Chapter One THE EISENHOWER PARADOX

Question 1

What did Claude Bernard state about poorly observed facts in medicine?

Answer 1

They form actual obstacles to science, as people insist they must be accepted as facts.

This highlights the challenge of anecdotal evidence in scientific discourse.

Question 2

At what age did President Dwight D. Eisenhower suffer his first heart attack?

Answer 2

Sixty-four years old.

Question 3

Where did Eisenhower’s first heart attack take place?

Answer 3

Denver, Colorado.

Question 4

What was Eisenhower’s condition on the night of his heart attack?

Answer 4

He experienced increasingly severe low substernal nonradiating pain.

Question 5

Which physician injected Eisenhower with morphine during his heart attack?

Answer 5

Dr. Howard Snyder.

Question 6

What was the outcome of the press conferences held regarding Eisenhower’s health?

Answer 6

They educated Americans, especially middle-aged men, about cholesterol and dietary fat.

Question 7

What significant lesson did Eisenhower learn after his heart attack?

Answer 7

To attend to cholesterol and fat in his diet.

Question 8

What was Eisenhower’s cholesterol level before his heart attack?

Answer 8

165 mg/dl.

Question 9

What dietary changes did Eisenhower make after his heart attack?

Answer 9

He ate little fat and less cholesterol, using soybean oil and polyunsaturated margarine.

Question 10

What did Eisenhower switch to when his weight did not decrease?

Answer 10

Melba toast and fruit.

Question 11

What was Eisenhower’s cholesterol level on January 19, 1961?

Answer 11

259 mg/dl.

Question 12

Who made the cover of Time magazine advocating for low-fat diets?

Answer 12

Ancel Keys.

Question 13

True or False: Eisenhower’s diet effectively lowered his cholesterol levels.

Answer 13

False.

Question 14

What was the role of the American Heart Association regarding dietary fat and heart disease?

Answer 14

They took ten years to support the hypothesis that dietary fat caused heart disease.

Question 15

What myths supported the national policy of low-fat diets?

Answer 15

• Paul Dudley White’s declaration of a ‘great epidemic’ of heart disease.* The changing American diet story.

Question 16

What did the heart-disease epidemic narrative suggest about coronary heart disease?

Answer 16

It was uncommon until the 1920s and became the nation’s number one killer.

Question 17

What medical advancement helped diagnose coronary heart disease more accurately?

Answer 17

The electrocardiogram.

Question 18

What was the primary cause of heart attacks associated with atherosclerosis?

Answer 18

Blood clots (thrombosis).

Question 19

What did the International Classification of Diseases add in 1949?

Answer 19

A new category for arteriosclerotic heart disease.

Question 20

What was the effect of the 1949 revision of the ICD on reported coronary disease death rates?

Answer 20

Raised coronary disease death rates by about 20% for white males and 35% for white females.

Question 21

What percentage of heart-disease deaths were attributed to ischemic heart disease by 1968?

Answer 21

90%.

Question 22

What misconception about heart disease was highlighted in the 2001 WHO report?

Answer 22

Much of the apparent increase in coronary heart disease mortality may be due to better certification and diagnosis.

Question 23

What was the main argument against the idea of a heart-disease epidemic?

Answer 23

The rise in diagnoses was likely due to better recognition rather than an actual increase in disease incidence.

Question 24

What did the World Health Organization committee state about the increase in coronary heart disease mortality in 2001?

Answer 24

Much of the apparent increase may simply be due to improvements in the quality of certification and more accurate diagnosis.

Question 25

What significant legislation was passed by the U.S. Congress in June 1948 regarding heart disease?

Answer 25

The National Heart Act, which created the National Heart Institute and the National Heart Council.

Question 26

How much funding did the National Heart Institute allocate to heart-disease research by 1949?

Answer 26

$9 million.

Question 27

What was the total amount invested by the American Heart Association in research by January 1961?

Answer 27

Over $35 million.

Question 28

True or False: The American Heart Association was founded in 1924 as a public health agency.

Answer 28

False.

Question 29

What was the charitable contribution to the American Heart Association in 1945?

Answer 29

$100,000.

Question 30

What campaign did the American Heart Association hold in 1948 to raise awareness and funds?

