Medicine: The Fat of the Land

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Widely touted preparations such as triparanol and nicotinic acid (one of the B vitamins, also called niacin) do lower blood cholesterol, but they have undesirable side effects. Triparanol interferes with the liver's formation of cholesterol, forces it instead to produce a suspicious substance called desmosterol that is chemically related to cholesterol—and may even have the same damaging effect on arteries. Nicotinic acid, to be effective, must be administered in massive doses. The result: flushing, itching, nausea, headaches, changes in the blood.

The only sure way to control blood cholesterol effectively, says Keys, is to reduce fat calories in the average U.S. diet by more than one-third (from 40% to 15% of total calories), and take an even sterner cut (from 17% to 4% of total calories) in saturated fats. He also warns against confusing the blood cholesterol level with cholesterol actually deposited in the arteries. No known diet will remove deposited cholesterol, and the object of all diets is only to keep deposits from growing to the point that they cut off the heart's blood supply.

His diet recommendations are fairly simple: "Eat less fat meat, fewer eggs and dairy products. Spend more time on fish, chicken, calves' liver, Canadian bacon, Italian food, Chinese food, supplemented by fresh fruits, vegetables and casseroles." Adds Keys: "Nobody wants to live on mush. But reasonably low-fat diets can provide infinite variety and aesthetic satisfaction for the most fastidious—if not the most gluttonous—among us." On such fare, Gourmet Keys keeps his own weight at a moderate 155, his cholesterol count at a comfortable 209.

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