The Drivers of the Herd, Part 1
Catalyst Corrected 1, The History of Diet-Heart, Part 1 (Ancel Keys, George Mann, and John Yudkin)
Slide 3 http://www.abc.net.au/catalyst/heartofthematter/
An Australian television network called ABC broadcast a two-part program called “Heart of the Matter.” It was a production of a primetime science show called Catalyst. Their first episode about the role of diet in heart disease was amazingly brain-dead and irresponsible.
Slide 4 http://www.abc.net.au/catalyst/stories/3881441.htm
Catalyst also aired an episode questioning the value of cholesterol-lowering drugs.
Slide 5 http://www.heartfoundation.org.au/news-media/Media-Releases-2013/Pages/cholesterol-medication.aspx
The National Heart Foundation of Australia responded to that one, as did many prominent doctors. I’m glad for that because these drugs are needed for those who have jeopardized their cardiovascular health through their diets. The first show about diet-heart, however, did not receive satisfactory rebuttals, in my opinion. If Catalyst’s producers really are opposed to statins, then it’s ironic that they chose to use their influence to promote diet choices that will necessitate the use of these drugs.
Slide 6 http://www.abc.net.au/catalyst/stories/3876134.htm
The host of those shows was Dr. Maryanne Demasi. She says her objective with her work on TV is to encourage critical thinking about health issues. She says others in the media aren’t thinking critically. They are just regurgitating old dogmas. This is a hypocritical statement from Dr. Demasi considering that her broadcast provided no evidence of critical thought on the topic of diet-heart at all. In fact, she used her show to bring new prominence to foolish old dogmas.
Slide 7 http://www.abc.net.au/mediawatch/transcripts/s3888657.htm
Another show on the ABC called Media Watch provided a valuable service by questioning the credibility of the cranks Dr. Demasi featured on Catalyst. I encourage you to see Media Watch’s take on this show.
Slide 8 As I see it, Dr. Demasi’s program had seven main arguments, here presented in no particular order. The first was that the cholesterol in your blood is simply good unless it’s oxidized. You can’t have too much of it. This would make it different from other constituents of the blood like glucose or albumin.
Slide 9 Another message was that you shouldn’t worry about your cholesterol numbers because you can’t do much about them anyway. You can’t lower your cholesterol by changing your diet. Eating saturated fats won’t raise your cholesterol.
Slide 10 Demasi also told us that the diet-heart idea originated from bad or even corrupt science. Ancel Keys was portrayed as particularly villainous in this regard.
Slide 11 We were also told that a few courageous scientists opposed recommendations for reductions in saturated fat and dietary cholesterol. These heroes were ignored by the authorities.
Slide 12 We also saw that major trials and small studies alike all failed to support the diet-heart idea. Somehow lots of Ph.D.’s and M.D.’s in positions of responsibility went along with a major shift in official dietary recommendations despite there existing no evidence to support it. Does that sound believable to you?
Slide 13 We also learned that sugar is the real cause of heart disease. We might infer from point number 5 that Dr. Demasi believes there’s a lot of evidence to support that, including mass field trials. But somehow no such trials were presented. Why? Because none exist.
Slide 14 Lastly, we learned that saturated fats are great because they are so stable, whereas vegetable oils are not good because they aren’t stable.
All of these claims will be addressed in this set of videos, but I’ll take them out of order. Let’s start with number 3. Ancel Keys was a bad scientist who actually withheld data in his quest to deceive us into believing that saturated fat consumption is linked to heart disease. Here’s what we were told by Dr. Demasi.
Slide 15 http://www.abc.net.au/catalyst/stories/3876219.htm
Demasi: “He compared the rates of heart disease and fat consumption in six countries. It was almost a perfect correlation - the more fat people ate, the higher the rates of heart disease. Except, there was just one problem. Keys withheld data for 16 other countries. Later, when researchers plotted all 22 countries, the correlation wasn't so perfect.”
Slide 16 http://www.plantpositive.com/3-the-journalist-gary-taubes-3/
This is a tired old libel against Keys that’s still around today only because so many dishonest people like Demasi keep repeating it. I’ve made several videos about this matter already.
