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Nutrition Past and Future

Anthony Colpo's Confusionist Mind

Anthony Colpo’s Confusionist Mind, Part 1

I can’t tell you how strange it is to wake up one day and see yourself attacked in a blog like this. It’s not just that it’s strange to be attacked. I’m anonymous, after all, so it’s not like I took this personally. But look at this language. Here is a grown man who insists on calling me “Pee Pee”. “Pee Pee” is Anthony Colpo’s witty twist on my pseudonym, Plant Positive. That’s the price I pay for alliteration, I guess. I have to admit, it didn’t occur to me that someone would call me Pee Pee. Maybe I should have focus group tested my assumed name with a panel of fourth grade boys.

It’s not just that, either. This screed goes on and on and on. This is all in response to about a three and a half minutes sequence about Colpo in my Primitive Nutrition Series video number 41. I have to be honest here. I put so much time into those videos. They totaled over nine and a half hours of runtime. I really wanted my project to be seen by someone out there. To have someone give it this much attention is really quite flattering. Anthony Colpo can call me whatever names he wants if it makes him feel better. I just really appreciate knowing I hit such a raw nerve for him. I am delighted by the attention he gave me.

In the bizarre little world of the pro-meat, pro-saturated fat blogosphere, Anthony Colpo is considered one of a handful of individuals who is to be taken seriously for no apparent reason. This guy compares his blog to that of the estimable Denise Minger. Impressive.

Chris Masterjohn thinks Colpo is a rigorous and thorough researcher who has made an important contribution to the fabricated controversy over cholesterol.

Colpo likes Masterjohn and Minger, too. He references their articles about the China Study here. The crowd I am criticizing often references one another, giving the impression they are a small club of elite minds. This is how you create an internet echo chamber.

Meat and fat advocate Michael Eades likes Colpo’s cholesterol book, too.

Paleo radiologist Kurt Harris faults Don Matesz for daring to contradict the likes of Eades, Masterjohn, and Colpo. How foolish he is to disagree with these authorities! By the way, I haven’t mentioned yet that Colpo is a personal trainer. I wonder if there are any other personal trainers Harris considers experts on cardiovascular disease.

At one time, Michael Eades thought of Colpo as his good friend.

But Colpo would later say Eades was either a shameless charlatan or one of the world’s most amateurish researchers. If he talks like this about his friends, I can hardly be upset by all the names he has called me.

In trying to respond to this, Eades felt the need to apologize for the length of his post. I understand where he’s coming from. You’ll see I, too, have decided to respond at length to Colpo.

If you just go by the commentary of some people, Colpo really kicked my ass in his blog with his impeccable logic and critical thinking. It’s as though this guy decided Colpo is a superior critical thinker without doing any thinking of his own. Imagine yourself in my position and you are reading this.

Here is Anthony Colpo wondering what I mean when I call him a “confusionist”. He links us to what he thinks is Wikipedia in his search for an explanation. But unbelievably, he is not linking to Wikipedia at all. He is sending us to a farcical website called the Uncyclopedia. Do you see the quote he retrieves? “Confusionism is a Far Eastern religion that started out as an elaborate way to state the blindingly obvious.” He asks in all sincerity, “what on Earth has this got to do with people who point out the cholesterol theory for the complete sham that it is?” Mr Colpo is confused, isn’t he?

Here is that Uncyclopedia link. You see it says, “Confusionism is a Far Eastern religion that started out…”, etc. Look at the banner. Who wouldn’t be able to tell this is a joke? Look at the left where it says it is the Content-Free Encyclopedia. No content? Actually, that makes it a perfect reference for Colpo!

Uncyclopedia’s joke is making reference to Confucianism, of course. The fact that Colpo didn’t understand that indicates he doesn’t know what Confucianism is, either. Mr Colpo really could have benefited from a modest liberal arts education to avoid pitiful embarrassments such as this.

Let’s go back to that Michael Eades quote. He says, “Anthony changes or removes his material when it proves to be an embarrassment for him.”

Well Colpo eventually became embarrassed by his ponderings of the word “confusionist”, because he has gone back and rewritten this section. He does not give any indication that his blog post of December 15 has been edited. What is so remarkable here is that even after he has been tipped off by someone that Uncylopedia is a humor site, he treats their definition as a real definition anyway and leaves in the part where he asked, “what on Earth has this got to do with people who point out the cholesterol theory for the complete sham that it is?” It seems he still has no concept of what parody is. Mr Colpo, that is a joke definition. It is not intended to be taken seriously. I am embarrassed for you. Really, man, you should have learned some humility by now. Your façade of belligerence and arrogance is just bad strategy. You should hedge your bets a little bit. You should try to come across as a little more mature. Don’t write such long blogs, especially when you’re so emotional. You’re just making it more likely you’ll something regrettable. And if you are going to call someone a moron you’d better be damn sure you’re not making a fool of yourself at the same time.

I really wish I could say I coined the term “confusionist”, but alas, I cannot. I took it from my reading about climate change denialism. Cholesterol denialism and climate denialism aren’t so different from one another. They both originate from political ideologies and not from impartial science. I’ll show you what I mean later.

Here’s another example of Colpo’s difficulties with language. He puts quotes around the word “apologizing”, as though he is quoting me. Mr Colpo, I call the handful of cranks like you saturated fat apologists. This is a reference to apologetics. To steer clear of unnecessary controversy, I’ll just leave it at that.

Here’s another embarrassing intellectual failure from this supposedly great critical thinker. He lists a few more things that he says I don’t want his readers to know about. He brings up the Masai. He says I pretend like they never existed. Of course, my channel viewers know that I created two videos about the Masai for The Primitive Nutrition Series. Now I don’t blame him for not watching all of my videos. He can stay as ignorant as he pleases. But what is so strange to me is that he seems so sure I haven’t looked into the Masai without even bothering to see if that is actually true. Is he completely unconcerned whether what he says can be shown to be completely false with almost no effort? Why assert this at all? What did he gain by this? All he is demonstrating is his recklessness and sloppiness. This gives us a valuable insight into the mind of someone who would invest so much in cholesterol denialism. This is not a careful thinker.

Along the same lines, he references a meta-analysis that stated that saturated fat did not appear to be linked to cardiovascular disease. He says I’m a shameless hypocrite for ignoring this, yet I included this very study in my video number 52. Again, I don’t expect that Colpo would watch my videos. I really don’t see him as the sort of person willing to learn anything that might upset the views he so desperately clings to, as if his whole world depends on it. This whole long, bitter diatribe suggests to me the state of mind of more of a cornered and wounded animal than a dispassionate intellectual. Again, why assert this blindly? It seems to please his readers, he only feels he has to act like he’s completely sure of himself, regardless of the fact that he’s completely shooting in the dark.

Again, imagine you are in my position reading all this, and you see that others think you are being schooled by this guy. In the first paragraph he says I think women should shut up, learn their place, and take their statins. Really? People read this and take it as rational thought? My cholesterol videos argue for choosing a diet that will lower your cholesterol levels so that drugs are not needed for that. And where did I say women should learn their place? Mr Colpo, why not call me a racist or a homophobe or a pedophile while your at it? If you did, your gullible readers would think you were making really good argument against me. Your pro-wrestler-style chest-thumping seems to be all that is needed to impress them. But that isn’t all. Then he says he would like to shove both his books up my keester, and later goes on to say I am the one who is mental and that my diet will cause anger and hostility. Is this self-parody? He is the one thinking about abusing my behind and I am the one who is mental? These ravings are like the scrambled thoughts of the lunatic mumbling away to no one in particular in a public park or a bus station. In public, no one would pay attention except perhaps a social worker, but on the internet, this level of discourse will earn you a following.

While on the subject of mental health, Mr Colpo addresses me personally. He says I should take large doses of statins. Mr Colpo, if you don’t understand what statins are, they are used to treat patients with high cholesterol. As you know, I am a whole food vegan, so I don’t need statins. Also, as a whole food vegan, I have no use for the margarine or oils you say I should eat. All of Colpo’s illogic here prepares us for his charming punch line: he wants to see people like me die to clean up the gene pool. Feeling just a little Hitler today, are you, Mr Colpo? All this is coming from someone making an argument based on mental health. Anthony Colpo’s mind is a strange place indeed.

 Here he imagines what he says would be a sane, intelligent, rational world. In it, people like me would be punished. This echoes Donald Miller’s fantasies based on the movie Sleeper which I referenced in my Confusionist Mind video. These deniers pine for alternate realities in which their views are considered mainstream. It’s a bit sad. These people don’t seem very happy in the real world.

Here’s another big pratfall. He suggests a doctor selling a book for $249 somehow has less integrity than him, since his book has a much lower price tag. Of course, Colpo’s book isn’t worth much, especially if you don’t want to waste your time on crackpot pseudoscience. But that’s not what I find so embarrassing about this comparison he makes between his book and the expensive one.

Here’s the German doctor’s book. It’s a textbook.

Here’s Colpo’s book. It’s not. Anyone who has been to college knows why textbooks cost a lot of money. They are frequently updated. They are exhaustively researched. The are often huge and beautifully produced. They have a limited market. Specialized medical textbooks can’t take much advantage of economies of scale. Cynically exploitive polemics like Colpo’s book are priced cheaply and targeted at a lay audience in hopes of making a profit through a high volume of sales. Colpo didn’t have to do work of any quality because he wasn’t trying to create a reference for young scientists. He was just trying to pander to anyone who loves meat and butter and doesn’t mind parting with 26 bucks to feel better about it.

By Colpo’s logic, the authors of the above $15 anti-vaccination book are somehow more noble than the editors of the $350 textbook you see beneath it, written for scientists who are actually responsible for creating effective vaccines.

And the author of the above totally free climate confusionist book can claim to be more honest than the editors of the below $239 textbook compiling research to help scientists find better strategies to manage climate change. No, Anthony Colpo apparently has never even set foot in a campus book store, yet he fancies himself an authority on cardiovascular disease.

Again, he says I am the one who is mental even as he zigzags between aggression and self-pity. He can’t see how having a book makes him professionally invested in maintaining his delusion. Actually, not only is he professionally invested in his incoherent ideas, his vitriol shows he is quite personally and emotionally invested as well. He thinks the proof of his integrity is his lack of exotic supercars and a supermodel girlfriend. To all you saturated fat apologists watching this, seriously, this is one of your thought-leaders? This is someone who you think is up to the task of understanding the science of heart disease?

Of course, he is personally invested in his delusions about saturated fat. Of course, he is opposed to a vegan like me. Look at his email address: He had a website by this name. This guy is not going to be persuadable to the vegan point of view, no matter how strong the arguments I present are. His sense of identity is wrapped up in eating meat, and his cholesterol denialism book and all his blog posts have made it impossible to change his mind at this point without a major loss of face.

Colpo actually contrasts his personal finances with the earnings of the big drug companies. They have billions. Well, yes, they do, Mr Colpo. You’re just one person. They are many persons. People pay them a lot of money hoping their drugs will keep them from dying of a heart attack. All that money these companies make pays their researchers, who don’t have supercars or supermodel girlfriends, either. Actually, they are more likely to be brilliant nerds with substantial debt from their many years of higher education, something you wouldn’t understand. People pay them because they actually produce real things using real knowledge. This makes them quite unlike you, sir.

Colpo wants us to think he deserves to be treated with the same respect that scientists receive. He sees himself as David against their Goliath. Mr Colpo, if you care so much about this why don’t you humble yourself and go to school so you understand this subject matter? Maybe if you demonstrated some mastery over the science by perhaps getting a passing grade on a test or two you might be able to put together an argument worth taking seriously.

Colpo tries to get personal with me even though he doesn’t know me. I don’t mind. I could do the same. I could have some fun suggesting he so easily upset because he is impotent from the effects of all that saturated fat on the blood supply to his key areas. I’ll try to show some restraint, though. There is an old saying about contests and skunks that applies here, so I’ll take the high road from here on out. In fact, I’ll pay Mr Colpo a compliment in part two.



 Anthony Colpo’s Confusionist Mind, Part 2


I guess Mr Colpo does deserve some credit. He bristles at the thought of being lumped in with the paleo crowd. I can understand why he would not want to be associated with them. For clarification, my Primitive Nutrition Series was grouped into three basic sections: Paleo diet misinformation, cholesterol denialism, and low carb, with some miscellany at the end. Colpo was in the cholesterol denialism section. I never said he was paleo, but I’ll give him full credit now for not completely hopping on the paleo bandwagon. And that’s my compliment.

I’ll try to clarify Colpo’s views on Paleo since he feels wronged by me. Paleo promoters are the object of his scorn. That’s not so unusual since Mr Colpo has more than enough scorn to go around.

He doesn’t like the way paleologic is used to rationalize low carb diets. That’s good. However, he completely buys in on the fallacious appeal to nature at the root of the Paleo idea. He thinks our evolutionary history dictates that we consume a particular Paleo-like diet. We’re back into Paleo truthiness territory here. Colpo has his own personal spin on the nebulous Paleo idea, just like most of the other Paleo promoters.

He thinks that certain foods shouldn’t be eaten because prehistoric humans didn’t eat them. Like the Paleo promoters, this allows him to litmus test what foods are permissible. Baked beans and tofu are likened to candy bars. In Colpo’s mind this makes sense. He also thinks the deep insights of the Paleo concept are necessary to know we shouldn’t eat processed foods, yet somehow he is in favor of nutritional supplements. Are we to believe powdered supplements are not highly processed? He thinks this inconsistency proves he is not dogmatic. What this reveals instead is his inability to develop a coherent philosophy, as he applies Paleo principles in ad hoc fashion at his sole discretion. Paleo justifies his beliefs except when it doesn’t. It seems to me, Colpo really is Paleo. He just won’t say so directly. He tries to give the impression he is somehow above that fad. He’s smarter than all the others. Colpo is too arrogant to merely attach himself to a wider trend. Your only source of quality information is, of course, him and his site.

Moving on, here is Colpo displaying his ignorance just like all the other saturated fat apologists about the myth of Ancel Keys and the 22 country graph. Again, had he watched my videos he would not have to suffer this public exposure of his failure research this.

Here’s a typical tactic for the confusionists. Drug companies make a lot of money, and scientific panels have a say in drug guidelines, so therefore everyone is in on a big scam.

Yes, in a world of freely available research publications Colpo would have us believe that the lipid hypothesis is being promulgated by an international, multigenerational, public and private conspiracy in which every participant is in it to get rich. Actually, Mr Colpo, if you think about it for a moment, it is far more likely that since heart disease is the number one killer in the US, most American researchers in the field have likely lost friends and family to heart disease. This makes such a conspiracy not so likely. To imagine how kooky the conspiracist belief system is, sometime read through a portion of a medical textbook in which some aspect of heart disease is explained and imagine the feverishly paranoid mind that would see purposeful lies all through it. Just try to channel the confusionist mind.

Colpo is a blatant hypocrite in casting himself as an opponent of the drug industry. First, he recommends people eat the foods that ensure the drug companies will have a steady supply of customers in the future. Only in a mind like his could someone who has provided copious information free of charge about how whole plant foods can lower the risk of heart disease be guilty of supporting the drug companies. But if he can convince himself I think women should shut up and know their place, then he can convince himself of anything. The only mystery here is why anyone reads his drivel.

Anthony Colpo is the drug lover and he’s quite open about it. Here he says statins exert a wide range of potentially beneficial anti-atherosclerotic and anti-clotting effects. Mr Colpo, I hope the makers of those statins are happy to have you out there acting as their salesman.

Just look at these two Anthony Colpo quotes. On the left he says I love statins, yet on the right in his published journal article he says statins have clinical benefits.

