rats. There is the incontrovertible fact that countless millions of
human beings in Asia, Africa, South America and elsewhere do
not consume fat in their diet. And yet they live to a health-normal
or beyond-normal life span; their physical or nutritional
development is not infrequently far superior to the people on a
high-fat or average American fat dietary intake.
Most certainly it is known now that these same people on a low-
fat or fat-free diet are virtually free from heart attacks and
strokes, which are so common among people on a fat diet.
Many have wondered whether the Eskimos have a high rate of
heart attacks and strokes as a result of their high fat diet. First it
should be remembered that the Eskimo days of existing
13
14
PHYSIOLOGY OF FAT
on blubber and whale alone are mostly over. Several years ago
physicians working with the National Geographic Society found
that the Eskimos who lived in the more modern settlements and
ate and lived like other Canadians or Americans in country vil -
lages, were subject to the same degree of atherosclerosis, high
blood pressure, and heart conditions.
On the other hand, in those Eskimo cases where fish and whale
fats constituted the basis of the diet, blood tests revealed that
cholesterol and fats in the blood were very low. This surprising
fact was later found to be due to the high concentrations of un-
saturated fatty acids in the large amount of fish and whale oils
consumed by these Eskimos. As will be shown later, these un-
saturated fatty acids have the unique power to lower the blood
levels of cholesterol and other fats, thus protecting the Eskimos
from the complications of atherosclerosis in the heart, brain,
kidneys, and other organs.
What is fat? First let us look at food in general. As long as
we are alive, breathing, with our hearts pumping, our bodies
are at work burning up energy—which is supplied by food.
Food or foodstuffs consist of six groups, all of which are basic
necessities essential for normal health. These are proteins,
carbohydrates, fats (which are also manufactured by the body),
vitamins, minerals, and water.
Protein is the keystone of human nutrition. It is es-
sential for every form of life for growth, pregnancy, formation
of blood, bone, and every vital tissue. It is essential for the heal-
ing of wounds, the warding off of infection, the maintenance of
body weight, and the conduct of vital organs and glands in the
body.
Meat is the greatest source of animal protein for human
consumption and man can live in good health on virtually an
exclusive fresh meat diet. Animal sources of proteins are meat,
fish, poultry, milk, eggs and cheese. These foods contain high
sources of protein, as well as carbohydrates and fats. Vegetable
sources of protein are wheat, beans, peas, lentils, soybeans, nuts,
PHYSIOLOGY OF FAT
15
corn, rye and yeast, although these also contain elements of
carbohydrate and fat.
Normal adults and growing children require one gram of
protein for every 2.2 lbs. of body weight. This means that the
average man or woman weighing 125 to 175 lbs. needs from
60 to 80 grams of protein daily for normal nu trition. This
would be contained in the equivalent of 1/2 pound of steak,
one chicken, a pound of fish or a pound of cottage cheese. Each
gram of protein supplies four calories of energy, as shown in
Chapter 6.
Carbohydrates are a main source of energy. Carbohy-
drates include the two main classes: starches and sugars. They
are one of the primary sources of energy of our diet. One gram
of carbohydrate yields 4 calories of energy. The amount of
carbohydrates necessary in the daily diet is very variable and
also depends on the amount of it eaten with the protein in meals.
The average American adult consumes anywhere from 150 to
400 grams of carbohydrate daily. It takes about 500 grams to
make a pound. Usually more than half the calories in the diet
(from 50 to 70 per cent) are supplied by carbohydrate.
Unfortunately, these carbohydrates are usually refined to
excess, as in the case of flours and sugars. Essential vitamins and
proteins are lost in this way and certain nutritional deficiencies
may result. If excessive carbohydrate is eaten in the diet, many
individuals will experience symptoms of gassy distress, flat -
ulence, belching, or bloating. Bread, flour, milk, cereals,
potatoes, cornstarch, cakes, rice, and puddings are examples of
dietary starch as are moat vegetables, although these contain
lesser amounts of both carbohydrates and protein. Sugars are
represented by cane sugar, corn syrup, honey, maple sugar and
syrup, milk sugar, malt sugar, jams, jellies, and most fruits.
Two of the most common symptoms or sensations that humans
feel daily are dependent on carbohydrate metabolism: that is,
hunger and fatigue. Certain endocrine glands in the body con -
trol the level of blood sugar in the body and are linked to the
16
PHYSIOLOGY OF FAT
feelings of hunger, fatigue, and exhaustion. When the blood
sugar falls abnormally low, one feels headaches, nervousness,
dizziness, or weakness.
