TPNS 62-65: China Studies

Primitive Nutrition 62:
China Studies, Part I

This may be the most controversial book about nutrition to appear in the last decade.  Yet it's not a diet book.  It doesn't give irresponsible advice.  It doesn't ask you to sacrifice your long-term health so you can drop a few pounds.  To the contrary, its whole focus is on improving long-term health.  What's more, it's written by someone who actually had a career in nutrition science.  Yet T Colin Campbell's  book, The China Study, might fairly be called radical, especially in a cultural sense.  It was not enough for Campbell to just say the healthiest foods are whole plant foods.  He went much further than that.  He said animal-sourced foods are big culprits in causing chronic disease.  Unlike what you'll see in the writings of other nutrition professionals, he does not make a virtue of moderation.  For Campbell, there is no middle ground.  Whole plant foods are where you'll find proper nutrition, period.  I can understand why that message would be hard to swallow for a lot of people.  He's asking a lot of us.

That's beside the point, however.  What interests me is whether or not he is right.  Being radical doesn't make you wrong.  Having researched these issues, I've concluded that his views are basically correct.  Now I'm sure it's no surprise to you at his point that I'd say that.  So rather than offering a T Colin Campbell puff-piece in this section, I'll engage his critics and take their charges seriously.  Campbell has really put himself out there with an uncompromising and unusual opinion, so if he's wrong, his critics should have no problem exposing his mistakes.

Search "The China Study" and you'll see his critics are many.  They appear soon after the usual sites you might expect for a prominent book: a Wiki page, the author's page, some shopping options.  Then look down a bit to the last three here, if you can make them out. The link third from the bottom, called "The China Study: Fact or Fallacy," is a critique created by Denise Minger.  The title doesn't make any sense, but I won't digress.  I wasn't all that interested in her take on this book and I originally didn't plan on including her in these videos.  Her posts about the China Study are pretty long and she is mostly just disputing the way numbers were crunched.  I don't have the expertise nor the interest to properly fact-check her analysis of it.   What pushed me to include her was that last search result you see on this slide.  Science-Based Medicine is a very useful and interesting site for anyone concerned about health matters, and it's most famous blogger, Steven Novella, is someone I admire a lot.

So you will understand my disappointment at this headline.  That Science-Based Medicine would be one of the sites bashing this book really disappoints me.  I want them to be better than this.  I'll show you what I mean.  The author of their article, Dr Harriet Hall,  says a new analysis of The China Study does not support Campbell's vegetarian ideology.  This has the ring of a news bulletin, as if the proper authorities have finally weighed in.   That's not the case.  This is about Denise Minger's blog.  This raises some questions for me.  A new analysis? Is it better than the original analysis?  How has Harriet Hall determined that?  Bear in mind this new analysis was not published in a peer-reviewed journal.  It was just a blog posting on a raw foodist’s personal site.

Does Dr Hall regularly read the raw food blogs?  Is there a reason she is confident in Minger's competence to analyze the copious data from the China Study?  Is she sure Ms Minger can produce a plausible, fair, and responsible interpretation of it?  Getting into the content, she faults Campbell for failing to tell us that in his data, wheat is strongly correlated with heart disease, but animal food is not.  This is what Minger says and apparently she is in full agreement with her.  Why is she so quick to accept this assertion?  I wonder what special skeptical tools she is using to assess all this.

After all, the nutrition transition is an important topic in  public health these days, and China is one of the countries experiencing it the most.  Their diets are changing fast, as are their rates of obesity and diet-related disease.

Is it their increased fruit consumption that is causing their problems?  Can grains be blamed even though they are being consumed less by all income groups in recent years? 

The trend in China is away from wheat consumption and toward greater meat consumption.  These trends are associated with increasing disease.  What could Minger have said to make Dr Hall ignore these basic facts?

Other studies showing similar conclusions about food and cancer to Campbell's were published before his.  Is she similarly suspicious of those?

If someone looks at The China Study with some skepticism, I can understand that.  After all, most published research findings are suspect, as I'll discuss in my Waking to Realities section.  However, one's degree of skepticism should be proportional to the claims being made and who is making the claims.  The China Study shouldn't stand out as such a lightening rod from this perspective. There is plenty of evidence to support his ideas beyond his own research.  You can take or leave his conclusions, but let's first put The China Study in context.  What have other researchers had to say about diet and health in recent years?

