Bad science, great blog atricle

GARY TAUBES
author of Why We Get Fat
and Good Calories, Bad Calories


I’m writing this post with a little more haste than is my wont. I’ve received dozens of e-mails asking me to comment on the recent news — ala the the New York Times — that meat-eating apparently causes premature death and disease. So this post is likely to contain more than my usual number of typos, egregious spelling mistakes, grammatical errors, etc. Bear with me. Rather than spend a week rewriting and editing, as I usually do, I’m going to do my best to get this up and out in a few hours.
Back in 2007 when I first published Good Calories, Bad Calories I also wrote a cover story in the New York Times Magazine on the problems with observational epidemiology. The article was called “Do We Really Know What Makes Us Healthy?” and I made the argument that even the better epidemiologists in the world consider this stuff closer to a pseudoscience than a real science. I used as a case study the researchers from the Harvard School of Public Health, led by Walter Willett, who runs the Nurses’ Health Study. In doing so, I wanted to point out one of the main reasons why nutritionists and public health authorities have gone off the rails in their advice about what constitutes a healthy diet. The article itself pointed out that every time in the past that these researchers had claimed that an association observed in their observational trials was a causal relationship, and that causal relationship had then been tested in experiment, the experiment had failed to confirm the causal interpretation — i.e., the folks from Harvard got it wrong. Not most times, but every time. No exception. Their batting average circa 2007, at least, was .000.
Now it’s these very same Harvard researchers — Walter Willett and his colleagues — who have authored this new article claiming that red meat and processed meat consumption is deadly; that eating it regularly raises our risk of dying prematurely and contracting a host of chronic diseases. Zoe Harcombe has done a wonderful job dissecting the paper at her site. I want to talk about the bigger picture (in a less concise way).
This is an issue about science itself and the quality of research done in nutrition. Those of you who have read Good Calories, Bad Calories (The Diet Delusion in the UK) know that in the epilogue I make a point to say that I never used the word scientist to describe the people doing nutrition and obesity research, except in very rare and specific cases. Simply put, I don’t believe these people do science as it needs to be done; it would not be recognized as science by scientists in any functioning discipline.
Science is ultimately about establishing cause and effect. It’s not about guessing. You come up with a hypothesis — force x causes observation y — and then you do your best to prove that it’s wrong. If you can’t, you tentatively accept the possibility that your hypothesis was right. Peter Medawar, the Nobel Laureate immunologist, described this proving-it’s-wrong step as the ”the critical or rectifying episode in scientific reasoning.” Here’s Karl Popper saying the same thing: “The method of science is the method of bold conjectures and ingenious and severe attempts to refute them.” The bold conjectures, the hypotheses, making the observations that lead to your conjectures… that’s the easy part. The critical or rectifying episode, which is to say, the ingenious and severe attempts to refute your conjectures, is the hard part. Anyone can make a bold conjecture. (Here’s one: space aliens cause heart disease.) Making the observations and crafting them into a hypothesis is easy. Testing them ingeniously and severely to see if they’re right is the rest of the job — say 99 percent of the job of doing science, of being a scientist.
The problem with observational studies like those run by Willett and his colleagues is that they do none of this. That’s why it’s so frustrating. The hard part of science is left out and they skip straight to the endpoint, insisting that their interpretation of the association is the correct one and we should all change our diets accordingly.
In these observational studies, the epidemiologists establish a cohort of subjects to follow (tens of thousands of nurses and physicians, in this case) and then ask them about what they eat. The fact that they use questionnaires that are notoriously fallible is almost irrelevant here because the rest of the science is so flawed. Then they follow the subjects for decades — 28 years in this case. Now they have a database of diseases, deaths and foods consumed, and they can draw associations between what these people were eating and the diseases and deaths.
The end result is an association. In the latest report, eating a lot of red meat and processed meat is associated with premature death and increased risk of chronic disease. That’s what they observed in the cohorts — the observation. The subjects who ate the most meat (the top quintile) had a 20 percent greater risk of dying over the course of the study than the subjects who ate the least meat (the bottom quintile). This association then generates a hypothesis, which is why these associations used to be known as “hypothesis-generating data” (before Willett and his colleagues and others like them decided they got tired of their hypotheses being shot down by experiments and they’d skip this step). Because of the association that we’ve observed, so this thinking goes, we now hypothesize that eating red meat and particularly processed meat is bad for our health and we will live longer and prosper more if we don’t do it. We hypothesize that the cause of the association we’ve observed is that red and processed meat is unhealthy stuff.
Terrific. We have our bold conjecture. What should we do next?
Well, because this is supposed to be a science, we ask the question whether we can imagine other less newsworthy explanations for the association we’ve observed. What else might cause it? An association by itself contains no causal information. There are an infinite number of associations that are not causally related for every association that is, so the fact of the association itself doesn’t tell us much.
Moreover, this meat-eating association with disease is a tiny association. Tiny. It’s not the 20-fold increased risk of lung cancer that pack-a-day smokers have compared to non-smokers. It’s a 0.2-fold increased risk — 1/100th the size. So with lung cancer we could buy as a society the observation that cigarettes cause lung cancer because it was and remains virtually impossible to imagine what other factor could explain an association so huge and dramatic. Experiments didn’t need to be done to test the hypothesis because, well, the signal was just so big that the epidemiologists of the time could safely believe it was real. And then experiments were, in effect, done anyway. People quit smoking and lung cancer rates came down, or at least I assume they did. (If not, we’re in trouble here.) When I first wrote about the pseudoscience of epidemiology in Science back in 1995, “Epidemiology Faces It’s Limits”, I noted that very few epidemiologists would ever take seriously an association smaller than a 3- or 4-fold increase in risk. These Harvard people are discussing, and getting an extraordinary amount of media attention, over a 0.2-fold increased risk. (Horn-blowing alert: my Science article has since been cited by over 400 articles in the peer-reviewed medical literature, according to Thomson Reuter’s Web of Knowledge.)
So how can we explain this tiny association between the risk of eating a lot of red and processed meat — the 1/100th-the-size-of-the-lung-cancer-cigarette effect–compared to eating virtually none? Again, we have an observation — or an association, two or more things happening in concert; let’s think of all the possible reasons that might explain why these two variables, meat-eating and disease, associate together in our cohorts of nurses and physicians. Here’s how the great German pathologist Rudolph Virchow phrased this in 1849: How, he said, can we “with certainty decide which of two coexistent phenomena is the cause and which the effect, whether one of them is the cause at all instead of both being effects of a third cause, or even whether both are effects of two entirely unrelated causes”? This is the hard part.
The answer ultimately is that we do experiments, which is what Virchow went on to discuss. But we’ll get back to this in a minute. Before we get around to doing the experiments, we must rack our brains to figure out if there are other causal explanations for this association beside the the meat-eating one. Another way to think of this is that we’re looking for all the myriad possible ways our methodology and equipment might have fooled us. The first principle of good science, as Richard Feynman liked to say, is that you must not fool yourself because you’re the easiest person to fool. And so before we go public and commit ourselves to believing this association is meaningful and causal, let’s think of all the ways we might be fooled. Once we’ve thought up every possible, reasonable alternative hypotheses (space aliens are out on this account), we can then go about testing them to see which ones survive the tests: our preferred hypothesis (meat-eating causes disease, in this case) or one of the many others we’ve considered.
So let’s think of reasonable ways in which people who eat a lot of meat might be different from people who don’t, looking specifically for differences that might also explain some or all of the association we observed between meat-eating, disease and premature death. What else can explain this association, which might have nothing to do with whatever happens when we consume meat or processed meat?
Zoe Harcombe made this point beautifully using the Harvard data. The obvious clue is that as we move from the bottom quintile of meat-eaters (those who are effectively vegetarians) to the top quintile of meat-eaters we see an increase in virtually every accepted unhealthy behavior — smoking goes up, drinking goes up, sedentary behavior (or lack of physical activity) goes up — and we also see an increase in markers for unhealthy behaviors — BMI goes up, blood pressure, etc. So what could be happening here?
If you go back and read my New York Times Magazine article on this research, you’ll see that I discussed a whole host of effects, known technically as confounders — they confound the interpretation of the association — that could explain associations between two variables but have nothing to do biologically with the variables themselves. One of these confounders is called the compliance or adherer effect. Heres’ what I said about it in the article:
The Bias of Compliance
A still more subtle component of healthy-user bias has to be confronted. This is the compliance or adherer effect. Quite simply, people who comply with their doctors’ orders when given a prescription are different and healthier than people who don’t. This difference may be ultimately unquantifiable. The compliance effect is another plausible explanation for many of the beneficial associations that epidemiologists commonly report, which means this alone is a reason to wonder if much of what we hear about what constitutes a healthful diet and lifestyle is misconceived.
The lesson comes from an ambitious clinical trial called the Coronary Drug Project that set out in the 1970s to test whether any of five different drugs might prevent heart attacks. The subjects were some 8,500 middle-aged men with established heart problems. Two-thirds of them were randomly assigned to take one of the five drugs and the other third a placebo. Because one of the drugs, clofibrate, lowered cholesterol levels, the researchers had high hopes that it would ward off heart disease. But when the results were tabulated after five years, clofibrate showed no beneficial effect. The researchers then considered the possibility that clofibrate appeared to fail only because the subjects failed to faithfully take their prescriptions.
As it turned out, those men who said they took more than 80 percent of the pills prescribed fared substantially better than those who didn’t. Only 15 percent of these faithful “adherers” died, compared with almost 25 percent of what the project researchers called “poor adherers.” This might have been taken as reason to believe that clofibrate actually did cut heart-disease deaths almost by half, but then the researchers looked at those men who faithfully took their placebos. And those men, too, seemed to benefit from adhering closely to their prescription: only 15 percent of them died compared with 28 percent who were less conscientious. “So faithfully taking the placebo cuts the death rate by a factor of two,” says David Freedman, a professor of statistics at the University of California, Berkeley [who passed away, regrettably, in 2008]. “How can this be? Well, people who take their placebo regularly are just different than the others. The rest is a little speculative. Maybe they take better care of themselves in general. But this compliance effect is quite a big effect.”
The moral of the story, says Freedman, is that whenever epidemiologists compare people who faithfully engage in some activity with those who don’t — whether taking prescription pills or vitamins or exercising regularly or eating what they consider a healthful diet — the researchers need to account for this compliance effect or they will most likely infer the wrong answer. They’ll conclude that this behavior, whatever it is, prevents disease and saves lives, when all they’re really doing is comparing two different types of people who are, in effect, incomparable.
This phenomenon is a particularly compelling explanation for why the Nurses’ Health Study and other cohort studies saw a benefit of H.R.T. [hormone replacement therapy, one subject of the article] in current users of the drugs, but not necessarily in past users. By distinguishing among women who never used H.R.T., those who used it but then stopped and current users (who were the only ones for which a consistent benefit appeared), these observational studies may have inadvertently focused their attention specifically on, as Jerry Avorn says, the “Girl Scouts in the group, the compliant ongoing users, who are probably doing a lot of other preventive things as well.”

