Metabolic Syndrome III: The Mistake that got it all Started

January 28, 2008

Metabolic Syndrome # 3 The “Pseudo - Science” That Got it all Started 

 Competency # 20 Lifestyles of the Long-Lived               ReferenceGood Calories, Bad Calories by Gary Taubes, 2007 

 Here is how it all got started.   The names are Ancel Keys and Jeremiah Stamler.  Keys was the alpha male of nutrition science after World War II.  He ran the Laboratory of Physiology at the University of Minnesota.  His name was the “K” in K-ration from World War II.  He was well known.  Stamler was a cardiologist in Chicago who liked to use the imagery of artery clogging fats.  Just like the plumbing in your kitchen sink, the imagery of arteries that plug up with cholesterol was one that the public could relate to, even before the means by which that “clogging” was understood.  You can imagine, you eat butter and it flows from your mouth right to your arteries.  Sounds ridiculous now, but we all have used that imagery.  

Prior to WWII, the best research on nutrition was being done in Germany and Austria.  Their work wasn’t published much in English, and their research institutions were all destroyed in the war.   WWII was such a huge disruption in everything that lots of folks in America, who had been doing nutrition research, had run out of steam and retired.  Stamler and Keys came onto a clean slate after WWII.  The Europeans were exhausted and the Americans were starting from scratch. Keys first research involved feeding men a diet laden with cholesterol, and found no effect on their blood cholesterol levels.   So he poo-pooed the cholesterol, heart disease connection.  

Then he had a conversion experience.  He went to a conference in Rome on nutrition and disease.  An Italian physiologist from Naples said that heart disease wasn’t a problem in Naples.  Keys bustled off to Naples with his wife, a lab technician skilled in measuring total cholesterol.  He interviewed poor folks, who were skinny and didn’t have heart disease.  His wife measured their cholesterol.  Then he visited the Rotary Club of Naples and found that the rich folks had pasta and rich meat and cheese sauce.  Their cholesterol was higher.  Their rate of heart disease was higher.  They were fatter.  And the disease of high cholesterol was born.  Keys believed.  It must be true.  They ate more meat and cheese and had more heart disease.   Ergo.  Presto.  Cholesterol must cause heart disease.  

He came back to the USA and began advocating that folks should reduce their intake of fat by a third.  The low-fat diet to fight heart disease was started. Bad conclusions were born!  And Keys attacked and ridiculed anyone who disagreed. Keys began to assemble “evidence” to bolster his argument.  He examined Japanese living in Japan and in America.  In America, Japanese immigrants became overweight and got coronary artery disease.  It must be the cholesterol.   Keys looked at the rate of coronary artery disease in European countries during WWII and how it dramatically declined.  He connected the dots that folks ate less fat during WWII and that’s WHY they had less heart disease.  He didn’t consider that they had many few calories too, and lost weight, and starved……  Keys continued to study heart disease in nations.  He looked at “7 nations” whose data supported high cholesterol and heart attack.  No one noticed that he didn’t mention the other 15 that didn’t and yet had similar populations and diets.  But the “Seven Nation” study has been quoted for 40 years as PROOF positive.  

 All he was going on was associations, in the countries that supported his idea.  He was confusing cause and effect and picking his sources.  He was trying to take the process of epidemiology, a scientific process that worked well with infectious diseases and applying the same logical inferences to nutrition.  Infections have one bug to blame, one cause, one effect.  Nutrition is more complex.  Increased fat may go along with increased calories, increased processing, more sugar, less fiber, less Vitamin D, and on and on.  None of those were in the mix in 1950.  The “science” of epidemiology of nutrition research requires a randomized controlled trial to complete the observations found in associations.  And an RCT has yet to be done.  Bad philosophy, bad logic, bad science.  But, we’ve lived with it for 40 years.  And it’s wrong, or at least not proven. 

 WWW:  What will work for me?  This is like a detective novel.  I grew up in medicine knowing the names of Stamler and Keys.  We took their studies without comment and just memorized their conclusions. “ You should advocate a low-fat diet.”  Along with that came NATIONAL GUIDELINES that said to eat more carbs.  I jumped right in and felt like I was doing a good thing with a second serving of rice.  So did all of us, from the looks of things.  It all seemed too complicated and huge a topic.  Next week we will look at how George McGovern carved “low fat” in stone.   I love detective mysteries.  I just don’t want to be the guy found lying on the floor of the library with a lead pipe in my hand, clutching my fat chest because some lousy CSI didn’t get their facts straight.

This column was written by Dr. John E. Whitcomb, MD, Brookfield Longevity, Brookfield WI, (262-784-5300)