Here is a major recent study of a large cohort in China that compared the effect on mortality rates of vegetable-rich, fruit-rich and meat-rich diets.  The conclusion states,

"In general, a fruit-rich diet was related to lower mortality, whereas a meat-rich diet appeared to increase the probability of death."

Here, a population based study of Chinese women found a link between animal proteins and saturated fats with breast cancer.

Here is a study that showed major health advantages for Chinese vegetarians, including lower BMI and blood pressure and better cholesterol numbers.  These advantages were bigger the longer someone was vegetarian.

The World Cancer Research Fund and the American Institute for Cancer Research examined the effects of various dietary factors on specific cancers.

They created a very clear chart to represent their assessments. You should have a look at it.  If you do, Campbell's ideas don't seem so radical.

The funny thing about the uproar over his book is that when a committed meat eater hears a result he or she doesn’t like from a modern, professional work like The China Study, you can be sure they will protest that correlation does not equal causation, yet if Denis Minger says wheat causes heart disease or Loren Cordain says that populations a hundred thousand years ago were free of chronic disease, they just accept it without question.  Whole wheat is associated with lower rates of cancer. 

It is also associated with lower rates of heart disease.  Why deny this?  And how are you going to do a population based study on people who died tens of thousands of years before civilization?  Some people have breathtaking double standards.

I'd like to point out that on the topic of carbs, Campbell seems rather mainstream.

Like virtually all health professionals, Campbell is not a promoter of refined carbohydrates. 

Harriet Hall calls herself The SkepDoc and she has been active in the skeptical community.   Unfortunately, just calling yourself a skeptic isn't enough to make you one.  Skeptics know they have their own biases, and they know they have to at least try to account for them.  Dr Hall had already made her biases concerning nutrition clear.

She had quite a skeptical take on the diet former president Bill Clinton adopted to achieve his dramatic weight loss.  She dismissed the work of the three doctors who informed his change in lifestyle.

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

She considers the connection between saturated fat and heart disease to be debunked by Gary Taubes.  Taubes used lots of references, she says, so I guess in her mind that means he's right.

You can find a far more informed and skeptical take on Gary Taubes than hers if you visit the website of the excellent low carb blogger, CarbSane.  You can see she has kept herself busy trying to fact check Gary Taubes and his book, Good Calories, Bad Calories. 

This blog recently debunked Taubes's core beliefs.  Dr Hall should check it out.

This thorough critique of Taubes by an obesity specialist should be on her reading list as well.  Why assume the science writer Taubes understands obesity better than a top obesity researcher, doctor?  Because you want to believe him?  Because he used a lot of footnotes?

Amazingly, she even references the International Network of Cholesterol Skeptics in her critique.

Her language reveals that she, like Uffe Ravnskov, may have hedonic barriers that prevent her from taking a clear-eyed look at nutrition.  She assumes Clinton's diet was a difficult lifestyle adjustment.  Has she tried it?  Did she skeptically research this?  She also thinks one must renounce avocados to meet the recommendations of these doctors for some reason. I'll get to that in a moment, but notice she indulges in some snarkiness with a rather personal parting shot at Bill Clinton at the end.  The Skepdoc is apparently not above pandering with this cheap non sequitur.

Where does she get the idea Bill Clinton can never again taste an avocado?  There is nothing about avocados in Dean Ornish's book about reversing heart disease, and he is one of the doctors she takes to task.

If he changed his mind when he wrote The Spectrum in 2007, he has a funny way of showing it.  Maybe his multiple tips for eating avocados are only there to tempt and torment heart disease patients.

Another doctor she turns her skepticism toward is Caldwell Esselstyn, who only restricts avocados for cardiac patients with elevated lipid scores.

Dr Campbell himself is practically an avocado pusher, telling you to eat all you want.  Dr Hall should at a minimum offer a retraction of her avocado-based fib.

Dr Hall has used her critical thinking skills to address fears over vaccines and autism.  In doing so, she is a defender of good science.

The National Academy of Sciences would agree with her. Their expert Food and Nutrition Board might wonder, however, why she trusts Gary Taubes and The International Network of Cholesterol Skeptics so much more than them.

I hope Dr Hall takes a look around the internet and asks herself if The SkepDoc should be endorsing fringe movements so uncritically.

Having vented about Science-Based Medicine, in Part II I'll turn to Denise Minger.

