HILDA LABRADA GORE: Nina Teicholz is an investigative journalist and author of The Big Fat Surprise, an international and New York Times bestseller. The Economist called it the number-one science book of 2014. It was one of the first publications to make the case that saturated fats—the kind found in dairy, meat and eggs—are not bad for our health. Nina, I understand you spent a decade researching dietary fat and nutrition policy to write your book. How did you get interested in this topic?
NINA TEICHOLZ: It does seem like a crazy amount of time to spend reading thousands of nutrition science papers. There were a couple things that initially interested me. First, when I moved to New York, I started doing a restaurant review column for a little neighborhood newspaper. The paper couldn’t afford to pay for the meals, so I had to just eat whatever the chef wanted to send out to me. I was a vegetarian at the time, but chefs are interested in showcasing meat and things like trifle, creamy sauces, foie gras and pȃté. All of these were things that either I had not eaten before or had not eaten in nearly two decades. I found these foods to be textured, earthy, rich, interesting and strangely satisfying. Within a month, I lost ten pounds without even trying! I went to the doctor, and he said, “Wow, your cholesterol levels look better than ever.” That was a mystery because it seemed contrary to everything we all believed about healthy diets.
The second thing was that Gourmet magazine assigned me to write a story about trans fats as part of a series of investigative food stories. I didn’t know anything about trans fats, but I started researching them. I found out that there was a much bigger story about how we had gotten everything about fat wrong. Fat is what our nutrition policy is most obsessed about—lowfat, nonfat, how much fat, good or bad fat. I started interviewing scientists who were terrified to talk to me. They couldn’t talk to me about or comment on dietary fat. People would hang up on me, or I’d get off the phone and I’d be shaking, feeling like I was investigating the mob. I wondered, “What is going on here?” There was a real story about how science had been suppressed. How scientists had been bullied and their careers ruined for not agreeing with the party line on dietary fat. That was incredibly intriguing and interesting to me as a journalist. I knew there was a big story there, but it took a long time to get to the bottom of it.
HG: I could see how that would draw you in. It’s like you’re walking into a mystery novel with all this intrigue. “Why are they hanging up on me if I’m just asking questions about fat?”
NT: In many quarters, questions such as “Do you think it’s true that maybe dietary fat is not bad for health?” or “Is it possible that fat doesn’t cause cancer?” or “Is it possible that saturated fat doesn’t cause heart disease?” are considered heretical. Nobody wants to go on record stating views contrary to prevailing dogma. You think science proceeds calmly, logically and rationally forward, step by step, but one thing that really shocked me in my research was the discovery that this was not at all the case in nutrition science. It is supposed to be normal for scientists to challenge ideas and discuss and debate them. Instead, in nutrition science (and maybe in other fields, too), scientists who raised questions had their grants canceled and were disinvited from conferences. Their careers would stall, and they would get drummed out of university departments. I have dozens and dozens of stories like that from scientists who merely contradicted the official line—that is largely still against dietary fat.
HG: Why is the party line still largely against dietary fat? Who was and is trying to clamp down on this information that fat might not be a problem?
NT: I have to go back and cast the history to give some structure to this story. It all started with saturated fat. Saturated fat in meat and dairy, eggs, and also coconut and palm oils. The idea that saturated fat, along with dietary cholesterol, clogged the arteries and caused heart disease came to the fore in the 1950s when heart disease came out of nowhere to become the leading number-one killer. President Eisenhower had a heart attack in 1955 and was out of the Oval Office for ten days. There was this panic in the nation about what causes heart disease. There were a number of other ideas out there—vitamin deficiencies, stress or Type-A personalities—but the idea that saturated fat and cholesterol caused heart disease took hold.
This idea was championed by a pathologist at the University of Minnesota named Ancel Keys. In 1961, Keys got the idea implanted into the American Heart Association and was on the cover of Time magazine. The very first official recommendations anywhere in the world to avoid saturated fat and cholesterol to prevent heart disease came out in 1961. By 1970, the American Heart Association had expanded its recommendations to cover not just saturated fat but total fat. The concept was also taking root that you could control your weight by cutting calories. The thinking went that fat is nine calories per gram, compared to protein or carbohydrate being four or five calories per gram. So it seemed prudent to cut back on fat as a means of cutting calories.
The U.S. government got on board with the whole lowfat, low-saturated fat, low-cholesterol program. In 1980, the first USDA dietary guidelines came out—and then the whole world copied us. We exported our dietary policy to most Western nations. Everybody got in line with our idea about fat—nearly all governments, the World Health Organization, all professional institutions and the American Heart Association, which is the largest non-profit in America. The belief was that fat didn’t just cause heart disease but also obesity and maybe diabetes and cancer. That thinking held true until recently.
