Uffe Ravnskov – life and work

Uffe Ravnskov was born 1934 in Copenhagen, Denmark. After having achieved his MD at the University of Copenhagen in 1961 he got his clinical education in various hospitals in Sweden. From 1968 to 1979 he was appointed at the Department of Nephrology and the Department of Clinical Chemistry at the University Hospital of Lund, and since 1980 he has worked as a private practitioner till his retirement in October 2000. He is still active as an independent researcher.

Ravnskov´s first original observation, the association between heart aneurysm and the post-myocardial-infarction syndrome, was made during his service at the Department of Medicine in Sandviken (E1-4). He was the first in Sweden to acknowledge the lack of association between urinary tract infection and chronic pyelonephritis (C10-12,14) and he also introduced the principle of ultra-short treatment of urinary tract infections in Sweden (C1-4,9), although with little immediate success. In a study of urinary tract infection in women he found that the major cause of dysuria was soap, not bacteria (C5-8).

In his Ph.D. thesis, On Renal Handling of Serum Proteins (D8,11-15) from 1973, he introduced the albumin/creatinine clearance ratio, a more accurate way to measure proteinuria and he was the first to describe the peritubular uptake of low-molecular-weight proteins (D15). His findings that most patients with glomerulonephritis excrete large amounts of tubular proteins (D8,13-14) and tubulospecific enzymes (D1) supported his more recent theory that glomerulonephritis primarily is a tubulointerstitial disease (see below). In experimental studies he demonstrated that the renal handling of proteins differs in man and other mammals (D4-6) implying that knowledge from animal studies cannot be applied to man.

Ravnskov´s major research interest concerns the association between hydrocarbon exposure and glomerulonephritis (B2,3,5,8,9,14,15,18-23,25). He was the first to demonstrate that a discontinuation of hydrocarbon exposure may improve the course of glomerulonephritis (B14,22), a finding that has been confirmed by follow-up studies of British researchers. In a recent meta-analysis he demonstrated that the discordant results from previous case-control studies can be explained by a selection bias: heavy exposure is mainly seen in patients with chronic or end-stage renal failure implying that the most important effect of the exposure is a worsening of renal function, and that progressive renal failure may be prevented by discontinuation of the exposure (B3). His findings inspired him to develop a new theory behind the genesis of glomerulonephritis, the toxic-allergic hypothesis (B2,4,6,8,10,11,12,16).

After the introduction of the cholesterol campaign in Sweden in 1989 he started to study the alleged associations between dietary fat, high cholesterol and cardiovascular disease. Very soon he realised that the scientific evidence behind the campaign was practically non-existing and since then he has argued in many papers and letters against it (A1-49). In one of his most important contributions, a meta-analysis of the cholesterol-lowering trials published in 1992 (A42), he demonstrated that coronary mortality was not lowered by cholesterol lowering, but total mortality was increased. He also demonstrated that the successful dissemination of the diet-heart idea may be due to authors systematically ignoring or misquoting discordant studies (A15,42). He was also the first to suggest that the positive effect of the statins may be due to other effects than cholesterol-lowering (A17,19), a view that has gained widespread acceptance. In a little-recognised paper he pointed to the crucial lack of association between the cholesterol concentration in the blood and the degree of atherosclerosis in the arteries (A47). In 1991 he summarised his criticism in a book, Kolesterolmyten (The Cholesterol Myth), which was first published in Sweden and the following year in Finland (A45), and recently an updated and expanded version has appeared in the United States (A1).

