Posted by: Joseph Dixon | May 15, 2014

Science: Unintended Consequences; Ancel Keys, Cholesterol, and the Transition to an Obese Society; Part V, Ancel Keys’ Career, Part 1: Getting Started

Ancel Keys Book Cover 5-2014

If you Google Ancel Keys today you will see a group of websites that vilify Ancel Keys and call him the main starting source for the “Cholesterol Myth.” The “Cholesterol Myth” is the term used for the idea that all of the research that focused on dietary cholesterol and fat as the causative factors for Coronary Heart Disease was incorrect and, in fact, the whole concept is a conspiracy to make the American people eat a certain way. One question that immediately comes to mind is, if the “Cholesterol Myth” is part of a grand conspiracy, what were the reasons for starting it, and what benefits would there be for scientific researchers, food companies, and the US government to continue to perpetuate this conspiracy?

Anyone with a basic scientific background can read “The Seven Countries Study” book and understand that Dr. Keys presented a balanced picture of the research and was, in fact, open minded about the biology behind the observations he and his colleagues made and the data they accumulated. In no waywasDr. Keys dogmatic in his descriptions or in his conclusions.

Furthermore, at the time of the “The Seven Countries Study,” only a very small part of basic cholesterol and lipoprotein metabolism in the body was understood.

If you look through the websites that mock Dr. Keys and his basic findings, it is obvious that each uses similar catch phases, and there is little comprehensive knowledge of the sciences of nutrition and medicine presented in their criticisms.

Let’s go back and review Dr. Ancel Key’s career and contributions to science and health. Dr. Keys attended the University of California where he earned a BA in economics, a MA in zoology, and a Ph.D. in oceanography and biology. With these degrees he worked at the Mayo Clinic for two years and then he became a professor of physiology at the University of Minnesota in 1939. During World War II he worked to develop small, easily transportable packets of food that later were called K-rations. He also began a study of the physiological changes that occur in humans during starvation. The participants in the study were 36 male conscientious objectors. The point of this study was to understand the basic physiological mechanisms that were in play during starvation, and what was the best way to treat a starving person from a medical and nutritional perspective. This information later was invaluable to doctors treating prisoners and starved civilians during and after World War II.

After World War II Dr. Keys turned his attention to the large number of men who were dying of heart attacks at a relatively young age. He first studied businessmen, ages 39 to 60, because this was the age that many of them were dying prematurely from CHD. If you look at the documentary film on Dr. Ancel Keys on the University of Minnesota Library website, it shows the men stopping in to Dr. Keys’ lab for their annual check up. These businessmen. in one way, were typical men of the 1940s-1950s. They were well fed and slightly overweight. They were usually dressed in a suit. And they appeared to all smoke. But they were not typical of most American men in another way. They were, for the most part, from the upper socioeconomic class found in the urban St. Paul-Minneapolis area. Twenty five percent were the presidents or vice–presidents of large businesses.

Dr. Keys’ seminal observation was that the men who had heart attacks tended to have higher concentrations of cholesterol in their blood. What is truly outstanding about this study is that it is one of the first of its kind. Modern medicine was just entering the age of true advances. The first antibiotic was used during World War II. The science of nutrition was just ending the discovery of vitamins phase. Little was known about why and how heart attacks occurred in middle aged humans who otherwise appeared to be healthy men and, to a lesser extent, healthy women. Although this was an important study it was flawed because of the group of men studied and its small size. However, Dr. Keys learned from this study and it was instrumental in guiding him during the development of the Seven Countries Study.

The research paper for this first study was published in 1963 after the fifteen year follow-up was completed:

Keys A, Blackburn HW, Taylor HL, Brozek J, Anderson JT, Simonson E. Coronary heart disease among Minnesota business and professional men followed fifteen years. Circulation 1963;28:381–395.

http://circ.ahajournals.org/content/28/3/381.abstract?ijkey=dd05bc49dc156911c4402cb92364fb11b2d3eeae&keytype2=tf_ipsecsha

Let’s revisit important parts of this study in Dr. Keys’ own words. Dr. Keys wrote:

“The main purpose of this report is to compare, in respect to the measurements considered here, the pre-disease characteristics of the men who developed coronary heart disease with the contemporary characteristics of their fellows who did not develop the disease.”

“The men in the present study are not a statistical sample of American men or even of middle-aged men in Minnesota. They were drawn from men in the upper socioeconomic class in the metropolitan area of St. Paul-Minneapolis; one fourth are (or were) presidents or vice-presidents of substantial corporations; more than half of the group were college men. This is a native-born and educated group, almost all with ancestral origins in the British Isles, the Scandinavian countries (mainly Norway and Sweden), and Germany.”

Cholesterol was the only parameter that was statistically significant in this study.

“The incidence of coronary heart disease tended to be higher among men above the median at first examination in relative weight, body fatness, systolic and diastolic blood pressure, and serum cholesterol concentration but these segregations were not statistically significant except with serum cholesterol, which was associated with p < 0.001.”

But some men did not have high cholesterol and still suffered heart attacks.

“The general conclusion seems warranted, then, that men who develop coronary heart disease in spite of having relatively low serum cholesterol values are men who tend to be at the upper extremes of blood pressure or relative body weight, or both.”

Conclusions:

This is an very good research paper. Dr. Keys and his colleagues described their methods exquisitely, they reported their findings in a balanced way, and they reported that the study was not representative and that it was too small.

Then they compared their results to the results of several other similar studies being carried on about the same time.

There were no wild hypotheses. There was no bombastic language. There was no indication that a zealot was window dressing his case.

From this rather small study, Dr. Keys and his colleagues went on to design a much larger study that would search for the answers to what was causing massive amounts of heart attacks in American men in the 1940s and 1950s.

 


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