In 2013, the American Heart Association eliminated its cap on total fat and basically started tip-toeing away from the lowfat diet. They still believe that saturated fat is bad for you, but they’ve dropped the restrictions on total fat. Now they say that you can eat more fat overall, but it has to be what they call the “good” kinds of fat. For them, that’s nuts, fish, seeds and vegetable oils. In the last year, our federal government, which has always been extremely close to the American Heart Association position, has just adopted the same recommendations. Now we are in a situation where we no longer officially recommend a lowfat diet, but that shift has happened quietly, with zero public announcement. Nobody knows that the lowfat diet is no longer recommended, which is extraordinary. People still avoid fat because they think it’s bad for health, and there are still caps on saturated fat.
The government and the American Heart Association also abandoned their prior recommendations to control dietary cholesterol through restrictions on egg yolks, shellfish and liver. The caps on those foods, which we largely have excised from our diet, are now gone. It turns out it doesn’t matter how much cholesterol you eat because your body regulates its own cholesterol. Cholesterol is an essential part of every cell in your body, so if you eat a lot, your body just downregulates its own production. That has actually been known since the late 1970s. The U.S. is the last country to give up its caps on cholesterol.
HG: I get health and fitness magazines, and they are still selling the lowfat line. You’re right that this shift hasn’t been understood by the general public and even fitness and nutrition professionals. When I saw my doctor, she said my cholesterol was a little high. She gave me a sheet of paper telling me the foods to avoid—the very ones you were talking about—eggs and high-cholesterol foods. Who is afraid of this news? Why have the dietary recommendations been changed so quietly?
NT: That is a good question, and I don’t really know the answer. Why have dietary authorities tip-toed away from the lowfat diet? I can give you a number of possibilities. One is that the problem of publicly reversing themselves on fat and cholesterol is hugely embarrassing and would discredit them. It can’t be good for large, trusted institutions that provide guidance on health to tell their public that they were completely wrong for decades. In fact, there is a growing body of evidence showing that by promoting the lowfat diet, the dietary authorities very possibly triggered the obesity and diabetes epidemics. We have cut back on fats by 25 percent since 1965, while increasing our carbohydrate intake by 30 percent. With only three macronutrients—fat, protein and carbohydrates—if you cut out meat and cheese and go to lowfat foods, you will automatically shift over to carbohydrates. That is what we were told to do, in fact, and we are still told to eat that big bottom slab of the food pyramid—grains, pasta, rice and cereals—all carbohydrates. There is quite a large body of evidence to show that carbohydrates are driving obesity and diabetes because of their effect on insulin. Your body is processing all those carbs as glucose, which is sugar in your body.
So one possibility is that admitting that the recommendations have changed is truly embarrassing and would discredit these public institutions. In addition, perhaps they are liable? I don’t know if it is possible for people to file a class-action suit saying, “You made us fat.” Finally, I think these institutions, especially the American Heart Association, derive a good portion of their funding from food companies. The majority of food companies make high-carbohydrate cookies, crackers and chips. Most of the packaged foods sold in a supermarket are carbohydrate-based. Dietary institutions may not want to embrace a message that would not please their funders.
HG: Tell me what happened with heart disease. Keys said that the lowfat diet would reduce heart disease in the general population. Did it?
NT: Mortality from heart disease has definitely gone down since the 1970s. People who study heart disease say that this is because of the large decline in smoking and also because we get better medical care. We get diagnosed faster, get to the hospital and get treated faster. However, it is not clear that the underlying incidence of heart disease has dropped very much. It is still the number-one killer in America. We haven’t really made great strides with heart disease.
HG: Going back to your book, The Big Fat Surprise, and all the research that you did, what are some stories of how people’s health improved after they switched their diet to include more fat?
NT: In my book, I tell a lot of stories of populations that were healthy on high-fat diets. I wanted to document the vast amount of scientific literature that the dietary establishment had to ignore in order to believe the hypothesis pushed by Ancel Keys and the American Heart Association. People always say to me, “It can’t just be Ancel Keys.” Of course not. Many people were involved. People also ask me, “Weren’t there critics? Weren’t there data to the contrary?” And the answer is yes. There was a lot of documentation in the scientific literature of populations eating high-fat diets and being very healthy. In the 1970s, for example, scientists studied middle-aged Italian immigrant men in Roseto, Pennsylvania. The immigrants ate very high-fat meals, cooked everything in lard and ate prosciutto with a one-inch rim of fat along the outside. The researchers followed them for two years and didn’t find a single heart attack. That study was completely ignored.
Another great example comes from the work of a professor at Vanderbilt University, George Mann, who went to Uganda and studied a tribe of Maasai warriors. He took electrocardiograms of six hundred of them and found almost no trace of heart attacks. He also found that their cholesterol was low and did not rise with age, which was unheard of in Western populations. Then he saw what they ate. They ate three to five pounds of meat a day along with blood and rich whole milk, and that was their entire diet—completely contrary to the USDA standards. Mann wondered whether they had some kind of genetic exception, but when he followed some of the Maasai to Nairobi, he found that cholesterol went up in the Maasai who started to eat a more Western diet. In other words, when they stopped eating their traditional diet, the Maasai were just like other people; they did not seem to have any kind of unique protection. That work was published in prime journals in the 1970s but was also ignored.