References

A. Kolesterol och koronarsjukdom

  1. Ravnskov U. The Cholesterol Myths. Exposing the fallacy that saturated fat and cholesterol cause heart disease. New Trends Publishing, Washington 2000. http://www.newtrendspublishing.com/
  2. Ravnskov U. VAT and fat. Evidence is contradictory. BMJ 2000;320:1469
  3. Ravnskov U. Är motion överlägsen statinbehandling? Läkartidningen 2000;97:2177.
  4. Ravnskov U. . Prevention of atherosclerosis in children. Lancet 2000;355:69.
  5. Ravnskov U. Why heart disease mortality is low in France. Author´s hypothesis is wrong. BMJ 1999;319:255-6
  6. Ravnskov U. Vilseledande kolesterolstatistik. Läkartidningen 1999;96:1947-8.
  7. Ravnskov U. . The questionable role of saturated and polyunsaturated fatty acids in cardiovascular disease. J Clin Epidemiol 1998;51:443-60. Denna artikel belönades med The Skrabanek Award 1998.
  8. Ravnskov U. Om hederlighet och enomättat fett. Läkartidningen 1998;95:4966.
    9.
  9. Ravnskov U. "Medelhavsdietens" förträfflighet är en myt. Läkartidningen 1998;95:4749-50
  10. Ravnskov U. Myten om det mättade och det fleromättade fettet. Tidskriften Medikament 1998;3(4):44-51 och 1998;3(5):48-53.
  11. Ravnskov U. Auktoriteter kräver tolkningsföreträde. Läkartidningen 1997;95:1022-3.
  12. Ravnskov U. The Cholesterol Myths. http://home2.swipnet.se/~w-25775/
  13. Ravnskov U. American College of Physicians Guidelines on Cholesterol Screening. Ann Intern Med 1996;125:1010.
  14. Ravnskov U. Ger medikamentell kolesterolsänkning cancer? Läkartidningen 1996;93:2040.
  15. Ravnskov U. . Quotation bias in reviews of the diet-heart idea. J Clin Epidemiol 1995;48:713-9
  16. Ravnskov U. Fedtsyrer og forvirrende signaler. Ugeskr Læger 1995;157:1534-35.
  17. Ravnskov U. Implications of 4S evidence on baseline lipid levels. Lancet 1995;346:181.
  18. Ravnskov U. Keys eller kaos. Svar. Ugeskr Læger 1995;157:3210
  19. Ravnskov U. Beneficial effects of simvastatin may be due to non-lipid actions. BMJ. 1995; 311:1436-7.
  20. Ravnskov U. Dietary fats and blood lipids as cardiovascular risk factors in the general population. A critical overview. Proceedings of the I. World Congress of Dairy Products in Human Health and Nutrition. Madrid 1993. Rotterdam: Balkema 1994, p 361-369. http://www.acponline.org/journals/annals/15dec96/letter1.htm
  21. Ravnskov U. Kolesterolsænkende lægemidler. Ugeskr Læger 1994;156:329
  22. Ravnskov U. Hypercholesterolemia does not cause coronary heart disease - evidence from the nephrotic syndrome. Nephron 1994;66:356-7.
  23. Ravnskov U. Är fleromättat fett en orsak till manlig sterilitet? Läkartidningen 1994;91:2308.
  24. Ravnskov U. . Ischaemic heart disease and cholesterol. Optimism about drug treatment is unjustified. BMJ 1994;308:1038.
  25. Ravnskov U. Ukritisk referat af kolesterolartikler. Ugeskr Læger 1994;156:4479.
  26. Ravnskov U. Is there a cause-effect relationship between high blood cholesterol and atherosclerosis? Workshop on cholesterol-lowering trials. National Heart, Lung and Blood Institute, Bethesda 1994.
  27. Ravnskov U. What do angiographic changes after cholesterol lowering mean? Lancet 1994;344:1297.
  28. Ravnskov U. Is intake of trans-fatty acids and saturated fat causal in coronary heart disease? Circulation 1994;90:2568-9.
  29. Ravnskov U. Doing the right thing: stop worrying about cholesterol. Circulation 1994;90:2572-3.
  30. Ravnskov U. Slutreplik om kolesterol. Läkartidningen 1994;91:117-8.
  31. Ravnskov U. Stoppa Kolesterolkampanjen! Läkartidningen 1993;90:4587-4588.
  32. Ravnskov U. Nya tongångar från USA. Kolesterolkampanjen ifrågasättas. Läkartidningen 1993;90:2528-9.
  33. Ravnskov U. Cardiovascular disease in developing countries. BMJ 1993;306:145-6.
  34. Ravnskov U. Tveksamheter om kolesterol. Suomen Lääkärilehti 1993;48: 1063-4.
  35. Ravnskov U. Flera tveksamheter om kolesterol Suomen Lääkärilehti 1993;48:1716-7.
  36. Ravnskov U. Tvivlsomme råd om kolesterolscreening hos børn. Ugeskr Læger 1993;155:1886-7.
  37. Ravnskov U. Reducing serum cholesterol. Lower cholesterol of doubtful benefit to anyone. BMJ 1993;307:125.
  38. Ravnskov U. Coronary atherosclerosis on angiography-progress or regress and why? Circulation 1993;88:1358-9.
  39. Ravnskov U. Livet forkortes når kolesterolet sænkes. Ugeskr Læger 1993;155:3678-9.
  40. Ravnskov U. Hvad er det rigtige svar i kolesteroldebatten? Ugeskr Læger 1992;154:1716.
  41. Ravnskov U. Kolesterol och Hälsa: En titt under mattan. Livsmedelsteknik 1992;4:7.
  42. Ravnskov U. Cholesterol lowering trials in coronary heart disease: frequency of citation and outcome. BMJ 1992;305: 15-19. Letters: BMJ 1992;305:420-422, samt 717.
  43. Ravnskov U. The fragile links of the diet-heart chain. Nutrition Quart 1992;16:19-21.
  44. Ravnskov U. Kolesterolmyten. Månedsskrift f praktisk Lægegerning 1991;70:131-8.
  45. Ravnskov U. Kolesterolmyten. Streiffert, Stockholm, 1991. Kolesteroli. Art House, Helsinki 1992.
  46. Ravnskov U. Atherogenicity and thrombogenicity indices. Lancet 338, 1328, 1991.
  47. Ravnskov U. An elevated serum cholesterol is secondary, not causal, in coronary heart disease. Medical Hypotheses 1991;36:238-41. Erratum: Medical Hypotheses 1992;38:95.
  48. Ravnskov U. Är fleromättat fett nyttigt? Läkartidningen 88, 1058, 1991
  49. Ravnskov U. Lowering cholesterol concentrations and mortality. BMJ 301, 814, 1990.

