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Jordan Tackett
Honors Core IV: Doug
April 7, 2015
Seven Countries, Six Decades and Five-Year Intervals: Dietary Guidelines
In 1955, President Dwight D. Eisenhower suffered a massive heart
attack. In less than six months, his entire diet was overhauled: fruits and
green vegetables replaced steaks and potatoes and he was limited to a
single egg each day (Taubes 4). By the Sunday after the attack, Harvard
cardiologist and American Heart Association founder Paul Dudley White was
called in to treat the president. The next day, Dr. White gave a televised
press conference. In this presentation, he stressed the dangers and causes of
heart disease, including smoking, stress, cholesterol and saturated fat. Two
other key factors for risk were carrying the XY chromosome, and having lived
more into the period known as middle age, 40 and 65 (dictionary.com;
Taubes 3).
A relatively large demographic in the mid-20th century, middle-aged
men compromised almost all CEOs, politicians, doctors, presidents, bankers,
and property holders. For six weeks after the presidents heart attack, Dr.
White held twice-daily conferences on Eisenhowers condition, consistently
lecturing on the points of risk. By the time the six weeks was up, most
Americans had been informed of the risks and had began to take action
(Taubes 4). Understandably, there were those who had their doubts. Where

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was the science to back up the fact that something as staple as meat and
potatoes could be killing them?
White used his public platform to write for other publications. For the
New York Times, Dr. White wrote a guest article about the condition of
President Eisenhower. In it, he outlines the possible risk factors including
race (too little data to make a conclusion), age (coronary thrombosis
increases in frequency as age increases), sex (males), body build
(mesomorph is more likely to develop the disease), personality (the
intensive, overactive, and ambitious person[s]) and heredity (seems to be
a definite factor, in part at least). He suggested exercise as an antidote. He
made remarks about the make-up of the American diet. He argued for more
funds for research (White). Yet, the most notable thing that Dr. White did was
name exactly one scientist, in the midst of all of this information: Ancel Keys.
Ancel Keys was born a naturally intelligent person. Keys spent most of
his childhood in Berkeley, California, with both of his parents. From an early
age, his notably high intelligence made him the subject of the Lewis Terman
Studies of Genius at (done by Terman, who is responsible for the current form
of the Stanford-Binet IQ Tests). Before finishing high school, Keys would hitch
hike to Arizona to sweep bat dung, work in a coal mine in Colorado, and haul
wood in a lumbar yard (Tucker 14-15). During his unique experiences, he
learned the value of a college degree. Working with his hands kept him in
shape as a young man, but demonstrated to him that a life in science was
preferable.

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After graduation, young Keys made his way to the University of
California, Berkeley. In his second year, Keys lost out against another (and in
Keys mind, less qualified) student. Stinging from a loss in competition for a
scholarship, Keys decided his new goal was to graduate school as quickly as
possible. Changing his major to economics and political science, Keys took
summer classes and graduated within a couple of years.
Keys went on to earn his Masters degree in Zoology in an astonishing
six months, despite never before having had a biology course. Keys was then
invited to work at the Scripps Institution on the beach at La Jolla, California
(Tucker 18). While living on the beach, Keys wrote a paper The Weight
Length Relation in Fishes in which he stated that a fishs weight was not
directly related to its length. This statement disproved the previously held
belief that they two were directly related. He carefully quantified every
aspect of the study, and took his paper back to Berkeley and ultimately
earned his first doctorate degree. It had taken him only three years. This kind
of success accompanied by a quick turnaround would be synonymous with
the rest of Keys career. Success was not only success, it was a confirmation
that he was Gods gift to science.
Next for Ancel Keys was an invitation by the National Research Council
to take a post-doctorate fellowship to study in Copenhagen. Under Nobel
Prize Winner Dr. August Krogh, Keys studied salinity in eel gills (Tucker 18).
While virtually unrelated to his other interests, Keys showed exemplary
perseverance in his study, which required him to build a syringe to measure

