Frequently Asked Questions

Page Contents

On key nutrition topics, what is the latest science?

Where does the data now stand on saturated fats?

Since 2014 when my book was published, the data exonerating saturated fats has grown even stronger. There are now more than 17 systematic reviews and meta-analyses of scientific studies looking at the relationship between saturated fats and heart disease. These studies include randomized, controlled clinical trials on more than 50,000 people, which is an enormous amount of the most rigorous kind of data available.

Nearly all of the analyses reviewing this data have concluded that:

  • Saturated fats have no effect on cardiovascular mortality and/or
  • Saturated fats are not associated with heart disease.
  • Don’t these studies conflict with our official nutritional advice?

They do. To understand why, one needs to know the history of why we believe these fats are bad for health.

Beginning in the 1950s, University of Minnesota pathologist Ancel Keys, launched the so-called “diet heart” hypothesis, which states that saturated fats and dietary cholesterol cause heart disease. Largely due to his outsized personality, Keys was able to get this idea implanted in the American Heart Association, which in 1961, became the first group in the world to recommend that the public cut back on saturated fat and cholesterol to prevent cardiovascular disease.

In subsequent decades, Governments and public health groups around the world spent billions of dollars on clinical trials (the “gold standard” of scientific evidence) trying to ‘prove’ this hypothesis, but all of these trials had “null” results—which is to say, they could not show that Keys was correct. In some cases, trials showed that reducing consumption of saturated fat and cholesterol (and replacing them wiht polyunsaturated vegetable oils) actually caused harm, including increased death rates from cancer and suicides.

Rather than respond to this ‘inconvenient’ data, however, scientists instead persevered in their belief that saturated fats must somehow be bad for health. These scientists, together with their funders at the National Institutes of Health, the American Heart Association, and elsewhere, ignored or even buried inconvenient data for decades. My book tells this story.

The story is largely one of politics: the influence of the food industry, the inability of large public health institutions, including our own federal government, to back out of a failed hypothesis, and the reality of nutrition experts who are unable or unwilling to change their minds, despite an overwhelming amount of evidence to the contrary.

Recently, however, there has been change. Beginning in 2010 with the work of Ron Krauss, scientists around the world have begun to unearth and reexamine the long-ignored literature on saturated fats, resulting in the 17 meta-analyses and reviews listed above.

Note that in response to this evidence, the Canadian Heart and Stroke Association in 2015 dropped its previous % limits on saturated fats.

Is there a short, non-book-length version of this story?

A short piece I wrote on how we came to believe that saturated fats are bad for health is “The Questionable Link Between Saturated Fat and Heart Disease,” in the Wall Street Journal (behind a paywall; also available here), which is adapted from my book. When it came out, it was the most emailed piece in the newspaper’s recent history.

Another option is an article that I wrote for Men’s Health magazine, “What if Bad Fat is Actually Good for You?” way back in 2007.

  • Given this enormous reevaluation of the literature on saturated fats over the past five years, why do the 2015-2020 U.S. Dietary Guidelines continue their caps on saturated fats?

The answer is that the expert committee for those Guidelines did not adequately or comprehensively review the recent data on these fats. This fact, which I reported for a 2015 article in The BMJ, was controversial and thus highly contested, yet it has stood up to multiple rounds of peer review, and is now confirmed as correct.

Another important paper on this subject is: “Evidence from randomised controlled trials does not support current dietary fat guidelines: a systematic review and meta-analysis,” BMJ Open Heart, 2016.

Why, then, do I keep seeing studies saying that saturated fats cause heart disease?

These studies are being published by epidemiologists and in particular, the nutrition department at the Harvard School of Public Health, which has published about one paper roughly every six months, based on data from its two epidemiological databases. These studies are flawed in numerous ways, and critiques of them can be found on pubpeer, here, here and here. More importantly, the Harvard studies are contradicted by the earlier clinical trial data reflected in those 17 reviews. That trial data (unlike Harvard’s epidemiological findings) can actually demonstrate cause and effect. It is therefore more definitive.

Indeed, the usual process in science is to start with an epidemiological association, which suggests a hypothesis, and then move on to test that hypothesis in clinical trials. Once properly tested in trials, there is no point in going back to look at hypothesis-generating epidemiological data again. It’s therefore not clear why Harvard keeps publishing these epidemiological associations or why informed reporters keep citing them.

In sum: the question of whether saturated fats cause heart disease has repeatedly been tested in large clinical trials, with null results. There is no need to go back to epidemiological data, which re-suggests a hypothesis that has already been thoroughly tested.

If I eat saturated fats, won’t my cholesterol go up?

The short answer is: Maybe, but not in a way that will increase your risk for heart disease. Saturated fat was originally demonized for its ability to raise total cholesterol. However, researchers in the 1980s discovered that total cholesterol did not turn out to be a reliable predictor of heart attack risk. The conversation then shifted to saturated fat’s tendency to raise LDL-cholesterol (the “bad” kind). However, yet again, clinical trials could not confirm LDL-C’s ability to predict heart attack risk. In many large clinical trials, LDL-C did not turn out to be correlated with the risk of dying from heart disease.

Also, it turns out that LDL-C has sub-fractions: some are small and dense, while others are light and buoyant. The small, dense ones have been found to predict increased risk, whereas the light, buoyant ones predict reduced risk. The kind of LDL that saturated fats cause to increase is the light, buoyant kind. Therefore, saturated fats actually appear to reduce heart-disease risk, not increase it.

Moreover, saturated fats are the only foods known to increase your HDL-C, the “good” cholesterol. When your doctor tells you to raise your HDL, s/he will recommend drinking red wine or getting more exercise, but a far easier way to raise HDL is simply to eat more saturated fats. Saturated fats reliably boost the “good” HDL cholesterol.

The first succinct publication of all this information was in an article that I wrote for Men’s Health magazine, “What if Bad Fat is Actually Good for You?” way back in 2007.

So, in sum, the effects of saturated fat on blood lipids can be said to be positive. Further explanation and references on all of the above can be found in my book.

Doesn’t it depend on what is eaten to replace saturated fats?

This is an argument promoted by defenders of the diet-heart hypothesis, and it is odd, because these same experts talk about other foods as simply being “good” or “bad” without insisting on a discussion about “what replaces them.” This discrepancy in approach leads me to believe that the “replacement” argument against saturated fats is probably a rhetorical maneuver aimed at creating confusion over the the data on saturated fats.

However, because this argument is being promoted by experts at the highest level, including those directing the review of saturated fats for the 2015-2020 Dietary Guidelines, it deserves a response.

Saturated fats vs. carbohydrates. All reviews agree that replacing saturated fats with “refined carbohydrates” leads to poorer cardiovascular outcomes. This position was confirmed by the expert committee for the US dietary guidelines as well as the latest American Heart Association “Presidential” advisory on saturated fats. However, if you look at data from randomized controlled clinical trials, saturated fats have never been replaced by “refined carbohydrates.” E.g., In no trial did researchers say: reduce saturated fats (in meat/dairy) and replace these foods with cookies, crackers, chips, and white flour. Instead, large clinical trials, including the Women’s Health Initiative (WHI) and the “Boeing Studies” counseled subjects to reduce the fats in meat/dairy and replace these with whole grains, fruits, and vegetables. The WHI, which measured “hard endpoints” (heart attacks and death) found no benefit of this diet. The Boeing Studies, which measured “soft endpoints,” found that the low-fat diet had mixed cardiovascular benefit (it lowered LDL-C but also lowered HDL-C and raised triglycerides).

Thus, the data show that replacing fats with total carbohydrates, including fruits, vegetables and whole grains, does not improve cardiovascular outcomes. Implication: It is healthier to eat a breakfast of eggs rather than whole-grain cereal or
oatmeal; cheese is a better snack option than crackers or fruit.

On sat fats vs. polyunsaturated vegetable oils. Remember that the original advice by the American Heart Association in 1961 was to replace saturated fats with polyunsaturated vegetable oils, so that hypothesis was tested on a massive scale. Thus, we have a huge volume of rigorous data, from government-funded, randomized, controlled clinical trials, conducted in the 1960s and 70s (which I describe in Ch. 2 in my book). This trial data has been reviewed in at least 9 meta-analyses and systematic reviews. These reviews universally conclude that replacing saturated fats with polyunsaturated vegetable oils has no benefit for cardiovascular or total mortality. Those studies that separately analyze strokes and heart attacks conclude that saturated fats have no effect on these outcomes. Only by ignoring that data and looking instead at the less definitive composite endpoint of “cardiovascular events,” a category that combines heart attacks with more subjective events such as angina, could the AHA arrive at its negative findings for saturated fats. For a full discussion of this issue including a table of the 9 meta-analyses, see this article that I co-authored with cardiologist Eric Thorn for the medical website Medscape.

This is the clinical trial data, which is the most rigorous and is the only kind of data that show cause and effect. There are multiple recent papers, mostly by the Harvard School of Public Health concluding that swapping saturated fats for polyunsaturated vegetable oils, but these studies are based on weak epidemiological data and involve complex modeling involving multiple assumptions. This kind of data can suggest hypotheses but not prove them. Because we have rigorous clinical trial data on this topic, that is far more definitive.