 

B. Glomerulonefrit

  1. Ravnskov U. Glomerulonefrit – en yrkessjukdom – nya rön om en sjukdom associerad med exposition för njurtoxiska ämnen. Läkartidningen 2000;97:3978-9.
  2. Ravnskov U. Hydrocarbon exposure may cause glomerulonephritis and worsen renal function. Evidence based on Hill´s criteria for causality. Quarterly Journal of Medicine 2000;93:551-6
  3. Ravnskov U. Hydrocarbons may worsen renal function in glomerulonephritis. A meta-analysis of the case-control studies American Journal of Industrial Medicine 2000;37:599-606.
    4.
  4. Ravnskov U. Glomerular, tubular and interstitial nephritis associated with non-steroidal antiinflammatory drugs. Evidence of a common mechanism. Br J Clin Pharmacol 1999;47:203-210
  5. Ravnskov U. Lösningsmedel och drivmedel orsakar kronisk njursvikt. Tidskriften Medikament 1999;2:80-84.
  6. Ravnskov U. . The subepithelial formation of immune complexes in membranous glomerulonephritis may be harmless and secondary to allergic or toxic factors. Scand J Immunol 1998;48:469-74.
  7. Ravnskov U. Renal complement synthesis in glomerulonephritis. Lancet 1994;343:235-6.
  8. Ravnskov U. Hydrocarbons and renal failure: Primary damage in glomerulonephritis is tubular, not glomerular. Nephron 1992;61: 243
  9. Ravnskov U. Glomerulonephritis, renal carcinoma, and solvent exposure: bias from choice of referents. Brit J Indust Med 47, 791-92, 1990
  10. Ravnskov U. Non-systemic glomerulonephritis: Exposure to nephro- and immunotoxic chemicals is primary and predisposes to immunologic harassment. Med Hypotheses 1989;30:115-122
  11. Ravnskov U. Focal segmental glomerulosclerosis in acute renal failure. N Engl J Med 1989;320:1218
  12. Ravnskov U. Focal glomerular lesions in glomerulonephritis may be secondary to tubulo-interstitial damage. Am J Kidney Dis 1988;12:250-251
  13. Ravnskov U. Hepatitis B virus and glomerulonephritis. Lancet 1987;2:691
  14. Ravnskov U. Influence of hydrocarbon exposure on the course of glomerulonephritis. Nephron 1986;42:156-160.
  15. Ravnskov U. Glomerulonefrit och organiska lösningsmedel. Läkartidningen 1986;83:1080-3
  16. Ravnskov U. Possible mechanisms of hydrocarbon-associated glomerulonephritis. Clin Nephrol 1985;23:294-298.
  17. Ravnskov U. Glomerulonephritis and organic solvents. Lancet 2, 566, 1985.
  18. Ravnskov U, Lundström S, Nordén Å. Hydrocarbon exposure and glomerulonephritis: evidence from patients' occupations. Lancet 1983;2:1214-16.
  19. Ravnskov U. Hydrocarbon exposure and glomerulonephritis. Nephron 1983;36:143.
  20. Ravnskov U. Acute glomerulonephritis and exposure to organic solvents in father and daughter. Acta Med Scand 1979;205:581-582.
  21. Ravnskov U, Forsberg B, Skerfving S. Glomerulonephritis and hydrocarbon exposure - a case control study. Acta Med Scand 1979; 205:575-579.
  22. Ravnskov U, Forsberg B. Improvement of glomerulonephritis after discontinuation of solvent exposure. Lancet 1979;1:1194
  23. Ravnskov U. Exposure to organic solvents - a missing link in acute poststreptococcal glomerulonephritis? Acta Med Scand 1978;203:351-356.
  24. Ravnskov U, Dahlbäck O, Messeter L. Treatment of glomerulonephritis with drainage of the thoracic duct and plasmapheresis. Acta Med Scand 202, 489-494, 1977.
  25. Ravnskov U. Exposure to organic solvents in acute poststreptococcal glomerulonephritis. Lancet 1977;2:258

