Why were middle-class Americans so receptive to Keys’s message? Part of its appeal was that it portrayed heart disease as a consequence of America’s economic success. As we have seen, in the late nineteenth
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century, bett er-off Americans were att racted to the idea that dyspepsia and neurasthenia were by-products of the fast pace of life in America’s booming business civilization. Now, with their country embroiled in the Cold War with the Soviet Union, Americans believed that the superiority of their system was exemplifi ed by their affl uence. Social scientists now saw practically all aspects of American society as products of affl uence, including some negative ones.⁴⁰ In his 1958 book Th e Affl uent Society , the economist John Kenneth Galbraith said that although private affl uence had led to the disappearance of all but a few “pockets of poverty,” there was persisting poverty in public services and institutions. Keys, who ad-mired Galbraith, struck a similar chord, portraying heart disease as “a disease of affl uence”—an unfortunate side eff ect of America’s economic success. In other countries, he said, heart disease affl icted mainly rich men, who were the only ones who could aff ord fatt y foods. Heart disease was much more widespread in the United States, he said, because practi-cally everyone there could aff ord a rich man’s diet.⁴¹
From the outset, the people raising alarms over the coronary plague had exploited this presumed association of heart disease with successful men. In 1947 the American Heart Association kicked off its fi rst national fund-raising drive by warning that coronary thrombosis struck doctors, lawyers, and business executives much more frequently, and at a younger age, than it did manual laborers and farmers. (It provided no data to sup-port this questionable claim.) The nationally syndicated medical colum-nist Dr. Peter Steincrohn, author of a book on heart problems, called men with heart disease “the successful failures . . . who accomplish much for their generation, but, like the busy bees, die off sooner than the rest of the hive.”⁴² This theme was repeated endlessly over the next ten years, culminating with Time, in its 1955 piece on Keys, calling it “a disease of successful civilization and high living. . . . The image of the tycoon who, at age 50, has att ained money, success, a yacht and a coronary thrombosis is almost part of American folklore.”⁴³
Other contenders for responsibility for the “coronary plague” were also regarded as products of America’s affl uent business civilization:
stress, obesity, sugar, and smoking, particularly the fi rst of these. All Keys did was to change the cause of the busy bees’ early demise from stress to “a rich man’s diet.”⁴⁴ This went along with a change of heart among nutritionists. They were beginning to think that their previous advice that “excess is preferable to limitation” was responsible for the obesity, atherosclerosis, and diabetes that now seemed prevalent among “the up-per income groups.”⁴⁵
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These fears of the consequences of over-indulgence were grounded in the perception that Americans were surrounded by an incredibly boun-tiful food supply. By the mid-1950s, the nation’s farmers were producing so much food that they had to be paid not to produce it. By 1961 the government was trying to fi gure out how to dispose of 100 million tons of surplus farm products. Supermarkets overfl owed with foods that had previously been unavailable or unaff ordable to most people. One of the att ractions of the major rival to Keys’s theory, that being overweight was the cause of the heart disease epidemic, was that it faulted those who could not resist the temptations of abundant food. (Keys himself said he found obese people “disgusting” but argued that obesity might be implicated with heart disease only to the extent that “fat people tend to eat more fats.”)⁴⁶ Keys played on this revulsion against the loss of self-restraint as well. Prosperity, he said, had allowed all Americans to “att ain the food heaven of the teenager—unlimited fat steaks, French fries, and triple dips of ice cream.”⁴⁷ Later, in 1975, Keys would use this appeal to restraint and simplicity when he repackaged his recommendations into the “Mediterranean Diet.”⁴⁸
However, as is so oft en the case, Keys’s theory also triumphed because there was so much money to be made from it. During the 1950s, Ameri-can food companies had become obsessed by what they called the “fi xed stomach”: That is, the idea that Americans were physically incapable of eating larger quantities of food than they already were. Some sought to increase profi ts by adding value to their products with new ways of pro-cessing and packaging. Others tried wresting a larger share of the static market away from similar foods. Among the most zealous at the latt er were vegetable oil producers, who energetically stoked fear of saturated fats to sell their products as replacements for butt er and lard.
They did this in the face of some early obstacles. Soon aft er the marga-rine manufacturers fi gured out how to replace the lard in their products with vegetable oil, it was discovered that the hydrogenation process they used to harden the oil transformed its unsaturated fats into the bogey-man, saturated fats. The result left margarine with as much cholesterol as butt er. However, they quickly adapted, and in late 1960 began mixing some liquid oil into their margarines, producing a “partially hydrog-enized” product with considerably less saturated fat than butt er.⁴⁹ From then on, they had the butt er producers on the run, fi rmly establishing their products as healthful heart-savers. Although some scientists warned of the possible dangers of the trans fats created by the process, Keys led the way in dismissing these concerns as groundless.⁵⁰
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By the end of 1961, then, Keys was riding very high indeed. His basic ideas about the dangers of cholesterol-laden foods were already part of the conventional wisdom. The media hailed him as the nation’s top ex-pert on food and health; the University of Minnesota lauded him as one of its star researchers; he traveled the world collecting data and advis-ing local authorities on their nations’ diets. But many scientists still re-mained skeptical, including some who were put off by his contemptuous treatment of those who disagreed with him. (He was, said one of them,
“prett y ruthless” and hardly apt to win any “Mr. Congeniality” awards.)⁵¹ Moreover, although a number of powerful interests were now dissemi-nating his ideas, others were challenging them. The next decades would see a host of interest groups—scientifi c, commercial, charitable, politi-cal, and professional—weigh in to the debate.