Yet One More Junk Paper in JAMA Internal Medicine

Will they EVER learn statistics?

The paper Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality, an “original investigation” (whatever that means, since they just crunched numbers), published on the 26th of August–this paper is behind a paywall. Interestingly, a nearly identical paper with a nearly identical title, published in the same journal in 2016: Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality, with the same outcome. And what is that outcome?

Animal Protein Causes Earlier Death

Instead of writing about the article, I just provide the commentary I sent to JAMA Internal Medicine last night, and which published this morning. It explains everything. If you wish to read my commentary online, visit here and scroll down to comments–mine is the first one. Here it goes:

August 29, 2019
Concerns about Misleading Interpretation and Incorrect Conclusion
Angela Stanton, PhD | Stanton Migraine Protocol Inc.,

The article by Budhathoki et al.,(1) is akin to the article  in 2016 by Song et al (2). A study of association is used to support causation without appropriate statistical proof.

The article states in the abstract that “Intake of animal protein showed no clear association with total or cause-specific mortality” and then in the next sentence “In contrast, intake of plant protein was associated with lower total mortality.” If there is no clear association between meat protein and mortality, how can plant protein be associated with lower mortality? If there is no association, then there is no association.
In my view, the authors main findings are incorrect, confusing, and misleading.

This research is based on food frequency surveys for the previous year, completed once every five years. Food frequency questionnaires are questionable at best, particularly when a past year’s consumption has to be recalled.

A frequent  error in a food frequency analysis is the substitution of plant protein for animal protein “on paper” with “isocaloric substitution interpretation,” without the subjects actually changing their diet. Such substitution cannot be used to conclude what would have happened had they actually changed their diet. So we cannot infer if their mortality changed.

And finally, none of the hazard ratios shown meet the Bradford Criteria of 2 to suggest that the associations are significant enough to consider causation for even further analysis, let alone conclude any causal significance. This study shows no association of mortality with the type of protein consumed.

1 Budhathoki, S. et al. Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality. JAMA Internal Medicine, doi:10.1001/jamainternmed.2019.2806 (2019).

2 Song, M., Fung, T. T., Hu, F. B. & et al. Association of animal and plant protein intake with all-cause and cause-specific mortality. JAMA Internal Medicine 176, 1453-1463, doi:10.1001/jamainternmed.2016.4182 (2016).

There. I think the trash quality of the article is clear.

Comments are welcomed, as always, and are monitored for appropriateness


About Angela A Stanton, Ph.D.

Angela A Stanton, PhD, is a Neuroeconomist focusing on chronic pain--migraine in particular--physiology, electrolyte homeostasis, nutrition, and genetics. She lives in Southern California. Her current research is focused on migraine cause, prevention, and treatment without the use of medicine. As a forever migraineur from childhood, her discovery was helped by experimenting on herself. She found the cause of migraine to be at the ionic level, associated with disruption of the electrolyte homeostasis, resulting from genetic variations of all voltage dependent channels, gates, and pumps (chanelopathy) that modulate electrolyte mineral density and voltage in the brain. In addition, insulin and glucose transporters, and several other variants, such as MTHFR variants of B vitamin methylation process and many others are different in the case of a migraineur from the general population. Migraineurs are glucose sensitive (carbohydrate intolerant) and should avoid eating carbs as much as possible. She is working on her hypothesis that migraine is a metabolic disease. As a result of the success of the first edition of her book and her helping over 5000 migraineurs successfully prevent their migraines world wide, all ages and both genders, and all types of migraines, she published the 2nd (extended) edition of her migraine book "Fighting The Migraine Epidemic: Complete Guide: How To Treat & Prevent Migraines Without Medications". The 2nd edition is the “holy grail” of migraine cause, development, and prevention, incorporating all there is to know. It includes a long section for medical and research professionals. The book is full of academic citations (over 800) to authenticate the statements she makes to make it easy to follow up by those interested and to spark further research interest. It is a "Complete Guide", published on September 29, 2017. Dr. Stanton received her BSc at UCLA in Mathematics, MBA at UCR, MS in Management Science and Engineering at Stanford University, PhD in Economics with dissertation in neuroscience (culminating in Neuroeconomics) at Claremont Graduate University, fMRI certification at Harvard University Medical School at the Martinos Center for Neuroimaging for experimenting with neurotransmitters on human volunteers, certification in LCHF/ketogenic diet from NN (Nutrition Network), certification in physiology (UPEN via Coursea), Nutrition (Harvard Shool of Public Health) and functional medicine studies. Dr. Stanton is an avid sports fan, currently power weight lifting and kickboxing. For relaxation (yeah.. about a half minute each day), she paints and photographs and loves to spend time with her family of husband of 45 years, 2 sons and their wives, and 2 granddaughters. Follow her on Twitter at: @MigraineBook, LinkedIn at and facebook at
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12 Responses to Yet One More Junk Paper in JAMA Internal Medicine

  1. chris c says:

    I’ll attempt to read it later, that or watch some paint dry. Looks like some more Seventh Day Adventist propaganda

    IMO the only way meat can do you harm is if you fry it in industrially produced Omega 6 seed oils and eat it with the bun and the fries and the Big Gulp.

