Last week I posted a review of Dr. Uffe Ravnskov’s outstanding new book, Fat and Cholesterol Are Good For You.  This book and Dr. Malcolm Kendrick’s The Great Cholesterol Con are the most informative and most readable works you’ll find on the shoddy science that led to the Lipid Hypothesis … and the bad science that keeps it alive today.

Afterward the review I sent Dr. Ranvskov a list of questions from readers, as well as a few of my own.  His answers are below.  He answered a few questions with “I’m not sure,” so I skipped those.


When I read your first book a few years ago, I was stunned to learn how little evidence actually supported the Lipid Hypothesis. 
Did you ever believe it yourself?  If so, what changed your mind? 

I have never believed it. In my coming book (Ignore the Awkward! How the Cholesterol Myths are Kept Alive) I shall tell you why.

What kind of reactions did you receive from other doctors when The Cholesterol Myths was published? 

Nobody reacted.

You’ve submitted quite a few letters and papers disputing the Lipid Hypothesis to scientific and medical journals.  How many of those have been accepted?  What reasons do the journals give for refusing to publish them?

On average my papers and letters have become rejected by five medical journals before their final publication. Some of them have never been published, but I haven’t recorded how many. In my coming book I am giving many examples on the irrelevant, illogical and often ridiculing answers that I have received.

My impression is that in other scientific disciplines, such as physics, researchers consider it almost a badge of honor to dispute each other’s theories.  But in the health and nutrition sciences, there seems to be something more like a mutual admiration club.  Any idea why is this is the case?

Most human beings follow their leaders.  Even scientists do. It is much more comfortable, more secure, more profitable and more rewarding. To question them is dangerous.

It seems that at least once per month, I read about yet another study purporting to show that saturated fat is bad for you.  If saturated fat isn’t actually bad for us, where are all these studies coming from?  How do the researchers reach their conclusions?

The only argument that persists in the new FAO/WHO report published last year is that an exchange of saturated fat with polyunsaturated fat is able to prevent cardiovascular disease. People probably think that this statement is based on dietary experiments, but it is not. It is a result of complicated statistical calculations using the dietary information given by participants in follow-up studies. The fact is that at least 30 such studies have shown that the risk of dying from heart disease for people who gorge on saturated fat is the same as for those who follow the official guidelines, and the risk of dying from a stroke is lower.

When you point out the contrary evidence to supporters of the diet-heart idea, how do they reply?

In most cases they don’t. To ignore the critics is most effective.

It seems to me that we could vastly improve health if our governments would just admit that the anti-fat campaigns were misguided and we should be eating more fat and fewer carbohydrates.  There must be people in our governments who know this.  What’s stopping them from just admitting it publicly?

Government people can’t do that — only the so-called authorities at the American Heart Association and NHLBI could, and I assume that they would rather walk naked on Fifth Avenue than admit that they have been wrong.

I’ve been telling people for some time that the best predictor for heart disease you can deduce from a cholesterol test is the ratio of triglycerides divided by HDL.  In your latest book, you propose that triglycerides, like LDL, serve a purpose.  Are you saying high triglycerides shouldn’t concern us? 

Triglycerides are a normal constituent of our blood with many important tasks. They go up after every meal and it takes 8-10 hours before they go down to the fasting state which means that most of us go around with high TG most of the time. It is true that very high TG-levels may be a marker of diabetes, but that doesn’t mean that it is causing any harm by itself.

High HDL is associated with a lower rate of heart disease.  Is the HDL  protective, or do you think it’s a marker for something else that prevents heart disease?

It is definitely a marker, but it may also be protective by itself as well, because all the lipoproteins partake in the immune defense system.

A lot of researchers are now suggesting that it’s small, dense LDL that should concern us, not total LDL.  Do you agree with that position? 

It is correct that the number of the small dense LDL particles is the best predictor, but that doesn’t mean that they are causing heart disease.

What about fasting blood glucose?  Is that a significant number to you?  If a patient’s fasting blood glucose is 130, would you be concerned, or it is non-issue?

Elevated fasting glucose indicates the presence of the metabolic syndrome or diabetes and this is certainly something to be concerned about.

