319 Suspect “Science” – the Low-Fat Diet

Fifty years ago I regularly read Organic Gardening and Prevention Magazine—back-to-the earth publications urging readers to embrace a simpler, more natural approach to life.   The articles contained much dietary advice, some of which I embraced and still follow.  I also heeded the advice set forth in Runners’ World, loading up on carbohydrates as the best fuel for active athletes.  Then when the leading “experts” in nutrition began promoting a “low fat” diet and my primary care physician urged me to embrace it, I more-or-less ate in accord with its dictates.  Now and then I heard of folks embracing a “low carbohydrate” rather than “low fat” regimen (as in the Atkins diet), but I assumed they were food faddists or kooks of some sort.   After all, the US Department of Agriculture had issued its “food pyramid” that supposedly summed up the nutritional experts’ evidence—the last word on it all.  Eating lots of carbs, following a near-vegetarian diet and exercising, I believed, was the sure way to good health.  

But recently my curiosity was piqued when my step-son and his family embraced the “Keto” diet.  Then I met a man who’d lost nearly 30 pounds following a “low carb” diet who he suggested I read Nina Teicholz’s The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet (New York:  Simon & Schuster, Kindle Edition, c. 2014).   I did so and found it both provocative and persuasive.  It’s a very personal book, since Teicholz had for many years devoutly followed the low-fat prescriptions promoted almost everywhere.  But then she moved to New York and found work writing restaurant reviews—and getting free meals!  “Suddenly,” she says, “I was eating gigantic meals with foods that I would have never before allowed to pass my lips:  pâté, beef of every cut prepared in every imaginable way, cream sauces, cream soups, foie gras—all the foods I had avoided my entire life.  Eating these rich, earthy dishes was a revelation. They were complex and remarkably satisfying.  I ate with abandon.  And yet, bizarrely, I found myself losing weight” (p. 2).  That led her to seriously question what she’d been told, and in time she came to believe “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.  . . . .  Finding out the truth became, for me, an all-consuming, nine-year obsession.  I read thousands of scientific papers, attended conferences, learned the intricacies of nutrition science, and interviewed pretty much every single living nutrition expert in the United States” (p. 2).

She discovered that a small coterie of nutritionists, trying to explain skyrocketing numbers of heart attacks, had “hypothesized that dietary fat, especially of the saturated kind (due to its effect on cholesterol), was to blame.  This hypothesis became accepted as truth before it was properly tested” (p. 3).  Critics of the hypothesis—and there were many—found themselves ostracized and effectively silenced, “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” (p. 4).  The dissenters, however, have been proven right!  For what Teicholz discovered “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.  This book lays out the scientific case for why 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” (p. 7).

Teicholz begins her presentation with some telling illustrations, including the story of Vilhjalmur Stefansson, who lived for several years with the Inuit natives in the Canadian Arctic a century ago.  They ate virtually nothing but fat meat and enjoyed good health.  Subsequently he and another man volunteered to duplicate the Inuit diet and thrived for a year (under medical supervision) eating nothing but meat.  Then comes evidence from Africa, where the Masai and other tribal peoples eat little except meat and dairy products without experiencing significant heart disease.  And in India, “Sir Robert McCarrison, the British government’s director of nutrition research in the Indian Medical Service and perhaps the most influential nutritionist of the first half of the twentieth century, wrote that he was ‘deeply impressed by the health and vigour of certain races there.  The Sikhs and the Hunzas,’ notably, suffered from ‘none of the major diseases of Western nations such as cancer, peptic ulcer, appendicitis, and dental decay.’  These Indians in the north were generally long-lived and had ‘good physique[s],’ and their vibrant health stood ‘in marked contrast’ to the high morbidity of other groups in the southern part of India who ate mainly white rice with minimal dairy or meat” (p. 14).

