June 16, 2020 • 47 mins
The Seven Countries Study was a fairly impressive, long-term study on the effects of fat in our diet, among other things. But it was very flawed and launched the misguided "War on fat." Learn all about today, then make up your own mind.
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Speaker 1 (00:00):
Hey, everybody, it's Josh and Chuck your friends, and we
are here to tell you about our upcoming book that's
coming out this fall, the first ever Stuff you Should
Know book, Chuck. That's right. What's the cool, super cool
title we came up with. It's Stuff you Should Know colon,
an incomplete compendium of mostly interesting things. That's right, and
(00:20):
it's coming along so great. We're super excited, you guys.
The illustrations are amazing, and there's the look of the book.
It's all just it's exactly what we hoped it would be.
And we cannot wait for you to get your hands
on it. Yes, we can't. Um, and you don't have
to wait. Actually, well you do have to wait, but
you don't have to wait to order. You can go
preorder the book right now everywhere you get books, and
(00:42):
you will eventually get a special gift for preordering, which
we're working on right now. That's right, So check it
out soon coming this fall. Welcome to Stuff you Should Know,
a production of My Heart Radios How Stuff Works. Hey,
and welcome to the podcast. I'm Josh Clark, and there's
(01:05):
Charles W. Chuck Bryant over there, and Jerry's here somewhere,
and this makes it stuff you should know, the Heart
Healthy Edition. Yeah, I've been wanting to do for a
very long time, Chuck. Yeah, and this was one that
was put together by our buddy Dave Ruse. But back
in February, and I lost it and thankfully you said, hey,
(01:27):
by the way, you know, we got that seven countries
thing just sitting there gathering dust. Ye, I said, Chuck,
don't lose it here. I lost it and then I
found it. I was lost, but now I'm found. And
fat is good for your body the end, I know.
But that's a that's such like a revolutionary statement these days,
(01:48):
radical even basically to say fat is good for your
body the end, especially our we I'll not even our age,
but anyone in America and the eighties and nineties, somebody
in our court. You mean, yeah, I do too. So um.
The reason why it's kind of radical to say that
(02:09):
fat is good for you is because, yeah, everybody, our age, Chuck,
knows that fat is horrible for you. And even if
you kind of know that fat's not as bad as
we used to think, you probably still don't realize how
much better it is for you than it actually is.
There still some part of you that demonizes it. And
during the eighties and the nineties you couldn't get fat
(02:30):
if you shook it out of a pig, like it
was nowhere to be found. In the United States, we
had low fat everything. Remember we had uh like potato
chips where they took out the fat and replaced it
with a like a diarrhea creating agent. Right, what were
those called the did this? But I think they were
(02:51):
like like um las ola. Weren't they called ola chips?
They should have been called oiv as. So yeah, like
we're doing all sorts of things. And one of the
worst things we did too, even worse than adding olean
or replacing fat with olean, was a takeout fat and
replace it with high fruit toast corn syrup. Because one
(03:13):
of the things that fat does is give food flavor,
and we take fat out of food, you still wanted
to have flavor, and if you're a food processor, one cheap,
easy way to put flavor back into it is to
put high fruit toast corn syrup into it. And so
they think that like all of this war on fat
that took place in the eighties and nineties is actually
(03:33):
at least partially, if not fully responsible for the outbreak
of chronic diseases that we're seeing now, including obesity and
um diabetes that is just epidemic right now in the
United States. Yeah, it was so ingrained in us that
even after doing this podcast episode and knowing what we
(03:55):
now know, it's still like you say things like, you know, boy,
that steak you just feel like like clogging up your
arteries as you know that fat just gets wedged in there.
You just get these mental images of fat just like
breaking off of food and sticking to your blood vessels. Right, Yeah,
like this is really unhealthier, this is super indulgent or
(04:17):
something like that, And that just may not necessarily be
the case, but yeah, we had a number done on us, basically,
and we're still crawling out from under it. And what's
the most magnificently amazing thing is that basically all of this,
the war on fat, the low fat trend, the possibly
the diabetes, and the obesity that resulted from taking out
(04:41):
faster and placing it with sugar, all of this stuff
came from one study that was conducted back starting back
in the fifties that some people are like, the study
isn't even legitimate methodologically, yeah, so that is the seven
country study. And uh. The creator of the seven country
(05:03):
study was someone named Dr Ansel keys Um who was
married and published and this is I'm not gonna We'll
just let this speak for itself. They published a number
of high volume selling books about the Mediterranean diet. That
these cookbooks and um sometimes like the very first one
(05:26):
was only what like two years after they started doing
this study. So they have been accused of cherry picking
their data and promoting correlation as causation and uh. As
a result of all this, the United States very famously
came out with the food Pyramid that we was drilled
into our heads in school and said fat is cholesterol
(05:50):
and that is heart disease and eating fatty things will
kill you. Yes, like ipso fact. Though, the problem is
is that it was all based those recommendations. That food
pyramid was all based on the study and not any
kind of like clinical data. It was just basically a
study that was set up and designed to support a hypothesis,
(06:14):
not really test a hypothesis so much as support this
hypothesis by Dr Antel keys that saturated fats uh rose
cholesterol levels in your blood and that increased cholesterol levels
in your blood would kill you through heart disease. And
so doctor keys Is been very much demonized over the
(06:36):
years as people have figured out like, no, fats aren't
bad for you and actually you need them. But there's
also been like an effort to reform him too. And
in his defense, he wasn't just some some psycho narcissist doctor.
From what I could tell, he is. Um. He invented
k rations. K rations are called that after him keys Um. Yeah,
(06:58):
that that like kept a law of g I S alive.
And World War two, Um, he was a major part
of the Minnesota's starvation experiment where volunteers conscious just objectors
and World War two volunteered to be starved um so
that the scientists could figure out how to refeed people
without killing them, which became very useful when we liberated
(07:21):
the pow cants in Germany and some of the occupied areas.
So he was like a good I don't okay, I
don't know enough about him to say he was a
good person, but I don't think he was like an
evil person by any stretch of the imagination. And also
the reason that he started conducting the study in the
first place was because there was an epidemic of middle
aged men, in particular in America who were just dying
(07:44):
left and right of heart disease, and he wanted to
figure out what the problem was. He also started the
K pop phenomenon, so catchy and great. I don't know
any K pop I know the kids love it, though
they do, they're not for it. That one B twos
band or something like that. I can't I can't remember
their name, no idea, but if they're called the B
(08:06):
fifty twos, then they should be sued because that's been taken.
So Dr Ansel Keys as an American from Minnesota, a
physiologist and in the forties when you know, uh, the
Don Drapers, although that was a little later, but the
Don Drapers of the world were falling over dead from
smoking cigarettes all the time and eating steak for lunch
(08:27):
and martinis for lunch. He said, you know what, I'm
gonna figure this out and see what's going on, and
I'm gonna identify some risk factors why men in this
country are developing heart disease and men around the world.
Is what it ended up being. But it started in
Minnesota where he did a little pilot study. And while
he was doing that, he got a message from a
(08:48):
colleague in Italy who said, in southern Italy we got
to no heart to disease. Everybody's a healthy And he said, really,
and and he also said, southern Italy is really nice.
You should come visit. And so he went there in
the nineteen fifties and a bet, I mean, Southern Italy
is still great, but a bet in the early nineteen
fifties it was just idyllic. And he went down there
(09:11):
and he started these informal studies comparing business business executives
with the working class men of southern Italy, measuring serum
cholesterol levels, talking about what you're eating, getting the data
on heart disease and heart attacks there from the hospitals,
and he started to form this hypothesis that you know what, dudes,
(09:34):
middle aged dudes that have higher serum cholesterol levels are
more likely to die or at least suffer from a
heart attack. Yes, yes, And that was like the beginning.
That was yeah, And that was his hypothesis. And it's
pretty sound hypothesis, especially based on some of the data
that he'd seen, because he around this time after his
(09:55):
he was intrigued by his friend in southern Italy and
his trip to southern Italy um, which, by the way,
he fell in love with Southern Italy so much he
shot shop there and I believe lived out his life
till age one oh one. Yeah. Um, And that proves it.
It basically does, because I believe he did adhere pretty
strictly to the Mediterranean diet he espoused. He was no hypocrite,
(10:18):
but um he uh. He started poking around and getting
his hands on whatever data he could four things like
fat intake in the diet and incidences of heart disease
and heart attacks wherever he could get it in the world.
And he compiled um data from twenty two different countries
(10:39):
and he said, wow, this is really kind of all
over the place. I'll just select six of these countries
that really proved my point. And he created what's known
as the six country graph, which a lot of people
confused with the seven country Study, but it pre pre
dated the seven country study. But it was this thing
that was kind of like the transition period between first
forming this hypothesis and begin the seven country study. The
(11:01):
six country graph was kind of like the connective tissue
between the two and it also told him where to
look to really find the biggest disparities that might support
or um undermine his hypothesis. And so we got to
work looking around and contacting people around the world and said, hey,
I have zero funding to offer you. I know that
(11:24):
World War two just ended and everybody is basically trying
to rebuild their economy and their nation in Europe is
kind of war torn and shattered, and um, Japan has
had bombs dropped on it. But do you want to
start studying whether eating steak is bad for you and
going to kill you? And actually, astoundingly some country said yes, yeah.
(11:44):
So the countries ended up being Italy, Spain, South Africa, Japan, Finland,
the US. And I guess was that Greece was the
last one. Did that count Okay, Greece increase counts? Well,
I mean I knew, yeah, I know, grease increases the word. So, um,
it was time in the in the mid nineteen fifties.
