The Truth About Ancel Keys: We’ve All Got It Wrong

(Note: This post was inspired by the “Ancel Keys” section in a recent series of paleo-challenging YouTube videos, which I may critique in the future. The anonymous videomaker “Plant Positive” highlighted some important misconceptions about Keys and his research that I’d like to broadcast to a larger audience, but didn’t address some equally important points tangled in the Keys saga, and likewise made some arguments I believe are incomplete or misleading. This blog post is an attempt to address those misconceptions in a more balanced and thorough way, and provide a broader context for how we view the infamous Mr. Keys.)

This is one of those “gotta bust me some myths no matter where they come from” blog posts. And by that, I mean I’m about to challenge a story that’s been so well-circulated among paleo, low carb, and real-food communities that most of us have filed it away in a little brain-folder called “Things We Never Have to Question Because They’re So Ridiculously True.”

I’m talking about the late, great Ancel Keys, and his equally late (but maybe not as great) role in the history of heart disease research. The oft-repeated tale goes something like this:

Once upon a time, a scientist named Ancel Keys did an awful thing. He published a study about different countries that made it look like heart disease was associated with fat intake. But the truth was that he started out with 22 countries and just tossed out the ones that didn’t fit his hypothesis! When other researchers analyzed his data using all the original countries, the link between fat and heart disease totally vanished. Keys was a fraud, and he’s the reason my mom made me eat skim milk and Corn Chex for breakfast instead of delicious bacon and eggs. LET HIS SOUL BURN. BURN! BUUUUUURN!

Depending on who tells the story, some of the details (and wishes for eternal hellfire) may differ. But in many cases, Keys’ infamous cherry-picking is attributed to his Seven Countries Study, a landmark project that helped sculpt our common beliefs about fat. Even the Seven Countries Study page on Wikipedia—the first hit when you Google “Seven Countries Study”—says that Keys shamelessly erased the data he didn’t like:

The study began with a great many more countries … but Keys deleted the countries whose results did not match his pre-conceived conclusions, leaving him with only Japan, Italy, Great Britain, Australia, Canada and the US. Full disclosure would have made a great deal of difference.

Ditto for the page on Ancel Keys himself:

Keys collected data on deaths from coronary heart disease and fat consumption from 22 countries. Despite the fact that 22 countries provided statistics, Keys cherry-picked the data from the 7 countries which supported his theory that animal fat was the main cause of coronary heart disease in order to publicize his opinions. The results of what later became known as the “Seven Countries Study” appeared to show that serum cholesterol was strongly related to coronary heart disease mortality both at the population and at the individual level.

…And we all know Wikipedia would never lead us astray. Other big-hitters in the nutrition blogosphere have repeated this version as well, dismissing the Seven Countries Study as manipulated bias, and claiming Keys’ theory fell apart once some discarded countries were added back in—making it all the more troubling that the study became so influential.

This, we’re told, is Keys’ cherry-picked graph:

The upward curve of doom.

And this, we’re told, is the graph with all 22 countries and a diminished fat-and-heart-disease association:

And this, we’re told, is the man who ruined the world:

Unfortunately, reality sometimes infringes on the things we’d prefer to consider “facts.” This is one such occasion.

The Truth:

  • Ancel Keys did not drop any countries from the Seven Countries Study. His most famous graph—the first one up above—is from a different paper he presented at a World Health Organization (WHO) conference in 1955. The Seven Countries Study didn’t even launch until 1958, and entailed much more than just plopping numbers into a pretty curve. (That said, the Seven Countries Study had plenty of problems too; some are mentioned on this site.)
  • Contrary to popular belief, the cherry-picked graph didn’t convince everyone that fat was evil. In fact, Keys was pretty much ridiculed for the weakness of his fat/heart disease theory by other scientists at the WHO meeting, and whenever his graph was cited in medical journals later on, it was usually paired with some criticism. Although Keys’ work definitely shaped our current beliefs about fat, this graph didn’t exactly take the world by storm. (More on this later.)
  • When all 22 countries were analyzed, the association between fat and heart disease did not go away. It actually remained statistically significant (meaning it probably wasn’t due to chance). And to make matters worse, the paper frequently cited as a “rebuttal” to Keys shows pretty clearly that animal protein had an even stronger association with heart disease than total fat did. The China Study was right all along! Time to go vegan, you guys. (Just kidding. But this part is the most interesting of all, and we’ll examine it in excruciating depth in a moment.)

Although some of his saga has been misconstrued, Keys was still far from perfect—and his eventual role in demonizing saturated fats (while glorifying polyunsaturated fats) has led us down an unfortunate road. My goal is neither to nudge Mr. Keys into sainthood nor to perpetuate his villain status—only to lay out the history and data as objectively as possible.

Here’s the more detailed scoop.

The six-country graph

Let’s look at this sucker again—smaller now, to symbolize its diminished importance (and to ease the burden of scrolling):

Keys published this graph in 1953 in a paper called called “Atherosclerosis: A problem in newer public health” (which is apparently so brilliant that neither the abstract nor full text is allowed to exist online). It was simple, really: he graphed fat consumption alongside heart disease mortality in men from six different countries—and voila! The data points landed in a tidy little line. Keys first unveiled his Wonder Curve to a handful of people at Mt. Sinai Hospital in New York, but his most famous presentation was at that WHO conference a few years later.

Curiously, instead of rolling around on the floor possessed by fat-phobia demons, his WHO audience reacted with skepticism. One report says another researcher challenged Keys to describe his “best piece of evidence” for the diet-heart idea, and effectively squashed Keys’ argument with his Oxford-educated debate tactics. As a result, poor Keys never got to show all the WHOs down in WHOville the full reasoning behind his theory, and left the conference rather defeated. (At least he didn’t steal Christmas.)

But the debate humiliation was small potatoes compared to what came next. In 1957, Jacob Yerushalmy and Herman Hilleboe—Berkeley statistician and New York State Commissioner of Health, respectively, who’d both attended the WHO meeting with Keys—wrote a scathing critique of Keys’ beloved graph. Their paper was titled “Fat in the diet and mortality from heart disease: A methodological note.” This, my friends, is the rebuttal that gets cited near and far as proof of Keys’ fraudulence, and is the source of that “original 22 countries” graph we saw a bit ago.

It’s a pretty good paper, almost clairvoyantly identifying problems that would plague epidemiology for decades to come. And like most pretty good papers, I can’t link to it for free anywhere online. Which means I’ll be screen-shotting excessively from a copy Peter at Hyperlipid kindly sent me a few months ago. (Thanks, Peter!)

It starts out with a nugget of wisdom about “indirect” studies (e.g., playing connect-the-dots with observational data):

It is well known that the indirect method merely suggests that there is an association between the characteristics studied and mortality rates and, further, that no matter how plausible such an association may appear, it is not in itself proof of a cause-effect relationship. But quotation and repetition of the suggestive association soon creates the impression that the relationship is truly valid, and ultimately it acquires status as a supporting link in a chain of presumed proof.

