If you've ever felt like the standard medical advice on diet, cholesterol, and chronic disease just doesn't add up with what you're seeing in real life, this book will feel like a breath of fresh air. Dr. Robert Lufkin, a seasoned physician and professor, pulls back the curtain on some of the biggest "lies" (or at least massive oversimplifications) he himself taught for decades in medical school.
He dives deep into topics like:
Why the low-fat diet dogma has been a failure
The truth about cholesterol and heart disease (spoiler: it's not the villain we've been told)
How Big Food and Pharma have shaped guidelines that keep us sick
The metabolic roots of obesity, diabetes, cancer, Alzheimer's, and more
It's genuinely fascinating and well-researched, backed by studies that the mainstream often ignores. Lufkin writes with the authority of someone who lived the old paradigm, saw its failures up close (including in his own health scare), and then had the integrity to change his mind when the evidence demanded it.
That said, the book does get repetitive after a while. No matter what disease or topic he's tackling—whether it's hypertension, autoimmune issues, or even mental health—the prescription almost always circles back to the same core advice: ditch processed foods, sugar, and refined carbs, and eat real, natural foods with plenty of healthy fats. In other words, some version of keto, paleo, or low-carb ancestral eating. It's not that the advice is wrong (far from it—it's probably the most powerful lever we have). It's just that by the tenth chapter, you’re thinking, “Yes, I get it—eat like your great-grandmother and move your body. Got it.”
Still, the repetition kind of drives the point home: almost all modern chronic diseases share the same root cause (metabolic dysfunction from processed foods), so yeah, the solution is going to sound similar every time. Bottom line: if you're already keto or low-carb, this book will feel like a victory lap with extra science ammo. If you're new to this world or still trusting the food pyramid, it could legitimately change (or save) your life. Highly recommended, especially if you're tired of being told to "eat less and move more" while everything keeps getting worse. Just be prepared to hear "eat real food" about 47 times.
I appreciate the book’s attempt to challenge old dogmas, but I think it swings too far into the opposite extreme when it comes to keto, “healthy fats”, and cholesterol. The idea that most chronic diseases can be fixed by going low carb and eating more fat is simply not as universally supported as the book implies. Yes, ultra-processed foods and sugar are major problems, and yes, metabolic health matters, but that does not automatically make keto or very high fat diets the optimal solution for everyone.
ReplyDeleteThe discussion about “healthy fats” also feels too one sided. The book treats saturated fat as almost harmless, yet the totality of evidence from large cohorts, randomized trials, and mechanistic studies still points to a clear relationship between high saturated fat intake, LDL cholesterol, and increased cardiovascular risk. You can criticize the old low fat era without pretending that LDL no longer matters. Even the most progressive lipid researchers agree that LDL particle burden is causal, and that dietary saturated fat reliably raises it. That is not something you can wish away by calling it “metabolic dysfunction”.
The same goes for cholesterol. Challenging oversimplifications is fair, but the book drifts into the familiar low carb narrative that LDL is irrelevant as long as insulin is low or triglycerides look nice. This just is not the standard in cardiology, and it ignores decades of consistent data. Metabolic markers matter, inflammation matters, but LDL still drives atherosclerosis. The “cholesterol is innocent” storyline is simply not balanced.
So while I agree with the focus on whole foods and the critique of processed diets, I am not convinced by the book’s insistence that keto, high fat eating, or dismissing LDL is the answer for everyone. In trying to correct mainstream dogma, it ends up creating its own.
Hi Anon, I've gone down this rabbit hole and I could not find good evidence to support your claim "LDL still drives atherosclerosis". Can you please tell me your favorite study or studies that back this up? The mainstream industry generally cites the statin studies to support this claim but these are wholly unconvincing.
DeleteI get that you’re skeptical, but the idea that LDL doesn’t drive atherosclerosis really collapses once you look at the full evidence, not just selective takes from low-carb circles. Four lines of data all point the same way:
ReplyDeleteGenetic evidence: people who are genetically programmed to have low LDL their whole lives have dramatically lower cardiovascular risk, which is exactly what you’d expect if LDL is causal.
Randomized trials: across decades of RCTs, lowering LDL consistently lowers events in a clear dose-response pattern.
Non-statin LDL lowering: ezetimibe and PCSK9 inhibitor trials cut risk by lowering LDL through totally different mechanisms, so the benefit isn’t just a “statin effect”.
Mechanistic and pathology data: LDL particles enter the arterial wall, get retained, oxidize, and drive plaque formation. This is basic vascular biology, not a controversial idea.
If you want a more diet-centered perspective, I’d genuinely recommend reading Dr. Michael Greger’s "How Not to Die" and also looking into Dr. Caldwell Esselstyn’s work reversing heart disease with a whole-food plant-based, very low-fat approach. Even if you don’t agree with every detail, both show how powerful diet is at lowering LDL and improving vascular health without hand-waving away the cholesterol data.
Hi Anon,
DeleteIt appears that as a whole, people with high LDL actually live the longest, suggesting at least some protective properties. There are some groups with high LDL who die early, but they appear to have other risk factors (e.g. triglycerides, metabolic disease). When those other risk factors aren't present, LDL does not appear to be a risk factor, which again suggests it has protective properties.