Just look at all the benefits Colpo claims for these drugs. Statin drugs, how does Anthony Colpo love thee? Let me count the ways. He loves you for your reversal of plaque formation. Anthony Colpo adores you for your effect on arterial function. He admires your anti-clotting effects and your antioxidant effects. I could go on. No wonder he is upset with me. He is only defending the ones he holds most dear. If people did what I say and stick with a whole food vegan diet, the statin market might one day evaporate. Mr Colpo, I hope your selfless devotion to the drug companies has not gone totally unrequited. You at least deserve a thank you note.

Evan Stein is an internationally recognized expert on cardiovascular disease, having worked in the field for 40 years. Here he addresses the so-called pleiotropic effects of statins, which are those claimed extra beneficial effects beyond cholesterol lowering that you just saw. Stein says arguments for these effects are put forth by the pharmaceutical industry as a way to help sell their drugs. Now I have no complaints about this. If people are going to insist on giving themselves cardiovascular disease with their diets, we’ll need some drugs to manage their problems, and the makers of those drugs are entitled to run their operations as a business. But realize these claims of pleiotropic effects are created by the companies that created the drugs, and they know them as well as anyone, certainly better than Anthony Colpo. Read about these pleiotropic effects and you’ll see that the drug companies are not agreeing with Colpo’s premise, however. The benefits of statins are in addition to cholesterol lowering, not instead of cholesterol lowering.

For example, here is one of Colpo’s references to the pleiotropic effects of statins, in this case the reversal of plaque formation. You see Colpo’s quote at the top. But look at the study for yourself. The effect in question is a secondary contribution in addition to cholesterol lowering. Moreover, for this study, atherosclerosis was induced in the experimental animals by feeding them cholesterol. Colpo doesn’t tell you that, of course. This study is the farthest thing from a challenge to the lipid hypothesis.

Here’s another one. Colpo says on the left that an important experiment demonstrated the ability of a statin to prevent the inflammation cascade. But look at the right to see what was actually stated in the paper. The effects in question are in addition to lipid lowering, not in place of it. The authors suggest that statins might also be used for a range of other conditions beyond high cholesterol, including psoriasis and rheumatoid arthritis. This is exactly what we would expect to see if we believe Evan Stein. New sales opportunities are proposed for statins. I think Dr Stein is right.

Colpo is one of those who say that low cholesterol or statins cause cancer, yet the author of the important paper he referenced thinks it is likely that statins are effective for shrinking cancer tumors. No one who actually works with these drugs in the laboratory seems to agree with Colpo’s analysis of them.

Let’s go back to Colpo’s journal article. It’s a bit strange to see a serious journal with a review of a major concept in medical science authored by someone described as a certified fitness consultant. Wow, he’s actually certified for that! That’s a serious qualification! This article appeared in the Fall 2005 edition of a medical journal called The Journal of American Physicians and Surgeons. What sort of journal would publish an opinion piece by a fitness instructor with no apparent relevant qualifications which states that the thousands of scientists with genuine qualifications have for decades been practicing “bad science”?

What sort of medical journal publishers thinks they are providing a service to science with a line like this, saying that despite popular perception, plaques are not simply big wads of fat and cholesterol stuck to the arteries like mud inside a pipe? I’m sure any PhD’s reading this are grateful to have Colpo dumb down heart disease for them so they can keep up. No doubt they lack the education to understand cardiovascular disease at a level above popular perception. Maybe if they became certified as trainers they could shed their ignorance.

Here are some other articles appearing in the same issue as Colpo’s. You see Dr Donald Miller, the subject of my Confusionist Mind video number 42, has found a soapbox here as well. Look to the center of my slide and you’ll see that also in this issue is an article called “Canadian Medicare: A Road to Serfdom”, an apparent reference to Friedrich von Hayek’s book, The Road to Serfdom, so this is suggestive of a strongly libertarian point of view for this journal.

Glenn Beck helped boost that book’s sales recently.

Hayek is referenced in an article at the bottom left as well. Are you starting to figure out what’s going on here?

On the right you see another interesting article from the same issue called “Homosexuality: Some Neglected Considerations”. Oh, dear. The concept of sexual orientation receives the sarcastic quote treatment here. Is the author saying there is no such thing? He believes sexual orientation is a purely political concept that has caused the medical and societal harm of homosexuality to be understated. His difficulties with the nature of homosexuality cause him to think of those with a different view as having a political agenda. Does this remind you of the climate change denialists, or the cholesterol denialists? These fringe characters who are at war with science see everyone else as political even as they are united by their own anti-government, anti-science ideologies. That’s how emotionally compelling story lines are created within the confusionist mind.

Sarcastic quotes are usually a good indicator of unserious scholarship. In the absence of reasoned argument, sarcasm will do.

Colpo, like Loren Cordain, has a strange fondness for the use of sarcastic quotation marks, or scare quotes. That last one here is especially out of place in a medical journal, mockingly referring to “health authorities” who Colpo thinks are really just propagandists. He seems to believe the “health authorities” don’t read this journal. No doubt he’s right.

The previous issue of this journal to the one with Colpo’s article addressed some interesting topics as well, including a linking of the Terri Schiavo case to a “culture of death”. The book reviews section covers a book about a perceived campaign to create a master race in the United States and a review of The Free Market and Its Enemies by Ludwig von Mises, another hero of libertarian economic theory.

Colpo is not the only writer with unexpected qualifications to be published in this journal. In the Summer 2003 issue a link was alleged between abortions and breast cancer by someone who’s only credential is serving as President of the Coalition on Abortion/Breast Cancer. Also in that issue was an article on “vaccination dissent” by a mathematician. The mathematician here is Roger Schlafly, a computer programmer and son of the famous conservative activist Phyllis Schlafly.

Another son of hers is Andrew Schlafly, the lawyer who founded Conservapedia.

And as the founder of Conservapedia, he started the Conservative Bible Project, a new version of the Bible minus perceived liberal distortions.

Mr Schlafly also published in the journal Mr Colpo selected on the subject of an alleged link between abortion and breast cancer. You can see he also renders legal services to the organization that publishes this journal.

Schlafly is a well-known critic of the theory of evolution. Anthony Colpo is not. He attempts to justify his Paleo-derived diet beliefs through evolution. While discussing evolution, he eagerly aligns himself with scientists and scholars. This is in sharp contrast to his rejection of the science of cholesterol. How do both of these attitudes inhabit the same mind? I’m not sure, but it probably helps to not think too hard about it.

In the Spring 2005 issue the president of the organization publishing this journal wrote an opinion piece on the prospect of single-payer health care in the US. He felt his argument was bolstered by reminders of Fidel Castro, Karl Marx, and Hitler, and an observation that a single-payer system exists in North Korea. Now I really don’t want to discuss politics in my videos. I point all this out for a couple reasons. The first is to show you what sort of journal Anthony Colpo was comfortable using as a platform for his views. I think it’s safe to say that if he seriously disagreed with the philosophy of the publishers of this journal, he probably would not have made a contribution to it. He chose to be published by them. The other reason I raise all this is to allow you to see that a radical suspicion of government keeps popping up as a theme for the denialists.

You’ll recall that Donald Miller has some views that are a bit out there on this subject as well.

Read this slide again if you don’t remember.

Chris Masterjohn likes to appeal to this mindset, too.

As does the Weston Price Foundation with their paranoid phrase “diet dictocrats”. They need this fearful spin to distract the reader from their vacuous reasoning. Butter couldn’t contribute to heart disease. It has nutrients, you see. Brilliant!

David Gorski of Science-Based Medicine has written that it is not an exaggeration to say that the publishers of this journal are waging a war on science- and evidence-based medicine in the name of politics. Maybe now you can see why.

Browse their articles and you will see Colpo’s hostility to the establishment of science-based guidelines for cholesterol is right at home there. Gorski says that if he were a crank or a quack, that journal is one of the first places he would send his papers for publication.

A recent blog post by Dr Steven Novella helps us to clearly see Colpo for what he is: a crank. Novella wrote about “Cranks and Physics”, but he may as well have been writing about Colpo.  At the bottom you see that he has observed that the casual assumption of one’s own genius is a common trait for the crank. Above, Colpo assumes a genuine expert in cardiovascular research feels threatened by his self-assuredness. I think Novella’s comment that the extreme arrogance of the crank is just a cover for his crushing insecurity applies perfectly to Colpo. I would think that anyone reading Colpo’s foul language and insults would immediately see his style as a pathetic and transparent overcompensation.