True that, Yerushalmy and Hilleboe. True. That. But I realize we’re not here for wisdom nuggets; we’re here to learn the truth about Ancel Keys and his picking of cherries. Here’s where the paper gets interesting:

Since no information is given by Keys on how or why the six countries were selected [for his graph], it is necessary to investigate the association between dietary fat and heart disease mortality in all countries for which information is available.

That’s right, folks. At the time he made his six-country graph, Keys actually had access to a much larger database of food intake and mortality statistics for 22 countries. Why he chose only six will forever remain one of life’s great mysteries.

And thusly, we’re presented with this. The graph with all the original countries in their non-manipulated glory. Drumroll, please. (For purposes of suspense and unbridled excitement, pretend you didn’t already see this graph a few minutes ago.) Here we have…

…a less defined, but existent upward trend. Yeah, it’s still there.

But wait! Wasn’t this graph supposed to demolish the association between fat intake and heart disease among the 22 countries? Aren’t we told that was the epic discovery of this paper? Yerushalmy and Hilleboe concede that although Keys’ six countries “greatly exaggerated the importance of the association,” the full graph still shows that there’s “some association in the conventional sense between the two variables.” And as we’ll see shortly, that “some association” was actually quite large—a statistically significant r-value of 0.59 (p < 0.02), which is pretty hefty in math-speak.

So here’s what we’ve got so far:

  1. Keys cherry-picked six countries and never told us why.
  2. The cherry-picking was shameful and terrible and unscientific, but the fat/heart disease association among his six countries was also present in the full set of data. Keys didn’t just make it up.

I’m not going to pat Keys on the back for deliberately choosing countries to make his case look stronger, but in terms of historical accuracy, we can’t say that he actually lied. His biggest error, in fact, had less to do with data-deletion and more to do with tunnel vision. Along with failing to explore reasons why fat might be linked to heart disease in a non-causal way, it seems Keys had his eyes locked so tightly on his lovely lipids that he didn’t notice the role of other dietary factors.

And indeed, this is where Yerushalmy and Hilleboe really hammer the heck out of Keys (he could surely never open a door again). In their paper, they explain that—in order to gauge whether the fat-heart disease relationship is really noteworthy—we also have to look at the relationship between heart disease and other elements of diet. Is fat as a category really the strongest link? Certain subsets of fat? A different macronutrient altogether? What’s the deal?

Luckily, the paper supplies us with a chart answering those very questions, using the same data Keys drew from. Apologies for the crookedness of it all. (Edit: A huge thank-you to Tynan Smith for removing said crookedness and emailing me the improved version below!)

There’s a lot going on here, so for now, let’s just look at that first column that says B-26. That’s neither a vitamin nor a rock band: it’s the official classification for “arteriosclerotic and degenerative heart disease,” which is the mortality category Keys used in his six-country graph.

To make it a little easier to prune through, here’s the B-26 column typed out. Values higher than about 0.43 (or less than -0.43) are considered statistically significant, meaning the association is very likely to be valid and not just due to random chance. Positive numbers indicate a positive correlation—heart disease goes up hand-in-hand with the food variable. Negative numbers indicate an inverse correlation—heart disease goes down as the food variable goes up.

  • Total calories: 0.723
  • Total calories from fat: 0.659
  • Total calories from animal fat: 0.684
  • Total calories from vegetable fat: -0.236
  • Total calories from protein: 0.709
  • Total calories from animal protein: 0.756
  • Total calories from vegetable protein: -0.430
  • Total calories from carbohydrate: 0.305
  • Percent of calories from fat: 0.587
  • Percent of calories from animal fat: 0.677
  • Percent of calories from vegetable fat: -0.468
  • Percent of calories from protein: 0.172
  • Percent of calories from animal protein: 0.643
  • Percent of calories from vegetable protein: -0.651
  • Percent of calories from carbohydrate: -0.562

No use in beating around the bush. After statistic-ifying all 22 countries, Yerushalmy and Hilleboe found that not only was “fat as percent of total calories” still associated with heart disease (r = 0.59), but animal fat was clearly driving that correlation. In fact, plant fat had a negative association with heart disease (-0.47) while animal fat was uber positive (0.68). And to rub salt into the wounds of omnivores everywhere, the animal protein/plant protein division was equally stark: animal protein as a percent of total calories had a correlation of 0.64 with heart disease, while plant protein had an inverse correlation of -0.65.

In number-free language, this means the countries eating more animal foods were—as a general trend—reporting more deaths from heart disease.

As with any observational data, this doesn’t tell us diddly squat about cause and effect. Drawing correlations between countries is particularly risky because of massive confounding that’s almost impossible to account for. But if we’re going to be honest about these specific numbers, a heart disease/animal food relationship is very much there.

Oh, the irony. The fat Keys focused on for his 1953 graph was basically a reflection of meat and dairy. We’ve lambasted him for not using all the available data, but if he had, he might’ve turned his “correlation is causation” laser-gaze onto animal foods and plumb gone vegan.

Come join us, Ancel.

In fact, the relationship with heart disease and animal foods rather than “fat as a percent of total calories” becomes even more obvious when we improve the data a bit. Yerushalmy and Hilleboe—those perceptive fellas—note that the countries with the lowest rates of “death from arteriosclerosis and degenerative heart disease” had suspiciously high rates of “death from other diseases of the heart” (or B-27, if you want to get fancy):

Odd, oui? Yerushalmy and Hilleboe offer the most logical reason:

…unless there is a reasonable explanation for the high rates in these countries in this less definitive group of “other diseases of the heart,” it may be safer to operate on the assumption that in these three countries [Chile, Mexico, and France] some deaths from arteriosclerotic and degenerative heart disease are being recorded under the broad group of “other diseases of the heart.”

Indeed, classifying heart disease deaths was pretty inconsistent in the mid-1900s—and even today, “death coding” practices vary widely between countries. To get a more accurate picture, Yerushalmy and Hilleboe recommend combining the “death from arteriosclerotic and degenerative heart disease” with “other diseases of the heart,” instead of using only B-26 like Keys did. And when we do that, our correlations shift a bit. Here’s the “B-26 + B-27” column from two charts ago:

  • Total calories: 0.593
  • Total calories from fat: 0.470
  • Total calories from animal fat: 0.562
  • Total calories from vegetable fat: -0.282
  • Total calories from protein: 0.694
  • Total calories from animal protein: 0.695
  • Total calories from vegetable protein: -0.153
  • Total calories from carbohydrate: 0.423
  • Percent of calories from fat: 0.390
  • Percent of calories from animal fat: 0.557
  • Percent of calories from vegetable fat: -0.509
  • Percent of calories from protein: 0.465
  • Percent of calories from animal protein: 0.608
  • Percent of calories from vegetable protein: -0.483
  • Percent of calories from carbohydrate: -0.386

Nearly all the correlations got weaker, but Keys’ favorite variable—”percent of calories from fat”—dropped off into statistical-insignificance land. Animal fat and protein, however, remained strongly associated with heart disease deaths. (Gasp shock horror!)

