One way I get my head going on a new project is to ingest new information about the topic; it seems to get the brain chewing on the problem and gets me motivated to move forward. Often, I do this by finding a book or two on the topic to read and use that to kick things off.
As part of deciding what to do about my diet, I decided to dig into the current thinking and guidance about nutrition, and so I picked up a copy of Nina Teicholz’s The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet. It follows the research started by Gary Taubes in his works like Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health.
What I thought would be a couple of evenings of casual reading turned into over a week of digging into the material. This is a heavily researched book, much like the Taubes’ works are, and it tells a very interesting story about how what we’re being taught and what we’re being offered to eat nutritionally is based on bad science and unproven assumptions.
This book calls into the question our current nutritional doctrine of low-fat, high-carbohydrate diets, so this is clearly controversial material, but it struck home to me. Her research is strong and deep, covering pretty much every nutritional study done in the last 50+ years. What really caught my attention was how she went back to the original research done by nutritional founders like Ancel Keys, evaluating the science and protocols.
What she finds, unfortunately, is a few key, persuasive scientists, starting with Keys, who came up with some ideas they believed would prevent heart disease and promoted them into the mainstream, and a scientific and political structure that took up those ideas and once they accepted them, became intolerant and hostile to any data or idea that attempted to contradict them. Instead of the ideal of science where you study and let the facts dictate what you do, we find ourselves in a situation where the scientists of the day came up with what they believed was the solution, ignored data that disproved or contradicted that belief, and was able to insert that belief into the governmental bureaucracies that made them the policies we all follow and became intolerant of any data or scientist that questioned the validity of this.
In her book, Nina Teicholz sums up her view after years of researching this problem thusly:
The advice that comes out of this book is that a higher-fat diet is almost assuredly healthier in every way than one low in fat and high in carbohydrates. The most rigorous science now supports this statement and leads, by simple logic, to the book’s other important conclusion, that unless you want to eat like an Italian peasant, drinking bowls of olive oil for breakfast, pretty much the only possible way to consume enough fat for good health is to eat the saturated fats found in animal foods. Practically speaking, this means eating whole fat dairy, eggs, and meat—even fatty meat. In short: all those rich, forbidden foods we’ve denied ourselves for so long, because these foods are necessarily part of a healthy diet.
That low-fat diet, it turns out, has been terrible for health in every way, as evidenced by skyrocketing rates of obesity and diabetes and the failure to conquer heart disease. Prescribed to the public by the AHA since 1961 to fight heart disease, and then adopted by the USDA in 1980 as the official dietary plan for all men, women, and children, this regime has failed.
It now appears that since 1961, the entire American population has, indeed, been subjected to a mass experiment, and the results have clearly been a failure. Every reliable indicator of good health is worsened by a low-fat diet.
Everything we know is wrong
Remember when eggs were declared unhealthy and we were all told to stop eating them? Cholesterol was the demon and reducing it in our diet? Turns out this was wrong and eggs are mostly okay today.
Remember when we were told to give up animal fats — lard, bacon fat, etc — in favor of healthier manufactured materials like margarine and hydrogenated vegetable oils (aka Crisco)? Except later on, they discovered trans fats in these fats, and trans fats turned out to be even nastier for us than the animal fats were. Their answer? To invent an even newer manufactured fat, called Interesterified fat and have us eat that instead. You’re probably not aware of these fats, because on your product labels, they’re just called vegetable oils based on what they were originally built from. The problem? There are no studies of these manufactured fats to see whether or not they’re healthy for us; but seriously, after what we learned with Trans fats, what could possibly go wrong?
This is the group that demonized animal fats in favor of vegetable oils, demonized eggs and cholesterol, demonized meat (especially red meat) and saturated fats and pushed us towards a diet higher in carbohydrates, lean meats and chicken (or vegetarianism), vegetable oils instead of lard and animal fats. Studies show that we have followed this advice, and eat massively more chicken as our protein, shifted from animal fats to vegetable oils and are eating more fruits and vegetables in our diet than our ancestors did in the 1930s.
And the result? Massive spikes in obesity and diabetes. Heart disease may or may not be reduced (and increased survivability in heart disease is due to medical advances, no diet) but our longevity not only hasn’t increased, it’s starting to decrease — the children born now will be the first generation to live shorter lives than their parents.