Since people with high cholesterol tend to live longer, should someone whose total cholesterol is 150 be concerned?  Should she be trying to raise her cholesterol?  If so, how?

Stop eating soy products, corn oil and sunflower oil and eat natural animal fat instead.

I’ve heard some doctors saying we should take Omega-3 supplements and others who say they’re worthless.  What’s your opinion on them? 

Eat more fatty fish instead. There is much omega-3 fat in food from birds and animals living in the wild as well, including sheep and goats.

How would you explain the success of Dr. Ornish’s very-low-fat program in actually removing plaques in the arteries? Why it’s bothering me is this:  I understand that it’s a lifestyle program including giving up smoking and starting meditation, which is the common answer I hear to this question. But this rather raises the even harder question if diet is important to this at all. If high-fat all by itself is helpful (and low-fat thus comparatively harmful), how come the intervention actually removed existing plaques?

If his method is able to change anything, which I doubt (see page 134 in my book), it is impossible to know which of the measures that work. Nobody has shown that his method removes plaques.

What changes in diet, if any, would you recommend to people who show any signs of heart disease?

As I consider atherosclerosis to be an infectious disease, I would recommend lowering the intake of carbohydrates, in particular if you are a diabetic. Vitamin D seems to be a protective factor, according to recent research. Vitamin C is also necessary. The concentration of vitamin C inside the leucocytes is about 80 times higher than in the blood and because glucose and vitamin C compete for transport by insulin and entry into cells, it is important to avoid high glucose concentrations and stimulate high ascorbic acid concentrations in the blood. Fred and Alice Ottoboni have written a good paper about that and they recommend 1-2 gram ascorbic acid a day, much more in case of an infection.

Your hypothesis that infections are the initial cause of heart disease is intriguing.  How are other doctors and researchers responding to it?

They do not respond at all. It is very difficult to promote new ideas in medical science.

I can see how this information benefits younger people who have time for their bodies to make changes, but how does this affect folks in their 50s, 60s, 70s and up who may already be on medication — some for years? Is there any danger at all in beginning a diet of eating healthy fats while at the same time slowly getting off the medication, if one wanted to do that?

Not at all.  Avoiding carbohydrates for example may have dramatic beneficial effects in patients with diabetes, for instance, and also for people who are obese.

Thank you, Dr. Ravnskov, for answering the questions … and more importantly, for writing a book that convinced two of my relatives to stop worrying about “elevated” cholesterol and to quit taking statins.

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25 Responses to “Interview: Dr. Uffe Ravnskov”
  1. Amy Dungan says:

    Interesting answers! Thanks for asking my question Tom. I’m already doing what he suggested, and have been for years, so I guess that means I just don’t worry about it?

    I think that’s the point here, Amy. Do what you know is right and don’t worry. We’re talking averages here: people with high cholesterol outlive people with low cholesterol on average. Plenty of people with low cholesterol will still live a nice long life, especially if they eat right, take vitamin D, exercise … which you’re doing.

  2. Sarah says:

    I think I’ve learned a valuable lesson after reading one of your “Naughtonisms” that says something long the lines of, “if an idiot is on a roll, don’t interrupt them.” It’s really, made me more zen when I come across people.

    http://www.youtube.com/watch?v=Gx87tW5kRgA&feature=related

    Side note, your search feature doesn’t seem to be working for me. It just collapses the side bar whenever I try to search for a term. I use IE if that means anything.

    Wow. He appears to be naturally thin and has no clue whatsoever about what causes weight gain. He should write speeches for MeMe Roth.

    The search feature doesn’t work for some versions of IE. I hope when I get around to upgrading my WordPress, the problem will go away.

  3. Laurie says:

    OMG! FACAGFY….. Amazing. Your review and interview- outstanding. Jimmy Moore’s interview with him- astonishing.
    I am particularly fascinated by the ‘Ornish’ q and a. In a preview to this in an earlier post of yours, there was this question of how Ornish’s low-fat diet reduced arterial plaque. I was thinking of a few possible scenario’s of how the Good Doc Ravenskov might respond, but the way he finally did blew me away. I hadn’t even considered this as an answer. He said that that was just a CLAIM of Ornish’s and there are NO studies to back up the claim! This has to be filed in ‘repeat anything enough and it becomes true’! I had been drawn into that a little bit, before (and it annoyed me), about the ‘paradox’ of the Ornish low-fat vegetarian diet reducing plaque. NO LONGER.
    Taubes and Ravenskov both have an impeccable creds. in that between them they have probably read all the literature on what they then write about- nutrition and heart disease. That has to be worth a lot.

