Are Low-Carb Diets Killing Sweden? (Also: New Interviews and Raw Vegan Immortality)

I’m occasionally stricken by a wave of crippling, all-consuming terror. Sometimes it’s because I can’t find my wallet. Sometimes it’s because I hear the unmistakable sound of Smitty throwing up on my bed. Sometimes it’s because I take a few wrong turns on Youtube and accidentally learn what Piccinini animal-human hybrids are (what is seen cannot be unseen). But these days, it’s usually because I’ve looked at the calendar and realized that—along with being 25 and really old now—I haven’t posted anything on this blog in almost four months.

What madness!

As most of you probably know, I’ve been chugging away on an upcoming book called “Death By Food Pyramid,” which is the main reason Raw Food SOS has been hosting more tumbleweeds than blog entries lately. Thanks to finding some unexpected political shenanigans to investigate (which I’m really excited to tell you guys about), the release date for “Death By Food Pyramid” is now September 2013. More details to come.

Earlier this month, I recorded an interview that touches upon the USDA’s seamy, pyramid-shaped underbelly (mostly in the second half):

I’ll be writing more about the book soon (and resuming my previous rapid-blogging schedule of six posts a year instead of four), but in the meantime, here’s a new installment of Bad Science Du Jour!

Are low-carb diets killing Sweden?

Last week, I wrote a guest post for Mark’s Daily Apple on a study that seemed to link Sweden’s “Low Carb High Fat” (LCHF) movement with an increased risk of heart disease. As often happens when media outlets are vying for readership, the headlines traded accuracy for alarmism—and it turned out the study had more to do with cheese-puffs and Justin Bieber than heart disease and carb restriction. You can read my breakdown of it here:

But it seems the Peer-Reviewing Powers That Be are smiling upon us this June, because Tuesday marked the arrival of yet another study on low-carbing Swedes—this one with a bit more meat on its bones. The BMJ paper (readable here until a paywall slurps it up) implied a grim future for carb-cutting ladyfolk. As Huffington Post UK reported (and you know they’re legit),

Women on Atkins-style diets are putting themselves at risk of heart disease and strokes, experts have warned. Those who regularly eat a low-carbohydrate, high-protein diet are at greater risk of cardiovascular disease than those who do not participate in such diets.

What’s the story, Wishbone? Do you think it’s worth a look?

This is a great study to tweeze apart for a few reasons, hence why it lured me out of blogging silence—but first, an important disclaimer:

I don’t think low-carb diets are universally flawless, especially if food quality isn’t emphasized—and if a long-term study emerges that shows legitimate concerns, I’ll be the first to tell you about it (or maybe the 10th, given my blogging speed). I deeply respect the success many folks have on low-carb regimens, and I have no doubt that this way of eating is often a lifesaver—sometimes quite literally—for folks facing obesity or certain health conditions, or who found themselves trapped in a low-fat-diet-hunger death spiral. At the same time, I think it’s clear by now that some people do well on the carbier end of the spectrum (myself included) and may run into problems on very-low-carb menus. And that’s okay! We’re all special snowflakes.

What I’m saying here is that I like to blog in defense of low carb not because I think it’s the holy grail of macronutrient ratios or the only healthy way to eat, but because it’s the bullied Poindexter of the diet world: no matter what its studies reveal, the media can’t help but punch it in the face, steal its lunch money, and drench it in buckets of pig blood à la Carrie. Few other diets receive such nasty—and generally unfounded—backlash. If we’re gonna embrace this whole “science” thing, we need to fight hard for objectivity wherever it may be lacking. En garde, y’all!

That said, I’ll spoil this study’s ending right off the bat and say that 1) it was observational and 2) it didn’t actually follow low-carbers. Yes, double whammy of ughness. We could technically stop right there and turn our thoughts to more important matters, like why traumatizing things exist on the internet (Piccinini hybrids, I’m looking at you), but I think that’d be a missed opportunity. This is actually a valuable study to analyze because it uses a “diet score” design that’s quite popular—and becoming ever more so—with observational health research. (I blogged about one such study in 2010, but there exists a wealth of other diet-score studies floating in the research sea, woefully undissected.)

Thusly, understanding this week’s study will help us understand the future ones—inevitably incubating in some researcher’s mind as we speak—that will one day hit the news with the same design, the same conclusions, and the same slew of limitations.

(Note before we kick things off: the following who-knows-how-many paragraphs are excruciatingly exhaustive, probably more than they need to be. My goal is to explain the details of this study in a way that makes this dissection relevant for future studies of a similar design. If you just want a summary of why the study is bad instead of my long-winded breakdown (no offense taken!), check out the study’s comment section on the BMJ website, where readers have pointed out many of the paper’s flaws in fewer words than I’ll be using.)

