PHYSIOLOGY OF FAT
IS FAT NECESSARY? IS LIKE ASKING "IS
Crime Necessary?" or "Is it Necessary to be Fat?" The implication alone is bad, like asking "How Often Do You Beat Your Wife?" Of course, the answer to all of these questions is "no."
Is fat essential in a healthy diet? Some nutritionists and scientists believe that a small amount of fatty acids or components of certain fats are essential to human nutrition. This has never been demonstrated for humans, although apparently it is true in rats. There is the incontrovertible fact that countless millions of human beings in Asia, Africa, South America and elsewhere do not consume fat in their diet. And yet they live to a health-normal or beyond-normal life span; their physical or nutritional development is not infrequently far superior to the people on a high-fat or average American fat dietary intake.
Most certainly it is known now that these same people on a low-fat or fat-free diet are virtually free from heart attacks and strokes, which are so common among people on a fat diet.
Many have wondered whether the Eskimos have a high rate of heart attacks and strokes as a result of their high fat diet. First it should be remembered that the Eskimo days of existing
on blubber and whale alone are mostly over. Several years ago physicians working with the National Geographic Society found that the Eskimos who lived in the more modern settlements and ate and lived like other Canadians or Americans in country villages, were subject to the same degree of atherosclerosis, high blood pressure, and heart conditions.
On the other hand, in those Eskimo cases where fish and whale fats constituted the basis of the diet, blood tests revealed that cholesterol and fats in the blood were very low. This surprising fact was later found to be due to the high concentrations of un-saturated fatty acids in the large amount of fish and whale oils consumed by these Eskimos. As will be shown later, these un-saturated fatty acids have the unique power to lower the blood levels of cholesterol and other fats, thus protecting the Eskimos from the complications of atherosclerosis in the heart, brain, kidneys, and other organs.
What is fat? First let us look at food in general. As long as we are alive, breathing, with our hearts pumping, our bodies are at work burning up energy—which is supplied by food.
Food or foodstuffs consist of six groups, all of which are basic necessities essential for normal health. These are proteins, carbohydrates, fats (which are also manufactured by the body), vitamins, minerals, and water.
Protein is the keystone of human nutrition. It is essential for every form of life for growth, pregnancy, formation of blood, bone, and every vital tissue. It is essential for the healing of wounds, the warding off of infection, the maintenance of body weight, and the conduct of vital organs and glands in the body.
Meat is the greatest source of animal protein for human consumption and man can live in good health on virtually an exclusive fresh meat diet. Animal sources of proteins are meat, fish, poultry, milk, eggs and cheese. These foods contain high sources of protein, as well as carbohydrates and fats. Vegetable sources of protein are wheat, beans, peas, lentils, soybeans, nuts,
corn, rye and yeast, although these also contain elements of carbohydrate and fat.
Normal adults and growing children require one gram of protein for every 2.2 lbs. of body weight. This means that the average man or woman weighing 125 to 175 lbs. needs from 60 to 80 grams of protein daily for normal nutrition. This would be contained in the equivalent of 1/2 pound of steak, one chicken, a pound of fish or a pound of cottage cheese. Each gram of protein supplies four calories of energy, as shown in Chapter 6.
Carbohydrates are a main source of energy. Carbohydrates include the two main classes: starches and sugars. They are one of the primary sources of energy of our diet. One gram of carbohydrate yields 4 calories of energy. The amount of carbohydrates necessary in the daily diet is very variable and also depends on the amount of it eaten with the protein in meals. The average American adult consumes anywhere from 150 to 400 grams of carbohydrate daily. It takes about 500 grams to make a pound. Usually more than half the calories in the diet (from 50 to 70 per cent) are supplied by carbohydrate.
Unfortunately, these carbohydrates are usually refined to excess, as in the case of flours and sugars. Essential vitamins and proteins are lost in this way and certain nutritional deficiencies may result. If excessive carbohydrate is eaten in the diet, many individuals will experience symptoms of gassy distress, flatulence, belching, or bloating. Bread, flour, milk, cereals, potatoes, cornstarch, cakes, rice, and puddings are examples of dietary starch as are moat vegetables, although these contain lesser amounts of both carbohydrates and protein. Sugars are represented by cane sugar, corn syrup, honey, maple sugar and syrup, milk sugar, malt sugar, jams, jellies, and most fruits.