    Liked by 1 person

    • Exactly. I am now experimenting with nearly raw beef–I already eat sashimi, which is raw fish, and loving it. I just sear my steak now for a few seconds on both sides and wow.. it melts in your mouth and I can eat a lot more of it without getting any uncomfortable fullness. I am still increasing my protein consumption–I am still eating less protein than I woudl like to eat for protein synthesis. Raw steak is getting me there.

      I now bought steak ground in front of my eyes instead of pre-ground stuff… so this time I will do the same with burgers as well. Just gonna pour melted cheese on top somehow.. gonna have to figure that one out: how to. lol.


      • chris c says:

        I eat mine as a farmer advised – grilled until it has nearly stopped mooing. That would probably be braised for you. I get some excellent Hereford rump steaks and eat them with seasonal greens, a couple of thickly buttered oatcakes and some Chilean Carmenere. I will also fry a slice of lamb’s liver and a giant mushroom in EVOO, grill some bacon and eat with the same seasonal greens,currently runner beans (pole beans?) earlier asparagus (buttered) and soon brussels sprouts or purple sprouting broccoli. Likewise takes next to no time to cook and transport costs are nearly nonexistent, it could walk here!

        I also do smoked gammon rashers and grate cheese to melt over the top, and with ground beef I usually chop up some bacon and add multicoloured peppers and chillies and assorted other things and put in lumps of Halloumi. That works!

        Now to re-read the other paper

        One big factor, look at the carb content of ALL the diets! Here’s the elephant in the room – animal protein comes with fat, some of which is saturated. Vegetable protein always comes with carbs. The FART-Lancet diet consists of 232g carbs which is about four times what I can handle and has been analysed as having a bunch of deficiencies. which I suspect our diets don’t.

        Liked by 1 person

        • I only eat meat and dairy now with some fruits. I stay away from veggies as much as I can. I woudl say I eat a salad maybe twice a month now but come fall I move back into carnivore with only a tiny mini pepper a day. I now started to eat some of my meat raw… so far beef, egg yolks, and fish raw (sashimi). This week I ate raw meat 4 days in a row. With beef, I keep it out on the kitchen counter under a bug-net half the day so it is very nice and soft. The other day I felt like melted cheese on top so I melted some cheese in a nonstick with nothing under, and then put the steak into it, flipped on my plate and yummy! Too bad I cannot insert an image into the comments without an http link.. duh..

          I don’t own any oil that is of plants at all. Plant oils replace cholesterol with plant sterols, and that is actually harmful. I ma not taking a chance on anything harmful prevent.

          So you gonna spend some time reading a bad article? 😉 It’s exactly as good as the one Jama published now… If I used printed paper, it would have some use as a fire starter or similar. It’s good for nothing else. Enjoy the laugh. 🙂


        • chris c says:

          I’m lucky most vegetation does me no harm, except wheat. Well I’m not good with fruit except berries or most root vegetables or other grains – too carby. Well there was that time my ex bought some Scotch Bonnet chillies and thinking they were cute little peppers I chopped up three and put them in the stir fry. Neither of us could finish it, and we both loved hot food. I shred a tiny piece of one, and other chillies, peppers, garlic etc. for flavour, also mushrooms and various greens, and nuts, along with my meat, poultry, game fish and dairy. I avoid Omega 6 seed oils but am fond of EVOO, again for the flavour, and also fresh ground black pepper with the salt, and sometimes other herbs and spices. Works for me though I guess not for you.

          I remembered that other paper, from the High Priests of the Seventh Day Adventist church. My verdict “you couldn’t even use it to wipe”.

          Our Leader Of The Opposition Jeremy Corbyn transitioned from vegetarian to vegan and now looks like a dead man walking with a severe case of Vegan Neck. I fear if he gets elected instead of the current moron he will be on board with banning meat.

          Liked by 1 person

        • Interestingly as I kept nearly a year break in vegetables, I can now tolerate a salad without getting sick from it. I suppose the body heals. I still avoid all other veggies. Eat the fruit-types like tomatoes, peppers, and similar, and some low carbs fruits. This summer I have been testing some high carbs fruits–cherries specifically that are all pure sugar–just to see how my migraines behave given that for migraineurs carbs are the worst thing. I did OK. Not a single migraine as long as I finished the fruit with salt. So cool! Theory has been proven extremely well.

          Yeah… none of those things you eat woudl work for me–cool though. Given an uninhibited island, we would not fight over food! 🙂 I am now experimenting with some raw meat–just beef and sashimi. Pretty darn good and so much easier to digest. I am quite hooked on them now.

          I had no idea Corbyn was vegan–he looks the part. I know nothing about politics, so not going there. I just feel sorry if he brings harm to UK. Hope that’s not going to happen.