The design… of doom

In the early ’90s, about 50,000 Swedish females—all between the ages of 30 and 49—filled out a diet-and-lifestyle survey as part of the Women’s Lifestyle and Health Cohort. The women self-reported (by memory) everything they’d eaten during the past six months, answered some lifestyle questions, mailed their survey back to the project leaders, and then went on their merry way. This was the only time women reported their food intake during the entire 16-year study.

After kicking some ladies off the data-island because their questionnaires were incomplete (or because they entered the study already diagnosed with cardiovascular disease), our researchers were left with 44,000 participants. They translated each woman’s food-frequency responses into daily intakes for protein, carbohydrate, fat, and total calories, and then arranged that new macronutrient data into deciles—10 equal groups divided at the 10th percentile of intake, 20th percentile, 30th percentile, 40th percentile, and so forth. In the case of protein, for example, the first decile would include data from women with the very lowest intakes of protein, while the 10th decile would include data from women with the very highest intakes of protein. (Another way to look at it, since this system is based on tens: if a woman falls in the first decile for protein, nine deciles’ worth of women—or 90% of the study population—are eating more protein than her. If a woman falls in the 6th decile for protein, only four deciles—or 40% of the population—are eating more protein than her.)

Lather, rinse, and repeat this decile system for carbohydrate intake, fat intake, and total calorie intake.

(Important note: to level the playing field for women with drastically different calorie needs, the researchers adjusted everything for “total energy” before making their decile calculations. This ensured that women with really low calorie intakes didn’t get lumped into the lowest deciles for each macronutrient just because they ate less of everything, and that women with really high calorie intakes didn’t get lumped into the highest deciles for the opposite reason.)

Isn’t math grand?

But we’re just getting started. Here’s where the “diet score” stuff enters the scene.

Diet patterns: the easiest way for a scientist to score

In order to extort information about low-carb diets from a non-low-carbing population (an ambitious feat, to say the least), the researchers created a “low carbohydrate, high protein” diet score, and assigned points to each woman based on which carbohydrate and protein deciles she landed in. For protein, women would get one point if they were in the first decile; two points if they were in the second decile; three points if they were in the third decile—all the way up to 10 points for falling in the 10th decile. The point-assigning system was inverse for carbohydrate: women would get 10 points if they were in the first decile, nine points in the second decile, eight points in the third decile—on and on—and one point if they were in the 10th decile.

Once those calculations were made, the researchers tallied up each woman’s protein points and carbohydrate points for her combined “low carbohydrate, high protein” score, which could range from 2 to 20.

The purpose of that score was to gauge how closely each woman’s diet resembled the low-carb, high-protein eating pattern the researchers wanted to study. Women with the lowest scores were the furthest away from that pattern; women with the highest scores were, rightly or wrongly, judged to be Atkins fangirls. Some score examples could go like this:

Woman eating lots of fruits, vegetables, and grains, but very little animal food (i.e. Campbell’s future BFF): 1st decile for protein, 10th decile for carbohydrate = 1 + 1 = score of 2

Woman eating lots of lean meats, skim milk, very little fat, and moderate grains and potatoes: 5th decile for protein, 4th decile for carbohydrate = 5 + 7 = score of 12

Woman eating a very low-carb, low-protein diet with abundant fats, organ meats, butter, and cream: 1st decile for carbohydrate, 2nd decile for protein = 10 + 2 = score of 12

Woman eating a very low-carb, high-protein diet with lean meats, egg whites, fish, and protein powder: 1st decile for carbohydrate, 10th decile for protein = 10 + 10 = score of 20

(If you spot the problem here, fear not—we’ll come back to this in a moment!)

Armed with their meticulously-calculated diet scores, the researchers embarked on their next mission: to see which women received a “cardiovascular disease” diagnosis between 1991 and the end of 2007, and—the study’s crux—how their diet in ’91 influenced their health over the next 16 years.

At last, the moment of truth.

After running a battery of sophisticated analyses—looking at cardiovascular disease both collectively and in subcategories, and adjusting for common confounders like smoking, body mass index, education, and exercise—the researchers found the same thing most studies of this kind uncover: that women with the highest “low carb, high protein” scores had a higher incidence of cardiovascular disease than women with the lowest scores.

Straight from the paper (emphasis mine):

We found that women had a statistically significant 5% increase in the incidence of cardiovascular events per 2 unit increase in the 20 unit low carbohydrate-high protein score. In practical terms, and taking into account the rough correspondence in the ranking of energy adjusted and crude tenths of intake, a 20 g decrease in daily carbohydrate intake and a 5 g increase in daily protein intake would correspond to a 5% increase in the overall risk of cardiovascular disease.

Although a 5% risk increase might not sound like much at first, keep in mind that it applies to each 20-gram decrease in carbohydrate intake—supposedly adding up to a much bigger risk for true low-carb adherents. No wonder the media gobbled this one up!