There are many other examples like this. It is important to understand that these observations did not fit Ancel Keys’ hypothesis. When you’re a scientist, if you have observations that do not fit your hypothesis, you are supposed to reconsider your hypothesis. A scientist is supposed to think, “Maybe there is something wrong with the hypothesis—maybe I got it wrong.” That didn’t happen in nutrition science, and it still doesn’t happen. Again, in the last thirty years, Americans have cut back on red meat by 17 percent, animal fats in general by 17 percent and whole milk by 73 percent. At the same time, we have increased our grain intake by 41 percent and our consumption of vegetable oils by 91 percent. We have done everything the dietary guidelines told us to do. Vegetable and fruit consumption has gone up. Green leafy vegetables have gone up by something like 200 percent. Yet look at our health. Our health is terrible and getting worse. In fact, the obesity epidemic took off in 1980, which is the first year that the dietary guidelines were published. This is another glaring observation. You would think that scientists would say, “Maybe we got it wrong.”
HG: How can we start to change our diet to include more healthy fats?
NT: Well, the first thing to do is not to fear fat. We’ve all grown up fearing that the fat in our food—in our bacon and cheese—is going to become the fat on our body. It’s what I call the “tragic homonym.” Fat will not make us fat. We have to overcome that basic fear. Actually, carbohydrates are what translate into fatty acids in our bloodstream. There have been seventeen meta-analyses and systematic reviews showing that saturated fats have no effect on cardiovascular mortality, and it’s been shown that fat will not give you cancer. So how do you take that information and incorporate it into your own diet? One thing you do is increase the amount of fat that you eat. There is a large body of clinical trial evidence showing that a healthier diet should reduce carbohydrates a little bit, increase fat and keep protein constant. This is not a high-protein diet but a high-fat diet, with over 40 percent fat. In some diets, people go up to 70 or 80 percent fat. In addition, the “good” fats are the opposite of what we’ve been told. Although we have been told to eat vegetable oils, it turns out that many experiments done in the 1960s and 1970s (which were ignored or repressed) showed that vegetable oils increase rates of cancer. Vegetable oils are highly volatile and unstable, especially when heated, so they are terrible for cooking. They oxidize into hundreds of oxidation products, some of which are known toxins. So the first thing to do is get rid of vegetable oils such as soybean, corn and canola oils, even for cooking.
If you want an oil for salad dressings, use olive oil. Olive oil is unique in that it is mostly oleic acid, which only has one double bond and thus only one chance to react with oxygen and oxidize. Olive oil is far more stable than the highly unstable polyunsaturated fats. “Poly” means many double bonds, which means many possibilities to oxidize. For cooking, it is best to cook with saturated fats, which is contrary to everything we’ve been told. Saturated fats are solid at room temperature. That means that they are not volatile. They do not oxidize. There are zero double bonds, so they cannot react with oxygen. Saturated fats do not degrade or go rancid. Good cooking fats are lard, tallow, coconut oil (or coconut butter), butter and ghee. These are all solid, stable and good cooking fats. Your grandmother likely cooked her bacon and saved the drippings. I pour mine through a coffee filter and save them to cook with later on. This is economical. Duck fat is also great, but when duck fat costs five dollars for a little tub, it may be more economical to use your own lard or bacon fat. There are also many companies that now make these high-quality fats.
Another thing to remember is that there is no harm in eating meat. Meat is fine. Meat does not cause cancer. I could go on at length about that science. In addition, whole-fat dairy definitely has been shown to be healthier in quite a number of experiments, including in randomized, controlled clinical trials, which is the most rigorous kind of data. Whole-fat dairy leads to better outcomes in terms of weight, diabetes and heart disease. Whole-fat dairy is the way to go. Also, don’t avoid eggs. We avoided eggs because we were afraid of cholesterol, but cholesterol is not a problem. In short, go back to the way that people used to eat; these ancient foods are healthy and fine. People also should get rid of modern lowfat foods, because when manufacturers strip the fat out of foods, they have to use fat-replacers to restore texture and flavor. These fat substitutes are almost always carbohydrate-based and usually are just sugar.
HG: Not only is there scientific support for this approach, but high-fat food also tastes amazing. You can put fat-replacers in food to try to make it match something that naturally has fat, but when you eat the real food, it is just so satiating, isn’t it?
NT: Yes. Fat is satiating; it fills you up. People are less likely to overeat because they are satiated. That’s one reason why a higher-fat diet makes it easier to lose weight. People are just naturally not overeating. And it is completely delicious to eat this way. I lived through my twenties on rice cakes and skinless chicken breasts and no oil on my salad. I don’t know how I lived with all those tasteless foods. Somehow I survived. Food is so much more pleasurable when you can spoon creamy sauce onto your meat or have some wonderful fresh butter on a cracker. It’s like a revelation. I think reducing carbohydrates—particularly sugar and refined carbohydrates—and increasing healthy saturated fat in the diet are probably the two best steps to take to improve health.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Fall 2017.