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    Cholesterol Myths by Uffe Ravnskov MD PhD: Myth 10: All Scientists Support the Diet-Heart Idea

    Posted by .(JavaScript must be enabled to view this email address)
    Wednesday, November 12, 2014 9:45 am Email this article

    “Only dead fishes go downstream.”
    — Polish proverb

    At this point you may probably wonder why you haven’t heard about all this controversy before and why not even your doctor knows anything.

    Criticism has been raised—a great deal of criticism. But it has been presented in journals and books that are not easily accessible to the layman, and critical voices have been drowned out in a flood of papers from the proponents. And the media, supported in large part by advertising revenues from pharmaceuticals and a food industry that has found it extremely profitable to use vegetable oils instead of animal fats, has consistently ignored the voices of dissent while hyping the recommendations for expensive drugs and dietary change.

    Furthermore, as I have exemplified here and there in the previous chapters, the pontiffs of the cholesterol crusade systematically ignore the contradictory findings. And the same people are brilliant in finding the few studies that apparently are in support, and if they are not, a magic spell may change the picture. And don’t forget that if your research is in accord with the wizards view, financial support from the drug and the food industry is almost endless. If not, you may risk both your funding and your position. Let me just remind you about Kilmer McCully, the American researcher who discovered the association between homocysteine and atherosclerosis. When he published his observation that the homocysteine, not the cholesterol concentration in the blood was associated with degree of atherosclerosis, he lost his position at Harvard Medical School and Massachusetts General Hospital and for two years he wasn’t able to get a new one anywhere.[268]

    And there are more brave researchers. Presented here, in alphabetic order, are a few of those who have had the courage to swim against the current. All of them have produced a large number of scientific studies of which I shall mention only the most important.

    Mary Enig[269]

    is an international expert in the field of lipid biochemistry, a nutritionist and a consulting editor to a number of scientific publications, including the Journal of the American College of Nutrition. She is also President of the Maryland Nutritionists Association. Her main research has concerned the hazards associated with consumption of trans fatty acids. She has published many scientific papers on the subject of food, nutrition, and food fats and oils; several chapters on nutrition for text books; and a primer for laymen and professionals on fats, oils and cholesterol. When asked whether saturated fats cause heart disease, she replied:

    “The idea that saturated fats cause heart disease is completely wrong, but the statement has been ‘published’ so many times over the last three or more decades that it is very difficult to convince people otherwise unless they are willing to take the time to read and learn what all the economic and political factors were that produced the anti-saturated-fat agenda.”

    Michael Gurr[270]

    was previously an associate professor of biochemistry at the School of Biological & Molecular Sciences in Oxford, previously editor-in-chief of Nutrition Research Reviews and editor of three other scientific journals. In a recent 50-page review published in Progress in Lipid Research, he presented the arguments of the cholesterol hypothesis in a thorough and honest way along with all the weaknesses of the theory. His main objections were the insufficient correspondence in vascular pathology between animal models and man and between familial hypercholesterolemia and atherosclerosis; the flaws and selection bias in the epidemiological evidence; the lack of correspondence between trends in coronary mortality and fat consumption patterns; the weak prediction achieved by measuring blood cholesterol; and the lack of improvement in mortality after dietary and pharmacological lowering of blood cholesterol. Professor Gurr’s final words provide a fitting summary of everything that we have discussed in this book:

    “The arguments and discussion of the scientific evidence presented in this review will not convince those ‘experts’ who have already made up their minds, for whatever reason, be it truly scientific or political, that a fatty diet is the cause of CHD. However, I hope that some readers, who were, perhaps, unaware that the lipid hypothesis had any shortcomings, will have been persuaded that the relationships between the fats we eat and the likelihood that we may die from a heart attack is by no means as simple as these simplistic statements imply.”

    George Mann[271]

    was previously a professor in medicine and biochemistry at Vanderbilt University in Tennessee. From his studies of the Masai, he realized that animal fat could not possibly be the main cause of high cholesterol and coronary heart disease. As long ago as 1977, in the New England Journal of Medicine, he presented his main arguments against the diet-heart idea:

    “the lack of relationship between dietary habits and blood cholesterol, the lack of correlation between this century’s trends in fat consumption and death rates in the United States, and the disappointing outcome of the cholesterol-lowering trials.”

    Eight years later, when the cholesterol education campaign was getting into gear, Professor Mann summarized his criticism of the diet-heart idea in Nutrition Today. “The diet-heart idea is the greatest scientific deception of our times, perhaps of any time,” he said. Mann is especially critical of the cholesterol-lowering trials. “Never in the history of science have so many costly experiments failed so consistently, he declared.”

