book review / commentary

The Big Fat Surprise: Why Butter, Meat & Cheese Belong in a Healthy Diet
Nina Teicholz
Simon & Schuster, 2014, 481 pages
Reviewed by T.J. Nelson

ver the past decade science has done a complete about-face on the dangers of saturated fats and cholesterol. Here's what one medical textbook said as recently as 2008 about the famous Framingham study:

Harrison's Principles of Internal Medicine (17th ed., 2008, p. 1505):
“The Framingham Heart Study provided rigorous support for the concept that hypercholesterolemia, hypertension, and other factors correlated with cardiovascular risk.”

Here is what a prominent nutrition textbook said in 2000 and in 2012:

Advanced Nutrition and Human Metabolism (3th ed., 2000):
“There is little doubt as to a causal relationship between hypercholesterolemia and the development of atherosclerosis.”

Advanced Nutrition and Human Metabolism (6th ed., 2012):
“Dietary lipid has been implicated in atherogenesis, the process leading to development of the degenerative cardiovascular disease called atherosclerosis.”

Health food

Now the cholesterol myth has been finally and conclusively debunked in an earth-shattering book by Nina Teicholz in a book called The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet.

This book is mandatory reading for anyone who eats food. I hereby assign it for you to read by next Thursday. There will be a quiz.

Despite its unpromising title, Teicholz's easy-to-digest book is thorough and devastating: it is destined to become a classic in science investigation. It also shows the seamy side of science (as the title of another great book puts it) that insiders are all too familiar with.

She describes Ansel Keys, the arrogant and ambitious scientist who formulated the fat hypothesis, as a monomaniacal egotist with tunnel vision. I know the type only too well.

Keys cherry-picked data to fit his hypothesis and committed other statistical sins that, if Teicholz is right, border on fraud. Keys's flawed research is a textbook case of how to do bad science. Yet it led the AMA to declare, in effect, that the war on heart disease was a war on dietary fat. Keys's phony indictment of fat let the real killer go free for decades.

The NIH conspired by blocking the finding, from the Framingham study, that saturated fat in the diet had no relationship with coronary heart disease. Teicholz says this finding was locked in an NIH basement for nearly a decade, then buried in the back of a 28-volume report.

But in clinical trials, the same finding kept reappearing: lowering dietary saturated fat reduced serum cholesterol, but had no effect on cardiovascular health. In some trials, deaths from cancer soared. Nutrition textbooks rarely mention this fact. Low cholesterol also consistently increases violent deaths, presumably by making people depressed. The nutrition establishment's response: not our problem. Fat is bad.

An increase in cancer would not be unexpected because polyunsaturated fatty acids react with oxygen in air to produce reactive peroxides, hydroperoxides, aldehydes, and free radicals. These are produced in abundance when vegetable oils are heated, which is probably why fast food might be bad for you (if indeed it is). But the fast food industry didn't choose vegetable oils voluntarily. It was dragged kicking and screaming into using them.

Ironically, the most reactive molecules don't survive as long in the gut, so they have lower bioavailability. The problem comes in when reactive molecules are produced in the body. For example, we once found that a little-known industrial chemical is metabolized by the blood vessel endothelial cells to produce acrolein, thereby causing cardiomyopathy and death by heart failure in industry workers exposed to it. That chemical is kept tightly controlled now, but one wonders: what else is out there we don't know about?

There are other lipid oxidation products, like 4-hydroxynonenal, that are even worse. For a time 4-hydroxynonenal, produced by overheating vegetable oil, was thought to be a possible factor in Alzheimer's disease. Some scientists even suspect that bacteria or bacterial products could be contributing to arterial plaques.

Polyunsaturated fatty acids are essential for life. They're good for the brain and the retina, but they're only healthy if they're fresh.

Bacon: Nature's perfect health food

Oxidized lipids and trans-fatty acids

Scientists are now convinced that oxidized fatty acids, not cholesterol, and not saturated fatty acids, are what constitutes the danger, such as it is, from fat. You can see this for yourself by eating a month-old bag of chips, and see what happens to your face. Those zits wouldn't happen if you could get them fresh. Unlike cholesterol, oxysterols can even cross the blood brain barrier. Twenty years ago reviewers would laugh at you if you said this in a grant. Now it's dogma.

Why oh why, you ask, didn't any scientist ever question this dogma? Oh, they did. Those that tried found themselves prevented from publishing, excluded from editorships, and finally defunded. George Mann, the leader of the Framingham study, was blocked from publishing in AHA journals and was deprived of funding, rendering him unable to do science, for opposing Keys's hypothesis. Teicholz relates how when the Women's Health Initiative (WHI), a $725 million clinical trial she calls the “Rolls Royce of Studies,” turned up absolutely no effect of a reduced fat diet, the principal investigators concluded that their own study must have been flawed. Subsequent studies showed that the null result was indeed correct. Low fat diets are consistently found to have no effect on heart disease, obesity, or diabetes. But the idea that fat is bad for you just won't die.