(Note: Even though adding “other diseases of the heart” to the mix probably gives a better picture of heart disease trends, it’s quite possible—maybe inevitable—that the mortality data is still skewed for some of the “healthiest” looking countries. A WHO paper called “Miscoding and misclassification of ischaemic heart disease mortality” (PDF) points out that countries like Japan, France, and Portugal have historically been “high ill-defined coders,” meaning they dump a large portion of heart disease deaths into the wrong category. This is typically because of insufficient diagnostic methods (especially for low-income countries), local medical practices (such as Japan’s tendency to write off coronary heart disease as “heart failure”), or simple physician error. Interestingly, the WHO paper also notes that the apparent rise in heart disease as countries become “more developed” is probably due to better classification on death certificates rather than an actual increase in the disease.)

But the story’s not over yet, folks.

Yerushalmy and Hilleboe ramp it up a notch by posing the question: “How does fat (and by extension, animal food variables) relate to other causes of death?” We’ve seen what happens with heart disease, but there are certainly many other ways for the human body to perish. Are the folks eating more fat, animal fat, and animal protein generally dropping faster than their more plant-focused counterparts?

Time for another table. Omnivores, wipe away your tears. Vegans, put away your kazoos. The playing field’s about to change.

Let’s look, first, at that middle column—deaths from everything other than diseases of the heart. Notice a pattern?

  • Total calories: -0.530
  • Total calories from fat: -0.674
  • Total calories from animal fat: -0.466
  • Total calories from vegetable fat: 0.296
  • Total calories from protein: -0.398
  • Total calories from animal protein: –0.505
  • Total calories from vegetable protein: 0.452
  • Total calories from carbohydrate: 0.172
  • Percent of calories from fat: -0.657
  • Percent of calories from animal fat: –0.481
  • Percent of calories from vegetable fat: -0.090
  • Percent of calories from protein: -0.080
  • Percent of calories from animal protein: -0.405
  • Percent of calories from vegetable protein: 0.521
  • Percent of calories from carbohydrate: 0.671

We’re basically staring at the reverse image of that earlier heart disease chart. Fat now has the strongest negative association with mortality out of any variable—a whopping -0.674 for “total calories from fat” and -0.657 for “percentage of calories from fat” (highlighted in purple). Animal fat and animal protein, but not plant fat or plant protein, are also strongly negatively associated with non-heart-disease mortality. You may notice, too, that the folks with a higher percent of calories from carbohydrate had the greatest mortality in this age range.

Even if we look at the first column for “death from all causes”—which is a little less impressive, because none of the numbers reach statistical significance—we see that all of the animal food correlations are negative. The only positive correlations, weak as they may be, are with plant protein and carbohydrates.

The results are clear. When we look at “non-cardiac deaths,” it’s the folks eating more animal fat and animal protein who are stayin’ alive. And when we look at overall mortality, animal foods sure don’t seem like stealthy killers.

Out of curiosity, I tried graphing the life expectancy for the countries in 1950 against their fat intake to see what would happen. Considering that the bulk of each nation’s fat intake came from animal sources, plotting animal food against life expectancy would probably turn out similar. (Life expectancy data taken from EarthTrends.)

Although the dots are pretty scattered when fat intake is below 25% of calories, the trend becomes unmistakable once that number passes 30%: countries with higher average fat intake had the longest life expectancies.

But does any of this—the life expectancy graph and the “death from other causes” table—prove that eating more fat and animal foods makes you live longer, or eating more carbohydrates makes you die sooner? Heck to the no. Same goes for interpreting the animal food/heart disease relationship in this data as a reason to go veggie. Yerushalmy and Hilleboe explain precisely why we shouldn’t assign a cause-and-effect relationship to anything we’ve seen so far (emphasis mine):

Table IV shows that fat calories and animal protein calories, which were seen above to be positively associated with heart disease, are here negatively associated with noncardiac diseases. A … plausible explanation is that the dietary components which according to the rank correlation coefficients appeared to be positively related to heart disease are indices of the various countries. That is, it may be that the amount of fat and protein available for consumption is an index of a country’s development, industrially, nutritionally, medically, and no doubt in other respects as well.

Bingo. Intake of fat and protein—particularly from animal sources—is usually a proxy for a country’s development. These foods goes hand-in-hand with other features specific to industrialization, making their relationship with disease likely to be confounded. Continuing on:

It may also be that countries with more abundant diet are more high developed and diagnostic acumen is greater. Hence, it is possible that in some of the countries in which less protein and fat are available, a certain percentage of deaths from arteriosclerotic and degenerative heart disease are recorded under the non cardiac groupings.

Bingo again. As we saw in the WHO paper I referenced earlier (PDF), diagnostic patterns vary tremendously between countries. This paper even points out that the countries with the highest apparent rates of coronary heart disease often have the most valid death classifications as well. In fact, if we X-out the countries with the worst track record for classifying heart disease and circle the countries whose accuracy was nearly perfect, our 22-country graph looks pretty striking. (Mexico gets an X because it didn’t even have a death-certificate system until the late 1950s (hat tip to Plant Positive for noting this on his Primitive Nutrition videos). Ceylon/Sri Lanka and Chile—numbers 4 and 5 at the bottom—aren’t mentioned in the WHO paper one way or another, but I imagine they deserve some Xs too.)

Keep in mind that the WHO paper looks at mortality data for the ’70s through ’90s, while the graph above uses mortality data from 1948 and 1949. It’s possible that some of the countries improved their death-classifying practices in the decades between, so this graph should be taken with a grain of salt. Especially if you have low blood pressure.

But back to Yerushalmy and Hilleboe for a moment because they’re so awesome:

Moreover, as Table IV shows, there are appreciable negative correlation coefficients between dietary components and death rates from B-45 (“senility, ill-defined and unknown causes”). The latter category may be considered a rough index of the accuracy of cause of death certification in the different countries. The negative association with protein and fat is further evidence of the non-“specificity” of the presumed association.

Indeed, if we glance at that third column from a couple graphs ago (click here to open it in a new window so you don’t get lost in scrolling-limbo), we’ll see that animal food variables have strong inverse associations with this death category, while the plant food variables have strong positive associations with it. Senility, ill-defined, and unknown causes are the equivalent of a doctor saying “Gee, I dunno why this person died so I’ll just file them away under one of these vague, essentially meaningless categories!” Such a scenario is much more likely in an under-developed area with shoddy medical care than an industrialized country with more diagnostic precision.

I wanted to explore this issue even further, so I dug up some data for each country’s gross domestic product (GDP) per capita in 1950. This is the measure of a country’s economic output divided by the population, and is a pretty good way to estimate standard of living. (Numbers taken from NationMaster; Israel and Ceylon/Sri Lanka are omitted because I couldn’t find their data from this year.)

