HEARTS AND DIETS

Greenberg, Selig

Hearts and Diets by SELIG GREENBERG THE FAT-RICH American diet is emerging more and more out of recent medical research findings as one of the major villains in the alarmingly high incidence in...

...Dietary moderation is as good an insurance as medical science knows of at the moment against the onset of heart disease...
...This, they say, can best be achieved by cutting down rather than by cutting out certain foods altogether...
...In Japan, which has an even lower consumption of dietary fat, the incidence of heart disease is only one-tenth of ours...
...Unsaturated fats include corn, cottonseed and peanut oils, fish oil, and some olive oils...
...Obesity does much of its damage by putting an extra strain on the heart...
...They distinguish between so-called "saturated" and "unsaturated" fats, which seem to act differently in the body...
...It is now generally recognized that arterial disease and its effects on the heart are the result of a complex of factors rather than any single cause...
...Hardening of the arteries—known in its severe form as atheriosclerosis—is the principal cause of heart disease, which annually snuffs out the lives of more than 800,000 Americans, including many thousands of men in their prime of life...
...Why do women, who eat pretty much the same foods as men, possess such a striking immunity...
...Saturated fats are solid at room temperature, while the unsaturated ones are liquid...
...People who are overweight also have more kidney trouble and diabetes and three times as much high blood pressure as do those of average weight...
...This leads to a far higher than normal incidence of heart failure among the obese...
...Cholesterol, the fatty material found to be excessively deposited in the blood vessels of coronary patients, has had its ups and downs in the search for the culprit in heart disease...
...Cutting down on fat also will help reduce your weight, which is one of the most effective practical measures for prolonging life...
...Most animal fats, including butter, are saturated...
...As the lining becomes thickened and hard, it starts to bulge into the artery channel...
...At the age of 50 the American male's chances of dying before 60 are 17 per cent greater than those of the average Englishman, 24 per cent higher than those of the average Italian, and 55 per cent above those of the average Swede...
...Leading authorities feel that the pursuit of these various lines of investigation will clear up the secrets of the mechanism of coronary illness and in the not too distant future pave the way for effective control of the nation's Number One Killer...
...It is nevertheless the opinion of many authorities that the best precaution you can take against developing heart trouble is to reduce the amount of fat in the food you eat...
...There is growing acceptance of the theory that some people are born with a constitutional defect, believed to be hereditary, in the chemical mechanism for metabolizing fat, analogous to the disturbance of sugar metabolism found in diabetics...
...While defective metabolism of fat is now commonly accepted as the root cause of hardening of the arteries, some medical scientists suspect that the degenerative process in the blood vessels which ultimately leads to heart failure may precede, and open the way for, rather than follow the accumulation of cholesterol in the linings of the blood vessels...
...They are exploring the questions of what, exactly, arterial tissue needs to stay in good condition, how it is influenced by defective fat metabolism, and what other causes might lead to the deterioration of blood vessels...
...The heart disease mortality rates rose again to the prewar levels with the return to peacetime diets...
...Experts on nutrition emphasize that in reducing your food intake and the proportion of calories derived from fat, you must be careful that your diet remains well-balanced and retains all of the nutrients essential for health...
...Recognition of the vital importance of the manner in which the body utilizes fat was another reason why the school of thought laying emphasis on the diet went into temporary eclipse...
...2. There appears to be a consistent relationship between the character of a country's diet and the extent to which it is plagued by heart disease...
...In the southern part of Italy, for instance, fat makes up only 20 per cent of food consumption, and the heart disease death rate for men is only one-fourth of that in the United States...
...heart while that vital organ is being operated on...
...But frequently excessive cholesterol in the blood begins to accumulate in the lining of the arterial walls...
...Such individuals are storing fat to an excessive degree instead of using it up in energy, and they also maintain an abnormally high concentration of cholesterol in their blood...
...Nutritional authorities say that the American diet is the fattest in the world...
...An excess of 30 pounds is believed to increase the chances of a person's death by nearly 30 per cent...
...It might also help explain the mechanics of the process whereby the arteries become blocked up...
...But even those scientists who are impressed by the possible role of factors other than fat metabolism in arterial degeneration now generally concede that the most hopeful approach to the prevention of heart disease will probably be provided by a clarification of the manner in which the body's normal utilization of fat is upset and by measures calculated to counteract such disorders...
