The Great Cholesterol Con

Malcom Kendrick

Why I looked at this book

I take statins, but I've always had my doubts about them - does the small individual benefit justify a medicalised life? I'm also interested in evidence based medicine: one gets the impression that the case for statins has a lot of evidence behind it, but presumably this book disagrees. I'm interested to see how the medical profession can seemingly get something so wrong in an era of evidenced based medicine.

First impressions

Kendrick introduces the basics of the cholesterol hypothesis - why cholesterol is thought to be bad for us - and starts the explanation of why he claims that it is wrong. I can well believe that the majority opinion is wrong, but I can't help feeling that Kendrick is playing for laughs a bit too much. In any case it promises to be a very readable book.

Main review

Kendrick introduces the reader to what is meant by dietary cholesterol - something different from the cholesterol molecule it seems. He goes on to look at the relation between cholesterol and heart disease and finds that it is pretty much non-existent, and that studies claiming to show that high cholesterol causes heart disease in fact show nothing of the sort. To get round this the medical profession then invents various ad hoc hypotheses, such as the protective nature of garlic or red wine (to explain why the French, with a high cholesterol diet have a low rate of heart disease). I was a bit worried to start with that Kendrick was playing for laughs, but I think that the book works well, being easy to read, with concepts explained in a non-technical manner.

So what does cause heart disease? That's the subject of the last bit of the book. Stress causes heart disease - as has actually been known for centuries. In particular social dislocation (especially if done by force) is a very good predictor of heart disease.

The book is very persuasive, especially in explaining the difference in rates of heart disease in different countries. However it does have quite a few problems.

Firstly statins: should we stop taking them or not? At some points in the book Kendrick claims that they are only any good for men with preexisting heart disease, but he isn't totally convincing that they don't do any good for the rest of us. He makes a persuasive argument that they don't work by lowering cholesterol, and I was expecting some idea of how he thinks they do work, but it wasn't forthcoming.

Secondly Kendrick is averse to having a list of references. He says that anyone can find a list of references to support their argument, but that isn't the point - what he wants to do is make sure he has arguments against the references which disagree with him. My first reaction on finding this book persuasive was to look for arguments against it - but I thought that it's lack of references (and even an index) meant that it didn't stand up well against such arguments.

To summarise: it's a very readable book, and makes a persuasive argument of why the medical profession may be wrong about heart disease, but I wouldn't give up on statins yet.

Reviews Elsewhere

There are plenty of Amazon Reviews , mostly very positive. It's interesting to note, though, that one of the 1* reviews has a list of references which is more than this book could manage (that review also has over 300 comments - clearly this issue generates a lot of interest). The Goodreads Reviews are also very positive (the average score is slightly lower than for Amazon, but that seems to be because some Goodreads reviewers are reluctant to award 5 stars).

Looking at reviews in general, it seems that everyone has an axe to grind, and there seems little point in reading reviews that just tell you about the reviewer's prejudices. I thought that the review at was reasonably balanced - they think that it is reasonable to question the cholesterol hypothesis, but think that it is done better in Anthony Colpo's book of the same name.