Dr. Ravnskov’s New Book: Ignore the Awkward!

One of the first books I read while researching Fat Head was The Cholesterol Myths, by Dr. Uffe Ravnskov. I was, to put it mildly, stunned. I highlighted so many sections, the ink began to bleed through. Too bad … that book is no longer in print, and pristine copies sell for hundreds of dollars. To fill the void, Dr. Ravnskov next published an updated and expanded version of The Cholesterol Myths titled Fat and Cholesterol Are Good For You, which I reviewed in a previous post.

Both books employ two of my favorite weapons — logic and math — to poke huge holes in the Lipid Hypothesis. Perhaps more effectively than anyone on the planet, Dr. Ravnskov declares that the Cholesterol Emperor has no clothes, then sets out to prove his case.

His latest book is titled Ignore the Awkward!  How the Cholesterol Myths Are Kept Alive. This time, Dr. Ravnskov focuses more on how the anti-cholesterol hysterics manage to keep applying body-paint to the emperor and insisting he’s all dressed up and ready to rule. As the introduction explains:

My aim with this book is to show how white has been turned into black by ignoring any conflicting observations; by twisting and exaggerating trivial findings; by citing studies with opposing results in a way to make them look supportive; and by ignoring or scoring the work of critical scientists.

If you haven’t read Dr. Ravnskov’s previous books, don’t worry: the first 45 pages are a shorter, simpler version of the evidence he originally presented in The Cholesterol Myths. (By simpler, I mean you don’t need to understand the difference between a one-tailed test and a two-tailed test for calculating statistical significance. You just need to follow along with a bit of math and logic, which is presented clearly.)

Most of the other 100 or so pages demonstrate how and why bad scientists keep the Lipid Hypothesis alive, despite the contrary evidence. I’m sure you can guess the why:  money, money, and money. Scaring people into believing their cholesterol is too high is a multi-billion dollar business.  As I explained in Fat Head and Dr. Ravnskov recounts in this book, the current cholesterol guidelines were created by a quasi-government organization called The National Cholesterol Education Program. Read the financial disclosures for the NCEP committee, and you soon realize the committee is essentially Big Pharma’s All-Star Team.

But it’s not just the all-stars who suckle at the bosoms of Merck and Pfizer … university research departments, medical journals, and countless individual doctors depend on regular injections of Big Pharma dollars. Papers published in medical journals are often written by pharmaceutical hacks, yet list prestigious researchers as the official authors. Those researchers merely review the articles and pocket a hefty fee — essentially renting out their names and reputations. (Perhaps we need a new label for those researchers. Statin Sluts comes to mind.  Pill PimpsPharmaHos.)

But it wasn’t the why that I found so interesting in Ignore the Awkward! — it was the how. In case you haven’t noticed from my posts and recent speech, I’ve become a bit obsessed with the topic of bad science. In chapters with titles such as How to Exaggerate Insignificant Results and How to Lie Convincingly, Dr. Ravnskov provides plenty of examples of how bad science is done.

One common technique is simple selection bias, otherwise known as cherry-picking. If you dig through the scientific literature, you can find studies that refute the Lipid Hypothesis. But you’ll have to dig deep because, as Dr. Ravnskov demonstrates with citation figures, if one study supports the Lipid Hypothesis and another published in the same year disputes it, the supporting study is far more likely to be cited in other papers — at least six times more likely.

Another technique is to cite supporting evidence that is not, in fact, supporting evidence. In one of its influential papers, the National Cholesterol Education Program wrote:

A large body of epidemiological evidence supports a direct relationship between the level of serum total and LDL-cholesterol and the rate of CHD.

Dr. Ravnskov examined the studies that were cited and found that most didn’t mention LDL at all, one concluded that LDL is not a heart-disease risk factor, and one — only one — concluded that LDL is a risk factor … but only in men ages 35 to 49 and women ages 40 to 44. So the “large body of epidemiological evidence” turned out to be a single study in which LDL was identified as a risk factor — but only for people in certain age groups.

