Book Review ~ Big Fat Surprise by Nina Teicholz

Investigative journalist, Nina Teicholz has written a book extolling the virtues of dietary fat (and saturated fat) and perpetuating the lie that is Americans on a low fat diet.  She calls it The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet.

Don't waste your money.  Spread the word so others can save as well.

I'm not going to review this entire book because I cannot stomach reading it.  It is a poor follow-up to her friend and manuscript reviewer Gary Taubes' Good Calories Bad Calories ... and its what ... over 6 years late in the game??

In the Highlight reel:
  • Teicholz claim Americans went from eating 43% fat to 33% fat.  Unreferenced assertion.  I.just.can't.
  • We will now know Ancel Keys middle name is Benjamin.  As if referring to him by his full real name makes the demonizing better somehow -- like scolding a child.  Pathetic.   I will have much to say about Keys in the coming week as regards revisionist history by so-called investigative journalists.
  • The Hunza survived primarily on animal foods.  
  • The Masai "considered fruits and vegetables fit to be eaten only by cows" (otherwise known as women and children?)
  • Lancet critics of lipid-heart hypothesis:  "statistical association must not be immediately equated with cause and effect."   Remember that folks ;-)
  • Invokes the Shai study with:  "Remember that the Shai study in Israel found that the Mediterranean diet group, eating a high proportion of calories as these “complex” carbohydrates, turned out to be less healthy and fatter than the group on the Atkins diet."   I guess she doesn't read Eades' blog OR original journal articles, or she'd know that the Mediterranean diet group lost as much weight as the Atkins group, the women on Mediterranean diet lost the most weight of any subgroup, diabetics fared better on Mediterranean diet, and ... well ... 4 year followup and it looks like the Atkins dieters were the fatter bunch


The Pima Indians of Arizona 
(and others)
Misrepresented ONCE AGAIN

I really just can't take this flagrant intellectual dishonesty any more.  Here are the direct quotes from the book:
Meanwhile, the Native Americans of the Southwest were observed between 1898 and 1905 by the physician-turned-anthropologist Aleš Hrdlička, who wrote up his observations in a 460-page report for the Smithsonian Institute. The Native Americans he visited were eating a diet of predominantly meat, mainly from buffalo, yet, as Hrdlička observed, they seemed to be spectacularly healthy and lived to a ripe old age. The incidence of centenarians among these Native Americans was, according to the 1900 US Census, 224 per million men and 254 per million women, compared to only 3 and 6 per million among men and women in the white population. Although Hrdlička noted that these numbers were probably not wholly accurate, he wrote that “no error could account for the extreme disproportion of centenarians observed.” Among the elderly he met of age ninety and up, “not one of these was either much demented or helpless.”
Hrdlička was further struck by the complete absence of chronic disease among the entire Indian population he saw. “Malignant diseases,” he wrote, “if they exist at all— that they do would be difficult to doubt— must be extremely rare .” He was told of “tumors” and saw several cases of the fibroid variety, but never came across a clear case of any other kind of tumor, nor any cancer. Hrdlička wrote that he saw only three cases of heart disease among more than two thousand Native Americans examined, and “not one pronounced instance” of atherosclerosis (buildup of plaque in the arteries). Varicose veins were rare. Nor did he observe cases of appendicitis, peritonitis , ulcer of the stomach, nor any “grave disease” of the liver. Although we cannot assume that meat eating was responsible for their good health and long life, it would be logical to conclude that a dependence on meat in no way impaired good health.     {Kindle Locations 305-318}
I think Grain Brain Perlmutter ought to read her source and reconsider how grains are causing dementia.  Ditto Wheat Belly and his claims about girth.  