Answer 30

A nationwide fund-raising campaign.

Question 31

Fill in the blank: The American Heart Association proclaimed the second week in February as _______.

Answer 31

National Heart Week.

Question 32

What did Ancel Keys claim about the American diet in relation to coronary disease in 1953?

Answer 32

The present high level of fat in the American diet did not always prevail.

Question 33

What did Senator George McGovern announce in 1977 regarding American diets?

Answer 33

The first Dietary Goals for the United States.

Question 34

What was the argument regarding the changing American diet and heart disease?

Answer 34

The diet shifted from plant-based foods to animal-derived foods, contributing to heart disease.

Question 35

What did the USDA food disappearance statistics suggest about American diets at the turn of the century?

Answer 35

Americans were eating 25% more starches and cereals and 25% less fats.

Question 36

True or False: The USDA food disappearance data are based on reliable evidence.

Answer 36

False.

Question 37

What historical observation was made about American dietary habits regarding meat?

Answer 37

Americans were traditionally a nation of meat-eaters, suspicious of vegetables.

Question 38

What effect did Upton Sinclair's book 'The Jungle' have on meat sales?

Answer 38

It caused meat sales in the United States to drop by half.

Question 39

During the heart-disease epidemic, what significant change occurred in vegetable consumption?

Answer 39

Vegetable consumption increased dramatically.

Question 40

What was the trend in whole milk and cream consumption from the end of World War II to the late 1960s?

Answer 40

Per-capita consumption of whole milk dropped steadily, and the use of cream was cut by half.

Question 41

How did the consumption of animal fats change during the heart-disease epidemic?

Answer 41

Decreased from 84 pounds to 71 pounds per capita.

Question 42

What did Jeremiah Stamler refer to cholesterol as?

Answer 42

The 'medical villain cholesterol.'

Question 43

What is cholesterol's role in the body?

Answer 43

An essential component of cell membranes and a constituent of various physiological processes.

Question 44

True or False: The initial evidence for the diet-heart hypothesis came primarily from human studies.

Answer 44

False.

Question 45

What did Nikolaj Anitschkow demonstrate in 1913 about cholesterol and atherosclerosis?

Answer 45

He could induce atherosclerotic-type lesions in rabbits by feeding them olive oil and cholesterol.

Question 46

What is the condition of having very high cholesterol called?

Answer 46

Hypercholesterolemia ## Footnote Cholesterol levels above 300 mg/dl are considered hypercholesterolemia.

Question 47

What did Nikolaj Anitschkow discover in his 1913 study on rabbits?

Answer 47

He could induce atherosclerotic-type lesions in rabbits by feeding them olive oil and cholesterol ## Footnote This research was criticized because rabbits are herbivores and would not naturally consume high-cholesterol diets.

Question 48

What factors can influence cholesterol levels in humans?

Answer 48

* Exercise * Weight gain * Weight loss * Seasonal changes * Body position * Stress * Hormonal changes * Certain medications ## Footnote Cholesterol levels can fluctuate by 20 to 30 percent over weeks.

Question 49

What did John Gofman conclude about cholesterol levels in patients with atherosclerosis?

Answer 49

There was no consistent evidence that patients with atherosclerosis had significantly higher cholesterol levels than those without it ## Footnote Some studies found elevated cholesterol levels, while others disputed this finding.

Question 50

What was the significance of the autopsy examinations conducted by Warren Sperry and Kurt Landé?

Answer 50

They found no direct correlation between cholesterol levels and the incidence or severity of atherosclerosis ## Footnote Their findings were significant in questioning the cholesterol hypothesis.

Question 51

Who is credited with promoting the cholesterol hypothesis linking cholesterol levels to heart disease?

Answer 51

Ancel Keys ## Footnote Keys argued that dietary fat was a significant factor in heart disease.

Question 52

What was Ancel Keys's hypothesis regarding diet and heart disease based on his observations in Naples?

Answer 52

The rich had higher cholesterol levels and more heart disease compared to the poor, who ate less meat ## Footnote This observation led Keys to conclude that dietary fat was linked to heart disease.

Question 53

What was the conclusion of Keys's studies on fat intake and heart disease rates across different countries?