(12:07):
He had the interested countries and the interested parties, so
in he developed these select populations and you kind of
teased it earlier calling us cohorts. These populations of men
they referred to as cohorts in the study so when
you hear say cohort, it's not like one guy, it's
a population of guys. Right. So the seven countries they
(12:29):
would monitor for twenty five years and ideally lead to
what risk factors would lead to heart disease. And that
was his goal was, I'm going to find out what
these risk factors are, provide some evidence, and then say
here's what you should be eating. Basically, Yes, so that
(12:50):
I mean, that's that's exactly what he did. Like you said,
within two years of starting this um study, which was
supposed to last and actually did twenty five and some
of the people who were the original participants were studied
for more than forty forty years. But um, within two
years he uh, he turned around and published that cookbook.
(13:13):
That's how certain he was of his hypothesis being correct. Yeah,
and I don't you know, we don't want to poop
of the Mediterranean diet. I think the idea, I'm sure
the Mediterranean diet is it can be quite healthy. The idea, though,
is is he shouldn't just be like, I'm gonna eat
low fat, because that's what happened in America. Everyone didn't say, hey,
we'll just eat Mediterranean. They said, we'll just eat junk
(13:36):
food full of sugar and hyproc dose corn syrup but
doesn't have fat. And and that was the other thing too,
is he is very frequently unfairly accused of demonizing fat.
He didn't do that. He said, you need to be
eating olive oil by the gallonful, just injected daily. Basically
he didn't say that. It's kind of paraphrasing, but he um.
(13:57):
He didn't leave out things like, um, you know, fats
from fish or from all of well, it was saturated
fat and particularly that he was convinced was the culprit
for heart disease and deaths from heart disease. Right, and uh,
eat a lot of grains, eat a lot of pasta,
eat a lot of fruit, eat a lot of bread,
(14:18):
a lot of vegetables. Sure vegetables are good for you. Yeah,
that's true, right. Yeah. And also I think one of
the other things that was so radical about the Mediterranean diet,
like even now you're like, oh, that sounds kind of exotic.
This is the fifties that this guy first introduced the
Mediterranean diet. But one of the other things that was
radical about it, and I should say, um, I didn't
(14:39):
I didn't give credit to his wife, Margaret, who co
wrote the first book with him, at least the first one,
if not more. Um, they wrote it together. But the
the the thing that was radical about it was that
he said, Hey, those fruits and vegetables and all that
make those the main like make the meat your side dish, like,
flip it over. You're gonna like live a lot longer
(15:01):
than you are just by eating a big steak and
some cream spinach on the side. Hey, I got no
problem with the man. There is definitely a case to
be made about eating what you like and living shorter.
It's tough to argue with in some cases. Hey, what
do we do when we occasionally on the road, We'll
go to a steakhouse together? We split a cream spinach
(15:23):
every time. Sure, I mean, how can you go to
a steakhouse and not eat cream spinach? It's the best
It makes you strong, right, Yeah, my forearm is just
a freakishly bulging. Should we take a break, Yes, all right,
go work out those four arms and we'll talk about
the cohorts right after this. If you want to know,
(15:51):
then you're in luck. Just chuck. Okay, So we're gonna
say it again cohorts cohorts. It's a study population that
bears some sort of similarity to one another, sort of.
(16:12):
There were sixteen in the seven countries study, and all
sixteen cohorts total twelve thousand, seven hundred and sixty three participants.
So it's a pretty good study. Sixteen different groups of
people more than twelve thousand total in seven different countries.
It's fairly impressive and ambitious study for the time. For sure,
it was. And I think there were at least two
(16:35):
in every country except for the U S which had
one cohort. And he never said we have to be fair.
He never said, you know what, this represents all men
in these countries and sort of all men around the world.
They never pretended like that was the case. But they
had to start somewhere and um, and we're not pooping
the whole study. Like the it was very robust. Uh.
(16:59):
And if you carry out a study in seven countries
with all of these men over twenty five years, it's
you know, they weren't slouches or anything like that. No,
but the very fact that he went around and said, oh,
these people eat a Mediterranean diet, I'm gonna include them.
These people eat what I consider the opposite of Mediterranean diet.
Include them, yea, rather than saying like, we'll just pick
(17:22):
these countries at random and and start studying them and
see if the their cholesterol intake is low and then
if so, if that correlates with the lower heart disease.
He didn't do that, and that is definitely worth criticizing
for sure. So let's I guess talk about some of
these cohorts and what they who they were, uh, former Yugoslavia.
(17:43):
He studied a couple of small towns um one that
had the Western European diet and one that was on
the Mediterranean diet largely. Finland was really interesting, I think
out of all these, because he compared two villages in
eastern and western Finland, because East Finlanders were recording a
(18:05):
lot more heart attacks, in fact, supposedly like the highest
record on planet Earth at the time. Yes, and for
good reason too, you would think, because they would eat
things like so great, this makes me hungry, Yeah, it
kind of does. Actually, they would eat a fish soup
that was just loaded with butter for breakfast. They would
(18:26):
he was called the Loggers launch, which was described by
one of the researchers as um, are you ready large
hunks of meat, suspended and congealed fat, enveloped in a
dark bread loaf, fully permeated by fat. I'm so sorry
to our being of vegetarian listeners because you're probably turning
it off right about now. Yeah, we should have spoiled
(18:46):
our trigger warning this one yeah too late, which, by
the way, I have to say, I have been really
doing my best to eat far less meat. Um, not
for health purposes, for ethical reasons, really sure, but I
gotta say that does sound kind of good to me.
Is like, if you put this in front of me
(19:06):
and say, here's your chance to eat a uh Eastern
Finland loggers lunch, I would I would take you up
on it. I think, Yeah, I'm cut down on meat too. Yeah, yeah,
I eat so. I don't mean a lot of red meat.
Don't eat a ton of pork anymore, can especially especially
pork from me. I I don't always eat meat, but
(19:27):
when I do, I try not to. Uh So. Then
so you've got your high fat diets in Finland. And
then he said, all right, I need to, like you
kind of mentioned earlier, I need to choose some some
opposite in my view, opposite countries of what they eat.
So where do you go. You go to Japan, of course,
(19:48):
where they eat a lot of fish, and he went
to a even a tiny little fishing village where they
all ate almost all fish. And then again in Greece
and the Greek islands, uh and in southern Italy also
where they were obviously eating the Mediterranean diet. Right, So
he takes all these different cohorts, takes all of their
different diets and starts just kind of looking at um,
(20:10):
all sorts of factors. That was one of the other
reasons you said it was a very robust study. One
of the other reasons that it was robust is because
they looked at all sorts of stuff. It wasn't just
their diet. They looked at things like, um, what they drank,
and what they smoked, and how much they smoked and
all this kind of stuff. It was a big, long study.
And again they followed these guys for at least twenty
five years, and some of the stuff that they found
(20:33):
we're basically this and this is this is the two
points that the Seven Countries study told the world, and
they just so happened to be the two points that
ansel Keys fully expected the seven countries to tell the
studies to tell the world, and it was that if
you have a high serum cholesterol, like a high concentration
of cholesterol in your blood, then there you're there's a
(20:56):
greater chance that you were going to die from cardiovass
killer disease. Right and Eastern Finland where those loggers were
eaten fat breads. That's a great name for a restaurant,
fat bread Sure. Oh yeah, I think wow, if restaurants
are still around in a few months, then we should
(21:18):
open one called fat breads. Um. So, those fat bread
eating loggers, they had average serum cholesterol levels of more
than two sixty and there were more than four heart attacks,
uh four heart attack deaths for every one middle aged
men five years after the study started. Right, okay, so Chuck,
I looked it up. They had an average of two sixty.
(21:41):
The window of normal or acceptable or your your um
you don't have like viscous blood is two d These
guys were averaging to sixty. That's a lot. It is
a lot. So the opposite of that was the former
(22:01):
Yugoslavian place uh Dalmatia, where they had the Mediterranean diet
and there men had an average serium cholesterol level and
had one death per one men over that same period.
And Dalmatia is where the Dalmatian dog they think is from.
I kind of assumed that, but you never know, did you?
It was worth saying anyway, Sure, this is a show
(22:23):
about facts in trivia. That's right. Um. Did you have
you ever been to Croatia? No? It is spectacular, man.
It's on the Adriatic and it is incredibly gorgeous. You
mean and I went on a cruise once that went
through there, and it is I've just wanted to go
back ever since. Was it one of those river cruises? No,
(22:44):
it was again, it was on the Adriaca. It was
a cruise all the way around Italy, from one side
to the down past the boot and then up the other.
It was love. Yeah, we're not like cruise people or
anything like that, but we went with Um Shandon the
Champagne Acre had a cruise that we're like, well, okay,
this is the one we're gonna take, and uh it
(23:06):
turned out to be really great because we're not like
Italy fans. You we have nothing against Italy, but we
were never like we got to go to Italy never,
We're never cruise fans. And then after we got off
of those were like, I want to go on another
cruise and I want to go back to Italy and
would a kill you to give me some more shand
on did you just drink tons of champagne? Yes, that's wonderful.
