Chapter 3-Fat, the Killer, on Trial

Here is How I Entered the Race | Is Cholesterol and Excess Fat Present in the Blood of Everyone with Atherosclerosis? | What about the Factor of Heredity? | Is There an Excess of Fat Imbedded in the Artery Wall Itself? | Are There Other Conditions that Cause Heart Attacks and Strokes? | The Role of the Liver in Protecting You from Excess Fats | Isn’t There Some Medicine That Will Stop Fat from Causing Heart Attacks? | Many Other Fat Preventing Agents Have Been Discovered and Found Wanting | How the Low-Fat Diet Proved Its Value | The Low-Fat Diet Proved to Be Effective in Reducing Weight and Promoting
General Good Health

In 1911, in Moscow, Russia, a scientist named Anitschkow made the first discovery that later led to the identification of fat as the killer in cases of hardening of the arteries. He gave us the first clue to the role that fat in the blood vessels plays in causing heart attacks and strokes. Pro­fessor Anitschkow, now a vigorous 86, fed animals with choles­terol, one of the purest of fats. He found that the arteries of these animals became blocked with fatty deposits, in a manner indistinguishable from the blocking found in human arteries. The experiment also brought about premature aging in the animals; they grew old and suffered a loss of health and general vitality long before their time. It was only after a gap of more than a generation that scientists got on the track of the killer fat, but now the pursuit is highly active all over the world. The culprit is now on trial, and evidence for his conviction is steadily mounting.

Here Is How I Entered the Race

Some 20 years ago, with research assistance from the American Medical Association, I was working on the development of a new treatment for cirrhosis of the liver caused by alcoholism. I was feeding fats, including cholesterol, to experimental animals for the purpose of produc­ing cirrhosis in them. New chemicals were than to be tested, to see whether one of them might be useful in curing this disease.

To my amazement, I found that in feeding the fat, I not only produced the liver condition, but that the heart blood vessels of the animals became plugged with fat, mostly cholesterol. Within a short time, the animals developed heart disease, just as it occurs in humans, and suffered changes common to human beings with atherosclerosis. This was a fascinating discovery. It excited my interest in the challenging problem of fat and its effect on the heart, and stimulated me to continue searching for clues and answers to this universal illness, which causes more deaths than any other disease.

My co-workers and I decided to carry the hunt still further. We wanted to track down this killer and to discover, if we could, how to ward off his devastating attack. This is how we went about it. First, we looked for the answer to this question:

Is Cholesterol and Excess Fat Present in the Blood of Everyone with Atherosclerosis?

The answer came to us after two years of work. We studied 200 patients who had had heart attacks and discovered that the great majority, and particularly those under 60, suffered from an excess of fats in their blood. Other patients who showed a normal level of cholesterol had other blood fat abnormalities. For it soon became clear that cholesterol was not the only important heralding factor an­nouncing the approach or actual presence of atherosclerosis. Several other fat components were involved as described in Chap­ter 2: beta lipoproteins, fat enzymes (see Chapter 2) called cholesterol esterases, large fat globules circulating in the blood after a meal, called chylomicrons, and special large complexes of fat molecules discovered by Dr. John Gofman and his team of biophysicists.

At present we now know that excesses or abnormalities in any one or more of these five "public enemies" are directly connected with the production of a heart attack, a stroke, or other complica­tion of atherosclerosis.

It is therefore perfectly possible to have a normal cholesterol blood level and yet have some of the other above abnormalities in the fat chemistry of the blood that help produce a heart attack or stroke. To date, in two study groups of atherosclerosis, the cholesterol factor has been found to be the predominant one. This is due to the fact that it is a very frequent finding in athero­sclerosis, and also because of the great difficulties encountered, both by physicians and scientists, in measuring the other four culprits mentioned above in the development of atherosclerosis.

What about the Factor of Heredity?

As research informa­tion piled up, another fact became clear. Of the 200 people studied, a substantial number had a family history of heart at­tacks or strokes. That is, members of their families were partic­ularly susceptible to these two diseases. The patients we were working with seemed to be unfortunate links in an heredity chain.

