Fat? Sugar? Which is it? - A reading list

For the last 50 or 60 years we have been told and taught that fat – particularly saturated fat – is unhealthy, makes us fat and causes heart disease. When I started training as a Nutritional Therapist, this was what I was taught, too. If you wanted to lose weight, if you wanted to avoid high cholesterol and consequently heart disease, you needed to watch your calories. The easiest way of reducing calorie intake is of course cutting fat: Fat has 9 kcal/g, protein and carbohydrate have 4 kcal/g. It’s a no-brainer.

As I am affected by a genetic condition called ‘familial hypercholesterolaemia’, I had always had a particular interest in information on cholesterol and statins, and an article in a complementary medicine magazine caught my eye in 2006 or so. It was an interview with the Danish doctor and scientist Uffe Ravnskov, discussing his findings when reviewing the scientific literature on the “lipid hypothesis”. These were summarised in his book “The Cholesterol Myths” (2002). This was the first time I had heard about anyone questioning the lipid hypothesis that, as far as I knew, had been proven and was a scientific fact. It was a fascinating read, to say the least. But this was just one guy, right? There’s always one rebel, isn’t there?


Not long after, I came across Dr Malcolm Kendrick’s “The Great Cholesterol Con”. It’s a rather different read from Dr Ravnskov’s, but the points they are both making are the same: The lipid hypothesis was wrong, the science flawed, cholesterol and dietary saturated fats have nothing to do with atherosclerosis, as we have been told for decades.


I went to a lecture given by a British cardiologist. Same story. In the break I got chatting to Justin Smith, author of “$29 billion reasons to lie about cholesterol”. Another book on the subject. Were they all crazy? At the time it seemed to me like there was a trickle of new books questioning the lipid hypothesis. Today, there is a wave of them. Type “cholesterol myth” into the search bar of any book site and you’ll get an impression.

In the 1970s and 1980s, when the lipid hypothesis was first established and gaining traction, one British doctor, physiologist and nutritionist – John Yudkin  - did not support it. In his opinion, sugar was the culprit. Sugar, not fat, was making us sick and not just causing heart disease, but also diabetes, cancer, obesity and other chronic diseases. He published “Pure, white and deadly” in 1972 (updated in 1986). Yudkin was going against the scientific consensus at the time, was discredited by his peers and his career never recovered. His book went out of print eventually … but now it’s back.


“Pure, white and deadly” is available again, now with a foreword by the American paediatric endocrinologist Dr Robert Lustig, author of “Fat Chance. The Bitter Truth about Sugar” (2012). Dr Lustig rose to fame after his 90 minute lecture “The Bitter Truth” went viral on YouTube in 2009. It has now been watched 6.3 million times (twice by me).


It is now established in the scientific community that John Yudkin was right 30 years ago and that sugar, not fat, is behind not only heart disease, but also other - if not all – major chronic diet and lifestyle related diseases.

The more recent books on the subject – after Ravnskov and Kendrick - are moving their focus away from the lipid hypothesis, although it does feature, of course, and on to the actual problem: sugar and insulin:


Gary Taubes: Good calories, bad calories. (2008)

Gary Taubes: Why we get fat and what to do about it. (2010)

David Ludwig: Always hungry? (2016)

Mark Hyman: Eat fat, get thin (2016)


So, how could this happen? Why did we get it so wrong? Did earlier researchers deliberately deceive us? Why would they? Or did they really not know any better? Was it money? Prestige? What?

If you would like to know the story of how the lipid hypothesis came about, how it became something so deeply entrenched in what we thought we ‘know’, why it is so hard to shift, and how it could be accepted as true for so long read the American food writer Nina Teicholz’s book “The Big Fat Surprise” (2014). Who knew that the goings on in the world of nutrition could be this exciting?


Last week, the British Medical Journal published a new study based on old data.  The scientific press was all over this, but it has hardly been mentioned in the mainstream media. Nearly 50 years ago, a controlled trial was conducted in Minnesota with nearly 10,000 patients in mental hospitals (where it was easy to control exactly what subjects ate). The results suggested that eating a diet higher in saturated fats (e. g. butter) was healthier than a diet higher in polyunsaturated omega-6 fats (vegetable oils). This was unexpected – as it didn’t fit the prediction based on the lipid hypothesis. The data was never published, at least not completely, and has now been unearthed by a research team from the US National Institute of Health. Their conclusion: “Available evidence from randomized controlled trials shows that replacement of saturated fat in the diet with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes.”


As you can see it remains interesting. If you would like to know more about cholesterol, what it is, what it does and whether or not we need any, why not attend my talk on the subject on Thursday, 21 April 2016, at space282 in Leigh-on-Sea. Click here to book and for details.