Author Topic: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk  (Read 7488 times)

bmjohnson35

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MM Community,

I recently finished reading "The Great Cholesterol Myth" and I was wondering if anyone can answer a question pertaining to the reduction in risk referenced throughout the book.  The author's explained the difference between absolute and relative risk.  According to the authors, the healthcare industry often uses relative risk to measure the results of their studies supporting the use of statins or diets of low fat consumption.  It's a common manipulation/representation of statistics to support an agenda. What is not clear is which type of risk is being referenced in Chapter 7 of the book.  Chapter 7 covers supplements that may reduce your risk of cardiovascular disease.  In other words, when they reference a reduction in risk when taking a particular supplement, are they quoting relative reduction in risk (like the Statin studies) or are they referencing absolute reduction in risk?  The author's dedicated a section of the book showing this misleading tactic, but they don't clarify what they are referencing when they get to the supplements section.  One of the author's has a web site and I just found out that he sells supplements online.  Now I wonder if the studies referenced later in the book is guilty of the misleading tactic of referencing relative risk reduction when describing the benefits of various supplements.

If I can't get an answer, my next step will be to start looking up each specific study referenced, to see if I can find out.

Thanks,
Bernie

Seamster

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #1 on: February 11, 2022, 01:36:38 PM »
Did you ever find out? I'm curious!

achvfi

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #2 on: February 11, 2022, 02:31:35 PM »
Check out this video summary of studies related to statins and cholesterol. It does address the relative vs absolute results. Its just infuriating how so much of cholesterol junk science has influenced almost all doctors.

https://www.youtube.com/watch?v=Odvt4EaGPLw

Statins can drive people to develop metabolic syndrome and cognitive issue over long duration.

cool7hand

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #3 on: February 12, 2022, 09:30:25 AM »
Agreed. Gary Taubes was writing about this more than 10 years ago.

salt cured

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #4 on: February 12, 2022, 01:53:53 PM »
Check out this video summary of studies related to statins and cholesterol. It does address the relative vs absolute results. Its just infuriating how so much of cholesterol junk science has influenced almost all doctors.

https://www.youtube.com/watch?v=Odvt4EaGPLw

Statins can drive people to develop metabolic syndrome and cognitive issue over long duration.

Thanks for posting this. I'm 40 and my doc would like me on a statin (LDL of 160mg and total cholesterol of 230mg but no other risk factors). My 10-year ascvd risk seemed low (to me), but I've been concerned about longer-term effects and read through a few studies. I pretty quickly zeroed in on the relative vs absolute risk issue, but I didn't know as much about side effects. More reading to do!

achvfi

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #5 on: February 13, 2022, 11:06:01 AM »
Thanks for posting this. I'm 40 and my doc would like me on a statin (LDL of 160mg and total cholesterol of 230mg but no other risk factors). My 10-year ascvd risk seemed low (to me), but I've been concerned about longer-term effects and read through a few studies. I pretty quickly zeroed in on the relative vs absolute risk issue, but I didn't know as much about side effects. More reading to do!

You are welcome! I hope the message gets more mainstream overtime. Just like finances we need to take control of our health as well, unfortunately we just cant depend on doctors advice alone. Only way is to learn more about it ourselves and weigh pros and cons.

salt cured

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #6 on: March 26, 2022, 11:56:54 AM »
Anecdotal: I've had high cholesterol for at least a decade but was referred to a cardiologist for a different issue. He suggested a CT to get a coronary artery calcium score before moving ahead with the statin my primary was advocating. My score was zero, so we'll be holding off. I was actually surprised the cardiologist didn't automatically suggest a statin (I'd heard the joke that most want it added to drinking water) and am glad to have some imaging evidence to back up the hesitancy I was feeling after reading some some meta-analyses.

clarkfan1979

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #7 on: July 01, 2022, 07:48:30 PM »
MM Community,

