The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet

The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet

by Nina Teicholz


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Product Details

ISBN-13: 9781451624434
Publisher: Simon & Schuster
Publication date: 01/06/2015
Edition description: Reprint
Pages: 496
Sales rank: 43,328
Product dimensions: 6.00(w) x 8.80(h) x 1.20(d)

About the Author

Nina Teicholz is an investigative science journalist and author as well as an advocate for evidence-based nutrition policy. Her work has appeared in The New York Times, The Wall Street Journal, The Independent, The Atlantic, and The New Yorker, among other places. She grew up in Berkeley, California, and now lives in New York.

Read an Excerpt

The Big Fat Surprise

  • I remember the day I stopped worrying about eating fat. It was long before I started poring over thousands of scientific studies and conducting hundreds of interviews to write this book. Like most Americans, I was following the low-fat advice set forth by the US Department of Agriculture (USDA) in its food pyramid, and when the Mediterranean diet was introduced in the 1990s, I added olive oil and extra servings of fish while cutting back further on red meat. In following these guidelines, I was convinced that I was doing the best I could for my heart and my waistline, since official sources have been telling us for years that the optimal diet emphasizes lean meats, fruits, vegetables, and grains and that the healthiest fats come from vegetable oils. Avoiding the saturated fats found in animal foods, especially, seemed like the most obvious measure a person could take for good health.

    Then, around 2000, I moved to New York City and started writing a restaurant review column for a small paper. It didn’t have a budget to pay for meals, so I usually ate whatever the chef decided to send out to me. Suddenly 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. In fact, I soon lost the 10 pounds that had dogged me for years, and my doctor told me that my cholesterol numbers were fine.

    I might have thought no more about it had my editor at Gourmet not asked me to write a story about trans fats, which were little known at the time and certainly nowhere near as notorious as they are today. My article received a good deal of attention and led to a book contract.

    The deeper I dug into my research, however, the more I became convinced that the story was far larger and more complex than trans fats. Trans fats seemed to be merely the latest scapegoat for the country’s health problems.

    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 past 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.

    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, some several times, plus scores more overseas. I also interviewed dozens of food company executives to understand how that behemoth industry influences nutrition science. The results were startling.

    There’s a popular assumption that the profit-driven food industry must be at the root of all our dietary troubles, that somehow food companies are responsible for corrupting nutrition recommendations toward their own corporate ends. And it’s true, they’re no angels. In fact, the story of vegetable oils, including trans fats, is partly about how food companies stifled science to protect an ingredient vital to their industry.

    Yet I discovered that on the whole, the mistakes of nutrition science could not primarily be pinned on the nefarious interests of Big Food. The source of our misguided dietary advice was in some ways more disturbing, since it seems to have been driven by experts at some of our most trusted institutions working toward what they believed to be the public good.

    Part of the problem is easy to understand. These researchers ran up against an enduring problem in nutrition science, which is that much of it turns out to be highly fallible. Most of our dietary recommendations are based on studies that try to measure what people eat and then follow them for years to see how their health fares. It is, of course, extremely difficult to trace a direct line from a particular element in the diet to disease outcomes many years later, especially given all the other lifestyle factors and variables at play. The data that emerge from these studies are weak and impressionistic. Yet in the drive to fight heart disease (and later obesity and diabetes), these weak data have had to suffice. And this compromise by researchers appears to have driven many of nutrition policy’s failures: well-intentioned experts, hastening to address growing epidemics of chronic disease, simply overinterpreted the data.

    Indeed, the disturbing story of nutrition science over the course of the last half-century looks something like this: scientists responding to the skyrocketing number of heart disease cases, which had gone from a mere handful in 1900 to being the leading cause of death by 1950, 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. Public health bureaucracies adopted and enshrined this unproven dogma. The hypothesis became immortalized in the mammoth institutions of public health. And the normally self-correcting mechanism of science, which involves constantly challenging one’s own beliefs, was disabled. While good science should be ruled by skepticism and self-doubt, the field of nutrition has instead been shaped by passions verging on zealotry. And the whole system by which ideas are canonized as fact seems to have failed us.

