Dr. Uffe Ravnskov, one of the most outspoken and published voices against the lipid hypothesis, often claims that the few studies that support it do so because of the inclusion of participants with familial hypercholesterolemia. I don’t think there’s any doubt that this disorder is associated with a greater risk of cardiovascular disease, but similar to your perspective, I think this may merely indicate an increased susceptibility rather than a direct cause. This is supported by the inconsistencies in mortality found when comparing populations with familial hypercholesterolemia to normal populations.¹

In my opinion, a much greater concern than a high serum LDL level is oxidized LDL, and perhaps the inability to properly metabolize LDL makes those with familial hypercholesterolemia more susceptible to the effects of oxidation. In addition, the vascular changes associated with familial hypercholesterolemia are said to be different than those of conventional atherosclerosis² which I think further justifies your suspicion of the lipid hypothesis and its relevance to FH.

I don’t blame you for not wanting to take statins. Although they’ve been shown to be more effective than diet at lowering cholesterol and have even reduced mortality in some cases, evidence indicates that it’s not a result of cholesterol lowering and that it’s instead due to other effects relating to inflammation.^3,4 This brings into question whether or not the undesirable side effects of statins are justified and if there are safer alternatives. It’s also another indication that the lipid hypothesis is flawed.

It’s great that you’ve overcome your stress and depression. This may be more relevant than you think since stress has been shown to be a much greater risk for heart disease (as well as cancer) than the typical risk factors.^b,c It’s unfortunate that our medical system tends to promote additional stress for patients with these diseases.

Thanks again for sharing your story. I wish you the best of luck with your continued health!

1. Sijbrands EJG, Westendorp RGJ, Defesche JC, de Meier PHEM, Smelt AHM, Kastelein JJP. “Mortality over two centuries in large pedigree with familial hypercholesterolaemia: family tree mortality study.” British Medical Journal. 2001. 322:1019-1023.

2. Stehbens WE. “Coronary heart disease, hypercholesterolemia, and atherosclerosis I. False premises.” Experimental and Molecular Pathology. 2001. 70(2):103-119.

3. Ravnskov U. “Is atherosclerosis caused by high cholesterol?” QJM. 2002. 95(6):397-403.

4. Ravnskov U. “Conclusions from the heart protection study were premature. British Medical Journal. 2002. 324:789.

5. Eysenck HJ. “Personality, Stress, and Disease: An Interactionist Perspective.” Psychological Inquiry. 1991. 2(3):221-232.

6. Allison TG, Williams DE, Miller TD, Patten CA, Bailey KR, Squires RW, Gau GT. “Medical and Economic Costs of Psychologic Distress in Patients With Coronary Artery Disease.” Mayo Clinic Proceedings. 1995. 70(8):734-742.

I read the commentary on this issue with particular interest. I have familial hypercholesterolemia. I am 40 years old. I have known of my “condition “since I was 18. I have never had a coronary event, nor a stroke. I have waivered between taking and not taking statins to bring my total cholesterol down to ” acceptable” limits. In my case, we are talking about high dosages of medication. For period of time in the last 10 years I have taken cholesterol medications on and off. The longest period was 2 years. The secondary effects were unpleasant to say the least. I took the medication out of fear because of the scare I was given by the doctors when I was first diagnosed. For many years, and as a young man, I was stressed about my mortality. It contributed to an episode of depression. I became a compulsive exerciser. I felt I was not in control of my own life or destiny. In my 30′s I became a father and we now have 3 beautiful children. I am in control of my life and I have made a decision that I am not convinced that the presence of cholesterol in itself is a cause of heart attack and stroke. I do believe that it is the combination of a number of factors, perhaps some of which we are not yet aware, which together contribute to heart disease and stroke. I realized that everything else in my lifestyle was NOT contributing to the known risk factors – I do not smoke, I do not drink excessive amounts of alcohol,I do not have high blood pressure, I exercise 5 days per week, I have healthy and fulfilling relationships, I enjoy my work life, I balance my diet.

I meet with the cardiologist every year – They scan my heart, do ECGs, measure my CRP levels ( extremely low). I have my major arteries scanned by ultrasound – No presence of arteriosclerosis AT ALL.

I am sure that I don’t have all the answers. One day I may fall victim to a stroke or heart attack. But I am at peace with my decision. It is a decision made after reading widely on the subject and taking every pro-active step I can to keep myself healthy without taking medication. I am sure that science has a long way to go to explain the genetics of my particular circumstances. I believe that we are all different and statistics are an approximation. One day medicine will be able to individually profile our genetic code to understand how each of us works. In the meantime I am listening to, and looking after my own body. I am just not going to make any more decisions out of fear, and not least when there are real doubts in my mind about what popular medical theory says on Cholesterol.

I completely agree that the selective use of data by Ancel Keys presents a much different picture. Dr. Ravnskov discusses this in detail in his book.