Primitive Nutrition 63:
China Studies, Part II

The chapter in The China Study that is most controversial is a distillation of Campbell’s findings while coordinating the China-Cornell-Oxford Project.  It was a collaboration of many researchers that was funded by several institutions.  This was a large-scale effort.  It was not a case of one radical scientist left in isolation to cobble together suspect findings.

The raw data generated by this project is freely available.  Denise Minger's critique is based on her interpretation of that data.  You can download the data, play with it, and blog about it, too, if you don’t mind going to the effort.  You probably wouldn't be any less qualified to do this than Ms Minger was.

Who is Denise Minger? The last I checked, her website says she is 23, but really, she says, you should think of her as 35.  She is not a doctor or dietitian, much less an epidemiologist or a nutrition scientist, but she says she will get a degree in something like that one day so you should give her credit for that, too.  It is upon that scholarly foundation that she has been able to make weighty scientific pronouncements, like her statement that the new USDA guidelines are hogwash and that the lipid hypothesis is feeble and unproven.  Look deeply into that close-up photo of her left eye and you will know she is right.

She has an interesting background with regard to food issues.  I learned what I'm about to tell you about her from her interview on The Livin La Vida Low Carb podcast number 405.  At 7 she almost choked on a piece of steak, which convinced her to stop eating meat.  She says she then became a "die-hard vegetarian."  At 7.  "I started young," she says.  At the age of 11 she had been sick for about a year when she went to a naturopath who put her on an elimination diet, and then progressively reintroduced foods.  Guess what food made her sick right away?  Wheat.  "Ever since I have not eaten wheat and I have not even wanted to because of that," she says.

At 15 she noticed she was feeling unwell after eating soy, which she had been eating five times a day.  That's a lot of soy.  That's when she found a web site about the purported dangers of soy.  Can you guess which one?  Of course you can.  It was the Weston A Price Foundation web site.  "At the time I was in my vegan la-la land," she recounts.  I guess the Weston Price people are not in la-la land in her opinion.  She was so impressed with their soy bashing, she asked herself, "what else can they teach me?"  I guess the site is well-targeted at15-year-olds.  When she saw they promoted raw milk she thought, and I quote: "What!  No!  Back one, back one, back one!"  (she’s talking about her browser back button.)

Back to the quote. "I had to get out of there as fast as I could so I could wash my poor vegan eyes out to with water to cleanse them of the filth they spread."  "I think it planted a seed," she said.  This was at 15 years old, mind you.  Ms Minger is part of an annoying phenomenon for me: people who become vegans for purely emotional reasons without much knowledge about nutrition who then, after somehow getting into trouble, blame veganism for their problems.  Remember, she became vegetarian on her own at age 7.

After the WAPF site ruined soy for her she became a raw vegan at 15.  Eventually her raw diet lead to: "dental problems, anemia, B12 deficiency, a lot of problems".  She called her experience a disaster.  So at 16 or 17 she "woke up from the vegan dream."

I want to address Harriet Hall one more time now.  So Skepdoc Harriet Hall MD, do you hear anything in this that presses your skeptic buttons?  Do you see any potential for bias in all this?  Vegetarian at 7?   Visits to a naturopath? How do you feel about naturopaths, doc? What about raw veganism?  Do you think she might be a bit biased against wheat given her problems with it?  Does the WAPF promote good, skeptical science in your view?  Do you recommend raw milk to patients?  Dr Hall, how do you feel about low carb diets? 

Dr Hall, do you find it interesting that she has created a presentation called, "How to Win an Argument With a Vegetarian"?  Does this indicate any bias to you?  Here you see she finds the conspiracist mindset an easy fit.  She thinks she knows how to do epidemiology better than the professional epidemiologists, who certainly would not think to check for confounders in population data such as other lifestyle factors.  She is just really on top of things, I guess.  The last slide referencing Seventh Day Adventists is interesting as well.  It's a reference to members of the American Dietetic Association, the most prominent nutrition science organization, which has endorsed well-planned plant-based diets.  I guess Ms Minger has uncovered that they're in on a vegan conspiracy.

The video of her presentation that used these slides can be viewed here.  I tried to watch it all but I only made it this far.  If you can get through more you are a more patient person than me. 

I got her slides from Slideshare, which is hosting presentations from something called the Ancestral Health Symposium.  MInger gave her talk there.

