The Secret of Health

I’m going to let you in on a secret. But before I get to that… There is much conflict over diet. Many will claim that their own is the one true way. And some do have more research backing them up than others. But even that research has been extremely limited and generally of low quality. Hence, all the disagreement and debate.

There have been few worthwhile studies where multiple diets are compared on equal footing. And the results are mixed. In some studies, vegetarians live longer. But in others, they live less long. Well, it depends on what kind of vegetarian diet in what kind of population and compared against which other diet or diets. The Mediterranean diet also has showed positive results and the Paleo diet has as well, although most often the comparison is against a control group that isn’t on any particular diet.

It turns out that almost any diet is better than the Standard American Diet (SAD). Eating dog shit would be improvement over what the average American shoves into their mouth-hole. I should know. I shudder at the diet of my younger days, consisting of junk food and fast food. Like most Americans, I surely used to be malnourished, along also with likely having leaky gut, inflammation, insulin sensitivity, toxic overload, and who knows what else. Any of the changes I’ve made in my diet over the years has been beneficial.

So, here is the great secret. It matters less which specific diet you have, in the general sense. That is particular true in decreasing some of the worst risk factors. Many diets can help you lose weight and such, from low fat to high fat, from omnivorian to vegetarian. That isn’t to say all diets are equal in the long term, but there are commonalities to be found in any healthy diet. Let me lay it out. All health diets do some combination of the following.

Eliminate or lessen:

  • processed foods
  • vegetable oils
  • carbs, especially simple carbs
  • grains, especially wheat
  • sugar, especially fructose
  • dairy, especially cow milk
  • foods from factory-farmed animals
  • artificial additives

Emphasize and increase:

  • whole foods
  • omega-3s, including but not limited to seafood
  • fiber, especially prebiotics
  • probiotics, such as fermented/cultured
  • foods that are organic, local, and in season
  • foods from pasture-raised or grass-fed animals
  • nutrient-density
  • fat-soluble vitamins

There are some foods that are harder to categorize. Even though many people have problems with cow milk, especially of the variety with A1 casein, more people are better able to deal with ghee which has the problematic proteins removed. And pasture-raised cows produce nutrient-dense milk, as they produce nutrient-dense organ meats and meat filled with omega-3s. So, it’s not that a diet has to include everything I listed. But the more it follows these the greater will be the health benefits.

It does matter to some degree, for example, where you get your nutrient-density. Fat-soluble vitamins are hard to find in non-animal sources, a problem for vegans. But even a vegan can vastly increase their nutrient intake by eating avocados, leafy greens, seaweed, etc. The main point is any increase in nutrients can have a drastic benefit to health. And the greater amount and variety of nutrients the greater the improvement.

That is why any diet you can imagine comes in healthy and unhealthy versions. No matter the diet, anyone who decreases unhealthy fats/oils and increases healthy fats/oils will unsurprisingly increase their health. But as an omnivore could fill their plate with factory-farmed meat and dairy, a vegan could fill their plate with toxic soy-based processed foods and potato chips. The quality of a diet is in the details.

Still, it is easier to include more of what I listed in some diets than others. Certain nutrients are only found in animal sources and so a vegan has to be careful about supplementing what is otherwise lacking. A diet of whole foods that doesn’t require supplementation, however, is preferable.

That is why there are a surprisingly large number of self-identified vegans and vegetarians who will, at least on occasion, eat fish and other seafood. That also might be why the Mediterranean diet and Paleo diet can be so healthy as well, in their inclusion of these foods. Weston A. Price observed some of the healthiest populations in the world were those who lived near the ocean. And this is why cod liver oil was traditionally one of the most important parts of the Western diet, high in both omega-3s and fat soluble vitamins and much else as well.

Whatever the details one focuses upon, the simple rule is increase the positives and decrease the negatives. It’s not that difficult, as long as one knows which details matter most. The basic trick to any health diet is to not eat like the average American. That is the secret.

* * *

Getting that out of the way, here is my bias.

My own dietary preferences are based on functional medicine, traditional foods, paleo diet, nutritional science, anthropology, and archaeology — basically, any and all relevant evidence and theory. This is what informs the list I provided above, with primary focus on the Paleo diet which brings all the rest together. That is what differentiates the Paleo diet from all others, in that it is a systematic approach that scientifically explains why the diet works. It focuses not just on one aspect but all known aspects, including lifestyle and such.

Something like the Mediterranean diet is far different. It has been widely researched and it is healthy, at least relative to what it has been tested against. There are multiple limitations to health claims about it.

First, the early research was done after World War II and , because of the ravages to the food supply, the diet they were eating then was different than what they were eating before. The healthy adults observed were healthy because of the diet they grew up on, not because of the deprivation diet they experienced after the war. That earlier diet was filled with meat and saturated fat, but it also had lots of vegetables and olive oil as. As in the US, the health of the Mediterranean people had decreased as well from one generation to the next. So, arguing that the post-war Mediterranean diet was healthier than the post-war American diet wasn’t necessarily making as strong of a claim as it first appeared, as health was declining in both countries but with the decline in the latter being far worst.

Working with that problematic research alone, there was no way to get beyond mere associations in order to determine causation. As such, it couldn’t be stated with any certainty which parts of the diet were healthy, which parts unhealthy, and which parts neutral. It was a diet based on associations, not on scientific understanding of mechanisms and the evidence in support. It’s the same kind of associative research that originally linked saturated fat to heart disease, only to later discover that it was actually sugar that was the stronger correlation. The confusion came because, in the American population because of the industrialized diet, habits of saturated fat consumption had become associated with that of sugar, but there was no study that ever linked saturated fat to heart disease. It was a false or meaningless association, a correlation that it turns out didn’t imply causation.

That is the kind of mistake that the Paleo diet seeks to avoid. The purpose is not merely to look for random associations and hope that they are causal without ever proving it. Based on other areas of science, paleoists make hypotheses that can be tested, both in clinical studies and in personal experience. The experimental attitude is central.

That is why there is no single Paleo diet, in the way there is a single Mediterranean diet. As with hunter-gatherers in the real world, there is a diversity of Paleo diets that are tailored to different purposes, health conditions, and understandings. Dr. Terry Wahl’s Paleo diet is a plant-based protocol for multiple sclerosis, Dr. Dale Bredesen’s Paleo diet is part of an even more complex protocol including ketosis for Alzheimer’s. Other ketogenic Paleo diets target the treatment of obesity, autism, etc. Still other Paleo diets allow more carbs and so don’t prioritize ketosis at all. There are even Paleo diets that are so plant-based as to be vegetarian, with or without the inclusion of fish and seafood, more similar to that of Dr. Wahls.

Which is the Paleo diet? All of them. But what do they all have in common? What I listed above. They all take a multi-pronged approach. Other diets work to the degree they overlap with the Paleo diet, especially nutrient-density. Sarah Ballantyne, a professor and medical biophycisist, argues that nutrient-density might be the singlemost important factor and she might be right. Certainly, you could do worse than focusing on that alone. That has largely been the focus of traditional foods, as inspired by the work of Weston A. Price. Most diets seem to improve nutrient-density, one way or another, even if they don’t do it as fully as the best diets. The advantage of the Paleo diet(s), as with traditional foods and functional medicine, is that there is scientific understanding about why specific nutrients matter, even as our overall knowledge of nutrients has many gaps. Still, knowledge with gaps is better than anything else at the moment.

The list of dos and don’ts is based on the best science available. The science likely will change and so dietary recommendations will be modified accordingly. But if a diet is based on ideology instead, new information can have no impact. Fortunately, most people advocating diets are increasingly turning to a scientific approach. This might explain why all diets are converging on the same set of principles. Few people would have been talking about nutrient-density back when the FDA made its initial dietary recommendations as seen in the Food Pyramid. Yet now the idea of nutrient-density has become so scientifically established that it is almost common knowledge.

More than the Paleo diet as specific foods to eat and avoid, what the most important takeaway is the scientific and experimental approach that its advocates have expressed more strongly than most. That is the way to treat the list I give, for each person is dealing with individual strengths and weaknesses, a unique history of contributing factors and health concerns. So, even if you dismiss the Paleo diet for whatever reason, don’t dismiss the principles upon which the Paleo diet is based (for vegetarians, see: Ketotarian by Dr. Will Cole and The Paleo Vegetarian Diet by Dena Harris). Anyone following any diet will find something of use, as tailored to their own needs.

That is the purpose of my presenting generalized guidelines that apply to all diets. It’s a way of getting past the ideological rhetoric in order to get at the substance of health itself, to get at the causal level. The secret is that there is no single healthy diet, not in any simplistic sense, even as every healthy diet has much in common.

Most Mainstream Doctors Would Fail Nutrition

“A study in the International Journal of Adolescent Medicine and Health assessed the basic nutrition and health knowledge of medical school graduates entering a pediatric residency program and found that, on average, they answered only 52 percent of eighteen questions correctly. In short, most mainstream doctors would fail nutrition.”
~Dr. Will Cole

That is amazing. The point is emphasized by the fact that these are doctors fresh out of medical school. If they were never taught this info in the immediate preceding years of intensive education and training, they are unlikely to pick up more knowledge later in their careers. These young doctors are among the most well educated people in the world, as few fields are as hard to enter and the drop-out rate of medical students is phenomena. These graduates entering residency programs are among the smartest of Americans, the cream of the crop, having been taught at some of the best schools in the world. They are highly trained experts in their field, but obviously this doesn’t include nutrition.

Think about this. Doctors are where most people turn to for serious health advice. They are the ultimate authority figures that the average person directly meets and talks to. If a cardiologist only got 52 percent right to answers on heart health, would you follow her advice and let her do heart surgery on you? I’d hope not. In that case, why would you listen to the dietary opinion of the typical doctor who is ill-informed? Nutrition isn’t a minor part of health, that is for sure. It is the one area where an individual has some control over their life and so isn’t a mere victim of circumstance. Research shows that simple changes in diet and nutrition, not to mention lifestyle, can have dramatic results. Yet few people have that knowledge because most doctors and other officials, to put it bluntly, are ignorant. Anyone who points out this state of affairs in mainstream thought generally isn’t received with welcoming gratitude, much less friendly dialogue and rational debate.

In reading about the paleo diet, a pattern I’ve noticed is that few critics of it know what the diet is and what is advocated by those who adhere to it. It’s not unusual to see, following a criticism of the paleo diet, a description of dietary recommendations that are basically in line with the paleo diet. Their own caricature blinds them to the reality, obfuscating the common ground of agreement or shared concern. I’ve seen the same kind of pattern in the critics of many alternative views: genetic determinists against epigenetic researchers and social scientists, climate change denialists against climatologists, Biblical apologists against Jesus mythicists, Chomskyan linguists against linguistic relativists, etc. In such cases, there is always plenty of fear toward those posing a challenge and so they are treated as the enemy to be attacked. And it is intended as a battle to which the spoils go to the victor, those in dominance assuming they will be the victor.

After debating some people on a blog post by a mainstream doctor (Paleo-suckered), it became clear to me how attractive genetic determinism and biological essentialism is to many defenders of conventional medicine, that there isn’t much you can do about your health other than to do what the doctor tells you and take your meds (these kinds of views may be on the decline, but they are far from down for the count). What bothers them isn’t limited to the paleo diet but extends seemingly to almost any diet as such, excluding official dietary recommendations. They see diet advocates as quacks, faddists, and cultists who are pushing an ideological agenda, and they feel like they are being blamed for their own ill health; from their perspective, it is unfair to tell someone they are capable of improving their diet, at least beyond the standard advice of eat your veggies and whole grains while gulping down your statins and shooting up your insulin.

As a side note, I’m reminded of how what often gets portrayed as alternative wasn’t always seen that way. Linguistic relativism was a fairly common view prior to the Chomskyan counter-revolution. Likewise, much of what gets promoted by the paleo diet was considered common sense in mainstream medical thought earlier last century and in the centuries prior (e.g., carbs are fattening, easily observed back in the day when most people lived on farms, as carbs were and still are how animals get fattened for the slaughter). In many cases, there are old debates that go in cycles. But the cycles are so long, often extending over centuries, that old views appear as if radically new and so easily dismissed as such.

Early Christians heresiologists admitted to the fact of Jesus mythicism, but their only defense was that the devil did it in planting parallels in prior religions. During the Enlightenment Age, many people kept bringing up these religious parallels and this was part of mainstream debate. Yet it was suppressed with the rise of literal-minded fundamentalism during the modern era. Then there is the battle between the Chomskyites, genetic determinists, etc and their opponents is part of a cultural conflict that goes back at least to the ancient Greeks, between the approaches of Plato and Aristotle (Daniel Everett discusses this in the Dark Matter of the Mind; see this post).

To return to the topic at hand, the notion of food as medicine, a premise of the paleo diet, also goes back to the ancient Greeks — in fact, originates with the founder of modern medicine, Hippocrates (he also is ascribed as saying that, “All disease begins in the gut,”  a slight exaggeration of a common view about the importance of gut health, a key area of connection between the paleo diet and alternative medicine). What we now call functional medicine, treating people holistically, used to be standard practice of family doctors for centuries and probably millennia, going back to medicine men and women. But this caring attitude and practice went by the wayside because it took time to spend with patients and insurance companies wouldn’t pay for it. Traditional healthcare that we now think of as alternative is maybe not possible with a for-profit model, but I’d say that is more of a criticism of the for-profit model than a criticism of traditional healthcare.

The dietary denialists love to dismiss the paleo lifestyle as a ‘fad diet’. But as Timothy Noakes argues, it is the least fad diet around. It is based on the research of what humans have been eating since the Paleoithic era and what hominids have been eating for millions of years. Even as a specific diet, it is the earliest official dietary recommendations given by medical experts. Back when it was popularized, it was called the Banting diet and the only complaint the medical authorities had was not that it was wrong but that it was right and they disliked it being promoted in the popular literature, as they considered dietary advice to be their turf to be defended. Timothy Noakes wrote that,

“Their first error is to label LCHF/Banting ‘the latest fashionable diet’; in other words, a fad. This is wrong. The Banting diet takes its name from an obese 19th-century undertaker, William Banting. First described in 1863, Banting is the oldest diet included in medical texts. Perhaps the most iconic medical text of all time, Sir William Osler’s The Principles and Practice of Medicine , published in 1892, includes the Banting/Ebstein diet as the diet for the treatment of obesity (on page 1020 of that edition). 13 The reality is that the only non-fad diet is the Banting diet; all subsequent diets, and most especially the low-fat diet that the UCT academics promote, are ‘the latest fashionable diets’.”
(Lore of Nutrition, p. 131)

The dominant paradigm maintains its dominance by convincing most people that what is perceived as ‘alternative’ was always that way or was a recent invention of radical thought. The risk the dominant paradigm takes is that, in attacking other views, it unintentionally acknowledges and legitimizes them. That happened in South Africa when the government spent hundreds of thousands of dollars attempting to destroy the career of Dr. Timothy Noakes, but because he was such a knowledgeable expert he was able to defend his medical views with scientific evidence. A similar thing happened when the Chomskyites viciously attacked the linguist Daniel Everett who worked in the field with native tribes, but it turned out he was a better writer with more compelling ideas and also had the evidence on his side. What the dogmatic assailants ended up doing, in both cases, was bringing academic and public attention to these challengers to the status quo.

Even though these attacks don’t always succeed, they are successful in setting examples. Even a pyrrhic victory is highly effective in demonstrating raw power in the short term. Not many doctors would be willing to risk their career as did Timothy Noakes and even fewer would have the capacity to defend themselves to such an extent. It’s not only the government that might go after a doctor but also private litigators. And if a doctor doesn’t toe the line, that doctor can lose their job in a hospital or clinic, be denied the ability to get Medicaire reimbursement, be blacklisted from speaking at medical conferences, and many other forms of punishment. That is what many challengers found in too loudly disagreeing with Ancel Keys and gang — they were effectively silenced and were no longer able to get funding to do research, even though the strongest evidence was on their side of the argument. Being shut out and becoming pariah is not a happy place to be.

The establishment can be fearsome when they flex their muscles. And watch out when they come after you. The defenders of the status quo become even more dangerous precisely when they are the weakest, like an injured and cornered animal who growls all the louder, and most people wisely keep their distance. But without fools to risk it all in testing whether the bark really is worse than the bite, nothing would change and the world would grind to a halt, as inertia settled into full authoritarian control. We are in such a time. I remember back in the era of Bush jr and as we headed into the following time of rope-a-dope hope-and-change. There was a palpable feeling of change in the air and I could viscerally sense the gears clicking into place. Something had irrevocably changed and it wasn’t fundamentally about anything going on in the halls of power but something within society and the culture. It made me feel gleeful at the time, like scratching the exact right spot where it itches — ah, there it is! Outwardly, the world more or less appeared the same, but the public mood had clearly shifted.

