Nina Teicholz’ book “The Big Fat Surprise” is at it’s core a well-researched history of nutrition science in this country over the past 100 years or so. Nina brings a background in biology and investigative reporting to bear on the questions of what’s changed in that time in what we’re eating and drinking, how that’s changed our bodies and bodies, especially the increased incidence of metabolic diseases, and why those changes were made, usually not for reasons based on decent science. Even though I’ve been studying the topic for two years, I learned quite a bit. Her writing style is very readable and personal. As well as evaluating the scientific literature, she made contact with the an amazing number of the people across the spectrum of industry, science, and government involved in all aspects of our food supply. She had some very candid conversations with key players in science and policy making, not to mention many of the insurgents trying to bring good science to bear on a bad situation.
The book is roughly chronological, starting at the beginning of the 20th Century. It traces the development of the bias and poor science that resulted in the low-fat diet recommendations that took over our food supply in the later half of the century. That continues for the first seven chapters, then Nina jumps back to the origin of vegetable oils as alternatives to animal fats at the beginning of the century–Crisco and its descendants. Chapter’s Eight and Nine trace vegetable oils into the current very uncharted territory of potentially toxic compounds that never occur in nature. Chapter Ten switches to focus on the benefits of ketogenic diets. It summarizes the work of important researchers and clinicians in the field. She also describes the research by Dr. Robert Krauss to determine what aspects of cholesterol testing really relate to risk of heart disease–not what’s being measured by your doctor (See my page on that topic). She concludes that the high saturated fat, meat-based diet Americans ate before the 20th Century is what’s healthiest. Conversely diets high in the most commonly used vegetable oils and carbohydrates (sugars) have serious effects on your health and elevate the risk of an array of physical and mental diseases. Throughout the book are description after description of relevant research studies, with good summaries of the design, outcomes, and assessment of the validity of those studies. I came away with a better understanding of the erratic construction of the oft-cited Seven Countries study that was the basis of Ancel Keys’ low fat diet pogrom that further poisoned our nation. That’s where Nina’s background in the biological sciences undoubtedly came into play.
There are a lot of topics this book doesn’t cover. That’s not a negative criticism. I think the author decided she needed to focus on understanding how and why our food supply has shifted to its current toxic state. It’s very much a story of human beings who aren’t evil, in fact often with decent motives, who have allowed their intellectual limitations, egos, and pressures of the moment, like research funding by the food industry, to obscure their vision. As a result, they have made changes in what you eat and drink that have caused untold suffering and mortality. Many of those people are still around and active in their profession, continuing to promulgate bad science and public policy. Nina also talks about the voices in the wilderness, scientists who have tried to do unbiased research in branches of applied science in which open hostility to alternate ideas surprises me. In the basic sciences where I come from, there are plenty of egos and nasty people, some of who defend their ideas instead of pursuing the scientific method. In the public health and nutrition sciences arena, this is carried to an unprecedented level of ugliness. I was struck by the account of the nutrition science “enforcers,” researchers who derive their funding from or where actually in the employ of the food industry. They actively worked to suppress publication of research that was unfavorable to their masters’ products. They attacked those researchers verbally at scientific meetings. From the accounts of Nina’s conversations with the enforcers, they seemed proud of their reprehensible behavior.
There’s no discussion in The Big Fat Surprise of the evolutionary origins of human taste for fatty flesh–the genesis of genus Homo as persistence hunters, i.e. predators. She does a good job of summarizing for the non-scientist Steve Phinney and Jeff Volek’s important work on the physiology of low carb, high fat diets. My M.D. wife and I have read Steve and Jeff’s “The Art and Science of Low Carbohydrate Living.” We thought it was excellent, but heavy going, even for us. She describes the clinical practice of Robert Atkins, of Atkins Diet fame, which led to Eric Westman’s experimental validation of Atkins’ keen observations. She reinforced my sense of the role science writer Gary Taubes has played in changing the national dialogue, shedding some light along the way on a feud of sorts I had heard alluded to between Gary and another well-known science writer, the New York Times’ Gina Kolata. Since I’ve corresponded with both, that was interesting. Gina is an accomplished runner and cyclist as well as a good writer. When I described to her the experiments we’ve done with keto-adaptation by members of the Tucson Trail Runners, I sensed a distinct disinclination to think about what I describing, which fits.
For me, the biggest knowledge gap this work filled was the twisted tale of the replacement of animal fats and diary products with vegetable oils. They were introduced as a cheaper alternative to lard and butter. This matches well with what I know of the ramp-up of temperate zone agriculture in the 20th Century, fueled by cheap petroleum. What does one do with all that corn, wheat, soybeans, and so forth? One thing is to convince people to eat the oils squeezed out and modified by industrial processes. Factory food, just like cane or beet sugar. Another use for all that corn, by the way, is to give it to cows and pigs, which results in meat with a high level of omega-6 fatty acids making the meat less healthy for our consumption. That’s something else she apparently decided not to go into in this volume. The trans fats that result from the industrial processing are molecules the human body had never seen. Nina describes autopsies showing the trans fats were incorporated into cell membranes, damaging the normal function of those cells, possibly in ways that promote heart disease. She describes the wars conducted by the temperate zone agriculture producers against the tropical oils, some of which which people can actually digest and thrive on. She documents the questionable claims of antiquity and health benefits from olive oil, driven by the olive oil industry’s desire to sell product. Methods included expense-paid junkets for nutrition and public health scientists to delightful places in the Mediterranean region. When the tide of public opinion turned against the modified (hydrogenated) vegetable oils due to their trans fat content, they were replaced by even more questionable oil formulations that produced aldehyde molecules when heated to fry foods. The aldehydes haven’t been studied properly, but what little evidence exists suggests they can be downright toxic. They seem to result in a varnish-like material that coats surfaces, including the dropping of poor rats in one experiment. The rats became stuck to the bottoms of their cages.
This is a deep, broad, rich work, the result of many years of diligent and careful scholarship, to say nothing of the incredible number of conversations with significant players in the societal drama that’s our food and health landscape. In a short review, I can only touch on a few of the specifics. This isn’t to say all the topics and researchers that I consider important were covered. In addition to what I’ve listed in the paragraphs above, Nina didn’t say anything about some researchers I’ve discussed on this site like Robert Lustig and Rick Johnson who are doing important research in the underlying mechanisms of sugar, specifically fructose. She didn’t have the seemingly obligatory paragraphs I’ve seen in other works trying to tie our nutritional needs to our evolutionary origins, let alone discuss the work of the evolutionary anthropologists I’ve cited. I sense that may relate to decisions of scope, not lack of awareness. She had a note at the end of the main narrative explaining that she understood there were enormous challenges with feeding 7 billion people high fat, meat-based diets, but that was beyond the scope of this project. As well as being a very readable account of straying down a bad path that is receiving considerable popular acclaim, the meticulous research and detailed notes and reference are likely to make this an important reference work in libraries of history of science and societal change.
Anyone who’s interested in their health and the health of those they care about should read this book. Anyone with an open mind and a willingness to think critically will come away with a different perspective, some of it not articulated in any of the other works I’ve seen to date. One would hope this work will cause a bit of soul-searching in some quarters, but that remains to be determined.