Book Review: Cholesterol and Saturated Fat Prevent Heart Disease

I receive a fair number of emails and comments from people urging me to add a section to the blog that lists studies supporting a low-carb diet.  Yes, that would be a worthy project, but it’s not one I’ll have time to tackle anytime soon.

However, I’ve frequently referred people to David Evans’ Healthy Diets and Science website, which is basically a compilation of health and nutrition study abstracts, conveniently indexed by topic in the right sidebar.  I don’t know where he manages to dig up all these abstracts, but there are nearly a thousand of them, spanning decades of research.

I’m pleased to announce that Evans has recently published a book with the provocative title Cholesterol and Saturated Fat Prevent Heart Disease – Evidence from 101 Scientific Papers.  The content is exactly what the title promises:  a list of 101 studies that dispute the hypothesis that fat and cholesterol cause heart disease, with quite a few of them suggesting that saturated fat and cholesterol are, in fact, good for us.  For each study, there’s a title, a citation and a brief summary (with occasional commentary) by Evans.

Here are just a few example titles:

Diets high in carbohydrates which have a high glycemic load increase heart disease risk by 98%.

Vegetable oils implicated in increased death rates.

A high saturated fat diet gives protection from heart disease.

These are the studies you don’t often read about in the media, and of course they’re also the studies most doctors have never heard of, much less actually read.  Many of them are observational studies, and I’ve pounded home the point over and over that observational studies don’t prove anything.  So does that make these studies worthless as evidence?

Not at all.

As I explained in my Science For Smart People speech, if someone spots a correlation between A and B in an observational study and proposes that A causes B, one of the questions we should ask ourselves is whether or not we see a link between A and B consistently.  If we don’t, it’s highly unlikely that A is causing B.

The example I gave in the speech was the observation that people who live near power lines have higher rates of cancer.  Naturally, plenty of journalists and ambulance-chasing lawyers immediately concluded that power lines cause cancer.  More cautious types pointed out that poor people are more likely to live near power lines, and poor people have higher rates of cancer for all kinds of reasons.

What finally put the power-line scare to rest was another observational study that found a completely opposite correlation:  people who work on power lines for a living – and are therefore consistently exposed to more electrical current than people who merely live near power lines – have lower rates of cancer than the population as a whole.  If proximity to power lines caused cancer, the people who work on them would have high rates of cancer.  But they don’t.  No consistency, no scientific validity, no cause and effect.

The same principle applies to observational studies about dietary fat and heart disease.  If several observational studies show that people who eat a lot of saturated fat have higher rates of heart disease, but several other observational studies show that people who eat a lot of saturated fat have lower rates of heart disease, then it’s extremely unlikely that saturated fat causes heart disease.  That’s the value of observational studies as evidence:  they’re better at disproving a hypothesis than they are at proving one.

There are plenty of clinical studies cited in the book as well, and you can already guess what the evidence Evans has compiled shows:  it’s not the fat in our diets that causes heart disease; it’s the sugars, refined carbohydrates, processed vegetables oils and other garbage.

For those of you who’ve written to me asking for evidence you can cite in a lecture or class paper, this is a book you need in your library.  For those of you who’ve written asking for evidence that will convince your loved ones your high-fat diet isn’t going to kill you, ditto.  For those of you who’ve written to tell me Fat Head is an irresponsible and dangerous film that will inspire people to eat high-fat diets and die of heart disease … well, never mind.  Nothing’s going to convince you anyway.

But for those of you who are interested in the actual science, this is a great little reference.


27 thoughts on “Book Review: Cholesterol and Saturated Fat Prevent Heart Disease

  1. bill

    Thanks. And thanks for what you do here.

    How ’bout this: There’s a correlation between obesity, diabetes and carbohydrate intake. I’d like to see a graph of divorce and carbohydrate intake. Should be somewhat the same as people have increased carbohydrate in the past 50 years and the divorce rate is up in that same period.

    Reasons? Maybe people on carb diets are unhappy, not nice, unsatiated, don’t feel well and a host of other ills. They also tend toward fat and ugly.

    People on LCHF diets are slim, satiated, relaxed, healthy and great looking.

    Whatcha think?

    I think you could find that correlation if you look hard enough.