The bluntness of reactionary right-wingers is caused by the very fact that the winds of change are turning against them. That is why they praise the crude ridicule of wannabe emperor Donald Trump. What in the past could have been ignored by those in the mainstream no longer can be ignored. And after being ignored, the next step toward potential victory is being attacked, which can be mistaken for loss even as it offers the hope for reversal of fortune. Attacks come in many forms, with a few examples already mentioned. Along with ridicule, there is defamation, character assassination, scapegoating, and straw man arguments; allegations of fraud, quackery, malpractice, or deviancy. These are attacks as preemptive defense, in the hope of enforcing submission and silence. This only works for so long, though. The tide can’t be held back forever.

The establishment is under siege and they know it. Their only hope is to be able hold out long enough until the worst happens and they can drop the pretense in going full authoritarian. That is a risky gamble on their part and likely not to pay off, but it is the only hope they have in maintaining power. Desperation of mind breeds desperation of action. But it’s not as if a choice is being made. The inevitable result of a dominant paradigm is that it closes itself not only to all other possibilities but, more importantly, to even the imagination that something else is possible. Ideological realism becomes a reality tunnel. And insularity leads to intellectual laziness, as those who rule and those who support them have come to depend on a presumed authority as gatekeepers of legitimacy. What they don’t notice or don’t understand is the slow erosion of authority and hence loss of what Julian Jaynes called authorization. Their need to be absolutely right is no longer matched with their capacity to enforce their increasingly rigid worldview, their fragile and fraying ideological dogmatism.

This is why challengers to the status quo are in a different position, thus making the altercation of contestants rather lopsided. There is a freedom to being outside the constraints of mainstream thought. An imbalance of power, in some ways, works in favor of those excluded from power since they have all the world to gain and little to lose, meaning less to defend; this being shown in how outsiders, more easily than insiders, often can acknowledge where the other side is right and accept where points of commonality are to be found, that is to say the challengers to power don’t have to be on the constant attack in the way that is required for defenders of the status quo (similar to how guerrilla fighters don’t have to defeat an empire, but simply not lose and wait it out). Trying to defeat ideological underdogs that have growing popular support is like the U.S. military trying to win a war in Vietnam or Afghanistan — they are on the wrong side of history. But systems of power don’t give up without a fight, and they are willing to sacrifice loads of money and many lives in fighting losing battles, if only to keep the enemies at bay for yet another day. And the zombie ideas these systems are built on are not easily eliminated. That is because they are highly infectious mind viruses that can continue to spread long after the original vector of disease disappeared.

As such, the behemoth medical-industrial complex won’t be making any quick turns toward internal reform. Changes happen over generations. And for the moment, this generation of doctors and other healthcare workers were primarily educated and trained under the old paradigm. It’s the entire world most of them know. The system is a victim of its own success and so those working within the system are victimized again and again in their own indoctrination. It’s not some evil sociopathic self-interest that keeps the whole mess slogging along; after all, even doctors are suffering the same failed healthcare system as the rest of us and are dying of the same preventable diseases. All are sacrificed equally, all are food for the system’s hunger. When my mother brought my nephew for an appointment, the doctor was not trying to be a bad person when she made the bizarre and disheartening claim that all kids eat unhealthy and are sickly; i.e., there is nothing to do about it, just the way kids are. Working within the failed system, that is all she knows. The idea that sickness isn’t or shouldn’t be the norm was beyond her imagination.

It is up to the rest of us to imagine new possibilities and, in some cases, to resurrect old possibilities long forgotten. We can’t wait for a system to change when that system is indifferent to our struggles and suffering. We can’t wait for a future time when most doctors are well-educated on treating the whole patient, when officials are well-prepared for understanding and tackling systemic problems. Change will happen, as so many have come to realize, from the bottom up. There is no other way. Until that change happens, the best we can do is to take care of ourselves and take care of our loved ones. That isn’t about blame. It’s about responsibility, that is to say the ability to respond; and more importantly, the willingness to do so.

* * *

Ketotarian
by Dr. Will Cole
pp. 15-16

With the Hippocratic advice to “let food be thy medicine, and medicine thy food,” how far have we strayed that the words of the founder of modern medicine can actually be threatening to conventional medicine?

Today medical schools in the United States offer, on average, only about nineteen hours of nutrition education over four years of medical school.10 Only 29 percent of U.S. medical schools offer the recommended twenty-five hours of nutrition education.11 A study in the International Journal of Adolescent Medicine and Health assessed the basic nutrition and health knowledge of medical school graduates entering a pediatric residency program and found that, on average, they answered only 52 percent of eighteen questions correctly.12 In short, most mainstream doctors would fail nutrition. So if you were wondering why someone in functional medicine, outside conventional medicine, is writing a book on how to use food for optimal health, this is why.

Expecting health guidance from mainstream medicine is akin to getting gardening advice from a mechanic. You can’t expect someone who wasn’t properly trained in a field to give sound advice. Brilliant physicians in the mainstream model of care are trained to diagnose a disease and match it with a corresponding pharmaceutical drug. This medicinal matching game works sometimes, but it often leaves the patient with nothing but a growing prescription list and growing health problems.

With the strong influence that the pharmaceutical industry has on government and conventional medical policy, it’s no secret that using foods to heal the body is not a priority of mainstream medicine. You only need to eat hospital food once to know this truth. Even more, under current laws it is illegal to say that foods can heal. That’ right. The words treat, cure, and prevent are in effect owned by the Food and Drug Administration (FDA) and the pharmaceutical industry and can be used in the health care setting only when talking about medications. This is the Orwellian world we live in today; health problems are on the rise even though we spend more on health care than ever, and getting healthy is considered radical and often labeled as quackery.

10. K. Adams et al., “Nutrition Education in U.S. Medical Schools: Latest Update of a National Survey,” Academic Medicine 85, no. 9 (September 2010): 1537-1542, https://www.ncbi.nlm.nih.gov/pubmed/9555760.
11. K. Adams et al., “The State of Nutrition Education at US Medical Schools,” Journal of Biomedical Education 2015 (2015), Article ID 357627, 7 pages, http://dx.doi.org/10.1155/2015/357627.
12. M. Castillo et al., “Basic Nutrition Knowledge of Recent Medical Graduates Entering a Pediatric Reside): 357-361, doi: 10.1515/ijamh-2015-0019, https://www.ncbi.nlm.nih.gov/pubmed/26234947.

Ancient Atherosclerosis?

In reading about health, mostly about diet and nutrition, I regularly come across studies that are either poorly designed or poorly interpreted. The conclusions don’t always follow from the data or there are so many confounders that other conclusions can’t be discounted. Then the data gets used by dietary ideologues.

There is a major reason I appreciate the dietary debate among proponents of traditional, ancestral, paleo, low-carb, ketogenic, and some other related views (anti-inflammatory diets, autoimmune diets, etc such as the Wahls Protocol for multiple sclerosis and Bredesen Protocol for Alzheimer’s). This area of alternative debate leans heavily on questioning conventional certainties by digging deep into the available evidence. These diets seem to attract people capable of changing their minds or maybe it is simply that many people who eventually come to these unconventional views do so after having already tried numerous other diets.

For example, Dr. Terry Wahls is a clinical professor of Internal Medicine, Epidemiology, and Neurology  at the University of Iowa while also being Associate Chief of Staff at a Veterans Affairs hospital. She was as conventional as doctors come until she developed multiple sclerosis, began researching and experimenting, and eventually became a practitioner of functional medicine. Also, she went from being a hardcore vegetarian following mainstream dietary advice (avoided saturated fats, ate whole grains and legumes, etc) to embracing an essentially nutrient-dense paleo diet; her neurologist at the Cleveland Clinic referred her to Dr. Loren Cordain’s paleo research at Colorado State University. Since that time, she has done medical research and, recently having procured funding, she is in the process of doing a study in order to further test her diet.

Her experimental attitude, both personally and scientifically, is common among those interested in these kinds of diets and functional medicine. This experimental attitude is necessary when one steps outside of conventional wisdom, something Dr. Wahls felt she had to do to save her own life — a motivating factor of health crisis that leads many people to try a paleo, keto, etc diet after trying all else (these involve protocols to deal with serious illnesses, such as ketosis being medically used for treatment of epileptic seizures). Contradicting professional opinion of respected authorities (e.g., the American Heart Association), a diet like this tends to be an option of last resort for most people, something they come to after much failure and worsening of health. That breeds a certain mentality.

On the other hand, it should be unsurprising that people raised on mainstream views and who hold onto those views long into adulthood (and long into their careers) tend not to be people willing to entertain alternative views, no matter what the evidence indicates. This includes those working in the medical field. Some ask, why are doctors so stupid? As Dr. Michael Eades explains, it’s not that they’re stupid but that many of them are ignorant; to put it more nicely, they’re ill-informed. They simply don’t know because, like so many others, they are repeating what they’ve been told by other authority figures. And the fact of the matter is most doctors never learned much about certain topics in the first place: “A study in the International Journal of Adolescent Medicine and Health assessed the basic nutrition and health knowledge of medical school graduates entering a pediatric residency program and found that, on average, they answered only 52 percent of the eighteen questions correctly. In short, most mainstream doctors would fail nutrition” (Dr. Will Cole, Ketotarian).

The reason people stick to the known, even when it is wrong, is because it is familiar and so it feels safe (and because of liability, healthcare workers and health insurance companies prefer what is perceived as safe). Doctors, as with everyone else, are dependent on heuristics to deal with a complex world. And doctors, more than most people, are too busy to explore the large amounts of data out there, much less analyze it carefully for themselves.

This maybe relates to why most doctors tend to not make the best researchers, not to dismiss those attempting to do quality research. For that reason, you might think scientific researchers who aren’t doctors would be different than doctors. But that obviously isn’t always the case because, if so, Ancel Keys low quality research wouldn’t have dominated professional dietary advice for more than a half century. Keys wasn’t a medical professional or even trained in nutrition, rather he was educated in a wide variety of other fields (economics, political science, zoology, oceanography, biology, and physiology) with his earliest research done on the physiology of fish.

I came across yet another example of this, although less extreme than that of Keys, but also different in that at least some of the authors of the paper are medical doctors. The study in question involved the participation of 19 people. The paper is “Atherosclerosis across 4000 years of human history: the Horus study of four ancient populations,” peer-reviewed and published (2013) in the highly respectable Lancet Journal (Keys’ work, one might note, was also highly respectable). This study on atherosclerosis was well reported in the mainstream news outlets and received much attention from those critical of paleo diets, offered as a final nail in the coffin, claimed as being absolute proof that ancient people were as unhealthy as we are.

The 19 authors conclude that, “atherosclerosis was common in four preindustrial populations, including a preagricultural hunter-gatherer population, and across a wide span of human history. It remains prevalent in contemporary human beings. The presence of atherosclerosis in premodern human beings suggests that the disease is an inherent component of human ageing and not characteristic of any specific diet or lifestyle.” There you have it. Heart disease is simply in our genetics — so take your statin meds like your doctor tells you to do, just shut up and quit asking questions, quit looking at all the contrary evidence.

But even ignoring all else, does the evidence from this paper support their conclusion? No. It doesn’t require much research or thought to ascertain the weak case presented. In the paper itself, on multiple occasions including in the second table, they admit that three out of four of the populations were farmers who ate largely an agricultural diet and, of course, lived an agricultural lifestyle. At most, these examples can speak to the conditions of the neolithic but not the paleolithic. Of these three, only one was transitioning from an earlier foraging lifestyle, but as with the other two was eating a higher carb diet from foods they farmed. Also, the most well known example of the bunch, the Egyptians, particularly point to the problems of an agricultural diet — as described by Michael Eades in Obesity in ancient Egypt:

“[S]everal thousand years ago when the future mummies roamed the earth their diet was a nutritionist’s nirvana. At least a nirvana for all the so-called nutritional experts of today who are recommending a diet filled with whole grains, fresh fruits and vegetables, and little meat, especially red meat. Follow such a diet, we’re told, and we will enjoy abundant health.

“Unfortunately, it didn’t work that way for the Egyptians. They followed such a diet simply because that’s all there was. There was no sugar – it wouldn’t be produced for another thousand or more years. The only sweet was honey, which was consumed in limited amounts. The primary staple was a coarse bread made of stone-ground, whole wheat. Animals were used as beasts of burden and were valued much more for the work they could do than for the meat they could provide. The banks of the Nile provided fertile soil for growing all kinds of fruits and vegetables, all of which were a part the low-fat, high-carbohydrate Egyptian diet. And there were no artificial sweeteners, artificial coloring, artificial flavors, preservatives, or any of the other substances that are part of all the manufactured foods we eat today.

“Were the nutritionists of today right about their ideas of the ideal diet, the ancient Egyptians should have had abundant health. But they didn’t. In fact, they suffered pretty miserable health. Many had heart disease, high blood pressure, diabetes and obesity – all the same disorders that we experience today in the ‘civilized’ Western world. Diseases that Paleolithic man, our really ancient ancestors, appeared to escape.”

With unintentional humor, the authors of the paper note that, “None of the cultures were known to be vegetarian.” No shit. Maybe that is because until late in the history of agriculture there were no vegetarians and for good reason. As Weston Price noted, there is a wide variety of possible healthy diets as seen in traditional communities. Yet for all his searching for a healthy traditional community that was strictly vegan or even vegetarian, he could never find any; the closest examples were those that relied largely on such things as insects and grubs because of a lack of access to larger sources of protein and fat. On the other hand, the most famous vegetarian population, Hindu Indians, have one of the shortest lifespans (to be fair, though, that could be for other reasons such as poverty-related health issues).

Interestingly, there apparently has never been a study done comparing a herbivore diet and a carnivore diet, although one study touched on it while not quite eliminating all plants from the latter. As for fat, there is no evidence that it is problematic (vegetable oils are another issue), if anything the opposite: “In a study published in the Lancet, they found that people eating high quantities of carbohydrates, which are found in breads and rice, had a nearly 30% higher risk of dying during the study than people eating a low-carb diet. And people eating high-fat diets had a 23% lower chance of dying during the study’s seven years of follow-up compared to people who ate less fat” (Alice Park, The Low-Fat vs. Low-Carb Diet Debate Has a New Answer); and “The Mayo Clinic published a study in the Journal of Alzheimer’s Disease in 2012 demonstrating that in individuals favoring a high-carb diet, risk for mild cognitive impairment was increased by 89%, contrasted to those who ate a high-fat diet, whose risk was decreased by 44%” (WebMD interview of Dr. David Perlmutter). Yet the respectable authorities tell us that fat is bad for our health, making it paradoxical that many fat-gluttonous societies have better health. There are so many paradoxes, according to conventional thought, that one begins to wonder if conventional thought is the real paradox.

Now let me discuss the one group, the Unangan, that at first glance stands out from the rest. The authors say that the, “five Unangan people living in the Aleutian Islands of modern day Alaska (ca 1756–1930 CE, one excavation site).” Those mummies are far different than those from the other populations that came much earlier in history. Four of the Unangan died around 1900 and one around 1850. Why does that matter? Well, for the reason that their entire world was being turned on its head at that time. The authors claim that, “The Unangan’s diet was predominately marine, including seals, sea lions, sea otters, whale, fish, sea urchins, and other shellfish and birds and their eggs. They were hunter-gatherers living in barabaras, subterranean houses to protect against the cold and fierce winds.” They base this claim on the assumption that these particular mummified Unangan had been eating the same diet as their ancestors for thousands of years, but the evidence points in the opposite direction.