The medical and nutrition establishment’s response hasn’t been to consider that maybe their advice is wrong, but to blame us as consumers for doing it badly and encouraging us to do it even more. But in fact, we have followed their advice:
Americans have dutifully followed official dietary advice to restrict fat and animal products for more than sixty years now, ever since the AHA first recommended this diet in 1961 as the best way to avoid heart disease and obesity. Nineteen years later, in 1980, the USDA guidelines joined in. Since then, the government’s own data shows that Americans have reduced their consumption of saturated fat by 14 percent and overall fat by 5 percent. Red meat consumption has steadily declined, replaced by chicken. According to a USDA report, Americans also complied with official advice to lower the dietary cholesterol found abundantly in egg yolks and shellfish, even though the cholesterol in food has long been known to have little impact on serum cholesterol.
The original rationale for cutting back on fat was to lower serum cholesterol, and Americans have successfully done that, too. Since 1978, total cholesterol levels among US adults have fallen from an average of 213 mg/dL down to 203 mg/dL. The portion of Americans with “high” cholesterol (over 240 mg/dL) has dropped from 26 percent to 19 percent. Moreover, most of that drop has been due to declines in LDL-cholesterol, the target most emphasized by officials for the past thirty years.
In 1952, when Ancel Keys first started arguing for the reduced-fat diet, he predicted that if “mankind stopped eating eggs, dairy products, meats and all visible fats,” heart disease would “become very rare.” This has certainly not been the case. Indeed, during these years, and despite or perhaps because of these efforts, Americans have experienced skyrocketing epidemics of obesity and diabetes, and the CDC estimates that 75 million Americans now have metabolic syndrome, a disorder of fat metabolism that, if anything, is ameliorated by eating more saturated fat to raise HDL-cholesterol. And although deaths from heart disease have gone down since the 1960s, no doubt due to improved medical treatment, it’s not clear that the actual occurrence of heart disease has declined much during that time.
I started digging into all of this when I became diabetic in 2009, because there was a logical disconnect I couldn’t get my head around. What I’d been taught growing up as the healthy way to eat: minimize fat, lean proteins and lots of carbohydrates — was considered best for my body, until I became diabetic, at which point carbohydrates become evil and need to be avoided. Something about this dietary about-face seemed wrong to me.
When I started looking into it and you look at the statistics I found a couple of data items that really bothered me:
- Despite this massive campaign to reinvent the American diet to make us healthier, we aren’t living longer. Where heart disease is reduced, we instead are dying of other things, with increases in cancer, accidents and suicides taking up the slack. In fact, the children being born today will be the first generation to live shorter lives than their parents. If we aren’t actually living longer, but instead simply dying differently, why are we doing this?
The growth rate of our Western Culture Diet epidemics very closely mimics the adoption rate of these new, healthier diets. When people eat this diet, they get fat and sick.
Everything they’ve been telling us is wrong, is not backed up by the research. But it’s become dogma within the medical and political establishments which have ignored or downplayed contradictory research and harassed and stigmatized researchers attempting to look beyond the dogma. It’s a massive case of science gone wrong, with a bureaucracy reinforcing a set of beliefs about what was right instead of investigating and validating them — because every time they tried, the data failed to back them up.
Saturated Fat is not evil
“Diet Linked to Cut in Heart Attacks,” reported the New York Times in 1962, when the coronary trial results started to come out: they showed that men who stayed on the diet saw a drop in both cholesterol and blood pressure and lost weight. Their risk for heart disease appeared to be slamming into reverse, an outcome that looked like a reassuring condemnation of saturated fats. But then, a decade into the trial, investigators began to find “somewhat unusual” results: twenty-six members of the diet club had died during the trial, compared to only six men from the controls. Eight members of the club had died of heart attacks, but not one of the controls.
In the discussion section of the final report, the authors (who no longer included Jolliffe, because he had died of a heart attack in 1961) emphasized the improved risk factors among the men in the diet club but ignored what those risk factors had blatantly failed to predict: their higher death rate. That result was buried in the study report. The authors avoided the very question that mattered most: Would someone live longer on a “prudent” diet? The answer from the Anti-Coronary Club was clearly no.
