I visited the University of Minnesota to meet Carrie Keys and Dr. Henry Blackburn. We met at the Aster café for brunch on Sunday, August 23rd. Carrie Keys is one of the three children of Ancel and Margaret Keys. She lives in the Minneapolis area and is retired after a career as a psychotherapist. She arrived at the Aster with her husband, Julian. She is an active reader and, in fact, has been a member of a book club for over 40 years. She related some remembrances of her early childhood. She also indicated that she is very excited about the book that historian Sarah Tracy is writing about her father and family. Carrie was very positive about my book, Genius and Partnership. She thought I portrayed an accurate picture of the interaction between her father and mother. She handed me a list of corrections and I was relieved that the list only contained two items, and one was a misspelling of the name of one of Ancel’s collaborators. When I started writing Genius and Partnership, I had no idea that I would ever meet one of Ancel and Margaret Keys’s children. I can tell you that it was a honor to meet Carrie Keys and her husband.
It was fun to meet up with Dr. Henry Blackburn and his wife, Stacy Richardson. Henry Blackburn is continuing to write his book on The History of Epidemiology. At the brunch at the Aster cafe, Henry sat in with Patty and the Buttons, one of the premier jazz groups in Minneapolis. We were especially lucky because Henry sat in for two sets. Stacy is a science writer and journalist.
Also at our brunch were Joanne Slavin, a Professor of Nutrition at the University of Minnesota, and her hubby, Mark Engstrom, an expert in dairy nutrition. A picture of the group is below.
The Aster Cafe: http://www.astercafe.com
The Group’s Website: http://www.pattyandthebuttons.com
Numbers on the graph refer to these historical occurrences in the “War Against Coronary Heart Disease”:
1 – 1952 – Initial visit to Naples, Italy by Dr. Ancel Keys and Margaret Keys
2- 1958 – Seven Countries Study officially began
3 – 1959 – Eat Well and Stay Well, by Ancel and Margaret Keys, published by Doubleday, and serialized in newspapers
4 – 1965 – Four articles on the fat and cholesterol feeding studies carried out in the Keys lab were published in Metabolism
5 – 1975 – How to Eat Well and Stay Well the Mediterranean Way, by Ancel and Margaret Keys, published by Doubleday
6 – 1977 – Landmark report: Gordon T. and colleagues. High density lipoprotein as a protective factor against coronary heart disease. The Framingham Study. Am J Med. 162(5):707-14.
7 – 1977 – Congressional Select Committee (McGovern committee) issued the “Dietary Goals for the United States.”
8 – 1980 – Seven Countries, by Ancel Keys and colleagues, published by Harvard University Press
9 – 1984 – National Heart, Lung, and Blood Institute’s Lipid Research Clinics Coronary Primary Prevention Trial was published
10 – 1987 – First statin, Mevacor, approved by FDA
11 – 1990 – Landmark report: Mensink R, Katan M. (1990) Effect of Dietary Trans Fatty Acids on High-Density and Low-Density Lipoprotein Cholesterol in Healthy Subjects. N Eng J Med. 323: 439-445. http://www.nejm.org/doi/full/10.1056/NEJM199008163230703
12 – 1996 – Pietinen P, Vartiainen E, Seppänen R, Aro A, Puska P. (1996) Changes in diet in Finland from 1972 to 1992: impact on coronary heart disease risk. Preventive Medicine 25(3): 243-250. http://www.sciencedirect.com/science/article/pii/S0091743596900535
Why was Ancel Keys Correct?
If you read Seven Countries (Harvard University Press) carefully, it is evident that Ancel Keys and his colleagues gave a balanced view of the hypothesis that diet was an important reason for the high rates of Coronary Heart Disease (CHD) in the U.S. in the 1950s and 1960s. In many places in the book Dr. Keys addressed other possible causes for the higher incidence of CHD in the U.S. But in the end, he concluded that age, sex, and blood cholesterol concentration were the three significant risk factors for CHD, and that diet was a major factor in determining blood cholesterol concentration. The other two risk factors were more difficult to change. At the time this hypothesis was raised by Dr. Keys, it was difficult to comprehend the underlying biology behind it, and Dr. Keys took wide criticism from other scientists and from agricultural commodity groups. In Genius and Partnership, I added a significant additional factor to be considered, in that I posited that the increase in the use of margarine, with its high content of trans fatty acids, in the U.S. in the period 1940s to early 1960s increased the rates of CHD to higher than what they were in northern European countries during the same period, except in the case of East Finland, which had the highest rates of CHD in the entire world.
The Seven Countries study that officially started in 1958 by Dr. Keys was a huge undertaking that followed 13,000 men in 16 regions of seven countries. The study was carefully performed and the differences in the blood cholesterol concentrations and in the rates of CHD between certain populations were fairly large. But the criticisms by certain scientists that Seven Countries was an ecological epidemiology study and involved populations with different and possibly unique genetic backgrounds cast some doubt at the time concerning the results observed by Dr. Keys and his colleagues.
