How good is Mr. Hurley’s diet?

Mr. Hurley, however, was a troubled man. Within a year, three of his friends and one of his close associates had suffered fatal heart attacks. Were these attacks, he wondered, totally unpredictable, or might these men have been warned by some finding made in the course of their periodic medical examinations?

Discussing this matter with the physician who examines Curtiss-Wright executives, Hurley learned that doctors can frequently identify people who are prime candidates for heart attacks and strokes. Even leaving aside subtle findings, such as those revealed by a stethoscope or an electrocardiograph, there are now impressive medical statistics, Hurley learned, showing that the likelihood of a heart attack correlates closely with abnormal elevation of three factors: weight, blood pressure, and cholesterol level of the blood serum. Marked elevation of any one of the three bodes trouble; elevation of any two or all three is cause for serious concern.

While cholesterol, a fatlike substance found in all animal tissue, has been much in the news recently, as well as figuring in advertisements for corn and cottonseed oils, few Americans yet know how much of it is circulating in their blood streams. There is evidence that high serum cholesterol is associated, in some manner, with the formation of fibrous plaques on the inner walls of the arteries. These encrustations, containing fat and cholesterol, restrict the free flow of blood and constitute the disease known as atherosclerosis. This disease, in turn, sets the stage for the vast majority of heart attacks and strokes. Nevertheless, many doctors still do not include a serum-cholesterol test (costing $5 to $15) in routine checkups because a single test may be misleading, and because of a persistent belief that its interpretation presents a problem.

The presumed problem is that not many people with a high serum-cholesterol level drop dead as soon as they walk out of the doctor’s office, while sometimes a person with a low cholesterol will. But the same is true of a prognosis based on weight or on blood pressure: some fat hypertensives live longer than thin people with low blood pressure. The prognostic significance of cholesterol level, weight, and blood pressure is simply that they tell you whether you belong—or do not belong—to a group in which heart attacks are common. Since heart attacks kill at least one-fourth of all American men over the age of thirty-five, a knowledge of the relevant statistics would seem of intense interest to every man—and to his wife, whose hormones evidently help shield her from a coronary.

Can you beat the odds?

What the statistics told Roy Hurley a year ago was that he was lucky to have reached the age of sixty-two without a heart attack. The large U.S. Public Health Service study in Framingham, Massachusetts, has shown that for men between the ages of forty and sixty, about one man in fourteen has a heart attack in a six-year period. Moreover, for men with serum cholesterols as high as Hurley’s the odds shorten drastically to about one in eight. Hurley’s cholesterol had been as high as 310 mg. per 100 cc. of blood serum, a figure about 25 per cent above the average for American men, and at least 50 per cent above the values of men with the fewest heart attacks.

Hurley was also about thirty pounds overweight, and life-insurance studies show that this alone would bracket him with men who have a mortality rate 40 per cent above average. There is some evidence from the Framingham study that elevated cholesterol and obesity make a particularly lethal combination, so that over the span of twenty years, between age forty and sixty, the odds of a coronary for Mr. Hurley should have been significantly worse than one in eight in any given six years.

The fact that Hurley, at sixty-two, had not yet had a heart attack even though he had gained seventy pounds since his twenties, and presumably had had a high serum cholesterol for many years as well, did not mean that the medical statistics had been suspended in his case. Some people will always beat the odds. Moreover, it is likely that factors more decisively prognostic than cholesterol, weight, and blood pressure will one day be discovered. Perhaps Mr. Hurley was just lucky, or perhaps he had been lucky in inheriting unusually durable coronary arteries.

Shocked by the death of his friends, however, Hurley was not willing to gamble that his luck would continue to hold. He was counting on the years just ahead to push to commercial success a number of research projects that he believed to be of great importance to Curtiss-Wright, and he found the odds of his suffering a coronary both personally and corporately alarming. Hurley resolved to change his way of life—if his doctors would tell him what to change.

