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The Cholesterol Myths: Exposing the Fallacy That Saturated Fat and Cholesterol Cause Heart Disease

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Would you buy a book that was literally set on fire by its critics on a television show about it in Finland? I would and so should you. The long-awaited English version of debunker extroidinaire Dr. Uffe Ravnskov's notorious book is now available from New Trends Publishing.

Ravnskov, a medical doctor with a PhD in Chemistry, has had over 40 papers and letters published in peer-reviewed journals criticizing what Dr. George Mann, formerly of Vanderbuilt University, once called "the greatest scam in the history of medicine": the Lipid Hypothesis of heart disease, the belief that dietary saturated fats and cholesterol clog arteries and cause atherosclerosis and heart disease.

If one thing comes through as you read the book, it is this: Ravnskov has done his homework. In painstaking detail, he critically analyzes and demolishes the nine main myths of the Lipid Hypothesis: (1) High-fat foods cause heart disease, (2) High cholesterol causes heart disease, (3) High fat foods raise blood cholesterol, (4) Cholesterol blocks arteries, (5) Animal studies prove the diet-heart idea, (6) Lowering your cholesterol will lengthen your life, (7) Polyunsaturated oils are good for you, (8) The cholesterol campaign is based on good science, and (9) All scientists support the diet-heart idea.

Equipped with a razor-sharp mind, an impressive command of the literature, and a deadly, needling sarcasm, Ravnskov methodically slaughters the most famous Sacred Cow of modern medicine and the most profitable Cash Cow for assorted pharmaceutical companies. Sparing no one, Ravnskov again and again presents the tenets of the Lipid Hypothesis and the studies which supposedly prove them, and shows how the studies are flawed or based on manipulated statistics that actually prove nothing. Ravnskov then answers the objections or rationalizations offered by diet-heart supporters, desperate to explain away inconsistencies and contradictions in their own data.

For example, Ravnskov opens with an analysis of the study that kicked off the Lipid Hypothesis in the 1950s: Ancel Keys' Six Countries Study (and later, the more famous Seven Countries Study). As most health professionals know, Keys' study showed that countries with the highest animal fat intake have the highest rates of heart disease. Keys' conclusion was that there was a cause and effect relationship because the country with the lowest animal fat intake (at that time, Japan) had the lowest rates of heart disease. Sounds convincing, right? Not so, says Dr. Ravnskov. And in a few pages the reader is informed how Keys hand-picked the countries he included in his studies, namely, the ones that supported his hypothesis, and conveniently ignored all of the other countries that didn't.

And this is just the beginning!

Ravnskov approaches true brilliance in his review of the studies that supposedly showed benefit from the current wonder-drugs pushed by the pharmaceutical industry: the statins. Hailed as miracle substances that "significantly reduce cholesterol and incidence of heart attacks," Ravnskov shows that these substances are probable carcinogens (women on the drugs had a much higher incidence of breast cancer) and that the overall statistical reduction of heart disease in the drug trials is negligible. Nevertheless, despite the dismal results of the very first trial (the EXCEL Trial which Ravnskov soberingly describes to the reader), the industry and its well-funded doctors urge their use, even in people who do not have heart disease.

Ravnskov warns: "Because the latent period between exposure to carcinogen and the incidence of clinical cancer in humans may be 20 years or more, the absence of any controlled trials of this duration means that we do not know whether statin treatment will lead to . . . cancer in coming decades. Thus, millions of people are being treated with medications the ultimate effects of which are not yet known."

If there is one weakness of the book, it is its lack of explanations of what DOES cause heart disease. Ravnskov comes close to fingering a few factors such as high stress, excessive polyunsaturated fat intake, trans-fatty acids, and smoking, but he never offers his own theory as to what causes the Western world's number one killer.

This is, however, a minor glitch. Ravnskov has done the world a major service in presenting his findings. All health professionals need to listen to this scholar and listen very carefully for the advice offered by the medical establishment for the last 50 years to beat heart disease has failed miserably. It is time to turn away from cholesterol-lowering drugs that have frightening side effects. It is time to turn away from tasteless low-fat diets that harm children and deprive people of fat-soluble vitamins. And it is time to turn away from the junk science that characterizes the Lipid Hypothesis and its supporters. It is time, instead, to listen to reason and view all of the evidence against a failed hypothesis and discover the true and varied risks and causes of heart disease. It is time to listen to Uffe Ravnskov....

