Flaws, Fallacies and Facts: Reviewing the Early History of the Lipid and Diet/Heart Hypotheses
Jennifer Elliott
Independent, Bega, Australia.
DOI: 10.4236/fns.2014.519201   PDF    HTML   XML   9,270 Downloads   15,676 Views   Citations


The lipid hypothesis of coronary heart disease proposes that a high total cholesterol level has a causative role in coronary heart disease (CHD), specifically in the development of atherosclerosis. It forms the basis for formulating target levels of serum cholesterol and hence the widespread use of statins for lowering cholesterol. An extension of the lipid hypothesis is the diet/heart hypothesis of coronary heart disease. This theory combines two ideas—that saturated fat raises cholesterol levels, and that a reduced saturated fat intake will lower cholesterol levels, thereby inhibiting the development of atherosclerosis and manifestations of CHD. Those who make diet recommendations or prescribe medication to reduce cholesterol may be unaware of the underpinning science. The original research behind these recommendations has given us “healthy heart” guidelines and preventive measures we assume to be true. While the lipid and diet/heart hypotheses are often presented as fact, they remain inadequately proven theories that have little agreement from experts. Historical perspectives can help us understand the basis of current-day beliefs. In the lipid hypothesis case, research from the 1950s and 60s was instrumental in its formation. This early work should not be considered irrelevant, outdated or obsolete because current recommendations from national heart associations in many countries continue to be shaped by these studies. This paper examines evidence used to formulate the lipid hypothesis and, subsequently, the diet/ heart hypothesis. By critically evaluating steps in the formation of the theory, inconsistencies, mistakes and alternate explanations become apparent and cast doubt on its validity.

Share and Cite:

Elliott, J. (2014) Flaws, Fallacies and Facts: Reviewing the Early History of the Lipid and Diet/Heart Hypotheses. Food and Nutrition Sciences, 5, 1886-1903. doi: 10.4236/fns.2014.519201.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] National Heart Foundation of Australia (2009) Healthy Eating and Drinking.
[2] British Heart Foundation (2011) Reducing Your Blood Cholesterol (Booklet HIS3).
[3] The American Heart Association (2013) The American Heart Association’s Diet and Lifestyle Recommendations.
[4] Robinson, C.H. (1954) The Low Cholesterol, Low Fat Diet. AJCN, 2, 353-355.
[5] Page, I.H., Stare, F.J., Corcoran, A.C., et al. (1957) Atherosclerosis and the Fat Content of the Diet. Circulation, 16, 163-178.
[6] Page, I.H., Allen, E.V., Chamberlain, F.L., et al. (1961) Dietary Fat and Its Relation to Heart Attacks and Strokes. Circulation, 23, 133-136.
[7] Silber, E., Pick, R. and Katz, L.N. (1960) Clinical Management of Atherosclerosis. Circulation, 21, 1193-1204.
[8] Katz, L. (1952) Experimental Atherosclerosis. Circulation, 5, 101-114.
[9] Dock, W. (1953) The Reluctance of Physicians to Admit That Chronic Disease May Be Due to Faulty Diet. The American Journal of Clinical Nutrition, 1, 247-249.
[10] Zilversmit, D.B. (1982) Diet and Heart Disease. Prudence, Probability, and Proof. Arteriosclerosis, Thrombosis, and Vascular Biology, 2, 83-84.
[11] Ross, R.S. (1975) The Case for Prevention of Coronary Heart Disease. Circulation, 51, 1-6.
[12] Pollock, H. (1957) Editorial: Dietary Fats and Their Relationship to Atherosclerosis. Circulation, 16, 161-162.
[13] Holman, R.L., McGill Jr., H.C., Strong, J.P. and Geer, J.C. (1959) Filtration versus Local Formation of Lipids in Pathogenesis of Atherosclerosis. JAMA, 170, 416-420.
[14] Ahrens Jr., E.H., Hirsch, J., Insull Jr., W., Tsaltas, T.T., Blomstrand, R. and Peterson, M.L. (1957) Dietary Control of Serum Lipids in Relation to Atherosclerosis. JAMA, 164, 1905-1911.
[15] Mann, G.V. (1977) Diet-Heart: End of an Era. The New England Journal of Medicine, 297, 644-650.