Questioning this assumption, Jeffery Gerber explains that, “During life (before 1756–1930 CE) not more than a few short hundred years ago, the 5 Unangan/Aleut mummies were hardly part of an isolated group. The Fur Seal industry exploded in the 18th century bringing outside influence, often violent, from countries including Russia and Europe. These mummies during life, were probably exposed to foods (including sugar) different from their traditional diet and thus might not be representative of their hunter-gatherer origins” (Mummies, Clogged Arteries and Ancient Junk Food). One might add that, whatever Western foods that may have been introduced, we do know of another factor — the Government of Nunavat official website states that, “European whalers regularly travelled to the Arctic in the late 17th and 18th century. When they visited, they introduced tobacco to Inuit.” Why is that significant? Tobacco is a known risk factor for atherosclerosis. Gideon Mailer and Nicola Hale, in their book Decolonizing the Diet, elaborate on the colonial history of the region (pp. 162-171):

“On the eve of Western contact, the indigenous population of present-day Alaska numbered around 80,000. They included the Alutiiq and Unangan communities, more commonly defined as Aleuts, Inupiat and Yupiit, Athabaskans, and the Tinglit and Haida groups. Most groups suffered a stark demographic decline from the mid-eighteenth century to the mid-nineteenth century, during the period of extended European — particularly Russian — contact. Oral traditions among indigenous groups in Alaska described whites as having taken hunting grounds from other related communities, warning of a similar fate to their own. The Unangan community, numbering more than 12,000 at contact, declined by around 80 percent by 1860. By as early as the 1820s, as Jacobs has described, “The rhythm of life had changed completely in the Unangan villages now based on the exigencies of the fur trade rather than the subsistence cycle, meaning that often villages were unable to produce enough food to keep them through the winter.” Here, as elsewhere, societal disruption was most profound in the nutritional sphere, helping account for the failure to recover population numbers following disease epidemics.

“In many parts of Alaska, Native American nutritional strategies and ecological niches were suddenly disrupted by the arrival of Spanish and Russian settlers. “Because,” as Saunt has pointed out “it was extraordinarily difficult to extract food from the challenging environment,” in Alaska and other Pacific coastal communities, “any disturbance was likely to place enormous stress on local residents.” One of indigenous Alaska’s most important ecological niches centered on salmon access points. They became steadily more important between the Paleo-Eskimo era around 4,200 years ago and the precontact period, but were increasingly threatened by Russian and American disruptions from the 1780s through the nineteenth century. Dependent on nutrients and omega fatty acids such as DHA from marine resources such as salmon, Aleut and Alutiiq communities also required other animal products, such as intestines, to prepare tools and waterproof clothing to take advantage of fishing seasons. Through the later part of the eighteenth century, however, Russian fur traders and settlers began to force them away from the coast with ruthless efficiency, even destroying their hunting tools and waterproof apparatus. The Russians were clear in their objectives here, with one of their men observing that the Native American fishing boats were “as indispensable as the plow and the horse for the farmer.”

“Here we are provided with another tragic case study, which allows us to consider the likely association between disrupted access to omega-e fatty acids such as DHA and compromised immunity. We have already noted the link between DHA, reduced inflammation and enhanced immunity in the millennia following the evolution of the small human gut and the comparatively larger human brain. Wild animals, but particularly wild fish, have been shown to contain far higher proportions of omega-3 fatty acids than the food sources that apparently became more abundant in Native American diets after European contact, including in Alaska. Fat-soluble vitamins and DHA are abundantly found in fish eggs and fish fats, which were prized by Native Americans in the Northwest and Great Lakes regions, in the marine life used by California communities, and perhaps more than anywhere else, in the salmon products consumed by indigenous Alaskan communities. […]

“In Alaska, where DHA and vitamin D-rich salmon consumption was central to precontact subsistence strategies, alongside the consumption of nutrient-dense animal products and the regulation of metabolic hormones through periods of fasting or even through the efficient use of fatty acids or ketones for energy, disruptions to those strategies compromised immunity among those who suffered greater incursions from Russian and other European settlers through the first half of the nineteenth century.

“A collapse in sustainable subsistence practices among the Aleuts of Alaska exacerbated population decline during the period of Russian contact. The Russian colonial regime from the 1740s to 1840s destroyed Aleut communities through open warfare and by attacking and curtailing their nutritional resources, such as sea otters, which Russians plundered to supply the Chinese market for animal skins. Aleuts were often forced into labor, and threatened by the regular occurrence of Aleut women being taken as hostages. Curtailed by armed force, Aleuts were often relocated to the Pribilof Islands or to California to collect seals and sea otters. The same process occurred as Aleuts were co-opted into Russian expansion through the Aleutian Islands, Kodiak Island and into the southern coast of Alaska. Suffering murder and other atrocities, Aleuts provided only one use to Russian settlers: their perceived expertise in hunting local marine animals. They were removed from their communities, disrupting demography further and preventing those who remained from accessing vital nutritional resources due to the discontinuation of hunting frameworks. Colonial disruption, warfare, captivity and disease were accompanied by the degradation of nutritional resources. Aleut population numbers declined from 18,000 to 2,000 during the period of Russian occupation in the first half of the nineteenth century. A lag between the first period of contact and the intensification of colonial disruption demonstrates the role of contingent interventions in framing the deleterious effects of epidemics, including the 1837-38 smallpox epidemic in the region. Compounding these problems, communities used to a relatively high-fat and low-fructose diet were introduced to alcohol by the Russians, to the immediate detriment of their health and well-being.”

The traditional hunter-gatherer diet, as Mailer and Hale describe it, was high in the nutrients that protect against inflammation. The loss of these nutrients and the simultaneous decimation to the population was a one-two punch. Without the nutrients, their immune systems were compromised. And with their immune systems compromised, they were prone to all kinds of health conditions, probably including heart disease which of course is related to inflammation. Weston A. Price, in Nutrition and Physical Degeneration, observed that morbidity and mortality of health conditions such as heart disease rise and fall with the seasons, following precisely the growth and dying away of vegetation throughout the year (which varies by region as do the morbidity and mortality rates; the regions of comparison were in the United States and Canada). He was able to track this down to the change of fat soluble vitamins, specifically vitamin D, in dairy. When fresh vegetation was available, cows ate it and so produced more of these nutrients and presumably more omega-3s at the same time.

Prior to colonization, the Unang would have had access to even higher levels of these protective nutrients year round. The most nutritious dairy taken from the springtime wouldn’t come close in comparison to the nutrient profile of wild game. I don’t know why anyone would be shocked that, like agricultural populations, hunter-gatherers also experience worsening health after loss of wild resources. Yet the authors of the mummy studies act like they made a radical discovery that throws to the wind every doubt anyone ever had about simplistic mainstream thought. It turns out, they seem to be declaring, that we are all victims of genetic determinism after all and so toss out your romantic fairy tales about healthy primitives from the ancient world. The problem is all the evidence that undermines their conclusion, including the evidence that they present in their own paper, that is when it is interpreted in full context.

As if responding to the researchers, Mailer and Hale write (p. 186): “Conditions such as diabetes are thus often associated with heart disease and other syndromes, given their inflammatory component. They now make up a huge proportion of treatment and spending in health services on both sides of the Atlantic. Yet policy makers and researchers in those same health services often respond to these conditions reactively rather than proactively — as if they were solely genetically determined, rather than arising due to external nutritional factors. A similarly problematic pattern of analysis, as we have noted, has led scholars to ignore the central role of nutritional change in Native American population loss after European contact, focusing instead on purportedly immutable genetic differences.”

There is another angle related to the above but somewhat at a tangent. I’ll bring it up because the research paper mentions it in passing as a factor to be considered: “All four populations lived at a time when infections would have been a common aspect of daily life and the major cause of death. Antibiotics had yet to be developed and the environment was non-hygienic. In 20th century hunter-foragers-horticulturalists, about 75% of mortality was attributed to infections, and only 10% from senescence. The high level of chronic infection and inflammation in premodern conditions might have promoted the inflammatory aspects of atherosclerosis.”

This is familiar territory for me, as I’ve been reading much about inflammation and infections. The authors are presenting the old view of the immune system, as opposed to that of functional medicine that looks at the entire human. An example of the latter is the hygiene hypothesis that argues it is the exposure to microbes that strengthens the immune system and there has been much evidence in support of it (such as children raised with animals or on farms being healthier as adults). The researchers above are making an opposing argument that is contradicted by populations remaining healthy when lacking modern medicine as long as they maintain traditional diet and lifestyle in a healthy ecosystem, including living soil that hasn’t been depleted from intensive farming.

This isn’t only about agriculturalists versus hunter-gatherers. The distinction between populations goes deeper into culture and environment. Weston A. Price discovered this simple truth in finding healthy populations among both agriculturalists and hunter-gatherers, but it was specific populations under specific conditions. Also, at the time when he traveled in the early 20th century, there were still traditional communities living in isolation in Europe. One example is Loetschenatal Valley in Switzerland, while visiting the country in two separate trips in the consecutive years of 1931 and 1932 — as he writes of it:

“We were told that the physical conditions that would not permit people to obtain modern foods would prevent us from reaching them without hardship. However, owing to the completion of the Loetschberg Tunnel, eleven miles long, and the building of a railroad that crosses the Loetschental Valley, at a little less than a mile above sea level, a group of about 2,000 people had been made easily accessible for study, shortly prior to 1931. Practically all the human requirements of the people in that valley, except a few items like sea salt, have been produced in the valley for centuries.”

He points out that, “Notwithstanding the fact that tuberculosis is the most serious disease of Switzerland, according to a statement given me by a government official, a recent report of inspection of this valley did not reveal a single case.” In Switzerland and other countries, he found an “association of dental caries and tuberculosis.” The commonality was early life development, as underdeveloped and maldeveloped bone structure led to diverse issues: crowded teeth, smaller skull size, misaligned features, and what was called tubercular chest. And that was an outward sign of deeper and more systemic developmental issues, including malnutrition, inflammation, and the immune system:

“Associated with a fine physical condition the isolated primitive groups have a high level of immunity to many of our modern degenerative processes, including tuberculosis, arthritis, heart disease, and affections  of the internal organs. When, however, these individuals have lost this high level of physical excellence a definite lowering in their resistance to the modern degenerative processes has taken place. To illustrate, the narrowing of the facial and dental arch forms of the children of the modernized parents, after they had adopted the white man’s food, was accompanied by an increase in susceptibility to pulmonary tuberculosis.”

Any population that lost its traditional way of life became prone to disease. But this could often as easily be reversed by having the diseased individual return to healthy conditions. In discussing Dr. Josef Romig, Price said that, “Growing out of his experience, in which he had seen large numbers of the modernized Eskimos and Indians attacked with tuberculosis, which tended to be progressive and ultimately fatal as long as the patients stayed under modernized living conditions, he now sends them back when possible to primitive conditions and to a primitive diet, under which the death rate is very much lower than under modernized  conditions. Indeed, he reported that a great majority of the afflicted recover under the primitive type of living and nutrition.”

The point made by Mailer and Hale was earlier made by Price. As seen with pre-contact Native Alaskans, the isolated traditional residents of Loetschenatal Valley had nutritious diets. Price explained that he “arranged to have samples of food, particularly dairy products, sent to me about twice a month, summer and winter. These products have been tested for their mineral and vitamin contents, particularly the fat-soluble activators. The samples were found to be high in vitamins and much higher than the average samples of commercial dairy products in America and Europe, and in the lower areas of Switzerland.” Whether fat and organ meats from marine animals or dairy from pastured alpine cows, the key is high levels of fat soluble vitamins and, of course, omega-3 fatty acids procured from a pristine environment (healthy soil and clean water with no toxins, farm chemicals, hormones, etc). It also helped that both populations ate much that was raw which maintains the high nutrient content that is partly destroyed through heat.

Some might find it hard to believe that what you eat can determine whether or not you get a serious disease like tuberculosis. Conventional medicine tells us that the only thing that protects us is either avoiding contact or vaccination. But this view is being seriously challenged, as Mailer and Hale make clear (p. 164): “Several studies have focused on the link between Vitamin D and the health outcomes of individuals infected with tuberculosis, taking care to discount other causal factors and to avoid determining causation merely through association. Given the historical occurrence of the disease among indigenous people after contact, including in Alaska, those studies that have isolated the contingency of immunity on active Vitamin D are particularly pertinent to note. In biochemical experiments, the presence of the active form of vitamin D has been shown to have a crucial role in the destruction of Mycobacterium tuberculosis by macrophages. A recent review has found that tuberculosis patients tend to retain a lower-than-average vitamin D status, and that supplementation of the nutrient improved outcomes in most cases.” As an additional thought, the popular tuberculosis sanitoriums, some in the Swiss Alps, were attractive because “it was believed that the climate and above-average hours of sunshine had something to do with it” (Jo Fahy, A breath of fresh air for an alpine village). What does sunlight help the body to produce? Vitamin D.

As an additional perspective, James C. Scotts’ Against the Grain, writes that, “Virtually every infectious disease caused by micro-organisms and specifically adapted to Homo sapiens has arisen in the last ten thousand years, many of them in the last five thousand years as an effect of ‘civilisation’: cholera, smallpox, measles, influenza, chickenpox, and perhaps malaria” It is not only that agriculture introduces new diseases but also makes people susceptible to them. That might be true, as Scott suggests, even of a disease like malaria. The Piraha are more likely to die of malaria than anything else, but that might not have been true in the past. Let me offer a speculation by connecting to the mummy study.

The Ancestral Puebloans, one of the groups in the mummy study, were at the time farming maize (corn) and squash while foraging pine nuts, seeds, amaranth (grain), and grasses. How does this compare to the more recent Piraha? A 1948 Smithsonian publication, Handbook of South American Indians ed. Julian H. Steward, reported that, “The Pirah grew maize, sweet manioc (macaxera), a kind of yellow squash (jurumum), watermelon, and cotton” (p. 267). So it turns out that, like the Ancestral Puebloan, the Piraha have been on their way toward a more agricultural lifestyle for a while. I also noted that the same publication added the detail that the Piraha “did not drink rum,” but by the time Daniel Everett met the Piraha in 1978 traders had already introduced them to alcohol and it had become an occasional problem. Not only were they becoming agricultural but also Westernized, two factors that likely contributed to decreased immunity.

Like other modern hunter-gatherers, the Piraha have been effected by the Neolithic Revolution and are in many ways far different from Paleolithic hunter-gatherers. Ancient dietary habits are shown in the analysis of ancient bones — M.P. Richards writes that, “Direct evidence from bone chemistry, such as the measurement of the stable isotopes of carbon and nitrogen, do provide direct evidence of past diet, and limited studies on five Neanderthals from three sites, as well as a number of modern Palaeolithic and Mesolithic humans indicates the importance of animal protein in diets. There is a significant change in the archaeological record associated with the introduction of agriculture worldwide, and an associated general decline in health in some areas. However, there is an rapid increase in population associated with domestication of plants, so although in some regions individual health suffers after the Neolithic revolution, as a species humans have greatly expanded their population worldwide” (A brief review of the archaeological evidence for Palaeolithic and Neolithic subsistence). This is further supported in the analysis of coprolites. “Studies of ancient human coprolites, or fossilized human feces, dating anywhere from three hundred thousand to as recent as fifty thousand years ago, have revealed essentially a complete lack of any plant material in the diets of the subjects studied (Bryant and Williams-Dean 1975),” Nora Gedgaudas tells us in Primal Body, Primal Mind (p. 39).

This diet changed as humans entered our present interglacial period with its warmer temperatures and greater abundance of vegetation, which was lacking during the Paleolithic Period: “There was far more plant material in the diets of our more recent ancestors than our more ancient hominid ancestors, due to different factors” (Gedgaudas, p. 37). Following the earlier megafauna mass extinction, it wasn’t only agriculturalists but also hunter-gatherers who began to eat more plants and in many cases make use of cultivated plants (either that they cultivated or that they adopted from nearby agriculturalists). To emphasize how drastic was this change, this loss of abundant meat and fat, consider the fact that humans have yet to regain the average height and skull size of Paleolithic humans.

The authors of the mummy study didn’t even attempt to look at the data of Paleolithic humans. The populations compared are entirely from the past few millennia. And the only hunter-gatherer group included was post-contact. So, why are the authors so confident in their conclusion? I presume they were simply trying to get published and get media attention in a highly competitive market of academic scholarship. These people obviously aren’t stupid, but they had little incentive to fully inform themselves either. All the info I shared in this post I was able to gather in about a half an hour of several web searches, not exactly difficult academic research. It’s amazing the info that is easily available these days, for those who want to find it.

Let me make one last point. The mummy study isn’t without its merits. The paper mentions other evidence that remains to be explained: “We also considered the reliability and previous work of the authors. Autopsy studies done as long ago as the mid-19th century showed atherosclerosis in ancient Egyptians. Also, in more recent times, Zimmerman undertook autopsies and described atherosclerosis in the mummies of two Unangan men from the same cave as our Unangan mummies and of an Inuit woman who lived around 400 CE. A previous study using CT scanning showed atherosclerotic calcifications in the aorta of the Iceman, who is believed to have lived about 3200 BCE and was discovered in 1991 in a high snowfield on the Italian-Austrian border.”

Let’s break that down. Further examples of Egyptian mummies is irrelevant, as their diet was so strikingly similar to the idealized Western diet recommended by mainstream doctors, dieticians, and nutritionists. That leaves the rest to account for. The older Unangan mummies are far more interesting and any meaningful paper would have led with that piece of data, but even then it wouldn’t mean what the authors think it means. Atherosclerosis is one small factor and not necessarily as significant as assumed. From a functional medicine perspective, it’s the whole picture that matters in how the body actually functions and in the health that results. If so, atherosclerosis might not indicate the same thing for all populations. In Nourishing Diets, Morell writes that (pp. 124-5),

“Critics have pointed out that Keys omitted from his study many areas of the world where consumption of animal foods is high and deaths from heart attack are low, including France — the so-called French paradox. But there is also a Japanese paradox. In 1989, Japanese scientists returned to the same two districts that Keys had studied. In an article titled “lessons fro Science from the Seven Countries Study,” they noted that per capita consumption of rice had declined, while consumption of fats, oils, meats, poultry, dairy products and fruit had all increased. […]

“During the postwar period of increased animal consumption, the Japanese average height increased three inches and the age-adjusted death rate from all causes declined from 17.6 to 7.4 per 1,000 per year. Although the rates of hypertension increased, stroke mortality declined markedly. Deaths from cancer also went down in spite of the consumption of animal foods.

“The researchers also noted — and here is the paradox — that the rate of myocardial infarction (heart attack) and sudden death did not change during this period, in spite of the fact that the Japanese weighed more, had higher blood pressure and higher cholesterol levels, and ate more fat, beef and dairy foods.”

Right here in the United States, we have are own ‘paradox’ as well. Good Calories, Bad Calories by Gary Taubes makes a compelling argument that, based on the scientific research, there is no strong causal link between atherosclerosis and coronary heart disease. Nina Teicholz has also written extensively about this, such as in her book The Big Fat Surprise; and in an Atlantic piece (How Americans Got Red Meat Wrong) she lays out some of the evidence showing that Americans in the 19th century, as compared to the following century, ate more meat and fat while they ate fewer vegetables and fruits. Nonetheless: “During all this time, however, heart disease was almost certainly rare. Reliable data from death certificates is not available, but other sources of information make a persuasive case against the widespread appearance of the disease before the early 1920s.” Whether or not earlier Americans had high rates of atherosclerosis, there is strong evidence indicating they did not have high rates of heart disease, of strokes and heart attacks. The health crisis for these conditions, as Tiecholz notes, didn’t take hold until the very moment meat and animal fat consumption took a nosedive. So what gives?

The takeaway is this. We have no reason to assume that atherosclerosis in the present or in the past can tell us much of anything about general health. Even ignoring the fact that none of the mummies studied was from a high protein and high fat Paleo population, we can make no meaningful interpretations of the presence of atherosclerosis among some of the individuals. Going by modern data, there is no reason to jump to the conclusion that they had high mortality rates because of it. Quite likely, they died from completely unrelated health issues. A case in point is that of the Masai, around which there is much debate in interpreting the data. George V. Mann and others wrote a paper, Atherosclerosis in the Masai, that demonstrated the complexity:

“The hearts and aortae of 50 Masai men were collected at autopsy. These pastoral people are exceptionally active and fit and they consume diets of milk and meat. The intake of animal fat exceeds that of American men. Measurements of the aorta showed extensive atherosclerosis with lipid infiltration and fibrous changes but very few complicated lesions. The coronary arteries showed intimal thickening by atherosclerosis which equaled that of old U.S. men. The Masai vessels enlarge with age to more than compensate for this disease. It is speculated that the Masai are protected from their atherosclerosis by physical fitness which causes their coronary vessels to be capacious.”

Put this in the context provided in What Causes Heart Disease? by Sally Fallon Morell and Mary Enig: “The factors that initiate a heart attack (or a stroke) are twofold. One is the pathological buildup of abnormal plaque, or atheromas, in the arteries, plaque that gradually hardens through calcification. Blockage most often occurs in the large arteries feeding the heart or the brain. This abnormal plaque or atherosclerosis should not be confused with the fatty streaks and thickening that is found in the arteries of both primitive and industrialized peoples throughout the world. This thickening is a protective mechanism that occurs in areas where the arteries branch or make a turn and therefore incur the greatest levels of pressure from the blood. Without this natural thickening, our arteries would weaken in these areas as we age, leading to aneurysms and ruptures. With normal thickening, the blood vessel usually widens to accommodate the change. But with atherosclerosis the vessel ultimately becomes more narrow so that even small blood clots may cause an obstruction.”

A distinction is being made here that maybe wasn’t being made in the the mummy study. What gets measured as atherosclerosis could correlate to diverse health conditions and consequences in various populations across dietary lifestyles, regional environments, and historical and prehistorical periods. Finding atherosclerosis in an individual, especially a mummy, might not tell us any useful info about overall health.

Just for good measure, let’s tackle the last piece of remaining evidence the authors mention: “A previous study using CT scanning showed atherosclerotic calcifications in the aorta of the Iceman, who is believed to have lived about 3200 BCE and was discovered in 1991 in a high snowfield on the Italian-Austrian border.” Calling him Iceman, to most ears, sounds similar to calling an ancient person a caveman — implying that he was a hunter for it is hard to grow plants on ice. In response, Paul Mabry writes in Did Meat Eating Make Ancient Hunter Gatherers Get Heart Disease, showing what was left out in the research paper:

“Sometimes the folks trying to discredit hunter-gather diets bring in Ötzi, “The Iceman” a frozen human found in the Tyrolean Mountains on the border between Austria and Italy that also had plaques in his heart arteries. He was judged to be 5300 years old making his era about 3400 BCE. Most experts feel agriculture had reach Europe almost 700 years before that according to this article. And Ötzi himself suggests they are right. Here’s a quote from the Wikipedia article on Ötzi’s last meal (a sandwich): “Analysis of Ötzi’s intestinal contents showed two meals (the last one consumed about eight hours before his death), one of chamois meat, the other of red deer and herb bread. Both were eaten with grain as well as roots and fruits. The grain from both meals was a highly processed einkornwheat bran,[14] quite possibly eaten in the form of bread. In the proximity of the body, and thus possibly originating from the Iceman’s provisions, chaff and grains of einkorn and barley, and seeds of flax and poppy were discovered, as well as kernels of sloes (small plumlike fruits of the blackthorn tree) and various seeds of berries growing in the wild.[15] Hair analysis was used to examine his diet from several months before. Pollen in the first meal showed that it had been consumed in a mid-altitude conifer forest, and other pollens indicated the presence of wheat and legumes, which may have been domesticated crops. Pollen grains of hop-hornbeam were also discovered. The pollen was very well preserved, with the cells inside remaining intact, indicating that it had been fresh (a few hours old) at the time of Ötzi’s death, which places the event in the spring. Einkorn wheat is harvested in the late summer, and sloes in the autumn; these must have been stored from the previous year.””

Once again, we are looking at the health issues of someone eating an agricultural diet. It’s amazing that the authors, 19 of them, apparently all agreed that diet has nothing to do with a major component of health. That is patently absurd. To the credit of Lancet, they published a criticism of this conclusion (though these critics repeats their own preferred conventional wisdom, in their view on saturated fat) — Atherosclerosis in ancient populations by Gino Fornaciari and Raffaele Gaeta:

“The development of vascular calcification is related not only to atherosclerosis but also to conditions such as disorders of calcium-phosphorus metabolism, diabetes, chronic microinflammation, and chronic renal insufficiency.

“Furthermore, stating that atherosclerosis is not characteristic of any specific diet or lifestyle, but an inherent component of human ageing is not in agreement with recent studies demonstrating the importance of diet and physical activity.5 If atherosclerosis only depended on ageing, it would not have been possible to diagnose it in a young individual, as done in the Horus study.1

“Finally, classification of probable atherosclerosis on the basis of the presence of a calcification in the expected course of an artery seems incorrect, because the anatomy can be strongly altered by post-mortem events. The walls of the vessels might collapse, dehydrate, and have the appearance of a calcific thickening. For this reason, the x-ray CT pattern alone is insufficient and diagnosis should be supported by histological study.”

As far as I know, this didn’t lead to a retraction of the paper. Nor did this criticism receive the attention that the paper itself was given. None of the people who praised the paper bothered to point out the criticism, at least not among what I came across. Anyway, how did this weakly argued paper based on faulty evidence get published in the first place? And then how does it get spread by so many as if proven fact?

This is the uphill battle faced by anyone seeking to offer an alternative perspective, especially on diet. This makes meaningful debate next to impossible. That won’t stop those like me from slowly chipping away at the vast edifice of the dominant paradigm. On a positive note, it helps when the evidence used against an alternative view, after reinterpretation, ends up being strong evidence in favor of it.

Health From Generation To Generation

Traveling around the world, Weston A. Price visited numerous traditional communities. Some of them hunter-gatherers and others agricultural, including some rural communities in Europe. This was earlier last century when industrialization had yet to take hold in most places, a very different time in terms of diet, even in the Western world.

What he found was how healthy these people were, whether they consumed more or less meat, dairy or not — although none were vegetarian (the typical pre-agricultural diet was about 1/3 to 2/3 animal products, often a large part of it saturated fat). The commonality is that they ate nutrient-dense foods, much of it raw, fermented, or prepared traditionally (the singlemost nutrient-dense food is organ meats). As a dentist, the first thing Price looked for was dental health. A common feature of these traditional societies was well-developed jaws and bone structure, straight uncrowded teeth, few cavities facial symmetry, etc. These people never saw a dentist or orthodontist, didn’t brush or floss, and yet their teeth were in excellent condition into old age.

This obviously was not the case with Price’s own American patients that didn’t follow a traditional diet and lifestyle. And when he visited prisons, he found that bone development and dental health was far worse, as indicators of worse general health and by implication worse neurocognitive health (on a related note, testing has shown that prisoners have higher rates of lead toxicity, which harms health in diverse ways). Between malnutrition and toxicity, it is unsurprising that there are so many mentally ill people housed in prisons, especially after psychiatric institutions were closed down.

Another early figure in researching diet and health was Francis M. Pottenger Jr, an American doctor. While working as a full-time assistant at a sanatorium, he did a study on cats. He fed some cats a raw food diet, some a cooked food diet, and another group got some of both. He also observed that the cooked food diet caused developmental problems of bone and dental structure. The results were worse than that, though. For the cats fed cooked food, the health of the next generation declined even further. By the third generation, they didn’t reach adulthood. There was no generation after that.

I was reading about this at work. In my normal excitement about learning something new, I shared this info with a coworker, a guy who has some interest in health but is a conventional thinker. He immediately looked for reasons for why it couldn’t be true, such as claiming that the generations of cats kept as pets disproves Pottenger’s observations. Otherwise, so the argument goes, domestic cats would presumably have gone extinct by now.

That was easy to counter, considering most pets are born strays who ate raw food or born to parents who were strays. As for purebred cats, I’m sure breeders have already figured out that a certain amount of raw food (or supplementation of enzymes, microbes, etc that normally would be found in raw food) is necessary for long term feline health. Like processed human food, processed pet food is heavily fortified with added nutrients, which likely counteracts some of the negative consequences to a cooked food diet. Pottenger’s cats weren’t eating fortified cooked food, but neither were the cats fed raw food getting any extra nutrients.

The thing is that prior to industrialization food was never fortified. All the nutrients humans (and cats) needed to not only survive but thrive was available in a traditional/natural diet. The fact that we have to fortify foods and take multivitamins is evidence of something severely wrong with the modern, industrialized food system. But that only lessens the health problems slightly. As with Pottenger’s cats, even the cats on a cooked food diet who had some raw food added didn’t avoid severely decreased health. Considering the emerging health crisis, the same appears to be true of humans.

The danger we face is that the effects are cumulative across the generations, the further we get from a traditional diet. We are only now a few generations into the modern Western diet. Most humans were still consuming raw milk and other traditional foods not that long ago. Earlier last century, the majority of Americans were rural and had access to fresh organic food from gardens and farms, including raw milk from pastured cows and fertile eggs from pastured chickens (pastured meaning high in omega-3s).

Even living in a large city, one of my grandfathers kept rabbits and chickens for much of his life and kept a garden into his old age. That means my mother was raised with quite a bit of healthy food, as was my father living in a small town surrounded by farms. My brothers and I are the first generation in our family to eat a fully modern industrialized diet from childhood. And indeed, we have more mental/neurocognitive health problems than the generations before. I had a debilitating learning disorder diagnosed in elementary school and severe depression clearly showing in 7th grade, one brother had stuttering and anxiety attacks early on, and my oldest brother had severe allergies in childhood that went untreated for years and since then has had a host of ailments (also, at least one of my brothers and I have suspected undiagnosed Asperger’s or something like that, but such conditions weren’t being diagnosed when we were in school). One thing to keep in mind is that my brothers and I are members of the generation that received one of the highest dosages of lead toxicity in childhood, prior to environmental regulations limiting lead pollution; and research has directly and strongly correlated that to higher rates of criminality, suicide, homicide, aggressive behavior, impulse control problems, lowered IQ, and stunted neurocognitive development (also many physical health conditions).

The trend of decline seems to be continuing. My nieces and nephews eat almost nothing but heavily processed foods, way more than my brothers and I had in our own childhoods, and the produce they do eat is mostly from nutrient-depleted soil, along with being filled with farm chemicals and hormones — all of this having continuously worsened these past decades. They are constantly sick (often every few weeks) and, even though still in grade school, all have multiple conditions such as: Asperger’s, learning disorder, obsessive-compulsion, failure to thrive, asthma, joint pain, etc.

If sugar was heroin, my nephew could be fairly called a junky (regularly devouring bags of candy and on more than one occasion eating a plain bowl of sugar; one step short of snorting powdered sugar and mainlining high fructose corn syrup). And in making these observations, I speak from decades of experience as a junkfood junky, most of all a sugar addict, though never quite to the same extreme. My nieces too have a tremendous intake of sugar and simple carbs, as their families’ vegetarianism doesn’t emphasize vegetables (since going on the paleo diet, I’ve been eating more organic nutrient-dense vegetables and other wholesome foods than my brothers and their families combined) — yet their diet fits well into the Standard American Diet (SAD) and, as the USDA suggests, they get plenty of grains. I wouldn’t be surprised if one or all of them already has pre-diabetes and likely will get diabetes before long, as is becoming common in their generation. The body simply can only take so much harm. I know the damage done to my own body and mind from growing up in this sick society and I hate to see even worse happening to the generations following.

To emphasize this point, the testing of newborn babies in the United States shows that they’ve already accumulated on average more than 200 synthetic chemicals from within the womb; and then imagine all the further chemicals they get from the breast milk of their unhealthy mothers along with all kinds of crap in formulas and in their environments (e.g., carcinogenic fire retardants that they breathe 24/7). Lead toxicity has decreased since my own childhood and that is a good thing, but thousands of new toxins and other chemicals have replaced it. On top of that, the hormones, hormone mimics, and hormone disruptors add to dysbiosis and disease — some suggesting this is a cause of puberty’s greater variance than in past generations, either coming earlier or later depending on gender and other factors (maybe partly explaining the reversal and divergence of educational attainment for girls and boys). Added to this mix, this is the first generation of human guinea pigs to be heavily medicated from childhood, much of it medications that have been shown to permanently alter neurocognitive development.

A major factor in many modern diseases is inflammation. This has many causes from leaky gut to toxicity, the former related to diet and often contributing to the latter (in how the leaky gut allows molecules to more easily cross the gut lining and get into the bloodstream where they can freely travel throughout the body — causing autoimmune disorders, allergies, asthma, rheumatoid arthritis, depression, etc). But obesity is another main cause of inflammation. And one might note that, when the body is overloaded and not functioning optimally, excess toxins are stored in fat cells — which makes losing weight even more difficult as toxins are released back into the body, and if not flushed out causing one to feel sick and tired.

It’s not simply bad lifestyle choices. We are living in unnatural and often outright toxic conditions. Many of the symptoms that we categorize as diseases are the bodies attempt to make the best of a bad situation. All of this adds up to a dysfunctional level across society. Our healthcare system is already too expensive for most people to afford. And the largest part of public funding for healthcare is going to diabetes alone. But the saddest part is the severe decrease in quality of life, as the rate of mood and personality disorders skyrockets. It’s not just diet. For whatever reason (toxins? stress?), with greater urbanization has come greater levels of schizophrenia and psychosis. And autism, a rare condition in the past, has become highly prevalent (by the way, one of the proven effective treatments for autism is a paleo/keto diet; also effective for autoimmune conditions among much else).

It’s getting worse and worse, generation after generation. Imagine what this means in terms of epigenetics and transgenerational trauma, as nutritional deficits and microbiotic decimation accumulates, exacerbated by a society driven mad through inequality and instability, stress and anxiety. If not for nutrients added to our nutrient poor food and supplements added to our unhealthy diet, we’d already be dying out as a society and our civilization would’ve collapsed along with it (maybe similar to how some conjecture the Roman Empire weakened as lead toxicity increased in the population). Under these conditions, that children are our future may not be an affirmation of hope. Nor may these children be filled with gratitude once they’ve reached adulthood and come to realize what we did to them and the world we left them. On the other hand, we aren’t forced to embrace fatalism and cynicism. We already know what to do to turn around all of these problems. And we don’t lack the money or other resources to do what needs to be done. All that we are waiting for is public demand and political will, although that might first require our society reaching a point of existential crisis… we are getting close.

The stumbling block is that there is no profit in the ‘healthcare’ industry for advocating, promoting, incentivizing, and ensuring healthy diet and healthy conditions for a healthy population. Quite the opposite. If disease profiteering was made illegal, there would be trillions of dollars of lost profit every year. Disease is the reality of capitalist realism, a diseased economic system and social order. This collective state of sickliness has become the norm and vested interests will go to great lengths to defend the status quo. But for most who benefit from the dysfunctional and destructive system, they never have to give it much thought. When my mother brought my nephew to the doctor, she pointed out how he is constantly sick and constantly eating a poor diet. The doctor’s response was that this was ‘normal’ for kids (these days), which might be true but the doctor should be shocked and shamed by his own admission. As apathy takes hold and we lose a sense of hope, low standards fall ever lower.

We can’t rely upon the established authority figures in seeking better health for ourselves, our families, and our communities. We know what we need to do. It might not be easy to make such massive changes when everything in society is going against you. And no doubt it is more expensive to eat healthy when the unhealthiest foods (e.g., high fructose corn syrup) are being subsidized by the government. It’s no accident that buying off the dollar menu at a fast food is cheaper than cooking a healthy meal at home. Still, if you are willing to go to the effort (and it is worth the effort), a far healthier diet is possible for many within a limited budget. That is assuming you don’t live in a food desert. But even in that case, there is a movement to create community gardens in poor neighborhoods, people providing for themselves what neither the government nor economy will provide.

Revolutions always begin from the bottom up. Or failing that, the foundations of our society will crumble, as the health of our citizenry declines. It’s a decision we must make, individually and collectively. A choice between two divergent paths leading to separate possible futures. As we have so far chosen suicidal self-destruction, we remain free to choose the other option. As Thomas Paine said, “We have it in our power to begin the world over again.”

* * *

Primal Nutrition
by Ron Schmid, ND
pp. 99-100

Parallels Between Pottenger’s and Price’s Work

While the experiments of McCarrison and Pottenger show the value of raw foods in keeping animals remarkably healthy, one might wonder about the relevance to human needs. Cats are carnivores, humans omnivores, and while the animals’ natural diet is raw, humans have cooked some foods for hundreds of thousands of years. But humans, cats, and guinea pigs are all mammals. And while the human diet is omnivorous, foods of animal origin (some customarily eaten raw) have always formed a substantial and essential part of it.

Problems in cats eating cooked foods provided parallels with the human populations Weston Price studied; the cats developed the same diseases as humans eating refined foods. The deficient generation of cats developed the same dental malformations that children of people eating modernized foods developed, including narrowing of dental arches with attendant crowding of teeth, underbites and overbites, and protruding and crooked teeth. The shape of the cat’s skull and even the entire skeleton became abnormal in severe cases, with concomitant marked behavioral changes.

Price observed these same physical and behavioral changes in both native and modern cultures eating refined foods. These changes accompanied the adoption by a culture of refined foods. In native cultures eating entirely according to traditional wisdom resulted in strength of character and relative freedom from the moral problems of modern cultures. In modern cultures, studies of populations of prisons, reformatories, and homes for the mentally delayed revealed that a large majority of individuals residing there (often approaching 100 percent) had marked abnormalities of the dental arch, often with accompanying changes in the shape of the skull.

This was not coincidence; thinking is a biological process, and abnormal changes in the shape of the skull from one generation to the next can contribute to changes in brain functions and thus in behavior. The behavioral changes in deficient cats were due to changes in nutrition. This was the only variable in Pottenger’s carefully controlled experiments. As with physical degenerative changes, parallels with human populations cannot help but suggest themselves, although the specific nature of the relationship is beyond the scope of this discussion.

Human beings do not have the same nutritional requirements as cats, but whatever else each needs, there is strong empirical evidence that both need a significant amount of certain high-quality raw foods to reproduce and function efficiently.

pp. 390-393

Certain groups of these cats were fed quality, fresh, undenatured food and others were fed varying degrees of denatured and processed food, then the effects were observed over several generations. The results from the inferior diets were not so startling for the first-generation animals but markedly and progressively so in subsequent generations. From the second generation on, the cats that were fed processed and denatured diets showed increasing levels of structural deformities, birth defects, stress-driven behaviors, vulnerability to illness, allergies, reduced learning ability, and, finally, major reproductive problems. When Pottenger attempted to reverse the effects in the genetically weakened and vulnerable later-generation animals with greatly improved diet, he found it took fully four generations for the cats to return to normal.

The reflections that Pottenger’s work casts on the health issues and dietary habits of modern-day society are glaring and inescapable. […]

Pottenger’s work has shown us that progressive generations with poor dietary habits result in increasingly more vulnerable progeny and that each subsequent generation with unhealthy dietary habits results in impaired resistance to disease, increasingly poor health and vitality, impaired mental and cognitive health, and impaired capacity to reproduce. It is all part of what we are seeing in our epidemic levels of poor health and the overwhelming rates of autism, violence, attentional disorders, childhood (and adult) behavioral problems, mental illness, fertility issues, and birth defects.

The Creed of Ancel Keys

“From the very beginning, we had the statistical means to understand why things did not add up; we had a boatload of Cassandras, a chorus of warnings; but they were ignored, castigated, suppressed. We had our big fat villain, and we still do.”
~ Trevor Butterworth, The Wall Street Journal

“The paradox is that medicine is supposedly more enlightened, but it has never been more tyrannical, hierarchical, controlled, intolerant, and dogmatic. Working doctors who dissent are cowed because failure to comply with the medical orthodoxy threatens livelihood and registration. Much of modern medicine is an intellectual void.”
~ Dr Des Spence, Scottish GP

“The suppression of inconvenient evidence is an old trick in our profession. The subterfuge may be due to love of a beautiful hypothesis, but often enough it is due to a subconscious desire to simplify a confusing subject. It is not many years ago that the senior physician of a famous hospital was distinctly heard to remark, sotto voce, “medicine is getting so confusing nowadays, what with insulin and things.” It is a sentiment with which almost everybody who qualified more than a quarter of a century ago is likely to sympathize…. But ignoring difficulties is a poor way of solving them.”
~ Raymond Greene, in a letter to The Lancet, 1953

A popular documentary out right now is The Magic Pill. It’s about the Paleo diet with some emphasis on ketosis (low-carb consumption causing fat to be primary energy for cellular metabolism). There are several varieties of the Paleo diet, as there was much diversity in ancient dietary patterns, but there are some key commonalities.

Earlier humans ate little if any grains or beans, often even well into the agricultural period (hunting and gathering remained a mainstay of the American diet for many up into the early-to-mid 20th century, such as my mother’s family when she was growing up). In the distant past and continuing into about a century ago, it was typical to eat lots of raw, fermented, and cultured foods — including meats.

And of course, animal fats with plenty of saturated fats have always been a major food component until the past few generations. It turns out some of the healthiest populations on the planet, including the Mediterranean people, traditionally ate high levels of saturated fats. The Masai, for example, are about as carnivorous as a population can be with heavy emphasis on saturated fats and their health is amazing:

“The Masai are almost pure carnivores, eating mostly milk, blood, and meat. A Masai man drinks up to a gallon of whole milk daily, and on top of that he might also eat a lot of meat containing still more saturated fat and cholesterol. Mann expected the Masai to have high blood cholesterol but was surprised to find it was among the lowest ever measured, about 50 percent lower than that of the average American.”
(Real Food by Nina Planck, p. 61)

Interestingly, Americans too used to load up on animal-related foods and saturated fats, also with a ton of raw whole milk, cheese, and butter. It was only after decades of decline in this earlier diet that Americans began having high rates of all the major diseases that now plague us: obesity, heart disease, diabetes, etc.

This leads us to Ancel Keys, the many who promoted much of the present mainstream dietary myths. More than a half century ago, he did some research comparing diets in different regions of the world, but he did so by cherry-picking what fit his preconceptions and ignoring all else (great analysis can be found in numerous videos, articles, and books by Sally Fallon Morell and Mary Enig and at the Weston A. Price Foundation). In Nourishing Diets, Morell writes that (pp. 124-5),

“Critics have pointed out that Keys omitted from his study many areas of the world where consumption of animal foods is high and deaths from heart attack are low, including France — the so-called French paradox. But there is also a Japanese paradox. In 1989, Japanese scientists returned to the same two districts that Keys had studied. In an article titled “lessons fro Science from the Seven Countries Study,” they noted that per capita consumption of rice had declined, while consumption of fats, oils, meats, poultry, dairy products and fruit had all increased. […]

“During the postwar period of increased animal consumption, the Japanese average height increased three inches and the age-adjusted death rate from all causes declined from 17.6 to 7.4 per 1,000 per year. Although the rates of hypertension increased, stroke mortality declined markedly. Deaths from cancer also went down in spite of the consumption of animal foods.

“The researchers also noted — and here is the paradox — that the rate of myocardial infarction (heart attack) and sudden death did not change during this period, in spite of the fact that the Japanese weighed more, had higher blood pressure and higher cholesterol levels, and ate more fat, beef and dairy foods.”

About the Mediterranean diet, Morell considers the historical context to Keys’ study:

“The question that the believers haven’t asked themselves is this: was the lean, so-called Mediterranean diet they observed after World War II the true Mediterranean diet? Or were they observing the tail end of deprivation engendered by half a decade of conflict? Were the inhabitants of Crevalcore and Montegiorgio abandoning the traditional diet, or were they taking it up again? And did Keys miss the sight of Italians enjoying rich food in the early 1950s because Italians had never done such a shameful thing, or was the visiting professor too poor at the time to afford anything more than plain pizza in a sidewalk cafe?” (pp. 157-8)

Morell then goes on to look at numerous books, including cookbooks, from the region. All the evidence points to the traditional Mediterranean diet consisting largely of whole fat dairy products, meat products (lots of sausage), oils and animal fats, and eggs. As emphasized in the paleo diet,

“Italians love their vegetables for sure, and that’s because they know how to make them taste good. They know that salads taste better with a good dressing of aged vinegar and olive oil; and cooked vegetables blossom when anointed with butter, lard or cream” (p. 160).

Keys didn’t really understand the societies he was studying, much less the societies he chose to ignore. Yet he was charismatic and, though other contemporary research contradicted his data, he was able to promote his views such that they became adopted as mainstream ideology. This new belief system was enforced by the US government and by corporations, often in heavy-handed ways. Adelle Davis was a biochemist and nutritionist who was inspired by Weston A. Price’s research on traditional diets. In response, as described Joann Grohman, “The FDA raided health food stores and seized her books under a false labeling law because they were displayed next to vitamin bottles” (Real Food by Nina Planck, p. 30). “I find it dismaying that,” Planck says in another section (p. 201),

“the dangers of trans fats were known for sixty years. Weston Price cited 1943 research that butter was better than hydrogenated cottonseed oil. In the 1950s, researchers guessed that hydrogenated vegetable oil led to heart disease. Ancel Keys, the proponent of monounsaturated fat, showed in 1961 that hydrogenated corn oil raised trigydcerides more than butter. Year after year, the bad news piled up. [So, even Keys ultimately knew that saturated fat wasn’t the real culprit.]

“One dogged researcher, Mary Enig, helped get the word out. The author of Know Your Fats, Enig waged an often lonely battle. I’m afraid her efforts were not always welcomed with bouquets of roses. In 1978, Enig wrote a scientific paper challenging a government report blaming saturated fat for cancer, in which she pointed out that the data actually showed a link with trans fats. Not long after, “two guys from the Instituted of Shortening and Edible Oil — the trans fat lobby, basically — visited me, and oh boy, were they angry,” Enig told Gourmet magazine. “They said they’d been keeping a careful watch to prevent articles like mine from coming out and didn’t know how this horse had gotten out of the barn.”

“The stakes were high. “We spent lots of time, and lots of money and energy, refuting this work,” said Dr. Lars Wiederman, who once worked for the American Soybean Association. “Protecting trans fats from the taint of negative scientific findings was our charge.””

That sounds a lot like the corporatist defense of profits as happened with the decades of lies, spin, and obfuscation pushed by the tobacco and oil companies. Another more recent example is given in The Magic Pill documentary. In South Africa, the government put a doctor on trial for daring to give dietary advice that was in line with millennia-old traditions of human eating habits — fortunately, the doctor won his case but only after the government spent immense amount of taxpayer money trying to destroy him.

Dominant paradigms die hard and only after an immense fight, backed by the full power of the government and millions of corporate dollars. But that is only one part of what slows down change. Ideologies as worldviews hold on so long because they become entrenched in our minds and cultures. As often is noted, old scientists (along with old doctors, professors, bureaucrats, etc) don’t change their minds but eventually die and are replaced by a new generation with new ideas.

This was demonstrated with Michael Pollan’s latest documentary, In Defense of Food (transcript). In it, the professor of nutrition Marion Nestle adds a note of caution: “And it should be written on every single epidemiological study, ‘Red flag, association does not necessarily mean causation.’” Does that stop Pollan from basing conclusions on Keys problematic research? Nope. Instead, he promotes the belief that Keys’ conclusions are still valid: “But based on the strong association Keys saw in his data between heart disease and saturated fat, he advised people to eat less of it.” Not a single mention of any doubt or criticism.

It might be noted that Pollan was born in 1955. That was right in the middle of this now dominant ideology coming into ascendance. He reached adulthood as Keys’ ideology was being promoted by the USDA and as it became the new creed in mainstream thought. Now in his sixties, he is one of the older generation still clinging to what they were taught growing up. Yet, as a Boomer, his influence is still at its peak. Despite all the Western ailments, conventional medicine has allowed people to live longer and that means ideologies will remain entrenched for longer.

It’s going to be an uphill battle for younger generations to challenge the status quo. But the shift is already happening. From a personal perspective, this time lag of common knowledge creates a sense of disorientation, as it will take at least decades for official advice and public opinion to catch up with the research that has been accumulating over this past century.

This point was emphasized for me in reading a book published two decades ago in 1998, The Fats of Life by Caroline M. Pond — the author, a mainstream academic and researcher, notes that, “Heart attacks are thus seen as arising from a deficiency of polyunsaturated fatty acids rather than from an excess of saturates of cholesterol” (p. 293). This is far from being new knowledge. Pond doesn’t mention Weston A. Price, but she does discuss “the Oxford physician and biochemist, Hugh Sinclair (1910-1990), who studied the diet and habits of the Eskimos in northern Canada in 1944. Sinclair noted that Eskimos rarely suffered from the heart disease or strokes in spite of a very high-fat diet that included reindeer meat.” She goes onto say that, “The Masai people of Kenya eat large quantities of ruminant milk and meat, and Jamaicans eat saturated fats in coconut oil, but few of them die from heart attacks.”

In The Magic Pill, it is pointed out that Americans have been following the USDA Food Pyramid in eating less red meat and saturated fats while eating more grains, legumes, vegetables, and fruits. More Americans have been eating as they were told. What has resulted of this drastic dietary change? All the diseases this diet is supposed to prevent have gotten worse. This stark reality has yet to sink in because it would require thousands of officials and authority figures to not only admit they were wrong but that they caused immense harm to so many.

But why do others continue on with the sham? We’ve known much of this info for a long time now. Why are we still debating it as if the conventional view still has any relevance?