It quickly became clear to him that whatever coronary preventive measures he might take would have to be centered primarily on diet. He couldn’t do much about the amount of stress in his life and still remain head of a $400-million corporation. As for exercise, another factor sometimes associated with strong hearts, he cared little for golf and had neither the time nor the inclination to take up, say, walking or cycling. In any event, he concluded that the evidence implicating psychological stress or lack of exercise with coronary disease was less impressive than that implicating diet. Hurley was not so naive as to believe that he could suddenly undo the physiological damage inflicted by a lifetime of careless eating, but he had reasons to believe, as we shall see, that he could shift the odds in his favor.

Man can live on walrus meat

When Roy Hurley became interested in nutrition for the first time in his life, he tackled the subject with all the aggressiveness and tenacity that had marked his engineering career. When his personal physician could not answer his questions, Hurley insisted that he hunt up answers or refer him to experts. Soon Hurley was touring nutrition laboratories at Yale and at St. Luke’s Hospital in New York, and pounding researchers with his questions.

Was serum cholesterol really the best index for gauging the progress of atherosclerosis? What was the best way to lower cholesterol? Should he cut back on all fats, or just on certain ones? Was corn oil better for him than cottonseed oil or olive oil? Would lecithin help reduce cholesterol? Should he give up alcohol? Should he eat eggs? Was sugar more harmful than starch? Should he take vitamins?

Some of these questions grew out of Hurley’s reading, which included the best-selling Let’s Eat Right to Keep Fit by Adelle Davis, The Low-Fat Way to Health and Longer Life by Lester M. Morrison, and Eat Well and Stay Well by Ancel and Margaret Keys. The most generally accepted of the three books, Hurley found, was the Keys book. Head of the Laboratory of Physiological Hygiene at the University of Minnesota, Ancel Keys has earned a worldwide reputation for his pioneer studies of the relationship between fat consumption in various countries and the mortality from coronary disease. While his book has the endorsement of Paul Dudley White and four other past presidents of the American Heart Association, there are still authorities who believe he has been premature in asserting that fat is the killer.

“I knew from long experience with scientists and engineers,” says Hurley, “that the experts are always jealous of their scientific reputations. They never want to publish anything until they are virtually 100 per cent sure it is right. In talking to nutritionists I told them I wanted to hear not just what they’d be willing to publish, but also things of which they might be only 60 or 70 per cent certain. If we waited for 90 per cent certainty in business, we’d never make any decisions.”

Hurley soon discovered why the young science of nutrition abounds in 60 per cent certainties. Of all higher animals, man is the only true omnivore. He can live about as well on nuts and berries as on a steady diet of walrus and blubber. In his evolutionary history he has survived flood, drought, and ice ages, eating heaven knows what, and he has proved that he can survive in modern concentration camps on a diet that would kill a rat.

In short, Hurley discovered that his engineers knew more about the fuel requirements of a Curtiss-Wright aircraft engine than the leading nutritionists knew about the complex and subtle “fuel” needs of the human body. And on the body’s needs, far less research is being done. The total U.S. expenditure for research on problems of human nutrition probably does not exceed $3 million a year.

Hurley became a familiar figure at St. Luke’s Hospital, where he was apt to pop in mornings at eight to discuss the latest findings on nutrition before heading for his office. At St. Luke’s, Theodore Van Itallie, forty-year-old Director of Medicine, has built up one of New York’s largest nutrition research departments in cooperation with the Institute of Nutrition Sciences of Columbia University School of Public Health. As part of a broad program, Van Itallie is devising methods of tracing dietary fats through the blood stream and to final deposition in the walls of the arteries or other body tissue.

The diet Mr. Hurley finally adopted this past May—after trying two or three other weight-and-cholesterol-lowering diets—was prescribed for him by Van Itallie, and is similar to that advocated by Ancel Keys in his book. Van Itallie, however, is less sure than Keys that the diet is the answer to coronary disease. “We must be careful to distinguish,” Van Itallie says cautiously, “between the hypothetical and tentative and the demonstrable. Our aim was to give Mr. Hurley a diet that was palatable and practical and that would lower his cholesterol.” Van Itallie believes that it can be safely adopted by anyone who would like to gain whatever protection the diet may afford.

