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Welcome all seeking refuge from low carb dogma!

“To kill an error is as good a service as, and sometimes even better than, the establishing of a new truth or fact”
~ Charles Darwin (it's evolutionary baybeee!)

Wednesday, June 25, 2014

Ancel Keys ~ The OTHER Minnesota Study


I preface this post with words of wisdom from a science journalist.



Long before Nina Teicholz burst onto the scene as the latest Atkins-mouthpiece (Chapter 10 of The Big Fat Surprise, I rest my case), from almost the very beginning of my exposure to the low carb internet community, I've been hearing how Ancel Keys was single handedly responsible for the low fat plague that has made us all fat and sick.  While I'm sure I'd heard the name Ancel Keys somewhere along the way during my formal studies, it never really rang a bell ... and I'd venture to guess that most outside this Incestral Health Community had not either.  This is the enduring legacy that appears to trace back to Gary Taubes' demonization of the man in Good Calories, Bad Calories.  It also appears to have origins in the Weston Price Foundation movement with the writings of Sally Fallon and Mary Enig, for example, The Oiling of America (2000).



This past May 1, I was sent a link to the sneak peek of a presentation by Dr. Cate Shanahan on a diabetes online summit.  Her description of Ancel Keys and low fat diet in diabetes really hit a nerve.  (You can read my initial response here, and more about her mangling of Keys here.)   


I tweeted out off-the-cuff, and said tweet gets auto posted to FB, and a discussion ensued.  I was basically taken to task for not acknowledging Keys' central role in all of this.  While I don't deny that the man and his work were important in forming government policies, etc., I just don't see that it all leads back to this one man and that all he had to stand on for his part in all of this was one graph with six countries on it.  The claim that decades later we've all just been duped and are still being lied to about how it "all went down" is more than a bit absurd at this point.   The only thing even more absurd is this notion that we were somehow eating LCHF before and we can "fix" this by going back to eating LCHF again.  

It doesn't help matters much that there are really two parallel hypotheses that are easily "confused".  I put that in quotes because I believe this is often deliberate.  There is lipid-heart based on early findings that elevated blood cholesterol correlated with heart attacks.  This has been refined and revisited in the decades since in search of the best lipid profile biomarker:  TC, LDL-C, HDL-C, non-HDL-C, trigs, this ratio or that ratio, particle size, particle number, apoB, etc.etc.etc.  But going back to the initial findings, the next step was the diet-heart hypothesis, which is probably better designated as diet-lipid.   If elevated blood cholesterol could be the cause of heart attacks, what then might be the cause of elevated blood cholesterol?   Is it dietary cholesterol, all dietary fat, just saturated fats, or animal fats?

All of this has been played out on the background of a nation obsessed with dieting  and an obesity epidemic where weight loss has become the primary goal of dietary intervention.  This all seems to get intertwined into one big low-fat-diets-made-us-fat-and-sick mantra that gets dragged out and recirculated every now and then.  It just so happens that a few days after Shanahan's interview, the prelude to The Big Fat Surprise, an editorial in the WSJ by Teicholz, triggered a tsunami of misinformation and the start of the Nu Atkins Revolution.  

As it turns out, what has been repeated often enough to be accepted as fact is not how things really happened after all.  No.  It has been the modus operandi of Big Butter & Bacon to drag out Keys' Six-Countries Plot and accuse him of cherry picking and all that implies.  This, more than anything, seems to unite and rally the troops.


Off to the Nutrition Texts I Went ...


So, back to the FB discussion.  If Keys were so instrumental in getting us to adopt a low fat diet, then there should be evidence all over the nutrition texts.    In the same way that you learn about Newton when gravity is discussed in a physical science class (no matter how general the class), so, too, should the low fat law of the land be attributed to Ancel Keys.  Given that low fat is even more every-day than gravity and such, Keys' middle name should be regular question in trivia games!   Over the past several years, I've amassed quite a collection of nutrition textbooks to complement the biochemistry and physiology texts in my collection.  Most are ebooks which have the added advantage of being searchable in short order.   My admittedly unscientific sampling of nine books (I got bored after that) turned up one off hand mention of the Seven Countries Study as the study that linked diet, cholesterol and CVD (cue ominous music).  In one of the other books, Keys was mentioned for his Minnesota Starvation Experiment, in, you guessed it, the section on starvation.   Heck ... just to make absolutely sure Keys wasn't really capable of time travel, I even checked the 1917 The Elements of the Science of Nutrition by Lusk.  No sign.


Then I remembered getting a hold of the book pictured at right a few months ago ... took me a bit to find it on the old hard drive, as I'd just downloaded a non-descriptly named file to save for future reference.  

Cardiovascular Diseases:  Nutritional and Therapeutic Interventions.  Edited by Nilanjana Maulik.  CRC Press.  2013.

I finally located the book and promptly initiated my search ... Ding ding ding!!!  Right there in the introduction.  OK ... Here we go I thought ... and I read on ...


The who what wut??  So first things first.  Here is the study ... and it's a rarity in that an early 60's full text is free to all, on the journal publisher's site.  IOW -- no excuses.   