Later, Dr. David Adlersberg and Dr. Charles Wilkinson, Jr., discovered that in some cases an excess of cholesterol in the blood was an inborn error of fat metabolism. Inability of some people to handle fat in their systems made them especially prone to atherosclerosis. This hereditary tendency could sometimes be traced accurately through the family of a patient; in those cases where the tendency was strong, deposits of fats in the arteries and skin could be predetermined, according to Mendelian, or genetic laws of inheritance.

One unforgettable case that is an example of the hereditary factor was that of Mrs. S. She was admitted to my teaching ward service in the hospital 10 years ago in a state of shock and coma from an excruciating chest pain. This young woman, only 29 years old, had been ironing clothes in her home when she ap­parently was seized by a sudden, lightning-like pain. In a faint­ing condition, Mrs. S. had collapsed to the floor. She fell with a cry, and her little girl, aged 5, also cried out and summoned the neighbors.

After only a few minutes in the hospital the patient expired, despite heroic efforts by our interne and resident, as well as physicians and nurses who were on duty at that moment.

Examination of the heart following death revealed to our surprise that Mrs. S. had a coronary thrombosis from extensive atherosclerosis. This was a rare cause of death in so young a woman, but one nevertheless that is occurring with greater frequency.

We immediately suspected a hereditary cause in her death and questioned the family, with the following results: The mother of Mrs. S. was in good health as late as age 56. However, the father had died at age 40 of a heart attack while driving an automobile. His only other brother had also died of a heart attack at age 52. Mrs. S.'s paternal grandfather had died of a heart condition in his fifties and his own brother had died of a "stroke."

Mrs. S. had no sisters and only one older brother, who was 32 years old and suffering from angina pectoris. (This is a heart condition caused, in most cases, by atherosclerosis of the coronary arteries.)

This strong family trend towards the incidence of a coronary artery disease and atherosclerosis is a striking example in the case of Mrs. S., although in this case at an unusually young age. At least one-third of the usual cases that I see in private practice, as well as those seen by other physicians of heart disease, are found to have a history of either heart attacks or "strokes" in the family.

When this atherosclerotic coat of arms has been handed down in a family, it is vitally necessary that double precautions be followed in strict adherence to the nutritional program set forth in this book.

Still another characteristic example of the powerful influence of inheritance in the development of atherosclerosis is the case of Mr. J., aged 39.

This patient suffered from pains in both calves of the legs whenever he walked for distances more than a block. He would have to stop and rest until the pains would subside, before he could continue again. We found a typical advanced degree of atherosclerosis of the arteries affecting both legs.

The father of Mr. J., a bank official, had already suffered a coronary thrombosis when he was 56. His two older brothers, in turn, had each died of the complications of atherosclerosis— one from a heart attack, and the other from a "stroke."

Mr. J. had one sister, age 52, who was troubled greatly by swellings in the ankles of both legs, which were discovered to be caused by Bright's disease* This condition, sometimes called "dropsy" in the old days, is caused by atherosclerosis or "hard­ening of the arteries," in the kidneys. This is still a very wide­spread condition and one that accounts for much sickness and death throughout the world, although it is an insidious process, like its fellow "assassins" in the heart and brain.

Mr. J.'s case was so advanced that nutritional care, diet, and weight reduction were of no avail and surgery had to be resorted to. By an ingenious technique, a team of four vascular surgeons who were experts in blood vessel surgery, grafted or transplanted two sets of new arteries in both legs, taken from blood vessel "banks." These storage "banks" keep normal healthy blood vessels available for operations and emergencies in the same way that blood is stored in blood banks for blood transfusions.

Mr. J. almost lost his life during the eight-hour operation but is now fully recovered and walking normally again. How­ever, he does follow the low-fat diet and nutritional program that apparently has arrested the progress of his former atherosclerosis and is well and vigorous once more.

Is There an Excess of Fat Imbedded in the Artery Wall Itself?

This proved to be a very difficult question to answer. A search through the medical literature disclosed that no one had reported any findings on this crucial question. We found that there were tremendous chemical problems blocking the answer to the mystery, but due to good luck and a brilliant chemical feat by our team, we discovered and reported the following facts.

The coronary artery that is damaged by an attack of athero­sclerosis has four times as much cholesterol and fat content as that of the person who dies of causes other than heart attacks. Subsequent to our findings, investigators both here and abroad corroborated our findings, tracking down the "killer" fat to his lair directly in the artery itself. We also noted that high blood pressure had the special effect of driving the cholesterol and fats into the artery wall with more speed and greater destructiveness than would normally be the case. Many patients with high blood pressure were particularly prone to heart attacks and strokes because of the extensive destruction wrought in their arteries by these fats.