I recently finished reading "The Great Cholesterol Myth" and I was wondering if anyone can answer a question pertaining to the reduction in risk referenced throughout the book.  The author's explained the difference between absolute and relative risk.  According to the authors, the healthcare industry often uses relative risk to measure the results of their studies supporting the use of statins or diets of low fat consumption.  It's a common manipulation/representation of statistics to support an agenda. What is not clear is which type of risk is being referenced in Chapter 7 of the book.  Chapter 7 covers supplements that may reduce your risk of cardiovascular disease.  In other words, when they reference a reduction in risk when taking a particular supplement, are they quoting relative reduction in risk (like the Statin studies) or are they referencing absolute reduction in risk?  The author's dedicated a section of the book showing this misleading tactic, but they don't clarify what they are referencing when they get to the supplements section.  One of the author's has a web site and I just found out that he sells supplements online.  Now I wonder if the studies referenced later in the book is guilty of the misleading tactic of referencing relative risk reduction when describing the benefits of various supplements.

If I can't get an answer, my next step will be to start looking up each specific study referenced, to see if I can find out.

Thanks,
Bernie

I don't have my textbook in front of me, but here it goes.

10 out of 100 smokers die of lung cancer

2 out of 100 non-smokers die of lung cancer

Relative risk: Smokers are 5 times more likely to die from lung cancer than non-smokers.

ender

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #8 on: July 01, 2022, 08:56:23 PM »
I've been really curious about this too.

Malcat

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #9 on: July 02, 2022, 03:34:56 AM »
One thing to remember is that the VAST overwhelming majority of nutrition science is experiments that the scientists would not bother doing if they weren't requested to do them by the food manufacturers who provide the bulk of their funding.

There are almost *no* totally independent nutrition researchers in the world.

So what this means is that almost all nutrition science is basically very expensive marketing copy, with the research design specifically engineered to generate results that look a certain way.

Then the Pharm science is exactly the same.

The net result is that virtually NONE of the science is actually designed to answer questions that are relevant to the public or patients. This is why it's so incredibly difficult to navigate the research in an effort to glean meaningful information for personal decisions.

Many doctors DO NOT know this about research either and are either taught clinical *facts* or are snowed by presentations that present research as "evidence based medicine" or on very very rare occasions actually read research themselves (which most don't have time to do), but it's not unusual that they aren't aware of the systemic problems with the way the research is commissioned and conducted.

That's how doctors became so complicit in the opioid epidemic, because they trusted the "research" put out by pain scientists and journals who were all funded or blatantly owned by the oxy company.

Doctors are not scientists, and not particularly scientifically literate. Some are, especially many types of specialists, but your typical physician can get through their entire career with minimal, minimal competency in understanding actual science and what it means.

I have coached drug and device sales reps on how to present research convincingly to doctors and dentists, and my number one most effective piece of advice has always been "dumb down the science."

So yeah, it's no coincidence that it's impossible to get a straight answer on this. The science is essentially useless for decision making *by design*.
« Last Edit: July 02, 2022, 04:58:48 AM by Malcat »

dcheesi

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #10 on: July 02, 2022, 06:03:57 AM »
Beyond the motivated reasoning angle, there's also the fact that doing truly effective studies on nutrition and lifestyle is nearly impossible. You can do an observational study, in which there are numerous confounding factors (aka "normal life") that cloud any conclusions. Or you can do an intervention, but that comes with lots of ethical restrictions and problems with adherence. You can't just lock people in a cell and control their every action and intake 24/7 for years, which is what it would take to have a truly conclusive study regarding nutritional factors, exercise, etc.

ender

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #11 on: July 02, 2022, 08:24:07 AM »
It's not just nutrition that falls into that category too.

A ton of research is done mostly because it gets funding, rather than because the research itself is worth doing.