Novella points out that in the age of the internet, cranks can form their own alternative communities, complete with their own journals. Of course, this is represented by Colpo’s fringe choice of journals for his piece as well.

I don’t even want to paraphrase Novella here. This is such a great observation. Go ahead and pause the video and read this. Colpo reflects these remarks so well. In his mind, his amazing talent makes up for his lack of education.

Colpo and the other cholesterol deniers follow the same playbook as other denialist movements. The Watching the Deniers blog is on point here. All these tactics are used by the cholesterol deniers, too. Rational Wiki also lays out the denialist strategy. I won’t belabor the points made here. Read some cholesterol denialist writings and you will see all these tactics in action.

Some people who really should know better choose to look past all this and ally themselves with Colpo anyway. His nastiness is made out to be a virtue because it’s entertaining. How nice! This blogger thinks Colpo gets the science right most of the time. From my perspective, Colpo fails about as badly as one can in this regard. I’ve made the following videos to make this very clear to you. I will run Colpo’s confusionist gauntlet next. I predict I will be unscathed on the other side of it.


Response to Denise Minger 6: Number Needed to Treat

Response to Denise Minger,
Part 6: Number Needed to Treat

Ms Minger says I am wrong to question the accuracy of Harriet Hall’s statement that if former President Clinton followed Caldwell Esselstyn’s advice, he could never eat another avocado.

Here she has me totally nailed. Esselstyn is only OK with avocados for those without heart disease. My apologies to Harriet Hall for my error. Ms Minger, thank you for that catch.

I’m guessing Esselstyn is basing his caution on information like this but I don’t know for sure.

 I still think it is an embarrassment that she refers to The International Network of Cholesterol Skeptics as though they are a reliable and respected source of information. At least she seems to understand that high LDL is a significant risk factor for heart disease.

I want to read to you an excerpt of Dr Hall’s blog post with my comments now. In referring to President Clinton’s new diet, she says, “Such drastic diet restrictions must be tested more carefully before any widespread adoption can be recommended.” Why? What is she worried about? Is she totally unaware of the research on diet and heart disease? When she looks around at how most Americans eat, does she really think they would be doing any worse for their health on a whole food plant-based diet? Doesn’t she know that most diet-related illnesses like diabetes, obesity, and heart disease are extremely unlikely to be promoted by such a diet, to put it mildly? She asks, “Are these people getting adequate nutrition? Does the diet increase the risk of other diseases?” Dr Hall, there is plenty of research on this already. Vegan diets are considered safe and healthy by major health institutions provided they are well-planned. Does she think typical Americans are getting adequate nutrition? She goes on, “Is the benefit worth the difficult lifestyle modifications?” Well, Dr Hall, if plant-based diets were adopted in a widespread fashion, as you say, the market would cater to people’s preferences so it wouldn’t be difficult. It really is not that difficult now. She continues. “What is the number needed to treat (NNT) to prevent one heart attack? What NNT would compensate for giving up the enjoyment of favorite foods for the rest of your life?” This, my friends, is a bad attitude, plain and simple.

To me this is a little like a doctor questioning whether the benefits of giving up smoking are worth the lost enjoyment to the smoker. I don’t see much difference between the smoking that caused the damage to the lung you see on the left and the cholesterol-raising diet that caused the atheroma on the right. There is very little chance either would have developed had their owners’ lifestyles been sufficiently focused on prevention.

Her use of the concept of number needed to treat seems to me to be totally inappropriate. Usually number needed to treat is discussed in reference to the value of a drug or other medical therapy. It is intended to clarify how many adverse events, such as fatal heart attacks, would be prevented in a population using the therapy.

I don’t understand why she thinks this is an appropriate metric for assessing a diet. First, a whole food plant-based diet offers obvious health benefits without side effects such as those that occur with drugs. Number needed to treat is a way of subjecting drug therapies to a cost/benefit analysis in evidence-based medicine. So what are the costs of following a healthy diet? What are the problematic side effects of a healthy diet?

Why evaluate a diet simply by adverse events avoided? Let’s imagine we have a hypothetical dietary trial that shows such a diet can spare one out of ten people a heart attack over ten years. What’s the cost to the other nine? Why would you assume that just that one among the ten would be the only person to experience a benefit? Maybe all ten will report weight loss or better energy levels. Maybe another won’t develop diabetes. Maybe someone else will sleep better. Maybe yet another will no longer be constipated. A healthy diet is not a targeted drug intervention, Dr Hall. It can help overall health. I’m sorry you can’t write a prescription for a drug that can do better.

I’m afraid it’s this undue skepticism of preventive and non-pharmacological approaches to our health challenges by some doctors that alienate many people from evidence-based medicine today. Some people understand how much better a proper diet can help them feel. They don’t see fruits and vegetables as a therapy for disease. They see them as the right and proper fuel for the human body, without which diseases like diabetes develop. They may not see diet as something hard to change; in fact they may find their new diet to be rewarding and enjoyable in unexpected ways. Hearing such skepticism from a doctor, some will doubt that they can get reliable health information from the mainstream and may be drawn instead to woo. Dr Hall, you may be having the opposite effect of what you intend. In reference to this slide, I would agree that following a balanced raw vegan diet requires extraordinary commitment, but a healthy plant-based diet really is not that hard to stick with these days.

When I see results like this, I have a hard time seeing how a physician can say, “Yeah, well maybe vegetarian diets can improve health, but won’t you miss those juicy steaks?” My response is that any doctor claiming to represent science should stick to the science. I’m skeptical of anyone who thinks personal preferences and cravings make for persuasive arguments. I don’t find that rational. I find that emotional. Maybe if the Skepdoc had her own quadruple bypass, she might have a lesser valuation of the few moments she is stimulated by her ice cream.

That’s the end of my response to Denise Minger. For all my criticisms of her, Minger kept her critique of me civil and I am grateful for that. I cannot say the same of Anthony Colpo. Mr Colpo made the mistake of writing under the influence of hostile emotions. He made himself an easy target. I start my session with this confusionist pinata next.


Response to Denise Minger 5: Wheat and Carbs

Response to Denise Minger,
Part 5: Wheat and Carbs

I decided to address Ms Minger’s credibility as a source of health advice by discussing her blog about that so-called “New China Study” instead of her blogs about the original China Study of T Colin Campbell when I heard her make this statement.  She said, “There was recently another China Study that came out … that showed (that) out of all the diet patterns in China, people who were eating wheat as opposed to rice as their staple grain were gaining more weight, had higher body mass indexes just in general and it was a … a very strong association.” I hope I’m quoting accurately. 

The phrase “China study” has apparently become a dog-whistle for her audience so she uses it liberally.  For example, here a study of people following low carb diets said, “a vegetable-based low-carbohydrate diet is probably healthier than an animal-based low-carbohydrate diet.” The participants were not Chinese nationals but the results of the study favored plant foods, so this study earned a comparison to the China Study by Minger anyway.  She hits a few more hot buttons with her audience to set her familiar tone of mockery, parroting Weston Price Foundation foolishness about phytoestrogens.  I guess at this point any study describing plant foods as healthier than animal foods will be compared to the China Study.

In my video #64, Minger suggests I am wrong for criticizing a study she blogged about because it used artificial food patterns, yet I made reference to a different study using food patterns to support my views. She is saying I should be categorically against studies based on food patterns, so this makes me a hypocrite.

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.

- Plant Positive

Ms Minger, I did not categorically criticize studies based on food patterns.  I said such studies are not without reason, but that I wasn’t sure they were such a good idea. That’s different.

My problem with the study Minger liked so much was the names of the patterns in question, which I explained very clearly in my videos.  “Vegetable-rich” was a very deceptive name for a pattern that emphasized eggs and milk more than fresh vegetables, don’t you think?

