Thursday, April 17, 2008

Masterjohn Reviews "The Cholesterol Wars"

Chris Masterjohn is one of my favorite Internet writers on topics of nutrition and health. He's very, very thorough and has an excellent ability to logically "connect the dots" without getting mired down in dogma. Chris recently posted a review of Daniel Steinberg's book The Cholesterol Wars: The Skeptics vs. the Preponderance of the Evidence, where Steinberg argues in favor of the lipid hypothesis of coronary heart disease (CHD). As usual, Chris not only reviews the book, but a lot of the surrounding science as well, and gives a pretty clear and cutting-edge picture of what probably really causes CHD, including some details of why various experiments (like statin treatment) have confounding effects that mislead scientists into thinking that cholesterol level (or more particularly, LDL:HDL ratio) are the root cause. He also points out where Steinberg is probably right (at least supported by the scientific evidence) and where some arguments typically advanced by cholesterol skeptics are probably off-base. Great stuff.

One interesting point is that Steinberg differentiates between the diet-heart hypothesis (the idea that dietary saturated fat and cholesterol affect CHD) and the lipid hypothesis (the theory that some defect of lipids in the blood affect CHD). That's an important distinction, which had never really occurred to me, nor apparently to just about everybody else, regardless of their position on this issue. I was coincidentally in the middle of writing a major post which amongst other things discusses the fact that there is just about zero biochemical evidence that dietary saturated fat affects LDL levels. I'm going to put that on hold until I read Steinberg's book, which apparently discusses some of the biochemical and metabolic aspects of lipoproteins in some detail.

You can read Chris' review here: