We thank Dr Ravnskov and colleagues(Reference Ravnskov, Diamond and Karatay1) for their interest in our editorial. Ravnskov et al. appear to ignore the large number of controlled metabolic studies relating fatty acid intake to plasma total and LDL-cholesterol as well as the overwhelming evidence that LDL is causally related to the atherosclerotic process.
The issues that Ravnskov et al. raise were raised earlier in sixty-two Letters to the Editor, which Dr Ravnskov has published about lipids and heart disease in the past 20 years(Reference Ravnskov2–Reference Ravnskov63). His letters have appeared in JAMA, the New England Journal of Medicine, the British Medical Journal, the Lancet, Science, the American Journal of Clinical Nutrition, Annals of Internal Medicine, the Journal of Clinical Epidemiology, the International Journal of Cardiology, Circulation, the Quarterly Journal of Medicine, the Journal of the National Cancer Institute, Nutrition Metabolism and Cardiovascular diseases, several Scandinavian medical journals, and now in the British Journal of Nutrition.
All these letters argue essentially the same point, namely that lowering blood cholesterol levels is of unproven value. We refer readers to the responses of dozens of reputable scientists set out in each journal's Letters section, where they have carefully responded to Dr Ravnskov's letters and shown that, by and large, Ravnskov's arguments are faulty.