Answer 53

Higher fat intake was associated with higher heart disease rates ## Footnote Critics noted that Keys's conclusions were based on selective data from only six countries.

Question 54

What did Jacob Yerushalmy and Herman Hilleboe argue against Keys's hypothesis?

Answer 54

They pointed out that including more countries in the analysis weakened the link between fat intake and heart disease ## Footnote They emphasized that correlation does not imply causation.

Question 55

What did researchers learn about dietary cholesterol's effect on blood cholesterol levels?

Answer 55

Dietary cholesterol has an insignificant effect on blood cholesterol for most people ## Footnote This finding contrasts with the common belief that dietary cholesterol significantly raises blood cholesterol.

Question 56

What was the common misconception about dietary fat and its effect on cholesterol levels?

Answer 56

That all dietary fat elevates cholesterol levels ## Footnote Research since the mid-1950s has shown that total dietary fat has little effect on cholesterol levels.

Question 57

Fill in the blank: The severe condition of atherosclerosis can be evaluated only after _______.

Answer 57

death

Question 58

True or False: Ancel Keys believed that dietary cholesterol was a significant factor in causing heart disease.

Answer 58

False ## Footnote Keys eventually concluded that dietary cholesterol had little relevance to heart disease.

Question 59

What was Ancel Keys' belief about dietary fat and cholesterol in the mid-1950s?

Answer 59

All fat, both vegetable and animal, elevated cholesterol ## Footnote Keys believed that to lower cholesterol, one should eat less fat.

Question 60

What did Laurance Kinsell demonstrate in 1952 regarding vegetable oil?

Answer 60

Vegetable oil decreases the amount of cholesterol circulating in blood ## Footnote Kinsell was the director of the Institute for Metabolic Research.

Question 61

What was J. J. Groen's finding about cholesterol levels in 1952?

Answer 61

Cholesterol levels were independent of the total amount of fat consumed ## Footnote Groen noted lowest cholesterol levels on a vegetarian diet with high fat.

Question 62

What crucial factor did Kinsell and Edward Ahrens identify in controlling cholesterol?

Answer 62

The degree of saturation and chain length of the fats ## Footnote Saturated fats tend to raise cholesterol, while unsaturated fats tend to lower it.

Question 63

What misconception is taught in high schools regarding animal and vegetable fats?

Answer 63

All animal fats are 'bad' saturated fats, and all 'good' unsaturated fats are found in vegetables and fish ## Footnote This oversimplification hinders understanding of diet and heart disease.

Question 64

What did the 1957 American Heart Association report conclude about dietary fat and heart disease?

Answer 64

There was not enough evidence to make a rigid stand on the relationship between fat content and heart disease ## Footnote The report criticized researchers for uncompromising stands.

Question 65

What change occurred in the AHA report released in December 1960?

Answer 65

It suggested Americans could reduce heart disease risk by reducing dietary fat and replacing saturated fats with polyunsaturated fats ## Footnote This was the AHA's first official support of Keys's hypothesis.

Question 66

What was Ancel Keys' proposed ideal heart-healthy diet according to Time magazine?

Answer 66

Increase carbohydrates to almost 70% of calories and reduce fat consumption to 15% ## Footnote This proposal was part of the coverage that enshrined Keys as a dietary authority.

Question 67

What did the AHA’s 1960 report indicate about those at high risk of heart disease?

Answer 67

Only those at high risk should eat less fat ## Footnote This included overweight middle-aged men who smoke and have high cholesterol.

Question 68

What is arteriosclerosis?

Answer 68

The condition in which atheroma accumulates in arteries throughout the body ## Footnote The term was often used interchangeably with 'atherosclerosis.'

Question 69

How much could decreasing cholesterol consumption from 400 mg to 300 mg a day affect cholesterol levels?

Answer 69

It would be expected to reduce cholesterol levels by 1 to 2 mg/dl ## Footnote This represents a decrease of perhaps 1 percent.

Question 70

What was notable about the references included in the 1960 AHA report?

Answer 70

It included recent scientific references, many of which contradicted the conclusions of the report ## Footnote The report was only slightly over two pages long and lacked comprehensive citations.