Ernst Wynder on the Nurses’ Health Study

It says a lot about the Nobel Prize in Medicine that Ernst Wynder, co-discoverer that smoking causes cancer, never got one. Wynder was also one of the founders of modern epidemiology. Here’s what he believed about the Nurses’ Health Study:

He had a strong skepticism about methods of dietary assessment, and always felt that the failure of analytic studies such as the Nurses’ Health Study to report associations between cancer and diet were due to a combination of random misclassification related to the imprecision of food frequency questionnaires and the narrow range of nutrient intake within a given population. I feel certain that he would have criticized the recent negative findings from the Women’s Health Study on dietary fat and breast and colon cancer on similar grounds. This was one area where he felt that international comparisons at the ecological [country-by-country] level provided better etiologic support than [more] analytic studies, and he published many studies over a period of decades to make just that point.

For example,

He developed a friendship with Kunio Aoki at the Aichi Cancer Research Institute in Nagoya, Japan, which resulted in our study which found that Japanese men with smoking habits similar to American men had considerably lower lung cancer risks.

I didn’t know that. It suggests that either Americans eat something that promotes cancer or the Japanese eat something that protects against it. I suspect it’s the latter — specifically, the big consumption of fermented food in Japan and not in America. I’m sure the food-frequency questionnaires Wynder criticizes, written by Americans, are tone-deaf to fermented food. I doubt they ask about kimchi or kefir or miso consumption, or distinguish between pickles aged for a day and pickles aged for a year. In Japan, people eat fermented food in many forms: vinegar drinks, yogurt, other fermented milk drinks, and alcoholic beverages. Above all, they eat miso and long-fermented pickles daily. They also have the longest life expectancy in the world.

23 Replies to “Ernst Wynder on the Nurses’ Health Study”

  1. i’ve heard that standing bare feet in ground (i.e., grass over ground not cement, sand) drains one of electromagnetic frequency that accumulates in one’s body, thereby eliminating the adverse health consequences of EMF’s. I’m starting to do this now and may report back to you.

  2. QUOTE:
    “It suggests that either Americans eat something that promotes cancer or the Japanese eat something that protects against it.”

    Interesting. I was just reading the WeeksMD blog, which said there is a very strong connection between sugar and cancer. I would guess that Americans eat much more sugar than the Japanese do … but I could be wrong.

    Cancer and sugar


  3. “It suggests that either Americans eat something that promotes cancer or the Japanese eat something that protects against it. I suspect it’s the latter”

    I suspect both. I think the high consumption of fructose, in sugar and high-fructose corn syrup, for example, coupled with the high intake of rancid omega-6 dominant fatty acids, such as in industrially processed vegetable oils, in the American diet both contribute to cancer and other diseases of civilization such as metabolic syndrome and autoimmune diseases.

  4. The typical Japanese male has at omega 6 to omega 3 ratio in their blood of 2 to 1 or less. The typical American male has a ratio of 20 to 1 or more.

  5. One additional thing I’d look into: do they smoke the same tobacco?
    Tobacco in US might be spiced a lot different than in Japan, which might have a big effect on health.

  6. Why shouldn’t it be a genetic difference?

    By the way, the cancer-smoking link was discovered by German workers in the Third Reich. I gather that it was ignored because people assumed they’d lied to please the virulently anti-smoking Fuhrer.

  7. The Nurses’ Health Study was discussed extensively by Taubes in Good Calories Bad Calories. IIRC it came out with the “wrong” answer. Dietary fat was not showing up as linked to heart disease. That lead to ideas like “we live in a toxic environment.” That became a justification for ignoring previous study results and promotion of forms of study that could only confound results. The Seven Countries study which ultimately became the foundation for the belief that dietary fat is bad was the result of this kind of thinking.

    If it is indeed true that smoking is not linked to lung cancer, (using the Taubes “bad scientist, bad result” hypothesis) my head is going to hurt. I’ve got a lot of anecdotal evidence in my head that says smoking -> cancer… Although I wonder about dose and other forms of tobacco…

    Woof. I’m still not going to take up smoking.

  8. Robert Reis, thanks, very interesting article about problems in the case against smoking. Wynder had experimental evidence (from mice) that cigarettes were carcinogenic — evidence not mentioned in that essay. And all that rating of evidence (“second-rate”) is misleading because the “second-rate” evidence is dismissed rather than examined to see what you can learn from it. I think the answer to the mysteries and paradoxes the article describes is that smoking does have beneficial effects. It’s another example of hormesis.

  9. In the US, about 90% of people with lung cancer are smokers or former smokers, but of all smokers, only about 10% get lung cancer. Assuming most smokers eat and are exposed to more or less the same things, this suggests that those who get lung cancer have a genetic predisposition to it. That might or might not somehow be triggered by one or more dietary factors, one or more environmental factors, something else entirely, or some combination of factors. Interestingly, the monoclonal antibody drug bevacizumab (Avastin), which treats cancer by blocking vascular endothelial growth factor, is significantly more effective in people of Asian descent. It’s possible that Japanese smokers have a genetic difference that makes them less susceptible to lung cancer. Cancer is extremely complex and highly variable and to think that single element can be responsible for causing or preventing it is simplistic. For example, mesothelioma is associated with asbestos exposure. However, most people who have extensive asbestos exposure from say a lifetime working in a shipyard never get this disease, and of those who do get it, probably less than half have any traceable asbestos exposure.

  10. Japanese differ from Americans in lots of habits, customs, genes, etc. If fermended food is making a different to the health of the Japanese population though, there is likely sufficient variation in its consumption to examine whether it is associated with health among Japanese.

  11. This question (If Americans eat something that promotes cancer) has already been answered: It’s in the milk. Casein is a powerful cancer promoter. The effect is very strong. How relevant the potential protective effect of fermented foods is, I don’t know, but the negative effect of cows-milk is proven to be very strong.

  12. I read something quite interesting the other week; while Japan has the longest life span, Asian-Americans in New Jersey live longer. This needs to tie into our overall understanding.

  13. Sorry Wilhelm, but you’re stretching when you say that “the negative effect of cows-milk is proven to be very strong.” The negative effects of isolated casein have been proven to be strong but that doesn’t tell us anything about milk itself. Whey, present in real milk but absent from the casein damning studies, has been shown to offer a preotective effect against cancer.

    On an observational level, where is the large amounts of cancer that we should be seeing amongst that Massai and other traditional dairy based cultures?

  14. The Japanese also eat a lot more sodium and LOT more iodine containing foods (seaweed and seafoods) than we do.

    It’s hard to compare their diet to America, I think. There’s just too many differences to pull out one variable.

  15. Nicole, I can’t think of any reason that eating lots of sodium or iodine will add 5 years to your life. On the other hand, there are plenty of reasons to think that fermented food is tremendously healthy.

  16. Japan has Marlboro and Camel. They’re all cigarettes.

    Given that seaweed is known to get rid of “hard to get rid of” toxins as well as nourish the lungs and throat (anything soft and slimy in the body), I’d say it’s a safe bet that part of the Japanese connection involves mass amounts of seaweeds.

    Call it a hunch…

  17. The basic statistic is…

    Japanese are a nation of heavy smokers and yet have very low rates of lung and heart disease.

    Japanese also consume more seaweed than most.


    smoking + no lung cancer + seaweed = Japanese

    smoking + lots of lung cancer + no seaweed = American

  18. I’ve been told that the genetic makeup of Japanese people precludes them from developing cancer from smoking. If your mother and father both smoked all of their lives lived into their 80’s and had no lung problems, chances are you too can safely puff away.

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