Alas, this study is the last place to look for anything informative about low-carbohydrate diets—or really any diets, for that matter. Although the researchers did a commendable job analyzing the data they had, the rest of this study is a hot mess of defects. You’ve probably spotted some of them already, but a few important problems are tucked out of immediate sight. And we’re about to blow them all open.

Let’s start at the very beginning: the Swedish diet survey from the early ’90s.

Food frequency questionnaires… of doom

If you haven’t read my Will Eating Red Meat Kill You? guest post on Mark’s Daily Apple from a few months ago (which I can’t hold against you, since I never posted the link!), I recommend hopping over there right now to skim the section on food frequency questionnaires. (If two long blog posts are too much Denise for one day, check out this classic piece by Chris Masterjohn on the unreliability of self-reported data instead.)

The bottom line—discussed more thoroughly in those aforementioned links—is that bad things happen when you ask people to report what they eat. That badness only amplifies when they’re reporting from memory, and becomes incrementally worse the further back in time you want them to recall. Most folks just aren’t that aware of what goes in their mouths, especially when those things went in their mouths six months ago. As a result, nearly everyone underestimates what they really consume, and some foods—usually the ones we think are bad for us—tend to be a major roulette-wheel spin in terms of accurate reporting. Health-conscious folk may be particularly likely to underreport their intake of “bad” foods out of sheer guilt (who wants those Saturday brownie binges emblazoned forever on paper?). And since not everyone misreports their food intake in a consistent way, no amount of statistical wand-waving can really make up for the inaccuracies in this type of data.

And if that hasn’t convinced you of food questionnaires’ inherent dodginess, maybe this will. Here’s the actual survey those 44,000 women of this study had to fill out in the early ’90s, when they first enrolled in the Women’s Lifestyle and Health Cohort. The diet questions start on page 13.

Here’s a prime example of the torture contained within:

And that’s only the first page. The full table includes 49 more items, just in case the ones above were too easy. I have to wonder how many people saw this questionnaire and were like,

And then filled it out like,

My guess is more than a few.

Indeed, the data from this survey seems pretty sketchy—both in terms of accuracy and in terms of being anything even remotely usable for “low carb” research. Even the validation study for the questionnaire, which was conducted to test how well the self-reported data matched direct diet records (where participants actually weighed and recorded their food each day), notes that refined grains, sweets, cooked and fried potatoes, vegetables, processed meat, poultry, fruit, and whole grains were over- or under-reported by at least 20%!

To illustrate the problem further, this table summarizes the diet data for the women in our current study:

Check out that calorie range! Based on the researchers’ translations of the survey data into dietary intakes, the women were eating 4241 kJ (only 1013 calories!) in the 10th percentile and 9053 kJ (2162 calories) in the 90th percentile. Think about that 1000-calories-a-day figure. Were thousands of ladies inexplicably eating starvation-level diets for months on end? Or were they, perhaps, just doing an unsurprisingly poor job of remembering how many broccoli florets, almonds, and tablespoons of salad dressing they’d eaten in the past year?

I’ll let you be the judge.

Equally damning is the data for macronutrients. The cutoff for the first decile of carbohydrate intake (the column marked “10th centile” in this table) is 123.7 grams a day—moderate carb at best, and far higher than most legitimately low-carb eating plans allow. Yet this, ladies and gentlemen, is the decile representing the lowest of the low carbers in our study. Women eating up to 123.7 g of carbohydrate per day received the full 10 “low carb” points when the researchers tallied up their scores. And since many women whose carbohydrate intake landed in the first decile are probably the same ones allegedly eating only 1000 calories a day, their true carbohydrate intake is likely much higher, making this already-not-a-low-carb-study even more so.

Macronutrient warz… of doom

By now, you’ve probably noticed one of this study’s many quirks: the researchers assume that carbohydrates and protein are hinged together on some sort of macronutrient seesaw—where reducing carb intake automatically means increasing protein intake, and vice versa. Although some low-carb plans do emphasize protein, it’s far more common for fat to be the nutrient that fills the calorie void when carbs go down, with protein changing to a much lesser degree. That’s because the vast majority of foods are either carbohydrate dominant (like grains, fruits, and starchy vegetables) or packed with plenty of fat (like meat, non-adulterated dairy products, and nuts), with relatively few whole foods—mostly shellfish and some non-fatty fish—being straight-up protein bombs. Unless you go wild with egg whites and protein powder and don’t mind meals that taste like nothing, it’s pretty hard to raise your protein intake particularly high, at least relative to fat and carbohydrate.

So why did the researchers fixate on a low-carb, high-protein diet score instead of a low-carb, high-fat one? Your guess is as good as mine. Perplexingly, they write in their paper that “The most popular among [weight-loss] diets emphasise reduction of carbohydrate intake, thereby encouraging high protein intake, as high fat diets are generally avoided in most Western societies.” Seems fair enough. But the paper they cite for that statement starts off by describing low carb as unabashedly fat-full:

The diet claims to be effective at producing weight loss despite ad-libitum consumption of fatty meat, butter, and other high-fat dairy products, restricting only the intake of carbohydrates to under 30 g a day.