So there we have it: more kindle for the idea that fat intake generally reflects a nation’s economic status and level of industrialization, and is hence vulnerable to confounding. (Or maybe correlation really is causation, and inhaling sticks of butter will make your country richer! Only one way to find out…)

One final, super-important point that could quite possibly render everything else useless: The diet data for our 22 countries comes from F.A.O. food balance sheets—which show how much food was available for consumption in each country, rather than how much food was actually consumed. If this sounds like a totally weird and unreliable way to measure what people eat, that’s because it is. Yerushalmy and Hilleboe explain the problem further:

These indices were constructed by the Food and Agriculture Organization of the United Nations from statistics on production, imports, exports, and on the proportion of available food used for purposes other than human nutrition. The underlying data are stated by F.A.O. to be subject to great limitations. Moreover, there are no doubt great differences in food “scraps” in the various countries compared. For example, it is highly probable that far more edible dietary fat is thrown into waste cans in the United States than in less fortunate countries.
Dur. Although this doesn’t mean the data for the 22 countries is bogus, it does mean the fat intake (as well as total calories) for wealthier nations may be overestimated. Maybe by a lot. Indeed, there’s a strong connection between how abundant food is and how much of it we waste.

That about covers it for the Yerushalmy and Hilleboe paper. Isn’t it neat that we just did a deeper analysis of the 1950s data than Keys himself probably did? Here’s a summary of the major points in case your eyes glazed over for any of that:

  • Yep, Keys picked some cherries—but a link between fat intake and heart disease mortality existed among all 22 countries, not just his six-country graph. And as Yerushalmy and Hilleboe’s paper revealed, the real force behind that correlation was animal fat intake, not just fat as a general category. Keys definitely should’ve facepalmed himself for not looking at the data more carefully, but even if he’d been scrupulous, he probably still would’ve launched the anti-saturated-fat crusade that defined his later career.
  • Although total fat, animal fat, and animal protein were associated with heart disease in this data, those variables were associated with less death from pretty much everything else. Overall, the countries with higher fat and animal food intake had longer life expectancies than the rest. This doesn’t prove that animal foods make you immortal or that plant foods will slit your throat in the middle of the night: it’s mostly a result of countries with more money and a higher standard of living tending to eat more animal products (along with having lower rates of infectious disease, better health care, diets higher in industrially processed foods, and so forth). There’s so much confounding involved with this subject that I don’t even wanna touch it with a ten-foot statistical pole.

  • A lot of countries suck at classifying heart disease deaths under the right label. Especially less-developed nations with sketchy medical care. This makes it look like some countries have abnormally low rates of heart disease, when in reality, they just have abnormally high rates of messing up.
  • The F.A.O. data that Keys (and others of his time) used is probably the most inaccurate way to measure food consumption ever invented. Because food-balance data doesn’t account for stuff people throw away, wealthier countries are always going to look like they have a higher intake of pretty much everything compared to poorer countries. It’s impossible to say how much this influenced the link between fat or animal foods and mortality rates, but the impact might’ve been pretty big.
  • Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t causation. Correlation isn’t a cucumber. (Just making sure you’re awake.)
Now back to Keys. I’m mostly interested in clearing up the confusion about the Yerushalmy and Hilleboe paper and what it really showed about Keys’ cherry-picked graph, so I’m not going to tweeze through the rest of his work with the same Aspergers-esque detail. (At least not in this blog post—the real Seven Countries Study probably deserves an eventual skewering.) But I do want to address something interesting about Keys that many people aren’t aware of, which is…

Keys on dietary cholesterol: one thing he got right

Although Keys was staunch in his belief that saturated fat causes heart disease by raising blood cholesterol, he was one of the brave few who insisted that dietary cholesterol was pretty much irrelevant. Thanks to a slew of early animal experiments—such as Nikolai Anitschkow’s famous rabbits—that used dietary cholesterol to induce atherosclerotic lesions, implicating dietary cholesterol with heart disease was all the rage for a while. For a long while, actually, considering how many folks today still to dump their egg yolks down the drain.

But Ancel didn’t buy it. In his paper “Human atherosclerosis and the diet” (PDF), he writes that “from these animal experiments only, the most reasonable conclusion would be that the cholesterol content of human diets is unimportant in human atherosclerosis.” Likewise, in some of his metabolic ward studies, Keys found that altering dietary cholesterol in the context of a normal diet had only minor effects on blood cholesterol, concluding that “attention to this factor alone accomplishes little.” And in his paper “The relationship of the diet to the development of atherosclerosis in man,” Keys is pretty clear about his views:

The evidence—both from experiments and from field surveys—indicates that the cholesterol content, per se, of all natural diets has no significant effect on either the serum cholesterol level or the development of atherosclerosis in man.

Good for him.

And since I probably won’t write any more blog posts until 2012 (unless someone surgically implants a new month between December and January), I want to use this final paragraph to tell everyone who reads this blog that I love you and appreciate your readership more than you could possibly imagine. I’m continually astounded that you guys not only bear with me through my sporadic blogging habits, but also create such awesome dialogues in the comment section. You people rock my world. If I were wearing socks right now, those would be rocked, too. I really mean it. Have a wonderful new year, everyone!



  1. I think when you work so hard to come up on a conclusion based on study of the actual data then you should be impartial and neutral and let the actual statistics do the talking. I think keys, instead of taking the pains of studying data from so many countries and had concentrated on only one country, India, which has got most heart patients than any other country in the world, would have saved lots of energy and probably had his preconceived notions busted because India is the only country in the world, which has got greatest number of vegetarians.

    1. Good point. The mark of a good research scientist is to search for evidence that is contrary to his theory. When evidence is found then his whole theory should be abandoned. This is where Campbell is a total fail. He completely ignores any evidence that does not support his beliefs. This probably is motivated by either income from selling a book or pushing his bias onto the public. Both? The French paradox is not a paradox…it is the reason the whole lipid theory should end in the toilet.

      1. Dr. Keyes KNEW dietary cholesterol had ZERO, ZIP, NADA to do with causing high cholesterol and heart disease. In brilliant HONEST Dr. Jerry Tennant’s book “Healing is Voltage” Dr. Tennant found that BEFORE and AFTER Dr. Keyes published some 100 papers – most likely all his papers were peer reviewed BS – Keyes wrote that dietary cholesterol has zero, zip, nada to do with one’s cholesterol level. We know from the Framingham study that has now gone on for over 40 years that the director says those who eat the MOST saturated fat, the most cholesterol and are slim (eating fat does provide healthier energy, healthier adrenals and does make one more easily saited and thus slim) have the least heart disease. So Keyes knew and Big Pharma wanted us to eat more grains that are high glycemic and cause leptin resistance and obesity. His info was 100% pure praganda designed to create disinfo and thus disease. Dr. Weston Price long ago proved those that eat grains and sugar and not a high fat cholesterol diet had more cavities, smaller jaws, brain and skeletal problems and disease. Watch “The Oiling of America” by Sally Fallon on youtube. Cholesterol is healthy for us if it is not pasteurized.