It is not clear why Harvard persists in publishing data on a topic that has already been tested in clinical trials, but one clue is that members of that group report receiving funds from vegetable oil companies, and the Harvard team appears to work closely with Unilever, one of the largest vegetable-oil manufacturers in the world. (Indeed, in one recent Harvard analysis, nearly half the authors were actually employees of Unilever.)

In sum, the extensive clinical trial data on this topic have concluded that saturated fats have no effect on heart attacks, stroke, cardiovascular mortality or total mortality.

Are there positive arguments for eating butter, meat and cheese?

Yes, there are the three major ones:

  1. These foods are far more nutrient dense than plant foods, and their nutrients have been shown to be more bio-available than those in plant foods. For instance, vitamin B12 is not available in plant foods. Fat-soluble Vitamins A, D, E and K need fat to absorb properly—and this fat comes naturally in animal foods. (The current USDA diet is inadequate in D vitamins without fortified foods.) Choline, lutein, and heme iron are scare in plant foods while abundant in animal foods–and so on. (I will post more links and information on this later.)
  2. Protein and fat have been shown, in clinical studies, to be far more satiating than carbohydrates. These satiating qualities mean that people are far less likely to “overeat” on these foods. For instance, most people, when they eat bacon and eggs for breakfast, are not hungry until lunch, whereas a breakfast of cereal and low-fat yogurt often has people starving by mid-morning. And as we all know, people “overeat” quite easily on carb-based foods like cookies, crackers, chips, bread, etc. Because protein and fat are found naturally paired together in animal foods, these are the most easily accessible, whole foods that make up this healthy and satiating diet.
  3. Finally, the historical record supports a diet higher in animal foods: One hundred and fifty years ago, we ate far more red meat, cheese, butter and lard than we do today (butter and lard were the principal fats that Americans used for cooking before 1900). We ate this way before the epidemics of heart disease, obesity and diabetes. I provide data on these facts in in my book and also debunk the myth that pre-1900, we just didn’t live long enough to suffer from the chronic diseases that appear later in life.

Where does the data stand on total fat?

It’s clear that a low-fat diet, defined in the scientific literature as between 20 and 35% of calories as fat, is not a healthy diet. This diet has been tested in multiple, NIH-funded clinical trials, on more than 55,000 people, all of which found that the low-fat diet was completely ineffective for combatting obesity, diabetes, heart disease, or any kind of cancer.

Worse than that, the low-fat diet has been shown to worsen various disease risk factors. According to the expert report for the 2015 US Dietary Guidelines, low-fat diets are “associated with dyslipidemia”—meaning that the low-fat diet is linked to heart disease. Worse than that, rigorous evidence shows that the low-fat diet actually causes these harmful effects. Low-fat diets reliably cause HDL-C (the “good” cholesterol) to drop and triglycerides to rise, both signs of increased heart-disease risk. These factors also signal the onset of the metabolic conditions that cause obesity and diabetes.

Given this data, the low-fat diet is no longer officially recommended by our major nutrition authorities. The American Heart Association (AHA) dropped its longstanding limits on total fat in 2013, and the US Dietary Guidelines (DGAs) followed suit by eliminating any reference to limits on total fat in 2015. This doesn’t mean that low-fat caps don’t still exist in the fine-print of the DGA report, but the official, topline advice, to eat a low-fat diet, recommended by the AHA since 1970 and the DGAs since 1980, is gone.

Even so, the government has yet to announce this important change to the public. There have been no press releases to let the American public know that the major dietary policy for disease prevention of the last 35+ years is now over.

Where does the science stand on dietary cholesterol?

The American Heart Association dropped its caps on dietary cholesterol in 2013. The US Dietary Guidelines followed suit in 2015. Why? Because since the 1950s, rigorous scientific evidence has shown that dietary cholesterol has little marginal effect on blood cholesterol. The more cholesterol you eat, the less your body itself produces. The back story and science on this subject is covered in my book, with references.

Is sugar uniquely unhealthy?

In his latest book, The Case Against Sugar, science journalist Gary Taubes makes the case that sugar has always been at the “scene of the crime” when populations have become obese/diabetic.

However, as Taubes acknowledges, even if sugar has the unique ability to cause obesity and diabetes, the cure is not the same as the cause. In other words, for people who are already obese or diabetic, many will not be able to manage conditions simply by eliminating sugar–because those people have already tipped over into an unhealthy metabolic state, quite different from that of a healthy person. A metabolically unhealthy person has conditions known as insulin resistance and hyperinsulenemia, which means that s/he can no longer effectively process carbohydrates. A large body of rigorous scientific evidence demonstrates that for these people to recover, they must reduce the total amount of carbohydrates they eat. For these people, even too many “healthy” whole grains cannot be tolerated. The science on this may change, with regard to what type of carbs can be tolerated (glucose vs. fructose, refined, unrefined, and so on), but currently our state-of-the-art understanding of how to reverse these diseases is that total carbohydrates must be restricted.