So the other thing that uh It said was the
(23:29):
other conclusion was diets higher and saturated fats will correlate
to more heart attacks. And the data did show a
big correlation between saturated fat in the regular traditional diet
and the heart attacks. And I think crete where saturated
fats equal between eight and nine percent of daily calories,
(23:49):
the average number of heart attack desper one hundred was
basically zero over that five years. And in the US,
where we only had the one cohort, I don't think
we said they were railroad workers, right, Yeah, in Minnesota,
Minnesota railroad workers, they had se saturated fats and their
(24:10):
diet and they had more than three deaths per one
during that five year period. Right, So all this stuff
just totally backs up what what um ansel Keys was saying, right,
and later studies that basically took the seven countries study
cohorts and drilled down into them a little more. UM.
There were two particular ones, the zoot Fins study from
(24:32):
the Netherlands and the Hail Project. UM. Both of them
looked at um just continued following people beyond the twenty
five years, so like the Hail study was dedicated to
looking at healthy aging, that kind of thing, and they
turned up some other stuff that you UM now basically
take his gospel as well, Like if you follow a
(24:53):
Mediterranean diet, your risk of heart attack drops precipitously, I
think thirt lower risk. UM, if you eat fish, it
lowers your risk of dying from a heart attack. Like
even just eating fish once or twice a week can
drop your risk of a fatal heart attack by Like
these were things that that came along, not not from
(25:14):
the seven country study, but from that thing being continued
on by supplementary studies. Yeah. And two of the big
ones that people like myself and my wife like to
spout is that you drink the two glasses of wine
a day, you're actually healthier than not drinking at all.
And if you eat that one square of dark chocolate
(25:35):
a day, you're actually healthier as well. Uh, if you
eat more than that and drink more than that, then
it goes the opposite way. But that two glasses of
wine and one square of chocolate is uh. People really
like to tout that one who like to drink wine
and eat chocolate. That's what they call a sweet spot. Yeah,
so like seriously think about it, though, if you drink
(25:57):
less than two wine two glasses of wine a date,
you're you're likelier to die of heart disease than if
you drink too. I mean that's what they're saying in
the study at least, right, And I mean, like, I
haven't seen anything that says Nope, that's not true, that's
b s. But the everybody makes that case that you
said to her, that makes that point that like, once
you go beyond too, not only does it have the
(26:18):
opposite effect, it gets really bad, really really fast. Yeah.
And what you can't do also is be like, well,
I haven't had any drinks for three nights, so I'll
have five glasses of wine tonight and that averages out
to super healthy. Yeah. Yeah, they say been shrinking is
way worse for you, but then they also say that
been shrinking is way better for you. We have no
handle on what drinking does to you. I just know
(26:40):
that drinking makes me feel like a S S the
next day. Uh yeah, I mean older you get, you
definitely have to pick and choose, dude, Like two beers can.
I don't want to say wreck me the next day,
but I am not love in life the next day
necessarily two beers dude. Yeah, My whole deal is sleep
(27:04):
Like I haven't had anything to drink for four nights,
and that was after a pretty big couple of nights
in a row for various reasons. And uh, I just
I sleep so much better. I wake up feeling so
much better. I mean it's irrefutable, you know. Um what
I do try to do now though in my old
(27:24):
ages is really drink a ton of water while I'm drinking.
And uh I use now take these. Uh I don't
know if I should buzz market the brand, but I
take a little supplement that is that is you know,
it's basically like a super vitamin that supposedly will help
curb a hangover, and like, have you noticed that it
(27:47):
actually has an effect? And if it does have an effective,
do you think it's just power suggestion or does it
really work? No? I think so, But it's not gobbled
e cook. I mean it's BE twelve and like things
that we know can probably help with a hangover. Yeah, yeah,
Have you ever gotten a BE twelve shot? I haven't,
Oh man. A lot of times they miss or it
doesn't work, or it's watered down or something like that.
(28:08):
It's really hard to get a good BE twelve shot.
When it works, brother, you can tell a difference and
you feel like a million bucks. You're not high, but
you're like high on life kind of. You're not not high,
I guess. Actually it's a really fair way to put it,
to tell you how long does that last? Like basically
(28:29):
all day you just feel great, You want to talk
to strangers. You you're like totally large and in charge.
You're getting stuff done. You never feel overwhelmed, like you're
like having you have a sense of humor. It's just
it just takes like all the best parts of your
personality and like bulks them up. Not in any kind
of speedy, manic way, but just you just feel like
(28:50):
you're running on all cylinders and you just wish to
God that like you were always like that, but and
that's what you got hat too, So that's why you're
not that's why you that's what you get one of
those hangover next day places, right, like an ivy and
a BEAT twelve shot. Yeah. Yeah, you could go to
like a medical clinic or you know, a med spa
or something like that, and they usually have it. Some
(29:10):
chiropractors have them. Um have to do that. Yeah, I
think you have to have some sort of medical degree
to inject it or whatever. But I've always kind of
been on the hunt to have B twelve prescribed to
me so I can inject it myself. So I guess
that there's any doctor listeners something you should know out there,
Hit me up because I need a prescription to BE twelve. Please.
(29:34):
Oh man, where were we? I think we're about to
take a break. Yeah, let's take a break and we'll
talk a little bit about the criticisms right after this.
If you want to know, you're in luck. Just to
(30:00):
exact fusion. Okay. So, I think we've kind of made
it clear that there are some people out there, uh communists,
Pinko's who hate the Seven Countries study, can't stand it,
and they have a lot of very valid points. Yeah.
(30:20):
I think one of the biggest criticisms is that it
was a very correlative relationship and not a causal relationship. Yes,
I mean that's kind of the biggest one. That and
the fact that it's a study. It's a it's called
an ecological study, which is uh, it's a study that
at the time it was you know who was this,
(30:41):
Dr Henry Blackburn, He was one of the original officers,
said it was state of the art for the time.
But he's like an ecologic study, and and correlation is
pretty weak. Uh. If you're talking about trying to find
a causal uh, I guess a causal inference. Yeah, Because
the thing is is you're taking all of these people
from all around the world and you're examining them to
(31:06):
see you're trying to find out what's the underlying cause
of their common affliction heart attacks, or what accounts for
the absence of that affliction again heart attacks. But the
problem is there's so many differences between somebody who is
on a Mediterranean diet and lives in Crete and somebody
(31:28):
who eats the loggers lunch in Finland. Besides just what
they eat, there's so many other factors, so many different
things involved that even if you can find a correlation
like you like, like ansel Keys did between saturated fats
and heart attacks. It doesn't mean that there's actually not
something else at play. And that's the biggest, the biggest
(31:51):
criticism of the study that most people widely level against it. Yeah,
and it's also an epidemiological study which follows a pop elation,
uh to something you know not so good for you
over a length of time. But if you want to
do that right, you can't, like you said, just they
have to be the same age, the same sex, they
(32:14):
have to do the same job, they have to be
the same ethnicity, they have to be in the same place,
and the only difference can be what they're eating, basically, right,
And like, and I get what he was doing. He
was trying to, you know, compare this type of diet
to that type of diet in different places around the world.
But it was just that's that's flawed, that's a flawed
(32:35):
that's an adventure. That's not a study, right exactly, that's
that's a that's a travel eating show basically. But it
was almost like he was trying to cram a dozen
studies into one rather than break it out and appropriately
into each different study, Like I'm going to study these
people and use this as the control. His study lacked
(32:57):
a control group or control um variable. Yeah, right, and
that's that's another big thing that's leveled against it as
as a big flaw and makes you wonder, you know, Okay,
is that correlation between saturated fat and heart disease even real? Yeah?
I mean even when they tried to kind of drill
(33:18):
down to an apples to apples, like in Finland, that
was one place where they had. All. Right, at least
we're all in the same country, so that's a good
place to start. Uh, let's see here the two finished cohorts.
I still love saying that, Um, they consumed relatively similar,
similar levels of saturated fat. So in the West they
had and the not a huge difference. That's so much though.
(33:43):
What three? Yeah, the railroad workers in nineteen fifties Minnesota,
we're eating of their diet was saturated fat. Yeah, close
to a quarter of your diet was saturated fat. But
the average number of heart attack deaths in the E
was twice as high versus I think four death per
(34:04):
one men versus two in the West. Yeah, so like
that there's something else going on, Yeah, exactly, because their
fat intake was similar but that you know that shouldn't
there's what would account for a double the increase? So
who knows? And they just the answer is they don't know.
We don't know. We don't know what would account for that. UM.
(34:25):
And there's there's a lot of other people who've looked
at this and said, Okay, there's still like a lot
to be said of this data. There's a lot you
can extract from it. UM. And some people have come
along the way and said, hey, you know, like you
can you can run this stuff through statistical analysis. Apparently
they did another that and they did when they originally
(34:45):
looked at the data back in the fifties or sixties
or seventies, and UM, they did it again for the
twenty fifth anniversary of this study. UM. And one of
the things that turned up was that sugar actually seemed
to orally more strongly. Sugar intake in the diet seemed
to correlate more strongly with heart disease, and even saturated
(35:07):
fats did it was almost roughly the same. But the
thing is that sugar bump. When you factored in saturated fats,
the sugar bump disappeared. And so they said, oh, well,
it's just an anomaly. It's really the saturated fats. From
what I could tell, if you had a saturated fat
bump and you factored in sugar, that would disappear as well.
So some people have come to think, like, if it's
(35:29):
not sugar, maybe it's a combination of sugar and saturated fats.
That's actually the real problem. Not saturated fats on its own,
but that it's not even necessarily sugar on its own,
but this combination of the two. And that's led a
lot of people, including one big critic of the Seven
Countries study, to say, um, like it's processed food. That's
(35:49):
what kills people. As processed food, this combination of bad
fats and in sugar, that is really proving to be deadly. Yeah,
and I think that's I think that's just so clear
now that real food is far in a way better
for you than processed food. Like, you can't, you just
can't refute that, No, you you can't. I mean even
(36:13):
if you just base it, and you know, we always
make fun of anecdotal data, but if you just base
it on how your body feels after you eat certain
kinds of food and then after you eat processed food,
the problem is is we don't know how to feed
um seven billion people on this planet without processing food.
