The Truth About Ancel Keys: We’ve All Got It Wrong

(Note: This post was inspired by the “Ancel Keys” section in a recent series of paleo-challenging YouTube videos, which I may critique in the future. The anonymous videomaker “Plant Positive” highlighted some important misconceptions about Keys and his research that I’d like to broadcast to a larger audience, but didn’t address some equally important points tangled in the Keys saga, and likewise made some arguments I believe are incomplete or misleading. This blog post is an attempt to address those misconceptions in a more balanced and thorough way, and provide a broader context for how we view the infamous Mr. Keys.)

This is one of those “gotta bust me some myths no matter where they come from” blog posts. And by that, I mean I’m about to challenge a story that’s been so well-circulated among paleo, low carb, and real-food communities that most of us have filed it away in a little brain-folder called “Things We Never Have to Question Because They’re So Ridiculously True.”

I’m talking about the late, great Ancel Keys, and his equally late (but maybe not as great) role in the history of heart disease research. The oft-repeated tale goes something like this:

Once upon a time, a scientist named Ancel Keys did an awful thing. He published a study about different countries that made it look like heart disease was associated with fat intake. But the truth was that he started out with 22 countries and just tossed out the ones that didn’t fit his hypothesis! When other researchers analyzed his data using all the original countries, the link between fat and heart disease totally vanished. Keys was a fraud, and he’s the reason my mom made me eat skim milk and Corn Chex for breakfast instead of delicious bacon and eggs. LET HIS SOUL BURN. BURN! BUUUUUURN!

Depending on who tells the story, some of the details (and wishes for eternal hellfire) may differ. But in many cases, Keys’ infamous cherry-picking is attributed to his Seven Countries Study, a landmark project that helped sculpt our common beliefs about fat. Even the Seven Countries Study page on Wikipedia—the first hit when you Google “Seven Countries Study”—says that Keys shamelessly erased the data he didn’t like:

The study began with a great many more countries … but Keys deleted the countries whose results did not match his pre-conceived conclusions, leaving him with only Japan, Italy, Great Britain, Australia, Canada and the US. Full disclosure would have made a great deal of difference.

Ditto for the page on Ancel Keys himself:

Keys collected data on deaths from coronary heart disease and fat consumption from 22 countries. Despite the fact that 22 countries provided statistics, Keys cherry-picked the data from the 7 countries which supported his theory that animal fat was the main cause of coronary heart disease in order to publicize his opinions. The results of what later became known as the “Seven Countries Study” appeared to show that serum cholesterol was strongly related to coronary heart disease mortality both at the population and at the individual level.

…And we all know Wikipedia would never lead us astray. Other big-hitters in the nutrition blogosphere have repeated this version as well, dismissing the Seven Countries Study as manipulated bias, and claiming Keys’ theory fell apart once some discarded countries were added back in—making it all the more troubling that the study became so influential.

This, we’re told, is Keys’ cherry-picked graph:

The upward curve of doom.

And this, we’re told, is the graph with all 22 countries and a diminished fat-and-heart-disease association:

And this, we’re told, is the man who ruined the world:

Unfortunately, reality sometimes infringes on the things we’d prefer to consider “facts.” This is one such occasion.

The Truth:

  • Ancel Keys did not drop any countries from the Seven Countries Study. His most famous graph—the first one up above—is from a different paper he presented at a World Health Organization (WHO) conference in 1955. The Seven Countries Study didn’t even launch until 1958, and entailed much more than just plopping numbers into a pretty curve. (That said, the Seven Countries Study had plenty of problems too; some are mentioned on this site.)
  • Contrary to popular belief, the cherry-picked graph didn’t convince everyone that fat was evil. In fact, Keys was pretty much ridiculed for the weakness of his fat/heart disease theory by other scientists at the WHO meeting, and whenever his graph was cited in medical journals later on, it was usually paired with some criticism. Although Keys’ work definitely shaped our current beliefs about fat, this graph didn’t exactly take the world by storm. (More on this later.)
  • When all 22 countries were analyzed, the association between fat and heart disease did not go away. It actually remained statistically significant (meaning it probably wasn’t due to chance). And to make matters worse, the paper frequently cited as a “rebuttal” to Keys shows pretty clearly that animal protein had an even stronger association with heart disease than total fat did. The China Study was right all along! Time to go vegan, you guys. (Just kidding. But this part is the most interesting of all, and we’ll examine it in excruciating depth in a moment.)

Although some of his saga has been misconstrued, Keys was still far from perfect—and his eventual role in demonizing saturated fats (while glorifying polyunsaturated fats) has led us down an unfortunate road. My goal is neither to nudge Mr. Keys into sainthood nor to perpetuate his villain status—only to lay out the history and data as objectively as possible.

Here’s the more detailed scoop.

The six-country graph

Let’s look at this sucker again—smaller now, to symbolize its diminished importance (and to ease the burden of scrolling):

Keys published this graph in 1953 in a paper called called “Atherosclerosis: A problem in newer public health” (which is apparently so brilliant that neither the abstract nor full text is allowed to exist online). It was simple, really: he graphed fat consumption alongside heart disease mortality in men from six different countries—and voila! The data points landed in a tidy little line. Keys first unveiled his Wonder Curve to a handful of people at Mt. Sinai Hospital in New York, but his most famous presentation was at that WHO conference a few years later.

Curiously, instead of rolling around on the floor possessed by fat-phobia demons, his WHO audience reacted with skepticism. One report says another researcher challenged Keys to describe his “best piece of evidence” for the diet-heart idea, and effectively squashed Keys’ argument with his Oxford-educated debate tactics. As a result, poor Keys never got to show all the WHOs down in WHOville the full reasoning behind his theory, and left the conference rather defeated. (At least he didn’t steal Christmas.)

But the debate humiliation was small potatoes compared to what came next. In 1957, Jacob Yerushalmy and Herman Hilleboe—Berkeley statistician and New York State Commissioner of Health, respectively, who’d both attended the WHO meeting with Keys—wrote a scathing critique of Keys’ beloved graph. Their paper was titled “Fat in the diet and mortality from heart disease: A methodological note.” This, my friends, is the rebuttal that gets cited near and far as proof of Keys’ fraudulence, and is the source of that “original 22 countries” graph we saw a bit ago.

It’s a pretty good paper, almost clairvoyantly identifying problems that would plague epidemiology for decades to come. And like most pretty good papers, I can’t link to it for free anywhere online. Which means I’ll be screen-shotting excessively from a copy Peter at Hyperlipid kindly sent me a few months ago. (Thanks, Peter!)

It starts out with a nugget of wisdom about “indirect” studies (e.g., playing connect-the-dots with observational data):

It is well known that the indirect method merely suggests that there is an association between the characteristics studied and mortality rates and, further, that no matter how plausible such an association may appear, it is not in itself proof of a cause-effect relationship. But quotation and repetition of the suggestive association soon creates the impression that the relationship is truly valid, and ultimately it acquires status as a supporting link in a chain of presumed proof.

True that, Yerushalmy and Hilleboe. True. That. But I realize we’re not here for wisdom nuggets; we’re here to learn the truth about Ancel Keys and his picking of cherries. Here’s where the paper gets interesting:

Since no information is given by Keys on how or why the six countries were selected [for his graph], it is necessary to investigate the association between dietary fat and heart disease mortality in all countries for which information is available.

That’s right, folks. At the time he made his six-country graph, Keys actually had access to a much larger database of food intake and mortality statistics for 22 countries. Why he chose only six will forever remain one of life’s great mysteries.

And thusly, we’re presented with this. The graph with all the original countries in their non-manipulated glory. Drumroll, please. (For purposes of suspense and unbridled excitement, pretend you didn’t already see this graph a few minutes ago.) Here we have…

…a less defined, but existent upward trend. Yeah, it’s still there.

But wait! Wasn’t this graph supposed to demolish the association between fat intake and heart disease among the 22 countries? Aren’t we told that was the epic discovery of this paper? Yerushalmy and Hilleboe concede that although Keys’ six countries “greatly exaggerated the importance of the association,” the full graph still shows that there’s “some association in the conventional sense between the two variables.” And as we’ll see shortly, that “some association” was actually quite large—a statistically significant r-value of 0.59 (p < 0.02), which is pretty hefty in math-speak.

So here’s what we’ve got so far:

  1. Keys cherry-picked six countries and never told us why.
  2. The cherry-picking was shameful and terrible and unscientific, but the fat/heart disease association among his six countries was also present in the full set of data. Keys didn’t just make it up.

I’m not going to pat Keys on the back for deliberately choosing countries to make his case look stronger, but in terms of historical accuracy, we can’t say that he actually lied. His biggest error, in fact, had less to do with data-deletion and more to do with tunnel vision. Along with failing to explore reasons why fat might be linked to heart disease in a non-causal way, it seems Keys had his eyes locked so tightly on his lovely lipids that he didn’t notice the role of other dietary factors.

And indeed, this is where Yerushalmy and Hilleboe really hammer the heck out of Keys (he could surely never open a door again). In their paper, they explain that—in order to gauge whether the fat-heart disease relationship is really noteworthy—we also have to look at the relationship between heart disease and other elements of diet. Is fat as a category really the strongest link? Certain subsets of fat? A different macronutrient altogether? What’s the deal?

Luckily, the paper supplies us with a chart answering those very questions, using the same data Keys drew from. Apologies for the crookedness of it all. (Edit: A huge thank-you to Tynan Smith for removing said crookedness and emailing me the improved version below!)

There’s a lot going on here, so for now, let’s just look at that first column that says B-26. That’s neither a vitamin nor a rock band: it’s the official classification for “arteriosclerotic and degenerative heart disease,” which is the mortality category Keys used in his six-country graph.

To make it a little easier to prune through, here’s the B-26 column typed out. Values higher than about 0.43 (or less than -0.43) are considered statistically significant, meaning the association is very likely to be valid and not just due to random chance. Positive numbers indicate a positive correlation—heart disease goes up hand-in-hand with the food variable. Negative numbers indicate an inverse correlation—heart disease goes down as the food variable goes up.

  • Total calories: 0.723
  • Total calories from fat: 0.659
  • Total calories from animal fat: 0.684
  • Total calories from vegetable fat: -0.236
  • Total calories from protein: 0.709
  • Total calories from animal protein: 0.756
  • Total calories from vegetable protein: -0.430
  • Total calories from carbohydrate: 0.305
  • Percent of calories from fat: 0.587
  • Percent of calories from animal fat: 0.677
  • Percent of calories from vegetable fat: -0.468
  • Percent of calories from protein: 0.172
  • Percent of calories from animal protein: 0.643
  • Percent of calories from vegetable protein: -0.651
  • Percent of calories from carbohydrate: -0.562

No use in beating around the bush. After statistic-ifying all 22 countries, Yerushalmy and Hilleboe found that not only was “fat as percent of total calories” still associated with heart disease (r = 0.59), but animal fat was clearly driving that correlation. In fact, plant fat had a negative association with heart disease (-0.47) while animal fat was uber positive (0.68). And to rub salt into the wounds of omnivores everywhere, the animal protein/plant protein division was equally stark: animal protein as a percent of total calories had a correlation of 0.64 with heart disease, while plant protein had an inverse correlation of -0.65.

In number-free language, this means the countries eating more animal foods were—as a general trend—reporting more deaths from heart disease.

As with any observational data, this doesn’t tell us diddly squat about cause and effect. Drawing correlations between countries is particularly risky because of massive confounding that’s almost impossible to account for. But if we’re going to be honest about these specific numbers, a heart disease/animal food relationship is very much there.

Oh, the irony. The fat Keys focused on for his 1953 graph was basically a reflection of meat and dairy. We’ve lambasted him for not using all the available data, but if he had, he might’ve turned his “correlation is causation” laser-gaze onto animal foods and plumb gone vegan.

Come join us, Ancel.

In fact, the relationship with heart disease and animal foods rather than “fat as a percent of total calories” becomes even more obvious when we improve the data a bit. Yerushalmy and Hilleboe—those perceptive fellas—note that the countries with the lowest rates of “death from arteriosclerosis and degenerative heart disease” had suspiciously high rates of “death from other diseases of the heart” (or B-27, if you want to get fancy):

Odd, oui? Yerushalmy and Hilleboe offer the most logical reason:

…unless there is a reasonable explanation for the high rates in these countries in this less definitive group of “other diseases of the heart,” it may be safer to operate on the assumption that in these three countries [Chile, Mexico, and France] some deaths from arteriosclerotic and degenerative heart disease are being recorded under the broad group of “other diseases of the heart.”

Indeed, classifying heart disease deaths was pretty inconsistent in the mid-1900s—and even today, “death coding” practices vary widely between countries. To get a more accurate picture, Yerushalmy and Hilleboe recommend combining the “death from arteriosclerotic and degenerative heart disease” with “other diseases of the heart,” instead of using only B-26 like Keys did. And when we do that, our correlations shift a bit. Here’s the “B-26 + B-27” column from two charts ago:

  • Total calories: 0.593
  • Total calories from fat: 0.470
  • Total calories from animal fat: 0.562
  • Total calories from vegetable fat: -0.282
  • Total calories from protein: 0.694
  • Total calories from animal protein: 0.695
  • Total calories from vegetable protein: -0.153
  • Total calories from carbohydrate: 0.423
  • Percent of calories from fat: 0.390
  • Percent of calories from animal fat: 0.557
  • Percent of calories from vegetable fat: -0.509
  • Percent of calories from protein: 0.465
  • Percent of calories from animal protein: 0.608
  • Percent of calories from vegetable protein: -0.483
  • Percent of calories from carbohydrate: -0.386

Nearly all the correlations got weaker, but Keys’ favorite variable—”percent of calories from fat”—dropped off into statistical-insignificance land. Animal fat and protein, however, remained strongly associated with heart disease deaths. (Gasp shock horror!)

(Note: Even though adding “other diseases of the heart” to the mix probably gives a better picture of heart disease trends, it’s quite possible—maybe inevitable—that the mortality data is still skewed for some of the “healthiest” looking countries. A WHO paper called “Miscoding and misclassification of ischaemic heart disease mortality” (PDF) points out that countries like Japan, France, and Portugal have historically been “high ill-defined coders,” meaning they dump a large portion of heart disease deaths into the wrong category. This is typically because of insufficient diagnostic methods (especially for low-income countries), local medical practices (such as Japan’s tendency to write off coronary heart disease as “heart failure”), or simple physician error. Interestingly, the WHO paper also notes that the apparent rise in heart disease as countries become “more developed” is probably due to better classification on death certificates rather than an actual increase in the disease.)

But the story’s not over yet, folks.

Yerushalmy and Hilleboe ramp it up a notch by posing the question: “How does fat (and by extension, animal food variables) relate to other causes of death?” We’ve seen what happens with heart disease, but there are certainly many other ways for the human body to perish. Are the folks eating more fat, animal fat, and animal protein generally dropping faster than their more plant-focused counterparts?

Time for another table. Omnivores, wipe away your tears. Vegans, put away your kazoos. The playing field’s about to change.

Let’s look, first, at that middle column—deaths from everything other than diseases of the heart. Notice a pattern?