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the salinity of the water the eels thrived in, and was rewarded with the
publication of his first paper in the Journal of Biochemistry. Following his
successes, Krogh set up a fellowship at Cambridge with Professor Joseph
Barcroft. At Cambridge, Keys earned his second doctorate degree in
physiology. His means of earning this degree were far from normal, as by he
gained this degree without writing a thesis, taking any examinations, and
without spending any money besides the funds for the graduation ceremony
itself (Tucker 19). This means of acquiring accolades through politics and
favors would become a common method for Keys in his future research for
nutrition.
In another two years, Keys returned to Harvard and began designing a
detailed study about the affects of altitude on human physiology. He was
inspired by Barcrofts altitude studies, as well as his own tenacity and desire
to be the most noteworthy. Keys ultimately picked Quilche which, at 17,500
feet above sea level, was the highest known human-inhabited establishment.
The trip took about 10 days. In 1933, Keys own blood became the only
arterial blood sample collected at 20,000 feet above sea level (Tucker, 24).
The results showed the bodys ability to adapt to an environment, including
blood pressure, which had previously been believed to be a stable number,
particular to the person. When the collection was complete, and the study
written and published, Keys went back to Harvard. He was completely
enamored with human physiology by this point. He stayed only until an offer
from the Mayo Clinic in Minnesota called. He arrived in Rochester in July of

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1937. While he stayed at the Clinic less than a year, he met and married his
second wife, Margaret, who would stay by his side during both studies and
personal time for the rest of his life (Tucker, 25). The pair stayed in
Minnesota, her home state, and took up a position establishing a
preventative school of medicinal studies at the University of Minnesota.
None could say at this point that Ancel Keys was anything other than
tenacious. One of his colleagues from Minnesota described Keys as direct to
the point of bluntness, critical to the point of skewering, and possessing a
very quick, bright intelligence (Teicholz 20). His new laboratory was
founded on the ideology of the exact measurement of human function and
the factors affecting human performance and behavior (Keys Notes). It
was here that Ancel Keys was first approached by the military to create more
portable rations that allow soldiers to be properly energized for War. The
total days meals contained 3,200 kcal, and weighed only 28 ounces (Reed).
Three separate meals for each day along with some other items like
cigarettes and toilet paper were able to be stored in paratroopers pockets. In
its best year, 1944, the army procured more than 105 million K rations
(Tucker, 31). Keys made many friends within government throughout this
project, leading to even more stability in his career.
By 1944, Keys was feeling settled in Minnesota. His work with the army
had continued, and he was well rewarded. He attended monthly meetings in
Washington, D.C. as special assistant to the secretary of war, which likely
was satisfying his adventuresome side. He and his wife now had two

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children, Caroline, and Henry (Tucker, 35). Keys was getting regular projects
from the Army. Life was stable, inside of the Keys home, while the rest of the
world was still reeling from the Second World War. It was from the influx of
information from the war that Keys first hypothesized a connection between
nutrition and heart disease.
According to the U.S. Public Health Service, Major cardiovascular
disease was responsible for 510.8 deaths per 100,000-population size.
While this number seems low, it was four times higher than the next leading
cause of death, cancer (Pearson education). In the Netherlands, however, the
war-torn and starving citizens had seen dropping rates of heart disease. Keys
found this information fascinating, and unsurprisingly ended up
revolutionizing the field of heart health, much to the misfortune of the
American public.
Up to this point, the best understanding of heart disease was from late
nineteenth century studies that had found cholesterol to be the prime base
for artery plaques (Teicholz 21). Cholesterol can be found in all body tissues,
is created in the liver, metabolizes sex hormones, and is most concentrated
in the brain. It is a kind of acidic alcohol, despite its waxy appearance. The
late 1940s provided only serum cholesterol as a measurement for
cholesterol levels, pulled and measured straight from blood samples (Teicholz
22).
Keys began his investigative trek in Minneapolis. He took blood
pressure measurements, weight measurements, documented self-reported

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family histories, urinalysis, blood samples, and ECGs (University of
Minnesota). The final number of participants was 281. The physicals were
performed every year for fifteen years, and then again in 1983. From 1948 to
1963, 32 deaths were reported, 17 of which were connected to coronary
heart disease. At the 35-year follow up, 183 subjects had died, 110 were
alive, and one could not be located (University of Minnesota). Keys
concluded, Entry body fatness, indicated by body mass index, skinfold
thickness at three sites, relative girth, and body density did not differ
significantly among 35-year dead from the living when analyzed in multiple
regression(University of Minnesota). Keys and his researchers did find that
factors increasing risk of cardiovascular difficulties included high blood
pressure, and high body weight. One of the studys biggest faults was cited
as being its low generability to a larger population: The 281 males were all
of high-socioeconomic status and thus well fed. Most of these results were
not gathered until after Eisenhowers heart attack, further displaying Keys
recommendations were more speculation that evidence.
Keys was satisfied with his results, but turned his eyes on bigger fish.
He sought countries outside of the U.S. to study the rates and causes of
heart disease. Finland and Japan were chosen as the two extremes of the
scale (Keys Adventures). The Finnish were observed to have meals when
butter would be put on cheese. They had a death rate caused by
cardiovascular disease was 992 for every 10,000. The Japanese were known
to consume rice and fish. The latters diet was virtually devoid of saturated

