Tuesday, June 14, 2016

Credit is Due to Uffe Ravnskov, et al. (Updated and Abridged)

“I have lived to see a diffusion of knowledge, which has undermined superstition and error…”
  - Richard Price

[Author’s note: this article is dedicated to the memory of Margaret Heineman Cihocki, kind teacher, mentor, and friend to many, and is an updated and condensed version of an earlier posted article with the same name For background information, see also Cholesterol and the Structure of Scientific Revolutions.]

Although there is a steadily growing number of health providers adhering to and promulgating the benevolent cholesterol paradigm—cholesterol and its protein carriers benefit humanity—few recognize the paradigm’s main proponents.  Credit where credit is due: the foremost proponents of the benevolent cholesterol paradigm are Drs. Uffe Ravnskov, et al.

There have been other proponents of a benevolent cholesterol paradigm that engaged the forming malevolent tradition.  The first was Edward R. Pinckney, M.D., author of The Cholesterol Controversy (1973).  This book was followed up by the compendious Diet, Blood Cholesterol and Coronary Heart Disease, A Critical Review of the Literature (1991) in conjunction with Russell L. Smith, Ph.D.[1]  Other notable advocates include Michael Gurr,[2] George Mann,[3] Thomas Moore,[4] Raymond Reiser,[5] Ray Rosenman,[6] William Stehbens,[7] and Lars Werkö.[8]

John Yudkin, of Pure White and Deadly (1972) fame, was a proponent of the benevolent cholesterol paradigm.[9]  So too were Dr. Robert E. Olson, principal author of a report entitled Toward Healthful Diets by the Food and Nutrition Board of the National Research Council, individual members of that committee, and, the more fervent proponent, Philip Handler, President, National Academy of Sciences.[10]  These proponents, however, were not successful in attracting an enduring group of adherents.

According to the originator of term, Thomas Kuhn, a paradigm serves implicitly to define the legitimate problems and methods of a research field for succeeding generations of practitioners.[11]  Dr. Uffe Ravnskov is the foremost proponent of the benevolent cholesterol paradigm because of two essential characteristics in addition to defining the problems and methods.  His achievements—not only falsifying the lipid hypothesis but creating a new hypothesis that has been severely tested, remains un-falsified and makes better predictions—is sufficiently unprecedented to attract an enduring group of adherents away from competing modes of scientific activity.  Simultaneously, his hypotheses are sufficiently open-ended to leave all sorts of problems for the redefined group of practitioners to resolve.

We can now begin to think about Dr. Uffe Ravnskov’s contributions and the brilliant people that—while they work on their own projects—adhere to, criticize, discuss, refine, and promulgate them.

Drs. Ravnskov, et al., have most recently shown that in free-living populations without pre-existing disease, higher LDL-cholesterol predicts a lower risk of death in those over 60. See, "Lack of an Association or an Inverse Association Between Low-Density Lipoprotein Choleterol and Mortality in the Elderly: a Systematic Review," written by Drs Ravnskov, Diamond, Hama, Hamazaki, Hammarskjold, Hynes, Kendrick, Langsjoen, Malhotra, Mascitelli, McCully, Ogushi, Okuyama, Rosch, Schersten, Sultan, and Sundberg. Note that none of the authors have any competing interests to disclose. For a good summary of that article, please see Professor Grant Schofield's, "The New BMJ Review of High Cholesterol and Mortality in the Elderly."

You can watch and hear about the benefits of cholesterol in two interviews with co-authors Dr. Aseem Malhotra on Sky News here and Dr. Malcolm Kendrick on BBC Breakfast here.

Consider next reviewing, "Vulnerable Plaque Formation from Obstruction of Vasa Vasorum," by Drs. Uffe Ravnskov and Kilmer S. McCully (2009).  Learn here that lipoproteins referred to as good or bad—or even “lousy” by some popular doctors—by anti-rational proponents of the malevolent cholesterol paradigm more likely comprise the body’s secondary immune system. This non-specific immune system binds and inactivates microorganisms and their toxins by complex formation.  Importantly, the article also presents a testable mechanism for developing atherosclerosis and cardiovascular disease more satisfying than inanities such as cholesterol sticks to or penetrates the arteries.

Following up on a problem to solve from that article, Drs. Ravnskov and McCully published “How Macrophages are Converted to Foam Cells” three years later in 2012.  In their view, oxidized LDL is produced inside the macrophages as a side effect of their oxidation of microorganisms or their toxic products.

“Vulnerable Plaque Formation…” was a logical outgrowth of work dating back to 2003, when Dr. Ravnskov published a review of the many studies that have shown LDL to be protective against infections, and put forward the hypothesis that high cholesterol, rather than promoting atherosclerosis, protects against it.  See “High cholesterol may protect against infections and atherosclerosis.”

Supplementing this hypothesis, a leading adherent showed how neither cholesterol nor its carriers are the cause of familial hypercholesterolemia, a misnomer for LDL receptor deficiency.  See  You are a Very Black Swan Indeed,” by Dr. Malcolm Kendrick.

In “Cholesterol Lowering Trials in Coronary Heart Disease: Frequency of Citation and Outcome,” Dr. Ravnskov demonstrated that coronary mortality was not lowered by cholesterol lowering, but total mortality was increased.

For Dr. Ravnskov’s biography and a complete listing of his articles, see “My Life and My Work,” and “The Cholesterol Myths.”  For articles by many of the equally brilliant adherents of Dr. Ravnskov’s paradigm, see “Links,” on the THINCS website.  Dr. Ravnskov has also written three accessible books: The Cholesterol Myths (2000), Fat and Cholesterol are Good for You (2009), and Ignore the Awkward (2010).  You are encouraged to read them all. 

