Back in April I reviewed and recommended Cholesterol and Saturated Fat Prevent Heart Disease – Evidence from 101 Scientific Papers, a book by David Evans, who somehow manages to maintain and constantly update a huge collection of study abstracts and synopses on his Healthy Diets and Science website.

After I posted that review, David asked me if I’d write the foreword for his next book, another collection of 101 studies which suggest that low cholesterol – despite everything we’ve been told – isn’t good for us.  I agreed, wrote the forward, then forgot about it until I received a copy of the new book this week.  I was actually a bit surprised when I saw Foreword by Tom Naughton in the table of contents.  Must be my advancing age.

Anyway, I like Low Cholesterol Leads to an Early Death — Evidence From 101 Scientific Papers for all the same reasons I like the previous one.  It’s not a book you’ll sit down and read for pleasure, but it’s an excellent, easy-to-use reference to keep on your bookshelf.  I frequently receive emails from readers asking me to point them to research they can wave in front of worried family or friends and say, “See?  Saturated fat isn’t going to kill me, and no, I don’t need to take the @#$%ing statin the doctor is pushing on me!”  (Or words that effect. )  If 101 studies won’t do the trick, nothing will.

As in the previous book, for each of the 101 studies there’s a title, a citation so you can look up the study yourself, and a brief summary with occasional commentary by Evans.  Papers published in medical journals tend to have sleep-inducing titles along the lines of Low-density lipoprotein as a predictor of mortality in a cohort of elderly Scandinavian patients, so Evans provides more colorful titles that get to the point.  You’ve got to love opening a book and seeing titles like these:

Heart attack survivors live longer if they have high cholesterol

Low cholesterol levels increase the risk of death from stroke, cancer and all causes

Low cholesterol levels predict death in patients with bacteria in the blood

Colon cancer deaths increase in men with low cholesterol

Many of these studies (and there are many of them) have been around for decades.  I doubt most doctors have ever read the studies or even heard of them.  If they had, I don’t see how they could possibly believe prescribing statins to beat down an elderly patient’s “high” cholesterol is a good idea.  As Evans writes in the book’s introduction:

The “high cholesterol is bad for your health” myth has survived for five or six decades.  The myth is why health-care practitioners, media advertisements and family and friends keep pressing home the message we should lower our cholesterol.  The myth is why, despite mounting scientific evidence showing the opposite, we are still advised to lower our cholesterol. The myth is why we are told we should eat tasteless, manufactured low-fat products to lower our cholesterol. The myth is why millions of healthy people are subjected to statins drugs (and their many side effects) that will lower our cholesterol.

The myth survives largely because the millions of people buying cholesterol-lowering cereals and swallowing cholesterol-lowering drugs represent billions of dollars in revenues.  We can’t change that.  But we can arm ourselves with evidence and hope to convince a few loved ones that lowering our cholesterol isn’t necessary or even a good idea.

If you’re arming yourself, this book is a great addition to your arsenal.

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32 Responses to “Book Review: Low Cholesterol Leads to an Early Death”
  1. I have David Evan’s first book – excellent! I just ordered this one. Thanks for bringing it to my attention, Tom!

  2. Ash Simmonds says:

    Been skimming it since it was released a week or two ago, I think nowadays I just buy these books out of habit even though there’s not much for myself left to be convinced of, but it’s good to have it there handy should I ever need it.

    Still, it baffles me how we got here, as in all one person needs is to say “high cholesterol is bad” and that comes across as a “yeah duh” assertion, but to counter that even a swimming pool full of lipoprotein research ( http://highsteaks.com/forum/whatever/cholesterol-52.0.html ) will be hand-waved away like it’s unimportant speculation.

    Guess we’re stuck with the scenario of cholesterol keeping its bad rap until everyone who doesn’t know better dies of not having enough.

    I don’t need to be convinced either, but I like having convenient collections of references.

  3. gallier2 says:

    Is the foreward thing an american thing? I thought it was foreword, like in the words that are before the book?
    Ok I checked and it’s an error on your part, sorry. You even mixed the 2 words.
    http://grammar.quickanddirtytips.com/forward-versus-foreword.aspx

    I apologize for being a grammar nazi but it surprized me a lot, because you’re usually one of the better spellers.
    You don’t need to publish that comment.

    I’m a grammar nazi as well, so I appreciate the heads-up. By writing “forward,” I may have been subconsciously supporting our president’s reelection, since that’s his campaign’s theme.

  4. NowyChris says:

    I don’t want to sound like too much of a devil’s advocate, but is there any evidence that, for certain people, low cholesterol can be a good thing?