I also agree that it’s a shame that research can be so influenced by business and politics. In regard to saturated fat, cholesterol, and heart disease, it makes me wonder how much this has set us back in terms of nutritional knowledge, how much it is costing in terms of health care, and how many lives it has negatively effected.

The national data was tabulated (country, fat intake %age of diet and CHD rate) and then sorted on fat intake (total or saturated) and then plotted with fat% (total or saturated) on the x-axis. Unfortunately I cannot add the figures here but
Figure 1 is for total fat; Figure 2 is for saturated fat. The saturated Fat Multiple R = 0.584; Regression = “p” < 0.00001 This was a negative correlation – more fat lead to less CHD. Not a good correlation but far better than the 0.36 found for cholesterol and CHD.

The data was then regressed using Quattro Pro. The regression line was drawn using the results. Both analyses show that doubling the national fat intake reduces the national Coronary Heart Disease rate by half! This clearly demonstrates the basic error in Dr Ancel Key's work. While it does not PROVE that increased fat intake reduces Coronary Heart Disease rate it certainly shows that it does not increase Coronary Heart Disease. It is unfortunate that I cannot add the figures themselves but anyone with a decent spreadsheet can do it themselves

An automatic corollary of this is that INCREASING CARBOHYDRATE INTAKE IS CORRELATED WITH INCREASING Coronary Heart Disease RATE! (And probably diabetes)

It is an unfortunate fact these days that medical research involved with fat and cholesterol is dominated by big Agri/Pharma business. Studies leave out data that contradicts the "official" view or obfuscates it so that only the the most careful reading will find it. For example, the JUPITER trial says nothing about the 50% greater death rate in the treated group compared to the placebo group. Table 3 has to be read very, very carefully and one has to do the sums oneself to establish this fact. Oh yes! at this time at early termination it was not significant but extend the rate and it rapidly becomes highly significant. An DO NOT FORGET THAT STATINS ARE USED FOR DECADES.

No wonder the study was terminated early on the grounds of ethics and beneficial secondary NON-FATAL endpoints. The fate of BAYCOL (another statin) loomed!

According to this review of Dr. Esselstyn’s book, it appears that you might be giving him too much credit. Same goes for Dr. Ornish and this review of his lifestyle heart trial.

I certainly can’t argue against vegetables being an excellent source of nutrition and a great promoter of natural healing, but contrary to what you seem to be suggesting, these characteristics give no indication of how good or bad it is for one to consume saturated fat. And because so many other variables were eliminated with these diets, it’s questionable to attribute any results solely to the elimination of saturated fat.

Dean Ornish and Caldwell Esselstyn. Both (independently) took high risk cardiac patients (already had heart attacks, bypasses etc).

They fed them strict vegetable diets with essentially no additional fat sources and extremely limited dietary cholesterol. They even avoided nuts/olive oil. Something it would take a heart attack to have me consider.

Probably the most extreme low fat eating pattern ever attempted. The result in both cases was reversal in coronary arterial narrowing. As far as I can tell, this is the only reversal I am aware of.

I had heard of Ornish but this was the first time I heard of Esselstyn. Esselstyn is interesting. His stats are from a group of 17 with advanced CHD, with 49 cardiac events between them, average cholesterol of 246.

After the admittedly extreme dietary changes, cholesterol fell to 137, ZERO cardiac events in the next 12 years.

Let me know when a doctor advocating lots of “healthy” saturated fats puts a bunch of people with advanced CHD on such a diet and what that outcome is after a decade.

I absolutely agree that genetics plays a factor and am a big proponent of the concept of nutritional individuality. Traditional Eskimos and Native American Indians, both known for vibrant health, consume significant amounts of protein and fat. Obviously, not everyone will thrive on this type of diet as they do.

I am by no means suggesting that everyone should follow this diet. However, I firmly believe that we all need at least some amount of animal fat in our diet to promote optimal health. I definitely don’t think everyone should eat significant amounts of saturated fat, but I do think the mainstream belief that saturated fat is a dietary villain is quite excessive.

I do not know what type of diet you’re referring to that has been shown to reverse arteriosclerosis, but I see where you’re probably going with this. Although atherosclerosis is only one form of arteriosclerosis, it’s often associated with heart disease and Ravnskov discusses it thoroughly and explains how the evidence associating it with cholesterol is weak.

According to Ravnskov, a study done in 1936 by Kurt Lande and Warren Sperry of the Department of Forensic Evidence at New York University provided early evidence that there was no correlation between blood cholesterol levels and the extent of atherosclerosis. This study was done on people who suffered violent deaths and the people who criticize it claim that cholesterol in the dead is not the same. However, this study addressed this issue by measuring regularly measuring the cholesterol of hospital bound veterans between the age of 60 to 70 and prior to their death. Like the previous study, no correlation was found. Another study determined that cholesterol measurements after death are valid, which supports the findings of Lande and Sperry, and also failed to find a correlation between blood cholesterol and the level of atherosclerosis. Additional studies support the same findings.