The most egregious technique (in my opinion, anyway) is what might politely be termed misinterpreting the results. (You may choose a more descriptive verb.) For example, in one clinical trial of a low-fat diet, men experienced a very slight reduction in heart disease, while women experienced no reduction at all. Yet the study authors wrote:

Although the results of this trial do not permit firm conclusions, they support the idea that also among female populations the serum-cholesterol-lowering diet exerts a preventative effect on CHD.

So the low-fat diet fails, but the results “support the idea” of prescribing low-fat diets. Ladies and gentlemen, welcome to scientific never-never land.

In another study, the data showed that people who had suffered heart attacks ate no more saturated fat than people who hadn’t suffered heart attacks. But in their conclusions, the authors wrote:

Within the context of the total literature, however, the present observations support the conclusion that the lipid composition of the diet affects the level of serum cholesterol and the long-term risk of death from coronary heart disease.

Look at the emperor’s new clothes, ladies and gentlemen!  In the context of his total entourage, he is wearing clothes, and they’re lovely!

Perhaps the most clever techniques for ignoring the awkward are those employed by pharmaceutical researchers. Did a statin produce an unacceptably high incidence of cognitive disorders in your clinical study? No problem … just subdivide those disorders into as many categories as possible: depression, mood swings, confusion, memory loss, etc. Now each subdivided disorder has an acceptably low incidence. Was the rate of new cancers too high in your previous statin study? Here’s your solution: in the next study, exclude everyone who’s ever had cancer from the patient pool. Then, if the statin takers end up with a higher rate of skin cancer, just refuse to report it as “cancer.”

As you might suspect, Dr. Ravnskov is not exactly a popular figure among the scientists who are paid by Cholesterol Panic Incorporated. He’s had scientists jab him in the chest and demand to know who funds his research. (The answer: Uffe Ravnskov.) Many of his papers have been rejected by numerous medical journals, often with laughable explanations:

It is highly unlikely that the experienced researchers who have written the dietary recommendations should have made such flawed conclusions as Ravnskov claims.

To answer Ravnskov, it is necessary to examine all of his arguments in detail. This is not possible.

The author may not be aware of a vast body of literature that convincingly supports the association between saturated fat and heart disease.

In other words, We can’t dispute the data presented here, so we’ll just declare that Dr. Ravnskov is wrong because so many of our peers say he’s wrong.

Not all anti-cholesterol hysterics are satisfied with merely saying Dr. Ravnskov is wrong. After all, he has managed to get some of his papers published, he’s written books, and he’s more or less elbowed his way into scientific conferences to present his case. He’s a threat.

So a handful of scientists have apparently waged a campaign to portray him as a crank or a conspiracy nut. Someone even managed to hijack his email account and send out kooky emails … including one that was full of foul language and informed the recipient You really need to get a clue, you stinky buttholed woman.

I’ve read Dr. Ravnskov’s books and some of his papers, I’ve interviewed him, and I’ve exchanged emails with him. Trust me, his rhetorical skills are a little more polished than that.

(By the way, one of my email accounts was hijacked recently.  I have no interest in selling Viagra to anyone, so if you received a pitch from me, ignore it.  Dr. Malcolm Kendrick replied by asking for a price list, but I’m reasonably sure he was joking.)

Unfortunately for the bad scientists and the lipophobes, the supposed crank actually wants you to check his references. Ignore the Awkward! is full of citations, and in the introduction, Dr. Ravnskov explains to his readers how to use those citations to look up the studies online, then urges them to do so:

If you find that what I have written is hard to believe, please consult the sources given at the end of each chapter … by doing this systematically, as I have done, you will not only discover the truth for yourselves, you will also learn more about cholesterol and the heart than most doctors.

Sadly, he’s right about that.

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76 thoughts on “Dr. Ravnskov’s New Book: Ignore the Awkward!