As you can see, it was endorsed by Loren Cordain, who thinks evolutionary medicine needs a Woodstock.  Do oncology or endocrinology have Woodstocks, too?  Minger is just one of many jumping on the Paleo fad bandwagon.

By the way, check out their imaginary Groks to the left.  If you find photos of any individuals from Loren Cordain's favorite hunter-gatherer cultures that look anything like these two silhouettes, I would love to see them.

Personally I find the these two real hunter gatherers to be a lot more interesting than the imaginary models in their graphic.

So that's the background on Denise Minger as I see it.  Let's look at what she says about The China Study.  Read this paragraph and you'll see she feels Campbell should have reported associations between heart disease and non-rice grains.  By her reckoning, wheat, corn, barley, even fiber require investigation for causing heart disease.  Comments like this are where her amateur status becomes a problem.  She knows enough to point out that these are unadjusted correlations which may be totally meaningless without any context, but she doesn't know how unlikely it is these are real contributors to heart disease because she doesn't seem aware of the body of nutrition science beyond The China Study.

Here's another example of her bizarre interpretations.  She has capitalized her phrase Green Veggie Paradox in the bottom left paragraph, as if such a thing exists, in order to say that people who eat more green vegetables aren't protected from stomach cancer.  She offers a suggestion that there may be a geography issue at play, but she doesn't say what she has in mind.

Now if she were to know anything about Chinese food culture, she might realize that they consume a lot of their vegetables pickled.  This practice has been associated stomach cancer.  Chinese health officials who are not bothering to pander to low-carbers suggest the solution is to eat less pickled food and more fresh fruits and vegetables.  The article here also points out that urban Chinese eat double the meat they did 20 years ago, and this is considered a contributor to their health problems.

Look into gastric cancer and you will see that fruits and vegetables are associated with less stomach cancer, and meats with more. 

This recent study shows this as well.  Minger apparently is unaware of this.

Here's another challenge she levels at Campbell.  She accuses him of a major oversight when he fails to factor into his observations of colon cancer rates the effects of a parasitic infection called schistosomiasis.  Because that parasite is linked to colon cancer, her point is that fiber intake may not be explanatory for rates of colon cancer.   That’s an interesting charge since on his website, Campbell says they found an association between schistosomiasis and colon cancer.  So he says they found an association for this parasite but Minger says he didn't account for it.  Who are you going to believe?

Once again, these issues do not occur in a vacuum.  Here is another piece of research that found that schistosomiasis is associated with colon cancer.  Colon cancer is also associated with animal foods and high cholesterol.  Green vegetables appear protective.  All these may be true at the same time.  Is Minger complaining about his study, too?

Here's another study she can complain about.  Cereals, with all their fiber, were found to protect against colon cancer.

And if she still is buying into the views of the Weston Price Foundation, she should know that soy appears to be protective of colon cancer in this study of Chinese women.

Here's one more issue she raises before I move one.  She says blood glucose levels are linked to Western diseases, sort of like the way cholesterol is.  She doesn't seem to know why this may be.  As I have shown you at length by now, saturated fats harm glucose metabolism, as seen in this study.

This brings us back to diabetes and Neal Barnard's insights into the effect of saturated fat on insulin resistance.    Minger panders to the typical low-carb belief that healthy carbs cause chronically higher blood sugar, which is just not true.  I can provide you with plenty of references to show you saturated fat is the real problem.  This is one.

Here is another.

And another.

Saturated fats make blood sugar less manageable for type 1 diabetics as well.

High-carb, high-fiber diets actually improve insulin sensitivity and therefore help your body control blood sugar.

Replacing saturated fats with healthier foods improves glucose disposal.

This study says that the insoluble fiber in cereals, which are so vilified by the Paleo crowd, is most protective against diabetes.

I hope you can see why I haven't investigated her claims about The China Study further.  I just don't find her ideas to be very well-informed. 

Rather than spend more time on her view of the Colin Campbell's research, I think I can show you why she isn't an especially authoritative voice in nutrition research by looking at this blog post of hers.  This is where it gets nutty.  Grab some aspirin and meet me in Part III.

Primitive Nutrition 64:
China Studies, Part III

This part of the Primitive Nutrition Series may give you a headache.  Things are about to get really confusing and really wacky at the same time. The purpose of this portion of my presentation is to show you how studies can be abused in all sorts of ways so that they seem to be supportive of nonsensical beliefs.  I hope the message you take away from this is caveat emptor when reading studies and blogs about nutrition.