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fats. Their death rate caused by cardiovascular disease was a mere 66 per
10,000. For reference, the United States rate was 570 deaths per 10,000.
From so humble a beginning, Ancel Keys began the studies that would define
his career, and the diet-heart debate.
1953 brought about the beginning of the end for dietary fat. Ancel Keys
published Atherosclerosis: A Problem in Newer Public Heath in the Journal
of Mt. Sinai Hospital. Keys gathered information on fat intake next to heart
disease mortality. In a single graph, he then showed rates of degenerative
heart disease 1948-1949 in men (Evelyn). He compared percentage of fat
calories in the total diet and deaths per 1,000 due to degenerative heart
disease. At the top, the U.S. 55-59 with 40% fat calories, and just shy of 7
deaths per 1,000. At the bottom, Japan, in the same age group with only
about .5 deaths per 1,000 due to degenerative heart disease. It shows the
data to be strongly polarizing, both between number of deaths, and age
groups. The 45-49 age range in the U.S. only had a 2 per 1,000 death rate
(Keys, Atherosclerosis). Keys claimed that No other variable in the mode of
life besides the fat calories in the diet is known which shows anything like
such a consistent relationship to the mortality rate from coronary or
degenerative heart disease (Keys, Atherosclerosis).
For the Seven Countries Study, Keys and his companions gathered
preliminary information on 16 countries, including almost 12,770 middleaged men (between 40 and 59) (Taubes 31). He wanted populations who
would strongly differ in diet and heart disease risk so that he could find

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meaningful relationships between the two variables. Launched in 1956, the
study mirrored the Minneapolis Business Men study in that when the men
signed up, they were given a physical examination. Every five years
following, the process was repeated. As they took in new information, Keys
continued publishing results. At one point, he co-wrote a cookbook called Eat
Well and Stay Well with his wife that limited fats (Tucker 209). Most of his
findings supported his theory about cholesterol levels and fat intake. Keys
first published the first full set of results of the study in 1970, which were
published by the American Heart Association. The researchers had measured
body weight, blood pressure, and cholesterol as well as having the men fill
out a survey considering diet and smoking (Teicholz 38). A few were chosen
to give samples of their weekly meals for lab testing.
The Seven Countries study is a controversial one, and the first of many
concerning the diet-heart hypothesis. However, it was clear on a few points.
The study clarified the fact that, due to such strikingly different rates of heart
disease mortality, heart attacks were not a natural part if aging past 50, and
that type of fat mattered more than overall fat (Teicholz 39). It seemed that
both sugar and saturated fat content of food seemed to predict heart disease
(Taubes 120). It was an enormous test, so far the largest done in nutrition.
Problems were hard to find, but were certainly there. Within countries,
Keys data was much less definitive about its results concerning cause of
mortality, and when countries such as France added into the studies,
association became marginally significant, if even that (Teicholz 39). County-

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to-country studies in Europe have shown that women with highest fat intake
are the least likely to be obese. Essentially there is no correlation between
fat intake and obesity (Hilleboe, Yerushalmy). One of the three food logs
from Crete occurred during Lent, which means that the amounts of animal
meats consumed would have nearly halved (Teicholz, 40). And finally, most
fatally, all of the information was gathered, not influenced or controlled. It
could show that two independent variables occurred in tandem, but could not
prove causation.
During the course of the Seven Countries Study, Keys stayed busy. The
American Heart Association had received funding and established a nutrition
committee. The association was feeling the pressure from the suffering
people of the U.S. to do something. Again, the Presidents heart attack was
fresh in the minds of citizens, and doctors were pressing for
recommendations. In the late 1950s that committee was asked to develop
some advice for the general public. Their response was not exactly expected.
Essentially, the evidence, in their eyes, was not definitive enough to say one
way or another how the American diet could change to prevent
cardiovascular deaths (Teicholz 49).
Then, in 1961, everything fell into place. Ancel Keys appeared on the
cover of Time magazine. In the accompanying article, Keys describes the
faults with America: they eat too much, and they eat too much fat. [Keys]
regards the cause-and-effect relationship between cholesterol and heart
disease as proved (The Fat of the Land). He prescribed lowering the

