This is the first in a series of articles on this topic.
Roots of the Cholesterol Theory
In Unhealthy Betrayal, I reported on how Ancel Keys, a biologist and physiologist, introduced the theory that heart disease was caused by dietary factors that raised our cholesterol levels, and that these raised levels were caused by high levels of dietary fat—specifically the saturated fats that were found in animal products, such as in butter, cheese, and the flesh of the red meats. [i]
Originally, in 1957, the American Heart Association (AHA) opposed Ancel Keys on the diet-heart issue, and produced a fifteen-page report, castigating researchers which included Keys for taking “uncompromising stands based on evidence that does not stand up under critical examination.” They further suggested; “There is not enough evidence available to permit a rigid stand on what the relationship is between nutrition, particularly the fat content of the diet, and atherosclerosis and coronary heart disease.”[ii]
Keys, had already embarked of his landmark study, the Seven Countries Study, which he launched in 1956, with an annual grant of $200,000 a year, which was a phenomenal sum in those days that he was able to obtain from the U.S. Public Health Service. Keys and his collaborators studied more than 13,000 middle-aged men from mostly rural populations; from Italy, Yugoslavia, Greece, Finland, the Netherlands, Japan and the United States. Results were published every five years (it was an on-going study). Deaths varied from 992 (deaths per decade) for every ten thousand men in the lumberjacks and farmers of North Karelia, Finland, to just 66 in Japan (the US figure was 570 per ten thousand). Keys maintained the results predicted that cholesterol levels predicted heart disease risk, and the amount of saturated fat predicted cholesterol levels and heart disease with remarkable accuracy. [iii]
By the turn of the 1960s the AHA was to change its position regarding diet and heart disease. At the time they criticised Keys, the group was a scientific society of cardiologists, but in 1948 they became the recipients of the largesse of Proctor and Gamble (PG), which launched them into the big time. By 1960 it had more than three hundred chapters and bought in more than $30 million annually, from PG, other food giants, and donations. It became the largest not-for-profit group in the USA. In this period, Keys had succeeded in manoeuvring himself and his chief ally, Jeremiah Stamler, a doctor from Chicago, onto the AHA Nutrition Committee. This resulted in the AHA report in 1961 which argued that the best scientific evidence at the time suggested Americans could reduce their risk of heart attacks and strokes by cutting the saturated fat and cholesterol in their diets. The report suggested the “reasonable substitution” of saturated fats with polyunsaturated fats such as corn oil or soybean oil as being part of a “prudent diet”. [iv]
Another important study that would affect the debate about cholesterol, was the Framingham Heart Study. Framingham is a small town near Boston in Massachusetts, in which began the study of more than 5,000 middle-aged men and women looking for factors that could predict heart disease. In 1961, after six years study, the Framingham investigators announced that they found high total cholesterol was a reliable predictor for heart disease.[v]
It wasn’t until The Nurses Health Study, led by the Harvard Epidemiologist Walter Willet, that people started to question the soundness of the advice to undertake a low fat diet. This study tracked the diets, lifestyle, and disease in nearly eighty-nine thousand nurses in the USA from 1982. They published their first report on fat and health in 1987 and revealed that over six hundred cases of breast cancer had appeared in the first four years of the study, and found that if anything, the less fat the women confessed to eating, the more likely they were to get breast cancer. This was supported by a further study undertaken by the National Cancer Institute (NCI) which found eating more fat, particularly saturated fat, correlated with less breast cancer. Willet produced a further report in 1992, publishing eight years of observations, which, once again, corroborated that those who seemed to eat the least fat had the highest levels of breast cancer, which included copious amounts of saturated fat. [vi]
The Politicising of heart disease
As I mention in Unhealthy Betrayal, there were further studies done but few achieved results supporting Keys hypothesis. There was, however a big campaign by the margarine and vegetable oil industries, supported by the American Medical Association (AMA) to win support for Keys theory. The case for condemning saturated fats reached new heights by the production of a publication announced by Senator George McGovern, the first Dietary Goals for the United States, which was the first Federal attempt to promote dietary guidelines for US citizens.
- The first dietary goal was to raise carbohydrate consumption to 50-60 percent of calories consumed.
- The second goal was to decrease fat consumption to 30 percent of all calories with less than 33 percent being supplied by saturated fats.
The initial response to the report at its press conference produced uproar. This prompted McGovern to hold further hearings and the production of a revised set of guidelines later that year. What really McGovern succeeded in doing, however, was to turn the whole discussion of cholesterol and saturated fats into a political issue instead of a question of science. [vii]
This, in itself, created a problem that would manifest in unforeseen consequences. Once the idea that saturated fats caused raised cholesterol levels that in turn led to heart disease, and strokes—was officially accepted as fact—would lead to repercussions that would impact generations to come, and not just in America. Once it became official policy to recommend cutting down on saturated fats in the world’s wealthiest country, with what was considered the most advanced healthcare facilities—other countries simply toed the line and danced to the same tune. Any people that wished to voice opinions that conflicted with this position, were simply not given space in the leading journals, they found their research funding drying up, invitations to speak being removed, and even their very livelihoods at risk.