Despite the perhaps counterintuitive names and construction of these patterns, Minger has said they represented all the diet patterns in China. I don’t understand why she says this. Remember, this study used a pattern called the “macho pattern”. This was one weird study.

So what about that other diet pattern study, the one Minger thinks I was hypocritical to use?

She is referring to this one, which said in its conclusion,

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

The patterns in question were called vegetable-rich, fruit-rich, and meat-rich. No “macho” pattern here. Look at the names of the authors.  I don’t have access to the full study to see what the exact patterns were, but…

Here you see all those same authors did a subsequent study based on food patterns. With the same researchers using patterns with the same names, it is very likely the patterns were very similar if not the same in both studies.

Look at the patterns and you’ll see they are named much more straight-forwardly.  The foods in the patterns much more closely matched the pattern names.  Sure, if you look at the long list of items they recorded, there were items in each category that don’t reflect the pattern names very well – again, I’m not a fan of the pattern idea - but there are a lot of foods in each pattern and the ones that match the pattern names are weighted much more heavily than the ones that don’t.  These patterns made a lot more sense, and not just because none were called “macho”. There is another reason I object to Minger’s suggestion that I was being inconsistent.

I am not disagreeing with the opinions of the researchers who conducted the study. They said a fruit rich pattern was associated with lower mortality and a meat-rich diet appeared to increase the probability of death. Sounds good to me.

Yet she downplays the high fat content of the “vegetable-rich” pattern in the study she used.  These researchers said the observed weight gain in their participants might be explained by all the fat they ate.  Now it is true, they did suggest wheat consumption was a problem here.

But as I said, the obvious issue was the wheat came in the form of noodles and dumplings.  Who says wheat is health-promoting when it’s refined and holding together a fried dumpling?  This isn’t hard, people.

These people ate very few whole grains – 298 grams of wheat flour versus only 15 grams of whole grains. Give me a break! Refined grains equal low fiber and poor nutrition.  This has nothing to do with wheat itself. It’s about processed and refined junk food.

She thought the authors were trying painfully hard to rationalize the association between wheat and weight gain through its higher energy density, yet she doesn’t think she is painfully rationalizing when she says wheat causes metabolic havoc. They are making more sense than Minger. Of course, if you remove the fiber from wheat, it will have higher energy density. That makes sense, even though they didn’t make that connection. Is Minger making sense when she says that wheat has to cause metabolic havoc?

Wheat has much different effects depending on how much it is milled and whether or not it has its normal, natural components like fiber. The graph on the left charts blood sugar, the one on the right represents insulin. Change the nature of the wheat and its effects change, too. These are important differences.

The purported problem with wheat is supposed to be its effect on insulin. I don’t really care that Campbell wrote this. It’s wrong.

Whole wheat bread is barely high-GI. This is because of its physical form, as I pointed out in video 23.  Cream of Wheat has a moderate GI like most other grains.  Ms Minger, the metabolic havoc in that pattern was much more likely to be the result of the high saturated fat consumption from foods like eggs and their interaction with refined, fiber-free junk carbs.

Having insulin go up after eating some food is completely normal and desirable.  I can’t make any sense of this low-carber fear of insulin.

Minger’s “New China Study” tracked weight change over a five-year time period.  She and the authors wondered if there was something about wheat that caused it to be associated with weight gain.

 She and they seem completely unaware of the fact that whole wheat is superior to the refined wheat flour in noodles and dumplings.  Here is a study tracking weight gain over an 8-year timespan.  The results state:

“In multivariate analyses, an increase in whole-grain intake was inversely associated with long-term weight gain. A dose-response relation was observed, and for every 40-g/d increment in whole-grain intake from all foods, weight gain was reduced by 0.49 kg.”

They conclude:

“The increased consumption of whole grains was inversely related to weight gain. This suggests that additional components in whole grains may contribute to favorable metabolic alterations that may reduce long-term weight gain.”

Ms Minger says she was only kidding about vegans plotting world domination in her AHS presentation. I missed the joke, she says. I’d hate for anyone to think I don’t have a sense of humor. I appreciate her clearing this up for me. I’m glad she was only kidding in that talk. Let me show you why I might have thought she was being a little more serious.

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.

- Plant Positive

In my video, I said her reference to a vegan conspiracy related to her interest in the American Dietetic Association and the Seventh Day Adventists.

Here’s what I had in mind.  These were Minger’s quotes.  She said, “I have some bones to pick with the American Dietetic Association.”
And in reference to ADA authors of position papers, “pretty much everyone since 1988 has been either a Seventh Day Adventist or a vegan for ethical reasons, so everybody who’s writing it has a reason to be promoting a plant-based diet, so there’s a lot of strange things going on with that, too, and it’s funny because people think the ADA is so credible but they are appointing people who have obvious bias to write their papers.” So I’m sorry to say I’m still not getting the joke. Were these comments to be interpreted as jokes as well?

So you don’t like the ADA’s supportive statements regarding plant-based diets. Let me ask you then, have the Seventh Day Adventists infiltrated the American Heart Association, who say well-planned vegetarian diets can be healthful and nutritionally sound?

What about the USDA or the NIH, who say much the same? Is the USDA run by vegans? Somehow I missed that.

Maybe they run the Mayo Clinic, too.

And the European Food Information Council. Have the Seventh Day Adventists caused all this?

Ms Minger, it might be more understandable for vegans and vegetarians to feel they are on the wrong side of a conspiracy. When Marion Nestle served on a committee advising the government on dietary guidelines in 1995, she said she felt forced to add cautions about the minimal health concerns associated with plant-based diets.

Ms Minger has a couple other comments I’ll address. You can pause and read this if you want to. She is saying I liked this one guy’s comments in one situation but not another. This section isn’t worth much comment other than to simply say that the same person can be right sometimes and wrong other times. I reference the work of others simply to point the viewer in the direction of information they can use. I’ll admit, one other minor reason I did this was to demonstrate that I am willing to give credit to people when they produce good work, even if I think they otherwise misinform. Ms Minger is apparently a fan of Gary Taubes, another cholesterol confusionist, even though he expresses absurd theories about carbohydrates having a special ability to make us fat.

Ms Minger says she eats 90% plants, so she must be eating plenty of carbohydrates. Clearly she doesn’t think Taubes makes any sense, either, unless she considers herself to be fat.

Ms Minger, you eat 90% plants and you aren’t fat. So what do you think of this quote from Gary Taubes? He says,

“...If somebody knows they are going to doom their kids to a life of obesity and diabetes cuz they’re going to make them vegetarians or vegans, then that’s fine as long as they understand that they’re not doing their kids any favors.”

This is the sort of insanity that comes out of Gary Taubes’ mouth all the time. Ms Minger, are you really going to associate yourself with someone this detached from reality?

Gary Taubes, if you didn’t know it, it looks like vegans have lower BMI’s than meat eaters.

And if vegetarianism causes diabetes, it might be hard to explain why these Seventh Day Adventists had such dramatically lower rates of diabetes. Wait, I forgot. You have books to sell, don’t you, Mr Taubes?

And you’re making lots of friends in the meat industry, aren’t you? Frankly, I’d be shocked if you did not intentionally mischaracterize vegetarian diets.

Getting back to Ms Minger’s comments, I didn’t rely only on bloggers to represent a different opinion from Taubes’ in criticizing Dr Hall. I included this excellent article by an actual expert in obesity. Don’t you remember seeing this, Ms Minger? It was there, I promise.

The next comment she makes about accepting non-peer-reviewed blog posts makes no sense to me. Are there any blogs that are peer-reviewed? And what does it mean to “accept” a blog post?

I have to admit it. Denise Minger caught me in a big goof. I’ll start the next video with that.


Response to Denise Minger 4: China Revisited

Response to Denise Minger,
Part 4: China Revisited

At this point I’d like to change my focus from the blog post she created about Ancel Keys to her remarks about my videos in her comments section. She says she wasn’t terribly impressed with my China Studies videos.  However, she clearly liked my Ancel Keys videos since she decided to represent my ideas as her ideas. Imitation is the sincerest form of flattery, is it not?