It is also true that there is not, currently, an adequate body of rigorous (clinical trial) evidence to conclude that sugar is a unique driver of metabolic diseases. As a result, population-wide recommendations limiting sugar intake are questionable. I reviewed this issue for a piece in The Atlantic, “The Limits of Sugar Guidelines.”

No doubt a major reason that the science is still lacking on sugar is that the sugar industry has manipulated the science in a number of ways. To learn more on this issue, you can read work by:

Nevertheless, I think it would be a mistake to blame the sugar industry for everything that has gone wrong in nutrition science and policy over the past 60 years. Having researched the history and politics of this field for more than a decade now, I know that many industries have played a role in manipulating nutrition science, including the vegetable oil industry, Big Pharma, the soy, grain and corn industries, as well as many manufactured food companies.

I made this point in an op-ed for the L.A. Times, “Don’t scapegoat Big Sugar. Lots of food producers profited from the demonization of fat.”

How can I change my diet to become healthier
(for weight loss, etc.)?

Are you really telling people to eat a lot of butter?

Butter, meat, and cheese have been condemned since the early 1960s based on their cholesterol and saturated fat content, yet now, these two pillars of the diet-heart hypothesis have been questioned: dietary cholesterol is no longer thought to lead to adverse blood lipids, and the link between saturated fat and cardiovascular mortality has been seriously challenged. If saturated fat and cholesterol do not cause disease, then there is no reason to avoid these foods. That doesn’t mean that we should gorge on them. It just means: let them out of jail. They’ve been unfairly condemned based on weak evidence.

Beyond that, there’s a large body of rigorous trial evidence demonstrating that a higher-fat diet (>35% of calories as fat) is healthy, safe, and highly effective in fighting obesity, diabetes, and heart disease. Americans, in fact, used to eat some 43% of calories as fat in 1965, before the epidemics of obesity and diabetes. So, how do you get to a higher fat diet? The best way to do that is to add natural fats to the diet. Vegetable oils are industrially produced, invovling a long process that includes high-pressure extraction with the solvent hexane, steam cleaning, treating with a nickel catalyst, mixing with soap-like emulsifiers, “deoderization” to remove bad odors, bleaching to remove the grey color, and “winterization.” By contrast, animal fats such as butter and lard are natural, involve almost no processing, and have been eaten by humans for millennia. For vegetarians, coconut and palm oil are good, natural sources of saturated fat. But for most Americans who come from northern climates where tropical fats are not part of their historic diets, a higher fat diet is likely to include natural fats like butter, lard, tallow, schmaltz, and suet.

This is not to say that some people do not thrive on high-carb diets: certainly they do. Human responses to diet vary enormously.

Yet for the majority of Americans who are overweight, pre-diabetic or diabetic, the most rigorous science strongly supports a diet restricted in carbohydrates and high in fat as the best tool for combating these diseases.

Won’t my cholesterol go up if I eat more saturated fat?

The short answer is: Maybe, but not in a way that will increase your risk for heart disease. Saturated fat was originally demonized for its ability to raise total cholesterol. However, researchers in the 1980s discovered that total cholesterol did not turn out to be a reliable predictor of heart attack risk. The conversation then shifted to saturated fat’s tendency to raise LDL-cholesterol (the “bad” kind). However, yet again, clinical trials could not confirm LDL-C’s ability to predict heart attack risk. In many large clinical trials, LDL-C did not turn out to be correlated with the risk of dying from heart disease.

Also, it turns out that LDL-C has sub-fractions: some are small and dense, while others are light and buoyant. The small, dense ones have been found to predict increased risk, whereas the light, buoyant ones predict reduced risk. The kind of LDL that saturated fats cause to increase is the light, buoyant kind. Therefore, saturated fats actually appear to reduce heart-disease risk, not increase it.

Moreover, saturated fats are the only foods known to increase your HDL-C, the “good” cholesterol. When your doctor tells you to raise your HDL, s/he will recommend drinking red wine or getting more exercise, but a far easier way to raise HDL is simply to eat more saturated fats. Saturated fats reliably boost the “good” HDL cholesterol.

The first succinct publication of all this information was in an article that I wrote for Men’s Health magazine, “What if Bad Fat is Actually Good for You?” way back in 2007.

So, in sum, the effects of saturated fat on blood lipids can be said to be positive. Further explanation and references on all of the above can be found in my book.

How can I eat a healthy, higher-fat diet?

