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Nutrition Past and Future

3 The Journalist Gary Taubes 3: Ancel Keys Was Very Bad 1

Ancel Keys has been cast as a notorious figure in the history of nutrition science by the low carbers. Listen to what Robert Lustig had to say about him to the audience of BBC Two.

NARRATOR: This man, Ancel Keys, claimed he had the answer to heart disease. His theory had a decisive impact on what we would all eat. But it also had a devastating side effect – creating the conditions for obesity.

LUSTIG: He was already pretty famous here in the America because he was the originator, the inventor, of the K-ration. (And) the K-ration was a way of getting 12,000 calories in a very small, compact little box that soldiers during World War II could carry with them as sustenance during battle.

NARRATOR: The K-ration contained a lot of very sweet food like chocolate because Keys believed sugar was energy, never for one moment that it could be harmful. Keys’s theory was that fat alone caused heart disease ...

I need to stop the video there because we are already knee-deep in nonsense. Where to begin? “Keys believed sugar was energy.” Believe it or not, sugar can be used by your body for energy. This is not a matter of belief. Also, did you notice how the narrator just leapt from K-rations to heart disease? Never believing for one moment that it could be harmful? Is he saying K-rations gave soldiers heart disease?

K-rations were intended to be eaten for only a few days at a time and they were not all sugar, as we are led to believe. They also contained low carber favorites made resistant to spoilage, such as pemmican and other meats and cheese. It’s commonplace  to hear inaccuracies from television personalities these days, but at least this guy isn’t presenting himself as an expert in nutrition, unlike Robert Lustig. Lustig had the most eye-popping error in that clip. Did you catch it?

LUSTIG: …  the K-ration was a way of getting 12,000 calories in a very small, compact little box ...

12,000 calories in a box! Do you mean to tell me that each compact little box our troops ate overseas, providing enough energy for one man for an entire day, contained 2000 to 4000 calories more than Michael Phelps ate in a day!? Lustig must not know how to work the Google machine.

The K Ration contained about 3300 calories. He's only off by around 8- or 9000 calories. Lustig is a low carber with the same talent as Gary Taubes. He can say things that are perfectly ridiculous in a way that sounds totally authoritative. It's a marketable skill. Let’s resume the video. We just heard that Keys linked dietary fat with heart disease.

NARRATOR: … an idea he picked up in Britain.

LUSTIG: (See) in 1952 Keys did a sabbatical in England where he saw the epidemic of heart disease himself and correlated it with the enormously poor British diet of fish and chips, etc. – you know what I’m talking about! – and decided that saturated fat had to be the culprit. And he actually said that back in the Fifties before he did any studies.

This is nearly all false.

Ancel Keys said he developed his ideas about diet and heart disease when he observed the dramatically lower rates of coronary heart disease in Italy and Spain. He introduced the concept of the Mediterranean diet to America, a diet he described as mainly vegetarian.

Even the noted historian of nutrition science Gary Taubes says he formed his early ideas on fat in Italy.

Here you can see that Keys actually published a paper based on his investigations of the cholesterol levels in Naples in 1954, which you will see was a few years before he focused on saturated fat. You can see that the Neapolitans had much lower cholesterol than the men he had studied in Minnesota. Maybe Lustig felt this story might be more effective for a British audience if he punched it up a bit.

Keys also said that he conducted experiments examining the effects of dietary fats on cholesterol in 1952, so that part of Lustig’s statement is false as well.

Here you see a paper by Keys from 1952 in which he described his work examining the effects of fat and dietary cholesterol on serum cholesterol. The word “saturated” does not appear in this paper.

You can see here that Keys said he began to focus on saturated fat in particular in 1957 after performing controlled experiments, experiments with findings that were in accord with the findings of other investigators.

Try as he might to give us a story that makes Keys look like a bad scientist, all this is out there to be seen, dates and all. You can’t rewrite history, Dr Lustig. Keys’ research was based on animal studies, human trials, and ecological studies. His work was duplicated by others. This is how science is supposed to work. Now let’s listen to Dr Lustig again.

LUSTIG: … and decided that saturated fat had to be the culprit. And he actually said that back in the Fifties before he did any studies. And he spent the next fifty years attempting to prove himself right.

Lustig speaks with utter conviction even when he is completely wrong. Does he imply that it was possible for a single scientist to hoodwink an entire generation of fellow scientists who are all the while performing their own experiments? Does it make sense that he would stubbornly pursue a decades-long effort to prove his second hypothesis right, the one about saturated fats instead of all fats, even though he had to revise his initial views to adopt that idea? And if he was such a clearly biased and agenda-driven researcher, why is he of enough importance today that we are blaming him for making us fat? Shouldn’t he have just been forgotten many years ago if he was such a poor scientist? Dr Lustig is taken seriously by the mainstream media despite his flights of fancy.

