Good Calories, Bad Calories

Throughout this process, I necessarily made judgments about the quality of the research and about the researchers themselves. I tried to do so using what I consider the fundamental requirement of good science: a relentless honesty in describing precisely what was done in any particular work, and a similar honesty in interpreting the results without distorting them to reflect preconceived opinions or personal preferences. “If science is to progress,” as the Nobel Prize–winning physicist Richard Feynman wrote forty years ago, “what we need is the ability to experiment, honesty in reporting results—the results must be reported without somebody saying what they would like the results to have been—and finally—an important thing—the intelligence to interpret the results. An important point about this intelligence is that it should not be sure ahead of time what must be.” This was the standard to which I held all relevant research and researchers. I hope that I, too, will be judged by the same standard.

Because this book presents an unorthodox hypothesis as worthy of serious consideration, I want to make the reader aware of several additional details. The research for this book included interviews with over 600 clinicians, investigators, and administrators. When necessary, I cite or quote these individuals to add either credibility or a personal recollection to the point under discussion. The appearance of their names in the text, however, does not imply that they agree with all or even part of the thesis set forth in this book. It implies solely that the attribution is accurate and reflects their beliefs about the relevant point in that context and no other.

Lastly, I often refer to articles and reports, for the sake of simplicity and narrative flow, as though they were authored by a single relevant individual, when that is not the case. A more complete list of authors can be found using the notes and bibliography.

Part One

THE FAT-CHOLESTEROL HYPOTHESIS

Men who have excessive faith in their theories or ideas are not only ill prepared for making discoveries; they also make very poor observations. Of necessity, they observe with a preconceived idea, and when they devise an experiment, they can see, in its results, only a confirmation of their theory. In this way they distort observation and often neglect very important facts because they do not further their aim…. But it happens further quite naturally that men who believe too firmly in their theories, do not believe enough in the theories of others. So the dominant idea of these despisers of their fellows is to find others’ theories faulty and to try to contradict them. The difficulty, for science, is still the same.

CLAUDE BERNARD, An Introduction to the Study of Experimental Medicine, 1865

Chapter One

THE EISENHOWER PARADOX

In medicine, we are often confronted with poorly observed and indefinite facts which form actual obstacles to science, in that men always bring them up, saying: it is a fact, it must be accepted.

CLAUDE BERNARD, An Introduction to the Study of Experimental Medicine, 1865

PRESIDENT DWIGHT D. EISENHOWER SUFFERED his first heart attack at the age of sixty-four. It took place in Denver, Colorado, where he kept a second home. It may have started on Friday, September 23, 1955. Eisenhower had spent that morning playing golf and lunched on a hamburger with onions, which gave him what appeared to be indigestion. He was asleep by nine-thirty at night but awoke five hours later with “increasingly severe low substernal nonradiating pain,” as described by Dr. Howard Snyder, his personal physician, who arrived on the scene and injected Eisenhower with two doses of morphine. When it was clear by Saturday afternoon that his condition hadn’t improved, he was taken to the hospital. By midday Sunday, Dr. Paul Dudley White, the world-renowned Harvard cardiologist, had been flown in to consult.

For most Americans, Eisenhower’s heart attack constituted a learning experience on coronary heart disease. At a press conference that Monday morning, Dr. White gave a lucid and authoritative description of the disease itself. Over the next six weeks, twice-daily press conferences were held on the president’s condition. By the time Eisenhower’s health had returned, Americans, particularly middle-aged men, had learned to attend to their cholesterol and the fat in their diets. Eisenhower had learned the same lesson, albeit with counterintuitive results.