    Once ideas about fat and cholesterol became adopted by official institutions, even prominent experts in the field found it nearly impossible to challenge them. One of the twentieth century’s most revered nutrition scientists, the organic chemist David Kritchevsky, discovered this thirty years ago when, on a panel for the National Academy of Sciences, he suggested loosening the restrictions on dietary fat.

    “We were jumped on!” he told me. “People would spit on us! It’s hard to imagine now, the heat of the passion. It was just like we had desecrated the American flag. They were so angry that we were going against the suggestions of the American Heart Association and the National Institutes of Health.”

    This kind of reaction met all experts who criticized the prevailing view on dietary fat, effectively silencing any opposition. Researchers who persisted in their challenges found themselves 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. Their influence was extinguished and their viewpoints lost. As a result, for many years the public has been presented with the appearance of a uniform scientific consensus on the subject of fat, especially saturated fat, but this outward unanimity was only made possible because opposing views were pushed aside.

    Unaware of the flimsy scientific scaffolding upon which their dietary guidelines rest, Americans have dutifully attempted to follow them. Since the 1970s, we have successfully increased our fruits and vegetables by 17 percent, our grains by 29 percent, and reduced the amount of fat we eat from 43 percent to 33 percent of calories or less. The share of those fats that are saturated has also declined, according to the government’s own data. (In these years, Americans also began exercising more.) Cutting back on fat has clearly meant eating more carbohydrates such as grains, rice, pasta, and fruit. A breakfast without eggs and bacon, for instance, is usually one of cereal or oatmeal; low-fat yogurt, a common breakfast choice, is higher in carbohydrates than the whole-fat version, because removing fat from foods nearly always requires adding carbohydrate-based “fat replacers” to make up for lost texture. Giving up animal fats has also meant shifting over to vegetable oils, and over the past century the share of these oils has grown from zero to almost 8 percent of all calories consumed by Americans, by far the biggest change in our eating patterns during that time.

    In this period, the health of America has become strikingly worse. When the low-fat, low-cholesterol diet was first officially recommended to the public by the American Heart Association (AHA) in 1961, roughly one in seven adult Americans was obese. Forty years later, that number was one in three. (It’s heartbreaking to realize that the federal government’s “Healthy People” goal for 2010, a project begun in the mid-1990s, for instance, was simply to return the public back to levels of obesity seen in 1960, and even that goal was unreachable.) During these decades, we’ve also seen rates of diabetes rise drastically from less than 1 percent of the adult population to more than 11 percent, while heart disease remains the leading cause of death for both men and women. In all, it’s a tragic picture for a nation that has, according to the government, faithfully been following all the official dietary guidelines for so many years. If we’ve been so good, we might fairly ask, why is our health report card so bad?

    It’s possible to think of the low-fat, near-vegetarian diet of the past half-century as an uncontrolled experiment on the entire American population, significantly altering our traditional diet with unintended results. That may sound like a dramatic assertion, and I never would have believed it myself, but one of the most astonishing things I learned over the course of my research was that for thirty years after the low-fat diet had been officially recommended and we were taking its supposed benefits for granted, it had not been subjected to a large-scale, formal scientific trial. Finally, there was the Women’s Health Initiative (WHI), a trial that enrolled 49,000 women in 1993 with the expectation that when the results came back, the benefits of a low-fat diet would be validated once and for all. But after a decade of eating more fruits, vegetables, and whole grains while cutting back on meat and fat, these women not only failed to lose weight, but they also did not see any significant reduction in their risk for either heart disease or cancer of any major kind. WHI was the largest and longest trial ever of the low-fat diet, and the results indicated that the diet had quite simply failed.

    Now, in 2014, a growing number of experts has begun to acknowledge the reality that making the low-fat diet the centerpiece of nutritional advice for six decades has very likely been a bad idea. Even so, the official solution continues to be more of the same. We are still advised to eat a diet of mostly fruits, vegetables, and whole grains with modest portions of lean meat and low-fat dairy. Red meat is still virtually banned, as are whole-fat milk, cheese, cream, butter, and, to a lesser extent, eggs.

