THE LIPID HYPOTHESIS IS DEAD. Animal Fat and Cholesterol are not Poisons.
Omnivores, carnivores do not develop Atheromatous Vascular Disease (AVD) until they regularly consume processed carbohydrate and or extracted sugar, sucrose. Homosapiens, us, as omnivores have added further ‘toxins’ from tobacco and most vegetable oils.
The community can be forgiven for having the perception that saturated fat, animal fat and cholesterol are nutrition entities that recently entered our lives and are poisonous. From the time our lineage commenced scavenging in East Africa about the Rift Valley from animal carcasses, birds, fish and eggs, when we abandoned a pure herbivore existence, our lineage has consumed generous quantities of all animal fats. We became 0mnivores between 2 and 3 million years ago. This change in nutrition practice by h.egaster, h.habilis and h.erectus coincided with an increase in skeletal size and brain volume. Biologically the nutrition change must have been responsible, hardly the result of pathology! These anatomical changes were reversed at the Neolithic period and for most of the planet population, have not reversed to pre-Neolithic dimensions.
Depending on the type of prey and the predator determined what was left available for the scavenger.Muscle and viscera were first choice for most predators and their families. The jackal, the prairey dog, the wolf are examples of scavengers, though not soley. These species were left with most of the boney skeleton, including the skull which contained the nutritous bone marrow , brain and spinal chord, composed largely of fats.
The Lipid Hypothesis arguably had its origins in Russia amongst the Tsar’s medical team, but was captured in the US with poor, disproven science, non-medical nutritionists, agriculturists, a processed food industry and political recommendations. It can only be described as the largest ‘medical con’ ever, that over more than a century has been shown to be false so often and yet it still lingers!
AVD was recognized by pathologists towards the end of the 19th century and symptoms of Angina were treated by clinicians at this time, but it is unclear whether symptoms of angina were linked convincingly with the AVD, seen at autopsy.
Its unclear who initially recognized the clinical presentation of coronary artery occlusion, heart attack, whether it was clinicians in Europe or the USA, such as Dudley White.What is apparent from the literature is that clinically and pathologically, coronary artery occlusion was first described early in the 20th century. Dudley White, the first US registered cardiologist in 1928, observed the explosion of CHD in the US until 1960’s-70’s and strongly opposed the Lipid Hypothesis until his death.
AVD, Coronary Heart Disease (CHD) and Heart Attack (AMI) have behaved like an infectious epidemic since, initially in the affluent and now extensively in the non-affluent world. Why? The prevalence, and mortality from CHD has varied to an extent in different locations, possibly due to avoidance intervention and other life practices. But inspite of the consumption of saturated fat and cholesterol in the USA hardly changing for more than a century, (a flat line)CHD and cancer are their leading causes of death, and climbing.
Why did Medicine become seduced with the concept that the atheroma lesions were caused by consuming cholesterol and saturated fat from animals? Well my reading of an extensive original and interpreted literature on the subject, over 5-7 decades, is that it largely did not, because there was no ‘convincing evidence’ and most studies contradicted one another or showed marginal advantages. Evidence supporting the Lipid Hypothesis was never marked or convincing. So why did it gain ‘legs’ and momentum?
Early pathology demonstrated features consistent with inflammation and an infectious culprit was considered. Lipid with cholesterol was commonly demonstrated in lesions and tenuous efforts to link blood cholesterol levels, oral consumption with the atheroma lesions, occupied researchers for many decades. It was a simplistic concept, because we had been consuming as omnivores, animal saturated fat for the time we as a species had existed, 2-300,000 years! Also animal fats provided only 4-5% of our daily cholesterol needs, the remainder was produced by us, largely in the liver!
The story of the Lipid Hypothesis I have tried to cover in “Stone Agers in the Wrong Lane”, while Gary Taubes in ‘Good and Bad Calories’, with others, outline the lack of acceptable evidence for its existence. In my next blog I will attempt to itemize the evidence that made the Lipid Hypothesis faulty and I believe untenable, but the dogma grew and captured ‘official health bodies’ and powerful vested interests, such as the processed food industry. It’s a sad story and should be given exposure, so hopefully it cannot happen again. I refer to it as a process of “Dumbing Down of Medicine’, where for too many decades, too many not trained in Medicine were infiltrating power and control fraternities of medicine and contributing to morbidity and mortality negatively. Since our fore-bears 2-3 million years ago graduated from herbivores to omnivores our homonid lineage has consumed saturated, mono-unsaturated and polyunsaturated animal fats and organs concentrated in fats, such as bone marrow, brain, liver, spleen, kidneys, pancreas etc.,The McGovern Committee and its recommendations for US nutrition to be ‘healthy’and avoid CHD, was to avoid saturated animal fat and cholesterol in the diet, is a glaring single example. No member had trained in Medicine!The US Department of Agriculture was making submissions and statements on diseases, like they had trained in medicine and specialised in metabolic vascular disease!