Those clips came from a program called “The Men Who Made Us Fat.”

Keys advocated for the adoption of the Mediterranean diet, a diet he encountered in Italy. Do you see how Italy’s rates of obesity compared to other nations? That line is a whole lot lower, isn’t it? Does Lustig think the pasta-eating Italians were thinner because they are a bunch of low carbers?

In a break from their historic pattern, you’ll find plenty of obesity in Italy today as Italians turn away from their traditional Mediterranean diet and consume more meat.

Their diet is no longer mainly vegetarian and that has made them fatter.

In this study which included several research locations in Italy, red meat, poultry, and processed meat were all positively associated with weight gain. Meat consumption had an especially strong association with weight gain among Italians. No, Dr Lustig, Ancel Keys, whose ideas were based on traditional Italian dietary patterns, was not a man who made us fat.

I think he can hardly be blamed for the processed junk food that was later marketed as low in fat.

Keys had an amazing education and career. It’s worth your time to pause the video to read this.

Look how far ahead of his time Keys was. He did not advocate eating products loaded with polyunsaturated fats. He objected to the belief that “plenty of meat” was needed to avoid protein deficiency. He deplored the message that “every body needs milk.” Keys favored a moderate, plant-based diet, and he was not influenced by industry in his recommendations.

Dr Lustig is far from the only low carb hero who feels he needs to resort to historical fiction to find fault with Keys. In his book Good Calories, Bad Calories, Mr Taubes tells us that in 1953 Keys compared the amounts of fat consumed in six countries with their rates of coronary heart disease mortality and found a “remarkable relationship” between them. Please note, Dr Lustig, this comparison focused simply on fat consumption, not saturated fat consumption. You are wrong. Taubes goes on to inform us that two researchers wouldn’t buy his fat hypothesis, and they demonstrated that had Keys used the data available for all the 22 countries that had available data, rather than the six countries Keys selected, the fat hypothesis fell apart. Now if you’ve already seen my previous Ancel Keys videos, you know already that those two researchers, named Yerushalmy and Hilleboe, were the ones who botched their data, not Keys. But let’s pause to notice that Mr Taubes, even as he gives a false account of this episode, did manage to avoid confusing Keys’ comparison of six countries in 1953…

With his famous Seven Countries Study of 1970. My channel viewers know that many others weren’t able to get this distinction right in their fevered reimaginings of Keys. Here are a couple more examples.

Dr Andrew Weil thinks the 1953 paper, with the supposedly missing countries, was the Seven Countries Study, apparently unaware that that was released in 1970.

Taubes didn’t make this mistake and Weil says he read his book and yet he makes this mistake anyway. He must be reading low carb blogs. He says Taubes did more than anyone else to deconstruct the mythology of Ancel Keys. Actually, Taubes created a mythology just to tarnish the man’s legacy. Do a photo search on Andrew Weil sometime and contemplate why he might be such an easy sucker for low carb fairy tales. I won’t get distracted with that here.

Even in this critical article by a prominent obesity researcher, Taubes is given a free pass for his distortions of Keys’ work. This is why I do these videos. I am convinced that today’s experts in obesity and heart disease simply do not know this history. There was never a time in school or in their later careers to go back and read the old papers so they can understand how we got here.

Here is Chris Masterjohn, the resident expert on cholesterol for the Weston Price Foundation, deep in confusion as well.

MASTERJOHN: As most of your listeners probably already know, there was data available for 22 countries and when all those countries are included the line doesn’t look very clean at all and in fact you could draw the opposite line if you wanted to cherry pick six different countries.

This low carb folk tale about the 22 countries needs some exposure to sunlight.

Here is the paper which faulted Keys for not using 22 countries. I’m going to show you what it really said, but before I do that, I need to show you the paper that Keys wrote first which this paper later criticized.

We are going to view a lot of it so you can judge its merits for yourself. You can decide if Keys comes across as the blundering and deceptive villain the low carbers want you to think he was. Here you can see why he was concerned with diet-heart. He believed the United States was in the midst of an epidemic of heart disease, and the medicine of the day was not up to the challenge this epidemic presented. He believed possible strategies for prevention should be investigated. Do you think it was appropriate for a medical professional to seek strategies to prevent unnecessary deaths?

He felt that the defeatist attitude of some in medicine about the heart disease problem should be rejected. Other countries were not suffering so much loss of life. Surely lessons could be learned from them. Do you think it was appropriate for him to find an explanation for why Americans were dying more from heart disease than other people from around the world?