You know, where's Norman Borlog, Yeah, I don't know. He's dead,
(36:37):
dead in the cold ground. God doesn't care about anything now.
So it hasn't been refuted, not necessarily, it hasn't been
completely refuted to where they say, just throw this thing
in the trash. Um. But I think the and hopefully
we've gotten this point across is the damage that it
(36:59):
did in the United States was we went all in
on it and they said fat is is the killer
and if you just avoid fat and eat these processed
low fat foods, you're gonna be just fine. Yes, So
like that, and you can't really lay that at ansel
Key's feet. That was the Department of Health and Human Services.
(37:22):
They just took these findings and ran with them. They
were like, well, we don't have any clinical data yet.
They're like, I can't hear you. I can't hear you.
I'm already at the printers getting these posters of the
food Pyramid Guide printed up UM. And that was definitely
a huge problem that UM that created this larger problem
because it led to this demization of all fats that
(37:43):
food pyramid that showed the little bit at the top
was like fats and sweets and stuff like that. Like
it didn't say, you know, just this kind of fat
or keep away from that kind of fact, it was fats.
You Americans are too fat and dumb to understand that
there's different kinds of fats, So just stay away from
fats all together. And that that's really what led to this,
because there are plenty of fats that are actually good
(38:04):
for your heart, like things like fats found in fish,
fats found in olive oil, and then even even potentially yeah,
avocados are about as good as it gets and then
potentially chuck. They're like the kinds of saturated fat that
people tend to associate, like with a steak, as being
bad for you. That's not necessarily true either. And again
(38:26):
it seems to be like we talked about in that
the peanut butter episode, those chemically processed or um industrially
processed fats that change things that make peanut butter shelf
stable and way more delicious, Like, those are the fats
that are actually really bad for you. Those are the
ones that you should avoid or eat in moderation, and
(38:48):
that that kind of nuances needed to actually have a
healthy diet, because we learned from this experiment that you
can't just cut fats out all together. We need a
lot of those fats to survive and be healthy. Yeah,
and the evans as far as um because you would think,
you know, this started in the nineteen eighties in America,
so surely we all got a lot healthier, right because
(39:08):
of the food pyramid and all the low fat food.
We cut fat anyway you can slice it. We cut
fat over two decades plus. People still, you know, think
fat as the demon in a lot of circles, and
America is as sick as we've ever been. Type two
diabetes has increased, Oh man, this is crazy, a hundred
and sixty six percent from nineteen eighty to twelve. I
(39:32):
don't know about twenty twelve till now. Um, I would
guess more of this. Yeah, I doubt if it reverse course. Uh.
We have beaten down heart disease some, but we've also
stopped smoking a lot more, and we've got better emergency
room care and better drugs like statins and stuff like that.
But it's still, you know, cardiovascular disease still kills people
(39:55):
more than anything else in the US. Yeah, despite those
advances in medical treatment, Um, it's still killing people more
than anything else. And like even exercising hasn't helped. Like
we exercise basically more than ever, but still a third
of the country is obese. The third of the United
States is obese, and all of this, Like, think about this,
(40:18):
All of those things are happened while we cut fat
essentially out of our diets. So that just goes to
show you, like that that didn't work. That's not going
to help that we have to rethink this whole thing
for sure. Yeah, and again we're not poopooing the Mediterranean diet.
There's also the flip side of this stuff with keto um,
the Atkins diet and paleo stuff like that. You know,
(40:42):
I think we've tried to you know, we're not gonna
tell anyone how to eat, and we're not dietitians, but
we've tried to preach over the past couple of years.
You know, eat real foods, eat balanced diets, try and moderation,
moderation and you know, calorie reasonable, calorie restriction and exercise. Yeah,
and and I mean portion control. Two is it sucks
(41:06):
when you first do it. It sucks to get used to,
but once you get used to it, it's it's um,
it's easy to maintain it. It's also easy to go
back on when you're like, I'm gonna eat this whole
box of Hamburger Helper tonight. I know, but how does
that make you feel? It makes you feel like garbage? Yeah,
ultimately emotionally and even if it's hitting a reward center.
(41:29):
And trust me, there so many reasons that people don't
eat the right things and eat too much of the
wrong things, emotional reasons and psychological reasons, and we're not
all that stuff is valid. But um, even if it's
hitting that reward center, it will probably also make you
feel awful emotionally and physically. It's true and like and
(41:52):
also just to say like, we're definitely on our high
horses right now, but we're no better than anybody else.
Like we know, I'm still sixty pound. I mean, we
had you mean and I split a whole roll of
Pillsbury cinnamon rolls last Yeah, I know, tough to turn
those down. Um, I can't even get this stuff. But
it's just the it's the well, no chucking, you're right
(42:17):
having it in your house is problem one. Not having
it in your house actually is helpful. It's crazy, it's weird,
but it actually works, especially during a quarantine when you
can't just pop up or you don't feel like you
should pop up to the store and get that. Ben
and Jerry's right exactly, like, yeah, yeah for sure, because
then you're you just your past around your kitchenutil this
(42:38):
time you go to bed, but you didn't need anything
get that. You know what I tried the other night?
What that that peanut butter and whipped cream? Oh? What
do you think? It's delicious? I'm sorry, I still haven't
eating a peanut butter and mayo sandwich yet. No, it's
really good. Emily made. She makes a good homemade whip cream.
And it was Oh yeah, it was delish. Yeah, it's
(43:01):
it's uh, it's hard to turn down. Now I want some,
but you know, have a little bit of that one night,
then I won't have any for a little while. Yeah.
And even I think what I was gonna say earlier
is walking around with this information is good and helpful,
and like you're never going to always adhere to it
probably wouldn't be that fun of a life to always
(43:22):
adhere to it, but they're just knowing it and kind
of using it as like a general compass or guide
that will make you healthier and we'll make you feel better.
And maybe at some point along the line, if you
already have this info, you're gonna get a kick in
the pants by something. Um, you're gonna hit like a
period of growth, and that might be part of it.
(43:43):
You might like loosen weight, you might get over a
chronic disease, you might all sorts of things might happen
because you know what to eat or how to start
thinking about your food. It's just good to keep in
your back pocket. At least it is. And uh, in
the end it what doesn't matter anyway, because it all
has to do with the health of your grandfather, right yeah.
(44:04):
Um hey. One other thing I want to say is
that critic Zoe dr Zoe Harcomb. She pointed out that
actually the strongest correlation that the seven countries study turned
up was um, the where the latitude of where the
person lived sunshine, right yeah, And which is really strange
(44:24):
until she points out and I'm not sure how much
she was pointing this out to basically undermine the seven
country studies, but it does make sense in a way too,
is she's saying, well, um, we synthesize vitamin D uh
in our skin from cholesterol in the skin when it's
exposed to sunshine. Um, and vitamin D has a lot
(44:45):
of protective qualities for the immune system, so maybe that
has to do with it. Yeah, I'm glad you pointed
that out. Yeah, well that's it for nutrition. We'll probably
never talk about it again. That's not true at all.
And since I said that, it's time for listener maiw
all right, I'm gonna call this, uh, Jackhammers. Why did
(45:07):
you do that? I don't know why not people asked me,
asked on Twitter, They're like, why why I thought you
guys hated this? And I said, yeah, I think Chuck's
got some weird self loathing going on trolling and I
just got caught up unfairly. Yeah. So we we have
often and long made fun of our Jackhammers episode, and
I re released it as a stuff you should have
(45:28):
select just to be cheeky, and this is about that
because Chris from Massachusetts really appreciated it. Hey, guys, just
finished listening to stuff you should have select on Jackhammers,
and I know you call it the most most boring,
worst one, but I actually enjoyed it. I'm a mechanical engineer.
In college, took a class on vibrations, which led to
conducting research on noise. On the noise that a jackhammer makes.
(45:50):
This is we did that show for this guy. Uh.
The noise or the ring that you hear when a
jackhammer strikes is the resonant frequency of the jackhammer Moyl
point after being struck by the inner pile driver. I
don't think we said any of that stuff. I was
working with my professor on developing an inner damper to
reduce that noise produced for the same reasons that you
(46:14):
named in your podcast. Some of the concepts he developed
we're quite amazing. You could take one of the moils
he designed and drop it on a concrete floor and
instead of alloud ringing you expect to hear, it would
land with a soft thud. Unfortunately, the concepts never quite
panned out, but we call them moils right exactly. Uh,
(46:34):
but your podcast reminded me of the many nights spent
in the lab collecting piles of data and the painful
ringing that you mentioned in the show. Thanks for the
countless amazing episodes. My girlfriend and I have gotten many
hours of entertainment from your show and truly appreciate all
the great content and laughs. Chris from Massachusetts. Chris, thank
you for getting in touch and thank you for your
(46:55):
attempted contribution to the world. Had it paid off, that
really would have been something. But thank you for even trying.
Um And if you want to be like Chris and
let us know that you're an unsung hero, we want
to hear about that. Uh. And if you know an
unsung hero, let us know about that person too. You
can send it in an email to Stuff Podcasts at
(47:17):
iHeart radio dot com. Stuff you Should Know is a
production of iHeart Radios. How stuff works for more podcasts
for my heart Radio because at the iHeart Radio app,
Apple Podcasts, or wherever you listen to your favorite shows.
