The Cholesterol Correlation – The Elephant in the Room

The Cholesterol Correlation – The Elephant in the Room

The publication in 1953 of the [now] infamous cherry-picked graphic by Ancel Keys [claiming a clear correlation between degenerative heart disease deaths and dietary doses of fat] encouraged John Yudkin to delve into the murky depths of diet, death and coronary heart disease.

John Yudkin (8 August 1910 – 12 July 1995) was a British physiologist and nutritionist, and the founding Professor of the Department of Nutrition at Queen Elizabeth College, London.

He gained an international reputation with his recommendation of a low-carbohydrate diet for those wishing to lose weight, and with his warnings that excessive consumption of sugar (sucrose) was dangerous to health.

The end of food rationing early in the 1950s brought with it an increase in the number of people who were suffering from obesity, and by 1958 slimming diets had proliferated, many of them with no scientific basis.

Yudkin showed that in most patients weight could be well controlled by restricting dietary carbohydrate.

‘’This Slimming Business’’ (1958), which expressed this idea in user-friendly language, proved popular: it was republished in paperback in 1962, reached its fourth edition in 1974, reappeared as ‘’Lose Weight, Feel Great’’ in the USA, was translated into Dutch and Hungarian, and spawned ‘’The Slimmer’s Cook Book’’ in 1961 and ‘’The Complete Slimmer’’ in 1964.

Yudkin’s ‘’Pure, White and Deadly’’, published in 1972, was written for a lay readership. Its intention was to summarise the evidence that the over-consumption of sugar was leading to a greatly increased incidence of coronary thrombosis, and that in addition it was certainly involved in dental caries, probably involved in obesity, diabetes and liver disease, and possibly involved in gout, dyspepsia and some cancers.

https://en.wikipedia.org/wiki/John_Yudkin

John Yudkin was unimpressed by the facts presented by Ancel Keys.

As more and more of these awkward facts turn up, one begins to have the uneasy feeling that both the proponents and opponents of a dietary hypothesis are quoting only those data which support their view.

A consideration of some of the more readily available data on the incidence of coronary deaths and on food consumption makes it difficult to support any theory which supposes a single or major dietary cause of coronary thrombosis.

It is suggested that relative over-consumption of food, associated with reduced physical exercise, may be one of several causes of the disease.

Diet and Coronary Thrombosis Hypothesis and Fact – John Yudkin
The Lancet – 27 July 1957
http://www.abc.net.au/catalyst/heartofthematter/download/Yudkinssugartheory.pdf

These luminaries were so unimpressed [with each other] they began a war of words.

The publication contains a number of quite incorrect and unjustified statement; for instance: that we had never tested our method for measuring sugar intake; that no one eats the amounts of sugar that we and others have used in our experiments; that it was absurd of me in 1957 to use international statistics of 41 countries as evidence for the relationship between sugar and heart disease (exactly the same statistics that Dr Keys had previously used for only six selected countries to show the relation ship between fat and heart disease).

He end by triumphantly pointing out that both sugar and fat intakes are related to heart disease, but that the cause must be fat, not sugar, because he had found in 1970 that fat intake and sugar intake are themselves closely linked. You will remember my own discussion of this point based on the fact that, as far back a 1964, I had demonstrated this same relationship between fat intake and sugar intake.

Dr Keys has at least been consistent in his views.

Pure, White and Deadly – John Yudkin – 1972 – Penguin Book

However, The Royal College of Physicians of London were so impressed with the techniques pioneered by Ancel Keys they decided to perform their own international comparison.

Many comparisons have been made in different countries between the smoking habits of patients of lung cancer and those of patients of the same age and sex with other diseases.

Smoking and Health – A report of The Royal College of Physicians on smoking in relation to cancer of the lung and other diseases – 1962
http://www.rcplondon.ac.uk/sites/default/files/smoking-and-health-1962.pdf

The The Royal College of Physicians of London even found a correlation [aka “association”] without an identified causation – just like Ancel Keys.

All have shown that more lung cancer patients are smokers, and more of them heavy smokers than are the controls.

