8 July 2017Belief and Truth, Low Carb Experts, Low Carbohydrate Diet, Science

BMJ Editorial – Are Some Diets “Mass Murder”?

Richard Smith’s article “Are some diets “mass murder”? uses a work of a popular commentator to reach his conclusions in his editorial in The BMJ published on 15 December 2014. Responses to Smith’s article, including mine, can be viewed at
https://www.bmj.com/content/349/bmj.g7654/rapid-responsesOpens in a new window.

Richard Smith is a British medical doctor and a previous editor of the BMJ (previously the British Medical Journal). He worked for the BMJ for twenty-five years (from 1979 to 2004) and was their editor from 1991 to 2004.

Smith writes:

By far the best of the books I’ve read to write this article is Nina Teicholz’s The Big Fat Surprise, whose subtitle is “Why butter, meat, and cheese belong in a healthy diet.” […] the forensic demolition of the hypothesis that saturated fat is the cause of cardiovascular disease is impressive. ¹

Smith’s conclusion that Teicholz demolishes the saturated fat hypothesis fails with just a little scrutiny. Below are several paragraphs from Smith’s editorial, followed by a brief commentary.

A short list of articles that validate the conclusions of The Seven Countries study are: ² ~ ³ ~ ⁴

Teicholz begins her examination by pointing out that the Inuit, the Masai, and the Samburu people of Uganda all originally ate diets that were 60-80% fat and yet were not obese and did not have hypertension or heart disease.

According to Teicholz, Mann found that “he could identify almost no heart disease at all” in the Maasai. Mann’s paper, Atherosclerosis in the Masai, stated,

Measurements of the aorta showed extensive atherosclerosis with lipid infiltration and fibrous changes but very few complicated lesions. The coronary arteries showed intimal thickening by atherosclerosis which equaled that of old U.S. men. ⁵

Smith’s and Teicholz’s assertion that heart disease was non-existent in the Maasai is clearly false.

“[Keys is] possessing a very quick, bright intelligence” but also “direct to the point of bluntness, and critical to the point of skewering.”

The actual quote from Blackburn is “Ancel Keys has a quick and brilliant mind, a prodigious energy, and great perseverance. He can also be frank to the point of bluntness, and critical to the point of sharpness.” Blackburn’s words of “can be” has been transformed into “as being”. Participants in the Minnesota starvation experiment spoke of Keys’s compassion. ⁶

Josef Brozek died January 18, 2004 died at the age of 90. He emigrated to the U.S. in 1939 and became a naturalized citizen in 1945. Brozek served 18 years on the faculty of the University of Minnesota where he was a professor in the laboratory of physiological hygiene in the School of Public Health.

He wrote:

Each afternoon at 3:30 we we gathered for tea. Everyone came, the scrubbers of the floor, the director [department head]. Everyone came. And when people came from abroad, they could not believe the atmosphere in that community. He was fair to everyone, fair to all the ideas, fair to the people. […] He was fair to the thoughts. He would listen. People were free to come up with ideas. ⁷

According to Nina Teicholz,

Keys launched his “diet-heart hypothesis” at a meeting in New York in 1952, when the United States was at the peak of its epidemic of heart disease, with his study showing a close correlation between deaths from heart disease and proportion of fat in the diet in men in six countries (Japan, Italy, England and Wales, Australia, Canada, and the United States). Keys studied few men and did not have a reliable way of measuring diets, and in the case of the Japanese and Italians he studied them soon after the second world war, when there were food shortages.

Keys could have gathered data from many more countries and people (women as well as men) and used more careful methods, but, suggests Teicholz, he found what he wanted to find. A subsequent study by other researchers of 22 countries found little correlation between death rates from heart disease and fat consumption, and these authors suggested that there could be other causes, including tobacco and sugar consumption.

Teicholz changed the heading of the relevant graph. Keys’ heading was “Degenerative Heart Disease 1948-49, Men”.

Teicholz changed the heading to “Heart Disease and Percentof Total Calories from Fat – Males age 55-59, 1950”.

This falsification can only be described as a dishonest attempt to discredit Ancel Keys.

According to Truswell, USA male mortality reached its peak in 1967 or 1968 – 15 years after Teicholz claims. Truswell also states that heart disease reached its peak in 1978 in England and Wales and Scotland in 1973 – because of the influence of John Yudkin. ⁸

These dates are nowhere near the unsupported date of 1952 as claimed by Teicholz.

Smith is confusing the later Seven Countries Study with Keys’ minor discussion paper of 1953. Keys did not gather the data for this paper but used data from a number of existing sources.