Two of the most common symptoms or sensations that humans feel daily are dependent on carbohydrate metabolism: that is, hunger and fatigue. Certain endocrine glands in the body control the level of blood sugar in the body and are linked to the feelings of hunger, fatigue, and exhaustion. When the blood sugar falls abnormally low, one feels headaches, nervousness, dizziness, or weakness.
Many of my patients combat these tendencies to hypoglycemia or low-blood sugar in the following simple ways: in between meals take fresh fruits, preferably bananas or apples, or canned fruit juices or fruits; English "tea" with whole wheat cookies or crackers, graham crackers, arrowroot cookies and if needed, some lean meat or fish in sandwich form; skim milk thickened and fortified with generous servings of skimmed milk powder; bread and jam; fat-free sherbet or ices; dietetic or low-fat ice cream; fruit jellos are refreshing; hard candies or chocolate bars are often very handy but not as desirable as the natural, healthful in-between meal "snacks," suggested above, as they often damage the teeth and may have too short-lived action on the blood sugar. Not infrequently sugar itself will cause a "rebound" reaction resulting in an even lower blood sugar fall one-half to one hour after the sugar has been eaten.
Countless business people and factory workers find their efficiency and capacity for work greatly increased by following the above dietary aids. It is not necessary to wait until the symptoms of low-blood sugar already signal the breakdown of bodily health.
The habit of drinking coffee alone at the coffee-break is like whipping the tired old horse harder to get it to climb up the hill. The artificial stimulant, caffeine, can never possibly substitute its artificial stimulant drug action for the flow of energy that comes from healthful, natural foods.
Vitamins and minerals are discussed later, in Chapter 5. The necessity of water for the maintenance of life is known to all. This brings us to fats.
Fats—What they are and what they do to you. The outstanding fats eaten daily in the United States and Europe are butter, eggs, whole milk, cream, meat, fish and poultry fats, and cheese in various combinations. These fats, at 9 calories per gram, contain more than twice the amount of calories than protein or carbohydrate does at four calories each per gram. As we have noted and shall describe in later chapters, excessive intake of fats leads to the shortening of life, premature death by heart attacks and strokes, obesity, and numerous crippling illnesses.
Fats (or lipids) contain the elements of carbon, hydrogen, and oxygen in various combinations of animal and vegetable fats. Examples of animal fats are butter, lard, cream, milk, eggs, and the fat in meats. Vegetable fats are soyabean oil, olive oil, cottonseed and corn oils, and peanut oils; these are found in nuts, coconuts, avocados, margarines and other vegetable fats used in cooking.
Fats do not dissolve in water, and when pure they are odorless and tasteless. They are found in most bodily tissues, particularly in combination with other elements, proteins, or minerals. Fats or lipids act as vehicles for the absorption of the natural fat-soluble vitamins such as vitamins A, D, and E.
In order for fats to be utilized by the body, they must first be digested and broken down into constituent parts before being absorbed. They are absorbed in the following manner: After the food is masticated and enters the stomach, the digestive system supplies its first fat enzyme called lipase, to begin the digestion of the fat. Enzymes or ferments are unique chemical compounds manufactured by the cells of the tissues. In the digestive tract they are vital for the chemical breakdown of all foods before they can be absorbed.
How are fats digested? The fat enzyme of the stomach, lipase, begins its job on the fats eaten. However, it is a rather weak enzyme, leaving most of its work to be carried out by steapsin, the fat enzyme manufactured by the pancreas, and by bile manufactured by the liver. In the bile are found bile acids and salts which, together with steapsin, split the fats ingested into the smallest molecules and particles possible. These can then be absorbed through the lining of the small intestine and
pass either into the liver or directly into the blood stream as chyle, a milky or creamy serum.
How fats are absorbed. When the fat particles are brought to the liver, they undergo further chemical breakdown and metabolic changes before they enter the blood stream in the form of cholesterol, phospholipids, fatty acids, neutral fats (which are neither acid nor alkaline), lecithin, and other fat derivatives. Much of the fat is broken down by the liver cells into cholesterol, which is excreted into the bile and goes back again into the intestine in various chemical forms. Once in the intestine, some of the cholesterol is reabsorbed again along with other fats and some is excreted from the body in the bowel movement. If the proportion of the cholesterol in the bile becomes too high, then it precipitates out of the bile and forms gallstones, which can produce attacks of pain and indigestion, and so often keep the surgeon busy.
Now that the fats or lipids have entered the blood stream, they circulate and are deposited in the various bodily tissues and in the great body storehouses called fat depots. These are located in the abdomen, on the hips, the chest, around muscles, under the skin, in the liver, and elsewhere. The fats consumed in the diet are called exogenous fats. The liver and other tissues, however, manufacture equally important quantities of fats or lipids normally found in the blood stream. These are called endogenous lipids.
