Group Interview

Quotes

I got interested in atherosclerosis when I was a resident in Iowa City at the University and the VA Hospital because we had patients that had coronary disease and nobody knew much about it. They didn’t even have much to offer except nitroglycerin and if they collapsed in arrhythmia, injecting adrenalin in the heart. That was the state of affairs. (3)

Epidemiology pointed the direction and the metabolic studies and clinical trials have cemented it. And the animal studies, too. I think it’s a beautiful illustration of the coalescence of many aspects of science. I always tell the medical students: “Think of the epidemiology and the geographic pathology. Think of the animal experiments, which show that geographical pathology is correct and then the human metabolic experiments and the composition of the plaques.” (3)

What about the Tarahuma Study?

A friend of mine in Los Angeles said, “I’ve been to see the Tarahumara and they don’t seem to have coronary disease. “Why don’t we take our sons …” [He had a son who was about, I think, 18 to 20 and I had my son, Rodney, who practices in Portland, Oregon] “Why don’t we take our sons and just go down there and look around?” We made connections with Father Verplankken. He’s coming here to give a talk before the group of people who contribute to the Tarahumaras. They have an annual meeting, an auction, and so on because the Tarahumaras are quite hungry. They are still pretty isolated and the Mexicans are coming in and cutting down the trees. So it’s not a good thing, it’s the same exploitation we did with our American Indians. But they are still fairly isolated. So we went down there and we found a hospital at Sisiguchi (unsure of word), which is in the backwoods sort of. You get there by a 30-mile, rough jeep road. But the sisters are there and the school is there and they translated The Bible into the Tarahumara language for those people.

We asked, “Can we do some studies in the Tarahumara?” And they said, “The people who study them come, they gather information and then they leave and we never hear from them again. Would you be that way?” I said, “No. We’ll come and gather information and we’ll send it to you.” So we made acquaintance with Bishop Liguna who is now deceased. I guess he was impressed that we were sincere so he said, “Come back.” So a larger group came back and my son came back with us and . . Martha McMurray….the dietitian. She spent a lot of time there. We simply went and observed and taught them to let us have a blood specimen and take their blood pressure and weigh them. They knew their age. There were older people. But, of course, the Tarahumara’s count differently, so age is always a question in people who don’t have a written language. So I had a backpack and we would draw blood sitting on a stone in a farmer’s field. We had another guy who translated Spanish into Tarahumara. And Bonnie spoke Spanish. I spoke a little. It was really a lot of fun. And we stayed in the village in Sisiguchi and at night the Tarahumaras would get drunk. . . on weekends. Mexican beer. They also make a hard liquor, which they ferment and it goes bad in about two or three days. So they have to drink it. So that was the survey and we had an article on the survey of lipoproteins and blood pressure….. We didn’t observe [their endurance races] We had indications of it, but we didn’t actually observe it. But they did the hundred mile race from Leadville to Aspen ……..(17)

What’s happened to your diet index?

We find it useful because it combines both cholesterol and saturated fat. But I don’t think it has caught on. The Cholesterol/ Saturated Fat Index is really derived from Hegsted’s Equation. Keys and Hegsted are not too far apart. I’m not sure why it hasn’t caught on because some agency that publicizes like the Department of Agriculture or the NIH, they haven’t found it useful. But I think it’s useful to have a single number to denote the pathogenicity of a food to raise LDL. So that’s the only value. (27)

What about the Eskimo?

He [Stephansson] came down to Iowa City when I was a medical student and lectured about the Eskimos and he told us about the diet of the Eskimos and the fact that he lived for one winter on the ice. The Eskimos thought he was crazy because nobody could live on the ice, but he knew that under the ice were seal and that seal had to have air. So he said, “There are going to be holes so when the seal come up for air I’ll harpoon them. So I ate raw seal.” For a winter he ate raw seal. But he said the Eskimos don’t seem to have Western diseases. (20)

Why don’t you talk about Omega-3s and fish oil therapy and bring me up to date

Yeah. We got started on that with the Arctic explorer, Stefansson, who said there wasn’t any coronary disease among the Eskimos and the reason was probably their diet, which was, of course, high in fat and high in cholesterol. That was always the question before the picture emerged and was clarified. Students would ask, “What about the Eskimos? They don’t have coronary disease, but they eat high cholesterol, high fat diets?” I think the pioneers there were Dyerberg and Bang of Denmark.

It’s observational epidemiology. It’s not very scientific, but they found lots of coronary disease among the Danes and not very much among the Greenlanders. And they did figure it out that it had something to do with the diet and they made some measurements of the bleeding time, which was longer in the Greenland Eskimos and they made some observations about the presence of EPA and DHA in the blood, particularly in the blood platelets.

We did some of the first controlled feeding studies comparing a diet high in [omega 3s]……We used a pound of salmon a day, which is a lot of salmon. People got tired of it after a while. But that led to triglyceride lowering, very impressive in patients with very high triglycerides, 1200 would come down to 300. And some cholesterol lowering. And then the platelets were less sticky; the bleeding times were prolonged. And thromboxin A2 is less and thromboxin B2 from the EPA was sort of impotent. So the balance was shifted in the direction of mild anticoagulation and certainly a hypolipidemic effect. And then the evidence began to emerge from some clinical trials and also some work that Alexander Leaf did that maybe there was another effect of Omega-3 fatty acids on the conducting system of the heart or the irritability of the heart. Oliver had the idea about free fatty acids, which probably is true. (36)

NIH policy

And we had, I thought, lots of good science and had two site visits and had good priority scores, 146, I think. And Lenfant didn’t fund it because he said, “This is not in the interest of the Institute.” (24)

Diet nuts

SC: . . .when I got in this business in 1968, the whole business, the diet-heart business was very unpopular in the medical arena. It wasn’t even known in the public arena. So we were nuts. And Bill was the far-to-the-left nut of all of the diet hypothesists, for I don’t know how many years – 10 years, or somewhere in that vicinity. Nathan Pritikin came along and made moderates out of us. (48)