    I ask because I’ve been low-carb/ketogenic for most of the year (January to Mid-June) before returning home to lower-fat, whole-foods cooking (grainless, and I try to add in butter/sour cream whenever possible). In August I had some bloodwork done and my cholesterol was actually lower than during my paleo experiment from last summer (from 149 to 121 total, LDL from the 90s to 70s, HDL from 53 to 43, but trigs went down from 55 to 33). I was actually surprised that this happened, and left me wondering if this is indeed the kind of result I was looking for. A part of me also suspects the doctor divided all the recent numbers by 1/2 to avoid prescribing statins, but I have no idea what his views are on them.

    Otherwise I’m “perfectly” healthy, young (23), and I haven’t had a fever in years (not saying “not sick” as a result of very rare cases of food poisoning, but my recovery is rapid).

    My belief is that your body knows how much cholesterol it needs to make. For some that will be low, for others it will be high. That assumes, of course, that you’re on a good diet.

  5. eddie watts says:

    http://donmatesz.blogspot.co.uk/2012/09/grass-fed-animal-products-prevent.html

    care to comment on this? not been looking at his site for some time but stumbled across this today.

    Interesting, but I don’t see those results in other traditional cultures. Where were all the fat, sick Plains Indians when they still lived on buffalo?

  6. Marilyn says:

    Tom wrote: “I agreed, wrote the forward, then forgot about it until I received a copy of the new book this week. I was actually a bit surprised when I saw Foreword by Tom Naughton in the table of contents. Must be my advancing age.”

    Well, you’re OK until you get to the point of one absent-minded professor. He went to a book store, picked out a book he thought looked interesting, and later discovered he had written it!

    I hope to avoid being quite that absent-minded.

  7. Lori says:

    With a total cholesterol of 140, I guess I’m living on the edge.

    If you’re on a good diet, I wouldn’t worry about it.

  8. So what tests should we be getting? I know you’ve written about this before, so I’m hoping you have your stuff indexed better than I do.

    I’ll be going to a new doc, and the first checkup will probably include the standard battery of blood work. I know giving a single cholesterol number is useless, that triglycerides are more important, and that the method of calculating one of the cholesterol numbers is indirect and misleading anyway. So if you were going to a doc for the first time and wanted to know the numbers that really matter, which would they be?

    All I really care about is my triglycerides/HDL ratio. Under 2.0 is good, close to 1.0 is better.

  9. Jason Brady says:

    Out of the 101 studies, are they all clinical? What is the ratio of clinical studies to observational studies?

    Some are clinical and some are observational. I’m not sure of the ratio. Observational studies don’t provide proof of a hypothesis, but they can be strong evidence that a hypothesis is wrong. If I propose that grey hair causes heart disease and we find an association between between grey hair and heart disease, that doesn’t prove cause and effect. However, if we find no association or a negative association, then it’s extremely unlikely that grey hair causes heart disease.

  10. Bret says:

    Awesome! Can’t wait to pick it up. My 85-year-old grandmother’s doc put her on a statin (grrrrrrrrrrrrrrrrrr!!!), and I have been biding my time for when and how to address this issue. I’ve learned through experience that people tune you out when you tell them their physician is giving them bad advice/drugs. Being that I’d like my five-week-old daughter to actually get to know her great grandmother and have some memories of her, I want to get this one right. Hopefully this book will give me the ammo I need.

    Statins for an 85-year-old woman … that’s just nuts.

  11. johnny says:

    I ordered a copy, although it won’t make a difference arguing with doctors.

    I have five doctors in my family and they all subscribe to the low cholesterol paradigm.

    What a battle in family reunions.

    However, in the last one, the oldest one – after a few chivas regals – admitted to me PERSONALLY that the paradigm was good for business.

    All right, let’s start giving doctors bottles of scotch and then talk about cholesterol with them.

  12. DebbieC. says:

    Very cool. I just ordered both books! I don’t need convincing either, but also like the idea of having them around for a convenient one-stop reference in case I would want to show them to a doctor.

  13. Rocky Angelucci says:

    Thanks for the review. I’m ordering it now.

    This will be a great tool for warding off low-cholesterol zombies this Halloween season.

    You can also hold up a cross made out of bacon.

  14. Nowhereman says:

    “Out of the 101 studies, are they all clinical? What is the ratio of clinical studies to observational studies?