Coronary Heart Disease among Minnesota Business and Professional Men Followed Fifteen Years  (Circulation. 1963; 28: 381-395 doi: 10.1161/​01.CIR.28.3.381)   Ancel Keys, Ph.D.; Henry Longstreet Taylor, Ph.D.; Henry Blackburn, M.D.; Josef Brozek, Ph.D.; Joseph T. Anderson, Ph.D.; Ernst Simonson, M.D.
Relative weight, body fatness (skinfold thickness), blood pressure, and serum cholesterol are reported from 281 Minnesota business and professional men, initially clinically healthy and aged 45 to 55, who were followed by annual examinations since the winter of 1947-48. In 15 elapsed years, coronary heart disease developed definitely in 32 men and possibly in 16 other men.

The incidence of coronary heart disease tended to be higher among men above the median at first examination in relative weight, body fatness, systolic and diastolic blood pressure, and serum cholesterol concentration but these segregations were not statistically significant except with serum cholesterol, which was associated with p < 0.001. The data for the last pre-disease year on the men who developed coronary heart disease showed a significant relationship between incidence and systolic blood pressure as well as for cholesterol. Average data over all pre-disease years showed significantly reduced risk among the men in the bottom quartile for diastolic as well as for systolic blood pressure, while the cholesterol level was significantly prognostic over the entire range of that variable. The few men who developed coronary heart disease with low cholesterol values tended to be in the top 20 per cent of the distribution of blood pressure or relative weight or both....

A True Pioneer ...


This folks, is the first prospective epidemiological study ever conducted on heart disease.   This was huge.  Hah-yooooge!!   Nevermind that snide science journalists and PubMed couch jockeys routinely write the entire science off as pseudo or junk science.  It is not.  As with clinical trials, there are the good, the bad and the ugly.  We don't write off well designed and implemented RCTs because there are poorly designed and implemented uncontrolled trials to be found.  The same standards should be applied to epidemiologic studies.  Many conducted in the realm of nutritional science are pretty bad, especially those designed to evoke provocative "medical news".  Self reporting of intake for a day or few over a period of years really doesn't give you high-integrity data to start with when trying to study diet and lifestyle.  So the red meat or dairy studies are usually to be taken with a grain of salt.  In a perfect world these same people would give the sugar studies of similar quality an equally ready dismissal, but consistency is never a strong trait of the dogmatic.

But there's the other type of epidemiological study that we rely on a lot these days.  Just about every person in the IHC, be they low carb, WAPF, paleo or the various veggie and vegan factions (I've decided to include everyone in the IHC ... it really is that incestral after all), uses this sort of epidemiology in one way or the other.  Whether you are crowing over your low LDL, high HDL, low HbA1c, CRP, apoB, FBG, LMNOP, whatever ... These biomarkers are the product of epidemiologic studies.  Observational studies where various measures are tracked over time and outcomes observed.  In the hopes of what?
Rather than treating the disease after it develops (or burying the victim),  preventing it from happening in the first place.   That's what.
This, dear readers, is Ancel Keys' MOST important contribution to science, in my opinion.  And it is one he should rightly be celebrated for instead of being the target of so much small-minded derision.   

But he was not done there.  You see, Ancel Keys was a critical thinker who believed the key to this prevention lay in diet and/or lifestyle:  that heart disease was not necessarily a foregone byproduct of aging or genetic preprogramming.   This is what sparked his curiosity to look at what dietary factors might be responsible for high rates of CVD in some countries while they remained an oddity in others, and indeed had been rare in the US at the turn of the century.    The way I see it, whether or not you agree with which factor(s) Keys focused on, you cannot dismiss the fact that he was looking for any such factors to begin with.


Hippocrates or Hypocrites?




Ring any bells?  Nobody could sit through a summit, an AHS, or PaleoFX, or frequent many a WAPF, Functional Medicine, Paleo, Low Carb, Vegan blog without coming across this one.   This is part and parcel of the whole "it's 80% nutrition" rule, etc.  

a random Google Images search on "let food be thy medicine"

So either you really believe that, or you don't.  And if you really do, then Ancel Keys is your modern day medical science hero.  No ifs, ands or buts.   Otherwise, you are a hypocrite.  There is no wiggle room here.   Folks are free to have their own ideas and opinions as to which foods are to be thine appropriate medicine, and conversely which they may consider to be poison.  But if you believe the premise of the above quote, then Keys is your guy.  I know this will make some heads assplode with cognitive dissonance of the highest order, but this really is Keys' legacy.  


So Why Haven't We Heard of This?


That's a good question, really.   When I first found the Minnesota Business Men study, that was the first question that came to mind.  It was a big deal.  Since then, in several biographies, it is prominently mentioned.  Indeed it is that Six-Countries Plot that is rather obscure.  Surely the ever inquisitive science journalist Gary Taubes, what with his penchant for pre-war through 60's research and citations, had come across the Minnesota Business Men study?!    So off to Kindle I went ... opened Good Calories, Bad Calories ... initiated several searches.  Nothing.  Not surprisingly, there was equally nothing to be found in mini-me-GCBC aka Nina Teicholz's The Big Fat Surprise.    These two books are both held up as meticulously researched ... taking us through the *real* history of the diet-heart or lipid-heart hypothesis/es.   And yet these two along with WAPF-inspired authors like Cate Shanahan, weave a tale where this seminal work seemingly does not exist.

