“The diet-heart hypothesis is the greatest scam in the history of medicine”

-Dr. George Mann

The original cholesterol hypothesis, also called, the diet-heart hypothesis, goes something like this: “eating excess saturated fat raises LDL (cholesterol) which causes a thickening and narrowing of the arteries, which eventually leads to heart disease.”

The man who championed this hypothesis was Ancel Keys. The study he conducted to first promote this hypothesis titled, The Seven Country Studies, is a deeply flawed epidemiological study that fit his narrative because he cherry-picked only the data that he agreed with. Ancel Keys also benefited from having a strong personality in an academic world where a man with the loudest voice simply won the argument whether or not he had the evidence to support his claims. As stated by Nina Teicholz, in her book, Big Fat Surprise, “To a surprising degree, in fact, the story of nutritional science is not, as we would expect, one of sober-minded researchers moving with measured, judicious steps.

It falls, instead, under the ‘Great Man’ theory of history, whereby strong personalities steer events using their own personal charisma, intelligence, wisdom, or wits. In the history of nutrition, Ancel Keys was, by far, the Greatest Man.”⁷

Through sheer force of will, Ancel Keys perpetuated the idea that cholesterol was associated with heart disease

However, the supposed link between cholesterol and heart disease was never there, it never existed. Simply put, half the people who suffer from heart attacks have low cholesterol. This alone should lay the diet-heart hypothesis to rest. A grade of 50% results in an F. And the sad thing is, this was known over fifty years ago. As stated by Gary Taubes, in his book, Good Calorie Bad Calorie,

“In 1964…the famous Houston heart surgeon Michael DeBakey reported similarly negative findings from the records on seventeen hundred of his own patients. And even if high cholesterol was associated with an increased incidence of heart disease, this begged the question of why so many people, as Gofman had noted in Science, suffer coronary heart disease despite having low cholesterol, and why a tremendous number of people with high cholesterol never get heart disease or die of it.”⁸

Before Ancel Keys proposed his hypothesis, the nation as a whole wasn’t afraid of fat or cholesterol

Ancel Keys should take the bulk of the blame for our hatred of cholesterol, “Ancel Keys deserves the lion’s share of credit for convincing us that cholesterol levels predict heart disease and that dietary fat is a killer¹…Keys’ abilities as a scientist are arguable—he was more often wrong than right—but his force of will was indomitable.”²  So much so, that he had the American Heart Association (AHA) completely change their stance on fat intake in under four years. In 1957, the AHA opinion on Keys’ hypothesis was that it didn’t stand up to scrutiny and that it would be a bad idea to tell a nation to limit dietary fat intake, however, in 1960, the AHA released a new statement recommending the nation lower their fat intake. There wasn’t any new compelling evidence against fat, or any new revelations on the working of heart disease.⁹ The only thing that changed was now Ancel Keys was a board member of the AHA. He was now in control of the narrative that was promoted by the media and the government.

Since Ancel Keys was a politically influential man, in the mid-1970’s when the American diet became a political issue, his ideas were viewed as absolute truths even though he never had the adequate data to back up his claims

In 1977, Senator McGovern and his committee on nutrition and human needs, recommended Ancel Keys’ low cholesterol/low-fat diet to the nation, officially turning this scientific debate into a political one. The primary author of the National Dietary Guidelines was a journalist named Nick Mottern. He was not a scientist or researcher or anything that might give him some level of credibility in the arguments concerning our diet. He coined the term “complex carbohydrates” to make sugar sound fancy (and everyone bought it). Before this, most dietary carbohydrates were simply referred to as “starch.” The bulk of McGovern’s committee members were ignorant, therefore, they weren’t aware that there was a scientific battle raging, with one group focused on saturated fat and another group focused on sugar. Taubes further confirms this stating, “McGovern’s staff were virtually unaware of the existence of any scientific controversy. They knew that the AHA advocated low-fat diets and that the dairy, meat, and egg industries had been fighting back.

Matz and his fellow staff members described their level of familiarity with the subject as that of interested laymen who read the newspapers.”³

Ancel Keys had his rivals, like John Yudkin. John Yudkin was a prolific researcher who was preaching that sugar was the true culprit in western diseases, including heart disease. However, Yudkin and others like him would eventually be shunned and forcibly removed from their positions in academia and their theories would go invalidated. 

Scientists, like Yudkin, saw that this hypothesis had flaws and tried hard to highlight them both in the media and through various government hearings

Yudkin knew that cholesterol wasn’t the devil that Ancel Keys made it out to be. He saw a huge hole in the theory which involved half the world’s population. He asked, if cholesterol is so bad why are women usually healthier than men even though on average they have higher cholesterol? Women also live longer, suffer from dementia at a much lower rate and don’t have as many heart attacks as their male counterparts. This was explained away by the believers of the diet-heart hypothesis by simply stating it was a “female paradox” (there’s also the French paradox, Inuit paradox, Masai paradox, its endless really). Proponents of the diet-heart hypothesis defended the female paradox by claiming that females’ hormones protect women from the harms of cholesterol. However, this wasn’t true either.