* * *

About silencing the critics:

Good Calories, Bad Calories
by Gary Taubes
pp. 191-194

This is where the story now takes some peculiar turns. One immediate effect of the revelation about HDL, paradoxically, was to direct attention away from triglycerides, and with them the conspicuous link, until then, to the carbohydrate hypothesis. Gordon and his colleagues had demonstrated that when both HDL and triglycerides were incorporated into the risk equations of heart disease, or when obesity and the prediabetic condition of glucose intolerance were included in the equations along with triglycerides, the apparent effect of triglycerides diminished considerably. This result wasn’t surprising, considering that low HDL, high triglycerides, obesity, and glucose intolerance all seemed to be related, but that wasn’t the point. The relevant question for physicians was whether high triglycerides by themselves caused heart disease. If so, then patients should be advised to lower their triglycerides, however that might be accomplished, just as they were being told already to lower cholesterol. These risk-factor equations (known as multivariate equations ) suggested that triglycerides were not particularly important when these other factors were taken into account, and this was how they would be perceived for another decade. Not until the late 1980s would the intimate association of low HDL, high triglycerides, obesity, and diabetes be considered significant—in the context of Gerald Reaven’s Syndrome X hypothesis—but by then the heart-disease researchers would be committed to the recommendations of a national low-fat, high-carbohydrate diet.

Heart-disease researchers would also avoid the most obvious implication of the two analyses—that raising HDL offers considerably more promise to prevent heart disease than lowering either LDL or total cholesterol—on the basis that this hadn’t been tested in clinical trials. Here the immediate obstacle, once again, was the institutional investment in Keys’s hypothesis. The National Institutes of Health had committed its heart-disease research budget to two ongoing studies, MRFIT and the Lipid Research Clinics Trial, which together would cost over $250 million. These studies were dedicated solely to the proposition that lowering total cholesterol would prevent heart disease. There was little money or interest in testing an alternative approach. Gordon later recalled that, when he presented the HDL evidence to the team of investigators overseeing MRFIT, “it was greeted with a silence that was very, how should I say it, expressive. One of them spoke up indicating he suspected this was a bunch of shit. They didn’t know how to deal with it.”

Indeed, the timing of the HDL revelations could not have been less convenient. The results were first revealed to the public in an American Heart Association seminar in New York on January 17, 1977. This was just three days after George McGovern had announced the publication of the Dietary Goals for the United States, advocating low-fat, high-carbohydrate diets for all Americans, based exclusively on Keys’s hypothesis that coronary heart disease was caused by the effect of saturated fat on total cholesterol. If the New York Times account of the proceedings is accurate, the AHA and the assembled investigators went out of their way to ensure that the new evidence would not cast doubt on Keys’s hypothesis or the new dietary goals. Rather than challenge the theory that excess cholesterol can cause heart disease, the Times reported, “the findings re-emphasize the importance of a fatty diet in precipitating life-threatening hardening of the arteries in most Americans,” which is precisely what they did not do. According to the Times, saturated fat was now indicted not just for increasing LDL cholesterol, which it does, but for elevating VLDL triglycerides and lowering HDL, which it does not, and certainly not compared with the carbohydrates that McGovern’s Dietary Goals were recommending all Americans eat instead.

In a more rational world, which means a research establishment not already committed to Keys’s hypothesis and not wholly reliant on funding from the institutions that had embraced the theory, the results would have immediately prompted small clinical trials of the hypothesis that raising HDL prevented heart disease, just like those small trials that had begun in the 1950s to test Keys’s hypothesis. If those confirmed the hypothesis, then longer, larger trials would be needed to establish whether the short-term benefits translated to a longer, healthier life. But the NIH administrators decided that HDL studies would have to wait. Once the Lipid Research Clinics Trial results were published in 1984, they were presented to the world as proof that lowering cholesterol by eating less fat and more carbohydrates was the dietary answer to heart disease. There was simply no room now in the dogma for a hypothesis that suggested that raising HDL (and lowering triglycerides) by eating more fat and less carbohydrates might be the correct approach. No clinical trials of the HDL hypothesis would begin in the U.S. until 1991, when the Veterans Administration funded a twenty-center drug trial. The results, published in 1999, supported the hypothesis that heart disease could be prevented by raising HDL. The drug used in the study, gemfibrozil, also lowered triglyceride levels and VLDL, suggesting that a diet that did the same by restricting carbohydrates might have a similarly beneficial effect. As of 2006, no such dietary trials had been funded. Through the 1980s and 1990s, as our belief in the low-fat heart-healthy diet solidified, the official reports on nutrition and health would inevitably discuss the apparent benefits of raising HDL—the “good cholesterol”—and would then observe correctly that no studies existed to demonstrate this would prevent heart disease and lengthen life. By 2000, well over $1 billion had been spent on trials of cholesterol-lowering, and a tiny fraction of that amount on testing the benefits of raising HDL. Thus, any discussions about the relative significance of raising HDL versus lowering total cholesterol would always be filtered through this enormous imbalance in the research efforts. Lowering LDL cholesterol would always have the appearance of being more important.

pp. 212-214

Reaven’s 1988 Banting Lecture is credited as the turning point in the effort to convince diabetologists of the critical importance of insulin resistance and hyperinsulinemia, but those investigators concerned with the genesis of heart disease paid little attention, considering anything having to do with insulin to be relevant only to diabetes. This was a natural consequence of the specialization of scientific research. Through the mid-1980s, Reaven’s research had focused on diabetes and insulin, and so his publications appeared almost exclusively in journals of diabetes, endocrinology, and metabolism. Not until 1996 did Reaven publish an article on Syndrome X in the American Heart Association journal Circulation, the primary journal for research in heart disease. Meanwhile, his work had no influence on public-health policy or the public’s dietary consciousness. Neither the 1988 Surgeon General’s Report on Nutrition and Health nor the National Academy of Sciences’s 1989 Diet and Health mentioned insulin resistance or hyperinsulinemia in any context other than Reaven’s cautions that high-carbohydrate diets might not be ideal for Type 2 diabetics. Both reports ardently recommended low-fat, high-carbohydrate diets for the prevention of heart disease.

Even the diabetes community found it easier to accept Reaven’s science than its dietary implications. Reaven’s observations and data “speak for themselves,” as Robert Silverman of the NIH suggested at a 1986 consensus conference on diabetes prevention and treatment. But they placed nutritionists in an awkward position. “High protein levels can be bad for the kidneys,” said Silverman. “High fat is bad for your heart. Now Reaven is saying not to eat high carbohydrates. We have to eat something.” “Sometimes we wish it would go away,” Silverman added, “because nobody knows how to deal with it.”

This is what psychologists call cognitive dissonance, or the tension that results from trying to hold two incompatible beliefs simultaneously. When the philosopher of science Thomas Kuhn discussed cognitive dissonance in scientific research—“the awareness of an anomaly in the fit between theory and nature”—he suggested that scientists will typically do what they have invariably done in the past in such cases: “They will devise numerous articulations and ad hoc modifications of their theory in order to eliminate any apparent conflict.” And that’s exactly what happened with metabolic syndrome and its dietary implications. The syndrome itself was accepted as real and important; the idea that it was caused or exacerbated by the excessive consumption of carbohydrates simply vanished.

Among the few clinical investigators working on heart disease who paid attention to Reaven’s research in the late 1980s was Ron Krauss. In 1993, Krauss and Reaven together reported that small, dense LDL was another of the metabolic abnormalities commonly found in Reaven’s Syndrome X. Small, dense LDL, they noted, was associated with insulin resistance, hyperinsulinemia, high blood sugar, hypertension, and low HDL as well. They also reported that the two best predictors of the presence of insulin resistance and the dominance of small, dense LDL are triglycerides and HDL cholesterol—the higher the triglycerides and the lower the HDL, the more likely it is that both insulin resistance and small, dense LDL are present. This offers yet another reason to believe the carbohydrate hypothesis of heart disease, since metabolic syndrome is now considered perhaps the dominant heart-disease risk factor—a “coequal partner to cigarette smoking as contributors to premature [coronary heart disease],” as the National Cholesterol Education Program describes it—and both triglycerides and HDL cholesterol are influenced by carbohydrate consumption far more than by any fat.

Nonetheless, when small, dense LDL and metabolic syndrome officially entered the orthodox wisdom as risk factors for heart disease in 2002, the cognitive dissonance was clearly present. First the National Cholesterol Education Program published its revised guidelines for cholesterol testing and treatment. This was followed in 2004 by two conference reports: one describing the conclusions of a joint NIH-AHA meeting on scientific issues related to metabolic syndrome, and the other, in which the American Diabetes Association joined in as well, describing joint treatment guidelines. Scott Grundy of the University of Texas was the primary author of all three documents. When I interviewed Grundy in May 2004, he acknowledged that metabolic syndrome was the cause of most heart disease in America, and that this syndrome is probably caused by the excessive consumption of refined carbohydrates. Yet his three reports—representing the official NIH, AHA, and ADA positions—all remained firmly wedded to the fat-cholesterol dogma. They acknowledge metabolic syndrome as an emerging risk factor for heart disease, but identify LDL cholesterol as “the primary driving force for coronary atherogenesis.” Thus, heart disease in America, as the National Cholesterol Education Program report put it, was still officially caused by “mass elevations of serum LDL cholesterol result[ing] from the habitual diet in the United States, particularly diets high in saturated fats and cholesterol.”

There was no mention that carbohydrates might be responsible for causing or exacerbating either metabolic syndrome or the combination of low HDL, high triglycerides, and small, dense LDL, which is described as occurring “commonly in persons with premature [coronary heart disease]. *53 In the now established version of the alternative hypothesis—that metabolic syndrome leads to heart disease—the carbohydrates that had always been considered the causative agent had been officially rendered harmless. They had been removed from the equation of nutrition and chronic disease, despite the decades of research and observations suggesting the critical causal role they played.

The Big Fat Surprise
by Nina Teicholz
pp. 57-58

It’s not that no one questioned Keys along the way, of course. There were plenty of skeptics, including esteemed, influential scientists. Remember that Swedish egg-eating doctor, Uffe Ravnskov? On my own travels through the world of nutrition as I researched this book, he was the first “skeptic” I met. Whereas once a large and prominent group of scientists had opposed Keys and his hypothesis, the great majority of them had disappeared by the late 1980s. Ravnskov picked up their torch later, with the publication of a book called Cholesterol Myths in 2000.

At a conference that we were both attending near Copenhagen in 2005, he stood out in the crowd simply because he was willing to confront this gathering of top nutrition experts by asking questions that were considered long since settled.

“The whole pathway, from cholesterol in the diet, to cholesterol in the blood, to heart disease—has this pathway really been proven?” he stood up and asked, rightly though rhetorically, after a presentation one day.
“Tsh! Tsh! Tsh!” A hundred-plus scientists wagged their heads in unison.
“Next question?” asked an irritated moderator.

The incident illustrated, for me, the most remarkable aspect of the nutrition research community, namely its surprising lack of oxygen for alternative viewpoints. When I started out my research, I expected to find a community of scientists in decorous debate. Instead, I found researchers like Ravnskov, who, by his own admission, was a cautionary tale for independently minded scientists seeking to challenge the conventional wisdom. His predecessors from the 1960s onward hadn’t been convinced by the orthodoxy on cholesterol; they’d just been silenced, worn out, or had come to the end of their careers. As Keys’s ideas spread and became adopted by powerful institutions, those who challenged him faced a difficult—some might say impossible—battle. Being on the losing side of such a high-stakes debate had caused their professional lives to suffer. Many of them had lost jobs, research funding, speaking engagements, and all the many other perks of prestige. Although these diet-heart opponents included a number of researchers who were at the top of their fields, including, notably, an editor of the Journal of the American Medical Association , they were not invited to conferences and were unable to get prestigious journals to publish their work. XIV Experiments that had dissenting results, they found, were not debated and discussed but instead dismissed or ignored altogether. Even being subject to slander and personal ridicule were surprisingly not unusual experiences for these opponents of the diet-heart hypothesis. In short, they found themselves unable to continue contributing to their fields, which of course is the very essence of every scientist’s hopes and ambitions.

To a surprising degree, in fact, the story of nutritional science is not, as we would expect, one of sober-minded researchers moving with measured, judicious steps. It falls, instead, under the “Great Man” theory of history, whereby strong personalities steer events using their own personal charisma, intelligence, wisdom, or wits. In the history of nutrition, Ancel Keys was, by far, the Greatest Man.

pp. 106-108

On the whole, said Manning Feinleib, an associate director at the NHLBI who attended the meetings as a rapporteur, the committee seemed to consider the downside of cancer to be less important than the upside of reducing heart disease. I spoke to him in 2009, and he was clearly dismayed that the issue of low cholesterol and cancer had still not been settled. “Oh boy, it’s been more than twenty-five years, and they have still not shed more light on what’s going on, and why not? That’s even more puzzling.”

In 1990, the NHLBI held yet another meeting on the problem of “significantly increased” death rates from cancer and other noncardiovascular causes for people with low cholesterol. The lower the cholesterol, the worse it looked for cancer deaths, and damningly, it looked especially bad for healthy men who were actively trying to reduce their cholesterol through diet or drugs. But there was no follow-up to these meetings, and the results did not change the enthusiasm for the “prudent diet.” The effects of low cholesterol are still not well understood.

When I mentioned all this to Stamler, he didn’t remember any part of this cancer-cholesterol debate. In this way, he is a microcosm of a larger phenomenon that allowed the diet-heart hypothesis to move forward: inconvenient results were consistently ignored; here again, “selection bias” was at work.

An Extreme Case of Selection Bias

There has been a lot of selective reporting and ignoring of the methodological problems over the years. But probably the most astonishing example of selection bias was the near-complete suppression of the Minnesota Coronary Survey, which was an outgrowth of the National Diet Heart Study. Also funded by NIH, the Minnesota Coronary Survey is the largest-ever clinical trial of the diet-heart hypothesis and therefore certainly belongs on the list along with Oslo, the Finnish Mental Hospital Study, and the LA Veterans Trial, but it is rarely included, undoubtedly because it didn’t turn out the way nutrition experts had hoped.

Starting in 1968, the biochemist Ivan Frantz fed nine thousand men and women in six Minnesota state mental hospitals and one nursing home either “traditional American foods,” with 18 percent saturated fat, or a diet containing soft margarine, a whole-egg substitute, low-fat beef, and dairy products “filled” with vegetable oil. This diet cut the amount of saturated fat in half. (Both diets had a total of 38 percent fat overall.) Researchers reported “nearly 100% participation,” and since the population was hospitalized, it was more controlled than most—although, like the Finnish hospital study, there was a good deal of turnover in the hospital (the average length of stay was only about a year).

After four-and-a-half years, however, the researchers were unable to find any differences between the treatment and control groups for cardiovascular events, cardiovascular deaths, or total mortality. Cancer was higher in the low-saturated-fat group, although the report does not say if that difference was statistically significant. The diet low in saturated fat had failed to show any advantage at all. Frantz, who worked in Keys’s university department, did not publish the study for sixteen years, until after he retired, and then he placed his results in the journal Arteriosclerosis, Thrombosis, and Vascular Biology , which is unlikely to be read by anyone outside the field of cardiology. When asked why he did not publish the results earlier, Frantz replied that he didn’t think he’d done anything wrong in the study. “We were just disappointed in the way it came out,” he said. In other words, the study was selectively ignored by its own director. It was another inconvenient data point that needed to be dismissed.

pp. 114-

In the United States, Pete Ahrens, who was still the prudent diet’s most prominent critic, continued to publish his central point of caution: the diet-heart hypothesis “is still a hypothesis . . . I sincerely believe we should not . . . make broadscale recommendations on diets and drugs to the general public now.” XVIII

By the late 1970s, however, the number of scientific studies had grown to such “unmanageable proportions,” as one Columbia University pathologist put it, that it was overwhelming. Depending on how one interpreted the data and how one weighed all the caveats, the dots could be connected to point in different directions. The ambiguities inherent to nutrition studies opened the door for their interpretation to be influenced by bias—which hardened into a kind of faith. There were simply “believers” and “nonbelievers,” according to cholesterol expert Daniel Steinberg. A number of interpretations of the data were possible and equally compelling from a scientific perspective, but there was only one for “believers,” while “disbelievers” became heretics outside the establishment.