With courage and care Dr. Ravnskov exposes the lack of experimental evidence for the diet-heart theory, which claims that eating less fat and cholesterol will prevent atheroslcerosis (hardening of the arteries) and myocardial infarctions (heart attacks). By examining original peer-reviewed literature, the author finds no support for the diet-heart theory. He gives examples of scientific fraud among efforts to support the theory, including the deliberate selective omission of data points, and the deliberate assignment of subjects in a clinical trial to treatment or to control groups by physicians with the subject's medical records in hand. He shows how the abstract or conclusions of a number of papers are at odds with the actual data in the papers. He demonstrates how the use of one statistical method in preference to another can give a false impression that there is an effect,where there is, in fact, none. He shows how the reporting of differences in fatality rates by per cent reduction (say, a 50% reduction in relative risk) is actually misleading when the actual death rates are quite small in both the treatment and control groups of subjects in diet or drug studies. For example, a treatment that changes the absolute survival rate over a multi-year period from 99.0% to 99.5% represents a 50% reduction in relative risk, from 1% to 0.5% absolute. This is often described in papers as a 50% reduction in death rate. However, when the difference is barely significant statistically, as was often the case, Ravnskov points out that there is no real reason to recommend adoption of the treatment, especially if there are serious side-effects.

“The truth, were it known, would send pharmaceutical stocks plunging. In most studies, the increased risk is present only above a level of cholesterol that includes just a small percentage of the total population. [These are the approximately 1% of people with a genetic defect called familial hypercholesteremia.] And women can stop worrying immediately because high cholesterol is not a risk factor for the female sex. Few comments have been made on this peculiar fact in all the vast literature on cholesterol. When it is mentioned at all, it is said that female sex hormones protect against heart attacks."

“In fact, it seems more dangerous for women to have low cholesterol than high. Dr. Bernard Forette and a team of French researchers from Paris found that old women with very high cholesterol live the longest. The death rate was more than 5 times higher for women who had very low cholesterol. In their report, the French doctors warned against cholesterol lowering in elderly women. But they could as well have warned against cholesterol lowering in any woman, or, to be more precise, in anyone at all."

Dr. Ravnskov went on to show that higher levels of high-density-lipoprotein (HDL, "good" cholesterol) are not protective against CHD, and that lower levels of low-density-lipoprotein (LDL,"bad" cholesterol) are not beneficial, although the expected associations of each with CHD are present. Here again, conclusions at odds with the researchersí own data were presented. Intimations that there are “many” or “definitive” studies in reports and papers were shown to be false by showing that citations often led to other reviews, each trusting the last, and ending at very few original studies.

“High-fat foods raise blood cholesterol." Dr. Ancel Keys was one of the main proponents of this myth. In a paper published in 1958, Keys showed a graph of the per cent calories from fat in the food of various countries vs. the mean serum cholesterol levels. The data points fell on a straight line, showing an excellent correlation. Dr. Ravnskov added data points from a number of countries deliberately ignored by Dr. Keys. These fall nowhere near the line. Furthermore, CHD death rates among subjects in Finland, Greece and Yugoslavia with similar serum cholesterol levels varied 5-fold depending on which area of the country they lived in!

Four studies in the US, one in the UK, one in Israel and one in Finland failed to show any correlation between diet and serum cholesterol levels.

“Numerous studies have shown that in people who eat a normal Western diet, the effect on blood cholesterol of eating 2 or 3 extra eggs per day over a long period of time can hardly be measured..."

Ravnskov presents the results of a number of trials of statin drugs in which total death rates are slightly lower than those of the controls. In an early trial of lovastatin (EXCEL) on 8,000 subjects the absolute death rate from all causes after just 1 year was 0.5% vs. 0.2% in the placebo group.