When you start digging into the original studies, you keep finding results like this, which are then explained away or ignored, because scientists knew if they didn’t confirm the conventional wisdom of the low-fat healthy diet, they’d lose their grant funding, their papers would be rejected. Career suicide. But the data is there, but nobody could fight the established bureaucracy.
Not until 1992, in fact, did a Framingham study leader publicly acknowledge the study’s findings on fat. “In Framingham, Mass, the more saturated fat one ate . . . the lower the person’s serum cholesterol . . . and [they] weighed the least ,”
The Inuit traditionally ate an almost all-meat diet, high in saturated fats. Obesity, diabetes, heart disease and cancer were almost unknow in their societies. Then they gained wide contact with western society and as they converted to a western diet, they got fat and diabetes and cancer spiked and people started dying of heart disease.
By contrast, wherever the Inuit ate carbohydrates instead of their traditional food, their health declined. Large numbers of women and children suffered from anemia, and he found his first case of diabetes, previously unreported in the Canadian Arctic, in an Inuit eating these “civilized” foods. He also found chronic ear infections and bad teeth.
The other major chronic disease whose appearance seemed to coincide with the coming of refined carbohydrates was cancer. Cancer went from being a rarity in isolated populations such as the Inuits, to a common killer, and the change happened whenever these populations began consuming sugar and white flour.
The same trend was found in native populations around the world: the western diet appeared, and the populations got less healthy.
There’s very little evidence showing meats and saturated fats damage your health; most evidence in fact shows that the opposite. Yet we’ve demonized saturated fat and red meats in our diet in favor of carbohydrates and lean meats such as chicken.
From 1971 to 2000, they increased their consumption of carbohydrates by nearly 25 percent, according to statistics from the Centers for Disease Control and Prevention (CDC), and they also successfully met the USDA goal of reducing overall fat consumption to 35 percent of total calories or less. Health authorities consider these accomplishments a step in the right direction, and as the years pass, their official message has remained the same: The USDA’s most recent set of Dietary Guidelines, in 2010, continued to emphasize that Americans should shift their food intake to a more “plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts and seeds.”
The reality in America from the 1970s onward was that the nation’s health was already worsening from the failure of the low-fat diet to prevent heart disease or obesity,
That heart disease, diabetes, and even cancer might be caused by the kinds of carbohydrates consumed in modern diets has also been the conclusion of many doctors and researchers who observed primitive populations as they began to eat these foods.
Do you start to see why, when you take a step back and look at the changes that have been forced on us on our diets in the last fifty years, and the resulting changes that have happened in lockstep with that to the population, that I started wondering if the core of what we were taught was flawed?
The sum of the evidence against saturated fat over the past half-century amounts to this: the early trials condemning saturated fat were unsound; the epidemiological data showed no negative association; saturated fat’s effect on LDL-cholesterol (when properly measured in subfractions) is neutral; and a significant body of clinical trials over the past decade has demonstrated the absence of any negative effect of saturated fat on heart disease, obesity, or diabetes.
Vegetable Oil is
Remember how I mentioned that even where we reduced deaths by heart disease we didn’t increase how long we lived? We simply died of other causes, and cancer rates increased to pick up the slack.
So it seems fair to say that at the height of the meat-and-butter-gorging eighteenth and nineteenth centuries, heart disease did not rage as it did by the 1930s. XIII Ironically—or perhaps tellingly—the heart disease “epidemic” began after a period of exceptionally reduced meat eating. The publication of The Jungle , Upton Sinclair’s fictionalized exposé of the meatpacking industry, caused meat sales in the United States to fall by half in 1906, and they did not revive for another twenty years. In other words, meat eating went down just before coronary disease took off. Fat intake did rise during those years, from 1909 to 1961, when heart attacks surged, but this 12 percent increase in fat consumption was not due to a rise in animal fat. It was instead owing to an increase in the supply of vegetable oils, which had recently been invented. Nevertheless, the idea that Americans once ate little meat and “mostly plants”—espoused by McGovern and a multitude of experts—continues to endure. And Americans have for decades now been instructed to go back to this earlier, “healthier” diet that seems, upon examination, never to have existed.