[16] McMichael, J. (1979) Fats and Atheroma: An Inquest. British Medical Journal, 1, 173-175.
[17] Lown, B. and Stare, F.J. (1959) Editorial: Atherosclerosis, Infarction, and Nutrition. Circulation, 20, 161-167.
[18] Reiser, R. (1978) Oversimplification of Diet: Coronary Heart Disease Relationships and Exaggerated Diet Recommendations. American Journal of Clinical Nutrition, 31, 865-875.
[19] Reiser, R. (1973) Saturated Fat in the Diet and Serum Cholesterol Concentration: A Critical Examination of the Literature. American Journal of Clinical Nutrition, 26, 524-555.
[20] Corday, E. and Rydén, L. (1989) Why Some Physicians Have Concerns about the Cholesterol Awareness Program. Journal of the American College of Cardiology, 13, 497-502.
[21] Ahrens, E.H. (1982) Diet and Heart Disease. Shaping Public Perceptions When Proof Is Lacking. Arteriosclerosis, Thrombosis, and Vascular Biology, 2, 85-86.
[22] Little, J.A., Shanoff, H.M. and Csima, A. (1967) Dietary Carbohydrate and Fat, Serum Lipoproteins, and Human Atherosclerosis. American Journal of Clinical Nutrition, 20, 133-138.
[23] Ahrens, E.H. (1979) Dietary Fats and Coronary Heart Disease: Unfinished Business. The Lancet, 314, 1345-1348.
[24] Bronte-Stewart, B. (1958) The Effect of Dietary Fats on the Blood Lipids and Their Relation to Ischaemic Heart Disease. British Medical Bulletin, 14, 243-252.
[25] Werkö, L. (1987) The Enigma of Coronary Heart Disease and Its Prevention. Acta Medica Scandinavica, 221, 323-333.
[26] Taubes, G. (2001) The Soft Science of Dietary Fat. Science, 291, 2536-2545.
[27] Kendrick, M. (2007) The Great Cholesterol Con. John Blake Publishing Ltd., London.
[28] Browner, W.S., Westenhouse, J. and Tice, J.A. (1991) What If Americans Ate Less Fat? A Quantitative Estimate of the Effect on Mortality. JAMA, 265, 3285-3291.
[29] Peterson, J.E., Wilcox, A.A., Haley, M.I. and Keith, R.A. (1960) Hourly Variation in Total Serum Cholesterol. Circulation, 22, 247-253.
[30] Peterson, J.E., Keith, R.A. and Wilcox, A.A. (1962) Hourly Changes in Serum Cholesterol Concentration: Effects of the Anticipation of Stress. Circulation, 25, 798-803.
[31] Beveridge, J.M.R., Connell, W.F., Mayer, G.A. and Haust, H.L. (1958) Plant Sterols, Degree of Unsaturation, and Hypocholesterolemic Action of Certain Fats. Canadian Journal of Biochemistry and Physiology, 36, 895-911.
[32] Messinger, W.J., Porosowska, Y. and Steel, J.M. (1950) Effect of Feeding Egg Yolk and Cholesterol on Serum Cholesterol Levels. Archives of Internal Medicine, 86, 189-195.
[33] Beveridge, J.M.R., Connell, W.F., Mayer, G.A. and Haust, H.L. (1960) The Response of Man to Dietary Cholesterol. Journal of Nutrition, 71, 61-65.
[34] Steiner, A., Howard, E.J. and Akgun, S. (1962) Importance of Dietary Cholesterol in Man. JAMA, 181, 186-190.
[35] Winitz, M., Graff, J. and Seedman, D.A. (1964) Effect of Dietary Carbohydrate on Serum Cholesterol Levels. Archives Biochemistry and Biophysics, 108, 576-579.
[36] McEachern, J.M. and Gilmour, C.M. (1932) Studies in Cholesterol Metabolism. 1. Physiological Variations in Blood Cholesterol. Canadian Medical Association Journal, 26, 30-33.
[37] Turner, K.B. and Steiner, A. (1939) A Long-Term Study of the Variation of Serum Cholesterol in Man. Journal of Clinical Investigation, 18, 45-49.
[38] Gertler, M.M., Garn, S.M. and White, P.D. (1950) Diet, Serum Cholesterol and Coronary Artery Disease. Circulation, 2, 696-704.