DK

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #12 on: July 02, 2022, 09:21:38 AM »
https://peterattiamd.com/tomdayspring6/

listen to all six of these and you'll basically know more than most doctors out there.

clarkfan1979

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #13 on: July 11, 2022, 10:32:10 AM »
It's not just nutrition that falls into that category too.

A ton of research is done mostly because it gets funding, rather than because the research itself is worth doing.

The funding itself is validation that someone considers the research worth doing. That "someone" is typically a review committee that represents a public or private organization. At the end of the day, it's an opinion. People disagree on what is more important all the time.

Malcat

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #14 on: July 11, 2022, 11:51:14 AM »
It's not just nutrition that falls into that category too.

A ton of research is done mostly because it gets funding, rather than because the research itself is worth doing.

The funding itself is validation that someone considers the research worth doing. That "someone" is typically a review committee that represents a public or private organization. At the end of the day, it's an opinion. People disagree on what is more important all the time.

Worth doing for whom though?

As I said above, many, many nutrition scientists do not consider the research they do to be worthwhile and would not bother with the experiments that they do were they not obligated to obtain funding from industry who guide what they research.

So is it worthwhile? Sure, to the food companies that want to generate marketing that has the veneer of objective validity that science gives it. But does that make it worthwhile in the larger scope of science? Absolutely not.

This is very, very well documented and understood within the health and nutrition world. The science has been basically co-opted for marketing purposes, and that's a HUGE problem.

It can't be brushed off as just the normal course of things, that's how entities like the Sacklers ended up co-opting the entire pain science field to promote the sale of their blatantly OBVIOUSLY dangerous narcotic.

Science being coopted for the sake of marketing is a massive global problem that has contributed to enormous human suffering and should not be taken lightly.

lost_in_the_endless_aisle

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #15 on: July 16, 2022, 05:12:57 PM »
Here is one study of industry funding:
Quote
Medline searches of worldwide literature were used to identify three article types (interventional studies, observational studies, and scientific reviews) about soft drinks, juice, and milk published between 1 January, 1999 and 31 December, 2003. Financial sponsorship and article conclusions were classified by independent groups of coinvestigators. The relationship between sponsorship and conclusions was explored by exact tests and regression analyses, controlling for covariates. 206 articles were included in the study, of which 111 declared financial sponsorship. Of these, 22% had all industry funding, 47% had no industry funding, and 32% had mixed funding. Funding source was significantly related to conclusions when considering all article types (p = 0.037). For interventional studies, the proportion with unfavorable conclusions was 0% for all industry funding versus 37% for no industry funding (p = 0.009). The odds ratio of a favorable versus unfavorable conclusion was 7.61 (95% confidence interval 1.27 to 45.73), comparing articles with all industry funding to no industry funding.

Though I'm not sure this is even nearly the biggest problem with nutrition "science". I spent some time reading maybe 100-200 papers last year in the field and came away with the general impression that there were very few well-controlled experiments (in particular, RCTs), and most of those were for very short duration and wouldn't much explain chronic health problems arising from years or decades of bad diet. Much of what out there are observational studies based on food-recall questionnaires plus, I'm guessing, some p-hacking to achieve significance in results (publish or perish!). Beyond that, the public health arena surrounding nutrition is still dominated by Ancel Keys-era dogma that is slow to melt away. As some have said, science sometimes moves forward because "ideas don't die, but fortunately, people do"

Malcat

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #16 on: July 16, 2022, 05:30:49 PM »
Here is one study of industry funding:
Quote
Medline searches of worldwide literature were used to identify three article types (interventional studies, observational studies, and scientific reviews) about soft drinks, juice, and milk published between 1 January, 1999 and 31 December, 2003. Financial sponsorship and article conclusions were classified by independent groups of coinvestigators. The relationship between sponsorship and conclusions was explored by exact tests and regression analyses, controlling for covariates. 206 articles were included in the study, of which 111 declared financial sponsorship. Of these, 22% had all industry funding, 47% had no industry funding, and 32% had mixed funding. Funding source was significantly related to conclusions when considering all article types (p = 0.037). For interventional studies, the proportion with unfavorable conclusions was 0% for all industry funding versus 37% for no industry funding (p = 0.009). The odds ratio of a favorable versus unfavorable conclusion was 7.61 (95% confidence interval 1.27 to 45.73), comparing articles with all industry funding to no industry funding.

