with the production of a heart attack, a stroke, or other complica-
tion of atherosclerosis.
It is therefore perfectly possible to have a normal cholesterol
blood level and yet have some of the other above abnormalities
FAT, THE KILLER, ON TRIAL
29
in the fat chemistry of the blood that help produce a heart attack
or stroke. To date, in two study groups of atherosclerosis, the
cholesterol factor has been found to be the predominant one.
This is due to the fact that it is a very frequent finding in athero-
sclerosis, and also because of the great difficulties encountered,
both by physicians and scientists, in measuring the other four
culprits mentioned above in the development of atherosclerosis.
What about the factor of heredity? As research informa-
tion piled up, another fact became clear. Of the 200 people
studied, a substantial number had a family history of heart at-
tacks or strokes. That is, members of their families were partic -
ularly susceptible to these two diseases. The patients we were
working with seemed to be unfortunate links in an heredity
chain.
Later, Dr. David Adlersberg and Dr. Charles Wilkinson, Jr.,
discovered that in some cases an excess of cholesterol in the
blood was an inborn error of fat metabolism. Inability of some
people to handle fat in their systems made them especially prone
to atherosclerosis. This hereditary tendency could sometimes be
traced accurately through the family of a patient; in those cases
where the tendency was strong, deposits of fats in the arteries
and skin could be predetermined, according to Mendelian, or
genetic laws of inheritance.
One unforgettable case that is an example of the hereditary
factor was that of Mrs. S. She was admitted to my teaching ward
service in the hospital 10 years ago in a state of shock and coma
from an excruciating chest pain. This young woman, only 29
years old, had been ironing clothes in her home when she ap-
parently was seized by a sudden, lightning-like pain. In a fainting
condition, Mrs. S. had collapsed to the floor. She fell with a cry,
and her little girl, aged 5, also cried out and summoned the
neighbors.
After only a few minutes in the hospital the patient expired,
despite heroic efforts by our interne and resident, as well as
physicians and nurses who were on duty at that moment.
30
FAT, THE KILLER, ON TRIAL
Examination of the heart following death revealed to our
surprise that Mrs. S. had a coronary thrombosis from extensive
atherosclerosis. This was a rare cause of death in so young a
woman, but one nevertheless that is occurring with greater
frequency.
We immediately suspected a hereditary cause in her death and
questioned the family, with the following results: The mother of
Mrs. S. was in good health as late as age 56. However, the father
had died at age 40 of a heart attack while driving an automobile.
His only other brother had also died of a heart attack at age 52.
Mrs. S.'s paternal grandfather had died of a heart condition in his
fifties and his own brother had died of a "stroke."
Mrs. S. had no sisters and only one older brother, who was 32
years old and suffering from angina pectoris. (This is a heart
condition caused, in most cases, by atherosclerosis of the coronary
arteries.)
This strong family trend towards the incidence of a coronary
artery disease and atherosclerosis is a striking example in the case
of Mrs. S., although in this case at an unusually young age. At least
one-third of the usual cases that I see in private practice, as well as
those seen by other physicians of heart disease, are found to have a
history of either heart attacks or "strokes" in the family.
When this atherosclerotic coat of arms has been handed down in a
family, it is vitally necessary that double precautions be followed in
strict adherence to the nutritional program set forth in this book.
Still another characteristic example of the powerful influence of
inheritance in the development of atherosclerosis is the case of Mr.
J., aged 39.
This patient suffered from pains in both calves of the legs
whenever he walked for distances more than a block. He would have
to stop and rest until the pains would subside, before he
FAT, THE KILLER, ON TRIAL
31
could continue again. We found a typical advanced degree of
atherosclerosis of the arteries affecting both legs.
The father of Mr. J., a bank official, had already suffered a
coronary thrombosis when he was 56. His two older brothers,
in turn, had each died of the complications of atherosclerosis—
one from a heart attack, and the other from a "stroke."
Mr. J. had one sister, age 52, who was troubled greatly by
swellings in the ankles of both legs, which were discovered to be
caused by Bright's disease* This condition, sometimes called
"dropsy" in the old days, is caused by atherosclerosis or "hard-
ening of the arteries," in the kidneys. This is still a very wide -
spread condition and one that accounts for much sickness and
death throughout the world, although it is an insidious process,
like its fellow "assassins" in the heart and brain.
