Does High Cholesterol REALLY Cause Heart Disease?
December 05 2009 | 61,668 views
An Interview with Uffe
Ravnskov, MD, PhD
When did you begin to suspect that
the cholesterol theory of atherosclerosis might be wrong? What led you
to this conclusion? Before then, had you believed in the cholesterol
theory? Was this part of your training?
I have never thought that it was true.
I heard about it for the first time in 1962 shortly after getting my
MD. My biochemical knowledge was still intact at that time and I knew
that cholesterol was one of the most important molecules in your body,
indispensable for the building of your cells and for producing stress
and sex hormones as well as vitamin D.
The idea that cholesterol in the blood
should kill us if its concentration is a little higher than normal,
as they wrote in the Framingham paper, seemed to me just as silly as
to claim that yellow fingers cause lung cancer.
Would you tell my readers about your
training, publications, university appointments, other professional
The first seven years as a doctor I worked
in different medical departments in Denmark and Sweden. In 1968 I started
my academic career at the Department of Nephrology, University Hospital
in Lund, where I got my PhD. After a few years I organized a research
team to investigate the association between hydrocarbon exposure and
Unfortunately I caught one of my coworkers
in producing a fraudulent paper. It was unfortunate, because it is risky
to be a whistleblower in the academic world. Instead of excluding the
fraudulent researcher it was my research that was questioned. The resistance
against my research from my superiors became intolerable, and I therefore
decided to go into private practice.
Nevertheless I succeeded in publishing
the main part of my research in major medical journals after having
left the department. I have summarized my
findings and conclusions on the web as well.
In the late eighties the cholesterol
campaign was started in Sweden. I was very surprised because I couldn’t
recall anything in the scientific literature in support of it. I started
reading it systematically, and I soon realized that I was right.
Since then I have published about eighty
papers and letter, and also books, translated into five languages, where
I present my arguments and criticism.
How has your work been received by
your colleagues; by healthcare professionals and consumers around the
In the beginning nobody took notice.
To ignore criticism is the most effective way to maintain a false idea.
My first book was published in Sweden in 1991 with a Finnish edition
shortly afterwards. The Swedish one made no impact whatsoever, and the
Finnish one was put on fire in a television show.
Ridicule and slander have been used as
well, as a means to muffle me
After I had aired my warnings against
statin treatment in Dutch television, for instance, Dutch researchers
described me in a following show as a crackpot who had been kicked from
the universities of Copenhagen and Lund. The directors of the show offered
my critics a possibility to discuss the issue with me on television,
but all of them declined. On his blog, Michael Eades has described
how one of them later on belittled me in a scientific paper.
But I have also realized that I am not
Seven years ago I started THINCS, The
International Network of Cholesterol Skeptics (www.thincs.org),
which by now includes about eighty doctors, professors and other researchers
from all over the world, who share my skepticism, and I have received
two international awards for my contributions.
Also encouraging is the hundreds of emails
that I receive every year from patients, who have regained their health
after having stopped their cholesterol-lowering treatment.
Your work seems to validate what
many integrative health care professionals have been saying for decades.
How does the alternative community respond to you?
There is a much more open attitude from
If the cholesterol hypothesis is
an error, does this mean that all of its therapies – low cholesterol
diet, cholesterol lowering natural therapies and medications -- are
Absolutely. This kind of treatment is
meaningless, costly, and has transformed millions of healthy people
Specifically, what are your views
Their benefit is trivial, and has been
seen only in male patients who already have heart disease.
Worse is that their many adverse effects
are ignored or cleverly belittled by the trial directors. Independent
researchers have found many more and in much higher numbers. If they
are true it means that today millions of previously healthy people probably
consider their weak and painful muscles, their bad memory, their sexual
failure, and their cancer to be a consequence of increasing age, and
so do their doctors.
of cancer is most alarming. Both animal experiments, epidemiological
studies and several of the statin trials have shown that low cholesterol
predisposes to cancer.
The widespread use of statin treatment
probably explains why the decrease of the smoking habit that has been
going on in many countries hasn’t been followed by a decrease
of cancer mortality. We should have seen a decrease because smoking
predispose not only to bronchial cancer, but to all kinds of cancer.
Drug companies market vigorously
the highest, strongest doses of statins. Lipitor is pushed at the highest
dosage, 80 mg. This dosage is the most powerful for lowering cholesterol
and LDL, but it also causes more adverse effects and costs more than
lower doses. What are your thoughts about this?
The outcome from these trials is a further
demonstration that the small benefit from statin treatment has nothing
to do with cholesterol.
For instance, although cholesterol plummeted
and remained at about 50 percent below the initial value during the
whole SEAS trial, it did not change mortality, but it increased the
number of cancer with statistical significance.
Even worse was the result of the ENHANCE
trial, where atherosclerosis in patients with familial hypercholesterolemia
progressed the most among those whose cholesterol was lowered the most.
If statins can be helpful in reducing
the incidence of heart attacks, who should take them?
In my view, nobody.
When I was practicing, I used to describe
the benefit in this way: Considering your age and your previous heart
attack, your chance to be alive in five years is about 90 percent. You
can increase that chance to 92 percent if you take a statin pill every
day, but then you may also expose yourself to its many adverse effects.
From the data I have seen, statins
have not produced a reduction in overall cardiac deaths. Do you have
any idea of why this is?
You are right. Heart mortality in Sweden
is going downwards, but the reduction started already in the 1960’s.
The cause is most probably that treatment of acute myocardial infarction
has improved, because the mortality curve has not changed after the
introduction of the statins.
The reason may be that their small benefit
is counteracted by an increasing frequency of heart failure.
As you know, the statins block not only
the synthesis of cholesterol, but also of other vital molecules, for
instance coenzyme Q10, and muscle cells, including those of the heart,
can’t function properly without Q10.