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average fat intake from 40% to a tiny 15% of total calories eaten. Also in
1961, the American Heart Association committee, chaired by both Ancel Keys
and his good friend Joseph Stamler, passed a policy recommending a
prudent diet, one that was low in saturated fat and cholesterol from animal
products specifically (Pollan 22). The position on the committee created an
invaluable position for Keys hypothesis. For the next 10 years, they would be
the reference for doctors prescribing diets for those who had, or were at risk
for heart disease. It was also the first official promotion of the hypothesis.
Still, there were those who were unsure about the theory, but with the
backing of such a prominent group, many chose not to question it.
Some of those brave enough to publish their disagreements included
Jacob Yuralshami, Jean Mayer, and Pete Ahrens. Jacob published a paper in
1957 to show that sugar was a contributing factor to heart disease, and also
implied that the so-called French paradox did not only apply to the French.
The initial graph that had made Keys famous by showing a correlation
between fat and diet was used as a starting point, then had 16 other
countries plotted, significantly decreasing the perceived relationship
(Yerushalmy graph). Jean Mayer ran a column that reached an estimated 35
million people each week. He was credited with calling the low-carbohydrate
diet mass murder (Teicholz,52). Finally, Pete Ahrens, who had an actual
medical degree, was the most outspoken. He conducted many studies on the
effects of cholesterol, ultimately determining that when dietary cholesterol
increased, the body could compensate by lowering the amount it produced

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naturally (McCaubrey). He also demonstrated the wide variations in how
different people metabolize cholesterol, and likely most foods. His largest
complaint with science of the day was the practice of making wide, vague
dietary recommendations. Later, Ahrens was quoted as saying that such
practices were essentially treating the citizens as ''a homogeneous group of
Sprague-Dawley rats. (McCaubrey). Though many more had their doubts,
Keys was unwilling to relent. Whenever questioned, or accused of faulty
advice, he replied, I have 5,000 cases. How many do you have? (Fat of the
Land).
The true irony was that Keys himself did not necessarily follow his own
advice. Keys drank skim milk, which at that time still contained 2% butterfat
(Fat of the Land). When asked about his own diet, which included steak,
chops, and roast around three times a week, said, Nobody wants to live on
mush. When speaking about other people, he said, People should know the
facts. Then if they want to eat themselves to death, let them. (Fat of the
Land) It was this sort of thinking, this disdain for other people, and idea that
he was an exception that made him unpopular as a person, despite his
influence in the right circles.
The biggest form of criticism for Keys came from the Framingham
Heart Study. The study involved the small town of Framingham,
Massachusetts was the largest attempt to correlate other habits, such as
smoking, with heart disease. For a period of two years, George Mann
collected and calculated food consumption data from some one thousand

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subjects. His results showed that there was virtually no relation between
saturated fat and heart disease. So why wasnt the information released?
[The National Institute of Health] wouldnt allow us to publish the data
Mann said (Teicholz 66). It would not be until 1992 that another Framingham
leader would admit that saturated fat had actually lowered total cholesterol
in the blood and had actually also shown relation to persons who weighed
the least (Teicholz 67).
The American Heart Association and National Institute for Health were
cohorts, and dominated the research funds, not from lobbying entities, at the
time. Run by the nutrition elite, such as Paul White, Ancel Keys, and Joseph
Stamler, the two groups continually funded research to prove Keys
hypothesis. For every million dollars spent trying to prove the theory, and
every administrative ruling to not report findings, the more difficult it
became to oppose the theory. Manns own dissention cost him a longtime
research grant. Every researcher like him found it more and more difficult to
fund their research of opposition (Teicholz 169). By 1977, the politics were
once again called upon to settle the score. A spike in chronic disease had
spread among the public, and action was needed to begin making
recommendations for the public as a whole. The Senate Select Committee on
Nutrition and Human Needs was chaired by Senator George McGovern, and
had been created in 1968 to solve the problem of malnutrition in America.
The committee staff was largely formed of lawyers and ex-journalists (Taubes
45). Over a period of two days in 1976, the committee held a hearing for