There’s a statistical correlation between the increase in use of vegetable oils in our diets and the rate of cancer in our lives. There is also data suggesting, but the links are far from proven, of these oils and suicide and other mental issues, including possibly an increase tendency towards violence. Yet these issues haven’t been significantly studied, even though public policy has caused us to shift our eating so that about 8 percent of our calories now come from these oils.
Remember that the NIH held a series of workshops in the 1980s to address the fact that the early clinical trials using diets high in soybean oil showed subjects dying of cancer at alarmingly elevated rates. Gallstones were also associated with diets high in vegetable oils. And a large body of subsequent research has demonstrated that these types of oils, which are high in a type of fatty acid called omega-6, compete with the healthier omega-3s, found in fish oils, for vitally important spots in every cell membrane throughout the body, including those in the brain.
The tsunami of omega-6s that have entered our diets via vegetable oils appears to have literally swamped the omega-3s (the supply of which has remained relatively constant over the past century). A large body of literature has now documented the apparent results: while omega-3s fight the kind of inflammation that is implicated in heart disease, omega-6s are largely proinflammatory. More speculatively, research over the past decades has shown that omega-6s are related to depression and mood disorders.
Remember that subjects in the early clinical trials who were eating a lot of soybean oil also had higher rates of death due to suicides and violence, which have never been explained. Because those trials were not well controlled, all their results, both positive and negative, have to be viewed with some skepticism.
Inflammation and the functioning of cell membranes may be equally if not more important to our health, and the evidence to date suggests these are negatively affected by vegetable oils. The unexplained clinical trial findings about violence are an additional worrisome data point. A full accounting of the influence of vegetable oils on health is vitally important because Americans are eating a lot of them, and the potential impact of vegetable oils—interesterified, hydrogenated, or even as just plain oils—is obviously huge.
This is another aspect of this huge, society-wide, generational dietary experiment we all find ourselves somehow enrolled in. It’s one that hasn’t yet surfaced into wide public view the way trans-fats did, but scientists are starting to take a closer look at it, and I expect what we find won’t make us happy.
What’s wrong with the Mediterranean Diet
The Mediterranean Diet has been the recommended diet for us to follow in the 1990s. It has a problem, however: it is an artificial creation and the Mediterranean Diet doesn’t actually exist.
More correctly, there are dozens of forms of the diet around the globe, each with major variations from what we’re being recommended to eat, but nowhere is there a culture that eats the Mediterranean Diet as it’s published as a recommendation, and there’s no culture with a historical record of having eaten a diet like that successfully over time.
Even olive oil, one of the backbones of the diet, has very little historical basis.
Did the use of olive oil as a food go back much beyond the early twentieth century even? Was it the “dominant item of the diet,” going back “at least four thousand years,” as Keys claimed? Amazingly, it seems not. “Less than 100 years ago, ordinary people in many parts of Greece ate far less oil than today,” wrote a French historian in 1993. Greek archaeologist Yannis Hamilakis, who has researched the subject extensively, looked at Crete in particular and found that the oil was insignificant as a subsistence crop before modern times.
The diet is based on the idea that the cultures around the Mediterranean were generally healthy and with few heart-related problems. Many of the studies were flawed, however. One early key study, Ancil Keys’ Cretan Study, had very few participants, was taken during Lent (a time of very little eating of meat) and also during the post-war time when food shortages existed and people were eating what they could get, not what they traditionally ate.
Another historical inaccuracy of the Mediterranean diet pyramid is the near-absence of red meat. This is ironic because the Cretans actually preferred red meat. “In Crete the meat is mostly goat, beef, and mutton, with an occasional chicken or rabbit. In Corfu, the meat is mostly beef and veal,” Keys wrote. An earlier survey of the Cretan diet also found the same thing. And it’s hard to find a cookbook or historical text on Italy, Spain, or Greece that does not make clear how the populations in these countries favored lamb, goat, and oxen over fowl.
Historically — if you look at historical documents and cookbooks — the Cretans loved and ate a lot of lamb and goat and beef. But when the diets were created around the idea of the Mediterranean Diet, since red meats were considered unhealthy they were dropped from the diet in favor of leaner proteins like chicken and fish.