Though I'm not sure this is even nearly the biggest problem with nutrition "science". I spent some time reading maybe 100-200 papers last year in the field and came away with the general impression that there were very few well-controlled experiments (in particular, RCTs), and most of those were for very short duration and wouldn't much explain chronic health problems arising from years or decades of bad diet. Much of what out there are observational studies based on food-recall questionnaires plus, I'm guessing, some p-hacking to achieve significance in results (publish or perish!). Beyond that, the public health arena surrounding nutrition is still dominated by Ancel Keys-era dogma that is slow to melt away. As some have said, science sometimes moves forward because "ideas don't die, but fortunately, people do"

Yep, health impacts of diets are virtually impossible to study with any degree of rigour. That's why diet research is so poor and seems so conflicting.

PeteD01

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #17 on: July 18, 2022, 12:09:08 PM »
Almost all nutrition science is junk science. Most studies are observational, rely on self reporting, lack a biological rationale beyond fitting into the fantasy universe of nutrtion science, or have issues regarding data mining, and those are only the most glaring deficiencies.

But recently I came across a very well done study:

"Effects of a low-carbohydrate diet on insulin-resistant dyslipoproteinemia—a randomized controlled feeding trial"

The study has the following characteristics:

There is a sound physiological rationale underlying the research
It is randomized (but not blinded or double blinded which would not be possible)
The intervention is precisely defined and controlled and allows for evaluation of dose/effect (the subjects received free food)
There was a proper run-in (all subjects were fed a hypocaloric diet leading to weight loss prior to the study period)
End points are well defined

There is more, but the listed characteristics are what distinguishes this study from nutrition junk science.


Here is an editorial explaining the physiologic model used for generating the research questions:

The carbohydrate-insulin model: a physiological perspective on the obesity pandemic

"According to a commonly held view, the obesity pandemic is caused by overconsumption of modern, highly palatable, energy-dense processed foods, exacerbated by a sedentary lifestyle. However, obesity rates remain at historic highs, despite a persistent focus on eating less and moving more, as guided by the energy balance model (EBM). This public health failure may arise from a fundamental limitation of the EBM itself. Conceptualizing obesity as a disorder of energy balance restates a principle of physics without considering the biological mechanisms that promote weight gain."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634575/


The study itself:

Effects of a low-carbohydrate diet on insulin-resistant dyslipoproteinemia—a randomized controlled feeding trial

https://academic.oup.com/ajcn/article/115/1/154/6369072


And a video discussing the study in lay terms (mostly) from Mayo Clinic:

https://www.youtube.com/watch?v=PWi3GKH0R-w
« Last Edit: July 18, 2022, 12:14:37 PM by PeteD01 »

lost_in_the_endless_aisle

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #18 on: July 18, 2022, 05:10:53 PM »
^Yes, that is a pretty good study, and the conclusions don't surprise me at all!

My dream study would be a multi-year RCT that varied macronutrient share by category as well as varying % of hyperprocessed food. My strong suspicion is that metabolically healthy people can eat any macronutrient mix (within reason) and be fine, as long as hyperprocessed foods are avoided. For people with deranged metabolisms, this may not hold, however--so would also be interesting to see outcomes as a function of starting metabolic metrics. It's too bad things like the Minnesota Coronary Experiment are now considered "unethical"

clarkfan1979

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #19 on: August 01, 2022, 03:33:49 AM »
It's not just nutrition that falls into that category too.

A ton of research is done mostly because it gets funding, rather than because the research itself is worth doing.