    Professor Mann severely criticized the LRC directors. The unsupportive results from the LRC study have not prevented them from bragging about this cataclysmic breakthrough. And he continued:

    “The managers at the National Institutes of Health have used Madison Avenue hype to sell this failed trial in the way the media people sell an underarm deodorant. The Bethesda Consensus Panel… has failed to acknowledge that the LRC trial, like so many before it, is saying firmly and loudly:

    ‘No, the diet you used is not an effective way to manage cholesterolemia or prevent coronary heart disease and the drug you so generously tested for a pharmaceutical house does not work either.’”

    People who are faced with the many distorted facts about diet, cholesterol and heart disease often ask me why almost all scientists unquestioningly accept the diet-heart idea. And you may have asked the same question after reading this book. Here is Professor Mann’s comment:

    “Fearing to loose their soft money funding, the academicians who should speak up and stop this wasteful antiscience are strangely quiet. Their silence has delayed a solution for coronary heart disease by a generation.”

    Professor Mann offers a little glimpse of hope at the end of his article in Nutrition Today:

    “Those who manipulate data do not appreciate that understanding the nature of things cannot be permanently distorted—the true explanations cannot be permanently ignored. Inexorably, truth is revealed and deception is exposed… In due time truth will come out. This is the relieving grace in this sorry sequence.”

    Edward Pinckney

    was previously an editor of four medical journals and former co-editor of the Journal of the American Medical Association. In 1973, he published a book called The Cholesterol Controversy, which summarized all the inconsistencies in the cholesterol idea.[272] It seems impossible that any sensible and honest doctor who has read this book could continue to teach his patients about the dangers of cholesterol.

    Pinckney describes all the factors that influence blood cholesterol in healthy people and how difficult it is to get a reliable measure of the cholesterol level due to uncertainties of the analysis:

    “The level of one’s blood cholesterol is, at best, nothing more than an extremely rough indication of a great many different disease conditions. At worst, it can be more the cause of stress and the diseases that stress brings on. To alter one’s life-style as a consequence of this particular laboratory test may well cause more trouble than it could relieve.”

    Pinckney thoroughly describes the dangers of lowering one’s cholesterol and devotes an entire chapter to the political drama preceding the cholesterol campaign. He had long wondered about the dairy industry’s passive acceptance of the slurs against its products. The explanation he found was that many dairy distributors also distributed polyunsaturated products at an even greater profit. And the dairy farmer does not protest because the federal government uses taxpayer money to buy the farmer’s surplus butter at a price far higher than what he could make by competing on the open market.

    The beginning of Chapter 1 in Pinckney’s book is worth citing:

    “Your fear of dying—if you happen to be one of the great many people who suffer from this morbid preoccupation—may well have made you a victim of the cholesterol controversy. For, if you have come to believe that you can ward off death from heart disease by altering the amount of cholesterol in your blood, whether by diet or by drugs, you are following a regime that still has no basis in fact. Rather, you as a consumer have been taken in by certain commercial interests and health groups who are more interested in your money than your life.”

    Raymond Reiser[273]

    was a professor of biochemistry at Texas A & M University. In 1973 he criticized the recommendations for dietary treatment of high cholesterol by declaring:

    “The authority quoted by these authors for the recommendation is not a primary source but another review similar to their own. It is this practice of referring to secondary or tertiary sources, each taking the last on faith, which has led to the matter-of-fact acceptance of a phenomenon that may not exist.”

    In his paper, Reiser continued with a thorough 30-page review of almost all experiments on the influence of dietary fatty acids on blood cholesterol levels. His main conclusions were that most experiments are biased by serious faults, that limited time frames and too few test individuals have been used, and that the diet studied has been too extreme to allow conclusions that are valid for ordinary people…

    “One must be bold indeed to attempt to persuade large segments of the populations of the world to change their accustomed diets and to threaten important branches of agriculture and agribusiness with the results of such uncontrolled, primitive, trial-and-error type explorations. Certainly modern science is capable of better research when so much is at stake.”

    More recently, Reiser analyzed the references used as support by the American Heart Association in its rationale for its dietary recommendations. He could not find any supportive studies. In fact, some of the studies had results that contradicted the diet-heart idea:

    “Thus the rationale is not a logical explanation of the dietary recommendations but an assemblage of obsolete and misquoted references. Since rational explanations for the recommendations are essential for their acceptance, the public to whom they are addressed is justified in remaining skeptical of them.”