Although there is some research that claims to have found an association between serum cholesterol and the severity of atherosclerosis, Ravnskov points out that the correlation is either weak, or that the conclusion of a correlation existing doesn’t agree with the data.

It’s also worth noting that the Masai people studied by George Mann who consumed significant amounts of saturated fat, had low cholesterol levels, and rarely suffered from heart disease also had “extensive” amounts of atherosclerosis. However, it’s important to note that this atherosclerosis involved “very few complicated lesions.” I’m not attempting to suggest that artery hardening doesn’t play a role in heart disease, but it certainly seems that it’s not a considerable risk factor in it’s own right and that it has little to do with cholesterol.

One has low cholesterol, one has very high. Neither are exercising. Genetics play a large role here.

Genetic factors will play too large role in determining the reaction to dietary intake to hand out blanket advice that meat and saturated fat should be eaten more and are beneficial for everyone.

If you are eating a paleolithic diet you can likely much better afford to extra saturated fats. If you blood pressure is unaffected and your cholesterol remains low, you are likely fine.

I fully agree on the negative affects of processes food, but I feel your saturated fat is good message is too easily take as it is a fine addition to any current diet for anyone, which I think will be disastrous for many.

If you researched this topic well, you can probably tell me the only dietary pattern actually documented as reversing arterial-sclerosis. Actual documented widening of arteries from a change in eating pattern. Do you think it was an increase in saturated fat intake?

Most of the “Cholesterol Myth” information sites on the internet have about as much weight as 911 conspiracies.

I can appreciate your concern about conspiracy theory, but this article is not based on such websites. It’s based on the work of a well respected Medical Doctor and PhD named Uffe Ravnskov. If you really want to get to the bottom of this issue and make an informed decision for yourself, I highly recommend reading his book The Cholesterol Myths.

In addition, conspiracy theories are generally not published in scientific journals. In January 2010, this research paper was published in The American Jounal of Clinical Nutrition concluding that “there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD.”

This is not an indication that high cholesterol is good. As noted they have LOW cholesterol and no heart disease. If you can eat all the meat you want and have a half the cholesterol of the average American, go for it. Chances are you can’t.

No, it’s not an indication that high cholesterol is good, but it is a good indication that consuming saturated fat and cholesterol from natural sources aren’t the cause of heart disease as is currently promoted. This is also supported by the study referenced above.

Although I am only a single individual and my physiological markers don’t mean much alone, I eat a significant amount of meat that’s full of saturated fat and cholesterol. The last time it was measured, my total cholesterol was 119 which is somewhat of a concern for being too low.

Also, in the documentary Fat Head, Tom Naughton was actually able to reduce his total cholesterol by eating more meat and saturated fat. Although it was only by a small amount, according to mainstream belief, his cholesterol levels should have increased substantially.

Even a former director of the Framingham study, William Castelli MD, admitted in this research paper that “in Framingham, Mass, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person’s serum cholesterol.” The Framingham Heart Study is one of the largest and most highly respected research projects on heart disease.

I have no doubt that overeating and heavy processed foods contribute to both high cholesterol and heart disease and that many factors contribute to heart disease, but high cholesterol certainly has significant correlation.

Certainly?

According to Ravnskov, data from some of Key’s work as well as data from this study and also this study from the WHO’s MONICA project present a number of contradictions challenging the idea that high cholesterol causes heart disease. This data shows countries with low cholesterol levels and a high mortality from heart disease as well as countries with high choleesterol levels and a low mortality from heart disease. Researchers who are motivated to support the diet-heart idea seem to ignore these contradictions.

Also according to Ravnskov, although the conclusion of this study suggests that heart disease is closely correlated with high cholesterol levels, the data shows that many of the participants who suffered heart attacks had normal or even lower than normal cholesterol levels. Data from another study that reevaluated this same population 30 years later showed very little correlation between cholesterol level and death from heart disease after the age of 47 which is when most heart attacks occur.

Some things to also consider is that no advice fits everyone and response to dietary fats will be highly impacted by genetic makeup. People with Familial Hypercholesterolemia, have high cholesterol from a young age, can develop Atherosclerosis before puberty, and can have heart attack and death before 30! Pretty direct correlation in these cases.

Yes, there absolutely is a strong correlation between the high cholesterol levels of those with familial hypercholesterolemia and heard disease, but these levels are much much higher than the “high” cholesterol we’re talking about, and the people with this disorder represent a small portion of the population.

This issue of familial hypercholesterolemia is thoroughly addressed by Ravnskov in his book, and in fact, some of the questionable research that supports a correlation between high cholesterol and heart disease misleadingly uses people with this disorder as test subjects.