    I don’t want to cite the full two pages Ravnskov devotes to the Ornish study, but in short, the participants weren’t randomized and weren’t balanced for age, weight, or smoking status, the study wasn’t blinded, some followup x-rays disappeared or were deemed inconclusive, etc. They also had to lower the statistical threshold in order to claim a very slight dose-dependent response.

    Add it all up, and by any marginally rigorous standard of scientific evaluation, the Ornish study can’t make any claims at all about the effects of his diet. As with many other studies, the best we can do is conclude that smoking is a bad idea. But we knew that.

  4. Felix says:

    I’m now waiting for the book to arrive…
    Dying to know what’s on page 134. 🙂
    But if Ornish’s study has the standard quality of that scientific field, it’s probably easy to tear apart.

    It was one of those multi-factor studies with so many variables, it’s impossible to attribute any improvements to diet.

  5. My recollection is that Ornish had angiographic evidence of reversal of heart artery blockages. In other words, dye was injected into the arteries before and after his program, and the pictures showed regression of blockages.

    I expect someone below will either confirm or refute my recollection.

    As mentioned above, Ornish’s program did so many different things, including group sessions/cameraderie, that it’s hard to say which intervention was most important. Or was it the synergy amongh the interventions?

    -Steve

    I seem to remember he claimed actual reversal as well, but the diet itself hasn’t compared well in controlled studies.

  6. Dave B. says:

    “What about fasting blood glucose? Is that a significant number to you? If a patient’s fasting blood glucose is 130, would you be concerned, or it is non-issue”?

    Was that like… a control question, like with a lie detector when they ask what your name is?

    Ha, not quite. Since he’s proposing a radically different view of heart disease, I wanted to distinguish between the numbers he believes truly matter and those that don’t. If heart disease is the result of infection, then perhaps elevated blood sugar doesn’t matter, at least for heart disease. But as he pointed out, glucose competes with vitamin C and so too much glucose leaves us vulnerable to infections.

  7. Zach says:

    Nice interview, Tom. Have read a lot about your work, glad I finally found my way over to your blog. I have a lot of archive reading to do. Looking forward to seeing your film soonest.

    Dr. Uffe Ravnskov, great concise answers. Your research will not be ignored forever, thanks to interviews like these the truth will emerge.

    I hope someday Dr. Ravnskov is recognized as the Galileo of heart-disease science.

  8. GoEd says:

    Regarding Ornish study,

    What he probably saw is reversal of endothelial dysfunction, i.e., he used a technique called “quantitative angiography.” which cannot quantify plaque. It only measures the diameter of the lumen (i.e., the diameter of the area filled with dye), which is readily manipulated by anything that induces arterial relaxation.

    By switching from a fast food, junk food diet to a plant-based, low-fat, high-grain diet a la Ornish you are quite likely to see some improvements in arterial relaxation. This is by no means proof of plaque reversal.

    That sounds about right. The diameter of the arteries was one of their measurements.

  9. Sylvie O says:

    Hi Tom.

    I really wish you had included the questions to which he answered “I don’t know”. I think it speaks volume when someone admits to not knowing everything, plus it would give us points to ponder/research in other avenues.

    Not to mention some people might have those exact questions in mind and think that you forgot to ask them.

    Most of them were questions about why the Lipid Hypothesis became accepted in spite of so little real evidence, and why it manages to stay alive in spite of so many studies that dispute it.

  10. CindyD says:

    Thanks for posting this. I’m looking forward to ordering his new book. I have a Amazon gift certificate that will be enough to cover his book and another Fat Head. I give them out as gifts. This one is going to my niece who believes everything Dr. Oz says and takes it as gospel. She’s also addicted to The Biggest Loser. If any thing can knock some sense into her, it is your funny and very intelligent movie.