The association between smoking and lung cancer has been confirmed by propective studies in which the smoking habits of large numbers of men have been recorded and their deaths from various diseases observed subsequently.

All these studies have shown that death rates from lung cancer increase steeply with increasing consumption of cigarettes.

Smoking may possibly contribute to the development of pulmonary tuberculosis, especially in the middle-aged and elderly.

Smoking appears to play a part in causing other arterial diseases but not high blood pressure.

Cigarette smoking is a cause of lung cancer, and bronchitis and probably contributes to the development of coronary heart disease and various other less common diseases.

It delays healing of gastric and duodenal ulcers.

Smoking and Health – A report of The Royal College of Physicians on smoking in relation to cancer of the lung and other diseases – 1962
http://www.rcplondon.ac.uk/sites/default/files/smoking-and-health-1962.pdf

The The Royal College of Physicians of London was so impressed with their correlation [without an identified causation] that they decided to go to war against smokers.

Decisive steps should be taken by the Government to curb the present rising consumption of tobacco, and especially of cigarettes.

Smoking and Health – A report of The Royal College of Physicians on smoking in relation to cancer of the lung and other diseases – 1962
http://www.rcplondon.ac.uk/sites/default/files/smoking-and-health-1962.pdf

The problem for these dieticians and physicians is that their correlations do not imply causation.

Without causation their pronouncements are just unscientific hysteria and scare-mongering.

However, the data presented by these professionals is very revealing when confirmation bias is excluded.

The data presented by John Yudkin does support his conclusion that it is “difficult to support any theory which supposes a single or major dietary cause of coronary thrombosis”.

1957 - Diet and Coronary Thrombosis

Diet and Coronary Thrombosis Hypothesis and Fact – John Yudkin
The Lancet – 27 July 1957
http://www.abc.net.au/catalyst/heartofthematter/download/Yudkinssugartheory.pdf

John Yudkin’s data also suggests coronary mortality was very low before 1928.

I have given the figures for coronary deaths in this country only since 1928.

The figures for the years before 1928, though based on a different classification, give no indication of any considerable fluctuation in mortality.

I do not therefore wish to attach any great importance to dietary changes before that date, but I have thought it worth while to include such earlier figures for the diets as are available (Hollingsworth 1957).

First, let me draw attention to the almost continuous rise in certified deaths due to coronary thrombosis since 1928, interrupted only by a slight fall in 1940-42 and in 1953 (figures from the Registrar-General’s Annual Statistical Reviews).

By 1943 the mortality-rate was the same as before the war, and by 1950 it had doubled.

Diet and Coronary Thrombosis Hypothesis and Fact – John Yudkin
The Lancet – 27 July 1957
http://www.abc.net.au/catalyst/heartofthematter/download/Yudkinssugartheory.pdf

This begs the questions:

1) Was fat and sugar so “good” before 1928 that it didn’t cause coronary mortality?
2) Did fat and sugar suddenly become “bad” in 1928?
3) Did fat and sugar become increasingly “bad” after 1928?

It appears very unlikely that the fat or sugar turned “bad” because consumption of these products dipped for [about] 15 years at the start of World War Two whilst the coronary mortality rate rose relentlessly from [about] 200 to [about] 500 per 100,000 during this dip in consumption.

Overall, the data suggests another factor caused coronary mortality to rise in 1924.

UK Sugar and Fat

The dataset presented by the The Royal College of Physicians of London presents a very similar conundrums regarding “good” and “bad” tobacco consumption.

From 1890 until the start of World War One men were consuming between 6 and 7 pounds of tobacco annually whilst lung cancer mortality rates were hovering [around] “one death annually in every 100,000 people”.

The importance of lung cancer as a cause of death has grown throughout most of the twentieth century.

In the early 1900s, lung cancer was a rare disease causing around one death annually in every 100,000 people.

By 1950, the lung cancer mortality rate had risen six-fold in men and three-fold in women, prompting the first epidemiological study that linked tobacco smoking and lung cancer in Great Britain.