Given such evidence, one wonders why meat and dairy products suddenly became the great culprits to be avoided!  In large part the notion “that saturated fat causes heart disease was developed in the early 1950s by Ancel Benjamin Keys, a biologist and pathologist at the University of Minnesota” (p. 19).  He and his colleagues zeroed in on cholesterol as the primary culprit causing heart disease.  Though it “is a vital component of every cell membrane, controlling what goes in and out of the cell,” it also helped form the “atherosclerotic plaques” which clogged “the arteries until it cuts off blood flow, [and it] was thought at the time to be the central cause of a heart attack” (p. 21).   Keys himself ran tests that involved giving volunteers massive amounts of cholesterol-rich foods without affecting the cholesterol levels in their blood.   “He found that ‘tremendous’ dosages of cholesterol added to the daily diet—up to 3,000 milligrams per day (a single large egg has just under 200 mg)—had only a “trivial” effect” (p. 23).  Disregarding his own research, Keys simply, instinctively knew better—eating fat must make you fat; cutting calories would cut down weight.  “‘No other variable in the mode of life besides the fat calories in the diet is known which shows anything like such a consistent relationship to the mortality rate from coronary or degenerative heart disease,’” he declared in 1954.  “If people just stopped eating eggs, dairy products, meats, and all visible fats, he argued, heart disease would ‘become very rare’” (p. 32). 

Soon thereafter, in 1955, President Dwight Eisenhower had the first of several several heart attacks and his personal doctor, a Harvard Medical School professor, Paul Dudley White strongly endorsed Keys’ position.  Speaking to the nation from Ike’s bedside, White explained why heart attacks occurred and urged everyone to stop smoking and eat less saturated fat and cholesterol-laden foods.  Writing a front-page New York Times article regarding the President’s health, White cited Ancel Keys’ “brilliant” work and urged the nation to follow his advice.  In fact, the President had no family history of heart disease and had quit smoking a decade earlier.  He exercised, had normal blood pressure, and his total cholesterol (167) was considered normal.  After his heart attack, however, Ike became “obsessed with his blood-cholesterol levels and religiously avoided foods with saturated fat; he switched to a polyunsaturated margarine, which came on the market in 1958, and ate melba toast for breakfast”(p. 33).  He rarely ate meat or eggs or cheese, but by the end of his presidency his cholesterol registered 259—just days after Ancel Keys appeared on Time magazine’s cover, urging everyone to embrace the heart-healthy diet Ike had been so diligently following.  In  Ike’s case, sadly enough, the more he dieted the more cholesterol flooded his system!  He died of heart disease in 1969.

To prove his diet-heart hypothesis, Ancel Keys orchestrated a “Seven Countries” study that seemed to do so.  Yet though frequently cited as evidence, his study at best established “an association between a diet low in animal fats and minimal rates of heart disease; it could say nothing about whether that diet caused people to be spared the disease” (p. 42).  Carefully examined, Keys’ study was full of flaws—nearly fraudulent in some aspects.  But though considerable evidence existed to suggest he had little demonstrable (i.e. clinical) proof, he managed to enlist the American Heart Association in his cause and persuaded the National Institutes of Health to subsidize his research.  Time magazine celebrated him as “Mr. Cholesterol” and he enjoyed virtually unanimous media support, urging folks to eat less meat, drink less meat, and eschew fats of all sorts. 

Columnists such as New York Times health writer Jane Brody relentlessly promoted Keys’ diet-heart hypothesis, and everyone of consequence agreed!  Brody urged everyone to follow a low-fat diet and in 1990 published a seven-hundred-page manifesto:  The Good Food Book: Living the High-Carbohydrate Way.  The message was crystal clear:  dietary fat elevated blood cholesterol 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” (p. 53).