H
Hey, everybody, it's Josh and Chuck your friends, and we
are here to tell you about our upcoming book that's
coming out this fall, the first ever Stuff you Should
Know book, Chuck. That's right. What's the cool, super cool
title we came up with. It's Stuff you Should Know colon,
an incomplete compendium of mostly interesting things. That's right, and
(00:20):
it's coming along so great. We're super excited, you guys.
The illustrations are amazing, and there's the look of the book.
It's all just it's exactly what we hoped it would be.
And we cannot wait for you to get your hands
on it. Yes, we can't. Um, and you don't have
to wait. Actually, well you do have to wait, but
you don't have to wait to order. You can go
preorder the book right now everywhere you get books, and
(00:42):
you will eventually get a special gift for preordering, which
we're working on right now. That's right, So check it
out soon coming this fall. Welcome to Stuff you Should Know,
a production of My Heart Radios How Stuff Works. Hey,
and welcome to the podcast. I'm Josh Clark, and there's
(01:05):
Charles W. Chuck Bryant over there, and Jerry's here somewhere,
and this makes it stuff you should know, the Heart
Healthy Edition. Yeah, I've been wanting to do for a
very long time, Chuck. Yeah, and this was one that
was put together by our buddy Dave Ruse. But back
in February, and I lost it and thankfully you said, hey,
(01:27):
by the way, you know, we got that seven countries
thing just sitting there gathering dust. Ye, I said, Chuck,
don't lose it here. I lost it and then I
found it. I was lost, but now I'm found. And
fat is good for your body the end, I know.
But that's a that's such like a revolutionary statement these days,
(01:48):
radical even basically to say fat is good for your
body the end, especially our we I'll not even our age,
but anyone in America and the eighties and nineties, somebody
in our court. You mean, yeah, I do too. So um.
The reason why it's kind of radical to say that
(02:09):
fat is good for you is because, yeah, everybody, our age, Chuck,
knows that fat is horrible for you. And even if
you kind of know that fat's not as bad as
we used to think, you probably still don't realize how
much better it is for you than it actually is.
There still some part of you that demonizes it. And
during the eighties and the nineties you couldn't get fat
(02:30):
if you shook it out of a pig, like it
was nowhere to be found. In the United States, we
had low fat everything. Remember we had uh like potato
chips where they took out the fat and replaced it
with a like a diarrhea creating agent. Right, what were
those called the did this? But I think they were
(02:51):
like like um las ola. Weren't they called ola chips?
They should have been called oiv as. So yeah, like
we're doing all sorts of things. And one of the
worst things we did too, even worse than adding olean
or replacing fat with olean, was a takeout fat and
replace it with high fruit toast corn syrup. Because one
(03:13):
of the things that fat does is give food flavor,
and we take fat out of food, you still wanted
to have flavor, and if you're a food processor, one cheap,
easy way to put flavor back into it is to
put high fruit toast corn syrup into it. And so
they think that like all of this war on fat
that took place in the eighties and nineties is actually
(03:33):
at least partially, if not fully responsible for the outbreak
of chronic diseases that we're seeing now, including obesity and
um diabetes that is just epidemic right now in the
United States. Yeah, it was so ingrained in us that
even after doing this podcast episode and knowing what we
(03:55):
now know, it's still like you say things like, you know, boy,
that steak you just feel like like clogging up your
arteries as you know that fat just gets wedged in there.
You just get these mental images of fat just like
breaking off of food and sticking to your blood vessels. Right, Yeah,
like this is really unhealthier, this is super indulgent or
(04:17):
something like that, And that just may not necessarily be
the case, but yeah, we had a number done on us, basically,
and we're still crawling out from under it. And what's
the most magnificently amazing thing is that basically all of this,
the war on fat, the low fat trend, the possibly
the diabetes, and the obesity that resulted from taking out
(04:41):
faster and placing it with sugar, all of this stuff
came from one study that was conducted back starting back
in the fifties that some people are like, the study
isn't even legitimate methodologically, yeah, so that is the seven
country study. And uh. The creator of the seven country
(05:03):
study was someone named Dr Ansel keys Um who was
married and published and this is I'm not gonna We'll
just let this speak for itself. They published a number
of high volume selling books about the Mediterranean diet. That
these cookbooks and um sometimes like the very first one
(05:26):
was only what like two years after they started doing
this study. So they have been accused of cherry picking
their data and promoting correlation as causation and uh. As
a result of all this, the United States very famously
came out with the food Pyramid that we was drilled
into our heads in school and said fat is cholesterol
(05:50):
and that is heart disease and eating fatty things will
kill you. Yes, like ipso fact. Though, the problem is
is that it was all based those recommendations. That food
pyramid was all based on the study and not any
kind of like clinical data. It was just basically a
study that was set up and designed to support a hypothesis,
(06:14):
not really test a hypothesis so much as support this
hypothesis by Dr Antel keys that saturated fats uh rose
cholesterol levels in your blood and that increased cholesterol levels
in your blood would kill you through heart disease. And
so doctor keys Is been very much demonized over the
(06:36):
years as people have figured out like, no, fats aren't
bad for you and actually you need them. But there's
also been like an effort to reform him too. And
in his defense, he wasn't just some some psycho narcissist doctor.
From what I could tell, he is. Um. He invented
k rations. K rations are called that after him keys Um. Yeah,
(06:58):
that that like kept a law of g I S alive.
And World War two, Um, he was a major part
of the Minnesota's starvation experiment where volunteers conscious just objectors
and World War two volunteered to be starved um so
that the scientists could figure out how to refeed people
without killing them, which became very useful when we liberated
(07:21):
the pow cants in Germany and some of the occupied areas.
So he was like a good I don't okay, I
don't know enough about him to say he was a
good person, but I don't think he was like an
evil person by any stretch of the imagination. And also
the reason that he started conducting the study in the
first place was because there was an epidemic of middle
aged men, in particular in America who were just dying
(07:44):
left and right of heart disease, and he wanted to
figure out what the problem was. He also started the
K pop phenomenon, so catchy and great. I don't know
any K pop I know the kids love it, though
they do, they're not for it. That one B twos
band or something like that. I can't I can't remember
their name, no idea, but if they're called the B
(08:06):
fifty twos, then they should be sued because that's been taken.
So Dr Ansel Keys as an American from Minnesota, a
physiologist and in the forties when you know, uh, the
Don Drapers, although that was a little later, but the
Don Drapers of the world were falling over dead from
smoking cigarettes all the time and eating steak for lunch
(08:27):
and martinis for lunch. He said, you know what, I'm
gonna figure this out and see what's going on, and
I'm gonna identify some risk factors why men in this
country are developing heart disease and men around the world.
Is what it ended up being. But it started in
Minnesota where he did a little pilot study. And while
he was doing that, he got a message from a
(08:48):
colleague in Italy who said, in southern Italy we got
to no heart to disease. Everybody's a healthy And he said, really,
and and he also said, southern Italy is really nice.
You should come visit. And so he went there in
the nineteen fifties and a bet, I mean, Southern Italy
is still great, but a bet in the early nineteen
fifties it was just idyllic. And he went down there
(09:11):
and he started these informal studies comparing business business executives
with the working class men of southern Italy, measuring serum
cholesterol levels, talking about what you're eating, getting the data
on heart disease and heart attacks there from the hospitals,
and he started to form this hypothesis that you know what, dudes,
(09:34):
middle aged dudes that have higher serum cholesterol levels are
more likely to die or at least suffer from a
heart attack. Yes, yes, And that was like the beginning.
That was yeah, And that was his hypothesis. And it's
pretty sound hypothesis, especially based on some of the data
that he'd seen, because he around this time after his
(09:55):
he was intrigued by his friend in southern Italy and
his trip to southern Italy um, which, by the way,
he fell in love with Southern Italy so much he
shot shop there and I believe lived out his life
till age one oh one. Yeah. Um, And that proves it.
It basically does, because I believe he did adhere pretty
strictly to the Mediterranean diet he espoused. He was no hypocrite,
(10:18):
but um he uh. He started poking around and getting
his hands on whatever data he could four things like
fat intake in the diet and incidences of heart disease
and heart attacks wherever he could get it in the world.
And he compiled um data from twenty two different countries
(10:39):
and he said, wow, this is really kind of all
over the place. I'll just select six of these countries
that really proved my point. And he created what's known
as the six country graph, which a lot of people
confused with the seven country Study, but it pre pre
dated the seven country study. But it was this thing
that was kind of like the transition period between first
forming this hypothesis and begin the seven country study. The
(11:01):
six country graph was kind of like the connective tissue
between the two and it also told him where to
look to really find the biggest disparities that might support
or um undermine his hypothesis. And so we got to
work looking around and contacting people around the world and said, hey,
I have zero funding to offer you. I know that
(11:24):
World War two just ended and everybody is basically trying
to rebuild their economy and their nation in Europe is
kind of war torn and shattered, and um, Japan has
had bombs dropped on it. But do you want to
start studying whether eating steak is bad for you and
going to kill you? And actually, astoundingly some country said yes, yeah.
(11:44):
So the countries ended up being Italy, Spain, South Africa, Japan, Finland,
the US. And I guess was that Greece was the
last one. Did that count Okay, Greece increase counts? Well,
I mean I knew, yeah, I know, grease increases the word. So, um,
it was time in the in the mid nineteen fifties.