This fact brings well to mind my patient, Mr. N., a 50-year old business executive, 40 pounds overweight, who had high blood pressure and angina pectoris. He complained of headaches and dizzy spells. He weighed 190 pounds and suffered from chest pain and shortness of breath on physical exertion or emo­tional excitement.

After a loss of 40 pounds by our nutritional methods, his blood pressure became normal and his heart aches and dizzy spells dis­appeared. However, whenever he had his regular twice weekly, tense committee conferences at the factory, his blood pressure would rise. Strangely enough he discovered that if he ate any fatty foods before these tense business conferences he would develop angina or chest pain and would have to take a tablet of nitroglycerine to relieve the severe heart pain.

His nutrition-minded wife astutely decided to pack his lunches herself into his brief case, along with his business papers and documents. Instead of eating the usual restaurant meals with his business associates, Mr. N. was able, thanks to his wife, to eat an enjoyable, low-calorie, fat-free meal. His heart pains left him. The great fear of death or crippling illness that had con­stantly oppressed him and made his life miserable disappeared completely.

Apparently, emotional stress at business would cause his susceptible blood pressure to rise. If fatty foods were eaten in addition, excess fat would accumulate in the blood and could be driven into the coronary artery blood stream of the heart. This would then produce the life-threatening heart pains of angina.

The transformation in Mr. N., after diet, weight and nutrition were corrected, was truly remarkable. His entire facial expres­sion (as well as his figure) was completely changed. In the place of a tense, pasty-colored, anxious-looking face was a cheer­ful, smiling, health-colored countenance. His step had become springy (and no wonder, with 20 pounds less to carry around), his walk buoyant, and his enjoyment and capacity for work enormously increased.

Are There Other Conditions That Cause Heart Attacks and Strokes?

To find the answer to this question we studied the hearts and arteries of 600 hospital patients who had died of various causes. After years of analysis we were able to report that in 100 cases of accidental death the great majority of men and women studied showed some degree of fatty deposits in their arteries. This was true in cases of people as young as 20, indicating that fat is a killer that has no respect for age. He often begins his work very early in a person's life.

In another 100 cases, diabetes was the cause of death; in another 100, underfunctioning of the thyroid gland was evident. In both instances, these patients showed excess cholesterol and fats in their blood, with a correspondingly high-fat content in their arteries. The degree of atherosclerosis of the heart and brain far outstripped that of any other condition, except one called xanthomatosis. This condition showed itself through fatty, yellow-white deposits in the skin around die eyes, hands, arms and legs. Whenever we found this condition, we also found that the arteries throughout the body, and especially in the heart, were most extensively damaged by fatty deposits.

In patients who were thin and wiry throughout their lifetime, the occurrence of atherosclerosis was generally much less than in all other cases. Women before the age of 50 also proved to be much better protected against degenerative artery disease than men. After 50, however, women began to develop heart attacks and strokes with the same frequency as men. The conclusion was that female sex hormones played an important role in pro­viding protection against the ravages of atherosclerosis. As soon as the change of life occurred in women, the protection of these hormones seemed lost; they then became the equals of men in suffering from heart attacks and strokes.

The Role of the Liver in Protecting You from Excess Fats

We found that the liver manufactures protective chemical sub­stances called phospholipids. These phospholipids in the blood help to ward off the effects of too much fat and help to protect you from heart attack. They suppress the damaging effects of cholesterol upon the arteries of the heart and brain.

This encouraging fact was first discovered by Dr. Aaron Kellner and Dr. E. H. Ahrens, who conducted experiments on animals (and brought it to light). If your liver is not function­ing normally and producing a sufficient quantity of these protec­tive agents, you can find them in certain foods. Some foods that contain phospholipids in abundance are soybeans and the liver of calves, steers, lambs, and chickens. The Vitamin-B complex vitamins also have the ability to increase the blood phospho­lipids. Defatted soybean lecithin in particular is an ideal pre­paration for increasing these protective phospholipids in the blood. (See Chapter 5 for a full discussion of food supple­ments that can be wonderful fighters in the battle against excess fat.)

