Fats & Heart Disease

"No prudent person who has had, or wishes to avoid, coronary heart disease should eat a high-fat diet of the type consumed by most Americans." So said Manhattan's famed Nutritionist Norman Jolliffe before New York's Orange County Heart Association this week. "This applies to all races and occupations, to the physically active and to the sedentary ... to the chain-smoking, tense, ambitious executive and to ... the satisfied, relaxed barkeeper."

A mere five years ago, Dr. Jolliffe pointed out, medical scientists were still asking whether fats in the diet had anything to do with coronary disease. Now they have answered that question with a fairly firm yes, and gone on to more precise questions such as "how great is the effect of fats in the diet?"

Eskimos & Bantu. This advance in knowledge of the relationship between diet and heart disease has been based on the highly advertised facts that in most heart-attack victims 1) blood carries an excess of fat compounds called beta-lipoproteins, which contain cholesterol (a fatty alcohol); and 2) the coronary arteries are usually lined with cholesterol. While the body makes some cholesterol of its own, the amount in fatty foods seems to be important. For a while it was thought that there was a significant difference between animal and vegetable fats. The countries where coronary disease is the No. 1 killer (the U.S., Britain, Canada, Australia and New Zealand) consume much animal fat, but people among whom the disease is rare (southern Italians, Asians, African natives) eat little animal fat, far more vegetable oils.

So far, so good. But a young British medical researcher at the University of Cape Town, Dr. Brian Bronte-Stewart, kept asking himself: "What about the Eskimos?" Although they eat lots of animal fat, such as seal oil, they have one of the world's lowest coronary disease rates. Dr. Bronte-Stewart was carrying on diet experiments with the Bantu; there were no Eskimos handy for him to test in South Africa. But there were seals around the South African coast, so why not feed the Eskimo staple--seal oil--to the Bantu? Bronte-Stewart tried it, and found that the oil acted as a kind of cholesterol depressor. After a high-fat diet--ten eggs a day--the Bantu's blood cholesterol rose sharply, dropped again when seal oil was added to the food. But Bronte-Stewart had already noted the same effect from sunflower-seed oil. Evidently, the dividing line between fats that raise blood cholesterol and fats that don't was not simply animal v. vegetable. What was it?

Fats are divided into two main groups; most oils from vegetables, fish and marine mammals are "unsaturated," i.e., their molecular structure is such that there is room for some extra hydrogen atoms. Most animal fats (including butter and egg yolks) are "saturated." It is Bronte-Stewart's and Jolliffe's theory that saturated fats help raise cholesterol levels while unsaturated fats help lower them.

Saturated or Not? Two significant changes have taken place in the average U.S. diet in the last 30 years, says Jolliffe: the proportion of fat has gone up from 31% to 41%, and the proportion of saturated to unsaturated fats has increased still more sharply. This is because unsaturated fats (corn, cottonseed and peanut oils and some olive oils) are usually liquid at room temperature, so they are messier than the solid saturated fats (lard, suet, butter). As a result, manufacturers of shortening usually hydrogenate their unsaturated fats--by adding a couple of hydrogen atoms under heat and pressure. This turns part of the unsaturated fats into saturated fats, which look better, smell better and keep better.

Jolliffe's startling conclusion: "Stress and strain, physical indolence, obesity, luxury living or tobacco play but a minor role in producing a high coronary heart disease rate under 65 years of age"--unless a high intake of saturated fats is added to these factors. He offered these dietary guides for voting-age men and postmenopausal women:

>> Leave visible meat fat on the plate; eat fish oftener; use nonfat milk and nonfat cheese.

>> Restrict fatty desserts, fat table spreads and fried foods to rare occasions.

>> Restrict visible fat consumption to one ounce a day. This is to include all butter and other table spreads, salad and cooking oils. In it should be the daily ration of unsaturated fat such as corn oil.

>> Use fat milk only in coffee and cereal.

>> Make up the resulting calorie deficit (provided there is no overweight problem) with bread, potatoes, vegetables, fruits.

To find out for certain whether Jolliffe's hopes and reasoning were right, New York City's Health Commissioner Leona Baumgartner announced a full-scale test. Men of 50 to 55 who have never had a heart attack, and men under 50 who have recently had one, will enroll in an Anti-Coronary Club. After exhaustive physical examinations, up to 5,000 volunteers will pledge themselves to abide by Dr. Jolliffe's diet rules. Within five years, Dr. Baumgartner hoped, there would be enough evidence to show whether they actually have fewer heart attacks than their fellows who stay on unrestricted diets full of saturated fats.

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