Good Calories, Bad Calories

Eisenhower was assuredly among the best-chronicled heart-attack survivors in history. We know that he had no family history of heart disease, and no obvious risk factors after he quit smoking in 1949. He exercised regularly; his weight remained close to the 172 pounds considered optimal for his height. His blood pressure was only occasionally elevated. His cholesterol was below normal: his last measurement before the attack, according to George Mann, who worked with White at Harvard, was 165 mg/dl (milligrams/deciliter), a level that heart-disease specialists today consider safe.

After his heart attack, Eisenhower dieted religiously and had his cholesterol measured ten times a year. He ate little fat and less cholesterol; his meals were cooked in either soybean oil or a newly developed polyunsaturated margarine, which appeared on the market in 1958 as a nutritional palliative for high cholesterol.

The more Eisenhower dieted, however, the greater his frustration (meticulously documented by Dr. Snyder). In November 1958, when the president’s weight had floated upward to 176, he renounced his breakfast of oatmeal and skimmed milk and switched to melba toast and fruit. When his weight remained high, he renounced breakfast altogether. Snyder was mystified how a man could eat so little, exercise regularly, and not lose weight. In March 1959, Eisenhower read about a group of middle-aged New Yorkers attempting to lower their cholesterol by renouncing butter, margarine, lard, and cream and replacing them with corn oil. Eisenhower did the same. His cholesterol continued to rise. Eisenhower managed to stabilize his weight, but not happily. “He eats nothing for breakfast, nothing for lunch, and therefore is irritable during the noon hour,” Snyder wrote in February 1960.

By April 1960, Snyder was lying to Eisenhower about his cholesterol. “He was fussing like the devil about cholesterol,” Snyder wrote. “I told him it was 217 on yesterday’s [test] (actually it was 223). He has eaten only one egg in the last four weeks; only one piece of cheese. For breakfast he has skim milk, fruit and Sanka. Lunch is practically without cholesterol, unless it would be a piece of cold meat occasionally.” Eisenhower’s last cholesterol test as president came January 19, 1961, his final day in office. “I told him that the cholesterol was 209,” Snyder noted, “when it actually was 259,” a level that physicians would come to consider dangerously high.

Eisenhower’s cholesterol hit 259 just six days after University of Minnesota physiologist Ancel Keys made the cover of Time magazine, championing precisely the kind of supposedly heart-healthy diet on which Eisenhower had been losing his battle with cholesterol for five years. It was two weeks later that the American Heart Association—prompted by Keys’s force of will—published its first official endorsement of low-fat, low-cholesterol diets as a means to prevent heart disease. Only on such a diet, Keys insisted, could we lower our cholesterol and our weight and forestall a premature death. “People should know the facts,” Keys told Time. “Then if they want to eat themselves to death, let them.”

Scientists justifiably dislike anecdotal evidence—the experience of a single individual like Eisenhower. Nonetheless, such cases can raise interesting issues. Eisenhower died of heart disease in 1969, age seventy-eight. By then, he’d had another half-dozen heart attacks or, technically speaking, myocardial infarctions. Whether his diet extended his life will never be known. It certainly didn’t lower his cholesterol, and so Eisenhower’s experience raises important questions.

Establishing the dangers of cholesterol in our blood and the benefits of low-fat diets has always been portrayed as a struggle between science and corporate interests. And although it’s true that corporate interests have been potent forces in the public debates over the definition of a healthy diet, the essence of the diet-heart controversy has always been scientific. It took the AHA ten years to give public support to Keys’s hypothesis that heart disease was caused by dietary fat, and closer to thirty years for the rest of the world to follow. There was a time lag because the evidence in support of the hypothesis was ambiguous, and the researchers in the field adamantly disagreed about how to interpret it.