(12:07):
He had the interested countries and the interested parties, so
in he developed these select populations and you kind of
teased it earlier calling us cohorts. These populations of men
they referred to as cohorts in the study so when
you hear say cohort, it's not like one guy, it's
a population of guys. Right. So the seven countries they
(12:29):
would monitor for twenty five years and ideally lead to
what risk factors would lead to heart disease. And that
was his goal was, I'm going to find out what
these risk factors are, provide some evidence, and then say
here's what you should be eating. Basically, Yes, so that
(12:50):
I mean, that's that's exactly what he did. Like you said,
within two years of starting this um study, which was
supposed to last and actually did twenty five and some
of the people who were the original participants were studied
for more than forty forty years. But um, within two
years he uh, he turned around and published that cookbook.
(13:13):
That's how certain he was of his hypothesis being correct. Yeah,
and I don't you know, we don't want to poop
of the Mediterranean diet. I think the idea, I'm sure
the Mediterranean diet is it can be quite healthy. The idea, though,
is is he shouldn't just be like, I'm gonna eat
low fat, because that's what happened in America. Everyone didn't say, hey,
we'll just eat Mediterranean. They said, we'll just eat junk
(13:36):
food full of sugar and hyproc dose corn syrup but
doesn't have fat. And and that was the other thing too,
is he is very frequently unfairly accused of demonizing fat.
He didn't do that. He said, you need to be
eating olive oil by the gallonful, just injected daily. Basically
he didn't say that. It's kind of paraphrasing, but he um.
(13:57):
He didn't leave out things like, um, you know, fats
from fish or from all of well, it was saturated
fat and particularly that he was convinced was the culprit
for heart disease and deaths from heart disease. Right, and uh,
eat a lot of grains, eat a lot of pasta,
eat a lot of fruit, eat a lot of bread,
(14:18):
a lot of vegetables. Sure vegetables are good for you. Yeah,
that's true, right. Yeah. And also I think one of
the other things that was so radical about the Mediterranean diet,
like even now you're like, oh, that sounds kind of exotic.
This is the fifties that this guy first introduced the
Mediterranean diet. But one of the other things that was
radical about it, and I should say, um, I didn't
(14:39):
I didn't give credit to his wife, Margaret, who co
wrote the first book with him, at least the first one,
if not more. Um, they wrote it together. But the
the the thing that was radical about it was that
he said, Hey, those fruits and vegetables and all that
make those the main like make the meat your side dish, like,
flip it over. You're gonna like live a lot longer
(15:01):
than you are just by eating a big steak and
some cream spinach on the side. Hey, I got no
problem with the man. There is definitely a case to
be made about eating what you like and living shorter.
It's tough to argue with in some cases. Hey, what
do we do when we occasionally on the road, We'll
go to a steakhouse together? We split a cream spinach
(15:23):
every time. Sure, I mean, how can you go to
a steakhouse and not eat cream spinach? It's the best
It makes you strong, right, Yeah, my forearm is just
a freakishly bulging. Should we take a break, Yes, all right,
go work out those four arms and we'll talk about
the cohorts right after this. If you want to know,
(15:51):
then you're in luck. Just chuck. Okay, So we're gonna
say it again cohorts cohorts. It's a study population that
bears some sort of similarity to one another, sort of.
(16:12):
There were sixteen in the seven countries study, and all
sixteen cohorts total twelve thousand, seven hundred and sixty three participants.
So it's a pretty good study. Sixteen different groups of
people more than twelve thousand total in seven different countries.
It's fairly impressive and ambitious study for the time. For sure,
it was. And I think there were at least two
(16:35):
in every country except for the U S which had
one cohort. And he never said we have to be fair.
He never said, you know what, this represents all men
in these countries and sort of all men around the world.
They never pretended like that was the case. But they
had to start somewhere and um, and we're not pooping
the whole study. Like the it was very robust. Uh.
(16:59):
And if you carry out a study in seven countries
with all of these men over twenty five years, it's
you know, they weren't slouches or anything like that. No,
but the very fact that he went around and said, oh,
these people eat a Mediterranean diet, I'm gonna include them.
These people eat what I consider the opposite of Mediterranean diet.
Include them, yea, rather than saying like, we'll just pick
(17:22):
these countries at random and and start studying them and
see if the their cholesterol intake is low and then
if so, if that correlates with the lower heart disease.
He didn't do that, and that is definitely worth criticizing
for sure. So let's I guess talk about some of
these cohorts and what they who they were, uh, former Yugoslavia.
(17:43):
He studied a couple of small towns um one that
had the Western European diet and one that was on
the Mediterranean diet largely. Finland was really interesting, I think
out of all these, because he compared two villages in
eastern and western Finland, because East Finlanders were recording a
(18:05):
lot more heart attacks, in fact, supposedly like the highest
record on planet Earth at the time. Yes, and for
good reason too, you would think, because they would eat
things like so great, this makes me hungry, Yeah, it
kind of does. Actually, they would eat a fish soup
that was just loaded with butter for breakfast. They would
(18:26):
he was called the Loggers launch, which was described by
one of the researchers as um, are you ready large
hunks of meat, suspended and congealed fat, enveloped in a
dark bread loaf, fully permeated by fat. I'm so sorry
to our being of vegetarian listeners because you're probably turning
it off right about now. Yeah, we should have spoiled
(18:46):
our trigger warning this one yeah too late, which, by
the way, I have to say, I have been really
doing my best to eat far less meat. Um, not
for health purposes, for ethical reasons, really sure, but I
gotta say that does sound kind of good to me.
Is like, if you put this in front of me
(19:06):
and say, here's your chance to eat a uh Eastern
Finland loggers lunch, I would I would take you up
on it. I think, Yeah, I'm cut down on meat too. Yeah, yeah,
I eat so. I don't mean a lot of red meat.
Don't eat a ton of pork anymore, can especially especially
pork from me. I I don't always eat meat, but
(19:27):
when I do, I try not to. Uh So. Then
so you've got your high fat diets in Finland. And
then he said, all right, I need to, like you
kind of mentioned earlier, I need to choose some some
opposite in my view, opposite countries of what they eat.
So where do you go. You go to Japan, of course,
(19:48):
where they eat a lot of fish, and he went
to a even a tiny little fishing village where they
all ate almost all fish. And then again in Greece
and the Greek islands, uh and in southern Italy also
where they were obviously eating the Mediterranean diet. Right, So
he takes all these different cohorts, takes all of their
different diets and starts just kind of looking at um,
(20:10):
all sorts of factors. That was one of the other
reasons you said it was a very robust study. One
of the other reasons that it was robust is because
they looked at all sorts of stuff. It wasn't just
their diet. They looked at things like, um, what they drank,
and what they smoked, and how much they smoked and
all this kind of stuff. It was a big, long study.
And again they followed these guys for at least twenty
five years, and some of the stuff that they found
(20:33):
we're basically this and this is this is the two
points that the Seven Countries study told the world, and
they just so happened to be the two points that
ansel Keys fully expected the seven countries to tell the
studies to tell the world, and it was that if
you have a high serum cholesterol, like a high concentration
of cholesterol in your blood, then there you're there's a
(20:56):
greater chance that you were going to die from cardiovass
killer disease. Right and Eastern Finland where those loggers were
eaten fat breads. That's a great name for a restaurant,
fat bread Sure. Oh yeah, I think wow, if restaurants
are still around in a few months, then we should
(21:18):
open one called fat breads. Um. So, those fat bread
eating loggers, they had average serum cholesterol levels of more
than two sixty and there were more than four heart attacks,
uh four heart attack deaths for every one middle aged
men five years after the study started. Right, okay, so Chuck,
I looked it up. They had an average of two sixty.
(21:41):
The window of normal or acceptable or your your um
you don't have like viscous blood is two d These
guys were averaging to sixty. That's a lot. It is
a lot. So the opposite of that was the former
(22:01):
Yugoslavian place uh Dalmatia, where they had the Mediterranean diet
and there men had an average serium cholesterol level and
had one death per one men over that same period.
And Dalmatia is where the Dalmatian dog they think is from.
I kind of assumed that, but you never know, did you?
It was worth saying anyway, Sure, this is a show
(22:23):
about facts in trivia. That's right. Um. Did you have
you ever been to Croatia? No? It is spectacular, man.
It's on the Adriatic and it is incredibly gorgeous. You
mean and I went on a cruise once that went
through there, and it is I've just wanted to go
back ever since. Was it one of those river cruises? No,
(22:44):
it was again, it was on the Adriaca. It was
a cruise all the way around Italy, from one side
to the down past the boot and then up the other.
It was love. Yeah, we're not like cruise people or
anything like that, but we went with Um Shandon the
Champagne Acre had a cruise that we're like, well, okay,
this is the one we're gonna take, and uh it
(23:06):
turned out to be really great because we're not like
Italy fans. You we have nothing against Italy, but we
were never like we got to go to Italy never,
We're never cruise fans. And then after we got off
of those were like, I want to go on another
cruise and I want to go back to Italy and
would a kill you to give me some more shand
on did you just drink tons of champagne? Yes, that's wonderful.
So the other thing that uh It said was the
(23:29):
other conclusion was diets higher and saturated fats will correlate
to more heart attacks. And the data did show a
big correlation between saturated fat in the regular traditional diet
and the heart attacks. And I think crete where saturated
fats equal between eight and nine percent of daily calories,
(23:49):
the average number of heart attack desper one hundred was
basically zero over that five years. And in the US,
where we only had the one cohort, I don't think
we said they were railroad workers, right, Yeah, in Minnesota,
Minnesota railroad workers, they had se saturated fats and their
(24:10):
diet and they had more than three deaths per one
during that five year period. Right, So all this stuff
just totally backs up what what um ansel Keys was saying, right,
and later studies that basically took the seven countries study
cohorts and drilled down into them a little more. UM.
