Emily's Reviews > The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet

This book exceeded my expectations in both form and content. The author assembles a devastating case against the low-fat diet that has been recommended by doctors and government agencies as a way to prevent heart disease. My interest was piqued because my family--dutiful "compliers" with health advice, one and all--zealously partook of the low-fat carb-fest that was the 1980s through 1990s. Several of my family members now have serious health conditions that I can hardly say were caused by this diet--but I'm sure it didn't help. Sample food selection from these days: unlimited snacking on low-fat pretzels. It's okay if they don't have surface salt!

What Teicholz shows is a cascade of inane decisions on top of each other, reminding me a bit of the episode of The Simpsons where they release lizards into the wild to kill birds, confident that they can then "unleash wave after wave of Chinese needle snakes" when the lizards proliferate, and then take care of the snakes with gorillas, who will "simply freeze to death" "when wintertime rolls around."

In this case, we have a weak association between cholesterol and heart disease, which turns into a frantic effort to lower cholesterol, which is achieved by eliminating saturated (animal) fats in favor of vegetable oils. These oils need to be made solid to be put in packaged food, so they got partially hydrogenated. Then we realized trans fats were bad for you so we replaced those with interesterated (sp?) oils, which turn out to be toxic when heated to high temperatures. No reliable evidence existed for many of these steps; for example, the vegetable-oil diet seemed to make heart-disease outcomes worse, but by that point, researchers were so religious in their quest to lower cholesterol, they didn't consider that important. In fact, any time researchers came up with evidence that ran counter to the "diet-heart hypothesis" they got shouted down, or their data was treated as a problem to be explained away rather than considered. Meanwhile, dietary fats got replaced with carbs, with results that we're all familiar with.

Some of the mistakes in this science are such boners that they're breathtaking. Remember the "Mediterranean Diet" that was supposed to be so ideal--lots of vegetables, grains, and olive oil, and not many animal products? The Europeans who followed this diet had low heart-disease and such natural lifestyles! It turns out that the original study about the Greek islanders was done during Lent.

As for the form of this book--it's almost entirely about heart-health rather than diabetes or obesity, and therefore contains zero-percent concern-trolling by volume. Nor is Teicholz very interested in providing actual diet advice to the reader (you could read some between the lines if you like). Instead, this is a story of the processes of science and publishing going wrong; of advocacy groups exerting disproportionate power; and of how extremely difficult it is to do ethical, conclusive research on such a complicated system as the human diet. The American Heart Association comes off particularly badly, and looking at this book alongside my recent read The Emperor of All Maladies you could become suspicious that correct scientific ideas don't need associations like this; the groups flourish when desperation to do something about a health problem outstrips knowledge of what is to be done. There's also one passage here--about how you can assert almost anything if you throw enough variables in the pot--that should be assigned in statistics classes.

Consider this not a diet guide but an analysis of a scientific community that lost its way and an indictment of government making recommendations without solid reasons. If it makes you feel free to enjoy a nice steak afterwards, that's just a bonus.