Restoring the Foundations of Modern Nutrition

The True Health Initiative sets the record straight on misrepresented research

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Ancel Keys was one of the most prominent, influential, and arguably most important nutrition scientists of the last half century. He was among the first, if not the first, to recognize something we all take for granted now: Heart disease is not an inevitable consequence of aging, and it can be affected—and potentially prevented—by diet and lifestyle.

Keys conducted important research, mostly as a member of the faculty at the University of Minnesota, for many decades, and was professionally active until not long before his death, at age 100, in 2004. He has a number of famous accomplishments, including the invention of the “K-ration,” portable meals of adequate nutrition for deployed military, named for him; and the first, formal recognition of a “Mediterranean diet.” Those in the nutrition or, for that matter, medical fields are also likely to have heard of the “Keys-Hegsted” equation, used routinely to estimate the effects of various fats in the diet on cholesterol levels in the blood.

The Seven Countries Study

Keys’ most famous and potentially most important work, however, was the Seven Countries Study. Begun in the 1950s, this was an effort to examine the variations in diet across countries and populations, and determine effects on heart disease. The study overlapped substantially with the comparably famous Framingham Heart Study.

The Framingham study taught us that blood cholesterol levels predict heart disease risk, another thing we tend to take for granted today, but which—of course—someone had to figure out in the first place. The Seven Countries Study taught us that blood cholesterol levels and heart disease risk vary in turn with dietary intake of saturated fat from meat, processed meat, and dairy. The higher the intake of saturated fat in the diet, the higher the rates of heart disease and premature death from it.

Decades ago, the work of Keys and his colleagues around the world was acclaimed and respected. Keys had his detractors, of course; anyone with thinking that is bold, innovative, and on public display does. But he was largely celebrated by peers around the world, and the public, as one of the key pioneers in our understanding of nutrition, heart disease, and modern epidemiology.  Perhaps the signature evidence of this respect, other than a TIME Magazine cover, was the development of a population-wide intervention in North Karelia, Finland, guided principally by the work and findings of Keys.

Focused on reducing saturated fat and sodium in the diet, and on reducing smoking in a population with exceptionally high rates of heart disease, the North Karelia Project reduced those rates of heart disease by over 80 percent, and added roughly ten years on average to life expectancy.

It is probably the single greatest demonstration we have of the power of lifestyle as medicine at the population level.

Twisting of the Facts

This narrative took a turn over the years leading up to, and since, Keys’ death. In the United States, unlike North Karelia, Finland, the findings of Keys and colleagues did not result in a population shift to less meat and cheese, more beans and leafy greens. Rather, a whole array of low-fat junk foods emerged as the idea that dietary fat should be cut wholesale took hold.

Neither low-fat junk foods, nor the reduction of all varieties of dietary fat conformed to the findings or recommendations of Keys, who was, in particular, an advocate for a Mediterranean diet of wholesome, whole foods, high in unsaturated fats. Nonetheless, his detractors pinned the blame for the various boondoggles of “low fat” eating on him. Since Keys was no longer around to defend himself, the allegations went mostly unanswered.

More recently, several specific allegations about the work, methods, and findings of Keys, and the Seven Countries Study in particular, have become salient themes in best-selling books and Internet commentary. The particular contentions are that countries were enrolled into the study selectively in an effort to prove a particular belief about diet Keys already had; that data from the study were presented selectively and in a biased manner in publications; that there were actually more than seven countries in the Seven Countries Study; and that the effects of sugar on heart disease risk were ignored, or even actively concealed.

There was a time when the expression of such opinions to the public required some kind of editorial filter. In this modern age of the blogosphere, however, that is no longer the case. Anyone with an opinion and Internet access can broadcast their view to likeminded recipients who are then prone to repeat it on social media. As noted ominously by Vladimir Lenin: “A lie told often enough becomes the truth.” That appears to be so for our modern politics, and is certainly true in modern nutrition.

This matters to us all. Arguments that Keys “fudged” data are used routinely to help make the case that we have been wrong about saturated fat all along, and can, and perhaps even should, eat more meat, butter, and cheese with impunity. The prevailing case underlying any number of prominent careers in nutritional contrarianism seems to be this: Keys’ work, and the Seven Countries Study, are part of the foundation of modern nutrition, and that foundation is flawed; therefore, everything built on that foundation is also flawed.

This would, indeed, be an essential reality check if it were true. However, it is not.

The True Health Initiative White Paper

Concerned that the work of Keys and colleagues was being misrepresented, the True Health Initiative—a non-profit organization I founded, which represents a global assembly of experts and influencers in lifestyle medicine and related disciplines—commissioned a comprehensive white paper on the matter, obtaining details not from oft-repeated blog fodder, but from original documents going back as much as 60 years; and by queries to Keys’ lead co-investigators around the world, who were there at the time.

The result is now available for all to see. Refer directly to the paper for the particulars, but in brief: Countries were not enrolled selectively or in a biased manner; data were not presented selectively or in a biased manner; sugar was not ignored, and its role in heart disease was reported exactly in accord with the data; and there were exactly seven countries in the Seven Countries Study. In other words, every popular allegation about Keys, and the study, is demonstrably false.

We have abundant evidence, entirely independent of Keys, that diets high in sources of saturated fat—meat, processed meat, dairy, fried foods, fast foods—are associated with high rates of chronic disease and premature death. We also have evidence that diets high in refined carbohydrate and added sugar have similar liabilities. Diets of principally whole, wholesome foods, mostly plants, low in saturated fat, like the Mediterranean diet favored by Keys, are decisively associated with the opposite: longevity, vitality, and the avoidance of chronic disease.

We know this from sources unrelated to the work of Ancel Keys, but we know it originally from the foundational work of Keys and his colleagues. The many popular claims of flaws in that foundation are themselves false. That foundation is sound, and the white paper—aimed only at disclosing the historically documented truth—serves to restore its integrity.

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