Slide 17 Keys, Ancel. “Atherosclerosis: a problem in newer public health.” J Mt Sinai Hosp N.Y. 1953. Jul-Aug (20)2: 118-39
Here’s the truth Demasi withheld from you. Keys explained why he chose the countries he did. He analyzed only the data that he concluded were probably reasonably accurate. He knew some countries had provided bad data so he didn’t use their data. This is basic due diligence for any researcher working with a data set.
(Please inform me of broken links).
He explained his thought process in the very article that was the source of that graph. That article is now hosted at this address. Download it and read it for yourself.
Slide 19 Yerushalmy, Jacob, and Herman E. Hilleboe. "Fat in the diet and mortality from heart disease; a methodologic note." New York State journal of medicine 57.14 (1957): 2343.
Somehow Dr. Demasi didn’t share this graph with you. The researchers who plotted all the 22 countries to whom you just heard her refer were named Yerushalmi and Hilleboe. This is another graph from the very paper to which Demasi is referring. You can see that they actually found a better correlation with heart disease with another component of the diet – animal protein. Here you can see that the more animal protein people ate in these 22 countries, the more they died of heart disease. Why not mention this, Dr. Demasi?
Slide 20 Didn’t you read their paper? The two researchers you brought up said, “In all categories of heart disease the association is strongest for animal protein expressed in total calories.” Dr. Demasi, does your version of “critical thinking” involve ignoring the text and just looking at the pictures? If you really were thinking, you’d realize the problem here was that Keys didn’t understand at that time that saturated fat was uniquely dangerous to heart health, so all fats wouldn’t show a strong association. But a disproportionate fraction of the fats in animal products are saturated, and so the association with animal protein was stronger.
Slide 21 These two researchers said Keys didn’t explain why he chose the countries he did. But that’s not true. Moreover, they used 22 countries when they really shouldn’t have.
Slide 22 http://high-fat-nutrition.blogspot.com/2009/02/cholesterol-presentation-between.html
That Catalyst program was basically the insular dogmas of an extremist low-carb blog elevated to the news magazine format. Here you see how this libel against Keys plays out online. This guy is trying to make the point that Keys could have chosen countries that made it seem like no association existed between fat and heart disease death. He’s using someone else’s graph and that graph is based on flagrant cherry picking. He apparently hasn’t read the papers in question. Of course, he never mentions the part about animal protein. You may notice he selected two countries that Keys didn’t, Mexico and Ceylon. He therefore implies these would have been equally valid countries for Keys to have chosen, just as good as the US or Canada.
Slide 23 Upon this basis he calls Keys a charlatan. It’s easy enough to say because Keys cannot respond since he’s dead.
Slide 24 http://www.who.int/bulletin/volumes/84/3/news20306/en/
If he could respond, he might say that Mexico didn’t have adequate mortality data back then. If large numbers of deaths are not being certified in a country, then that country’s mortality data will be useless.
Slide 25 Padley, Richard. "Cause-of-death statements in Ceylon: A study in levels of diagnostic reporting*." Bulletin of the World Health Organization 20.4 (1959): 677.
Keys might also point out that in Ceylon, people with no medical training were filling out the cause of death codes in their records. Why on earth would Keys have analyzed garbage data? Why did Yerushalmy and Hilleboe make the choice to use this garbage data? And why didn’t Dr. Demasi look into this first before broadcasting this nonsense?
Slide 26 “National Food Supplies and Vital Statistics”. Dairy Council Digests. Vol. 28, No. 1. (September 1956).
For this video I looked into this affair once more and I found a couple interesting facts you don’t ever hear mentioned by the saturated fat promoters. First, this criticism by Yerushalmy and Hilleboe was not an original argument. Who made this argument first? The anonymous authors of a trade publication for the dairy industry gave this same interpretation of that mortality data in the previous year. They wrote, “When all countries are considered, no relationship is apparent between incidence of arteriosclerotic and coronary heart disease and any element of the diet.” It looks like Yerushalmy and Hilleboe were just carrying the water of an industry that found itself on the defensive. You can see here that these employees of the dairy industry singled out the Netherlands as a country with high animal fat consumption but lower heart disease death rates. This is supposed to convince us that fat is unrelated to heart disease.
Slide 27 Cronkite, Walter. "Poverty and Want Rip Netherlands." The New York Times 29 Sept. 1944: 4. ProQuest Historical Newspapers.
But this was a blatantly disingenuous argument. As Walter Cronkite reported, the Dutch suffered privation under German occupation during the war. They had hardly anything to eat. Cronkite said they were “living almost wholly on cabbages, turnips, and backyard vegetables.” That sounds like quite the low-fat diet to me.
Slide 28 Jolliffe, Norman, and Morton Archer. "Statistical associations between international coronary heart disease death rates and certain environmental factors." Journal of Chronic Diseases 9.6 (1959): 636-652.
Another part of this story which is conveniently omitted from the accounts of the fat-apologists like Demasi is that this correction by Yerushalmy and Hilleboe of Ancel Keys was itself soon corrected by Norman Jolliffe and Morton Archer. They pointed out that Yerushalmy and Hilleboe had ignored contemporary findings about the differing effects of different fats. They never distinguished between saturated fat and unsaturated fat. This information hadn’t been available to Keys but Yerushalmy and Hilleboe should have known better.
Slide 29 Joliffe and Archer produced a scatter plot of their own, using 20 countries instead of six, that is even more obscure to low-carbers than the one you just saw for animal protein. The y-axis shows B-26 deaths, which was the code at the time for arteriosclerotic and degenerative heart disease. You can see how this correlated to saturated fat consumption. Dr. Demasi, how do you like this graph? Why didn’t you show this one to your viewers?
Slide 30 These authors were clear in their conclusions. They were the first to take advantage of the new understanding at the time about the importance of the degree of saturation of fats in their analysis. This new and improved analysis found that saturated fat consumption had the most powerful correlation with heart disease. The second best correlation could be found with animal protein consumption.
Yet listen to what Michael Eades told the Catalyst audience about all this.
Slide 31 Eades: “He more or less cherrypicked countries. You could show just the opposite. You could show that the more saturated fat people ate, the less heart disease they had, if you cherrypicked the right countries.”
Dr. Eades has constructed his own propagandized history of diet-heart. He doesn’t have the least interest in learning the real story because he has too many diet books and supplements and kitchen gadgets to sell. Telling the truth would hurt his sales.
Slide 32 http://www.epi.umn.edu/cvdepi/index.html
If you’d like a more reality-based sense of how Ancel Keys worked on the diet-heart problem and where his ideas came from, I suggest you visit this University of Minnesota School of Public Health website, which preserves information from this era. If you poke around there, you’ll see that Keys started out hostile to the idea that dietary fat is linked to heart disease. Fortunately, he had intelligence and integrity, so his views evolved.
This discussion about Keys brought up a funny contradiction in their show.
Slide 33 Demasi: “Dr. Eades says that even if fat consumption trends in the same direction as heart disease, it doesn't prove anything.”
Eades: “Just because there's a correlation, doesn't mean that there's causation. It's like people who are fat have big belts, but that doesn't mean that if you go and buy smaller belts, you won't be fat. I mean, that's not the causation. That's what these observational studies show. It's just a correlation.”
So you got that? Correlations don’t mean anything. That’s not exactly true but let’s pretend it is anyway. Then they tell us this.
Slide 34 Demasi: “Cholesterol did correlate with heart disease, but that disappeared by the time you reached your late 40’s.”
Bowden: “After the age of 47, high cholesterol is probably protective. The people who had the highest cholesterol lived the longest…”
So now correlations do mean something? We just went from a correlation among six diverse countries that didn’t matter to one homogeneous town with a correlation that did matter? How did that happen?
Slide 35 p.41. Hu, Frank B. Obesity Epidemiology. Oxford: Oxford University Press, 2008. Google Books.