Thus, the normal defenses of modern science had been flattened by a perfect storm of forces gathered in postwar America. In its impressionable infancy and compelled by an urgent drive to cure heart disease, nutrition science had bowed to charismatic leaders. A hypothesis had taken center stage; money poured in to test it, and the nutrition community embraced the idea. Soon there was very little room for debate. The United States had embarked upon a giant nutritional experiment to cut out meat, dairy, and dietary fat altogether, shifting calorie-consumption over to grains, fruits, and vegetables. Saturated animal fats would be replaced by polyunsaturated vegetable oils. It was a new, untested diet—just an idea, presented to Americans as the truth. Many years later, science started to show that this diet was not very healthy after all, but it was too late by then, since it had been national policy for decades already.

pp. 142-145

The Consensus Conference

If a large portion of middle-aged American adults are now cutting back on meat and taking statin pills, it is due almost entirely to the step that the NHLBI took next. Dispensing drugs and dietary advice to the entire US population is a huge responsibility, and the NHLBI decided it needed to create a scientific consensus, or at least the appearance of one, before moving forward. Also, the agency needed to define the exact cholesterol thresholds above which it could tell doctors to prescribe a low-fat diet or a statin. So once again, in 1984, NHLBI convened an expert group in Washington, DC, with a public meeting component attended by more than six hundred doctors and researchers. Their job—in an unrealistic two-and-a-half days—was to grapple with and debate the entire, massive stack of scientific literature on diet and disease, and then to come to a consensus about the recommended cholesterol targets for men and women of all ages.

The conference was described by various attendees as having preordained results from the start, and it’s hard not to conclude otherwise. The sheer number of people testifying in favor of cholesterol lowering was larger than the number of spaces allotted to challengers, and powerful diet-heart supporters controlled all the key posts: Basil Rifkind chaired the planning committee, Daniel Steinberg chaired the conference itself, and both men testified.

The conference “consensus” statement, which Steinberg read out on the last morning of the event, was not a measured assessment of the complicated role that diet might play in a little-understood disease. Instead, there was “no doubt,” he stated, that reducing cholesterol through a low-fat, low-saturated-fat diet would “afford significant protection against coronary heart disease” for every American over the age of two. Heart disease would now be the most important factor driving dietary choices for the entire nation. After the conference, in March 1984, Time magazine ran an illustration on its cover of a face on a dinner plate, comprised of two fried-egg eyes over a bacon-strip frown. “Hold the Eggs and Butter!” stated the headline, and the story began: “Cholesterol is proved deadly, and our diet may never be the same.”

As we’ve seen, LRC had nothing to say about diet, and even its conclusions on cholesterol were only weakly supported by the data, but Rifkind had already demonstrated that he believed this extrapolation was fair. He told Time that the results “strongly indicate that the more you lower cholesterol and fat in your diet, the more you reduce the risk of heart disease.”

Gina Kolata, then a reporter for Science magazine, wrote a skeptical piece about the quality of the evidence supporting the conference’s conclusions. The studies “do not show that lowering cholesterol makes a difference,” she wrote, and she quoted a broad range of critics who worried that the data were not nearly strong enough to recommend a low-fat diet for all men, women, and children. Steinberg attempted to dismiss the criticisms by calling her article a case of the media’s appetite for “dissent [which] is always more newsworthy than consensus,” but the Time cover story in support of Steinberg’s stated conclusions was clearly an example of the opposite, and on the whole, the media supported the new cholesterol guidelines.

The consensus conference spawned an entirely new administration at the NIH, called the National Cholesterol Education Program (NCEP), whose job it remains to advise doctors about how to define and treat their “at-risk” patients, as well as to educate Americans themselves about the apparent advantages of lowering their cholesterol. In the following years, the NCEP’s expert panels became infiltrated by researchers supported by pharmaceutical money, and cholesterol targets were ratcheted ever lower, thereby bringing greater and greater numbers of Americans into the category that qualified for statins. And the low-fat diet, even though it had never been properly tested in a clinical trial to ascertain whether it could prevent heart disease, became the standard, recommended diet of the land.

For longtime critics of the diet-heart hypothesis such as Pete Ahrens, the consensus conference was also significant because it marked the last time they could speak openly. After this conference, Ahrens and his colleagues were forced to fold their case. Although members of the nutrition elite had, over the previous two decades, been allowed to be part of the debate, in the years following the consensus conference, this was no longer true. To be a member of the elite now meant, ipso facto, supporting the low-fat diet. So effectively did the NHLBI-AHA alliance silence its antagonists, in fact, that among the tens of thousands of researchers in the worlds of medicine and nutrition over the next fifteen years, only a few dozen would publish research even gingerly challenging the diet-heart hypothesis. And even then, they worried about putting their careers on the line. They saw Ahrens, who had risen to the very top of his field and yet found himself having a hard time getting grants, because there was “a price to pay for going up against the establishment, and he was well aware of that,” as one of his former students told me.

No doubt this is why Ahrens, in looking back on the conference, which came to be his swan song, spoke with an uncharacteristic lack of reserve. “I think the public is being hosed by the NIH and the American Heart Association,” he declared. “They desire to do something good. They’re hoping to God that this is the right thing to do. But they are not acting on the basis of scientific evidence, but on the basis of a plausible but untested idea.” Plausible or even probable, however, that untested idea had now been launched.

pp. 319-328

These pioneering researchers of the Atkins diet continued to expand their work throughout the 2000s, conducting trials on a range of subjects: men and women, athletes, and those suffering from obesity, diabetes, and metabolic syndrome. XV XVI And while the gains have varied, they have consistently pointed in the right direction. One of the more extraordinary experiments involved 146 men suffering from high blood pressure who went on the Atkins diet for almost a year. The group saw their blood pressure drop significantly more than did a group of low-fat dieters—who were also taking a blood-pressure medication.

In most of these experiments, the diet with the best results contained more than 60 percent of calories as fat. XVII This proportion of fat was similar to what the Inuit and the Masai ate but was startlingly high compared to the official recommendations of 30 percent or less. Yet no other well-controlled trials of any other diet had ever shown such clear-cut advantages in the fight against obesity, diabetes, and heart disease, and for so many different kinds of populations.

Despite the consistency of these results, Westman and his colleagues have remained outsiders in the world of nutrition. Their work has perhaps predictably been met with silence, scorn, or both. Getting their research published in prestigious journals has been difficult, and invitations to major conferences are rare. Volek says that even when he’s been invited to present his findings at meetings, displaying research that confronts the very foundation of the conventional wisdom on diet, the reception is incurious: “people are just quiet.” And despite the substantial body of evidence now supporting the high-fat, low-carbohydrate regime as the healthiest option, his colleagues still routinely refer to the diet as “quackery” and a “fad.” Persevering in this field can be dispiriting, Volek told me. “You do deal with bias. . . . It’s very difficult to find grant money or journals that want to publish our studies.”

Westman has written poignantly about the predicament of working toward paradigm change when the existing bias is so strong: “When an unscientific fear of dietary fat pervades the culture so much that researchers who are on study sections that provide funding will not allow research into high-fat diets for fear of ‘harming people,’ ” as we’ve seen at the NIH and AHA, “this situation will not allow science to ‘self-correct.’ A sort of scientific taboo is created because of the low likelihood of funding, and the funding agencies are off the hook because they say that researchers are not submitting requests for grants.” […]

Gary Taubes and “The Big Fat Lie”

While these researchers have been ignored by most mainstream medical and nutrition communities, the one person who has successfully redirected the nutrition conversation over the past decade toward the idea that carbohydrates, not fat, are the drivers of obesity and other chronic diseases is the science journalist Gary Taubes. In 2001, he wrote a critical history of the diet-heart hypothesis for Science magazine, which was the first time a major scientific journal had published a thorough analysis of the low-fat dogma’s scientific weaknesses—at least since Pete Ahrens had ceded the battle against Ancel Keys in the mid-1980s. Taubes also reviewed all the science, from those prewar German and Austrian obesity researchers on through Pennington, and concluded that obesity was indeed a hormonal defect and not the result of gluttony and sloth. In his Science piece, Taubes described how the hormone causing obesity is most likely insulin, which spikes when one eats carbohydrates. One of his primary conclusions, in fact, was that dietary fat itself is the nutrient least likely to make you fat, because it’s the one macronutrient that doesn’t stimulate the production of insulin.

Other researchers and scientists had published critiques of the diet-heart hypothesis, but Taubes was the first to put together all the various ideas on the topic into one comprehensive narrative. And Taubes could reach a national audience. He followed up with a second foray in the New York Times Magazine , under the headline, “ What if It’s All Been a Big Fat Lie?” In 2007, he published a book on the subject, Good Calories, Bad Calories , a densely annotated and meticulously researched work that made a comprehensive and original case for an “alternative” hypothesis on obesity and chronic disease. It argued that the refined carbohydrates and sugars in our diet are what cause obesity, diabetes, and related diseases, and not the dietary fat or the “excess calories” that are thought to come from eating more than we should.

Taubes has been the most influential recent challenger to the diet-heart hypothesis. Even Michael Pollan, the popular food writer who says we should eat “mostly plants,” praised Taubes for exposing the pseudoscience in the low-fat dogma and dubbed him the Alexander Solzhenitsyn of the nutrition world.

Taubes’s work shattered dogma to such an extent that most nutrition experts have been unable to respond except by simply dismissing him, as the field has managed to do with challengers so many times before. When Taubes’s book came out, Gina Kolata, medical writer for the New York Times , called Taubes “a brave and bold science journalist” but ended her review with an airy, “I’m sorry, I’m not convinced.” XXIII The chill in the nutrition community toward Taubes was so palpable in the mid-2000s, when I started my own research for this book, that although many diet-and-heart experts had apparently read Taubes, I found that no one was willing to talk about him. Taubes’s work as a science journalist had won him many awards, including three science-in-society awards from the National Association of Science Writers, the most that the group allows for any single science reporter. Yet roughly two thirds of my interviews with nutrition experts began with something like: “If you are taking the Gary Taubes line, then I’d rather not talk to you.”

Taubes, in turn, was a provocative critic of nutrition science and its practitioners. After one talk at a research institute, a senior faculty member asked, “Mr. Taubes, is it fair to say that one subtext of your talk is that you think we’re all idiots?” “A surprisingly good question,” Taubes wrote later on his blog. He explained that generations of researchers weren’t unintelligent; they had simply been educated into a biased way of thinking. Yet if the pursuit of science is about getting the right answer, wrote Taubes, then “getting the wrong answer on such a huge and tragic scale borders on inexcusable.” In the last line of his 2002 New York Times Magazine article, he quotes a researcher asking the not-so-rhetorical question: “Can we get the low-fat proponents to apologize?”

Despite the no-love-lost nature of the relationship between Taubes and mainstream nutrition experts, much of what he wrote seemed so eminently believable that it was almost immediately adopted. Of course sugar and white flour were bad! Nutrition experts spoke as if this had always been known. A 2010 headline in the Los Angeles Times declared, “Fat Was Once the Devil. Now More Nutritionists Are Pointing Accusingly at Sugar and Refined Grains.” Researchers around the country who had read and digested Taubes’s work were suddenly studying sucrose, fructose, and glucose, comparing them to each other and looking at their insulin effects. Some investigators have made the case recently that the fructose found in fruits, honey, table sugar, and high-fructose corn syrup may be worse than glucose in provoking the inflammation markers linked to heart disease. XXIV The glucose found in sugar and starchy vegetables, meanwhile, seems to work more closely with insulin to cause obesity. The science on these different types of refined carbohydrates is still in its infancy, so we don’t really know if all carbohydrates play a role in obesity, diabetes, and heart disease, or if some types are worse than others.

The one statement that seems safe to make is that the refined carbohydrates and sugars that we were recommended to eat by the AHA as part of a healthy, fat-avoiding diet, are not merely indifferent, “empty calories,” as we’ve long been told, but are actively bad for health in a variety of ways. XXV Moreover, the clinical trials in recent years imply that any kind of carbohydrate, including those in whole grains, fruits, and starchy vegetables, are also unhealthy in large amounts. Remember that the Shai study in Israel found that the Mediterranean diet group, eating a high proportion of calories as these “complex” carbohydrates, turned out to be less healthy and fatter than the group on the Atkins-style diet, although they were healthier than the low-fat alternative. The Women’s Health Initiative, too, in which some 49,000 women were tested on a diet high in complex carbohydrates for nearly a decade, showed only marginal reductions in disease risk or weight. This big-picture message about how even too many unrefined carbohydrates might be bad for health is alienating for Americans, however, since we are now used to viewing these foods as healthy. And no doubt it would be difficult for nutrition experts to contradict their own half-century’s worth of high-carbohydrate advice.

Even so, whatever scientific progress has been made toward our greater understanding of carbohydrates generally in recent years has clearly been due to Taubes’s work. “This has been his most important contribution to the field,” said Ronald M. Krauss, an influential nutrition expert and the director of research at the Children’s Hospital Oakland Research Institute. For a journalist, it was an astonishing coup in the world of science. In 2013, Taubes became one of the rare journalists to write a peer-reviewed article for the highly respected scientific publication, the British Medical Journal . Yet given the stranglehold that Keys’s ideas have held on nutrition researchers for so many decades, it is perhaps inevitable that an alternative hypothesis had to come from an outsider.

Lore of Nutrition
by Tim Noakes & Marika Sboros
pp. 27-31
Preface by Marika Sboros

He explained that there was nothing new to what he was saying, that the evidence had been there for years, and that those in positions of power and influence over public nutrition advice had either ignored or suppressed this evidence. He directed me to scientific people, papers and places I didn’t even know existed.

I ended the conversation feeling unsettled. Noakes sounded eminently rational, reasonable and robustly scientific. I started reading all the references he gave me. I read the work of US physician-professors Stephen Phinney and Eric Westman, and Professor Jeff Volek. I read Eades; US science journalist Gary Taubes, author of Good Calories, Bad Calories and Why We Get Fat (and most recently The Case Against Suga r ); and one of British obesity researcher Dr Zoë Harcombe’s many books, The Obesity Epidemic . I also read The Big Fat Surprise by US investigative journalist Nina Teicholz. That book thoroughly rocked my scientific worldview, as it has done for countless others.

The Wall Street Journal said of Teicholz’s book: ‘From the very beginning, we had the statistical means to understand why things did not add up; we had a boatload of Cassandras, a chorus of warnings; but they were ignored, castigated, suppressed. We had our big fat villain, and we still do.’ Former editor of the British Medical Journal Dr Richard Smith wrote about The Big Fat Surprise in a feature for the journal in 2014, titled ‘Are some diets “mass murder”?’ LCHF critics have suggested that prescribing a diet restricted in carbohydrates to the public is ‘the equivalent of mass murder’. Smith gained a very different impression after ploughing through five books on diet and some of the key studies to write his feature. The same accusation of ‘mass murder’ can be directed at ‘many players in the great diet game’, Smith said. In short, he said, experts have based bold policies on fragile science and the long-term results ‘may be terrible’. 3

For her book, Teicholz researched the influential US dietary guidelines, which were introduced in 1977 and which most English-speaking countries, including South Africa, subsequently adopted. She discovered that there was no evidence to support the guidelines’ low-fat, high-carb recommendations when they were first introduced, and that any evidence to the contrary was ignored or suppressed for decades.

My research into LCHF left me uneasy. As a journalist, I’m a messenger. I began to wonder whether I had been giving the wrong messages to my readers for decades. Had I unwittingly promoted advice that harmed people suffering from obesity, diabetes and heart disease? Among those was my father, Demetrius Sboros, who suffered from heart disease for many years before his death in 2002. Had I given him advice and information that shortened his life?

I put those worries aside and wrote up my interview with Noakes. The backlash was instant. On Twitter, total strangers called me irresponsible, unscientific, unethical and biased. Astonishingly, some were medical doctors, mostly former students of Noakes. They said that I was Noakes’s ‘cheerleader’, and even accused me of having a ‘crush’ on him. Some said that Noakes must have been paying me handsomely to say nice things about him. (For the record, he has never paid me anything, nor would he think to offer to pay me or I to accept.) Others said I was a ‘closet Banter’, as if that was the worst possible insult.

At first I was irritated. After all, I had quoted Noakes accurately. I had reflected what critics said about him, to ensure that I gave both sides. And anyway, I readily confess to bias, but only in favour of good science. I’ve always said that if anyone can show me robust evidence that Noakes is wrong about LCHF, I will publish it. Knowing him as I do, so will he.

Most of all, though, I was shocked at the venom behind the attacks on Noakes. He had simply done what any good scientist does when faced with compelling evidence that contradicts a belief: he had changed his mind. I’ve never seen much sense in having a mind if you can’t change it.