Kilmer S. McCully, Ph. D., M. D., in technical papers and a book: “The Heart Revolution: the Extraordinary Discovery that Finally Laid the Cholesterol Myth to Rest”, Harper Perennial, 2000, wrote: “But no study anywhere has ever proven that lowering the amount of cholesterol in the diet reduces the risk of heart disease. And lowering cholesterol through drugs won’t prevent arteries from hardening if homocysteine is high.” McCully is the discoverer of the fact that the undesirable amino acid called homocysteine is an actual cause of atherosclerosis and CHD.

Based on Ravnskov’s meticulous analyses as well as the considerable support for his stance shown by others who have also studied the cholesterol data, this book is recommended without reservation. Physicians and other health professionals as well as anyone threatened with cholesterol-lowering treatments would be enlightened, and better able to resist worthless treatments. Health insurers might reconsider compensation for frequent (or any) clinical assays for cholesterol or triglycerides, let alone expensive treatments to lower cholesterol levels that reduce quality of life without prolonging it significantly.

...

I am 76 years old and have had a high blood cholesterol level for at least the past 25 years. A normal cholesterol is considered to be under 200 mg/dl and mine ranges from 250 to 316. My LDL (the so-called bad cholesterol) is high and my HDL (the so-called good cholesterol) is low. While I have had health problems, they do not include heart or blood vessel disease. My blood pressure is about 130/80 which is pretty good for an old man. Yet, according to what I have read, I am at high risk for heart and blood vessel disease. A number of years ago I decided to look into it. I plugged the word "cholesterol" into Yahoo, and one site that I came up with was a web site by Uffe Ravnskov called The Cholesterol Myth. It said that what I had been hearing and reading about high cholesterol being bad for you was hokum. He made a good case for the thesis that if you exclude those people who have the gene for high cholesterol and early death, that cholesterol levels are meaningless. Also, that cholesterol level is not appreciably influenced by diet. That was not enough for me; I wanted the documentation, so I started a correspondence with him. One consequence was that, several years ago, he e-mailed me a copy of the English version of his book The Cholesterol Myths which had been published in Swedish and Finnish. That book, revised, expanded and fully documented, has just been published by New Trends Publishing. Ravnskov is both a physician and researcher. His publications have been in first rate medical journals and he is highly respected by his peers, including me. His book is extremely well researched and is well documented. It is clearly written; much more clearly than many publications that I have read by people whose native language is English. Ira Pilgrim For the complete review , go to Ira Pilgrim's Home Page

This book should be read by everyone, especially doctors and especially those who specialize in cardiology. My own heart doctor has been trying to push statins on me for two years, despite the fact that my heart "epsiode" (a very minor infarction) took place 20 years ago, my total cholesterol is just 210, and high cholesterol (250+) with *zero* heart disease runs in my family. You should see him shudder at the abnormality of that figure, warning me that yet another drop in "normal" limits is on the AHA and NHLBI horizon. In his opinion, my total cholesterol should be 160 -- or dire consequences could result!

As its subtitle states, The Cholesterol Myths exposes the fallacy that saturated fat and cholesterol cause heart disease. Dr. Ravnskov is no "wacko"; his book is well-annotated and examines many of the major relevant studies over the past 50 years. I've checked a few of the references myself and have found them accurate. I've checked literature available on the AHA and NHLBI websites and seen for myself how they distort the truth.

In one example, the NHLBI states flatly that "international studies find that CHD is uncommon in cultures with low levels of serum cholesterol, even when... hypertension and cigarette smoking is relatively high." A check of the footnotes cited the "Seven Countries" study and "MONICA" project, both taken to task in Dr. Ravnskov's book. What the NHLBI did was choose only a few of the datapoints from these studies (Japan, China), where their statement was indeed true -- but they conveniently ignored all 25 or so other datapoints which clearly showed that overall there was no correlation between countries' cholesterol levels and CHD whatsoever!

A major contribution of Myths is its explanation of the way pro-cholesterol myth "scientists" and the drug companies use the "relative reduction" method of presenting their "wonder drugs'" value. If I, for example, take no drugs, my chances of a cadiac event might be 6% over the next 10 years. If I take statins for ten years, this might go down to 3%, which the drug companies present as a reduction of 50%! Sounds good, but the more sensible view would be to say that if I take no drugs, there's a 94% chance that nothing will happen to me, and if I take statins, there's a 97% chance -- wow, a whopping 3% gain! Would *you* take a drug (that can screw up your liver and muscles) for the rest of your life to go from 94% to 97%? Not me! This expose of statins is another fantastic contribution to medical common sense, and there are many more.