  2. greensleeves

    Here’s your list – From Dr. Eenfeldt’s site (

    “Shai I, et al. Weight loss with a low-carbohydrate, mediterranean, or low-fat diet. N Engl J Med 2008;359(3);229–41.
    Gardner CD, et al. Comparison of the Atkins, Zone, Ornish, and learn Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women. The a to z Weight Loss Study: A Randomized Trial. JAMA. 2007;297:969–977.
    Brehm BJ, et al. A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women. J Clin Endocrinol Metab 2003;88:1617–1623.
    Samaha FF, et al. A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity. N Engl J Med 2003;348:2074–81.
    Sondike SB, et al. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. J Pediatr. 2003 Mar;142(3):253–8.
    Aude YW, et al. The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat. A Randomized Trial. Arch Intern Med. 2004;164:2141–2146.
    Volek JS, et al. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutrition & Metabolism 2004, 1:13.
    Yancy WS Jr, et al. A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet To Treat Obesity and Hyperlipidemia. A Randomized, Controlled Trial. Ann Intern Med. 2004;140:769–777.
    Nichols-Richardsson SM, et al. Perceived Hunger Is Lower and Weight Loss Is Greater in Overweight Premenopausal Women Consuming a Low-Carbohydrate/High- Protein vs High-Carbohydrate/Low-Fat Diet. J Am Diet Assoc. 2005;105:1433–1437.
    Krebs NF, et al. Efficacy and Safety of a High Protein, Low Carbohydrate Diet for Weight Loss in Severely Obese Adolescents. J Pediatr 2010;157:252-8.
    Summer SS, et al. Adiponectin Changes in Relation to the Macronutrient Composition of a Weight-Loss Diet. Obesity (Silver Spring). 2011 Mar 31. [Epub ahead of print]
    Halyburton AK, et al. Low- and high-carbohydrate weight-loss diets have similar effects on mood but not cognitive performance. Am J Clin Nutr 2007;86:580–7.
    Dyson PA, et al. A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects. Diabet Med. 2007 Dec;24(12):1430-5.
    Keogh JB, et al. Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of cardiovascular disease risk in subjects with abdominal obesity. Am J Clin Nutr 2008;87:567–76.
    Volek JS, et al. Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet. Lipids 2009;44:297–309.
    Daly ME, et al. Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes–a randomized controlled trial. Diabet Med. 2006 Jan;23(1):15–20.
    Westman EC, et al. The effect of a low-carbohydrate, ketogenic diet versus a low- glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr. Metab (Lond.)2008 Dec 19;5:36.”

    Another good list.

  3. Sol y Sombra

    Thank you very much for this post and thanks for linking to the website, this is extremely useful and interesting information. And good for convincing open-minded people too 🙂 The problem is, there are still people who are either exceptions to the rule or simply will not give the low-carb, high-fat (or primal, or paleo – these are just variations) way of eating the time it needs to work its magic… I have a very stubborn friend who refuses to believe anything I say (and I quote studies, not just random blogs I’ve read). She says she doesn’t eat any sugar and not too much carbohydrates and still has high cholesterol (LDL) and triglycerides. And her HDL goes down and her LDL and triglycerides go up, if she eats a little more red meat than usual (i.e. almost none) during the month prior to having the tests done…

    Still, it is very comforting to see that study upon study shows that most people suffer no harm from eating a saturated fat, but do fare poorly on high-carb diets.

    It’s very, very unusual for someone who eats low carb to have high triglycerides, but there can be outliers.

  4. Scott Moore

    Tom, keep up the good work, as always.

    Concerning a list of relevant low carb articles you mentioned at the beginning, I have put together a Web page containing some information. Of course, it’s somewhat idiosyncratic, but at least it’s a start that some people might find useful: .


    You’ve pulled together a nice list there, Scott. I added it to the Helpful Links section.

  5. Darren

    Hey Tom, great post. When I was in my early 20’s I participated in a “Mock Trial” that lasted a weekend. I was one of the jurors. The case was presented to us as if it was actually happening. The issue was a woman was trying to sue the power company in her state because her house was close to some power lines and she stated she contracted a type of cancer from their proximity.

    Short ending, all of the jurors sided with the power company as the evidence the prosecutors presented was extremely weak at best.

    Also on a side note I want to say a very, very big thank you for your movie. I watched it for the first time just over a year ago while at work, then I went home and watched it again. Taking the time to analyze and ingest what you were proposing. I have seen it about 8 times so far.

    I am a 41 one year old male that has struggled with my weight almost my entire life. I started the low carb high fat process the next day. I have lost 50 pounds and now weigh less than I did in my teens. I also read Wheat belly and have passed that book around to everyone I know that cares. I was on board anyway but I wanted to know the science behind why grains and wheat are so bad for us.

    So in closing, thank you from the bottom of my heart you changed my life.