These protective agents lower the blood cholesterol and bring about a better balance between the amount of phospholipids and cholesterol in the blood. The lowering in the amount of choles­terol protects you against the development of atherosclerosis.

Isn't There Some Medicine That Will Stop Fat from Causing Heart Attacks?

Medical science has searched diligently for some new chemical or medicine that would provide the answer to this question. Some progress has been made, and the full answer will come in time. Here's what we have found out so far:

In 1940 I developed an extract from the arteries of cattle. This extract was administered first, with success, to animals for a period of three years. Then for several years it was given to human patients suffering from heart and artery disease. I rea­soned that if a weakness or deficiency existed in the wall of the damaged artery, then the administration of the healthy, vital substance missing in the artery might rejuvenate the diseased artery and restore its health. This same principle was used in the discovery of insulin.

Although the extract was effective, it had some drawbacks. One problem was that to be effective, it had to be injected daily for the duration of life. A group of research biochemists headed by Dr. N. T. Werthessen and specializing in atomic medicine studied the preventative and curative effects of the extract that I had developed. They used radioactive chemicals to trace the ex­tract in the blood of experimental animals. It was found to be highly effective in preventing atherosclerosis. Nevertheless, I felt it was necessary to abandon the use of the extract, even though we had obtained remarkable results in the treatment of heart, brain, and other circulatory illnesses. The excessive costs of manufac­turing and testing the extract, and the need to inject it daily, made its use impractical.

Many Other Fat Preventing Agents Have Been Discovered and Found Wanting

For example, my associates and I found, more than 10 years ago, that in various experimental animals certain members of the Vitamin-B complex were effective in preventing and treating atherosclerosis. These protective, vitamin-like agents were called lipotropic, or fat preventing. Although these findings were repeated and corroborated by many investigators, many medical scientists could not agree, and the use of such fat preventing agents never became generally ac­cepted. Subsequently, they have been replaced by more promis­ing medicines in the treatment of heart attacks and strokes.

Another promising substance was heparin, which is a fat-clearing, anti-clotting medicine. Dr. Hyman Engelberg and other investigators have found heparin very valuable for controlling blood fats in the treatment of heart cases. Various other physi­cians, however, do not agree with these results. Moreover, the necessity of injecting heparin at frequent intervals and the need for greatest care in its administration made it difficult to use it on a wide scale.

In certain cases, thyroid extract has been effective in reducing excessive cholesterol and fats in the blood. It was most helpful in those patients who had a sluggish or abnormally low basal meta­bolism rate, a sign of an underfunctioning thyroid gland. But unfortunately, it has not proved generally effective in all cases.

Years ago, my co-workers and I explored the potential of plant sterols as fighters of fat. These sterols, which are plant or vegtable extracts, when eaten, block the absorption of cholesterol and fats from the intestine. Some interesting results were ob­tained, but their action was variable at best. Many of these plant extracts were not practical because large quantities had to be consumed before each meal.

Female sex hormones have been widely explored. Many in­vestigators have advocated their use in controlling fat metabolism in the blood and arteries. Here too, the results of treatment in cases of heart disease were interesting, but treatment was handi­capped by the feminizing effects that such hormones had on men.

Thus the need for something that would be useful to all people, something that would bring definite results in fighting off the killer, fat, remained. The low-fat diet holds great promise for everyone, whether the person has atherosclerosis or not. The low-fat way of life can be followed by anyone, anywhere, and it is simple, safe, effective. Let us see why.

How the Low-Fat Diet Proved Its Value

Throughout the world, fats and heart disease appear to be inseparable com­panions. When investigators found one, they generally found the other, no matter in what countries they searched. A host of reports began to pour in on the scarcity or absence of heart, brain, and vascular disease in those populations where a low-cholesterol, low-fat diet were common. (Example: Asians, Africans, Costa Ricans, Okinawans, Chinese, Ceylonese, and Bantus.)

In sharp contrast, the exact reverse was found in those parts of the world where a high-fat diet was prevalent. A high rate of atherosclerosis of the heart, brain, and kidney was common in the countries of Europe and in the United States and Canada. Pathologists, doctors, and medical researchers, have since pro­duced overwhelming evidence to show that when blood choles­terol and fats are high, the arteries were correspondingly high in the degree of damage or destruction by atherosclerosis. And when the blood levels of fat were low, the damage to heart and brain was also low.

