Ancel Benjamin Keys Ph.D. was heroic in personality and achievement. Dr. Keys, a man of great energy, initiative and courage, was a world class research collaborator and leader of other distinguished researchers. His work shaped my thinking and my care of my patients throughout my career. His life gives me inspiration to this day.
Late in his career he published on his seminal collaborative work that began the world wide interest in the benefits of the Mediterranean Diet. All the research, all the writing, all the blogging, all the discussion in the media about healthy eating with a focus on the Mediterranean Diet began with Dr. Keys.
Dr. Keys gave the world compelling, informative and influential research on nutrition throughout his career. His research and writing early in his career gave direction to me early in my career.
I first heard the name, Ancel Keys, in 1981 on a trip to Minneapolis in order to visit with a team of psychiatrists treating eating disorders at the University of Minnesota in Minneapolis. I went with a dear friend and collaborator of mine, Muni Patel M.D., who passed away several years ago. We launched an eating disorders program in Milwaukee Wisconsin that year at a moment in time when very little was known about the causes and treatment of anorexia nervosa and bulimia nervosa, and binge eating disorder was not yet a term in the psychiatric nomenclature. We were in search of direction in developing the program we led. The psychiatrists at the University of Minnesota were generous with their time and guidance. They told us of Ancel Keys.
The Minnesota Starvation-Recovery Experiment
In 1950 Dr. Keys published what is to this day the definitive work on the physiology and psychology of starvation, The Biology of Human Starvation. Based on his research team's starvation and rehabilitation of thirty-six men who gave up their health and well-being in an humanitarian project, the data gathered informed the United States military in World War II and thereafter professionals across the world in the treatment of the eating disorders.
Todd Tucker described the research of Dr. Keys in his 2006 book, The Great Starvation Experiment: The Heroic Men Who Starved So That Millions Could Live. Thirty-six were studied at the University of Minnesota in 1944. They were carefully chosen to be men of good health and strong character. In a study of twelve months, they were observed over twelve weeks to ascertain what was the optimal diet for each man, then subjected to semi-starvation for twenty-four weeks. Over the twenty weeks that followed the semi-starvation phase, they went through twelve weeks of controlled refeeding and eight weeks of unrestricted eating. Each man lost and regained approximately twenty-five percent of his healthy, ideal body weight.
The observations and insights of "The Starvation Study" gave pioneering eating disorders clinicians direction in treating the eating disorders.
In starvation, human beings withdraw and shrink in size, emotion, and spirit. In the midst of starvation, no one with anorexia nervosa and bulimia nervosa can successfully engage in psychotherapy. Starving individuals shrink in thought with little capacity to learn. Refeeding and weight restoration must proceed successful psychotherapy. Refeeding and weight restoration became a treatment cornerstone for the eating disorders in Milwaukee, one of the first eating disorders programs in the United States.
The work of Dr. Keys and his colleagues made it possible for my colleagues and me to follow a protocol of treatment to bring health to hundreds of patients in my care and thousands in the care of those professionals who started their careers in the program in Milwaukee.
Dr. Keys was a man of great stamina and courage. In the Bulletin of the History of Medicine, Sarah W. Tracy Ph.D. writes of the early years of the career of Dr. Keys in "The Physiology of Extremes: Ancel Keys and the International High Altitude Expedition of 1935". Dr. Tracy writes in the 2012 article, "Until 2009, the record for the world's highest arterial blood draw was held by physiologist Ancel Keys. The blood was taken from Keys’ arm in June 1935, at 20,140 feet, just shy of the summit of the Chilean volcano Cerro Aucanquilcha."
The Mediterranean Diet
Dr. Keys’ career included research and recommendations to the United States military leading to the production of K-rations supplied to American troops in World War II. The "K" in K-rations stands for Keys. Although in my view, the greatest achievement of his greatest legacy came in the second half of his magnificently long career.
In his book Mr. Tucker describes Dr. Keys’ childhood experience in Oakland, California of the early twentieth century, living close to University of California.
Mr. Tucker writes, "If college was part of the background noise of Ancel’s boyhood, so was a healthy and unusually varied diet. Growing up in California, Keys regularly enjoyed a variety of fresh foods that were regarded as exotic or extravagant in the rest of the country, foods like oranges, olives, lemons and almonds."
