The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet. Nina Teicholz, 2014.

Teicholz, Nina. 2014. The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet. New York: Simon & Schuster

Excerpts

Nina Teicholz is a journalist who has tracked the history of dietary recommendations in the United States of America and throws up some shocking findings. Her book draws from several references and tracks how power and money allowed some opinions to get hardened as facts while others were not give due attention.

In her book she writes “The more I probed, the greater was my realization that all our dietary recommendations about fat—the ingredient about which our health authorities have obsessed most during the past sixty years—appeared to be not just slightly offtrack but completely wrong. Almost nothing that we commonly believe today about fats generally and saturated fat in particular appears, upon close examination, to be accurate”

She says that the popular notion that the food industry drives diet related issues and is true on instances, but the real culprits were those who were trusted as scientists and experts from institutions that were expected to do due diligence.

The crisis of heart related disease and the need to urgently do something overrode normal protocols and principles that underlie research. The hypothesis that dietary fat, especially saturated raised cholesterol and therefore directly contributed to heart disease was treated as an unquestionable dogma inspite of several indications that alternative points of view or evidence needed to be factored in.

“This hypothesis became accepted as truth before it was properly tested. Public health bureaucracies adopted and enshrined this unproven dogma. The hypothesis became immortalized in the mammoth institutions of public health. And the normally self-correcting mechanism of science, which involves constantly challenging one’s own beliefs, was disabled. While good science should be ruled by skepticism and self-doubt, the field of nutrition has instead been shaped by passions verging on zealotry. And the whole system by which ideas are canonized as fact seems to have failed us.”

“Researchers who persisted in their challenges found themselves cut off from grants, unable to rise in their professional societies, without invitations to serve on expert panels, and at a loss to find scientific journals that would publish their papers. Their influence was extinguished and their viewpoints lost. As a result, for many years the public has been presented with the appearance of a uniform scientific consensus on the subject of fat, especially saturated fat, but this outward unanimity was only made possible because opposing views were pushed aside.”

Inspite of Americans diligently following the prescribed guidelines – since 1970s, the consumption of fruits and vegetables went up by 17%, grains by 29% and fats reduced from 43% of calories to 33% or less. Cutting down on fats has meant increased consumption of carbohydrates such as grains, rice, pasta and fruit.

“A breakfast without eggs and bacon, for instance, is usually one of cereal or oatmeal; low-fat yogurt, a common breakfast choice, is higher in carbohydrates than the whole-fat version, because removing fat from foods nearly always requires adding carbohydrate-based “fat replacers” to make up for lost texture. Giving up animal fats has also meant shifting over to vegetable oils, and over the past century the share of these oils has grown from zero to almost 8 percent of all calories consumed by Americans, by far the biggest change in our eating patterns during that time.”

However, in this same period, the health of Americans worsened.

“When the low-fat, low-cholesterol diet was first officially recommended to the public by the American Heart Association (AHA) in 1961, roughly one in seven adult Americans was obese. Forty years later, that number was one in three”.

“During these decades, we’ve also seen rates of diabetes rise drastically from less than 1 percent of the adult population to more than 11 percent, while heart disease remains the leading cause of death for both men and women”.

Teicholz expresses shock that even 30 years after the official recommendation of a low fat diet, it has not been subjected to a large scale, formal scientific trial. The Women’s Health Initiative )WHI) which enrolled 49,000 women in 1993, showed that a low fat and meat diet with an increase in fruits, vegetables and grains neither helped to lose weight nor show a reduction in risk of either heart diseases or cancers.

“What I found, incredibly, was not only that it was a mistake to restrict fat but also that our fear of the saturated fats in animal foods—butter, eggs, and meat—has never been based in solid science. A bias against these foods developed early on and became entrenched, but the evidence mustered in its support never amounted to a convincing case and has since crumbled away.”

She categorically states that “our bodies are healthiest on a diet with ample amounts of fat and why this regime necessarily includes meat, eggs, butter, and other animal foods high in saturated fat.”

“By 1950, elevated serum cholesterol was broadly viewed as a probable cause of heart disease, and many experts believed that it would be safer for anyone with high blood cholesterol to try to nudge it lower.”

“One of the early ideas for how people might lower cholesterol was simply to consume less of it. The notion that cholesterol in the diet would translate directly into higher cholesterol in the blood just seemed intuitively reasonable, and was introduced by two biochemists from Columbia University in 1937. The assumption was that if we could avoid eating egg yolks and the like, we could prevent cholesterol from accumulating in the body. The idea is now lodged firmly in our minds………….In fact, eating two to three eggs a day over a long period of time has never been shown to have more than a minimal impact on serum cholesterol for the vast majority of people.”