    Some are clinical and some are observational. I’m not sure of the ratio. Observational studies don’t provide proof of a hypothesis, but they can be strong evidence that a hypothesis is wrong. If I propose that grey hair causes heart disease and we find an association between between grey hair and heart disease, that doesn’t prove cause and effect. However, if we find no association or a negative association, then it’s extremely unlikely that grey hair causes heart disease. ”

    Jason, Tom, I think the most telling and important thing about this that the observational data IS backed up by clinical. If the book was all observational, then the argument could be made that “correlation does not always equal causation”, but the fact that this book shows that observations’ correlations are proving to be causation, lends it that much more credibility. That is how the scientific method should work; you make observations, propose a hypothesis, and then test it rigorously. But in this case we now know that the Lipid Hypothesis is flat out wrong and needs to be discarded in favor of something else.

  15. Marilyn says:

    Tom wrote: “Statins for an 85-year-old woman … that’s just nuts.”

    And even nuts-er is statins for a nearly 95-year-old woman who’s been progressively losing her short-term memory. And, oh yes, she’s been on that stinkin’ statin for many years.

    That is nuts-er.

  16. LurkerWhore says:

    Sorry, meant to link to this youtube:

    “This doctor’s presentation is basically Fathead—and even splices some liberal (heh) Fathead clips in his presentation.”

    Did he contact you?

    No, I’ve never heard from him. Looks like he used the clips I uploaded to YouTube, which is okay by me, but it would have been nice if he’d named the source.

  17. Marilyn says:

    I went and looked around David Evans’s website. Maybe I would find the answer to this if I spent more time there, but do you know if all the %s he throws around are relative or absolute percentages?

    Percentages are usually relative.

  18. Nathaniel Russell says:

    There was a cholesterol drug commercial on TV the other day. It said it was possible to lower your cholesterol below 100. I thought that was ridiculous!

    The fact that your body produces it is reason enough that it isn’t bad. Why would your own body be trying to kill you?

    Your body apparently wants to support Pfizer and Merck.

  19. Walter B says:

    Colesterol below 110???? Isn’t that well inside the danger zone? I suppose the powers that be aren’t considering suicide, murder or being murdered in their assessments. Much less are they considering just becoming T-totally obnoxious.

    Their blinders only allow them to look at heart-disease numbers.

  20. Wiz says:

    Re: The Mongols, quoting from the article:

    “2. The residents of Murun, a north Mongolian city, eat large amounts of meat, milk, dairy products, and wheat flour products, but little vegetables, fruits, or fish.”

    Aren’t dairy and wheat the first two things you are supposed to avoid?

    Wheat is certainly at the top of my to-avoid list, along with sugar.

  21. Firebird says:

    I would love to send this book, along with Fat Head, Why We Get Fat, The Sugar Fix and the Meat Fix to my doctor, anonymously. I don’t like being condescended to by him, and he’s good at it.

    That’s why the punchline of the old joke is “No, that’s God. He just thinks he’s a doctor.”

  22. Carl says:

    Does the book get into LDL-P counts, or is it focused on debunking old style Cholesterol measures?

    I didn’t see studies specifically dealing with particle counts. Most of the studies refute the theory that high total cholesterol or high LDL are dangerous.

  23. LurkerWhore says:

    I think dairy is a special case.

    Certain cultures (famously, many north American Indian tribes) never had dairy as part of their diet until the last millennium.

    But others, such as the ancient Irish, had a lot of dairy; in fact, a shockingly large portion of the ancient Irish diet was milk or milk based. They had as many names for types of milk as the proverbial (but I’m told apocryphal) names that Eskimos have for snow. And the ancient Irish were never known to be fat.

    Since there is known lactose intolerance, whether milk is “bad” for you might be gene based; Mongolian, Irish DNA might thrive on it, while it may make an American Indian’s body sick.

    Anyway, that’s my long shot argument. I still eat cheese and drink milk and have lost 15 lbs on a paleo-fathead diet. And I tell everyone to watch your movie. I even converted a very fat hot dog vendor, and he told me he’s lost 10 (I haven’t seen him since he started on it).

    It’s not such a long-shot argument. Our ability to handle certain foods is very likely a function of how far back in time our ancestors adopted them. Grain were grown in the Middle East perhaps 12,000 years ago, but only reached Ireland and Scandinavia 3,000 – 4,000 years ago. So it’s no surprise that the Irish and Scandinavians have higher rates of celiac and other forms of grain intolerance.

  24. @Nathaniel

    I believe the statin ad stated it would “reduce ‘bad’ cholesterol below 100.”

    They’re evil bastards, but they know better than to kill their human revenue streams.

