The FAT Dilemma
Reading Nina Teicholz's "The Big Fat Surprise" is a bit like taking a walk through the history of nutritional science, the focus being on the studies and individuals behind the development and promotion of the 'diet-heart hypothesis'.
So, you know how saturated fat and animal foods elevate cholesterol, and how high cholesterol puts you at risk of heart disease, and how reducing this risk involves eating a diet low in saturated fat, right? WRONG! According to Teicholz's research, all the well-known dietary recommendations about fat, and saturated fat in particular, appear to be based on years of inadequate and inappropriate data surrounding the diet-heart hypothesis.
With high costs making the necessary clinical trials prohibitive, epidemiological studies have been used over the years instead, regardless of the fact that such studies are methodologically flawed when it comes to studying health issues that are not epidemics (such as heart disease). Regardless of the flawed nature of gathering this information, a mere association (which, as Teicholz stresses, cannot prove causation) between saturated fat and elevated cholesterol, and between elevated cholesterol and heart disease was ‘found’. This association was then promoted, by both strong and passionate characters, and the burning desire to find a solution to the ever-increasing problem of heart disease. This led to the political backing and mass-projecting of unsubstantiated data, which elevated it to the level of national nutritional policy. It was very much a case of: we don’t have the appropriate data, only some unconfirmed associations, but as that is all we have right now, let’s run with it; ultimately jumping the gun, and making official recommendations before proper trials had been conducted.
With high costs making the necessary clinical trials prohibitive, epidemiological studies have been used over the years instead, regardless of the fact that such studies are methodologically flawed.
In a nutshell, it turns out cholesterol is not that great an indicator for heart disease - it is in fact not so much an issue of the level of cholesterol, but the type of cholesterol (factors such as particle size and their tendency to unstick from arterial walls and cause blockages are proving far more important). Furthermore, the cholesterol-lowering (ie low-fat) diet that is so very much promoted, does indeed lower ‘bad’ LDL cholesterol, but also lowers ‘good’ HDL cholesterol, and can increase triglycerides (very bad). Furthermore, the only food which has been proven to increase HDL cholesterol is fat, and saturated fat in particular. For the various reasons outlined in Teicholz's book, researchers mistakenly have chosen to focus solely on LDL levels, while conveniently ignoring other markers which have repeatedly reacted unfavourably to the diet-heart hypothesis. Conflicting data has of course appeared over the years. The response? To discredit it and to throw obscene amounts of money at attempts to prove the original diet-heart hypothesis and defend the decisions and statements that were made and the policies that were imposed so very fervently, because heaven forbid anyone admits they got it wrong!
As a result, saturated fat, and to a lesser extent fat overall, became the devil, and the new-fangled, then-untested, vegetable oils which were cheap to produce and thus had a higher profit margin than animal products, were pushed into the health spotlight, and onto the public’s plates.
These beliefs became so deeply entrenched and promoted over the years, that when contrary voices, studies or evidence made any kind of appearance, they were immediately silenced, discredited and buried. Coming to terms with the reality that the nutritional policy that had been promoted for decades not only did not solve the problems it was intended to, but could actually make them and overall health worse, did not bear thinking about. And the more years passed, the more the world took these ‘facts’ for granted, and the harder it was to accept any alternative. Indeed, the propaganda machine is still working ceaselessly, and there is no shortage of convincing presentations. I am not saying that one theory or another is outright wrong. I am not qualified to do that. I just feel so confused by all the conflicting information - each side can be so convincing!
Two inevitable, and undeniable, consequences of the vilification of saturated fats have been the embrace of and rapidly-increasing reliance on mono- and poly-unsaturated vegetable oils, and the replacement of the fats in our diet with carbohydrates.
However, two inevitable, and undeniable, consequences of the vilification of saturated fats have been the embrace of and rapidly-increasing reliance on mono- and poly-unsaturated vegetable oils, and the replacement of the fats in our diet with carbohydrates.
As Teicholz demonstrates, the rush to banish animal fats from the diet ultimately exposed us to the health risks of trans fats and oxidizing vegetable oils (the release of toxins when these oils reach high temperatures). Furthermore, the true ‘devil’ of the story seems more likely to be carbohydrates and the havoc they play with insulin in the body. A mere glance at human history demonstrates that fat has always been a staple in our diet, but carbohydrates and sugar are far newer introductions that seem to coincide with the increase of a multitude of health concerns (diabetes, obesity, cancer, chronic auto-immune disorders etc). Fat finally appears to have been exonerated by more recent, and highly overdue, clinical studies. Even so, I have to admit that while reading this book, even though I have always been in the anti-low-fat camp, reading that a breakfast of eggs and bacon could actually be healthier than cereal with fresh fruit, really struggled to sink in.
Fat finally appears to have been exonerated by more recent, and highly overdue, clinical studies.
The book is specific to the issue of cholesterol and heart disease, with a secondary glance at diabetes and metabolic syndrome. However, from an IBD perspective I was unnerved to read that “[b]y 1981, nearly a dozen sizable studies on humans had found a link between lowering cholesterol and cancer, principally for colon cancer”. Now, following Teicholz’s own advice, such a statement must be taken with a pinch of salt, as the mentioning of a ‘link’ suggests an association stemming from an epidemiological study, which she stresses is not enough to establish clear-cut causation. Nonetheless, it is still interesting to note, even at this level of mere association, as it suggests that fat, and saturated fat at that, is somehow beneficial or helpful to maintaining colon health. This seems to support the theories behind diets such as Paleo, Ketogenic and GAPS, with their heavy inclusion of fat and animal-based meals.
While I am not in a position to argue with the facts covered in this book, I am troubled by the implication that a healthier diet involves the inclusion of more animal-based products. This concern does not stem from a fear of fat, not at all, but more from the idea of increasing consumption of meat and other animal by-products. True, this could well be the entrenched prejudices rearing their ugly head, but there is also the undeniable fact that the meat (and all its associated by-products) of today, cannot hold a candle to that eaten by our ancestors in terms of nutritional value. Furthermore, where do the potential harmful effects of all the antibiotics etc, which today’s animal products are undeniably saturated with, weigh in? Of course, the same can be said for all vegetables, fruits, grains etc - the use of pesticides and the over-farmed and mineral-stripped land cannot yield the health-giving produce that was once a given.
From an IBD perspective I was unnerved to read that “[b]y 1981, nearly a dozen sizeable studies on humans had found a link between lowering cholesterol and cancer, principally for colon cancer”.
On a personal side note, as it is beyond the scope of the current discussion, I also have to mention how troubled I am by the issue of ethics surrounding meat and animal by-products, and generally the treatment of animals whose destiny it is to feed us, as well as the potential environmental impact. I am neither full vegetarian or vegan, but I do incorporate such meals as much as possible (when my gut can handle it) motivated purely by this moral dilemma. As a result, the idea of increasing meat consumption makes me uncomfortable.
So what do we do? What do we eat? It really feels like a catch-22 situation: damned if we do, damned if we don’t. There is just so much conflicting information, with plenty of convincing arguments from the opposing camps. Sadly however, it is clear that we cannot take what we are told on faith. We cannot trust that the people who are meant to know better than us, the people to whom we have entrusted our wellbeing, actually do know better. We cannot take it for granted that there are no vested interests at play, or that they even have the right information to pass on to us! This book was a fascinating, and unnerving read. What is certainly clear is that there are no simple answers or solutions, and we need to discover for ourselves what makes sense to, and works best for, each of us. After all, that's why there are so many dietary theories out there: different things work for different people. There is no one-size-fits-all.
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