Mr. J.'s case was so advanced that nutritional care, diet, and
weight reduction were of no avail and surgery had to be resorted
to. By an ingenious technique, a team of four vascular surgeons
who were experts in blood vessel surgery, grafted or transplanted
two sets of new arteries in both legs, taken from blood vessel
"banks." These storage "banks" keep normal healthy blood
vessels available for operations and emergencies in the same
way that blood is stored in blood banks for blood transfusions.
Mr. J. almost lost his life during the eight-hour operation
but is now fully recovered and walking normally again. How -
ever, he does follow the low-fat diet and nutritional program that
apparently has arrested the progress of his former atherosclerosis
and is well and vigorous once more.
Is there an excess of fat imbedded in the artery wall
itself? This proved to be a very difficult question to answer.
A search through the medical literature disclosed that no one had
reported any findings on this crucial question. We found that
there were tremendous chemical problems blocking the answer
to the mystery, but due to good luck and a brilliant chemical
feat by our team, we discovered and reported the following facts.
32
FAT, THE KILLER, ON TRIAL
The coronary artery that is damaged by an attack of atherosclerosis
has four times as much cholesterol and fat content as that of the
person who dies of causes other than heart attacks. Subsequent to our
findings, investigators both here and abroad corroborated our
findings, tracking down the "killer" fat to his lair directly in the
artery itself. We also noted that high blood pressure had the special
effect of driving the cholesterol and fats into the artery wall with
more speed and greater destructive-ness than would normally be the
case. Many patients with high blood pressure were particularly
prone to heart attacks and strokes because of the extensive
destruction wrought in their arteries by these fats.
This fact brings well to mind my patient, Mr. N., a 50-year old
business executive, 40 pounds overweight, who had high blood
pressure and angina pectoris. He complained of headaches and dizzy
spells. He weighed 190 pounds and suffered from chest pain and
shortness of breath on physical exertion or emotional excitement.
After a loss of 40 pounds by our nutritional methods, his blood
pressure became normal and his heart aches and dizzy spells dis-
appeared. However, whenever he had his regular twice weekly, tense
committee conferences at the factory, his blood pressure would rise.
Strangely enough he discovered that if he ate any fatty foods
before these tense business conferences he would develop angina or
chest pain and would have to take a tablet of nitroglycerine to
relieve the severe heart pain.
His nutrition-minded wife astutely decided to pack his lunches
herself into his brief case, along with his business papers and
documents. Instead of eating the usual restaurant meals with his
business associates, Mr. N. was able, thanks to his wife, to eat an
enjoyable, low-calorie, fat-free meal. His heart pains left him.
The great fear of death or crippling illness that had constantly
oppressed him and made his life miserable disappeared completely.
Apparently, emotional stress at business would cause his
FAT, THE KILLER, ON TRIAL
33
susceptible blood pressure to rise. If fatty foods were eaten in
addition, excess fat would accumulate in the blood and could be
driven into the coronary artery blood stream of the heart. This
would then produce the life-threatening heart pains of angina.
The transformation in Mr. N., after diet, weight and nutrition
were corrected, was truly remarkable. His entire facial expres-
sion (as well as his figure) was completely changed. In the
place of a tense, pasty-colored, anxious-looking face was a cheer-
ful, smiling, health-colored countenance. His step had become
springy (and no wonder, with 20 pounds less to carry around),
his walk buoyant, and his enjoyment and capacity for work
enormously increased.
Are there other conditions that cause heart attacks and
strokes? To find the answer to this question we studied the
hearts and arteries of 600 hospital patients who had died of
various causes. After years of analysis we were able to report
that in 100 cases of accidental death the great majority of men
and women studied showed some degree of fatty deposits in
their arteries. This was true in cases of people as young as 20,
indicating that fat is a killer that has no respect for age. He
often begins his work very early in a person's life.
In another 100 cases, diabetes was the cause of death; in
another 100, underfunctioning of the thyroid gland was evident.
In both instances, these patients showed excess cholesterol and
fats in their blood, with a correspondingly high-fat content in
their arteries. The degree of atherosclerosis of the heart and
brain far outstripped that of any other condition, except one
called xanthomatosis. This condition showed itself through fatty,
yellow-white deposits in the skin around die eyes, hands, arms
and legs. Whenever we found this condition, we also found that
the arteries throughout the body, and especially in the heart,
were most extensively damaged by fatty deposits.