What they were talking about was blood cholesterol, not anything in the diet. The reason blood cholesterol is less closely associated with heart disease in older populations is because of reverse causation. Various health problems have been observed to drop cholesterol levels and older people get these problems more often. So these people trying to teach you about cholesterol have their arrow of causation backward. One also must consider the problem of survivor bias. The people with the highest cholesterol would have died of heart disease before reaching old age.
Slide 36 Kuller, Lewis H. "Invited commentary: circular epidemiology." American Journal of Epidemiology 150.9 (1999): 897-903.
Pause the video and read this reference. This extremely accomplished M.D. and Ph.D. expressed his frustration in this paper at the repeated forgetting of the confounding effects of comorbidities on cholesterol levels. Demasi did her best to keep this misunderstanding alive a while longer, which is more than she did for her viewers.
In her reimagining of the history of diet-heart, Demasi told us about a rival of Ancel Keys named John Yudkin.
Slide 37 Demasi: “But Keys was politically powerful, and publically discredited Yudkin's theory.”
Taubes: “By the early 1970s, Ancel Keys was ridiculing John Yudkin and his theory in papers, and just on the basis of that sort of personality and political struggle, the nutrition community embraced this idea that saturated fat was the problem, working through dietary cholesterol, and began to think of the idea that sugar could heart disease as akin to quackery, and Yudkin was eventually ridiculed.”
That’s a pretty disturbing story. Apparently, Keys was so good at poking fun at Yudkin, and Yudkin was so unable to defend himself, that the other experts at the time didn’t even notice that Yudkin had all this great science to support his argument about sugar. Does that sound like a realistic depiction of the culture of the scientific community to you?
Slide 38 http://www.abc.net.au/catalyst/heartofthematter/
It’s an odd narrative to put forth considering that Catalyst is hosting a copy of Keys’ paper criticizing Yudkin’s claims. I read it. It didn’t come off as empty ridicule to me. If Dr. Demasi is unaware, scientists work out their competing hypotheses in public in articles just like this one. This is normal.
Slide 39 Keys, A. "Sucrose in the diet and coronary heart disease." Atherosclerosis14.2 (1971): 193-202.
Here’s a portion of it. I don’t see any jokes or personal attacks in there. I see references to study after study in which Yudkin’s sugar hypothesis failed to gain support. Is Demasi faulting him for bad manners? What is her criticism, exactly?
Slide 40 Bierman, Edwin L. "Carbohydrate and sucrose intake in the causation of atherosclerotic heart disease, diabetes mellitus, and dental caries [human and animal experiments]." American Journal of Clinical Nutrition 32 (1979).
Here’s a contemporary doctor’s take on Yudkin’s sugar idea. It lacked support from animal experiments. Epidemiology didn’t support it. No trials validated it. There was no support for it from autopsy studies. Are these political criticisms or scientific ones?
Slide 41 http://phil.cdc.gov/phil_images/20030718/11/PHIL_846_lores.jpg
Does Gary Taubes think atherosclerotic plaques are filled with cholesterol or sugar? When I ask that question, does he hear it as a political question?
Slide 42 Gordon, Tavia, et al. "Diet and its relation to coronary heart disease and death in three populations." Circulation 63.3 (1981): 500-515.
Why didn’t Demasi, who seems to think Framingham generated such important data, mention that in that population the people who consumed more sugar lived longer? There are the numbers. But I guess she thinks correlations don’t mean anything when she doesn’t like what those correlations imply.
Slide 43 http://www.plantpositive.com/4-the-journalist-gary-taubes-4/
This, too, is a topic I’ve covered in greater depth already.
Slide 44 Next, Demasi shows us an article by a very prominent critic of diet-heart named George V. Mann. Before we check it out, let’s hear from one of her assorted crackpots first.
Slide 45 Sinatra: “We created this new disease called hypercholesterolemia. And if we created this new disease, we got to create drugs to neutralize it.”
We just learned from Dr. Sinatra, an actual cardiologist, that hypercholesterolemia is some phony condition made up by the drug companies. It’s not a real problem.
Slide 46 Mann, George V. "Coronary Heart Disease - Doing the Wrong Things.“ Nutrition Today 20.4 (1985): 12-15.