There were two particular ones, the zoot Fins study from
(24:32):
the Netherlands and the Hail Project. UM. Both of them
looked at um just continued following people beyond the twenty
five years, so like the Hail study was dedicated to
looking at healthy aging, that kind of thing, and they
turned up some other stuff that you UM now basically
take his gospel as well, Like if you follow a
(24:53):
Mediterranean diet, your risk of heart attack drops precipitously, I
think thirt lower risk. UM, if you eat fish, it
lowers your risk of dying from a heart attack. Like
even just eating fish once or twice a week can
drop your risk of a fatal heart attack by Like
these were things that that came along, not not from
(25:14):
the seven country study, but from that thing being continued
on by supplementary studies. Yeah. And two of the big
ones that people like myself and my wife like to
spout is that you drink the two glasses of wine
a day, you're actually healthier than not drinking at all.
And if you eat that one square of dark chocolate
(25:35):
a day, you're actually healthier as well. Uh, if you
eat more than that and drink more than that, then
it goes the opposite way. But that two glasses of
wine and one square of chocolate is uh. People really
like to tout that one who like to drink wine
and eat chocolate. That's what they call a sweet spot. Yeah,
so like seriously think about it, though, if you drink
(25:57):
less than two wine two glasses of wine a date,
you're you're likelier to die of heart disease than if
you drink too. I mean that's what they're saying in
the study at least, right, And I mean, like, I
haven't seen anything that says Nope, that's not true, that's
b s. But the everybody makes that case that you
said to her, that makes that point that like, once
you go beyond too, not only does it have the
(26:18):
opposite effect, it gets really bad, really really fast. Yeah.
And what you can't do also is be like, well,
I haven't had any drinks for three nights, so I'll
have five glasses of wine tonight and that averages out
to super healthy. Yeah. Yeah, they say been shrinking is
way worse for you, but then they also say that
been shrinking is way better for you. We have no
handle on what drinking does to you. I just know
(26:40):
that drinking makes me feel like a S S the
next day. Uh yeah, I mean older you get, you
definitely have to pick and choose, dude, Like two beers can.
I don't want to say wreck me the next day,
but I am not love in life the next day
necessarily two beers dude. Yeah, My whole deal is sleep
(27:04):
Like I haven't had anything to drink for four nights,
and that was after a pretty big couple of nights
in a row for various reasons. And uh, I just
I sleep so much better. I wake up feeling so
much better. I mean it's irrefutable, you know. Um what
I do try to do now though in my old
(27:24):
ages is really drink a ton of water while I'm drinking.
And uh I use now take these. Uh I don't
know if I should buzz market the brand, but I
take a little supplement that is that is you know,
it's basically like a super vitamin that supposedly will help
curb a hangover, and like, have you noticed that it
(27:47):
actually has an effect? And if it does have an effective,
do you think it's just power suggestion or does it
really work? No? I think so, But it's not gobbled
e cook. I mean it's BE twelve and like things
that we know can probably help with a hangover. Yeah, yeah,
Have you ever gotten a BE twelve shot? I haven't,
Oh man. A lot of times they miss or it
doesn't work, or it's watered down or something like that.
(28:08):
It's really hard to get a good BE twelve shot.
When it works, brother, you can tell a difference and
you feel like a million bucks. You're not high, but
you're like high on life kind of. You're not not high,
I guess. Actually it's a really fair way to put it,
to tell you how long does that last? Like basically
(28:29):
all day you just feel great, You want to talk
to strangers. You you're like totally large and in charge.
You're getting stuff done. You never feel overwhelmed, like you're
like having you have a sense of humor. It's just
it just takes like all the best parts of your
personality and like bulks them up. Not in any kind
of speedy, manic way, but just you just feel like
(28:50):
you're running on all cylinders and you just wish to
God that like you were always like that, but and
that's what you got hat too, So that's why you're
not that's why you that's what you get one of
those hangover next day places, right, like an ivy and
a BEAT twelve shot. Yeah. Yeah, you could go to
like a medical clinic or you know, a med spa
or something like that, and they usually have it. Some
(29:10):
chiropractors have them. Um have to do that. Yeah, I
think you have to have some sort of medical degree
to inject it or whatever. But I've always kind of
been on the hunt to have B twelve prescribed to
me so I can inject it myself. So I guess
that there's any doctor listeners something you should know out there,
Hit me up because I need a prescription to BE twelve. Please.
(29:34):
Oh man, where were we? I think we're about to
take a break. Yeah, let's take a break and we'll
talk a little bit about the criticisms right after this.
If you want to know, you're in luck. Just to
(30:00):
exact fusion. Okay. So, I think we've kind of made
it clear that there are some people out there, uh communists,
Pinko's who hate the Seven Countries study, can't stand it,
and they have a lot of very valid points. Yeah.
(30:20):
I think one of the biggest criticisms is that it
was a very correlative relationship and not a causal relationship. Yes,
I mean that's kind of the biggest one. That and
the fact that it's a study. It's a it's called
an ecological study, which is uh, it's a study that
at the time it was you know who was this,
(30:41):
Dr Henry Blackburn, He was one of the original officers,
said it was state of the art for the time.
But he's like an ecologic study, and and correlation is
pretty weak. Uh. If you're talking about trying to find
a causal uh, I guess a causal inference. Yeah, Because
the thing is is you're taking all of these people
from all around the world and you're examining them to
(31:06):
see you're trying to find out what's the underlying cause
of their common affliction heart attacks, or what accounts for
the absence of that affliction again heart attacks. But the
problem is there's so many differences between somebody who is
on a Mediterranean diet and lives in Crete and somebody
(31:28):
who eats the loggers lunch in Finland. Besides just what
they eat, there's so many other factors, so many different
things involved that even if you can find a correlation
like you like, like ansel Keys did between saturated fats
and heart attacks. It doesn't mean that there's actually not
something else at play. And that's the biggest, the biggest
(31:51):
criticism of the study that most people widely level against it. Yeah,
and it's also an epidemiological study which follows a pop elation,
uh to something you know not so good for you
over a length of time. But if you want to
do that right, you can't, like you said, just they
have to be the same age, the same sex, they
(32:14):
have to do the same job, they have to be
the same ethnicity, they have to be in the same place,
and the only difference can be what they're eating, basically, right,
And like, and I get what he was doing. He
was trying to, you know, compare this type of diet
to that type of diet in different places around the world.
But it was just that's that's flawed, that's a flawed
(32:35):
that's an adventure. That's not a study, right exactly, that's
that's a that's a travel eating show basically. But it
was almost like he was trying to cram a dozen
studies into one rather than break it out and appropriately
into each different study, Like I'm going to study these
people and use this as the control. His study lacked
(32:57):
a control group or control um variable. Yeah, right, and
that's that's another big thing that's leveled against it as
as a big flaw and makes you wonder, you know, Okay,
is that correlation between saturated fat and heart disease even real? Yeah?
I mean even when they tried to kind of drill
(33:18):
down to an apples to apples, like in Finland, that
was one place where they had. All. Right, at least
we're all in the same country, so that's a good
place to start. Uh, let's see here the two finished cohorts.
I still love saying that, Um, they consumed relatively similar,
similar levels of saturated fat. So in the West they
had and the not a huge difference. That's so much though.
(33:43):
What three? Yeah, the railroad workers in nineteen fifties Minnesota,
we're eating of their diet was saturated fat. Yeah, close
to a quarter of your diet was saturated fat. But
the average number of heart attack deaths in the E
was twice as high versus I think four death per
(34:04):
one men versus two in the West. Yeah, so like
that there's something else going on, Yeah, exactly, because their
fat intake was similar but that you know that shouldn't
there's what would account for a double the increase? So
who knows? And they just the answer is they don't know.
We don't know. We don't know what would account for that. UM.
(34:25):
And there's there's a lot of other people who've looked
at this and said, Okay, there's still like a lot
to be said of this data. There's a lot you
can extract from it. UM. And some people have come
along the way and said, hey, you know, like you
can you can run this stuff through statistical analysis. Apparently
they did another that and they did when they originally
(34:45):
looked at the data back in the fifties or sixties
or seventies, and UM, they did it again for the
twenty fifth anniversary of this study. UM. And one of
the things that turned up was that sugar actually seemed
to orally more strongly. Sugar intake in the diet seemed
to correlate more strongly with heart disease, and even saturated
(35:07):
fats did it was almost roughly the same. But the
thing is that sugar bump. When you factored in saturated fats,
the sugar bump disappeared. And so they said, oh, well,
it's just an anomaly. It's really the saturated fats. From
what I could tell, if you had a saturated fat
bump and you factored in sugar, that would disappear as well.
So some people have come to think, like, if it's
(35:29):
not sugar, maybe it's a combination of sugar and saturated fats.
That's actually the real problem. Not saturated fats on its own,
but that it's not even necessarily sugar on its own,
but this combination of the two. And that's led a
lot of people, including one big critic of the Seven
Countries study, to say, um, like it's processed food. That's
(35:49):
what kills people. As processed food, this combination of bad
fats and in sugar, that is really proving to be deadly. Yeah,
and I think that's I think that's just so clear
now that real food is far in a way better
for you than processed food. Like, you can't, you just
can't refute that, No, you you can't. I mean even
(36:13):
if you just base it, and you know, we always
make fun of anecdotal data, but if you just base
it on how your body feels after you eat certain
kinds of food and then after you eat processed food,
the problem is is we don't know how to feed
um seven billion people on this planet without processing food.