Types of cancer – Lung cancer – Cancer Research UK
http://www.cancerresearchuk.org/cancer-info/print/%20?files=CRUKMIG_100019758,CRUKMIG_100019760,CRUKMIG_100019763,CRUKMIG_100019761,CRUKMIG_100019764,CRUKMIG_100019762,CRUKMIG_1000197598parentfile=CRUKMIG_100019764

Additionally, although “women hardly ever smoked before 1920” their mortality from lung cancer reached [about] 100 deaths annually [per 100,000 people] by 1924.

Cigarettes have largely replaced other forms of smoking in the past seventy years, during which time tobacco consumption has steadily increased. It is still increasing.

Women hardly ever smoked before 1920: since then they have smoked steadily increasing numbers of cigarettes.

Smoking and Health – A report of The Royal College of Physicians on smoking in relation to cancer of the lung and other diseases – 1962
http://www.rcplondon.ac.uk/sites/default/files/smoking-and-health-1962.pdf

These observations beg a few questions:

1) Was tobacco consumption “good” for men before 1914?
2) Did tobacco suddenly become “bad” for men after 1914?
3) Did tobacco become increasingly “bad” after 1914?

However, it appears very unlikely that tobacco turned “bad” after 1914 because male deaths from lung cancer decreased at the start of World War Two whilst consumption rates increased to [about] 11 pounds per year.

Overall, the data suggests another factor caused lung cancer mortality to rise after 1914.

UK Smoking and Heart Disease

Intriguingly, the data presented by The Royal College of Physicians of London includes a phenomena that they studiously ignored: WAR.

Therefore, an alternate hypothesis for the dramatic increase of coronary heart disease and lung cancer after 1914 is that it was caused by Chemical Weapons during World War One.

A total 50,965 tons of pulmonary, lachrymatory, and vesicant agents were deployed by both sides of the conflict, including chlorine, phosgene, and mustard gas.

Official figures declare about 1.3 million casualties directly caused by chemical warfare agents during the course of the war.

Of these, an estimated 100,000-260,000 casualties were civilians.

To this day, unexploded World War I-era chemical ammunition is still uncovered when the ground is dug in former battle or depot areas and continues to pose a threat to the civilian population in Belgium and France and less commonly in other countries.

After the war, most of the unused German chemical warfare agents were dumped into the Baltic Sea, a common disposal method among all the participants in several bodies of water.

Over time, the salt water causes the shell casings to corrode, and mustard gas occasionally leaks from these containers and washes onto shore as a wax-like solid resembling ambergris.

https://en.wikipedia.org/wiki/Chemical_warfare

WW1 Lung Cancer

Furthermore, this alternate hypothesis suggests a range of fatal conditions [including coronary heart disease and lung cancer] were exacerbated by Nuclear Weapons and Nuclear Fallout after 1945.

The first nuclear weapon was detonated as a test by the United States at the Trinity site on July 16, 1945, with a yield approximately equivalent to 20 kilotons of TNT.

The first hydrogen bomb, codenamed “Mike”, was tested at the Enewetak atoll in the Marshall Islands on November 1, 1952 (local date), also by the United States.

The largest nuclear weapon ever tested was the “Tsar Bomba” of the Soviet Union at Novaya Zemlya on October 30, 1961, with the largest yield ever seen (as of December 2013), an estimated 50–58 megatons.

In 1963, three (UK, US, Soviet Union) of the four nuclear states and many non-nuclear states signed the Limited Test Ban Treaty, pledging to refrain from testing nuclear weapons in the atmosphere, underwater, or in outer space.

The treaty permitted underground nuclear testing.

France continued atmospheric testing until 1974, and China continued until 1980.

Neither has signed the treaty.

https://en.wikipedia.org/wiki/Nuclear_weapons_testing

Nuclear fallout, or simply fallout, is the residual radioactive material propelled into the upper atmosphere following a nuclear blast or a nuclear reaction conducted in an unshielded facility, so called because it “falls out” of the sky after the explosion and shock wave have passed.

It commonly refers to the radioactive dust and ash created when a nuclear weapon explodes, but such dust can also originate from a damaged nuclear plant. Fallout may take the form of black rain (rain darkened by particulates).

https://en.wikipedia.org/wiki/Nuclear_fallout

WW2 Leukaemia

The next few postings will explore this alternate hypothesis…

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