It’s this compliance effect that makes these observational studies the equivalent of conventional wisdom-confirmation machines. Our public health authorities were doling out pretty much the same dietary advice in the 1970s and 1980s, when these observational studies were starting up, as they are now. The conventional health-conscious wisdom of the era had it that we should eat less fat and saturated fat, and so less red meat, which also was supposed to cause colon cancer, less processed meat (those damn nitrates) and more fruits and vegetables and whole grains, etc. And so the people who are studied in the cohorts could be divided into two groups: those who complied with this advice — the Girl Scouts, as Avorn put it — and those who didn’t.
Now when we’re looking at the subjects who avoided red meat and processed meat and comparing them to the subjects who ate them in quantity, we can think of it as effectively comparing the Girl Scouts to the non-Girl Scouts, the compliers to the conventional wisdom to the non-compliers. And the compliance effect tells us right there that we should see an association — that the Girl Scouts should appear to be healthier. Significantly healthier. Actually they should be even healthier than Willet et al. are now reporting, which suggests that there’s something else working against them (not eating enough red meat?). In other words, the people who avoided red meat and processed meats were the ones who fundamentally cared about their health and had the energy (and maybe the health) to act on it. And the people who ate a lot of red meat and processed meat in the 1980s and 1990s were the ones who didn’t.
Here’s another way to look at it: let’s say we wanted to identify markers of people who were too poor or too ignorant to behave in a health conscious manner in the 1980s and 1990s or just didn’t, if you’ll pardon the scatological terminology, give a sh*t. Well, we might look at people who continued to eat a lot of bacon and red meat after Time magazine ran this cover image in 1984 — “Cholesterol, and now the bad news”. I’m going to use myself as an example here, realizing it’s always dangerous and I’m probably an extreme case. But I lived in LA in the 1990s where health conscious behavior was and is the norm, and I’d bet that I didn’t have more than half a dozen servings of bacon or more than two steaks a year through the 1990s. It was all skinless chicken breasts and fish and way too much pasta and cereal (oatmeal or some other non-fat grain) and thousands upon thousands of egg whites without the yolks. Because that’s what I thought was healthy.
So when we compare people who ate a lot of meat and processed meat in this period to those who were effectively vegetarians, we’re comparing people who are inherently incomparable. We’re comparing health conscious compliers to non-compliers; people who cared about their health and had the income and energy to do something about it and people who didn’t. And the compliers will almost always appear to be healthier in these cohorts because of the compliance effect if nothing else. No amount of “correcting” for BMI and blood pressure, smoking status, etc. can correct for this compliance effect, which is the product of all these health conscious behaviors that can’t be measured, or just haven’t been measured. And we know this because they’re even present in randomized controlled trials. When the Harvard people insist they can “correct” for this, or that it’s not a factor, they’re fooling themselves. And we know they’re fooling themselves because the experimental trials keep confirming that.
That was the message of my 2007 article. As one friend put it years ago to me (and I wish I could remember who so I could credit him or her properly), when these cohort studies compare mostly health advice compliers to non-compliers, they might as well be comparing Berkeley vegetarians who eat at Alice Water’s famous Chez Panisse restaurant once a week after their yoga practice to redneck truck drivers from West Virginia whose idea of a night on the town is chicken-fried steak (and potatoes and beer and who knows what else) at the local truck stop. The researchers can imply, as Willett and his colleagues do, that the most likely reason these people have different levels of morbidity and mortality is the amount of meat they eat; but that’s only because that’s what Willett and his colleagues have to believe to justify the decades of work and tens, if not hundreds, of millions of dollars that have been spent on these trials. Not because it’s the most likely explanation. It’s far more likely that the difference is caused by all the behaviors that associate with meat-eating or effective vegetarianism — whether you are, in effect, a Girl Scout or not.
This is why the best epidemiologists — the one’s I quote in the NYT Magazine article — think this nutritional epidemiology business is a pseudoscience at best. Observational studies like the Nurses’ Health Study can come up with the right hypothesis of causality about as often as a stopped clock gives you the right time. It’s bound to happen on occasion, but there’s no way to tell when that is without doing experiments to test all your competing hypotheses. And what makes this all so frustrating is that the Harvard people don’t see the need to look for alternative explanations of the data — for all the possible confounders — and to test them rigorously, which means they don’t actually see the need to do real science.
As I said, it’s a sad state of affairs.
Now we’re back to doing experiments — i.e., how we ultimately settle this difference of opinion. This is science. Do the experiments. We have alternative causal explanations for the tiny association between meat-eating and morbidity and mortality. One is that it’s the meat itself. The other is that it’s the behaviors that associate with meat-eating. So do an experiment to see which is right. How do we do it? Well you can do it with an N of 1. Switch your diet, see what happens. Or we can get more meaningful information by starting with your cohort of subjects and assigning them at random either to a diet rich red meat and processed meat, or to a diet that’s not — a mostly vegetarian diet. By assigning subjects at random to one of these two interventions, we mostly get rid of the behavioral (and socio-economic and educational…) factors that might associate with choosing of your own free will whether to be a vegetarian (or a mostly-vegetarian) or a meat-eater.
So we do a randomized-controlled trial. Take as many people as we can afford, randomize them into two groups — one that eats a lot of red meat and bacon, one that eats a lot of vegetables and whole grains and pulses-and very little red meat and bacon — and see what happens. These experiments have effectively been done. They’re the trials that compare Atkins-like diets to other more conventional weight loss diets — AHA Step 1 diets, Mediterranean diets, Zone diets, Ornish diets, etc. These conventional weight loss diets tend to restrict meat consumption to different extents because they restrict fat and/or saturated fat consumption and meat has a lot of fat and saturated fat in it. Ornish’s diet is the extreme example. And when these experiments have been done, the meat-rich, bacon-rich Atkins diet almost invariably comes out ahead, not just in weight loss but also in heart disease and diabetes risk factors. I discuss this in detail in chapter 18 of Why We Get Fat, ”The Nature of a Healthy Diet.” The Stanford A TO Z Study is a good example of these experiments. Over the course of the experiment — two years in this case — the subjects randomized to the Atkins-like meat- and bacon-heavy diet were healthier. That’s what we want to know.
Now Willett and his colleagues at Harvard would challenge this by saying somewhere along the line, as we go from two years out to decades, this health benefit must turn into a health detriment. How else can they explain why their associations are the opposite of what the experimental trials conclude? And if they don’t explain this away somehow, they might have to acknowledge that they’ve been doing pseudoscience for their entire careers. And maybe they’re right, but I certainly wouldn’t bet my life on it.
Ultimately we’re left with a decision about what we’re going to believe: the observations, or the experiments designed to test those observations. Good scientists will always tell you to believe the experiments. That’s why they do them.


Egregious (and embarrassing) error correction: In an early version of the post, I suggested that if you read the chapter on nutritional epidemiology in the textbook Modern Epidemiology, you’d see that the best epidemiologists agree that this pursuit is pathological. A reader from my institution — a UC Berkeley grad student — pointed out that the chapter on nutritional epi in the textbook was actually written by Walter Willett and that, not surprisingly, it does not agree with this position. Here’s how Willett ends that chapter:
The last two decades have seen enormous progress in the development of nutritional epidemiology methods. Work by many investigators has provided clear support for the essential underpinnings of this field. Substantial between-person variation in consumption of most dietary factors in populations has been demonstrated, methods to measure diet applicable to epidemiologic studies have been developed, and their validity has been documented. Based on this evidence, many large prospective cohort studies have been established that are providing a wealth of data on many outcomes that will be reported during the next decade. In addition, methods to account for errors in measurement of dietary intake have been developed and are beginning to be applied in reporting findings from studies of diet and disease.
Nutritional epidemiology has contributed importantly to understanding the etiology of many diseases. Low intake of fruits and vegetables has been shown to be related to increased risk of cardiovascular disease. Also, a substantial amount of epidemiologic evidence has accumulated indicating that replacing saturated and trans fats with unsaturated fats can play an important role in the prevention of coronary heart disease and type 2 diabetes. Many diseases—as diverse as cataracts, neural-tube defects, and macular degeneration—that were not thought to be nutritionally related have been found to have important dietary determinants. Nonetheless, much more needs to be learned regarding other diet and disease relations, and the dimensions of time and ranges of dietary intakes need to be expanded further. Furthermore, new products are constantly being introduced into the food supply, which will require continued epidemiologic vigilance.
The development and evaluation of additional methods to measure dietary factors, particularly those using biochemical methods to assess long-term intake, can contribute substantially to improvements in the capacity to assess diet and disease relations. Also, the capacity to identify those persons at genetically increased risk of disease will allow the study of gene–nutrient interactions that are almost sure to exist. The challenges posed by the complexities of nutritional exposures are likely to spur methodologic developments. Such developments have already occurred with respect to measurement error. The insights gained will have benefits throughout the field of epidemiology.
Now the reason I made this mistake is because I was rushing (no excuse, despite the warning up front) and so working from memory about a chapter that the UCLA epidemiologist Sander Greenland, one of the editor/authors of Modern Epidemiology, sent me when I was writing the New York Times Magazine article in 2007. The chapter Greenland was discussing and that he had sent me at the time was one he had authored, chapter 19 — “Bias Analysis” — and it was discussing observational epidemiology in general.
Here’s Greenland on the problem with all these studies — nutritional epi included — and how they’re interpreted:
Conventional methods assume all errors are random and that any modeling assumptions (such as homogeneity) are correct. With these assumptions, all uncertainty about the impact of errors on estimates is subsumed within conventional standard deviations for the estimates (standard errors), such as those given in earlier chapters (which assume no measurement error), and any discrepancy between an observed association and the target effect may be attributed to chance alone. When the assumptions are incorrect, however, the logical foundation for conventional statistical methods is absent, and those methods may yield highly misleading inferences. Epidemiologists recognize the possibility of incorrect assumptions in conventional analyses when they talk of residual confounding (from nonrandom exposure assignment), selection bias (from nonrandom subject selection), and information bias (from imperfect measurement). These biases rarely receive quantitative analysis, a situation that is understandable given that the analysis requires specifying values (such as amount of selection bias) for which little or no data may be available. An unfortunate consequence of this lack of quantification is the switch in focus to those aspects of error that are more readily quantified, namely the random components.
Systematic errors can be and often are larger than random errors, and failure to appreciate their impact is potentially disastrous. The problem is magnified in large studies and pooling projects, for in those studies the large size reduces the amount of random error, and as a result the random error may be but a small component of total error. In such studies, a focus on “statistical significance” or even on confidence limits may amount to nothing more than a decision to focus on artifacts of systematic error as if they reflected a real causal effect.


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Comments
Morgan M says:
March 14, 2012 at 7:23 pm
After reading this – and both of your books on nutrition – I’m amazed that I used to follow Michael Pollan’s word as if it were gospel. It felt like he was preaching to me: “Eat food. Not too much. Mostly Plants.” Eat what your grandma used to eat! No need for this “science,” just eat what healthful and traditional, it’s all so very obvious, he said! We know in our souls what is healthy (like grandma!). And I ate it up.

Now I see Pollan’s work for what it is: a denunciation of science. And while he is right to criticize what passes for science in the field of nutrition as you do here, his message–that we don’t need science–is so, so wrong. Pollan’s little mantra only “feels” right (he presents so little proof) because it fits within a dogma that we’ve all embraced, one that has never been held to any degree of scientific rigor.

I’m so glad you’re out there–the anti-Pollan–reminding us that nutrition needs to be treated like a proper science if we’re ever going to make progress. Science, not gospel. Experimental evidence, not feelings or anecdotes. We can’t rely on common sense. Science never does, and only science can save, improve, and lengthen our lives. Bravo, Gary!

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js290 says:
March 15, 2012 at 1:46 pm
Other than Food Inc and a few of his lectures, I don’t know Pollan’s work that well. However, it should be noted that the purpose of science is to explain nature. And, if science hasn’t figured it out yet, it may be safer (at least nutritionally) to default to nature.

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Brian says:
March 15, 2012 at 6:35 pm
Great point. I follow Pollan’s writing often and he doesn’t preach an agenda i.e. vegetarianism. Most of what he puts out there is honest and true regarding food etc. I agree with him that we don’t need nutritionism to figure out what is healthy, in nature it’s clear: whole fresh foods, grown locally, sustainably, unprocessed etc.

However, when Big Media comments on flawed studies, it’s important to address the bias in the study like GT and Zoe Harcombe have done.

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Pamela says:
March 15, 2012 at 3:17 pm
Of course, Pollan fails to understand that some French Canadian grandmas ate food like pigs feet, blood sausages and poutine! I follow his advice to eat like my Grandma (albeit not too much poutine) and buy humanely-raised meat, but ditched the rest.

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Marc Brazeau says:
March 16, 2012 at 9:07 am
Pollan’s take is that the science of nutrition is so rudimentary in what we actually know, that traditional foodways provide a more reliable algorithm to answer the question of how to eat healthfully. He says that the science is important and needs to be done, but in its current form it doesn’t provide a useful guide for the average lay person.

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Charly says:
March 16, 2012 at 1:48 pm
If I ate what my grandma ate, I would eat very little in plant based foods. She grew up in Norway, where the diet is heavy in fish, dairy, meat, eggs and only seasonal fruits and vegetables. Vegetables and fruits in the winter were preserved with salt, vinegar, as were out of season animal products, and sugar, lots of it. Lamb, goat meat, chicken and fish, butter, sour cream, contributed the most calories. Cheese extremely important. She never heard of Michael Pollan, probably would have shrugged her shoulders and ignored him, or called him an elitist fool. My grandmother lived to be 100, was only in the hospital once in her life, and only for a day and a half. She introduced me to my favorite breakfast treat – pumpernickel rye bread topped with brown-sugar-sweetened sour cream. Yum.

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Jeffrey of Troy says:
March 16, 2012 at 2:59 pm
My reaction upon first reading GCBC was that it was the first time anybody had actually applied the scientific method to the relationship between diet and health. It makes apparent that all the claims and assurances of the authorities before then were (and are, sadly) insane gibberish.

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England says:
March 17, 2012 at 1:57 pm
I just started rereading Omnivores Dilemma when the NYT article came out. I noted in Pollan’s Introduction he gives Dr. Atkins a backhanded slam by mentioning him with the phrase, “…the formly discredited Dr. Atkins…” Then on the next page he says that we are surprised by the “French paradox” for how could the French eat foie gras and triple cream cheese and stay slim. Well, to me, Atkins clearly explained why the French or anyone could do that.

