How to Fortify Yourself Against Cardiovascular Misinformation

If you spend any time in the online cardiovascular health world, you have probably noticed something. The same debates keep showing up over and over again. Different faces, different Instagram posts and Youtube shorts, but the same playbook. Once you can see the moves, you start to see through the playbook and know the difference between information that can help you and information that can harm you.

Contrarian Papers

It seems like every few months a new post drops with a title like "Is Lower LDL Really Better? A Critical Examination." Sometimes it's even a published paper in a medical or science journal. Because of the provocative nature of the title and content, it gets shared everywhere within hours like a bombshell.

But an authoritative post, or even review paper is not new data. It is essentially an argument, built by cherrypicking studies to emphasize and leaving out ones that don't support the narrative. Unfortunately, the average listener/reader doesn't realize this and thinks it's just a thorough investigation. Even worse, a lot of the published literature out there like this is literally a closed loop, with the same small group of authors citing each other's prior papers over and over, as if that were independent evidence. It looks like a mountain, but it's really just a house of cards. A short list of names that show up again and again as examples of this are:

David Diamond, Uffe Ravnskov, Malcolm Kendrick, Paul Saladino, Paul Mason, Ben Bikman, Zoe Harcombe, Aseem Malhotra, Nina Teicholz, Robert DuBroff

Seeing one of these names attached to a paper does not guarantee all of what the paper is saying is wrong. It just means you are reading a highly biased voice in a familiar debate, with a track record of cherry picking and recirculating work from others that fit the narrative and use the same tactics. This is not a neutral observer stumbling onto something new. Ecological Fallacy

This one is worth understanding because there is a real point buried in it. The argument goes something like: Sure, trials show that on average LDL lowering helps, but some individual patient data shows no benefit. Therefore, maybe LDL was never the real driver.

The methodological point is legitimate. Group level associations do not always hold at the individual level. But what happens next is the key. That reason for caution in interpreting a study then quietly gets stretched into "therefore LDL isn't causal for atherosclerosis," a much bigger claim against and idea that has mountains of evidence from a wide variety of angles supporting it.

Survivorship Bias

You will see this constantly with familial hypercholesterolemia. Elderly FH patients with sky high LDL their whole lives are still alive and fine, so LDL cannot be that dangerous, right?

Except you are only looking at the survivors. The ones who had events in their forties due to the same condition are already gone from that dataset and so not being counted. The leftover, elderly FH patients still standing are, almost by definition, an outlying subset of these people who almost undoubtedly also harbor some other biology unique to there bodies, or highly impactful lifestyle habits that protected them along the way. Their story is not a true paradox. This is called survivorship bias and it may not in any way shape or form apply to the next person.

Retraction Rebound

We just watched this with KETO CTA. A high profile, but technically tiny and very messy paper built off observational data with no intervention and no control group still gets celebrated across low carb spaces as proof LDL/apoB does not track with plaque progression does not matter on keto because of what it (inappropriately) concluded and because it supports this approach to eating (in this case, a popular documentary was even built around it!). Then the serious errors it has surface later (after all the hype), corrections follow, and then it actually gets retracted with a new paper now just a preprint that has yet to even be peer reviewed and still looks like a mess, but this part only gets a fraction of the attention the original splash got. The narrative built on the original conclusions just keeps circulating anyway. What's worse, many popular people in the community misinterpret and/or overstate what was even said and circulate things the paper didn't even say, while propping up the paper as evidence in support of their unsupported statement.

If you remember one thing from this post, remember this. Misinformation has a "first mover advantage". The headlines and the original claims travel fast, but the corrections travel slowly and are often ignored, and the wrong idea already has a home in a hundred thousand heads.

Cherry Picked Trials

Small, messy, weak, underpowered, or early terminated trials get pulled out again and again to argue LDL targets do not matter. Real methodological weaknesses show up sometimes, small sample sizes, high dropout rates, results that are so sensitive even a small handful of flipped outcomes would erase the significance. You cannot wave away a trial's flaws when it disagrees with you then lean on others over and over again that have major problems just because they support you. Perfect examples are the KETO-CTA study, the Minnesota Coronary trial, and the Sydney Heart study. Please watch this short video and this short video and this short video for more info.

Real Mechanisms Ignored

Almost every one of these arguments works by simply not engaging with the causal framework that explains the messiness they are pointing at. ApoB containing particles like LDL are the wood to a fire, and inflammation, metabolic dysfunction, high blood pressure, smoking, and certain types of genetics, act like gasoline. Perfect LDL numbers do not always guarantee halted progression, because the accelerants matter too, and high LDL numbers do not always guarantee disease (at least not at expected timing) because some unique factors that certain people harbor or practice can have a sufficiently offsetting effect that the signal is not as clear in them. The point though is that this is not a contradiction of the model, it is an example of the multifactorial nature of the disease. If you want to control, it, control all the factors as well as you can. Don't ignore some of them and hope the others are good enough.

So How Do You Fortify Yourself

1. Find the most objective resources you can, who are adept at just neutrally analyzing data and stick to their info as much as possible. Even though I would never say I agree with absolutely everything anyone says, some of my favorite resources who have really taught me a lot about how to think and analyze things are:

   1. Nutrition Made Simple

   2. Viva Longevity

   3. The Proof

   4. Physionic

   5. Dr Matthew Nagra

   6. Dr Idz

2. Slow down before believing (or sharing) anything that sounds like a bombshell.

3. Look at who wrote it and what they have written before. A pattern of the same authors making similar arguments across years is a major tell, and social media influencers who share them while ignoring other science are too.

4. And hold your own views a little loosely. I was a major LDL skeptic myself once, before a more open minded look at better evidence changed my views. Staying open to being wrong is not a weakness.
   

To be clear, none of what I'm saying means I think you should tune out every contrarian voice. The goal is telling the difference between a genuine challenge to the evidence and a well worn playbook with a new headline.

Stay skeptical and curious in both directions, and keep asking what the whole picture looks like, not just the slice someone handed you on platter, especially when you'd really like for it to be true.