It’s a head scratcher, that one.

As it stands, in this study, a true low-carbing woman with a moderate protein intake would only get a midrange score—and could easily end up with the same number of points as someone eating lots of carbs but also lots of protein. The bizarre “low carb, high protein” scoring system ultimately does a poor job of identifying any true low carbers in the cohort.

And best of all: towards the end of their paper, the authors eventually acknowledge that the “low carb, high fat” diet pattern in this study was a far cry from what actual low-carb programs promote (emphasis mine… as always):

Among the women studied, carbohydrate intake at the low extreme of the distribution was higher and protein intake at the high extreme of the distribution was lower than the respective intakes prescribed by many weight control diets. However, the underlying trend between low carbohydrate-high protein score and incidence of cardiovascular disease was essentially monotonic, indicating that our findings are applicable across the spectrum of carbohydrate and protein intakes of the participating women.

Translation: “We realize our low-carb study wasn’t actually a low-carb study, but let’s not let that prevent us from using it as evidence that eating low carb is bad.”

What about fat? Could that be the real reason the lowest-carb women got more heart disease?

Now here’s where things get interesting.

In the paper’s Results section, we see a brief (but important) note about fat: “The additive low carbohydrate-high protein score was … positively correlated with lipid intake (Spearman r=0.28 for saturated lipids; Spearman r=0.17 for unsaturated lipids)”—which means that as women progressed upwards on the low-carb, high-protein scale, their intake of fat was generally going up too. No brainer, considering high-protein foods often have plenty of fat.

But the researchers were apparently so committed to making this study only about low-carb, high-protein diets that they did something quite surprising: they designed their statistical models to adjust for both saturated and unsaturated fat intake (in the same way they adjusted for smoking, BMI, and so forth), to completely remove the influence of all things lipid! In other words, the results of this study can’t arguably be linked to any form of dietary fat, because the researchers statistically removed its effects. Whatever was driving the women’s cardiovascular disease risk was decidedly non-greasy.

Presumably, the researchers figured saturated fat would contribute to cardiovascular disease and thus treated it as a confounder. But since saturated fat is—at least by mainstream wisdom—deemed a major reason for the unhealthfulness of low-carb diets, it seems odd that the researchers totally removed it from the equation. What’s left to take the blame for the increased cardiovascular disease? The lowness of the carbohydrates? The highness of the protein?

The researchers offer a pretty standard explanation:

With respect to the biomedical plausibility of our findings, vegetables, fruits, cereals, and legumes, which have been found in several studies to be core components of healthy dietary patterns, are important sources of carbohydrates, so that reduced intake of these food groups is likely to have adverse effects on cardiovascular health.

(I probably don’t need to point out the obvious—that many low carbers end up eating more vegetables than their non-dieting peers, and that no heart-healthy nutrient exists in grains that can’t be obtained elsewhere—but given that the lowest low carbers in this study were still eating up to 123 grams of carbohydrate a day (and likely much more due to underreporting), I doubt they were suffering en masse from a grain-and-legume deficiency.)

Incidence rate ratio… of non-doom

Now that we’ve determined that this study 1) draws on terribly unreliable self-reported data, 2) doesn’t examine diets in a genuine low-carb threshold, and 3) has nothing to do with saturated fat, let’s take a look at just how risky the “low carb, high protein” pattern really was for cardiovascular health.

The researchers—and the media outlets that reported on this study—describe the results as showing that for every 20-gram decrease of carbohydrate intake (and every 5-gram increase in protein), the women’s cardiovascular disease risk rose by 5%. Less publicized was that when the researchers used women with a “low carbohydrate, high protein” score of six or less as their baseline, they found that women with scores above 16 had an incidence rate ratio of 1.60—or a 60% increase in risk compared to their carb-loving, protein-shunning counterparts.

But numbers are a tricky, sneaky thing when they’re relative. Here’s a table showing the actual quantity of cardiovascular disease diagnoses for various score categories (the “incidence rate” is per 10,000 woman years):

Let’s focus on that All cardiovascular disease category. The researchers note that “potential confounding influences have not been accounted for” in this table, so the incidence numbers—especially in the highest- and lowest-point categories—are likely reflecting influences other than diet. But we’ll let that slide for now.

From this table, we can see that for women with a score of six or less, 2.2%—or 22 out of every 1000—were diagnosed with cardiovascular disease during the course of the study (188 incident cases divided by 8343 women). For women with a score of 16 or higher, 3.6%—or 36 out of every 1000—were diagnosed with cardiovascular disease (302 incident cases divided by 8395 women). That’s an absolute increase of only 1.4%, even though it represents a scarier-sounding relative increase of about 60%. And considering the 1.4% is a confounder-riddled value likely to over-represent the actual difference, that number becomes even less impressive.

But that’s not all. Let’s look again at the incidence rate ratios the researchers (and beloved media) gave us earlier: 1.05 for every two-point increase in the “low carb, high protein” score (or for every 20-gram drop in carbohydrate intake/5-gram rise in protein intake). Is that really a noteworthy ratio?

Lo and behold, the researchers help us answer that very question. In a table too unwieldy to capture in a screenshot, they list the incidence rate ratios (age-adjusted) for all cardiovascular disease diagnoses, based on a variety of characteristics unrelated to food:

  • Being a current smoker (versus no smoking history): 2.78 — a 178% risk increase
  • Having a body mass index in the “obese” range (versus in the normal range): 2.48 — a 148% risk increase
  • Having a body mass index in the “underweight” range (versus the normal range): 2.17 — a 117% risk increase
  • Having a hypertension diagnosis (versus no hypertension): 2.50 — a 150% risk increase
  • Having the highest self-rated level of physical activity (versus the lowest): 0.37 — a 63% risk decrease
  • Having over 13 years of education (versus 10 or less): 0.45 — a 55% risk decrease
  • Being over 170 cm in height (67 inches, or 5’7″) (versus being 160 cm/63 inches or under): 0.77 a 23% risk decrease

Compared with things like going to school for a few extra years and not being vertically challenged, the risk associated with the “low carb, high protein” diet score is minuscule!

But frankly, it hardly matters anyway. All these numbers are based on a single survey from 1991 – ’92, with absolutely no follow-up questionnaires to see if the women’s diets or lifestyles changed afterwards. This whole study rests on the assumption that 44,000 women not only accurately reported their yearly food intake in the early ’90s, but that they kept eating, exercising, and weighing the same for the next 16 years. (Or conversely, that whatever they ate in 1991 singlehandedly determined the fate of their health for the rest of their lives.)

To sum it all up…

  1. This study is observational—meaning it tells us nothing about cause and effect.
  2. This study relies on one food frequency questionnaire that the women filled out upon enrollment in the Women’s Lifestyle and Health Cohort. We have no idea what they were eating during the next 16 years.
  3. Women reported their food intake during the early ’90s, when low-fat diets were the gold standard for healthy eating. The most health-conscious women were likely to be eating the most carbohydrate at that time.
  4. Food frequency questionnaires are all sorts of terrible and don’t let anyone ever tell you otherwise.
  5. The study’s “diet score” design assumes that all low-carbohydrate diets are necessarily high in protein—resulting in a point-assigning system that doesn’t always identify true low carbers.
  6. The women with the lowest carbohydrate intake in this study were still eating up to 123 grams of it a day (an amount that’s probably wildly underestimated, to boot)—meaning they weren’t actually eating a low-carbohydrate diet.
  7. The true increase in cardiovascular disease risk from scoring high on the “low carb, high protein” scale is pretty minor—and pales in comparison to other lifestyle variables.

That’s it!

If your eyes are glazing over and all you care about is this blog entry being over, just remember this one thing:

Good math can’t make up for bad data.

This applies to every single study in the whole world that relies on food frequency questionnaires. These studies are not your friends. It doesn’t matter whether they yield results that make you feel better about your chosen lifestyle or worse for it—they’re all built on shaky ground, and not even the finest statisticians can change that fact. In order to have reliable results, a study needs reliable data. And for the most part, food-questionnaire-dependent studies are not the place to find it.

Likewise, any type of “diet score” study using data from the general population will suffer from one fatal flaw: these studies try to squeeze information about specific, clearly defined diets from people who—by and large—don’t actually eat those diets. It’s sort of the nutritional equivalent of flying to Paraguay to study Greek architecture. The reason this type of study design is popular isn’t because it has many redeeming qualities, but because it’s a heck of a lot easier (and cheaper!) to fiddle around with pre-existing data from large cohorts than to run controlled experiments where you make people do what you want them to do.

So basically, this study tells us nothing about nothing. Most other studies like it also tell us nothing about nothing. What does that leave us with?

Something like this, I’d say:

Adoringly borrowed from SMBC Comics

Although observational studies are a bucket of fun to peel apart, they’re also the sitting ducks of the research world—easy targets, limited by design, and utterly feeble behind their smokescreens of media hype. There’s only so much you can do with ’em before the study-dissection process becomes redundant and you start feeling bad about attacking something too incapacitated to fight back. When I’m back here blogging more regularly, I’ll be covering a great many topics other than observational studies—I promise!


…What, you thought this was over? I’m not letting you go that easy!

What follows is an assortment of things that don’t really deserve their own blog posts but that I want to mention somewhere, so I’m just going to tack them awkwardly onto the end of this entry and hope you guys don’t notice how weird it is.