I became convinced that the killer had been identified. This conviction I arrived at in the following way: I decided to see what the effects would be of stopping one group of patients from eating fats and comparing them with another group who continued to eat the usual amounts of fats found in the Ameri­can diet. It was important to work with people who had proven cases of atherosclerosis. I therefore selected 100 patients who had survived heart attacks or coronary thromboses and who had been discharged from the hospital. These patients had all had atherosclerosis of the coronary arteries and were ideal for the purpose of proving or disproving the whole concept of high fat as the cause of heart attacks. The 100 cases were divided into two groups of 50 patients each. One group was placed on a low-fat, low-cholesterol diet; the other continued on a diet containing the regular fat intake that they had grown accus­tomed to before their heart attacks occurred.

Both groups were carefully observed for over 10 years. By the end of the third year, the answer began to grow clear. At the end of eight years of study, the answer was conclusive. Of the 50 patients who ate their regular dietary fat quota, 38 (or 76 per cent) had died of arterial or heart diseases.   Of the 50 people who had followed the low-fat diet faithfully, only 22 (or 44 per cent) had died of the same illnesses. In other words, the low-fat diet had enabled heart patients to live twice as long as those who followed a regular diet and had saved a significant number of lives in the process.

The Low-Fat Diet Proved to Be Effective in Reducing Weight and Promoting General Good Health

An equally important result of this research was this: We found that a substantial weight reduction of about 20 pounds was achieved by both men and women on the low-fat diet. This took place over a period of three years, and the weight loss was safe, gradual, healthful.

Typical of this group of patients was Mr. B., a stocky, short man of 180 pounds, who had just recently recovered from his coronary thrombosis. But he now complained of great fatigue and shortness of breath on exertion. He just couldn't seem to be able to resume his work as a builder. For his height and bodily frame, he was easily 36 pounds overweight. On the low-fat diet he lost a pound each week.

At the end of the year he weighed 145 pounds. In his own words, he "felt like a million dollars." He found himself vigorously back at work again, clambering about his construction jobs and housing projects with ease and enjoyment.

The patients on the low-fat diet also gained some remarkable and unexpected health dividends. Many patients, for example, experienced a striking improvement in energy and vitality.

The case of 47-year old Mrs. R. is an excellent one in point. She had made a fairly good immediate recovery from her cor­onary thrombosis. But even before her heart attack, her house­hold activities were always a series of endless chores to her. To "get through the day," became a daily and finally a mon­umental challenge. First, it had been the race to get her three children off to school and husband off to work without even a chance to answer nature's call to the bathroom (the new Ameri­can mother's form of colonic martyrdom!).

Next the hurry to get the house cleaned and straightened up and the noon meal cooked before the children were back from school for lunch. After this kind of fire-alarm rush, the quick run over to shop, buy and prepare dinner. As the zero-hour drew near, Mrs. R. often felt like giving up; she just felt too exhausted, too miserable, and too weak; the task appeared too formidable and depressing for her dwindling strength.

The doctor who had examined Mrs. R. had not been able to find any actual disease present. She was advised to "relax" and "try to take it easy." The "change of life" is hard on some women. Mrs. R. should have watched her weight and her cal­ories, as she was easily 25 pounds overweight. She was only 5 feet tall, a little woman. Then her heart attack had struck and stunned the patient and the family before Mrs. R. had a chance to do anything about it. But after a year on the low-fat diet and nutritional program, she made a complete recovery and had lost 25 pounds of weight. Mrs. R. was a changed person. Below the layers of fat emerged an attractive, vivacious woman whose vitality was apparent in her home. Relieved of the excess tonnage she had constantly carted around her house, Mrs. R. walked with a light* quick step. The family could not believe the transformation that had taken place; the entire home had become cheerful and a pleasure to live in.

Mr. R. privately confided to me that he had also been de­pressed by his wife's former miserable state. He now promptly responded to the new healthy, cheerful atmosphere. He himself came to enjoy his home and family. Previously his footsteps had dragged; he used to feel nothing but uneasiness and anxiety when he came home, when he found an exhausted and depressed wife. Now he really could barely wait to get home. It was almost like rediscovering his wife^-his wife as she had been in her youth.