Drugs that lower LDL are also doing other things, like thinning blood, lowering cardiac events in the short-term. By the way, in many of these studies, which are of course funded by the companies that want to push their drugs (and so the ones that don't confirm the narrative get shelved), even though cardiac events are reduced with the drugs, in many cases total fatalities rise or stay the same, providing more evidence of the protective nature of LDL.
I get it that you're skeptical; that's a good thing! For more information, specifically relating to high LDL where other risk factors aren't present (e.g. obesity, metabolic dysfunction etc.) so we can focus in on the LDL as a factor by itself, I highly recommend this meta-analysis: https://www.tandfonline.com/doi/full/10.1080/17512433.2018.1519391#abstract
If you're not into the nitty-gritty of the papers, you may prefer this presentation: https://www.youtube.com/watch?v=VUMUhp1pSyM
I checked the video, and it really feels like a low-carb echo chamber — all the studies cited reinforce one narrative (LDL = harmless), while the broader evidence is ignored. I was deep in that world myself: I did low-carb for 5–10 years, thinking LDL didn’t matter — until I actually measured mine. It came back over 300, and I had chest pain I kept brushing off. Once I changed things and lowered my LDL to under 80, the pain went away.
ReplyDeleteHere’s a good meta-analysis that contradicts the “LDL is protective” thesis: Association of low-density lipoprotein cholesterol levels with the risk of mortality and cardiovascular events: A meta-analysis of cohort studies with 1,232,694 participants. It found that LDL-C ≥ 160 mg/dL (very high) is associated with much higher risk of CVD death and all-cause mortality, compared to LDL-C in the 70–129 mg/dL range.
https://pubmed.ncbi.nlm.nih.gov/36482567/
If you want a diet-first, non-pharma-biased perspective, check out Dr. Michael Greger (How Not to Die) and Dr. Caldwell Esselstyn — they both take LDL very seriously, but focus on whole-food, plant-based ways to control it. And avoid the low carb bubble, it can be harmful to your life.
Hi Frommi,
DeleteIf the useful/good evidence points one direction, it may indeed feel like an echo chamber!
I just read the study you linked. It did not account for other risk factors. That's a problem because LDL can be correlated with other risk factors. It's important to account for other risk factors because you would say LDL is the cause of the problem, but someone else might say the body has problems and is trying to protect itself with more LDL. But you can't conclude either way with a study like this.
So I used to be obese and have other risk factors (e.g. triglycerides, blood pressure). On low-carb I have lost 45 lbs, and all my risk-factor markers came down, except for one, LDL, which rose. So here, the LDL correlation with other risk factors appears to break down, and I don't know why. I'm not the only one where this correlation went in the opposite direction; it sounds like it may have happened to you too, but even if not there are a lot of others, and here's a study that addresses that: https://pubmed.ncbi.nlm.nih.gov/35938780/
When I look at the research that looks at many markers, LDL does not appear to be a risk factor. Things like waist circumference, metabolic disease, smoking, age (can't change this one!) appear to be major factors and may be causal. LDL as a risk factor disappears when you take these into account.
Here are some links to youtube channels with a more balanced approach to nutrition that helped me:
ReplyDeletehttps://www.youtube.com/@NutritionMadeSimple
https://www.youtube.com/@Physionic
https://www.youtube.com/@TheProofWithSimonHill
and for more nerdy stuff:
https://www.youtube.com/@conqueragingordietrying123
I think any diet that moves people off processed stuff and into the whole foods we evolved to eat over human history, is likely to improve markers. We may both be doing that, just in a different way.
DeleteYes as a very first step, its good to get rid of processed stuff, here we agree. And i was in your shoes just 2 years ago, i also lost 20 kg on a low carb diet. And than another 5 kg on a plant based diet.
ReplyDeleteBut look, I have no stake in this and nothing to lose, my cholesterol numbers are perfect now. But you’re gambling your health — and your readers’ — on a very narrow interpretation of the evidence. If you’re wrong, the downside isn’t abstract. Plenty of low-carb guys with great triglycerides and low insulin still ended up with early heart attacks because they ignored the broader science on LDL and atherosclerosis. (For example Atkins the inventor of "low-carb" was known to have plenty of heart problems and died early and than there is this: https://www.acc.org/About-ACC/Press-Releases/2023/03/05/15/07/Keto-Like-Diet-May-Be-Linked-to-Higher-Risk?utm_source=chatgpt.com .)
You’re taking a huge personal risk for a tiny reward. I bet in investing you would never take a bet like this — risking everything, and the best-case scenario if you’re right is simply that you don’t have to change your diet. Is that really worth it?
Hi Frommi,
DeleteThe reward has been massive, as I've never been healthier. It may have saved my life! That happened because I *did* change my diet, after researching what I need to change, starting with books like Why We Get Fat and Good Calories, Bad Calories (Taubes), which I also recommend.
I think your comparison to investing is apt. Most people don't read filings or bother to understand them, they just buy what the industry/media or other people tell them to. In the same way, few people read the primary research or bother to interpret it, they just try to eat what the industry/media or other people tell them to.
By the way, I'm not gambling any reader's health. Just like when I post a stock on here, I'm not gambling my readers' wealth. I'm laying out what I see, and it's up to everyone to make their own decisions.
By the way, a quick search reveals Atkins died from a head trauma at age 72, and had previously had a viral infection of his heart.
ReplyDelete