Who gave it or how did the Lipid Hypothesis get legs and momentum is a publication in itself. Initially and for too long, a nutritionist Ancel Keys must be seen as a dogmatic misguided protagonist, who in this instance was the culprit. He had been involved in malnutrition and starvation studies and was contracted by the US Armed Forces to provide portable food rations during WWII, known as the K-rations. He had an academic position in nutrition, but how he came to have power to get a major study done and financed, The 7 Countries Study, to determine the relation of blood cholesterol and CHD, is frightening.
Key’s primary concept was that Italy had little CHD and word of mouth amongst nutritionists, was they consumed little saturated fat and cholesterol. France next door consumed much more saturated fat and cholesterol and had significantly less CHD, which he ignored. Doll and Yudkin, medical researchers in the UK, dismissed his concept and results from the 7 Countries Study. Several years later, early 1970’s, he accepted their criticism and admitted it was sucrose sugar largely with processed carbohydrate, responsible for CHD. He retired to Southern Italy and lived to 101 years, possibly on his amended nutrition.
The Lipid Hypothesis should have been buried then, as Key’s study was increasingly revealed and accepted as faulty and not able to acceptably prove the link of animal saturated fat, cholesterol and CHD. A collection of studies on this topic were demonstrating the same, although not as large.Why did this concept not die a scientific death?Could Big Business, the processed food industry, have seen a potential market using the processed grains, sugar and all the vegetable oils to make a vast number of artificial foods? It was in their interests to have traditional foods with saturated fat and cholesterol promoted as causing heart disease, CHD, the world and US’s leading killer. They could not have written this script better themselves.
Key’s was accused of ‘cherry picking’ his data and nations involved in his study. Serious statistical mistakes were made in the study and medicine was left with no definitive answers to the conflict. That did not bother the non-medical McGovern committee and too many ‘health bodies’.
My professional opinion is that Keys would not have conceived or conceived for long his fat-cholesterol, then saturated fat-cholesterol theory, then his study, if he had studied medicine. His perceptions would have been different and he would have understood the medical criticisms. He was intolerant of Indigenous studies.
A major and critical mistake was made in the 1960’s either by Keys or the US Department of Agriculture. It was accepted that from 1910 to 1950 saturated fat consumption increased by 34% in the USA. The prevalence of CHD and mortality climbed steeply from the 1930’s to the mid 1970’s. Were they linked? Decades later it was determined that figure of 34% included all fats and the increase was due to the inclusion of vegetable oil fats! Reviews of saturated fats consumption since 1910 until now, shows a near straight line with a gradual descent from the 1960’s. I hold Keys responsible because he was sophisticated enough to dissect that data and know when dealing with edible fats, you have saturated, mono-unsaturated and poly-unsaturated from vegetable oils. The Lipid Hypothesis should have died then, not six decades later and arguably more than half a billion premature deaths avoided.What type of ‘Medical Manslaughter’ would the Law call that?
It was a difficult hypothesis to eliminate in certain areas of medicine, all official health bodies and still is, inspite of no evidence to support it. It was given a life line when statin drugs appeared to confer a morbidity and mortality value after a myocardial infarction, unrelated to cholesterol!! Meta-analysis of over 50 studies by Krauss and Chowardry recently, has shown no relation between serum cholesterol and CHD!
Reviewing the medical literature since 1900 and the history of homosapiens since our for-bears seperated fom Concestor 3 has been most informative from a disease aspect. Many billions have been spent on research into the origins of atheroma and because there has been a constellation of factors influencing its failure, I feel there are two that could have potentially been avoided and led to an earlier and better outcome.
There is a potent professional hierachy in world academic medicine, that for over 100 years was so intolerant and dismissive of too many satisfactory academic studies, intelligent professional observations, that have been fundamental to our adaption and evolution as a species. It has been exposed in the hunt for the origins of atheroma, CHD.
Complicating the latter has been what I refer to as the ‘democratising of medicine’, or the ‘dumbing down of medicine’.I intend to complete a post on the same. It broadly means and includes the insinuation, inclusion of persons, organisations in the assessment and prescription of medical concepts, facts, science and practice.Its a big subject and involves polititians, pressure groups, etc., In the instance of CHD, there have been too many without medical training, with too much power and no knowledge or little, influencing decisions on diseases most can’t spell.
Dr Dudley White, America’s first registered cardiologist would not accept the Lipid Hypothesis. He is reported to have said in 1956, he started practice in 1921, saw his first heart attack patient in 1928 and observed a steady and marked increase until the late 1960’s. In 1900 1% were obese, few had type 2 diabetes, hypertension was rare, eggs, lard, tallow and butter were freely consumed, when sugar was a luxury and vegetable oils, margarine, were non existent in the US. He suggested the US return to that diet, when they did not have heart attacks. Few listened and a nutritionist and Government body determined the explosion of CHD subsequently until now.The ‘dumbing down of medicine’ continues under a corporate practice delusion of expertise, that is false and opposed by medicine. The Lipid Hypothesis ‘con’, is but one disaster.
Dr.Lindsay.A.Green FRACP. FCSANZ.
This was the basis of a presentation at the Taree Hospital Physicians Grand round in August, 2011.