Fat

A third famous clinical trial that is cited again and again is the Finnish Mental Hospital study. I first heard about this study from a top nutrition expert who assured me that it was really “the best possible proof” that saturated fat is unhealthy.

In 1958, researchers seeking to compare a traditional diet high in animal fats to a new one high in polyunsaturated fats selected two mental hospitals near Helsinki. One they called Hospital K and the other, Hospital N. For the first six years of the trial, inmates at Hospital N were fed a diet very high in vegetable fat. Ordinary milk was replaced with an emulsion of soybean oil in skim milk, and butter was replaced by a special margarine high in polyunsaturated fats. The vegetable oil content of the special diet was six times higher than in a normal diet. Meanwhile, inmates of Hospital K ate their regular fare. Then the hospitals swapped, and for the next six years, Hospital K inmates got the special diet while Hospital N returned to their normal one.

In the special-diet group, serum cholesterol went down by 12 percent to 18 percent, and “heart disease was halved.” This is how the study is remembered and is the conclusion that the study directors, Matti Miettinen and Osmo Turpeinen, themselves drew. In a population of middle-aged men, they said, a diet low in saturated fats “exerted a substantial preventive effect upon coronary heart disease.”

But a closer look reveals a different picture. Heart disease incidence (which the investigators defined as deaths plus heart attacks) did go down dramatically for the men at Hospital N: there were sixteen such cases among men on the normal diet compared to only four on the special diet. But the difference found in Hospital K was not significant. Nor was any difference observed among the women. The biggest problem with the study, however, was that, like the subjects in the LA Veterans Trial, its population was a moving target. With admissions and discharges over the years, the composition of the groups changed by half. A shifting population means that an inmate in the group who died of a heart attack might have been admitted three days earlier and the death would have had nothing to do with his diet; and, vice versa, a patient who was released might have died soon thereafter but would not have been recorded in the study.

This and other design problems were so great that two high-level NIH officials together with a professor at George Washington University felt moved to criticize the study in a letter to The Lancet asserting that the authors’ conclusions were too statistically weak to be used as any kind of evidence for the diet-heart hypothesis. Miettinen and Turpeinen acknowledged that their study design was “not ideal,” including the fact that the study population was far from stable, but asserted in their defense that a perfect trial would be “so elaborate and costly . . . [that it] may perhaps never be performed.” Their imperfect trial, meanwhile, would have to stand: “we do not see any reason to change or modify our conclusions,” they wrote. The research community accepted this “good-enough” reasoning, and the Finnish Mental Hospital study earned a spot as one of the linchpins of evidence for the diet-heart hypothesis.

Nina Teicholz - Page 77

The Author, Richard Mackarness, was the doctor who ran Britain's first obesity and food allergy clinic. The book merges anecdotal observations from this clinic with a comprehensive review of all medical evidence throughout the world up to the mid-1970s. In the 1975 edition, this includes a historical analysis of diets from Harvey-Banting to Robert Atkins and Herman Taller, and features the work of Blake Donaldson, Vilhjalmur Stefansson and Alfred Pennington, who all promoted an Inuit-style meat-only diet. Mackarness extols the virtues of Pemmican, discusses food allergies, examines carbohydrate addiction and touches on related psychology.

Mackarness's philosophy has three main features:-

• A person's metabolism falls into one of two distinctive types, the constant-weight always-slim type, and the fatten-easily type.

• Weight gained by people in the latter group is due to an inability to break down carbohydrates fully because of a metabolic defect, and not as the public at large believe, because of weak-willed gluttony.

• Man's problems with obesity began 8,000 years ago, with the advent of cereal planting. For 4 million years before that, man was a hunter who survived by killing and eating meat, which has led to complete biological adaptation to a meat diet, but not to a cereal diet, because it is too recent.

WE TRAVELED FROM NOWHERE TO NOWHERE IN A WORLD ALL WHITE, eleven dogs, a long sled, a fur-clad Inuk and I. We had spent a week at the floe edge, the limit of landfast ice, and the hunting had been good. Jes had shot and harpooned eight seals. We had eaten well and our sled was heavy with meat - food for his family and dogs - and with seal pelts he would sell at the store. 

We felt the coming of the storm. The air was still and oppressive. Gulls, screaming, flew toward the distant land. The sky turned leaden black. We should have left hours ago. But a pod of narwhals was feeding close to the floe edge; the eerie stillness was filled with the plosive "pooff," "pooff," "pooff" of their breathing. Small plumes of exhaled breath hung briefly in the icy air, and a few times we saw the gleaming ivory tusks of the males. 

Jes wanted a whale. His entire hunter's spirit was focused on those whales, wishing them closer, closer. He was the perfect predator, quietly poised in total concentration, the ultimate Arctic hunter, as his people had been since the dawn of time. The whale meant food and life and glory, the primal thrill of being, and at that moment nothing else mattered. 

While Jes's soul was in that strange mystic sphere that links the hunter to his prey, I sat apart and nursed my white man's worries. I had spent far too many years in the Arctic not to know that the coming storm would be hell, the trip home utter misery and, if the ice broke up, exceedingly dangerous. It was 60 miles (96 km) back to the village. 