1. For anyone who hasn’t seen it yet, I added a “For Vegans” page at the top navigation bar with some health tips for committed vegans. Link here:

2. A few months ago, I wrote a summary of the major flaws in The China Study”—mostly based on my Wise Traditions presentation from last year—that you can read here:

3. For organizational purposes, here are my two most recent guest posts at Mark’s Daily Apple that I forgot to link to from this blog:

4. Are raw vegans immortal? Once in a while, I like to peruse the search-terms page on WordPress to see how wayfaring Googlers find my blog. After the standard pileup of “China Study” and “Forks Over Knives” phrases and various creative spellings of my name, things start getting weird. This came up not too long ago:

And then there’s tons of this:

Although I can’t honestly say I know why someone “loves popcorn craves” (or what that even means), I can say that vegans do get cancer, and raw vegans definitely die. Sometimes from cancer, no less. I think the general vegan community is pretty realistic about the fact that becoming a vegan—even the junk-food-shunning, non-smoking, non-drinking, non-drugging, non-rabid-honeybadger-owning variety—isn’t the same as putting on an invincibility cloak and forever evading disease, but raw vegans often have more confidence in their eternal immunity, which I find concerning. Case in point: the responses to this post from 30 Bananas a Day.

At any rate, the can-vegans-get-cancer question seems to be the most common of the bunch, and I’m not surprised. I’ll wager that “The China Study,” especially Campbell’s research with casein, has left some folks with the impression that—even if you’re exposed to a nasty carcinogen like aflatoxin—cancer can only happen if you’re eating enough animal protein to feed it. Raw vegans often feel they’ve got added protection because they’re eating nothing but quintessential health foods.

Can’t touch this.

At the risk of being kind of morbid, I want to put up a list of some really-long-term raw vegans (and a few non-raw ones) who got diseases they weren’t supposed to get. I don’t think this is common knowledge—I’ve only gathered this list piecemeal from hanging out in the vegan gossip stream for much of my past—so here it is for the rest of the world to see.

There are definitely some long-lived cooked vegans (like Donald Watson, who invented the word “vegan,” remained one for 60 years, and died peacefully at the age of 95). But so far, raw veganism has had a less-than-impressive track record for longevity. The raw foodists who’ve made it into old age in good health typically included some animal products. Fifty-year raw foodist Norman Walker—who lived to be 99 (despite rumors of a supercentenarian status)—used goat’s milk, raw cream, and cottage cheese. Bernando LaPallo, a still-living 109-year-old, mostly-raw foodist from Arizona, eats fish along with his fresh fruits and veggies.

Hopefully people who google “can vegans get cancer?” will now find this page.

Now I’ll let you guys go. Here’s a picture of some baby hedgehogs so we end on a happier note.


  1. protein are amino acid and most difficult to digest and utilizes energy from fat or carb. and if u intake less carb or fat then protein will will use your existing body fat to digest and that how body fat is reduced and your weight.

  2. Denise Minger’s latest lecture ends with “Ditch government advice and look at what healthy populations are doing.”

    Well the Wilcox data on the Okinawan’s eating habits of 1950 has them eating 0 eggs, 0 dairy, 0 meat, 1% fish.

    Good advice.

  3. ^ the available data on the New Guinea Kitavans (who have the highest @birth life expectancy of any known hunter-gatherers) has them at:

    70% of calories from carbs, 20% from fat, 10% protein.

    They, like the Okinawans, eat 0 eggs, 0 dairy, 0 meat, negligible fish

    1. As I remember from the Blue Zones work by Buettner, Okinawans eat eggs, though never more than one a day, that they eat pork simmered in broth with sea vegetables, and that fish is by no means unknown in their meals. The Kitavan fish intake is not described as negligible by the researcher, Staffan Lindeberg, who studied their diet.

      Lindeberg said something very interesting about the Kitavans: that less than 0.2% of their diet is Western. That is, the Kitavans do not eat industrial seed oils, sugar, refined starches, and the other foodlike substances making up the base of the Standard American Diet. The same used to be true of the Okinawans where, sadly, soda and snacks are an ever-larger part of the diet of the youth.

      All of Buettner’s Blue Zones groups had in common the lack of Western “foods”. In Costa Rica, eggs were common in the diet, eaten daily along with large amounts of lard. Pork was eaten whenever it could be afforded, usually for Sunday lunch, or when a pig was killed. Most of the groups were very poor, and engaged in daily hard labour, even when old. The wealthy Loma Linda-ers were not all vegan, and it was noted that the healthier community members were those who ate fewer doughnuts and cookies.