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Ben Atlas says:
March 14, 2012 at 7:56 pm
Thank you very much for this post, I was waiting for it. I find it peculiar that they lumped together meat with the processed meat. What if the additives in the processed products account for the entire variable?

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Warren Dew says:
March 15, 2012 at 5:21 pm
The study actually provides separate numbers for processed and unprocessed meat. There are a lot of things wrong with the study, but that’s not one of them this time around.

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Sam Mackrill says:
March 16, 2012 at 10:25 am
Only if you classify hamburgers as unprocessed meat. And you think that people can accurately assess this when filling-in dietary questionnaires every four years (four!)

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George Henderson says:
March 14, 2012 at 7:58 pm
Lucid as always (not bad for a vomit draft). All this low-risk stuff, if you take it seriously, is a form of gambling.
Gambling with health, as opposed to investment in it.
One quibble; you called the paper a trial – too kind, as nothing was trialed. I’d call it a study.
The problem I have with processed meats is that vegetable contaminants often creep into them, especially that filthy soy, and that rat gluten.

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George Henderson says:
March 14, 2012 at 8:00 pm
“Eat Animals. Mostly fat. Enjoy”
- the anti-Pollan

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Galina L. says:
March 15, 2012 at 7:15 pm
I just started to use the Fitday after more than 4 years of being on a weight-loss diet. It is almost amazing how little veggies add to the nutritional content when listed. It is mostly fiber and a some carbs, also a lot of flavor and texture.
I personally think there is something strange in human interest in strong favors. Why wild life attacking my garden can’t stand orange jest and rosemary essential oils, but I gladly put it on my food? Why raccoon thinks it is a poison, but it makes food more rewarding and palatable for me? It is boring to eat only meat, of course, but from nutritional perspective it looks less questionable than veggies.

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Margaretrc says:
March 18, 2012 at 10:36 am
Love that, @ George Henderson. Think I’m going to use it in the future. I’m not totally anti Pollan–he has done a lot to steer people away from factory farmed meat and monocultured crops. And he is right that, in the absence of scientific information, what Grandma ate is a good guide–if one’s metabolism has not been broken. But we have scientific information–from GT, Atkins, Phinney, Wortman, etc. So we don’t need to use Pollan as a guide.

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Drew @ WIllpower Is For Fat People says:
March 14, 2012 at 8:47 pm
I’ve been waiting to see what you’d say about this one. And I’m not disappointed.

I’m hoping you might have pointers to some good references for diet compliance. I’ve been searching for weeks and can’t find any good statistics for how many people stick with different diets, how often the diets are effective, and total weight loss.

The A TO Z addresses the outcomes; are you aware of any that address compliance and effectiveness in a non-clinical setting?

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Bawdy says:
March 15, 2012 at 5:00 am
I’ve been wondering about this, too. I just finished reading Primal Body, Primal Mind by Nora Gedgaudas. In the foreword written by Brent Pottenger is a reference to the psychological concept of “overshadowing.” He writes that overshadowing “occurs when the initial stimulus is so strong that it blocks the perception of a second, downstream effect. For example, when people drink a soda, the initial stimulus from the sugar is so great that it overshadows the energy crash and feelings of poor health that follow shortly after consumption. In this way, overshadowing inhibits people from responding appropriately to the poisons they ingest and inhibits their ability to learn via conditioning degrade as a result.”

Unfortunately, I can’t seem to find the discussion of this in the book. I was hoping to learn some new coping mechanisms or something that would help me make better choices. I don’t have an issue avoiding sugars, starches, or grains, but I do like a “wee nip o’ the Irish” in the evenings. If I have one, I’m fine. If I have two, I’ll fall asleep with no problem but then wake up at 1:30 or 2:00 am and not be able to fall asleep again until around 4:30 am.

And yet, does knowing this stop me from having that second drink? Uh, no. It’s the classic example of the initial stimulus blocking perception of the second, downstream effect.

As I said the other day to someone, “Why do I do what I do when I know what I know?” It’s the ultimate disconnect.

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Mason McClellan, LAc says:
March 14, 2012 at 9:17 pm
Thanks Gary, I hope one day the Nobel crowd will acknowledge your efforts and contribution to the world of science and obesity research!

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Elenor says:
March 15, 2012 at 6:37 am
The heck with Nobel (well, okay, in *addition* to the Nobel….), Gary should get a McArthur Genius Grant! (Higher prize money…. and does he ever deserve it!)

Bravo Gary — excellent, amazing, wonderful essay — as always!

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jake3_14 says:
March 15, 2012 at 9:05 am
Not to criticize Gary; he’s worthy of the award. I just think Gary should share it with other intellectual giants: Denise Minger, Dr. Uffe Ravnskov, Dr. Richard Fineman, Dr. Jeff Volek, Dr. Stephen Finney, and probably a few others I can’t think of at the moment.

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Paula says:
March 15, 2012 at 6:52 pm
Hi jake3_14! Just so people don’t miss him due to the spelling error, I have to point out it’s Richard Feiman – Richard D. Feinman no less with a great blog at rdfeinman.wordpress.com. He is very funny. Also, tho it will dilute the award monetarily, let’s divvy up a bit for the Drs. Eades (Mike and Mary Dan) and Mark Sisson. And what about Richard Bernstein?

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Sue says:
March 16, 2012 at 8:55 am
Speaking of intellectual giants, make sure to read what Denise Minger wrote about this study on Mark’s Daily Apple (dated March 14), too–eye-opening, funny, witty.

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Mary says:
March 14, 2012 at 10:21 pm
Thanks for the post Gary. When I heard the NPR story on this article I thought — sounds like a bunch of epidemiologists published a paper. Then, I kept hitting your blog looking for your commentary. The work you have done to shed light on the poor science around nutrition is having an effect — I have anecdotal evidence. ;-D The commercial from a local supermarket that is going to label shelves for carb-smart food. The people in my daily life I run into who are avoiding carbs. The number of low or no carb choices in the supermarket or at a restaurant. It will be interesting to see what the “recommended diet” is in 5 or 10 years…

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Sam says:
March 15, 2012 at 12:14 pm
Thanks Gary for another great post; Just another biased “study” meat is evil; from the usual suspects. Making scientific inferences from large retrospective studies using the p-value is not the best way to evaluate the evidence. Steve Goodman, professor of biostats and oncology at Johns Hopkins makes that point in this paper:

http://www.annals.org/content/130/12/995.abstract

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G-man says:
March 14, 2012 at 11:26 pm
I’m currently reading Robb Wolf’s book, “the Paleo Solution, the Original Human Diet.” Much of what he says coincides with your findings. My one concern/question is whenever he mentions meat, he specifically states “lean” meat. He states to stay away from eggs if you have autoimmunity issues. What is your take on this and in general, Mr. Wolf’s approach and recommendations?

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Robert M says:
March 15, 2012 at 6:38 am
You should listen to Robb Wolfs latest pod cast. He goes into the reasons he suggests lean meats in his book. It basically boils down to not wanting to scare people off, he wants to reach as many people as possible and get them hooked before they’re introduced to the suggestion that fatty meat is not something to avoid. Not sure I agree with the approach tbh.

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Margaretrc says:
March 18, 2012 at 10:54 am
I like Robb Wolfe, but I think he’s wrong on this one. Rational people can be very easily and quickly persuaded to lose their fear of fat when presented with the proper scientific evidence. I was. On the other hand, eating lean meat, even if you’re eating Paleo, is an invitation to either get too much protein or continue to eat too many carbs from potatoes and such. There are non grain sources of carbs. And if you go low carb and low fat, that’s dangerous and the very people whom he is trying to convince to go Paleo may soon quit because they don’t feel good/have enough energy with all that protein.

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Steak & eggs says:
March 15, 2012 at 7:18 am
Robb wolf using the term “Lean Meats” is just a ploy. He doesent want to scare off fat fobic people who have been following the SAD. Listen to his latest podcast and he explains it better than I. bacon = awesome

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Steak & eggs says:
March 15, 2012 at 7:20 am
Robert beat me to the punch!

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Todd says:
March 15, 2012 at 7:23 am
G man, go to Robb’s website and listen to his latest podcast. Or read the transcript. He addresses this issue in question number 7. He actually doesn’t have a problem with fatty cuts of meat. But, his main objective is to get people off of grains, vegetable oils, sugars, packaged food, etc. He fears that if he also tells people (at least in the beginning) that eating fat is healthy, it will be too much of a “shock” for people to accept and they won’t give it a try. Here are some quotes:

“it’s so easy to disseminate information that it’s
easy to then create the firewall that is so complex that then people just
bail and they’re done. That’s where the lean meat part comes in. People
in the beginning need to hear lean meat. They just do because if they
don’t, they’re going to freak out. They’re going to be like, “Oh, it’s
Atkins,” and they’re gone.
So what this is, is just learning over the course of time to tell people what
they need to hear so that we get them bought in long enough so that
their life is transformed. Then we can say, “Oh, by the way, the real story
is this.” Like, “You don’t have to worry so much. You can have bacon with
breakfast, and it’s not going to be the end of the world. That’s all cool.” If
we lead with that, we’re not going to get any type of buy in. We’re going
to peel people out and it’s not going to serve them in the long run.”
…
“That’s why I still say lean meat because when you think about
the people entering the site, they need to hear these things because they
need to be pacified long enough to be able to buy in enough. To be able
to make some progress and it kind of sucks. I’m definitely iconoclastic
about some things, but I’ve just learned over the course of time that
you’ve got to tell people what they want to hear long enough to actually
get them what they want. Even though the route that they used to get
there isn’t necessarily the one that they thought it was going to be.”

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Todd says:
March 15, 2012 at 7:24 am
Doh! Beat me to the punch too!

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elton says:
March 15, 2012 at 4:07 pm
I don’t know anything about Robb, but there is a danger of getting too much protein if you only consume large amounts of Lean Meat. I would be careful as a lot people may have issues with too much protein and not enough fat.

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G-man says:
March 16, 2012 at 5:46 pm
Thanks to all who replied to my inquiry. Makes me feel better about having my bacon with eggs. LOL Seriously, I’m sold on what Gary Taubes has to say and so far (if any of you have read Robb Wolf’s book) I like what Mr. Wolf has to say as well and good to see they’re not in contradiction. It appears Mr. Wolf too talks about the influence of carbs on hormones. He does take it a step farther with the exercise component and seems to be even a bit more restrictive diet-wise than Gary.

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David Pryor says:
March 19, 2012 at 7:16 am
I’m sorry I cannot remember the exact quote, or source, but I think there is another reason Robb Wolf discusses “lean” red meats. If you are not buying grass-fed meat, the FAT of the feed-lot animals you are eating is going to have a less-than-optimal content of “bad” fats, hormones, and other dietary hazards. Under those conditions, you are better off getting your fat calories from things like coconut oil, avocadoes, etc.

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Mloader says:
March 15, 2012 at 12:09 am
This type of work is having an effect, no doubt. Ten years ago all fat was bad now they are hanging on to saturated fat as a killer. We have “healthy picks” food labels at our cafeteria at work and the hard boiled eggs are tagged. Ten years ago, you would never have seen that.

It is interesting to me that many people who are champions of dietary fat, and are also interested in science, cite so much of Gary’s work. And they will say they became enlightened in mid 2000′s right around the time Gary started getting the word out.

I think the reason Gary’s work isn’t having a larger impact is he offers information, not a product. People want to work 40 hours a day and use the money they earn to solve other issues. He isn’t selling a box or a diet plan, nor should he. Every time I evangelize his work, people always say ‘what can I eat?’ and I tell them the most important part is knowing why, not what or how. If you only know the how without the why, it really is not meaningful.

On the other hand, this kind of stuff is useful, it is inspiring to see all the responses. One quote I saw on Twitter was great:
@terrysimpson:
@MloaderGraphics the only way red meat will kill you is if it is alive and bigger, faster and hungry – oh, and also eats red meat

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Kuma says:
March 15, 2012 at 5:14 am
Spot on! I love that quote you found too, @MloaderGraphics the only way red meat will kill you is if it is alive and bigger, faster and hungry – oh, and also eats red meat.

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Hillary Anderson says:
March 15, 2012 at 6:45 am
Somebody needs to make a bumper sticker with this quote and I want one! or maybe I will market it myself. Love it!

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Margaretrc says:
March 18, 2012 at 10:57 am
Me, too!

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J. Stanton says:
March 15, 2012 at 1:31 am
I hope it’s not pedantic to point out that, in addition to all the other problems of epidemiology Gary has mentioned, the reported food intake data from the Nurses’ Health Study is not just suspected to be shaky — it’s been studied, validated, and found to be almost completely unrelated to actual food intake.