The US could easily be shown to be suffering more deaths from heart disease than other countries. He anticipated objections that might be made against such a comparison. Some might say that death statistics from country to country were not necessarily accurate or standardized. To allay this concern, he explained why Italy could be viewed as an example of a country with apparently reliable death records.

He noted that among the many possible classifications of death, deaths from degenerative heart disease in the US stood out in comparison to Italy as much higher. Italy had much less of a problem with heart disease.

Keys looked around for other countries that might be compared to the US. He found some with what he considered to be good vital statistics. Some countries had too few people to produce enough data so he disregarded them. He eliminated from consideration countries affected to a greater degree by the Second World War. Do you think he was wrong to exclude countries in which circumstances had recently changed dramatically due to the upheaval of war?

Keys understood that any comparison would be imperfect. He believed, however, that comparisons between groups would produce useful information. Would you rather he didn’t bother with all this?

He studied the ways countries classified their deaths according to international norms and found good reason to believe the ones he selected used similar standards. Why did he think about this issue if he was intent on cherry picking?

Here you see he chose only six countries because they were the only ones with what he called “fully comparable dietary and vital statistics.” This section is Keys explaining how he selected the countries he would be comparing. One may agree or disagree with his choices, but he does explain himself. This is the answer to the false “cherry-picking” accusations against him. Those who glibly make this accusation never read this paper for themselves. Instead they gleefully accept the incorrect old interpretations of Yerushalmy and Hilliboe as facts. Why? Is that fair to Keys?

In his paper about the problem of atherosclerosis, Keys also factored into his views other scientific research on the diet-heart hypothesis. In animal experiments, cholesterol feeding could induce heart disease. Notice that all the way back then he correctly postulated that the cholesterol build-up in arterial plaque got there from the blood, where it had to have been carried by protein structures.

Yet he was cautious in interpreting the results of animal studies. He understood that humans and rabbits were quite different, and that humans would not normally be subjected to the extreme conditions applied to animals in experiments. Do you think his skepticism of the effects of dietary cholesterol is consistent with his image today as an agenda-driven and unsophisticated researcher?

He understood even in 1953 that measurements of cholesterol in the blood at one moment might not reflect the same conditions in the blood that promoted disease in the individual over decades. This idea is called intra-individual variation. I’ll talk about this in my Cholesterol Confusion videos. He was well ahead of the curve on this one. He also knew that if he were to compare large groups of people, this problem would be less of a concern because such random variations would cancel each other out with enough data. Keys understood how to best use cross-sectional studies even then. If you read this, the “giant molecule” he mentions here is roughly what we call the IDL today, which is atherogenic.

After discussing the relative lack of effect of dietary cholesterol on blood cholesterol levels, Keys turned to the results of controlled experiments with humans showing that there were dietary modifications that could lower cholesterol, quite dramatically, in fact. Here he talks about the effects of a rice-fruit diet. Should he have ignored the work of other researchers?

Keys knew that if someone were given a diet restricted in calories, their cholesterol would very likely fall. We can see now that he would have easily seen through the bogus studies being published these days to support low carb. Calorie restriction is used to make low carb diets seem healthy in modern trials sponsored by the Atkins Foundation. We’ll get back to discussing that tactic in my Cherry-Picked Research videos.

This is the graph Keys used in that paper. You can see why it is so bothersome to low carbers like Lustig and Taubes. Among these reasonably comparable countries, we can see a clear relationship between fat consumption and heart disease. Realize he created this graph without the benefit of his later knowledge of the specific effects of saturated fats.

Dr Lustig, have a look at this. Keys said that “any attempt to reduce the total fat intake must, then, begin with cooking fats and oils.” Meats, poultry, fish, and butter were less of a concern to him. Again, this paper was written in 1953. No, he did not fixate on saturated fat without having done any prior experiments. Will Lustig offer a retraction? Don’t hold your breath. He is pretty committed to his scientific feelings.

Read this and you will see that Keys didn’t claim to have everything figured out at that time. His paper proposed a hypothesis and suggested a course for future research.

He said, “The facts and relationships indicated here are of such importance as to warrant a large extension of this type of epidemiological research.” This is exactly what he did in the Seven Countries Study, as well as in other studies. Should he not have recommended this type of research? If you are Gary Taubes, the answer is that he shouldn't have because he believes that epidemiology is a pseudoscience. That is a topic for another day.

Now that you have seen the original paper of Ancel Keys, it is time to consider the criticisms made of it by Yerushalmy and Hilleboe. That’s where I’ll resume in the next video.