Folks, as it turns out -- THANK YOU GOOGLE -- Hrdlička's book is available in full for free.   Here are some links:  PDF from Medical Heritage Libraries, Google Play link (to read online or "buy" free and download) .  For anyone interested, here's Frank Russell's The Pima Indians. I found the Google ebook by searching on Hrdlicka Pima and buffalo, because this was a new one to me!  Even Taubes doesn't make such an outlandish claim as that Hrdlicka reported predominant meat consumption.   In his lectures he even mentions corn and wheat and fishing the Gila river.  Here is what it says in another Hrdlička piece:

Perhaps she meant Buffalo clams??  In any case, Teicholz doesn't specify the Pima in the book, despite dragging out Fat Louisa in her TEDxEast talk.  Still, I thought I'd give her the benefit of the doubt and that there must be some other Native Americans Hrdlička was talking about.  Here's the beauty of ebooks and Google's digitizing -- search feature (this does not appear to work on downloaded PDF).  So I searched on buffalo and there were four hits:  
  • p.86 file/74 book, where water to wipe a baby's butt was brought in a buffalo horn
  • p. 253 file/203 book, where an albino named White Buffalo is discussed
  • p. 280 file/236 book, where woman treated her gonorrhea with an herbal concoction containing "buffalo eat ears"
  • p. 453 file/420 book, where Buffalo appears in publishers address
I did, on the other hand, find copious references to legume, grain and fruit consumption.  The Appendix is particularly interesting.  Here is an excerpt on the Pima -- the legume-hating Paleos might want to pay particular attention along with Taubes and Teicholz.  

Sprinkled with water.  Eaten without further preparation.    Mesquite bean juice  --from crushed beans in cold water -- "makes them well" .  Between the Pima and the Masai, it's a wonder these two cultures survived all the plant-borne toxins to become the favorite poster children for fad diets and "science" fiction journalists.  

See?  No need for lengthy preparation apparently, and the grinding would count as HIIT vs. cardio so you're safe there.  Note that the water is consumed not discarded.   Screw-bean -- Proposis odorata or Propopis pubescens --I think that will make a good nickname for a diet book author (grin).   Then there's the seeds.

The gathering and prep sounds too much like cardio though.  But remind me ... the seeds of a grass ... I think we call that grain.  Teicholz, who hilariously cautions against the cholesterol havoc-wreaking properties of fruit in a Mashable interview, might do well to read this entire section and take note of the Mescal consumed more by other tribes, and the various and sundry cactus fruits and such they consumed.   I encourage everyone to read the full Appendix on this topic.  Throw in some freshwater fish (they tend to be quite low fat), clams and a wild deer here or there ....

I could end this here, but I would be remiss if I didn't share the hilarity that is Dr. Eades coming out of blog semi-retirement to review this book:

Some choice quotes interspersed with my commentary ...
I think it is one of the most important books on nutrition ever written. Maybe the most important.
You have GOT to be kidding me.  Even coming from Eades, I find this outrageous.
Second, this book is so brimming with valuable information that I was almost paralyzed in trying to figure out which parts to excerpt.
This book is more distinguished by what is not in it, rather than what is.
I can categorically tell you that there are not enough superlatives – at least not in my vocabulary – to adequately describe how wonderful and important this book is. But I’m going to try because I really believe it is that good.
As if your readers needed further evidence as to the value of our opinion on matters nutritional and scientific.   Make no mistake, this wasn't the usual review from a skimmer, he had a hand in shaping this manuscript!   Somehow he missed the image of pentane put forth as an example of what a fatty acid looks like I suppose.  Oh it's all a bit too much.  

image link, hat tip Seth at The Science of Nutrition
Eades throws in an appeal to his own intellectual authority reminding us of his "own research on Paleolithic man and his diet", upon which he bases his opinions that they ate mostly meat (nevermind what real anthropologists say) ... and then it comes ... the long excerpt of Teicholz' version of Hrdlička's findings.  The same one that I included above.  

Folks, this is beyond a mistake or even bias at this point.  This is journalistic malfeasance.  This would earn you an F if not get you thrown out of school in some places.  It's been a while since I've read Taubes' version, but I don't think he goes so far as to misrepresent the Pima diet entirely in his book ... he more skews it around refined carbohydrate and makes inferences in his lectures.  Teicholz one upped him with her take.  It's wrong.  But none of the manuscript reviewers caught it?  Because I guess Eades has never really researched the Pima first hand.  After marveling at the number of centenarians quoted in his excerpt, Eades smugly writes:
How did we go from a meat-eating, butter-slathering, lard-cooking society to the fat-fearful, heart attack prone, constantly dieting people of today? The blame for that can be laid directly at the doorstep of one man.
Ancel Benjamen Keys.
He's ABK now y'all, got it?!  Yeah, those Southwest Native Americans were really into that before Ancel came along .....   Give me a break already.  I'm flummoxed at how any investigative journalist who claims to have read thousands of journal articles and has a background in history left out Keys' seminal work -- hint: it was not the 6-7 Countries, and it wasn't even the Minnesota Starvation Experiment, though he deserves recognition for it.  But it's a good thing we know his middle name now.  And he was tall according to Shanahan.  Important stuff in nutrition science!

