In Conversation With Uffe Ravnskov

14 Oct 2019

Originally published in CrossFit Health

His name is synonymous with “cholesterol skeptic.” Danish physician Uffe Ravnskov has gained worldwide significance for his persistent and courageous fight against the demonization of cholesterol.

“It’s nonsense,” he says, referring to the prevailing advice to drastically lower cholesterol. “Hopefully I’ll see it change before I die.”

Ravnskov is quick to mention his most recent annoyance: the 2019 guidelines by the European Society of Cardiology and the European Atherosclerosis Society (EAS) for the management of dyslipidemia (abnormal blood lipids).

“Have you seen the author’s conflicts of interest?” he asks rhetorically. “Most of the authors are paid by drug companies.” And Ravnskov is right. It strains credulity when you see the guideline document is 50 pages in length and is followed by a statement of financial disclosures that is 66 pages.

The authors advocate slashing cholesterol levels. “Lower is better,” they claim — something Ravnskov unequivocally rejects. “There is substantial evidence that high total or LDL-cholesterol is not the cause of atherosclerosis, not even in familial hypercholesterolemia,” he rebuts.

In his typical, no-nonsense manner, Ravnskov blames decades of poor dietary advice and the fervent push to prescribe cholesterol-lowering drugs for the obesity and diabetes epidemics. “It’s why we are in this health crisis,” he laments.

Ravnskov says he’s “getting on” in age but clearly remembers when his colleague first told him about the Framingham study in the early 60s. Researchers were building a case that would implicate cholesterol as a cause of heart disease.

“I laughed,” Ravnskov recalls. “I still had my biochemistry knowledge and knew how important cholesterol was in the body.” In the years that followed, he assumed that more research would out the absurdity of a narrative that cast saturated fats and cholesterol as dietary villains (a narrative that became popularly known as the diet-heart hypothesis).

Of course, the opposite happened. While Ravnskov was focusing his efforts on researching glomerulonephritis (kidney disease), the medical community was becoming enamored with the diet-heart hypothesis.

By the mid-80s, Michael Brown and Joseph Goldstein won a Nobel Prize for describing the role of cholesterol in heart disease, paving the way for a new class of cholesterol-lowering drugs called statins.

Ravnskov’s interest was reignited after the cholesterol campaign had kicked off in Sweden, where he was based at the time. He says he had not seen any studies to support the cholesterol hypothesis. The fact there was a modifiable risk factor (LDL cholesterol) that could be managed with life-long medication turned out to be a boon for the pharmaceutical industry and generated the most profitable drug in the history of medicine: Lipitor.

Ravnskov says the period throughout the 90s and early 2000s was revealing. Despite achieving massive reductions in LDL-cholesterol with statins, the drug companies could not reliably show that these reductions translated into a meaningful benefit to longevity.

Over the next three decades, Ravnskov published his critiques in peer-reviewed journals and did not pull any punches. He claimed poor methodology, data manipulation, and deceit had tainted the statin literature.

It was an era with poor oversight of the conduct of clinical trials, which Ravnskov and others say permitted unethical practices and fraudulent behaviour by drug companies. Perhaps his most troubling concerns were those regarding the 4S study.

Experts often cite the 4S study as the most robust evidence we have for the benefits of statins. But Ravnskov argues that the manufacturer, the same entity that stood to profit from the outcome of the trial, oversaw the trial design, data collection, analysis, and written manuscript.

Most notably, the level of benefit achieved in the 4S study was never replicated. And that remains true to this day. Yet, the 4S study underpins prescribing guidelines and has cultivated the consensus that statins, at the very least, benefit people at high risk of heart disease.

“I published many papers in major journals, but they were ignored,” Ravnskov says with a tone of disbelief. The lack of trust in much of the scientific literature is a recurring theme during my conversation with him. Listening to a career scientist talk about his ever-increasing skepticism of science brings me (and others) great discomfort.

“I cannot trust trials that have been published by drug companies,” he says defiantly. Even when pressed about the fact that, nowadays, there are more stringent requirements for disclosing financial conflicts, Ravnskov said such requirements do not do enough to stop statistical deception that can lead to the misrepresentation of results.

So who is to blame? “Drug companies, researchers, editors of medical journals — they’re all to blame,” Ravnskov says. The publish-or-perish mentality, industry influence, fear of being ostracized, and a lack of funding opportunities for non-orthodox research are only some of the factors contributing to the corruption of science.

But Ravnskov is not alone on this voyage. A growing number of doctors and scientists have come out saying “the emperor has no clothes,” which has inspired Ravnskov to form a coalition of experts called The International Network of Cholesterol Skeptics (THINCS). Many in this group have helped carry the mantle to mitigate the spread of misinformation about the cholesterol campaign.

Ravnskov acknowledges the tide is turning. He mentions a paper he and his co-authors published last year, titled “LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature.” He proudly points out that it was the most downloaded paper in 2018 among more than 10,000 scientific articles published by Taylor and Francis.

Ravnskov is stoic. Some might even say stubborn. Either way, it’s clear these qualities have armed him with the tools needed to endure public accusations of heresy from those defending orthodoxy.

He has been referred to as a fundamentalist, irresponsible, fringe, and controversial. Critics have compared his research to Flat-Earthism and claimed his work has only been published in minor, obscure journals.

But a cursory glance at the scientific literature reveals his critics are plainly wrong. Ravnskov has published more than a hundred papers and editorials, many of them in top-tier medical journals such as the BMJ, Lancet, New England Journal of Medicine, and Journal of the American Medical Association.

Ravnskov’s conviction remains steadfast. I ask him how he has reacted to the public criticism. “I don’t care,” he quips without hesitation. “I have no regrets.”