University of Minnesota

‘Diet-Heart’ in Britain

“The ‘diet-heart’ hypothesis, which is deeply entrenched and widely accepted in the statements of the American Heart Association and other North American bodies, has not been endorsed or denied by British authorities but allowed to float in the background without any firm statement being made by major official bodies, government or other” (Shaper 2002). In 1953-1956, [when I was] Registrar to [leading academic Professors] McMichael and Shillingford, the research emphasis was on clinical cardiology and catheters. There was little interest in the nature of atherosclerosis, in the lipid hypothesis, or in possible nutritional aspects of cardiovascular disease.

Coming from a medical school [Cape Town], where inter-ethnic studies in blood lipids and cardiovascular disease [Bronte-Stewart], nutrition and chronic disease [Brock] and coagulation and fibrinolysis [Mersky] were in full swing, with stimulating visits from Ancel Keys and other American workers, the lack of interest in this area in the U.K. was marked–and disappointing. The atmosphere in the U.K. at that time was, in fact, hostile to the American views on nutrition as a fundamental factor in atherosclerosis.

A key development at this time was the setting up of a Joint Working Party of the Royal College of Physicians of London and the British Cardiac Society to produce a report on the “Prevention of Coronary Heart Disease.” The group was brought together by Keith Ball and Dick Turner and included in its membership Michael Oliver, Geoffrey Rose, John Goodwin, Walter Somerville and others, with contributions to the report from Harry Keen and Hugh Tunstall-Pedoe.

Finally published in 1976, [the report] was distributed by the CMO to all doctors in the U.K. There is little in the report that would not be acceptable today, with its focus on diet and with dietary recommendations for the whole community (ibid.).

In the aftermath of the report’s release . . . there were prominent individuals in British cardiology who vigorously opposed the dissemination of this report, and throughout the late 1970s, ‘80s, and into the ‘90s, there was continued concern that lowering blood cholesterol by any means, including dietary change, might have a deleterious effect on human biological systems. It is of considerable interest to note that these concerns have not subsided, and with the widespread use of drugs for lowering blood lipids, there is renewed concern in this direction” (Shaper 2002; Reynolds and Tansey 2006; Rogers 2005).

McMichaels in particular editorialized using the classic argument about “lack of proof,” in which he refers to experiment as the only acceptable test of diet-heart:

“With the absence of any proof of benefit from the reduction of blood lipids, we have reached the stage where we must admit that this regimen has failed when tried out on subjects at risk of coronary disease and therefore, the imposition on the public of dietetic restrictions for its prevention has no scientific justification.”

“This is creating alarm in the public and it is urgent that our professional advice should get back on an even keel and put a stop to this propaganda, which threatens to become a cruel imposition terrifying mothers of families” (McMichaels 1979).

McMichael’s early and longstanding attacks on diet-heart concepts and on any formal public recommendations for diet, as well as his personal campaign against epidemiologists and their research strategies, appeared to go beyond scientific argument. Gerald Shaper surmised that McMichaels considered the whole notion of a diet-cholesterol-heart disease relationship to be “nonsense”–because it was “an American idea!” (Shaper 2002). (Henry Blackburn)


McMichael, J.,1979. Fats and atheroma—an inquest. British Medical Journal 1:173-175.

Reynolds, L.A.; Tansey, E.M. 2006. Cholesterol, atherosclerosis and coronary disease in the UK, 1950-2000 : Witness Seminar held by the Wellcome Trust Centre for the History of Medicine at UCL, London, on 12 October 2004.

Rogers, Lois (Medical Editor). 2005. Deaths linked to heart drugs. The Sunday Times. March 6.

Shaper, G. 2002. Interview by Henry Blackburn near London. Transcript in U. of Minnesota CVD History Archive, Minneapolis.