How did this whole idea that ‘all fat is bad’ originally start? The idea that saturated fat and cholesterol are bad for health? How did we get to the point where two thirds of our society is overweight or obese?
We need to go back to the late 1950s, when the western world was in a panic over the rising tide of heart disease over the last decade, that had pretty much come out of nowhere. In the early 1900s heart disease was rare, yet by the ‘50s it had become the western world’s number one killer.
The players are a pathologist at the University of Minnesota named Ancel Benjamin Keys, who had a theory, one hell of an ego, was career-driven, and friends in the right places. We also have President Eisenhower who triggered the whole myth unintentionally, and his personal physician, Paul Dudley White.
In 1955, which he was on the golf course on the 9th hole, President Eisenhower had a heart attack. He was out of the Oval Office for ten days, which was unheard of – imagine, a President being out of action for ten days, and all the more so at a time when nobody really knew back then what caused heart disease. Peoples' fathers hadn’t died of heart disease; it was a new killer of unknown origin, all of a sudden killing men in their prime.
Before this, cardiologists had been known to practice for decades, some even their entire careers, without ever running into a heart attack case, but now there was a new phenomena. The rate of heart attacks had dramatically increased in the past decade or so, and Eisenhower's heart attack was a pivotal moment in the history of medicine. He was a much-loved President, so in the midst of this terrifying moment in American history, the word ‘heart attack’ became something that people were hearing for the first time, and were immediately terrified of it.
When the discomfort started, President Eisenhower initially thought it was indigestion because he’d just had a giant greasy hamburger for lunch, which he did often, and frequently experienced heartburn soon after. He thought the pain would pass, but it didn't, so his personal physician, Paul Dudley White, examined him, concerned that this was actually a heart attack, but very much out of his depth because there was a very poor understanding of what a heart attack even was. The news broke, and the stock market plummeted six percent, $14 billion in a day.
His treatment involved strict bed rest, and he was told to stop eating butter and switch to margarine, to give up red meat and to eat dry crackers and bread. This didn’t spare him as not long afterwards he had another heart attack which killed him. He was also a four pack a day smoker.
Into this vacuum came a professor named Ancel Benjamin Keys, who had an idea that Eisenhower’s heart attack was due to saturated fat causing raised cholesterol, which would ‘clog your arteries like hot grease down a cold pipe’ and give you a heart attack and die. This idea became known as the ‘diet-heart hypothesis’.
What Eisenhower’s heart attack did was enable a career-driven man with an agenda to create this mythology around fat. Ancel Keys was able to secure funding for a major study and had already been building a reputation for himself as somewhat of an expert in this area. His idea was starting to establish itself that the cause of heart attacks was related to dietary indulgences, particularly saturated fat.
With all this attention, Ancel Keys’ ego was growing. He became known for an aggressive, domineering personality and he was able to convince people of anything, exhausting every objection thrown at him. As a result, he was able to get his ‘diet-heart hypothesis’ implanted into the American Heart Association. He got in to their nutrition committee, and in 1961 issued the first advice worldwide: "Avoid saturated fat and cholesterol in order to prevent heart disease." This was the tiny acorn that grew into the giant oak tree of advice that we now have all over the world.
Now re-enter Paul Dudley White, Eisenhower’s former GP. Ancel Keys ultimately compelled him to his way of thinking due to a study he’d done on the causes of heart-attacks. Thing is, there were many flaws in the study.
The "Seven Countries Study" was an epidemiological study (the study and analysis of the distribution (who, when, and where) and determinants of health and disease conditions in defined populations), which meant it only showed association and not causation, so straight away there was a fundamental flaw, but it was the only study that people had at the time - there were no counter studies to show anything else. So, this was the study that prevailed, and what it appeared to find was that the people who ate diets higher in saturated fat were more likely to raise their cholesterol and die of a heart attack.
It’s now well known that Ancel Keys clearly cherry-picked the countries that he visited; he knew that if he went to the southern parts of Spain, Italy, Yugoslavia, they didn't eat a lot of saturated fats and lived long lives.
He also knew to avoid countries like Northern Italy, Switzerland, France and Germany, where they ate a lot of butter and red meat yet they lived just as long, with equal rates of heart disease post World War II. Ancel Keys knew that the stats from these countries would contradict his hypothesis.
The ‘Seven Countries Study’ became one of the most famous cardiology studies of all time, being cited tens of thousands of times by articles later. And it’s this that convinces Paul Dudley White, who also happens to be one of the founding members of the AHA. And when the AHA went from a small, underfunded professional organization to a much bigger powerhouse, it was Paul Dudley White's doing because he was a great fundraiser; he brokered a connection between Proctor & Gamble that gave the AHA a $1.7 million endowment.