For Edmund Burke—the anti-rationalist author most noted for his 1790 book Reflections on the Revolution in France—resisting the temptation to construct a society from the ground up on the basis of untested rationality was the beginning of political wisdom and the essence of political prudence.  But after reading the works of Ravnskov, et al., perhaps even Burke would say of adherents of the lipid hypothesis—those traditionalists that continue to say artery-clogging cholesterol causes heart disease—that “Their science is presumptuous ignorance.”[12]  You yourself may come to that same conclusion.  Or you may conclude as I have, similar to how Ludwig Wittgenstein quipped about philosophy: “I have learned the jargon as well as anybody.  It is very clever and captivating.  In fact, it is dangerously captivating; for the simple truth about the matter is that it is much ado about nothing—just a lot of nonsense.”

For Further Reading

Burke, Edmund.  Reflections on the Revolution in France.  New Haven and London: Yale University Press, 2003, p. 68.   First published 1790.

Kuhn, Thomas S.  The Structure of Scientific Revolutions.  The University of Chicago Press, Chicago, IL, 2012.  First published 1962.

Popper, Karl.  Conjectures and Refutations.  New York: Routledge Classics, 2002.  First published 1963 by Routlede & Kegan Paul.


[1] For a particularly good historical overview of the developing tradition in the United States, see Smith, Russell L. and Pinckney, Edward R.  Diet, Blood Cholesterol and Coronary Heart Disease, A Critical Review of the Literature.  Sherman Oaks: Vector Enterprises, 1991, V. 2, Chapter 2. 
[2] See, for example, Dietary Lipids and Coronary Heart Disease: Old Evidence New Perspective,” Michael I. Gurr, Prog. Lipid Res. Vol. 31, No. 3, pp. 195-243, 1992.  Article.  For something more recent, see Gurr, Michael I.  Lipids in Nutrition and Health: A Reappraisal.  Isles of Scilly, UK: The Oily Press, 1999, 2009.  Book.
[3] See for example “Dr. George Mann Says Low Cholesterol Diets are Useless, but the ‘Heart Mafia’ Disagrees,” by Kent Demaret and Judith Weintraub, People Magazine, January, 1979.  Article.  See also Mann, George V.  Coronary Heart Disease: The Dietary Sense and Nonsense.  London: Janus, 1993.  He is most known for having said, “The diet-heart hypothesis has been repeatedly shown to be wrong, and yet, for complicated reasons of pride, profit and prejudice, the hypothesis continues to be exploited by scientists, fund-raising enterprises, food companies and even governmental agencies. The public is being deceived by the greatest health scam of the century.” There is also the shorter version of the comment: “Saturated fat and cholesterol in the diet are not the cause of coronary heart disease. That myth is the greatest ‘scientific’ deception of the century, and perhaps any century.”  See Diet-Heart: End of an Era,” George V. Mann, Sc.D., M.D., N Engl J Med 1977; 297;644-850, Sept. 22, 1977.  Article.
[4] Although flawed, see Moore, Thomas J.  Heart Failure.  New York: Touchstone Books, 1989.  A chapter from the book was published in the Atlantic Monthly a few months before the book was published.  See “The Cholesterol Myth,” T.J. Moore, The Atlantic, Vol. 264, September, 1989, p. 37(25), ISSN: 0276-9077.  Article.
[5] Keys’s idea that a high intake of saturated fat raises cholesterol was questioned by Raymond Reiser  in 1973.  In a thorough review of 40 trials he pointed at several types of methodological and interpretational errors.  See Reiser, R.  “Saturated fat in the diet and serum cholesterol concentration: a critical examination of the literature.”  Am J Clin Nutr 1973: 26; 524-555.  Article.
[6] In an extensive review, Rosenman found that serum cholesterol is not strongly related to or primarily regulated by diet. He also cited widespread discordant beliefs about a causal role of diet in coronary artery disease.  See Rosenman, RH, “The Independent Roles of Diet and Serum Lipids in the 20th-CenturyRise and Decline of Coronary Heart Disease Mortality.”  Integr Physiol Behav Sci.  1993 Jan-Mar;28(1):84-98.  Abstract: Risk factors are causally related to coronary heart disease (CHD), but in widely varying historic, geographic, socioeconomic, and individual relationships.  Serum cholesterol is only one of many risk factors that, even when considered together in prospective studies, account for well under half of the CHD incidence. It is neither primarily regulated by the diet nor significantly related to it. Many findings discordant with widespread beliefs about a causal role of the diet in CHD are reviewed. It may be concluded that dietary fats are largely not responsible for relationships of serum cholesterol to CHD, or for its 20th-century rise and decline.  Article.
[7] See for example, “Science, Atherosclerosis and the “Age of Unreason”: A Review,” Stehbens, WE, Integr Physiol Behav Sci. 1993, Oct-Dec;28(4):388-95.  Article.
[8] See for example “Risk factors and coronary heart disease—facts or fancy?”  Werkö, Lars.  American Heart Journal.  Volume 91, Issue 1, Pages 87-98, January 1976.  Article.
[9] See, for example, Dr. Yudkin’s letter published in the British Medical Journal, October 3, 1964, p. 874.  Letter.
[10] For an interesting summary of the issues between Toward Healthful Diets and Diet, Nutrition, and Cancer, see the National Academy of Sciences’ Reports on Diet and Health—Are They Credible and Consistent?   Report by the U.S. General Accounting Office, August 1, 1984.  FullText.
[11] Kuhn, Thomas S.  The Structure of Scientific Revolutions.  The University of Chicago Press, Chicago, IL, 2012, p. 10-11.
[12] Burke, Edmund.  Reflections on the Revolution in France.  New Haven and London: Yale University Press, 2003, p. 68.   Originally published 1790.

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