        • chris c says:

          I was always meh on salads, I prefer my veggies cooked. I just had a succulent lamb chop which I grill (broil) for long enough that the glorious fat turns into crackling.

          An uninhibited island sounds good, even better than an uninhabited one!

          It seems a lot of people have problems with nightshades, fortunately I’m not one of them, except for potatoes – too carby.

          Politically we’re between a rock and a hard place, Boris will sell the NHS to the Yanks (no offence, I mean your insurance companies and HMOs) and Corbyn will make us vegan.

          Liked by 1 person

        • hahahahhahaha I am typo queen.. I have been holding this title all my life I suppose to never pass it on to others… I am fine with night shades. Love tomatoes and peppers. I cannot eat spinach or Brussels sprouts–or otehr cruciferous veggies much. I am a super taster for those nasty chemicals in spinach and will give you a sourpuss face from one leaf. it doesn’t matter if thy are cooked or raw. I don’t usually eat any veggies. I will stop salads in October and move back into the shoes of a hypercarnivore, eating only a tiny pepper as my only non-animal source food for the whole winter.

          I watched BBC today while on the treadmill… not sure he will be in power by the time I am back in carnivore mode.. he is an odd character I must say. Know nothing about Corbyn–only saw his white face hurry into a car. At least, for now, while Trump is in power, we have choices for medical insurance. I love my healthcare and medical insurance place (they are one and the same in my Kaiser, which is an HMO) and I get the best care on a moment’s notice. I need not even see my doctor–they now have 10-minute phone consults for non-emergencies I can set up with my doc. And for meds, I can send an email and request. It is awesome. I sure hope this won’t change…


        • chris c says:

          I’m the typo king! I catch most but not all of them. Best one was when I wrote elationship – which is exactly what it was!

          Vegetables defend themselves with toxins. We have evolved to detoxify some of them and even use them as drugs. Some people are better at this than others, mainly it is seeds I do not do well with. A dietician used to troll a diabetes forum warning of the “extreme dangers” of low carb diets, which mainly included scurvy and halitosis, which of course no-one ever suffered from while they got their A1c below 6 which doesn’t happen when you “base every meal on starchy carbohydrates”, advice which even the ADA has backed away from. They write the same stuff about the carnivores, who likewise do not seem to suffer from the “expected” dietary deficiencies.

          When we moved here fourteen years ago the health centre was excellent, you could see a doctor within a few days and they had no problem making simultaneous or adjacent appointments for my mother and me. Then they were turned into crap by The Management and the doctors complained they were being monitored by Big Brother. Now they have improved again but it can still take three or four weeks to see a doctor, probably because they spend most of their time testing well people for drug deficiencies. Since I’m hardly ever ill now, I have my sole prescription (for Amlodipine) on automatic renewal and just drop in to collect it every month. I believe Kaiser are one of the few who are NOT interested in buying the NHS, I’ve heard good things about them from others too.

          Liked by 1 person

        • Yes, there would be no interest by Kaiser in turning everything into NHS USA because that will destroy Kaiser. So I hope they stay for as long as my kids and I live… they are excellent.

          Stuff just happened to me in coming off of some meds I had been taking for asthma but eating carnivore and now back to keto cured my asthma. So I quit the inhaler but had this darned pill that is not possible to cut, so no chance to reduce. My pulmonary doc responded back to my email upon my asking for the child-dose, which is a chewable sweetened nonsense but can at least be cut, to just quit.

          So I quit but 3 day after I felt things tightening up so I took the pill again. I woke up in the morning with over a kilo of water retained and face so swollen I could hardly open my eyes! To cut to the chase, I wrote him again telling him that the abrupt quit was a bad idea and asked once more for the child chewable but he never responded–this was Friday afternoon and he may already have gone home.

          I sent an email off to my primary care doc, and my prescription was ready in one hour, picked it up right away.. ahead and forward now with a 90-day supply to reduce by little nips…

          All these would not have been possible under any medical plan other than Kaiser. So yes, I want to keep Kaiser. It’s 24/7 for everything, including pharmacy.


        • chris c says:

          I live near the coast, and something that has always amused me is that we have the wild versions of a lot of vegetables – and they are pretty much inedible. Sea kale and sea cabbage have leathery leaves, wild carrot and wild parsnip have roots like hawsers. Much breeding required to make edible versions. Sea beet (= spinach) is slightly better. Wild asparagus and samphire are edible as is with minor cooking, Asparagus is a local crop on the sands. Samphire grows on the marshes but strangely Fish Van Man gets it imported from Holland. Anyway I wonder how starving people must have been to eat some of this stuff, especially when they were surrounded by fish and shellfish.

          Shortly I shall stir-fry some bacon and pheasant breast with multicoloured peppers and chillies, garlic and olives, and a small portion of basmati rice to soak up the juices.

          Liked by 1 person

        • Basmati rice??? So you eat the SAD only replacing veg and seed oils with olive oil? That’s it?

          I agree on the impossibility of the carbs craze based on what they believe humans must have eaten for eons. In the meantime, read and watch this.


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