From The Health Journal Club comes this book review of the book by that name by Uffe Ravnskov.
Wednesday, January 26, 2011
Book Review: "Fat and Cholesterol are Good for You!"
Uffe Ravnskov, MD PhD
Fat and cholesterol good for your?? Why its preposterous I tell you! And if this wasn't such a serious and important topic it might be worthwhile to spend a good deal of time simply on the reaction of mainstream medicine to Dr. Ravnskov's positions. To point out how this medical doctor, nephrologist and PhD could not get an English language publisher for his first book on the topic, "The Cholesterol Myths" until Sally Fallon in the alternative medicine field published it through her own company. How, despite being literally burned on a Finnish talk show, the original book was in such demand that it was selling often selling for well over 100 dollars for a used copy until the publication of the current book. Even with the publication of "Fat and Cholesterol are Good for You!" which covers and expands upon the material in the first book, used paper back copies of The Cholesterol Myths sell for over twenty dollars and new copies around $40.
The topic of heart disease is a serious one, however, and rather then spend more time on the reaction to these writings it is necessary to try and at least scratch the surface of what Dr. Ranvskov is actually saying. This is not so easy in that the numerous chapters are wide ranging, controversial and generally include some 30 - 70 references a piece. While it has become more fashionable recently to question the cholesterol lowering campaign, to my knowledge, even to the present no one has put together such a well-referenced, well organized and cogent critique of the cholesterol lowering campaign as Dr. Ravnskov. Personally, this was the first book I read which led me to begin to question much of the conventional medical wisdom I had been taught in medical school and beyond. If cholesterol lowering for heart disease may be in error, what other precepts of modern medicine might not be equally idolatrous? I also suspected when I first heard of this book, that despite the author's credentials it would almost certainly be laughably bad, well I was in for a surprise.
While every medical student is taught the results of the vaunted Framingham study which underpins much of the cholesterol lowering campaign, a stance reinforced by unanimity among instructors and peers, as well as a nearly unavoidable multi decade media blitz, Dr. Ravnskov did something I never had, he went back and looked at the relevant medical literature with a critical eye and a fine tooth comb. So for example, one learns that the Framingham study was an exception to more numerous studies at the time which found no association between cholesterol and heart disease. Without going into the compelling detail found in the book, the Framingham study itself, upon examination is shown to have serious methodological flaws which call into question it's conclusions. Similarly, multiple studies since the Framingham study, have also not documented an association between cholesterol levels and heart disease. Once the cholesterol heart disease meme became entrenched, and while not dwelt on by the author, financially profitable, the discrepant findings were ignored or explained away, often with quite convoluted reasoning.
Mainstream medicine, though it knows better, often presents cholesterol as some unmitigated evil which by happenstance exists only to predispose one to heart disease. If it only could be eliminated, there would be no more heart disease. Cholesterol itself though, is not some aberration of physiology, it is present in all membranes and is involved in numerous crucial metabolic pathways including production of steroid hormones among others. Dr. Ravnskov also points out the anti-infective properties specifically of cholesterol in conjunction with low density lipoprotein, LDL cholesterol, and notes numerous other examples of cholesterol's protective effects in disease states. To suppose that there is not the potential for deleterious effects from lowering such a ubiquitous and important molecule as cholesterol makes about as much sense as saying there is no lower healthy boundary for glucose, sodium, aldosterone etc.
Indeed, regulation of cholesterol levels is so important that dietary changes in cholesterol are compensated for by endogenous production of cholesterol by the liver. While this fact is often obliquely acknowledged by physicians Dr. Ravnskov does an excellent job of documenting that diet has zero effect on cholesterol level.
In similar fashion, the author refutes the decades old contention, first popularized by Ancel Keyes that saturated fat plays a significant role in either heart disease or obesity. Considering the enormous efforts undertaken to provide consumers with "low-fat" alternatives to all manner of healthy traditional foods it somehow feels both liberating and subversive to realize the whole low fat edifice is based on a foundation of sand. The unspoken jab in so much of the low fat marketing is that if one doesn't buy their product one is somehow a glutton. How freeing to know that if you like a big slab of grass fed cow butter on your bread you are neither being unhealthy nor any more likely to put on excess weight. Certainly the attempt to restrict dietary fat has failed miserably as a means of decreasing obesity rates. After reviewing the literature, the author concludes that you are no more likely to get fat from eating fat then you are likely to turn green from eating green vegetables.
This review has really barely scratched the surface of this mind bending, meticulous and important work. I could go on for much greater length on this book, however, Dr. Ravnskov has also just released a new work, Ignore the Awkward: How the Cholesterol Myths Are Kept Alive, and I want to give myself time to read and hopefully review that one as well. As I mentioned, heart disease is both a serious and important topic, for those who are interested in their health, it is likely worthwhile to consider the findings of one who has done an honest and exhaustive review of the literature in this area rather than only solely and uncritically accepting the stance of a media campaign for a thirty billion dollar a year industry that says buy our pill or you'll drop dead. While I don't want to overly simplify a complex topic, I suppose if there were one dramatic medical literature based finding brought out in this book that has really stuck with me it is that, on average, elderly people with high cholesterol live longer. Whoda thunk it.
"Fat and Cholesterol are Good for You" is available at Amazon.