  2. Lovely stuff.

    I’ve just spent half an hour (!) reading the comments and did not even get half way! No mention of what surely is a huge elephant in the blog: Did Keyes have some connection (whether overt or covert) with the margarine industry. I wouldn’t mind betting that he did.

    Pierre Meneton:
    “Qui dit intérêts économiques dit manipulation des données » (Wherever you find vested interests you will find manipulation of the data).

    Pierre Meneton – French government researcher and whistleblower sued for defamation by the French salt industry for daring to speak out about the financial links between vested interests and supposedly independent researchers and saying that salt consumption in France was double what all nutritional experts knew was the safe level. The case was dismissed.

  3. Thanks for your personal marvelous posting! I actually enjoyed reading it, you’re a great author.I will make sure to bookmark your blog and will come back in the foreseeable future. I want to encourage that you continue your great writing, have a nice morning!

  4. Denise, I’m new to your blog and, more generally, ALL of these online nutritional debates. Unlike many (or most) here and in the nutrition blogosphere, I don’t really have any predetermined view or agenda at all. I am not a particularly healthy person (I like beer and I’m an intermittent smoker (GASP)). As a semi-lucid American, I’m interested in the obesity epidemic, especially as it hits my pocketbook and bankrupts my country. I’m not a vegan or vegetarian, and, honestly, I think the Paleo diet’s intellectual underpinnings are sort of funny. If we can’t figure out our own nutritional biosphere, trying to emulate one from 10,000 years ago seems….aggressive. And kind of fun, actually (which I believe is criminally underrated by the serious nutrition crowd. I fell into the arena while researching my personal cholesterol issues (10+ years of very high TC (like 375) very high LDL, very high HDL and low triglycerides; at ideal weight and active, no signs of insulin resistance). I had read a few articles by Gary Taubes on sugar/simple carbs and they are very difficult to fault, and then a week ago I ran across Dr. Peter Attia’s site. I’ve generally avoided nutrition blogs because everyone seems to have a preformed opinion and all data is molded to fit such (much like some of the comments in this section…). What caught me about your site, Attia’s and some others is how…even handed you generally are. I am quite intellectually curious (I have been accused of hating conventional wisdom) and I have been amazed at how little evidence there is for the low fat diet’s health benefit, or the high fat diet’s danger (notwithstanding some fellow named Richard’s opinions). My goal is not health maximization, but truth maximization, so that I and others can make decisions based on the best science out there. I might decide to eat more healthy so I can sneak a few more cigs with less guilt, after all. I’d also like to have a solid enough understanding of both nutrition and blood chemistry to make reasoned decisions about my own healthcare, primarily the use of pharmaceuticals to control cholesterol. I don’t want to hear “never” and I don’t want to hear “always” from people whose motivations I distrust, or who don’t have the intellectual chops to really understand the current state of scientific research (speaking of…that Attia fellow is something else!). If nothing else, you and Dr. Attia have taught me how to critically review epidemiological studies in order to form my own opinions. Honestly, I’ve read the media reports for these for years, screaming “correlation is not causation!!!” Thank you, and I look forward to your future work. I’d also like to add that I am unbelievably impressed with your willingness to take on the intellectual establishent in its own living room as an outsider. The world has truly changed, and for the better, such that brilliant and hard working outsiders can legitimately do so. I hope you have a thick skin!

  5. I would highly recommend going to the website. He does more than just “highlight some misconceptions about Keys ” , he presents a full historical and scientific basis for Keys’ significant and groundbreaking research. The ‘controversy’ over his research is essentially fabricated. The discussion is incredibly compelling and easy to absorb.

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      1. The great irony here is that, as the article points out, it’s likely a ‘vegan’ product, all the vegetable oils widely consumed in the typical American diet, at the heart of heart disease. Denise has also pointed out that another vegan product, wheat, has an association with heart disease from the China Study data.

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  11. I haven’t read through the comments section, so I don’t know if anyone has added these thoughts yet or not, but I felt they were relevant to the discussion:

    1) Ancel Keys himself died at 100 years of age. While he refused to attribute it to his diet due to lack of a study following 5000 people on the same diet, I am curious to know at what age Yerushalmy and Hilleboe died?

    2) As for “all causes of death”, you briefly mention infectious diseases but does this classification also include homicides, suicides, and accidents? Wouldn’t that also skew these statistics?

    3) Ancel Keys did say that dietary cholesterol was not correlated with blood cholesterol, but he also attributed it to dietary saturated fat which caused the liver to manufacture its own cholesterol. Saturated fat is in both vegetable (avocados/coconuts) fats as well as animal.

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  13. Thank you Denise, I very much enjoyed your article and its in-depth analysis. I do have one question relating to Keys’ 22 country graph. I am finding it hard to reconcile the discrepancies in the data.

    Israel’s fat intake is about the same as France and some of the South American countries, but its incidence of mortality is more than 400% higher.

    Similarly, Fat intake in Europeans is very similar to North America but mortality rate is less than half.

    These are clinically very large differences.

    The other factor is the actual incidence of heart disease and its mortality rate, which may be more telling than the absolute mortality.

    Your analysis is insightful and thorough and most informative. The other interesting factor in this puzzle is the role of epigenetics where expression of genes can be modulated by diet. There is one group, in particular, in whom a low fat diet leads to an increase in sdLDL-C whereas a ‘Mediterranean’ moderate fat diet actually lowers their LDL-C. With all these confounding factors it is difficult to definitively identify myths.

    In the presence of a family history of heart disease a high cholesterol is said to be grounds for statins. However, I am not aware of any good evidence that shows lowering cholesterol in this group actually alters their outcome. I suspect that it is the family history (genetics) that is relevant rather than their cholesterol.

    Thank you once again for your thoughtful insights.

    1. Seems to me the disparity between the countries you mentioned shows that there many be other factors, not fat, causing the disease. I recall that sugar was also correlated, in the same data, with heart disease, if not more so correlated. I believe that as nations become wealthier, and thus consume more fat/protein from animals, they also consume much more processed foods. I believe it is the refines, processed junk causing the disease, not the fat.

  14. you propagate Yerushalmy and Hilleboe’s statement uncritically:
    “Since no information is given by Keys on how or why the six countries were selected [for his graph], it is necessary to investigate the association between dietary fat and heart disease mortality in all countries for which information is available”
    i think it might advance the discussion if you actually read Key’s paper, where he clearly explains his selection process. even though it might include less details than you might want, the Y&H claim is false at face value

  15. One thing I do not understand is this..
    If statins and other Cholesterol-production inhibitors are taken (and they ARE known to be effective [i’m not saying its good!] in inhibiting cholesterol production in the human body) AND eating animal food with cholesterol does NOT end up with that cholesterol in the blood stream, how come people who take statins and do eat animals STILL have cholesterol in their body, as opposed to dangeriously VERY low levels of cholesterol?
    My father for example, took statins, while his diet includes meat, poultry, fish, eggs and milk.. yet his cholesterol was still high. where did the cholesterol come from? Is is claimed that statins are NOT really inhibiting cholesterol production?

