MEDICAL researchers studying heart disease are coming reluctantly to a revolutionary conclusion. The Federal Government, they suggest, may have to intervene and decree a radical change in the prevailing American diet. This would involve taking most of the fat out of those marbled steaks and from those billions of gallons of milk, as well as altering the chemical constitution of cooking oils and fats.
Many conservative physicians recoil in horror from such a suggestion. But more and more investigators are beginning to despair of finding any other way to combat the ravages of heart disease, which results largely, they believe, from overindulgence in foods that are too rich in animal fats and sugar. Of course, no responsible researcher believes that diet is the sole cause of atherosclerosis, the form of coronary artery disease that leads to most heart attacks. Nonetheless, diet seems to be the factor most susceptible to correction.
Mushy Deposits. In their hunt for clues to the causes and mechanisms of heart disease, researchers have learned that huge populations in many parts of the world, notably in Japan, can be well fed and still remain virtually immune to the Western type of heart disease. Why?
Significantly, they eat little or no hard, or “saturated,” fat.* They also eat little of the foods that contain much cholesterol, such as egg yolks, shellfish and organ meats. On the basis of early research, scientists assumed that the cholesterol found in mushy, atheromatous deposits in diseased coronary arteries came from the cholesterol consumed in foodstuffs. They had to abandon this simplistic view as soon as they realized that the human body manufactures cholesterol from several raw materials, notably the hard animal fats.
Medical researchers then began to campaign for 1) a reduction in the total fats in the American diet, and 2) a switch from saturated to polyunsaturated fats. Easier said than done. The diet of the average well-nourished American derives 40% of its calories from fats, 40% from carbohydrates (sugars and starches), and 20% from protein. Just as they refuse to cut down on cigarettes, most Americans refuse to cut down seriously on fats. A more practicable solution, it appeared, would be to change the kind of fat, from mostly saturated to mostly polyunsaturated.
No Difficulty. To see whether a diet modified in this fashion would be acceptable to the average American male, and whether his average wife would go along with it, the Cleveland Clinic’s Dr. Irvine H. Page organized a federally financed study of 2,000 men who lived for up to two years on specially prepared foods. One thing that the Cleveland test proved was that the U.S. food industry has no difficulty in preparing such foods, and can certainly do so at a profit, provided there is sufficient consumer demand. It also proved that the diet was effective in lowering the men’s blood levels of cholesterol—generally accepted as an index of potential damage to coronary arteries and therefore of the risk of heart attacks.
Page, along with many other cardiologists, now wants the U.S. Government to finance a far more comprehensive study, putting no fewer than 40,000 men on an engineered diet for ten years. The cost would be at least $100 million.
At recent sessions of the American Heart Association and affiliated arteriosclerosis research groups, and of the American Medical Association, hundreds of cardiologists and angiologists, physiologists and epidemiologists, have presented scores of learned papers on the findings from their research on Bantu and Eskimos, Finns and Yugoslavs, Norwegians and Japanese, Britons and Americans.
Among the most intensively studied Americans are the townsfolk of Framingham, Mass., where 6,500 men and women out of a population of 45,000 have had their blood pressure, cholesterol levels, weight and smoking habits checked for a dozen years against their development of heart disease and their incidence of heart attacks. The Framingham results to date, says Dr. William B. Kannel, indicate that a man with high blood cholesterol has almost three times the average risk of a heart attack. More alarming, if one man is exposed to two threefold risk factors—a heavy smoker with high blood cholesterol, for example—the two risks are not added together but multiplied, thereby giving him approximately a ninefold disadvantage.
These jigsaw pieces do not fit together into a neat picture. Dr. Robert H. Furman of the University of Oklahoma says that the dietary habits of men who have died of heart attacks, as compared with the diets of survivors of the same age, living on the same street, doing the same work, smoking as much and exercising as little, show no consistent difference. This means, to Furman, that the men who have heart attacks—in many cases, fatal—early in life are a metabolically distinct group. The trouble is that so far no one has found a quick test to determine who the susceptible men are, so that they might take special precautions.
Label Blackout. For the average man who has no special susceptibility, Furman believes, the customary diet can be altered without imposing hardship. The 40-40-20 ratio of calories from fats, carbohydrates and protein need not be modified, provided only that the nature of the fats is changed. Furman’s prescription: twice as much polyunsaturated fat as saturated fat.
How can the average man tell how much polyunsaturated fat he is getting? That is difficult, says Furman, since the U.S. Food and Drug Administration has forbidden food manufacturers to state the polyunsaturated fat content on the labels of their cooking oils and margarines. The FDA contends that such a statement is meant as a health claim, and would be so regarded by consumers. The ban, says Furman, denies the buyer information to which he is entitled.
Regardless of the degree of saturation in his fat intake, every man is a highly complicated metabolic factory. His system stashes away some cholesterol in the tissues. It makes more cholesterol in the liver. It combines cholesterol and other fatty substances with proteins in two major forms, alpha and beta lipoproteins, so that they can circulate in the watery medium of the blood. A change in the ratio of the alpha and beta types may encourage the development of artery disease through the deposit of atheromatous (mushy, fatty) plaques in the narrow vessels. Further complicating the picture is a class of fats known as triglycerides, which may be as important as the better known cholesterol group.
In a culture in which everyone seems to indulge in pill popping for every conceivable (and one nonconceivable) purpose, many doctors suggest that a near-ideal solution would be the discovery of a one-a-day pill that would enable people to eat all the luxury foods they want without damaging their arteries. As yet, no such drug is in sight. That is why heart researchers are turning toward the notion of Government-imposed diet control, which they rather euphemistically call “environmental engineering.” “It is futile,” says Framingham’s Kannel, “to try to get the public to defer something now for future benefit.” No matter how frightening the statistics, the public will go on getting 40% of its calories from fats that are almost 100% saturated. “Government,” Kannel suggests, “may have to engage in a little environmental engineering to make sensible diet an automatic, unconscious part of everyday life.”
This means that the Government would have to see to it that only health-promoting foods are made available, Kannel says, although the public need not know that it is being deprived of its saturated fats: “Everything would taste the same as before.” Chicago Dr. Jeremiah Stamler has chided Kannel for lack of faith in the American public, but Stamler also believes that something should be done at the Governmental level. “We didn’t just ask people to use sterilized water,” he points out. “We cleaned it up for them.” If the FDA would lift what Stamler calls its “ridiculous restrictions” on labeling, he believes, food processors would soon be making polyunsaturated foods—even hot dogs—to meet public demand.
*Most fats that remain solid at room temperature are derived from land animals and classed by chemists as “saturated” because they have hydrogen atoms attached at all available points in their carbon chains. Some vegetable fats have one such point with two fewer hydrogen atoms and are “monounsaturated.” Many vegetable and seed oils, and all fats from fish and marine mammals, lack the full complement of hydrogen atoms at two or more points and are “polyunsaturated.” These fats are liquid at room temperature.
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