However, in the 25 year period after the Seven Countries study started, the decreases in CHD that occurred in East Finland (not really shown above as the data in the graph is from Finland as a whole; but reviewed in Genius and Partnership) from 1965 to 1990 following significant efforts to change the Finnish diet, is the strongest evidence to date that diet can affect the blood cholesterol concentration and influence the rates of CHD.
Now the analysis of the changes in the rates of CHD across many countries throughout the world during the past 40 to 50 years provides strong support that the results and conclusions reached by Ancel Keys were absolutely correct. Rates of CHD have decreased in many countries where dietary intervention was implemented and stressed.
The graph above is a compilation of two graphs that were in the excellent article by M Mirzaei, A S Truswell, R Taylor, and S R Leeder. Coronary heart disease epidemics: not all the same. Heart 2009;95:740–746. http://heart.bmj.com/content/95/9/740.long
In this graph it can be easily seen that the “War on Coronary Heart Disease” (essentially comprised of the following: a) the awareness and education campaigns that were fostered by Ancel Keys and his colleagues, b) the research supported by the National Institutes of Health, c) the myriad of efforts performed by the American Heart Association, plus d) the improved treatment of patients by clinicians, and later on, e) the development of more powerful LDL cholesterol lowering drugs) brought the rates of deaths due to CHD by the year 2000 down to levels that approached those observed in Mediterranean countries.
No matter what the “nutrition media experts” say to try to convince the general public that dietary saturated fat is not a factor in the development of CHD, the sum total of all the research that has been performed in the past 60 years proves the “nutrition media experts” wrong. The data in this graph shows convincingly that the efforts to lower total dietary fat, and especially to lower dietary saturated fat, were indeed successful in reversing the epidemic of deaths due to CHD that were observed by Ancel Keys and other scientists in the time after World War II.
I attended Book Expo America (BEA) this year (May 27 – 29) in New York City. The photos below were taken by one of the speakers, Ashley, and posted on her website at
Ashley was one of the speakers at Blogger Con, which was a conference that ran concurrently with the first day of BEA. Ashley is an expert at WordPress and her talk was fantastic! Her talk definitely showed that she has an immense amount of knowledge concerning the WordPress platform. Follow her blog if you wish to learn tips about WordPress!
On Wednesday I went to the bloggers conference and found it to be extremely interesting as I have 3 blogs and I am trying to get more out of them. What was the most positive thing about the conference was meeting a whole group of fairly young people who were very nice and had very interesting tidbits to say about blogging and technology.
On Thursday I went to the exhibits and that was like being in a candy store. Never having attended a book expo like this, I was overwhelmed. My goal was to find a small publisher for my second book. I was also looking for some publicity companies for Genius and Partnership. I didn’t mean to visit with any authors and get signed books, but that all changed when I happened on Mika Brzezinski totally alone at a signing table and I walked up to her and she graciously signed her new book for me. Later I received signed books from two new mystery novel writers and had great short conversations with them and one asked me to contact him.
Another goal was assess the state of legacy publishing versus self-publishing, and in fact, I had productive conversations with two senior editors of small publishing companies.
I showed Genius and Partnership, produced with the wonderful Pressbooks program/platform, to quite a few publishing professionals at the Book Expo, and most were fairly positive about its look and design. I went around and tried to find books that are also full of color images like Genius and Partnership and, except for art books with beautiful color plates, the classic 6 x 9 non-fiction book either has a small section of color images inserted into the book, or the images throughout the book are all black and white. Only one publisher that I browsed through had anything similar to what I did with Genius and Partnership. A couple of people who looked at Genius and Partnership thought it looked “self-published.” I was completely insulted but I have to have an open mind as what I like may be not what most of the world likes. Of course, they could just be jealous too. But there were others who were very impressed. That made me feel better.
I self-published Genius and Partnership for several reasons. First and foremost was that I could not get any University Academic Presses interested in the book. A typical response was, “It does not fit into our catalog.” I translated this as saying, “We don’t think it is a compelling story.” But when you think about it, how many editors would be knowledgeable enough concerning the history of the research that identified blood cholesterol as a risk factor for coronary heart disease to be able to evaluate the book? Although Rutgers University Press was interested in the book, they did not wish to publish it because they concentrate on the social sciences and not on biological sciences. However, the editor there gave me very good advice and feedback and I am thankful to him for this. Another important consideration is the design of the book. The book contains many color photographs and diagrams, and University Academic Presses are extremely worried about the copyright issues involved in a book with many images. And finally, the costs of printing a book with many color images are considerable. Most major publishes use the cheapest paper for the interior of their books (take a look at the books on your bookshelf). Books that have color images throughout the entire interior require high quality paper and the cost of color printing is very high. Therefore, major publishers will not be able to make sufficient money on a book like Genius and Partnership. Taking all this in mind, I decided to self-publish Genius and Partnership. And if you buy the printed book you will be surprised how nice the color printing on high quality paper came out. But the downside of the book is that the cost of the printed book on Amazon is $31.99. Because of the above issues, if you buy a printed book from Amazon, I receive a royalty of less than a dollar per book! That is why I set the price of the Ebook at $4.99. When you buy the Ebook, you get the color images and, if read it on your computer when on the internet, you have the ability to instantly see most of the full articles referenced in the book by clicking on the hyperlinks! Therefore, the Ebook version of Genius and Partnership is definitely a bargain!
