Regarding Controversies Sparked by Nina’s 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.