It’s sad but true that most Australian GPs still consider blood cholesterol to be heart attack enemy number one. 

Patients get ‘called in’ urgently to be given a new script for statins or to increase their current dose. There is now more than enough evidence to reassure patients that cholesterol is not the primary culprit. It should not be the focus of attention.

But patients faced with conflicting advice are looking for help. 

A client sent me this question:

“I’m wondering if you have any quality research that shows it is triglycerides not cholesterol that contributes to artery blockages. What is the consensus about all the fat we are eating?  

My husband is doing Keto and has recently been called in to his doctor’s office because his cholesterol was high. However, his triglycerides are very low and HDL very high although LDL is also high.

The doctor has advised him to cut back on fat. I’ve told him not to worry. It’s the triglycerides that causes most of the issues but would love to find great research supporting that.”

So, where do we go for the ‘quality research’ the killer scientific paper that will settle the argument?

You may not be surprised to hear, there isn’t one. 

Nutritional medicine is both extremely complex and nuanced.  The medical profession is not trained to ascertain the underlying truths behind the endless stream of ‘scientific’ papers. Or for that matter, the ‘scientific’ reviews of papers. 

They need a simple one-liner: ‘What do I tell my patient?’  Overwhelmingly the only clear answer comes from the pharmaceutical industry.

What is Big Pharma’s Role?

The pharmaceutical industry can be summarised by the work of Sir Rory Collins, and the Cholesterol Treatment Trialists’ (CTT) Collaboration

Their role is to analyse the drug company studies and publish meaningful results.

The main criticism of their work is that they have repeatedly refused to publish their original raw data.

There is no way of independently reviewing their findings.  This is anathema to true scientists. It is undeniable that their output will be biased.

Walter Willett was commencing a career as an epidemiologist when Ancel Keys was in his prime. Their relationship, covered well in ‘The Big Fat Surprise‘ evolved the focus on vegetarianism and veganism and the Mediterranean Diet.

Willett’s work with the Harvard School of Public Health resulted in a mountain of research. Based on a couple of epidemiological studies, it is roundly criticised by his opponents. Recently retired, he has published Eat-Lancet. It has achieved massive publicity including even more criticism. 

Opposition to the Status Quo

Check out Dr. Georgia Ede’s detailed appraisal. Also, check out the response from the Nutrition Coalition.

The views of the most vocal opponents are important. Unlike the CTT, their work is independent.  To the best of my knowledge, none of them receive any financial support, apart maybe, from speakers’ fees.  I guarantee there is no support from the drug companies. 

Their views are summarised by these scientists:

  • Dr. David Diamond – Demonisation and Deception in Cholesterol Research
  • Dr Malcolm Kendrick, with his well known YouTube presentation, is worth a look. 
  • Dr. Michel de Lorgeril – a good summary which leads to the full article
  • Prof Zoe Harcombe – we have got cholesterol completely wrong Zoe writes regular and in-depth criticisms of just about every significant nutritional study many of which cover fat and cholesterol.  In addition, check out the Abstract of her landmark Ph.D. thesis.
  • Nina Teicholz, who wrote the important book ‘The Big Fat Surprise‘ with 55 pages of references and a 50-page bibliography. Nina went on to found The Nutrition Coalition which lobbies the US government to base their dietary guidelines on evidence.
  • Dr. Uffe Ravnskov and his organisation THINCS, The International Network of Cholesterol Skeptics is highly regarded. However, English is not his first language.

Final Thoughts

In summary, there is no ‘proof’ available from either side.  Therefore, I tend to look to common sense.

  • Cholesterol is a fundamental ingredient in every cell in the animal kingdom
  • Plants do not contain cholesterol
  • Cholesterol is made in every animal cell
  • Blood cholesterol levels are independent of dietary consumption
  • Up to 50% of every cell membrane is cholesterol
  • The brain is the most cholesterol-rich organ in the body
  • 25% of body cholesterol is in the brain
  • Cholesterol first appeared on the planet about 2,000 million years ago
  • Cholesterol was declared the cause of heart disease in 1977. 
    The role of sugar was ignored
  • The first statin drug was released in 1988
  • Statins are one of the most commonly prescribed and financially most successful drugs ever
  • Heart disease is not a statin deficiency disease.

Heart disease is a modern disease almost unheard of 100 years ago.  Animal fats are rich in cholesterol. They have been part of our diet and all the other carnivorous species for millions of years. 

Modern, highly processed seed oils were invented in the 20th century. Notably cotton seed (1911), sunflower (1946) Canola (1978), etc. Soy provides about 80% of the world’s production of seed oil and bears no resemblance to the traditional brewed variety.

It makes absolutely no sense to blame good quality animal protein and fat for cholesterol. It’s been part of the natural diet of the animal kingdom for 2,000 million years. Cholesterol is a disease that only appeared when we started eating far more carbohydrates just over 100 years ago. 

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