“In 1992, one of the most comprehensive analyses of this subject concluded that the vast majority of people will react to even a great deal of cholesterol in the diet by ratcheting down the amount of cholesterol the body itself produces. In other words, the body seeks to keep its internal conditions constant. ….Responding to this evidence, health authorities in Britain and most other European nations in recent years have rescinded their advisories to cap dietary cholesterol. The United States, however, has continued recommending a limit of 300 mg per day for healthy people (the equivalent of one and a half eggs). Moreover, the Food and Drug Administration (FDA) continues to allow food products to advertise themselves as “cholesterol-free,”

In 1952, Keys introduced the diet heart hypothesis showing close correlation between fat intake and death rate from heart disease in six countries and that if the this curve was extended back down to zero fat intake then risk of heart disease would nearly disappear. This led to the mistrust of fat to which was attributing not just heart disease but also obesity, cancer, diabetes etc.

Because fat contains a little more than 9 calories/gm, Keys thought that it made people fat in addition to causing atherosclerosis and that eating less fat meant consuming fewer calories.

“Frustratingly for Keys, the data from the Seven Countries study showed that although a diet low in saturated fat appeared to be associated with fewer deaths from heart disease (within those countries, at least), that advantage did not extend to total mortality. People eating diets low in saturated fat had just as high a risk of dying as their fat-gorging counterparts. The animal food minimalists simply died of other causes. In the study, the people who survived the longest overall lived in Greece and the United States, and their longevity showed no relationship to the amounts of fat or saturated fat they ate, nor to the cholesterol levels in their blood.”

“In 1999, when the Seven Countries study’s lead Italian researcher, Alessandro Menotti, went back twenty-five years later and looked at data from the study’s 12,770 subjects, he noticed an interesting fact: the category of foods that best correlated with coronary mortality was sweets. By “sweets,” he meant sugar products and pastries, which had a correlation coefficient with coronary mortality of 0.821 (a perfect correlation is 1.0). Possibly this number would have been higher had Menotti included chocolate, ice cream, and soft drinks in his “sweets” category, but those fell under a different category.” 

“By contrast, “animal food” (butter, meat, eggs, margarine, lard, milk, and cheese) had a correlation coefficient of 0.798, and this number likely would have been lower had Menotti excluded margarine. (Margarine is usually made from vegetable fats, but researchers at the time tended to lump it in with animal foods because it looked so much like butter.)”

“In the absence of trial data, as we’ll see again and again over the last 50 years of nutrition history, epidemiological evidence has therefore been made to suffice. Even though it cannot, by its very nature, make claims about causation, it has repeatedly been employed in just this way. This practice of using epidemiological data as a basis for official dietary guidelines was pioneered by Keys himself. Keys aggressively drove home his study’s main “takeaway” point, that eating saturated fat leads to high cholesterol and that high cholesterol leads to heart disease.”

“In 1961, the AHA committee brought out a report stating that “the best scientific evidence available at the present time” suggested that Americans could reduce their risk of heart attacks and strokes by cutting the saturated fat and cholesterol in their diets.The report also recommended the “reasonable substitution” of saturated fat with polyunsaturated fats such as corn or soybean oil......These guidelines are influential not only in the United States but around the world.”

For the media and nutrition experts alike, the chain of causation that Keys had proposed seemed to make eminent sense: dietary fat caused cholesterol to rise, which would eventually harden arteries and lead to a heart attack. The logic was so simple as to seem self-evident. Yet even as the low-fat, prudent diet has spread far and wide, the evidence could not keep up, and never has. It turns out that every step in this chain of events has failed to be substantiated: saturated fat has not been shown to cause the most damaging kind of cholesterol to go up; total cholesterol has not been demonstrated to lead to an increased risk of heart attacks for the great majority of people, and even the narrowing of the arteries has not been shown to predict a heart attack.

In the 1950s, Pete Ahrens set up the first gas liquid chromatography lab in the United States and examined various kinds of dietary fats. They are basically made up of chains of carbon atoms surrounded by hydrogen atoms. These chains can be of various lengths and also have different types of chemical bonds holding them together. It is the type of bond that makes a fatty acid saturated or unsaturated.

A bond refers to the way that two atoms are linked together. A double bond is less stable and doesn’t lie neatly against its neighbours and this comprises oils. Single double bond makes it monounsaturated as seen with olive oil. More than one double bond makes polyunsaturated fat as seen with vegetable oils such as canola, safflower, sunflower, peanut, corn, cottonseed, soybean etc. Saturated fatty acids on the other hand, contain no double bonds, only single bonds. They are straight chain and pack together densely making them solid at room temperature such as lard, butter, suet and tallow.