Teicholz writes how the consumer group CPSI, along with the American Soybean Association (ASA), pressured food manufacturers to put partially hydrogenated soybean oil, which contains trans-fatty acids, in their food. The much-maligned food industry resisted but lost out. Since then the FDA has banned trans fatty acids as unsafe. Margarine, which people think is healthy, is full of them, and is far worse for you than butter.

Trans-fats also reduce membrane fluidity, which is bad. But the food industry is suffering because there aren't any good replacements: the public is afraid of everything that's healthy, especially cholesterol. Industry people are world experts on how to bake crackers. They've discovered that if their crackers shoot out the other end five minutes after you eat them (think Olestra) they just don't sell. But they can't go back to beef tallow or palm oil, and the available new alternatives look pretty bad.

The science behind the toxicity of trans-fatty acids is not as solid as we would like. But whatever they replace trans-fats with could well turn out to be much worse.

Mass murder by food

Are some diets “mass murder”? That is the question Jean Mayer asked back in 1965, quoted here.

When I walk through a grocery store, I understand the feeling. Nutritional myths are everywhere: meat with every trace of fat carefully scraped away. Nonfat milk bought for children. Food with high energy content but devoid of actual nutrients. Vegetables so stressed they taste bitter. Food with taste so bland, thanks to a lack of fat, that manufacturers have to add sugar and salt to make it palatable.

In an attempt to fight obesity, lawmakers in Connecticut contemplated a new law forbidding schools from feeding whole milk to children. Even 2% milk is on their list of foods to ban. They are convinced, as are many Americans, that eating fat makes you fat. But as Gary Taubes put it, that's a big fat lie.

Scientifically it makes about as much sense as the theory, published in PLoS One, that living at high altitudes where the air is thinner makes you thin. If school food tastes as bad as it sounds, kids will probably do what they always do: use it for entertainment purposes. It will no longer be perceived as food, but as a cool liquid to be sprayed out the nose.

Those kids who survive it will have something to astound their grandchildren with in their old age: “In my day,” they will someday say, “teachers were so stupid we would get thrown out of school for pointing a carrot at somebody! We weren't allowed to drink real milk. And if we were bad, they gave us powerful stimulant drugs!”

But even worse than that is the people dreaming up genetically modified cows and pigs with lower fat. This would be a ghastly crime against nature. We can't blame the food industry—they are providing what people say they want. But by now the people must feel like a herd of cattle being driven around in circles.

The industry tried to accommodate them by creating the pseudo-fat substitute, Olestra, which even Time Magazine called one of the fifty worst inventions ever. Now they're trying another tactic: leave out the explosive-diarrhea-inducing ingredients, but make the food really little. Last time I bought a hamburger, it was about 2½ inches in diameter. The static warp bubble around hamburgers today is contracting frightfully fast.

Sweet grapefruit, thin pigs, and other abominations

Researchers are also trying to create a new type of grapefruit that is sweeter, less “bitter” and presumably more tasteless than the current ones, following the well trodden path of tasteless tomatoes, listless lettuce, and abominable pomegranates. The problem with grapefruit seems to be furanocoumarins, which inhibit the breakdown of statins, causing an overdose. So even if your cholesterol is already low, you WILL be made to suffer.

You might think this barrage of inedible, tasteless foods would cause Americans to become thinner, but the opposite happens: the body craves nutrients, and it will make you eat whatever quantity of food is necessary to acquire them. So dilute the trace nutrients, and people automatically eat more.

James Rhodes at the Daily Telegraph said “Why don't we tax the hell out of fast foods, cigarette style?” He calls fast food “child abuse” and advocates subsidizing “healthy” foods for low income households, “fin[ing] parents who continue to ram this stuff down their kid's throat,” and banning TV ads for fried chicken. This food fascism is what industry people have had to deal with for over a century. It's what got us into this mess in the first place.

Of course the industry does it too. Teicholz describes how the soybean industry got the government to effectively block imported palm oil by taxing the heck out of it. Now they're sorry because they can't use soybean oil anymore, but the public is still afraid of palm oil, and they're having trouble keeping their crackers from collapsing into a puddle of goo.

Maybe Weston A. Price, who noticed in 1939 that Fiji Islanders became unhealthy after they gave up cannibalism, had a point: humans are the perfect food. Of course, eating humans carries its own unique health risks—such as a 5000% increase in the incidence of being executed. Well, all diets have risks. Your best advice in the grocery store is to bring a Ph.D. biochemist along with you. And a lawyer. But keep them separate, or they'll start conspiring again.

QUIZ
1. Does a low-fat diet prevent heart disease?      □ Yes □ No □ Not sure anymore
2. Are trans-fatty acids as bad as the FDA says?     □ Yes □ No □ Not sure anymore
3. Do nutrition scientists really know what they're doing?     □ Yes □ No □ Not sure anymore
4. Does the government know what it's doing?     □ Don't be silly