The Cholesterol Myths is simply a must-read.

P.S. I did confront my cardiologist, and he declined comment. I have a new one now....

The first sin is misdirection. Many studies indicated there were inverse relationships between mortality and cholesterol, especially at advanced age, and with women. The researchers ignored this, and stated unequivocally the data showed a direct proportional relationship between cholesterol and mortality.

The second sin is data cherry picking. Ancel Keys, leading advocate of cholesterol theory, gathered data from 22 countries. He deducted that % of calories derived from fat in diet is related to cholesterol and higher mortality rate by selecting only the 7 countries that supported his hypothesis.

The third sin is ignoring qualitative differences in cultural practices. In U.S., coronary heart disease (CHD) is diagnosed related to uncertain causes of death 33% more often than in England and 50% more often than in Norway. As a result, the three countries respectively are associated with a high, moderate, and low level of (CHD). Yet, their consumption of cholesterol is similar. Keys ignored these factors and took out the countries that did not support his conclusion.

The fourth sin is confusing association with causation. Researchers sometimes derived that higher cholesterol was causing CHD. Meanwhile, the true cause may have been age, weight, or diabetes. The author shows how you could similarly demonstrate that radio ownership is correlated with mortality rate!

The fifth sin is not doing a random sampling. The Framingham study included a postmortem analysis concluding that cholesterol does cause atherosclerosis. But, this was after selecting only the 14% of the test subjects who died prematurely. A large proportion had familial hypercholesterolemia. This is a rare disorder associated with high cholesterol and CHD. But, this relationship between cholesterol and CHD does not exist in the general population.

The sixth sin is using the wrong test to boost significance. The two-tail t test is the appropriate one in medical hypothesis testing. But, researchers often used the one-tail t test to inappropriately boost confidence level from 90% to 95%. This allowed them to claim their findings were significant when they were not.

The seventh sin is not looking at the whole picture. When testing the impact of cholesterol lowering drugs, researchers focused on the reduction in death from CHD while ignoring increase in death from other causes. Those drugs often boosted total mortality.

The eight sin is focusing on relative risk vs absolute risk. If a drug reduces mortality from 0.7% to 0.6%, the pharmaceutical industry will broadcast that it reduces mortality rate by 14% (change in relative risk). This improvement overstates that it will reduce mortality by only 0.1% or save only one in 1000 lives (change in absolute risk). Medical studies use relative risk to boost claims of drug merits. They use absolute risk to minimize implication of side effects.

The ninth sin is adding variables to get the prediction you want. Researchers never found statistically adequate evidence that high cholesterol causes CHD. So, they added smoking. They found that the combination of smoking and high cholesterol did cause CHD. But, smoking was responsible for most of the CHD.

The tenth sin is not doing a double blind test. Many of the studies were done with doctors knowing who were the patients who received the drug. Invariably, such studies result in overly optimistic assessment of the tested drug.

The eleventh sin is believing frequency of a study's citation is proportional to its quality. Within medical research, the studies that demonstrate that a cholesterol lowering drug reduce CHD risk are cited 10 to a 100 times more often than the ones who don't.

The twelfth sin is testing the same hypothesis over and over. The scientific method consists in testing a hypothesis once. If results reject such hypothesis, the researchers should come up with a different hypothesis. Instead, medical researchers test whether lowering cholesterol reduces CHD until they get the results they want. That's not science.

The thirteenth sin is believing the consensus is more important than the source of funding. The reverse is true. The pharmaceutical industry funds the majority of studies. Thus, researchers reach their financiers' consensus. The few dissenters are dismissed. But, their judgment is not distorted by Big Pharma.

By uncovering statistical flaws, the author debunks the merits of the Mediterranean diet and the French Paradox. Similarly, he refutes the concept of good vs bad cholesterol and the related multiple between the two as a metric for CHD also falls apart.