  • Total calories: -0.530
  • Total calories from fat: -0.674
  • Total calories from animal fat: -0.466
  • Total calories from vegetable fat: 0.296
  • Total calories from protein: -0.398
  • Total calories from animal protein: –0.505
  • Total calories from vegetable protein: 0.452
  • Total calories from carbohydrate: 0.172
  • Percent of calories from fat: -0.657
  • Percent of calories from animal fat: –0.481
  • Percent of calories from vegetable fat: -0.090
  • Percent of calories from protein: -0.080
  • Percent of calories from animal protein: -0.405
  • Percent of calories from vegetable protein: 0.521
  • Percent of calories from carbohydrate: 0.671

We’re basically staring at the reverse image of that earlier heart disease chart. Fat now has the strongest negative association with mortality out of any variable—a whopping -0.674 for “total calories from fat” and -0.657 for “percentage of calories from fat” (highlighted in purple). Animal fat and animal protein, but not plant fat or plant protein, are also strongly negatively associated with non-heart-disease mortality. You may notice, too, that the folks with a higher percent of calories from carbohydrate had the greatest mortality in this age range.

Even if we look at the first column for “death from all causes”—which is a little less impressive, because none of the numbers reach statistical significance—we see that all of the animal food correlations are negative. The only positive correlations, weak as they may be, are with plant protein and carbohydrates.

The results are clear. When we look at “non-cardiac deaths,” it’s the folks eating more animal fat and animal protein who are stayin’ alive. And when we look at overall mortality, animal foods sure don’t seem like stealthy killers.

Out of curiosity, I tried graphing the life expectancy for the countries in 1950 against their fat intake to see what would happen. Considering that the bulk of each nation’s fat intake came from animal sources, plotting animal food against life expectancy would probably turn out similar. (Life expectancy data taken from EarthTrends.)

Although the dots are pretty scattered when fat intake is below 25% of calories, the trend becomes unmistakable once that number passes 30%: countries with higher average fat intake had the longest life expectancies.

But does any of this—the life expectancy graph and the “death from other causes” table—prove that eating more fat and animal foods makes you live longer, or eating more carbohydrates makes you die sooner? Heck to the no. Same goes for interpreting the animal food/heart disease relationship in this data as a reason to go veggie. Yerushalmy and Hilleboe explain precisely why we shouldn’t assign a cause-and-effect relationship to anything we’ve seen so far (emphasis mine):

Table IV shows that fat calories and animal protein calories, which were seen above to be positively associated with heart disease, are here negatively associated with noncardiac diseases. A … plausible explanation is that the dietary components which according to the rank correlation coefficients appeared to be positively related to heart disease are indices of the various countries. That is, it may be that the amount of fat and protein available for consumption is an index of a country’s development, industrially, nutritionally, medically, and no doubt in other respects as well.

Bingo. Intake of fat and protein—particularly from animal sources—is usually a proxy for a country’s development. These foods goes hand-in-hand with other features specific to industrialization, making their relationship with disease likely to be confounded. Continuing on:

It may also be that countries with more abundant diet are more high developed and diagnostic acumen is greater. Hence, it is possible that in some of the countries in which less protein and fat are available, a certain percentage of deaths from arteriosclerotic and degenerative heart disease are recorded under the non cardiac groupings.

Bingo again. As we saw in the WHO paper I referenced earlier (PDF), diagnostic patterns vary tremendously between countries. This paper even points out that the countries with the highest apparent rates of coronary heart disease often have the most valid death classifications as well. In fact, if we X-out the countries with the worst track record for classifying heart disease and circle the countries whose accuracy was nearly perfect, our 22-country graph looks pretty striking. (Mexico gets an X because it didn’t even have a death-certificate system until the late 1950s (hat tip to Plant Positive for noting this on his Primitive Nutrition videos). Ceylon/Sri Lanka and Chile—numbers 4 and 5 at the bottom—aren’t mentioned in the WHO paper one way or another, but I imagine they deserve some Xs too.)

Keep in mind that the WHO paper looks at mortality data for the ’70s through ’90s, while the graph above uses mortality data from 1948 and 1949. It’s possible that some of the countries improved their death-classifying practices in the decades between, so this graph should be taken with a grain of salt. Especially if you have low blood pressure.

But back to Yerushalmy and Hilleboe for a moment because they’re so awesome:

Moreover, as Table IV shows, there are appreciable negative correlation coefficients between dietary components and death rates from B-45 (“senility, ill-defined and unknown causes”). The latter category may be considered a rough index of the accuracy of cause of death certification in the different countries. The negative association with protein and fat is further evidence of the non-“specificity” of the presumed association.

Indeed, if we glance at that third column from a couple graphs ago (click here to open it in a new window so you don’t get lost in scrolling-limbo), we’ll see that animal food variables have strong inverse associations with this death category, while the plant food variables have strong positive associations with it. Senility, ill-defined, and unknown causes are the equivalent of a doctor saying “Gee, I dunno why this person died so I’ll just file them away under one of these vague, essentially meaningless categories!” Such a scenario is much more likely in an under-developed area with shoddy medical care than an industrialized country with more diagnostic precision.

I wanted to explore this issue even further, so I dug up some data for each country’s gross domestic product (GDP) per capita in 1950. This is the measure of a country’s economic output divided by the population, and is a pretty good way to estimate standard of living. (Numbers taken from NationMaster; Israel and Ceylon/Sri Lanka are omitted because I couldn’t find their data from this year.)

So there we have it: more kindle for the idea that fat intake generally reflects a nation’s economic status and level of industrialization, and is hence vulnerable to confounding. (Or maybe correlation really is causation, and inhaling sticks of butter will make your country richer! Only one way to find out…)

One final, super-important point that could quite possibly render everything else useless: The diet data for our 22 countries comes from F.A.O. food balance sheets—which show how much food was available for consumption in each country, rather than how much food was actually consumed. If this sounds like a totally weird and unreliable way to measure what people eat, that’s because it is. Yerushalmy and Hilleboe explain the problem further:

These indices were constructed by the Food and Agriculture Organization of the United Nations from statistics on production, imports, exports, and on the proportion of available food used for purposes other than human nutrition. The underlying data are stated by F.A.O. to be subject to great limitations. Moreover, there are no doubt great differences in food “scraps” in the various countries compared. For example, it is highly probable that far more edible dietary fat is thrown into waste cans in the United States than in less fortunate countries.
Dur. Although this doesn’t mean the data for the 22 countries is bogus, it does mean the fat intake (as well as total calories) for wealthier nations may be overestimated. Maybe by a lot. Indeed, there’s a strong connection between how abundant food is and how much of it we waste.

That about covers it for the Yerushalmy and Hilleboe paper. Isn’t it neat that we just did a deeper analysis of the 1950s data than Keys himself probably did? Here’s a summary of the major points in case your eyes glazed over for any of that:

  • Yep, Keys picked some cherries—but a link between fat intake and heart disease mortality existed among all 22 countries, not just his six-country graph. And as Yerushalmy and Hilleboe’s paper revealed, the real force behind that correlation was animal fat intake, not just fat as a general category. Keys definitely should’ve facepalmed himself for not looking at the data more carefully, but even if he’d been scrupulous, he probably still would’ve launched the anti-saturated-fat crusade that defined his later career.
  • Although total fat, animal fat, and animal protein were associated with heart disease in this data, those variables were associated with less death from pretty much everything else. Overall, the countries with higher fat and animal food intake had longer life expectancies than the rest. This doesn’t prove that animal foods make you immortal or that plant foods will slit your throat in the middle of the night: it’s mostly a result of countries with more money and a higher standard of living tending to eat more animal products (along with having lower rates of infectious disease, better health care, diets higher in industrially processed foods, and so forth). There’s so much confounding involved with this subject that I don’t even wanna touch it with a ten-foot statistical pole.

  • A lot of countries suck at classifying heart disease deaths under the right label. Especially less-developed nations with sketchy medical care. This makes it look like some countries have abnormally low rates of heart disease, when in reality, they just have abnormally high rates of messing up.
  • The F.A.O. data that Keys (and others of his time) used is probably the most inaccurate way to measure food consumption ever invented. Because food-balance data doesn’t account for stuff people throw away, wealthier countries are always going to look like they have a higher intake of pretty much everything compared to poorer countries. It’s impossible to say how much this influenced the link between fat or animal foods and mortality rates, but the impact might’ve been pretty big.
  • Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t a cucumber. (Just making sure you’re awake.)
Now back to Keys. I’m mostly interested in clearing up the confusion about the Yerushalmy and Hilleboe paper and what it really showed about Keys’ cherry-picked graph, so I’m not going to tweeze through the rest of his work with the same Aspergers-esque detail. (At least not in this blog post—the real Seven Countries Study probably deserves an eventual skewering.) But I do want to address something interesting about Keys that many people aren’t aware of, which is…

Keys on dietary cholesterol: one thing he got right

Although Keys was staunch in his belief that saturated fat causes heart disease by raising blood cholesterol, he was one of the brave few who insisted that dietary cholesterol was pretty much irrelevant. Thanks to a slew of early animal experiments—such as Nikolai Anitschkow’s famous rabbits—that used dietary cholesterol to induce atherosclerotic lesions, implicating dietary cholesterol with heart disease was all the rage for a while. For a long while, actually, considering how many folks today still to dump their egg yolks down the drain.

But Ancel didn’t buy it. In his paper “Human atherosclerosis and the diet” (PDF), he writes that “from these animal experiments only, the most reasonable conclusion would be that the cholesterol content of human diets is unimportant in human atherosclerosis.” Likewise, in some of his metabolic ward studies, Keys found that altering dietary cholesterol in the context of a normal diet had only minor effects on blood cholesterol, concluding that “attention to this factor alone accomplishes little.” And in his paper “The relationship of the diet to the development of atherosclerosis in man,” Keys is pretty clear about his views:

The evidence—both from experiments and from field surveys—indicates that the cholesterol content, per se, of all natural diets has no significant effect on either the serum cholesterol level or the development of atherosclerosis in man.

Good for him.

And since I probably won’t write any more blog posts until 2012 (unless someone surgically implants a new month between December and January), I want to use this final paragraph to tell everyone who reads this blog that I love you and appreciate your readership more than you could possibly imagine. I’m continually astounded that you guys not only bear with me through my sporadic blogging habits, but also create such awesome dialogues in the comment section. You people rock my world. If I were wearing socks right now, those would be rocked, too. I really mean it. Have a wonderful new year, everyone!


  1. I really enjoy your blogs and they are very informative. I wish you would add a summary or “conclusion” section at the end (which sometimes your do…) because I am not a researcher and sometimes get lost (or distracted) in the stream of data.

    1. This blog is the best out there I have seen in it’s presentation of unbiased facts and the scrupulous research done by the author. Keep up the good work!

  2. She did – it’s right under the “Fat Intake and GDP Per Capita, 1950” graph.

    Great work as always Denise! Love how you make statistical dissection entertaining every time ;)

    1. If you read Dr. Jerry Tennant’s book “Healing is Voltage” you will see Dr. Tennant, brilliant man, exposed that Keys knew that cholesterol had nothing to do with heart disease. Tennant wrote something to the effect that before Keyes published the 100 papers and after he published those papers that Keyes wrote dietary cholesterol has zero, zip, nada to do with one’s cholesterol level. He knew. He absolutely knew.

      One only has to read Dr. Broda Barnes book as well to know that the cause of heart disease clearly had nothing to do with eating dietary cholesterol but rather than not eating increase the placquing of the arteries 3 to 4 fold! Dr. Broda Barnes went to Austria every year where hypothyroidism was so high only 1 to 4 babies out of 100 would live longer than a few months after birth. When WWII came along, he did over 70,000 autopsies and found that atherosclerosis increase three to four fold when the troops got all the meat, cheese, butter and egg rations and the people had to live on carbs. Dr. Barnes proves the only reason people were not dying of heart disease was because the thyroid is key to one’s pH and one’s pH is key to one’s oxygen levels in the body and thus one’s immune system – and thus people were dying of tuberculosis and pneumonia before they could die of heart disease. (Oxygen keeps the bugs, virus, bacteria, fungus and parasites from eating one up.) When people become hypothyroid, more bugs and virus create inflammation, more inflammation creates more calcium deposits (atherosclerosis) in the arteries and thus heart disease results.

      With all the fluoride, chlorine and now bromine (now bromine is being put in over half of our foods including meat and cheese), all these halides block iodine consumption and thus cause hypothyroidism. Dr. Albert Syent Georgi, Noble Prize winner, said the optimum amount of iodine consumption per day is 62 mg based on 100 years of research from 1850 to 1950 around the world. This is 400 times more than the US Recommended Daily Amount and is 100 times more than the Japanese eat per day of iodine, a country with the longest longevity and the least cancer, heart disease, infant mortality, menopausal issues, etc. To learn more go to and listen to the audio of Dr. Flecha, Dr. Miller and Dr. Russell Blaylock on iodine.

      1. Sounds like Martin Luther’s Ninety-Five Theses nailed to the door of All Saints’ Church in Wittenberg
        All I know is that my mom is now 83 and she has HeFH – only learned she had a cholesterol of 13 in her 60’s. My sons, however, that’s another story. They both inherited from me and at 34 my eldest got quintuple bypass surgery. I went onto Keto and it halved my cholesterol. Not doing it any longer – if my sons is afraid of it than I am not going to either. If he dies, what’s the point? Plus my younger son also has it. BOTH my sons. The women with the mutation lived to old age but the men did NOT! I am quite floored and sick of everything.

    2. I think you missed out the second last paragraph there. Denise says that Keys knew well enough that cholesterol levels were not a factor in heart disease.

      1. Actually, Rob, the second last paragraph was not about cholesterol levels not being a factor in heart disease; it was about “dietary cholesterol” (i.e., cholesterol content of the food eaten) not being a factor in blood serum cholesterol levels or atherosclerosis. Confusing huh?

        Supposedly there is a strong epidemiological evidence for the ‘link’ between high blood serum cholesterol levels and heart disease, which is why doctors hand out statins to anybody with slightly elevated levels. It is claimed that taking statins lowers ones risk of death from heart attack by 30%.

        This is the science I’d really like to see dissected.

        1. I’m not sure how old this post is but when they report that statins reduce heart attack risk (and the papers I’ve read report it as being 50% reduction) they are actually reporting a relative risk…which is some pretty sneaky accounting. The way it works is fi you put 100 people on statins and 100 people on placebo, in the stating group 1 dies and in the placebo group 2 people die, you can report that as relative risk and say that statins reduced heart attack by 50% (1 vs. 2). That’s how that is done. There are several quotes saying that LOWERING CHOLESTEROL may actually be worse for people but that Stains do provide protection, NOT because they lower cholesterol but because something else in statins behaves like an anti-oxidant.

          I don’t have time to post links etc…very busy making a workshop for healthy eating…but this info is out there.

        2. Statins are HORRIBLE for women and no woman should take them. Women need to maintain certain amounts of fat/cholesterol for hormonal balance and optimal health. They don’t have that effect on men.

  3. Fantastic again! You may think your posts are too long or something, but I’m always disappointed when I finish them! Why? Because I won’t be learning anything else. I have been reading everything on low carb eating for about 5 years but you continually add to what I know.