Today, after conscientiously following the Van Itallie diet—to which Hurley has made a few modifications, to be noted—Hurley says he never felt better. He weighs 185 pounds and his serum cholesterol has plunged to a phenomenal 160, or equal to that of Bantus and Japanese farmers, in whom coronary disease is almost unknown. While Hurley had been able to lower his serum cholesterol below its peak value of 310 before going on the Van Itallie diet in May, the greatest part of the drop has occurred since then. The over-all drop of 150 points is far beyond that usually achieved by dietary measures alone.

Goodbye to butter

Here, in slightly abridged form, is the diet that Van Itallie handed Hurley. It provides some 2,200 calories per day and can be scaled up or down as required to suit individual needs. If it is scaled upward, Van Itallie recommends that extra calories come chiefly from oils, bread, cereals, lean meats, and fish. If scaled downward, fatty meats should be dropped first.

Food to include:
Milk, skimmed or non-fat dry milk, 1 pint per day, use in cooking or as a beverage.
Eggs, 5 per week, white of eggs are not restricted.
Vegetables, at least 2 servings per day, one should be a yellow or green leafy vegetable, either raw or cooked.
Fruits, 3 servings per day, include 1 serving of citrus fruit per day.
Breads, 4 slices per day, enriched or whole-grain breads, rolls, and crackers.
Cereals, 2 servings per day, enriched or whole-grain cereals, dry or cooked.
Potatoes, 1 portion per day, white or sweet.
Oils, 1 ounce (2 table-spoons per day), corn or cottonseed oils (on salads, in cooking, or blended in skimmed milk.)
Fats, use mayonnaise or special margarine, at least 3 table-spoons daily, these can be used to flavor cooked vegetables or to spread on bread.
Cheese, as desired, cottage or pot cheese only.
Meats, poultry, Lean group—veal, liver, kidney, chicken, turkey—5 times a week. Fat group—beef, lamb, pork, ham, Canadian bacon, tongue, duck—no more than 6 4-ounce portions a week. Meats and poultry may be broiled, roasted, or fried, using corn or cotton-seed oil. Frying oil should not be allowed to smoke and should not be reused.
Fish, 5 times a week, especially salmon, sardines and tuna in oil, mackerel, whitefish, herring. Fish may be broiled, baked, or fried, using corn or cottonseed oil.
Dried beans, chick peas, 1 serving may be substituted once a week for meat.
Sugar, to taste.

Sample meal plan

Breakfast: Citrus fruit, cereal, egg, bread with special margarine, tea, coffee, skimmed milk.
Lunch: Meat, poultry, or fish. Potato. vegetable. Bread with special margarine. Fruit. Tea, coffee, skimmed milk.
Dinner: Meat, poultry, or fish. Vegetable. Rice. Raw vegetable salad with oil dressing. Bread with special margarine. Fruit. Tea, coffee, skimmed milk.

DO NOT EAT:
1. Pastries, pies, cookies, cakes, muffins, doughnuts, unless prepared at home using corn or cottonseed oil or special margarine as the only source of fat.
2. Bacon, sausages, corned beef, luncheon meats.
3. Whole milk, ice cream, chocolate candy, butter, ordinary margarine, sour or sweet cream, lard, hard cheeses, cream cheese, or creamed cottage cheese.
4. Gravy or salad dressings unless made with corn oil, cottonseed oil, mayonnaise, or special margarine.
5. Cream soups.
6. Potato chips, popcorn, and other fried foods, unless prepared using oils as instructed.

FOR VARIETY:
1. Among desserts, include fruit, flavored gelatin, water ices, and angel-food cake.
2. Hard candy, liquor, wine, and beer permitted in moderation.