Many of my patients combat these tendencies to hypoglycemia
or low-blood sugar in the following simple ways: in between
meals take fresh fruits, preferably bananas or apples, or canned
fruit juices or fruits; English "tea" with whole wheat cookies or
crackers, graham crackers, arrowroot cookies and if needed,
some lean meat or fish in sandwich form; skim milk thickened
and fortified with generous servings of skimmed milk powder;
bread and jam; fat-free sherbet or ices; dietetic or low-fat ice
cream; fruit jellos are refreshing; hard candies or chocolate bars
are often very handy but not as desirable as the natural, health -
ful in-between meal "snacks," suggested above, as they often
damage the teeth and may have too short-lived action on the
blood sugar. Not infrequently sugar itself will cause a "re -
bound" reaction resulting in an even lower blood sugar fall one-
half to one hour after the sugar has been eaten.
Countless business people and factory workers find their ef -
ficiency and capacity for work greatly increased by following
the above dietary aids. It is not necessary to wait until the
symptoms of low-blood sugar already signal the breakdown of
bodily health.
The habit of drinking coffee alone at the coffee-break is like
whipping the tired old horse harder to get it to climb up the hill.
The artificial stimulant, caffeine, can never possibly substitute
its artificial stimulant drug action for the flow of energy that
comes from healthful, natural foods.
Vitamins and minerals are discussed later, in Chapter 5.
The necessity of water for the maintenance of life is known to
all. This brings us to fats.
Fats— What they are and what they do to you. The out-
standing fats eaten daily in the United States and Europe are
butter, eggs, whole milk, cream, meat, fish and poultry fats, and
cheese in various combinations. These fats, at 9 calories per
PHYSIOLOGY OF FAT
17
gram, contain more than twice the amount of calories than
protein or carbohydrate does at four calories each per gram.
As we have noted and shall describe in later chapters, excessive
intake of fats leads to the shortening of life, premature death by
heart attacks and strokes, obesity, and numerous crippling ill-
nesses.
Fats (or lipids) contain the elements of carbon, hydrogen, and
oxygen in various combinations of animal and vegetable fats.
Examples of animal fats are butter, lard, cream, milk, eggs,
and the fat in meats. Vegetable f ats are soyabean oil, olive
oil, cottonseed and corn oils, and peanut oils; these are found
in nuts, coconuts, avocados, margarines and other vegetable fats
used in cooking.
Fats do not dissolve in water, and when pure they are odor -
less and tasteless. They are found in most bodily tissues, parti-
cularly in combination with other elements, proteins, or minerals.
Fats or lipids act as vehicles for the absorption of the natural
fat-soluble vitamins such as vitamins A, D, and E.
In order for fats to be utilized by the body, they must first
be digested and broken down into constituent parts before being
absorbed. They are absorbed in the following manner: After
the food is masticated and enters the stomach, the digestive sys-
tem supplies its first fat enzyme called lipase, to begin the diges-
tion of the fat. Enzymes or ferments are unique chemical com-
pounds manufactured by the cells of the tissues. In the digestive
tract they are vital for the chemical breakdown of all foods
before they can be absorbed.
How are fats digested? The fat enzyme of the stomach,
lipase, begins its job on the fats eaten. However, it is a rather
weak enzyme, leaving most of its work to be carried out by
steapsin, the fat enzyme manufactured by the pancreas, and by
bile manufactured by the liver. In the bile are found bile acids
and salts which, together with steapsin, split the fats ingested
into the smallest molecules and particles possible. These can
then be absorbed through the lining of the small intestine and
18
PHYSIOLOGY OF FAT
pass either into the liver or directly into the blood stream as
chyle, a milky or creamy serum.
How fats are absorbed. When the fat particles are brought
to the liver, they undergo further chemical breakdown and me-
tabolic changes before they enter the blood stream in the form
of cholesterol, phospholipids, fatty acids, neutral fats (which are
neither acid nor alkaline), lecithin, and other fat derivatives.
Much of the fat is broken down by the liver cells into cholesterol,
which is excreted into the bile and goes back again into the
intestine in various chemical forms. Once in the intestine, some
of the cholesterol is reabsorbed again along with other fats
and some is excreted from the body in the bowel movement. If
the proportion of the cholesterol in the bile becomes too high,
then it precipitates out of the bile and forms gallstones, which
can produce attacks of pain and indigestion, and so often keep
the surgeon busy.
