Good Calories, Bad Calories

The second event that almost assuredly contributed to the appearance of an epidemic, specifically the jump in coronary-heart-disease mortality after 1948, is a particularly poignant one. Cardiologists decided it was time they raised public awareness of the disease. In June 1948, the U.S. Congress passed the National Heart Act, which created the National Heart Institute and the National Heart Council. Until then, government funding for heart-disease research had been virtually nonexistent. The administrators of the new heart institute had to lobby Congress for funds, which required educating congressmen on the nature of heart disease. That, in turn, required communicating the message publicly that heart disease was the number-one killer of Americans. By 1949, the National Heart Institute was allocating $9 million to heart-disease research. By 1960, the institute’s annual research budget had increased sixfold.

The message that heart disease is a killer was brought to the public forcefully by the American Heart Association. The association had been founded in 1924 as “a private organization of doctors,” and it remained that way for two decades. In 1945, charitable contributions to the AHA totaled $100,000. That same year, the other fourteen principal health agencies raised $58 million. The National Foundation for Infantile Paralysis alone raised $16.5 million. Under the guidance of Rome Betts, a former fund-raiser for the American Bible Society, AHA administrators set out to compete in raising research funds.

In 1948, the AHA re-established itself as a national volunteer health agency, hired a public-relations agency, and held its first nationwide fund-raising campaign, aided by thousands of volunteers, including Ed Sullivan, Milton Berle, and Maurice Chevalier. The AHA hosted Heart Night at the Copacabana. It organized variety and fashion shows, quiz programs, auctions, and collections at movie theaters and drugstores. The second week in February was proclaimed National Heart Week. AHA volunteers lobbied the press to alert the public to the heart-disease scourge, and mailed off publicity brochures that included news releases, editorials, and entire radio scripts. Newspaper and magazine articles proclaiming heart disease the number-one killer suddenly appeared everywhere. In 1949, the campaign raised nearly $3 million for research. By January 1961, when Ancel Keys appeared on the cover of Time and the AHA officially alerted the nation to the dangers of dietary fat, the association had invested over $35 million in research alone, and coronary heart disease was now widely recognized as the “great epidemic of the twentieth century.”

Over the years, compelling arguments dismissing a heart-disease epidemic, like the 1957 AHA report, have been published repeatedly in medical journals. They were ignored, however, not refuted. David Kritchevsky, who wrote the first textbook on cholesterol, published in 1958, called such articles “unobserved publications”: “They don’t fit the dogma and so they get ignored and are never cited.” Thus, the rise and fall of the coronary-heart-disease epidemic is still considered a matter of unimpeachable fact by those who insist dietary fat is the culprit. The likelihood that the epidemic was a mirage is not a subject for discussion.

“The present high level of fat in the American diet did not always prevail,” wrote Ancel Keys in 1953, “and this fact may not be unrelated to the indication that coronary disease is increasing in this country.” This is the second myth essential to the dietary-fat hypothesis—the changing-American-diet story. In 1977, when Senator George McGovern announced publication of the first Dietary Goals for the United States, this is the reasoning he evoked: “The simple fact is that our diets have changed radically within the last fifty years, with great and often very harmful effects on our health.” Michael Jacobson, director of the influential Center for Science in the Public Interest, enshrined this logic in a 1978 pamphlet entitled The Changing American Diet, and Jane Brody of the New York Times employed it in her best-selling 1985 Good Food Book. “Within this century,” Brody wrote, “the diet of the average American has undergone a radical shift away from plant-based foods such as grains, beans and peas, nuts, potatoes, and other vegetables and fruits and toward foods derived from animals—meat, fish, poultry, eggs, and dairy products.” That this changing American diet went along with the appearance of a great American heart-disease epidemic underpinned the argument that meat, dairy products, and other sources of animal fats had to be minimized in a healthy diet.