[39] Pomeranze, J., Beinfield, W.H. and Chessin, M. (1954) Serum Lipid and Fat Tolerance Studies in Normal, Obese and Atherosclerotic Subjects. Circulation, 10, 742-746.
[40] Anderson, J.T., Keys, A. and Grande, F. (1957) The Effects of Different Food Fats on Serum Cholesterol in Man. Journal of Nutrition, 62, 421-444.
[41] Hegsted, D.M. and Nicolosi, R.J. (1987) Individual Variation in Serum Cholesterol Levels. Proceedings of the National Academy of Sciences of the United States of America, 84, 6259-6261.
[42] Epstein, F.H., Simpson, R. and Boas, E.P. (1956) Relations between Diet and Atherosclerosis among a Working Population of Different Ethnic Origins. American Journal of Clinical Nutrition, 4, 10-19.
[43] Keys, A., Anderson, J.T. and Grande, F. (1957) Prediction of Serum-Cholesterol Responses of Man to Changes in Fats in the Diet. The Lancet, 273, 959-966.
[44] Shrapnel, W.S., Truswell, A.S., Nestel, P.J., et al. (1994) Dietary Fatty Acids and Blood Cholesterol. National Heart Foundation of Australia.
[45] Consensus Conference (1985) Lowering Blood Cholesterol to Prevent Heart Disease. JAMA, 253, 2080-2086.
[46] Shrapnel, W.S., Calvert, G.D., Nestle, P.J., et al. for the National Heart Foundation of Australia (1992) Position Statement Diet and Coronary Heart Disease. Medical Journal of Australia, 156, S916.
[47] Hegsted, D.M., McGandy, R.B., Myers, L. and Stare, F.J. (1965) Quantitative Effects of Dietary Fat on Serum Cholesterol in Man. American Journal of Clinical Nutrition, 17, 281-295.
[48] Conner, W.E., Stone, D.B. and Hodges, R.E. (1964) The Interrelated Effects of Dietary Cholesterol and Fat upon Human Serum Lipid Levels. Journal of Clinical Investigation, 43, 1691-1696.
[49] Newbold, H.L. (1988) Reducing the Serum Cholesterol Level with a Diet High in Animal Fat. Southern Medical Journal, 81, 61-63.
[50] Keys, A. (1980) Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Harvard University Press, Cambridge.
[51] Keys, A. (1953) Atherosclerosis a Problem in Newer Public Health. Journal of the Mount Sinai Hospital, New York, 20, 118-139.
[52] Yerushalmy, J. and Hilleboe, H.E. (1957) Fat in the Diet and Mortality from Heart Disease. A Methodologic Note. New York State Journal of Medicine, 57, 2343-2354.
[53] Keys, A. and Anderson, J.T. (1955) Symposium on Atherosclerosis. National Academy of Science, National Research Council.
[54] Yudkin, J. (1957) Diet and Coronary Thrombosis, Hypothesis and Fact. The Lancet, 270, 155-162.
[55] Trulson, M.F. (1959) The American Diet: Past and Present. American Journal of Clinical Nutrition, 7, 91-97.
[56] Keys, A., Vivanco, F., Minon, J.L., Keys, M.H. and Mendoza, H.C. (1954) Studies on the Diet, Body Fatness and Serum Cholesterol in Madrid, Spain. Metabolism: Clinical and Experimental, 3, 195-212.
[57] Keys, A. (Ed.) (1970) Coronary Heart Disease in Seven Countries. Circulation, 41, 1-211.
[58] Hartog, C.D., Buzina, R., Fidanza, F., Keys, A. and Roine, P. (1968) Dietary Studies and Epidemiology of Heart Diseases. Stichting Voeding. The Hague.
[59] Kromhout, D., Keys, A., Aravanis, C., Buzina, R., Fidanza, F., Giampaoli, S., et al. (1989) Food Consumption Patterns in the 1960s in Seven Countries. American Journal of Clinical Nutrition, 49, 889-894.
[60] Blackburn, H. On the Trail of Heart Attacks in Seven Countries.
[61] National Heart Foundation of Australia. Cardiovascular Conditions.
[62] American Heart Association (2008) What Can Cholesterol Do? How Does Atherosclerosis Start? American Heart Association.
[63] The Heart and Stroke Foundation South Africa (2013) Atherosclerosis.