Now that the fats or lipids have entered the blood stream, they
circulate and are deposited in the various bodily tissues and in
the great body storehouses called fat depots. These are located
in the abdomen, on the hips, the chest, around muscles, under
the skin, in the liver, and elsewhere. The fats consumed in the
diet are called exogenous fats. The liver and other tissues,
however, manufacture equally important quantities of fats or
lipids normally found in the blood stream. These are called
endogenous lipids.
These lipids are manufactured from proteins and carbohy-
drates through certain remarkable processes inherent in vital
bodily tissues and glands such as the liver or the adrenal glands.
Energy and vital cellular constituents for the body result from
these lipids. When present to excess, their effects become dev-
astating to humans, as shown in the chapters on overweight and
atherosclerosis. (See Chapters 7 and 3.)
We now come to the fats circulating freely in the blood stream.
Let's see how they get into the artery walls to actually damage
or destroy the artery with atherosclerosis.
Fig. 1. Cross Section, Coronary Artery.
This diagram shows the three coats of the coronary artery and the
channel through which the blood flows to nourish the heart muscles.
Fig. 2. Cross Section of Coronary Artery in
Coronary Thrombosis.
PHYSIOLOGY OF FAT
19
How fats damage or destroy your arteries. Extensive
research in experimental animals has been able to demonstrate
how these lipids can leave the bloodstream and enter the artery
wall within 24 hours. The atherosclerosis produced in these
animals becomes indistinguishable from the atherosclerosis
seen in human arteries. However, the exact details of the
mechanism whereby fats actually enter into the wall of the
artery are not yet known. What is known and what is important
is that there is a definite ratio or relation between the amount
of fats in the blood stream and in the artery wall, and this is
surprisingly predictable in most cases. Also, the relationship
of the fats in the artery wall itself is very close to that in the
bloodstream. This direct relationship between the two seems
to be in fairly constant balance.
As described in the first chapter, the artery wall consists of
three different layers. If the reader can picture a garden hose
as representing the artery, it presents an innermost layer called
the intima, a middle layer called the media, and an outer layer
called the serosa. (See Fig. 1).
The fats circulating in the blood stream are of course closest
to the innermost layer of the artery, with which they are in direct
contact. When conditions are right for atherosclerosis, the fats
attach themselves and enter the inner or intima layer of the
artery. A kind of wart or excrescence on the artery is then
formed, called a plaque of lat. When the plaque grows larger,
it encroaches upon the passageway of the artery. As it grows
larger and larger, it may finally block or obstruct it partly or
completely. When this clogging or obstruction of the artery
takes place in the vital coronary arteries of the heart, then a
coronary thrombosis or heart attack assails the victim. If the
blockage from these fatty or atheromatous plaques occurs in
the brain, then a stroke strikes down the victim. (See Figure 2.)
However, if the artery is only partly blocked by this accumula-
tion of fatty plaques, then the vital organs supplied by the
arteries suffer from a lack of the necessary amount of blood and
20
PHYSIOLOGY OF FAT
nutriments contained in it to sustain normal function and health.
Along with the fatty deposits of cholesterol, fatty acids,
neutral fats, etc., which make up these atheromatous plaques,
calcium and other minerals are also deposited. These make the
artery feel hard, giving rise to the term commonly in use—
"hardening of the arteries." Actually we see a softening of the
arteries which takes place first because of these fatty deposits.
It is often noticed in many individuals that this free fat will
be floating in the blood stream for hours after a meal containing
fat has been eaten. The blood is then called lipemic, which
means loaded with fats. When these fats are easily visible to
the naked eye, scientists speak of such neutral fats as chylo-
microns. These fats in the blood are regarded by many scientists
to be as dangerous as is cholesterol, in entering the artery wall.
A great proportion of these fats in the blood is combined with
proteins, called lipoproteins, which also have been the subject
of research by many investigators. Scientists have only recently
discovered by new tools of investigation that in these lipoproteins
two separate portions can be measured: the alpha and the beta
lipoproteins. The first have been shown to be protective against
the development of atherosclerosis. They are found predominat-
ing in infants, children, and young women who have no evidence
of atherosclerosis.
On the other hand, the beta-lipoproteins have been found
universally in excessive amounts in most cases of active athero-
sclerosis and so are called atherosclerosis producers or "ather -
ogenic." The protective alpha-lipoproteins are spoken of as
"anti-atherogenic."