    Thanks for all of your hard work and attention to detail.

    And happy holidays to you, too.

  4. I love this! I have the interest, but not the focus, or the smarts to do what you do so well. Thanks for sharing all your work with us! I look forward to your book and blog posts of 2012! Happy New Year!

  5. Great post, as usual. It sure is hard to sort through old studies and compare them against (un)popular opinion. I will definitely use this post next year as a teaching tool in my Ancestral Health course.

    Although 0.59 (for the 22 countries) is statistically significant, the R squared (proportion of variance accounted for) is relatively small at 0.35. Nothing that most would write home about, or make a big deal about when writing a scientific paper!

    1. Japan is an obvious outlier. Remove it and the whole association looks very weak indeed. I assume (I can’t be bothered recalculating) it probably becomes non-significant (r2<0.3).

    2. The other statistic is the eyeball test. If the data were predictive then a Norwegian w average consumption of fat who went to the effort of reducing intake by 10 or 15 % (that’s how these data are usually interpreted) would have an equal chance of increasing risk as lowering…and these are for averages within countries. Sometimes you can tell a book by it’s title “the Cult of Statistical Significance” is not a great book — simultaneously too technical and too colloquial but you can tell all from the title. What Keys gave up on is common sense (and of course science which he seems not to have understood). The original curve did suggest causality — the tight association was compelling but once that was destroyed so-so correlation meant nothing.

      1. Perhaps there was pressure to not use his “common sense”. Funding my industry that stood to gain the most by the outcome. I definitely see the confounding issue and directly makes to idea that correlation is not causation so much more plausible in this case.

      2. But Ancel Keys WAS using the eyeball test and common sense. That’s the principle behind cherry picking. All you have to do is compare Finland and Italy, then dive in on finding the significant dietary/lifestyle differences. You don’t need 7 nations or 22 nations to see why he invented the Med Diet. Just those two countries will do.

  6. Marvelous and well thought!

    The one that jumps out at me is that this is 1950 data and for much of Europe there were 6 years of societal and dietary distress in the proceeding decade. Degenerative diseases can take decades to manifest themselves. More recent data from politically stable countries is more telling since the seventies we were replacing fat with carbs and degenerative disease rates have skyrocketed.

    This is the most straightforward analysis of Keyes I have seen.

    Thank You

  7. Ah, a new post by Denise = early Christmas present!

    As always, fascinating and entertaining.

    Happy holidays, and vivement le prochain texte!

  8. Am living proof that high cholesterol does not produce heart attacks. I have inherited hypercholesterolemia, and have always had LDL levels 10X my age. Do the math. I’m now 68, walk 5 miles a day, eat things with wings, and things with fins (mercury-free, of course), eggs, cold-pressed, organic olive oil. I also abstain from wheat, corn, dairy, and soy. Have been off dairy, except for clarified butter (ghee) for 25 years and my bones are fine. Have been off wheat for almost 10 years, and my cookbook, Gluten Freedom, EveryWay Comfort Foods, has helped many of my clients to transition easily without giving up their favorite chow. The connection between the activation of inherited genetic disease markers to food intolerance’s creation of circulating cytokine proteins will be the next frontier for prevention of inflammatory aging. My ancestors were not so lucky. They died early, in their 50’s, even though they abstained from cream, butter, and eggs, following the 1950’s mantra.
    Thanks for all your great work, geeky or otherwise. Saw Forks Over Knives three times, and kept arguing with the images on the screen. “Olive oil is not the culprit! Rancid, non-organic olive oil is the real villain. But I digress.
    Have a great holiday and keep up the great work. We all need the light pointed in the dark corners of “known” science, and your abilities in this regard are superb.

    1. I have a friend with familial hypercholesterolemia, and was curious… are you on statins of any sort? He’d like to get off them, but is unsure if he can manage the condition through diet alone. Thanks!

      1. Do your friend a favor. Do a web search about the cholesterol myth and the dangers of statins. There is no “condition” requiring treatment.

        1. No, we’re both aware/have discussed and researched the basic falsity of the “cholesterol myth”, Uffe Ravnskov, etc… but familial hypercholesterolemia, according to some sources is a unique case. Looking for others with specific experience with that.

  9. Thanks for the nerd-gasm Denise. I’m spent…as I’m sure you are after knocking this epic out, and I believe it is you who is the sock rocker in this instance. All the best for 2012.

  10. The 1st part of this article seems a bit contradictory, bashing those that say Keys cherry-picked, when in fact he did. And as Gary Taubes points out, if one were to pick another 7 countries, the inverse could be said, fair is fair right.

    And while you can still see a trend with 22 countries, there are still several countries with a higher fat consumption and lower HD rates than coutnries with lower fat fat consumption.

    The rest of the article was nicely done however.

    1. Ancel Keys only needed the best and worst countries to come up with the Med Diet, and it served him well personally. Under what circumstances would anyone eat and live Finnish when they could eat and live Italian? By living and traveling in Europe, Ancel experienced it all in a way that the dusty old graphs don’t convey.

      Once again Gary Taubes proves that he doesn’t understand science. He writes about it, sells books about it, but it’s not his profession.

  11. I must add to the kudos and thank yous. You saved me from going completely vegan, which would have killed me through causation of an indirect correlation to my wife. I love the way you infuse humor in your writing and I suspect it may be one of the reasons we all read your blogs to the bitter end. It’s time (if you haven’t already) to write that book debunking modern dietary myths and get your rosey red cheeks on The Daily Show and Colbert Repor…seriously. Merry Xmas, happy new year and I can’t wait for the wheat tome.

  12. Wonderful! I just love how you take us beneath the surface of our “sacred cows” — and with humor! Happy whatever-holidays-you-celebrate!

    (Chris Sturdy, an R-squared of .35 is huge. 35% of the variance accounted for is seldom seen in health and nutrition research. What that means or doesn’t mean is a separate question.)

  13. Valuable analysis which should be published in a high rank journal so as to get many more researchers’ eyes on it! Thanks so much for the incrediblyimportant work you are doing!

  14. Awesome post. It’s good to be informed about this as most people just dismiss the seven countries study armed only with the knowledge that keys “cherry picked” his data. Thanks for setting the record straight, as usual. Any chance you can just drop your current career path and write a monthly research review?

  15. I know you already bolded this Denise, but maybe you should super-bold it and put a double underline in there too…

    “the amount of fat and protein available for consumption is an index of a country’s development, industrially, nutritionally, medically, and no doubt in other respects as well”

    Highly significant correlation coefficients could just mean very strong correlation between getting heart disease and being rich.

    Now when are you going to debunk Kitava and Inuit? (not that they are debunk-able, but this Keys piece was fun to read). Also, is Ancel Keys really the great-grandfather of Alicia Keys, or is that just an unfounded rumor as well???

  16. Happy Holidays D.

    Best line: “This doesn’t prove that animal foods make you immortal or that plant foods will slit your throat in the middle of the night”

  17. Denise, you are funny and smart and I like you, but I’m not going to read this crap because it is completely meaningless. Saturated fat DOES contribute to cardiovascular disease, but only in certain contexts. Unless we have data that controls for context we are seriously at risk of false positives. Even if we have extremely good data showing that there is basically no way that an association is explained by anything other than causation, we still don’t have -necessary- causation. There’s the obvious point, that saturated fat is associated with affluence which is associated with processed crap and stress, possibly pollution at the time. But then there is also the very important biochemistry. Saturated fat does impair endothelial function, but only in the context of an omega-3 deficiency

    The informed and intelligent conclusion from clinical nutritionist Byron Richards is that DHA helps saturated fat function properly in the body

    If you want to talk red meat we can do that, if you want to talk alcohol or sugar, we can do that too, if you want to talk any number of things that people think is unhealthy, we can do that too, and we’re always going to find mitigating factors. Epidemiology is the conversation starter.

    The concept of the mitigating factor has set epidemiology back another 50 years in my mind. Until they identify, quantify, and incorporate mitigating factors into epidemiology, it isn’t worth much to me.

    1. I like your comment. A sentence like this:
      “There’s the obvious point, that saturated fat is associated with affluence which is associated with processed crap and stress, possibly pollution at the time” is bound to attract my attention. I was thinking about stress and the existence of so many other factors while reading Denise’s piece which I liked too, but you’re right.

      1. It seems to me unlikely that people in the developed world have a dramatically higher level of stress than people in earlier times. Not too long ago, one could easily have ones friends and relatives dying suddenly at any moment and at a high rate (e.g. of infectious disease), which strikes me as a major stressor.

        I also read somewhere (dunno how true) that a major cause of death of prehistoric people was murder, which strikes me as a stressful way to live too.

        1. Well, why don’t you look at the date of Keys’s graph and check what “wonderful” experience some people of this generation went through? I actually had specific “stressful” circumstances in “wonderful” “civilized” European developed countries in the first half of the 20th century.

          1. In my comment (11:13:40) I was responding to Beth Kirby’s comment (00:34:43) which starts with “It seems …”
            People, this blog’s comment section should be redesigned. All these IT admirers could actually make a real contribution instead of promoting the latest food fad, such as “eat animals, particularly their fat only.”

        2. stress is not only emotional – i think equally as important are the huge amount of environmental stresses we now have (that our ancestors did not) regarding industrial toxins, ag toxins, air pollution etc etc–

          those count as much or perhaps even more than the fear of your sister getting chomped by a saber tooth – and even that was de rigueur in those days so such an event was not necessarily so dramatic (stressful) either–

    2. Okay sorry, maybe “not going to read this crap” is a bit harsh. I’ll probably read it just for the laughs when my cortisol levels are lower. But damnit, I hate epidemiology like I hate the wide array of logical fallacies that are possible.

        1. Hey Grok! We’re just into different things, if I took up an interest in endurance running I might check out your stuff more. I’m not against fruit or carbs, and I think that low carb and very high protein can be big mistakes for a lot of people, I’m just more focused on preventing disease, I like my exercise to be shorter, mostly with weights and light activity rather than endurance.

          I’m glad that you agree that -some- people spend way too much time looking at epidemiology, it’s annoying and what’s worse awesome people like Denise get sucked into addressing it and giving it so much credence.

          1. Stabby, you trouble-maker! Let me just say…

            1. Epidemiology is fun.
            2. One possible takeaway from Denise’s post is that this stuff is indeed sorta meaningless because of how quickly interpretations change when you change the outcome definition, number of data points, etc.
            3. Stabbing is highly correlated with heart-related mortality.

            1. Yeah it is good, and I have learned stuff from her posts, but should we really be arguing over whether or not X food is associated with Y way to die in Ancel Keys of T. Colin. Campbell’s studies? I want to see Denise make big and important points while incorporating epidemiology, but I make a point of not giving credence to the grounds for a hypothesis, especially when it has already been tested and failed to be demonstrated. It is fun, and we can learn some things from it, but it gets waaay too much attention. It is good that we don’t keep saying that there was nothing at all to Keys’ study, but I don’t say much about it anyway. I say “well that’s a statistical association, but here are ones where there was none, so maybe we should just go look at the clinical evidence.”

              And I am glad we agree on that last point. But it is inversely correlated with iron overload, don’t forget it!

              Totally agree with 3. W

    3. If saturated fat causes problems with the endothelium in the presence of omega-3 deficiency, the obvious answer here is that it’s the omega-3 deficiency causing the endothelium problems. By the way, saturated fat preserves omega-3 in the body, so you don’t need to eat as much of it.

      Low-carbers like to say that dietary fat only makes you fat in the presence of carbohydrate. Again, cause and effect are confused. It’s the carbohydrate, though the mechanism of insulin-production triggering, causing the fat storage. The fat’s just there. It’s not doing anything by itself.

      1. Right right, I was insinuating that it isn’t a problem in certain contexts. And as for low carbers, neither of those is true, but both of them are worse than each alone in the context of extreme inflammation and the metabolic syndrome, their metabolism is bad and it does damage to the body, but it’s neither of their fault or even the combination, it is the inflammation and deficiencies.

      1. You need to study the latest research…saturated animal fat does not lead or contribute to heart disease or blockage or any heart problems.

  18. The crooked charts are setting off my OCD and making it hard to enjoy an otherwise FANTASTIC POST!!!

    If you want me to straighten them and color correct them in Photoshop, send me an email, or I’ll give you an FTP address to download them from.

    Straight _], sharp, not all c/r\o/o\k/e\d/ and washed out.

    Whaddya say?

    Ben Fury

      1. Nah, just sloppy copying.

        Can’t stand it. I don’t have any other OCD issues, but that one really puts my teeth on edge.

        When I get older crooked copied papers, I just have to rip the pages, straighten them in Photoshop and re-PDF them. Then I can read them in peace. LOL!

  19. Thanks! I have always thought the problem with the Keys data is not his analysis, but the way the authorities ran with it. His analysis was actually quite good for the time (no computers!). The problem is that others used it to set rigid nutritional policy instead of using the data as a springboard for further research. We are still living today with the bad results of such rigidity.
    Another unfortunate practice has been quite prevalent until recently, that of taking data from a small subset of men, extrapolating it to everyone and then chastising others (mostly women) when the recommendations do not work as predicted.
    Perhaps the biggest problem with such studies, and a problem that is still carried up to this very day, is the practice of substituting an analysis of group means for an analysis of individual people. If Keys had the data and the means to do analysis based on individuals, I am sure he would have. To put it bluntly, correlations based on country or group means and rates are mostly a crock.

    1. Agreed. The farmers switched from pigs and beef to soybeans and corn. Either way people gotta eat it, and it’s up to the guvment to make ’em.

  20. All I know is that Dana on vegetable oils is crazy and moody and b?!chy to an unbelievable degree, especially when lots of grain carbs are added on, while Dana on animal fats and saturated fats generally is a lot more pleasant to be around and a lot more in control of her own mental faculties.

    And no, that’s not placebo effect. It was only after a year or two of having introduced butter and other saturated fats back into my diet that I even came to this realization. I also found I had better response to the carbs I did eat because the fat was blunting it all.

    Also, animal fats come with their own complement of fat-soluble vitamins that the human body desperately needs. It is shaping up to look as if humans don’t convert plant precursors to the fat-soluble vitamins very efficiently, when at all. This is certainly true for A and K and, of course, D doesn’t show up in plants at all, appearing only in fungus and then only sometimes and THEN as ergocalciferol, which we *also* have a lot of trouble with.

    I see no reason to drop my animal-food or saturated-fat intake just because of a few charts. I’m at risk of cardiovascular events *anyway*, primarily stroke, because I am a migraineur. I think I will enjoy my butter and cream and beef fat and bacon and coconut oil while I can. And I will be saner, and my periods will be easier to tolerate, and my skin will look nicer (no small consideration with me, I have keratosis pilaris), and so on and so on.

    1. Dana,
      The chances of you being a Blood Type O are pretty good. And your symptoms may very well be activated by an intolerance to wheat, rye, and barley which can often set off migraines, as well as activating 147 other diseases of body and brain for those who are genetically programmed. There are 8 known genes, so far, and only 2 of them are pure celiac. The remaining 6 are intolerance genes, which activate the elevation of cortisol in the blood and circulate cytokines which set of the epigenetic markers that we each carry and which vary from person to person. Lutein supplements will reduce the aura and allow the constriction of the vessels to abate. But the real cure may be to get off gluten and give the gut lining the 3 months it needs to repair itself.