    A line of argument in favor of eating these whole-fat animal foods has sprung up among cookbook authors and “foodies,” who can’t believe that all the things their grandparents ate could really be so bad for them. There are also the Paleo eaters, who swap information on Internet blogs and survive on little else but red meat. Many of these recent animal foods devotees have been inspired by the doctor whose name is most closely associated with the high-fat diet: Robert C. Atkins. As we will see, his ideas have endured to a surprising extent and have been the subject of a great deal of scholarship and scientific research in recent years. But newspapers still carry alarming headlines about how red meat causes cancer and heart disease, and most nutrition experts will tell you that saturated fat is absolutely to be avoided. Hardly anyone advises otherwise.

    In writing this book, I had the advantage of approaching the field as a scientifically minded outsider free from affiliation with or funding from any entrenched views. I’ve reviewed nutrition science from the dawn of the field in the 1940s up until today to find the answer to the questions: Why are we avoiding dietary fat? Is that a good idea? Is there a health benefit to avoiding saturated fat and eating vegetable oils instead? Is olive oil truly the key to a disease-free long life? And are Americans better off having attempted to rid the food supply of trans fats? This book does not offer recipes or specific dietary recommendations, but it does arrive at some general conclusions about the best balance of macronutrients for a healthy diet.

    In my research I specifically avoided relying upon summary reports, which tend to pass along received wisdoms and, as we’ll see, can unwittingly perpetuate bad science. Instead, I’ve gone back to read all the original studies myself and in some cases have sought out obscure data that were never intended to be found. This book therefore contains many fresh and often alarming revelations about flaws in the foundational work of nutrition as well as the surprising ways in which it was both ill-conceived and misinterpreted.

    What I found, incredibly, 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. The Big Fat Surprise takes us through the dramatic twists and turns of fifty years of nutrition science and lays out the evidence, so that a reader can fully understand the evidence to see for him- or herself how we arrived at our present understanding. At its heart, this book is a scientific investigation, but it is also a story about the strong personalities who corralled colleagues into believing their ideas. These ambitious, crusading researchers launched the entire American population, and subsequently the rest of the world, on the low-fat, near-vegetarian diet, a regime that ironically may have directly exacerbated many of the ills it was intended to cure.

    For all of us who have spent much of our lives believing and following this diet, it is of vital importance to understand how and what went wrong, as well as where we might go from here.