Check back, we’re developing this section as a resource for you.

How can I help my kids eat more healthfully?

As the mother of a teen and pre-teen, I know how hard it can be to help children make good food choices, especially when so many of their peers are eating junk food. The whole area can be a psychological mine field with kids. I have just a few pieces of advice, based on my own trial-and-largely-error efforts:

  • Do not take away food from kids or make them feel deprived. Instead, supply them with fun, healthy alternatives that are as close as possible to what they are replacing. And let’s not pretend hard-boiled eggs are as fun as pizza. Instead of pizza give them low-carb pizza. Instead of a chocolate bar full of sugar, give them a low-carb chocolate bar with artificial sweeteners. It makes no sense to be a purist about artificial sweeteners if your kid is just going to sneak out and eat sugar. Try Fat Bombs. I like this book.
  • When a child craves something sweet, feed them fat instead. This is a good rule for grown-ups, too! Fat fills you up and will often simply wipe out the sweet craving. It can also be fun: a bowl of whipped cream with a touch of sweetener and cocoa powder, for instance. A few tablespoons of coconut butter (incredibly satiating and nutty-delicious). A savory fat bomb.
  • Ultimately, you want to get your child away from the taste of sweet things altogether—because a taste for sweet stuff does seem to be addicting, and thus, self-perpetuating. But it’s important to be realistic about what you can accomplish in this toxic food environment, especially when your children are older children and more responsive to peer pressure than they are to parental advice.
  • If your children are younger, you have more control, obviously. Try to create a home environment that is healthy and relatively low-carb, and help them develop good tastes/habits. Limit snacking and instead focus on full, satisfying healthy meals that start with a healthy protein, then add vegetables and plenty of healthy, natural fats (which means no vegetable oils). Limit bread and starchy foods. Make dessert a special treat, maybe once a week (like it used to be a century ago), and not something eaten daily.

If your child is obese or has Type 2 diabetes, the situation is more urgent. Here are a couple of groups that can help:

Resources to educate kids:

Resources for lunchboxes and other food ideas:

Do you have a list of favorite books/recipes/websites/foods?

Check back, we’re developing this section as a resource for you.

What do you eat?

This section under development. Meanwhile, you can read this essay that I wrote for Family Circle magazine, “Fat vs. Fiction: The Truth About Fat in Your Diet.”

My doctor disapproves of a higher-fat diet. What should I tell him/her?

I would recommend giving your doctor a copy of my book, because most clinicians are unlikely to be persuaded by even a stack of articles. I find that people need to read the full story–the science, the politics, the influence of the food industry—in order to experience a paradigm shift. Plus, my book is not boring; The Economist called it a “nutrition thriller.” Plus it has 150 pages of footnotes, so it’s highly credible. I think it’s a lot to ask of someone to change decades of thinking—to believe the opposite of what they always thought was true. In my experience talking to people now for years on this subject, I find that people really need to read the whole story to understand.

However, as a short introduction, here is an interview with me on the subject of saturated fat on Medscape, which is a source that doctors tend to trust.

On saturated fats and heart disease, a short piece I wrote is “The Questionable Link Between Saturated Fat and Heart Disease,” in the Wall Street Journal (behind a paywall; also available here), which is adapted from my book. When it came out, it was the most emailed piece in the newspaper’s recent history.

Regarding controversies sparked by your work.

Why is your work controversial?

I knew that challenging an entrenched status quo, supported by Big Pharma, Big Food, and the US government, was likely to cause controversy, and no surprise, it did! The experience has unquestionably been bruising for me, but in fact I’m proud of the extent to which my work has changed the conversation on healthy fats. Experts at the highest level have responded to this work, and as far as I can see, there are no serious counter arguments to my book. Specifically, there are no serious counterarguments to my central claim, namely that saturated fats (and dietary fat generally) have been unfairly villainized and are not, in fact, bad for health.

This lack of any valid scientific argument is presumably why critics have instead resorted to the politics of trying to silence me, either by trying to impugn my motives or character, or trying to get my work retracted.

Why do you write in the language of macronutrients when we should really be talking about foods?

I agree it would be preferable to talk about foods rather than macronutrients. It’s clearly more appealing. And, as I write in my book, no one asks their mom for 40% carbs and 20% fat for dinner—they ask for spaghetti and meatballs—of course! However, the reality is that for last 50 years of nutrition science, studies have been conducted on macronutrients. If you read 3,000 nutrition studies, you will find 90% of the rigorous clinical trials test the % fat, saturated fat, carbohydrates, etc. in the diet. Therefore, any analysis of that science must be on its own terms. That’s where we have the data. Thus, while it’s nice to talk about foods, we don’t actually have much rigorous science in this area. (Note: I do believe that we can talk about “real” foods from two perspectives: (1) their historical presence in the human diet and (2) their micro- and macronutrient compositions.)