    Paul Rosch[274]

    is President of the American Institute of Stress, Clinical Professor of Medicine and Psychiatry at New York Medical College, Honorary Vice President of the International Stress Management Association and Chairman of its US branch. He is the editor or subeditor of three well-known medical journals, and he has served on the board of several other journals. He has served as President of the New York State Society of Internal Medicine, as Chairman of the International Foundation for Biopsychosocial Development and Human Health and has been an Expert Consultant on Stress to the United States Centers for Disease Control. He has written extensively over the past forty-five years on the role of stress in health and illness, with particular reference to cardiovascular disease and cancer. He has appeared on numerous national and international television programs such as The Today Show, Good Morning America, 60 Minutes, Nova and on CBS, NBC, PBS, BBC and CBC network presentations. His editorials and comments have been published in every major medical journal, and he has also been interviewed and widely quoted in numerous major American newspapers and magazines.

    As the author of the Newsletter of the American Institute of Stress, Professor Rosch has published several articles about the cholesterol hypothesis and the diet-heart idea. His conclusions are close to those presented in this book:

    “A massive crusade has been conceived to ‘lower your cholesterol count’ by rigidly restricting dietary fat, coupled with aggressive drug treatment. Much of the impetus for this comes from speculation, rather than any solid scientific proof.”

    “The result is well-known. The public is so brainwashed, that many people believe that the lower your cholesterol, the healthier you will be or the longer you will live. Nothing could be further from the truth.”

    How can this go on year after year? Professor Rosch has several explanations:

    “The cholesterol cartel of drug companies, manufacturers of low-fat foods, blood-testing devices and others with huge vested financial interests have waged a highly successful promotional campaign. Their power is so great that they have infiltrated medical and governmental regulatory agencies that would normally protect us from such unsubstantiated dogma.”

    Rosch reminds us that practicing physicians get most of their information from the drug companies. But… “compared to their peers a half century ago, most doctors don’t have the time or skills to critically evaluate reports, very few know anything about research, nor did the generation that taught them.”

    Now in his eighties, Rosch is still active and his critical voice appears now and then in the scientific press.

    Ray Rosenman[275]

    is the retired Director of Cardiovascular Research in the Health Sciences Program at SRI International in Menlo Park, California, and previously associate Chief of Medicine, Mt. Zion Hospital and Medical Center in San Francisco. He has been a cardiologist and a researcher since 1950. He has published four books, many textbook chapters and numerous journal articles about cardiovascular diseases. His main interest has been the influence of neurogenic and psychological factors on the blood lipids, but he has also written reviews critical of the diet-heart idea. Here is the conclusion from his most recent review:

    “These data lead to a conclusion that neither diet, serum lipids, nor their changes can explain wide national and regional differences of CHD [coronary heart disease] rates, nor the variable 20th century rises and declines of CHD mortality.”

    “This conclusion is supported by the results of many clinical trials which fail to provide adequate evidence that lowering serum cholesterol, particularly by dietary changes, is associated with a significant reduction of CHD mortality or improved longevity. It is variously stated that the preventive effects of dietary and drug treatments have been exaggerated by a tendency in trial reports, reviews, and other papers to cite and inflate supportive results, while suppressing discordant data, and many such examples are cited.”

    Russell Smith[276]

    was an American experimental psychologist with a strong background in physiology, mathematics and engineering. In cooperation with Edward Pinckney, he studied all aspects of the diet-cholesterol-heart issue with extreme thoroughness and presented his findings in two large scientific reviews of the literature containing more than 700 pages with more than 3000 references, as well as in a popular book. No review written by the proponents of the diet-heart idea can compare with Russell Smith’s books when it comes to completeness and scientific depth. Volume 1 of his review is an overview of the entire issue. Smith’s summation is devastating for the diet-heart proponents:

    “Although the public generally perceives medical research as the highest order of precision, much of the epidemiologic research is, in fact, rather imprecise and understandably so because it has been conducted principally by individuals with no formal education and little on-the-job training in the scientific method. Consequently, studies are often poorly designed and data are often inappropriately analyzed and interpreted. Moreover, biases are so commonplace, they appear to be the rule, rather than the exception. It is virtually impossible not to recognize that many researchers routinely manipulate and/or interpret their data to fit preconceived hypotheses, rather than manipulate hypotheses to fit their data. Much of the literature, therefore, is nothing less than an affront to the discipline of science.”

    Russell Smith concluded:

    “The current campaign to convince every American to change his or her diet and, in many cases, to initiate drug “therapy” for life is based on fabrications, erroneous interpretations and/or gross exaggerations of findings and, very importantly, the ignoring of massive amounts of unsupportive data… It does not seem possible that objective scientists without vested interests could ever interpret the literature as supportive.”