        1. Anna,
          Most headaches are the brain’s way of notifying the owner of an existing compromised oxygen delivery system via red blood cells that move through the vascular network of arteries, veins and capillaries. Gluten inflammation can be a possible cause.
          Oxygen delivery can be compromised by: constriction of vessels from circulating cortisol; blood clots that obstruct the network, especially the capillaries, where size matters. Sinus mucus, that can put pressure on nerves in the head. Fluid in the inner ear compromising balance. Usually mucus membranes are more influenced by the skim in dairy, than the gluten in wheat, but it might be either.

  21. Is there any study out there that you can not skewer? I’m glad you weren’t my 10th grade science teacher… or maybe I’m not – mine was a real uggo.

  22. Beautifully done, Denise. So the takeaway is… Keys’s study is largely irrelevant but not for the reasons we believed?

  23. Someone help me!

    So, the data do correlate; Keyes DID find a positive correlation between saturated fat and heart disease, but since it’s just a correlation, we can all just relax (as long as we take our fish oil)?

    Are we asking for trouble by eating red meat five or ten times a week, or do we have nothing to fear (forgive the black and white) because all-cause death is lower for meat eatin’ countries? Wouldn’t the correlation with HD still be there after correcting for lower all-cause death, because lower all-cause is likely due to better medical care, etc.? Or do we need to just throw out the entire study because the data are so prone to confounding factors they’re essentially useless?

    I feel like we’re retreating behind ‘correlation doesn’t equal causation’ here, when there appears to be data linking sat fat and HD in Keyes’ work. But I’m notoriously slow…am I missing a huge, honkin’ point?

    Oh – and Happy Holidays, Denise. I heart your blog and your work and of course, by extension, you. :) Thanks for the big plate of ‘food for thought’ to chew on over holiday!

    1. Many researchers get sidelined by “correcting for other factors”, just another more refined way to make a silk purse out of a sows ear. The information you seek just may not be available in the data. It is my opinion that epidemiology studies are essentially useless other than perhaps pointing some ways to further study. Unfortunately, there is this trend among some major research centers to collect a huge amount of data, mine it and then crank out tons of papers, and then train us to believe that there is some sort of real research behind it.

    2. “Are we asking for trouble by eating red meat five or ten times a week, or do we have nothing to fear (forgive the black and white) because all-cause death is lower for meat eatin’ countries”
      You’re not the only one who’s wondering. But according to our “gentlemen” here we are not supposed to wonder. March, march, march in nice rows and chant “Meat and fat, meat and fat, meat and fat.”
      I am surprised that nobody’s ordered you to behave and questioned your intelligence. Ah, maybe because, such treatment is reserve for those whose English isn’t the first or second.

    3. My own take on it is that don’t want to exaggerate the principle. Correlation does implyi causation — in some sense, that’s all there is. You have to have a reasonable hypothesis which you test with a correlation. As Einstein put it: your theory determines what you measure. The hypothesis may have been ok and the original data supported causation because the correlation was strong as Keys presented it. When the correlation was shown to be weak by Y&H, the theory was no longer supported. Now, stronger or relations would be needed but the 7-country study wasn’t like that — one limitation on my post on Mediterranean diet What you do in science is you try to trash your own theory. You try to put it to the test. Showing consistency is weak. Yes, we throw out the whole study. Maybe sat fat is in loved but this is no good. By analogy, w court of law, you cannot be found innocent, only not guilty. Curren perspective: sat fat should never have been indicted at least as sole perp.

      1. I do not agree at all that correlation implies causation. Correlation implies an association. We always seem to want to separate variables into the drivers and the passengers, but in this type of study, all the things researchers are caring about may just be along for the ride with a giant, lurking, driving variable that we just don’t understand yet.

        1. A couple of comments.
          1. First, I am not “Richard.”
          2. I did not mean, of course, that any association implies causality but rather that association is really what you do in science. It is the strength of the association and the underlying theory that led you to measure the association in the first place. I would say that these absolute statements about science come from medical literature and are unknown to physical scientists. There is no gold standard, that is, one kind of experiment for everything. You have a hypothesis when you start to measure associations.
          3. Anyway, Denise did a great thing bringing out Y&H which most of us only knew second hand. Y&H, however, did effectively destroy the 6-country study and Keys knew it and that’s why he did the 7-country study. If you look at the full curve from the 6-country study, you see that the highest fat intake had a wide scatter of points. US had 3X the CVD incidence as Norway which would not make any sense if the independent variable were fat intake. The association, that is, the trend is held up by a couple of points at the low end. As Denise showed, Y&H said you could make an association with all kinds of things and that is the problem with this correlation studies. Take any of the Nurses health studies associating X with Y and you are likely to find in the paper a good association of Z with Y.
          4. When Keys did the 7-country study, he found similar effects. The two countries with the highest fat intake had the lowest CVD (Crete) and the highest CVD (Finland) and he assumed (as in the 6 country study) that that could not mean that this was random error and he decided that it was the type of fat, saturated (Finland) or unsaturated (Crete) which gave rise to the Mediterranean diet. Of course, when diet-CVD did not correlate in other parts of Finland that did not bother Keys.
          5. Keys paper is of historical value. It led us down the primrose path of scientific error. I believe it is still cited by the American Dietetic Society which made me think of BF Skinner’s critique of psychoanalysis. He pointed out they were still quoting Freud from fifty years before. If you haven’t improved on fifty year old studies, something is wrong.
          Anyway, that’s my take on it and, again, I am not “Richard.”

          1. Well said! But, I believe that the paper is significant mostly as an example of policy run amok, not so much the bad statistics. The funny thing I guess, if it can be considered funny, is that the ADA, while adamant that folks use “good” research studies, declines to do so themselves. Their recommendations are built on a pile of sand, and would have been gone by now if not for the buttressing by thousands of “registered” dietitian foot-soldiers and their handlers.

          2. Professor Feinman if a person does not have enough powers of discrimination to distinguish between your comments and the one from the troll called Richard, he or she will have to live with him/herself and one can only pity the intellectual mediocrity and squalor of such a life. Respectfully submitted. J.

      2. I wish it was as simple and as straight forward as you put it prof. Richard. The reality is often quite different. Once we have -epidemiologically or otherwise- established concurrence, we try to prove causation through studies where we try to control or account for as many of the possible confounders as we can. Then we shout from the roof tops, or even sneakier we publish the results but precede the results with an abstract that may or may not represent exactly what we found.

    4. “I feel like we’re retreating behind ‘correlation doesn’t equal causation’ here, when there appears to be data linking sat fat and HD in Keyes’ work. But I’m notoriously slow…am I missing a huge, honkin’ point?”

      The upshot is richer people can afford to eat more meat and also better health data collection. We may be looking at the effects of better measurement, not an actual increase or correlation of heart disease, because it’s so tough to accurately categorize the health status across countries with massively different standards of health data collection and categorization.

      But if you’re concerned, eat more salmon. :) Definitely stop eating sugar and white flour. That should take care of the majority of your issues right there! :)

    5. Well, consider that Keys did act on his discovery and invented the Med Diet, ate that way and moved from Minnesota to Italy to live it out. It served him well for 100 years. You have to ask yourself whether eating red meat five or ten times a week is going to get the same result for you.

  24. What’s always bothered me about all these studies is the massive effect of WWII and the Great Depression. People at a certain way, and then came WWI in Europe – which forever changed the way folks ate. War rationing parts of Europe continued for 5 or more years after WWI. So much food such as meat, coffee, sugar and butter were artificially restricted by the war. Then came the depression, where meat, sugar, tobacco, and butter disappeared again because they were unaffordable for many people. Then came WWII, with more intense rationing. WWII Rationing continued in parts of Europe until 1952 and in Japan for longer. One of the first things to return was apparently tobacco. I just don’t see how you can make judgements about long-term dietary trends with such intense factors in place. Are we sure we’re not just looking at what happens when folks deprived of smoking are suddenly able to smoke like chimneys again for 5 years or more?

    1. …and, you are just talking about mainly dietary factors. Most of the diet studies do not include other factors, like pollution, cell-phones, plastics, pesticides, on and on. Of course you would expect nutrition researchers to look for a nutritional answer, but what if the major answers (and questions) are somewhere else?

      1. over 2000 nuclear bombs have been exploded all over planet Earth since 1945: on the ocean, in the ocean, on land, underground, and at every level of the atmosphere.

        it’s not just about radiation at the point of explosion, but moreso the radioactive particles, which we and the animals we eat can inhale and ingest. What has that done re: disease rates? (and this is in addition to accidents at reactors, of course)

        but this is never mentioned in mainstream analyses of scientific studies.

        1. The particles from all those nuclear explosions are not a problem. The earths surface to a depth of 6 feet has about 50 pounds of uranium per acre.
          The half life of uranium is very long, more than 4 billion years; not very radioactive.
          The problem is when uranium decays to radon which has a half life of less than 4 days meaning it is very radioactive. Radon is responsible for more than 20,000 lung cancers a year in the US.

    2. This is a extremely interesting and thought-provoking point of view IMO. The implications are numerous. Gives me a headache.

      It’s more an more tempting to me to start considering all epidemiology as being as good as using ouija boards or crystal balls. The usual standards just feel far too low.

      Still, there ARE obviously good and insightful minds at work in the field, so I choose to keep an open mind.

        1. I certainly agree, that’s exactly what I generally say epidemiology *should* be used for (forming hypotheses) and nothing else. The problem is that it is so easily twisted, and that it’s so difficult to explain to the average Joe why the epidemiologic studies that some bad scientists wield as proof, are nothing but.

          Forgive me if some of my comments happen to sound strange, I’m extremely tired. I need my bed. :-) Time to stop posting.

  25. I would think there is one other factor “embedded” in high-fat countries being higher-development: it means that everything else they are eating that is not animal fat, may be more prone to being problematic for health (as well as other issues of stress, environmental toxins, etc.). In short, that we could say that “better developed” countries mostly have more heart disease for all the reasons you list, but also for probably 400 reasons you don’t, which are separate from the issue of fat. I know you know that — as you pointed out, there’s just way too many compounding factors here.

    Gotta love a girl willing to be clear about both sides. :-)

  26. Denise, you are so brillant that when you make me look like a fool (I am among those who tend to spread the romantic version of the debunking of Keys’ seven studies story), you make me actually.. enjoy it! C’est fort. Très fort.

    This post was about as enthralling as a novel, with this treasure-hunting feeling (showing those papers by Yerushalmy and Hilleboe felt a little like showing pieces of the treasure map…) which is exciting and very entertaining. I enjoyed myself so much that didn’t even realise that it was actually informative (kidding of course).

    I am baffled by your ability to pull off such a difficult mix of humour and science. It is quite unique, and extremely valuable in our times.

    Je dirais tout ça mieux en français of course, I wish english was my mother language so to write a more poetic song of praise to you.

    Summary: thanks. :-)

    1. Thank god you’re not any better in English my dear Wizzu, you could embarrass the lady. The fact is of course, we are often surrounded by so much mediocrity and self serving comments that a decently designed analysis and carefully balanced statements come across as something otherworldly, which of course does not take away from the fact that Denise does a great job. Still for me the critique of Campbell’s China Study is in a different category and will be something to refer to for some time to come.
      This here is only the beginning of a serious discussion that is sure to start and where the focus most likely will be on the confounders. What caused what and under what conditions and to what extent and what were the possible ameliorating factors

  27. Wow, Denise! Your writing style is a craft of genius. You’re like a female version of CMast, er something. But seriously I enjoyed this piece. Plus… word on the street (I don’t really know which street) is that you were a hit at the AHS 2012. A fair amount of folk in the Paleo world have a crush on you. It’s super fantastic to have you in this community of people who continue to diligently seek the real truth(s) about our food culture and health and wellness in today’s world. A huge thanks to you for your contirbutions.

  28. I’ve said it before and I’ll say it again: The NY Times needs to can frauds Jane Brody and Mark Bittman and BEG you to be their nutrition writer.

  29. Denise, you are the best. You write the most brilliant, interesting, scientific and nerdy post about topics, I never imagined to be anything but dry. Maybe science makes them deliberately boring, so we don’t pay to much attention and question the data. Please keep up the good work in the new year.

  30. “This is typically because of insufficient diagnostic methods (especially for low-income countries”
    I’ll respond with an anecdote (sadly factual). Two decades ago, a 70 year old woman started to show signs of dementia. She was brought to a professor in a premier hospital in New York. The professor wasn’t sure and ordered MRI. After MRI she anounced: “You see there are changes here and here. I think she has mini-strokes.” Several weeks later, a friend of her daughter suggested: “Give a call to a friend of mine (educated in a low-income country, passed all examinations, now practicing medicine here). After a brief exchange (questions – answers), the doctor said the following “You know that I can’t diagnose over the phone without seeing the patient, but I am pretty sure that your mother has Alzheimer’s.” Guess who was right. This foreign born doctor also said something of interest: “Sadly American doctors rely to much on tests, without thinking. Among other things, they miss the fact, that there are typical aging changes, but the healthy adults are not tested.”

    1. The bigger question is what can or should be done to treat the patient. If mini-strokes and Alzheimer’s both are treated by trying to keep the person from walking in front of a bus, it doesn’t matter too much which it is. OTOH, the MRI’s are expensive …

      1. “OTOH, the MRI’s are expensive.” Beth, I think you missed my point. I actually think that in this case there was no need for any high-tech – the symptoms were obvious.” I didn’t suggest MRI testing of all seniors, but only recommended understanding of test results.

        1. What I meant is, if the treatment isn’t different in either case, the diagnosis doesn’t matter. Doing an expensive test doesn’t help provide better care.

          The situation isn’t that simple, because when the diagnosis adds up to “your mother is sick and is going to die” people (understandably) tend to grasp at straws. We like to think that our high tech can cure illness. Sometimes it can, sometimes not, but people like to feel that they have done all they can.

  31. Diane, thanks for doing the legwork that 99% of us our unwilling to do. As always, you are a gem.

    I suspected that something like your findings might be the case and I know how thorough you are, so I’m going to assume you did your homework and continue to avoid reading Keys’ original research, as I’m a lazy-assed bastard with zero interest in Keys’ recommended low-fat diet. ;-)

  32. The truth is seldom as simple as we would like it to be :)

    Nice to see some objective digging into the graveyards of the past. BTW, Denise was a big hit at the Wise Traditions 2011 conference in November as well. She was definitely my favorite speaker as far as audience attention and entertainment value. The presentation quality was very good too, right up there with Paul Jaminet and Chris Masterjohn, whose presentations were also very popular.