The funding itself is validation that someone considers the research worth doing. That "someone" is typically a review committee that represents a public or private organization. At the end of the day, it's an opinion. People disagree on what is more important all the time.

Worth doing for whom though?

As I said above, many, many nutrition scientists do not consider the research they do to be worthwhile and would not bother with the experiments that they do were they not obligated to obtain funding from industry who guide what they research.

So is it worthwhile? Sure, to the food companies that want to generate marketing that has the veneer of objective validity that science gives it. But does that make it worthwhile in the larger scope of science? Absolutely not.

This is very, very well documented and understood within the health and nutrition world. The science has been basically co-opted for marketing purposes, and that's a HUGE problem.

It can't be brushed off as just the normal course of things, that's how entities like the Sacklers ended up co-opting the entire pain science field to promote the sale of their blatantly OBVIOUSLY dangerous narcotic.

Science being coopted for the sake of marketing is a massive global problem that has contributed to enormous human suffering and should not be taken lightly.

I think I took one class in grad school in which we read a few nutrition papers. The only paper I remember reading was on soy diets for infants. I remember the health benefits of soy diet being greater for a specific period of time. Soy diet health benefits maxed out at like 18-24 months and then decreased.

I have worked on grant funded projects since 2002. No system is perfect, but as a scientist, I have never felt pressure from the funder to find a specific result. I have also never heard of that from any of my academic friends. You write a proposal based on what you personally want to do as a scientist. If the funder likes your idea, they grant you the money.

Junk science does exist within pay to publish journals. I agree that is 100% marketing. However, those journals and results have zero value within the actual scientific field.

Malcat

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Re: The Great Cholesterol Myth - Relative vs. Absolute Reduction of Risk
« Reply #20 on: August 01, 2022, 05:43:12 AM »
It's not just nutrition that falls into that category too.

A ton of research is done mostly because it gets funding, rather than because the research itself is worth doing.

The funding itself is validation that someone considers the research worth doing. That "someone" is typically a review committee that represents a public or private organization. At the end of the day, it's an opinion. People disagree on what is more important all the time.

Worth doing for whom though?

As I said above, many, many nutrition scientists do not consider the research they do to be worthwhile and would not bother with the experiments that they do were they not obligated to obtain funding from industry who guide what they research.

So is it worthwhile? Sure, to the food companies that want to generate marketing that has the veneer of objective validity that science gives it. But does that make it worthwhile in the larger scope of science? Absolutely not.

This is very, very well documented and understood within the health and nutrition world. The science has been basically co-opted for marketing purposes, and that's a HUGE problem.

It can't be brushed off as just the normal course of things, that's how entities like the Sacklers ended up co-opting the entire pain science field to promote the sale of their blatantly OBVIOUSLY dangerous narcotic.

Science being coopted for the sake of marketing is a massive global problem that has contributed to enormous human suffering and should not be taken lightly.

I think I took one class in grad school in which we read a few nutrition papers. The only paper I remember reading was on soy diets for infants. I remember the health benefits of soy diet being greater for a specific period of time. Soy diet health benefits maxed out at like 18-24 months and then decreased.

I have worked on grant funded projects since 2002. No system is perfect, but as a scientist, I have never felt pressure from the funder to find a specific result. I have also never heard of that from any of my academic friends. You write a proposal based on what you personally want to do as a scientist. If the funder likes your idea, they grant you the money.

Junk science does exist within pay to publish journals. I agree that is 100% marketing. However, those journals and results have zero value within the actual scientific field.

I'm basing this opinion on reports from nutrition scientists who have said that they feel enormous pressure to produce science that can be used for marketing purposes, and that the majority of nutrition scientists say they would not bother to even do the experiments that they do were they not obligated to by funding from the food companies.

The nutrition science industry is particularly problematic. I say that as someone who also used to do research science and also knows how funding and publishing works.
« Last Edit: August 01, 2022, 05:44:50 AM by Malcat »