These lipids are manufactured from proteins and carbohydrates through certain remarkable processes inherent in vital bodily tissues and glands such as the liver or the adrenal glands. Energy and vital cellular constituents for the body result from these lipids. When present to excess, their effects become devastating to humans, as shown in the chapters on overweight and atherosclerosis. We now come to the fats circulating freely in the blood stream. Let's see how they get into the artery walls to actually damage or destroy the artery with atherosclerosis.
Fig. 1. Cross Section, Coronary Artery.
This diagram shows the three coats of the coronary artery and the channel through which the blood flows to nourish the heart muscles.
Fig. 2. Cross Section of Coronary Artery in Coronary Thrombosis
How fats damage or destroy your arteries. Extensive research in experimental animals has been able to demonstrate how these lipids can leave the bloodstream and enter the artery wall within 24 hours. The atherosclerosis produced in these animals becomes indistinguishable from the atherosclerosis seen in human arteries. However, the exact details of the mechanism whereby fats actually enter into the wall of the artery are not yet known. What is known and what is important is that there is a definite ratio or relation between the amount of fats in the blood stream and in the artery wall, and this is surprisingly predictable in most cases. Also, the relationship of the fats in the artery wall itself is very close to that in the bloodstream. This direct relationship between the two seems to be in fairly constant balance.
As described in the first chapter, the artery wall consists of three different layers. If the reader can picture a garden hose as representing the artery, it presents an innermost layer called the intima, a middle layer called the media, and an outer layer called the serosa. (See Fig. 1).
The fats circulating in the blood stream are of course closest to the innermost layer of the artery, with which they are in direct contact. When conditions are right for atherosclerosis, the fats attach themselves and enter the inner or intima layer of the artery. A kind of wart or excrescence on the artery is then formed, called a plaque of lat. When the plaque grows larger, it encroaches upon the passageway of the artery. As it grows larger and larger, it may finally block or obstruct it partly or completely. When this clogging or obstruction of the artery takes place in the vital coronary arteries of the heart, then a coronary thrombosis or heart attack assails the victim. If the blockage from these fatty or atheromatous plaques occurs in the brain, then a stroke strikes down the victim.
However, if the artery is only partly blocked by this accumulation of fatty plaques, then the vital organs supplied by the arteries suffer from a lack of the necessary amount of blood and nutriments contained in it to sustain normal function and health.
Along with the fatty deposits of cholesterol, fatty acids, neutral fats, etc., which make up these atheromatous plaques, calcium and other minerals are also deposited. These make the artery feel hard, giving rise to the term commonly in use— "hardening of the arteries." Actually we see a softening of the arteries which takes place first because of these fatty deposits.
It is often noticed in many individuals that this free fat will be floating in the blood stream for hours after a meal containing fat has been eaten. The blood is then called lipemic, which means loaded with fats. When these fats are easily visible to the naked eye, scientists speak of such neutral fats as chylo-microns. These fats in the blood are regarded by many scientists to be as dangerous as is cholesterol, in entering the artery wall.
A great proportion of these fats in the blood is combined with proteins, called lipoproteins, which also have been the subject of research by many investigators. Scientists have only recently discovered by new tools of investigation that in these lipoproteins two separate portions can be measured: the alpha and the beta lipoproteins. The first have been shown to be protective against the development of atherosclerosis. They are found predominating in infants, children, and young women who have no evidence of atherosclerosis.
On the other hand, the beta-lipoproteins have been found universally in excessive amounts in most cases of active atherosclerosis and so are called atherosclerosis producers or "ather-ogenic." The protective alpha-lipoproteins are spoken of as "anti-atherogenic."
The problem of preventing atherosclerosis and its human ravages is the search for ways of increasing the protective alpha-lipoproteins. Chapter 5 discusses lecithin and other nutritional supplements and shows how to use these protective substances against the development of atherosclerosis.
One of the greatest factors influential in the current epidemic of heart attacks has unquestionably been the startling increase in fat intake. In the United States alone, the fat content of our
diet has just about doubled in recent times. Where fat formerly constituted some 15 to 20 per cent of our meals 50 years ago, it now has jumped to 30 and 40 per cent or more.