Specifically, for unprocessed animal meat, the data is anywhere from 1.5% to 15% accurate…i.e. worthless. Furthermore, the intake of foods thought to be healthy was dramatically exaggerated, and the intake of foods thought to be unhealthy was dramatically underreported.

“Always Be Skeptical Of Nutrition Headlines: What Pan et.al Really Tells Us”

JS

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jake3_14 says:
March 15, 2012 at 9:32 am
I don’t understand what this “Food-based validation of a dietary questionnaire” analysis was comparing the FFQ to — was it another self-reporting mechanism (“recorded their food consumption for seven consecutive days, four times during the one-year interval”)? If so, why would we expect the second questionnaire to be an accurate benchmark?

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J. Stanton says:
March 15, 2012 at 7:54 pm
Yes, the verification is still self-reported — the subjects themselves measured the foods they were eating. This is clearly far more accurate than simply mailing in a survey once every four years that asks “On average, what did you eat last year?” However, you’re correct that the act of self-reporting still changes one’s habits, usually for the better: if we know we’ll have to write down that we ate a whole tub of ice cream, we’re less likely to actually do it. And, of course, we might just fudge the numbers or lie completely.

In conclusion, yes, a tiny 1.4%-15% correlation is the best possible case. The reality is probably even worse.

JS

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FrankG says:
March 16, 2012 at 11:54 am
J Stanton writes:

This is clearly far more accurate than simply mailing in a survey once every four years that asks “On average, what did you eat last year?”

We could only wish that the food frequency questionnaire (FFQ) was that open-ended and even-handed… Denise Minger supplied a link to the FFQ http://www.channing.harvard.edu/nhs/questionnaires/pdfs/NHSI/2002.PDF and what ;lea[t straight out at me were leading questions like “What brand and type of cold breakfast cereal do you usually eat?” and “What form of margarine do you usually use?”… not even do you eat these items but straight to what brand?!?

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Stipetic says:
March 15, 2012 at 2:25 am
Attaboy, Gary.

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Alan Sausse says:
March 15, 2012 at 3:08 am
Gary – an outstanding article. I think you’ve pretty much put this one to bed, and plenty of other nutrition-based scare stories with it. Thanks and best wishes from Merrie England.

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mark glen says:
March 15, 2012 at 3:16 am
Rhetorical question: Is it more likely a study will be swayed in favor of a meat diet by the 99% of the population and industries that stands to gainfrom meat consumption OR is it more likely a study wlil be swayed against meat because someone cares about animals or wants to gain attention?

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Lanie says:
March 15, 2012 at 4:06 am
Nice post, Gary. Thanks for your quick response to this media hype.

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Mike says:
March 15, 2012 at 4:26 am
Great job on the interview with Tom Woods. Thanks!

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Andrea Hilborn ND says:
March 15, 2012 at 5:16 am
Alas, it would be more convenient for me as a healthcare provider making nutrition recommendations if I could just go with the crowd.
Instead I will tweet your article and hope my colleagues read it and do not make a complaint against me to my Board.
Thank you!

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Thor Falk says:
March 15, 2012 at 6:00 am
Great article! You forgot two points though (or were you just being nice?)
(1) The people at Harvard are not generally stupid, and what you have explained here is really statistics and scientific reasoning 101 – there is no way this did not come up in their own studies (and if it did not, someone would by now have explained it to them); on the other hand there is “publish or perish” – who would accept a paper that says “there is an association between red meat and mortality, but we think it is because of the Girl Scout effect
(2) if you throw enough hypothesis at a given set of data, some will always be statistically significant; by definition, if you test 100 “random” hypothesis, then 5 out of them will be “statistically significant (at the 95 level)”, meaning five papers that can be written

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Dana says:
March 15, 2012 at 4:33 pm
Answer to #1: There was barely any association between red meat and mortality. There’s more association, frankly, between being born and mortality. A lot, lot more.

And that should take care of #2.

Criminey, man… there’s more of a connection between wheat and mortality, as shown in the China Study data (see also Denise Minger). How many Harvard experts do you see telling us all to ditch wheat?

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John Miklavcic says:
March 18, 2012 at 4:07 pm
Re: point 2.

When significance is set at 95% (alpha = 0.05), it is a statement regarding type I error; that is, rejecting the null hypothesis when it should not be rejected.

More accurately, when the SAME hypothesis is tested 100 times, the true relationship will be divulged about 95 times and a false conclusion will be made about 5 times.

ie.
hypothesis: smoking causes lung cancer
therefore, null hypothesis: smoking is not the cause of lung cancer
(for the purposes of this example, let’s say the true relationship reflects our hypothesis: smoking causes lung cancer)
when the same study is repeated 100 times, the true relationship (causative) will be concluded about 95 times and the false relationship (not causative) will be concluded about 5 times.
It is not practical to repeat an experiment 100 times, so in any ONE study that (correctly) concludes that smoking causes lung cancer, it is understood that there’s a 5% chance that the conclusion is incorrect.

Not all significant research is published. Specifically, research performed in industry as opposed to academia.

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Chris Beeby says:
March 15, 2012 at 6:08 am
Hi Gary
I’ve long been a fan of yours.
It occurred to me some years ago that our current “obesity epidemic” started at approximately the same time that high-carb, low-fat diets became the orthodoxy.
It also occurs to me that a cheapish experiment could be conducted with pigs rather than humans as the subjects. Am I not right in thinking that pigs (like humans) are omnivores and in many ways biologically very similar to humans – so much so that (if memory serves) heart valves from swine were once considered possibly suitable for transplantation into people? The results of feeding high-carb diets to one group of porkers and high animal fat diets to another might be instructive, though not, of course, conclusive.
Keep up the good work!
Chris

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Margaretrc says:
March 18, 2012 at 11:03 am
I believe that experiment has been done, though not exactly in a laboratory, @Chris. They used to feed pigs coconut oil in the hopes of fattening them up. Instead, they got lean and now they feed them coconut oil when they want a source of lean meat for all the fat phobes. When they want to fatten them up, they feed them corn and soy.

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Tracy says:
March 15, 2012 at 6:21 am
Thank you for this, Gary. My local news reported on this ‘study’, and interviewed 2 nutritionists for the supporting side – and not one for the dissenting view. For that, they interviewed people on the street about how much they liked meat (and eating crap from food trucks)… basically, making it seem like scientists etc know the truth, but regular folk are rebellious know-nothings who are going to do what we want regardless, and that’s why we’re all so damn fat and unhealthy.

My n=1 tells me otherwise.

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Anthony from TheKetogenicDiet.org says:
March 15, 2012 at 6:30 am
So glad you decided to put out this article, Gary. This is exactly what I was waiting for. I’ve been telling everyone I’ve talked to that this “study” holds no water and is nothing to be concerned about. Finally I have a legitimate resource to reference. Thanks again!

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John Miklavcic says:
March 16, 2012 at 11:51 am
That’s a joke, right?

If I post my opinion on johnmiklavcic.com, it is the furthest thing from legitimate. It is 100% subjective.

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FrankG says:
March 16, 2012 at 12:12 pm
Except that what Gary has posted above is not just his personal (subjective) opinion but things that are verifiable by independent (objective) 3rd party sources — several of which he has already detailed.

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John Miklavcic says:
March 16, 2012 at 2:07 pm
Are you referring to 3 of the citations in the article that HE authored?

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FrankG says:
March 16, 2012 at 2:23 pm
No, I’m not

John Miklavcic says:
March 16, 2012 at 2:52 pm
In all of my future writings, I can cite my own articles indefinitely from http://www.sweatrxmag.com and I’d be infinitely correct.

Mark Weaver says:
March 15, 2012 at 6:48 am
Exactly right, Gary, thank you! And right on about the “no amount of ‘correcting’ for BMI and blood pressure… can correct for this.” Nassim Taleb said “Multiple regression is plain, dressed up bullsh*t.” As a PhD-level statistician (but one who actually understands the true values of randomization), I completely agree. And if multiple regression is bad, “time-dependent proportional hazards” regression is even worse. If people knew the assumptions behind this method, they’d realize how insane these models are, coupled with the fact that they’re almost always, *virtually 100% of the time*, done incorrectly! Sheesh.

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Mark Weaver says:
March 15, 2012 at 6:49 am
Sorry, should have made it clear that the time-dependent PH models are what were used in the Willet paper.

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Agentzero says:
March 15, 2012 at 9:23 am
Do the authors of these papers ever make their underlying calculations available? Shouldn’t they have to, so that other statisticians can examine their work? If they don’t, should we give their conclusions any more weight than “because I said so”?

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Mark Weaver says:
March 15, 2012 at 9:33 am
Agentzero,

Great questions, here are my personal answers: not often, yes, and it wouldn’t really matter too much because it’s still an observational study… regardless of who does the calculations, hypothesis generation should be the name of the game.

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jake3_14 says:
March 15, 2012 at 9:46 am
Mark,
You should team up with Denise Minger to co-author more critiques. It’s always wonderful to have people who can explain the statistics to those of us who don’t have the training to understand the raw information.

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BlueEyesSf says:
March 15, 2012 at 7:00 am
This is great GB but the elephant in the room is Marion Nestle’s new book “proving” CI/CO. No one has th guts or ability to take that one on. These bad studies are easily attacked. Marion’s the real deal. Can anyone take her down? If not, the insulin hypothesis will truly be dead.

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Adam says:
March 15, 2012 at 11:23 am
BlueEyes,

You’re right. CI/CO is the enemy not only of the insulin hypothesis but also of humankind. Unless/until the Calorie Wizards’ spell is broken, America is doomed.

It’s high time that all of us who care about good health and justice coalesce around Taubes’ idea that our problem is Overstoring not Overeating. It’s a simple mantra. Arguably as simple as “Eat less exercise more.”

We need “simple smart” to fight “simple stupid.” So say it with me now, everyone!

It’s Overstoring, Not Overeating
It’s Overstoring, Not Overeating
It’s Overstoring, Not Overeating

IONO not CICO!

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Chris H says:
March 17, 2012 at 4:39 am
Adam,

Spot on. Very much agree we need a snappy response and this is great.

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Margaretrc says:
March 18, 2012 at 11:09 am
I like it Adam. ONO!

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Margaretrc says:
March 18, 2012 at 11:09 am
Oops. I mean IONO.

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Dana says:
March 15, 2012 at 4:37 pm
Marion’s a human being with letters after her name. I don’t care about human beings with letters after their names. I care about the words said human beings are speaking. If the words can be independently tested and verified, fine. If not, no amount of alphabet soup after one’s name ought to save one’s career.

Marion’s gone around telling people it’s fine to be vegan if you’re an adult. I can think of four vitamins off the top of my head that you absolutely positively cannot get on a vegan diet, which should have laid veganism to rest a long, long time ago, but some people can’t let go of the notion that a diet *requiring* vitamin supplementation to avoid *death from deficiency* could be anything but healthy.

That’s pretty much becoming my gold standard. If veganism is OK with you (and by “OK with you” I mean you’re going around saying it’s healthy, *ever*–I wouldn’t outlaw veganism, if you want to adopt a dumb diet then that’s your business) then I pretty much dismiss anything else you’ve got to say unless you can back it up with good science. You could tell me the sky’s blue at noon on a cloudless day and I think I’d have to go outside and see for myself.

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Margaretrc says:
March 18, 2012 at 11:12 am
Agreed, @Dana. 100%.

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Jim Bowron says:
March 16, 2012 at 1:19 am
GT does not dispute that you will gain weight if you input more calories than you expend- his issue is that you have to go to the next step, and find out why you are inputting more calories. His basic position, as I understand it, is that because insulin blocks export of fat stores from cells, when your body burns all the ‘fuel’ from the carbohydrates that you just ate, it goes looking for more energy sources. Since it can’t access fat stores, your cells demands more fuel, and thus you overeat.

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Margaretrc says:
March 18, 2012 at 11:15 am
Yes, @Jim Brown, and Marion Nestle doesn’t do that next step. She thinks that it doesn’t matter where the calories come from–at least according to her blog. I haven’t read the book. Yet. Don’t know that I won’t, but if I do, I will read it with skepticism engendered by reading the works of GT, Drs. Eades, Phinney, Wortman, Attia, and others.

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Stephen Harris says:
March 16, 2012 at 9:46 am
What’s CI/CO?

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Michael says:
March 16, 2012 at 11:17 am
Calories in/ calories out

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mhanch says:
March 15, 2012 at 7:26 am
Thanks for the write-up Gary. This has been a hot-button issue and it, as always, is great to hear your take on the issue.

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Matthew @ Fig & Fork says:
March 15, 2012 at 7:53 am
I appreciate the both sides offered on this topic. I enjoyed reading the depth of this.

