Unintended Consequences

In my last post, we saw how the diabetes/obesity epidemic spawned in the 1990’s and has grown to epic proportions despite the best intentions of government, public health officials, and doctors.  While the cause of this epidemic is certainly multi-factorial, I think it’s important to consider the historical context of health and dietary policy.  Now, if you’re looking for a thoroughly annotated and detailed historical account, I suggest you read Gary Taubes’ latest book.  But in the interest of time (no pun intended), allow me give you a brief of diet and health in America using TIME covers to illustrate.

Though we could begin this story 10,000 years ago when the development of agriculture forever changed human lifeways, I’d like to fast forward a bit and pick up the story in 1955.  Why 1955?  We’ll start the story there  because that’s when–for possibly the first time–health became a major concern for everyday Americans.  No, it wasn’t because an awesome blog post got people motivated to look into their health and find ways to improve it…it’s because 1955 was the year that President Eisenhower suffered a major heart attack while in office.  While such an event would barely register in today’s bizarre political environment, it was a huge national story at the time.  With the President struck down seemingly out of the blue from heart disease, American men and women began to fear this unseen killer and heart disease awareness took off.

With the public’s newfound awareness and interest in preventing heart disease, millions of government dollars started flowing to solve the problem.  Government panel were convened, scientific symposia were held, and groups such as the American Heart Association were chartered to tackle the growing threat from heart disease.  Enter Ancel Keys.  Equipped with a strong personality and captivating research, Keys silenced his critics and rose to prominence in the scientific community throughout the 1950’s and 60’s, eventually becoming the de facto authority on diet and health.  Although his work was rewarded with the TIME cover in 1963, his real prize was the outsized influence he had on US health policy in the 1960’s.  His influence lasted for decades, as often happens in the world of academia, where influential voices remain influential because they control editorial boards and academic tenure promotions.  Likewise, Keys’ protégés gained prominent positions in universities and government health offices for decades.  Although the life and career of Keys is fascinating in its own right, it’s the message he so tirelessly and effectively promoted that merits further inspection: that dietary fat–particularly the saturated variety–raises blood cholesterol levels, which in turn clog your arteries and cause heart attacks.

By the 1980’s Keys’ thesis had taken root.  Dietary fat and cholesterol were understood as the drivers of heart disease and were avoided or eliminated.  I grew up in the 1980’s under the strong influence of Keys’ ideology.  Eggs and bacon were eaten in moderation or with guilt.  Traditional meals containing animal fat/protein, along with nuts, dairy, and eggs that had been consumed for generations were quickly shunned and replaced with “heart healthy” meals full of artificial ingredients or processed carbohydrates.  Fear of cholesterol gave birth to an entire industry of low fat/no fat foods–even the monster known as trans-fats.  Yes, initially promoted by low-fat experts in a misguided attempt to improve health, trans-fats are now illegal and will be eliminated from the US food supply within a year.

By the early 2000’s the few persistent and inquisitive researchers who were not silenced by the prevailing low fat dogma began to get a new message across: the evidence that dietary fat and serum cholesterol are the primary drivers for cardiovascular disease is weak at best.  Finally, a mere 50 years after Keys set the course for dietary policy in this country, the medical community and public health authorities begin to admit that heart disease is more complicated than “eat butter, clog arteries, have heart attack.”  Despite the gross oversimplification of cardiovascular physiology and lipid biology implicit in Keys’ “diet-heart hypothesis,” it remains so entrenched in the collective conscious of Americans that to say or think otherwise seems blasphemous.  I still hear people talk about how a steak or bacon and eggs is a “heart attack on a platter.”

But let’s circle back to the beginning of this post: the obesity epidemic.   Isn’t it interesting that we’ve gotten sicker and fatter after a collective public health awareness had developed around diet in response to the heart disease epidemic?  Is it possible that our “heart healthy” diets have caused, or at least contributed to, the obesity epidemic?  If so, this would be the most profound example of the law of unintended consequences at work.

~Brendan