In 1956, the four groups published a report in the American Heart Association journal Circulation, with a minority opinion written by Gofman and his Berkeley colleagues and a majority opinion authored by everyone else. As the majority saw it, based on the state of Gofman’s research in 1952, cholesterol was indeed a questionable predictor of heart disease risk, but the measurements of lipoproteins added little predictive power. “The lipoprotein measurements are so complex,” the majority report declared, “that it cannot be reasonably expected that they could be done reliably in hospital laboratories.” Gofman’s minority opinion, based on the state of his research in 1955, was that LDL and VLDL, the very low-density lipoproteins, were good predictors of heart disease, but that the single best predictor of risk was an atherogenic index, which took into account these two lipoprotein classes measured individually and added them together. The greater the atherogenic index, the greater the risk of atherosclerosis and heart disease.

Gofman would later be vindicated, but the majority opinion prevailed at the time: studying lipoproteins held no value in the clinical management of heart disease. Gofman and his Berkeley collaborators continued the research alone through 1963, when Gofman left to establish a biomedical-research division at the Lawrence Livermore National Laboratory and spent the rest of his career working on the health effects of radiation.

Lost entirely in the contretemps were the dietary implications of Gofman’s research. “While it is true that, for certain individuals, the amount of dietary fat is an important factor,” Gofman explained, “it turns out that there are other more significant factors that need to be considered. Human metabolism is so regulated that factors other than the actual dietary intake of one of these constituents may determine the amount of that constituent that will circulate in the bloodstream. Indeed, important observations have been made which indicate that certain substances in the diet that are not fatty at all may still have the effect of increasing the concentration of the fat-bearing lipoprotein substances in the blood.”

Though Gofman’s studies had demonstrated that the amount of LDL in the blood can indeed be elevated by the consumption of saturated fats, it was carbohydrates, he reported, that elevated VLDL—containing some cholesterol and most of the triglycerides in the blood—and only by restricting carbohydrates could VLDL be lowered.