“Pleading heart” (Cholesterol contrarians)

HEARTHELP

I consume cheese, milk, and butter, with halfhearted consideration about limiting my intake of such. But such concerns are unfounded according to some cholesterol contrarians who consider the lipid molecule benign or even beneficial. Stemming from this belief is an additional conviction that since cholesterol levels are irrelevant, no one needs statins to lower those numbers.

However, WHO and similar organizations consistently make it known that butter, cheese, milk, and red meat are fine in moderation and as part of a balanced diet. But they also stress that excess saturated fat may cause the liver to overproduce bad cholesterol, which can lead to heart disease, the country’s leading killer.

The cholesterol contrarians are led by Uffe Ravnskov, who insists “the reason why so-called experts say that I am mistaken is that the vast majority are paid generously by the drug companies.”

But while the funding for the research materials and laboratories may come from pharmaceutical companies, individual scientists receive no money from them. And the reason pharmaceutical companies fund research is for the same reason the auto industry pays for crash test studies. Both enterprises want their products to be as safe as possible because they are potentially liable if they irresponsibly put a dangerous one on the market.

As to cholesterol-conquering statins, the Guardian’s Sarah Boseley wrote that the metadata of studies published in the Lancet concluded that over five years, a daily statin would prevent 1,000 heart attacks, strokes, and coronary artery bypasses among 10,000 people who had already experienced one of these medical maladies. Further, statins could prevent heart attacks in those at increased risk because of high blood pressure or diabetes. Weight, age, blood pressure, and family history can help doctors estimate the chances of a patient having a heart attack, and statins are recommended for anyone with a 10 percent chance of one.

The SkepDoc, Harriet Hall, notes that prevention is much more than gulping statins and refraining from having a bacon double cheeseburger. A balanced approach would include healthy weight maintenance and exercise, a genetics also plays a key role. I have been a vegetarian for half my life and still have slightly elevated cholesterol levels. My love of cheese and milk contributes to that, but so does what I inherited.

Indeed, cholesterol is only one factor leading to heart attacks. Skeptic leader Robert Todd Carroll explained that, “There is not a strong body of peer-reviewed published research that shows that a person who eats a low-fat diet is guaranteed to have low cholesterol, which will prevent that person from getting atherosclerosis, which in turn will prevent that person from getting a heart attack. Nor is there strong evidence that a person who eats lots of animal fat will get high cholesterol and get atherosclerosis and die of a heart attack as a result. Other factors include past health history and the current state of your health, your family history with cholesterol levels and heart disease, your genetic predisposition to high cholesterol and/or heart disease, and do you smoke, are you grossly overweight, and do you exercise?”

While it is a near consensus among nutrition scientists that excess amounts of bad cholesterol is detrimental, those same persons hold that it is but one factor in a person’s heart attack susceptibility. But Ravnskov creates a strawman that those scientists feel diet alone causes high cholesterol, which in turn is the sole determinant for heart attacks.

He also misuses statistics to try and bolster his point. For example, he cited the Framingham Heart Study, which concluded that decreasing levels of cholesterol are associated with increased mortality among older participants. He interprets this to mean that either decreasing cholesterol is detrimental for all or that cutting cholesterol intake is a significant causal factor for mortality. He further notes that since 1970, fatal heart attacks in Japan have declined while animal fat consumption has increased. He considers this evidence that animal fat in the diet is not a major cause of heart disease and that “good cholesterol” is redundant.

But this is post hoc reasoning as wells as confusing correlation and causation. First, as an elderly person’s health declines, they tend toward malnourishment, which will invariably lower cholesterol. Second, persons are surviving heart attacks more often today because of better focus on proper nutrition and medical advances such as statins and a daily aspirin following such incidents. To prove his point, Ravnskov needs to show data that as persons increase animal fat intake, their chances of a fatal heart attack decrease.   

Ravnskov also considers it a myth that high fat foods cause heart disease since studies do not show that a diet high in saturated fat is a sufficient condition to bring on a heart attack or that a diet low in saturated fat is a sufficient condition to prevent a heart attack.

But he mixes up “cause” with “sufficient condition.” Carroll wrote, “Some causes are necessary but not sufficient conditions. For example, some viruses must be present and thus are necessary conditions for certain diseases to occur. But they are not sufficient conditions, as the virus may be present but not manifest itself in illness.” Similarly, a high fat diet by itself may be an insufficient condition to cause heart disease, but it can be a major contributing factor in some people, as can family medical history, smoking, obesity, and stress.

In another misunderstanding of statistics, Ravnskov noted that 20 percent of those who die from heart attacks have never had atherosclerosis so he therefore concludes that the condition doesn’t cause heart attacks. But only 10 percent of smokers get lung cancer, while just .1 percent of nonsmokers do. The reasonable conclusion here is not that tobacco is relatively harmless with regard to lung cancer since only 10 percent of smokers get it. Rather, the logical lesson it that smoking is hazardous because it increases one’s chances of getting lung cancer by 100 times.  

The cholesterol contrarian also plays the Galileo Gambit by saying he is persecuted for his beliefs. And perhaps he is. But that’s because he’s dispensing lethal medical advice, not because he’s being repressed by a powerful cabal of pharmaceutical executives, scientific stooges, and skeptic bloggers.

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