    Happy holidays Denise and hope you give us a great book before too long :)

  33. What’s everyone make of this? Saturated fats and clotting

    “Saturated fats can also cause blood platelets to stick together and form blood clots that can cause a heart attack or stroke.”
    Transcend, Ray Kurzweil and Terry Grossman MD

    Blood vessels and saturated fats General UC Berkeley Nutrition lecture

    Dr Oz interviewing Gary Taubes @5m (says more likely to clot) and prevent vasodilating (constrictive)

    Gary Taubes GCBC book:
    In preventive medicine, benefits without risks are nonexistent. Any diet or lifestyle intervention can have harmful
    effects. Changing the composition of the fats we eat could have profound physiological effects throughout the body.
    Our brains, for instance, are 70 percent fat, mostly in the form of a substance known as myelin that insulates nerve
    cells and, for that matter, all nerve endings in the body. Fat is the primary component of all cell membranes. Changing
    the proportion of saturated to unsaturated fats in the diet, as proponents of Keys’s hypothesis recommended, might
    well change the composition of the fats in the cell membranes. This could alter the permeability of cell membranes,
    which determines how easily they transport, among other things, blood sugar, proteins, hormones, bacteria, viruses,
    and tumor-causing agents into and out of the cell. The relative saturation of these membrane fats could affect the aging
    of cells and the likelihood that blood cells will clot in vessels and cause heart attacks.’

    Denise Minger never replied

    1. I’ve never understood this argument. Low fat eaters have higher amounts of saturated fat in the blood than low carb eaters. If saturated fat is truly the problem, carbs should be the first to go.

        1. I have to say, I watched a few minutes of that video, and couldn’t stop myself from thinking, “this guy is imitating Bill Maher”!

          Other than that, the information is not applicable across the board. All high fat diets are not the same. The type of saturated fat is important. Incidentally, my sister was on the Atkins diet a few years ago and all her blood markers improved. Plus, her blood pressure went back to normal and she did lose a bunch of weight. I am not advocating the Atkins diet, but had to point out how ridiculous it is to base an opinion on one example.

          1. Heidi you’re right, all fat is not the same and this is a cardinal mistake made by researchers it seems, that is not realizing this. It seems baffling to me. While running errands a couple days ago I was listening to a local radio program discussing some new research on obesity. They were interviewing the lead researcher of a paper on obesity induced in rodents. What they found was an alteration in the brain of the mice which regulates fatty metabolism (in a nutshell). They kept talking about ‘high fat diets’ do this and that. I was really irked because I know that all fats aren’t the same. I also happen to know that ‘high fat’ rodent chow (thanks to Chris Masterjohn) is actually a lot higher in omega-6 fatty acids than previously thought, and they’re also quite high in carbohydrates.


            there was no clarification about the type of fat, but ‘saturated fat’ became demonized a couple of times, as if it’s a single molecular entity. There was no breakdown of anything, what amount of linoleic acid, etc. they fed the rats. They DID talk about inflammation seeming to cause the problems in the brains which gave me a really good clue that they were feeding these mice lots of linoleic (omega-6) fats.

            Good grief.

            1. Also, people aren’t rats. Rats get fat on high fat diets, but people don’t unless the diets are also high calorie relative to the metabolic needs.

              More precisely, when rats are fed high fat diets, they start to overeat, where normal weight people on high fat diets (but low in carbs/sugar) don’t spontaneously overeat.

              It’s not actually that simple, of course, because it seems that obese people are damaged in some way that induces high calorie intake which is not necessarily reversed by removing sugar or whatever is the trigger. It also isn’t obvious what the trigger(s) is/are, but sat fat is not a likely candidate.


    2. I too am curious to hear her reply, but as it doesn’t fit into her preconceived theory, I’m sure she is afraid to touch it.

  34. I think the idea that it’s all just classification is questionable. In particular, Pauling’s theory on vitamin C and atherosclerosis would predict that a high starch diet would cause noncoronary deaths due to weakening of blood vessel walls, while a high fat diet should reduce those deaths due to higher rates of fat deposition on those walls, which would likely also result in higher heart disease deaths. In addition, glucose displacing vitamin C in white blood cells would be predicted to increase deaths from infectious diseases.

    We don’t have proof that there’s a correlation between percentage of dietary fat – or perhaps dietary saturated fat – and percentage of deaths from heart disease, but we shouldn’t consider it dosproven either.

  35. I often find myself coming back to Weston A Price and his findings. For instance in Europe he noted the difference in the quality of milk from the isolated Swiss alps region compared to the ‘modernized’ regions. We know that feeding ruminants and chickens ‘feed’ that is high in corn and soy changes the fatty acid profile of these animals, skewing them highly towards omega-6 composition. I have to wonder if this data somehow inadvertently shows this negative effect modernized animal husbandry practices have on humans downstream. After all there is this correlation with vegetable oils and disease, has the data made the mistake of calling animal fat ‘saturated’ merely because it comes from animals (after all we know a lot of animal fat is also mono-unsaturated) when it may be were just looking at a lot of excess omega 6 consumption?

    1. mrchristophersea,
      This is an excellent hypothesis and one I share. Your question is well worth posing. The 20th century’s increasing use of GMO soy, cotton, and corn, either upstream, directly off the cob, or downstream, in the animals we feed on, correlates with the rise of diabesity, among other diseases. If we are lucky enough, to be among those able to effectively digest animal protein, then obtaining a source with lower Omega 6’s is worth pursuing. Joel Saladin, of Polyface farm in Swope, VA, is Michael Pollan’s go-to farmer on the subject of healthy animal husbandry, and where I’m lucky enough to purchase my turkey, chicken, and eggs at a monthly drop spot. I visited the family farm on a tour narrated by Joel, and observed firsthand the ingenious techniques he espouses. The extra dollars I spend on healthier meats, vegetables, and neutraceuticals are offset by my lower healthcare costs. I end up ahead of the curve, both financially and healthwise. Among others, I also intake Omega 3 Norwegian Salmon Oil gelcaps daily, to keep my arteries clear and my brain operating at peak efficiency. I’m outliving my ancesters and am productive and healthy. This allows me to pass on the knowledge to others in my coaching practice, and help them to find their own best practices.

      1. I’ve become kind of fascinated by this aspect of the fat issue, how feeding practices have altered the fatty acid profile of animal foods. I quit making bone broths from chickens, even ‘organic’ chickens from my local market, because they’re ‘vegetarian fed’ (meaning soy, corn, etc.). I know this affects the fats in the broth which I’m not thrilled with. So I’ve switched to making beef bone broths from a new brands of 100% grass fed beef the market now caries. What I noticed was the fat that accumulates at the top of the broth once I’ve let it cool over night in the fridge is a hard layer of fat (perhaps you could call it tallow?). Even if I take it out and let it sit and warm somewhat it stays relatively hard, like coconut oil. I never had this with the chicken broths, it was mushy at its hardest quickly liquid if let warm just a bit. I had this sneaking suspicion it was because it was composed of both mono- and likely a lot of polyunsaturated oils as a result of the ‘vegetarian’ diet. Granted I haven’t found a purely pastured chicken yet to compare broth wise with (which I really want to do) but for now I’m switching over entirely to beef broths. I am lucky enough to have access to several sources of (mostly) pastured chicken eggs, the quality being demonstrably better than regular eggs.

        I guess my point is that I have to wonder if this is something also contributing to the omega-6 imbalance problem that’s such a part of the SAD diet today. Ornish, Campbell, Esselstyn, McDougall, etc., may be inadvertently preventing their heart patients from yet another source of damaging omega 6s by not allowing them to eat commercially produced meats (and then just claiming it’s ‘saturated’ fat avoidance that’s doing the trick). I’m just speculating here of course.

        It also really obscures the the notion that you can even say ‘animal fat’ and ‘saturated fat’ nowadays interchangeably (which is so common, especially from the vegan folks extolling how bad they are, etc.).

        Just as a side note also, I don’t take fish oil supplements. My sense is that I’m getting enough EFA’s from pastured eggs, raw grass fed milk, and dairy to satisfy my needs. I would need to find the exact quote, but I’m pretty sure I read on Chris Masterjohn’s blog that this is the case when eating high quality pastured products. I could be wrong though.

        1. I think you’re absolutely right about the Omega-3 supplements. I also eat clean nutritious food and I have never had to supplement. When I did supplement some years ago, I found it thinned my blood too much and I kept getting nose bleeds. Then I discovered that a significant proportion of the cheap fish oil supplements on the market were synthetic ethyl esters, In any case, the lesser-known fact is that, just like everything else in the diet, Omega-3 has a small healthy range – too little (common) doesn’t balance Omega-6 intake and too much (rare) is toxic. The healthy range is about 1 gram per day.

          Unfortunately, the problem arises because too many people are consuming Omega-6 in the toxic range. Here’s where your chickens come in.
          It’s true what you say about chickens fed non-organic, genetically modified grain. However, chickens (birds) do have a larger proportion of Omega-6 fat than animals that graze.

          If I were to supplement on Omega-3, I would do it with chicken, and I would choose Krill and Calamari.

  36. Hopefully this post reaches a broad spectrum of bloggers and academics! Super.

    “Correlation isn’t causation. ” It isn’t. And therefore we need randomized outcomes trials, even if RCTs are not devoid of error and bias either. All studies will remain imperfect.

    However, there are only two large randomized dietary outcome trials that have shown a *substantial* benefit on coronary heart disease in terms of both fatal and non-fatal events. They are Oslo Diet Heart Study and Lyon Diet Heart Study.

    These two studies both reported 44-76 % decrease in cardiovascular events. In Lyon Diet Heart cholesterol levels in control and active group were similar. Well in line with what Keys also suggested. In Oslo study there was a difference in cholesterol levels.

    What is the link between these two outstanding trials? In the active arms vegetable oils (soy/rapeseed), marine food, nuts, vegetables, fruit and whole grains were recommended (or even supplied) while the use of (processed) meat, refined grains and saturated (and even trans fat) was discouraged.

    In my opinion, these two trials are hard evidence for Mediterranean type diet. Your post and the latest prospective cohort trials have also shown that advice to eat plenty of fish, plant-based unprocessed food and reduce processed meat intake is the best advice. At least in terms of cardiovascular health.

    Isn’t it exciting to see the Predimed study results soon?

    1. Agreed. That’s why Ancel Keys invented the Med Diet and lived it out to age 100. He didn’t have the Oslo and Lyon studies to draw from, but a national comparison of diets between Finland and Italy is enough to create a suitable diet plan.

  37. Minger, still dwelling in the Weston-Price la-la-land? I love the primitive-nutrition serie on Denise Minger, videos (62-65), they were brilliant, and really put Denises analytical skills on much needed scrutiny. Glad you, Denise were inspired by this video-serie. I recommend also the chapters on cholesterol, 34-35, and ofcourse the video on Chris Masterjohn, video 26

    The framingham study showed that once your cholesterol is under 150mg/dl one is basically immune for heart-attacks, Esselstyns study provided clinical evidence of this, the average cholesterols of his patients were around 137mg/dl

    “The 17 patients in the study had 49 cardiac events in the years leading up to the study, and had undergone aggressive treatment procedures. Several had multiple bypass operations. After beginning the eating plan, there were no more cardiac events in the group within a 12-year period”.


    “You know, we know that if I can get your total cholesterol down around let’s say 100 to 130 or so, and I have maybe not quite a billion people on the earth like that, and those people cannot get atherosclerosis. You know in the China Study, for example, when Chou En-lai was dying of cancer he started a study in China just like the Framingham Study. The only difference was it was in 880,000,000 people so it was a little larger than the Framingham Study. But you know they found these villages in China where you couldn’t get a heart attack or you couldn’t get diabetes and the women couldn’t get breast cancer and you know their total cholesterol were 127, but the chances we could ever get Americans down that low with diet and exercise are not good”.

    William Castelli, the principal scholar of the Framingham study

    Folks, be carefull with that cholesterol-laden food.

    1. I just listened to the critique of Denise’s China study analyis. You should go back and read Denise’s actual critique. The guy who did those critiques, part 3 and 4, has got a massive axe to grind and completely misrepresented the great work Denise did on that., Shame he did not look at Denise’s work as objectively as she looked at Campbell’s.

    2. I just listened to part 2 now. The author basically just does a character assassination of Denise. His grasp of the issues and data are, unfortunately for him, far behind Denise’s grasp. Big ego and not much substance.

      1. Mario,
        I watched and listened to the critiques as well and found them incredibly ad hominem throughout.

        Richard – “Folks, be careful with that cholesterol-laden food”…
        So you are saying that dietary cholesterol impacts serum cholesterol?

        Also, those people with total cholesterol below 137 or so (really tough for me since my HDL is 106) that are immune to atherosclerosis, are they dying from other causes before the atherosclerosis can get them (like cancer or some other diseases?)? What about the study (Forette, et al., 1989) that found after the age of fifty, LOW cholesterol is clearly associated with an increased risk of dying from a variety of causes:
        The study of old women indicated that a cholesterol level of 270 mg. per 100 ml. was associated with the best longevity, “Mortality was lowest at serum cholesterol 7.0 mmol/l [=270.6 mg%], 5.2 times higher than the minimum at serum cholesterol 4.0 mmol/l, and only 1.8 times higher when cholesterol concentration was 8.8 mmol/l. This relation held true irrespective of age, even when blood pressure, body weight, history of myocardial infarction, creatinine clearance, and plasma proteins were taken into account.”

        1. Don

          skip the pseudoscientific garbage, get serious with science, yes exactly dietary cholesterol impacts serum cholesterol, saturated might just even excarcebate this process. Clinically it’s irrelevant

          The people of rural Asia and even more so the folk Central-Africa who consume very near vegan diets are completely free of most of cancers,diabetes, obesity, alzheimer, dementia, impotence, etc. These folk all have cholesterols under 150mg/dl and actually pretty high calory consumption, unlike the myth would suggest. Once you are under these digits with cholesterol, you are pretty much bullet-proof from loads of ill stuff. Unless you are genetically very gifted, meaning having extremely efficient cholesterolcleaning mechanisn, you have to be as close as vegan you can, and it won’t hurt avoiding the skip the plant oils as well. Those are typically not consumed in the aforementioned places, after all their diet is very low in fat.

          William Roberts, the chief editor of cardiology knows what he talks about, only biologically herbivores can get heart-disease (by feeding them animal products), and human is a one.

            1. Richard wrote: “completely free of most of cancers,diabetes, obesity, alzheimer, dementia, impotence, etc”. I find it interesting that Richards states being free of certain diseases and overall very healthy as the marker for a particular eating pattern. But the same can’t possibly be true for people who exhibited these same patterns and ate animal foods. This is precisely what Weston A Price did, he found people with high degrees of resistance to modern diseases, especially noting excellent dental health. He never found a single group of people who were vegan, they all ate animal foods to one degree or another. The idea that humans are herbivores is at odds with traditional eating patterns where certain animals foods were prized (organ meats as an example). And the fact that Price figured out it was the fat soluble vitamins A, D, and K as being the cornerstone nutrients makes it clear humans thrive when using animal products.

              1. Watch the primitive nutrition serie of Inuits (videos 27-28) and Masai. The idea that these folk were healthy on their natural diet is beyond ridicilous.

                1. Does it talk about Masai and Inuits who eat a pre-westernised diet or a westernised diet? There is a difference.

                  There is no sign of chronic disease in Masai and Inuits who ate their natural pre-westernised diet, but as soon as they ate a westernised diet chronic diseases appear.

                  And for the record, both Inuit and Masai’s pre-westernised diet is HIGH IN ANIMAL FAT.

