Photo: Reuters
Photo: Reuters

Opinion | It’s time to take apart the Big Fat Lie about cholesterol

Does eating fats raise cholesterol? And does high cholesterol cause heart disease? The answer to both may be no

I began to huff and puff after short exertions in 2005. I was 53 and it didn’t feel right at all. My first angiogram, at Bengaluru’s Wockhardt Hospital confirmed that my left descending aorta was 80% blocked. No big deal, apparently. In a few minutes, the attending cardiologists had nuked the blockage to shreds and installed a stent.

I was told to avoid saturated fats (coconut oil) and red meats. No more rogan josh. Statins were prescribed to get my cholesterol into shape. I began to understand that it was all about one thing: managing cholesterol.

I don’t like popping pills. And I am sceptical of data that seems to benefit big pharma. My antennae also tingled when the US, arbiter of so many world standards, quietly removed cholesterol as a “nutrient of concern" from its 2015 Dietary Guidelines after almost five decades of villainizing it.

What had they learnt about it? Have we been fed a Big Fat Lie all these years?

The earliest rigorous studies linking dietary saturated fat to heart disease came from American physiologist Ancel Keys. His famous and controversial Seven Countries Study looked at diet and heart health in the US, Finland, the Netherlands, Italy, Yugoslavia, Greece, and Japan—and claimed to find a correlation between dietary fats and high levels of cholesterol. France, with high saturated fat consumption and low heart disease, apparently couldn’t afford to join the study. Since atherosclerosis—the build-up of waxy plaques in the aorta—was the problem, cholesterol was assumed to be the villain. Lowering it was assumed to be the solution.

However, correlation is not the same as causation. Just because high cholesterol and heart disease are seen together doesn’t mean that one is causing the other.

Damning evidence contradicting the diet-heart hypothesis existed even then. The world’s longest-running study of diet and heart health, the Framingham Heart Study, now in its third generation, unequivocally found the opposite to be true. Its director, Dr William Castelli, stated flatly in 1992: “[In the study], the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person’s serum cholesterol."

I have my layman questions: If saturated fats are so lethal, why didn’t places like Kerala, Sri Lanka, the Philippines and Indonesia, with diets rooted in coconut oil and red meats, perish from rampant heart disease?

Why were native Americans, eating a fat-rich diet of mainly red buffalo meat, so spectacularly healthy, with chronic and malignant diseases non-existent? A Smithsonian Institute study of over 2,000 Native Americans found only three cases of heart disease.

How come Eskimos, surviving on diets of whale blubber rich in saturated fats have such low levels of cholesterol and heart disease?

Here’s a question: Who benefits if I wrongly believe that high cholesterol causes heart disease?

It gets interesting right away. Around the time Keys published his findings, the American Soybean Association (ASA) was looking for a hook to promote processed polyunsaturated oils based on soy beans. The diet-heart hypothesis, it seems, was tailor-made for them. A mixture of intense lobbying, high-profile advertising campaigns and funded research created the right climate for new government-approved dietary guidelines that deified low-fat diets and exiled coconut and palm oils, as well as most red meats from diets.

Since then, we have seen 50 years of diet chaos—low carb, high carb, meat only, vegan, paleo, Atkins—and scientific “evidence" to okay almost any health regimen you prefer. America is battling an epidemic of obesity, diabetes and heart disease.

Meanwhile, the consumption of soybean oil in the US increased by more than 1,000-fold in the 20th century. Once cholesterol was established as a thing to be feared, selling statins became a global growth industry valued at $19.3 billion in 2016.

I remember simpler days when we didn’t need a consultant to tell us what to eat for breakfast, lunch and dinner. Our mothers somehow knew, and they didn’t need weighing scales either. We all lived more or less healthy, without stressing about food 24/7.

The spirit of it was captured perfectly by the legendary Dr Cherian Varkey, family friend and cardiologist who oversaw my stent procedure. He invited me over for dinner the next evening, but cooked a disturbing meal: pork curry in orange sauce and beef Viennoise with noodles, delicious and afloat in oil.

Later, eyes twinkling, he said: “Gopi, when a building is as old as you are, what would you expect to find in its plumbing? We found your 53-year-old plumbing to be a little clogged, as we’d expected. We cleaned it out, put in a stent, and you’re good as new again. You have a choice now: live in fear, treating yourself as a fragile person with heart disease. Or you could go back to enjoying life again—eating what you love, doing what you love, living happily. Of course, don’t overdo anything. But for heaven’s sake, don’t underdo anything either!"

C.Y. Gopinath is a journalist, author, designer and cook who lives in Bangkok