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Fritz Ziegler says:
March 15, 2012 at 8:03 am
Thank you for this, Gary. I feel better. The popular reporting about nutritional received wisdom is so against low-carb-high-fat eating that I need constant reminders, even though my personal N=1 experiment has been going so well since I read “Good Calories, Bad Calories” more than three years ago.

What distinguishes your work is the lack of nihilism. You point out the problems with nutritional “science” while showing the way to good science. It’s like the difference between PBS NewsHour and all the network news shows. You and Jim Lehrer give me hope.

Fritz

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Matt Taylor says:
March 15, 2012 at 8:40 am
This flawed observational epidemiology remind me of the scene in Monty Python and the Holy Grail where Sir Belvedere teaches the villagers how to tell if a women is a witch:

Sir Bedevere: There are ways of telling whether she is a witch.
Peasant 1: Are there? Oh well, tell us.
Sir Bedevere: Tell me. What do you do with witches?
Peasant 1: Burn them.
Sir Bedevere: And what do you burn, apart from witches?
Peasant 1: More witches.
Peasant 2: Wood.
Sir Bedevere: Good. Now, why do witches burn?
Peasant 3: …because they’re made of… wood?
Sir Bedevere: Good. So how do you tell whether she is made of wood?
Peasant 1: Build a bridge out of her.
Sir Bedevere: But can you not also build bridges out of stone?
Peasant 1: Oh yeah.
Sir Bedevere: Does wood sink in water?
Peasant 1: No, no, it floats!… It floats! Throw her into the pond!
Sir Bedevere: No, no. What else floats in water?
Peasant 1: Bread.
Peasant 2: Apples.
Peasant 3: Very small rocks.
Peasant 1: Cider.
Peasant 2: Gravy.
Peasant 3: Cherries.
Peasant 1: Mud.
Peasant 2: Churches.
Peasant 3: Lead! Lead!
King Arthur: A Duck.
Sir Bedevere: …Exactly. So, logically…
Peasant 1: If she weighed the same as a duck… she’s made of wood.
Sir Bedevere: And therefore…
Peasant 2: …A witch!

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FrankG says:
March 16, 2012 at 12:19 pm
Witch: It’s a fair cop…

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Mike says:
March 15, 2012 at 8:48 am
Epidemiology studies smell a lot like looking for Bible codes or stock-picking schemes. Past results are not indicative of future returns.

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Jose Marti says:
March 15, 2012 at 8:59 am
Great post.A lot of the problems with these Studies is that they always fail to isolate an independent variable,in this case meat eating,and then test it.I wonder how difficult or costly would be to do an experiment like the one done on Stefansson in 1928.Pick 50 subjects,preferably with Metabolc Syndrome,measure all Health Indicators and then put them in a controlled environment eating meat and fat only for say six months.Experiments like that would go a long way to shed light upon all these nutritional issues.And the cost would certainly be within the range of the Major Universities and Research Centres.

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jake3_14 says:
March 15, 2012 at 9:54 am
“I wonder how difficult or costly would be to do an experiment like the one done on Stefansson in 1928.”
Very difficult and extremely costly. In addition, there would be political penalties and a loss of future funding for reporting the truth. That’s why no major institution does experiments like these. Gary and Dr. Peter Attia are trying to get funding for their NuSi Institute, which will do good experiments on a smaller scale.

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FrankG says:
March 16, 2012 at 12:22 pm
In Stefansson’s case didn’t he get backing from the Meat Packers? Along with the strict caveat that they would have no say in the study design etc… ?

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tess says:
March 15, 2012 at 9:03 am
It occurs to me that, by Medawar/Popper standards, Guyenet is NOT “DOING” SCIENCE AT ALL. He certainly isn’t paying attention to arguments which knock holes in his HYPOTHESIS (because it hasn’t been tested properly, it can’t be the “theory” that so many people label it)….

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Donna E says:
March 15, 2012 at 9:16 am
Terrific arguments, Gary, as always. But I sure would like to know what you think of Ajit Varki et.al.’s research on neu5gc: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2596253/?tool=pubmed

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Exceptionally Brash says:
March 15, 2012 at 9:17 am
Uh oh, I am going to probably drop dead soon, I haven’t been all that good about listening to my doctor lately. He wants me to eat less, move more, and cut out the saturated fats! Thank you!

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John Bailey says:
March 15, 2012 at 9:31 am
Gary, I am a N=1 experiment. In March 2011 I beagen to reduce carbs and increased red meats.
During this last year, there were no other key lifetsyle changes. Due to back pain, overall I exercised somewhat less. Here are the results one year later:
Weight: From 199 lbs to 176 lbs; my doctor says I should be no more than 185 lbs. Average since 2000 was 193 lbs.
Blood Pressure: 130/85, normal, same as since 2000;
HDL: up to 2.17 from 1.63 ; report says that ideal HDL is more than 1.6.
LDL: 1.91, unchanged;
Triglycerides; decreased signficantly , from 1.87 down to 0.54, half the level of the average since 2000.
My doctor’s report says that “cardiac aerobic exercise and certain medications increase HDL”. I had neither.
I believe your book indicated that fatty meats may increase good cholesterol – HDL. This is what happened to me. I also believe many think that waist size for men and HDL are two strong indicatos of healthiness. All of my wieght loss was from my gut, and I have dropped 4-5 inches in waist size.
I hope my experiment can help your arguments about red meats and carbs.

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Katie P says:
March 15, 2012 at 10:10 am
We eat mostly red meat in our house. My husband recently had his blood work done and his cholesterol is 110, triglycerides are on the very low end of normal/healthy, his blood pressure is right where it needs to be and his doctor says he has the healthiest heart he’s ever seen! My numbers are similar to his. We don’t eat fast food, however, don’t smoke, drink rarely and exercise every day. The red meat we do eat is lean and we always balance our meals. Lots of fruits and vegetables too. We don’t eat any synthetic food or processed food. Just what nature gives us, including copious amounts of red meat.

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Stephanie says:
March 15, 2012 at 10:11 am
Or, as I put it:
surveys+statistics NOT=science.

Interesting post as always. I wish the media would report that these same “scientists” were the ones who told us to take HRT to prevent heart attacks! WTF Harvard, get some standards!

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Sue says:
March 15, 2012 at 12:09 pm
Thanks for your tell it like it is insights! Over the years I’ve worked for a couple of marketing research companies and I can tell you first hand that studies that have people filling out lengthy questionnaires are notoriously flawed! Especially the kind that are done at home and mailed in over long periods of time. I could spend the next several hours stating all the ways these studies are flawed and still wouldn’t even scratch the surface.

You need to keep reminding people that these studies are based on just such questionnaires. Until people really get it drummed into their heads that THIS ISN’T SCIENCE, they will keep being led like sheep to believe almost anything an observational study tells them to believe….as long as it’s in the media of course, because if it’s in the media it must be true!!!! Keep telling it like it is Gary!

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fred hahn says:
March 15, 2012 at 1:17 pm
Good one Gary.

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Greg says:
March 15, 2012 at 1:22 pm
Thanks for a great post Gary. I do have some issue with your assertion that seems to imply that the only good science comes from a type of Popperian falsification. Granted, the study in question is BAD science, but it is a form of science nonetheless. As you say, even an N=1 offers some form of data that adds knowledge. We just must understand its limits–as the authors of the Harvard study did not!

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Stabby says:
March 15, 2012 at 2:32 pm
Brilliant article, thanks for this. And the first part of Good Calories Bad Calories. Debunking bad methods as it pertains to nutrition research is where you shine. Possible confounding factors that Walter Willet would agree absolutely influence mortality:

Trans fat intake. Is the meat coming from a grass-fed rancher or from Mcdonalds? The latter has partially-hydrogenated oils. But these studies don’t even try to control for trans fats and I’m skeptical of their ability to do it even if they tried.

Cooking intensity: Meat that is cooked too much is carcinogenic. Is it reasonable to believe that those eating the most red meat are also going to have the highest intake of heat-formed mutagens and toxins, which can probably be tied to any degenerative disease? I’d say so. But this isn’t a criticism of meat, per se. Just the technique used to prepare it.

Drug use: Okay it’s not polite to talk about it but isn’t it a factor in mortality? Is this controlled for at all? Sure it is probably associated with non-compliance to the government-knows-best program but to try to say that it is accounted for when we control for whole grains and exercise is going to be inaccurate.

I’m sure we could sit around and come up with more. But will we ever be able to accurately control for all of this? If you think people are inaccurate about their meat intake (which they are) then just think of how much they will tuck their drug intake into the back of their minds.

Oh well, we do have controlled trials and actual knowledge. And we have Gary Taubes and some other good minds

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Dana says:
March 15, 2012 at 4:44 pm
Until they control for every other factor that is known to lead to early mortality I’m not even going to try to surmise what in red meat could be cutting lifespans short. We’ve been eating red meat for a good couple million years now and, until the advent of agriculture, it was accidents and infections killing us early, not our diets.

By the way, because you’ll hear this at some point and it might freak you out, there are trans fats in red meat whether it’s cooked at McDonald’s or not. Trans fats that occur naturally in beef and dairy are actually good for you. Conjugated linoleic acid is one of them and there’s another whose name I have not yet committed to memory. But the press is reporting that they are implicated in *decreasing* heart disease and type 2 diabetes risk–which is *odd*, given their other brash statement that red meat kills you.

As for nitrates in processed meat, those exist in vegetables too. They’re thought to be one reason vegetable-eating reduces your blood pressure. Uncomfortable implications for eating processed meats, if so. I just don’t worry about it, especially given that processed meats are more likely to contain organ meats, which most of us don’t eat at all anymore and which have been keeping human beings healthy for a very long time now.

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Stabby says:
March 15, 2012 at 6:47 pm
Yep I’m familiar with CLA. It does seem to combat cancer and heart disease in the lab, although that isn’t necessarily an argument for red meat if this association actually represents the truth. It could be that the CLA in meat is beneficial but just not as good as red meat is bad. I doubt it, though. Grassfed meat has a lot more of it so whether or not the beef that most Americans eat is protective or not, grassfed meat would be expected to be better.

Nitrites are indeed present in vegetables, however I think that there is an important distinction but an easy solution. Vegetables have vitamin c which if present facilitates the reduction of nirites to nitric oxide rather than what they would end up otherwise, the damaging nitrosamines. http://www.ncbi.nlm.nih.gov/pubmed/1860156

Thinking about it we might be able to say that bacon + an orange is a more heart-healthy breakfast than an orange alone!

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Margaretrc says:
March 18, 2012 at 11:22 am
Actually, I think it’s nitrites that exist in vegetables, more than nitrates.

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Josef Boberg says:
March 15, 2012 at 3:11 pm
Wi have to eat “real food” to feel good – as I see it.

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Melinda S says:
March 15, 2012 at 3:15 pm
Another plausible explanation, that goes along well with your point about not being able to compare the groups well, would be that many people who eat the standard American diet eat almost no vegetables and little fruit. Compared to vegetarians, they might actually fare worse. But that is not necessarily the meat’s fault.

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Dana says:
March 15, 2012 at 4:46 pm
The Inuit also ate almost no vegetables or fruit on their traditional diet. I don’t think the lack of plant foods is the problem. It *is* worth noting that people who eat red meat are also very likely to eat more refined carbs such as hamburger buns, French fries and potato chips. They’re probably also more likely to smoke.

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LowCarbGran says:
March 16, 2012 at 9:47 am
Yes indeed Dana. And Cokes, 7Up and sweet sauces. To not measure these burger-variables means they cannot be controlled for. To then say that “..we have controlled for all other variables..” is outrageous. This “study” stinks. Because 50% of red US meat is consumed as burgers the study actually measured the (diluted) effect of junkfood on health. Junkfood, the worst known offender was not controlled for or even mentioned in spite of it significant prevalence in possibly 50% of the red meat consumed.
But to mix variables is a well used trick by so called “scientists” that produced this study, or its conclusions. I call them charlatans.

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mezzo says:
March 18, 2012 at 2:35 am
And why are they more likely to smoke and have other unfortunate habits? Because as long as red meat is demonized only people who like to misbehave will eat substantial quantities of. People who try to lead a so-called “clean” life usually try to eat mostly vegetarian, will not smoke and try to exercise regularly. Had this study been conducted in, say, Argentina, where a meal without red meat is not seen as a proper meal the outcomes might have been mighty different.

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Tony M says:
March 15, 2012 at 4:00 pm
Gary – this is exactly what you shuld be doing more of on your blog. I get it that you want to be careful and considered, but it’s a blog, not an academic paper. It’s invaluable to have you delvier your insight when the discussion is current. Thank you.