Ahrens’s own research had opened up another line of inquiry, suggesting that the carbohydrates found in cereals, grains, flour, and sugar might be contributing directly to if not actually causing obesity and disease. And he correctly predicted that a fat-reduced diet would only increase our consumption of these foods. While nearly everyone else was exclusively obsessed with serum cholesterol, Ahrens was instead interested in triglycerides, which are molecules made up of fatty acids circulating in the blood. With Margaret Albrink he found that high triglyceride levels were far more common than high cholesterol in coronary patients; so they posited that triglycerides, not total cholesterol, were a better indicator of heart disease. The probable cause that Albrink had identified was carbohydrates.

According to the Ahrens model, carbohydrates, not fat, were the cause of heart disease. Ahrens was concerned that the low-fat diet being prescribed to the American public would worsen their triglyceride levels and thus exacerbate the problem of obesity and chronic disease.

Another prominent scientist who made a public show of his skepticism of the diet heart hypothesis was George Mann, the Vanderbilt biochemist who had gone to Africa to study the Masai. He was one of the first scientists to raise the alarm about trans fats, in 1955, and he speculated that the sudden breaking off of plaque in the arteries must be a more important factor in heart attacks than the slow clogging-up of the arteries. He was proven correct, but not until decades later.

However, thirty years later, in the Framingham follow-up study—when investigators had more data because a greater number of people had died—it turned out that the predictive power of total cholesterol was not nearly as strong as study leaders had originally thought. For men and women with cholesterol between 205 and 264 milligrams per deciliter (mg/dL), no relationship between these numbers and heart disease risk could be found. In fact, half of the people who had heart attacks had cholesterol levels below the “normal” level of 220 mg/dL. And for men aged forty-eight to fifty-seven, those with cholesterol in the midrange (183–222 mg/dL) had a greater risk of heart attack death than those with higher cholesterol (222–261 mg/dL). Total cholesterol turned out not to be a reliable predictor for heart disease after all. This data was not publicised very strongly.

The Framingham data also failed to show that lowering one’s cholesterol over time was even remotely helpful. In the thirty-year follow-up report, the authors state, “For each 1% mg/dL drop of cholesterol there was an 11% increase in coronary and total mortality [italics added].” This is a shocking finding, the very opposite of the official line on cholesterol lowering. Yet this particular Framingham finding is never discussed in scientific reviews, even though many large trials have found similar results. It was also clear that saturated fat was not related to heart disease. Concerning the incidence of coronary heart disease and diet, the authors concluded, simply, “No relationship found.”

Since 1900, Americans have switched from eating animal fats to vegetable oils. The change in consumption itself was astronomical: the oils went from being completely unknown before 1910 to representing somewhere around 7 percent or 8 percent of all calories consumed by Americans by 1999, according to two scholarly estimates. Vegetable oils were marketed in the 1970s for their polyunsaturated-fat content and ability to lower cholesterol, following the advice of the American Heart Association.

Converting oil into a hard fat transformed it from a relatively useless culinary commodity into one of the most important and serviceable ingredients that the food industry has ever known.

In the Framingham study, men with cholesterol levels below 190 mg/dL were three times more likely to get colon cancer than men with cholesterol greater than 220 mg/dL. In fact, ever since corn oil had been shown to double the rate of tumor growth in rats in 1968, there had been a baseline level of concern about vegetable oils and cancer.  on the ingredient list is usually partially hydrogenated oil.

In the wake of the Dietary Guidelines, the low-fat, low-cholesterol diet spread far and wide in the 1980s, expanding from the original class of high-risk, middle-aged men to encompass all Americans, women and children alike. It became the diet of the entire nation. Setting strict cholesterol targets, the new NCEP guidelines were not only directed at more people, but they also extended their dietary reach. The proposed regime no longer required cutting back just on saturated fat and cholesterol but on fat overall.

 No studies had been done on whether a low-fat diet was better—or even safe—for infants, children, adolescents, pregnant or lactating women, or the elderly, yet the diet-heart hypothesis had taken hold to such a degree in the expert community that it was just considered a commonsense measure of prevention against heart disease for everyone at any stage of life over the age of two to start on this regime.

The National Academy of Sciences, in its Toward Healthful Diets report, agreed, objecting that it was “scientifically unsound” for the government to include children in its low-fat recommendations. “The nutritional needs of the young, growing infant are distinctly different from those of the inactive octogenarian,” stated the academy.

Even as experts at the NHLBI and the AHA pressed the American Academy of Pediatrics (AAP) to prescribe the low-fat diet to all children, the AAP refused. In an editorial published in the AAP journal, Pediatrics, in 1986, the group’s nutrition committee said that any change toward a more restrictive diet in the first two decades of life should “await demonstration that such dietary restrictions are needed.” The editorial emphasized the differences in the nutritional needs of growing children, especially during the growth spurt of adolescence, compared to those of middle-aged men with high cholesterol. “The proposed changes would affect consumption of foods currently providing high quality protein, iron, calcium, and other minerals essential for growth,” stated the authors.

