Good Calories, Bad Calories

^*25“Among women high blood cholesterol is not associated with all-cause mortality nor even with cardiovascular mortality,” wrote UCSF epidemiologist Steve Hulley and his collaborators in a 1992 Circulation editorial about these data, entitled “Health Policy on Blood Cholesterol: Time to Change Directions.”“We are coming to realize that the results of cardiovascular research in men, which represents the great majority of the effort thus far, may not apply to women.”

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^*26 Conspicuously absent from the final analysis, because it was not a “randomized” trial and so the results could not be trusted, was the famous Helsinki Mental Hospital Study that had been cited by three generations of investigators, including The Surgeon General’s Report on Nutrition and Health and the National Academies of Science Diet and Health report, as providing the most compelling evidence that cholesterol-lowering diets lowered mortality, not just heart disease.

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^*27 In Across Australia, Baldwin Spencer and F. J. Gillen describe embarking on an expedition through central Australia in the late 1890s with eight thousand pounds of flour (forty bags, each weighing two hundred pounds) and seven hundred pounds of sugar.

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^†28 A typical diet of one Australian Aborigine settlement, according to a joint American/Australian expedition in 1948, “consisted of white flour, rice, tea and sugar, buffalo and beef.”

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^*29 In 1938, C. P. Donnison confirmed this observation in his book Civilization and Disease, using British Colonial Office yearly medical reports, which listed hospital inpatient diagnoses in all the British colonies. Many of the colonial physicians, wrote Donnison, reported that diabetes had never been seen in their local native populations. “Others say they have seen an odd case or two during many years experience.” In those populations that had been more influenced by civilization, he continued, “a greater incidence is recorded.”

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^*30 Such as peas, beans, and lentils.

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^*31 Joslin also cited a 1936 article by Himsworth in The Lancet, but this latter article, if anything, tended to implicate carbohydrates as a cause of diabetes.

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^*32 Although, he noted in the 1946 edition of his textbook, “Dr. F. G. Brigham tells me Mrs. K. with multiple sclerosis developed diabetes after starting in to eat candy to gain weight.”

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^*33 This close relationship temporarily diverged at the end of World War II, when sugar rationing was relaxed. As Cleave noted, however, this coincided with the introduction of penicillin into clinical use to treat the infections that often kill adult diabetics. Diabetes management and control also improved dramatically with the development of the standard insulin syringe in 1944, and long-acting insulin two years later.

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^*34 Although, as we noted earlier (Chapter 1), the amount of animal fat Americans ate decreased during this period, and so the increased total fat consumption was entirely due to the increased consumption of vegetable fats.

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^*35 There is even a plausible biological mechanism to explain how refined carbohydrates and sugars could cause or exacerbate cancer. See Chapter 13.

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^*36 John Higginson, director of the World Health Organization’s International Agency on Cancer Research, later described Non-infective Diseases in Africa as a “brilliant review” that had been “regrettably ignored.”

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^*37“The title Western diseases is preferred to that of the diseases of civilization,” they explained, “for it proved obnoxious to teach African and Asian medical students that their communities had a low incidence of these diseases because they were uncivilized.”

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^*38 According to records from the local trading ships, this increase was nearly tenfold between 1961 and 1980: from seven pounds per person per year to sixty-nine pounds.

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^*39 Although Reaven deserves much of the credit for identifying the syndrome and compelling the diabetes and heart-disease research communities to take notice, I will refer to it as metabolic syndrome, because that is now the preferred public-health terminology, rather than Syndrome X, except when discussing Reaven’s work in particular.

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^†40 The first time the Washington Post mentioned metabolic syndrome or Reaven’s research was in 1999, in an article about popular weight-loss diets. The second time was in 2001, in an article that actually discussed metabolic syndrome as a risk factor for heart disease. By that time, the paper had published a couple of thousand articles that at least touched on the issue of cholesterol and heart disease.

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