By their telling, Keys just woke up one day and plucked his ideas from thin air.  (Which is an interesting phrase where he's concerned as he did some high altitude research between earning his PhDs.)    In Shanahan's case, it is even more ridiculous as she cites that 1958 CBS The Search program in her book Deep Nutrition (see this post for lengthy excerpts).   Both Charles and Karin get a hat tip from me for finding the video on YouTube.  Thanks!!


Right after Keys knocks over the random wooden pin-men -- as he relays the ominous reality that in that day and age, we didn't know who might suddenly drop dead of a heart attack or why -- do you know what they show footage of?  Hint:  NOT Ancel Keys pointing to a graph.    They show various men arriving, by car or bicycle, at his Minnesota Laboratory of Physiological Hygiene.  These were participants in this, the first ever prospective epidemiological study on heart disease.   The narration leaves zero doubt.    It's quite humorous to watch the men taking stress tests on treadmills with their black dress socks and garters!    

Narrator:  It was the start of Keys' search for what later would be called risk factors for heart disease.

Nah ... Cate would rather you believe the ego-driven eel expert just decided saturated fat caused heart disease and ran with it because the makers of Mazola were greasing his pockets.   And Taubes and Teicholz would rather you didn't know about this study at all, because the results of it were confirmation that Keys was on the right path.  In 1958 he already had a notion of how things were going in his study, and was looking concurrently at what dietary factors might be responsible for the elevated cholesterol that was associated with heart attacks.  No ... he did not presume a causal relationship.  Yes, he looked at other factors, including hydrogenated oils.  


Through the Eyes of Keys and Blackburn:



There's a 2007 book,  The Development of Modern Epidemiology: Personal reports from those who were there, in which Henry Blackburn recants his account of Keys' role in pioneering cardiovascular epidemiology.  Chapter 7, aptly entitled Cardiovascular disease epidemiology, was written by Blackburn and is available here.   Most probably recognize Blackburn's name as being associated with his characterizations of Keys' blunt nature.  When you read this chapter, as I hope you will, it's not so much that I care about the personal side, but that is shows how unfair these isolated (some might say cherry-picked) phrases about Keys' persona are.   That these seem to be all that make it into books that ostensibly seek to recant not just the science, but the "back story history" of it all, becomes rather offensive after a while.   

Since she's fresh on my mind, Shanahan's telling of the Keys story is especially bothersome.  She makes him out to be some egotistical empty scientific suit of a man who accrued a cult following based on his physical stature and appearance?  In this day and age of celebrity everythings (doctors, lawyers, housewives ... heck, why not scientists!) one might see how this could happen on a relatively small scale.   But we're talking about a man who was almost sixty when the Minnesota Business Men Study was published in the Sixties (he was born in 1904), and of retirement age when the first of the Seven Countries publications hit the journals.  Unlike Teicholz, there was no multimedia book tour to be had.  There was no Ancel Keys Facebook page to "like" or Twitter feed or blog or whatever.  There was no Keys movement cult with "boxes" strewn across the land at which his minions regurgitated his nutritional dogma.  

Heck, even peer review is a shadow of its former self.  Surely some innovative thought was squelched in those days where there was a pecking order and necessary chops to be earned before one reached a stage of some stature and respect.  And yet, even reports by venerable scientists -- like Keys' presentation of the Six-Countries Plot -- were often met with criticism by peers published in the same or competing journals (the Lancet review of Dayton/LA Veterans comes to mind as an example of the latter).    In those days criticism seemed to mean something.  There seems to be a lack of this nowadays.  It is quite rare to see serious back and forth letters to the editor.    

But nowadays we all take for granted that we can have our doctors run some blood tests to see if we are at risk.   Oh ... and all you non-diabetics in the audience pricking your fingers to keep an eye on your blood sugars and diabetes risk?  A. Ben Keys!   He did not invent the test and such, but he began the search for *risk factors*, those measures of something in or about you that might predict disease before a frank diagnosis or sudden death, in the hopes that it might be prevented entirely.

Two excerpts from the chapter:

1.  In discussing The Minnesota Business and Professional Men’s Study, Blackburn cites it as a first but sets it up as the predecessor of larger studies from which more definitive risk factors would be derived, and as a stimulus for Seven Countries.  Then:

Of greater historical interest is how the Minnesota study was conceived in the first place.  In 1948, Keys, who was a physiologist and nutritional scientist, had just completed a classic study of experimental starvation.  In it, he had been struck by the rapid modifiability of heretoforeconsidered ‘constitutional’ characteristics such as body type, blood pressure, blood cholesterol, and vascular responses.  Meanwhile, he had become curious about the phenomenon of epidemic heart attack, apparently from Minnesota newspaper reports of the day (Keys 1999).  We know from an action photograph taken in 1946 that Keys had plotted a hypothetical projection toward intersection of the rising slope of heart deaths and the falling slope of other deaths in the city of Minneapolis.  This antedated by two decades published discussions of ‘the epidemiological transition’.   Keys recounts in his memoirs:

As news of the war and its aftermath receded from the newspapers, I was struck by the frequency of reports of executive men dropping dead, victims of what seemed to be a new plague, an increase in the frequency of coronary heart disease. ... The cause ... was unknown.   I thought that we could record the characteristics of a large number of executives when they were apparently healthy, and then follow their status over the years, during which time some of them would develop coronary heart disease.   By comparing the records of the afflicted men with those of the group that stayed healthy, we could discover which characteristics were related to the tendency to develop the [arterial] deposits.  Keys (1999)
2.  On the Seven Countries Study:
In the 1950s, a different epidemiological approach to understanding the causes of CVD focused on comparisons among whole populations across a wide spectrum of diet or lifestyle in efforts to define the mass, as well as the individual, characteristics related to high or low population risk.  The Seven Countries Study tested specific hypotheses among largely rural, traditional populations contrasting greatly in habitual diet. It was carried out by Ancel Keys and international colleagues in a collaboration starting in the late 1950s and ongoing today (Keys et al. 1970, 1980; Kromhout et al. 2002).   Major differences in CVD risk were found among samples of working middle-aged men followed for 30 years in 14 areas of seven countries, with the lowest rates in Japan and the Greek islands and the highest in the United States and Finland.
The Seven Countries Study provided the first credible data about major population differences in CHD and stroke rates. It also confirmed large variations in death rates from all causes.  It found that a habitual diet of less than 10% calories from saturated fatty acids, with its associated lower blood cholesterol values, was apparently a necessary factor in lower population rates of CVD, whereas other risk factors failed to ‘explain’ the geographical differences.Within Seven Countries populations having different mortality, however, the ‘traditional’ CVD risk factors of diet, serum cholesterol, blood pressure, and cigarette smoking were universally predictive of an individual’s risk, albeit with culturally different ‘slopes’ or force of the relationship (Keys et al. 1972; Kromhout et al. 2002).
The Seven Countries Study provided new and strong evidence for a policy of risk reduction at the population level. And it infected with the epidemiological method and mystique the medical and public health ‘virgin forest’ in each of its seven countries. 

Concluding ... For now ...


There is actually quite a bit more to be said about the research of Ancel Keys and what he is and is not responsible for.  The "other" Minnesota study contains some interesting tidbits as well, that I will discuss some time in the hopefully near future.  

I will leave you with this.  The well-funded anti-establishment forces are quick to point out such things as funding sources, conflicts of interest, so-called errors or flaws in methodology in the science, lack of controlled trials and evidence upon which to base recommendations, etc.   These same forces are blinded to and even cover up their own more egregious issues with all of the preceding.  There are no RCT's showing that eating more fat reduces CVD mortality or morbidity or that for other diseases like diabetes.  There aren't even epidemiological studies demonstrating better health with higher fat consumption.  Absent this there are no cultures they can point to as relevant pinnacles of health and longevity.  No the Masai and Inuit are not such cultures, enough with that nonsense already, OK?   

Exactly what diet does Richard Feinman want people to march on Washington and have the USDA replace current recs with?    Are these people so blinded by ketophoria they don't see that even their long-term adherents are constantly tweaking and twerking to fix new-found health issues they blame on their diets of years and even decades past?   It would be amusing if it weren't for the health of so many that lies in the balance.  And no, I'm not a lipophobe either, there's a whole wide spectrum between the extremes.   

But what diet should we replace it with?  Atkins?  Seriously?  That makes a ton of sense.  Not!   The truth is, as we see from the full 23 ... err ... 22 countries in Yerushalmy & Hilleboe (and let's not forget that those are just a sampling of all of the countries on Earth at the time!!), the "low fat" diet was hardly some reckless human experiment.  Even if all the scientific evidential ducks were not neatly lined up, there were enough actual living human testaments to its benefits, not to mention verifiable historical records and tradition.   Low carb, high fat?  Zilch, zero, nada.  Remind me, just who is ignoring the science? 

47 comments:

David Pete said...

Great Post!

charles grashow said...

http://ish-world.com/data/uploads/keys_yusuf_article.pdf

"Between 1955 and 1958 Keys began to organize teams of clinicians and scientists in several countries. The study would require fieldwork that took researchers deep into the
lifestyles of predominantly rural populations. It required the transportation of bulky medical equipment, such as electrocardiograph machines that were much larger and more primitive than those in use today. For each area chosen, the entire male population between the ages of 40 and 59 had to be convinced to participate. Once the data was collected, it was sent to back to ‘‘Gate 27,’’ the nickname for Keys laboratory under the bleachers at the University of Minnesota stadium. The techniques that were developed eventually formed the basis for a manual published by the World Health Organization on cardiovascular disease survey methods. From the thousands of electrocardiograms that
were collected and sent to Gate 27, the team developed a precise system for coding electrocardiographic abnormalities. It came to be known as the Minnesota Code, and is
still one of the most widely used coding systems for population studies and clinical trials."

"The countries included in the study were Yugoslavia, Italy, Greece, Finland, the Netherlands, the United States, and Japan. Why were these particular countries chosen?
Yugoslavia offered coastal and inland populations with vegetable fat versus animal fat diets. Italy represented a prototypical Mediterranean lifestyle, with a diet full of grains, pasta, legumes, fruits and vegetables, olive oil, bread, and wine. Greece provided a setting with very high dietary fat intake, principally in the form of olive oil, but very little saturated fat. Finland had an exceptionally fit population, but high rates of heart disease, and a diet extremely high in saturated fat. The Netherlands repre-ented a European population with an intermediate dietary pattern, with meat, butter, and tuberous vegetables. The United States component consisted of railroad workers, originally chosen to study the effects of different activity levels on heart disease, but then incorporated into the Seven Countries Study because the participants tended to remain in one place over time, making follow-up relatively simple. Finally, Japan was chosen as representing a lifestyle with minimal dietary fat intake."