The essence of the diet is that it bans outright or severely restricts foods that are rich in saturated fats: butter, whole milk, most cheeses, ice cream, shortenings, and conventional margarine. In their place it puts foods that are rich in the highly unsaturated liquid fats. These fats are abundant in the common vegetable oils extracted from corn, cottonseed, and soybeans, and also in most fish. Early cholesterol-lowering diets attempted to achieve their purpose by cutting down on foods containing cholesterol, but it has since been shown that the body manufactures for its own needs much more cholesterol than anyone might obtain from food. The Van Itallie diet lowers serum cholesterol in a roundabout way (actually, no one knows quite how), by changing the saturated-unsaturated fat ratio.

A saturated fat is one containing a full complement of hydrogen atoms along the carbon chain that forms the backbone of the fat molecule. If the chain is lacking one pair of hydrogen atoms, the fat is called monounsaturated. The principal fat of this type, oleic acid, constitutes about 80 per cent of the fat in olive oil. Oleic acid seems to be “neutral” in its effect on serum cholesterol, though some experts believe it may cause a slight elevation.

The oils shown to have the greatest cholesterol-lowering effect are the polyunsaturated fatty acids, which are lacking two or more pairs of hydrogen atoms. The most abundant and best researched polyunsaturate is linoleic acid, which constitutes 40 to 55 per cent of corn, soybean, and cottonseed oils. Because linoleic acid cannot be manufactured by the body, and is probably a necessary nutrient, at least for infants, it is often called an essential fatty acid.

When vegetable oils are hardened by hydrogenation to form margarine, or shortenings like Crisco and Spry, the linoleic-acid content drops to 12 per cent or less, the rest being converted to oleic acid or to saturated fatty acids—hence the “special margarine” called for in the diet prescribed for Hurley. This is Emdee, which is about 40 per cent linoleic acid. Made by the drug firm of Pitman-Moore, it is sold only in drugstores and costs a whopping $1 a pound.

Except perhaps for linoleic acid, the body can get along on amazingly little fat, though no one knows exactly how little. Many Japanese get only 8 per cent of their total calories in the form of fat. In the typical U.S. diet, fat supplies at least 40 per cent of the calories, a figure that has been rising almost steadily for the last half-century. As nations get richer they add fats to their diets, and the fats they add are predominantly the saturated ones and oleic acid. In the U.S., milk, butter, cheese, ice cream, margarine, and shortenings supply over 600 of the 1,400 calories of fat in the typical diet, but they contribute only negligible amounts of linoleic acid: about four grams, or thirty-six calories per day.

“I simply resolved…”

To the one American in four of Roy Hurley’s generation who is obese, the interesting question beyond how Hurley lowered his cholesterol is how he managed to lose thirty pounds. For this, Hurley was given no magic formula, nor is there any, despite endless claims to the contrary. Hurley actually had lost about twenty pounds before adopting the Van Itallie diet.

“I simply resolved to lose weight,” says Hurley, “and asked my doctor to tell me when I was losing too fast.” Hurley initially cut his intake to 1,000 calories a day—and was hungry all the time. This melted off half a pound a day, however, and Hurley stayed on 1,000 to 1,200 calories until he had dropped from 216 to 195 pounds. It was at about this point that he switched to the Van Itallie diet, scaled to provide 1,500 calories a day. “When I did this and ate at least half of my calories at breakfast,” he says, “I didn’t feel hungry any more.” In another two months he was down to 185 pounds, his present weight.

Hurley has become a great believer in a hearty breakfast, but his idea of hearty may not appeal to everyone, and it is not what Dr. Van Itallie ordered, though he sees no harm in it if Hurley enjoys it. Hurley’s breakfast, inspired by Lester Morrison’s book, consists of the following, all mixed up in a bowl: corn oil, wheat germ, powdered lecithin, non-fat milk mixed 50 per cent overstrength from the powder, and fruit (sweetened to taste with Greek honey). Along with this he has a slice of bread, spread with Emdee.

The only beverage Hurley drinks at breakfast is a glass of orange juice. He used to love coffee but has lost his taste for it since adopting his new diet. His breakfast mixture contains over 1,000 calories, which is just about half of the 2,200 to 2,300 he finds he needs to hold his weight in check.

