We are all aware of the idea that the fats we eat from butter, dairy and meat raise the levels of cholesterol, especially the artery clogging LDL (low-density lipoprotein), known as the ‘bad ‘cholesterol.
This, in turn, apparently causes heart disease. This ‘idea’ had gained traction in the 1960s and subsequently launched a billion-dollar statin drug industry and an even more lucrative market of low-fat foods.
So where is the evidence to prove this idea? The US Surgeon General’s Office employed four project officers for 11 years to produce a definitive report on the connection between fats and heart disease. In 1999, the Office shut the project down, unable to find any evidence to support the theory. Following this, project leader Bill Harlon said: “The report was initiated with a preconceived opinion of the conclusions.” He concluded that the science behind the theory just wasn’t there (Science, 2001).
The other part of the theory – that cholesterol causes heart disease – has also never been definitively established. Even the prestigious Framingham study, which has tracked the heart health of that small town in Massachusetts since 1948, concluded that high cholesterol levels did not predict fatal heart attacks. In fact, researchers found quite the opposite: people with low cholesterol levels were more likely to die of heart disease (JAMA, 1987)
One of the theory’s sternest critics has been Danish researcher Uffe Ravnskov, who heads up The International Network of Cholesterol Sceptics. He says that all cholesterol (including HDL and the so-called ‘bad’ LDL) are vital for our health. “As we age, LDL cholesterol is important for maintaining brain health.”
Now a team of researchers from America’s National Institutes of Health (NIH) have been uncovering data from old research projects (stored away in boxes and never published) which would have established that the cholesterol theory was wrong.
The investigation was sparked by a discovery made by one of the NIH team members, Robert Frantz, a cardiologist at the Mayo Clinic. Frantz had uncovered a box of research papers in the basement of the home of his father, Ivan Frantz, who died in 2009.
Frantz’s father had also been a medical researcher and had headed up the Minnesota Coronary Experiment, which ran from 1968 to 1973. The biggest ever study into diet, cholesterol and heart disease, the experiment involved more than 9,000 patients recruited at six mental hospitals and a State-run nursing home in Minnesota and set out to demonstrate that fats in our food cause heart disease.
Half the patients were fed a high-fat diet, including meat and dairy, while the rest were given a ‘healthier’ diet of vegetable oils high in linoleic acid, which replaced saturated fats. The patients on the healthier diet saw their cholesterol levels fall (as expected). However, their chances of a fatal heart attack rose.
This trial, despite being the largest ever undertaken in this field, wasn’t published until 1989. All the ‘difficult’ data and confounding results were omitted. That is what has been gathering dust in Frantz’s basement and stayed there until discovered by his son.
Sugar could be one trigger of inflammation, which scientists are now beginning to quietly accept has a much closer association
Frants sent this research to Chris Ramsden, a medical investigator at NIH. Coincidentally, he had just finished analysing another set of data that had also been hidden. They found the exact same results, albeit with a smaller trial, involving just 458 men recently diagnosed with heart disease. This was a trial in Sydney and, although it was reported that more men on the healthy diet died, they did not report that the cause was heart disease (Adv.Exp. Med. Biol., 1978).
Ramsden and his team published their re-analysis of the Sydney study in 2013, which put the record straight. Following the deaths of more of those on the healthy diet from coronary heart disease and cardiovascular disease, they concluded that increasing the amount of linoleic acid, we eat might be adding to the risk of heart disease (BMJ, 2013).
So why hadn’t the original data been published? Conspiracy theorists believe that the older Frantz had been leaned on at the very highest levels, whereas others thought the editors of medical journals simply didn’t want to publish heretical data.
“It could be that they tried to publish all of their results, but had a hard time getting them published,” Daisy Zamora, one of the researchers who worked with Ramsden, said.
On the other hand, Frantz junior felt it could have been more a case of self-censorship; his father just couldn’t believe the data.
So if the cholesterol theory is wrong, what is causing heart disease? It is still the number one killer in the west. During the 1950s, when Ancel Keys (a researcher at the University of Minnesota) was laying the blame at the door of the high-fat diet, other scientists were suspecting it had more to do with sugar, which was just beginning to appear in processed foods in post-war America.
Sugar could be one trigger of inflammation, which scientists are now beginning to quietly accept has a much closer association than previously thought with heart disease and atherosclerosis, where arterial walls become rigid with plaque.
However, inflammation isn’t a cause; it is the body’s response to stress, infection, a bad diet and environmental pollutants. Some believe cholesterol is playing a positive role in all of this. Cholesterol, and LDL in particular, is trying to repair inflamed arteries. So attempts to reduce levels can actually increase our risk of dying from heart disease (BMJ, 2000).
The story continues. A good book which looks at it from a doctor’s point of view is The Great Cholesterol Con, written by Malcolm Kendrick and published by John Blake.
kathryn@maltanet.net