  1. Tammy

    Tom – Thanks for posting about the new book – I have a copy of “Fat and Cholesterol are Good for You” great book. I’m placing my order today for the new book. Actually I have quite the library at home of anti-establishment health books. Whenever I make a comment to family or friends like “you know there’s nothing wrong with saturated fat” and they give me that look, I just go grab a couple books and offer the books to them. Then they usually kind of believe me. (Or they start thinking I’m a real kook).

    A funny story just this past weekend I was at the deli counter in the grocery store ordering a 1/2lb of Mortadella (yummy Italian bologna with pistachios and peppercorns) and the deli lady said she’s always wondered what all the white stuff in it was, she’d never tried it. I told her it was fat – you should’ve seen the look on her face. I said it was yummy and she said that they do sell alot of it. She and the other deli clerks were still making the “grossed out” comments when I walked away, I was just laughing because I felt like saying something like – “Look at me do I look fat? No? That’s because I eat fat” 🙂

    She didn’t know it was fat?!

    Reply
  2. Isabel

    This is for Debbie- I also see an endocrinologist for Hashimoto’s. I was seeing one who continued to insist that I should finish having babies so that I could go ahead and have bariatric surgery! Needless to say, I found another endocrinologist that is 100% on board with my low-carb weight loss success and is not brainwashed into thinking that low-carb will kill me someday. I recommend that you try a different endocrinologist until you find one that is willing to work with you.

    Reply
  3. Aaron Curl

    I really wonder when humans started being so greedy and horrible. My guess is when we started a monetary system. All that is wrong in the world is based on greed. You and all the other “truth providers” should be proud of what you’re doing. I know I am thankful.

    I think greed has always been part of the human condition.

    Reply
  4. Isabel

    This is for Debbie- I also see an endocrinologist for Hashimoto’s. I was seeing one who continued to insist that I should finish having babies so that I could go ahead and have bariatric surgery! Needless to say, I found another endocrinologist that is 100% on board with my low-carb weight loss success and is not brainwashed into thinking that low-carb will kill me someday. I recommend that you try a different endocrinologist until you find one that is willing to work with you.

    Reply
  5. KD

    “To answer Ravnskov, it is necessary to examine all of his arguments in detail. This is not possible.”

    This is utterly disgraceful… It would take too much time to see if his argument has merit, so they’re just not going to try at all? Seriously? I can believe that someone would think and act like this, but to actually SAY it publicly? The audacity!

    They were at least smart enough not to say it publicly. Dr. Ravnskov copied the explanations from notes given by peer-reviewers who recommended the journals reject his papers.

    Reply
  6. KD

    “To answer Ravnskov, it is necessary to examine all of his arguments in detail. This is not possible.”

    This is utterly disgraceful… It would take too much time to see if his argument has merit, so they’re just not going to try at all? Seriously? I can believe that someone would think and act like this, but to actually SAY it publicly? The audacity!

    They were at least smart enough not to say it publicly. Dr. Ravnskov copied the explanations from notes given by peer-reviewers who recommended the journals reject his papers.

    Reply
  7. Jack Challem

    Tom, I hate to say it, but the evidence is shifting strongly in Uffe’s direction. You might look at the meta-analysis conducted by Ronald Krauss, MD, published in the March 2010 American Journal of Clinical Nutrition. He found absolutely no link between saturated fats and cardiovascular disease. He explained that the emphasis on saturated fat as a risk factor seems related to publication bias.

    Yup, I saw that. There’s hope.

    Reply
  8. Jack Challem

    Tom, I hate to say it, but the evidence is shifting strongly in Uffe’s direction. You might look at the meta-analysis conducted by Ronald Krauss, MD, published in the March 2010 American Journal of Clinical Nutrition. He found absolutely no link between saturated fats and cardiovascular disease. He explained that the emphasis on saturated fat as a risk factor seems related to publication bias.

    Yup, I saw that. There’s hope.

    Reply
  9. Lars Berglund

    The Swedish food authority SLV said Ravnskov is not worth attention because it it “one man´s opinion”. With all his source references, it is unclear to me how they can claim sometning like that. But it was effective as a way to get out of a bind. The interviewer had no further question. That´s called media coverage.

