Ancel Keys Had A Tiny One

      52 Comments on Ancel Keys Had A Tiny One

Yup, and I can prove it:  Ancel Keys had a tiny dataset — but that didn’t stop him from leaping to big conclusions.  Nina Teicholz wrote about Keys’ problematic data in the terrific book The Big Fat Surprise, and I just came across an old paper that backs her up.

The paper appeared in a 1989 edition of The American Journal of Clinical Nutrition and was (of course) based on Keys’ famous Seven Countries study.  You’ll recall that Keys supposedly recorded what people in seven countries ate and then followed their health outcomes for several years.

Here’s a description of the study’s design from the paper:

During the base-line survey 13,000 men, aged 40- 59 y, were medically examined. Information on diet was collected in random samples from each cohort by use of the record method.  Detailed data on food consumption patterns have been published only for 9 of the 16 cohorts. Therefore, the food intake data were coded once again into a standardized form by one person. Then the foods were summarized in a limited number of food groups. The average daily consumption per person of these food groups was calculated for each cohort.

So Keys had food records, although that coding and summarizing part sounds a little fishy.  Then he followed the health of 13,000 men so he could find associations between diet and heart disease.  So we can assume he had dietary records for all 13,000 of them, right?

Uh … no.  That wouldn’t be the case.

The poster-boys for his hypothesis about dietary fat and heart disease were the men from the Greek island of Crete.  They supposedly ate the diet Keys recommended:  low-fat, olive oil instead of saturated animal fats and all that, you see.  Keys tracked more than 300 middle-aged men from Crete as part of his study population, and lo and behold, few of them suffered heart attacks.  Hypothesis supported, case closed.

So guess how many of those 300-plus men were actually surveyed about their eating habits?  Go on, guess.  I’ll wait …

And the answer is:  31.

Yup, 31.  And that’s about the size of the dataset from each of the seven countries:  somewhere between 25 and 50 men.  It’s right there in the paper’s data tables. That’s a ridiculously small number of men to survey if the goal is to accurately compare diets and heart disease in seven countries.

But wait … so far we’re assuming the dietary records were accurate.  As Teicholz pointed out, Keys took one of his food-recall surveys in Greece during Lent, when religious Greeks abstain from animal foods.  I’d call that a bit of a confounding variable.  And then there’s this, directly from the paper:

In Crete the villages involved were Agies, Paraskies, Thrapsano, and Kastelli. In Corfu the villages were Ano Korakiana, Skriperon, and San Marco. About 30 men were involved in each dietary survey. However, the original 7-day records were no longer available.

No original records?!  So you dumped the study, right?

It was therefore decided to reconstruct the diets of these cohorts on the basis of results of the dietary surveys mentioned in a publication by Keys et al.

Uh … so you swapped in the results from an earlier paper.  Okay, got it.  But tell me we’re at least talking about a genuine dietary survey here.

When no information about the consumption of certain foods, eg, fruits and vegetables, was available food balance sheet data from Greece in 1961-65 were used as a substitute.

Head.  Bang.  On.  Desk.

Getting the picture?  Keys followed the health of more than 300 men from Crete.  But he only surveyed 31 of them, with one of those surveys taken during the meat-abstinence month of Lent.  Oh, and the original seven-day food-recall records weren’t available later, so he swapped in data from an earlier paper.  Then to determine fruit and vegetable intake, he used data sheets about food availability in Greece during a four-year period.

And from this mess, he concluded that high-fat diets cause heart attacks and low-fat diets prevent them.

Keep in mind, this is one of the most-cited studies in all of medical science.  It’s one of the pillars of the Diet-Heart hypothesis.  It helped to convince the USDA, the AHA, doctors, nutritionists, media health writers, your parents, etc., that saturated fat clogs our arteries and kills us, so we all need to be on low-fat diets – even kids.

Yup, Ancel Keys had a tiny one … but he sure managed to screw a lot of people with it.


52 thoughts on “Ancel Keys Had A Tiny One

  1. Theresa

    Hi Tom,
    It is good to see Keys’s work being openly questioned. Can you please put up the name of the author and the title of the paper?

    I am currently doing a Biochemistry of Food paper and think it could be a great reference for one of my assignments 🙂

    One of my papers last semester was on interpreting research which I really enjoyed although I spent a lot of time reading research papers asking myself “are you kidding me?”. I’ve become very skeptical (as I am sure was the intention of the paper in the first place), especially of what researchers choose to exclude and include and why. Also on how data is collected. One paper extrapolated diet in relation to heart disease in a population over a life time by using only one 24 hour dietary recall. Too bad if you went to a junk laden kids party the day before the interview and were honest about it – the records would show that junk is all you had ever eaten for your entire life.

    1. Tom Naughton Post author

      Food consumption patterns in the 1960s in seven countries. Kromhout, Keys, Aravanis et al. American Journal of Clinical Nutrition, 1989;49:889-894.

      Good luck with the paper.