      This leads inevitably to the suspicion that what healthy people do NOT eat on their diets, traditional or self-selected, may be just as important as what they do eat. Fortunately there is an immense study, Nutrition and Degenerative Diseases, that compared and contrasted the health of peoples eating their traditional diets with groups of the same peoples – hence same genetic stock, same environmental conditions – eating Western foods, mostly white flour, white sugar, jam, condensed milk, and canned meats. The British islanders who were astoundingly healthy on fish and potatoes, the Swiss highlanders whose health and strength on rye bread and goat cheese was legendary, leading to high demand for their services as personal guards to kings and popes, the Africans thriving on millet, yams, and fish, all lost their health within two generations. Not included in this book is the case of the thriving Pima in the USA, who went,, within the same two generations, from healthy and wealthy on their corn, beans, squash, meat and fish diet, to obese and diabetic when confined to reservations and issued white flour, white sugar, jam, canned meat, canned lard…American Army rations…

      The work of Robert McCarrison is particularly valuable and interesting in this light, as is Wrench’s book, The Wheel of Health.

      Another factor to be considered is evolution. Traditional peoples who have coevolved with their food supply develop physical adaptations to it. For example, peoples whose ancestors have, for hundreds or thousands of years, eaten a low starch diet, have very few copies of the gene coding for salivary amylase, AMY-1, which not only starts the conversion of starch to sugar in the mouth but continues it in the small intestine, while those whose ancestors ate a high starch diet have multiple copies. The genes for lactase persistence evolved separately in Europe and Africa, and different genes are involved, giving a fortunate 30% of the world’s population the ability to drink the milk of cows, sheep, goats, horses, water buffalo, and camels.

      Then there are enterotypes. Humans have three basic gut biomes, made up of specific guilds of the bacteria that do most of our digestion. Each enterotype, which irreversibly alters the gut to suit itself only shortly after the birth of a baby, works best on particular food groups. The Japanese have a gut bacterium that permits them to digest seaweed.

      I think that the day will come when we are all food typed at birth just as we are currently blood typed. We owe our success as a species as much to the plasticity of our gut as to the size of our brain or our bipedal gait. Wherever we went, there were at least a few individuals who could digest the local food offerings, and that is the key to survival!

  4. I think low carb diet should be opted for, when there is an ardent desire to loose extra pounds. Once desired weight is achieved then the regular and balanced diet should be resumed. It is unhealthy to continue with it for a longer period of time.

  5. The problem with returning to the “regular and balanced diet” is that the pounds usually return, bringing with them a few friends, relatives, and general hangers-on…

    There is no reason for a low carb diet to be unhealthy regardless of duration if the carbs are chosen to be low starch and low sugar. Many low carbers eat the greatest volume of their food as veggies and fruit.

    I’ve found that I can tweak my weight up and down by 6-7lb, while keeping calories and exercise constant, simply by tweaking the starch content of my diet. At more than 30% starch, up goes my weight! My bloodwork comes back to me with “Beautiful” Keep it up!” written across it, my colonoscopy was likewise described as “Beautiful!” and the Archimedes algorithm gives me less than 3% lifetime risk of heart disease or diabetes. The low starch, low sugar, diet also minimizes the frequency and intensity of both hot flashes and migraines.

  6. “Low carb” is not a diet, it is the natural way to eat – adapted to the needs of the particular individual. There is no regular and balanced diet.

    1. I keep getting this error page…

      “An Error Has Occurred!
      Sorry Guest, you are banned from using this forum!
      This ban is not set to expire.”

  7. Ross Horne drank a beer almost daily and ate whatever his wife cooked him. He promoted 811 as the ideal although when it came to walking the walk he failed in those regards.

    Bif Naked said herself she was an accidental raw vegan for almost a decade and has been fruitarian for almost 3. Just from that you can gather that she is not vegan for the health reasons and her primary motive is for ethical reasons. When she was diagnosed she said she was like an anorexic boy, that is a clear sign that she was undernourished. She is also very pale and clearly needs to get some more sun.

    Harvey Milstein constantly medicated himself at a young age dropping some antibiotics at the first sign of a cold. It wasn’t until he got kidney stones for the second time that he changed his lifestyle to follow being a natural hygienist. Though he still admitted to using raw honey. He was not vegan.

    There is very little to support Robin Gibb following a vegan diet. Apparently it was just one blog that mentioned this. I doubt he was high carb and he probably consumed vegan junk food. He also would have led a pretty destructive lifestyle in his younger years. According to his son he did not die from the cancer which had gone into remission and was undetectable. He suffered a kidney/liver failure which was the side effect of his chemotherapy treatment. Medical staff neglected the families wishes for how he was to be cared and made decisions which ultimately lead to a rapid decline in his health resulting in his death.

    There is little on Vihara Youkta and the only information is that she was under a lot of life stresses at the time of her declined health. Out of all the examples she seems like the person that should have been the one to die this way the least.

