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Review of Article the cholesterol cult and heart mafia
https://mindandmatter.substack.com/p/the-cholesterol-cult-and-heart-mafia
Main Themes:
This article critically examines the enduring influence of the "diet-heart hypothesis" – the belief that dietary saturated fat and cholesterol increase blood cholesterol, leading to cardiovascular disease – and argues that its widespread acceptance and translation into public policy is less a result of robust scientific evidence and more a consequence of "narrative selection," a social process where ideas are adopted and spread based on their social utility, particularly in reinforcing the status quo and expanding institutional power. The author contends that the "consensus" surrounding the diet-heart hypothesis is an illusion manufactured by institutions and driven by social dynamics rather than purely objective scientific validation.
Key Ideas and Facts:
The Diet-Heart Hypothesis: The article begins by illustrating the prevalence of the diet-heart hypothesis in popular belief, referencing an exchange with Elon Musk and Bill Gates' statements about the health benefits of artificial meat due to lower cholesterol content.
Quote (Musk interaction): "Wow, steak & eggs with coffee in the morning really feels like a powerup! ... Sounds like a heart attack in the long-term."
Quote (Bill Gates): "It’s slightly healthier for you in terms of less cholesterol."
Limited Impact of Dietary Cholesterol: The author highlights that dietary cholesterol has only a modest impact on serum cholesterol levels due to the body's own cholesterol synthesis and negative feedback mechanisms.
Key Fact: Eating three extra boiled eggs per day is expected to increase LDL-C by less than 10 mg/dL on average.
"Fiat Science" and Social Transmission of Beliefs: Many people, including influential figures like Bill Gates, hold beliefs about diet and health not from personal scientific investigation but through "fiat" – being told by perceived authorities (government guidelines, media, experts) that something is "The Science™." This is likened to catching a meme or a cold.
Quote: "We received the ideas by fiat—credentialed experts told us it was The Science™."
The Illusion of Consensus: Despite a widespread belief in the diet-heart hypothesis among medical experts and its entrenchment in public policy (dietary guidelines, statin prescriptions), the author argues this consensus is illusory.
Narrative Selection: Scientific ideas spread not solely based on evidence quality but on their "social utility" – how well they integrate into narratives that justify the growth and expansion of institutions and secure the positions of high-status individuals.
Quote: "In the Darwinian battle of ideas, a meme will spread insofar as it can be integrated into a social narrative that justifies the growth and expansion of institutions."
Social Crises and Hasty Adoption: The rise of the diet-heart hypothesis was facilitated by the cardiovascular disease epidemic in the mid-20th century, creating pressure for immediate solutions and elevating the status of those who proposed them, like Dr. Ancel Keys.
Key Event: President Eisenhower's heart attack in 1955 heightened public concern.
Questionable Evidence and Cherry-Picking: The initial evidence supporting the diet-heart hypothesis, particularly Ancel Keys' "Seven Countries Study," had significant shortcomings, including being largely correlational, relying on animal studies with metabolically different species (rabbits), and potentially involving cherry-picked data.
Quote (Robert Lustig on Ancel Keys): "However, when you look at the data, he cherry picked it. Okay? And all the countries that he picked in his Seven Countries Study, even though there were 22, he picked the seven that made his case."
Competition for Social Status: Scientists, like all individuals, are motivated by social status. Ancel Keys' success was not solely due to his research but also his "salesmanship" and ability to network with influential figures. The "marketplace of ideas" is not a level playing field, as high-status individuals and institutions can bias it towards their preferred ideas.
Key Event: Ancel Keys appeared on the cover of Time Magazine, becoming a national hero.
Suppression of Contradictory Evidence: Evidence that challenged the diet-heart hypothesis was actively suppressed by influential institutions ("heart mafia" – AHA, NIH). The Framingham Heart Study, despite initial findings linking high cholesterol to heart disease, also revealed potential risks of very low cholesterol, which were overlooked. A study within Framingham by Dr. George Mann showing no correlation between saturated fat intake and heart disease was allegedly buried and prevented from publication.