First, there has never been a study showing that estrogen or other female sex hormones protect women from heart disease, ever. Further, exams done on women who had their sexual organs removed showed no difference in their defense against these conditions compared to woman who still had their ovaries.¹¹

So maybe their elevated cholesterol was the real reason they lived a healthier life. For these reasons alone, giving a statin (a cholesterol-lowering drug) to women should be criminal. It removes their innate defense mechanism to numerous health problems. Statins also inhibit the body’s ability to make Coenzyme Q-10. This is a major component needed for the electron transport chain in mitochondrial respiration. Basically, this enzyme is required for the heart to produce energy. So reduced Co Q-10 can lead to compromised heart performance. So in their attempt to help your heart through prescribing a statin, unknowing or simply irresponsible doctors are doing more harm than good. 

Here’s some info on cholesterol which should help sway your inherent negative opinion

Every cell in the human body, besides neurons, can produce cholesterol. On average your body will produce roughly 2000mg of cholesterol a day. That’s approximately a dozen eggs worth of cholesterol. Even that number doesn’t fully embrace the true scope of the amount cholesterol in our bodies. Taking an average cholesterol value of 200 mg per dL, with an average blood volume of 5 to 7 liters, this equates to 10,000 to 14,000 mg of circulating cholesterol.⁴ These figures don’t take into account that cholesterol constitutes 40 percent of our cellular membranes throughout our entire body.

The recommended daily intake of 300mg of cholesterol is preposterous. 

Not only is cholesterol found in abundance throughout our entire body providing structure and support, it is also the backbone for numerous hormones, including testosterone, estrogen and cortisol

It is also a primary component in our cell membranes, giving our membranes the flexibility needed to maintain life and the antioxidants to resist oxidation. Cholesterol is also used as a natural “band-aid,” repairing injuries to our arterial lining, which is one of the reasons why researchers find cholesterol in the plaque which clogs arteries. Consider the following metaphor to explain the presence of cholesterol in plaque: If you were an alien looking down on earth for the first time, you would assume that ambulances caused car accidents. Why? Because every time you saw an accident, you also saw an ambulance. But in all reality, we know that ambulances are there to help fix the problem, not cause it. However, this alien logic was used to blame cholesterol. We now know that cholesterol is used to heal the body, not harm it.

Cholesterol as a healing factor hasn’t been talked about in the media because everyone has been told since the 1970’s to watch how much cholesterol they eat, implying that it is harmful

This statement can’t be further from the truth. Honestly, it doesn’t matter how much cholesterol you eat because our body at best absorbs 50 percent of ingested dietary cholesterol. As stated by Mary Enig in Know Your Fats,

“The amount of cholesterol that is absorbed by the intestinal cells varies, but generally it amounts to much less than half of the amount consumed.”⁵

This is partly due to the chemical structure of ingested cholesterol and the fact that cholesterol is absorbed whole. Not like protein which breaks down into amino acids prior to absorption, or carbohydrates which are broken down into simple sugars before absorption. Even Ancel Keys, the author of the diet-heart hypothesis, and the man who’s life work was damning cholesterol in every way, admitted to this, stating,

“There’s no connection whatsoever between cholesterol in food and cholesterol in blood. And we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit.”⁶

Our body is smart and it has a negative feedback loop so if we ingest more cholesterol, our body will simply produce less itself. This was shown to be true through the Framingham study which started in 1948 and is still ongoing to this day. It is the longest running, most influential, study on heart disease to ever take place, and the director, Dr. William Castelli stated, “the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol.”

Since cholesterol is produced by our body, it isn’t defined as an “essential nutrient.” An essential nutrient is defined as something we have to get through our diet since our body can’t produce it, however that isn’t always the case. Certain individuals don’t make enough cholesterol on their own and a diet high in cholesterol has been shown to help with declining mental acuity in the elderly.¹⁰

I’ll finish with a quote pulled straight from the Framingham study, “there is a direct association between falling cholesterol levels over the first 14 years [of the study] and mortality over the following 18 years, 11% overall and 14% CVD death rate increase per 1mg/ dl per year drop in cholesterol levels” That pretty much means that as your cholesterol lowers, your chances of heart attacks and strokes increases. Crazy, I know. So my advice would be to consume all the cholesterol you want. Eat all the eggs. Eat all the steak. Your body can handle it. 

References

1. Taubes, Gary. Good Calories, Bad Calories (Kindle Locations 666-667). Knopf Doubleday Publishing Group. Kindle Edition
2. Taubes, Gary. Good Calories, Bad Calories (Kindle Locations 659-660). Knopf      Doubleday Publishing Group. Kindle Edition.
3. Taubes, Gary. Good Calories, Bad Calories (Kindle Locations 1235-1237). Knopf Doubleday Publishing Group. Kindle Edition.
4. Enig, Mary. Know Your Fats. Pg 187. Published by Bethesda Press. 1st Edition.
5. Enig, Mary. Know Your Fats. Pg 56. Published by Bethesda Press. 1st Edition.
6. Kendrick, Dr. Malcolm. The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How to Avoid It (p. 21). John Blake. Kindle Edition. 
7. Teicholz, Nina. The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet (p. 46). Simon & Schuster. Kindle Edition. 
8. Taubes, Gary. Good Calories, Bad Calories (Kindle Locations 654-658). Knopf Doubleday Publishing Group. Kindle Edition. 
9. Taubes, Gary. Good Calories, Bad Calories (Kindle Locations 759-761). Knopf Doubleday Publishing Group. Kindle Edition. 
10. Enig, Mary. Know Your Fats. Pg 57. Published by Bethesda Press. 1st Edition.
11. Kendrick, Dr. Malcolm. The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How to Avoid It (p. 102). John Blake. Kindle Edition.