This set the stage for the AHA to become the powerhouse that it is today. And in doing so, it paved the way for Proctor & Gamble to manufacture foods made with vegetable oil instead of natural, unsaturated fat; in other words, the beginnings of a potentially biased connection between big food industry and medicine.
Now here’s another thing - Ancel Keys originally made a name for himself originally in the military. He created what was known as the K-ration (the K standing for Keys), which was a processed foodstuff which fed soldiers during World War II. It was the first completely ready-meal, as in rip and eat, no cooking required.
Jump forward again to the early 1960’s and the AHA’s connection to Proctor & Gamble, and Keys is now opening the door for processed food manufacturers to sell us whatever they wanted as long as it was low in saturated fat.
It’s 1961 and by now, everyone’s blaming fat and cholesterol. Ancel Keys appears on the cover of Time Magazine in the same year that the AHA, the only health organization out there counselling people on how to avoid heart disease, takes this message worldwide –
“In order to avoid a heart attack, you need to avoid saturated fat and cholesterol. Eat less meat, less cheese, fewer eggs, more grains, more cereals, fruits and vegetables, and vegetable oils.”
The dark side
It’s generally thought that Ancel Keys genuinely believed fat was bad for health, but he didn’t behave like a scientist, who are supposed to question and doubt their beliefs and try to prove themselves wrong, trying every angle to find the truth, not necessarily the promotion of your own ideas. However, he would disregard or actually bully and squash anybody who challenged his ideas.
He didn't just collect data on saturated fat, he also collected data on smoking. The countries that had the most heart disease on his Seven Countries study also had the highest rates of smoking, and he saw this over and over again.
But that's not what he published. That's not what he talked about. He talked about saturated fat. In his interview with Time Magazine, where Time Magazine talked about the other factors being blood pressure, hypertension and smoking, Keys said, "Those don't play very much of a role. It's cholesterol. It's the saturated fat driving up cholesterol." Despite the fact that he had the data proving otherwise.
The Seven Country Study data was in by 1958. Time Magazine interviewed him in 1961. Yet he lied, knowing it was going to be good for Proctor & Gamble. The real cause of heart attack death in Ancel Keys' time was cigarette smoking; it wasn't diet at all because at that point in time, there wasn't that much vegetable oil. The die was cast for Americans to be lied to by the AHA and by their doctors for the next half century.
As Keys' ‘diet-heart hypothesis’ grew in popularity and was adopted by the established western countries’ authorities, it became more difficult for scientists to speak out. One prominent lipidologist named Ed Pete Ahrens, Rockefeller University, was an outspoken critic of Ancel Keys. Increasingly he would be disinvited from expert panels, had trouble getting his papers published, and he was known to tell his colleagues that his career suffered greatly for opposing Ancel Keys.
Another scientist, George Mann, University of Vanderbilt, said in an interview that he used to call Ancel Keys and the tight group around him, who controlled all of expert panels and medical journals, the "diet mafia". He also claims that Keys ruined his career. He’d been an extremely prominent biochemist, and had run many studies for the National Institutes of Health. He claims that he was told that if he continued to oppose Ancel Keys, it would cost him his research grant. Sure enough, he lost it.
Scientists who spoke out were clearly punished. If the NIS stopped your research grants, it took the life blood away from the progression of science. As the next generation of scientists came along, they’d seen what had happened to the generation before them, and so they self-censored. This practice continued throughout the 1980s, 90s and early 2000s.
It really didn't start up again until 2010 when Gary Taubes had an article on the cover of the New York Times Magazine saying, “What if it's all been a big mistake? Maybe it's carbohydrates instead that are really the dietary villains.”
And so this idea disseminated out through the expert community and professors started researching this idea. By now, with growing rates of obesity, governments and major institutions knew they needed new science. As a result, several ambitious, randomised control clinical trials were carried out to see if they could prove Ancel Keys right. Ultimately, over 65,000 people were tested on his hypothesis: does saturated fat and cholesterol cause heart disease? And here’s what’s astonishing - in none of those experiments could they show that to be true. None of the results supported his hypothesis.
As far as the medical profession is concerned, the only way to lower cholesterol levels is through pharmaceuticals called statins. Which means that the processed food manufacturers have benefitted because they don’t use saturated fat, i.e. butter and eggs and actual food. The pharmaceutical companies have benefitted because the only way to get somebody's cholesterol levels into the alleged healthy zone is with drugs.
Ancel Keys set off an atom bomb in health and it changed the course of history. Back in his day, Type 2 Diabetes was unheard of. These days, the rates of obesity or unhealthy diets have so dramatically accelerated that now children aged 2 are being diagnosed with Type 2 Diabetes, with strokes and heart attacks at age 3 and 4.
Since the early 2000s there have been a huge volume of studies now looking at carbs as the cause, which has led to a large and fast growing volume of literature that makes the case that Gary Taubes was right; that we need to reduce carbohydrates in order to be healthy.