In patients who were thin and wiry throughout their lifetime,
the occurrence of atherosclerosis was generally much less than in
all other cases. Women before the age of 50 also proved to be
34
FAT, THE KILLER, ON TRIAL
much better protected against degenerative artery disease than
men. After 50, however, women began to develop heart attacks
and strokes with the same frequency as men. The conclusion
was that female sex hormones played an important role in pro-
viding protection against the ravages of atherosclerosis. As soon
as the change of life occurred in women, the protection of these
hormones seemed lost; they then became the equals of men in
suffering from heart attacks and strokes.
The role of the liver in protecting you from excess fats.
We found that the liver manufactures protective chemical sub-
stances called phospholipids. These phospholipids in the blood
help to ward off the effects of too much fat and help to protect
you from heart attack. They suppress the damaging effects of
cholesterol upon the arteries of the heart and brain.
This encouraging fact was first discovered by Dr. Aaron Kell-
ner and Dr. E. H. Ahrens, who conducted experiments on
animals (and brought it to light). If your liver is not function -
ing normally and producing a sufficient quantity of these protec-
tive agents, you can find them in certain foods. Some foods that
contain phospholipids in abundance are soybeans and the liver
of calves, steers, lambs, and chickens. The Vitamin-B complex
vitamins also have the ability to increase the blood phospho-
lipids. Defatted soybean lecithin in particular is an ideal pre -
paration for increasing these protective phospholipids in the
blood. (See Chapter 5 for a full discussion of food supple -
ments that can be wonderful fighters in the battle against excess
fat.)
These protective agents lower the blood cholesterol and bring
about a better balance between the amount of phospholipids and
cholesterol in the blood. The lowering in the amount of choles-
terol protects you against the development of atherosclerosis.
Isn't there some medicine that will stop fat from caus-
ing heart attacks? Medical science has searched diligently
for some new chemical or medicine that would provide the
answer to this question. Some progress has been made, and the
FAT, THE KILLER, ON TRIAL
35
full answer will come in time. Here's what we have found out
so far:
In 1940 I developed an extract from the arteries of cattle.
This extract was administered first, with success, to animals for
a period of three years. Then for several years it was given to
human patients suffering from heart and artery disease. I rea -
soned that if a weakness or deficiency existed in the wall of the
damaged artery, then the administration of the healthy, vital
substance missing in the artery might rejuvenate the diseased
artery and restore its health. This same principle was used
in the discovery of insulin.
Although the extract was effective, it had some drawbacks.
One problem was that to be effective, it had to be injected daily
for the duration of life. A group of research biochemists headed
by Dr. N. T. Werthessen and specializing in atomic medicine
studied the preventative and curative effects of the extract that I
had developed. They used radioactive chemicals to trace the ex-
tract in the blood of experimental animals. It was found to be
highly effective in preventing atherosclerosis. Nevertheless, I felt
it was necessary to abandon the use of the extract, even though we
had obtained remarkable results in the treatment of heart, brain,
and other circulatory illnesses. The excessive costs of manufac-
turing and testing the extract, and the need to inject it daily,
made its use impractical.
Many other fat preventing agents have been discovered
and found wanting. For example, my associates and I found,
more than 10 years ago, that in various experimental animals
certain members of the Vitamin-B complex were effective in
preventing and treating atherosclerosis. These protective,
vitamin-like agents were called lipotropic, or fat preventing.
Although these findings were repeated and corroborated by many
investigators, many medical scientists could not agree, and the
use of such fat preventing agents never became generally ac-
cepted. Subsequently, they have been replaced by more promis-
ing medicines in the treatment of heart attacks and strokes.
36
FAT, THE KILLER, ON TRIAL
Another promising substance was heparin, which is a fat-
clearing, anti-clotting medicine. Dr. Hyman Engelberg and other
investigators have found heparin very valuable for controlling
blood fats in the treatment of heart cases. Various other physi-
cians, however, do not agree with these results. Moreover, the
necessity of injecting heparin at frequent intervals and the need
for greatest care in its administration made it difficult to use it
on a wide scale.
In certain cases, thyroid extract has been effective in reducing
excessive cholesterol and fats in the blood. It was most helpful in
those patients who had a sluggish or abnormally low basal meta-
bolism rate, a sign of an underfunctioning thyroid gland. But
unfortunately, it has not proved generally effective in all cases.
Years ago, my co-workers and I explored the potential of
plant sterols as fighters of fat. These sterols, which are plant or
vegtable extracts, when eaten, block the absorption of cholesterol
and fats from the intestine. Some interesting results were ob -
tained, but their action was variable at best. Many of these plant
extracts were not practical because large quantities had to be
consumed before each meal.