Minger began her criticisms of my video by quoting me saying I don’t have the time or expertise to properly fact check her criticisms of Colin Campbell’s China Study and its related papers.  Is she suggesting I don’t have the proper training in epidemiology but she does? She says it is hard to engage in an actual discussion of the data with me since I haven’t even tried to look at it. Well, yes, it is generally hard to discuss something that interests you with someone who does not share that interest. No, I didn’t want to get into the weeds with the China Study monograph, so I didn’t. She wants to debate that data but I don’t.  Frankly, I have received enough comments about how overly long and technical my project was as is.  Making a video debating the China Study monograph might only have made my videos useful to put people to sleep.  I didn’t think it was necessary, as I said, because I could demonstrate Minger’s biases and faults as a critic in a much easier way.  So no, Ms Minger, if you want to debate that data, you’ll need to find another dance partner.

I’ll try to give you an example what such a debate might look like.  Minger says I referenced only one county labeled “PD” in the China study when I said, “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.” Again, she is saying I am referring to someplace called “PD”.

It seems that in the passage in the The China Study referencing this amazingly low rate of cardiac mortality, Campbell is thinking of not one, but two counties, one in Guizhou province and another in Sichuan province.

And he isn’t calling any of the localities in question “PD”. So who is right? Isn’t it more likely Minger is the one who is mistaken? Why is she saying “PD”? What about the villages Campbell is referencing? Are they the same as “PD”?  Then why doesn’t he call them “PD”? And were their recorded causes of death accurate or not? This is the sort of tangle I’m not very interested in sorting out.

Her link to the China monograph is 225 pages of tables that look like this. Would you spend much time arguing over the accuracy of all these numbers? Isn’t it more likely that the people who recorded these data, including many who were not named T Colin Campbell, were in a better position to account for their accuracy than Denise Minger?

As I said, the China-Cornell-Oxford Project was an expensive cross-national collaboration of many researchers that was supported by several institutions.  It generated a lot of data, which was not sorted through by untrained bloggers but rather by professional researchers. Going to the effort to analyze and debate the data would have been a waste of my effort, especially when I could show more readily how suspect her analytical skills are by discussing another blog post of hers, which I’ll come back to.

Anyway, the upshot of the China Study is that the rural Chinese had very, very low rates of heart disease and cancer while consuming predominantly plant-based diets. The low rates of Western chronic disease observed among these people led in part to T Colin Campbell’s current views about nutrition.  This is why Denise Minger has wanted to discredit his work and it is why she is so popular with her low carb and Paleo audience.  Disputes like this over the accuracy of mortality statistics are just distractions from the information people need to live healthier lives. She is doing a disservice to the public.  If her motivation were to help her audience live better, she would provide some fair context to all this minutiae. Had she done so, she could have debated Campbell’s numbers while not misleading her audience.

As I have said, the low rates of cardiac death and the low consumption of saturated fat in China in past decades is well-studied. This isn’t really in question.

Here’s another reference she could have used for context. I used this slide in video 62.  She could have added to her blogs that in a separate study of Chinese women, animal proteins and saturated fats were linked with breast cancer.

I also showed you this study, which tells us that vegetarian Chinese enjoyed superior vascular health, BMI, and blood pressure. Minger could mention this but she doesn’t.

Remember, the reason low carb and saturated fat apologists are so united in opposition to T Colin Campbell is because he published findings like this, revealing that rural Chinese at one time had very low blood cholesterol levels as well as very low rates of heart disease.  This makes him an irritant.  It’s hard to sustain nonsense low carb beliefs when confronted with this information, so a way must be found to discredit the man and distract from his work.

She said she wasn’t impressed with my China Studies videos because I didn’t address her data, but she didn’t address any of the criticisms I made of her for not presenting fair context or responsible commentary.  Since she didn’t answer my concerns in her comments, I’ll repeat them here and try to make them harder to ignore.

Why does she think grains should be investigated for heart disease? Does she think they haven’t been already?

Why does she say grains should be investigated for heart disease? Does she think they haven’t been studied in this way already? Does she really think no one has considered this possibility beside modern low carbers? See my videos called The Futility of Cholesterol Denialism for more on this.

Why does she suggest there is a Green Veggie Paradox that links green vegetables with stomach cancer? Why does she not mention the practice of the pickling of vegetables as a more important consideration here?  Was she unaware of this practice?

Was she unaware that T Colin Campbell’s principal Chinese collaborator separately co-authored a comparison of stomach cancer mortality across China?  He found an inverse relationship between green vegetable consumption and stomach cancer.  Why did this international collaboration fail to find a Green Veggie Paradox if it’s a real thing?

Is she unaware that saturated fat likely impairs glucose metabolism? Why does she fail to mention this?

She thinks Campbell overlooked blood glucose levels as a risk factor in some chronic diseases. Is she unaware that saturated fat likely impairs glucose metabolism? Why does she fail to mention this?

Ms Minger thinks blame should be placed upon wheat for heart disease. She is not making a distinction between whole and refined wheat. I don’t understand why.

Here was a cross-sectional study examining the effects of whole-grain consumption on a variety of risk factors.  Those who consumed the most whole grains had lower BMIs, lower weight, less abdominal fat, and better glucose disposal. Only refined grains were associated with higher fasting insulin levels.

In this examination of the effects of whole grains, those who ate three or more portions per day of whole grains had better risk factor scores for heart disease and diabetes. These benefits were not associated with refined grains.

This review of 20 years of research indicated that whole grain and whole wheat bread had a strong inverse association with heart disease.

Here was a controlled study that compared the effects of refined and whole grains on insulin sensitivity. Fasting insulin levels were lowered and glucose disposal was improved by whole-grain foods.

Look at the foods they used and you’ll see there was plenty of wheat involved.

Why would I be at fault for not entertaining the possibility that wheat may cause heart disease?

I think I have good reason not to share her suspicions.

She says Campbell himself surmised that wheat may be a problem, as it might lower concentrations of something called sex hormone-binding globulin. I guess she thinks I would not dare contradict something Campbell has written. Ms Minger, it doesn’t make any difference to me that he wrote this. He was probably incorrect back then. The world has moved on. This is the game the low carb apologists play.  It’s not about the science, it’s about the people involved. Wheat most likely does not affect sex hormone-binding globulin levels. To imply that it does today is to misinform your readers. Do you really care about this issue, or are you just playing games now, Ms Minger?

In discussing Campbell’s old remarks on this issue, she said, “wheat-fearers, you’ll enjoy this one.”  Could it be any more plain she is pandering to her audience? She tells us low SHBG is bad, and high SHBG is good, and Campbell found an association between low SHBG and wheat.

Ms Minger, do you recall writing this?  I gather your point was that correlation does not equal causation, correct?

Then you should forget about this one instance of correlation between wheat and SHBG. This 2008 survey of the literature on the topic could not link any dietary component to SHBG levels.  Campbell’s conjecture 12 years earlier doesn’t seem to have panned out.  Minger shouldn’t be giving her readers a false impression to the contrary

Instead, if she cared more about SHBG levels than playing games, she might have considered informing her readers of this study, which showed that vegetarians have higher SHBG levels than omnivores. The authors say this may partly explain vegetarians’ lower risk of developing diabetes. Diabetes, of course, is a disease of impaired glucose regulation. That‘s pretty interesting, isn’t it, Ms Minger?

Is she unaware that saturated fat impairs glucose metabolism? Why does she fail to mention this?

Ms Minger, isn’t saturated fat a more appropriate object for your scrutiny if you care about insulin sensitivity? Don’t you remember all my slides?

In case you forgot them, here they are again.  Saturated fat potentiates insulin resistance.

Saturated fats are insulin-antagonizing.

Saturated fats were worse for insulin sensitivity.

Saturated fat harms glycemic control.

Saturated fats impede glucose disposal.

Here’s a bonus. Saturated fats inhibit insulin signaling.

Here’s another bonus: In animal models, saturated fat is strongly linked to the development of obesity and insulin resistance.