In fact, while Keys was promoting his hypothesis a multitude of careful, clinical studies—“some of the biggest and most ambitious trials of diet and disease ever undertaken in the history of nutrition science” disputed it (p. 57).  Triglycerides, not cholesterol, looked like a more probable culprit.  Total cholesterol apparently has little significance, for HDL-cholesterol (the “good” kind) contributes to good health whereas LDL-cholesterol (the “bad” kind) proves deleterious.  Consuming vegetable oils, not animal fats, appeared closely linked to the increased incidence of heart disease.  And carbohydrates, not fat, seemed to actually cause obesity.  One of the most celebrated studies—the Framingham Study—early seemed to substantiate Keys’ position, but in 1992, a study leader admitted:  “‘the more saturated fat one ate . . . the lower the person’s serum cholesterol . . . and [they] weighed the least’” (p. 67).  More alarmingly, many studies revealed  “an extremely uncomfortable fact for the promoters of the diet-heart hypothesis:  people who eat less fat, particularly less saturated fat, appear not to extend their lives by doing so. Even though their cholesterol inevitably goes down, their risk of death does not” (p. 74).  “Another study in Israel followed ten thousand male civil service and government employees for five years and found no correlation between heart attacks and anything they ate.  (The best way to avoid a heart attack, according to the study, was to worship God, since the more men identified themselves as being religious, the lower was their risk of having a heart attack” (p. 98).

Yet such dissenting studies failed to register with the American public.  In large part this was because the federal government threw its massive weight into promoting the low-fat diet.  In 1977 Senator George McGovern issued a committee report—“Dietary Goals”—which declared that Americans’ diet was harming their health.  Eating too much meat and eggs and dairy products was responsible for “heart disease, cancer, diabetes and obesity,” whereas eating grains, fruit, and vegetables, would improve the nation’s health.  Though the Dietary Goals came out of a typically brief Senate hearing—not a demonstrative scientific study—it had enormous impact.  “We cannot afford to await the ultimate proof before correcting trends we believe to be detrimental,” said the senators.  “So it was that Dietary Goals . . . without any formal review, became arguably the most influential document in the history of diet and disease.  Following publication of Dietary Goals by the highest elective body in the land, an entire government and then a nation swiveled into gear behind its dietary advice” (p. 120).  Thereafter the Dietary Guidelines for Americans was published, including the USDA food pyramid which was widely endorsed as a guide to good health.  “Here, then, was the new reality:  a political decision had yielded a new scientific truth” (p. 125).   As of 2010 the USDA was still promoting a plant-based diet—grains, vegetables, fruits and nuts.

Yet the USDA had no good evidence for its edict!  In fact, “the largest and longest trial of the low-fat diet ever undertaken” (the Women’s Health Initiative) demonstrably failed.  “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” (p. 173).  Unfortunately:  “Despite the original good intentions behind getting rid of saturated fats, and the subsequent good intentions behind getting rid of trans fats, it seems that the reality, in terms of our health, has been that we’ve been repeatedly jumping from the frying pan into the fire. The solution may be to return to stable, solid animal fats, like lard and butter, which don’t contain any mystery isomers or clog up cell membranes, as trans fats do, and don’t oxidize, as do liquid oils.  Saturated fats, which also raise HDL-cholesterol, start to look like a rather good alternative from this perspective” (p. 285).

That “good alternative,” Teicholz believes, is conveniently set forth in the Atkins Diet.  Robert Atkins was a cardiologist who helped tens of thousands of patients lose weight.  “Based on his experience treating patients, Atkins believed that meat, eggs, cream, and cheese . . . were the healthiest of foods.  His signature diet plan was more or less the USDA pyramid turned on its head, high in fat and low in carbohydrates.  Atkins believed that this diet would not only help people to lose weight but also fight heart disease, diabetes, and possibly other chronic diseases as well” (p. 287).  As an active physician, however, he had no “scientific studies” to bolster his claims.  He urged academic “experts” to look at his files, but none was interested.  Though many considered Atkins a faddish innovator, his dietary prescriptions actually had a long, impressive history, beginning with William Banting’s 1863 pamphlet, Letter on Corpulence, Addressed to the Public, which sold thousands of copies around the world and enabled him personally to shed unwanted pounds.  Then:  “In the United States, Sir William Osler, a worldwide medical authority in the late nineteenth century and one of the founders of Johns Hopkins Hospital, promoted a variation of the diet in his seminal 1892 medical textbook.  And a London physician, Nathaniel Yorke-Davis, used a version of the low-carbohydrate diet to treat the obese President William Taft from 1905 on, helping him lose 70 pounds” (p. 293).

