THE (HINA STUDY 118 Angeles He started a study in 1946 (two years before the Framingham Study) to "determine the relationship of dietary fat intake to the incidence of atherosclerosis."22 In his study he instructed fifty heart attack survivors to maintain their normal diet and fifty different heart attack survivors to consume an experimental diet In the experimental diet group he reduced the consumption of fat and cholesterol One of his published sample menus allowed the patient to have only a small amount of meat two times a day: two ounces of "cold roast lamb, lean, with mint jelly" for lunch, and another two ounces of "lean meats" for dinner.22 Even if you loved cold roast lamb with mint jelly, you weren't allowed to eat much of it In fact, the list of prohibited foods in the experimental diet was fairly long and included cream soups, pork, fat meats, animal fats, whole milk, cream, butter, egg yolks and breads and desserts made with butter, whole eggs and whole milk 22 Did this progressive diet accomplish anything? After eight years, only twelve of fifty people eating their normal American diet were alive (24%) In the diet group, twenty-eight people were still alive (56%), almost two and one-half times the amount of survivors in the control group After twelve years, every single patient in the control group was dead In the diet group, however, nineteen people were still alive, a survival rate of 38%.22 While it was unfortunate that so many people in the dietary group still died, it was clear that they were staving off their disease by eating moderately less animal foods and moderately more plant foods (see Chart 5.2) CHART 5.2: SURVIVAL RATE OF DR MORRISON'S PATIENTS 50 0'1 C s;: ~ 40 ::;:J Vl ):a c(1) 30 -+-Diet ~ a '+- _Control 20 ~ 10 E ::;:J z 0 Time (years) 12 BROKEN HEARTS 119 In 1946, when this study began, most scientists believed that heart disease was an inevitable part of aging, and nothing much could be done about it While Morrison didn't cure heart disease, he proved that something as simple as diet could significantly alter its course, even when the disease is so advanced that it has already caused a heart attack Another research group proved much the same thing at about that time A group of doctors in Northern California took a larger group of patients with advanced heart disease and put them on a low-fat, lowcholesterol diet These doctors found that the patients who ate the lowfat, low-cholesterol diet died at a rate four times lower than patients who didn't follow the diet 23 It was now clear that there was hope Heart disease wasn't the inevitable result of old age, and even when a person had advanced disease, a low-fat, low-cholesterol diet could significantly prolong his or her life This was a remarkable advance in our understanding of the number one killer in America Furthermore, this new understanding made diet and other environmental factors the centerpieces of heart disease Any discussion of diet, however, was narrowly focused on fat and cholesterol These two isolated food components became the bad guys We now know that the attention paid to fat and cholesterol was misguided The possibility that no one wanted to consider was that fat and cholesterol were merely indicators of animal food intake For example, look at the relationship between animal protein consumption and heart disease death in men aged fifty-five to fifty-nine across twenty different countries in Chart 5.3.16 This study suggests that the more animal protein you eat, the more heart disease you have In addition, dozens of experimental studies show that feeding rats, rabbits and pigs animal protein (e.g., casein) dramatically raises cholesterol levels, whereas plant protein (e.g., soy protein) dramatically lowers cholesterol levels 24 Studies in humans not only mirror these findings, but show that eating plant protein has even greater power to lower cholesterol levels than reducing fat or cholesterol intake 25 While some of these studies implicating animal protein were conducted in the past thirty years, others were published well over fifty years ago when the health world was first beginning to discuss diet and heart disease Yet somehow animal protein has remained in the shadows while saturated fat and cholesterol have taken the brunt of the criticism These three nutrients (fat, animal protein and cholesterol) characterize 120 2o o THE CHINA STUDY CHART 5.3: HEART DISEASE DEATH RATES FOR MEN AGED 55 TO 59 YEARS AND ANIMAL PROTEIN CONSUMPTION ACROSS 20 COUNTRIESI6 800 o 600 • • • R = 64 • 400 200 Percent of total calories coming from animal protein animal-based food in general So isn't it perfectly reasonable to wonder whether animal-based food , and not just these isolated nutrients, causes heart disease? Of course, no one pointed a finger at animal-based foods in general It would have led immediately to professional isolation and ridicule (for reasons discussed in Part IV) These were contentious times in the nutritional world A conceptual revolution was taking place, and a lot of people didn't like it Even talking about diet was too much for many scientists Preventing heart disease by diet was a threatening idea because it implied that something about the good old meaty American diet was so bad for us that it was destroying our hearts The status quo boys didn't like it One status quo scientist had a good time making fun of people who appeared to have a low risk of heart disease In 1960, he wrote the following piece of "humor" to mock the then-recent findings 26 : Thumbnail Sketch of the Man Least Likely to Have Coronary Heart Disease: An effeminate municipal worker or embalmer, completely