"The Cholesterol Myths" - opinions?

[jimtron]

I'd love to hear opinions on this book, especially from those with expertise in this area. I did find a few related threads. A related title is "Nourishing Traditions: The Cookbook that Challenges Politically Correct Nutrition and the Diet Dictocrats" (this title sounds a bit strawmanesque to me).

I have not yet read Cholesterol Myths, which may answer this question, but how could organizations like the American Heart Association be so wrong (if Ravnskov is right) about cholesterol's effect on heart health? I'm all for questioning authorities and conventional wisdom, but I must say that so far I'm skeptical about the book.

From a Ravnskov article, The Benefits of High Cholesterol:

People with high cholesterol live the longest. This statement seems so incredible that it takes a long time to clear one´s brainwashed mind to fully understand its importance.

Ok, brainiacs, what do you think?

Or is this just good cholesterol/bad cholesterol confusion?

 

[skeptifem]

they dont really explain what is causing narrowing of arteries if it isnt cholesterol. i see it when people eat something full of fat before coming in for a blood draw, the serum in the blood becomes completely opaque as a result of the fat. I honestly dont see how this could not build up in the vascular system and cause artery narrowing/hardening(unless they are saying it doesnt happen- which is completely insane!). If they had a more plausable idea of what could cause that I would be much more willing to listen, but all they offer is denial.

they also focus solely on heart attacks when its not the only vascular problem people suffer. also, they focus on old people, and obviously they die of all sorts of things, its not as though elderly people arent at a higher risk of heart attacks because more of them die of other medical problems first.

 

[Dymanic]

I must say that so far I'm skeptical about the book.

I must say I think your instincts are good there.

is this just good cholesterol/bad cholesterol confusion?

No, it's not. It's part of a whole ball-o-confusion, an approach to health and medicine which seems (to me) best described as "contrarian". Basically, you just look at whatever mainstream medicine has to say about a subject, and embrace whatever the opposite of that would be. Don't vaccinate, don't do root canals, don't pasteurize milk, etc. Oh yeah, and absolutely chelate (yikes). Whatever idea strikes your fancy, it probably won't be hard to find support for it in some book or other written by someone with letters after his name (just what letters doesn't seem to matter very much). Dr. Weston Price, DDS is another contrarian hero.

Arguing science with contrarians is a lot like arguing science with creationists. It seems like easy sport at first, if not very sporting. Like wrestling quadraplegics. It becomes tiring after a while, though, once you realize that no matter how many times you pin them to the mat, they're never -- EVER -- going to give up.

"These contrarians call themselves skeptics but their goal is not to examine all the evidence and think critically about it in the large context of our medical knowledge. Their goal is to cherry pick data to support their contention that low cholesterol is bad for you and high cholesterol is positively good for you."

http://skepdic.com/refuge/bunk28.html

 

[casebro]

Have you heard the TV commercials that say "our drug has NOT been shown to prevent death"?

The assumption that is upheld by many statin studies is that "Taking Cholesterol Medications Prevents Heart Attacks". Well, it seems to. It also lowers cholesterol. But commonality is NOT causality.

Other cholesterol lowering medications lower cholesterol, but don't lower CVD rates. Also, in head to head studies, taking an aspirin tablet seems to do 80% of exactly what statins do. So, as I see it, statin drugs work via their anti-inflamatory action, not via cholesterol lowering. There is a huge CRP tie to statins. (CRP is an indicator if inflamation).

So, amongst all the other health problems that I have, I suffered my first heart attack 5 years ago, at 49. Three angiplasties so far, with 7 stents. My choleesterol levels have usually been about 230- not high enough to casue that kind of premature problem. I can't abide statins, due to a pre-existing myopathy. Nobody in my family can. Then, about 5 weeks ago, I tried a Gluten Free diet. Wa-Laa, everything about me has gotten better. I suspect that my sub-clinical allergy to gluten was inflammatory. Now my skin is better, crotch rot is gone, fungal toe nail fell away with it's fungus. I'm needing less insulin, suffering much less myopathy, less ear wax poduced, better cardiovascluar endurance, lower blood pressure, my hair is better, my children smarter.

So, I'm voting inflamation, NOT cholesterol. Peanut allergies can kill, immediately. 25% of us have the gene for Gluten Intolerance. How many of us have other sub-clinical allergies? What are their long term effects? Is anybody even looking, or do they think Cholesterol is the be-all?

Oh, I migth add that Cholesterol level is the #5 risk factor for CVD. In approximate order: Age, Heredity, Weight, Height, Cholesterol. It is the top CONTROLLABLE risk factor, but just ain't worth a damn as far as CAUSE.

 

[Dymanic]

The assumption that is upheld by many statin studies is that "Taking Cholesterol Medications Prevents Heart Attacks".

It is upheld by statin studies, yes. Just what you'd expect if the underlying assumption -- that high cholesterol is a significant risk factor for heart attack -- is valid. That assumption was not arrived at by statin studies, however.

I suffered my first heart attack 5 years ago, at 49. Three angiplasties so far, with 7 stents.

Yikes.

My choleesterol levels have usually been about 230- not high enough to casue that kind of premature problem.

Probably not, but it's not like there's some magic number at which it "causes" a problem; by itself, 230 is high enough to place you at increased risk, particularly in the presence of other risk factors such as those you mention.

I can't abide statins, due to a pre-existing myopathy.

When I got a score like that, my doc wanted to write me for Lipitor. I says: "give me a chance with diet and exercise first". I had it down to 160 in less than a year. What's your cholesterol now?