Quote (Dr. Orrin Devinsky on Dr. Mann's study): "What they found was no correlation between how much saturated fat you ate and what your cholesterol was, nor any relationship between how much saturated fat you ate and your heart health. ... What happened to that study? He was forbidden from publishing it."
"Heart Mafia": Dr. Devinsky uses the term "heart mafia" to describe the American Heart Association and the NIH, suggesting they exerted undue influence to prevent dissenting research from emerging.
Persistence of Dogma: Once a hypothesis becomes public policy, it can solidify into dogma, resisting challenges even in the face of contradictory evidence. This rigidity is characteristic of cult-like belief systems.
Emerging Evidence Against the Diet-Heart Hypothesis: The author points to large randomized controlled trials and epidemiological studies (like PURE) that have failed to show a link between saturated fat intake and cardiovascular disease mortality, and some even suggesting potential benefits or no association with negative outcomes. Reviews of the evidence also increasingly question the need to limit saturated fat.
Quote (Review conclusion): "the totality of available evidence does not support further limiting the intake of such foods [saturated fat-rich foods]."
U-Shaped Relationship with Cholesterol: Cholesterol levels have a U-shaped relationship with mortality risk – both very high and very low levels are associated with increased all-cause mortality. Current guidelines may be setting cholesterol thresholds too low, leading to unnecessary statin prescriptions and potentially overlooking the risks of low cholesterol.
Key Fact: The lowest risk of death is often seen at cholesterol levels just above 200 mg/dL.
Personal Experimentation (n=1): Individuals should consider their own health data (e.g., bloodwork) as the ultimate study, as individual responses to diet can vary. The author's personal experience showed a decrease in cholesterol levels despite increased saturated fat and cholesterol intake.
Narrative Selection and Institutional Goals: Institutions like the American Heart Association may promote narratives that align with their goals of expanding influence and client base, even if those narratives are not fully supported by empirical evidence. This is exemplified by the American Diabetes Association's dietary recommendations.
Quote: "Institutions will try to preserve the problem to which they are the solution."
Science as a Political Process: The process of scientific consensus-making is heavily influenced by competition for social status and the alignment of ideas with dominant social narratives, potentially leading to a divergence between "The Science™" of public policy and empirically justified findings.
Implications:
The Cholesterol Cult: Science into Public Dogma
1 source
This source critiques the diet-heart hypothesis, the long-held belief that dietary saturated fat and cholesterol increase blood cholesterol, leading to heart disease. The author argues this idea evolved into public policy, becoming "The Science™" through a process called "narrative selection", where social factors and institutional goals, rather than just evidence, drive the acceptance of scientific ideas. The text contends that this "consensus" is illusory, highlighting flawed evidence, suppressed contradictory research, and the influence of social status and funding in shaping what becomes accepted as scientific truth. Ultimately, the author suggests individuals should critically evaluate health information and consider their own bodies as primary data.
The "diet-heart hypothesis" posits that dietary saturated fat and cholesterol increase blood cholesterol levels, which in turn drives the development of cardiovascular disease. This belief commonly leads to advice to minimize saturated fat and cholesterol intake, favoring low-fat and plant-based alternatives.
Many people believe that dietary cholesterol directly and significantly increases serum cholesterol levels. The author suggests that dietary cholesterol has only a modest impact on serum cholesterol, with a diminishing returns effect and negative feedback mechanisms in the body regulating cholesterol synthesis.
"Narrative selection" is a social process by which institutions choose scientific ideas for integration into broader narratives that justify their social goals and the existing social order. The author argues this process, driven by status competition, can lead to the widespread acceptance of ideas as "The Science™" even without strong empirical support.