Ironically, Eades points out that a non-scientist wrote some final governmental report suggesting fat in the diet be cut.  OH THE IRONY, when Teicholz has ZERO background in the sciences (per twitter exchange, her "study" of biology at Yale and Stanford must have been a general course for non-majors as her degrees are apparently in history and politics).   He goes on.  I skipped to the end, where he writes:
I predict that within a few years, one of two things will have happened as a result of this important book.
Either Nina will be burned at the stake. Or we will all be eating our food cooked in lard, butter, beef tallow and duck fat, just as we ate it back in the days before Ancel Keys came on the scene. We’ll eat the way we ate when a case of heart disease was an anomaly.
As you can see, the narrative is in place.  Criticizing this book will be seen as ad hominem burning of the messenger at the stake.    I feel bad in a way after reading the Acknowledgement about how this book has consumed a decade of Teicholz' life.  But if that were truly the case, she should have done a MUCH more thorough and objective job in her research.  Perhaps had she included an objective reviewer during the writing process, she might have done just that.  But with Taubes and Eades  as reviewers (and I bet Taubes loved the fawning martyr schtick in her book!), along with Phinney and Westman, she didn't stand a chance.    Ronald Krauss also had a hand along the way.  Wonder what he said.

On that note.  I guess I'll write a review for Amazon soon.  It's looking interesting there already!!  Lots of 5-stars and 1-stars.  Guess what mine will be?  :-)


Lighthouse Keeper said…
I always thought Ancel Keys middle name was Satan, after all he was born evil and actually had horns.
You must be referring to the original paleo gospels. In the revised Testament of Grok, he's known as Apollyon.
LWC said…
I have not read the book, but I read the Eades review (and of course yours).

Based on the timeline presented by Eades, I don't understand about the obsessive need to pin the blame on Keys. Heart disease was all but unknown prior to the 1900s. I read through the papers Eades linked and did some further research. It's not a matter of not knowing how to recognize the conditions, autopsies occurred regularly in the 1800s, especially in Europe.

The curve for CVD deaths begins to rise around 1905-- 47 years before Keys attempted to say what caused CVD. The trend picks up speed in the 1920s, which is still 30 or so years before he publishes. Keys and his recommendations didn't cause the trend, he was trying to explain it and arrest it. He wasn't (as I understand it) talking about obesity at all.

There's a hole in the timeline.

Presumably during the 47 years prior to Keys publishing, people in the US ate meat and fat with abandon. And continued to die from CVD, all without any . Stephan Guyenet in 2009 did a series about the rise in CVD. Cigarette use, sugar consumption and Crisco (transfats) use also correlate with CVD deaths. The rise in CVD deaths predates the rise in obesity by decades.

CVD deaths were rising before any low fat guidelines were adopted. The guidelines may not have helped, but I'm mystified how they (and Keys) can be blamed for something that existed before and after he wrote.
Wuchtamsel said…
Don't try to understand anything about the difamation(!) of Keys. This man has written more interesting and stil RELEVANT scientific papers than Eades & Co have ever READ. It's one of the most disgusting details of this sick subculture.
Lighthouse Keeper said…
Splendid imagery kade. A destroying angel with attendant cloud of locusts ( a winged paleo snack ). Truth be told, Keys blew the final trumpet on these jokers years ago.
charles grashow said…
According to Keys dietary cholesterol has little if any effect on serum cholesterol

So - shouldn't they be embracing rather than rejecting him? He is supporting one of their main tenets.
carbsane said…
Thank you for this comment as it pretty much nails this issue on the head. I would say, however, that obesity was already a concern in the 50's and had been on the slow (not consistent) rise and were in the low teens if memory serves. While nothing compared to today's statistics, this is high compared to most traditional cultures.
charles grashow said…
Seth Yoder said…
Regarding BFS, I was doing a bit of fact-checking today and found some serious errors in the book that I might blog about in the future, but one error I found kind of amusing...