    The Dr.’s new book will be for me. Thanks for telling us about it!

    Dr. Ravnskov and I both appreciate the support.

  11. Crusader says:

    That sounds about right. The diameter of the arteries was one of their measurements.

    Diameter is one measure, elasticity is another important measure. I’m sure Ornish did not check that out.

    I haven’t read the original Ornish study, but in Dr. Ravnskov’s description it was diameter they measured.

  12. Dave B. says:

    “By switching from a fast food, junk food diet to a plant-based, low-fat, high-grain diet a la Ornish you are quite likely to see some improvements in arterial relaxation”.

    That kind of surprises me. Grains, from what I know, contribute to arterial inflexibility which contributes to high blood pressure. When I ditched grains, my BP dropped 25 points.

    But I still want his new book!

  13. Ed says:

    I wrote Dr. Ravnskov several years ago after reading his first book with a number of questions, specifically related to the reversal of heart (coronary) disease through diet and he was unable to objectively answer nor validate his statements when I asked him to. More specifically, I forwarded peer-reviewed information from Dr. Caldwell Esselstyn and Dr. K. Lance Gould who have both shown a dietary approach can and does reverse arterial blockage. While he disputes the findings, he doesn’t have any objective criteria through which he does this.

    Dr. Ravnskov simply cites works by others. Other than criticizing, where are angiograms or PET scans from Dr. Ravnskov which disprove vegan or low fat approaches like Drs Esselstyn and Gould.

    There was a quote from Gary Taubes who noted he wasn’t sure if he would bet his life on a diet like Dr. Ravnskov is recommending. At this point, until more objective information is published and validated which shows low carb diets work as well as Esselstyn’s or Gould’s, I wouldn’t either.

    I believe diet can reverse heart disease. That’s what Dr. William Davis does with his patients. But I doubt the Ornish diet does because it’s so high in carbs. When Chris Gardner (a vegetarian himself) ran a controlled study on three diets, the people on the Atkins diet showed the greatest improvements in lipids, better than Ornish. Gardner said it pained him to report the results.

    From the site promoting Esselstyn’s diet, I see that his diet lowers cholesterol. Big deal. Since there’s no statistical correlation between cholesterol and heart disease except in men under 50, that’s meaningless, especially since people with low cholesterol have shorter average lifespans. I wouldn’t want my cholesterol to drop to 150, which is what he’s pushing.

    And here’s an interesting quote from the site:

    “With this eating plan, sufferers of heart disease will maintain cholesterol levels low enough to ensure that they will never have a heart attack.”

    Nonsense. People have heart attacks at all cholesterol levels. Aborigines have one of the highest rates of heart disease in the world … with average cholesterol in the 130s.

    If people living on sugar and trans fats and other crap switch to a lowfat, plant-based diet, I’d expect to see improvements. But that doesn’t mean a lowfat, plant-based diet is the best option. It just means it’s better than a truly crappy diet, which is what most people eat.

    Gary Taubes is betting his life on the diet Ravnskov recommends, because he now eats lots of fat and very few carbs.

  14. CindyD says:

    When I first started my dietary research a few years ago, I did buy into McDougall and Esselstyn. I was hungry all of the time following their diets and had to make these complicated recipes with tofu, random items, and about 10 spices each meal to make edible the fake soy foods that they recommended. That just can’t be natural. Life is so much easier now and I weigh 120 lbs. I live a paleo/low carb life, I’ve lost the weight, and I’m rarely hungry. That seems much more natural to me.

    Ugh, I remember those tofu scrambles from my vegetarian days. You’re exactly right; you have to spice the heck out of that stuff to make it edible. But a fried egg is delicious all by itself.

  15. Todd says:

    I remember one of my professors saying that M.D.s in general made poor researchers, as they had no training in experimental design and research methodology. In reading Taubes, for example, and the studies you comment on here, I’m inclined to agree with that professor (a neuroscientist). I know there are some physicians who are superb at research, but they either have an M.Sc., a Ph.D., or a personal drive to be scientists, not preachers.

    That seems to be the case, although it’s disappointing … you’d think given the number of science classes required for pre-med, there would be more emphasis on the scientific method.