This is not what George Mann thought. He called it “hypercholesteremia” and he wanted ways to effectively control it. He just didn’t think you could affect it through diet. He was wrong about that.
Slide 47 http://www.abc.net.au/catalyst/heartofthematter/
Catalyst is hosting this paper, too. You can see that Mann said high cholesterol is a disorder. I scanned the previous slide from the hard copy before I saw that Catalyst was hosting a digital copy. Did Demasi bother to read it? Or did she just like the title?
Slide 48 http://www.abc.net.au/catalyst/heartofthematter/
Here’s another paper currently hosted on their site that she apparently only skimmed over. She says the Anti-Coronary Club program from 1966 showed us that the substituting of saturated fats with polyunsaturated fats was shown to kill more people.
Slide 49 http://www.plantpositive.com/12-the-journalist-gary-taubes/
Of course, I’ve covered this already, too.
Slide 50 Christakis, George, et al. "Effect of the anti-coronary club program on coronary heart disease risk-factor status." JAMA: The Journal of the American Medical Association 198.6 (1966): 597-604.
You can see she has generously highlighted the parts she likes in her copy of this paper. More people died in the experimental group than the control group. Therefore, she thinks, we learned that the oils they were eating killed them.
Slide 51 But she didn’t point out to you that the two groups were not matched. The experimental group had more problems at the start that put them at greater risk of death. More of them were obese.
Slide 52 More of them had high blood pressure.
Slide 53 More of them had high cholesterol.
Slide 54 Fewer of them had no risk factors.
Slide 55 More of them had multiple risk factors. So is it really surprising that a few more of them died at the end of the trial?
Slide 56 Demasi also didn’t seem to notice that in regard to the actual focus of the study, which was the incidence of coronary disease and new coronary events, the people in the control group who were eating more saturated fats had nearly three times as many problems. So whatever they did in that experimental group to deal with heart disease, oils and all, it gave them a dramatically better chance at avoiding heart disease. I took these tables from her very own copy, hosted on the Catalyst page. Why didn’t she point these things out?
There was an interesting tell in her broadcast that indicated that Dr. Demasi isn’t dealing straight with us. You just saw that her fringy expert guest, Stephen Sinatra, said hypercholesterolemia is a made-up problem. But Demasi herself said this …
Slide 57 Demasi: “Aside from people with a genetic condition, like familial hypercholesterolemia, diet has long been the focus of how we can lower our cholesterol.”
She knows there is a genetic disease called familial hypercholesterolemia, or FH, that gives people high cholesterol that is uncontrollable through diet. Does this mean hypercholesterolemia is a real thing to her then? Then why did she air Sinatra’s outrageous denial that high cholesterol is a problem? Does she think hypercholesterolemia only matters when it’s of genetic origin? Why would that be? Where’s the science behind that?
Slide 58 http://www.plantpositive.com/26-cholesterol-confusion-9-bro/
This, too, is a topic I’ve covered already. FH is a serious and potentially tragic condition.
Slide 59 http://www.genome.gov/25520184
[If] left untreated, people who have it die far too young from heart disease. There is no other reason for their high risk of cardiac death beside their high cholesterol concentrations. Demasi must know this. Why would she give air time to some clown who says hypercholesterolemia is not a problem when we get our clearest indication how dangerous it is from these genetically-afflicted people.
Slide 60 We’ve covered messages numbers 3 and 6 at this point. FH brings us back to number 1. You definitely can have too much cholesterol in your blood.
Slide 61 National Institutes of Health. "Third Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III)." NIH publication 1 (2001): 3670.
Graphs like these are why serum cholesterol is more and more of a problem as it increases. The blue lines are for people with higher cholesterol. The black lines are for people with lower cholesterol. Higher cholesterol means higher lifetime risk. These aren’t just little graphs cooked up by one guy working on a hunch. These can’t be dismissed with fairy tales the way the Keys graph is. The data behind these curves came from, of all places, Framingham.