On page 288 she says "The diet was a tremendous success for him and then for his patients. Atkins tweaked the Wisconsin paper and expanded it into an article for Vogue magazine (his regime was called the Vogue Diet for a while)." In the references she cites the following: "Beauty: Vogue's Take It Off, Keep It Off Super Diet. . . Devised with the Guidance of Dr. Robert Atkins." Vogue 155, no. 10 (1970): 84-85.

I downloaded the entire Vogue magazine issue from ProQuest today. I can link it if anyone is interested, but it's a whopping 128 MB. The title article isn't there, and what are on pages 84-85 don't have anything to with what she's talking about (please correct me if I am wrong). As it happens, Dr. Atkins is discussed in an article titled "How to STAY 10 lbs Thinner" on page 158 of that same issue.

I was wondering how she could be so off on the citation. Then I found the Robert Atkins Wikipedia page: It cites Vogue in precisely the wrong way, too!

Am I missing something here or did Teicholz just copy-paste a Wikipedia reference?
Tolovana said…
Ahh, but Cigarettes where touted as a way to loose weight . . .
Screennamerequired said…
But with people on a low fat diet, dietary cholesterol does raise plasma cholesterol. I believe keys got that one wrong.
charles grashow said…
Did you read the studies?
charles grashow said…
"Collette Heimowitz, director of research and education for Atkins Nutritionals, said that the new advice was intended to clarify the correct approach for dieters.

She said: "The media and opponents of Atkins often sensationalise and simplify the diet as the all-the-steak-you-can-eat diet. This has never been true."
"Responding to years of criticism from scientists that the Atkins version of a low-carbohydrate, high-fat regimen might lead to heart disease and other health problems, the director of research and education for Atkins Nutritionals, Colette Heimowitz, is telling health professionals in seminars around the country that only 20 percent of a dieter's calories should come from saturated fat."
dancer80 said…
Does Hrdlička have living relatives who can help dispel the outright lying and pillaging of his work? Really, is it too late to point such blatant misuse of research to Teicholz's publishers? Infuriating that Teicholz is able to get away with lies, sad to know there will be the usual paleo brigade quoting her book while blindly rejecting those like you, Evelyn, who present them with factual information from research attributed to Hrdlička, and also intellectual dishonesty by Teicholz.

This is an interesting study which might shed some light in this dietary fat/ cholesterol in CVD. The percentage of atherosclerosis amongst US soldiers killed in combat/ unintentional means was very high, atherosclerotic lesions were found in autopsies of Korean War soldiers, even those in their early 20s and without presentation of disease itself. The percentage of measurable atherosclerotic plaque dropped for Vietnam War soldiers, and the largest drop was in recent Iraq intervention/ war whatever you want to call it. The study spells out strengths and weaknesses of its methodology used and other variables. But I find it interesting that in the early 1950s Korean War era, young men in their 20s eating typical American diet of that time would have such high prevalence of atherosclerosis. I'm assuming those young men before their lives were unfortunately cut short by war, did not consume low fat/ whole grain/ high veg+ fruit diet denounced by certain misinformed paleo followers as being contributory to CVD and Diabetes.
charles grashow said…
charles grashow said…
Good critique you posted on - spot on - now let's see how many negative responses you get. BTW - it would be appreciated if you could go into greater detail.
carbsane said…
This is amazing Seth. Sooooooooooo many errors and issues. Each one on its own enough to dismiss this as a credible work :(
Pretty much what Charles posted earlier. Damage control has begun. Lol.
charles grashow said…
Another paper co-authored by Ancel Keys
Effect of Dietary Cholesterol on Man's Serum Lipids
Susanne said…
Meant to reply to this before, but really busy this week. I think the atherosclerosis issue in Korean War soldier autopsies is also supposed to be complicated by high incidence of cigarette smoking. The decline in smoking from what I've read is a big factor in the decline of heart disease in past decades. Interestingly also a risk factor for diabetes.

"Research linking smoking to lung cancer began appearing in medical journals as early as the 1920s, but the dangers didn’t reach the popular press until 1952, when Reader’s Digest published “Cancer by the Carton.” Still, smoking rates continued to rise. Between 1940 and 1964, consumption more than doubled to nearly 4,500 cigarettes per adult per year. They were everywhere: Hollywood movies, military rations, the workplace, you name it.Finally, in 1964, Luther L. Terry, the surgeon general, unveiled a report titled “Smoking and Health.” He called a Saturday news conference in which, for the first time, the government acknowledged that “smoking is causally related to lung cancer.”