He also refutes the merit of Dr. Ornish draconian diet (only 10% of calories from fat). He indicates that Dr. Ornish own study included so many variables (exercise, lifestyle, meditation) that he could not tell the low fat diet contribution. Ravnskov advances Dr. Ornish program would work as well without the diet component.

I recommend three other books: Charles McGee's "Heart Frauds", Lynne McTaggart's "What Doctors Don't Tell You" and Nortin Hadler's "The Last Well Person." The first book covers cardiovascular treatment. The other two books cover Western medicine. The books messages converge. Western medicine is costly, overly invasive, and not always effective.

I am a physician and felt this book was very educational. After reading books by Sally Fallon and Mary Enig this was next. I am a firm believer that cholesterol is not the culprit nor red meat but all the bad oils we are eating. I think Ravnskov proves his point well. So well that I have taken my husband off his statin even with a cholesterol of 320. I constantly preach to my patients about the evils of partially hydrogenated oils and trans fats and of the benefits of omega-3. This is a must read for anyone whose doctor is trying to put them on a statin.

Every year millions of Americans are badgered by their physicians into taking a class of cholesterol lowering drugs called "statins". Doctors have become so obsessed with the dangers of high cholesterol that it has become difficult to get treated for anything else. The National Heart Lung and Blood Institute has issued guidelines that urge that even more Americans be put on statins. The large pharmacutical companies earn billions annually on the sale of statins. If these drugs were merely innocuous and expensive, the situation wouldn't be so bad, but statins can have many dangerous side effects. If you are doubtful about the wisdom of taking statins, Uffe Ravnskov's book can provide you with the ammunition you need to resist your doctor's urging to take these drugs.
What makes this book compelling is Ravnskov's careful avoidance of accusations and ad-hominem attacks, and his heavy reliance on facts. Quoting one clinical study after another, he quietly demolishes the myth that cholesterol is dangerous. He then presents a detailed analysis of the various clinical trials involving statins, explaining the difference between relative risk and absolute risk. Drug companies love to tout the benefits of a drug in terms of relative risk, and minimize the side effects in terms of absolute risk. If you dig into Ravnskov's data, you can find some intriguing bits of information. Two trials involving Lovastatin actually showed higher overall mortality rates in the treatment group. One study of Pravastatin, which included women, showed a 1300% increase in breast cancer. The most successful statin trial showed a 42% reduction in fatal heart attacks, but only a 27% reduction in total mortality. Hmmm.
If Ravnskov's book has a flaw, it is his lack of alternatives to taking statins. Studies not mentioned in the book have shown that eating moderate amounts of fatty fish, or taking a fish oil supplement, can be just as beneficial as taking statins. Avoiding trans fats can give you a similar reduction in risk. Still it is an excellent book and well worth reading.

Although cholesterol is an essential constituent of the human body it is commonly spoken of as if it were a toxic substance which should be avoided as completely as possible. The truth is that, far from being an undesirable toxic substance, cholesterol is an essential constituent of the human body. Cholesterol is so important to our bodies that they actually manufacture it. In fact, our bodies typically manufacture two-thirds or more of the cholesterol which they contain. Only one-third or less of the cholesterol in our bodies comes from the foods we eat.

Yet, despite the importance of cholesterol to our bodies, the frenzy to avoid it has become so strong that many wholesome foods which happen to be rich in cholesterol -- such as eggs -- have seen their consumption plummet, whereas all sorts of junk foods which do not contain cholesterol have their lack of cholesterol emblazoned on their containers and in their advertising, and many health-conscious people buy and eat them them despite their low nutritional content -- and, frequently, dangerously high sugar content.

The current obsession with cholesterol levels came about because cholesterol is (incorrectly) alleged to be the principal cause of clogged arteries and resultant heart disease. However, many people with high cholesterol levels never get any form of heart disease; and, on the other hand, many other people with "ideal" blood cholesterol levels die of heart attacks. Furthermoore, statistics now indicate that cholesterol levels which are too low may be risky. Low blood cholesterol levels have been shown to correlate significantly with increased incidence of cancer as well as with increased incidence of depression, violent behavior, and suicide. Clearly the cholesterol situation is not as simple as it's often portrayed to the public.