Scores of other researchers reached the same conclusion, for during the first half of the 20th century it was discovered how insulin profoundly affects body-weight.  “The body secretes insulin whenever carbohydrates are eaten.  If carbs are eaten only occasionally, the body has time to recover between the surges of insulin.  The fat cells have time to release their stored fat, and the muscles can burn the fat as fuel.  If carbohydrates are eaten throughout the day, however, in meals, snacks, and beverages, then insulin stays elevated in the bloodstream, and the fat remains in a state of constant lockdown.  Fat accumulates to excess; it is stored, not burned.” However, “the absence of carbohydrates would allow fat to flow out of the fat tissue, no longer held hostage there by the circulating insulin, and this fat could then be used as energy.  A person would lose weight, theoretically, not because they necessarily ate less but because the absence of insulin was allowing the fat cells to release the fat and the muscle cells to burn it” (p. 296).  A small group of scholarly researchers have been compiling compelling evidence regarding the advantages of a low-carb, high-fat diet, though they have as yet failed to dislodge the dominant “consensus” regarding healthy diets. 

Yet to Teicholz:  “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.  In other words, every plank in the case against saturated fat has, upon rigorous examination, crumbled away.  It seems now that what sustains it is not so much science as generations of bias and habit—although, as the latest 2013 AHA-ACC guidelines show, bias and habit present powerful, if not impenetrable, barriers to change” (p. 326).

So the low-fat mantra is dutifully repeated in most sectors, and Americans have obediently reduced their consumption of red meat, eggs, and butter.  “Americans continue to avoid all fats:  the market for ‘fat replacers,’ the foodlike substances substituting for fats in processed foods, was, in 2012, still growing at nearly 6 percent per year, with the most common fat replacers being carbohydrate-based” (p. 330).  Yet what they’ve believed lacks credibility.  Angel Keys declared, in 1952, that heart disease would “become very rare” if folks followed his low-fat diet.  In fact, while following his prescription “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” (p. 327).

Teicholz concludes her presentation with these sobering words:  “If, in recommending that Americans avoid meat, cheese, milk, cream, butter, eggs, and the rest, it turns out that nutrition experts made a mistake, it will have been a monumental one.  Measured just by death and disease, and not including the millions of lives derailed by excess weight and obesity, it’s very possible that the course of nutrition advice over the past sixty years has taken an unparalleled toll on human history.  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.  Whereas diets high in fat have been shown, again and again, in a large body of clinical trials, to lead to improved measures for heart disease, blood pressure, and diabetes, and are better for weight loss.  Moreover, it’s clear that the original case against saturated fats was based on faulty evidence and has, over the last decade, fallen apart.  Despite more than two billion dollars in public money spent trying to prove that lowering saturated fat will prevent heart attacks, the diet-heart hypothesis has not held up. In the end, what we believe to be true—our conventional wisdom—is really nothing more than sixty years of misconceived nutrition research” (p. 330).

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Much that Nina Teicholz says in The Big Fat Surprise was earlier set forth, in much more detail and scholarly erudition, by Gary Taubes in Good Calories, Bad Calories (New York:  Knopf Doubleday Publishing Group, Kindle Edition, c. 2007).  “The reason for this book is straightforward,” he says:  “despite the depth and certainty of our faith that saturated fat is the nutritional bane of our lives and that obesity is caused by overeating and sedentary behavior, there has always been copious evidence to suggest that those assumptions are incorrect, and that evidence is continuing to mount. ‘There is always an easy solution to every human problem,’ H. L. Mencken once said—‘neat, plausible, and wrong’” (#216).  That easy solution—the low-fat diet—was promoted by Universities and federal bureaucracies, but doing so has not particularly affected death rates or overall health because total cholesterol—the big bogeyman in dietary circles—has little to do with heart disease!   But Ancel Keys had insisted, based on statistical data, the contrary.  And he won the day, making low-fat diet virtually mandatory for folks desiring to live well.  Yet he may well have been wrong!  And we’ve all paid the price for his error!