It still took until 1970 for Congress to ban cigarette advertising on TV and radio; until 1975 for the military to stop including cigarettes in rations..."

Onsmoking and diabetes, see here
Tim Sullivan said…
Hopefully you'll actually read/complete the book before commenting on Amazon. This is a screed...for from a helpful critique.
carbsane said…
I'm sorry you don't find it helpful to have egregious errors and misstatements pointed out to you. I see no reason to read the entire thing before reviewing it. I've read enough to write an extensive review, and can always amend that. I presume you will be going around to all of those who are recommending this highly without reading it, as well :-)
Tim Sullivan said…
Awfully touchy/defensive. 1) Yes, you can get the gist of a book without finishing it, but if you - or anyone - is going to review it you should have finished it. Otherwise it's simply intellectual malpractice. 2) And, yes, that includes positive reviewers and advocates. But yours is the only review I've read so far that asserts they haven't completed the book.
carbsane said…
Let's see ... you came here and called my post a screed. Do you have any comment on what I discussed? Have no respect for the time involved in the partial, yet considerable, review that I did? No. Now you say I'm touchy?

I don't care about the gist of this book. One can get that from a few paragraphs. Don't lecture me on needing to read it cover to cover in order to review it. MOST reviewers don't even read a full chapter. Truth. Some even say so! As in "haven't read it yet but go buy it!!". So please do go to Amazon and comment on each and every 5 star that calls this well researched and or referenced or a scientific examination. I have a list I can no longer count on my fingers of errors that render this book trashworthy. Screed.
carbsane said…
PS. Why don't you go ask Dr. Eades how it was that he included the Hrdlicka passage in his own review but failed to realize how badly she misrepresented his work and the true diets of these peoples?
Peter said…
LOL at the Pentane part! (:
George said…
Yes, pentane would have 2 more hydrogens. I wondered if anyone would notice that. Nina after all is not a chemistry teacher.
What we have is a section of an alkane hydrocarbon chain, as found in SFAs. The picture is ambiguous and a flawed representation of SFA without more description, but the identification with pentane is wrong.
George said…
Keys is a brilliant writer and thinker. He is very convincing. He's working with a bunch of data that's incomplete compared to ours, and part of this is his own fault for refusing to consider sugar etc. as confounders.
You've got to respect the guy who could think of a convincing explanation, even if it turned out to be wrong. Freud still has his place in history though most of what he wrote would not be believed today.
carbsane said…
Yes that was noticed as well, but something that is nowhere near as relevant as this molecule containing no oxygens and the characteristic ~COOH functional group that distinguishes such acids. ... NOT "a chain of carbon atoms surrounded by hydrogen atoms".

What is depicted is not a section of something as the H's on the ends are angled. So its doubly radical pentane :-)

But thanks for pointing out that it's not even a valid chemical structure.
Da St said…
You didn't cite the most direct part, which also refutes Teicholz' characterization. On p. 19 of "Physiological and Medical Observations Among the Indians of Southwestern United States and Northern Mexico":

The principal article of diet among the Indians throughout the Southwest and Mexico is maize, which is eaten in the form of bread of various kinds, or as mush, or boiled entire. It is also parched on charcoal and eaten thus, or is ground into a fine meal, which, sweetened, constitutes the nourishing pinole of some of the tribes. Wheat is used in similar ways but less extensively. Next in importance to corn and wheat in the Indian diet are meat and fat and beans. Meat is scarce....

On p. 24: The Pima are great wheat growers. Occupying a very fertile valley, when the water supply is sufficient their crops leave but little in the way of food to be supplied; nevertheless, they are acquainted with, and use on occasions, many of the native edible fruits, greens, and roots ( see Appendix). Formerly the Pima successfully hunted the deer. They also ate a certain kind of lizard, and rats likewise were included among their edibles. They never had an aversion to fish, clams (which formerly abounded in the Gila), or any other aquatic animal, and the younger members of the tribe have no objection to pork, poultry, eggs, and milk.
carbsane said…
Thanks for these quotes!
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