The cardiovascular disease epidemic in the United States, particularly President Eisenhower's heart attack in 1955, created a social crisis and intense pressure for public health solutions, making the seemingly definitive diet-heart hypothesis attractive to policymakers.
Major shortcomings included the reliance on correlational studies that couldn't prove causation, flawed animal studies using species with different metabolisms (like rabbits), and human epidemiological studies with issues like small sample sizes and cherry-picked data, such as in Keys' "Seven Countries Study."
The "social fitness landscape" represents the dynamic social environment where ideas compete for dominance. High-status individuals and institutions can influence this landscape, favoring ideas that reinforce their status, potentially leading to the widespread adoption of socially useful rather than empirically accurate ideas.
The author points to large randomized controlled trials showing no reduction in cardiovascular or total mortality despite lower cholesterol from reduced saturated fat, the PURE study finding no association and even inverse associations between saturated fat and mortality, and numerous reviews questioning the need to limit saturated fat intake.
The Framingham study found that very low cholesterol levels were associated with higher rates of cancer, accidental death, and suicide deaths, and that overall mortality for men with very low cholesterol was not significantly different from those with high cholesterol. The author claims this contradictory evidence was suppressed and unpublished for decades due to its conflict with the prevailing dogma.
According to the author, excessively low cholesterol levels have been linked to negative health outcomes, including an increased risk of all-cause mortality, cancer mortality, accidental death, and suicide.
The author advocates for individuals to become their own "n=1" experiments by getting regular bloodwork done, especially when making significant dietary or lifestyle changes, to observe their personal responses rather than solely relying on generalized population-level data and guidelines.
Glossary of Key Terms
Diet-Heart Hypothesis: The theory that dietary saturated fat and cholesterol increase blood cholesterol levels, leading to a higher risk of cardiovascular disease.
Narrative Selection: A social process by which institutions select and promote specific ideas, often from scientific literature, to create narratives that justify their social goals and maintain or expand their influence.
The Science™: The author's term for scientific ideas that have evolved into public dogma and are presented as unquestionable truth, often driven by institutional and social forces rather than purely empirical evidence.
Fiat Science: Scientific beliefs that are accepted and disseminated based on the authority of institutions and experts, rather than through individual critical evaluation of the underlying evidence.
Illusion of Consensus: The appearance of widespread agreement among experts on a scientific issue, which may not reflect the true diversity of scientific opinion due to factors like suppression of contradictory evidence or social pressures.
Social Fitness Landscape: An analogy to evolutionary biology, representing the dynamic social environment where ideas compete for adoption based on their utility in improving an individual's or group's social status.
Persona Non Grata: A person who is no longer welcome or accepted, often used in the context of Dr. George Mann being ostracized for his research contradicting the diet-heart hypothesis.
Heart Mafia: The author's term (attributed to Dr. Orrin Devinsky) for powerful institutions like the American Heart Association and the NIH, suggesting they used their influence to suppress evidence that contradicted the diet-heart dogma.
Public Policy: Government rules, regulations, and guidelines that are intended to address societal issues, in this context, particularly those related to public health and dietary recommendations.
Meme: In this context, a unit of cultural information that spreads from person to person, often through imitation or repetition, such as a widely held belief about health or diet.
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1. What is the diet-heart hypothesis, and why has it been so influential?
The diet-heart hypothesis is the belief that dietary saturated fat and cholesterol increase blood cholesterol levels, which in turn drives the development of cardiovascular disease. This hypothesis has been highly influential in Western society since the mid-1900s, shaping dietary guidelines, public health campaigns, and even food product marketing. It gained traction due to several factors, including a perceived rise in heart disease, the advocacy of influential figures like Dr. Ancel Keys, and the social pressure to find a solution to a major public health crisis.