lacking in physical and mental alertness and without drive, ambition or competitive spirit who has never attempted to meet a deadline of any kind A man with poor appetite, subsisting on fruit and vegetables laced with corn and whale oils, detesting tobacco, spurning BROKEN HEARTS 121 ownership of radio, TV or motor car, with full head of hair and scrawny and un-athletic in appearance, yet constantly straining his puny muscles by exercise; low in income, B.P (blood pressure), blood sugar, uric acid and cholesterol, who has been taking nicotinic acid, pyridoxine and long term anticoagulant therapy ever since his prophylactic castration The author of this passage might just as well have said, "Only REAL men have heart disease." Also notice how a diet of fruits and vegetables is described as "poor" even though the author suggests that this diet is eaten by those people who are least likely to have heart disease The unfortunate association of meat with physical ability, general manliness, sexual identity and economic wealth all cloud how the status quo scientists viewed food, regardless of the health evidence This view had been passed down from the early protein pioneers described in chapter two Perhaps this author should have met a friend of mine, Chris Campbell (no relation) Chris is a two-time NCAA Division wrestling champion, three-time U.s Senior wrestling champion, two-time Olympic wrestler and Cornell Law School graduate At the age of thirty-seven he became the oldest American ever to win an OlympiC medal in wrestling, weighing in at 198 pounds Chris Campbell is a vegetarian As a man not likely to have heart disease, I think he might disagree with the characterization above The battle between the status quo and the dietary prevention camp was intense I remember attending a lecture at Cornell University during the late 1950s when a famous researcher, Ancel Keys, came to talk about preventing heart disease by diet Some scientists in the audience just shook their heads in disbelief, saying diet can't pOSSibly affect heart disease In those first decades of heart disease research, a heated, personal battle flared , and open-mindedness was the first casualty RECENT HISTORY Today, this epic battle between defenders of the status quo and advocates of diet is as strong as ever But there have been significant changes in the landscape of heart disease How far have we come, and how have we proceeded to fight this disease? Mostly, the status quo has been protected Despite the potential of diet and disease prevention, most of the attention given to heart disease has been on mechanical and chemical intervention for those people who have advanced disease Diet has been 122 THE CHINA STUDY pushed aside Surgery, drugs, electronic devices and new diagnostic tools have stolen the spotlight We now have coronary bypass surgery, where a healthy artery is "pasted" over a diseased artery, thereby bypassing the most dangerous plaque on the artery The ultimate surgery, of course, is the heart transplant, which even utilizes an artificial heart on occasion We also have a procedure that doesn't require cracking the chest plate open, called coronary angioplasty, where a small balloon is inflated in a narrowed, diseased artery, squishing the plaque back against the wall, opening up the passage for increased blood flow We have defibrillators to revive hearts, pacemakers and precise imaging techniques so that we can observe individual arteries without having to expose the heart The past fifty years have truly been a celebration of chemicals and technology (as opposed to diet and prevention) In summarizing the initial widespread research on heart disease, one doctor recently highlighted the mechanical: It was hoped that the strength of science and engineering devel- oped after World War II could be applied to this battle [against heart disease] The enormous advances in mechanical engineering and electronics that had been stimulated by the war seemed to lend themselves particularly well to the study of the cardiovascular system Some great advances have been made, to be sure, which may account for the fact that our death rate from heart disease is a full 58% lower than what it was in 1950 A 58% reduction in the death rate seems a great victory for chemicals and technology One of the greatest strides has come from better emergency room treatment of heart attack victims In 1970, if you were older than Sixty-five years, had a heart attack and were lucky enough to make it to the hospital alive, you had a 38% chance of dying Today, if you make it to the hospital alive, you only have a 15% chance of dying The hospital's emergency response is much better, and consequently huge numbers of lives are being spared In addition, the number of people smoking has steadily been decreasing,27,28 which in turn lowers our death rate from heart disease Between hospital advances, mechanical devices, drug discoveries, lower smoking rates and more surgical options, there clearly seems to be much to cheer about We've made progress, so it seems Or have we? ... saturated fat and cholesterol have taken the brunt of the criticism These three nutrients (fat, animal protein and cholesterol) characterize 120 2o o THE CHINA STUDY CHART 5.3: HEART DISEASE DEATH... healthy artery is "pasted" over a diseased artery, thereby bypassing the most dangerous plaque on the artery The ultimate surgery, of course, is the heart transplant, which even utilizes an artificial... stimulated by the war seemed to lend themselves particularly well to the study of the cardiovascular system Some great advances have been made, to be sure, which may account for the fact that