  16. M. Cawdery says:

    The response from leaders of research to something that contradicts their views is a challenge to their status. I call it the Galileo Syndrome; as you may remember Galileo was only absolved by the Roman Catholic Church in 1965. As Max Planck is reputed to have said “Science progresses FUNERAL by FUNERAL”

    Having read extensively on this subject, I find that the research reports often leave data out or manipulate results to suit their purposes. For example, the HPS report failed to point out that only 3 per 1000 were ESTIMATED to be “saved” p.a. while five times more, 15 in 1000 died despite therapy! Have you ever heard of a doctor who told his patients that when prescribing statins?

    Another example is the JUPITER study which was terminated early on “ethical grounds” because of statistically significant NON-FATAL secondary beneficial end points. However, they obfuscated on the 50% greater death rate (relative much loved by the medical profession to inflate the importance of their results) in the TREATED group compared to the Placebo group.! See their Table 3 but be prepared to read it very, very carefully and then do your own sums.

    While at this stage this was not significant, but risk rates and Hazard rates
    are usually assumed to be constant over time. Extending this 50% rate to 5 years (the protocol duration) brings it close to significance; further extension (and statins are supposed to be taken for decades) brings the death rate to a highly significant effect. Given the removal of BAYCOL, a statin, from use because of deaths, it is clear that the real cause for early termination was the possibility of a FATAL, significant end point. There was also the problem of a significant increase in diabetes in the treated group; this was rejected as a statistical quirk – which emphaises the need to complet the full protocol duration. In short, misrepresentation of the data.

    Interestingly, this study has prodded AstraZeneca into proposing that inflammation (and presumably infection as well) is a major cause of atherosclerosis as was predicted by Dr Graveline and DR Ravnskov years ago. But NO admission that cholesterol etc are nothing more than mathematical associations like the presence of firemen at fires – NOT CAUSAL!

    All good points. And you have yourself why studies that were originally scheduled for, say, 5 years are suddently stopped at 3.5 or 4 years. They stop those trials at exactly the point where the lower rate of heart disease barely reaches statistical significance.

  17. marina says:

    Does Dr Ravnskov by any chance know where the following quote from Ancel Keys PhD, professor emeritus at the University of Minnesota, 1997, originated ? Or is it bogus ? I have been trying to track it down, but cannot find an original paper or talk where it might have come from.

    ‘There’s no connection whatsoever between cholesterol in food and cholesterol in blood. And we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit.’

    No, it’s not bogus. Keys came to that conclusion. Unfortunately, he still believed saturated fat in the diet would kill you.

  18. marina says:

    Many thanks for answering, but have you any idea where the above quote comes from? It is widely available on the internet, but always without a source.

    I’m not sure where you’d find a documented source.

  19. marina says:

    Thanks again. So as i understand it, we believe Ancel Keys made the following quote because that was what he was thought to have come round to thinking…

    ‘There’s no connection whatsoever between cholesterol in food and cholesterol in blood. And we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit.’

    but a documented source is not easy to find, and we do not know what that documented source maybe. So in effect it is not a reliable quote at all, and could have been made up.

    Not a quote to use then. Pity.

  20. Diogenes says:

    ” Since there’s no statistical correlation between cholesterol and heart disease except in men under 50″

    –do you have a source for this? And why would such a correlation exist anyway?

    Dr. Ravnskov has reviewed all the studies. The correlation showed up in the Framingham study and became enshrined in the medical establishment as proof that cholesterol causes heart disease. The same correlation wasn’t found in other studies. In the American Heart Assocation’s own published data, people with “high” cholesterol have slightly less than their share of hear attacks, for example.

    As for why the correlation exists at all, there are several theories. Cholesterol is required for stress hormones, and risk factors that cause stress on the arteries — smoking, emotional anxiety, high blood sugar — may also increase cholesterol production as a result.