"The variables that were measured were smoking, overweight status, physical activity, resting pulse rate, lung capacity, blood cholesterol level, blood pressure, and diet. Keys and his team used multivariate logistic analyses to build mathematical models that combined all the measured variables and then determined which ones were related to heart attack rates."

charles grashow said...

http://www.happyhealthylonglife.com/happy_healthy_long_life/2010/12/ancel-keys.html

What Did Keys Eat? Was He As Healthy As He Expected Others To Be?

Here's how my friend described Keys' retirement:

Ancel
Keys was 155 pounds and 5' 71/2" with a BMI of 23.9--a tad on the
heavy side, but certainly not overweight. He left academia at the age
of 68 in 1972 and retired to a small seaside village south of Naples
Italy in the area where he first discovered the lack of heart disease
and the Mediterranean Diet--in the southern Italian population.

He and his wife Magaret built a seaside villa there from the royalties that they got from their three diet books.

Here are their typical meals:

Breakfast:

1/2 grapefruit, dry cereal with skim milk (2% fat), unbuttered toast, jam & coffee

Lunch :
sardine sandwich, olives, cookies and a glass of skim milk -- always
brown bagged when he was working; he followed lunch with a 10-minute
doze.

Dinner:
2 hours with classical music & candlelight, multiple courses, a
pre-dinner cocktail (a martini or negroni -- (¼ gin, ¼ Campari bitters, ¼
sweet or dry vermouth, ¼ soda water, over ice in an old-fashioned
glass)), 1,000 calorie meal with less than 20% fat.

Sample menu:
Turkey broth with noodles, veal scallopini a la Marsala, green beans,
tossed salad dressed with tarragon vinegar and corn oil, homemade bread,
cookies, expresso, fruit. They would have meat no more than 3X a week
in the form of a "carving roast"-steaks, chops or roast.

This was a much more moderate diet than I would have expected, but it still generated the right results in the end for both of the Keys. They were getting a daily dose of alcohol from their cocktails and their "a la Marsala" cooking style. Keys did like his cookies. Ancel died at age 100 in 2004. His wife Magaret died at age 97 in 2006.

His diet recommendations are fairly simple: "Eat less fat meat, fewer eggs and dairy products. Spend more time on fish, chicken, calves' liver(?), Canadian bacon, Italian food, Chinese food, supplemented by fresh fruits, vegetables and casseroles."

Adds Keys:
"Nobody wants to live on mush. But reasonably low-fat diets can provide infinite variety and aesthetic satisfaction for the most fastidious—if not the most gluttonous—among us." On such fare, Keys-the gourmet-keeps his own weight at a moderate 155, his cholesterol count at a comfortable 209.

Some glaring diet contradictions, perhaps?: Keys recommended calf livers (high in saturated fats and cholesterol) as well as Canadian bacon. These recommendations seem to contradict his research. I guess both Keys & his wife must have really liked liver
and Canadian bacon--and yes, he could definitely be described as a "foodie". He also had a cholesterol level of 209, in spite of the fact that he knew that other populations with low heart disease had much lower levels. This high of a cholesterol level would suggest that his diet was not as perfect as what he was recommending.

charles grashow said...

http://thescienceofnutrition.files.wordpress.com/2014/03/the-fat-of-the-land-ebscohost.pdf

charles grashow said...

http://deepblue.lib.umich.edu/bitstream/handle/2027.42/34138/0000422.pdf?sequence=1

charles grashow said...

http://ajcn.nutrition.org/content/7/4/444.full.pdf+html

Serum Cholesterol Response in Man toOral Ingestion of Arachidonic Acid

justjuliebean said...

Thank you, I wish everybody would stop spouting on about how low-fat is deadly and high fat is awesome. Why is everyone so against any middle ground? Especially bad are the evangelists who don't seem to understand that there's something between high fat low carb and the standard american convenience diet.

How's this, bitches - I eat paleo + legumes. And some grains. And dairy. And lots of lovely, lovely fruit. No low-fat. No low-carb. And I sure am healthy!

charles grashow said...

http://circ.ahajournals.org/content/22/6/1091.full.pdf

Serum Cholesterol and Relative Body Weight of Coronary Patients in Different Populations
ANCEL KEYS and FLAMINIO FIDANZA

charles grashow said...

http://edepot.wur.nl/287595
The Seven Countries Study - A scientific adventure in cardiovascular disease epidemiology

Paleo Nouveau said...

So what is more likely to be true? One person single handedly bullied, coerced or dazzled academia, politicians & the public with his erroneous yet egotistical pseudo science principles. That always seems to sway scientists! One person! (By the way I think you forgot to mention the rabbits. Remember they don't eat cholesterol so feeding them cholesterol will obviously give them atherosclerosis.)
Or a highly curious & assertive individual decided to find some type of associations that could lead him to formulate a hypothesis that may provide some clues to why we were dying from heart disease in this country yet other countries weren't. Nah! Not with a name like Ancel Benjamin Keys! Like all assassins he has 3 names. Lee Harvey Oswald. John Wilkes Booth. James Earl Ray.