Y&H criticised the 1953 paper in a document published in 1957. ⁹

The Y&H paper (which uses FAO data from 1951-1953 that was published in 1956) shows the correlation between heart disease and total calories consumed, animal fat consumption and animal protein consumption at approximately 70%. They were disputing the classifications of heart disease and Keys’s methodology – not the lack of correlation.

Even if data from all the 22 countries are included, it still shows:

positive correlations between heart disease and total calories consumed, fat consumption, animal fat consumption, and animal protein consumption, and
negative correlations with heart disease and carbohydrate consumption, vegetable protein consumption, and vegetable fat consumption.

The above correlations are clearly noted in Y&H’s paper.

Note that Keys first presented his discussion paper in Amsterdam in 1952 which is before the time that the data used by Y&H was available.

Tobacco is not mentioned in this paper. Possibly Smith and Teicholz are confused by a later disagreement that Yerushalmy had with researchers who claimed that women who smoked had lower birth-weight infants. He suggested that smoking was not the cause of low-birth weight but the result of “mode of life” differences between the smoking population and non-smoking populations. ¹⁰

In recent years, far too much attention is paid to one page of a discussion paper written in the early 1950s. Keys writes that the purpose of the paper was to demonstrate that,

The fact that the present high rate from degenerative heart disease in the United States is not inevitable is easily shown by the comparison with some other countries.

The comment that Keys could have gathered data from many more countries and people (women as well as men) obviously refers to Keys’ later Seven Countries Study – not the 1953 discussion paper. Keys explained why women were not involved – the invasiveness of the physical examinations and the fact that heart disease is much less prevalent in women.

An average of 95.9% of all eligible men participated in the Seven Countries Study — excluding the cohorts in the Netherlands and the U.S.

The subjects of the research were 16 cohorts of men in seven countries aged 40-59. The cohorts were chosen across a wide variation of dietary patterns but with low variance of other characteristics. It would be pointless enbarking on a study to determine the impact of smoking when comparing two populations in which everyone smoked.

Teicholz writes in The Big Fat Surprise that Keys claimed:

If people just stopped eating eggs, dairy products, meats, and all visible fats, he argued, heart disease would “become very rare.” Keys advised a “sharp reduction” in dietary fats, especially those naturally occurring in animal foods—and a switch to vegetable oils instead. [* Keys asserted these claims in no fewer than twenty papers in top scientific journals in 1957 and 1958.]

Really!! Twenty papers in 1957 and 1958? Name one of them.

Maybe Teicholz is confusing the quote by Eric Rimm, professor of epidemiology and nutrition of the Harvard School of Public Health, who stated:

But avoiding it [trans-fats] if at all possible is ideal. We can’t tell people to stop eating all meat and all dairy products. Well, we could tell people to become vegetarians. If we were truly basing this only on science, we would, but it is a bit extreme. ¹¹

William Banting, in 1864 in his best selling Letter on Corpulence and widely recommended by medical authorities until the 1950s. The diet was tested in the A TO Z Weight Loss Study in 311 overweight or obese premenopausal women over a year against three other diets, including that advocated by Dean Ornish, another US physician, which requires that fewer than 10% of energy comes from saturated fat.

Banting was 165 cm tall and weighed 92 kg on 26 August 1862 at the start of his high-fat, low-carbohydrate diet. Over twelve months he lost 21 kg resulting in a weight of 70.8 kg. It was a big improvement but not exactly slim. He is still very overweight with a BMI of 26. ¹²

Smith states that the Ornish Diet requires fewer than 10% energy from saturated fat. This simple view assumes that a criteria for a healthy diet is defined by the macronutrient ratio by energy intake. A person consuming a whole-food, plant-based diet as advocated by Ornish will consume about 10% fats, 10% protein and 80% carbohydrate. This diet will also be high in fibre, phytonutrients and low in saturated fats. Added oils are absent.

The Gardner study referenced by Smith completely misrepresented the Ornish Diet. The diet consumed by the participants comprised of 52% carbohydrate, 30% fat and 18% protein. The amount of fibre consumed was very low at 19.3 g/d. Ornish wrote a letter to the editor of the journal complaining about the misrepresentation of his diet but it was not published. ¹³

Professor Colin Campbell, Professor Emeritus of Nutritional Biochemistry at Cornell University wrote:

In my letter, the flaw that I found especially repugnant–and obvious–was their comparison of the Atkins diet results to the low fat, plant-based diet of Dean Ornish pejoratively called “extremely low” by the researchers.