C. Urinvägsinfektion

  1. Ravnskov U. Behandlingstidens längd vid urinvägsinfektion. Läkartidningen 1987;84:1339.
  2. Ravnskov U. Avvisa inte singeldosbehandlingen vid urinvägsinfektion! Läkartidningen 1987;84:1535.
  3. Ravnskov U. Singeldos vid urinvägsinfektion fungerar med rätt dos och rätt preparat. Läkartidningen 1987;84:2946.
  4. Ravnskov U. Singeldos-behandling av okomplicerad cystit och asymtomatisk bakteriuri. En översikt. Läkartidningen 1986;83:45-47.
  5. Ravnskov U. Dysuri kan orsakas av tvål. Läkartidningen 1985;82: 836
  6. Ravnskov U. Dysuri skyldes som regel sæbe. Ugeskr Læger 1985;147:1493-94.
  7. Ravnskov U Sæbe og dysuri. Ugeskr Læger 1985;147:2093
  8. Ravnskov U. Soap is the major cause of dysuria. Lancet 1983;1:1027-8
  9. Ravnskov U. Strikta indikationer, kort tids terapi - lösningen på sulfaproblemet. Läkartidningen. 1982;79:1350.
  10. Ravnskov U. Bakteriuri og vejen til iatrogenese. Ugeskr Læger 1978;140:2256-2257.
  11. Ravnskov U. Medikaliserat samhälle?. Läkartidningen 1976;73:1298
  12. Ravnskov U. Långtidsprognosen vid urinvägsinfektion och asymtomatisk bakteriuri. Läkartidningen 1975;72:1796-98
  13. Ravnskov U. Urinary tract infection with disappearance of urinary creatinine. Scand J Urol Nephrol 1973;7:94-95.
  14. Lindholm T, Ravnskov U. Bakteriuri och pyuri - är det farligt? Läkartidningen 1972;69: 3538-41

