This change in the American diet was attributed to nutritionists’ emphasizing the need for vitamins from the fruits and green vegetables that were conspicuously lacking in our diets in the nineteenth century. “The preponderance of meat and farinaceous foods on my grandfather’s table over fresh vegetables and fruits would be most unwelcome to modern palates,” wrote the University of Kansas professor of medicine Logan Clendening in The Balanced Diet in 1936. “I doubt if he ever ate an orange. I know he never ate grapefruit, or broccoli or cantaloup or asparagus. Spinach, carrots, lettuce, tomatoes, celery, endive, mushrooms, lima beans, corn, green beans and peas—were entirely unknown, or rarities…. The staple vegetables were potatoes, cabbage, onions, radishes and the fruits—apples, pears, peaches, plums and grapes and some of the berries—in season.”

From the end of World War II, when the USDA statistics become more reliable, to the late 1960s, while coronary heart-disease mortality rates supposedly soared, per-capita consumption of whole milk dropped steadily, and the use of cream was cut by half. We ate dramatically less lard(13 pounds per person per year, compared with 7 pounds) and less butter(8.5 pounds versus 4) and more margarine (4.5 pounds versus 9 pounds), vegetable shortening (9.5 pounds versus 17 pounds), and salad and cooking oils (7 pounds versus 18 pounds). As a result, during the worst decades of the heart-disease “epidemic,” vegetable-fat consumption per capitain America doubled (from 28 pounds in the years 1947–49 to 55 pounds in 1976), while the average consumption of all animal fat (including the fat in meat, eggs, and dairy products) dropped from 84 pounds to 71. And so the increase in total fat consumption, to which Ancel Keys and others attributed the “epidemic” of heart disease, paralleled not only increased consumption of vegetables and citrus fruit, but of vegetable fats, which were considered heart-healthy, and a decreased consumption of animal fats.

In the years after World War II, when the newspapers began talking up a heart-disease epidemic, the proposition that cholesterol was responsible—the “medical villain cholesterol,” as it would be called by the Chicago cardiologist Jeremiah Stamler, one of the most outspoken proponents of the diet-heart hypothesis—was considered hypothetical at best. Cholesterol itself is a pearly-white fatty substance that can be found in all body tissues, an essential component of cell membranes and a constituent of a range of physiologic processes, including the metabolism of human sex hormones.