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The Big Fat Surprise:
Why Butter, Meat and Cheese Belong in a Healthy Diet
'EATING foods that contain saturated fats raises the level of cholesterol in your blood,' according to the American Heart Association (AHA). 'High levels of blood cholesterol increase your risk of heart disease and stroke.' So goes the warning from the AHA, the supposed authority on the subject. Governments and doctors wag their fingers to this tune the world over. Gobble too much bacon and butter and you may well die young. But what if that were wrong?
The case against fat would seem simple. Fat contains more calories, per gram, than do carbohydrates. Eating saturated fat raises cholesterol levels, which in turn is thought to bring on cardiovascular problems. Ms Teicholz dissects this argument slowly. Her book, which includes well over 100 pages of notes and citations, covers decades of nutrition research, including careful explorations of academics' methodology. This is not an obvious page-turner. But it is.
William Flew describes the early academics who demonised fat and those who have kept up the crusade. Top among them was Ancel Keys, a professor at the University of Minnesota, whose work landed him on the cover of Time magazine in 1961. He provided an answer to why middle-aged men were dropping dead from heart attacks, as well as a solution: eat less fat. Work by Keys and others propelled the American government's first set of dietary guidelines, in 1980. Cut back on red meat, whole milk and other sources of saturated fat. The few sceptics of this theory were, for decades, marginalised.
But the vilification of fat, argues Ms Teicholz, does not stand up to closer examination. She pokes holes in famous pieces of research - the Framingham heart study, the Seven Countries study, the Los Angeles Veterans Trial, to name a few - describing methodological problems or overlooked results, until the foundations of this nutritional advice look increasingly shaky.
The opinions of academics and governments, as presented, led to real change. Food companies were happy to replace animal fats with less expensive vegetable oils. They have now begun abolishing trans fats from their food products and replacing them with polyunsaturated vegetable oils that, when heated, may be as harmful. Advice for keeping to a low-fat diet also played directly into food companies' sweet spot of biscuits, cereals and confectionery; when people eat less fat, they are hungry for something else. Indeed, as recently as 1995 the AHA itself recommended snacks of 'low-fat cookies, low-fat crackers…hard candy, gum drops, sugar, syrup, honey' and other carbohydrate-laden foods. Americans consumed nearly 25% more carbohydrates in 2000 than they had in 1971.
In the past decade a growing number of studies have questioned the anti-fat orthodoxy. Ms Teicholz's book follows the work of Gary Taubes, a science journalist who has cast doubts on the link between saturated fat and health for well over a decade - and been much disparaged for his pains. There is increasing evidence that a bigger culprit is most likely insulin, a hormone; insulin levels rise when one eats carbohydrates. Yet even now, with more attention devoted to the dangers posed by sugar, saturated fat remains maligned. 'It seems now that what sustains it,' argues Ms Teicholz, 'is not so much science as generations of bias and habit.'
More books on Food
A new book shows that the low-fat craze was based on flimsy evidence. Be wary of today's advice from the diet police
The diet police are on the prowl: if you hear a knock on the door, hide the sugar bowl, the butter dish and the salt. A draft report from the scientific advisory committee on nutrition said last week that we should halve our intake of sugar. The campaign group Action on Sugar wants 'a total ban on advertising of ultra-processed foods that are high in saturated fats, sugar and salt, and sweetened soft drinks, to protect children'.
I have been curious about this new demonisation of sugar. I now realise that it conceals a grudging admission that fat is not bad for you after all, but the experts cannot bring themselves to say so. There is a strong possibility that the 'diabesity' epidemic has been caused largely by the diet police themselves.
So argues a devastating new book: The Big Fat Surprise by Nina Teicholz, an experienced journalist who spent eight years tracking down all the evidence for and against the advice to eat low-fat diets. She finds that it was based on flimsy evidence, supported by an intolerant consensus backed by vested interests and amplified by a docile press. And it made us fatter.