You know, where's Norman Borlog, Yeah, I don't know. He's dead,
(36:37):
dead in the cold ground. God doesn't care about anything now.
So it hasn't been refuted, not necessarily, it hasn't been
completely refuted to where they say, just throw this thing
in the trash. Um. But I think the and hopefully
we've gotten this point across is the damage that it
(36:59):
did in the United States was we went all in
on it and they said fat is is the killer
and if you just avoid fat and eat these processed
low fat foods, you're gonna be just fine. Yes, So
like that, and you can't really lay that at ansel
Key's feet. That was the Department of Health and Human Services.
(37:22):
They just took these findings and ran with them. They
were like, well, we don't have any clinical data yet.
They're like, I can't hear you. I can't hear you.
I'm already at the printers getting these posters of the
food Pyramid Guide printed up UM. And that was definitely
a huge problem that UM that created this larger problem
because it led to this demization of all fats that
(37:43):
food pyramid that showed the little bit at the top
was like fats and sweets and stuff like that. Like
it didn't say, you know, just this kind of fat
or keep away from that kind of fact, it was fats.
You Americans are too fat and dumb to understand that
there's different kinds of fats, So just stay away from
fats all together. And that that's really what led to this,
because there are plenty of fats that are actually good
(38:04):
for your heart, like things like fats found in fish,
fats found in olive oil, and then even even potentially yeah,
avocados are about as good as it gets and then
potentially chuck. They're like the kinds of saturated fat that
people tend to associate, like with a steak, as being
bad for you. That's not necessarily true either. And again
(38:26):
it seems to be like we talked about in that
the peanut butter episode, those chemically processed or um industrially
processed fats that change things that make peanut butter shelf
stable and way more delicious, Like, those are the fats
that are actually really bad for you. Those are the
ones that you should avoid or eat in moderation, and
(38:48):
that that kind of nuances needed to actually have a
healthy diet, because we learned from this experiment that you
can't just cut fats out all together. We need a
lot of those fats to survive and be healthy. Yeah,
and the evans as far as um because you would think,
you know, this started in the nineteen eighties in America,
so surely we all got a lot healthier, right because
(39:08):
of the food pyramid and all the low fat food.
We cut fat anyway you can slice it. We cut
fat over two decades plus. People still, you know, think
fat as the demon in a lot of circles, and
America is as sick as we've ever been. Type two
diabetes has increased, Oh man, this is crazy, a hundred
and sixty six percent from nineteen eighty to twelve. I
(39:32):
don't know about twenty twelve till now. Um, I would
guess more of this. Yeah, I doubt if it reverse course. Uh.
We have beaten down heart disease some, but we've also
stopped smoking a lot more, and we've got better emergency
room care and better drugs like statins and stuff like that.
But it's still, you know, cardiovascular disease still kills people
(39:55):
more than anything else in the US. Yeah, despite those
advances in medical treatment, Um, it's still killing people more
than anything else. And like even exercising hasn't helped. Like
we exercise basically more than ever, but still a third
of the country is obese. The third of the United
States is obese, and all of this, Like, think about this,
(40:18):
All of those things are happened while we cut fat
essentially out of our diets. So that just goes to
show you, like that that didn't work. That's not going
to help that we have to rethink this whole thing
for sure. Yeah, and again we're not poopooing the Mediterranean diet.
There's also the flip side of this stuff with keto um,
the Atkins diet and paleo stuff like that. You know,
(40:42):
I think we've tried to you know, we're not gonna
tell anyone how to eat, and we're not dietitians, but
we've tried to preach over the past couple of years.
You know, eat real foods, eat balanced diets, try and moderation,
moderation and you know, calorie reasonable, calorie restriction and exercise. Yeah,
and and I mean portion control. Two is it sucks
(41:06):
when you first do it. It sucks to get used to,
but once you get used to it, it's it's um,
it's easy to maintain it. It's also easy to go
back on when you're like, I'm gonna eat this whole
box of Hamburger Helper tonight. I know, but how does
that make you feel? It makes you feel like garbage? Yeah,
ultimately emotionally and even if it's hitting a reward center.
(41:29):
And trust me, there so many reasons that people don't
eat the right things and eat too much of the
wrong things, emotional reasons and psychological reasons, and we're not
all that stuff is valid. But um, even if it's
hitting that reward center, it will probably also make you
feel awful emotionally and physically. It's true and like and
(41:52):
also just to say like, we're definitely on our high
horses right now, but we're no better than anybody else.
Like we know, I'm still sixty pound. I mean, we
had you mean and I split a whole roll of
Pillsbury cinnamon rolls last Yeah, I know, tough to turn
those down. Um, I can't even get this stuff. But
it's just the it's the well, no chucking, you're right
(42:17):
having it in your house is problem one. Not having
it in your house actually is helpful. It's crazy, it's weird,
but it actually works, especially during a quarantine when you
can't just pop up or you don't feel like you
should pop up to the store and get that. Ben
and Jerry's right exactly, like, yeah, yeah for sure, because
then you're you just your past around your kitchenutil this
(42:38):
time you go to bed, but you didn't need anything
get that. You know what I tried the other night?
What that that peanut butter and whipped cream? Oh? What
do you think? It's delicious? I'm sorry, I still haven't
eating a peanut butter and mayo sandwich yet. No, it's
really good. Emily made. She makes a good homemade whip cream.
And it was Oh yeah, it was delish. Yeah, it's
(43:01):
it's uh, it's hard to turn down. Now I want some,
but you know, have a little bit of that one night,
then I won't have any for a little while. Yeah.
And even I think what I was gonna say earlier
is walking around with this information is good and helpful,
and like you're never going to always adhere to it
probably wouldn't be that fun of a life to always
(43:22):
adhere to it, but they're just knowing it and kind
of using it as like a general compass or guide
that will make you healthier and we'll make you feel better.
And maybe at some point along the line, if you
already have this info, you're gonna get a kick in
the pants by something. Um, you're gonna hit like a
period of growth, and that might be part of it.
(43:43):
You might like loosen weight, you might get over a
chronic disease, you might all sorts of things might happen
because you know what to eat or how to start
thinking about your food. It's just good to keep in
your back pocket. At least it is. And uh, in
the end it what doesn't matter anyway, because it all
has to do with the health of your grandfather, right yeah.
(44:04):
Um hey. One other thing I want to say is
that critic Zoe dr Zoe Harcomb. She pointed out that
actually the strongest correlation that the seven countries study turned
up was um, the where the latitude of where the
person lived sunshine, right yeah, And which is really strange
(44:24):
until she points out and I'm not sure how much
she was pointing this out to basically undermine the seven
country studies, but it does make sense in a way too,
is she's saying, well, um, we synthesize vitamin D uh
in our skin from cholesterol in the skin when it's
exposed to sunshine. Um, and vitamin D has a lot
(44:45):
of protective qualities for the immune system, so maybe that
has to do with it. Yeah, I'm glad you pointed
that out. Yeah, well that's it for nutrition. We'll probably
never talk about it again. That's not true at all.
And since I said that, it's time for listener maiw
all right, I'm gonna call this, uh, Jackhammers. Why did
(45:07):
you do that? I don't know why not people asked me,
asked on Twitter, They're like, why why I thought you
guys hated this? And I said, yeah, I think Chuck's
got some weird self loathing going on trolling and I
just got caught up unfairly. Yeah. So we we have
often and long made fun of our Jackhammers episode, and
I re released it as a stuff you should have
(45:28):
select just to be cheeky, and this is about that
because Chris from Massachusetts really appreciated it. Hey, guys, just
finished listening to stuff you should have select on Jackhammers,
and I know you call it the most most boring,
worst one, but I actually enjoyed it. I'm a mechanical engineer.
In college, took a class on vibrations, which led to
conducting research on noise. On the noise that a jackhammer makes.
(45:50):
This is we did that show for this guy. Uh.
The noise or the ring that you hear when a
jackhammer strikes is the resonant frequency of the jackhammer Moyl
point after being struck by the inner pile driver. I
don't think we said any of that stuff. I was
working with my professor on developing an inner damper to
reduce that noise produced for the same reasons that you
(46:14):
named in your podcast. Some of the concepts he developed
we're quite amazing. You could take one of the moils
he designed and drop it on a concrete floor and
instead of alloud ringing you expect to hear, it would
land with a soft thud. Unfortunately, the concepts never quite
panned out, but we call them moils right exactly. Uh,
(46:34):
but your podcast reminded me of the many nights spent
in the lab collecting piles of data and the painful
ringing that you mentioned in the show. Thanks for the
countless amazing episodes. My girlfriend and I have gotten many
hours of entertainment from your show and truly appreciate all
the great content and laughs. Chris from Massachusetts. Chris, thank
you for getting in touch and thank you for your
(46:55):
attempted contribution to the world. Had it paid off, that
really would have been something. But thank you for even trying.
Um And if you want to be like Chris and
let us know that you're an unsung hero, we want
to hear about that. Uh. And if you know an
unsung hero, let us know about that person too. You
can send it in an email to Stuff Podcasts at
(47:17):
iHeart radio dot com. Stuff you Should Know is a
production of iHeart Radios. How stuff works for more podcasts
for my heart Radio because at the iHeart Radio app,
Apple Podcasts, or wherever you listen to your favorite shows.
H
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