    Cheers

  25. Sally N says:

    “It’s not such a long-shot argument. Our ability to handle certain foods is very likely a function of how far back in time our ancestors adopted them. Grain were grown in the Middle East perhaps 12,000 years ago, but only reached Ireland and Scandinavia 3,000 – 4,000 years ago. So it’s no surprise that the Irish and Scandinavians have higher rates of celiac and other forms of grain intolerance.”

    So, where was the obesity epidemic prior to the 1990′s if wheat has been around for 4,000 years? But no, I doubt it’s related to fast food. Can’t blame those big business as a feet sucking libertarian, now can we Tom?

    P.s. your stand up routine isn’t funny except maybe to a few burned out baby boomers who can’t watch Cosbey anymore because he’s senile.

    I take it you’ve neither seen Fat Head or read much of the blog. If so, your comprehension skills are severely lacking. What’s changed is that 1) We were told to base our diets on grains and starting eating more of them, and 2) the wheat itself was radically altered in the 1970s. It’s now a food that zero humans ate throughout human history.

    If fast food is to blame, where was the obesity epidemic prior to the 1990s, since fast food has been around since long before then? Or do you only apply that logic when it suits you? Once again, if you actually read the blog before chiming in, you’d see that I’ve posted about studies showing there’s no relationship between proximity to fast-food restaurants and obesity rates. Also, if you actually understood anything about libertarian beliefs, you’d know we don’t promote big business, small business, or any particular business. We promote freedom. There are plenty of big businesses that are only too happy to use the power of government to restrict economic freedom and squash their competition.

    Yeah, nobody finds my standup funny. That’s why all those comedy clubs and cruise ships kept booking me over and over.

  26. Judy says:

    @ LurkerWhore – Celiac disease damages the villi in the small intestine. The tips go first, which is where the lactase enzyme is released to break down lactose. Many people who are celiac are also lactose intolerant, simply because their villi have been damaged so badly. Some have been able to reintroduce dairy products back into their diet after healing their gut by going gluten-free.

    I guess what I’m trying to say is that I think most (not necessarily all) lactose intolerance is caused by grains. Too bad so many people (my family members included) think it’s easier to give up dairy products than to give up their bread.

  27. Nowhereman says:

    George McGovern, one of the big figures most responsible for our current dietary mess, is in hospice after a year of various health problems:

    http://news.yahoo.com/ex-presidential-nominee-george-mcgovern-hospice-233504330.html

  28. BA says:

    Coincidentally, David Evans also happens to be the real name of the guitarist from U2!

    Talented guy then, playing guitar and writing science books.

  29. The latest study David Evans has posted on his blog is about statins increasing pneumonia in service personel: http://healthydietsandscience.blogspot.co.nz/2012/10/statin-use-is-associated-with-higher.html
    there was a 15% increased risk.
    (these are the same small odds ratios seen in “meat will kill you” studies; the studies Evans uses often reverse the conventional wisdom using the same kind of barely-significant results as the studies that support it. The evidence either way is often weak; but in other cases, the benefit of high cholesterol is indeed clinically significant).
    Back to the study: I had a series of colds and flus (before I started taking ore vitamin D) a few years back and bought some Chinese mushrooms to get my immunity up. I chose Oyster mushrooms because they were cheap and I liked the taste.
    After a few days I came down with pneumonia.
    Oyster mushrooms are the natural source of statins.

    Why are they giving statins to military personell? Don’t they have standards of physical fitness in the military? Is this why they have to fight using robots?

    I’m sure Evans knows some of the increased risks are small in absolute terms, but I suspect he’s adding those studies to his list as ammo against people who cite similarly weak risks or benefits to promote low-fat diets or statins.

  30. Davida says:

    My husband retired last year after 20 years in the Marine Corps. A few years ago they gave him statins because his cholesterol was over 200 (I don’t remember the number, but I don’t think it was over 230, and may have been more like 205). They gave him Baycor first, then another. He had to stop taking them…. they were causing muscle weakness and interfering with his pt. You CAN’T be a proper Marine if you can’t even complete your normal pt routine.

  31. M. Aziz says:

    The cholesterol hypothesis is definitely a myth. The data shows no connection whatsoever between cholesterol and heart disease.

    However, a few things blur the matter; though early statins failed to reduce heart disease at all, current generation ones at least are fairly useful (ignoring side effects and death from something other than heart disease), but then they must be doing something else too.
    I think they mop up inflammation and fight against arterial calcification, albeit in an imperfect manner. How do they do this? Hate to be spammy, but visit my site and see if that stirs any interest.

    Yes, reducing inflammation is probably the key, since statins have the same (small) effect even on people who don’t have high cholesterol.

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