    T.C. Fry came to Natural Hygiene at the age of 45 in very poor health with a battered and bruised body. He was practically on deaths doorstep. He switched to raw Natural Hygiene overnight which resulted in a massive recovery in health and a healing of his illnesses and ailments. This is what sparked him to promote the lifestyle. He did however have occasional slips as everyone does during lifestyle transitions. Due to switching overnight this means that he went straight back to bad choices in foods that were on the complete opposite end of the spectrum of natural hygiene. Leading up to his death he was not following natural hygiene principles despite declining in health he was eating cooked foods and following other alternative treatments which were neither anything to do with natural hygiene or modern medical treatments. Joel Fuhrmen noted his vitamin B12 levels were extremely low however he only presented his opinion towards his death and this was not confirmed as cause of death. In fact about 40% of the US are in the low normal range of B12 and 6% are outright deficient. So to use this as an argument against veganism is ridiculous. Other sources note that he was low in DHA however it is clear that he was not even following the lifestyle correctly so his use in the argument is also null and void.

  8. @Wade: It can be argued, in exactly the same way, that unhealthy omnivores are not doing the diet correctly.

    The weakness of the “not doing it properly argument” is its basic assumption that there is a single correct diet that is correct for everybody, and that any deviation from said diet will lead to sickness and premature death – and that will serve you jolly well right, you sinner! The wages of sin, you know…

  9. Denise! That was sneaky. You knew some of us just can’t resist scratching our curiosity itch, I just had to click over to look at those Piccinini Hybrids. EEEW . . .

  10. To the poor souls subscribed to comments on this site: apologies for the deluge of spam lately! I just tightened moderation, so that hopefully won’t be a problem anymore. Sorry for making y’all wade through gibberish and hyper-link-stuffed advertisements.

    Blogging and updates to resume in T-minus three weeks.

  11. I didn’t read more than a paragraph of your blog as I got side tracked googling human animal hybrids, which has inspired me to begin an independent study looking into the diets of scientists who are interested in creating animal human hybrids. It will likely be a 15 year study but I will keep you posted as the study reaches it’s mid point.

  12. Denise, These sentences in your summary concern me: “But so far, raw veganism has had a less-than-impressive track record for longevity. The raw foodists who’ve made it into old age in good health typically included some animal products.” Are you implying that the mere 7 cancer related deaths of raw vegans you that described are enough to establish a “track record” of any kind? Or that the 2 raw foodists who consumed animal products constitute any kind of “typical”? I’m surprised and disappointed you made blanket statements like that without ample evidence/data. (In this article anyway – maybe you have other articles with the data that backs up these statements?)

    1. debiamh, I believe those are clearly Denise’s own opinions on the matter. She didn’t imply anything she stated raw veganism has had a less-than-impressive track record for longevity, it doesn’t IMPRESS her. This is based on her opinion and analysis after sticking around raw food vegan boards for a really long time. She’s not required to produce some mythical 50-year longitudinal study for every impression she gets. She just compiled a list of the well-known raw food vegans who died early, partly I suppose to prove she knew what she was talking about… she didn’t suppress another 10 that lived until their 90s. I’m still a little suspicious after her strange turnaround in the wild and ancient fruit article where at one point she stated her readers were a specific group of people and she wouldn’t make those claims to a group of esteemed pomologists… but I think at this time it’s safe to say that from her and from lots of people… raw food vegans should not expect to live longer than raw foodists who add a little meat… if she really based it on those examples they should barely expect to live longer than people who eat SAD every day of their lives.

  13. Love this fab blog! Exciting. I’m a lover of animals but I can’t help needing to eat meat usually grass fed. Looking forward to legit, non toxic lab generated meat that actually tastes like meat produced in an environmentally smart method.
    Kraft, General Foods…carb. loaders are eventually doomed so they better get smart and jump on the bandwagon of reality by investing their ill gotten fortunes for humane and healthy food options. Sugar, gluten and starch are slow killers and these magnet producers are the demons of the world if they keep marketing their poisons especially their garbage candy laden cereals to growing children. Yes, Coke is a Joke, thank’s for that handy catchphrase Dr. Mercola.
    Every time I see a school shooting or hear about kids bullying I know part of the underlining causation.
    Currently loving Dr. Perlmutter’s, Grain Brain. We are catching on and it’s about time.

  14. low carb is high fat, not high protein, that is a common misconceptions. Until the scientific studies take that into consideration all tests will be flawed. After a year of Lchf dieting my triglycerides went down and my hdl went up, my blood pressure went down and i even had my hypothyroid medication lowered. All the studies that compare low carb high fat to low fat high carb diets show that things like triglycerides and hdl fair better in lchf. High protein is the real danger, too much protein creates problems and your body will end up metabolizing it like sugar and the combo of high fat high carb is the real danger.

  15. Denise, I have to ask:
    HOW does one go about maintaining good health when there is an incredible amount of factors to consider?! I mean, if, or even blood tests cannot tell me if my diet is supplying me with adequate nutrients, must I pay to see a naturopath? Or is it simply necessary for me to invest an incredible amount of time for researching, as you have, in order to achieve the knowledge necessary to manage my own health?

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