Hurley’s use of lecithin deserves special comment. Lester Morrison’s book has persuaded Hurley that there is perhaps a 60 per cent chance that lecithin has some unique and exceptional values in human nutrition. Lecithin is a fatty, phosphorus-containing compound that is normally present in animal tissues. It is produced commercially from soybeans and is sold at drug and health-food stores for about $2.50 for an eight-ounce jar. Morrison describes lecithin (which he likes to capitalize) as “one of our most powerful weapons against disease,” and “one of the most important nutritional supplements developed in the last fifty years.” He contends, on the basis of limited evidence, that lecithin may actually remove atherosclerotic plaques from artery walls.

To Van Itallie, and to many other leading nutrition researchers, the probability that lecithin will turn out to have the magical properties that Morrison ascribes to it seems almost nil. Moreover, nutritionists view Roy Hurley’s breakfast mixture as typically faddist. This is their term for a food, or food combination, that its user believes to have a unique value that cannot readily be duplicated by other, cheaper, and more conventional foods. They also regard Hurley’s breakfast as mighty unappetizing.

At breakfast Hurley takes two vitamin tablets, one a vitamin-mineral formula of therapeutic potency, and the other a combination of lysine (one of eight essential amino acids) and B vitamins. Hurley became convinced from his reading that he should take supplemental vitamins as “insurance,” and these two were selected for him by his private physician. Van Itallie has pointed out to Hurley that his diet contains an ample supply of all essential nutrients. Hurley’s reply is that he definitely feels better when he takes the vitamins.

Like Van Itallie, most nutritionists believe that Americans are consuming vitamin pills in wholly irrational quantities (over $300 million worth a year). They reject the notion that an excess of vitamins can produce a state of “super” health. They believe that vitamin supplements should be taken only by people with a demonstrable—and usually temporary—need for them. In support of their position, nutritionists point to a survey of household food consumption, conducted in 1955 by the U.S. Department of Agriculture, which found that about 90 per cent of all families were buying food capable of supplying at least two-thirds of the recommended daily allowances of every nutrient listed by the National Research Council. And these allowances, for the most part, are generous.

Recapturing life expectancy

Has Mr. Hurley’s diet given him a new lease on life? Again, there is no answer except those provided by statistics, and so far these relate only to weight reduction. A new study just published by the Society of Actuaries reviews the mortality experience of five million policyholders, classified by age, weight, height, blood pressure, and certain other medical factors (though not by serum cholesterol). The study was directed by Edward A. Lew, actuary and statistician for Metropolitan Life Insurance Co.

Some of the key findings relating to obesity and blood pressure are charted below. The most significant finding, from Mr. Hurley’s point of view, is that fat people who reduce their weight substantially can expect to recapture most, if not all, of a normal life expectancy. To be sure, the statistics refer to people who reduced at a much younger age than Mr. Hurley, but the figures are heartening nonetheless.

600 “prudent” New Yorkers

Whether or not a reduction in cholesterol level produces a similar extension in life expectancy may be statistically demonstrated in the next few years. The evidence should come from two large studies now going forward under sponsorship of the New York City and Chicago health departments. Two and a half years ago, New York established an “Anti-Coronary Club,” more formally known as the Diet and Coronary Heart Disease Study Project. Involved in the project are about 600 men, twenty to fifty-nine, who have volunteered to adopt for life a “prudent” diet, much like Hurley’s, and to undergo periodic examinations. The club represents a cross-section of New Yorkers.

The Anti-Coronary Club was conceived by Norman Jolliffe, the prominent food expert who heads the city’s Bureau of Nutrition and who devised the club’s “prudent” diet. The serum cholesterol of Anti-Coronary Club members in the critical fifty-to-fifty-nine age group dropped from about 250 to 220 after six months on the “prudent” diet. This has been an exciting accomplishment, since many nutritionists had previously doubted that “free-living” Americans (as opposed to laboratory subjects) would be able to lower their cholesterol significantly.