So the Mediterranean Diet is not a regional cuisine, but an artificial construct built to support the idea of the low-fat, no-red-meat dietary ideas, using various foodstuffs that are used by the cultures around the Mediterranean, but these were arbitrarily chosen to fit the diet, rather than a diet created around what was shown to be a historically healthy eating culture.
That said, olive oil is proving to be a much healthier oil for us to eat (along with tropical oils like Palm) than the other vegetable oils we’ve been forced to adopt like Safflower or Canola. Much of the core of the diet is good — except in most of the cultural diets it’s supposed to represent, you’ll find a lot more meat, and a lot of that meat will be red meats. Studies are starting to show this:
Therefore PREDIMED, like the Israeli trial, simply demonstrated that the Mediterranean diet was better than the low-fat diet . XXX If the Israeli trial had never existed,
The Mediterranean diet may very well have outperformed the low-fat diet simply because it delivered more dietary fat, since the largest difference between the low-fat and Mediterranean groups was the amount of nuts and olive oil they ate.
In creating our current dietary programs, the medical establishment ignored historical facts in favor of building a nutritional program around their ideas of what a healthy diet should be.
The loss of a historical perspective about our food traditions is perhaps the overriding reason that our nutrition policy has gone so far astray. Authorities tell us that there’s “no record” of any long-term “data” on humans eating a diet high in saturated fats, and by this they mean that there are no clinical trials lasting two or more years on a diet high in animal products. But there are four millennia of human history that these experts could have consulted. Cookbooks, histories, diaries, memoirs, novels, food logs, or accounts by missionaries, doctors, explorers, and anthropologists—altogether a virtually limitless number of books, from the Bible to the plays of Shakespeare—which make clear how animal foods made up the core of human meals for thousands of years. During these times, people had shorter life expectancy, true, but they died young of infectious diseases. As adults, their lives and deaths were all but free of the chronic diseases of obesity, diabetes, and heart disease that we die from now; and if they did suffer the latter, it was not at anywhere near the epidemic rates that we do today.
Unfortunately, it’s becoming more and more obvious that this is a flawed system; we aren’t healthier, we aren’t living longer, and nutritionally-based illness is spiking into epidemic numbers. To me, that means it’s time for a rethink, and this piece was an attempt to get my head around those ideas.
All of the quoted material in this piece is from the Teicholz book, and is my attempt to summarize what I’ve found in my dietary studies, most recently with the Teicholz book. My goal here was to raise your awareness of the issues at hand, not explain them in detail, and I tried to avoid falling into TL;DR land along the way.
My strong recommendation is that you get a copy of the book and read it, and study the science that it discusses. There are a lot of big, complicated issues here and a lot of conflicting advice. I am not recommending any dietary advice; I am suggesting you listen to the message Teicholz is issuing and decide how or if you want to make changes based on what you learn.
I do think much of what we’ve been taught about diet and nutrition is wrong. The link between the shift from the 1950’s style diet to today’s healthy diet and the rise of obesity, diabetes and cancer is too strong to be ignored — and I find the argument that we’re simply not following the experts advice well enough to be self-serving and arrogant by the establishment. They’re so convinced they’re right that they’re ignoring the fact that by following their advice millions of us have gotten fat and sick, not healthy. Any rational look at the result of these dietary changes should be one of reconsideration, not telling us to do it even more to make the results happen.
The dogma surrounding this dietary advice is starting to break down. The issues raised, first by Gary Taubes and now by Teicholz, have at least started allowing scientists to study this without having to fit the results into the mainstream ideas, and I expect over the next five or ten years we’re going to see an increasing number of never mind moments like we saw with the demonization of the egg.
If you take the Ornish diet as one extreme and the Atkins diet as the other, the data is increasingly starting to show the Atkins side of the equation to be healthier, although I personally find the Atkins diet too extreme and not-sustainable. I know too many people who lost a big chunk of weight on Atkins, fell off the wagon, and gained it all back. For me, though, the Atkins model is a signpost to where we want to get, but with more moderate and a diet aimed at long-term adoption.
