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?
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.