The second study is under Jeremiah Stamler, who is directing the Heart Disease Control Program for the Chicago Board of Health. An authority on the development of atherosclerosis in experimental animals, Stamler is convinced that faulty diet is a decisive cause of the disease in man. “There is,” he says, “no counter hypothesis, convincing or otherwise, to account for the high levels of serum cholesterol and the high rates of coronary disease in our middle-aged men.” Stamler plans to enlist 500 volunteers in his Coronary Prevention Evaluation Program, which is now well under way.

The Chicago volunteers must be between forty and fifty-nine years old and in the “high-risk” category by virtue of having at least two of the following “defects”: elevated cholesterol, excess weight, elevated blood pressure. A cholesterol level above 325, with no other defects, is also grounds for admission. The men must be free of any detectable heart trouble at the start of the experiment.

Stamler will consider the Chicago experiment successful if the changes in eating habits he prescribes—similar to Dr. Van Itallie’s advice to Hurley—reduce the incidence of coronary attacks from the expected level of one for every ten men, over a four-year period, to one in twenty.

Despite the wide attention being given to the cholesterol-coronary relationship, it still remains, as Dr. Van Itallie stresses, a hypothesis.

What other culprit?

The cholesterol level can be raised or lowered by a number of factors. While it has been amply demonstrated in experimental animals that the cholesterol level of the blood is related to the development of atherosclerosis, this is harder to demonstrate in man. Nor has cholesterol been directly related to the coronary attack, which commonly results from atherosclerosis. What Keys, Stamler, Jolliffe, and others believe is that the cholesterol level is a demonstrably useful index for estimating the risk of severe, early atherosclerosis.

Factors besides diet that seem to affect cholesterol level include hypothyroidism, diabetes, smoking, and stress. Martha F. Trulson and Mary B. McCann of the nutrition laboratory of the Harvard School of Public Health have found that men who smoke more than a pack of cigarettes a day have, on the average, cholesterol levels ten to fifteen points higher than nonsmokers. (And one leading mortality study shows that the coronary death rate is 70 per cent higher for men who smoke cigarettes than for nonsmokers.) Psychological stress also may produce transient increases in cholesterol level.

A number of substances are known to lower cholesterol, and the drug houses are busy searching for still more effective ones. No drug, however, is likely to be recommended for nonprescription use by the general public.

Thus dietary changes would seem to remain the best prophylaxis. It is possible, however, that saturated fat may not be the only culprit in the diet. There is striking evidence that in rats, at least, a diet high in sugar raises cholesterol level, while a diet high in starch lowers it. So far, this finding has not been duplicated in monkeys or humans. Nevertheless, sugar and starch are currently under intense study in the laboratories of the USDA and elsewhere. Significantly, perhaps, per capita consumption of sugar in the U.S. has increased 25 per cent in the last fifty years, while starch consumption has tumbled 50 per cent. This radical change in the American diet has exactly paralleled the sharp rise in coronary disease that most experts agree has taken place in the U.S. Significant also, perhaps, is the fact that the countries with the highest starch consumption—e.g., Japan, Italy, France—are among those with the lowest coronary death rates.

What should the ads say?

It is quite clear that the U.S. food industry is in for a turbulent time if the New York and Chicago diet-and-coronary studies bring in a verdict of guilty for the saturated fats. The $11-billion dairy-products industry will be especially hard hit, unless it changes its historic emphasis on butter and butter fat to an emphasis on milk proteins and calcium. Actually, except for breaking the strong sentimental ties to butter, the transformation of the dairy industry need not be too painful. Since skimmed milk contains only about half as many calories as whole milk, Americans could drink twice as much of the skimmed without putting on weight, and at the same time get valuable proteins, riboflavin, and calcium as a bonus.