          1. Richard,
            Why is it that if YOU believe it, it is science, and if you don’t it’s pseudoscientific garbage? Have you looked in detail into the study I noted (I was looking for an honest appraisal or rebuke, not a flippant remark that teaches me nothing (at least about the research in question). Who are these peoples in Asia and Africa you speak of? How much longer do they live than the rest of us (since they are bullet proof)? Who funded the studies? How were those studies performed? I have read of several disparate groups of the longest lived peoples from around the world who eat diets that are in completely different from each other – most eating animal protein of some form or another though; if I let them know of your “research” should they all change their diets so as to live longer? You are so arrogant in your remarks/responses I feel you must have iron clad evidence for your positions (possibly even some research you have performed yourself (or at least a strongly researched and intelligently written critique of the all the research in question – much like what Denise provides). You argument comes off as viscerally charged: high (understandably) on emotion but low, unfortunately, on any smoking guns. I am asking to be convinced, not preached at.

            1. ” I am asking to be convinced, not preached at.”

              Gosh; this sums it up so nicely! Kudos for having nailed it down this way. :-) Thas was also exactly my feeling but I couldn’t find the words to express it. You did.

            2. Don,

              you should start from square one. No one is talking about longitude here. People in Central-Africa and rural Asian die quite young in diseases of infection, when you are lacking antiobiotics and WC you cannot expect to live long. However, most epidemiologic studies, don’t worry who have financed them, they are not designed to make headlines, are age matched. That means, average life-expectancy doesn’t matter. We are talking about cohorts with hundred of thousands of people, so they have plenty of people from all age categories, despite the low average life-span.

              If you hear someone saying “correlation does not equal causation” run as fast you can. People who push these lines are always on agenda. Are you fool enough to think that people who deal with these issue have not heard about a concept that is taught in every entry level statistics course. The chances for you getting sincere information from Mrs Minger are zero. It’s about revenge against veganism. If I put my dog do analysis on the China raw data, it couldn’t get worse than Minger did it.

              Anyways, start watching primitivenutrition youtubeserie, chronologically from the video 2 forwards.

              1. > “People who push these lines are always on agenda”

                > “It’s about revenge’

                Look who’s talking. :rolleyes:

                > “start watching primitivenutrition youtubeserie, ”

                I did. It was painful. Sophomoric work at best. Mediocrity and lack of insight written all over it. I could have done better in high school. Really painful. I wish I hadn’t wasted my time on these.

              2. What a load of dung. Without question you did not read Denise’s critique of the China Study. You just made yourself look like an arrogant fool. Her analysis (starting with the raw data) was scholarly, and your posts are shameless.

              3. Thanks for your opinion. Denise (and many others) have made better arguments (in my opinion) with less bias or agenda (more parenthesis here) than I find in your arguments. I feel comfortable knowing I can still enjoy this holiday season with a healthy (not huge) portion of animal protein, eaten with confidence, no guilt, and seasoned liberally with an unhealthy amount of alcohol. I really hope you have a Happy Holiday season as well.

      2. LOL….why don’t actually watch those videos before you keep spreading that carbage. If the guy was totally loonie, I am sure Denise would have something to say about it, especially after vegans are throwing parties because of these videos. But, but no response. Wouldn’t it be rational to first address the issue that are most closest related to you. Well, maybe the silence is better, after all you americans have coined the best sayin’ in the world “once you are in a hole, stop digging”.

        Judge yourself, be smart, don’t fall for pseudoscientific BS which Denise embraces.

        1. Well, this is not Denise’s fault, but again I am going to cancel my subscription to comments. I suppose vegans’ blogs are not getting sufficient hits that you have to retort to contaminate with your stupidities and rudeness those of others. Perhaps you are not aware that nobody with the brains to understand what Denise writes is going to give your babble any second thought. Your advising us a youtube channel is sufficient to not wasting time seeing it, thanks.


        2. Here’s an American saying that you should embrace, Richard:

          “Better to remain silent and be thought a fool than to speak out and remove all doubt.”


        3. Perhaps you should take your own advice. I read every word of Denise’s criticism of the China Study and Campbell’s supposed rebuttal (basically just attacking Denise’s credentials and ignoring the actual arguments) and listened to this clown in the videos you presented. He totally misrepresented Denise’s analysis. What she has said in her criticism and what he said she says are more different than chalk and cheese. Why don’t you do the same. Read every word of her analysis of the China study which is on this blog (it will take a long while, but is very much worth the time) and if you think what she says in any way remotely resembles what that clown in the video says she said, well then… I can’t help you. You just want to believe what you want to believe.

        4. No reply from you on MY questions? Hmmm… I know how you hate that…
          I have some more:
          Who said loonie? What’s carbage? Vegans love a good party, so? Who said I was American?

      1. It’s so interesting that instead of making them stop and consider that their hypothesis may not be right, they just assume that the cholesterol isn’t low enough yet.

    3. Hi Richard, I watched the four China Study videos in the Primitive Nutrition series tonight and wasn’t terribly impressed. Regarding my China Study critique, the narrator says right off the bat “I don’t have the expertise nor the interest to properly fact-check her analysis of it “(minute 2:10 on video 62). It’s hard to engage in an actual discussion about the data if he hasn’t even tried looking at it.

      Next, he criticizes Harriet Hall of Science-Based Medicine on several accounts. At 3:37, he mentions the part of my critique (as relayed by Harriet Hall) that questions why Campbell didn’t explore the wheat/heart disease relationship in his book, since apparently this link is too far-fetched to even entertain as a possibility. I’ll assume the narrator never saw the paper Campbell himself published (“Association of dietary factors and selected plasma variables with sex hormone-binding globulin in rural Chinese women”) that looked at the China Study data and found:

      “Significant differences in the diet of rural Chinese populations studied suggest that wheat consumption may promote higher insulin, higher triacylglycerol, and lower SHBG values. Such a profile is consistent with that commonly associated with obesity, dyslipidemia, diabetes, hypertension, and heart disease. … Wheat may be unique in its relative capacity to stimulate insulin. …The relative differences in the fatty acid proportions and/or amylose content for wheat and rice may thus be responsible for modulating serum SHBG, triacylglycerols, and insulin.”

      Next, the narrator says:

      “In reference to Colin Campbell, she [Harriet Hall] dismisses his amazing assertion that over a period of years, some provinces of China didn’t report a single heart attack in anyone under 64, even though their populations were in the tens of thousands. That doesn’t tell us anything, she says. Thanks for the serious analysis, doc.”

      Here, he’s referencing the county labeled “PD” in the China Study, which recorded zero deaths from ischaemic heart disease in women during the survey years, and only 3 deaths per 100,000 for men — at least in the China Study II (; maybe it was zero for men as well in the earlier survey. However, we can see this county also had very high rates of stroke (page 227 in the above PDF) — 224 per 100,000 for men, compared to only 40 per 100,000 for men in the US at the same time. This county also had high rates for other forms of vascular disease, suggesting some of the ischaemic heart disease deaths might’ve been recorded under the wrong name. I’m not sure the “zero heart attacks” really proves they’re healthy if they’re dying a lot more from related diseases.

      He then criticizes Harriet Hall for saying Gary Taubes debunked the connection between saturated fat and heart disease, pointing out that Gary’s work has been questioned by other bloggers such as Evelyn at Carbsanity and Stephan Guyenet at Whole Health Source. The irony is that Stephan also vocally rejects the diet-heart hypothesis — so if the narrator finds Stephan’s blog credible enough to trust his critiques of Gary Taubes, he should also find Stephan’s blog credible enough to trust his numerous posts disassembling the saturated fat = heart disease theory.

      It also seems odd that he suggests we accept non-peer-reviewed blog posts criticizing Taubes, but not accept my non-peer-reviewed blog posts criticizing Campbell.

      The narrator then criticizes Harriet Hall for suggesting that Bill Clinton can’t eat avocados anymore and indicates her research of Clinton’s heart-disease-reversal diet is sloppy. He says, “She also thinks one must renounce avocados to meet the recommendations of these doctors for some reason,” and then spends a while quoting from plant-based diet books trying to refute her. Considering Caldwell Esselstyn (Clinton’s main doctor) believes all fats (including plant fats) cause endothelial damage and excludes them from his diet plan, Harriet’s statement is absolutely accurate. You can see Esselstyn’s recommendation to avoid avocados in the excerpt from “Prevent and Reverse Heart Disease” on his website: — near the bottom in the bulleted lists: “Generally, you cannot eat nuts or avocados.” Esselstyn states you can only eat avocados in very limited amounts if you don’t have heart disease, but Bill Clinton does have heart disease, which is the whole reason he’s on this diet in the first place. So he’s certainly in the no-avo category, and Harriet Hall was correct in stating he can’t eat them. (This all may seem like a very nit-picky point, but the video narrator seemed to find it important enough to dwell on.)

      The second video (#63) spends the first five minute or so talking about my personal history rather than discussing any data, as well as taking a literal interpretation of some AHS slides that were essentially jokes (i.e., vegans plotting world domination). I suppose humor doesn’t always translate well from PowerPoint slides so I won’t blame him for that.

      At the six minute mark, he quotes a paragraph from my China Study response questioning why Campbell didn’t mention the associations between heart disease and wheat, corn, barley, etc. that were much higher than anything he found with animal products. The narrator states that “this is where her amateur status becomes a problem.” This seems to be more misinterpretation of my writing, because I wasn’t suggesting those foods necessarily cause heart disease — just that Campbell’s focus on weaker correlations in the data (and tendency to view them as showing causality) between animal foods and disease reveal his bias.

      Video 64 discusses another study I blogged about that found a “vegetable-rich eating pattern” was associated with weight gain in China. Here, the narrator criticizes this type of study for using artificially assembled “eating patterns” based on unreliable recall surveys rather than direct food measurements, and (in the next video) calls such studies “impenetrable and useless.” However, back in video 62 at the 5:07 mark, he cited this *exact* same type of study as evidence that a “fruit-rich eating pattern” was associated with less cardiovascular disease, stroke, and diabetes in China than a “meat-rich eating pattern.” He accepts these results as evidence for the superiority of plant-based diets without pointing out the methodological flaws like he does in video 64. Does he consider this study design reliable when it supports his views, and “useless and impenetrable” when it doesn’t?

      I sort of skimmed through video 65 because it didn’t seem worth it to keep critiquing.

      As for the Ancel Keys videos, I *really* appreciate that the “Plant Positive” guy pointed out the frequent misunderstandings about Keys and the six-country graph that are often repeated within the paleo community. However, he admits to not having access to the Yerushalmy and Hilleboe paper, and it looks like he’s mainly referencing two graphs from it that were reproduced in a later paper by Stamler in 1958.

      As a result, he leaves out some of the most important points of the Y&H paper, including the unreliability of using food-balance data, the authors’ explanations of why animal food and fat intake can be correlated with heart disease in a non-causal way due to its association with a country’s industrial and medical development, and the discussion of what the inverse association between fat/animal protein and “death from other causes” really means.

      Also, the video narrator tries to selectively drop countries off the 22-country graph to make the fat/heart disease association look stronger: his rationale is that Norway, Denmark, the Netherlands, and Sweden — which had high fat intakes but low-ish heart disease mortality — don’t belong on there because their heart disease rates were probably still recovering from plummeting during the war years. Yet one of the abstracts he flashes to support this idea says point-blank “Denmark didn’t have any reduction in heart disease mortality during the war,” so his rationale for deleting its data point is bunk, and he doesn’t explain why other countries affected by war rations (like Finland and Austria) should stay on the graph. Likewise, if he wants to delete data points, he’d also need to get rid of Japan and France and Italy because they notoriously under-reported death from heart disease.

      There’s a lot more, but again, I don’t feel like it’s worthwhile to critique this particular video series. If he creates a transcript of the videos, I’d be more willing to prune through that, because at least I could skim through the huge sections of the videos that are basically nothing but personal attacks on various paleo figures and low carbers.

      1. Fair well, Denise

        when we do we get your interpretion published on a scientific platform, peer-review process encourages for scientific rigorosity, as you sure did know by now. Considering the sheer aggressiveness of the animal-based diet promoters I am sincerely puzzled how come now one has published your interpretation/lessons from the China Project raw data. LOL! Still Waiting.

        You don’t seriously believe skeptics are going to invest reading a work by lady who thinks Lierre Keiths book is great piece.

        I see you cleverly managed to sidestep from the fact that Campbells study is short from unique.

        “because at least I could skim through the huge sections of the videos that are basically nothing but personal attacks on various paleo figures and low carbers”

        LOL…’on, this was a much needed critical look on the science behind low-carbers. I recommend everyone the videos 2-3 for starters. You cannot argue against that the clips about, let say Mark Sisson Weston Price Foundation were not funny. Maybe your next blog post could be about refuting the alleged good health of Inuits (videos 27-28) or Masai (vid 29), I see you all animal-based diet pushers got it wrong on those as well.

        1. No please, fair well Richard and your ad hominem attacks. It is obvious you do not like us omnivores. Why try to save us, then? Why don’t you just let us shuffle off, dragging our knuckles, to our early deaths?

          1. That certainly sounds like a temptating though. If you are idiot enough to listen these “saturated fat is good for you”-bloggers, maybe you actually deserve to get one of those sympton-free leathal strokes.

            However, for the environments sake, I wish people could cut down the animal foods.

            1. “However, for the environments sake, I wish people could cut down the animal foods.”

              Animal foods? Non mon cher, you mean meat. I don’t see why butter, dairy and eggs, if from pastured animals (and not from poor sick grains-fed animals in CAFO), can’t be environmentally sustainable.

              “If you are idiot enough to listen these “saturated fat is good for you”-bloggers, maybe you actually deserve to get one of those sympton-free leathal strokes.”

              Yes, yes, we do, we do!

              Just let us die! :-)

              1. “Animal foods? Non mon cher, you mean meat. I don’t see why butter, dairy and eggs, if from pastured animals (and not from poor sick grains-fed animals in CAFO), can’t be environmentally sustainable”

                Animal husbandry is inherently, no matter of the feeding practise, always unsustainable, and a distress to our ecologic system. Something we 7 billion people cannot afford.

                1. Richard,

                  You said “Animal husbandry is inherently, no matter the feeding, always unsustainable, and a distress to our ecological system.”.

                  There are places that are unsuitable for growing fruits, vegetable, and grain, yet certain forage could be grown there. New York state is an example.

                  Peters, Cj, Fick GW, Wilkins JL. Testing a complete-diet model for estimating the land resource requirements of food consumption and agricultural carrying capacity: The New York State example. Renewable Agriculture and Food Systems. 2007; 22(2): 145-153


                  Below is a quote by Christian Peters, M.S. ’02, Ph.D. ’07. A Cornell postdoctoral associate in crop and soil sciences and lead author of a research study, published in the journal Renewable Agriculture and Food Systems, examining the land requirements of complete diets. The researchers compared 42 diets with the same number of calories and a core of grains, fruits, vegetables and dairy products (using only foods that can be produced in New York state), but with varying amounts of meat (from none to 13.4 ounces daily) and fat (from 20 to 45 percent of calories) to determine each diet’s “agricultural land footprint.”