    In his books and papers Russell Smith criticized a large number of leading scientists from the National Heart, Lung and Blood Institute and the American Heart Association, which he calls the alliance. He considered their work incompetent and sloppy:

    “The fraud is so blatant and so pervasive that it was considered necessary to take some liberties with the usual staid rhetoric of a scientific review and inject stronger language to emphasize the problem.”

    Russell Smith was aware that he was up against some extremely powerful institutions:

    “The political and financial power of the NHLBI and AHA team… is enormous and without equal. And because the alliance has substantial credibility in the eyes of the public and most practicing physicians, it has become a juggernaut, able to use its power and prestige to suppress a great body of unsupportive evidence and even defy the most fundamental tool of scientists, logic.”

    The scientists who have produced the misleading papers and reviews are, of course, the first with whom Russell Smith finds fault. But he added:

    “Equally culpable are the editors of the many journals who publish articles without regard to their quality or scientific import. It is depressing to know that billions of dollars and a highly sophisticated medical research system are being wasted chasing windmills.”

    William Stehbens[277]

    a former professor at the Department of Pathology, Wel?ling?ton School of Medicine, and director of the Malaghan Institute of Medical Research in Welling?ton, New Zealand, is another articulate critic. Based on his own studies and on extensive reviews of the literature, he has effectively demonstrated the many fallacies of the diet-heart idea. In a thorough review of the experimental studies he concluded:

    “Upon examination of this evidence and consideration of the specific criteria for the experimental production of atherosclerosis, any pathologist of independent mind and free from preconceived ideas would conclude that human atherosclerosis and the lesions induced by the dietary overload of cholesterol and fats are not one and the same disease.”

    Stehbens has also pointed out the weaknesses of the epidemiological studies that have used mortality statistics as proof for causality:

    Continued, unquestioned use of unreliable data has led to premature conclusions and the sacrifice of truth. The degree of inaccuracy of vital statistics for CHD is of such uncertain magnitude that, when superimposed on other deficiencies already indicated, the concept of an epidemic rise and decline of CHD in many countries must be regarded as unproven, and governmental or health policies based on unreliable data become completely untenable.

    According to Stehbens, atherosclerosis is due to wear and tear of the arteries, and not to high cholesterol levels in the blood, an idea he supports with many good arguments.

    The following words from a 1988 paper summarize Stehbens’s view on the diet-heart idea:

    The perpetuation of the cholesterol myth and the alleged preventive measures are doing the dairy and meat industries of this and other countries much harm quite apart from their potential to endanger optimum nutrition levels and the health of the populace at large…. It is essential to adhere to hard scientific facts and logic. Scientific evidence for the role of dietary fat and hypercholesterolemia in the causation of atherosclerosis is seriously lacking… The lipid hypothesis has enjoyed undeserved longevity and respectability. Readers should be aware of the unscientific nature of claims used to support it and see it as little more than a pernicious bum steer.

    Lars Werkö[278]

    was previously a professor of medicine at Sahlgren’s Hospital, Gothenburg, Sweden, scientific director at the Astra Company, and then head of the Swedish Council on Technology Assessment in Health Care, a governmental agency. Professor Werkö has been an opponent of the diet-heart idea for many years. In 1976 he criticized the design of the large epidemiological studies aimed at preventing coronary heart disease, most of all the Framingham study.

    According to Werkö, the dogma is based on questionable “facts” rooted in hopes, wishful thinking and studies using selected materials.

    “No studies have proved anything, but instead of formulating new hypotheses, diet-heart supporters call the current one the most probable truth, and they have intervened in people’s lives because they will not wait for the final proof.”

    In another paper, he pointed to a number of inaccuracies and sloppy data gathering in the MR.FIT trial.

    At the age of 90 Werkö is still active. Recently he was awarded by the Swedish medical journal Dagens Medicin for his many critical contributions to today’s debate around Swedish health care.


    Here are links to the other chapters in the book.


    This chapter is from the book
    The Cholesterol Myths: Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease
    by Uffe Ravnskov, MD, PhD.

    Dr. Ravnskov has given me the permission to share this version of his book to help educate the world about the cholesterol campaign.

    Information about Uffe Ravnskov, MD, PhD is posted here.

    More information about Cholesterol Myths is posted on his website here.

    Dr. Ravnskov posted his book for free here.

    Several versions of the ebook can downloaded from Dropbox here or from SmashWords here.

    Uffe Ravnskov, MD, PhD is the founder of The International Network of Cholesterol Skeptics (THINCS.org) which can be found here.

    Articles on the same subject can be found here:


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