Then, about 5 weeks ago, I tried a Gluten Free diet. Wa-Laa, everything about me has gotten better. I suspect that my sub-clinical allergy to gluten was inflammatory. Now my skin is better, crotch rot is gone, fungal toe nail fell away with it's fungus. I'm needing less insulin, suffering much less myopathy, less ear wax poduced, better cardiovascluar endurance, lower blood pressure, my hair is better, my children smarter.

It's not just that that's way more detail than I would have asked for, it's that it doesn't include any of the right kind of detail. Besides eliminating gluten, have there been any other recent changes in your diet or lifestyle?

So, I'm voting inflamation, NOT cholesterol.

Voting?

How many of us have other sub-clinical allergies? What are their long term effects? Is anybody even looking, or do they think Cholesterol is the be-all?

I assume that your questions are rhetorical. Of course they're looking. You must know this. The answers are less definitive than is the case with cholesterol. Nobody thinks cholesterol is the be-all, but while we wait for better answers regarding other mysteries, enough is know about the effects of high cholesterol to justify certain recommendations.

It is the top CONTROLLABLE risk factor, but just ain't worth a damn as far as CAUSE.

If all you're saying is that a risk factor isn't the same thing as a cause, then I certainly can't disagree; but it seems like a fairly trivial observation. The claims being made by Ravnskov and his ilk are less trivial, and also less agreeable.

 

[JoeTheJuggler]

Isn't there anything yet that directly shows whether or not cholesterol is involved in forming plaque? I think that's the smoking gun they're holding out for.

 

[Dymanic]

Isn't there anything yet that directly shows whether or not cholesterol is involved in forming plaque?

It is well known that cholesterol is an important component of plaque (not hard to determine; just scrape some of the stuff out of an artery and analyse it) and that plaque forms more readily when levels of cholesterol are high (which pretty much follows). It is also known that there are other factors. One of these, as casebro notes, is inflammation. What isn't well known is the importance of the role of cholesterol relative to these other factors. BTW, taking (say) inflammation as the starting point, you'd end up at the same place: yes, it is a factor; no, it probably isn't enough by itself to produce plaque; and no, we don't know all the details. Whatever the ultimate truth is, we aren't going to reach it by popular vote.

Cholesterol isn't foreign to the body; it is produced in the liver and transported to places where it is needed to form cell membranes, nerve sheaths, hormones. You need cholesterol, but since it is produced in-house, you don't need to ingest it -- but, for the same reason, not ingesting much of it may not be enough to insure that you don't have too much of it in your system; plus, even if the total amount of cholesterol is ok, plaque can still form if too much of it is LDL versus HDL.

 

[Eos of the Eons]

Your liver will make the cholesterol with whatever you dump in your body. There are good fats, and bad fats. http://www.americanheart.org/presenter.jhtml?identifier=180

There's also genetics behind how you build up cholesterol in your body. I don't eat sooo much fat, and am not overweight, but I have high cholesterol. So I try to watch what I eat and exercise too:
http://heartdisease.about.com/cs/cholesterol/a/raiseHDL.htm

So, when those numbnuts say that people with high cholesterol live longer, did they verify what kind of cholesterol it is that these supposed long-lifers have?

I'd also like to see the study protocols behind their claims.

I can also ask Harriet Hall about the sources. She had it out with the guy who presented at TAM about so-called "cholesterol myths". Basically it was all very messy, and Harriet was able to demonstrate the flaws in the information included in the presentation. Then they had a drawn out email exchange that was quite over my own head.

I'll give it a go, and see if she can comment on the topic again.

 

[jimtron]

I'll give it a go, and see if she can comment on the topic again.

Swell, thanks.

 

[The SkepDoc]

Harriet Hall (The SkepDoc) Replies

For a start, you might want to read what the Skeptics Dictionary has to say about Ravnskov's book at http://skepdic.com/refuge/bunk28.html

Ravnskov makes some good points, but he doesn't put them into perspective. There have been plenty of good reviews of all the literature, including the studies that Ravnskov cites, and the consensus of scientists is clearly not consistent with Ravnskov's claims. Our understanding of the link between lipids and heart disease is being rapidly refined, so some of the arguments he makes are to a straw man that no longer exists. This is a complex subject: heart disease is multifactorial, and it is easy to find studies that seem to support almost anything. Ravnskov and others have formed a group of International Cholesterol Skeptics, and that in itself is cause for concern. Science doesn't advance through activist groups, but through better evidence. There was no need for an International Ulcer Skeptics group to convince the world to treat H. pyloris with antibiotics.

Some of you will remember an extensive debate I had with Dr. Deutsch a little over a year ago. He is one of Ravnskov's disciples. It should be available in the archives. In particular, we went into great detail about the pros and cons of statins, what they have and haven't been shown to do, the risk of side effects, the need to consider all risk factors and prescribe selectively, the difference between primary and secondary prevention, and the NNT (number needed to treat) to benefit one patient.

The idea that people with high cholesterol live longest misrepresents what the data actually show. Low cholesterol can be a marker for malnutrition, cancer, and chronic disease, and this confounds the statistics. When you look at groups of matched patients who are otherwise healthy, higher LDL cholesterol and lower HDL cholesterol are consistently associated with greater cardiovascular risk.

 

[fls]

Some of you will remember an extensive debate I had with Dr. Deutsch a little over a year ago. He is one of Ravnskov's disciples.

I just went looking for the thread. I didn't realize that you were Dr. Hall, the author of one of my favourite lines (in Skeptic Vol 12, No. 3); "Deutsch's article was so flawed that several of us seriously questioned whether he had written it as a spoof of how not to do science." I still remember the delicious thrill (and relief) it gave me to read that, because it captured my sense of bewilderment.

Linda