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Nathan Ton says:
March 15, 2012 at 9:35 pm
Gary Tabes thanks for the informative email Ive had lots of Co-worker telling me I’m going to DIE! I’m hardcore Meat Eater I eat almost exclusivley meat/fat/cheese in that order. I’m a machine lean strong could not feel better Thanks for your books I wish I could pass on the message as you have….. Almost nobody wants to listen its very sad state we live in.

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Tom Bunnell says:
March 16, 2012 at 4:28 am
“I have found the “devil”. Genuinely. — I know that you don’t believe that. Nobody does. — It’s the “adrenaline like effects” of sugars and hybrid carbohydrates”. This is the devil, for sure and for true. — My discovery, I share with you. Thank you.
-Tom Bunnell

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Lolly McIver says:
March 16, 2012 at 6:22 am
I’m so thankful that you are obsessive about this issue.

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Tom Bunnell says:
March 16, 2012 at 7:19 am
Yes, Thank you. Little did we know..

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Emily says:
March 16, 2012 at 8:28 am
Awe Gary!
Your writing makes it look like an epidemiologist ran over your dog.
In case you haven’t read it, the original article is here: http://archinte.ama-assn.org/cgi/content/full/archinternmed.2011.2287 . I think your issue is with the media portrayal of the study, which gave it a causal spin (nowhere in the article does it claim causality). Epidemiologists are well aware of the strengths and limitations of their tools, and discussion is generally restricted within those confines. Often the interpretation of results can be confused/sensationalized by people external to the field. I think you might have meant to aim your lengthy diatribe towards them.
….but wait, that sounds very familiar. Someone who is external to the field but who communicates broadly with the public, putting their spin on things…..ah now I see why you’ve chosen to criticize the scientists rather than the media.

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Agentzero says:
March 16, 2012 at 10:41 am
Emily,

Perhaps you did not read the article. For your convenience, I excerpt below the phrases in which the authors let slip that they have confused correlation with causation:

“the adverse effect of red meat intake on mortality risk;” “we could not assess whether lean meat has the same health risks as meat with higher fat content;” “the additional harm of processed meats;” “replacement of red meat with alternative healthy dietary components may lower the mortality risk.”

In other words, while the authors (mostly) speak in terms of correlation, they are not consistent about it, and I have no doubt that they believe — and want their readers to believe — they have identified a causal link.

Did you notice the paragraph in the article in which the authors state that they have only observed a correlation and that experiments would be warranted to attempt to determine whether there is a causal relationship? Me neither … it isn’t there.

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GT says:
March 16, 2012 at 10:46 am
Hi Emily,
Regrettably, and not surprisingly. I disagree with you. Here’s the last line of the abstract: “We also estimated that 9.3% of deaths in men and 7.6% in women in these cohorts could be prevented at the end of follow-up if all the individuals consumed fewer than 0.5 servings per day (approximately 42 g/d) of red meat.” If that isn’t an implication of causality, I don’t know what is. Yes, they’re not saying this would happen, only that it could, but they shouldn’t even be doing this. At best they should be suggesting that tests be done to check this hypothesis. And, yes, the journalists are to blame as well, but if the journals didn’t put out press releases, if the universities didn’t put out press releases, and if the researchers refused to speak to the journalists, the journalists would not be able to over-interpret the data and would have little motivation to do so. I discussed this point in my Science article back in the mid-1990s. The epidemiologists would like to blame it on the press coverage, but they’re pushing this stuff as well. So, yes, I’m external to the field, but that doesn’t make my criticisms invalid. And when I do criticize in these articles, I’m only echoing the better researchers in the field and giving voice to their criticisms.
A last note, after I wrote the NYT Magazine article in 2007, I was invited out to Berkeley to lecture at the School of Public Health and also to meet with the epidemiology doctoral students for two hours, no other faculty present. The students gave me a list of questions they were going to ask in advance about the NYTM article. One of them, perhaps the only serious criticism of the article, was why did I focus the article on the Nurses’ Health Study and the Harvard group because “everyone knows they’re terrible.” (This is being recalled from memory after four-plus years, so that quote may not be verbatim but it’s certainly close.) My response when I met with the students in Berkeley was that it’s not good enough in a functioning field of science to know other researchers are terrible. Researchers have to police their own fields. They have to weed out the, well, weeds. And so they had to expose the bad science of the Harvard group and get them out of the field. I don’t know how that would be done, but I think about it a lot.
gt

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Mark Weaver says:
March 16, 2012 at 1:13 pm
Emily,

Agentzero and Gary already replied more than adequately to your comment, but I’ll just add that if that phoney baloney, piss poor methodology “substitution association” analysis that they did wasn’t aimed at causality, then what was its purpose? If you substitute one thing for another (which is exactly the kind of manipulation that one would assess within a randomized trial), then how much longer will you live… that’s obviously all about causality even if they play with words like “association” within the manuscript. Yes, the reporting was overblown, but the “research” was complete garbage in the first place.

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Stipetic says:
March 19, 2012 at 1:10 am
This is a quote from the New York Times’ article about them deadly red meat:

“When you have these numbers in front of you, it’s pretty staggering,” said the study’s lead author, Dr. Frank B. Hu, a professor of medicine at Harvard.

I mean, what is the public, or anyone for that matter, suppose to make of this? Just sayin’.

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Natalie says:
March 16, 2012 at 8:31 am
Perhaps the compliance effect is not anything in particular that the ‘Girl Scouts’ do – but rather, the fact that Girl Scouts believe they have the power to improve their health. Studies on well-being would indicate that people – children, pregnant women, pensioners, etc. – do better when they are more involved in processes and have more responsibility. Remember the nursing home studies that found giving patients a potted plant to care for seemed to be correlated with better health? Maybe compliance effect measures the same thing – not only do ‘Girl Scouts’ care about their health, but they believe it is in their power to do something about it (as opposed to feeling overwhelmed and helpless).

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John Miklavcic says:
March 16, 2012 at 11:42 am
Gary suggests that compliance is an issue is observational studies. This is a misplaced critique. Compliance, by definition, cannot be an issue in retrospective observational studies since there is no intervention; there is no treatment or placebo group that requires a protocol in which to adhere.

The intervention that Gary suggests does not adequately test whether a diet high in red meat impacts mortality. He suggests a study in which one group is randomized to high meat, and the other to low meat, high vegetables, and high whole grains. The objective of science is to test one independent variable only, but there are 3 variables which have been altered (meat, vegetables, grains). Gary’s study design has introduced confounders- and in his article, Gary also suggests that no amount of correction can adequately adjust for confounders in studies. Gary’s logic is paradoxical. As such, the conclusion of such a study would not definitely ascertain whether red meat is a culprit. If the high red meat group was found to have increased mortality upon completion of the study, interpretations could include that diet high in phytonutrients or fibre decreases mortality, since the comparison group was consuming more vegetables and whole grain. Another issue is that the composition of protein, fat and carbohydrate is radically different between both test groups. Therefore, one is not necessarily testing whether red meat consumption causes an increase in mortality, but whether higher protein and fat (characteristics of red meat) diet causes an increase in mortality.

There are ethics review panels needed for approval of research. Literature to date suggests that red meat is associated with increased mortality, therefore, no review panel will approve a research study that proposes intervention with high red meat content.

Gary critiques a (Harvard) study that measures mortality as the outcome. Gary addresses “successful” Atkins’ intervention studies which measure weight loss as an outcome. As weight correlates to obesity, this a measure of morbidity, not mortality. Apples and oranges. It is also important to note that in scientific literature, just about ANY diet intervention is successful in short-term, clinically-measured weight loss.

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Agentzero says:
March 16, 2012 at 12:57 pm
What John says Gary says:
” Gary addresses “successful” Atkins’ intervention studies which measure weight loss as an outcome.”

What Gary actually says:
“And when these experiments have been done, the meat-rich, bacon-rich Atkins diet almost invariably comes out ahead, not just in weight loss but also in heart disease and diabetes risk factors.”

Please try again.

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John Miklavcic says:
March 16, 2012 at 1:39 pm
Agentzero effectively supports my point. The focus of the article is a critique of a study in which the outcome is mortality. Gary’s suggestion to discern the true relationship between red meat consumption and mortality (death) is to “Do the experiments,” and Gary suggests “These experiments have effectively been done.” Yet he references (as Agentzero adequately cited above) a dietary invention which measures morbidity (weight, heart disease, diabetes) outcomes.
He is saying that these intervention studies address his perceived “flaw” or the (Harvard) study. Yet, he is looking a completely different outcome, morbidity instead of mortality.

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Sam says:
March 16, 2012 at 2:01 pm
To me all Gary is saying is common sense if health markers improve in these trials were meat is eaten, why meat will cause increase mortality.

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Margaretrc says:
March 18, 2012 at 11:37 am
And does “morbidity” not affect “mortality”? Are you saying it’s not reasonable to assume that people with more morbidity will also have a higher rate of mortality? I think you’re reaching for straws and missing the overarching point of Gary’s analysis. There are many “studies” out there that equate increased morbidity with increased mortality. Sicker people do tend to die off sooner (of natural causes, I mean) than the healthy ones, no?

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John Miklavcic says:
March 18, 2012 at 2:19 pm
The major cause of death in North America is heart disease, not natural causes.
Morbidity does not necessarily correlate with mortality; rather, there are varying associations. Inflammatory bowel diseases are a set of disorders characterized as a co-morbidity and very low mortality. Death rates between IBD patients and healthy individuals do not differ significantly.

Let’s look at the case of prostate cancer morbidity.
In an 11-year period, prostate cancer mortality is 107/100,000 afflicted persons (0.11%/11 years; Schroder et al. NEJM 2012. 366(11):981-90).
All-cause mortality rate for men in Canada is 748/100,000 (0.75%/year; StatsCanada, 2005). Over an 11-year period, that equates to 8228 deaths (748*11 = 8228). 107 of these deaths can be attributed to prostate cancer, meaning 8121 deaths are caused by something else (8228 – 107).
In the case of prostate cancer, there is a 76x greater chance (8121/76) of dying WITH prostate cancer than dying OF prostate cancer. I hope this helps answer your question above.

brittany says:
March 16, 2012 at 12:17 pm
Thanks Gary. You are always a trusted source of reason. I especially like this point “The hard part of science is left out and they skip straight to the endpoint, insisting that their interpretation of the association is the correct one and we should all change our diets accordingly.” How very true and very concerning.

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A Country Farmer says:
March 16, 2012 at 12:26 pm
Seems like there should be a 30 year, randomized trial study comparing the atkins vs USDA.

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Joshua Bey says:
March 16, 2012 at 12:37 pm
The compliance-effect is a good way to explain this. I’ve always called it the “Flanders” effect, which makes sense to any fan of The Simpsons out there:
“The family goes to the car wash to get rid of the dust, and when Homer is there, he sees that Ned Flanders gets a senior discount. At church, Flanders admits to Homer that he is sixty years old. After he is exposed by Homer in the church, Ned says that he follows the three “c”s of success: clean living, chewing thoroughly, and “a daily dose of vitamin Church!” However, he also has never lived impulsively, and never really had any fun in life. The rest of the town stops admiring Ned for living so well, and begins to pity him for having never truly lived at all.”
http://en.wikipedia.org/wiki/Viva_Ned_Flanders

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jesse says:
March 16, 2012 at 12:48 pm
Hi Gary,

Appreciate the article, rushed as it was it was still valuable. For this particular set of cohorts is socioeconomic status a valid confounder? I thought they were all doctors and nurses.

Jesse

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Joe says:
March 16, 2012 at 2:37 pm
Just a few concerns:
- How could an RCT be done to study this exact question (to get individual level inference) ?
- These so-called girl scouts and truckers all graduated from either medical school or nursing school (and so obviously gave enough of a s**t about their health education to complete it, and also to show up for 20+ years follow-up for these studies). Although I am not naive enough to believe that this is a homogenous group (when it comes to lifestyle behaviors); I also don’t think that these 2 groups (meat eaters and non meat eaters) are incomparable.
- As the authors of the study pointed out, bias as a result of measurement error is likely towards the null (hence the 0.2 fold increase in risk is likely an underestimate). But even if it wasn’t an underestimate, considering the number of people who eat meat around the world, the implications are still huge!!
- Finally, Walter Willet is a scientist (perhaps the best nutritional epidemiologist in the world). He does research and puts himself out there. It is easy to shoot down his and others work, but can you design a better study?

Ultimately, red meat is one factor (out of about a billion) that exists in our world and that may or may not be associated with health. We shouldn’t be too quick to rush and alert the media (and the entire world) that eating red meat will kill them, but should remind them that: the poison is almost always in the dose!