    1. Statins do help, but in other way, not by lowering cholesterol. They have an anti-inflammatory effect, and inflammation is very bad for the arteries. The conclusion is that you could lower inflammation with much less dangerous supplements. Whoever takes statins, they should also take CoQ10 enzime with it, because the statin gets ride of this very important heart muscle helping enzime.
      To your question, I think there is actually a negative correlation between blood and dietary cholesterol. You only get like 10% of your cholesterol from diet, but the less you get, the more your body is going to make. At least that is my view, based on people eating food full of cholesterol and still lowering their blood cholesterol level.

  16. Hi Denise, Thank you for the article.

    Have you looked into who funded these Cholesterol/Heart Disease research?

    I heard it was Crisco Cooking oil and their ilks that funded Ancel Keys and Nikolaj Anichkov. Is this true?

    Thanks again

  17. Doesn’t matter how the fukin science is interpreted. Cause/correlation/whatever. The gobbly-gook changes with the (fart)wind, anyway. This country alone will double in another 70 or so years and there will never be enough protein to go around. There won’t be enough fossil fuel to irrigate. BUT it will be a lot easier to gmo plants than to clone animals. –Bon Apetit.

  18. i particularly like the part where all scientific endeavour since 1960 is excluded from the conversation !!

  19. Just dissected a study on SFA, cholesterol, animal fat and IHD in UK 1980s that runs the same way as Keys and his critics – using a vegetarian volunteer group (who should have had all the advantages) and friends and family as controls; strong associations between cholesterol, SFA, animal fats and IHD.
    Strong protective associations between these things and all other causes of death, with NO net change in mortality at all associated with these risk factors.

    Here we do not have ecological fallacy. The study was biased to favour the vegetarians, who were allowed to volunteer (or opt out), and who were motivated health nuts compared to controls.

  20. Thanks! I had been fooled by the paleo bs that had Keys for a liar. So what if he trimmed the data to a few countries. Many researchers do this especially when they think that the countries will interest their audience, and especially when the trend was in the full data set. And thanks for the full set of correlations. Carbs aren’t as bad as meat, and vegetables are the answer!

    1. Trimming data is extremely important! If I trim the data down to 4 countries #4,5,8, and 13 I prove that more fat% means LESS death!!! Also you can pick 7 countries at the far right in an almost vertical line (very little fat% difference) but huge 250% death rate difference! That would mean that this 7 countries study proves that fat% has no effect whatsoever on death rate!!!

  21. I think the fact that Ancel Keys later shifted his blame from ALL fat to saturated fat only may have something to do with the fact that he took the Yerushalmi paper to heart. Apparently, throughout the 1950s, he maintained that all fat was bad. His shift toward the “Mediterranean diet” and plant oils occurred later.

    1. Reading Eat Healthy Stay Healthy (1959) closely, Keys linked the body’s ability to purge excess cholesterol in the liver with unsaturated fats, particularly safflower oil. At that time statins were unknown, and unsaturated fat and niacin were competing theories. Keys did not like safflower oil, feeling that it should not be sold as an expensive drug, and recognizing that it had very high calorie density.

      This has very little to do with CVD health though. Today Americans get about 50% of dietary calories from fat (2/3 as added fat in processed foods). Keys would not approved of this, as his ideal diet was 30% fat. The current American fats are hydrogenated vegetable oils which mimic the animal fats he avoided. The results for CVD health and obesity speak for themselves.

  22. As I can’t understand most of this, I would like to look at it from the simpleton’s viewpoint. Ancel Keys lived to 100, his wife to 97 (as a matter of very secondary importance Yerushalmy made 69). So whatever the debate…he just about had it right. Now did he actually follow his own advice?

    1. Sample sizes of n=1 or n=2 are completely irrelevant and you have no measure of variables…that comment promotes nothing. Lets consider Jim Fixx.

      James Fuller “Jim” Fixx (April 23, 1932 – July 20, 1984) was the author of the 1977 best-selling book, The Complete Book of Running. He is credited with helping start America’s fitness revolution, popularizing the sport of running and demonstrating the alleged health benefits of regular jogging. Fixx died of a heart attack while jogging at 52 years of age.

      So whatever you do, don’t run…

    2. As far as I can determine, yes. He moved from Minnesota to Italy and lived there for at least 20 years. I found a typical menu for what he was eating in his 90’s. It included cocktails, wine, pasta, seafood (octopus), sauteed fresh vegetables, bread and fresh fruit for dessert. All prepared with liberal use of olive oil. The Med Diet, eaten by the man who invented it.

  23. Funny blog, but wrong conclusion on Keys cherry picking countries. The data does or can prove the exact opposite. Connect countries # 13,4,5 and 8. This 4 countries study proves that more fat means less death! Now connect countries #22,3,6,21,16,19,17 and you get another 7 countries study that proves that although the fat % is almost the same, the death rate increases by 250%!!! Thus fat has nothing to do with death rate….

    So dear blogger, you might want to correct your conclusion. That would make Keys look more evil…

    What I never got about Keys was, what drove him? Was Big Pharma behind him or what? Not to mention he had a degree in economy, political science and zoology, hardly something to classify him to make my food pyramid. Although he did get a biology degree later on but he wasn’t a doctor….

    1. There’s nothing evil about living to 100 and lecturing in your late 90’s.

      Keys was a researcher and was his own lab rat on his “best diet” theories. The Med Diet came directly out of this country study, and he ate that diet for 50 years. Whether it’s the excessive fat, the excessive sugar or the excessive flour, the Nordic White Food Diet Keys attacked wasn’t healthy! Cherry pick Italy vs Finland and you’ll see. I grew up on that diet, and by 54 I was obese and diabetic like all my Nordic relatives.

      Show me similar contributions to science by ANY HFLC promoter. They named them K Rations, not A Rations. Put that in your Atkins pipe and smoke it.

  24. Good blog. However, I don’t understand your claim that he did not cherry pick his data. Why were these 7 countries chosen when there was data for 22? Did Keys not have access to the data from all 22 countries? Just curious.

    1. Hi Bill,

      If you’re talking about the Seven Countries Study, there was no way to cherry-pick that because the study was ‘prospective’ — meaning they chose countries before they had any data available for the citizens they were studying.

      If you’re talking about the six countries graph (a much more minor part of Keys’ career), Keys wrote that he excluded certain countries because their data was unreliable — due to post-war population shifts, or having too few citizens, or having poor birth and death record systems, etc. He claimed to picked only the countries whose data was comparably reliable.

      1. Neisy – And do you actually believe this? Working with data as a profession, I think everyone I know would call bs on this or as we do too often do just sit back and watch it burn. Both the process of picking countries to begin with and the exclusion based on blah blah blah.

        I don’t think his analysis would even make it out the gate. The science of food as with the science of medicine in general isn’t really science at all. I would classify it more in the realm of marketing. Pick the data and pretty pictures we want and “Let’s go sell this!”

        History over Science any day.