Within the last three years a number of food and container companies have given the Nutrition Foundation—an agency that grants research funds on behalf of the food industry—a sum of about $ 1 million to look into the question of the saturated and unsaturated fats. As a result of this study, the margarine industry seems to be ready at last to reduce the saturated-fat content and to raise the linoleic acid content of its product. It is likely that the linoleic will be raised from the present average of 9 per cent (typical range, 6 to 14 per cent) to at least twice that, and some manufacturers may go all the way to match Emdee’s 42 per cent. The first of the new margarines, Cornette, made by the Best Foods division of Corn Products, is now being test-marketed. While it contains somewhat less linoleic acid than Emdee (27 vs. 42 per cent), it also contains less saturated fat (18 vs. 26 per cent), so the ratio of linoleic to saturated fat is about the same in the two products.

(Fleischmann’s new Supreme margarine is not the equivalent of Emdee, though many people have been led to think so. While its saturated-fat content is roughly the same as Cornette’s, the linoleic-acid content claimed for it is only 15 per cent.)

C. Glen King, director of the Nutrition Foundation, who previously advised the margarine industry to move slowly in making changes, now believes it is appropriate to market margarines containing 20 to 40 per cent linoleic acid. He emphasizes, however, that advertising should not imply that the new products will prevent atherosclerosis or heart attacks.

Unsaturating the U.S. diet

If the margarine makers increase linoleic acid, the shortening makers will almost surely follow suit. Procter & Gamble, the leader of the industry, says it could readily raise the linoleic-acid content of Crisco from the present 10 to 12 per cent to 20 to 25 per cent without changing its consistency. But if higher linoleic levels were thought desirable, it might be necessary to change over to a liquid shortening.

When high-linoleic shortening becomes generally available, the whole gamut of cake mixes and commercial baked goods will begin to carry less of the saturated fats, and a gradual change in the American diet will be under way. The change will be gradual, for even if all margarine and shortening were suddenly doubled in linoleic-acid content, the gross amount of polyunsaturates consumed by the average American would be increased no more than 10 per cent. For families that use margarine to the exclusion of butter, the increase in linoleic might amount to 15 per cent—or enough, perhaps, to produce a modest decline in serum cholesterol. However, to lower the cholesterol of the American male from a typical 240 to a reasonably “safe” 210 would require adoption of a Hurley-like diet.

Food producers have an opportunity to show more statesmanship than the cigarette makers, who have monotonously retorted “unproved” to every new study associating cigarette smoking with lung-cancer. The only valid response to evidence that one’s product may be killing people is either to refute the evidence with better evidence, or effectively to alter the product.

The nostrum vendors

The food industry has more reason than most to be statesmanlike, for it is already the target of a large number of vociferous, self-styled experts on nutrition who have converted millions of Americans to an appalling variety of food fads. The fads, in turn, have kept business booming for the health-food stores scattered coast to coast.

Gullibility is so ubiquitous that nutrition scientists have little hope that any first-rate book on nutrition will ever become a runaway best-seller. The nearest thing recently to an exception has been Eat Well and Stay Well, the Margaret and Ancel Keys book, which made the best-seller lists briefly when it appeared last spring but was soon outdistanced by D. C. Jarvis’ Folk Medicine, which has induced countless people to consume apple cider vinegar and honey as a broad-spectrum aid to health and vigor.

One of the most durable sellers is Adelle Davis’ book, Let’s Eat Right to Keep Fit, which first appeared in 1954 and is still a staple on the book racks of health-food stores. Miss Davis, who has an M.S. in biochemistry, is especially rankling to academic nutritionists because much of what she says is basically sound. For example, she advises eating breakfast “like a king, lunch like a prince, and dinner like a pauper.” But Miss Davis submerges her sound advice in unproved claims and mere hunches. “Nutrition-wise,” she admits, “I believe in playing my hunches; I have played hunches about vitamin E for twenty-three years.” As it happens, a vitamin E deficiency in adults is almost unknown.

Pikers on research

The strongest counterattack that the U.S. food industry could make against food faddism would be to stop deploring it and get down to some real research on human nutrition. The $50-billion-a-year food-products industry is by far the largest single industry in the U.S., yet it ranks close to the bottom of the list in the size of its research and development budget. According to the National Science Foundation, it spent only $68 million on R. and D. in 1957, or less than 0.002 per cent of sales.

