The Big Fat Surprise – Book Review

Fat. Healthy or unhealthy? Saturated vs unsaturated, trans fat. Fat science, fat politics. Diets: low fat, Mediterranean, paleo, low carb.  Dean Ornish vs Robert Atkins. Gary Taubes. These are covered in The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet, by Nina Teicholz. I was fascinated as I read about how the book turns conventional dogma about fat upside down. Teicholz, a writer and apparently not a doctor or nutritionist, spent ten years on this book and gives us about a hundred pages of documentation, including notes and bibliography, for her assertions that the last sixty years’ advice on fats have been wrong.

To quote the author, “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 pat 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. “(p. 2).

Teicholz points out that once the low fat, low cholesterol hypothesis was in place, it was very difficult to write or talk against it. She goes through the history of America’s advice and experiments about dietary fats. According to Teicholz, studies that contradicted accepted belief were often not given credibility or not published; researchers were unable to get funding for further studies. Even prominent experts in the field were not believed. Meanwhile, Americans found themselves with growing epidemics of chronic disease related to diet.

Much of the book examines the story of nutrition science regarding dietary fats as its advice went from bad to worse. In the 1950s medical experts looked for ways to reduce heart disease and came up with the idea that saturated fat, or primarily animal fat, caused heart disease. Ancel Keys developed what various writers have called the cholesterol hypothesis, which said that high cholesterol caused heart disease. From that came the low fat diet, and advice to replace fats with carbohydrates. Teicholz takes us from that to saturated fat to polyunsaturated fat conclusions, bolstered by President Eisenhower’s heart attack. Lots of science, both good and bad, appears here. Bad or flawed science comes from studies which were designed with a particular conclusion in mind, or studies with data points that support the hypotheses but not the ones that do not, and other flaws of design, participation or follow-up. Teicholz read and reported on a great many studies.

Sugar never got much study, according to this book. Teicholz suggests that studies have shown that sugar causes heart disease, not saturated fat. And so Americans went from the saturated fat veto to the low fat diet, to trans fats and manufactured fats to the Mediterranean diet to high fat low carb. At the end the Atkins diet wins after being scorned by doctors and nutrition people for many years. The Atkins diet is characterized by high fat meat and low carb vegetables. Teicholz reports the studies, large and small. She credits nationally known food journalist Gary Taubes with breaking through the accepted story because he is outside the system, not a doctor or nutritionist. She also says she was able to write the book for the same reason.

Food manufacturers are not vilified in this book, but the part they played in creating foods for these diets is told, as is the politics of food that gave us the food pyramid. The USDA continues to say stay the course and avoid saturated fats. Teicholz says that death from heart disease has declined but the actual occurrence of it has not appeared to decline, possibly because medical treatment has improved. She points out that Americans “have experienced skyrocketing epidemics obesity and diabetes.” (p. 327). She says that recent studies have showed the absence of negative effect of saturated fat on heart disease, obesity or diabetes. She concludes that “bias and habit present powerful, if not impenetrable, barriers to change.” (p. 326).

Teicholz does not address the effect of her conclusions on the environmental consequences of trying to feed animals to millions of people beyond saying that she recognizes it but environmental impact is not within the scope of her book. She also does not advocate for or against vegetarian diets but shows that they come up in studies of fats.

This book is one more addition to my library of ideas on how to eat well as a way to stay healthy. I read other well qualified writers and understand that not all agree with her dietary conclusions.