        1. If Ancel was cherry picking, why did he exclude Finland? In my readings, it was the poster child for the Nordic White Diet of starchy fatty sausage laden foods, and had very high CVD rates. Ancel was rebelling against this diet specifically, and probably slanted his analysis to making it look bad. High fats, which at that time were mainly animal fats, were part of the whole bad package. Today’s Americans create the same effect using vegetable fats, which constitute 50% of dietary calories (mostly as added fats in processed foods).

  25. Just discovered this blog post and got to say (if you even get this comment that is) it is amazing.
    I’m a nutrition adviser and work self-employed and currently writing a nutrition booklet and was about to include the stuff about Keys being a big fibber! I’m a big advocate of full fat diets and that saturated fat is not the enemy but I thought I’d do a little digging about this theory of him altering his results and I’m so glad I did!
    Informative, interesting (which is f*cking difficult with stats, as my last university module taught me haha) and all round a great read. I’m going to keep researching for an hour or so but I’ll certainly be re-wording my page on Mr. Keys!

    Many thanks! You’ve gained a new follower (not that you needed any!) 🙂

    1. Read Eat Healty Stay Healthy. Then weigh how much that was affected by the Nations study. Ancel invented the Med Diet and lived it out for 50 years in Italy. Despite the criticism of cherry picking, he tried to pick the best and lived it out to age 100.

      1. Oops again. Eat Well and Stay Well. Ancel and Margaret co-wrote it, but the long preamble on coronary disease appears to be Ancel’s work alone.

  26. I think your “analyses of the analyses” was 80-20 spot on; meaning if I had to lean one way or another, I would by far lean in the direction of agreeing with your conclusions.
    1. Kudos for extracting all of the R-square values and drawing conclusions on those. This was quite revealing. In fact, it opened the door to number 2…
    2. I believe that there is a missing factor. (Well, it’s not necessarily missing, you did reference the high correlation to carbohydrates or known to some of us as sugar.) I say that it is missing because IMHO the original study tried so hard to demonize fats that it just ‘glazed over’ (notice the doughnut pun) this evil culprit and what some consider to be THE drug that America and other western cultures are killing themselves with. Too much Sugar=> Too much Insulin => Arterial Inflammation=> Plaque forms on lesions and inflammation of the arteries.
    3. I believe there is ANOTHER missing factor. The Keys Study was presented in 1955. Well, in the early 50’s, we Americans still had doctors on widely spread cigarette adds. Smoking is one of the leading causes of atherosclerosis. Tobacco Chemicals => Arterial Inflammation=> Plaque forms on lesions and inflammation of the arteries. Imagine if Keys would have had to fight the tobacco industry and Madison Avenue, too. He may have become as scarce as Jimmy Hoffa. Hmm, In fact, I want to know the answer to which of those 22 countries were heavy smokers at the time?

    Finally, this has been a thought provoking article. Thank you, Denise

    1. There is no doubt that he data Dr. Keys used is bad, but how bad can it be? He’s shown England and Wales average fat increase as around 30% between 1947 and 1949. If my memory serves me correctly during 1947 and 1949 food rationing was in place in the UK with a weekly allocation of 4oz of bacon and 8oz of milk, butter and eggs were similarly rationed.

      I’m also failing to see how you can make a correlation between fat and heart disease in Fig 3 from the Y&H paper. There is no correlation if, say, a 35% fat intake results in death rates spread between 200/100000/ annum and 700/100000/annum for around the same intake of fat.

      If there is a correlation in that chart it’s that you’re more likely to die of heart disease than pretty much anyone else in the world if your native language is English!

      Still, like others I liked this blog post a lot, you’ve brought the story together nicely. thanks

    2. Quoting Ancel on the tobacco effect on coronary heart disease (from Eat Well and Stay Well, 1959):

      “These differences between populations are not explained by personal habits such as the habitual use of tobacco or alcohol. Many of the populations who suffer relatively little coronary heart disease contain plenty of men who are heavy smokers or drinkers or both. If tobacco or alcohol have any effect, this does not seem to be primary.”

  27. Of course it would be real interesting to see the the consumption of sugar plotted alongside those death rates.
    Having done my own experiment since 2012 and improved all my blood work by cutting out all sugar and aiming for 50% of my calories in Quality Saturated Fats, i know the path i will be following.

    1. Keys path led him to create the Med Diet, and he lived to age 100. The path you have chosen has an unknown outcome, but Robert Atkins HFLC path ended at age 72 with CVD problems. The diet that made him lean in his 40’s made him overweight for the last decade of his life.

  28. I was almost convinced until I read this line –

    “The China Study was right all along! Time to go vegan, you guys.”

    and realized that this entire post was a crock of misleading shite. 🙂

  29. Over two years since the last comment, and I’m reading Eat Healthy Stay Healthy written by Ancel Keys in 1959. I’m trying to figure out what nuances he used to live to be 100. I think it has a lot to do with the 7 Nations study published at about the same time. From what I can determine, Ancel was trying to determine the causes for the CVD unhealthiness of the “Nordic White Foods” diet. Finland was the poster child (and also not one of the 7 included nations, but clearly the worst at the time). If he was cherry picking, it was probably to simplify and illustrate how to move from bad diet to better diet, working with the mortality data available at the time.

    Remarkably, Ancel lived out his theory for 50 years. He invented what is now known as the Med Diet and moved from Minnesota to sunny Italy. He almost completely removed meat and animal fats from his diet (but kept seafood and eggs in), and ate a lot of bread, pasta, olive oil, soup (made from homemade beef stock – AKA bone broth), sauteed vegetables, and fresh fruit. He drank cocktails and wine.

    EHSH strongly recommends eating a highly variable diet in order to make eating as enjoyable as possible. But it’s nuanced, and not an unlimited feast. Calories count (remember that Ancel was into rationing – one of his principle contributions to winning WWII), and are tabulated for both foods and different forms of exercise. The first half of the book lays out the science and philosophy as known in 1959. The second half lays out sample diet plans and recipes, which seem complex and regimented…though much less so than the nonagenarian Julia Child’s….

    In 2015 could anyone live their life this way? A proper bone broth takes 4 hours to prepare starting with good meaty bones. Someone has to be ready to spend most of their day in the kitchen and market EVERY DAY to pull this off. And to be able to pack up and move to Italy for 20 years of ones life is not happening for most people. But all that sun and fresh food availability is important. At least someone did it, and the results in longevity speak for themselves. Ancel, an ordinary guy from Minnesota, was able to recreate the national advantage (Italy, France, Okinawa, whichever you pick) to his own personal benefit.

  30. The more I read from Eat Healthy Stay Healthy, the more I realize that the HFLC is hung up in a self-enforced Ludditism. Ancel benefitted from the nations study by picking the best cherry he could see (Italy) and discarding the worst (Finland). He lived it out for 100 years, avoiding a diet which he called “rich foods”, distinguished by lots of sugar, starch, dairy and fat.