The original Ornish diet–and other similar diets– contains only 10-12% fat like other whole food, plant based diets but Gardner et al inappropriately tested a grossly distorted “Ornish diet” that contained 29% fat! To add further insult, they called this falsely fabricated diet “extremely low in fat”. The distortion of the diet was even more serious because the Gardner version of the “Ornish” diet contained 18% protein, which is 70-80% higher than the amount recommended and which is usually found in Ornish type diets.

Four of us in the profession therefore duly submitted our letters to the editor of JAMA to point out these flaws and to seek the investigators’ comments. Most of the time, such letters, after some modest peer review, are routinely published, but not in this case. ¹⁴ ~ ¹⁵

Unfortunately, both Smith and Teicholz have numerous mistakes, For example, Teicholz describes cholesterol as being “yellow”—it is white. Lent is a 40-day period – not 48 days as described by Teicholz.

From the conclusion of The Big Fat Surprise, the overweight Teicholz proclaims:

The advice that comes out of this book is that a higher-fat diet is almost assuredly healthier in every way than one low in fat and high in carbohydrates. […] Moreover, we now know that there are many good reasons to eat animal foods like red meat, cheese, eggs, and whole milk: they are particularly dense in nutrients— far more so than fruits and vegetables. […] And after all, red meat, cheese, and cream are delicious! Not to mention eggs fried in butter, cream sauces, and the drippings from a pan of roasted meats.

According to Ancel Keys, who originated the term, the best Mediterranean diet is “almost vegetarian (or lactovegetarian)” and consists of “pasta in many forms, leaves sprinkled with olive oil, all kinds of vegetables in season, and often cheese, all finished off with fruit, and frequently washed down with wine.” ¹⁶

Perhaps Smith’s conclusion could be extended to, “it’s surely time for better science and for humility among popular commentators.”

Last updated on Tuesday 16 June 2026 at 16:55 by administrators

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Footnotes

Teicholz, N. (2014) The Big Fat Surprise: why butter, meat, and cheese belong in a healthy diet. Scribe.
Stamler, J. (2010) Diet-heart: a problematic revisit. The American Journal of Clinical Nutrition. 91 (3), 497–499.
Pett, K. D., Khan, J., Willet, W. C., & Katz, D. L. (2017, August 1). Ancel Keys and the Seven Countries Study: An Evidence-based Response to Revisionist Histories. True Health Initiative.
Blackburn, H. (2014, July 18). In defense of U research: The Ancel Keys legacy — Star Tribune. http://www.startribune.com/in-defense-of-u-research-the-ancel-keys-legacy/267581481/
Mann, G. V. et al. (1972) Atherosclerosis in the Masai. American Journal of Epidemiology. 95 (1), 26.
Blackburn, H. (n.d.) Ancel Keys – by Henry Blackburn, MD. Available from: https://mbbnet.umn.edu/firsts/blackburn_h.html
Regents of the University of Minnesota (2002) Health Revolutionary: The Life and Work of Ancel Keys. Available from: http://purl.umn.edu/91263.
Truswell, A. S. (2010) Cholesterol and Beyond: The Research on Diet and Coronary Heart Disease 1900-2000. Sections 31.1, 31.4
Yerushalmy, J. & Hilleboe, H. E. (1957) Fat in the Diet and Mortality from Heart Disease. New York State Journal of Medicine. 57 (14), 2343–2354.
Parascandola, M. (2014) Birthweight and mortality: Jacob Yerushalmy on self-selection and the pitfalls of causal inference. International Journal of Epidemiology. 43 (5), 1373–1377.
Fox, M. (2002) Trans-fat increase cholesterol levels [online]. Available from: http://jawawa.id/index.php/newsitem/trans-fat-increase-cholesterol-levels-1447893297Opens in a new window (Accessed 29 March 2017).
Banting, W. (1869) Letter on Corpulence. Fourth Edition. London: Harrison, 59 Pall Mall.
Gardner, C. D. et al. (2007) Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. Journal of the American Medical Association . 297 (9), 969–977.
Campbell, T. C. (2010) Imaginary Science: Commentary on ‘The New Atkins for a New You’. Available from: https://nutritionstudies.org/imaginary-science-commentary-new-atkins-new/.
Campbell, C. (2026) The Upper Safe Limit for Protein Consumption. [online]. Available from: https://nutritionstudies.org/the-upper-safe-limit-for-protein-consumption-excerpt/.
Keys, A. (1995) Mediterranean diet and public health : personal reflections. American Journal of Clinical Nutrition. 61 (6), 1321S–1323S.

Tags: ancel keys bmj cholesterol eggs gi heart disease henry blackburn hilleboe hypertension japan keys maasai masai mediterranean diet olive oil plant based diet robert atkins teicholz yerushalmy

BMJ Editorial – Are Some Diets “Mass Murder”?

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