Heart Attacks and Us
The very plausible assertion has been made that the modem diet is responsible for the extraordinary prevalence of heart disease in the 20th century industrial societies. I’m inclined to think that’s true. The further claim has been made that our rich, high fat diet is the culprit. Long ago, I imagined this was true, too, until I began to look at the historical evidence.
You may wonder what history has to do with it. Actually, quite a lot. You see, the main focus of intellectual attention with regard to the overall prevalence of heart disease has been directed to what medicine calls epidemiological studies. These are studies of the statistical breakdown of illness in various population groups. This is a crude and speculative way of studying illness but also a very intriguing one.
Let’s suppose a researcher is struck by the fact that nomadic desert Bedouin don’t get any heart disease but that New York City pastrami slicers do. He could scrutinize the differences between the two groups, note that the deli workers ate considerably more corned beef fat and conclude on the basis of this correlation that fat is the cause of their heart disease. Of course, if he did that, he would have overlooked the fact that heart disease also correlated with the consumption of rye bread and mustard and the use of subway tokens, TV sets, and meat slicers. Or that the absence of heart disease correlated with riding camelback.
More seriously, for epidemiology really isn’t ludicrous, he might have concluded that the pastrami slicers get less exercise than the Bedouin or that they smoke more cigarettes or that they eat more sugar, or that they lead more driven, stressful lives. If he were interested in environmental factors, he might cast an evaluating eye over the quantities of lead, ozone, and other chemicals that the unfortunate counterman daily absorb.
But, for the most part, if our epidemiologist is a typical epidemiologist and wants to be chief of epidemiology one day, he will do what’s expected of him and conclude that dietary fat did it. (As Claude Rains put it in Casablanca, âœRound up the usual suspects.â) That he jumps to this conclusion is part of the paradigm conformed to by a medical statistician at a modem American medical school, but it is easy to show that it is not a necessary conclusion from the evidence.
In virtually all the societies in which it is suggested that high fat causes heart disease, the main dietary modification in this century has been an increase in the consumption of sugar, high fructose com syrup, and white flour all refined carbohydrates. Surgeon Captain T. L. Cleave, who wrote the classic study, The Saccharine Disease, argued convincingly that increases in coronary artery disease could be traced to increases in refined carbohydrate intake.2 He noted that diabetes, hypertension, ulcers, gall bladder disease, varicose veins, colitis, and heart disease, to name a few, are all virtually non existent in primitive cultures until refined carbohydrates are introduced into the culture. And there were no exceptions. The process took twenty years to develop and so Cleave proposed the Rule of 20 Years that’s how long after sugar or other refined carbohydrates are added to a culture before diabetes and heart disease begin to appear in that group of people.