The trouble with stifling dialogue, particularly in the field of science, and more specifically in the field of health is that you put health at serious risk. And, the consequences can spiral into a phenomenal health crisis if left unchecked. So here’s the problem we have, his theory was simply wrong.
Flaws started appearing from the beginning. One of the scientists who was troubled by the stampede into the idea that saturated fats caused heart disease was George Mann, the Vanderbuilt biochemist, who had gone to Africa and had extensively studied the Masai. The Masai seemed to thrive on a diet of meat, blood and milk, and were found to have some of the lowest cholesterol levels in the world. They did not suffer from heart disease, nor did they from any other chronic diseases. Mann also was one of the first scientists to raise the alarm over trans fats, in 1955. Several universities were disturbed by Mann’s revelations about the Masai, and they dispatched their own scientists to Kenya to look for flaws in Mann’s data, but they only succeeded in corroborating his findings. Keys himself, simply dismissed Mann’s findings, and stated “the peculiarities of those primitive nomads have no relevance.” [viii]
President Dwight D. Eisenhower succumbed to his first heart attack Friday September 23rd 1955. It happened the day he played a game of golf, when following lunching on a hamburger with onions, which seemed to give him indigestion. Later that night he awoke with severe pain. On Saturday he was taken to hospital, by midday Sunday, Dr Paul Dudley White, the world-renowned Harvard cardiologist, had been flown it to consult. Eisenhower’s heart attacked, I mention here because it had a profound effect on the whole issue regarding heart disease in the USA, it seemed to focus people’s minds on the issue. Facts about his recovery and his dietary habits became part of the public record. George Mann, who worked with White at Harvard, took an interest in Eisenhower’s circumstances. It was known he exercised regularly, and had given up smoking five years previous to his attack, his cholesterol was below normal, and his blood pressure was only occasionally elevated. These circumstances should not have raised concern for his health.
We know that following Eisenhower’s attack, he dieted religiously, had his cholesterol checked regularly, and ate little fat. His meals were cooked in either soybean oil or the newly developed polyunsaturated margarine which appeared on the market in 1958 (apparently as a palliative for high cholesterol). His weight increased with his new diet, which caused Eisenhower considerable anguish. In March 1969, following reading about a group of middle-aged New Yorkers that attempted to reduce their cholesterol by renouncing such things as butter, lard, and cream, and even margarine by replacing them with corn oil—influenced Eisenhower to switch also. His cholesterol continued to rise, however, which caused him such consternation that his doctor would give him a lower figure for his cholesterol reading that it actually was. On Eisenhower’s final day in office, 19th January 1961, his cholesterol was 259mg/dL, which is a level that physicians would come to consider dangerously high. This reading was taken just six days after Ancel Keys made the cover of Time Magazine. [ix]
Eisenhower eventually succumbed to heart disease, and died of a heart attacked on 28th March 1969. Whatever dietary advice he followed had evidently not protected him from the congestive heart failure that eventually took his life.
We can only guess the effect Eisenhower’s circumstances had on Mann. He was an associate director on the Framingham Heart Study. He would, however, have been aware of the evidence that was revealed by the Framingham follow-up study, 30 years after the initial study was commenced, when it was found that total cholesterol turned out to not be a reliable predictor for heart disease after all. The new study revealed that for men aged 48-57, those with cholesterol in the mid-range (183-222mg/dL), had a greater risk of heart attack and death than those with higher cholesterol levels (222-261mg/dL). They, in fact, found that for every 1% mg/dL drop in overall cholesterol there was a subsequent increase in coronary mortality. According to Nina Teicholz, Mann’s research supported the idea that saturated fat was not related to heart disease which was so abhorrent to his funders, the National Institute of Health (NIH), that he was not permitted to publish the data he had accumulated, and as a result it lay in an NIH basement for almost a decade. Teioholz reports Mann’s comments in a report he wrote in 1977 which begins: “A generation of research on the diet-heart question has ended in disarray,” and suggests he further condemned it as “a misguided and fruitless preoccupation.” [x]
In Unhealthy Betrayal, I discuss the cholesterol controversy and offer a number of studies that showed the flaws in Keys theory. But let’s suffice for now, to use the evidence of the major studies themselves, such as the landmark Framingham study, and here is a quote by Dr William Castelli, director of the Framingham Study, in 1992:
In Framingham, Massachusetts, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol.[xi]
Dr Malcolm Kendrick, author of, The Great Cholesterol Con—The Truth about what really Causes Heart Disease, and How to Avoid it, discusses many of the flaws in Keys theory. He mentions one of the criticisms against Keys was the way he manipulated the Seven Countries Study to serve his theory simply by the way he carefully chose the countries for the study. Kendrick illustrates this point by choosing the following countries: Finland, Israel, Netherlands, Germany, Switzerland, France and Sweden. Simply choosing these countries for the study at that time would have proved no link with cholesterol levels and heart disease.[xii]
Whilst we are on the subject of the flaws in Keys hypothesis, as regards the Framingham study, Nina Teicholz, draws our attention to the Crete survey, which fell during the forty-eight-day fasting period of Lent. This was a strict Greek Orthodox fast, when the population abstained from all foods of animal origin, including fish, cheese, eggs and butter. She points to a study undertaken in Crete in 2000 and 2001 which showed saturated fat halved during lent. This would, of course, have skewed any results, particularly if this information was not revealed or any allowance made for it, which was not the case.[xiii]
Another critic of the whole cholesterol controversy, Dr Uffe Ravnskov, who wrote an excellent volume, titled Fat and Cholesterol are Good for You! In this volume he discusses why cholesterol is good for you, and declares ‘The cholesterol Campaign is medical quackery of the first order.’ He also quotes George Mann, one of the leading Framingham researchers who we have already mentioned: ‘In fact, the eminent American physician and scientist George Mann called it “the greatest scientific deception of this century, perhaps of any century.” Ravnskov also mentions how since his first publication on the cholesterol controversy, The Cholesterol Myths, in 1991 that the evidence continues to go contrary to Keys original hypothesis:
Much has happened in this area since then, but nothing that has changed my mind. On the contrary, many more studies have appeared that contradict the current view. What is particularly interesting and surprising is that a steadily increasing number of studies have found that high cholesterol is beneficial.[xiv]
Well are you all confused now? Not only is cholesterol not bad for us, it is actually good for us? What is going on here? This is interesting. This raises a number of important questions (some of which I discuss in Unhealthy Betrayal). If cholesterol is not the bad guy what is actually happening here? There is now talk of the so called ‘good’ and ‘bad’ cholesterol (a subject we will discuss in a following article in this series), and it looks as if the goal posts have now been moved.
For me one, of the important questions to ask, is, if saturated fats are not the cause of heart disease, then what is? Another important question to ask is: what affect has following what appears to be totally erroneous advice on diet, accomplished, what affect has it had on our health? These are the important question we discuss in the accompanying articles.
Andrew A D Burgoyne
[i] Andrew Burgoyne, Unhealthy Betrayal, Fundamental Press, 2015, p14.
[ii] Gary Taubes, The Diet Delusion, Ebury Publishing, 2007, p20.
[iv] Nina Teicholz, The Big Fat Surprise—Why butter meat and cheese belong in a heathy diet, Scriba Publications, 2014.
[vi] Gary Taubes, The Diet Delusion, Ebury Publishing, 2007, p73.
[vii] Andrew Burgoyne, Unhealthy Betrayal, Fundamental Press, 2015, p17.
[viii] Nina Teicholz, The Big Fat Surprise, Scriba Publications, 2014, p62.
[ix] Gary Taubes, The Diet Delusion, Ebury Publishing, 2007, p4.
[x] Nina Teicholz, The Big Fat Surprise, Scriba Publications, 2014, p71.
[xi] Dr Malcolm Kendrick, The Great Cholesterol Con—The Truth about what really Causes Heart Disease, and How to Avoid it, John Blake Publishing Ltd. London, 2007, p35.
[xiii] Nina Teicholz, The Big Fat Surprise, Scriba Publications, 2014, p41.
[xiv] Dr Uffe Ravnskov, Fat and Cholesterol are Good for You! GB Publishing, Sweden, 2009.
 Andrew Burgoyne, Unhealthy Betrayal, Fundamental Press, 2015, p14.
 Gary Taubes, The Diet Delusion, Ebury Publishing, 2007, p20.
 Nina Teicholz, The Big Fat Surprise—Why butter meat and cheese belong in a heathy diet, Scriba Publications, 2014.
 Gary Taubes, The Diet Delusion, Ebury Publishing, 2007, p73.
 Andrew Burgoyne, Unhealthy Betrayal, Fundamental Press, 2015, p17.
 Nina Teicholz, The Big Fat Surprise, Scriba Publications, 2014, p62.
 Gary Taubes, The Diet Delusion, Ebury Publishing, 2007, p4.
 Nina Teicholz, The Big Fat Surprise, Scriba Publications, 2014, p71.
 Dr Malcolm Kendrick, The Great Cholesterol Con—The Truth about what really Causes Heart Disease, and How to Avoid it, John Blake Publishing Ltd. London, 2007, p35.
 Nina Teicholz, The Big Fat Surprise, Scriba Publications, 2014, p41.
 Dr Uffe Ravnskov, Fat and Cholesterol are Good for You! GB Publishing, Sweden, 2009.