    Perhaps they believe Dr. Ravnskov has multiple personalities, they all publish in journals.

    Reply
  10. Lars Berglund

    The Swedish food authority SLV said Ravnskov is not worth attention because it it “one man´s opinion”. With all his source references, it is unclear to me how they can claim sometning like that. But it was effective as a way to get out of a bind. The interviewer had no further question. That´s called media coverage.

    Perhaps they believe Dr. Ravnskov has multiple personalities, they all publish in journals.

    Reply
  11. Tim Savidge

    You’re right – Statins are not the answer and never were. I’ve been exploring this for years and realise that the industry – and it is a big INDUSTRY – is a huge con.

    For those who wish to see what the answer is if it is not statins, have a look at my website.

    View the extraordinary stories of the High Desert Heart Institute and interviews with some of the world leading pioneers in preventative and remedial heart treatment. If you not convinced you may just as well give up and consider the emperor to be wearing clothes.

    Talk to me and see how you can change the world and save lives of those close to you.

    Reply
  12. Tim Savidge

    You’re right – Statins are not the answer and never were. I’ve been exploring this for years and realise that the industry – and it is a big INDUSTRY – is a huge con.

    For those who wish to see what the answer is if it is not statins, have a look at my website.

    View the extraordinary stories of the High Desert Heart Institute and interviews with some of the world leading pioneers in preventative and remedial heart treatment. If you not convinced you may just as well give up and consider the emperor to be wearing clothes.

    Talk to me and see how you can change the world and save lives of those close to you.

    Reply
  13. Shaun

    My wife went to pick up her cholesterol results yesterday armed with this book. The doctor looked to the ceiling and said “How boring” when she started to explain Ravnskov’s work. “Why so many investigations?” the doctor asked. It’s obvious some of them do not like the internet because it means they get found out not being the god-like figures they like to pretend they are.

    Incidentally, her results were:

    TC 293
    Tri’s 87
    HDL 92
    LDL 161

    After 3 months without any symptoms of colitis my wife pushed the boat out a bit over the holidays with wheat, sugar, PUFAs and, like clockwork, back her problems came with a vengeance. The doc refuses to see a link between her colitis and her diet. Only drug intervention can help apparently.

    One last thing, Tom, I have to thank you for the “painting the lawn green” metaphor regarding statins in another post. It is a valuable argument I will be using a lot. Cheers.

    Cheers to you, Shaun. Your wife’s HDL is incredible, and the triglycerides are impressively low. I’d say the diet is working.

    Reply
  14. Shaun

    My wife went to pick up her cholesterol results yesterday armed with this book. The doctor looked to the ceiling and said “How boring” when she started to explain Ravnskov’s work. “Why so many investigations?” the doctor asked. It’s obvious some of them do not like the internet because it means they get found out not being the god-like figures they like to pretend they are.

    Incidentally, her results were:

    TC 293
    Tri’s 87
    HDL 92
    LDL 161

    After 3 months without any symptoms of colitis my wife pushed the boat out a bit over the holidays with wheat, sugar, PUFAs and, like clockwork, back her problems came with a vengeance. The doc refuses to see a link between her colitis and her diet. Only drug intervention can help apparently.

    One last thing, Tom, I have to thank you for the “painting the lawn green” metaphor regarding statins in another post. It is a valuable argument I will be using a lot. Cheers.

    Cheers to you, Shaun. Your wife’s HDL is incredible, and the triglycerides are impressively low. I’d say the diet is working.

    Reply
  15. pam Ray

    I went to get cholesterol checked and I have been eating much healthier.Chia sees, v.c.o,and my last test was 100.This one 259.The nurses have me convince I nee to cut out the coconut oil because of my levels.I feel so discouraged.Like I have one foot in the grave.~~~~Pamela

    Reply
  16. pam Ray

    I went to get cholesterol checked and I have been eating much healthier.Chia sees, v.c.o,and my last test was 100.This one 259.The nurses have me convince I nee to cut out the coconut oil because of my levels.I feel so discouraged.Like I have one foot in the grave.~~~~Pamela

    Reply
  17. Steve @ thriveful.com

    Hi Tom

    Thanks for a great review. I am just about to buy the book and this review has confirmed that it is a must read. I am already a total cholesterol sceptic, but having move good information to ‘fight the good fight’ is essential if we are going to turn this thing around.