Also, the reality in the scientific literature is that the macronutrient ratio of one’s diet is a key factor in determining whether that diet is effective in fighting metabolic diseases such as obesity, heart disease and diabetes. The variation in success of low-carb diets is directly related to their macronutrient ratios. Of course, there are other factors that contribute to weight loss and metabolic health. These include nutritional sufficiency, sleep, stress, and other hormones. Yet according to the scientific evidence, macronutrient ratio is crucial.

Please explain the controversy over your article for The BMJ.

This article was an investigative critique of the science used to underpin our US Dietary Guidelines. For years, experts have criticized the lack of scientific evidence supporting the US Guidelines, yet none has been so controversial as my BMJ piece. My analysis showed that the guidelines are based on a miniscule amount of rigorous data, while ignoring a vast amount of evidence to the contrary. In sum, my article concludes that they are not the “gold standard,” as claimed. The implication is that the guidelines should be reformed so that they are an accurate, comprehensive reflection of the best and most current science.

The Center for Science in the Public Interest, a longtime DC-based advocacy group that supports the Dietary Guidelines, organized a large group of scientists to try to get the the article retracted. An overview of the story is here.

This retraction effort was unsuccessful. The BMJ stood strongly by the article. See a statement by The BMJ editor-in-chief, here, and other coverage by me here and here.

You traveled to S. Africa to testify in the trial of Professor Tim Noakes.

This section is under development.

What about the charges that your book is “full of errors” and “cherry picks the literature?”

In the nearly three years since publication of The Big Fat Surprise, a number of researchers from prominent universities (Harvard, Yale, NYU) have levied accusations that my work is “error laden” and the product of “cherry picking the data”—yet none of these researchers have provided any substantiation for their claims.

To my knowledge, the only serious attempt to fact check my book came from a blogger, Seth Yoder , who has a degree in nutrition (focusing on plant lignans, not nutrition) and now works as an engineer while also moonlighting as a fact checker for vegetarian/vegan researchers.

The fact that Yoder has written the only serious critique of my book in these years tells me that in fact, the arguments in my book are extremely solid. These arguments have now been pressure tested at the highest level—by top media outlets around the world, in debates and in top science journals—and at the moment, I can say that they’ve held up.

Seth went through every single one of my citations to check them, an exercise that must have taken him hundreds of hours, and this makes his critique unique and important. Here’s what Yoder found: I had made some mistakes. There were some sources that were wrong, some inaccuracies, and two drawings that had been done incorrectly. Although I did hire two professional fact checkers, it’s just reality that any book based on thousands of references will inevitably contain errors, especially when it comes under the degree of extreme scrutiny that mine was. I am fully responsible for those errors. The paperback edition contains all the corrections. If you have one of the original hardcovers, the correction sheet can be downloaded here.

However, crucially, none of these corrections altered any of the book’s assertions.

Many of Yoder’s mistakes derive from the fact that, as a newcomer to the field, he failed to understand the larger historical context in which scientific papers on diet and disease over the past 50 years have been written. For decades, researchers have been under extreme pressure to conform to the diet-heart hypothesis. In my book, I document extensively how believers in this hypothesis simply could not acknowledge evidence to the contrary, even when their own research data yielded contradictory results. Often they would simply deny it. Sometimes even the written conclusions of their papers inaccurately reflect what their own data documents. The result has been that knowingly or not, researchers consistently buried “inconvenient” results. One such instance I describe in the book involves Jeremiah Stamler who, in writing about his Western Electric Study, dismisses his own study results, since they do not support the diet-heart hypothesis. Instead, he concludes the opposite of what his data says, with the real buried and obscured deep inside his paper. Again and again, one sees this kind of bias in reporting data, but this reality only becomes obvious to someone who has read thousands of papers and studied the history and politics of the field. Time and again, I found that Yoder simply took the scientific literature at face value and failed to grasp these subtleties. Without the experience and understanding of the field, he only understood the literature superficially.

In other cases, Seth’s accusations were simply sloppy. For instance, he elaborated at length about how I copied the 2010 thesis of a graduate student, David Schleiffer. Actually, the lines of information sharing here were reversed. Schleiffer found me via a 2004 article on trans fats that I wrote for Gourmet magazine. I shared with him my insights as well as many of my interviews with food-company executives and a number of other materials. If you search his thesis, you’ll find that my name is cited 24 times, often to make clear that the people he quotes are from the interviews that I conducted. He also cites me in the acknowledgments.