[64] Saphir, O. and Gore, I. (1950) Evidence for an Inflammatory Basis of Coronary Arteriosclerosis in the Young. Archives of Pathology, 49, 418-426.
[65] Hamilton-Craig, I. (2007) The State of the Heart. Cholesterol & Triglyceride Control. Barclay Sterling Publishing Pty Ltd., Adelaide.
[66] Duguid, J.B. (1946) Thrombosis as a Factor in the Pathogenesis of Coronary Atherosclerosis. The Journal of Pathology and Bacteriology, 58, 207-212.
[67] Duguid, J.B. (1949) Pathogenesis of Atherosclerosis. The Lancet, 254, 925-927.
[68] Kendrick, M. Atherosclerosis and Greasy Sewer Lines. THINCS: The International Network of Cholesterol Skeptics.
[69] Paterson. J.C. (1952) Factors in the Production of Coronary Artery Disease. Circulation, 6, 732-729.
[70] Lande. K.E. and Sperry, W.M. (1936) Human Atherosclerosis in Relation to the Cholesterol Content of the Blood Serum. Archives of Pathology, 22, 301-312.
[71] Paterson, J.C. and Dyer, L. (1960) Serum Cholesterol Levels in Human Atherosclerosis. Canadian Medical Association Journal, 82, 6-11.
[72] Boas, E.P. (1948) Hereditary Disturbance of Cholesterol Metabolism: A Factor in the Genesis of Atherosclerosis. American Heart Journal, 35, 611-622.
[73] Pickering, G. (1979) Fats and Atheroma. British Medical Journal, 1, 1015.
[74] Cliff, W.J. and Schoefl, G.I. (1989) Medical Experiments on Animals and Human Populations. In: Coronaries and Cholesterol, Chapman and Hall, London, 58.
[75] Mann, G.V. (Ed.) (1993) Coronary Heart Disease: The Dietary Sense and Nonsense—An Evaluation by Scientists. Janus, London, 22-27.
[76] McLetchie, N.G.B. (1952) The Pathogenesis of Atheroma. American Journal of Pathology, 28, 413-435.
[77] Ross, A.C., Minick, C.R. and Zilversmit, D.B. (1978) Equal Atherosclerosis in Rabbits Fed Cholesterol-Free, Low-Fat Diet or Cholesterol-Supplemented Diet. Atherosclerosis, 29, 301-315.
[78] Dawber, T.R., Moore, F.E. and Mann, G.V. (1957) Coronary Heart Disease in the Framingham Study. American Journal of Public Health and the Nations Health, 47, 4-24.
[79] Oppenheimer, G. (2006) Profiling Risk: The Emergence of Coronary Heart Disease Epidemiology in the U.S. 1947-1970. International Journal of Epidemiology, 35, 515-519.
[80] Dawber, T.R. and Kannel, W.B. (1962) Application of Epidemiology of Coronary Heart Disease to Medical Practice. Modern Medicine, 30, 85-101.
[81] US Department of Health, Education and Welfare (1964) Surgeon General’s Report, Smoking and Health. Report of the Advisory Committee to the Surgeon General of the Public Health Service. PHS Publication No. 1103. Government Printing Office, Washington DC.
[82] Anderson, K.M., Castelli, W.P. and Levy, D. (1987) Cholesterol and Mortality. 30 Years of Follow-Up from the Framingham Study. JAMA, 257, 2176-2180.
[83] Okuyama, H., Ichikawa, Y., Sun, Y., et al. (2007) The Association of Total Cholesterol with Coronary Heart Disease Differs among Different Age Groups, Which Is Likely to Be Correlated with Familial Hypercholesterolemia. In: Okuyama, H., Ed., Prevention of Coronary Heart Disease from the Cholesterol Hypothesis to Omega 6/ Omega 3 Balance Prevention of Coronary Heart Disease World Rev Nutr Diet, Karger, Basel, Vol. 96, 27-31.
[84] Albrink, M.J. (1962) Triglycerides, Lipoproteins, and Coronary Artery Disease. Archives of Internal Medicine, 109, 345-359.
[85] Volek, J.S. and Feinman, R.D. (2005) Carbohydrate Restriction Improves the Features of Metabolic Syndrome. Metabolic Syndrome May Be Defined by the Response to Carbohydrate Restriction. Nutrition & Metabolism, 2, 31.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.