Medicine: Cholesterol Controversy

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On the hazards of obesity and the necessity for counting calories, the medical profession is almost unanimous. On the dangers of cholesterol and its role in heart disease, doctors remain stubbornly divided. In fact, says Manhattan's Dr. Arthur M. Master, one of the foremost of U.S. cardiologists, the current preoccupation with cholesterol is one of the heart-health fads on which "the ablest and most reputable physicians and scientists have diametrically opposed views."

The problem has been oversimplified for the layman, Dr. Master complains. Men with a lot of cholesterol in their blood tend to have heart attacks earlier in life than others. Though some foods contain readymade cholesterol, the body manufactures more of it from saturated fats in meat and dairy products. So the argument runs: Cut down on saturated fats in the diet, thus lowering the cholesterol level in the blood and reducing the danger of artery disease and heart attacks.

Snacks or Squares? But the medical facts are not so straightforward as all that. Though cholesterol is found in diseased coronary arteries, it is not yet certain whether cholesterol is the original cause of damage or a secondary invader. Many high-cholesterol men never have heart attacks at all. While doctors use the cholesterol level as a guide to the amount of fat in the blood, it is a crude and unreliable measure: it varies with exercise and whatever drugs the patient may have taken; it depends on whether he has been nibbling snacks or eating three meals a day. It changes with his emotional ten sion (how worried is he about this test?), and even with the amount of tourniquet pressure on his arm when the nurse draws a blood sample.

"It cannot be taken for granted," Dr. Master told the American Medical Association, "as many physicians and lay persons do, that lowering the blood cholesterol will reduce the incidence and mortality of coronary disease and coronary thrombosis. There is as yet no proof that a diet low in saturated fats, or a drop in the blood cholesterol, will prevent or in fluence coronary disease." Although the medical profession cannot yet make up its collective mind on these matters, Dr. Master gave much credit for pioneer research to Dr. Ancel Keys (TIME cover, Jan. 13, 1961) and the late Dr. Norman Jolliffe, who founded New York City's Anti-Coronary Club (former and potential coronary cases).

Meanwhile the mere hope that a change in diet will prolong life is filling U.S. kitchens and men's stomachs with hitherto esoteric oils; housewives are chattering with superficial knowingness about polyunsaturated fats.* Americans get an average of 40% to 45% of their daily calories in fats, and before the cholesterol craze came along, most of the fat was saturated. Some doctors have urged simply cutting down fats, of whatever kind, to about 30% of the total caloric intake. Others have advocated substituting polyunsaturated fat for much of the saturated stuff, and worrying less about the total intake. Conservative Dr. Master adds a warning: "The ingestion of large amounts of polyunsaturated acids is unnecessary and may actually be harmful."