Slide 62 Law, Malcolm R., and Nicholas J. Wald. "An ecological study of serum cholesterol and ischaemic heart disease between 1950 and 1990." European journal of clinical nutrition 48.5 (1994): 305.
If Dr. Demasi likes scatter plots of international comparisons she might take an interest in this one. You’re seeing cholesterol against deaths from heart disease here. I think you’ll agree the relationship is obvious. High cholesterol is deadly. We have many forms of evidence about this.
Slide 63 http://www.cardiffandvaleuhb.wales.nhs.uk/what-is-lipoprotein-apheresis
For example, in my video about FH I talked about the different methods of bringing LDL cholesterol under control in these people with this genetic problem. One is LDL apheresis, which filters their blood using a machine at bedside. This is not a drug like a statin, with the possibility of multiple effects. All this device does is selectively remove their bad cholesterol particles.
Slide 64 Mabuchi, Hiroshi, et al. "Long-term efficacy of low-density lipoprotein apheresis on coronary heart disease in familial hypercholesterolemia." The American journal of cardiology 82.12 (1998): 1489-1495.
And LDL apheresis is very effective at this. It also dramatically lowers their rate of adverse events. FH and its many treatments clearly demonstrate the harm in having too much LDL cholesterol.
Slide 65 Buchwald, Henry, et al. "Overall mortality, incremental life expectancy, and cause of death at 25 years in the program on the surgical control of the hyperlipidemias." Annals of surgery 251.6 (2010): 1034-1040.
Another method of dealing with high cholesterol that has nothing to do with drugs is partial ileal bypass surgery. This long term trial has demonstrated that it is effective at lowering LDL cholesterol. Again, the only mode of action of this procedure relevant to heart disease is a lowering of cholesterol.
Slide 66 And this lowering of cholesterol pays off in the form of longer survival and fewer cardiovascular events.
Slide 67 Valsta, Liisa M., et al. "Explaining the 25-year decline of serum cholesterol by dietary changes and use of lipid-lowering medication in Finland." Public health nutrition 13.6 (2010): 932.
Diet improvement has also been used at the population level to deal with high cholesterol. In Finland, butter fat and other high-fat dairy products were consumed less as a result of public health campaigns. Vegetable oils replaced those fats.
Slide 68 Consequently, population-wide cholesterol levels dropped.
Slide 69 Vartiainen, Erkki, et al. "Thirty-five-year trends in cardiovascular risk factors in Finland." International journal of epidemiology 39.2 (2010): 504-518.
This was accompanied by a dramatic reduction in the number of people like you and me dying from heart disease.
Slide 70 National Institutes of Health. "Third Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III)." NIH publication 1 (2001): 3670.
Of course, statins have repeatedly confirmed the value of LDL-lowering. This includes primary prevention trials.
Slide 71 von Birgelen, Clemens, et al. "Relation between progression and regression of atherosclerotic left main coronary artery disease and serum cholesterol levels as assessed with serial long-term (≥ 12 months) follow-up intravascular ultrasound." Circulation 108.22 (2003): 2757-2762.
By using non-invasive imaging techniques on coronary arteries, it has been demonstrated that in order for atherosclerotic plaques to stop worsening, LDL cholesterol must be maintained at or below 75 mg/dL. If your LDL is above this mark, it is likely your plaque burden is increasing day by day.
Slide 72 De Biase, Simone Grigoletto, et al. "Vegetarian diet and cholesterol and triglycerides levels." Arquivos brasileiros de cardiologia 88.1 (2007): 35-39.
The patients in that study were taking cholesterol-lowering drugs to achieve such low LDL numbers. The only technologically modern populations that maintain such low LDL levels without drugs are those who abstain from all animal products in the diet. It is only through healthy plant-based diets that it is possible for most of us to achieve these low cholesterol levels without resorting to pharmaceuticals.
Slide 73 I just showed you that diet can affect your cholesterol levels, contradicting Demasi’s assertion number 2, but I have much more to say on that subject because she did, too. For now, though, I’d like to focus on other major events in the history of diet-heart. Number 4 says that the government promoted low-fat diets despite valid scientific objections raised against them. This is what I’ll discuss in the next video.