...The sex differential in coronary mortality has been growing...
...There is reason to believe that diet is only one of the factors in hardening of the arteries and that other mechanisms are implicated in the sclerotic process...
...Some authorities hold that the saturated fats do more harm by raising blood cholesterol readings...
...It has increased fully 20 per cent in the last 20 years among men between the ages of 45 and 60, a trend which accounts for the fact that the life expectancy of the middle-aged American male is considerably lower than that of men of his age in fifteen other countries...
...Hearts and Diets by SELIG GREENBERG THE FAT-RICH American diet is emerging more and more out of recent medical research findings as one of the major villains in the alarmingly high incidence in this country of diseases of the heart and the arteries...
...This does not mean that you should sacrifice good nutrition...
...Some scientists felt— and still do—that the way in which the body builds up and breaks down its deposits of fat and regulates the fat content of the blood plays a far more crucial role in the degeneration of the blood vessels than does the character of the diet...
...They are using heart-lung machines to take over temporarily the work of the SELIG GREENBERG, writer on medical affairs for the Providence Journal and Evening Bulletin, has twice been honored by the Lasker Foundation for distinguished writing on medicine and is the winner of the Associated Press Managing Editors' Association Award for his series of articles on the problems of the aged...
...On the face of it, it is hard to explain away the apparent connection between the high incidence of heart disease in the United States and the high ratio of fat in our diet...
...Coronary mortality is lowest in countries where people get a much smaller proportion of their calories from fats and seems to go up as the fat content of the diet rises...
...Despite the immense complexity of trying to establish why and how metabolic mechanisms go wrong, this approach has cleared away much of the fatalism which once surrounded cardiovascular disease...
...Regardless of whether or not surgical ingenuity will ever be able to tackle successfully this major area of heart disease, the greatest hope of amelioration of the problem lies, first, in the discovery of the causes of atheriosclerosis and, second, in how successful medical science can be in devising effective means of prevention...
...A serious disadvantage here is that while female sex hormones bring down the level of fatty material in the blood, they also have feminizing effects on men...
...In order to reduce the body's blood requirements during such immensely delicate and complex surgery, they frequently chill the patient to a body temperature 10 degrees or more below normal...
...The result has been that the use of saturated fats has increased even more sharply than the overall proportion of fat in the American diet...
...Spectacular advances in heart surgery now make it possible to correct many coronary defects which only a few years ago were often fatal...
...The pendulum has now swung back, however, to the view that the level of cholesterol is clearly influenced by the kind of food we eat...
...Excess fat has to be nourished by miles of tiny blood vessels which must be serviced by the overworked heart...
...This means cutting down on such foods as fatty meats, whole milk, cream, butter, eggs, margarine, salad dressings, and rich gravies and sauces —all of which are rich in cholesterol, the fat-like substance that figures prominently in the plugging of the blood vessels...
...Arterial degeneration is no longer regarded as an inevitable manifestation of aging but to a large degree as the result of an upset in the body's normal ability to handle fatty substances...
...Believed to be involved too are defects in the body's capacity to handle fat, our increasingly sedentary habits, the high prevalence of obesity among Americans, and the tensions of modern life...
...The arteries—the lifelines of our body—normally are soft and elastic, thus allowing all the blood flow the various organs require...
...The an-swer appears to be that female sex hormones provide women with a built-in protective device against heart disease...
...This can be done by eating lean meats and more fish, by leaving visible meat fat on the plate, by restricting egg and whole milk consumption and using more nonfat milk and non-fat cheese, by eating fried foods only occasionally and by foregoing fatty desserts and table spreads...
...And scientists are confident that when the nature of this upset is further clarified, it will be possible to counteract it with chemical means and probably even to prevent it...
...This theory suffered a serious setback when it was discovered that the body manufactures its own cholesterol, regardless of what we eat, a discovery which tended to discredit the notion that there was any direct connection between the amount of fat in a person's diet and the level of cholesterol in his blood...
...The maladies are about two and a half times more prevalent among men than among women in the middle-aged group and account annually for well over 100,000 more male than female deaths in the United States...
...Researchers are trying to develop synthetic female sex hormones from which the undesirable properties will be eliminated...
...The issue of the exact role of diet in cardiovascular illness is still far from settled and remains the subject of lively debate among medical scientists and nutrition experts...