And high-fiber, high-carb foods enhance insulin sensitivity.  Come on, Ms Minger.  Impress me.  Show me why all these references are wrong.

Ms Minger, why don’t you be more scrupulous and tell your readers that it is high-saturated fat diets that are believed to impair insulin sensitivity and glucose disposal? No, she doesn’t get into any of this because it is more useful for her to keep giving her low carb audience reasons to blame wheat for their problems.  This gets us into her responses to my take on her so-called “New China Study,” which I’ll look at next.


Response to Denise Minger 3: Cherry Picking

Response to Denise Minger,
Part 3: Cherry Picking

Denise Minger, in her professed effort to tell the truth about Ancel Keys and lay out the facts as objectively as possible, repeatedly accused him of cherry-picking.

Therefore she is basically accusing him of dishonesty. He selected examples that fit his hypothesis and rejected ones that did not. His ethics as a researcher took a back seat to his agenda.

In Minger’s comments addressing my videos about him, she says I tried to selectively drop countries from the Yerushalmy and Hilleboe graph to make the diet-heart disease association look stronger.  Now she is accusing me of cherry-picking, too.

Here's another problem with using that data for 22 countries to argue against the Seven Countries Study, if that’s really what the confusionists insist on doing.  As I said, that data came from a statistical compilation by the FAO.  That was not data used in the Seven Countries Study.  The Seven Countries Study was a prospective cohort study. Researchers were dispatched within the seven countries to collect their own data using uniform standards.  Individuals were studied prospectively, or over time, so they were considered cohorts.  This study was not created by merely crunching someone else’s data, which is what Yerushalmy and Hilleboe did.  Keys was working with far better and more useful data than those two.  I'll give you an example of a problem with their data.

- Plant Positive

If you listen to and try to understand what I actually said in the video, my point was that the data from all the different countries were not necessarily of equal value, and they were not as good as the data Keys used in his Seven Countries Study.  Minger missed my point, apparently.  Moreover, I didn’t drop these countries, Ancel Keys did.  I simply tried to show why an intelligent person like Keys might have chosen not to use some of these data.  Minger’s nitpicking actually isn’t helpful to her cause. Let me show you why.

Here on the left is the graph representing the countries Keys wanted to talk about, and on the right is the Yerushalmy and Hilleboe graph of the 22 countries.

In red, I’ve circled the countries on the 22-country graph that are represented by the Keys graph on the left.  These are the supposedly cherry-picked countries, the ones he used to fabricate a pattern. Just for a moment, let’s pretend Minger and the other Keys-bashers are right that these data are not representative of reality somehow. Let’s pretend they aren’t there for a moment.

Here I’ve circled in blue the countries which I addressed in my video. Mexico’s mortality data were as poor as it gets and the others were subjected to the privations of World War II. Those countries’ histories actually argue in favor of the connection between animal foods and heart disease, as I’ve said, but let’s pretend they aren’t here, either. We’re agreeing now that all these countries are unrepresentative of the diet-heart relationship, so if we ignore all the circled countries we should have a better graph.

Then Minger says I didn’t explain why Finland and Austria should stay on the graph, which is basically putting words in my mouth. Again, my purpose was not to try to make much out of all this bad data.  She is pretending I set out to comment on every country on the graph for some reason. Watch my video and it should be obvious that I didn’t even try to do that.  She also seems to think Japan, France and Italy should be removed because of their poor record keeping.  It’s not so smart for her to say this but let’s just exclude them anyway.

All the countries she just named are in yellow.  It looks like by the time you remove the countries I said were problematic, along with the ones Minger says she wants removed, to go with the original six that were supposedly cherry-picked, we’ve removed a lot of countries, haven’t we?  It seems we are coming back around to my original point that this was not a very good collection of data, so it gets harder to see why Minger thinks this is such awesome material to blog about.  It seems to me that this exercise creates a problem for her, not me. But the poor quality of the data here isn’t her biggest problem.

Now I’ve added green circles to the countries Keys himself left out that showed strong associations between fat and heart disease, including Finland, with its much-studied remarkably high heart disease burden during that time.  Ms Minger, here’s an important question. If Keys were biased, why did he leave out countries that would have made his case stronger?  Why didn’t he use Finland? Wouldn’t that have helped him a lot if he had an agenda? Isn’t this proof that your allegations of cherry-picking are entirely without foundation?  Moreover, look at the countries not mentioned yet by any of us, which remain without colored circles.  Even they show an increase in heart disease with increased fat!

Here they are on an uncluttered graph plus Finland, which Keys left out despite how much it would have helped his case. Anyone looking at this can see that there is an apparent relationship between fat consumption and heart disease in this data. Even if we agree that Keys cherry picked, it still looks like his point was correct. So I ask, how does this discussion help the cholesterol deniers?

It seems any way you look at it, this is a reasonably strong association, just as Yerushalmy and Hilleboe said, although it wasn’t as strong as the association for animal protein.  Their observation, which Ms Minger thinks is so revelatory, is that increased animal food consumption is reflective of national wealth. Since the countries eating more animal foods would have had better health care by this logic, it would seem their higher rates of heart disease would be doubly damning for animal foods

Jeremiah Stamler was making this very point about wealth and animal food consumption back in 1958. The only counterargument Minger offers to this problem for animal food proponents like herself is that these countries would have had more accurate data on mortality, making comparisons between them and poorer countries unfair to the wealthier countries. Wealthy countries’ mortality statistics would have been better, so they would seem to have a bigger problem with heart disease on paper.

So let’s look at mortality data to include all the other likely classifications that might have absorbed mischaracterized heart disease deaths. This graph eliminates the issue of misclassification. Look closely. This also shows us more countries Keys left out that could have helped his argument, like Guatemala. There you see Guatemala all the way on the bottom, with the least problem with cardiovascular disease.

The ordering is not all that different, is it?  Notice Finland, the heart disease leader, is still up on top with other high saturated fat-consuming nations of the day like Australia, the US, and Canada.

In this comparison of Americans and Guatemalans, the diet-heart idea is very strongly reinforced. Rural Guatemalans ate much less fat, had much lower blood cholesterol, and experienced vastly better heart health than typical Americans of the time.  Yet Keys did not include them in his paper. Once again, her cherry-picking claim crumbles and lipid-hypothesis is reaffirmed.

Here’s something else that’s being missed by those who whine about cherry picking. I won’t linger on this, but the point of a cross-cultural comparison is that you are using contrasting cultures to reveal real differences.  Many of the countries Keys left out were not markedly different in their dietary practices from one another.  I don’t think he should be faulted for selecting appropriately contrasting cultures.

Let’s go back to Minger’s point that France, Italy, and Japan should be ignored because of their record keeping.  I am more than happy to eliminate France since that country is the famous exception to the diet-heart pattern.  Has Minger not heard of the French Paradox?  I’m glad she is not compelling me to make this detour now.  But what about Italy and Japan?

I doubt Italy could be the subject of any argument about food waste, as they were the original source for the idea of the Mediterranean diet.

A more inclusive accounting of their mortality would have put them somewhere between the US and Japan, so that would leave the diet-heart idea intact.  What about Japan?  Could they have actually been suffering far more heart disease than the data suggested back then?

Well, as I pointed out in The Primitive Nutrition Series, the diet of the Japanese and its relationship to their incidence of heart disease was very well-studied.  Ms Minger, you don’t want to go there.  There is a lot of material like this to be found.  Yes, the Japanese really had much lower rates of heart disease and ate much less saturated fat.

Others beside Ancel Keys studied this.  One of the difficulties I have with my chosen style of presentation is that I present a lot of information fast, whereas the confusionists like Minger will create a long blog post based on only one unimpressive paper.  Why don’t they devote as much space to comparisons of genetically identical populations living in different environments that were carefully studied like the Japanese, rather than clinging to exceptional and isolated cases like the Masai?

Ancel Keys did not trick the world into believing the Japanese had lower rates of heart disease while eating their traditional diets.  Even this doctor, who maintained a very cautious attitude toward epidemiology, did not doubt for a moment the accuracy of the low reported rates of heart disease in Japan.