    Today Americans eat the rich diet. In 2005 this consisted of 50% fat calories, 2/3 of which come from added fat in processed foods like chips and cookies. Animal fat is gone, replaced by vegetable fats manipulated with hydrogenation to give the same mouth feel as butter and lard did in the 50’s. This is not anything that Ancel was responsible for, not the way he ate, and nothing he would approve of. Converting it back to an animal fat basis wouldn’t fix it.

    1. I’m still eating bacon too @stephen. I had a BLT for lunch with some chips and a little glass of madiran wine. Does your diet allow this, or do you eat what the ketostix tell you to eat?

      I’ve been thinking about another success that Ancel Keys had. The whole reason for the Nations studies was to understand and reduce CVD mortality. In the US CVD mortality peaked in 1968, and has fallen dramatically ever since. Dixon summarizes this in the following link.

      Despite the obesity epidemic, and our massive increases in fat and carb consumption, our hearts have gotten healthier. This is a multifactorial effort, involving better therapies, statins, reduced smoking….and diet. The last was Ancel’s part. Trans fats are more or less wiped out (he always hated margarine), and McDonald’s no longer fries in lard.

      True there was much ado. But as a result of CVD mortality reduction we now live on average 5 years longer than we used to, even though we are fatter. Heart attacks in 50-somethings are way less common. That’s something. That’s what Ancel lived for.

  31. It would take a really bizarre list of specific character traits to work through everything you wrote in this post. Apparently, I have those traits. This is some fabulous analysis, commentary and humor. We are not worthy. Someday I will reach these heights.

  32. I wish to point out that Ancel Keys actually DID what he preached. He moved to the Cilento area of Italy and lived there for 28 years eating a mediterranean diet (Actually he ate the Cilento Diet). He died just shy of his 101st birthday (you can verify on Wikipedia). Compare this with the Atkins diet and Dr Atkins who died at 72 years old. Whose advice would you take? The town of Acciaroli in Cilento is still in the news today has having a disproportionately high number of people over 90 yo and making it to 100 is no big deal there (10% do so). the paleo diet is an interesting theory and makes sense. but if a village of people lives well into their 90s and 100s, why not do what they do (eat homegrown chicken and rabbit and fish for fresh anchovies and put rosemary on everything). Also take a look at the Italian region of Marche, where the number of centenarians has increased fivefold since the year 2000. And their diet is not really “mediterranean”, yet they have the longest average lifespan for Men AND Women in Italy. Acciaroli is a village of 700 people. Marche is a region of 1.5 million. Average lifespan is over 85 years for women and 80 years for men. It beats Japan, where by the way, a lot of their centenarians are “missing” like in “Dead”. Try googling “missing japanese centenarians” and see what you get. Additionally the longevity data from Okinawa cannot be validated, because they were reconstructed after the originals were lost during WWII. So it is not possible to verify the actual ages of people there. Draw your own conclusions.

  33. Keys got nothing correct randomized controlled trials have proved his theories in valid. If you have the stamina review the HSPCA court testimony in the Noakes trial. Its a lot you could skip to part 60 on cholesterol and heart diseas and go from there but there is good and valid information in all 78 depositions

  34. Well written. I arrived here from searching for a definition of the “Keys score” in the epidemiological literature, but I was hooked on the writing! I like the style of the author. Casual but with a purpose.

  35. Really great blog post. So thorough and clear. I am investigating the validity of the Mediterranean Diet – in particular in relation to saturated fat – and this has given me some clarity on the primary research in this area. If you have any good sources of up-to-date research on health and diet I would love to hear from you!

  36. Dear Denise,
    Thank you very much for such an illuminating post. Although I was a vegan before I read this post carefully and I am still a vegan after, you did clarify a few points about the muddled history of the diet-heart hypothesis and Ancel Keys . However, you obviously stayed clear of more recent data from dietary intervention RCT studies.
    Thanks again.

  37. Hi very interesting read. Am researching for my dissertation on successful ageing. One point on the Keys data. He did not look at sugar independently, just carbohydrate as a whole. This video has some very interesting bio chemistry showing ITS IMPACT. I think this is a factor that has been overlooked by public health bodies . Sugar:The Bitter Truth

  38. You are a genius. I have the Yerushalmy and Hilleboe article before me and have been trying forever to figure out what most of it actually means. I do not know how you did it, but it makes total sense now. Plus you made it an entirely accessible and interesting read and included lots of other important and intriguing information. Thank you and now please help us figure out some of the other messes we are in [smiley face]

  39. Few questions for my clarification.

    Q. How come after 50 years, CAD is still the number 1 killer in America and around the world? In 2019, 49% of America has T2D or at least pre Diabetic and has MetS. Assuming low fat high carb diet still works.

    Q. How come you forgot to mention (probably because it happened in 2017 and you didn’t know when you wrote the article), so at least this will tell every one know, that one person who followed AHA Diet (Low fat High Carb) the most, had a heart attack recently, is the President of AHA at the age of 52.

    How come you forgot to mention Fructose Metabolism which actually leads to LDL CB and high Triglycerides. And also that the ratio of TG to HDL plays more important role in CAD. And tha Fructose cause the ratio to go higher.

    Q. How come you forgot to write about Lipitor, that has made Pfizer 1 trillion USD since it was first marketed after Cholesterol was demonized.

    Q. How come you never mentioned that Upper limit of normal Cholesterol was dropped from 300 to 200, since then more patients were put on Lipitor and rate of CAD and entire MetS was doubled since then.

    Q. How come an Epidemiology study is being regarded as a double blind, cohort study, which actually is for causation, instead of correlation which epidemiology studies are in built to be doing?

    Q. How come you never mentioned Omega 3 to Omega 6 ratio that should be 1:1 ish and veg oils have 1:10 or 1:15? By the way if you noticed, the veg oil revolution started after Ancel Keys’ study gained approval.

    Q. How come you never mentioned all the studies which showed dif types of LDL-C and never mentioned that which part is more important causative factor in CAD?

    Q. How come you forgot to mention Trans fats in veg oils which were invented in 1960s only after the study showed that Low fat diet is the key. I mentioned about Omegas above.

    How come you forgot to mention that Mother’s Milk contains more than 50% fat as saturated fat.

    I can probably write a longer article then yours on the flaws in your blog post but let’s start with these questions.

    The rebuttles of low fat high carb diet can be summarized in one sentence. Eat what your ancestors eat. That’s all. No bigy.

    It was unheard off for the son to die before his father before Veg Oils all thanks to Ancel Keys.

    Let’s see the answers. May be I am wrong. The science is still evolving. But I need to be convinced by facts.

    As someone once said “In God we trust. Everyone else has to show reliable, unbiased data”.

    Don’t be a corporate hack. A calorie is not a calorie. Period. No matter what Coca Cola tried to make you believe.

  40. This is the most informative, fair, and accurate article I’ve ever come across. Such a relief in a world of immature, sensationalized, cherry picking, table banging BS. And hilarious. Please keep writing. And start a fact checking site we can actually rely on, because you may be the most impartial person on the internet. Thank you.

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