...Because prepared vegetable shortenings are messy to handle in liquid form, manufacturers have increasingly tended to treat them chemically, turning them into saturated fats which look and keep better...
...An intensive search is going on for chemical means of reducing the accumulation of cholesterol in the blood...
...Many researchers regard this as a highly promising field and are hopeful that chemical fat inhibitors— drugs which could be used both as a cure and a preventive for atheriosclerosis—will eventually be developed...
...It not only lowers the fat level of your blood but helps bring down your weight...
...While heart disease rates among women have declined substantially during the past two decades, male mortality from this cause has continued to rise...
...So even if it is assumed that some people have a built-in defect in the manner in which their bodies utilize fat, diet does have an effect on the concentration of cholesterol...
...Surgery aimed at correcting what is by far the most frequent of acquired heart defects—the plugging and scarring of the blood vessels over the years by processes still far from clear—is still a matter for the future...
...Until they pass the child-bearing age, women are far less susceptible than men to coronary conditions...
...It does mean that you should get fewer of your calories from fats...
...Until, and unless, research discloses contrary evidence, the advice of most medical authorities is this: Cut down substantially the amount of fat in your diet...
...They report that in the past 30 years of increasing heart disease the proportion of fat in our diet has risen from 31 to 41 per cent, and there has been an even bigger jump in the consumption of the kind of fats believed to be harmful...
...So are margarine and vegetable shortenings...
...When the character of the fat metabolism is clarified, we will begin to understand why some people tend to be fat and others can eat a lot and still be lean...
...In one way or another, all of these factors are believed to involve a defect in metabolism—the process whereby the body uses food as fuel and building materials to carry on life...
...Much stress is laid by nutritional experts on the advisability of reducing the use of some cooking fats...
...The greatly expanded scope of investigation in the cardiovascular field is producing a picture which is both far more complicated and a lot more hopeful than was thought possible only a few years ago...
...Regardless of whether or not obesity is directly effective in the development of heart disease or merely contributes to its aggravation, there is no question that overweight is a serious hazard to health and shortens life...
...Studies recently conducted in Capetown, South Africa, showed that the native Bantus, who eat very little fat, have a much lower rate of coronary illness than both European South Africans and American Negroes with their much richer diet...
...Women have a much lower fat content of the blood than men, a basic difference that gradually becomes less marked with the dwindling in sex hormone output occurring in women at the time of the menopause, when the female coronary disease rate goes up sharply...
...Discovery of the cholesterol-heart disease relationship at first led to the conclusion that this fatty substance in the blood could be eliminated by abstaining from cholesterolrich foods—eggs, milk, butter, and such organ meats as liver and kidneys...
...Wartime food shortages in these countries forced a reduction in dietary fats, but led to a sharp drop in coronary deaths...
...Frequently cited in support of the theory that the incidence of heart disease is a matter of food habits and not of race is the experience of Norway and Finland during World War II...
...But the preponderance of the available evidence indicates there is a definite relationship between the proportion of fat we consume and the development of coronary sclerosis—the often fatal process by which the blood vessels nourishing the heart muscle are clogged and narrowed...
...Eating less fat can be of dual benefit...
...This not only narrows the arterial tube and obstructs the normal flow of blood to the heart but often leads to the formation of scar tissue as the arterial walls are injured, and to blood clotting and consequent heart attacks and strokes...
...This clue has opened up another promising avenue of experimenta-tion—the administration of female sex hormones to male victims of heart attacks...
...But, for the time being at any rate, heart surgery is confined largely to congenital heart defects and to injuries suffered as a result of such diseases as rheumatic fever...
...No such dis-crepancy exists between American women and women elsewhere...
...Proponents of this view cite these two pieces of evidence: 1. While it is true that the body makes some cholesterol of its own, the accumulation of this fatty chemical in the blood is definitely raised by the excessive consumption of foods rich in fat...
...One of the most significant leads in the investigation of the causes of cardiovascular disease is provided by the marked differential between the sexes in vulnerability to this ailment...
...It does not mean that you should give up such high-fat but nutritionally desirable foods as meat, milk, and eggs...
...Surgeons have learned how to stitch, graft, and rebuild damaged coronary valves and blood vessels...

Vol. 21 • July 1957 • No. 7


 
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