I recently published a book, Low-Carbohydrate Mania: The Fantasies, Delusions, and Myths. The first part of the book examines four commentaries that promote high-fat, low-carbohydrate diets and shows in some detail how they are deliberately misleading (well, lying to) the public. These commentaries are: Nina Teicholz’s The Big, Fat Surprise; TIME magazine’s article of June 2014, Don’t Blame Fat; Australian Broadcasting Corporation’s documentary Heart of the Matter-Dietary Villains; and BBC’s The Men Who Made Us Fat.At the beginning of the Catalyst program, Dr Maryanne Demasi states, “Is the role of cholesterol in heart disease really one of the biggest myths in medical history?”.
Other popular commentators include Gary Taubes who published an article “What if It’s All Been a Big Fat Lie?’ in The New York Times Magazine in July 2002. He was espousing the virtues of Robert Atkins’ high-fat, low-carbohydrate diet. All the experts he interviewed for the article later stated that he completely misrepresented their views.
Atkins died at the age of 72 in New York in 2003, after falling on ice. His report was mistakenly released to the public. The report suggested that Atkins had “a history of heart attack, congestive heart failure and hypertension.” It also states that his death was caused by a “blunt impact injury of head” and records his weight and height at 258 pounds [117 kg] and 6 feet [182 cm] tall, which is classed as “obese”. At the request of his family, an autopsy was not performed. His supporters state Atkins suffered from cardiomyopathy, which was likely caused by a virus.
Denis Stewart is an obese Hunter Valley herbalist who blames Ancel Keys for the current state of ill-health. He also advocates a Mediterranean-style diet, completely unaware that it was Keys that coined the term. Keys and his wife Margaret lived in a village in southern Italy for 26 years, promoting the virtues of the diet, which Keys described as “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.”
Professor John Funder was chairman of Obesity Australia until his retirement in November 2016. He is obese and believes that “carbohydrates make you fat”. Whatever his beliefs, it did not work for him.
Popular commentators frequently accuse Keys of manipulating data in his 1953 paper, Atherosclerosis, A Problem in Newer Public Health. This study is sometimes referred as the “Six Countries Study”. On page 17 of this 22-page paper there is a graph showing the mortality rate for degenerative heart disease and fat intake for six countries. The food data was obtained from FAO for the year 1949.
A number of popular commentators think this is the Seven Countries Study—they count England & Wales as two countries.
This paper was presented in Amsterdam in 1952 and in January 1953 in New York.
This graph causes a great deal of consternation in the popular press. The claim is made that Keys “cherry-picked” his data, which is stating that he was dishonest.
Yerushalmy and Hilleboe criticized this paper in the publication Fat in the Diet and Mortality from Heart Disease claiming that Keys only choose 6 countries (Japan, Italy, England & Wales, Australia, Canada, U.S.) that supported his hypothesis instead of using the World Health Organization data from the 22 countries that was available. The data for the 22 countries that Yerushalmy and Hilleboe listed were for the years 1951-1953, a period which is after the publication of Keys’s paper.
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.
Y&H state that animal protein is a at least as strong predictor of heart disease as animal fat.
Yerushalmy was later involved in a disagreement with researchers who claimed that women who smoked had lower birth-weight infants. He suggested that smoking was not the cause of the lower birth weight but a result of “mode of life” differences between the smoking population and non-smoking population.
Far too much attention is paid to a minor discussion paper from the early 1950s.
The French paradox is the observation that the French a low incidence of coronary heart disease while having a diet rich in saturated fats, which is an apparent contradiction of standard dietary advice.
France has eight different dietary regions and significant difference in mortality rates. The north and north-west has greater mortality rates than other areas of France.
Ancel Key’s Seven Countries Study (1958 – 1980)
Ancel Keys and colleagues performed surveys between 1958-1970 in populations of men aged 40-59, in sixteen areas of seven countries. Follow-up surveys were continued until the 1990s. A total of 12,763 men were enrolled in the program – approx. 95% of eligible population.
Preliminary studies were carried out in Italy and the Greek island of Crete in 1957. A preliminary study was also performed in Hawaii. American men of European background were compared with Japanese living in Japan and Hawaii. The Japanese, who consumed a traditional Japanese diet had cholesterol levels of 4.1 mmol/L (160 mg/dL) whilst Americans in Hawaii had similar cholesterol to those on the mainland.
The Seven Countries Study was the first to explore associations among diet, risk, and disease in contrasting populations.
Teicholz claims, “A number of critics have since pointed out that had Keys taken the critiques of Yerushalmy to heart, he might have selected a European country to challenge his fat hypothesis, like Switzerland or France (or Germany or Norway or Sweden). Instead, he chose only those nations (based on national statistics) that seemed likely to confirm it.”
