A Review of “The Big Fat Surprise” by Nina Teicholz

In her informative, extremely readable and often exasperating history of how saturated fat came to be demonized and shunted aside in favor of less healthy food choices, Nina Teicholz shows us how dietary orthodoxies are established and research is directed and interpreted to support the status quo, no matter how misguided and inaccurate.  Teicholz also reveals how those who came to present evidence that questions this orthodoxy, no matter how compelling or well-researched, have been ignored, trivialized, or vilified.

We have all been victims of this deception, no matter how well-intentioned some of its perpetrators may have been, and Teicholz’s work is a cautionary tale, urging all to cultivate a skepticism of authority which is not simply reflexive, but grounded in evidence that supports an alternative view.

Starting in the 1950s, as heart disease rates in the US and worldwide began to rise, doctors and health authorities looked for ways to reverse this trend.  One scientist, Ancel Keys, imposed his formidable will on this process.  Keys saw a connection between high cholesterol and heart disease and, seeing that saturated fat (found in animal products and some plant oils) raised cholesterol levels, identified saturated fat as an independent risk factor for heart disease.

Keys went on to champion this idea, which came to be known as the Diet Heart Hypothesis,  and government money and industry support propelled Keys and his supporters’ theory to become THE way to eat.

Teicholz shows that Keys never produced any clinical trials which showed that a saturated fat/heart disease link exists, but that he instead extrapolated a connection based on a higher cholesterol (and later, LDL cholesterol specifically) level from a saturated fat diet. Keys assumed, as many did in those days, having found cholesterol in arteries of those dying from heart disease, that higher cholesterol is THE major cause of heart attack and stroke.

We now know that saturated fat DOES raise cholesterol, the good (HDL) and the “bad” (LDL), but overall improves heart disease risk markers in the blood by producing larger LDL particles which are protective.  A low fat, higher carbohydrate diet lowers HDL, and increases the prevalence of smaller particles of HDL and LDL.

Teicholz is fearless and thorough in taking on many sacred cows of medical nutritional orthodoxy, including the Framingham Heart Study, The Seven Countries Study, The Mediterranean Diet and more.

For example, Teicholz reveals that the Mediterranean Diet, specifically that of Crete, is shown to have been based on a sample partially collected during Lent, when few were eating meat or other fatty foods. Yet, the idea of a diet low in saturated fats as being “Mediterranean” persists, in spite of much evidence to the contrary.

With books such as this, along with Gary Taubes’ Good Calories, Bad Calories and cookbooks, websites and blogs supporting a healthy diet which is not fat-restricted, the health-conscious consumer has many places to go to become better-informed and healthier.

I enjoyed Teicholz’s book and recommend it wholeheartedly.  You will be infuriated, amused and often captivated by this nutritional whodunit. Be prepared to have all your assumptions challenged.

PLEASE NOTE:  As a physician, I am in no way endorsing this or any other diet as appropriate for all people.  If you want to change your way of eating, I recommend checking with your health care provider first.

In Health,

Dr. Jonathan Goodman