                  “Surprisingly, however, a vegetarian diet is not necessarily the most efficient in terms of land use,” said Peters.

                  “The reason is that fruits, vegetables and grains must be grown on high-quality cropland”, he explained. “Meat and dairy products from ruminant animals are supported by lower quality, but more widely available, land that can support pasture and hay. A large pool of such land is available in New York state because for sustainable use, most farmland requires a crop rotation with such perennial crops as pasture and hay.”

                  “Even though a moderate-fat plant-based diet with a little meat and dairy uses more land than the all-vegetarian diet. It feeds more people (is more efficient) because it uses more pasture land, which is widely available.”


                  Miriam Goler ’09, president of Farm to Cornell explained the importance of the energy aspect of the agricultural footprint.

                  “Much land in New York State is not suitable for growing row crops. For example, if land is too steep, erosion and soil loss will be a major problem if you try to till it. However, some of this land may be suitable for growing forage crops, which can be used to graze livestock. Therefore, if we use this land in its most productive way, we need to be eating some meat in order to maximize the number of people that are fed”.


                2. “Animal husbandry is inherently, no matter of the feeding practise, always unsustainable, and a distress to our ecologic system. Something we 7 billion people cannot afford.”
                  That’s the biggest load of nonsense yet. Unrestrained population growth would eventually make any system unsustainable. Idiot.

                  1. “That is mere opinion. Bring on the evidence.

                    Oh LORD, no… Now Richard will start directing you to a bunch of other moronic videos!

                    Make it stop!

            2. I’ve butchered quite a few animals and they were never mistreated. All farm animals I have seen have always been well treated. That is why very few run away. Chickens, goats, pigs will always return to their home. Cows just wander until they want to get milked and them moo loudly until they are found.

            3. And again with the ad hominem attacks! Also Richard use a spell checker!

              I think there are much bigger problems affecting the environment besides animal food production. e.g. HAARP, mining industry, toxic waste, plastics etc.

        2. “I recommend everyone the videos 2-3 for starters”

          I recommend everyone to avoid wasting his/her time with these videos. Which are not really ‘videos’ BYW, just a powerpoint-like presentation with a voice over.

          They are very amateurish and basically just and opinionated, superficial and (I like ot repeat it..) sophomoric high school work.

          The one thing that I do like with them, is linked to my old belief that the worst enemies of an idea are not its detractors, but it’s poor defenders. And these are very poor defenders! :-)

        3. Hmm, seems like a double standard you’ve posed here. You won’t take Denise seriously because of ‘peer review’ but you want us to watch a couple of videos on YouTube (by a guy who by admission doesn’t have the “expertise nor the interest to properly fact-check” the data) which I’m guessing are also not peer reviewed and published in scientific journals.

          1. No, not at all double-standards, most of the ideas expressed by the paleo-community are not peer-reviewed, Ravnskovs book is not peer reviewed, the idea that Inuits and Masai stay healthy on their natural diets is not a peer-reviewed, Keys alleged crime is not peer-reviewed, etc. So it’s basically sorting out misconceptions and psedoscience. Highly recommended channel. If it wasn’t then Minger would have hardly shared any of the ideas expressed in it for her readers.

            Anyways, what do we have? Animal protein carries a huge correlation with heart disease in the 22 country data, In the Y & H paper “Calories from protein” had values of r= 0.709 with “arteriosclerotic & degenerative heart disease”.

            The fact that vegetable protein had higher correlation with non-heart disease category as opposed to animal products is irrelevant. That correlation has no biological plausibility.

            High plant-consumption in Europe at the time was a proxy for poor socio-economic status and everything that followed from it: poor sanitation, poor access to health-care, etc. This should be reversed by now, high plant-consumption in Europe today would be correlated with high socio-economic status and everyting that follows from that, better health-care, higher life-expectancy, etc. And let us not forgot that heart disease was and still is the most common disease of the West. Atherosclerosis, cancer and rheumatoid arthrisis is prevalent everywhere where animal products are highly consumed (the Inuits and Masai makes no exception) and reverse is true where starches are on high demand (Central-Africa, rural Asia, Papua New Guinea, etc)

            Avoiding saturated fat and replacing that with fruits or non-processed starches is a very clever move. “Calories from carbohydrates” had the lowest positive correlation of all: 0.305 with “arteriosclerotic & degenerative heart disease”.

            1. “That correlation has no biological plausibility.” That just shows your bias. The fact that data from the China Study points to a vegan source of food (wheat) as a strong correlate with of heart problems should give you pause about that assertion.

              At the end of the day, the massive rise in cancers and heart disease during the course of the 20th century is now supposedly caused by OLD FOODS. Foods humans have been consuming for a very long time. It just doesn’t work. What has happened, and documented very clearly by Price, was the rapid change in human dietary patterns leading rapidly to degenerative diseases, marked skeletal changes and terrible dental health. OLD FOODS did not cause this rapid change in poor health. It was abandoning these food patterns in favor of ‘modernized’ processed foods.

              Seriously, the fact that vegan foods (sugar, refined wheat, vegetable oils, etc) can put one at risk for heart problems is actually exemplified by some interesting research on the Masai from the early 1970s.

              The short of it is that during a 15 to 20 year period when men exist almost exclusively on meat, milk and blood they have ‘low cholesterol’ and very low rates of atherosclerosis. While there were no deaths from heart attacks, a rise in atherosclerosis parallels their re-entry into the rest of Masai culture which had access to processed foods.


              You can see the papers and graphs above along with a more thorough rundown. The issue is that the Masai began developing problems as they abandoned their traditional, non-Westernized diets.


              1. ^Don’t worry I know the old story, that’s why asked Minger to do a refutal about it, so that you’d know as much as I do.

                Primitive Nutrition serie on Inuits (27-28) and Masai is highly recommended (29-30).

                Atherosclerosis was observed even in ancient Egyptian Mummies, the hair molecyle analysis showed them to have eaten loads of “real food”, meat and eggs that is.

                Weston Price Foundation is meat lobbying foundation, and heck yeah, they portray a nice picture of dairy and meat. What are the odds that you get sincere information from sick, confused and emotional wheat-hater such as Minger? I tell, you the odds are next to nothing. One thing I give her, she is very good in sidetracking the issue at hand (her amateur status) to pinpoint inconsistencies on other debators, but don’t be fooled by the facade.

                1. She has consistently made you look like a fool and your videos criticizing her China study work are little more than character assassination with no substantiation.

                  The fact is you don’t like her work not because it is flawed, but because it conflicts with your belief system.

                  In some ways it is almost amusing. Most people like yourself who attack Denise and others who support a diet that includes animal products try to portray them as nuts who want to essentially live on meat products. For the most part, that is complete nonsense. They are people who have a serious concern about health and wellness and who basically just eat “real” food and eschew all “manufactured” food. This means they eat an abundance of vegetables, some fruit, meat, eggs, nuts etc… They eschew grains, vegetable oils and sugar and shockingly, they are extremely healthy… imagine that.

                  Your criticism of the Weston A Price foundation is very lame. Suggesting it is some kind of industrial lobby group shows you haven’t looked into it one iota. It is a small underfunded organization that supports family farms, pasture fed organic meats (particularly organ meat) and rails against large commercial farming operations that force feed beef corn, load them with antibiotics and growth hormone etc… Yes the powerful “liver and kidney” family farm lobby.

                  If you actually took the time to read anything Denise has written on the China study and to actually watch her “How to win an argument with a vegetarian” video which was in large part very humorous, you might actually be able to contribute something to the discussion other than useless blather.

                  1. “Most people like yourself who attack Denise and others who support a diet that includes animal products try to portray them as nuts who want to essentially live on meat products. For the most part, that is complete nonsense. They are people who have a serious concern about health and wellness and who basically just eat “real” food and eschew all “manufactured” food”

                    Oh, com’on I am sure Denise is a nice lady, but let’s be honest. You have to quite a blue-eyed to expect her delivering sincere information. Her only and sole concern in this world is that people keep loading themselves with animals. She is not a good person. All diets goes except veganism.

                    1. You obviously know absolutely nothing about what Denise stands for. You are either just trolling, or you are a complete idiot who won’t take time to inform himself in any way about what he argues. Denise barely eats any animal products by the way. The vast majority of her diet is plant based. It’s bad enough that you walk around in ignorant bliss, but try to do it without assassinating someone’s character whose intellect absolutely dwarfs your own.

                2. Egyptians actually had a diet high in grains.

                  At the end of the day you are a vegan with an agenda. Most of your posts do not make sense except to demonise animal products!

          1. Richard stop using ad homonym attacks, it totally discredits any argument you are making. The UN is dodgy and has an agenda, i wouldn’t put much trust in anything they say.

            I think most of us on this forum are all for animal welfare and are against factory farming methods and artificially fed animal products. Stopping humans from eating other animals is like trying to stop a Lion or a Wolf from eating other animals.

            There are also many other critics of the china study besides Denise. Do further research instead getting emotional and using personal attacks against people just because they differ in opinion from you.

        4. Hi Richard,

          When is Dr. Campbell going to publish his ‘results’ in the China Study under peer-review?

          Where are the peer-reviewed studies from the China Project linking animal protein and disease?

          When do you think he’ll get around to that?

          Why is it exactly that Dr. Campbell had to write a non-peer-reviewed book to link animal protein to disease instead of using the China Project data to write peer-reviewed research?

          I really don’t see how Vegans constantly miss the irony of calling Denise’s critique out for not being peer reviewed. “The China Study” is not peer reviewed!!!!

          If this link is so strong, is it really that hard to publish peer-reviewed research showing it?

          1. Guess somebody’s got to do it. I’ve given up on it.

            Since you haven’t changed the time in your blog settings, the record will forever show it to actually be Christmas Eve ;)

      2. Well the only problem with the China study is it might as well be Sci-Fi, like the Key’s report is, not worth the paper it is written on let alone to be used,

  38. And, no! Denise did not come up this, she merely just recited the primitive-nutrition serie on Keys and put up her own pseudoscience on the mix. Videos on Keys, 36-39. She got nailed to the extent, she had nothing to say about the videos about herself.

    Primitivenutrition series is highly recommended to all who wants to explore further from the paleo-blogopsphere, including Minger.

  39. Sorry, Denise, not to mean to spam your blog, but more thing. Why didn’t just copypaste the primitivenutrition videos on Keys and shared them with the readers. After all 95% of your text came from them. Instead, you put people to endure to horrible mammuth post. Besides, now there’s a risk that people actually think you are more than just a simple, silly and confused persona :)

    Since you didn’t do it, I feel it’s my obligation. Don Matesz certainly shared the videos, and not pretent he was expressing his own work. Moreover, putting your readers to go these videos, they’d learn heaps of other things as well: to realize what mess this these animal-based fad diet promoters are, and to stay away from Ravsnkovs book, unless looking for comedy.

  40. Shit, just when I almost promised to not to contribute anymore, I remembered this; the high mortality of high-fat meat eaters has been shown in multiple cohorts, from first rate, AAA-level, top-snotch countries. Unless it was the whole-wheat bun in the burgers….LOL

  41. Proof that Ancel Keys was not an uber-villain but only a human trying his best to further the lot of mankind. Aah, something about good intentions and a road?

    Thank you for this!

    PS: Consider making these huge blogposts available in episodic form, so that we your loyal readers can chew on a little at a time. It meshes better with at least my blog reading habits…

  42. Ancel Keys was ofcourse right, animal products induce heart-disease. The fact that plant-protein had higher correlation with all-around mortality has no biological fact, it merely reflects poor socio-economic status. The more plant consumed at Europe at the time, the poorer the consumer. This may be hard to understand in US, but industrial animal food in Europe isn’t that old thing. The social differences in Europe during the post-war and prior era were huge. The poor plant-consumers in rural parts of the country hardly had even the loo at the house, let alone access to quality health-care. In my country it was an issue to brag about if your family had pork of butter during the war and immeadiate post-war years, it was only something that the rich folk had. The fact that poor people have higher mortality in non-heart related categories is perfectly understandable.

  43. Has no biological plausibilty, that is :)

    “The poor plant-consumers in rural parts of the country”

    at the continent, that is.

    1. “The poor plant-consumers in rural parts of the country”
      Not only in rural parts. In many families, poultry/meat was rationed within families, and basically went to children. That’s why I asked above to look at the date of Keys’s graph.
      This what I’ve noticed in some discussions – lack of historical context. It seems to be comical when I hear people discussing with certainty the “details” of paleo lives when frankly we can know very little, but ignoring recent history which in some cases is at least history of close relatives if not our own.
      Yes, significant part of Europe had a different nutrition pattern than the U.S. in the 1940s/early 50s.

      1. *LOL* Excellent

        Come to my street. I’ll be the only one to laugh, though.

        They don’t even know what a cucumber is, let alone a correlation. “Denise Minger” could be some brand of chocolate cookies. The whole picture would be as mysterious to my neighbours, as a chinese receipe from the 15th century.

  44. Denise, thankyou for dedicating so much time to genuinely trying to set the picture straight, on this and all your posts. I love you are always genuinely unbiased. You have changed the world of health forever, and for the better.

    And you can talk about really serious technical stuff, and still make everyone smile :)

    1. I wish Richard would go away. Talk about gumming up a blog with idiocy and ad hominem attacks. {eye roll} (Yes,that’s an ad hominem… or it could just be disgust with him for wasting my time.) Maybe if we all get really quiet and don’t answer when he’s hanging around, he’ll think we’re not home and he’ll go away!!

      1. Campbell said we shouldn’t listen to Minger because she’s not old enough. Well, we shouldn’t listen to Richard because he’s not tall enough. Goodbye Richard.

      1. Richard, I am with you on that. Let me explain. There is at least one generation of Americans who were taught in an interesting way: learn how to write correct MANIPULATIVE (CYA and the like) sentences … and you are set for life and success in corporate America. You don’t have to know anything else. Ah, and remember to smile permanently and idiotically and millions and billions and of course the automatic admiration of the idiotic crowd is all yours. Simple. Easy. Idiotic.
        dr anna writing in her 7th language

        1. @Anna

          do you blog or something? I am fascinated to learn to write better, what you just said made huge sense to me, and along the lines I’ve been thinking but couldn’t quite nail it by myself. With the skill of writing you can be 24 years of age, graduated from a worthless “red brick” uni, have no training in medicine nor statistic and still fool bunch of people to believe you’ve actually debunked a peer-reviewed body of work. That’s so intriguing. Is there a way I can get in touch with you? I am curious to know and learn more.

          1. Wrong, Richard, wrong.
            Actually, I think that Ivy students/graduates are the most brainwashed and opportunistic. After all they are the most ambitious and want really to succeed in corporate America.
            A decade ago or so, exactly at the time when David Brooks wrote his piece (only half good) in Atlantic monthly (?) “The Corporation Man,” I started to have nightmares, after having a close encounter with the New York Ivy students. After one nightmare, I woke up with a poem (my first, my last, a masterpiece) – see below.
            Marching zombies, marching zombies, marching zombies march,
            Marching zombies, marching zombies, marching zombies march
            They don’t think, they don’t dream
            They march, they march, they march
            Marching zombies march … etc.

