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The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet Hardcover – May 13, 2014
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"A wonderful book [that] takes on everything we think we know about nutrition and examines it.." (Ruth Reichl, former editor-in-chief, Gourmet magazine)
About the Author
Nina Teicholz is an investigative science journalist and author as well as an advocate for evidence-based nutrition policy. Her work has appeared in The New York Times, The Wall Street Journal, The Independent, The Atlantic, and The New Yorker, among other places. She grew up in Berkeley, California, and now lives in New York.
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I've decided to edit my review and include some more detailed information about how I reached my conclusions concerning this book:
Although reports of health and vitality of the Inuit and Masai abound, actual information on the reasons for their premature mortality are surprisingly not too easy to find. The following information comes from the Inuit people themselves and is a fact sheet about various concerns of the Inuit peoples:
Lung cancer rates for Inuit men and women in Canada are the highest in the world and these rates are rising. (Circumpoloar Cancer Review)
The death rate from strokes is twice as high for men and women in Inuit communities than for all Canadians.
Women in Inuit communities have a COPD death rate that is 10 times that of other Canadian women.
Death rates for perinatal and congenital conditions are more than 2 times higher for those in Inuit communities.
The same is true for mortality information of the Masai peoples.
Questionnaires are sent into the interior of Tanzania and the Masai list their causes of death. This information comes from a doctoral thesis with the following citation:
Coast, Ernestina (2001). Maasai demography. Ph.D. Thesis. London : LSE Research Online.
The Masai list their cases of death as Land mine, Cattle raiding, Fever, Typhoid, Amoebic dysentery, Curse, Drowning, and Snake bite
More information about the Masai mortality can be found in a 2013 volume of the American Journal of Epidemiology. It sites a comprehensive study of the Masai by the Vanderbilt U School of Medicine...it is still considered relevant and a synopsis is listed below:
"Mann, G. V. (Vanderbilt Univ. School of Medicine, Nashville, Tenn. 37203), A. Spoerry, M. Gray, and D. Jarashow. Atherosclerosis in the Masai. Am J Epidemiol 95: 26-37, 1972.-The hearts and aortae of 50 Masai men were collected at autopsy. These pastoral people are exceptionally active and fit and they consume diets of milk and meat. The intake of animal fat exceeds that of American men. Measurements of the aorta showed extensive atherosclerosis with lipid infiltration and fibrous changes but very few complicated lesions. The coronary arteries showed intimal thickening by atherosclerosis which equaled that of old U.S. men. The Masai vessels enlarge with age to more than compensate for this disease. It is speculated that the Masai are protected from their atherosclerosis by physical fitness which causes their coronary vessels to be capacious."
So unless you're willing to exercise all day long like a Masai, adapting their high fat diet may not be for you...
For anyone interested, there are irrefutable sources for information such as T. Colin Campbell's "The China Study," which is the most comprehensive study of human nutrition ever conducted. The Institute of Aging and National Geographic are also great resources of information, with their research into diet, well-being, and longevity and their Blue Zones research.
At any rate, BFS is not much different than the other low-carb books on the market. In fact, it's quite similar to the book Good Calories, Bad Calories (GCBC) by Gary Taubes, published in 2007. Other Amazon reviews agree. Start with the title: both authors use the same play on words ("big fat surprise" and "big fat lie"). Both structure their citations in the exact same format. Teicholz uses many of the same figures that are in GCBC, either in this book or her recent TEDx talk. Teicholz discuss the very same peculiar issues that Taubes does (including the Masai people, the Samburu people, the MRFIT, the Anti-Coronary Club trial, the Seven Countries study, the American Heart Association, the Western Electric study, Vilhjalmur Stefansson, Native Americans living in the southwest, Framingham, George McGovern... the list goes on).
Now if you're going to write about a history of nutrition policy in the US there will naturally be some overlap of coverage. But this level of overlap is quite extraordinary. I counted 140 references that Teicholz uses that were also used in GCBC; ranging from the popular that any nutrition expert should know to the amazingly obscure (at least one was written in a foreign language). In many cases they both pluck the exact same quotes from a specific text. For example, on page 75 Teicholz discusses a dietary trial by Dayton et al and quotes from Dayton's paper stating: "'Was it not possible,' he asked, 'that a diet high in unsaturated fat...might have noxious effects when consumed over a period of many years? Such diets are, after all, rarities.'" This is part of a larger argument by Teicholz to paint unsaturated fats as unhealthy and potentially dangerous. The funny thing is that on page 37 of GCBC Taubes uses the very same quote and phrases it the exact same way, ellipses and all! Isn't that strange?
