Good Calories, Bad Calories (109 page)

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It’s always dangerous, when chal enging beliefs that are so passionately embraced, to acknowledge that you have paid attention to the skeptics who preceded you. This can be used as evidence that you are exceedingly gul ible and wil believe anything you read. Nonetheless, I concede that I indeed took seriously and am grateful for the efforts of those who trod portions of this path before me: in particular, Russel Smith, Uffe Ravnskov (and his International Network of Cholesterol Skeptics), Wolfgang Lutz, James Le Fanu, and Thomas Moore on the relationship between cholesterol and heart disease; Alfred Pennington, Herman Tal er, and Robert Atkins on the subject of diet and weight; and Peter Cleave and John Yudkin, who came closest to putting it al together. I read the works of these authors with skepticism, but no more or less than that of other contributors to the literature. The book that may have been most influential in altering my perspective and yet never made it into this text, for reasons of narrative flow and length rather than relevance, was Weston Price’s 1939 classic Nutrition and Physical Degeneration: A Comparison of Primitive and Modern Diets and Their Effects.

Drafts of this book were read in part or in whole and corrections suggested by Robert Bauchwitz, John Benditt, Kenneth Carpenter, Michael Eades, Richard Feinman, Mark Friedman, Richard Hanson, David Jacobs, Cynthia Kenyon, Ron Krauss, Mitch Lazar, Jamie Robins, Bruce Schechter, Jeremy Stone, Clifford Taubes, Nina Teicholz, and Eric Westman. I am deeply grateful to al these individuals for their time, their efforts, and their acumen. Any errors in either fact or form, however, remain mine alone. I would also like to thank the literal y hundreds of researchers, clinicians, and public-health authorities who took the time to speak with me at length, many of whom did so repeatedly, even though they fundamental y disagreed with articles I had already written on this subject.

I am grateful to Colin Norman and Tim Appenzel er for their invaluable help and encouragement at Science on the series of investigations that took me ever more deeply into the questionable practices of preventive medicine and public health. I’m grateful to Hugo Lindgren and Adam Moss, both formerly of The New York Times Magazine, for taking the chance on the very controversial article—“What If It’s Al Been a Big Fat Lie?”—that led directly to the work on this book.

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 assistant 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 Glassner for his camaraderie, Charles Mann for his friendship 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 Vassilakis (1949–2004) for making one otherwise cold and cacophonous corner of Manhattan feel like home.

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 933–936. 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.” 60–73. 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.

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 Association of Science Writers—the only print journalist so recognized—as wel as awards from the Pan American Health Organization, the American Institute 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 Nobel 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.

   Bad Science:

   The Short Life and Weird Times of Cold Fusion

   Nobel Dreams:

   Power, Deceit and the Ultimate Experiment

*1 When the first American edition of The Physiology of Taste was published in 1865, it was entitled 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 Association 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 accumulates 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 reanalysis 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 Kushi, who worked in Keys’s department at the University of Minnesota. Kushi 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 reanalysis as producing “particularly impressive results,” Kushi 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 butter 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 Association in 1975. A smal chart documenting 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 constituted 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 associated 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 associated 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 association” 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 Association 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 associated 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.