Conducting no significant research beyond product development in their own laboratories, the big food companies (including one food chain, Safeway) are satisfied to contribute a meager $500 to $10,000 a year—pledged in advance for a minimum of five years—to support the Nutrition Foundation, and about two-thirds of the major food firms contribute nothing at all. The foundation currently administers a research budget of about $500,000 a year. In the eighteen years since its creation, it has distributed just under $5 million for basic research. This sum, tiny as it is, has helped support some of the most significant work on nutrition that is being done in universities and hospitals.

All told, there are probably no more than a dozen laboratories in the U.S. spending as much as $100,000 a year on nutrition research. Perhaps the largest nongovernment laboratory is operated by the Department of Nutrition in the Harvard School of Public Health, on a total budget of only about $500,000. This laboratory, under the able guidance of Fredrick J. Stare, has trained a sizable fraction of the country’s top-flight young nutritionists. (Stare himself recommends, from his studies, that Americans reduce their intake of saturated fats.) Continuously under pressure to find money to support his work, Stare is now trying to scrape together $900,000, which, with matching government funds, would provide his staff with adequate laboratories.

The deadly salt shaker

While Stare asserts that the food industry is doing an excellent job over-all, he feels it has barely awakened to its heavy public responsibility as a “tastemaker” in the literal sense. One example of this taste-making is the inordinate fondness of Americans for common table salt. Stare believes that excess salt may be hurting even more Americans than saturated fats. He points out that adults normally need only about half a gram of salt a day. Most, however, consume ten to fifteen grams, and much of it is already incorporated in the food they buy. Many cardiologists are coming to believe that the excessive U.S. consumption of salt is uniquely related to a significant part of the high blood pressure, or hypertension, found in Americans. As the new life-insurance study clearly shows, hypertension is as dangerous as obesity in hastening the death of many Americans.

To change is prudent

Except as food is altered at the source, it is quixotic to hope to change suddenly the diet patterns of a whole nation. Motivating fat people to reduce—and the great majority of Americans are too fat—will take all the educational skill that the medical profession and the life-insurance companies can muster.

There is hope, however, that the food industry, by making carefully considered changes in its staple products, can alter on a large scale the ratio of the various nutrients that Americans consume. Thus the cereal-enrichment program, inaugurated in World War II, by adding thiamine, riboflavin, niacin, and iron to white bread and white flour, helped greatly to eliminate deficiencies of these nutrients among Americans.

The evidence is now overwhelming that increasing the ratio of polyunsaturated fats to saturated fats in the diet will lower serum cholesterol in the great majority of people. Since a reasonable change in this direction seems safe, practical, and desirable, there is every reason for margarine and shortening makers to change their products.

At the same time, the food industry as a whole could take steps to make up for its shameful neglect of basic research in nutrition.

Bad news for the overweight

Even average weight is too much:
Men, 45 years old, 5’8″ tall
40 pounds underweight—100%
20 pounds underweight—85%
Average weight (165 pounds)—100%
20 pounds overweight—110%
40 pounds overweight—125%
100 per cent=normal mortality ratio for 45-year-old men

Women, 45 years old, 5’4″ tall
40 pounds underweight—105%
20 pounds underweight—95%
Average weight (140 pounds)—95%
20 pounds overweight—100%
40 pounds overweight—150%
100 per cent=normal mortality ratio for 45-year-old women

Best “biological weight” for men is about twenty pounds below the average. Men of average weight, as well as those forty pounds under, have a mortality rate equal to that of “standard risks” in insurance parlance—shown as 100 per cent in the chart at top. For men age forty-five, twenty pounds under average weight, the mortality rate is only 85 per cent of normal. Women benefit less from being thin, risk less by being twenty pounds over, but fare worse than men do when they are forty pounds over average. Source: the Society of Actuaries.