- Paperback: 320 pages
- Publisher: Newtrends Publishing, Inc. (October 1, 2000)
- Language: English
- ISBN-10: 0967089700
- ISBN-13: 978-0967089706
- Product Dimensions: 6.1 x 0.7 x 8.9 inches
- Shipping Weight: 15.2 ounces
- Average Customer Review: 86 customer reviews
- Amazon Best Sellers Rank: #552,019 in Books (See Top 100 in Books)
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The Cholesterol Myths: Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease Paperback – October 1, 2000
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...he is not a lone voice in the wilderness and he deserves to be taken seriously. -- Michael Gurr, PhD--Renowned Lipid Chemist
Dr. Ravnskov has done a magnificent service. . . must reading for all interested persons, nutritionists and physicians. -- Ray H. Rosenman, MD--Former Director of Cardiovascular Research, SRI
Dr. Ravnskov's measured and clear-eyed analysis actually serves as a sledgehammer that breaks down barriers to healthy, sensible eating. -- Sally Fallon, author of Nourishing Traditions
From the Author
The Cholesterol Myths is out of print. A new, updated and simplified version entitled Fat and Cholesterol are GOOD for You! is now available from amazon
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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.
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.