Keys and his colleagues studies sixteen contrasting regions in seven countries (Italy, Yugoslavia , Greece, Japan, Finland, Netherlands, USA). They did not study counties. Finland included because it had the highest rate of heart disease in the world and North Karelia had the highest rate in Finland. A contrasting region on the coast was included.
Japan had the lowest rate and tow contrasting regions were examined – a farming region and a coastal fishing region.
Netherlands was included because it was reputed to have a high-fat diet but low heart disease. There were also funding and personnel issues.
Jolliffe (1959), using data from 20 countries, showed a strong correlation with saturated fat and heart disease. This data included Switzerland, France, Germany, Norway, and Sweden.
Artaud-Wild et al (1993), using data from 40 countries, showed a strong correlation with the Cholesterol-Saturated Fat Index per 1000 kcal/day. Even though Artaud-Wild is the lead author of this paper, it is known as the Connor study.
There are strong regional variations in diet and disease patterns in France. Eight different dietary regions in France – with significant health consequences. A north-south-east gradient exists for all-cause mortality, cardiovascular mortality, hypertension, obesity, and MS.
Sugar & Cancer
The proponents of the low-carbohydrate diet contend that the real cause of heart disease is sugar. Frequently, all carbohydrates are made the villain—not just sugar.
John Yudkin was professor of nutrition at Queens College in London. Professor Stewart Truswell was his successor. He wrote Pure, White and Deadly that advocated sugar as being the cause of heart disease, based entirely on the assumption that sugar consumption had increased along with the incidence of heart disease. No references are in the book.
A small case-control study comparing sugar intake of 20 men with heart disease with those that did not. Those with heart disease did consume more sugar.
Also a small rodent trial: high sugar diets raised triglycerides but raised cholesterol less significantly.
A paper published in the International Journal of Cancer, the researchers followed 435,000 subjects for over 7 years. They investigated the association of total sugars, sucrose, fructose, added sugars, added sucrose and added fructose in the diet with risk of 24 cancers.
“We found no association between dietary sugars and risk of colorectal or any other major cancer.”
Protein & AMDR
Russell Henry Chittenden was professor of physiological chemistry at Yale from 1882 to 1922. He was not convinced that the Voit Standard protein requirement was correct. As Chittenden explained:
Fats and carbohydrates when oxidized in the body are ultimately burned to simple gaseous products.
He reduced his own protein intake from 150 grams a day to around 40 grams a day. He lost weight and become healthier.
He repeated the experiment on five sedentary Yale staff (62 g protein per day), then thirteen members of the Army Corps of Engineers (61 g protein per day) who were physically fit and active. Finally, eight Yale Olympic-class athletes repeated the experiment consuming an average of 64 g protein per day. They improved their performance by 30-35% and maintained a positive protein balance—that is, they consumed more protein than they lost.
Note that the Recommended Daily Intake (RDI) is two standard deviations above the average requirements. It meets or exceeds the requirements of 98% of the population. AMDR is the Acceptable Macronutrient Distribution Range.
|Chittenden - 1907||60-64 g / day|
|Human milk - infant requirements||6%|
|Adult requirements - RDI (0.8 g / kg)||8%|
|70 kg male with moderate activity||56 g /day|
|AMDR Protein (Aust)||15%-25%|
|AMDR Protein (USA)||10%-35%|
|US and Australia average protein consumption||16%|
Why is the AMDR 2-4 times greater than required when eating more protein is detrimental?
Effect of war
- The blockade of Germany on World War II saw a marked decrease in heart disease.
- Strom and Jensen – death rate from heart disease decreased when invaded Germans invaded Norway. When the Germans were driven out in 1945, the death rate started to climb again.
- The first Low-Cholesterol Diet book published in 1951 which is prior to Keys 1953 paper.
Seventh Day Adventist’s Studies
60 years of research comparing the effects of vegetarian diets on health. Within the SDA community, the more vegetarian the diet, the better the health outcomes.
Vegan Seven-day Adventists are possibly the healthiest group of people on the planet.
The AHS-1 study showed 30-year-old Adventist males lives 7.3 years longer than the average 30-year-old white Californian male and with females living 4.4 years longer than the average Californian white female. For vegetarians, it is 9.5 years longer for men and 6.1 years longer for women.