In her blog, Minger is bringing to our attention what she is calling a new China Study. 

This is the first source of confusion.  For one thing it’s nothing like Colin Campbell’s China Study, which I’ll explain in a moment.  Next, it’s one of three papers from the same authors.  All three are the products of their work with what  looks like a single big cohort of Chinese participants.  She is calling one a new China study and you’ll see Michael Eades is calling another a new China study.  I guess conformity is valued more than originality in the low carb echo chamber.

You know we're in for some weird, wild stuff when you read excerpts from the three publications.  "A vegetable-rich food pattern is related to obesity in China."  "The vegetable-rich food pattern was positively associated with metabolic syndrome."  "The vegetable-rich pattern was positively associated with weight gain."  You might wonder why they keep using this phrase, "vegetable-rich food pattern."  I'll show you what that's about later, but the direct answer for now seems to be simply to confuse you. 

We will be dealing with two of these studies now.  One is what I'll call the Minger China Study, which is the one on the right in blue about dietary pattern and weight change.  The other one was published earlier than the Minger China Study.  It is the one on the top left that is about obesity.  I'll call that the Eades China Study, because Michael Eades seized upon that one to push his fringe agenda.  I'll get to that one soon.

First Minger tells us she thinks her study is a gem.  The Minger China
Study says a vegetable-rich dietary pattern is associated with weight gain.  Before you learn anything beyond that, ask yourself what the chances are that a study saying such a thing is a gem.  I hope you're skeptical.  She says she is going to give us some background and to do this she will tell us about the Eades China Study.  She says that one reached a half-baked conclusion because, quote, "no one wants to think vegetables make people fat."  What is she saying?  That vegetables make you fat but fatty animal foods don't?   She then explains that her new China study was really about wheat even though the authors say it was about a "vegetable-rich" dietary pattern, not a "wheat-rich" pattern.  So the authors of her gem of a study couldn't even correctly choose the right word to use - vegetable or wheat – in the study title, according to her.

Here's the article she sends us to by that promoter of ketosis, Michael Eades.

Remember, Eades is writing about the one on the top left that says a vegetable-rich food pattern is related to obesity.

Pause the video and read this if you like.  His starting premise is to give you a way of refuting what he considers unsupported claims in nutrition he thinks you will often hear.  This is all perfectly ridiculous. Take the fourth and the last bullet points, for example.  "Fruits and vegetables don't make you fat."  And "Show me the study!", which I guess is what he wants you to say in response to an imaginary vegan inquisitor challenging your meaty diet.  This is his set-up.  He thinks he is about to show us that fruits and vegetables make you fat.  Good luck with that one, Dr Eades.

In the next paragraph he says this study is special because it comes from the company that publishes the journal Nature.  He seems to think there is a transitive property of prestige from flagship journals to their lesser journals.

If that's so, he'll have his mind blown to see that the Nature publishers also gave us these studies.  High fat promotes obesity.  The lowest weight gain was seen in people who changed to a diet containing fewer animal foods.  A vegan diet was associated with significantly greater weight loss.  Meat consumption is associated with obesity.  Those are some important findings, aren't they, Dr Eades?

Minger mentions someone at the bottom of this slide named Stephan Guyenet as the person who clarified that her China study was really a wheat study.

I won't talk about Stephan Guyenet much here.  Just bear in mind as I go through this that like Minger he saw Dr Eades blog about his China study, did not find fault with his analysis of it, and readily accepts that eating more vegetables in place of other foods does not have any bearing on whether you'll become obese or not.  Eating more low calorie, high water, high fiber vegetables will not protect you from being overweight.  That's his opinion.  Like Eades and Minger, he's a popular blogger with the Paleo and low carb believers.  As I explain these studies, ask yourself if any of these people seem to have any clue about what they actually show.

Mr Guyenet, Ms Minger and Dr Eades, please pause the video and take as long as you need to understand this slide.  Look at the serving sizes and calories. Bacon has 23 times the number of calories as spinach for the same serving size.  Dr Eades, how do the vegetables make up this huge difference in energy and somehow make you fat?  Mr Guyenet, is this basic fact not a way vegetables will protect you from being overweight?  Ms Minger, iff you think vegans are in la-la land, what would you say about the low carb apologists?  The reason no one wants to think that vegetables make you fat is because that is not plausible.