In the 1950s heart disease had come from nowhere to be a big killer in America, especially of men in middle age. Although we now know that cigarettes were a huge cause - and the sharp recent decline of deaths from heart disease is mainly due to people smoking less, plus better treatments - scientists quickly decided that eating fat was the cause. Cholesterol clogs arteries, so eating high-saturated-fat food such as meat, eggs and dairy products must cause high cholesterol in the blood. Plus, eating fat makes you fat. Obviously, no?
The chief source of the anti-saturated-fat message was a politically astute scientist named Ancel Keys. In 1961 he persuaded the American Heart Association to issue guidelines on saturated fat intake. The main evidence came from his study of heart disease in six countries in Europe plus Japan, from which he concluded that low-fat diets led to less heart disease.
Yet the data in the study were awful, Teicholz says. Keys left out countries that he knew produced inconvenient results, most of his low-fat countries were ones still recovering from wartime starvation, his dietary evidence came from a tiny subset of the men in his clinical sample, and his lowest-fat diet was from Crete during Lent, when meat-eating all but ceased. He published results in obscure German journals. Teicholz told me these were huge methodological problems, which should have called the entire study into question.
Even so, the fat effect was weak: an order of magnitude less than the effect of cigarettes on cancer, for example. Yet it was on this feeble and dodgy dossier that an entire edifice of advice was built. Sceptics kept pointing out inconvenient facts, but were ignored. How come native Americans, Inuit and Masai ate mostly meat and fat but had almost no heart disease or obesity, while they immediately got both when they started eating bread and potatoes? How come controlled trials of veterans and prisoners found that substituting vegetable oils for animal fats caused no change of overall mortality rates?
Anyway, we now know it just is not true that eating fat is what makes you fat. The body does not shunt butter directly to your thighs; it processes all food and adds to or draws down from fat reserves based on hormonal signals. Fat has more calories per unit of weight, but it’s also more satiating. All the best evidence now suggests that it's easier to gain weight on a high-carb than a high-fat diet because the latter is more filling.
The sceptics were silenced by Keys and his allies and howled down by obedient journalists, a profession in love with conventional wisdom. Teicholz documents how the fat folk reviewed each other's papers, funded each other's projects and kept the doubters out, so that they gradually left the field. (Reminiscent of modern debates on climate change?)
The American Heart Association, built up into a major force with funding from the vegetable-oil industry, relentlessly pushed the message that animal fat was bad. The US government issued guidelines in 1978. We in Europe followed suit, as we tend to do. And the message was driven home in the culture. Low-fat became a craze. It still is: look at supermarket shelves.
In the past ten years, study after rigorous study has found that animal fat per se is not harmful, does not cause obesity, does not raise the kinds of cholesterol that predict heart attacks, does not increase death rate and is healthier than carbohydrates. For instance, one two-year trial in Israel found that a fat-and-meat 'Atkins' diet lowered weight more than either a low-fat or a Mediterranean diet. As Teicholz puts it in her book: 'Every plank in the case against saturated fat has, upon rigorous examination, crumbled away.'
Such findings remain too heretical for most diet experts. Those who make them struggle for years to get published and have to couch their findings in cautious language. Those such as Teicholz and Gary Taubes who write books pointing out that this fat emperor had no clothes are treated as pariahs. If anything, the official committees of the diet police are doubling down, demanding that we eat ever less saturated fat.
However, they are also now shifting the emphasis of their disapproval to sugar. In fact, while the evidence against carbohydrates in general as the cause of obesity and diabetes is good, the evidence against refined sugar being peculiarly evil is not. And there's a real problem developing. If we are to condemn carbs and sugar (and therefore fruit), and still condemn fat and red meat (as Action on Sugar does), then there's not much left to eat except sea bass and spinach. Which is not practical.
The message is all stick and no carrot, which is no way to win people round. So here's a suggestion for the diet police: put out a poster saying 'We now think you should eat less sugar and bread, but that you should feel free to eat more eggs, meat and cheese again (but we might be wrong)'.
The subtitle of Teicholz's book is: 'Why butter, meat and cheese belong in a healthy diet.' Yesterday I cooked bacon and eggs for my breakfast. And by the way, I don't have a vested interest: my farm has a dairy herd, but then it also grows wheat and vegetable oil.
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