Californians are much healthier than the average American. Asians and Hispanics are much healthier than the average white person in the USA.
|Category||%||BMI||Type 2 diabetes
Odds ratio (*)
No red meat, fish, poultry, dairy, eggs
Vegan with eggs and milk
Vegan with fish, milk and eggs
Red meat, poultry less than once a week plus fish, milk, and eggs
Red meat, poultry more than once a week plus fish, milk, and eggs
(*) After adjustment for age, sex, ethnicity, education, income, physical activity, television watching, sleep habits and alcohol use.
Relative Risk or Odds Ratio of cardio-metabolic-related factors among vegan and lacto-ovo-vegetarian Adventists compared with non-vegetarians
|Cause of Mortality||Lacto-ovo-vegetarian||Vegan|
|Ischemic heart disease||0.82||0.90|
Hazard ratio of all-cancer and site-specific cancers among vegan and lacto-ovo-vegetarian Adventists compared with non-vegetarians
As the diet becomes more vegetarian then the risk factors decreased for all categories except for female ischemic heart disease and female urinary tract cancers.Note that the comparisons are within the Adventist community, which is much, much healthier than the general U.S. population.
North Karelia Project
The Seven Countries Study highlighted the high death rate, particularly from heart disease, in North Karelia and Finland. North Karelia is an inland region in Eastern Finland that borders Russia.
The North Karelia Project is documented in a 300-page document produced by Finland’s National Institute for Health and Welfare (THL), in collaboration with the North Karelia Project Foundation.
In 1973, Finland had a highest country death rate for men from cardiac heart disease and North Karelia had the highest rate in Finland.
By 2007, the heart disease death rate for men dropped by 80%. Saturated fat intake decreased from 22% of dietary energy intake to 13% and total fat from 38% to 31–32%.
Over the period from 1971 to 2006, life expectancy at birth rose 8.2 years for males and 7.0 years for females.
Colin Campbell was a nutritional biochemist at Cornell University. In the 1960s, he was involved in nutritional programs in the Philippines to help families provide for their critically undernourished children. Peanuts were one of their preferred sources of protein. It is a legume—great for improving the soil, easy to grow, and is nutritious and tasty.
At the same time, children younger than 10, were dying at alarming rates from liver cancer. Normally liver cancer is an adult disease—and the children dying from the disease were from the most affluent suburbs in Manilla. These are the families that could afford the best housing and the best food.
Whilst in the Philippines, he read a paper in an obscure medical journal. Rats were fed aflatoxin—one of the deadliest carcinogens known. One group of rats was given a diet of 20% protein —and they all died of liver cancer. The second group was given a diet of 5% protein—and they all lived. 100% deaths compared to zero deaths. They were all fed aflatoxin—but only those rats that had a high protein diet died.
A 20% diet of wheat protein, gluten, or pea protein did not result in liver cancer deaths whereas casein, which comprises of 80% of the protein found in cow’s milk, and albumin, which is found in egg white, did result in liver cancer deaths. Plant-based diets are often considered to be lysine deficient. However, adding the amino acid lysine to the wheat protein to match the level found in casein also resulted in cancer deaths.
Significantly, peanuts and corn in the Philippines were often contaminated by aflatoxin—and the wealthy ate Western-style diets, one rich in protein.
Type 2 Diabetes and Insulin Resistance
The result of Type 2 diabetes is that the body does not process sugar effectively, which results in high levels of glucose in the blood.
- high-carbohydrate diet consisting of sugar, candy, syrup, baked potatoes, bananas, and oatmeal, rice, and white bread
- high-fat diet consisting of olive oil, butter, mayonnaise, egg-yolks, and cream
- high-protein diet consisting of lean meat, lean fish, and egg-whites
- the fourth group was placed on a fasting regime
After only two days on their experimental diets, the only group showing a normal, healthy response to the glucose tolerance test was the high-carbohydrate group.
Normally, insulin attaches to protein receptors on the cell’s surface and signals the cell membrane to allow glucose to enter. If there is an accumulation of fat in the cell, it interferes with insulin’s signaling process and glucose cannot enter the cell. Fat can accumulate inside muscle cells even in slim people.
An intervention trial, published in 2006, compared 99 individuals being treated for type 2 diabetes. 49 were placed on a low-fat vegan diet and 50 on a diet following the American Diabetes Association (ADA) diet. The results were compared after a 22 week period.
In every criteria measured, the participants in the low-fat vegan diet performed better than those following the ADA diet. The values shown are the average of the two groups.
Joseph Goldstein and Michael Brown are two of the giants of twentieth century medical research. They discovered the low-density lipoprotein (LDL) receptors on the surface of cells that bind to the low-density lipoproteins (LDL) that transport cholesterol. This allows cholesterol to enter the cells from the blood. This work earned them the Nobel Prize in Physiology or Medicine in 1985.