Regarding the charge of cherry picking the data that Yoder and others have alleged: Cherry picking means selectively choosing studies that support one’s hypothesis while ignoring those that do not. Quite simply, this accusation cannot be levied against me because I am not proposing a hypothesis about what causes nutrition-related diseases. Instead, I am critiquing an existing hypothesis, and here, the standards are different. To critique an existing hypothesis, one needs only to find facts that contradict it. The main subject of my book is the critique of the hypothesis that saturated fat and cholesterol cause heart disease. And here, I found plenty of facts to contradict this idea–such as the Masai warriors in Uganda or the Italians in Roseto, PA, or the 1 million railway workers in India, all of whom were documented as being healthy on high-fat diets. “The great tragedy of science is the slaying of a beautiful hypothesis by an ugly fact,” said the great British biologist Thomas Huxley. Finding those ugly facts is what I have done in my book.

If I were arguing my own hypothesis about what causes heart disease or obesity, I would be open to the critique of cherry picking, but I don’t do that. I entertain some ideas on this subject (carbohydrates, vegetable oils), but I don’t make any sustained arguments, and these are not the focus of the book.

Questions about The Big Fat Surprise.

I listened to the audio book. Can I get access to the references?

Indeed you can, here.

I have the hardcover book. Is the paperback the same?

A number of corrections were made for the paperback edition. These can be downloaded here. (No worries–these corrections are minor and did not changed any of the assertions in the book.)

Can I get an autographed copy?

Yes, please order from the Hickory Stick Bookshop and indicate in the “comment” section on the order page if you’d like a particular inscription.

Is the book available in other languages?

  • Yes: Spanish (Mexico—Penguin Random House), Portuguese (Brazil–WMF Martins Fontes), Mandarin (China–Commercial Press), Czech (Jota), Estonia (Peramotsa Press), Korea (Window of Times), Slovakia (Publixing), Taiwan (Ark Culture), Vietnam (Thai Ha Books).
  • English-language books in the UK, South Africa, Australia, and New Zealand can be obtained from Scribe Publications.
  • Please contact your local publisher for details on how to obtain a book.

Who paid for your book?

The only funds I received for the book were from my US publisher, Simon & Schuster. During the nearly 10 years that I spent researching and writing the book, I financed myself from my savings (exhausting an inheritance left to me by my grandmother) and also by relying upon my husband (thank you, Gregory!).

What are the similarities and differences between your book and Good Calories, Bad Calories, by Gary Taubes?

I’d venture to say that there’s no writer today challenging the low-fat diet policy who is not drawing upon the work of Gary Taubes. He pretty much single-handedly launched this entire field of inquiry, and we all owe him a great debt. Indeed, in my book, I credit his work throughout and have also included him in the acknowledgements. Beyond that, he is a major character in Chapter 10 of my book, where I seek to set his place in history so that it might never be forgotten (an effort that has turned out, sadly, to be ever more necessary as researchers, doctors and journalists on a regular basis claim to have themselves invented the contributions that rightfully belong to Taubes).

For people who’ve read Good Calories, Bad Calories, here’s how my book is different. The Big Fat Surprise:

  • Is written more for a general audience. It is somewhat less technical and has more of a story-telling quality to it. The Economist, which named it the #1 book of 2014, called it a “nutrition thriller,” which is my favorite description. Many Amazon reviewers say that it reads like a mystery ‘Who-done-it.”
  • Goes off in some entirely new directions. For instance, it covers the history of vegetable oils, tropical oils, trans fats and what replaced them, the Mediterranean Diet, and the story of nutrition science since 1986 (where Taubes’ book leaves off). And it includes the story of Gary Taubes himself and how he changed nutrition history, along with some brave and groundbreaking researchers.

It’s true that in my book, I recount many of the same events and studies as Taubes did in his work. This is necessary because in outlining the mistakes of nutrition history since 1950, certain events must be repeated, in the same way that any telling of the story of the Civil War must include the battle of Fort Sumter. It might seem redundant to anyone who already knows Civil War history, but retelling these events is necessary. I think it’s fair to say, too, that the story of our failed low-fat policy is so important that it bears repeating, many times over and in as many ways possible, until it becomes a matter of common knowledge.

On this topic, Gary Taubes himself agrees, and provided the following statement (July 23, 2015):

“The accusation that The Big Fat Surprise plagiarizes or “cribs” from my work is unjustified and naive. As Teicholz herself notes, any critical recounting of nutrition policy inevitably includes certain key events that must be addressed. I’d like to think my writing has in some way led to awareness of these events and to how they should be interpreted. Moreover, I believe that Teicholz, throughout her book, amply credits my books and articles as well as my role in exposing some of the bad science underlying the dietary fat hypothesis of heart disease and in developing the alternative hypothesis for chronic disease.”