Fat may be your "poison". Many individuals have now developed an intolerance to fat. Some of my patients can't seem to handle any fat at all. As an example, one plump 40-year old mother of three develops severe gas and bloating after eggs or any other fatty food. Mrs. R. is often embarrassed to dine out for fear of overflowing right out of her girdle if friends supply her with a fatty food at their homes. At other times she has been embarrassed by solicitious friends who have delightedly congratulated her upon her "unexpected" and "surprise" pregnancy after eating some fat food!
Other patients of mine develop actual attacks of gallstone colic following a meal containing fat. Some 20 years ago, I studied the causes and effects of gallstones in humans by passing rubber tubes through the mouth and down into the digestive tract and then draining off the bile or gall manufactured by the liver and stored in the gall bladder. At that time I examined and found the cholesterol and fat content of the bile abnormally high in most patients who suffered from gallstones, liver, and gall bladder diseases. A fat-free diet was able to eventually reduce and restore the bile to its normal cholesterol and fat content, not to mention the well established fact that most patients felt vastly improved and often free of pain or distress.
Of especial interest to me is the case of a 46-year old automobile dealer, Mr. C, who used to have disabling and terrifying attacks of pain over his heart. (We call such pain angina pec-toris.) The pains began only after he had eaten breakfast and was preparing to leave for his business. His breakfast was a hearty one. It consisted of bacon and two scrambled eggs, fruit juice, some delicious coffee cake with two pats of butter, plus two cups of coffee containing generous portions of cream. He was a husky, strapping ex-athlete and burned up a great deal of energy in business activities.
When Mr. C. changed his breakfast habits and ate a good breakfast on the low-fat diet (as explained and described in later chapters) his anginal pain stopped as if by magic. Clearly he was one of the many individuals whose circulation could not tolerate fats.
This was again just recently shown in most convincing and dramatic ways by Doctors Peter Kuo and H. Joyner of the University of Pennsylvania Hospital and Medical School. These investigators studied the effects of fat meals in a series of heart cases and others afflicted with atherosclerosis over a several year period. One group of their patients suffered severe heart attacks every time a fat meal was administered to them. Studies of the heart and the blood were made during actual heart attacks by Electrocardiographs and other scientific instruments. It was found that when the blood stream contained its peak load of fat content, the heart attacks were most severe and threatened the very life of the patients. Such striking studies and findings were also the experience of other research physicians.
How much fat are you stowing away? Look at the following sample daily menus for fat content that the average American consumes, as taken from the front page of the New York World Telegram.
Fat Content Calories
Breakfast:
One-half grapefruit 70
Two eggs 12 grams 150
Two slices of bread 130
Two pats of butter 12 grams 120
One cup of coffee with % tablespoonful of
cream and two teaspoons sugar 3 grams 100
Lunch:
Boiled ham, 2 slices 20 grams 200
Two slices of bread 130
Two pats of butter 12 grams 120
Lettuce and tomato 30
Mayonnaise, 2 teaspoonsful 6 grams 60
Cup of coffee with cream and sugar 3 grams 100
Danish bun, prune filled 8 grams 150
PHYSIOLOGY OF FAT
23
Dinner:
Melon slice 20
Steak or beef with gravy, 4 ounces 40 grams 500
Potato and peas, or salad 100
Two pats of butter (or oil dressings) 12 grams 120
Cup of coffee with cream and sugar 3 grams 100
Ice cream 12 grams 250
Cherry pie 12 grams 350
155 grams 2800 calories
Total fat for the day 155 grams.
Total cholesterol 800 milligrams.
Total calories for the day 2800.
Total calories in fat 1400.
How much fat can you really live with? In contrast, compare the sample menu used on the low-fat diet:
Meal Plan Sample Menu Fat Content Calories
Breakfast:
Fruit juice Orange Juice 80
Cereal Shredded wheat 100
Skimmed milk Skimmed milk 65
Bread Whole wheat toast 65
Coffee, tea, Postum —
Sugar 15
Noon Meal:
Soup Skimmed milk pea soup 50
Meat or cheese Cold roast lamb 10 grams 300
Vegetables String beans 50
Salad Sliced tomato 20
Fruit or dessert Canned pineapple 100
Bread Whole wheat bread 65
Milk Skimmed milk 65
Evening Meal:
Fruit Cocktail Grapefruit cocktail 50
Meat and Potato Lean meats 10 grams 250
Baked potato 100
Vegetables Banana squash 25
Asparagus 20
Salad and dressing Fresh pear salad 25
Boiled dressing 5 grams 50
Dessert Lemon ice 200
Bread Whole wheat bread 65
Milk Skimmed milk 65
25 grams 1800 calories
24 PHYSIOLOGY OF FAT
Total fat for the day 25 grams
Total cholesterol 75 milligrams
Total calories for the day 1800 calories
Total calories in fat 225 calories
What an extraordinary contrast these two sample menus present in fat content and calories! On the one hand, the total calorie content of a typical American daily diet is about 2800 calories, of which almost 50 per cent is fat. The low-fat diet provides approximately 1800 calories (1000 calories less), which is the normal healthy amount for the average adult housewife or light worker. Here the fat content is about 15 per cent of the total dietary calorie content and is the amount found in the diets of millions of non-Americans who are virtually free of atherosclerosis or heart attacks and strokes. What a clear-cut and simple choice is given us for better health and longer life!