Brown and Goldstein’s discovery of scavenger receptors on macrophage (a type of white blood cell that engulfs foreign particles) cells was another of their important findings. Macrophages cross into the sub-endothelial space and engulf the LDL that contain oxidized cholesterol. The process of inflammation was (and still is by some popular commentators) regarded as a competing hypothesis to the role of fats and cholesterol in heart disease. However, the inflammatory process is always preceded by high serum cholesterol.
In a speech at the 2006 International Achievement Summit in Los Angeles, Brown tells the Academy’s students that heart disease is totally preventable.
Cholesterol skeptics ignore the extensive work of Goldstein and Brown and do not attempt to dispute their results.
Multiple Sclerosis – Roy Swank – late 1940s Norway
- Associated MS with animal foods – saturated fats
- Inland dairy areas of Norway had higher MS rates than coastal areas
- 144 MS patients recruited from the Montreal
- Comprehensive records kept for 34 years
- Compared good dieters with poor dieters
- Good dieters: “about 95% remained mildly disabled for thirty years.” – only 5% of those patients died
- 80% with early MS with the “poor” diet died of MS
Eric Rimm, Walter Willett, James Anderson
Eric Rimm, a nutritional epidemiologist at the Harvard School of Public Health
Walter Willet – Harvard epidemiologist – Director of Harvard Nurses’ Study
It should be noted that living with diabetes is not always practical either.
William Roberts is a leading cardiovascular pathologist. He is the current editor (at 2016) of the American Journal of Cardiology—a position he has held since 1982. He has published over 1,500 articles. Roberts served as the first head of the pathology service at the National Heart, Lung, and Blood Institute at the National Institutes of Health from 1964 to 1993. He has been located at Baylor Heart and Vascular Institute and Baylor University Medical Center in Dallas, Texas since 1993.
Dr Roberts wrote an editorial titled, We think we are one, we act as if we are one, but we are not one. He was referring to us thinking that we are “carnivores”. His conclusion is:
Carnivores have claws to hunt prey, smaller stomach and intestines, synthesize vitamin C, lap water, have sharper teeth, and have stronger jaws. Try catching a buffalo or a mammoth with your bare hands and making a meal out of the carcass without tools.
Dr Roberts has also suggested cholesterol goals should be less than 4.0 mmol/L for total cholesterol and less than 1.5 mmol/L for LDL cholesterol. He also contends there is only one risk factor for heart disease—that is, “It’s the cholesterol, stupid”, and that the HDL-cholesterol is largely irrelevant.
- McLaughlin, K. & Winslow, R. (2004) Report Details Dr. Atkins’s Health Problems. New York Journal. 10 February. [online]. Available from: www.wsj.com/articles/SB107637899384525268. (Accessed 23 November 2015).
- Keys, A. (1995) Mediterranean diet and public health : personal reflections. American Journal of Clinical Nutrition. 61 (6), 1321S–1323S.
- Tunstall-Pedoe, H. (2008) The French Paradox : Fact or Fiction? Dialogues in Cardiovascular Medicine. 13 (3), 159–179.
- Chittenden, R. H. (1904) Physiological economy in nutrition, with special reference to the minimal protein requirement of the healthy man. An experimental study. New York: Frederick A. Stokes Company.
- Tonstad, S. et al. (2009) Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. 32 (5), 791–796.
- Fraser, G. E. (1999) Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. The American Journal of Clinical Nutrition. 70 (3), 532s–538s.
- Le, L. & Sabate, J. (2014) Beyond Meatless, the Health Effects of Vegan Diets: Findings from the Adventist Cohorts. Nutrients. 6 (6), 2131–2147.
- Campbell, T. C. & Campbell, T. M. (2006) The China Study. Dallas USA: Benbella Books.
- Barnard, N. D. et al. (2006) A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes. Diabetes Care. 29 (8), 1777–1783.
- Fox, M. (2002) Trans-fat increase cholesterol levels [online]. Available from: http://jawawa.id/index.php/newsitem/trans-fat-increase-cholesterol-levels-1447893297 (Accessed 29 March 2017).
- Kolata, G. (1990) Animal Fat is Tied to Colon Cancer – New York Times [online]. Available from: http://www.nytimes.com/1990/12/13/us/animal-fat-is-tied-to-colon-cancer.html (Accessed 28 January 2017).
- Anderson, J. et al. (1987) Dietary fiber and diabetes: a comprehensive review and practical application. Journal of the American Dietetic Association. 87 (9),
- Roberts, W. C. (1991) We think we are one, we act as if we are one, but we are not one. American Journal of Cardiology. 66 (10), 896.