  • Table of Contents

    Illustrations xi

    Introduction 1

    1 The Fat Paradox: Good Health on a High-Fat Diet 9

    2 Why We Think Saturated Fat Is Unhealthy 19

    3 The Low-Fat Diet Is Introduced to America 47

    4 The Flawed Science of Saturated versus Polyunsaturated Fats 72

    5 The Low-Fat Diet Goes to Washington 103

    6 How Women and Children Fare on a Low-Fat Diet 135

    7 Selling the Mediterranean Diet: What Is the Science? 174

    8 Exit Saturated Fats, Enter Trans Fats 225

    9 Exit Trans Fats, Enter Something Worse? 259

    10 Why Saturated Fat Is Good for You 286

    Conclusion 331

    A Note on Meat and Ethics 337

    Acknowledgments 339

    Notes 341

    Glossary 405

    Bibliography 409

    Permissions 457

    Index 459

    Customer Reviews

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    The Big Fat Surprise: Why Butter, Meat, and Cheese Belong in a Healthy Diet 4.4 out of 5 based on 0 ratings. 19 reviews.
    Anonymous More than 1 year ago
    This book is an excellent review of the history of the cholesterol controversy starting during the epidemic of heart disease in the middle of last century. We see a repeated history of intellectual bullying taking the place of science. Her reading of the original literature is similar to mine. There is not much evidence to support the cholesterol hypothesis and a lot of evidence to refute it. She is very aware of the limitations of observational studies and is scientifically more astute than most observers in this field. I recommend the book to anyone who is interested in preventing diabetes and heart disease and anyone who enjoys a good historical story. I am a physician and have a PhD
    Anonymous More than 1 year ago
    The one negative review is puzzling? Did this person even read the book? Here are but just two of the studies mentioned in the book. The Boeing Employees Fat Intervention Trial and the Women's Health Initiative study which followed 49,000 women for ten years, one full decade. I quote..."Robert Thun, director of epidemiological research at the American Cancer Society, told the New York Times, the results for cancer and heart disease were "completely null." " I conclude there is absolutely no evidence the negative reviewer even read the book.
    Anonymous More than 1 year ago
    Bought two more copies for my 30-ish nephew and niece. Enjoyed Teicholz's chronological development of the "diet-heart hypothesis". Enjoyed learning of newer science trying to "redefine the problem". I do not believe diet alone can provide better results for the diversity of our human cultures. Planning on reallocation of calories. More red meat and less carbos. Fruits and veges will remain unchanged.
    Anonymous More than 1 year ago
    Easy to read full of fascinating behind the scenes info on what may be the biggest health farce to date
    Anonymous More than 1 year ago
    This book is a good read. Although there are parts where the statistics are mind-numbing, push on past them to get to the point. It's also not as long as it seems - only ~380 pages. The rest is sources and bibliography information. The world, but mostly the American public, has had a great fraud perpetrated on us with regard to food. It is amazing the lobbying and political power that some groups have, and how pushing their agenda while ignoring ALL the data was really more important than the public's actual health. You'll have to rethink everything you've been told for the last 50 - 60 years after reading this book.
    LongLife57 More than 1 year ago
    This book is an excellent.....the poster claiming otherwise (one star reviewer) is a nut job and continues to drink the cool-aide. Incorrect health information as published by the AHA, AHLBI and NIH is killing the American Population and has caused an epidemiological nightmare.
    Anonymous More than 1 year ago
    Very well researched, very revealing, hard to put down. Cherry picked at first and then was compelled to read the whole book. Really appreciated the personal interviews with many of the key players. Brought life to the whole exposition.
    Book_Lover_Bob More than 1 year ago
    This lady did a excellent job of explaining why low-carb diets are actually healthy and how the eating healthy fats has been wrongly demonized.
    Anonymous 9 months ago
    Fascinating, well-written deep dive into faulty nutrition science that has been dictating policy and diets for years. A real eye opener!
    Anonymous More than 1 year ago
    I really enjoyed the book. Definitely a good read if you're into well-sourced scientific journalism or just nutrition in general. Teicholz sources every claim she makes, and what she uncovers about bad early nutrition science is pretty fascinating.
    Josh Koebert More than 1 year ago
    This book does an excellent job of laying out the case that the science guiding decades of dietary guidelines in the United States is, at the very least, flawed. The author deftly points out errors in methodology and conclusions, as well as presenting existing studies that have been largely ignored because the evidence they produced contradicts the government's position in regards to diet and health. The book not only points out what is wrong with current guidelines, it presents alternative culprits for America's health epidemic along with evidence to support those claims. After reading this book, it seems obvious that a major overhaul of America's food policy and the scientific basis for that policy is sorely needed. Beyond the amount of high quality information that the book presents, it is very easy to read, taking a topic like the criticism of scientific methodology that could very easily become dry and overwhelming and presenting it in a way that is entertaining and easy to read without sacrificing the quality of the content. Highly recommended for anyone interested in diets and dieting, food policy, food science, or just food in general.
    Anonymous 9 months ago
    Great book–very enlightening & insightful. I'm impressed with Nina's unapologetic effort to defy the norm and present what she has discovered from her research and experience. She provides the facts objectively with material to back it up. Worth the read whether or not you're into the Keto diet or not.
    Anonymous More than 1 year ago