Yeah his low fat BS decimated us. HFLC is the solution for all our ailments! It's been proven over & over in all of long lived societies & is being recognized by all researchers worldwide, now that Ancel Benjamin Keys has passed & cannot bully them or dazzle them with his handsomeness!


Sorry for the unscientific diatribe, but it really is sad to hear such BS regurgitated without fact checking. Thanks to you for this informative article and kudos to Charles for the invaluable links!
And for the record I was guilty once of regurgitating the BS against Keys when I started my journey to improve my health!

Mike Victor said...

LC attempts to character assassinate Keys remind me of creationist attempts to character assassinate Darwin, bringing up things like his family's support of eugenics, the fake deathbed renunciation of evolution, blaming him for the creation of communism and Nazism. I guess if you're trying to discredit an idea, in this case, the Diet-Heart Hypothesis, trying to discredit its founder (in fact, a genetic fallacy) is an effective propaganda technique.

charles grashow said...

http://wholehealthsource.blogspot.com/2014/06/fat-and-carbohydrate-clarifications-and.html

"I don't think fat or carbohydrate are inherently unhealthy. Many cultures have thrived on carbohydrate-rich diets, and although there are fewer examples of cultures eating fat-rich diets, overall they seem to have stayed relatively healthy as well. Thinking about this from the point of view of evolution, it makes no sense to design a human that can only eat carbohydrate or fat. Humans evolved in an environment that contained carbohydrate-rich and fat-rich foods, and some weeks our ancestors got more of one than the other.

It is worth noting that the ancestral African hunter-gatherer diet was probably not high in fat on most days, at least not animal fat. African game is characteristically extremely lean, and the only African hunter-gatherer group I'm aware of that gets a fair amount of fat is the !Kung, and most of that fat comes from mongongo nuts (although the mongongo fruit/nut is mostly carbohydrate by calories, a fact that
Staffan Lindeberg recently pointed out to me). Most African game just doesn't contain much fat, even if you include the brain and marrow, and the primary exceptions, like hippos, are extremely dangerous to hunt with stone-age weapons.

I have yet to see a single credible account of an African hunter-gatherer group that regularly eats a diet high in animal fat. Ifyou know of one, please cite it in the comments.

I've come across a lot of arguments that the ancestral human diet was typically high in fat, but these invariably strike me as wishful thinking. One argument I frequently encounter is that the plant foods we ate were mostly "fat", due to the fact that the calories they provided were mostly via fatty acids produced by the intestinal fermentation of fiber. Therefore, we should eat a lot of lard to replicate this. However, the short-chain "fatty acids" that are produced by intestinal fermentation are not at all analogous to what we normally think of as dietary fat. These are technically fatty acids, but is vinegar (acetic acid, one of the primary "fatty acid" products ofintestinal fermentation) equivalent to lard? Of course not. It's completely different on almost every level, from the role it plays in our diet, to the way in which it's absorbed, to the way in which it's metabolized*.

Fat probably has the greatest potential to be fattening among macronutrients, yet it isn't necessarily fattening. Nuts, avocados, and dairy are probably not very fattening relative to other foods, although it's possible to overeat almost anything. Lean meat is one of the most slimming foods, despite the fact that most lean meats still contain a fair amount of fat.

In the end, I believe the best diet is the one that keeps you relatively lean and healthy. That diet might differ based on your background, current lifestyle, genetic makeup, and goals. A diet's macronutrient composition is one variable that determines body fatness, although it's probably not the most important variable. It's simply one of the easiest to understand."

Mike Victor said...

If I'm not mistaken, that calves' liver/Canadian bacon quote is from 1959 shortly after the Seven Countries Study had started. So the "contradiction" stems from the fact that he hadn't fully developed his theories yet. Also, a TC of 300 mg/dl was considered normal in the 1950s. The idea of 206 being high or even borderline high would have been unheard of back then.

StellaBarbone said...

That's my diet too! My LDL is in the 90s, my HDL is in the 90s, and my blood sugar is normal. Despite my belief in science, I have never purchased margarine and was unaware that the USDA food pyramid promoted the consumption of sugary snack food. When menopause, aging joints and overly large portions conspired to make me what can only be described as "fat", calorie counting prevailed. Even though calorie counting can not possibly work, I lost about 3/4 lb per week probably due to Ancel Keys monkeying with my bathroom scale from the grave.

Mike Victor said...

Shanahan:

"Plants didn't evolve with the idea that they should be good to eat. In fact, plants spend a great deal of energy thwarting overzealous grazers and other creatures that would gladly eat them into oblivion. Not as helpless as they may seem, plants protect their foliage, stems, seeds, roots, and to a lesser degree even their fruits, with natural insecticides and bitter toxins that make some plants unsafe for human consumption. Unless your species has evolved the physiologic means to neutralize them, a plant's various hemagglutinints [sic], enzyme inhibitors, cyanogens, anti-vitamins, carcinogens, neurotoxins, and allergens say, "Eat at your your own risk."