This book discusses the truth about cholesterol and discusses the real causes of atherosclerosis and heart disease. If you are concerned about staying healthy and living longer -- and are willing to cope with information which goes against orthodox dogma -- I beg you to read this book.

The high ratings from the other reviewers already show that this is a very important book; a reality check for those with fear of fresh cholesterol foods, or with concerns about cholesterol levels.

With cholesterol lowering drugs about $1000/year one can see the pressures to prescribe them from their makers, as a friend cardiologist was just offered $5000 simply to provide names for a cholesterol study -he called it a bribe and moved on.

The TV and print ads suggest dire consequences from cholesterol and it is easy to see that most people and doctors fear the stuff. Busy doctors may -out of fear of law suits or lack of time to read the studies- follow guidelines that in the U.S. and Canada were overwhelmingly written by those receiving payment from the drug companies [that alone is a scandal by itself].

This book shows the science and reveals the fact that lowering cholesterol by any means does not reduce mortality rates, that there are peoples with high cholesterol without heart disease and that, at the very least, the science for lowering cholesterol in virtually anybody is rotten.

The largest North American cholesterol lowering trial ever [2002 ALLHAT] and the largest trial in the world with the #1 selling cholesterol-lowering drug Lipitor [2003 ASCOT] showed mortality after 3 or 6 years that was totally identical, while a trial in elderly [2002 PROSPER] showed increased cancer and also nobody saved. The science in women is even worse than in men.

An early trial, EXCEL, was stopped at 11 months at a 2.75x greater mortality from the drug -but for the next 5 years we have publications as to how well the stuff [Mevacor] is tolerated [nobody keels over instantly] and how well it reduces "bad" cholesterol. I bet your doctor would like to know that.

I've seen Dr. Ravnskov give talks to three large U.S. medical audiences and you could feel the collective relief that here we have a widely published fellow doctor who has analyzed the science and found cholesterol not to be a cardiovascular boogie man -which, in their hearts they knew but may have doubted.

I suggest that if you are concerned about cholesterol you read this book, AND then give it to your doctor or cardiologist.

Other reviewers pointed out that the book gives few tips for heart disease prevention -that is not the book's purpose- and for that McCully's "The Heart Revolution" book [ISBN 0060929731] is probably best. In fact, get both books and take turns with your doctor reading them. A fine book. Eddie Vos www.health-heart.org E-mail: vos@health-heart.org

The lipid hypothesis of heart disease claims that elevated serum cholesterol levels cause heart disease, and it is dietary cholesterol and saturated fat that elevate serum cholesterol. Therefore, claim the lipid theorists, dietary cholesterol and saturated fat cause heart disease. Never mind that saturated fat and cholesterol have been an integral part of the human diet since time immemorial, and that the modern spread of heart disease correlates far more closely with the increasing consumption of refined carbohydrates and polyunsaturated vegetable-source fats...

The lipid hypothesists also claims that high HDL levels and low LDL levls are protective against heart disease, that cholesterol reductions are favourable in the majority of the population, and that cholesterol-lowering drug therapy should be used when dietary intervention fails to lower cholesterol levels.
Ravnskov systematically destroys all these myths and more in this landmark book, highlighting the numerous contradictons, inconsistencies, and outright lies inherent in the cholesterol theory of heart disease.

This book should be mandatory reading for all cholesterol researchers and medical practitioners. However, thanks to the influence of the 'Cholesterol Cartel', most of these individuals will continue to remain blissfully unaware of the true facts surrounding the lipid hypothesis. Individuals wanting to learn the real facts will therefore have to educate themselves, and Ravnskov's book is an excellent place to start.

I can't recommend this book highly enough! I would also STRONGLY recommend "The Cholesterol Conspiracy" by Russell L. Smith, Ph.D, published by Warren H. Green (Ravnskov makes mention of Smith's work in his book), a condensed version of an extensive 2 volume review by Smith of the lipid hypothesis. This book is truly outstanding, and leaves one shaking their head at how such a ludicrous, contradictory, fanciful theory ever became such an embedded feature of modern medicine. Unfortunately Amazon does not sell this one, the only source I know of is direct from the publisher.