Vegetables have the highest ratio of nutrition to calories of all foods.  This unavoidable fact makes them an unlikely candidate to make you fat.  It could even be argued that celery delivers negative net calories.

When Minger calls the paper she is praising a "new China study," she may be trying to mislead you into believing it is somehow comparable to the huge project Campbell oversaw.

The Minger China Study had a lot fewer participants, and the data about their diets just came from their recollections submitted through questionnaires.

Campbell's study, however, was a whole different animal.  It was much bigger and covered a much more diverse population.  Questionnaires weren't enough.  He actually had blood and urine samples collected.  His workers even examined the food sold in the markets where his participants shopped.

Another difference is that the Minger and Eades China Studies are based on dietary patterns.  Here's what they look like.  What does this mean?  This is where that oddly repeated phrase "vegetable-rich pattern" comes from.  Unlike Campbell's big study, which looked at individual foods and categories of foods that you might think naturally belong together, like meats or dairy products,  this bunch of papers use dietary patterns they created and gave their own names.  That's why the apologists can't even agree if the Minger China Study is about wheat or vegetables.  It's actually about neither of those.  It's about these patterns.

Here you see the four patterns with which they started.  In addition to the vegetable-rich pattern, there are the traditional, sweet-tooth, and macho patterns.  Yes, we are supposed to take seriously a study of macho foods.

I don't have access to the content of the Eades China Study, but you can see that the vegetable-rich patterns from the other two studies are very similar.  I think I'm safe in assuming the first study used similar patterns to these, especially since the patterns had the same names.

The use of dietary patterns instead of naturally related foods and food groups is not totally without reason.  Using dietary patterns theoretically lets them see complex interactions between contrasting foods.  I'm not sure that's a very smart strategy, but we must accept that this is how these studies were done.  So if someone says one of these studies shows us that, "The more wheat you eat, the fatter you get," that suggestion is actually quite at odds with the way the study was designed and how the data were analyzed.  These studies were not meant to address specific foods.

This is important, but neither MInger nor Eades seem to understand that.

Then we need to think about how they used these patterns.  That's where the numbers come in, which they call factor loadings.  These researchers needed to somehow turn the foods named in their questionnaires into data they can play with.  Let's see what they did with the data their approach gave them.

Here's the explanation.

"Dietary patterns (main independent variables) were identified by factor analysis using the standard principal

component analysis method. Factors were rotated with an orthogonal (varimax) rotation to improve interpretability and minimise the correlation between the factors. The number of factors retained from each food classification method was determined by eigenvalue (greater than 1), scree plot, factor interpretability and the variance explained (greater than 5 %) by each factor. Labelling of the factors was primarily descriptive and based on our interpretation of the pattern structures.“

I'll stop there. 

You can pause and read the rest if you like.

If you don't understand it, I'll explain.  What you should realize is that people were not organized into cohorts, given a diet to follow, and then assessed for their compliance and results with that diet over time.  There were not separate groups of people with contrasting diets that would let us see what diet worked best.  Instead, they took every individual and measured their diets against every pattern, and then proportionally assigned them to different quartiles depending on how close their reported diets were to these patterns.  Still don't get it?  I don't blame you.  It's pretty convoluted. 

I'll try to make it simpler.  They are basing all this on the recollections of the participants only and then interpreting these recollections through these patterns they created.  Imagine what people would say if the raw data in the real China Study were left so open to interpretation and so dependent on memory and then measured so indirectly.  People would probably say, "garbage in, garbage out."  Yet the low-carb apologists think these studies are enlightening somehow.

Given all this, it seems Minger's use of the word "adherence" is a little misleading.  People were just doing what they normally do.  They weren't trying to adhere to anything.

Take a look at what exactly these patterns were that they used.  Here are two of them, the "traditional" and the "vegetable-rich."  Would you have guessed that the traditional pattern weighted fresh vegetables much more heavily than the vegetable-rich pattern?  Would you have guessed the vegetable-rich pattern included eggs but the traditional did not?  Would you have guessed the vegetable-rich pattern positively weighted milk and milk powder?  And notice the heavy emphasis upon pickled vegetables in the vegetable-rich group.   Understand the implications of this.  These patterns may have been truly representative of not a single person in the study.  The patterns are just their tools for crunching their data and nothing more, no matter what they name them.  How wacky is that?   To show you how misleading this can be, let's take the second-most heavily weighted factor in the traditional group, fresh vegetables.  You might think that means some people in the study were eating a lot of raw vegetables.  But you shouldn't assume that.