Uh, HELLO! What animal wants to be eaten? Pretty sure if you approach a wild animal with a spear or a bow, it's either going to run away or fight back. Even then, there are still indigestible animal bits like bones, shells, scales, hair, gristle, quills, feathers, etc. This chick needs to, you know... think.

charles grashow said...

http://bobbarnetthealth.com/wp-content/uploads/2013/02/AncelKeys.TONICS.pdf
It is dusk in Pioppi. Ancel’s wife, Margaret, invites me to pick peas; white flowers bloom on the vines. We come back inside. Cocktails are served. Dinner is simple. She sets out a carousel of wine and water, and pretty pottery bowls of steaming bow-tie pasta. In the center of the table is a bowl of aromatic, maroon-colored octopus sauce. Margaret says it’s made by sauteeing fresh octopus, and adding tomatoes, garlic, parsley, salt, pepper, and olive oil. After pasta, she brings out fresh
green beans and mushrooms, sauteed in olive oil. Crusty, whole-wheat bread appears. For dessert, perfectly ripe pears and apples on a plate with a sharp knife. Margaret is in her late 80s; Ancel, his early 90s. They have been eating this way for about half a century, and it appears
to agree with them.

charles grashow said...

http://holdthetoast.com/content/ancel_keys

"Keys faked his data. Oh, it's absolutely true that he had a lovely graph showing seven countries with their rates of saturated fat consumption paralleling their rates of heart disease. However, Keys had data from 22 countries. And when you look at the data for all 22 countries, the tidy rising line vanishes. Take a look at the two graphs, one with just seven countries, and one with all twenty two. No pattern at all. Finland, with only a bit more than 20% of their calories coming from fat, had nearly as high a heart disease rate as the US, with 40% of calories from fat, while Sweden, eating as much fat as the US, had less than half of the US's heart disease rate.

To be fair, I'm sure Keys meant well. I have to agree with him about his opposition to "the North American habit for making the stomach the garbage disposal unit for a long list of harmful foods," though we would disagree as to what those harmful foods are. And the
man did make it to the age of 100, so whatever he was doing it apparently was a pretty good fit for his body.

But the bottom line is that Ancel Keys lied. He dressed his personal opinions up in the garb of science and trotted them out to change public policy -- and it worked. The explosion of pro-inflammatory, carcinogenic omega-6 fatty acids in the American diet, the substitution of hydrogenated oils for animal fats in restaurant fryers (and home kitchens) throughout the land, the breeding of leaner and leaner hogs and cattle, the demonizing of egg yolks that makes That Nice Boy I Married sad, the rise in carb intake, and the diabetes and obesity epidemic it has caused, can all be blamed, to one degree or another, on Ancel Keys and his well-intentioned lie.

I admit freely that I, too, voice my personal opinions regarding nutrition. The difference is that I openly admit to being an educated layperson; I do not cloak myself in a veil of science. I'm a smart housewife who lost weight and improved her health, and reads a lot.
That's it.

It all calls to mind the famous quote from Mark Twain: "Be careful when you read health books. You could die of a misprint."

I wonder how many people have died because of Ancel Keys' well-meant deception?"

charles grashow said...

http://www.military-nutrition.com/Expert/Publications/119?n=Ancel%2BKeys


277 publications

Nigel Kinbrum said...

Pseudoscience:-
"In extreme cases, this leads to what they call alternative science, the result of a chain reaction of pseudoscientific claims. In the end, you have replaced all of science with an alternative version of reality."

Screennamerequired said...

Irrational plant food phobia is one of the main tenants of paleo/primal/lchf/ etc.
You can point to almost any food and show that it could be detrimental to certain people. Plant foods are major component of "ancestral" diets. Phytic acid, lectins, indigestible fibre, legumes, etc.


They're all more "paleo" than bacon and butter.

Screennamerequired said...

That was a good post by Stephen. A bit of common sense.

Screennamerequired said...

"How's this, bitches - I eat paleo + legumes. And some grains. And dairy"



Haha. Aren't paleo's main selling points is that they avoid legumes, grains and dairy?


It's kind of like saying I eat a vegan diet + eggs, pork and beef.

Nigel Kinbrum said...

http://huntgatherlove.com/content/just-kale-me-how-your-kale-habit-slowly-destroying-your-health-and-world :-D

carbsane said...

Thanks!

carbsane said...

Sounds like TWICHOO to me!

carbsane said...

One of my favorites ever! Melissa got quite a bit of "hate mail" for that one from those who didn't realize it was a spoof.

carbsane said...

I think that was the point :p Tongue in cheek!

carbsane said...

In that video they say Keys had some special equipment made in his lab. I think they developed the invisible dry immersion tank. The ghost of Keys obviously had one installed around your bathroom scale. It is the only logical explanation!

Nigel Kinbrum said...

And dear, dear Fred alas!

Nigel Kinbrum said...

Which is why she had to add a note at the beginning for those who became incandescent with rage & stopped reading before getting to the dénouement.

Mike Victor said...

The Zeroing In On Health community certainly takes that to an extreme. I recall a thread on there where they were claiming vegetables are toxic and that the only reason primates eat fruit is to get to the insects at the center (didn't know there were any insects).

carbsane said...

Yep! How DARE she string them along like that!

carbsane said...

Thanks ... it's been a while in the making :-)

Craig_in_CT said...

