (actually it was 223). He has eaten only one egg in the last four weeks; only one piece of cheese. For breakfast he has skim milk, fruit and Sanka. Lunch is practically without cholesterol, unless it would be a piece of cold meat occasionally." Eisenhower's last cholesterol test as president came January 19, 1961, his final day in office. "I told him that the cholesterol was 209," Snyder noted, "when it actually was 259," a level that physicians would come to consider dangerously high.

Eisenhower's cholesterol hit 259 just six days after University of Minnesota physiologist Ancel Keys made the cover of Time magazine, championing precisely the kind of supposedly heart-healthy diet on which Eisenhower had been losing his battle with cholesterol for five years. It was two weeks later that the American Heart Association—prompted by Keys's force of will—published its first official endorsement of low-fat, low-cholesterol diets as a means to prevent heart disease. Only on such a diet, Keys insisted, could we lower our cholesterol and our weight and forestall a premature death. "People should know the facts," Keys told Time. "Then if they want to eat themselves to death, let them."

Scientists justifiably dislike anecdotal evidence—the experience of a single individual like Eisenhower. Nonetheless, such cases can raise interesting issues. Eisenhower died of heart disease in 1969, age seventy-eight. By then, he'd had another half-dozen heart attacks or, technically speaking, myocardial infarctions. Whether his diet extended his life will never be known. It certainly didn't lower his cholesterol, and so Eisenhower's experience raises important questions.

Establishing the dangers of cholesterol in our blood and the benefits of low-fat diets has always been portrayed as a struggle between science and corporate interests. And although it's true that corporate interests have been potent forces in the public debates over the definition of a healthy diet, the essence of the diet-heart controversy has always been scientific. It took the AHA ten years to give public support to Keys's hypothesis that heart disease was caused by dietary fat, and closer to thirty years for the rest of the world to follow. There was a time lag because the evidence in support of the hypothesis was ambiguous, and the researchers in the field adamantly disagreed about how to interpret it.

From the inception of the diet-heart hypothesis in the early 1950s, those who argued that dietary fat caused heart disease accumulated the evidential equivalent of a mythology to support their belief. These myths are still passed on faithfully to the present day. Two in particular provided the foundation on which the national policy of low-fat diets was constructed. One was Paul Dudley White's declaration that a "great epidemic" of heart disease had ravaged the country since World War II. 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 heart-disease epidemic vanishes upon closer inspection. It's based on the proposition that coronary heart disease was uncommon until it emerged in the 1920s and grew to become the nation's number-one killer. The epidemic was a "drastic development—paralleled only by the arrival of bubonic plague in fourteenth-century Europe, syphilis from the New World at the end of the fifteenth century and pulmonary tuberculosis at the beginning of the nineteenth century," the Harvard nutritionist Jean Mayer noted in 1975. When deaths from coronary heart disease appeared to decline after peaking in the late 1960s, authorities said it was due, at least in part, to the preventive benefits of eating less fat and lowering cholesterol.

The disease itself is a condition in which the arteries that supply blood and oxygen to the heart—known as coronary arteries because they descend on the heart like a crown—are no longer able to do so. If they're blocked entirely, the result is a heart attack. Partial blocks will starve the heart of oxygen, a condition known as ischemia. In atherosclerosis, the coronary arteries are lined by plaques or lesions, known as atheromas, the root of which comes from a Greek word meaning "porridge"—what they vaguely look like. A heart attack is caused most often by a blood clot—a thrombosis—typically where the arteries are already narrowed by atherosclerosis.

The belief that coronary heart disease was rare before the 1920s is based on the accounts of physicians like William Osler, who wrote in 1910 that he spent a decade at Montreal General Hospital without seeing a single case. In his 1971 memoirs, Paul Dudley White remarked that, of the first hundred papers he published, only two were on coronary heart disease. "If it had been common I would certainly have been aware of it, and would have published more than two papers on the subject." But even White originally considered the disease "part and parcel of the process of growing old," which is what he wrote in his 1929 textbook Heart Disease, while noting that "it also cripples and kills often in the prime of life and sometimes even in youth." So the salient question is whether the increasing awareness of the disease beginning in the 1920s coincided with the budding of an epidemic or simply better technology for diagnosis.

In 1912, the Chicago physician James Herrick published a seminal paper on the diagnosis of coronary heart disease—following up on the work of two Russian clinicians in Kiev—but only after Herrick used the newly invented electrocardiogram in 1918 to augment the diagnosis was his work taken seriously. This helped launch cardiology as a medical specialty, and it blossomed in the 1920s. White and other practitioners may have mistaken the new understanding of coronary heart disease for the emergence of the disease itself. "Medical diagnosis depends, in large measure, on fashion," observed the New York heart specialist R. L. Levy in 1932. Between 1920 and 1930, Levy reported, physicians at New York's Presbyterian Hospital increased their diagnosis of coronary disease by 400 percent, whereas the hospital's pathology records indicated that the disease incidence remained constant during that period. "It was after the publication of the papers of Herrick," Levy observed, that "clinicians became more alert in recognizing the disturbances in the coronary circulation and recorded them more frequently."

Over the next thirty years, recorded cases of coronary-heart-disease fatalities increased dramatically, but this rise—the alleged epidemic—had little to do with increasing incidence of disease. By the 1950s, premature deaths from infectious diseases and nutritional deficiencies had been all but eliminated in the United States, which left more Americans living long enough to die of chronic diseases—in particular, cancer and heart disease. According to the Bureau of the Census, in 1910, out of every thousand men born in America 250 would die of cardiovascular disease, compared with 110 from degenerative diseases, including diabetes and nephritis; 102 from influenza, pneumonia, and bronchitis; 75 from tuberculosis; and 73 from infections and parasites. Cancer was eighth on the list. By 1950, infectious diseases had been subdued, largely thanks to the discovery of antibiotics: male deaths from pneumonia, influenza, and bronchitis had dropped to 33 per thousand; tuberculosis deaths accounted for only 21; infections and parasites 12. Now cancer was second on the list, accounting for 133 deaths per thousand. Cardiovascular disease accounted for 560 per thousand.

Copyright © 2007 by Gary Taubes.