MALCOLM KENDRICK, MbChB, MRCGP (email - malcolm@llp.org.uk )

November 28, 2002

Part 1, Part 2, Par t3, Part 4, Part 5

WHY THE CHOLESTEROL-HEART DISEASE THEORY IS WRONG

Find A Long-Term Study Showing That A High Cholesterol Or Saturated Fat Diet Has Any Impact On Blood Cholesterol Levels In A Normal Healthy Population - Or Any Effect Whatsoever On The Rate Of Death From Coronary Heart Disease


Cholesterol is a much maligned substance, the ‘‘cause'' of heart disease. If it is, it must have killed billions of people. Far more than the plague, every war ever fought, and all plane, train and car crashes ever - all added together, then multiplied by three.

But if it does cause heart disease, how does it do it? The simple ‘‘answer'' is that, if you eat too much cholesterol, the level in your blood rises, the cholesterol then travels through the artery wall causing cholesterol-laden plaques to develop which then rupture and kill you. That''s the initial cholesterol hypothesis. Dead simple, couldn't be more simple.

First little problem - dietary intake of cholesterol has no impact on the level of cholesterol in your blood. If we look at two major long-term studies, Framingham and Tecumseh, it is clear that those who ate the most cholesterol had exactly the same level of cholesterol in their blood as those who ate the least cholesterol.

Table: Cholesterol intake - The Framingham Heart Study Blood Cholesterol

This is hardly news. The man, who, more than any other, is responsible for the creation of the diet heart hypothesis fully agrees. To quote Ancel Keys, from a paper in 1956:

‘‘In the adult man the serum cholesterol level is essentially independent of the cholesterol intake over the whole range of human diets.''

What did Ancel Keys think, more recently, about the connection between cholesterol in the diet, and cholesterol in the blood?

"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." Ancel Keys, Ph.D., professor emeritus at the University of Minnesota 1997.

Does this come as a surprise?

So, it doesn't matter one jot how much cholesterol you eat, it has no impact whatsoever on blood cholesterol levels. Which just blows up a fairly important part of the cholesterol hypothesis.

‘‘But, hold on, that doesn't matter,'' (the sound of goalposts being desperately moved fills the air) ‘‘It is not cholesterol in the diet that causes the cholesterol level to rise, it is the consumption of saturated fat?''

Look again at the Tecumseh study.

To explain that table in a little more detail. Basically, it divides people into thirds with high, average or low blood cholesterol levels. The absolute values are not important.

Having done this we can examine the level of saturated fat consumed by these three groups. As can be seen:

1. Those in the lowest third of cholesterol levels consumed 52g/day of saturated fat
2. Those in the mid-range consumed 54g/day of saturated fat
3. Those with the highest levels consumed 54g/day of saturated fat

Which lead to the conclusion, from the authors that:

‘‘Serum cholesterol and triglyceride values were not positively correlated with selection of dietary constituents.''

I shall translate those weasel words into plain English. ‘‘You can eat as much saturated fat as you like and it makes no difference whatsoever to your blood cholesterol levels.''

And what of Framingham and saturated fat. Let us quote William Castelli, director of the Framingham study for many years.

"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...we found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories weighed the least and were the most physically active." Dr William Castelli 1992 (Director of the Framingham study)

OOOPS!
Now you may think that I am just quoting studies that support my ideas. However, a special prize to the man, or woman, who can find a long-term study showing that a high cholesterol, or high saturated fat diet, has any impact on blood cholesterol levels (in a normal, healthy population). Or, indeed, has any effect whatsoever on the rate of death from CHD.

Quick, time to move those goalposts again.

It's not saturated fat in the diet, it's the ratio of polyunsaturated to saturated fat ratio…….. the P/S ratio. Hey, can't you people just give up and admit that fat, of whatever sort, in the diet and cholesterol levels just are not related?
But how could they be? For, in the next episode I shall make it clear that there is no way you can link fat intake with cholesterol levels in the blood. The two substances are completely unrelated chemically, and only ever meet when they are, coincidentally, rammed together inside a lipoprotein.

And then I will show why a high blood cholesterol level cannot cause heart disease. Ladies and gentlemen, roll up, roll up and gasp in amazement as the fearsome cholesterol hypothesis disintegrates in front of your very eyes.