What about concerns regarding animal welfare and the environment?

Since I didn’t eat red meat for 25 years, I understand the feelings that people have on this score. People may choose not to eat meat for ethical reasons. There’s great concern now about the environmental impact of cattle. And there’s the sense, going back to Frances Moore Lappe’s book, Diet for a Small Planet, that growing a pound of meat, compared to a pound of plants, consumes too many of the earth’s resources.

Here are some points to consider: what if a pound of plants cannot provide the same nutrients and nourishment as a pound of meat? What if they are not actually equal? Meat (and eggs and dairy) contain far more essential nutrients than do plant foods, and –this is a critical point—more of those nutrients are more bioavailable when consumed from meat and dairy than from plants, meaning that our bodies can absorb and use these nutrients better. For instance, heme iron is not particularly bioavailable when eaten in spinach (plus you’d have to eat a roomful of it), compared to when it is eaten in meat. Plants foods do not include B12 and and are lacking in micronutrients such as choline and lutein. It takes careful planning and artificial supplements to stay healthy on a plant-based diet. So it is quite clear that a pound of plants does not provide the same kind of nourishment that enables good health, compared to a pound of meat.

Moreover, the plant-based diet is almost inevitably high-carb, which is a diet that even the 2015 Dietary Guidelines advisory committee acknowledges is linked to heart disease. A great deal of science shows, in fact, that this high-carb diet causes heart disease by lowering HDL-C, the good cholesterol, as well as raising triglycerides—both reliable indicators of increasing heart-disease risk. The low-fat, high-carb diet is also strongly associated with increases in obesity and diabetes.

Thus, if a pound of (high-carb) plants comes with the burdens of nutrition-related diseases, the externalities of treating these diseases (estimated by some to be $1billion a day, not to mention the cost of human suffering) must be factored into the equation. By contrast, if a pound of meat sustains healthy human life, without obesity, diabetes and heart disease, then this lightens the ‘load’ of meat on us humans. The point is that we need to reconsider all these factors when calculating the effects of plants vs. meat.

Regarding the impact of red meat on global warming, I’m a bit skeptical of that science, just because I know that the anti-meat bias has become extremely strong over the past decade, and I never trust science done in the climate of prejudice. Also, there’s some data that contradicts the hypothesis that cow emissions (farts) drive global warming. For example, cattle herds in the US have declined by 30% over the last 3 decades, and beef consumption has dropped by more than 35%. So how is it that cattle could be responsible for global warming? For a serious analysis of this science, I would suggest following the work of a fellow former vegetarian, Nicolette Nieman, who wrote the book Defending Beef.

The cultivation of livestock is an ancient practice: Abel was a shepherd; sculpted on the Parthenon friezes are ancient Greeks walking their cows to the festival of Athena. Humans domesticated animals so that they could have a convenient source of protein without having to deplete the forests and land of wild animals. (Cows, as we know them, would not exist unless humans had domesticated them.) It’s simply hard to believe that raising livestock could be the main cause of global warming, as many vegetarians claim, especially when you look at other factors that have changed in recent decades: industrialization, loss of nature to cities, the proliferation of cars and factories, etc. These are massive changes that would seem to dwarf any impact of the (declining) cow population.

But even assuming that cows do drive global warming, we still need to separate out the scientific questions. The nutritional question is: can a diet without meat sustain human life, including healthy growth (children) and reproduction (pregnant women)? Meat is the best source of iron and folate, which are crucial for growth and fetal development. This is separate from the environmental question.

It is not scientific to merge these questions together.

At this time, there is no rigorous (clinical trial) trial data to support the vegetarian or vegan diet as one that can support a healthy human life over the long term. Moreover, there is no example of humans surviving multi-generationally this way in history. Thus, it does not seem wise to launch into what would be an experimental diet for the human species without evidence that this will be safe. Moreover, I believe nutrition experts should be humbled by their poor track record to date in prescribing experimental diets: obviously the low-fat diet has been a mistake, as have been restrictions on dietary cholesterol. These are excellent arguments to proceed with caution.

Finally, if cows do drive global warming, then we ought to ask ourselves, how can we reduce their impact? Do they make a contribution to the ecosystem that will be lost if we eliminate these animals? And what, then, will be our alternative source of healthy protein given that fish are disappearing from the oceans?

How can I help change nutrition in my community or in America?

How can I help change the food environment in our schools, nursing homes, hospitals, supermarkets, etc.?

This section is under development.

Meanwhile, you can follow the work of The Nutrition Coalition, on Facebook or Twitter (@4dietaryreform). This group is organizing to bring to light the failure of our current nutritional guidelines and how they can be reformed. Watch that space.