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Heike T says:
March 16, 2012 at 3:07 pm
I have not heard of any studies that compare the impact grass-fed/grass-finished meat has on our health as opposed to the factory-farmed, antibiotic-laden, hormone-injected, pesticide and herbicide-containing, GMO-tainted garbage that is being sold as meat these days. It doesn’t need much genius to figure out that that kind of meat is the problem. Wouldn’t it be great if our mainstream media would occasionally show some remote capacity for critical thinking? Pink slime? You bet you will get chronically ill when eating that stuff. A ratio of Omega 3s to Omega 6s that is way out of proportion and contributes to high levels of inflammation? No CLA that typically can only be found in grass-fed beef and has been shown to have a role in reducing the risk for cancer? We are not talking about what nature has designed for us. It is not the nature of red meat that is to blame for disease; it is the man-made alteration, manipulation, and distortion of what should be a staple in our diet. Unfortunately, what is being called “science” these days is so heavily shaped by conflict of interest that I think it is high time that we start thinking on our own again and occasionally trust our own intuition again. On a different note, the whole cholesterol question is also a complete marketing ploy. Cholesterol is a symptom of an underlying condition your body is attempting to repair. To lower cholesterol means to interrupt a healing process. Wow, do we have it all backwards….

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John Miklavcic says:
March 16, 2012 at 3:41 pm
Gary suggests that a 0.2-fold (20%) increase in mortality is too modest to warrant media attention. He also cites other epidemiologists who suggest that 3- to 4-fold (300-400%) differences also do no justify attention.

See the abstract of a study published in 1986: http://www.ncbi.nlm.nih.gov/pubmed/2871418
Vitamin A intervention study was performed and it was found to decrease all-cause mortality by upwards of 34% in Sumatran children.

As concerned citizens of the world, we’d be unreasonable not to think that we should get vitamin A to kids in 3rd world countries. On the other hand, Gary and the epidemiologists he cites would consider this a small fold difference, not worthy to note.

Gary is quick to address limitations in methods of epidemiology, but doesn’t give credit to its strength as highlighted above. Small percentage (fold) differences mean monumental impact in huge populations where life and death are concerned.

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FrankG says:
March 16, 2012 at 4:21 pm
I read that abstract as stating “…mortality in control villages … was 49% greater than in those where supplements were given”, so you are really just adding to my initial suspicions that you are either having trouble with reading comprehension or are being deliberately misleading.

The study you cite was a random controlled intervention trial (RCT) that set out to test a specific hypothesis (real science in other words) and apparently it did so.

On the other hand the retrospective observational study that triggered the discussion in this blog post was not even designed to test if red meat increases health risks… the best it could be used for would be to propose hypotheses that could then be tested in RCTs.

A 49% increased mortality in the control group for an RCT bears no comparison to an estimated 20% risk based on a four yearly questionnaire whicj has some very dubious data such as: the group with the lowest reported red meat consumption claiming an average of 1,200 calories per day — hard working nurses, on their feet for 12 hour shifts at 1,200 calories per day… seriously?

But nice tug at the heart strings ;-( those poor Sumatran children won’t convince me that read meat kills.

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John Miklavcic says:
March 16, 2012 at 4:24 pm
The start of the sentence you refer to says “at baseline.” That means before the intervention. Intervention with vitamin A decreased mortality.

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FrankG says:
March 16, 2012 at 4:34 pm
50 villages in northern Sumatra were randomly assigned to either participate in a vitamin A supplementation scheme (n = 229) or serve for 1 year as a control (n = 221). 25 939 preschool children were examined at baseline and again 11 to 13 months later. Capsules containing 200 000 IU vitamin A were distributed to preschool children aged over 1 year by local volunteers 1 to 3 months after baseline enumeration and again 6 months later. Among children aged 12-71 months at baseline, mortality in control villages (75/10 231, 7.3 per 1000) was 49% greater than in those where supplements were given (53/10 919, 4.9 per 1000) (p less than 0.05). The impact of vitamin A supplementation seemed to be greater in boys than in girls. These results support earlier observations linking mild vitamin A deficiency to increased mortality and suggest that supplements given to vitamin A deficient populations may decrease mortality by as much as 34%.

I read that as “the children were aged 12-71 at baseline” and that among this group of children “mortality was 49% greater where supplements were not given”

I do see where you get the 34% although that figure seems to take into consideration other studies and only specifies “vitamin A deficient populations” which may include adults for all we know; based on just this abstract.

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John Miklavcic says:
March 16, 2012 at 5:16 pm
I get 34% from inverse proportions.
Consider that relative to 0.67, 1.00 is a 49% increase (0.67 * 1.49 is approximately equal to 1.00).
Consider that going down to 0.67 from 1.00 is a 33% decrease (1.00 – 0.67 = 0.33), hence, why I specified upwards of 34%, it’s also written in the last sentence of the abstract. Am abstract needs to respect brevity and therefore does not present that above calculations.
I’m glad you found a passion regarding the injustice of basic nutrition is 3rd world countries. There are several great NGOs set up to help kids in such cases, one or another may resonate strongly with you and compel you to action.

FrankG says:
March 16, 2012 at 4:37 pm
…“the children were aged 12-71 months at baseline”* obviously

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FrankG says:
March 16, 2012 at 4:45 pm
As a personal aside I am furious and saddened to live in a world where nearly half of these children could die for lack of basic nutrition… I’d suggest that any need for vitamin A supplementation is just indicative of lack of decent food.

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Bill Barendse says:
March 18, 2012 at 6:40 pm
A 20% increase in risk is not the same as a 20% increase in incidence. So we are all worried if the incidence goes up by 20% but not if the risk goes up by that amount. If the relative risk (RR) is 1.2 (ie., 20% higher) then the increased incidence in the subset is the overall incidence times the RR. So let’s say that death from coronary heart disease (CHD) has an overall incidence of 25%, then in the subpopulation the incidence is 1.2 times 0.25 = 0.30, so the overall incidence has gone up 5%. Had the overall incidence of CHD been 5% then the incidence in the subpopulation would have been 1.2 x 0.05 = 0.06 or 6%, and increase of 1% in the incidence. Clearly, the overall incidence of the disease and the RR determine how important the observation is.

The main point about RR of >= 3 being a standard for observation has more to do with reproducibility than importance. The smaller the sample the more likely it is that a RR will need to be large to be detected in the first place, the more likely it will be to be overestimated in the first place to be statistically significant, and the more likely for it not to be observed in the next study. But RR > 3 tend to be relatively stable unless the first study was dreadfully small in size. With the giant studies dealing with tens of thousands of observations this is less of a problem, although the GIGO law will always hold.

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England says:
March 17, 2012 at 1:38 pm
Thanks Gary. I enjoyed your article as I continued my n=1 experiment by eating a good amount of meat. Specially, while reading your blog at lunch time today, I had about 2 oz. of roast beef, 2 oz. of liverwurst and 2 oz. of Andouille sausage with several olives and pile of pumpkin sweetened with cinnamon and Stevia – a la Bernstein.
You are a confident man. Calling out a top tenured professor of nutritional science at one of the top university in the world! And saying that he does not do proper science implying that he does not know how and/or is lazy and/or has other egotistical and/or financial reasons not to do proper science. I’m glad you did. And I agree that it is a sad state of affairs.

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Scott says:
March 18, 2012 at 9:44 am
I too am skeptical of the recent research on red meat — above all because, even if we take it at face value, the effect is minuscule. Moving from the lowest quintile to the highest quintile increases your chance of dying of heart disease from 0.8% to 0.9%. Meh…

However, I’m not sure that this critique really nails it.

It’s never possible to control for every possible confound. But the researchers do seem to have controlled for most of the obvious ones. And, more to the point, adding lots of other factors wouldn’t necessarily make much difference. A generally “health conscious” person might do lots of things that improve their health, but all these things are likely to be correlated with each other (ie health conscious people walk more, and smoke less, and buy more organic food, and watch less TV and so on). And because they correlate, adding them to the statistical model doesn’t add any extra information. (For the geeks out there, this is the problem of multicollinearity.)

Also, it’s not really fair to say that the study was the equivalent to comparing “Berkeley vegetarians” and “redneck truck drivers”. After all, the participants in the study were all doctors and nurses. I’m sure they varied in their degree of compliance, but not as much as is implied.

This is not to say that I agree with the study’s findings, just to say that by dismissing it on weak grounds unnecessarily weakens the case for real food.

II’m not sure what an ideal critique would look like… they would certainly include the unreliability (and social desirability effects) of the food questionnaires that were used). But my main objection is that these studies are not putting low-carb / primal / paleo claims to the test. After all, what distinguishes the paleo diet is not its reliance on meat. Rather, it is about replacing bad quality meat with good quality meat, and replacing grains with vegetables and fat. These studies don’t tell us anything about whether this diet is better (or not). So, who cares what they say?! (Who wants to defend the consumption of factory-farmed meat!) But, as Taubes points out, there are plenty of other studies that have tested versions of these claims, with good results. That’s what you should be citing next time some SADsack upbraids you for ordering the steak.

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Mark says:
March 19, 2012 at 6:48 am
Scott,

Two points here. First, there is indeed a way to control for every possible confounder, it’s called randomization. You’ll probably say something like “confounding is even possible with randomization”, but that’s just not true. Random covariate imbalance is indeed possible (and ubiquitous) with randomization, but it doesn’t induce a stochastic bias like true confounding does. As the most excellent statistician Stephen Senn has said, there are “two incontrovertible facts about a randomized trial: 1) over all randomizations the groups are [always] balanced; 2) for a particular randomization they are unbalanced.” This is no big deal, it all comes out in the randomized wash.

Second, epidemiologists really need to understand that controlling for all known or “obvious” confounders does not necessarily reduce the overall confounding bias, it can actually increase bias. Confounding, like any bias, can be either positive or negative. This is the fundamental reason why any causal inference based on observational data should be taken with a HUGE grain of salt, regardless of how fancy the mathematical models were.

Sorry, one more thing… multicollinearity is completely irrelevant here, much as it usually is.

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Margaretrc says:
March 18, 2012 at 10:06 am
Thanks, Gary, for injecting a bit of sanity into this nonsense. Please keep doing what you are doing. Dr. Marion Nestle’s new book, “Why Calories Count” is out and has just been reviewed (positively, I presume) by Nature. I confess I haven’t read the book–yet–but I read her blog and honestly, she doesn’t have a clue. Thinks it doesn’t matter where our calories come from, it’s all about CICO, etc. etc. How someone with an advanced degree in Biochemistry can still carry on with that stuff is totally beyond me. She does indict sugar, however, and that’s a good thing. Unfortunately, she has apparently not made the connection that healthywholegrains are a source of sugar as well. One can only hope that people who have read your books and articles will take what she says with a grain of salt. I know you are very busy, but I hope some day to see a review of her book by you in the NYTimes or elsewhere. Dr. Nestle is quite popular and has a pretty large following (not that you don’t) and some of us worry that this will be a big setback to the LCHF movement.

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Ida Fiorella says:
March 18, 2012 at 12:16 pm
Living a low-carb lifestyle for over 10 years, I can attest to the health benefits of eating proteins (including red meat and bacon!), healthy fats, and lots of green vegetables. My doctors have stated that my cholesterol is perfect, and I am in excellent health according to check-ups. This was not the case before I started low-carb. Several friends are now following the same low-carb plan, and they are experiencing the same health benefits. I am very thankful, Gary, that you are able to so articulately and patiently explain what the true studies show, and that you don’t let the researchers in their ivory towers get away with serving us “conclusions” that don’t even respect the basic “scientific method” they learned in grammar school. I truly enjoy your blog.
Ida (co-author of Thin and Thinner)

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Elsa says:
March 18, 2012 at 11:03 pm
I love your analytic mind and scientific approach to the whole issue. You inspire confidence. Whatever the studies say; the proof is in the pudding, not so? People, like me, who have become obese by eating high carbohydrate/low fat all their life and have consequently suffered the effects of this way of eating healthwise can and will testify that their health in general has improved hundred-fold – amazingly, for me, in only 3 months! What more proof does one require?