The AAP had long considered high-quality proteins to come from meat, dairy products, and eggs, which would be restricted under the low-cholesterol, low-fat diet. “Dairy products provide 60 percent of dietary calcium; and meat is the best source of available iron,” the academy wrote. The AAP feared that rates of iron deficiency, which had not been a problem among children for decades in the United States, might rise if children started cutting back on meat.

Not so many years earlier, meat, dairy, and eggs had been considered the best foods to promote growth. The expert who chaired the National Academy of Science’s controversial report had alluded to this point when he said the country should not abandon a diet that produced Americans who were healthy and tall. This belief was based on research conducted before the field of nutrition became absorbed by the study of heart disease. Nutrition experts in the 1920s and thirties were less interested in atherosclerosis, which was still emerging, and focused instead on what constituted an optimal diet for growth and reproduction.

In the 1920s, when nutrition investigators started identifying some of the specific vitamins in “protective” foods, the focus of research turned away from these whole foods and toward the vitamins instead. An entire era of vitamin-based research took off. Ultimately, the idea of separating vitamins from their native foods would prove to have some unfortunate consequences, since Americans mistakenly came to believe that they could meet their nutritional needs simply by taking a supplement or eating fortified foods such as breakfast cereal. Yet a number of essential vitamins, including calcium and the fat-soluble vitamins A, D, K, and E, cannot be fully absorbed if eaten unaccompanied by fat.

In the Bogalusa Heart Study on children aged eight to ten, for instance, those children eating less than 30 percent of calories as fat were found to have a significantly higher chance of failing to meet the RDAs for vitamins B1, B12, and E, as well as thiamin, riboflavin, and niacin, compared to the group eating more than 40 percent fat.

When the authoritative Cochrane Collaboration, an international group that commissions experts to perform objective reviews of science, finally weighed in on the evidence in 2001, it concluded that avoiding fat couldn’t be shown to prevent heart disease in normal children. The data couldn’t even show that such a diet helped at-risk children with a genetic predisposition to heart disease. If a low-fat diet were the answer, Cochrane concluded, the evidence didn’t exist to make that claim.

Moreover, the diet didn’t even appear to be effective in helping children lose weight.

Diets with less than 30 percent of calories as fat started to get nutritionally worrisome, and at 22 percent, they were associated with growth faltering. Those numbers stood in stark contrast to the 40 percent–plus fat that healthy, growing children were reported eating in the wealthier countries of Germany and Spain.

As far back as the 1950s, however, researchers had been warning that women responded differently to fat and cholesterol than did men and therefore needed to be studied separately. Atherosclerotic symptoms don’t occur in women until ten to twenty years later than men, for instance, and women generally do not suffer high rates of heart disease until after menopause.

Where data existed examining the sexes separately, the disparities were fairly astonishing. In the Framingham Study, one of the few early studies that included women, for example, women over fifty years old showed no significant correlation between total serum cholesterol and coronary mortality. Because heart disease occurs only very rarely in women under fifty, this finding meant that the great majority of American women have been needlessly cutting back on saturated fats these past few decades, since the impact on their blood cholesterol is meaningless for their coronary risk. Yet this important finding was omitted from the study’s conclusions when they were published in 1971. In 1992, an NHLBI expert panel reviewed all the heart disease data on women and found that total mortality was actually higher for women with low cholesterol than it was for women with high cholesterol, regardless of age.

Another widely held belief about women’s health that turned out not to be supported by the scientific evidence was the notion that dietary fat caused cancer. Since the 1980s, women have been advised by health authorities to reduce their consumption of fat in order to prevent breast cancer—which of course was part of the wider recommendations against dietary fat for all cancers and all people.

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Also listen to Nina Teicholz here Why Dietary Guidelines are Making us Fat

As far back as 1987, the epidemiologist Walter Willett at the Harvard School of Public Health had found fat consumption not to be positively linked to breast cancer among the nearly ninety thousand nurses whom he had been following for five years in the Nurses’ Health Study. In fact, Willett found just the opposite to be true, namely, that the more fat the nurses ate, particularly the more saturated fat they ate, the less likely they were to get breast cancer.

A review in 2008 of all studies of the low-fat diet by the United Nation’s Food and Agriculture Organization concluded that there is “no probable or convincing evidence” that a high level of fat in the diet causes heart disease or cancer. And in 2013 in Sweden, an expert health advisory group, after spending two years reviewing 16,000 studies, concluded that a diet low in fat was an ineffective strategy for tackling either obesity or diabetes. Therefore, the inescapable conclusion from numerous trials on this diet, altogether costing more than a billion dollars, can only be that this regime, which became our national diet before being properly tested, has almost certainly been a terrible mistake for American public health.

The USDA and AHA have both quietly eliminated any specific percent fat targets from their most recent lists of dietary guidelines.