The attacks against him grew more gratuitously vicious and libellous. Then, in July 2014, researchers at UCT and the University of Stellenbosch published a study in PLoS One that became known as the Naudé review. 4

In August 2014, four of Noakes’s UCT colleagues published a letter in the Cape Times . Dubbed the UCT professors’ letter, it accused him of ‘making outrageous unproven claims about disease prevention’ and of ‘not conforming to the tenets of good and responsible science’. […]

As I continued my research, it became apparent why so many doctors, dietitians, and food and drug industries want to silence Noakes. He threatens their businesses, reputations, careers, funding and sponsors. And cardiologists and endocrinologists are not the only ones at risk of class-action lawsuits if, or more likely when, LCHF diets become mainstream, especially to treat health problems such as obesity, diabetes and heart disease. All doctors and dietitians may be at risk if it is shown that they knew about LCHF but deliberately chose not to offer it as an option to their patients.

When the HPCSA eventually charged Noakes in late 2014 with allegedly giving unconventional advice to a breastfeeding mother on Twitter, I began to prepare to report on the hearing. The deeper I dug, the more unpleasant the experience became. In 2015, for example, I was having what I thought was a relatively civil phone call with Johannesburg cardiologist Dr Anthony Dalby. I asked for comment on research suggesting that the diet-heart hypothesis was unproven. ‘If you believe that, then I leave it to you,’ he said, and hung up on me. Other doctors, academics and dietitians followed suit, avoiding my emails, or slamming the phone down if I ever managed to get past their gatekeepers.

Teicholz told me of similar experiences while doing research for The Big Fat Surpris e . In response to a question on fat, an interviewee suddenly said, ‘I can’t talk about that,’ and hung up. Teicholz was shaken. ‘It felt as if I had been investigating organised crime,’ she said. The analogy was apt for her then. It became apt for me too.

The wall of silence I came up against while reporting on the HPCSA hearing should not have surprised me. I had a good working relationship with Claire Julsing Strydom, the dietitian who laid the initial complaint against Noakes – that is, until I started writing about her role in the whole affair. Strydom was president of the Association for Dietetics in South Africa when she lodged the complaint. Once I began asking uncomfortable questions, she stopped talking to me. ADSA executives and academics have followed suit, clearly acting on legal advice.

Like many, I enjoy a good conspiracy theory. However, at the first abortive attempt at a hearing session in June 2015, I wasn’t convinced of an organised campaign to discredit Noakes. By the trial’s end, I was.

Strydom and ADSA deny a vendetta against Noakes. Yet the signs were always there. Another ADSA executive member, Catherine ‘Katie’ Pereira, lodged a complaint with the HPCSA against Noakes in 2014 that was even more frivolous than Strydom’s. During an interview for a newspaper, Noakes had said that he didn’t know of any dietitian who told poor people not to drink Coca-Cola and eat potato crisps. (Most orthodox dietitians I know tell people that it’s fine to eat and drink these products as long as they do so ‘in moderation’.) The journalist made that comment a focus of the published interview. Pereira was offended on behalf of the entire dietetic profession. The HPCSA initially – and sensibly, to my mind – declined to prosecute. Strydom then intervened and pleaded with the HPCSA to charge Noakes. That case is still pending.

Nevertheless, to me, Strydom and ADSA have always looked more like patsies – proxies for Big Food and other vested interests opposed to Noakes. And this book turned into not so much a ‘whodunnit’ than a ‘why they dunnit?’.

pp. 32-34
Introduction by Marika Sboros

This is the story of a remarkable scientific journey. Just as remarkable is the genesis of that journey: a single, innocuous tweet.

In February 2014 , a Twitter user asked a distinguished and world-renowned scientist a simple question: ‘Is LCHF eating ok for breastfeeding mums? Worried about all the dairy + cauliflower = wind for babies??’

Always willing to engage with an inquiring mind, Professor Tim Noakes tweeted back: ‘Baby doesn’t eat the dairy and cauliflower. Just very healthy high fat breast milk. Key is to ween [ si c ] baby onto LCHF.’

With those few words, Noakes set off a chain of events that would eventually see him charged with unprofessional conduct, caught up in a case that would drag on for more than three years and cost many millions of rands. More difficult, if not impossible, to quantify is the devastating emotional toll that the whole ordeal has taken on him and his family, as critics attacked his character and scientific reputation at every turn.

At the time, it was open season on Tim Noakes. Doctors, dietitians and assorted academics from South Africa’s top universities had been hard at work for years trying to discredit him. They did not like his scientific views on low-carbohydrate, high-fat foods, which he had been promoting since 2011 . His opinions contrasted sharply with conventional, orthodox dietary ‘wisdom’, and the tweet provided the perfect pretext to amp up their attacks and hopefully silence him once and for all.

Within 24 hours of his tweet, a dietitian had reported him to the Health Professions Council of South Africa for giving what she considered ‘incorrect’, ‘dangerous’ and ‘potentially life-threatening’ advice. To Noakes’s surprise, the HPCSA took her complaint seriously.

Noakes is one of the few scientists in the world with an A 1 rating from the South African National Research Foundation (NRF) for both sports science and nutrition. In his home country, he has no equal in terms of expertise in and research into LCHF. Few can match his large academic footprint – quantified by an H-index of over 70 . The H- or Hirsch index is a measure of the impact of a scientist’s work. Noakes’s impact is significant. He has published more than 500 scientific papers, many of them in peer-reviewed journals, and over 40 of which deal exclusively with nutrition. He has been cited more than 17 000 times in the scientific literature.

Yet, remarkably, the HPCSA chose to back the opinion of a dietitian in private practice over an internationally renowned nutrition research scientist. They charged him with ‘unprofessional conduct’ for providing ‘unconventional advice on breastfeeding babies on social networks’ and hauled him through the humiliating process of a disciplinary hearing.

The public quickly dubbed it ‘the Nutrition Trial of the 21 st Century’. I’ve called it Kafkaesque. The HPCSA insisted that it was a hearing, not a trial, but the statutory body’s own conduct belied the claim.

At the time of Noakes’s tweet, I wanted to give up journalism. After more than 30 years of researching and writing about medicine and nutrition science, I was frustrated and bored. People were growing fatter and sicker, and the medical and dietetic specialists I wrote about weren’t making much difference to patients’ lives. Neither was my reporting.

Then I started investigating and writing about the HPCSA’s case against Noakes. The more questions I asked, the more walls of silence came up around me, and from the most unexpected sources. There’s an old saying that silence isn’t empty, it is full of answers. I found that the silence was loudest from those with the most to hide. I could not have foreseen the labyrinthine extent of vested inter ests ranged against Noakes, or the role played by shadowy proxy organisations for multinational sugar and soft-drink companies in suppressing and discrediting nutrition evidence.

It took a US investigative journalist to join many of the dots I had identified. Russ Greene’s research led to the International Life Sciences Institute (ILSI), a Coca-Cola front organisation. In an explosive exposé in January 2017 , Greene showed how the ILSI has worked to support the nutrition status quo in South Africa, as well as the health professionals and food and drug industries that benefit from it. It has opened a branch in South Africa and has funded nutrition congresses throughout the country. It has also paid for dietitians and academics opposed to Noakes and LCHF to address conferences abroad . *

Of course, it might be coincidence that so many doctors, dietitians and academics with links to the ILSI became involved, directly and indirectly, in the HPCSA’s prosecution of Noakes. Then again, maybe not.

The HPCSA’s conduct throughout the hearing and since its conclusion has been revelatory. To a large extent, it confirms the premise of this book: that those in positions of power and influence in medicine and academia were using the case to pursue a vendetta against Noakes. The trial highlighted the inherent perils facing those brave enough to go against orthodoxy. It is in Noakes’s DNA as a scientist to seek truth and challenge dogma. He has done it many times before and has been proved right every time. I have no doubt that this time will be no different. On this latest journey, he has demonstrated the unflinching courage, integrity and dignity that are his hallmarks as one of the most eminent scientists of his time.

pp. 112-113

In retrospect, I could not then appreciate the extent to which the Centenary Debate was the opening salvo of what I believe to have been a much wider campaign, the ultimate goal of which was to silence me through public humiliation. It is a well-known technique called refutation by denigration. My perception is that if the actions of my colleagues meant that my status as an A1-rated scientist, who had contributed greatly to the scientific and financial efforts of UCT’s Faculty of Health Sciences over 35 years, was destroyed, well, in their opinion, that was just too bad. According to their worldview, I was the architect of my own downfall.

Only later, when I read Alice Dreger’s Galileo’s Middle Finger: Heretics, Activists, and One Scholar’s Search for Justice , did I begin to appreciate what I was really up against. Dreger’s book explores the unrelenting battle between scholars who put the pursuit of hard truths ahead of personal comfort and the social activists determined to silence them. She uses the voice of the social activist to explain what drives activists in their battles with empirical science and scientists:

We have to use our privilege to advance the rights of the marginalized. We can’t let [scientists] say what is true about the world. We have to give voice and power to the oppressed and let them say what is true about the world. Science is as biased as all human endeavors, and so we have to empower the disempowered, and speak always with them. 64

The difference, of course, is that the activists I was facing, in my view, were not motivated to advance the voices of the oppressed and disempowered, but, either wittingly or by proxy, rather the opposite.

In the face of this, what is the responsibility of those scientists who see their role as the pursuit of ‘truth’? Dreger’s answer is this:

To scholars I want to say more: Our fellow human beings can’t afford to have us act like cattle in an industrial farming system. If we take seriously the importance of truth to justice and recognize the many factors now acting against the pursuit of knowledge – if we really get why our role in democracy is like no other – then we really ought to feel that we must do more to protect each other and the public from misinformation and disinformation … 65

We scholars had to put the search for evidence before everything else, even when the evidence pointed to facts we did not want to see. The world needed that of us, to maintain – by our example, by our very existence – a world that would keep learning and questioning, that would remain free in thought, inquiry, and word. 66

In the end, she concludes: ‘Justice cannot be determined merely by social position. Justice cannot be advanced by letting “truth” be determined by political goals.’ 67 Nor, I might add, can commercial interests be allowed to determine what is the ‘truth’.

Dreger’s final message is this: ‘Evidence really is an ethical issue, the most important ethical issue in a modern democracy. If you want justice, you must work for truth. And if you want to work for truth, you must do a little more than wish for justice.’ 68

As the media onslaught began, I did not understand that these academic activists seemingly did not care about the science. Neither did the tabloid journalists or Twitter trolls, including some medical colleagues, who at about the same time began to target me on social media. Were they also willing co-conspirators in the rush to silence my voice?

pp. 123-129

At the time, I was en route to the Western Cape nature reserve Bartholomeus Klip, near the village of Hermon. Early the next morning, I opened my email and read the attached letter with growing incredulity. It carried the names (but not signatures) of four UCT academics, as well as – importantly – the logos of UCT and the UCT Faculty of Health Sciences. It therefore, in effect, signalled my ultimate academic rejection by all members of the university, and especially the medical faculty that I had served with distinction for 35 years. Only the deaths of my parents, Bob Woolmer and a few other close friends surpassed the emotional devastation this email caused me. […]

What struck me most about the letter was its cruelty and inhumanity, and that the authors showed not the slightest hint of conscience in publicly shaming me. Medicine is meant to be a caring profession in which we are concerned with the emotional health and needs of not just our patients, but also our colleagues and students. De Villiers appears to understand this. When he was eventually appointed rector and vice chancellor of the University of Stellenbosch in December 2014, his university profile stated: ‘He believes the University should offer an experience that is pleasant, welcoming and hospitable – in an inclusive environment.’ 7 Those admirable sentiments were remarkable for their absence from the Cape Times professors’ letter.

Instead, the letter is a textbook example of academic bullying, a topic recently reviewed by Dr Fleur Howells, senior lecturer in psychiatry at UCT. Howells writes that there are three forms of academic bullying. The third, ‘social bullying, also known as relational aggression, is the deliberate or active exclusion or damage to the social standing of the victim through, for example, publicly undermining a junior academic’s viewpoint’. 8 The four key components of bullying are intent to harm, experience of harm, exploitation of power and aggression. The professors’ letter thus neatly fulfils all the diagnostic criteria for academic bullying.

Jacqui Hoepner is currently completing her PhD thesis at the Australian National University, studying the use of these bullying tactics to suppress or silence dissenting scientific opinions. 9 In a discussion with Daryl Ilbury, author of Tim Noakes: The Quiet Maveric k , Hoepner disclosed her original assumption that most cases of academic suppression or silencing arise from outside academic circles. To her surprise, she discovered the opposite – ‘the bulk of suppression or silencing came from within academia, from colleagues and competitors’, she told Ilbury. ‘This suggests that the assumed model of respect and disagreement between academics is inaccurate.’

Hoepner was astonished to uncover 43 different ‘silencing behaviours’ that fly in the face of the concept of academic freedom: ‘Every policy and university guideline I looked at suggested that academic freedom was absolutely central to what academics do and their place in society … [But] there’s a real disconnect between what academics think they are guaranteed under academic freedom and what the reality is for the life of an academic.’

She also discovered that the nature of these silencing attacks was ‘more of a personal gut response: that someone has crossed a boundary and we need to punish them. The exact motivation differed from case to case, but it seemed very much a visceral response.’

Typically, attacks are ad hominem, with accusations of conflicts of interest ‘to undermine credibility … without any attempt by the claimant of the accusations to provide any evidence’; and with allegations such as ‘You’re doing real harm’, ‘You’re causing confusion’ or you’re undermining the public’s faith in science; and ending with summons that the researcher be ‘fired or disciplined in some way’.

Perhaps with direct relevance to my experience, Hoepner said: ‘If a scientist discovers evidence that contradicts decades of public health messaging and says that data doesn’t support the messaging, and that person is attacked, and publicly … that’s insane!’

Returning to the professors’ letter, it is also blatantly defamatory because it implies that I, as a medical practitioner: promote a diet that may cause harm (‘heart disease, diabetes mellitus, kidney problems … certain cancers’); make ‘outrageous unproven claims’; malign the integrity and credibility of peers who disagree with me; and undertake research that is not ‘socially responsible’ in the judgement of UCT.

The letter also breaches the HPCSA’s own ethical guidelines. Professor Bongani Mayosi, another signatory to the letter, was involved at that time in a review of the HPCSA management and functioning, and therefore should have been well versed in the ethical guidelines of the organisation he was investigating.

pp. 145-146

I presented De Villiers and Mayosi with copies of Nina Teicholz’s book, The Big Fat Surprise , and an editorial published the previous week in the British Medical Journal ( BMJ ). The editorial was a review of Teicholz’s book written by a former BMJ editor, Dr Richard Smith. 26 In it, he wrote the following:

By far the best of the books I’ve read to write this article is Nina Teicholz’s The Big Fat Surprise , whose subtitle is ‘Why butter, meat, and cheese belong in a healthy diet.’ The title, the subtitle, and the cover of the book are all demeaning, but the forensic demotion of the hypothesis that saturated fat is the cause of cardiovascular disease is impressive. Indeed, the book is deeply disturbing in showing how overenthusiastic scientists, poor science, massive conflicts of interest, and politically driven policy makers can make deeply damaging mistakes. Over 40 years I’ve come to recognize what I might have known from the beginning that science is a human activity with the error, self deception, grandiosity, bias, self interest, cruelty, fraud and theft that is inherent in all human activities (together with some saintliness), but this book shook me.

After describing the bad science underlying all aspects of Ancel Keys’s diet-heart hypothesis, Smith concluded:

Reading these books and consulting some of the original studies has been a sobering experience. The successful attempt to reduce fat in the diet of Americans and others around the world has been a global, uncontrolled experiment, which like all experiments may well have led to bad outcomes. What’s more, it has initiated a further set of uncontrolled global experiments that are continuing. Teicholz has done a remarkable job in analyzing how weak science, strong personalities, vested interests, and political expediency have initiated this series of experiments. She quotes Nancy Harmon Jenkins, author of the Mediterranean Diet Cookbook and one of the founders of Oldways, as saying, ‘The food world is particularly prey to consumption, because so much money is made on food and so much depends on talk and especially the opinions of experts.’ It’s surely time for better science and for humility among experts.

In 2017, the other great British medical journal,

The Lancet , published a similar review, concluding: ‘This is a disquieting book about scientific incompetence, evangelical ambition, and ruthless silencing of dissent that shaped our lives for decades … Researchers, clinicians, and health policy advisers should read this provocative book that reminds us about the importance of good science and the need to challenge dogma.’ 27