    Darren Crisp

    Thank you, Darren. That’s always nice to hear.

  6. junebug

    Wow! I’ve been downloading like crazy. I’ve been looking for research about statins being ineffective in women without much luck, but this site had it. Thank you.

  7. Ricardo

    Heart Disease is caused by excess Carbohydrates and Insulin and your blood sugar levels has a far more powerful influence on your future heart attack risk than cholesterol could ever dream of. In my opinion if people were to cut out as much sugar from their diet a much as possible it would proboly cut disease rates by about 95%

  8. Firebird7478

    Nice website, Scott, but you contradict yourself in teaching teen athletes when you write the following:

    “Never drink any calories — no milk, no fruit juice, no Gatorade, no Coke, nothing. Acceptable drinks are water (and more water), coffee, tea (black or green), and diet sodas.”

    Then you say:

    “Learn to drink a protein shake (with minimal carbs) right before and right after working out.”

  9. Stacie

    I think we low-carbers have fallen into the same trap as the lipophobes. They insist that fat/cholesterol cause heart disease. We insist that excess carbohydrate/sugar cause heart disease. I think that several things can cause heart disease. Dr. Malcolm Kendrick has a great theory, as does Linus Pauling, Dr. Dwight Lundell, etc. Several things contribute to endothelial dysfunction, not just carbs/sugar. Also, improving, by diet, so-called “risk factors” for heart disease does not necessarily reduce or change your risk. Some people, like my husband, continue to have high triglycerides despite being on a LC diet. His HbA1C is great, fasting BG and insulin are all normal. High triglycerides on the SAD are a reflection of too many carbs. On a LC diet, who knows. Maybe, as Dr. Ravnskov says, they are protective. If we do not believve the Lipid Hypothesis, and eat well, why are we so concerned about lipids? Why the push to have triglycerides so low? Anyway, there is much more to heart disease than just excess carbs/sugar. One thing is for sure: statins are useless, even for men between the ages of 45-65 who have heart disease.

    I don’t believe excess refined carbs are the only cause of heart disease. If the root cause is damage to the lining of the coronary arteries (which I believe it is), high blood sugar is one of many possible triggers. Smoking, stress, infections, chronic inflammation and toxins may all contribute as well.

    I want my triglycerides low not because triglycerides are damaging in and of themselves (they may be, but we don’t know that), but because low triglycerides indicate that your body is producing large, fluffy LDL instead of the small, dense stuff. If there is any damage in your coronary arteries, you don’t want small, dense LDL showing up to do the repair job. You want the fluffy LDL showing up, since it’s far less likely to get sucked into and behind the wall of the artery.

  10. Stacie

    Hi Tom:

    Yes, I understand your thinking about triglycerides. However, I think that large, fluffy vs small, dense LDL is yet another variation of the Lipid Hypothesis. Actually, I call it the “Morphing Hypotheses.” It continues to change to perpetuate itself. If you have read Dr. Kendrick’s book, which I think you have, then you know what I am saying. Also, I thought it was Lp(a) which is in plaques. Also, there are other things involved, like Apo E. Depending upon which variation you have (there are six), that can affect triglyceride levels as well. Also, I am not sure about LDL getting sucked into and behind the wall of the artery. How, exactly, does that happen?? The bottom line is that heart disease is a complex issue, not simply “cholesterol clogging arteries.” (One of the most stupid things I have ever heard!) The Pharma-Medical Complex has done a splendid job of perpetuating myths/falsehoods, and also withholding from the people the facts about heart disease. For instance, most people believe that the more an individual artery is “clogged”, the greater your risk of heart attack. Not so. In the majority of cases, it is the small, vulnerable, non-fibrous capped plaques that rupture, causing heart attack,/death. These plaques do not show up on angiogram. So technically, you could have a stent put in an artery which is 70+% blocked, and still have a small plaque rupture and you have a heart attack. Of course, if people knew this, they might not be so willing to have this done. There are othwer ways to improve blood flow in an “occluded” artery. A LC diet is a great way. You lose weight, blood pressure drops, arteries relax, etc. Anyway, thank God for the internet and people like yourself who are willing to challenge the “status quo”, and give people the information and tools to learn for themselves.

    I wouldn’t call the process I described a variation of the Lipid Hypothesis. The Lipid Hypothesis proposes that dietary fat raises cholesterol and high cholesterol clogs arteries. In this case we’re not blaming dietary fat, and we’re not pointing to LDL (of any kind) as the instigator. We’re saying it matters which type of cholesterol shows up to repair the damage caused by other factors. We know cholesterol ends up behind the wall of the artery because that’s where plaque forms and cholesterol is one of the components of plaque. How exactly it gets there may not be fully explained, but it’s delivered via the bloodstream.