  2. Ash Simmonds

    The only 300 Greek men he should have followed are the Spartans:


    “Spartans primarily ate pork stew, the ‘black broth’. According to Plutarch, it was ‘so much valued that the elderly men fed only upon that, leaving what flesh there was to the younger’.”

    “The 2nd–3rd century author Aelian, claims that Spartan cooks were prohibited from cooking anything other than meat.”

    1. Tom Naughton Post author

      Keys probably would have convinced themselves they died in battle before the heart disease could develop.

  3. B35

    So this is the glorious Mediterranean study that the Anointed has told us about so much and cited in almost every single one of their works. It’s amazing what cross-checked, detailed and accurate information they gave us!

    1. Tom Naughton Post author

      The next time my doctor asks how many fruits and vegetables I eat, I’ll quote food-availability figures from the U.S.

  4. Jesrad

    When Mainstream Science shifts to high-fat, all the blame will be piled up on Ancel Keys’ shoulders, because he’s dead and cannot fight back, and because at that point no one will want to take even a fraction of that huge pile of blame for the hundreds of thousands of evitable deaths and the millions more of Alzheimer cases the war on fat has caused.

    And those who are just as responsible and guilty for advancing their own careers at the public’s expense will continue to lead successful careers and lives.

  5. Josh

    “However, the original 7-day records were no longer available.”

    The original version of a hard drive crashing.

  6. Justin B

    It’s kind of astonishing that we’re still uncovering details about a decades-old study. I guess it just goes to show how far they went to attempt to cover up the details that didn’t match up. Back when I watched your movie, I was under the impression that I knew everything I was ever going to know about the 7 countries study. But the fact that it’s even worse than the information that initially was able to convince me? Wow.

    1. Tom Naughton Post author

      Astonishing indeed. Although to clarify, the section on Keys and his cherry-picked data in Fat Head was about a study he conducted in the 1950s. The Seven Countries study came later.

  7. Pat

    When I was still teaching, I used to have my students analyze a scientific paper section by section – what was good, what was bad, what was not clear, what should have been in it but was omitted. The “Materials and Methods” and “Results” sections are the most important – they show how well (or not) the research was done. I wish I were still teaching, we would have such fun ripping this paper to shreds.

    1. Tom Naughton Post author

      I think whenever the public at large becomes aware of a particular condition, you’re going to get people who imagine they have that condition but don’t. So that’s a fair point. But celiac disease has really and truly quadrupled in the last 50 years (that’s based on blood samples, not self-reported symptoms), most people with celiac are never diagnosed, and by the time a person IS diagnosed with celiac, considerable damage has already been done. So yes, there’s a problem with the gluten in today’s wheat.

      1. Walter Bushell

        In any event wheat is only good as an emergency food. For one thing wheat is addictive. For another it doesn’t taste good by itself it needs sugar or fat to be remotely palatable. And it’s been transmorgified by genetic engineering into something humans have not been historically exposed.

        If you avoid sugar, wheat and industrial seed oils, you are 90% of the way home.

  8. Betsy Goulet

    Informative and HILARIOUS – perfect format for reinforcing the absurdity of the Keys study and how it was the foundation for medical dietary advice…..let the revolution continue!!!

      1. Bret

        “It takes a BIG man to admit he’s been wrong.”

        Our entire western culture could stand to adopt the same motto, and not just on dietary issues.

        There is way too much chest beating all throughout society, with everybody claiming they know the answers to all of life’s problems.

        Lots of folks talking (shouting even), few listening.

  9. Kristin

    I wasn’t going to get this book figuring I knew most of what was in it. It was your review, Tom, that convinced me. I’m half way through it and still being shocked by what I”m reading and glad to have the expanded perspective.

    While many of the actors in this tragedy may have been blinded or misguided, I no longer extend that generosity to Keys or a few others . They built lucrative careers via calculated bullying and fraud sacrificing the health of the country and now the planet to their greed.

    1. Tom Naughton Post author

      I agree on both counts. The book told way more of the story than I previously knew, and I’m now convinced Keys wasn’t just wrong — he was an arrogant fraud

  10. tony

    Evidently someone adopted this flawed study because it helped certain agenda. USDA price supports? Big Food, AMA, Big Pharma? The fact is these lies have made some very wealthy (blood money).

    1. Walter Bushell

      And the vegan or vegetarian agenda. Lots of people become nutritionists etcetera to forward the vegan agenda. If the study shows that their diet it wrong, the study is obviously incorrect and must be properly interpreted.

      I don’t think I have to name names here. (TCC)

      1. Tom Naughton Post author

        Initials will work just fine. And TCC chose to ignore the rather strong association between wheat and bad health in his own data.

  11. Stephen

    Did the scientific method really fail in this case? Did no one propose a competing idea? Surely the scientific method is robust, even in the face of fraud or incompetence. Did no one try to repeat his work with a different data set? Did LCHF diets never get studied or considered this whole time?

    Also, I can’t blame anyone but myself for binging on junk food and gaining 35kg. It was hard to break the addiction, but since I got started, it’s been fun and easy losing 25kg over the last year.