D. Njurfysiologi, proteinuri

  1. Hultberg B, Ravnskov U. The excretion of N-acetyl-ß-glucosaminidase in glomerulonephritis. Clin Nephrol 1981;15:33-8.
  2. Ravnskov U. Serum ß2-microglobulin and glomerular function. N Engl J Med 1976;294:611.
  3. Ekman R, Johansson BG, Ravnskov U. Renal handling of Zn-a 2-glycoprotein as compared with that of albumin and the retinol-binding protein. J Clin Invest 1976;57:945-54.
  4. Ravnskov U, Johansson BG. Isolation and partial characterization of a porcine low molecular weight protein occurring in plasma and urine. Internat J Biochem 1976;7:579-83.
  5. Ravnskov U, Johansson BG, Ljunger L. Proteinuria in pigs with experimentally induced renal damage. Contrib Nephrol 1975;1:50-61.
  6. Ravnskov U, Karatson A. Renal handling of human ß2-microglobulin in the rat: The importance of sham-operation. Acta Physiol Scand1975;94:467-471.
  7. Ravnskov U. Low molecular weight proteinuria in association with paroxysmal myoglobinuria. Clin Nephrol 1975;3:65-69.
  8. Ravnskov U. Proteinuria after renal transplantation. 2. A functional identification of two types of rejection crisis. Scand J Urol Nephrol 1974;8:45-49.
  9. Ravnskov U, Johansson BG. Renal handling of ß2-microglobulin. Protides of the biological fluids. 1974;21:513-517.
  10. Johansson BG, Ravnskov U. Urinproteinanalys vid kadmiumförgiftning. Läkartidningen 1973;70:2310 .
  11. Ravnskov U. Albuminuria in acute and chronic renal failure. Acta Med Scand 1973;194:59-64.
  12. Ravnskov U. On renal handling of plasma proteins. Thesis. Scand J Urol Nephrol 7, suppl 20, 1973.
  13. Ravnskov U. Proteinuria after renal transplantation. 1. Excretion of a 2-microglobulin, ß2-microglobulin, lysozyme and albumin. Scand J Urol Nephrol 1974;8:37-44.
  14. Johansson BG, Ravnskov U. The serum level and urinary excretion of a 2-microglobulin, ß2-microglobulin and lysozyme in renal disease Scand J Urol Nephrol 1972;6:249-56.
  15. Ravnskov U, Johansson BG, Göthlin J. Renal extraction of ß2-microglobulin. Scand J Clin Lab Invest 1972;30:71-75.
  16. Ravnskov U. Muramidase and acute rejection of kidney grafts. Lancet 1972;2:716.
  17. BG Johansson, Ravnskov U. Analyses of proteins in urine. Aids and limitations. Scand J Clin Lab Invest 1972;29,suppl 126.

D. Ochratoxin-nefropati

  1. Krogh P, Axelsen NH, Elling F, Gyrd-Hansen N, Hald B, Hyldgaard-Jensen J, Larsen AE, Madsen A, Mortensen HP, Møller T, Petersen OK, Ravnskov U, Rostgaard M, Aalund O. Experimental porcine nephropathy. Changes of renal function and structure induced by Ochratoxin A-contaminated feed. Acta Pathol Microbiol Scand Suppl 246, 1974.
  2. Krogh P, Elling F, Gyrd-Hansen N, Hald B, Larsen AE, Lillehøj EB, A Madsen,HP Mortensen, Ravnskov U. Experimental porcine nephropathy: changes of renal function and structure perorally induced by crystalline ochratoxin A. Acta Pathol Microbiol Scand 1976;84 A:429-434.
  3. Krogh P, Elling F, Friis C, Hald B, Larsen AE, Lillehøj EB, Madsen A, Mortensen HP, Rasmussen F, Ravnskov U. Porcine nephropathy induced by long-term ingestion of ochratoxin A. Vet Pathol 1979;16:466-475.

 

E. Postmyokardieinfarkt-(PMI)-syndromet

  1. Ravnskov U. Steroidbehandling av Dresslers syndrom? Läkartidningen 1978;75:768.
  2. Ravnskov U. Fluctuating pericardial effusion. N Engl J Med 1969;281:854.
  3. Ravnskov U. Aneurysm of the heart and the post-myocardial-infarction. Acta Med Scand 1968;183:393-395.
  4. Ravnskov U. Fall av PMI-syndrom. Läkartidningen 1967;64:436-438.