    Thanks

    Reply
  18. Steve @ thriveful.com

    Hi Tom

    Thanks for a great review. I am just about to buy the book and this review has confirmed that it is a must read. I am already a total cholesterol sceptic, but having move good information to ‘fight the good fight’ is essential if we are going to turn this thing around.

    Thanks

    Reply
  19. Razwell

    These tactics against Dr. Ravnskov, who is a great man, are a classic example of how peer – review simply does not mean anything. Lots and lots of junk is published every single day. Lots of junk gets by the referees as well.

    This system has major problems and is often abused. Good science has been left out and crap has gotten through many times.

    It is worth noting Isaac Newton’s Principia Mathematica, Albert Einstein’s Theory of General Relativity and Darwin’s Evolution of Species Theory were NOT peer-reviewed. Yet, they represent some of the finest science in the history of this human endeavor/creation.

    What is not taught often enough to the public is that:

    *Most scientific ideas are wrong.

    *Most experiments are wrong, too, the first time they are done.

    These two points are essential.

    The ONLY thing that matters in science is this: If somebody else finds your work interesting…. And they take it up…. And they perform detailed observations and experiments… And it works….. And it gets to be done more and more and more and more.. Then , and only then, does something become part of the cannon of science.

    And replication from different groups globally is not even enough…

    In science, the more important your discovery , the more important it is to verify it. Scientists do this not only through replication BUT ALSO developing many different independent testing techniques and methods. When all of these multiple techniques/methods of testing point int he same direction or get the same result , it is very likely you are correct.

    Global replication from different scientific groups who are all using MANY multiple independent and different testing methods/techniques. That is what is needed and what was done int he discovery of Dark Matter and Dark Energy for instance.

    Peer – review is not the arbiter of ANYTHING. It is NOT the arbiter of truth whatsoever. It is often a bunch of stuffy codgers who are journal editors wanting to keep the status quo.

    There is talk of doing away with it entirely in favor of something better.

    Sincerely,
    Razwell

    Reply
  20. Razwell

    These tactics against Dr. Ravnskov, who is a great man, are a classic example of how peer – review simply does not mean anything. Lots and lots of junk is published every single day. Lots of junk gets by the referees as well.

    This system has major problems and is often abused. Good science has been left out and crap has gotten through many times.

    It is worth noting Isaac Newton’s Principia Mathematica, Albert Einstein’s Theory of General Relativity and Darwin’s Evolution of Species Theory were NOT peer-reviewed. Yet, they represent some of the finest science in the history of this human endeavor/creation.

    What is not taught often enough to the public is that:

    *Most scientific ideas are wrong.

    *Most experiments are wrong, too, the first time they are done.

    These two points are essential.

    The ONLY thing that matters in science is this: If somebody else finds your work interesting…. And they take it up…. And they perform detailed observations and experiments… And it works….. And it gets to be done more and more and more and more.. Then , and only then, does something become part of the cannon of science.

    And replication from different groups globally is not even enough…

    In science, the more important your discovery , the more important it is to verify it. Scientists do this not only through replication BUT ALSO developing many different independent testing techniques and methods. When all of these multiple techniques/methods of testing point int he same direction or get the same result , it is very likely you are correct.

    Global replication from different scientific groups who are all using MANY multiple independent and different testing methods/techniques. That is what is needed and what was done int he discovery of Dark Matter and Dark Energy for instance.

    Peer – review is not the arbiter of ANYTHING. It is NOT the arbiter of truth whatsoever. It is often a bunch of stuffy codgers who are journal editors wanting to keep the status quo.

    There is talk of doing away with it entirely in favor of something better.

    Sincerely,
    Razwell

    Reply

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