      1. Stephen

        Well, I’m not going to argue. I started losing weight as a vegan, but right now I’m trying to slow cook a beef brisket. I will be eating the stew over rice though.

  12. LuckyMama

    I’m reading A Big Fat Surprise at the moment – it’s AWESOME!!!!

    It’s amazing how unscientific these scientists were in their “research”. However, it happens far too often. I’d lose my job if I behaved the same way.

    Loving your blog – loving the last line of this particular one. Keys was an arrogant little prick.

  13. Boundless

    > Nina Teicholz wrote about Keys’ problematic data …

    Nina’s book itself is now starting to be cited, from just last week:
    “Dietary Carbohydrate restriction as the first approach in diabetes management. Critical review and evidence base”
    footnote 48

    This paper, by the way, is a blatant challenge to consensus diet and medical practice. You’ll recognize many of the contributing MDs. As DietDoctor pointed out “But the name that stands out to me is Arne Astrup, the influential Danish professor and nutrition researcher who in recent years became convinced and changed sides in the debate.”

  14. JanC

    I posted a link to your article on my Facebook page (Low-Carb Resources) which is linked to Twitter. Yesterday I was bombarded by tweets from someone who has ‘Warrior’ as part of their Twitter name and for good reason, it seems – they are certainly aggressive. You were described as ‘a film maker who fancies himself as a nutrition guru, and no offense he’s full of shit’. I’ve just this minute had 17 notifications, and that’s just Monday’s offering. It seems that this person is probably a vegan.

    Why do they behave in such a way? They are so aggressive, it’s unbelievable. I’ve tried to answer everything calmly but now I’m just getting a tirade of stuff which I have to ignore because I’m trying to work. Here’s the response to my explanation about lard that caused much upset from our warrior buddy: Me: ‘Lard is pork fat. Pork is eaten widely in Med countries and all the animal is used. The fat is used in cooking even today.’ Reply: ‘you’re quite gifted at Gish gallop’. I’ve no idea what this person is on about. I’m just a simple British cookery and diet editor who often eats food in the Mediterranean – what do I know? It’s time to stop feeding the troll – I should have known better.

    1. Tom Naughton Post author

      If this person is a vegan, then the anger is the result of their belief that killing animals is morally equivalent to murder. Given that belief, they cannot accept that the bounty of the murder (pork fat) is good for your body. It would be like someone claiming your health will improve if you eat children.

      1. JanC

        We got on to lard because the original comment from Warrior was that he/she said Ancel Keys emphasised fruit and veg and not low in fat but high in oil. I said that widespread use of olive oil for cooking was relatively new and that many Med countries used lard (and still do to some degree). He/she then went into orbit about how dangerous sat-fat is. Low-carb seemed to hit rather a lot of spots too. So I’m not sure whether murdering pigs was the top priority. At least he or she had the good grace to shut up when I said politely that I wasn’t continuing with the discussion. It’s just not possible on Twitter. I earlier asked if they had ever eaten Mediterranean food in the Med. No reply. I think they would be very surprised at the amount of meat eaten (esp. dried meat in Spain for example), which is all made with pork. Plus they eat a lot of cheese there. It really isn’t anything like the diet that many people who haven’t been there think it might be.

        1. Tom Naughton Post author

          The warrior is just plain wrong. Keys did emphasize limiting total fat. He later gave the official version (i.e., not the real version) of the Mediterranean diet his stamp of approval, as long as olive oil accounted for the higher intake of fat.

          Lots of vegans prefer to argue about the supposed dangers of meats and saturated fats because they know if they argue the animal-murderer angle, most people will laugh them off.

        2. Firebird

          Much like Chinese food. What they eat in China is nothing close to the #3 platter at your local restaurant.

  15. Heather D

    I just read an amazing article on Diabetes In, a website for physicians of patients with type 1 and type 2 diabetes. I’ll put the link in, but first, an amazing quote (maybe there is light at the end of the tunnel and we won’t have to bang our heads too much longer)
    Barbara Gower, Ph.D., professor and vice chair for research in the UAB Department of Nutrition Sciences and one of the study authors, stated that, “Diabetes is a disease of carbohydrate intolerance.” “Reducing carbohydrates is the obvious treatment. It was the standard approach before insulin was discovered and is, in fact, practiced with good results in many institutions. The resistance of government and private health agencies is very hard to understand.”

    Wow! Here is the link…

  16. Rick

    Keys is clearly not to blame. Pretty sure he himself did not eat much sugar, refined grains or ‘vegetable’ oils ,this is what the food industry created out of their interpretation of his works. I guess we should find what Keys, who had
    a huge vegetable garden on the Mediterranean, ate and

    1. Tom Naughton Post author

      Keys is very much to blame. Among other scientific sins, he buried one of his own studies (recently discovered) because the group that switched from animal fats to vegetable oils had an increase in heart attacks. That means he was a freakin’ liar and more interested in promoting his anti-saturated-fat beliefs than the truth. That agenda took hold and convinced millions of people to switch from butter and lard (which don’t cause heart disease) to vegetable oils that cause inflammation and thus heart disease.


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