Butter nonsense: the rise of the cholesterol deniers

I think it's confusing to generalize about fat/cholesterol being good or bad. In a complex system, labeling an actor as good or bad depends on multiple factors.

If you're obese, have markers of inflammation and eat a poor diet high in carbs and fats (i.e., a standard american diet), you're probably high risk for developing cardiovascular disease, type II diabetes and other chronic disorders. An alarming majority of adults in the US fall into this category (60-70%).

Under this scenario, when a patient's diet and lifestyle factors remain unaddressed, prescribing statins seems to yeild little benefit.

On the other hand, when a patient improves their diet/lifestyle and gets their weight under control, in most cases the patient can return to acceptable cholesterol levels without statins. Obviously this is the ideal outcome, but physicians have little influence over patients eating habits and lifestyles. Standard medical protocol directs primary physicians to treat these risk factors proactively with statins.

So is dietary fat good or bad? If you are at a healthy weight with no/low markers of inflammation or other metabolic disorders and follow a balanced diet (meat and veggies, avoiding processed foods), fat is fine. Yes fine. Fat intake should probably be moderated due to its high calorie density, but other than that it's fine (note: excepting deep-frying food with polyunsaturated oils). Animal fats: fine. Nut oils: fine. Vegetable oils: ok provided you don't use in a fryer (or cook at high temps).

In sum, the countering theory is that cholesterol is benign-- it's not the enemy. Cholesterol has many important functions in the body: It's a key part of the body's hormone production, cellular repair and energy regulation systems. In the overall picture it's a passenger and not the primary driver of cardivascular disease. Its presence becomes a risk when other negative health markers are present.

The "deniers" believe that the prevailing lipid hypothesis fails to adequately explain the causes of cardiovascular disease, and statins not strongly associated with positive outcomes. They assert that inflammation is a marker of arterial stress, with cholesterol being implicated in heart attacks and strokes due to its role in the formation of plaque (i.e., cholesterol repairs damaged artery walls which contributes to plaque buildup). In this hypothesis, the underlying cause of cardiovascular disease is more closely tied to inflammation rather than the sole presence of cholesterol in the bloodstream.