Whatever else you think about the paleo narrative, i.e, low fat dietary guidance triggered the obesity epidemic, at least it is temporally consistent: the goverment recommendations precede the epidemic by some number of years.

But the material you've posted about A.B. Keyes suggests an older epidemic, the rise in CVD among prosperous or middle class men, which apparently became noticeable in the early 1940's. And that epidemic could not have been explained by the advice to eat low fat, since that advice wouldn't come for another couple of decades.

So has anyone ever attempted to look at what might have changed in the 1920's and 1930's to produce a rise in CVD among middle class men in the 1940's? The possible impact of smoking on CVD comes to mind. You also likely had dietary alterations prompted by events leading up to WW2.

Lighthouse Keeper said...

Sounds like those scales are due an exorcism - sprinkle them with Paleo Water whilst chanting "I cast thee out unclean Spirit"

carbsane said...

Needs Virgin Sprinkles! http://www.thevirginstore.com/product-p/zfulfilling-tvdspk-cf.htm

carbsane said...

Men have always been more susceptible to heart disease than women (until menopause anyway). Smoking could explain part of that back then when women didn't smoke nearly as much. But further we add affluence to the mix. A ready supply of calorie dense food seems to predispose towards nutrient overload.

Nigel Kinbrum said...

Crisco hit the marketplace in 1911. See http://en.wikipedia.org/wiki/Crisco

Kade Storm A.K.A. Hedonist said...

Stephan's posts are one thing, but it's the pathetic tears of cognitive dissonance by some of the lost paleo tribe folk in his comments section that's the real hilarious.


"But! But! O teh low fat consiraciez gais! No wai! All animals and wild life consume less than 40% carbs!"

It's like they've lost their noble prophet to the enemy.

Lighthouse Keeper said...

There's a lot of blurb there considering it's just a substitute sweetener - so many fears to assuage.

MacSmiley said...

Nasty stuff!

galianoandometepe said...

"One argument I frequently encounter is that the plant foods we ate were
mostly "fat", due to the fact that the calories they provided were
mostly via fatty acids produced by the intestinal fermentation of fiber.
Therefore, we should eat a lot of lard to replicate this"

This is probably mentioned in the original blog, but if the originally plentiful plant foods in the diet were converted to fat via intestinal fermentation, wouldn't the way to replicate this be to eat more plant foods to duplicate the process, rather than eat animal fats?

billy the k said...

"...if the originally plentiful plant foods in the diet were converted to fat via intestinal fermentation, wouldn't the way to replicate this be to eat more plant foods to duplicate the process, rather than eat animal fats?"

Western Lowland Gorillas get ~57.3% of metabolizable energy from short-chain fatty acids (SCFA) derived from colonic fermentation [and 2.5% energy as fat, 24.3% protein, and 15.8% available carbohydrate: [http://jn.nutrition.org/content/127/10/2000.full.pdf]

The problem with humans trying to get that same ~57.3% of metabolizable energy from SCFA's derived from colonic fermentation is—to put it simply—we ain't got the guts for it:

"Mammalian intestines have a high metabolic rate, and in large, mostly vegetarian species like great apes, intestines tend to be busy all day, starting with the postdawn meal and continuing ceaselessly until hours after the animal goes to sleep.
All this time the guts are engaged in several energy-intensive functions, such as making stomach acid, synthesizing digestive enzymes, or actively transporting digested molecules across the gut wall and into the blood. Active guts consume calories at a consistently high rate, so their total energy expenditure depends on their weight and on how much work they [their guts] are doing. Carnivores...have smaller intestines than plant eaters; fruit-eating chimpanzees or spider monkeys have smaller guts than the leaf-eating gorillas or howler monkeys. Those reduced guts use less total energy than larger guts and therefore give species with a high-quality diet some spare calories to allocate elsewhere in the body. [the reason that lard is a "higher-quality" food than is a mature leaf is that it "costs" much less in calories to merely digest, and so it thereby provides the eater a much bigger caloric bang for the buck.]"

And this "elsewhere" turned out to be—brains: "...primates that spend less energy fueling their intestines can afford [the extra "cost"] to power more brain tissue. Big brains are made possible by a reduction in expensive tissue [i.e., intestinal tissue]." [Richard Wrangham. Catching Fire. (©2009) p.112-113]

(Plus, family get-togethers would all sound like the campfire scene in Blazing Saddles!)

carbsane said...

Short Chain Fatty Acids are not "fat"

http://carbsanity.blogspot.com/2011/02/when-is-fat-fat.html

billy the k said...

I know. But it's also good for fat phobes to remember that the huge amount of fiber that gorillas ferment into short chain fatty acids ain't "carbs" either.

galianoandometepe said...

Something is not making sense to me here:

Does not the "we" in the argument [the plant foods *we* ate were mostly "fat", due to the fact that the calories they provided were mostly via fatty acids produced by the intestinal fermentation of fiber] refer to paleolithic humans (rather than gorillas)? And isn't the core argument for eating "paleo" that our system has not evolved significantly since then, but our diet has (due to agriculture); so the paleolithic diet (whatever it actually was) is the one we should replicate?


Or is the argument referring to more distant, non-human ancestors, which necessarily would have had different digestive systems, and as the example with gorilla shows, limited utility for informing what the optimal human diet should comprise?

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