The storm struck, and Jes did not get his whale. He rose slowly, reluctantly. The tension seeped out of him and then he smiled a marvelously boyish smile, shrugged, and said: "Ayornamat. (It can't be helped.)" An Inuk does not rant and rave; his language has no swearwords. He does not rail against God or Nature, but simply accepts adversity. He does his best; the rest is fate. 

We lashed the load upon the long pliant sled with utmost care, passing the bearded-seal thong back and forth, pulling it tight with all our strength. Jes called to the dogs. Normally they would have leapt into a joyous gallop. Now they moved without enthusiasm, their tails, usually cockily curled, drooping sadly. Like me, they feared the storm. 

At first, brief lulls alternated with vicious gusts. Then the storm became steady and we traveled into a hissing, roaring avalanche of snow. The dogs hated it. The wind-lashed ice spicules hurt their eyes, and they tried to veer away from the wind. Jes beat them, coaxed them, directed them. There was only snow, the screaming wind, and nothingness; we seemed suspended in time and space. But Jes was guided by sastrugi, snow ripples created by prevailing winds, and by the knowledge of a thousand trips since he had first gone to the floe edge as a small boy with his father. 

We traveled for hours, our faces seared by the wind, our fur clothing plastered with snow. The ice changed, became rugged, hummocky. We were in a tidal zone, close to a coast. For a moment I saw a cliff and then it vanished again in the whirling white. Jes walked ahead now, leading the dogs through a maze of ice blocks. Near the base of the cliff he tied the dogs securely to a stone upon the ice. "Come," he said. We clambered up an incline, perhaps a beach in summertime, walked past a house-high rock, squeezed through a triangular hole between the rock and the cliff, and were suddenly in a spacious cave. Jes laughed, delighted by my amazement, the magician who has performed the perfect trick. 

Jes unharnessed and tethered the dogs, then cut up a seal and fed them. They rolled into balls, noses tucked under bushy tails, and soon the snow covered them with an insulating blanket. I lugged our sled load into the cave, shook the snow out of the bedding furs and my clothing, and made supper: a big pot of seal meat boiled on a Primus stove. 

After the elemental chaos of the storm, the cave felt calm and secure. It had obviously served as sanctuary to other Arctic hunters for hundreds, perhaps thousands of years. In the back were low sleeping platforms of pebbles and flat stones. Soot streaks along the walls and roof showed where seal-oil lamps had burned and flared. The cave floor was scattered with bones, remnants of past meals. Bone, stone, and ivory shavings and splinters marked places where men had sat and made or repaired tools or hunting weapons, and broken toys spoke of children who had once played in the cave. 

We ate the steaming seal meat; drank the fat, scalding broth; and glowed with marvelous warmth. Jes made tea, boiled it until it was coffee-black, and we drank it syrupy-thick with sugar. We were safe, warm, full of food, relaxed and utterly content. Long, long ago, said Jes, Tunit had lived in this cave, a giant people but stupid, and the Inuit had killed them. His stories - part myths, part ancient oral history - - spanned the ages. The Primus hissed, and outside roared the storm. 

We spread our furs on the ancient sleeping platforms and, minutes later, his deep, even breathing told me that Jes was sound asleep. Cozy in my furry cocoon, I looked at the soot patterns on the cave wall, listened to the eldritch screeching of the storm, and thought sleepily about my other life: our pleasant, book-filled home in Montreal; my wife; our children. It was early May. Maud would be working in the garden. The boys should be home from school. The first tulips would be blooming. As I drifted off to sleep, it seemed part of a dream.

"These studies, like those of SHAPER among the Samburu and of GSELL AND MAYER among the mountain Swiss show no support for the contention that a large intake of dairy fat and meat necessarily causes either hypercholesterolemia or coronary heart disease. Indeed, if such dietary habits are causes of hypercholesterolemia, atherosclerosis and clinical cardiovascular disease, one must invoke overriding protective mechanisms among the Masai. It cannot be a failure to reach the susceptible age. We should have found coronary heart disease among the 233 Masai men examined who were 30 years or over if the prevalence rate is near that of American men."

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Summary

A field survey of 400 Masai men and additional women and children in Tanganyika indicates little or no clinical or chemical evidence for atherosclerosis. Despite a long continued diet of exclusively meat and milk the men have low levels of serum cholesterol and no evidence for arteriosclerotic heart disease. The reasons for this disagreement with the popular hypothesis relating animal fat intake to coronary disease are examined. The authors concede that some overriding protective mechanism such as freedom from emotional stress or abundance of physical exercise may be present. They favor the conclusion that diet fat is not responsible for coronary disease.

In 1964, F.W. Lowenstein, a medical officer for the World Health Organization in Geneva, collected every study he could find on men who were virtually free of heart disease, and concluded that their fat consumption varied wildly, from about 7 percent of total calories among Benedictine monks and the Japanese to 65 percent among Somalis. And there was every number in between: Mayans checked in with 26 percent, Phillippines with 14 percent, the Gabonese with 18 percent, and black slaves on the island of St. Kitts with 17 percent. The type of fat also varied dramatically, from cottonseed and seasme oil (vegetable fats) eaten by Buddhist monks to the gallons of milk (all animal fat) drunk by the Masai. Most other groups ate some kind of mixture of vegetable and animal fats. One could only conclude from thees findings that any link between dietary fat and heart disease was, at best, weak and unreliable. 

- Nina Teicholz - The Big Fat Surprise - page 56