Others on the low-fat diet found that they gained strength and were able to work and take part in physical activities that would otherwise be denied them.

After the loss of 22 pounds, another patient in this group, Mr. L., found that after three years on the low-fat nutritional way of life, he now got more out of his job as a carpenter, with a loss of his old fatigue and a greater ease in actual working then ever before.

Many patients found their whole philosophy of life changing. Those who had been depressed and discouraged came to know a surprising sense of well-being. Cheerfulness and optimism took the place of morose resignation and negative pessimism.

Mrs. T. never tired of admiring herself in the mirror after a year on the diet and nutritional supplements. And no wonder, for in the place of the unsightly bulk that made her resolve to do something tomorrow, there was a slim, attractive figure, a clear, fresh skin, and a sparkle in the eyes that had never been there before. What pleased her most, however, was the smiling face and cheerful expression that habitually greeted her in the mirror and that radiated and was reflected in the rest of her family.

Some of the patients had suffered for years from heart (angina) pain and other circulatory illnesses. Many of those who followed the low-fat diet faithfully found these symptoms gradually disappearing.

Cases like Mr. C, Mr. 0. and Mrs. W. were typical. Follow­ing the diet and nutritional changes, weight losses of 20 to 40 pounds resulted. In the place of the old chest pain, discomfort or pressure due to angina or heart pain, there was now a feeling of lightness, ease, and freedom from the frightening distress that used to come on so quickly after exercise or excitement.

These remarkable improvements in all the patients on the low-fat diet were accomplished by the healthy teamwork in body chemistry and tissues of vitamin and nutritional supplements, diet, and weight reduction. Identical findings were reported by investigators abroad, particularly in Europe. The benefits were especially strong in cases of atherosclerosis of the brain (stroke).

These cases of cerebral atherosclerosis are so widespread they are virtually universal. Chapter 11 contains a detailed account of the recent and extraordinary discoveries that have resulted from treatment of this condition by the low-fat diet and nutritional supplements.

A recent scientific publication of mine in the medical journal Geriatrics (for elderly people) describes some remarkable changes in patients with cerebral atherosclerosis. Over 100 of these patients, some of them suffering from strokes, were treated very intensively by the low-fat diet and massive amounts of lecithin, vitamin-B complex supplements, liver extract, and soya oil (as described in detail in Chapter 6) showed remarkable changes, often within two to three months. Increased strength —as noted by mechanical measuring devices and increased mus­cular ability, coordination and ability to walk—were frequently found.*

Mental improvement was often seen by improved powers of concentration, greater clarity of thinking, expression, and perception.

Emotional changes were often remarkable. Depression and lack of communicativeness gradually disappeared and in its stead there frequently developed a feeling of well-being, cheer­fulness, and optimism. Patients were much easier to get along with and were keenly interested in their improved nutrition and progress, where as before they had often felt only apathy and a fatalistic resignation to their condition.

These encouraging discoveries, although extremely important, do not mean that there are no other factors that play a part in causing atherosclerosis or help it to develop. As I have already mentioned, we must not forget such additional factors as heredity, sex, metabolic and glandular disturbances, local con­ditions within the arteries themselves, and possibly, still other undetermined causes. However, what is important for you to remember is this: diet and weight are two powerful forces for health that you can control. You can do something about diet, and you can follow the low-fat diet with no difficulty, without having to suffer a bland, unexciting series of daily menus. And you can lose excess (unhealthy) weight easily, safely, and with­out having to starve yourself or restrict your diet to only a few foods such as lettuce and cottage cheese. You don't have any­thing to say about your heredity or your sex, but you can do something about what you eat and what you weigh. This book will show you how.

In the following chapters you will discover exactly how to eat and what to eat in order to prolong your life and increase your health and vitality. The low-fat program given in this book can do wonders for your general health and well-being. It may even save you or your loved ones from heart attacks, strokes, and other illnesses in which the role of the "killer" fat is unmistakable. Now that we know that fat is guilty, let's see exactly what we can do to keep this silent menace from destroy­ing your heart and your health.

* The Use of Lipotropic Combinations in Clinical Practise" Geriatrics, Decem­ber, 1953, Vol. 8, No. 12, pages 649-655.

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