Childhood experience can proceed inspiration for adult accomplishment.
In his 1980 publication, The Seven Countries Study, described in elaborate detail at www.sevencountriesstudy.com, Dr. Keys initiated the worldwide interest in the Mediterranean Diet and its health benefits. The seven countries were the United States, Finland, Netherlands, Japan, Yugoslavia, Greece and Italy. The study began in 1952.
To quote the website on “The Seven Countries Study”: “‘The Seven Countries Study was a pioneering endeavor in study design that influenced and enhanced many studies to follow. It showed that serum cholesterol, blood pressure, diabetes and smoking are universal risk factors for coronary heart disease. Ancel Keys and his Italian colleague Flamino Fidanza and their colleagues were central to the modern recognition, definition and promotion of the eating pattern they found in Italy and Greece in the 1950s and '60s called 'The Mediterranean Diet.'"
As a clinician, I speak of “The Seven Countries Study” research to inform and support my patients and their families. The traditional diet of the Mediterranean basin works because it is healthy, easy to prepare and, most importantly for someone to incorporate it as a lifelong habit, tastes wonderful.
All four of my grandparents were born and raised in Sicily. I was fortunate. I grew up eating the Mediterranean Diet. For those not as familiar with the Mediterranean Diet, I particularly recommend the books of Lydia Bastianich - chef, author teacher. A good introduction to Lidia Bastianich is lidiasitaly.com.
The nonprofit organization, Oldways, spreads the message of Dr. Keys and nutritional researchers who followed. The organization's website, oldwayspt.org, is an excellent resource for education regarding healthy eating, informing not only regarding the Mediterranean Diet but also healthy nutritional patterns around the world.
A Long Productive Career of Collaboration
In his book about Dr. Keys and his wife, Genius and Partnership: Ancel and Margaret Keys and the Discovery of the Mediterranean Diet, Joseph L. Dixon, Ph.D. writes of the long collaboration of Dr. and Mrs. Keys. Among the publications they wrote together was their 1975 book, How to Eat and Stay Well the Mediterranean Way. Knowing of my interest in Dr. Keys, over three decades ago one of my patients gave me a copy of a book possessed by her physician father, the 1959 book by Dr. and Mrs. Keys, Eat Well and Stay Well.
In describing the remarkable relation of Ancel and Margaret Keys, Dr. Dixon notes the work of George E. Vaillant M.D. and the “Grant Study”. You can refer to the " Lessons Learned" entitled "Adaptation to Life" and to the website www.adultdevelopmentstudy.org, https://www.adultdevelopmentstudy.org/grantandglueckstudy to learn about Dr. Vaillant and the “Grant Study”.
Dr. Dixon writes of the ‘Grant Study”, results of the study are complex, but one of the most stunning findings was that an important component found in most happy and productive lives was having a real, close working partnership...Ancel Keys and Margaret Keys had a successful partnership in their worldwide search for the cause of coronary heart disease..."
Dr. Dixon writes, "Ancel and Margaret Keys had three children, a boy and two girls. Dr. Keys was forced to retire from the University of Minnesota in 1972. He continued working for another 25 years or so, mostly at his home south of Naples, on the Mediterranean coast. Margaret Keys was at his side all the time. Due to many factors (genetics, personal traits, diet) that can't possibly be known for any individual, but one would like to think the Mediterranean Diet played an important role, Ancel Keys lived to be 100 years old. He died in Minneapolis on November 20, 2004, two months short of his 101st birthday.
Margaret died in 2006 at the age of 97. It is safe to say that Ancel and Margaret had a long and productive partnership, and that they were giants in the field of nutrition and medicine. "
Dr. Keys was a genius of imagination, foresight, scientific rigor and leadership. He brought together men and women of distinction in their own right. They informed the world of healthy nutrition and its effects on the human condition.
I keep the research lessons of Dr. Ancel Benjamin Keys in mind in working with my patients and their families. I keep his life in mind as a model of what can be a long, happy and productive life. There are many lessons to learn from Ancel Keys.