  11. tro

    Thanks for the review. I’d like to see your take on book’s “X prevent Y” part of the claim, is it based on good science? I can see disproving “X causes Y” the easier one but I still have my doubts about the ‘prevent’ part.

    The studies were clinical trials in which diets high in saturated fat were tested against diets equally high in monounsaturated fat or trans fat. The high sat-fat diets reduced levels of Lp(a) and/or increased the particle size of LDL the most.

    Those are good signs, but without putting people on those diets for many years and measuring outcomes, we can’t make a blanket claim that saturated fat prevents heart disease. Studies like that are extraordinarily expensive and difficult to monitor for compliance, so I’m not holding my breath. It’s not as if Pfizer will pony up the hundreds of millions of dollars that would be required.

  12. Labhrain

    Thank you for reviewing this book, Tom. It’s yet another to add to my “arsenal.” I’m happy to say that the information I’ve learned over the past 18 months, including that from your movie and Website, helped in getting my boss (a 53 year old very healthy woman) to refuse statins last week. She knows I read a lot about cholesterol/diet/statins, and so she came to me when the doctor prescribed them for her. I gave her some resources and she decided to decline the drug.

    The Wisdom of Crowds effect in action. Your boss owes you one.

  13. Kristian Joensen

    There is great progress happening here and there. But we certainly haven’t war the war. Now the danish heart association is saying that 900,000 danes aren’t getting enough cholesterol lowering drug(Probably statins).

    There are many battles ahead, but I believe the momentum is on our side.

  14. Greg

    Scott, is your book one of Amazon’s print-on-demand products? If so, you might want to consider submitting a new cover with more interesting typography. That combined with the product description filled with capitalized words that shouldn’t be capitalized and gratuitous ellipses everywhere makes it hard to want to forward that to anyone…makes it look amateurish, which is a problem with this topic, since it’s coming from a non-mainstream position. Sorry! Even myself, I’m reluctant to click “buy” because I’m afraid the book will be poorly-written, good info or no!

    PS: I just went to the product page again and see that the Random Capitalization Problem is gone … … but still … anyway, if you need someone to fix up your cover, let me know (no charge)!

  15. Nathan

    I think one of the most compelling diets to debunk the “fat and protein is bad for you” thinking is the diets of the Inuit. They believed that plant food was not “real human food” and ate meat, fish, and whale blubber.

    Btw, thanks for recommending Good Calories, Bad Calories. One of the best science/history books that i’ve ever read.

    Glad you enjoyed it.

  16. Sol y Sombra

    Actually this was right on time for me. As it turns out, my mom’s cholesterol test showed an apparently increased value (304) and now her general practitioner is sending her to a cardiologist and says she should take statins… My mom is 61 and has been eating a relatively low-carb, high-fat diet for the past 6 months and lost 22 lbs. Of course, nothing else was tested, just the total cholesterol, but that is obviously reason enough for statins to be recommended… So now I am going over the website and printing out abstracts from studies, showing that dietary fat and cholesterol are good, statins are bad (and not only NOT beneficial to women, but even harmful) and low-carb/high-fat diets improve all blood lipids. I really don’t believe my mom’s cardiologist is that enlightened and up to date though…

  17. Danny J Albers

    How about the correlation between people who read books like this then immediately adopt a low carb diet???? 😉 Or does adopting a low carb diet make you seek out books like these????

    Does A cause B, or does B cause A? What if both A and B are caused by C? C being an unwillingness to blindly accept what everyone else considers to be fact and try for ourselves.

    I say we throw a D in there and make it totally confusing.

  18. David Rogers

    I have never seen a bigger pile of bullshit in my life. Your documentary should be banned. Do you actually believe your the nonsense you say. I would swear that McDonalds funded your project. It was not objective whatsoever. You had an agenda and you used whatever means to prove it. Let’s see if this comment makes on your website.

    I do believe what I say because it isn’t nonsense and it’s backed up by the research. If you’d like to explain which sections of the film you believe are nonsense and cite your references, feel free.

  19. cisco

    Hey Tom, would love to know your thoughts on Brian Peskin’s research, specifically regarding the danger of fish oil supplements and the efficacy of Parent Essential Oils (PEO). He offers up some pretty convincing research on his site, in particular his IOWA study. Thanks.

    I haven’t seen it.


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