Raw vegetables aren't eaten very much there.  For one thing, Chinese medicine sees them as energetically depleting because they aren't warm.

A more compelling reason for the Chinese to avoid eating raw vegetables would be the practice of using "night soil" as fertilizer, which is raw and untreated human excrement and I'm not kidding.  You would cook or pickle your vegetables, too, if they were grown this way.  How they cooked them is important.  They used lots of oil, adding high amounts of empty calories in the form of fat.

The researchers can add whatever value they want to fresh vegetables, but if people aren't eating many raw, and they are frying the rest, they won't have the effect you might expect.  Also, the factor loadings are not necessarily based on the amount they eat directly.  They are based instead on the degree of variance for that factor.

Given all this, I hope you can see how disingenuous Minger is being.  She thinks this study can be used to say wheat causes what she calls "metabolic havoc."  She panders to the conspiracist mindset when she says she recommends reading the study fast before the capitalized "Powers That Be" hide it from you.  How silly! 

Here is the link for the study.  It's up now.  Ms Minger, if there are Powers That Be, it seems they can't take this down, or more likely, they just don't give a damn about it.

All this is just a prelude to showing you what total messes these blogs and studies are.  That's next in Part IV.

Primitive Nutrition 65:
China Studies, Part IV

Back to these mind-numbing studies and their kokamami patterns.

These are their descriptions of the four dietary patterns.  Notice there is a heck of a lot more information being provided for one than the other three.  The vegetable pattern on the bottom is the one generating their headlines, but that is not the one they show you in detail.  That's a big problem.  What we're left with is a detailed assessment of what they are calling the traditional pattern.  As I said, they just assigned people numerical values to weight their similarity to these patterns. 

They divided the data they got from this into quartiles, which run across the top from Q1 to Q4.  This allows for comparisons beyond just the simple patterns themselves.  Now we can compare based on what Minger calls adherence within a pattern, which really is just how close they happened to be to the pattern.  She is basing her argument on wheat because that is one of the big differentiators between the quartiles in this pattern.  But let's not forget what is going on here.  This is just the crunching of numbers from a big number soup.  There are not different groups of people, Q1 through Q4.  Rather, everyone is in every pattern and in every quartile.  That's where the factor loading comes in.

Look at the last paragraph here.  Participants were assigned pattern-specific factor scores.  We are looking at groupings of scores, not groupings of people.  This is tricky, isn't it?

Here's something else that's tricky.  In this study they reported energy as kilojoules.

In the previous study the energy was reported as kilocalories.  Why the needless complication?

But wait there's more!  To obscure matters further, the Eades China Study doesn't even use consistent weight measures, instead reporting some foods in local weight units called liang. 

By now maybe you are starting to think these studies were designed to be both impenetrable and useless.  I wouldn't disagree.  I don't think it's coincidental that a bunch of studies implying that vegetables make people fat are this weird.

For comparison, here is the sort of information generated by Campbell from his work in China. Here's a nice, clean comparison between Americans and rural Chinese at the time.  You see the Americans ate a lot more protein and fat, and a lot less fiber, iron, and vitamin C.  They were also much heavier and had much higher cholesterol.  I think that's refreshingly straightforward by comparison.

So back to our Minger China Study about weight change.  What she notices is that the biggest weight change in their graphs happens between the first and second quartiles in the traditional pattern.

Because there is a lot more wheat flour represented in the first quartile, 298 grams versus 40, she has decided that this is really all about wheat.  She isn't telling you about the line right below, though.  Look at the differences in whole grains and you'll see all that wheat flour was not from whole wheat.

That wheat flour was instead coming in the form of noodles and dumplings.  Once again we have a low carb apologist forgetting to tell you they are talking about refined junk carbs, stripped of nutrition, because it suits their agenda.  Who in the health business says you should eat refined grains instead of whole grains?

This is why all quartiles have pitifully low intakes of fiber.    Despite all that information for the traditional pattern, sugar is not listed.  Sugar intake is really important.  I can't believe that was a simple oversight.  Notice also that quartile 4 had the highest fruit and fresh vegetable consumption and was the only quartile in their whole mess that maintained body weight, which you can see in the graph all the way at the top left.  Locate Q4. Zero point zero. So Dr Eades, if I wanted to show you that fruits and vegetables don’t make you fat with a study, I could use this one.