 

F. Blandat

  1. Ravnskov U. Benskörhet kan vara iatrogen - skona äggstockarna! Läkartidningen 1993;90:3844.
  2. Ravnskov U. Beredskap mot forskningsfusk. Läkartidningen 1993;90:2116.
  3. Ravnskov U. Kinesisk Mädchenfanger-metod bästa sättet att reponera en handledsfraktur? Läkartidningen 1989;86:3068-3069.
  4. Ravnskov U. Patientförsäkringen och Larssons arm. Läkartidningen 1989;86:3901-2.
  5. Ravnskov U. Accusation of fraud. Lancet 1988;i:539.
  6. Ravnskov U. Försäkringskassan, sparkniven och AIDS. Läkartidningen 1988;85:4583.
  7. Eksmyr R, Fex G, Jagell S, Johansson BG, Ravnskov U, Samuelsson G. Low molecular weight proteinuria and slight hyperlipoproteinemia in three mentally retarded brothers. Acta Pædiatrica Scandinavica 65, 521-525, 1976.
  8. Svensson L, Ravnskov U. a 1-microglobulin, a new low molecular weight plasma protein. Clin Chim Acta 1976;73:415-422.
  9. Ekman R, Johansson BG, Ravnskov U. Gel chromatography on Sephadex gels with narrow particle size distribution obtained by dry elutriation. Anal Biochem 1976;70:628-631.
  10. Ravnskov U. Uremic polyneuropathic motor paralysis and immobilization hypercalcemia. Scand J Urol Nephrol 1973;7: 63-67.
  11. Hegedüs V, Ravnskov U. Cortical volume in apparently normal kidneys. Scand J Urol Nephrol 1972;6:159-165.

G. Tidningsartiklar

  1. Ravnskov U. Många är njursjuka i onödan. DN-debatt. Dagens Nyheter 11. april 1999
  2. Ravnskov U. Kritisk medicinjournalistik – finns det? Journalisten 29/30, 23-29 oktober 1997.
  3. Ravnskov U. Ingen risk med fett. DN-debatt. Dagens Nyheter 7. juli 1997
  4. Ravnskov U. Ny hjärtmedicin kan ge cancer. DN-debatt. Dagens Nyheter 22. april 1997
  5. Ravnskov U. Har Stakeberg och Redfors läst boken? Elfsborgs Läns Allehanda 28 feb 1992.
  6. Ravnskov U. Logik och kolesterol. Sundsvalls Tidning 2. maj 1992.
  7. Ravnskov U. Fortsat kolesterolgalskab. Information 26/6 1992
  8. Ravnskov U. Goddag kolesterol - økseskaft. Information 17/6 1992.
  9. Ravnskov U. Fedtkampanjen - humor eller kvaksalveri? Information 25/5 1992.
  10. Ravnskov U. Overlæge Færgeman ude at sejle. Jyllandsposten Oktober 1992.
  11. Ravnskov U. Kolesterolhypotesen pulveriseret. Jyllandsposten. Oktober 1992.
  12. Ravnskov U. Fats suffer from 'selective' research. Bulletin of the National Renderers Association Oct-Dec. 8, 1992.
  13. Ravnskov U. De äter världens fetaste mat - utan att få hjärtinfarkt. Land 12. juli 1991
  14. Ravnskov U. Kolesterol är ofarligt. DN-debatt. Dagens Nyheter 2. feb 1990.
  15. Ravnskov U. Kuren värre än sjukdomen. Sydsvenska Dagbladet 29. jan. 1984.

H. Lite skämtsamt

  1. Ravnskov U. Högt blodtryck. Läkartidningen 1995;92:1296.
  2. Ravnskov U. Rosor för mullvadar. Sydsvenska Dagbladet Juli 1991.
  3. Ravnskov U. Gatfloran kremeras. Sydsvenska Dagbladet 4/7 1990.
  4. Ravnskov U. Don Quijotes hämnd. Läkartidningen. 1990;87:344
  5. Ravnskov U. Häxdoktorn. Läkartidningen 1990;87:912
  6. Ravnskov U. Intressekonflikt. Läkartidningen 1989;86
  7. Ravnskov U. Ett (osakligt?) inlägg i kolesteroldebatten. Läkartidningen 1990;87:555

Updated januari 10, 2001