            Now, excuse me, Richard, but I didn’t watch a single video of yours and have no intention. I did read Denise’s article, brilliant as usual. I don’t know how Denise got so smart (a genius?), but I know that she is outstanding in method and style (exceptionally sophisticated, light and witty).
            Somehow, she (and probably many others) escaped the required zombie training.

            1. Denise, please, please, please redesign this comment section. My “Wrong, Richard, wrong” comment was a response to Richard’s address to me several miles earlier.

          2. Richard, you’re welcome to post here if you have something to contribute about data I’ve presented, specific points in the Primitive Nutrition videos (not just “watch these videos, end of discussion”), or other relative topics. Part of my goal for 2012 is to keep the comments section of this blog more hospitable for people who want to have an intelligent dialogue, and right now, you’re definitely skirting troll territory.

            Feel free to express your anger towards me via email. If you keep doing it here I’ll ban ya. :)

            1. Denise, please ban Richard from comment section. This guy has been writing his arrogant messages to many blogs and discussion forums and I can tell you it’s impossible to have an intelligent discussion with him. Having him here commenting and other people answering to him is just waste of everyone’s time.

            2. Denise I seem to be developing the habit, but I would seriously consider following through on your threat.. We live in a democratic society where we allow everybody to be part of the process of communicating his/her ideas. If these ideas contribute to the general discussion so much the better. If they hinder the discussion, if they become detrimental, if they become ad hominem, if they cause others to refrain, I think you have the right, maybe the duty to expel. We will otherwise be losing valuable contributions and as I mentioned in my comments to dr. Feinman and Wizzu, I have a feeling that this only just the beginning of a much wider discussion. Furthermore Richard has shown he is not interested in that discussion at all. I could use a pars pro toto for such a person but I will stop short.

              1. James, Denise has the absolute right to totally sensor everything posted on her blog. There is no democracy at this site. She is in control. Freedom of speech means the “government” can’t pass laws against speech.

            3. Sorry for off-topic posts, and apologies for writing “worthless red brick uni”, totally uncalled move. Every accredited educational institution deserves my utmost respect.

          3. It seems to me that it is a good thing that Denise has a thick enough skin to be able to handle snark — or at least, I hope she does, since some of the comments that have been posted are very snarky. The comment Richard made qualifies as serious snark in spades.

            I could ask what Richard think he is adding to the conversation, but I am a bit afraid that the answer would just be more abuse.


          4. Figures.

            It’s getting more and more probable that Richard and Anna are pals in real life, or even the same person.

            That level of connivence and mutual support after such a limited communication on some blog, is highly improbable. I’ve never met it. And I’m on the internet since 1997 and have been a moderator on a dozen forums.

            Of course people sometimes ‘fraternise’ quickly but not on the specific mode displayed here. It’s like a bad hollywood script.

            Denise, I have the feeling that you are dealing with more than ‘average’ trolls here. There is pattern feeling to it. It sounds… organized. You banned a too-obvious troll recently, so they’re back with more subtle tactics.

            Maybe I’m just being paranoid. But since the moment when I have been called a neo-nazi supporter by ‘Dr.’ I’m-holier-than-thou-with-froth-at-the-mouth, I’m enclined to trust my intuition.

            Merry Christmas BTW! :-)

          5. Uh no. You actually have to have an IQ off the charts, a great understanding of statistics and incredible patience to go through all the data the way Denise did to come up with that work. It was so good, that the only criticism Capmbell or any of his supporters have ever come up with are similar to yours…. attack the messenger because you can’t attack the message. Not a soul has been able to come close to attack the actual work Denise has done, and believe me, it isn’t because they don’t want to. It is because they can’t. Read it yourself. What she did is bullet proof. Too bad your preconceived notions won’t let you see it.

        2. I think it’s should be obvious that individuals raised in this manner don’t know that English ISN’T the only language in the world (they don’t know anything) and of course have no experience of learning a single foreign language. Why would they do it if “we, the best and the brightest,” need only the mastery of manipulative memo writing. In English, of course.

          1. Not knowing that English isn’t the only language is only one aspect. Not knowing the differences between different mediums, differences between spontaneous, emotional and and polished, “calculated” writing etc. is something else. What is common is ignorance, ignorance, ignorance.

            1. This stress on correctness of grammar is common particularly among geeks, narrow, very narrow educated, with huge complexes who tend to strike “cultural” poses: “You see I know that this incorrect. I am so well educated.” No, you are not.

    2. He could also maybe look into the Australian aboriginal population, who have some of the lowest naturally occurring cholesterol levels coupled with very high incidences of cardiovascular disease. But his head might explode.

  45. Wow,
    Great post Denise, and the comments!! The Australian Aborigines are by and large subjected to a very poor Standard Aussie Diet, that is killing them with diabetes, heart disease and kidney failure. Remote indiginous communities have very little access to food that is reasonably priced or fresh, and the implications on their well being is huge.
    As an aside linked to the way countries report and measure things, I had recent bloodwork done, and my total cholesterol is 8mmol/143mg/dl, which here in Oz is considered at deaths door, with the range being 3.9mmol/l to 5.5mmol/l. However from what I have read here and elsewhere my reading isn’t too bad! Needless to say there are an awful lot of people on horrible statins here in Oz, but I wont be joining them.
    I wish everyone a safe and joyous Christmas wherever you are,
    cheers :)

    1. @ Heather
      The Australian Aborigine reference was more to demonstrate (to Richard) that having low cholesterol is no guarantee you will not suffer from cardiovascular disease.

  46. I adore you. Just found this and spent two hours reading your blog. You have a new fan. Between you and Mercola (yes I know, he gets preachy/strident sometimes, plus you are way cuter and write better), my needs are covered.

    I am a type A, as far as blood type goes, so generally I do better with lots of veggies and less heavy meats. However, I have come to believe that with higher stress, meat – the high quality, that is – and raw milk – are good for me, I get too weak on vegan diet. If I was a monk or librarian, perhaps vegan could work… but not now.

    I do much better when I am gluten free, too, however I tend to tolerate the german rye bread ok, in small doses.

    I think most people – especially in the US – would do so much better, if they cut out sugar + grains for a little while, as well as pasteurized dairy. The US food chain is ****ed. I am lucky to live in a place with access to several farmer’s markets.

    Corn is ***ed in the US, as is soy. I don’t touch soy with a ten foot stick.

    Speaking of wheat… I know of several people whose tolerance of wheat is much better when in France/Italy, rather than when in the US. Same goes for me and wine, interestingly. CA wines kill me, generally. I think the more unadulterated the foods are, the better the tolerance, perhaps? Of course that could be because they (people, not foods) are on vacation, too:) Correlation is not a cucumber, indeed.

    But I have often wondered – as the whole GMO and hybridization of crops, such as say, wheat, increased pace in 20th/21st centuries – could it be partially a reason for some of the growing intolerances? Our bodies took a while to evolve and figure out ways to deal with our staple foods. As we tinker with them on molecular level, I wonder…

    I just wish vegans would stop bashing Weston Price. And it seems like any time a vegan goes public to say: sorry, folks, I tried, but it didn’t work, let me tell you why – they are instantly branded as meat industry shills, blah blah blah…

    I get it about animal cruelty and speciesm and all that good stuff. But ideological stridency in lieu of common sense annoys me.

    Plus, I also think low B12 is linked to aggression, paranoia and fuzzy logic. ;)

    1. “I know of several people whose tolerance of wheat is much better when in France/Italy, rather than when in the US.”

      this touches on something I wish Davis had addressed in Wheat Belly: quick-rise yeast, which doesn’t give time to neutralize the phytic acid. (in addition to his good points re: modern dwarf wheat, I mean)

    1. Didn’t you read the post? She linked to it in this sentence: “In fact, it was his glossed-over portrayal in a recent series of anti-paleo YouTube videos that inspired me to write this post.”

    2. Please just go away Richard. Every time you write something, you sound more paranoid, less informed and more belligerent. You have added absolutely nothing to the discussion in any way, shape or form. Honestly, you just sound unable to construct an argument for yourself or to respond to anyone else’s arguments.

  47. “I wish Richard would learn how to write and spell…”
    Now, this comment is truly idiotic and obviously is made .. by a marching product of American education. Richard’s response was correct.

    1. Actually Anna, you need to get a perspective. It is an English language message board, whether you like it or not. Richard writes in English in a confusing and difficult to understand way, whether you like it or not. So do you for that matter. The author of that post expressed a frustration with being able to understand Richard. Your arrogant attitude towards others who write on this board is a little lame too. It might be your 7th language, but you have yet to express yourself in an intelligent way in this language, only badgering others and offering little of your own.

      1. Sorry, Mario, I disagree. I don’t care whether the author is frustrated or not. Why don’t you tell her to take her frustration somewhere else. Her comment is IDIOTIC. You can’t change facts.
        Secondly, I can assure you that I didn’t write anything which is not intelligent. You are accustomed to simplicity of something else, it’s your problem. That you see things the way you do, is not surprising. Everyone sees things his/her way. But to tell me to see the way you do is absurd and insulting. Yes, I am multilingual, multicultural and “multidegreed” and I worked hard to see things the way I do. Give orders to someone else, this idiot for example.
        dr anna

        1. Dear Mario, if I understand it correctly, this isn’t the meeting place where promoters of “eat meat and fat only or die” promote EACH OTHER and tell everyone else to get lost. If I understand it correctly, it’s an open forum where people of various views and level of expertise share their opinions, serve facts, learn (personally, I am here to learn), etc.

        2. Look Anna. I am generally a pretty patient person. You have spent more time picking fights and insulting others (actually, insulting an entire nation and its educational system) than you have debating issues. You are whole heartedly correct that it is a forum to express different points of view. However, it is a better forum if people express those points of views in ways that we can all understand. Richard, and to a lesser extent yourself, have difficulty doing that. Despite your consistently patting yourself on the back about your great intellect and your ability to communicate in multiple languages, at the end of the day, you have made very few points worth remembering and generally just write words that don’t mean much. If you want to add to the discussion, I am all ears. And by the way, my native tongue is french, and at least I can be properly understood in both my languages.

          1. You see Vachon, you don’t understand simple things, such as that there is a difference between the second language and the seventh. Seems to be simple, but you have trouble understanding. Similarly, your seem to believe that only repeating endlessly “people should eat meat and fat only” is a contribution. You’re wrong, Vachon. Somewhere in the discussion there is a great contribution by a woman who asks a simple question (very intelligent in my view) whether we’re supposed to eat meat seven days a week. Her contribution is totally ignored while “meat and fat” people praise each other and attack some lonely “eat grain and grass only” poster (and me). Simple, but probably wrong in its simplicity.
            So, maybe you don’t understand me not because of my English.

            1. Anna, has anyone in this post, or in Denise’s entire blog ever said, “eat meat and fat only”? Are you like Don Quixote and love to swing at windmills? And you have certainly given Wizzu credibility in his belief that you and Richard are the same by referring to Richard as a “she”. No language issue there Anna. In any case, if you want to be taken seriously, quit blowing your own horn about your linguistic abilities and great intellect and just stay on topic. If you make good points, they will be recognized. If you just insult entire nations and compliment yourself, you will be taken for a fool.

              1. Mario, Il n’est pas possible de convaincre un troll. Ils ne sont pas intéressés par le résultat. Ils sont désespérés de contact, quelle que soit la forme ou la forme. Alors, soit vous continuez pour le fun ou tout simplement arrêtez.

                1. Thanks James. :-)

                  Mario, effectivement je pense qu’avec Anna ça n’ira jamais nulle part, ne vous cassez pas la tête. Vous avez totalement fait mouche avec l’image des moulins à vents. Laissez tomber…

                  The only thing I’d still like to clarify is that personally, I eat a plant-rich diet and certainly not preach to eat meat and fat only.

                  While I’m not sure that such a “meat and fat only” diet could have any ill effects if the meat is organic and organs are liberally eaten, my hunch goes towards what I currently eat which is “vegetables, fats, dairy and eggs” based low-carb diet, with some meat and organs on the top (about 4-5 times a week), and no grains.
                  . Vegetables: everything, seasonal. Very liberal amounts. The base of my own food pyramid.
                  . Fats: saturated or partially saturated (butter, coconut, lard) and monounsaturated (olive oil, hazelnut oil..), some complex n-6/n-3 vegetable oils (walnut, camelina sativa), no n-6 rich oils, no processed oils.
                  . Dairy: organic and raw – cream, butter and cheese (no milk)
                  . Eggs: organic, up to 3-4 a day, raw yolks as a supplement
                  . Meat: fatty cuts, organic
                  . Organs: what I can find from organic circuits, which here is mainly beef liver.
                  Some seasonal fruits from time to time.
                  Olives. Cocoa. Coconut. Red wine. Green tea.

                  Now that this is out of the way, on the other hand I don’t think that those who want to go “meat and fat only” for some time are wrong. I’m even enclined to think that people who have been damaged by grains and/or poorly implemented vegetarian diets, can greatly benefit from such a diet.

                  I’m just not convinced yet that it can be a long-term sustainable way of eating, for both health and environmental reasons. YMMV, and I keep my mind open (I even read J. Stanton’s and enjoy it very much).

                  1. You both confirm that I am right. Life is simple – I am troll who isn’t interested etc. March, march and label anyone who stops to think as …
                    BTW, Mario, for your information – not a single nation (let alone a huge and diverse one) is so monolithic that one can insult “the entire nation.” Pomposity doesn’t mean correctness. But we do have to stop.

        3. Frankly speaking, I think I would like to ask Denise to remove those who order others to write perfectly in English – looks like harassment to me.

  48. Denise,
    Interesting post but I think you’ve mixed up the 6- and 7- country studies. The 6-country study was the one that was attacked by Y&H and, although there is still an association, it is not nearly as strong as Keys claimed. It is good that you went back to Y&H. I didn’t realize that they made the argument that should be made on all these kinds of studies: if there are many kinds of associations, it is questionable that any mean anything.
    Anyway, the 7-country study (not the one with all the points) came after and found, in fact, that there was no association with total fat and CVD but rather with what he attributed to saturated fat. This also had problems as you point out. I cite an interesting one on my Mediterranean Interlude, namely that he collected data during lent:

  49. Denise, it amazes me how your mind works. You are the Einstein when it comes to thinking outside the box. I am so happy that you are following your passion in life–this is what you were born to do–and helping so many thousands of people at the same time. Thanks to many other people: Mark Sisson, Chris Masterjohn, Sally Fallon, Robb Wolf, etc. for spreading the nutrition word and improving the health and happiness of so many people worldwide.
    Happy 2012!!

  50. First of all: A heartfelt thanks Denise! Of course you of all people realize full well that the work is now only just beginning. When talking about fats from animal sources we are dealing with both sat- as well as mono-unsaturated. Often in equal amounts. It is also true that fats are incredibly important at all levels and that they carry many nutrients not water soluble. A lot of fat from plant sources is poly-unsaturated, high in n-6. (see also Homer Black’s work on skin carcinogens)
    And then of course there is, as far as I am concerned the one diet constituent that is undoubtedly present in all the different countries, that may quite well pose a, up till now, a still under estimated danger : wheat.
    Yes, yes, I know, if you only have a hammer, you see all problems as nails.
    Have a Wonderful New Year.

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