Female sex hormones have been widely explored. Many in-
vestigators have advocated their use in controlling fat metabolism
in the blood and arteries. Here too, the results of treatment in
cases of heart disease were interesting, but treatment was handi -
capped by the feminizing effects that such hormones had on men.
Thus the need for something that would be useful to all people,
something that would bring definite results in fighting off the
killer, fat, remained. The low-fat diet holds great promise for
everyone, whether the person has atherosclerosis or not. The low-
fat way of life can be followed by anyone, anywhere, and it is
simple, safe, effective. Let us see why.
How the low-fat diet proved its value. Throughout the
world, fats and heart disease appear to be inseparable com-
panions. When investigators found one, they generally found
the other, no matter in what countries they searched. A host of
reports began to pour in on the scarcity or absence of heart,
FAT, THE KILLER, ON TRIAL
37
brain, and vascular disease in those populations where a low-
cholesterol, low-fat diet were common. (Example: Asians,
Africans, Costa Ricans, Okinawans, Chinese, Ceylonese, and
Bantus.)
In sharp contrast, the exact reverse was found in those parts of
the world where a high-fat diet was prevalent. A high rate of
atherosclerosis of the heart, brain, and kidney was common in the
countries of Europe and in the United States and Canada.
Pathologists, doctors, and medical researchers, have since produced
overwhelming evidence to show that when blood cholesterol and
fats are high, the arteries were correspondingly high in the degree
of damage or destruction by atherosclerosis. And when the blood
levels of fat were low, the damage to heart and brain was also low.
I became convinced that the killer had been identified. This
conviction I arrived at in the following way: I decided to see what
the effects would be of stopping one group of patients from
eating fats and comparing them with another group who continued to
eat the usual amounts of fats found in the American diet. It was
important to work with people who had proven cases of
atherosclerosis. I therefore selected 100 patients who had survived
heart attacks or coronary thromboses and who had been
discharged from the hospital. These patients had all had
atherosclerosis of the coronary arteries and were ideal for the
purpose of proving or disproving the whole concept of high fat as
the cause of heart attacks. The 100 cases were divided into two
groups of 50 patients each. One group was placed on a low-fat,
low-cholesterol diet; the other continued on a diet containing the
regular fat intake that they had grown accustomed to before their
heart attacks occurred.
Both groups were carefully observed for over 10 years. By the
end of the third year, the answer began to grow clear. At the end of
eight years of study, the answer was conclusive. Of the 50
patients who ate their regular dietary fat quota, 38 (or 76 per
cent) had died of arterial or heart diseases. Of the 50
38
FAT, THE KILLER, ON TRIAL
people who had followed the low-fat diet faithfully, only 22 (or
44 per cent) had died of the same illnesses. In other words,
the low-fat diet had enabled heart patients to live twice as long
as those who followed a regular diet and had saved a significant
number of lives in the process.
The lowfat diet proved to be effective in reducing
weight and promoting general good health. An equally
important result of this research was this: We found that a
substantial weight reduction of about 20 pounds was achieved
by both men and women on the low-fat diet. This took place
over a period of three years, and the weight loss was safe,
gradual, healthful.
Typical of this group of patients was Mr. B., a stocky, short
man of 180 pounds, who had just recently recovered from his
coronary thrombosis. But he now complained of great fatigue
and shortness of breath on exertion. He just couldn't seem to
be able to resume his work as a builder. For his height and
bodily frame, he was easily 36 pounds overweight. On the
low-fat diet he lost a pound each week.
At the end of the year he weighed 145 pounds. In his own
words, he "felt like a million dollars." He found himself
vigorously back at work again, clambering about his construction
jobs and housing projects with ease and enjoyment.
The patients on the low-fat diet also gained some remarkable
and unexpected health dividends. Many patients, for example,
experienced a striking improvement in energy and vitality.
The case of 47-year old Mrs. R. is an excellent one in point.
She had made a fairly good immediate recovery from her cor-
onary thrombosis. But even before her heart attack, her house-
hold activities were always a series of endless chores to her.
To "get through the day," became a daily and finally a mon -
umental challenge. First, it had been the race to get her three
children off to school and husband off to work without even a
chance to answer nature's call to the bathroom (the new Ameri -
can mother's form of colonic martyrdom!).