    I thought this book was informative and well-written. Controversial, yes, but I never found any of her claims to be totally unsubstantiated.
    Anonymous More than 1 year ago
    Fantastic read! Nina does a great job of challenging the status quo of how we traditionally think about fat and the standard American diet.
    Anonymous More than 1 year ago
    Such an eye opening read. Nina is renowned investigative journalist and it shines through in this book. Totally changed my thinking. I picked this book up after hearing her on a podcast. I was NOT disappointed.
    Anonymous More than 1 year ago
    GerrardMcCarrot More than 1 year ago
    Hasn't nutrition moved on from demonising macronutrients or is the attraction that it still sells books because it sounds like a simple solution. The reasoning goes that the government gave out bad advice (low fat) based on Ancel Keys and people followed it (presumably to the letter) and it caused obesity. She says "How did we go from a meat-eating, butter-slathering, lard-cooking society to the fat-fearful, heart attack prone, constantly dieting people of today? The blame for that can be laid directly at the doorstep of one man." - Ancel Keys I have a problem with this, if this was really the case why didn't people stop eating fatty foods completely and why did KFC, MacDonalds and the meat trade continue to do so well, did high fat foods tank in this period? By this same reasoning did people stop eating "carbs" when Dr Atkins told them to in the 1980s and that caused obesity since? Why do food companies spend vast amounts of money on neuroscience if insulin is the simple answer? Isn't demonising "carbs" as foolish as demonising fat? People can succeed on a low carb or low fat diet why? Could it be as Volkow, director of the National Institute on Drug Abuse says “The common denominator of such diets is that neither allows consumption of the very caloric and seductive foods that combine high fat with high carbohydrates” People like ideas that "challenge conventional wisdom", but obesity is a complex state and it will not be shoehorned into simplistic hypotheses. According to literally thousands of publications spanning nearly two centuries, the brain is the only organ that is known to regulate body fat mass in humans and other animals-- neither fat tissue itself, nor the insulin-secreting pancreas have the ability to regulate body fat mass as far as we currently know. As Stephan Guyenet (Phd neurobiology) says in his wholehealthsource blog "If elevated insulin leads to increased fat storage and increased food intake, then experimentally elevating insulin in animals should replicate this (since insulin acts on fat cells in the same manner in humans and non-human mammals). However, this is not observed. Insulin injections at a dose that does not cause frank hypoglycemia do not increase food intake, and in some cases they even reduce it (48). Chronically increasing circulating insulin without causing hypoglycemia reduces food intake and body weight in non-diabetic animals, without causing illness, contrary to what this idea would predict (49, 50). If anything, insulin constrains food intake and body fatness, and research indicates that this action occurs via the brain. Insulin infused into the brains of baboons causes a suppression of appetite and fat loss, which is consistent with the fact that insulin and leptin have overlapping functions in the brain (10, 11). Knocking out insulin receptors in the brain leads to increased fat mass in rodents, suggesting that its normal function involves constraining fat mass (12). Then we come to the errors and the references that appear to me difficult to follow: Nina says "The Native Americans he visited were eating a diet of predominantly meat, mainly from buffalo" Hrdlička's book is available online thanks to google books I suggest you search it for "buffalo" No mention to the comsumption of buffalo in that book, but you can find copious references to legume, grain and fruit consumption. If they were healthy as Nina states then could the beans, grain and fruit have helped?
    Anonymous More than 1 year ago
    This book and those like it put peoples lives at risk. You should only be able to publish a book like this when it has been scientifically proven through multiple studies that your conclusions are valid. The author is supposedly an investigative journalist, yet she ignores the totality of the research conducted by cardiologists, and practicing physicians,  and instead relies on anecdotal conclusions based on subjective perceptions. There is absolutely no evidence from science that the conclusions of this book, namely, eating a diet of steak, bacon, eggs, high in saturated fat, and cholesterol  is good for you. In fact, physicians and specifically cardiologists have been able to prove the reversal of heart disease and diabetes through a plant based diet program.  I understand that many in the US, 1. Want to believe in the conspiracy theory that we have been lied to by some large cover up of the "real truth."  2. That saturated fatty foods are good for you. But the reality is that the conclusions of plant based advocates have been tested and proven through documented science in multiple trials, and through multiple time periods, and sample sizes. The Atkins, Paleo crowd can not claim the same level of rigor in their science. At present the Atkins/Paleo advocates are operating on shaky science and subjective assumptions at best. Once real scientific studies have been conducted, and they have demonstrated the ability to prevent or reverse heart disease, cancer, or other diseases, then maybe they will have a reason to be taken seriously. Until then, science tells us what is healthy...and its not saturated fat. Those who follow the authors instruction may be mortgaging their long term health, for an unproven hypothesis.
    Anonymous More than 1 year ago
    All you idiots who believe bacon, eggs, and meat are healthy deserve every stroke and heart attack you come down! One or two biased studies does not a paradigm make. Plant-based nutrition has thousands of studies and they are irrefutable. Not to mention all the physicians who actually cure heart disease through a plant based-diet. It happens all the time. Let's see you cure heart disease by eating bacon and eggs. Ha!