This is despite more calories in that quartile than any other.  Q4 is at 10,207 kilojoules of food energy yet Q4 showed no weight change.  That seems a lot more interesting than any observation about noodle consumption, but Minger is not interested in that for some reason.  Also notice the so-called "vegetable-rich" pattern at the bottom represents 524 more calories in the 4th quartile compared to the first quartile.  None of the other patterns show such a big difference in food energy between quartiles.  I wonder if Minger understands that eating more calories or kilojoules is a better explanation for adding on the pounds than any wacky beliefs about wheat.  But she can't eat wheat herself, so that's where her mind automatically goes, I suppose.

Minger should know calories are a much more obvious explanation than wheat.  The Eades China Study tells us this.  For all their convoluted patterns and statistics, they came up with a plausible reason why vegetables might have some association with being overweight in China.  They eat their vegetables in stir-fries with a lot of oil.  Oil is just empty fat calories, so using a lot of it consistently might easily add up to weight gain.

Let's now take a closer look at that Eades China study and his thoughts on it.  On the left I have selected food components of the vegetable-rich pattern this study said were associated with obesity.  Get ready, here is another source of potential confusion for you.  In the Minger China study, the lowest quartile number, Q1, was the one that was closest to a pattern.  For this one, it's backwards, so here Q4 means this grouping is most like the pattern, such as the vegetable-rich pattern you see here.  At the right you see Eades' commentary.  He scoffs at the authors for saying the reason for increased weight gain in the highest quartile is from all the cooking oil.  Instead, he says it's the carbs that make you fat, to paraphrase.  No, he is not subtle. Yes, carbohydrate is a bit higher in quartile 4. 
But calories are higher, too, as is protein.  The protein comes in the form of more fish, milk, and eggs.

Another China Study!!!

The eggs caught the attention of the same authors in yet another China study.  They put out a later paper pointing out that in their Chinese participants, those eggs were associated with diabetes, as well as higher triglycerides and cholesterol.  I put the vegetable-rich pattern to the right to show you that eggs were a positively weighted factor in their scheme.  Eades didn't seem to notice that.

But here's the real kicker for Eades.  If you stop the video and read this, you will see he is under the mistaken belief that there were actually distinct groups of people in this study.  He is making it clear he is unaware this was a pattern-based study and not a cohort study.  He doesn't understand how they used their data, yet he judges the integrity of the researchers and the conclusions they drew.  One reason they might arrive at this conclusion is because they know it it is practically impossible for vegetables alone to make you fat.

This slide is so embarrassing, even for Eades!

Dr Eades might look at a few news items or recent studies if he wants to understand what is making the Chinese fatter these days.  The study he looked at will make more sense to him if he does.  The same people who are eating more vegetables are also eating more of everything else, including meat and junk food, because they have more money now.

The Chinese also develop diabetes more easily than Caucasians.  At the same BMI, they are in worse health.

You can't blame wheat for this, Ms Minger.  It's been going down while the meat has been going way up.

As I said, China is an example of a nation experiencing the nutrition transition.  Their diets have less fiber and more animal foods and fat now.

Here's one of the craziest quotes you will ever see from an MD. 

"It is obvious from the first two sentences of the quote right above what the bias of these researchers is: fruits and vegetables are good for you. And more of them is even better. Problem is that there really isn’t any definitive research showing this, although it is widely believed."

We are to believe the good doctor has scoured the medical literature for studies showing that fruits and vegetables are good for you and has come up empty-handed.  Only someone with diet books to sell would say something so absurd.

Here are two pictures of Dr Eades.  The one on the left is from his website.  It's how he wants you to imagine him.  The picture to the right is a little more recent.  There are some differences, of course, but the one that jumps out to me is the orange tint he has on the left.  This reminds me of a recent study...

Did you see this one, Dr Eades?  People look healthier when they have skin coloration suggestive of vegetable consumption.

I find it interesting that Dr Eades would choose a photo of himself for his site that gives him that healthy vegetable-eating glow. There is a way to have a healthier appearance without Photoshop.  The Onion knows what this doctor does not.

Steve Hoyer has it right.  Maybe he should write half a dozen diet books, too.

Despite all these videos, I know I've let some pet issues for the primitive nutrition believers slip through the cracks.  I'll try to catch some of them next.