Here, the Japanese were shown to have around one seventh the rate of fatal heart attacks as Americans.  It would be difficult for a confusionist like Minger to dispute this. It’s too big a difference.

This argument she has chosen to make about cherry picking can be seen as weak without any further investigation.  Here’s Minger’s logic in action.  In one sentence, she says Keys never explained why he picked the countries he did.  In the next sentence, she says this alleged cherry picking was shameful, terrible, and unscientific.  Ms Minger, how do you know they were cherry-picked if you don’t know why he picked them?  How can you say he was being unscientific even as you are speculating about his motives?  There are excellent reasons to believe he did not cherry pick them.  First, as I said, he chose appropriately contrasting countries.  Next, he chose the countries that were likely to have the most accurate data and left out all the rest.  How can anyone say he cherry picked given these facts alone?

Then, if you look at his writings, it is clear he was aware of the problem of the reliability of data and uniformity of standards in cross-cultural comparisons.  Ms Minger, he said in 1953 that, “Broadly speaking, death rates ascribed to specific causes are not very reliable under the best of circumstances.”  He was completely aware of these issues and factored them into his observations, noting that differences in heart disease were so great between some countries that any inconsistencies in their methods of death certification would not have altered their relationships between each other. He said American men died of heart disease at around 10 times the rate of Japanese men at the time.

He also compared the frequency of the recording of other causes of death to identify countries with similar practices to the United States.  For example, Italy’s death rates were similar for other diseases like cancer and cirrhosis of the liver.  Only heart disease killed at dramatically different rates in the two countries.  Moreover, he was clearly aware of the effects of food supply disruptions during the war in some countries, as you can see to the right, so when Ms Minger says I tried to drop off some countries to make the associations look stronger, I was actually just looking at this data in the same rational way that Keys did.  For contrast, you might ask what an irrational analysis of this data might look like.

Donald Miller gives us various examples of real cherry picking. Here he thinks he is somehow making a point by choosing different countries to show different relationships between fat and heart disease, but actually he is showing us that he has done zero research into the quality of the data, has no historical frame of reference, and has not tested his own beliefs for weaknesses. He just sees a bunch dots he can arrange on a graph.  A child could do this, too, but this guy is an MD. This is the sort of intellectual firepower brought by the confusionists against Ancel Keys. It’s pretty embarrassing. 

Remember, Donald Miller is using the same data that Yerushalmy and Hilleboe did, and they, the same guys Minger thinks were so awesome, showed that while there was a correlation with dietary fat, animal protein correlated even more strongly.  So not even these heroes to low carbers would lend the least validity to Miller’s ridiculous graphs.  This demonstrates a truly amazing fact.

Back in those days Ancel Keys did not understand the unique problems with saturated fats, but when we look at his work, we can see he mostly got the relationships right.

Yet Donald Miller, fifty years later and with all the research that has happened since then, is getting it wrong. Decades later, with a huge body of scientific research just sitting there to educate him if he would only look at it, Miller still has not advanced beyond a simple game of connect the dots.

This same data Keys used was reexamined by Jolliffe and Archer in 1959, who found the most important factor in accounting for different rates of ischemic heart disease between countries was saturated fat.  The authors of this paper, who were more restrictive in the data they used, also found a significant negative correlation for cereals with ischemic heart disease.  Are you seeing that, Ms Minger?

Minger had a few other comments in this paragraph. She says my rationale for removing Denmark from the graph is bunk.  She quotes a slide of mine as saying, “Denmark didn’t have any reduction in heart disease mortality during the war.” Minger is right about this – I am about to correct myself - but she didn’t help her case by bringing this up.

I had two slides on Denmark.  Here is one.  This makes no reference to death rates so this can’t be the one she is talking about. It seems to imply lower consumption of a number of animal products during the war there.

Here’s the other slide that I used.  This must be the one to which she is referring.  It says, “In Denmark, where the total fat consumption certainly declined but where the butter and egg consumption increased no fall was noticed in the death rate from arteriosclerosis during the war, but there was some increase during the two years immediately following the end of the war.”  So there is an apparent disagreement between my slides regarding the consumption of animal foods during the war.  This raises two points.

First, this illustrates the exceptional circumstances in Denmark, which may have explained why Keys left it out of his comparison.  The other issue is that her correction of me here doesn’t help her case.  She is asking us to look closely at a slide that said in Denmark, heart disease mortality remained the same during the war and increased afterwards, and it also says their consumption of butter and eggs increased.  The author wrote this in 1950, before saturated fat’s dangers were understood, but he found reason to be suspicious of animal fats.  Now we can read this and say, well of course heart disease mortality didn’t decline in Denmark.  They just kept right on eating eggs and butter!  He says at the bottom that in Denmark, the consumption of animal fats was risking public health. 

After having examined this further, I see now this was indeed the case in Denmark. She has corrected me. I said their consumption of animal foods dropped during the war, but that was incorrect. I thank her for this correction because it further supports the lipid hypothesis. Denmark’s export market failed during the war, resulting in increased consumption of artery-damaging butter and eggs, so they kept right on dying from heart disease just like they had been before the war.

Here is what took place in Denmark during the war years.  On the left you see deaths from atherosclerosis.  On the right you see egg consumption.  The trend lines track closely.  The connection between fatty animal foods and heart disease is demonstrated yet again.

 I misinterpreted this slide because I had not considered the fact that Denmark had been a major exporter of animal foods, so while their production may have declined, their consumption did not. I didn’t make this distinction at the time.

Here are some news accounts from the war describing their surpluses of eggs and meat.  No wonder their heart disease deaths continued apace.

It’s true, then, Ms Minger. My point about Denmark was bunk.  I was in error, and I appreciate this correction, and I will happily give you credit for it.

But what matters is not whether I or Colin Campbell or Ancel Keys or anyone else is right all the time.  What matters is that people understand the real science and history of cholesterol, and that is what confusionists like you try every day to obscure.

In this vein, she also raises Finland and Austria.  Once again, I didn’t say they belonged on the graph.  Yerushalmy and Hilleboe did.  Keys left them out.  I don’t understand her point.  Does she really want to talk about Finland? 

As I said in my video number 38, Finland was experiencing extraordinary levels of heart disease, leading to a major public health campaign to improve their risk factors.  Saturated fat consumption eventually went down there. Lives were saved. The campaign was successful.

What about Finland during the war?  Here you see a line representing their atherosclerosis mortality rates, the second line from the bottom.  Sure enough, deaths from heart disease fell during the war and increased afterward.  Once again, her beliefs don’t seem to be supported by the facts. 

And what about Austria?  Well, Minger herself says tuberculosis infections there were the major factor causing a drop in deaths from heart disease. She is here referencing a doctor named Broda Barnes who studied autopsies in Graz, Austria during this time. Those who died from tuberculosis also had diseased arteries.

Barnes thought tuberculosis was causing hypothyroidism, resulting in heart disease. 

Minger may not know that hypothyroidism causes an elevation of cholesterol, including LDL bad cholesterol.  So again, I don’t see how she is arguing against the lipid hypothesis in any way here. Fine, chalk up the drop in recorded heart disease deaths to tuberculosis. But think about this for a moment.

I did not mention Austria at all, I didn’t think the 22-country graph was worth much to begin with, yet she says I didn’t explain why it should stay on the graph even though she has given reason herself why it wouldn’t belong there.  Are you following this? Once again, Keys left it off and she seems to agree with his decision.  Look at the top and you’ll see she also mentions Norway in this blog post.  Is she implying that tuberculosis might have affected heart disease mortality in Norway, too?  If that is what she wants to imply, she would be wrong.

Look at the red line here.  That represents the drop in tuberculosis they experienced back then due to vaccinations.  Therefore, there is nothing here in the data from Norway that a cholesterol confusionist like Minger can twist and misrepresent to obscure the diet-heart relationship. 

Minger also expressed objections to my China Studies videos.  I’ll get into that next.

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