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Tom Bunnell says:
March 19, 2012 at 5:36 am
Better said: Revised and Edited:

‎”I have found the “devil”. Genuinely. — I know that you don’t believe that. Nobody does. — Stimulants. — It’s the “adrenaline like effects” of sugars and hybrid carbohydrates”. This is the devil, for sure and for true. “It’s God, too”. — Not just the profound effects on our bodies and body chemistry, like diabetes and heart disease and cancer and mental disease and obesity and anorexia and whatnot, our entire earths population. But the adrenaline like effects and high energy that fuels and effects our minds and intelligence and emotions and feelings and senses and sexuality and thought processes, profoundly. Our being. — Our thoughts and our decisions and our perceptions. What we see and what we think and what we feel. Our spirits, our souls, our psyche, our ego, our self esteem, our aggressiveness, our passivity. — Alcohol is the highest form of sugar. All are stimulant drugs that make us crazy. But we don’t know that and when we hear it, we think of it as absurd and we don’t believe it. We think it’s laughable. Man’s taking over of the whole world, and effecting what we see and think and feel, by stimulants. Wheat and flour and fruit and vegetables and milk, being stimulants. “This is whacko rants and raves of a lunatic madman. Foolishness, personified. Idiocy. Idiosyncrasy. Extremism, Ignorance, Myth, Imagination, Fantasy, Dreams, Hallucinations, Paranoia. — My discovery, I share with you. Yes, it is all of the above, and more. Sugar and hybrid carbohydrates. Man made stimulant drugs. Thank you.
-Tom Bunnell

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elaine bergstrom says:
March 19, 2012 at 5:47 am
As the daughter of a butcher, I ate my share of steaks and chops. But in his last years, my father lamented that he could not find a decent pork chop (the other white meat had been leaned to the state of shoe leather). The point is, my father bought his lambs (in his case) from a local farmer, had them slaughtered locally and cut the meat himself. So did the beef dealers in his coop market. The point is, maybe this study had some credence, but it may not be the red meat itself but all the junk that is fed these poor beefers at their feedlots, all the chemicals in their bodies, all the stress hormones of their last days. I don’t want to sound like a PETA person, but really so much of what we eat is no longer natural. Now most chicken is grown without hormones or antibiotics. Wish the beefers were, too, and sadly I can’t afford free range.

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Thire says:
March 19, 2012 at 6:20 am
Thank you for these insights. As a nutritionist myself, I have often struggled with what constitutes science when doing nutrition research and the demonizing of foods based on statistics that can be easily manipulated to tell the story the scientist wants to tell. I will use this article to help clients, family and friends to help better understand nutrition ” facts” reported in the media.

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Nigel Tanner says:
March 19, 2012 at 7:42 am
As you admitted at the beginning of the article on the red meat controversy, spelling errors are not always detected by the author. An example is in the title of an article quoted by you:

‘When I first wrote about the pseudoscience of epidemiology in Science back in 1995, “Epidemiology Faces It’s Limits”, … ‘

The error as you’re probably aware is that “it’s” is a contraction of “it is” and so is incorrect in this context.

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Trackbacks
Does Red Meat Cause Early Death? | Sans Carbs says:
March 15, 2012 at 3:57 am
[...] and early death. I was about to do a Random Research Dissection on it, but then I went over to Gary Taubes site and it turns out he’s already done it. And he links to Zoe Harcombe, who has done a [...]

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Will Eating Red Meat Kill You? says:
March 15, 2012 at 4:35 am
[...] Interesting to see that Denise included a link to the Food Frequency Questionnaire (FFQ) used for the Nurses Health Study… I was expecting a fairly free-form "what have you been eating for the last 4 years?" but instead found the questions to be quite leading… rather than "do you eat breakfast cereal or margarine?" they ask "What brand and type of cold breakfast cereal do you usually eat?" and "What form of margarine do you usually use?" — then going on to ask for specific brand details. Is it just a given that everyone eats cereal for breakfast and uses margarine? — Gary Taubes has also posted a blog entry about this study announcement, Science, Pseudoscience, Nutritional Epidemiology, and Meat… [...]

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Science, Pseudoscience, Nutritional Epidemiology, and Meat « Thor's Reads says:
March 15, 2012 at 6:01 am
[...] Science, Pseudoscience, Nutritional Epidemiology, and Meat. Share this:FacebookTwitterRedditMoreLinkedInDiggStumbleUponTumblrPinterestPrintEmailLike this:LikeBe the first to like this post. [...]

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Transterrestrial Musings - That Latest Meat Study says:
March 15, 2012 at 7:56 am
[...] Taubes comments on the pseudoscience behind [...]

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The Paleo Rag | Science, Pseudoscience, Nutritional Epidemiology, and Meat says:
March 15, 2012 at 9:51 am
[...] and editing, as I usually do, I’m going to do my best to get this up and out in a few hours. Read More » Be Sociable, [...]

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Köttlarm, dålig vetenskap och varför de som äter placebo blir friskare | Kostdoktorn.se says:
March 15, 2012 at 10:52 am
[...] mycket läsvärt nytt blogginlägg av Gary Taubes om hur osäkra observationsstudier verkligen är:Taubes blogg: Science, Pseudoscience, Nutritional Epidemiology, and Meat (Inlägget är kort, för att vara Taubes)Läs merCissi Wallin, LCHF och gallstenen [...]

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Meat, Pseudoscience and Why People Who Eat Their Placebo Are Healthier | Dietdoctor.com says:
March 15, 2012 at 11:14 am
[...] nice blog post by Gary Taubes about how uncertain the observational science behind them really is:Taubes blogg: Science, Pseudoscience, Nutritional Epidemiology, and Meat (a short post, for Taubes) Print This entry was posted Thursday, March 15, 2012 at 19:13 and is [...]

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Paleo Diet News: Gary Taubes on the Red Meat Study » Your source for Paleo Diet information says:
March 15, 2012 at 11:54 am
[...] it was wrong, I didn’t see the need to beat it up here. But I would like to share with you Gary Taubes’ take on the red meat study done by the Harvard School for Public Health.. He goes deeper into the [...]

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Gary Taubes weighs in on the “Meat Kills” article | Gym C2 says:
March 15, 2012 at 12:59 pm
[...] a big fan of meat so I really enjoyed Gary Taubes’s response on the recent “Meat Kills” article. Share this:Like this:LikeBe the first to [...]

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Karen De Coster » Nutritional McCarthyism: Red Meat To Blame for Death, Global Warming, Tsunamis, Mine Collapses, and Terrorist Attacks says:
March 15, 2012 at 6:34 pm
[...] is Robb Wolf, who referred to the red meat scaremongering as “nutritional McCarthyism.” Gary Taubes also commented on the horrendous science behind the study: The problem with observational studies like those run by [...]

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Nutritional McCarthyism: Red Meat To Blame for Death, Global Warming, Tsunamis, Mine Collapses, and Terrorist Attacks « LewRockwell.com Blog says:
March 15, 2012 at 6:43 pm
[...] is Robb Wolf, who referred to the red meat scaremongering as "nutritional McCarthyism." Gary Taubes also commented on the horrendous science behind the study: The problem with observational studies like those run by [...]

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Thursday, March 15th, 2012a : CrossFit Costa Mesa says:
March 15, 2012 at 8:09 pm
[...] Link Love Read, I’m serious, read this – Science, Pseudoscience, Nutritional Epidemiology, and Meat [...]

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Red Meat To Blame for Death, Global Warming, Tsunamis, Mine Collapses, and Terrorist Attacks – WNYTruthers.org says:
March 16, 2012 at 8:56 am
[...] there is Robb Wolf, who referred to the red meat scaremongering as “nutritional McCarthyism.” Gary Taubes also commented on the horrendous science behind the study: The problem with observational studies like those run by [...]

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Not so fast with my bacon, ya Hah-vard barnies. | says:
March 16, 2012 at 2:23 pm
[...] Here‘s a great article on the faults of the recent Harvard media release Red Meat Consumption Linked to Increased Risk of Total, Cardiovascular, and Cancer Mortality. The article author, Gary Taubes, also wrote Why We Get Fat; a book we highly recommend. An exerpt from the article: This is an issue about science itself and the quality of research done in nutrition. Those of you who have read Good Calories, Bad Calories know that in the epilogue I make a point to say that I never used the word scientist to describe the people doing nutrition and obesity research, except in very rare and specific cases. Simply put, I don’t believe these people do science as it needs to be done; it would not be recognized as science by scientists in any functioning discipline. Like this:LikeBe the first to like this post. This entry was posted in Uncategorized and tagged clayton, crossfit, disease, fitness, Gary Taubes, gateway crossfit, gym, meat, missouri, nutrition, personal training, st louis. Bookmark the permalink. ← Biggest Loser Winner Goes CrossFit! [...]

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Red Meat To Blame for Death, Global Warming, Tsunamis, Mine Collapses, and Terrorist Attacks says:
March 16, 2012 at 4:33 pm
[...] [...]

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Cave CrossFit says:
March 17, 2012 at 8:35 am
[...] the article in the New York Times about red meat? Well read it and then get a reality check from Gary Taubes here and a great response from Roxy Richardson of Function 5 Fitness [...]

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Weekend Link Love - Edition 182 | Mark's Daily Apple says:
March 18, 2012 at 8:01 am
[...] Taubes tackles the latest red meat scare study, and discusses the problems with epidemiology in [...]

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Bad Science Again – Red Meat « Maximum Wellness says:
March 18, 2012 at 8:56 am
[...] Gary’s article teaches us why the study is flawed. It is a great article, but a little dense. It will give you a good foundation in understanding good and bad science. Read More [...]

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Weekend Link Love | TrenchPress says:
March 18, 2012 at 9:13 am
[...] Taubes tackles the latest red meat scare study, and discusses the problems with epidemiology in [...]

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The Harvard Evil Red Meat Study is Actually the Harvard Red Bullshit Study | Daily Pundit says:
March 18, 2012 at 10:15 am
[...] Science, Pseudoscience, Nutritional Epidemiology, and Meat [...]

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Weekly Round Up « Highbrow Paleo says:
March 18, 2012 at 11:19 am
[...] links for your reading pleasure: original journal article, here is what Zoe Harcombe has to say, Gary Taubes says this, Anthony Colpo weighs in here, Dean Ornish does his thing here, Mark Sisson hires a Minger to [...]

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A fictiony Sunday « jacobceaton says:
March 18, 2012 at 3:18 pm
[...] writers acknowledge imperfection, inaccuracy or haste in prefacing their work? Gary Taubes’ latest blog post is the most recent example I can recall. Is it better to come off strong or modest? Regardless, [...]

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Monday 120319 | | DEKA CROSSFITDEKA CROSSFIT says:
March 18, 2012 at 9:30 pm
[...] Gary Taubes reacts to the bad science rampant in public nutrition: “Science, Pseudoscience, Nutritional Epidemiology, and Meat“. [...]

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New 6:30am class! « says:
March 18, 2012 at 10:36 pm
[...] Red Meat Linked to Cancer Flaws in the Study Science, Pseudoscience, Nutritional Epidemiology and Meat [...]

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Monday 120319 | CrossFit Scottsdale says:
March 19, 2012 at 1:05 am
[...] Gary Taubes reacts to the bad science rampant in public nutrition: “Science, Pseudoscience, Nutritional Epidemiology, and Meat“. [...]

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Monday 120319 | coachricheng.com says:
March 19, 2012 at 1:21 am
[...] Taubes reacts to the bad science rampant in public nutrition: “Science, Pseudoscience, Nutritional Epidemiology, and Meat“. designed by elegant themes [...]

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Fat Head » The ORI Speech says:
March 19, 2012 at 8:22 am
[...] gave it a worthy whack and pointed readers to Denise Minger’s slice-and-dice. Gary Taubes also took the study apart and made the remaining points I would have made (and then some), so I won’t bother weighing in on [...]

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BOOKS

Why We Get Fat (2011)

An eye-opening, paradigm-shattering examination of what makes us fat. In the New York Times best seller Good Calories, Bad Calories, acclaimed science writer Gary Taubes argues that certain kinds of carbohydrates—not fats and not simply excess calories—have led to our current obesity epidemic. Now he brings that message to a wider, nonscientific audience in this … [Read more]
Good Calories, Bad Calories (2007)

[released as The Diet Delusion in the U.K.] In Good Calories, Bad Calories, Taubes tries to bury the idea that a low-fat diet promotes weight loss and better health. Obesity is caused, he argues, not by the quantity of calories you eat but by the quality. Carbohydrates, particularly refined ones like white bread and pasta, raise insulin … [Read more]
ABOUT
Gary Taubes (born April 30, 1956) is an American science writer. He is the author of Nobel Dreams (1987), Bad Science: The Short Life and Weird Times of Cold Fusion (1993), and Good Calories, Bad Calories (2007), which is titled The Diet Delusion in the UK. … [Read More...]
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ARTICLES
Do We Really Know What Makes Us Healthy?
Is Sugar Toxic?
Is This Any Way to Lose Weight? (Reader's Digest)
Letter to the Editor: Response to Dr. George Bray’s Review of Good Calories, Bad Calories
Letter to the Editor: Response to Tara Parker-Pope's article "The Fat Trap" (NYTimes Magazine)
The (Political) Science of Salt
The Scientist and the Stairmaster
The Soft Science of Dietary Fat
What If It’s All Been A Big Fat Lie?
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