If I understand correctly, the original source is this. I can't find any way to access it online, but everyone who talks about it says the results mentioned in that blog post and no one says otherwise, so I'm assuming they didn't just make it up.

Perhaps I don't trust people enough on the internet. Especially when they're trying to sell books of their own. See down below. Perhaps most of the people who talk about it haven't seen it themselves, but are happy to spread the good message anyway. Perhaps the guy who sold it forged it. There are many points where someone could be lying, so you don't have to blame a guy you like. There are some very dishonest people in my personal life so maybe this is a bias. It's also pretty amazing to me that google gives only 563 results for "Framingham Diet Study", because I guess this should be kind of a big deal. I'd really like to get my hands on it.

Right, but the studies on niacin and ezetimibe showed that they decreased cholesterol (ie were being used successfully and correctly) but failed to decrease cardiovascular endpoints.

I agree it's very weird, but again the decrease in cholesterol not helping is hardly the only explanation for the results. Confounding factors are not fiction. Unfortunately I don't have time to scrutinize them, as I'm not going to prescribe these drugs. (EDITED)

I see where you're coming from. On the other hand, there is a $40 billion diet industry telling people to eat less fat and causing a spectacular amount of mental anguish around this idea (I don't know if this is true in Finland; it's definitely a big deal in America).

Living in Finland might indeed be the source of my confusion. Since most of the studies come from the US, I should update that this industry affects our nutrition more than I'd currently like to think. Nutrition here is a frequent topic, but excluding a couple of cases I've never come across the emotional turmoil that it seems to cause in americans. Isn't there an industry pushing back too, and how are these people not just trying to make money?

You're right that the measurements were taken within 24 hours, but I've heard this isn't such a big deal, and according to the full-text version of the Fonarow study (sorry, didn't find it until this morning) they agree with me. Also, if I'm reading their table right patients having acute coronary events had higher, not lower, cholesterol than those coming in with chronic complaints, and if the effect were really only 5-15% it wouldn't significantly affect the main finding of the paper by much.

Thank you, definately saving them. Edit: The first study says "Although fasting blood samples were not mandated on the admission baseline test, subsequent samples collected on days 2 and 4 were in the fasting state. " This means the baseline probably seems higher than it should. See the chapter "Limitations" in the Fonarow study. I can't see how they agree with you (See Edit3 below, though).

The chronic cases receive statins after the disease has mostly developed so I guess that should explain the results. 30 % of the chronics received lipid lowering medication. 20 % of the admitted patients overall received lipid lowering medication. In the fifth table, lipid lowering medication is the strongest predictor of lower LDL. Edit2 This might also better explain why admitted patients overall have lower LDL than the general population, and can also be combined with the acute effect observed. It just means that patients at risk are properly recognized and treated, although probably too late.Edit3 Read more thoroughly and did some unit conversions from mg/dl to mmol/l, it doesn't. However what is considered normal varies from risk group to risk group, and can be as low as 70 mg/dl. The authors of this study are supporting lowering the limits of what is considered normal, and I suppose you wouldn't agree with this.

Framingham says that "there is a direct association between falling cholesterol levels over the first 14 years and mortality over the following 18 years (11% overall and 14% CVD death rate increase per 1 mg/dL per year drop in cholesterol levels"

In people over 50 years, if I understand correctly. Might be an english issue or then the issue is really with my understanding. So if people have more diseases (or they have progressed further) after 50 years that cause starvation (or some other mechanism that lowers cholesterol you can agree with) ie. IBD, depression, dementia, heart failure AND CVD mortality (edit), it makes sense that mortality follows falling cholesterol levels in that age group. Combine this with what I said before. As they speculate, "After age 50 years the association of mortality with cholesterol values is confounded by people whose cholesterol levels are falling--perhaps due to diseases predisposing to death." They only ruled out CVD and cancer after all. I'd like to find the full copy for free because I have slight difficulty parsing the abstract. Of course it's the study itself versus their speculation based on some "background knowledge" so I have to admit that your position is the stronger one here.

Yes, I agree with this. But the thesis of Good Calories, Bad Calories is that this allows enough degrees of freedom to be able to back up infinite amounts of confirmation bias.

Now I definately have to read this book! I promise.

At the very least, you have to admit the Cochrane review showing restricting dietary fat had no effect on anything means that something has gone atrociously wrong somewhere between what doctors say to their patients and reality

Our national guidelines already say that the effect of recommended diet (and exercise!) on cholesterol is tiny, but positive. After this discussion I'm even less enthusiastic about giving dietary advise. Concerning diabetes the guidelines might be even more wrong, but lets not open that can of worms this time!

And if you see a study that opposes your hypothesis, you say "in light of my background knowledge that my hypothesis is right, we can't take this study at face value", then seize on the first flaw you find in the study and use it to throw it all out.

Yeah, this culture is very prevalent in medicine, but of course varies from person to person. University hospital doctors are very status oriented people. I've read Heuristics and Biases, and as I understand knowing about biases doesn't help much. Then again, I don't think it's only (dis)confirmation bias, but caution (a bias in itself), and I think everyone has difficulty differentiating these two. To be honest at this level of my education if I seriously start questioning my elders about everything I'll be scared shitless in my daily work.

While time allows for additional studies, I feel like I can only concentrate on a few topics to master them. I was previously interested in a few fringes of neurology, mainly MS, but I'm starting to see that this is hardly rational from a utilitarian perspective.