  21. Butch says:

    Interesting interview – I’ve read Ravnskov’s “Cholesterol Myths” and had to say I was intrigued – especially by the revelations about the Ancel Keys. However, I wish somebody would bring up PET scans and documented blood flow. Not only Ornish, but Drs. K. Lance Gould and Caldwell Esselstyne (whose diet is like Ornish except no nonfat diary or eggwhites and who did NOT confound his study with other stuff like meditation/stress reduction and exercise) always cite PET scans showing vastly improved blood flow to the heart after only a few weeks on their very low fat, plant based diets (and also complex carbs only) diets, even though lumen size would not have been affected in such a short time. I think there is something to Ornish et al’s argument that low-carb people fixate on improvement in “risk factors” (like increased HDL) which – as Ravnskov himself would argue – do not establish causation. But I find it less hard to dismiss PET scans, which appear to be much less subjective than angiography. So does a very low fat, complex carb diet indeed vastly improve blood flow to the heart, or not??? And what does a high fat (especially saturated fat diet) do to blood flow? After all, the bottom line is blood flow, not lab results. Why not address this issue? It would seem a reasonably accurate study using cardiac PET scans after a few months on several different diets would not be that expensive or difficult to design.

  22. Jalal says:

    I’ll second Butch’s question, after having read up on Dr. Ravnskov and a short email exchange with him. How can we determine the efficacy of our dietary choices? What markers to check in blood tests and/or imaging to see what our bodies are doing? Are there studies like this now taking place?

    There are of course many lab tests you could take. I mainly watch triglycerides and HDL. It’s clear from the research that carbohydrates raise triglycerides and lower HDL, which is the opposite of what you want. A high-fat diet raises HDL and lowers triglycerides — if not directly, then by substituting fat for carbs. I supposed in theory you could eat enough fat to cause damage, but most of find it difficult to binge on high-fat, low-carb diets.

  23. Jim says:

    The closest to a quote citation I have been able to locate for the Ancel Keys “There’s no connection between cholesterol in food and cholesterol in blood. And we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit.” is that it was cited in an interview in an Internet Magazine called “Eating Light” sometime around 1997.

    However, I have been unable to find an easy way to get back isues of the magazine, to which you can evidently still subscribe.

    You can find a very similar quote of his published in a letter to the editor of the New England Journal of Medicine August 22, 1991 page 584. You can google that.

    “… Dietary cholesterol has an important effect on the sholesterol level in the blood of chickens and rabbits, but many controlled experiments have shown that dietary cholesterol has a limited effect in humans. Adding cholesterol to a cholesterol-free diet raises the blood level in humans, but when added to an unrestricted diet, it has a minimal effect……”

    The paper under consideration was about an elderly man who ate 25 eggs (boiled) per day and had basically normal blood cholesterol values. This article had been published in the same journal a few months earlier. N Engl J Med 1991:324; 896-9. (Kern F Jr. Normal plasma cholesterol in an 88-year old man who eats 25 eggs a day: mechanisms of adaption)

    You can download the letter page and the paper from the journal in PDF form, for your own records.

  24. Rajendra Pathak says:

    Ravnskov is perhaps one of the most brilliant and honest scientific writers of the last 50 years. His book on cholesterol myths is not only very tongue- in- cheek when it comes to exposing the false luminaries of medicine, it is a work of very good science writing. I am 69 years old and I can state that this is among the five most valuable books that I have ever read. I hope this man lives to be at least a hundred. His book saved me from taking statins, and in a way it is a kind of
    bible for me. My cholesterol is way above 320 (for at least the last 30 years). I almost never get a cold or am otherwise sick.

  25. Fabrice says:

    I think Dr Ravnskov has good idea but he forgot that human have a different mecanisme to repaires their arteries in fact when we have arteriosclerosis we produce lipo A and animals cannot because they produce vitamine C instead, so by keeping our vitamine C high in the blood we ovoid arteriosclerosis and virus or bacteria cannot attack the arteries, the lipo A is a reparation factor that will block the arteries only if we lack vitamine C and to remove the plaque of atheroma it is just required to take proline and lysine which will get rid of the lipoA this is how we reverse the atherosclerosis problem and if the arteriosclerosis is cause by homocysteine then we just need to take vitamine B to convert it into cysteine and methionine, the good thing is that we need cholesterol since our body is producing it for 2/3 in conclusion take your daily vitamine C and you will not get any calcification or atherosclerosis all this was well explained by Dr Matthias Rath google his name and you will find all of it

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