2. According to the author, what are some of the problems with the evidence supporting the diet-heart hypothesis?
The author argues that the evidence supporting the diet-heart hypothesis has significant shortcomings. Much of the early evidence was correlational, failing to establish a direct cause-and-effect relationship between dietary saturated fat and cholesterol and heart disease. Animal studies were often conducted on species like rabbits, whose metabolic response to cholesterol differs greatly from humans. Additionally, some influential human studies, such as Keys' "Seven Countries Study," have been accused of cherry-picking data. More recent and larger studies have also failed to consistently support the hypothesis, with some even suggesting potential benefits of saturated fat.
3. The author discusses "narrative selection." What does this term mean in the context of scientific ideas and public policy?
Narrative selection is the process by which institutions choose certain scientific ideas to integrate into broader narratives that justify specific social goals. This selection is not solely based on the strength of the scientific evidence but also on the social utility of the idea, particularly its ability to support the growth and influence of institutions and the status of high-status individuals within those institutions. In essence, ideas that fit existing power structures and institutional agendas are more likely to be promoted and become "The Science™" guiding public policy, even if their empirical grounding is weak.
4. How did the social crisis of rising heart disease in the mid-20th century contribute to the acceptance of the diet-heart hypothesis?
The surge in cardiovascular disease in the mid-20th century created intense social pressure for solutions. Policymakers were eager to implement expert-approved strategies quickly. This environment incentivized experts to present promising ideas, like the diet-heart hypothesis, as more definitive than the evidence at the time warranted. The urgency of the crisis allowed Dr. Keys and his supporters to gain influence and have their hypothesis adopted by major institutions, even with limited evidence.
5. The author mentions an "illusion of consensus." How was this created around the diet-heart hypothesis, and what were some consequences?
The illusion of consensus around the diet-heart hypothesis was manufactured through several mechanisms. Influential institutions like the American Heart Association (AHA) strongly promoted the idea, sometimes with financial incentives. Evidence that contradicted the hypothesis, such as studies showing no correlation between saturated fat and heart disease or even potential risks of very low cholesterol, was often suppressed or ignored. Researchers who challenged the dogma faced marginalization and loss of funding. This created a scientific landscape where it appeared that all experts agreed, even when significant dissenting evidence existed. The consequences included the widespread adoption of low-fat diets, the demonization of saturated fats and cholesterol, and potentially overlooking other important factors in heart disease and overall health.
6. What role did social status and competition play in the rise and persistence of the diet-heart hypothesis?
The author argues that the pursuit of social status is a crucial factor in the spread and entrenchment of scientific ideas. Individuals, including scientists, are motivated by recognition and career advancement. Dr. Ancel Keys, for example, gained immense public and professional status for championing the diet-heart hypothesis. This created a social fitness landscape where endorsing and promoting the dominant narrative was advantageous for career progression and securing funding. Conversely, challenging the established dogma carried significant risks, further solidifying the perceived consensus, regardless of the underlying scientific validity.
7. What evidence contrary to the diet-heart hypothesis has emerged over time, according to the author?
Despite the dominance of the diet-heart hypothesis, accumulating evidence has challenged its core tenets. Large randomized controlled trials replacing saturated fats with polyunsaturated fats often failed to show reductions in cardiovascular or total mortality. Major epidemiological studies, like the PURE study, found no association between saturated fat intake and cardiovascular disease mortality, and even suggested potential benefits. Numerous reviews of the available evidence have concluded that limiting saturated fat intake is not supported by the totality of the data. Furthermore, research has highlighted a U-shaped relationship between cholesterol levels and mortality, indicating that very low cholesterol may also be detrimental.
8. What does the author suggest as a way for individuals to better understand their own health in relation to these ideas?
The author emphasizes the importance of individual experimentation and data collection. He recommends getting regular bloodwork done, especially when making significant dietary or lifestyle changes, to observe personal responses. He argues that while population-level studies provide general insights, individual biology can vary, and each person's health journey is, in essence, an "n=1" experiment. By taking an active role in monitoring their own health markers, individuals can gain a more personalized understanding that may or may not align with widely accepted dogmas.