The problem of preventing atherosclerosis and its human
ravages is the search for ways of increasing the protective alpha-
lipoproteins. Chapter 5 discusses lecithin and other nutritional
supplements and shows how to use these protective substances
against the development of atherosclerosis.
One of the greatest factors influential in the current epidemic
of heart attacks has unquestionably been the startling increase
in fat intake. In the United States alone, the fat content of our
PHYSIOLOGY OF FAT
21
diet has just about doubled in recent times. Where fat formerly
constituted some 15 to 20 per cent of our meals 50 years ago,
it now has jumped to 30 and 40 per cent or more.
Fat may be your "poison". Many individuals have now
developed an intolerance to fat. Some of my patients can't seem
to handle any fat at all. As an example, one plump 40-year old
mother of three develops severe gas and bloating after eggs or
any other fatty food. Mrs. R. is often embarrassed to dine out
for fear of overflowing right out of her girdle if friends supply
her with a fatty food at their homes. At other times she has been
embarrassed by solicitious friends who have delightedly con-
gratulated her upon her "unexpected" and "surprise" pregnancy
after eating some fat food!
Other patients of mine develop actual attacks of gallstone
colic following a meal containing fat. Some 20 years ago, I
studied the causes and effects of gallstones in humans by passing
rubber tubes through the mouth and down into the digestive tract
and then draining off the bile or gall manufactured by the liver
and stored in the gall bladder. At that time I examined and
found the cholesterol and fat content of the bile abnormally high
in most patients who suffered from gallstones, liver, and gall
bladder diseases. A fat-free diet was able to eventually reduce
and restore the bile to its normal cholesterol and fat content,
not to mention the well established fact that most patients felt
vastly improved and often free of pain or distress.
Of especial interest to me is the case of a 46-year old auto-
mobile dealer, Mr. C, who used to have disabling and terrifying
attacks of pain over his heart. (We call such pain angina pec -
toris.) The pains began only after he had eaten breakfast and
was preparing to leave for his business. His breakfast was a
hearty one. It consisted of bacon and two scrambled eggs, fruit
juice, some delicious coffee cake with two pats of butter, plus
two cups of coffee containing generous portions of cream. He
was a husky, strapping ex-athlete and burned up a great deal of
energy in business activities.
When Mr. C. changed his breakfast habits and ate a good
22
PHYSIOLOGY OF FAT
breakfast on the low-fat diet (as explained and described in
later chapters) his anginal pain stopped as if by magic. Cl early
he was one of the many individuals whose circulation could not
tolerate fats.
This was again just recently shown in most convincing and
dramatic ways by Doctors Peter Kuo and H. Joyner of the
University of Pennsylvania Hospital and Medical School. These
investigators studied the effects of fat meals in a series of heart
cases and others afflicted with atherosclerosis over a several year
period. One group of their patients suffered severe heart attacks
every time a fat meal was administered to them. Studies of the
heart and the blood were made during actual heart attacks by
Electrocardiographs and other scientific instruments. It was
found that when the blood stream contained its peak load of fat
content, the heart attacks were most severe and threatene d the
very life of the patients. Such striking studies and findings were
also the experience of other research physicians.
How much fat are you stowing away? Look at the fol-
lowing sample daily menus for fat content that the average
American consumes, as taken from the front page of the New
York World Telegram.
Fat Content Calories
Breakfast:
One-half grapefruit ..............................................................
70
Two eggs ........................................................... 12 grams
150
Two slices of bread ...............................................................
130
Two pats of butter .......................................... 12 grams
120
One cup of coffee with % tablespoonful of
cream and two teaspoons sugar ................ 3 grams
100
Lunch:
Boiled ham, 2 slices ......................................... 20 grams
200
Two slices of bread ..............................................................
130
Two pats of butter ........................................... 12 grams
120
Lettuce and tomato ..............................................................
30
Mayonnaise, 2 teaspoonsful ........................... 6 grams
60
Cup of coffee with cream and sugar ................ 3 grams
100
Danish bun, prune filled ................................. 8 grams
150
PHYSIOLOGY OF FAT
23
Dinner:
Melon slice ...........................................................................
20
Steak or beef with gravy, 4 ounces ................ 40 grams
500
Potato and peas, or salad.....................................................
100
Two pats of butter (or oil dressings) ............ 12 grams
120
Cup of coffee with cream and sugar ................ 3 grams
100