Ravnskov cites this study in which 6 of 214 familial hypocholesterolemia patients died before the age of 40. This is certainly a much higher risk than in the average population, but is not as significant as it’s often made out to be. He also cites this study which found that out of a total of 412 familial hypercholesterolemia patients, those who lived in the 19th century had a lower mortality than the rest of the population. This suggests that it is more so a characteristic of common lifestyle changes in the 20th century that make hypocholesterolemia patients more susceptible to death from heart disease.

I have no doubt if I have cholesterol deposits in my eyes like a senior, I probably have similar arterial issues. I have massive regrets about my assumptions of invincibility while I freely ate animal fats in my 20′s. Note I don’t advocate medication. I have never taken any and I still eat meat pretty much every day. But in much more moderate amounts.

Just because your blood pressure was higher in your 20s than it is now doesn’t mean that the same relationship applies with your cholesterol. You’re assuming that the same factors that cause high blood pressure always cause high cholesterol as well, and in particular, you’re assuming this factor to be saturated fat and/or dietary cholesterol. There are many factors that contribute to high blood pressure, some of which you may have inadvertently addressed with your effort to improve your health.

I don’t think you should blithely be handing out “cholesterol is good” message to a population that probably has double what a natural population would have.

I appreciate and respect your opinion, but I find your suggestion that I am promoting a message that lacks thought or consideration to be unfair. You have your opinion and I have mine. I’m sharing mine because I believe it’s based on important information, and most importantly, I have disclosed the material from which it’s based. My only intent is to provide information that may help people make their own decisions and I think I’ve done a very fair job of that. The only thing here that I consider to be blithe is your use of the word.

I don’t know what you mean by “natural population”, but if you’re referring to a traditional population that is virtually forced to follow healthy habits by being isolated from modern influences, than this would describe the populations studied by Dr. Weston A Price. Much of the information that I “blithely hand out” on this site is based on the healthy habits of these populations and their consumption of natural whole foods which in many cases happen to contain significant amounts of saturated fat and cholesterol.

A recent study to chew of those that believe cholesterol concerns are some kind of conspiracy

Whether it be heart disease or the dementia discussed in this article, high cholesterol is a risk factor, and it’s important to realize that this is not the same thing as a cause. Accept for a moment that cholesterol levels in the 200s are normal. If this is the cause, this is where the largest percentage of the population will be, and would therefore be likely to also represent the largest percentage of people with dementia. I bet there’s also a correlation between dementia and gray hair, but this doesn’t mean that having gray hair causes it.

Also note when you mention contradictions above: “The diet of this tribe consisted entirely of milk, blood and meat. They ate no vegetables whatsoever and consumed excessive amounts of dietary cholesterol and saturated fat. In direct contrast to Key’s theory, they had no incidence of heart disease and their cholesterol levels were 50% lower than those of Americans!”

This is not an indication that high cholesterol is good. As noted they have LOW cholesterol and no heart disease. If you can eat all the meat you want and have a half the cholesterol of the average American, go for it. Chances are you can’t.

I have no doubt that overeating and heavy processed foods contribute to both high cholesterol and heart disease and that many factors contribute to heart disease, but high cholesterol certainly has significant correlation.

Some things to also consider is that no advice fits everyone and response to dietary fats will be highly impacted by genetic makeup. People with Familial Hypercholesterolemia, have high cholesterol from a young age, can develop Atherosclerosis before puberty, and can have heart attack and death before 30! Pretty direct correlation in these cases.

When I was in my 20′s I loved meat/eggs/cheese and ate them freely, thinking being young, lean, fit from exercise(runner+lifting) made it a non issue. In my late 20′s I had my BP checked for the first time. Even after several followups it was shown to be around 150/90. Very high for a fit, lean person my age. I decided to start improving my diet.

In my thirties I cut down on meat/eggs/cheese, ate only whole grains, added more fruit/nuts/veg, and my BP returned to the healthy range(~120/70).

My next wakeup was recently around 40. I had never had my cholesterol checked and my diet was now much better and I thought levels should have followed.

I was getting an eye exam and the eye doc asked if I had my cholesterol checked, and said I better, because he could see cholesterol deposits in my eyes that he only sees in seniors. I got it checked and I am around 200(it must of been scary high in my twenties). So I will continue to adjust down the animal fats in my diet.

I have no doubt if I have cholesterol deposits in my eyes like a senior, I probably have similar arterial issues. I have massive regrets about my assumptions of invincibility while I freely ate animal fats in my 20′s. Note I don’t advocate medication. I have never taken any and I still eat meat pretty much every day. But in much more moderate amounts.

I don’t think you should blithely be handing out “cholesterol is good” message to a population that probably has double what a natural population would have.

A recent study to chew of those that believe cholesterol concerns are some kind of conspiracy.