The new cover for Genius and Partnership was designed in just a few days. What happened is that I emailed my friend, Peter Serko, and wrote that the previous cover was disliked by almost everyone who saw it. I attached a photo of the original front cover. I did not even ask him to attempt a new cover. That night I received several versions of the above cover. How was it that Pete designed the cover so fast? Well it turned out that for dinner that night Pete and his wife, Sue, were eating a salad containing olives, lettuce, red pepper, and onions covered with olive oil and balsamic vinegar. Pete, who is an artist and photographer, happened to catch a shot of the salad and captured what turned out to be an amazing dream-like photograph. Also in the photograph was a glass of wine and a bottle in the background that I thought at first was a bottle of wine. I emailed back to Pete that we would need to get permission from the winery to use their bottle of wine on the cover. Pete sent back a closeup of the bottle, which is shown below.
The bottle was, in fact, aged balsamic vinegar from the Glover Street Market in Twisp, WA. If you have time, please investigate the website of this market because it is one of the nicest that I know. http://www.gloverstreetmarket.com I contacted the owner, Molly Patterson, and she graciously gave me permission to use the bottle in the photograph in the cover. So that is the story of how the new cover for Genius and Partnership was designed. If you wish to have any book cover designed for your books, please contact Pete (PeterSerko.com).
One thing I learned from publishing my first book is to perform research on the title and the book cover way ahead of time. The first title of my book was, Genius and Partnership: Ancel Keys, Cholesterol, and the Discovery of the Mediterranean Diet. When I tested this title with only days to go to publish here is some of the feedback I received:
What is Ancel Keys, a chemical or vitamin?
I don’t want to read about cholesterol!
What does cholesterol have to do with the Mediterranean Diet?
There is so much on Margaret Keys in the book, why isn’t she on the cover. Are you sexist?
Therefore, I changed the title to Genius and Partnership: Ancel and Margaret Keys and the Discovery of the Mediterranean Diet.
I believe this is a much better title in several ways. But, someone who is fairly knowledgeable asked, “Who in the world are Ancel and Margaret Keys?”
I replied, “That’s why I wrote the book. So you and millions of others will find out who they were!”
Why do I consider Ancel Keys a true genius?
It was the late 1940s and Ancel Keys had already achieved several major scientific accomplishments including:
- He formulated ready-to-eat meals (called K-rations) for the American armed forces during World War II.
- He led a major study during World War II on starvation that provided important information on how to treat starved prisoners and civilians.
Ancel Keys became aware of the increase in heart attacks occurring in apparently healthy Americans and he decided to study the causes of coronary heart disease. To do this Dr. Keys followed two major strategies: 1. In his laboratory at the University of Minnesota he developed methods for investigating lipids and coronary heart disease and set in motion a series of well controlled feeding studies in men in order to precisely measure the effects of different dietary fats on blood cholesterol concentration. 2. He traveled the world (often with Margaret Keys) to gather insights into the causes of coronary artery disease, and overtime, these travels led to the formation of a team of international collaborators that helped Dr. Keys begin and carry out the Seven Countries Study. The Seven Countries Study was not a small study– it followed 13,000 men in seven countries during a time before computers, email, faxes, and rapid travel by jet airplane–most of the trans-Atlantic travel was carried out by ocean liner. In this aspect of his approach, Dr. Keys developed a whole new discipline of scientific study – the epidemiological study.
But Dr. Keys and Margaret did not stop at developing new knowledge about the causes of a devastating disease and writing scientific articles that report the findings, they went further, and disseminated their knowledge by writing three cookbooks that would help Americans to eat healthier. The writing of these cookbooks completed the circle of scientific investigation by distilling their findings into practical advice.
The cookbooks were Eat Well and Stay Well (1959), and an updated and expanded version, How to Eat Well and Stay Well the Mediterranean Way (1975). Both of these books were featured on the New York Times best seller list. The Keyses also wrote a third book, The Benevolent Bean, published in 1967, and it was also successful. A collage of the covers of the three books is shown below:
The original cover for Genius and Partnership was designed to showcase the iconic cookbooks that were written by Ancel and Margaret Keys. However, a survey of about 30 readers, including scientists, artists, and general readers, indicated that this cover was not inviting enough so that readers would be drawn into the book. So I decided to have a new cover designed. I contacted my friend, Peter Serko, who is a photographer, stage performer, and playwright (PeterSerko.com). Pete rapidly designed a new cover and it was unanimous that this cover was far superior to the previous cover. Although my feelings were hurt, I decided to use the cover designed by Pete. The original cover is below:
I am happy to have my book on Ancel Keys published (on March 30, 2015) as an Ebook on Amazon. In a few days it will be available on other online sites such as Kobo. In a few weeks the print version should also be available.