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The Killer Diseases. They heard from a variety of voices. To some degree or
another, each person agreed on a laundry list of issues. The list included
suggestions that Americans should eat less, move more, eat less fat and
sugar, eat more fruits and vegetables, and cereal products. The report, called
the Dietary Goals for the United States represented hopes for a common
voice and recommendation. It was the first time a strictly government
organization had chimed in.
Since then, the government has published Dietary guidelines every 5
years. Whenever a leader within the publishing committee tries to move the
fat guideline, such as Ronald Krauss did as head of the American Heart
Association nutrition committee in the early 2000s. He raised the fat
recommendation to 10%, still moderately low for the population. As soon as
he stepped down in 2006 though, his successor brought them back down to
5-6%, much lower than even Keys himself and prescribed (Teicholz 320).

April of 1961 was a difficult one for President Eisenhower. By then, his
personal doctor, Dr. Howard Snyder had begun lying to the president about
his cholesterol levels. The president had been dieting religiously, a low diet,
of the kind that Paul Dudley White and Ancel Keys prescribed, since his first
heart attack in 1955 (Teicholz 20). Just a few days before Keys graced the
cover of Time to promote his diet, President Eisenhowers cholesterol levels
were at an amazing 259. The American Heart Association currently says that
any score higher than 240 is at a level more than twice the desired levels

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(American Heart Association). After 14 years of following the Keys diet, and
nearly half a dozen other myocardial incidents, President Dwight Eisenhower
died of heart disease in 1969, age 78.

References
American Heart Association. "What Do My Cholesterol Levels Mean?" (2012):
n. pag. American Heart Association. American Heart Association. Web.
3 Apr. 2015
The Fat of the Land." Time 77.34 (1961): 48-56. Academic Search Premier.
Web. 15 Mar. 2015.
Evelyn. "The Truth About Ancel Keys: We've All Got It Wrong." Raw Food SOS.
N.p., 22 Dec. 2011. Web. 06 Apr. 2015.
Hegsted, Mark. "Washington Dietary Guidelines." (n.d.): n. pag. Food Politics:
Washington Dietary Guidelines. Food Politics. Web. 5 Apr. 2015.
Keys, Ancel. Adventures of a Medical Scientist: Sixty Years of Research in
Thirteen Countries. 1999. Print.
Keys, Ancel. Atherosclerosis: A Problem in Newer Public Health. Journal of
Mt. Sinai Hospital, New York 20, no 2. p134.
Keys, Ancel. Notes on the Laboratory of Physiological Hygiene, University of
Minnesota, Minneapolis. February 9th, 1945.." (n.d.): 69. Web. 5 Apr.
2015.
Mccoubrey, Carmel. "Edward Ahrens Cholestrol Researcher, Is Dead at 85."
The New York Times. The New York Times, 15 Dec. 2000. Web. 06 Apr.

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2015.
"Middle-Aged." Dictionary.com. Dictionary.com, n.d. Web. 06 Apr. 2015.
Pearson Education. "Death Rates by Cause of Death: 1900 -2011."
Infoplease. Infoplease, 2011. Web. 06 Apr. 2015.
Reed, Christopher. "Obituary: Ancel Keys." The Guardian (2004): n. pag. Web.
4 Jan. 2015.
Teicholz, Nina. The Big Fat Surprise: Why Butter, Meat, and Cheese Belong in
a Healthy Diet. New York, NY: Simon and Schuester Paperbacks, 2014.
Print.
Tobey, James A. "The Biology of Human Starvation." American Journal of
Public Health and the Nations Health 41.2 (1951): 236-37. Web. 4 Apr.
2014.
Tucker, Todd. The Great Starvation Experiment: The Heroic Men Who Starved
so That Millions Could Live. New York, NY: Free, 2006. Print.
"Ancel Keys, 100; Diet Researcher Developed K-Rations for Troops." Los
Angeles Times. Los Angeles Times, 25 Nov. 2004. Web. 06 Apr. 2015.
University of Minnesota. "Minnesota Business and Professional Mens Study."
Heart Attack Prevention. University of Minnesota, 15 Oct. 2012. Web.
06 Apr. 2015.
White, Paul. "Heart Ills and Presidency: Dr. White's Views." New York Times 30
Oct. 1955: n. pag. Print.

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Yerushalmy, J and Herman E. Hilleboe, Fat in the Diet and Mortality from
Heart Disease: A Methodology Note, New York State Journal of
Medicine 57, number 14 (July 1957).