Do you think mainstream medicine
will ever relinquish its view that elevated cholesterol causes heart
disease, and that statins are the magic bullet?
I hope so. The failures of the most recent
statin trials have been commented on by several journalists in the major
U.S. newspapers. In Sweden a revolution is going on. Here, a general
practitioner treated her own obesity successfully by eating a low-carbohydrate
diet with a high content of animal fat. When she advised her obese and
diabetic patients to do the same, she was reported to the National Board
of Health and Welfare for malpractice.
After a two-year-long investigation she
was acquitted, as her treatment was considered to be in accord with
At the same time, the Board dismissed
two experts, who had been appointed for updating the dietary recommendations
for diabetics, because it came up that they were sponsored by the food
industry. Instead the Board has asked independent researchers to review
the scientific literature.
The subject has gained general attention
due to a number of radio and television shows, where critical experts
including myself have discussed the issue with representatives of the
Most important, thousands of patients
have experienced themselves that by doing the opposite as recommended
by the current guidelines they have regained their health!
The effect has been that the sales of
butter, cream, and full-fat milk are increasing in Sweden after many
years of decline, and a recent poll showed that a majority of Swedish
people today think that the best way of losing weight is by a low-carbohydrate,
Further progress was achieved this spring.
Several times, colleagues of mine and also I, have asked the Swedish
Food Administration for the scientific basis of their warnings against
saturated fat. We have been met with the argument that there are thousands
of such studies, or by referrals to the WHO guidelines or the Nordic
As the main argument in the latter two
-- that saturated fat raises cholesterol -- we were not satisfied with
their answer, and finally the Food Administration published a list with
72 studies that they claimed were in support of their view on saturated
fat, and twelve that were not.
We scrutinized the lists and found that
only two of the 72 studies supported their standpoint; eleven studies
did not concern saturated fat at all, and the unsupportive list was
incomplete, to put it mildly.
We published a short report with our
comments to these lists in the Swedish medical journal Dagens Medicin.
A response from the Food Administration appeared seven weeks later in
which they pointed out that their recommendations were directed to healthy
people, not to patients. They maintained that they were based on solid
scientific evidence, without mentioning anything about saturated fat,
and without answering our critical comments.
But this is not all. Earlier this year
et al reported that the mean cholesterol in 137,000 patients with
acute myocardial infarction was lower than normal.
As usual, the authors didn’t understand
their own findings, but concluded that cholesterol should be lowered
even more. A few months later Al-Mallah
et al. came up with the same result and conclusion, although they
also reported that three years later, mortality was twice as high among
those who had been admitted with the lowest cholesterol.
These results created a fierce debate
in one of the major Swedish newspapers. It was opened by ninety-one-year
old Lars Werkö, the ‘Grand Old Man’ in Swedish medical
science, retired professor in internal medicine and former head of The
Swedish Council on Technology Assessment in Health Care, together with
Tore Scherstén, retired professor in surgery and former secretary
of the Swedish Medical Research Council.
“Now it is time to sack the cholesterol
hypothesis and to investigate the reason of this scientific breakdown”
They also criticized American researchers
in AHA and NHLBI and their followers for sloppy and fraudulent science.
They were of course attacked by two professors
and representatives of the current view, but none of them came up with
any substantial evidence, only with personalities.
Are there other risk factors that
should be followed? Such as: C-reactive protein, fibrinogen, homocysteine,
lipoprotein A... Any other factors?
Such analyses may be helpful for doctors
to put the right diagnosis in patients with a disease of unknown origin.
But to check healthy people’s blood
to find deviations from normal is the freeway to unnecessary medication.
Are there other alternative therapies
besides statins that people might consider?
There is no reason for healthy people
to take drugs, or anything else to prevent heart disease, as long as
we do not know the very cause.
Don’t forget that people who die
from a myocardial infarction have on average lived just as long as other
people. In my talks I used to ask people, who put the same question
to me, if they know a better way of dying?
What diet do you recommend people
I do not give medical advice to people
I haven’t seen and examined myself, and as I am retired, it means
that I give no advice at all except to my family and nearest friends.
I inform people by writing and lecturing. Then they have to decide themselves
what to do.
In 20 years, do you expect changes
in how we view heart disease, its causes and treatments?
I am confident that we will see a change
in the next few years. There is a growing skepticism among medical scientists.
What is happening in Sweden these days may hopefully inspire researchers
in other countries to air their skepticism openly.
Recently, experts selected by WHO and
FAO published a new
report. Here the authors concluded that there was no satisfactory
or reliable evidence to support the idea that saturated fat causes heart
disease, or diabetes or obesity.
A revolutionary change of direction,
you may say. However, they did not change their recommendations!
Together with Kilmer McCully, the discoverer
of the association between homocysteine and atherosclerosis, I have
presented another hypothesis (You can read
that paper in its entirety at this link.)
We think this hypothesis is much more likely because we are able to
explain the many observations that do not fit with the present one.
Finally, I assume that much of what I
have mentioned here may seem incredible, but all the facts, including
references to the scientific literature, are available in my new book
And Cholesterol Are GOOD For You!
About Uffe Ravnskov, MD, PhD:
Dr. Ravnskov graduated from the University
of Copenhagen with an M.D in 1961.
1961-1967: Various appointments at
surgical, roentgenological, neurological, pediatric and medical departments
in Denmark and Sweden.
1968-1979: Various appointments at
the Department of Nephrology, and the Department of Clinical Chemistry,
University Hospital, Lund, Sweden.
1979-2000: A private practitioner
and independent researcher, specializing in internal medicine and nephrology.
Honored with the Skrabanek Award 1998, and author of: The
For more information, see Dr.
Ravnskov's Web site.
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