The question may still arise, "Isn't fat necessary for normal health and nutrition?" As mentioned previously, the need for fat in humans has never been proven, although certain essential fatty acids contained in some vegetable oils are very valuable for keeping the blood fats lowered.
In some people, fat seems to be necessary. The Hottentots are an example. These South African tribes, related to the Australian bushmen aborigines, are unique amongst humans in that their women have enormously developed buttocks, due to extraordinary deposits of fat!
At one time these huge posteriors were thought to be an interesting example of attractive, secondary sex charactertistics in women. But anthropologists later found that the excessive fat deposits had been developed through the ages by Mother Nature to protect these women from the continuous famines and droughts from which these tribes suffered. Nature gave these women and their tribes survival by developing in them fat storage depots or warehouses. In times of starvations or drought, these storage warehouses were called on to supply food and energy, enabling
PHYSIOLOGY OF FAT 25
the women and their young children to survive the famine and to perpetuate the species.
Nature had found that the ideal location for these storage banks of fat was on the buttocks and hips. Some of this hereditary tendency is still seen in African descendants who now live in the United States; their ancestors had been brought over in slave ships only one or two hundred years ago to this country. Curiously enough, this primitive trend seems to be becoming popular in some "quarters," particularly in the world of entertainment, such as the motion pictures!
Another interesting demonstration of the importance of body fat in a society was the old custom among Turks and Arab peoples of measuring beauty in their women by the amount of avoirdupois! Many a rich man among them proudly regarded his wealth by the number of fat wives and women in his home or harem. In times of food scarcities and daily uncertainties of living, an ample supply of food as shown by obesity was the best visible sign of affluence and prosperity. The husband's success then carried over into standards of feminine beauty as evidenced by his ability to pad and fatten his women.
This concept was very popular in the "gay nineties" of our own country. The comic "beef trust" troupes in theatrical vaudeville and burlesque occasioned both fun and admiration for so much concentrated female pulchritude in a chorus-line of 200 to 300 pounders!
Take a lesson from the pig. Finally, let us look at the startling new discoveries made in swine. The hog or pig has always been associated in every mind as the epitome of fatness. The expression "to be fat as a pig" or as a hog is one of the most common expressions in our language. Fat and food from swine is one of the most frequent sources of nourishment used by humans, i.e. ham, bacon, pork, lard and so on. Yet only very recently has it been discovered that pigs are virtually the only animals subject to the natural or spontaneous development of atherosclerosis.
26 PHYSIOLOGY OF FAT
Several teams of researchers have published numerous convincing photographs of the development of atherosclerosis in many vital arteries of swine. This startling news was provided by Doctors J. H. Bragdon, J. H. Zeller, and J. W. Stevenson of the National Heart Institute of Bethesda, Maryland, who confirmed the original findings made in this research by a team of Wisconsin scientists headed by Doctors H. Gottlieb and J. J. Lalich.
The amazing facts were that about 50 per cent of the swine examined carefully showed the natural development of atherosclerosis in the main arteries of the body. This disease in the arteries was virtually the same as atherosclerosis seen in humans!
In addition, still other investigators such as Doctors Irving Page and Lena Lewis of the Cleveland Clinic found that hogs had unusually high levels of blood cholesterol and fats. There was a special increase in the swine studied of the atherogenic portion of the lipoproteins, so important in the development of atherosclerotic heart disease in humans.
It has always been thought that fat on the hog was natural and did not harm the animal, but just those humans who made "hogs" of themselves. Now all these extraordinary discoveries show us that even the pig is victim to fatty deposits in the arteries; to eat high on the hog even damages the hog. Let us "eat to live, not live to eat."
By following the instructions contained in the following pages on what to eat and what to weigh, you can learn to enjoy your food, and most important, enjoy better health and increased vitality and reap a harvest of added years to your life.