There’s still a lot we need to know here, but I think we can agree the existing system is broken: the results we’ve gotten out of this culture-wide experiment is obesity and diabetes, and that’s not acceptable.
Until the studies are done and the scientific community accepts them there’s going to be confusion and conflict and to some degree we’re going to have to be on our own figuring out what works for us. If what you’re doing works — don’t change it. But if it’s not….
I think it’s useful to look to the past, before all of these changes are pushed into our daily diet. That is, I think,the goal we need to navigate towards, and that means to stop worrying around red meat and saturated fat, being wary of vegetable oils (and use olive oils when you can), do away with the low-fat, high-carbohydrate diet in favor of a more balanced one, and to try to eat more traditionally and eat quality ingredients.
The enemies are not beef and saturated fat and eggs. The enemies are flours (especially white flours) and sugars. Carbohydrates, not fats.
And that means un-learning everything they’ve been teaching us about what we ought to be eating.
My Action Plan
So, what does this mean for me?
In reality, not a lot; my diet is actually very close to the ideal diet, thanks for a lot of work over the years reinventing myself away from the days of burgers and fries six days a week.
My goal is to be eating at least 25% of calories from proteins, and no more than 35% of my calories from carbohydrates, and limiting carbohydrates to < 15% coming from sugars. By definition, the rest will come from fat; while I am trying to keep saturated fats under 40% of those calories, I’m not worrying about the percentages as long as I eat a reasonably healthy mix of foods in the diet.
My reality: when I started logging my food over the last ten days my carbohydrates were too low (around 20%), especially early in the day, so I’ve added some to the mix (not what I expect). That’s actually reduced the morning/afternoon hunger/snack temptations and reduced my overall calorie count while balancing out my mix. I’m currently at about 24% protein, 33% carbohydrate and 44% fat, with about 18% of carbohydrate calories coming from sugars and about 40% of fat calories saturated. The one number I need to dig into more deeply is sodium intake, which is high, but a big part of that is that I really love my cheese, and there’s not much I can do about the sodium embedded in it.
I have, over time, worked pretty successfully at breaking my sweet tooth habit; I’ve cut out 90% of my alcohol and 99% of my fast food eating. Over the last year I’ve been cutting back my Starbucks runs to once or twice a week. Based on the info I’ve gotten from this book, I need to go and take a closer look at vegetable oils in the diet, but we’ve been big users of olive oil already and I don’t think there’s a major change I need to make there.
I’m going to stop feeling guilty about my occasional tryst with a package of salami when the idea of eating more turkey at lunch just bores me. Over time I’ve shifted my lunches to include more protein (primarily ham or turkey) and less cheese, but while I’d like to get that protein percentage up, in reality, there’s only so much turkey you can eat, and with my nut allergy common protein sources are blocked — I can’t do the walnut/cashew/almond snack thing.
It’s actually kind of nice to come out of this kind of review thinking hey, things are in pretty good shape. Now that I have a baseline my next step is to work on reducing portion sizes at dinner to cut about 200 calories out of the meal, which will be where I work to kick off trying to reduce the weight. That, and get the exercise moving. I’ve started that, with everything that impacts, it’s a slow process, but it’s started.
My recommendations for you?
- Read the book. Consider what it says, and think about whether you want to make changes
- If you want to make changes, whole grains instead of white flour is one starting point.
- Another is examine which oils you’re using, and seeing where you can shift to olive oil.
- Look closely at the sugars in your diet, whether white sugar, fructoses and fruits, or (horror) high yield fructose. I’m convinced that’s a driver in the problems we’ve found and the evidence is starting to mount on it, just as with fats, we ran into the problems of the industrialized trans fats.
- Eat closer to nature. The less processing the better is a good first goal.
And realize we have a long way to go before we really know the answers here, because the establishment was so sure it already had the answers that it didn’t need to go prove itself right. And when it tried, it couldn’t. And because so many people have staked their careers on the status quo, expect the necessary corrections to take a long time and at times be a very loud and painful process.
This is sad, but this is what happens — to an entire generation of us — when science forgets science and allows dogma to dominate the answers.
But at least it seems we have finally started the course correction to a truly healthier diet.