What's also interesting is that Teicholz and Taubes both completely misrepresent the paper. Dayton actually asks that question in the beginning of the paper to kind of whet the reader's appetite, so to speak. He then goes on to answer that very question in the text with an answer that would not be favorable to Teicholz's (or Taubes's) argument. Do you want to know if the experimental diet has noxious effects? Well there's a section in the results portion of the study titled "Does the Experimental Diet Have Noxious Effects?" where Dr. Dayton states: "As indicated in table 29 and discussed in some detail above, the excess mortality in nonatherosclerotic categories was not sufficiently impressive to justify the conclusion that harmful effects had been demonstrated." AND "One may also wonder whether the experimental diet may have exerted its effect on mortality data primarily by accelerating nonatherosclerotic deaths (see table 28), decreasing the atherosclerotic mortality by inducing early death due to other cause. Such a mode of action would be associated with higher numbers of deaths in the experimental group compared with the controls, whereas the reverse was true in this trial (fig. 13)." AND "The other observation which raised some question of a possible toxic effect was the low arachidonic acid concentrations in atheromata of long-term, high-adherence subjects on the experimental diet (tables 37 to 40). For reasons already cited, this may be more appropriately viewed as evidence of a salutary rather than a toxic effect."
There are many more examples of misrepresentation and quote-mining, but I'm not sure how many I should give on a simple Amazon review. I'll discuss a couple more, and if anyone would like further evidence of the poor scholarship and serious dishonesty in the book I can provide more in the comments. I actually have most of the texts that she cites in her bibliography. I will likely at some point write a more comprehensive critique of the book and edit this Amazon review with a link to it if Amazon will allow it.
In GCBC, a scientist named Ancel Keys is cast as the villain. In BFS the volume on Keys hate is ratcheted up to a point I've never seen it in any other book. After reading the book you will likely come away with the idea that Keys is just shy of the devil himself bent on very slowly destroying humanity by suggesting America eat more fruits and vegetables. (I'm not even close to exaggerating, by the way.) On page 23 Teicholz tries to paint Ancel Keys as an idiot and a flip-flopper by claiming that Keys stated in 1952 that there was "overwhelming evidence" for the theory that dietary levels of cholesterol affect serum cholesterol levels and three years later doing an about-face on the idea and arrogantly walking the statement back by saying that tremendous amounts of cholesterol have only a trivial effect on serum cholesterol and that "this point requires no further consideration." Damn, this guy sounds like an arrogant prick considering he wholly endorsed the theory a few years before, right?!
...Except if you look at the 1952 paper where Teicholz pulls that quote Keys says the EXACT OPPOSITE of what Teicholz claims. In the paper Keys argues that the animal experiments that have shown that feeding high cholesterol to, say, rabbits have no relevance to humans, going on to say "No animal species close to man in metabolic habitus has been shown to be susceptible to the induction of atherosclerosis by cholesterol feeding." AND "From the animal experiments alone the most reasonable conclusion would be that the cholesterol content of human diets is unimportant in human atherosclerosis." AND "Direct evidence on man in this connection is unimpressive." The part where Teicholz plucked the deliberately misleading quote is where Keys claims an association between serum cholesterol and atherosclerosis. See the HUGE difference??
Continuing to libel a dead scientist, Teicholz makes some more accusations about Keys with very little evidence. Starting on page 27 she describes something of an academic tiff between Ancel Keys and some other researchers. I have described the issue in greater detail here: [...] but it will have to suffice to say that Keys wrote something in an obscure journal in 1953 and years later some other researchers took issue with it. Teicholz seems to think that this "incident" was effectively the genesis of America's fear of fat. She even says Keys received "enormous attention" from this 1953 paper, and began "promoting his graph" around the world and developing sizable followings complete with scientific acolytes and minions that would be complicit in his dietary deceit. The whole issue is blown WAY out of proportion.
For instance, there is no evidence at all that Keys's 1953 paper received "enormous attention." In fact, the evidence that exists would suggest the opposite. According to Google Scholar this highly influential paper has only been cited 247 times since its publication, which spans 61 years as of this writing. An average of four citations per year. It was cited merely 99 times from the time it was published to 1973, a full twenty years after its publication. For comparison, on page 159-160 Teicholz mentions a study whose results she claims were "ignored." That study was published in 1992 and has received 682 citations. (She kind of misrepresents that study, too, but I won't get into that here.)
On page 11-12 Teicholz discusses the Masai tribe of Africa and how they consume quite a bit of milk daily yet have very low cholesterol (much like Taubes does in ch. 2 of GCBC). She also mentions that and are not fat they don't have high blood pressure. I don't know why she throws that the blood pressure and leanness in there since no one claims that milk causes high blood pressure, nor that these African tribes that walk about 30 miles per day and burn 300-500 kcals/hour would be fat because they drink milk. The real crime here is one of omission. In support of her argument that diets heavy in saturated fat won't lead to high cholesterol and atherosclerosis because the Masai do it, she cites an article published in the NEJM titled "Some Unique Biologic Characteristics of the Masai of East Africa." The entire point of that article was to claim that the reason that the Masai have such low cholesterol levels (and therefore atherosclerosis) despite a diet heavy in saturated fats was because they have a unique feedback mechanism that suppresses endogenous cholesterol synthesis that most of us don't have. Yet there of course is no mention of this in the text (or GCBC) because to suggest that their low cholesterol was due to genetics would hurt her meat-is-good-for-you narrative.
I would also like to point out the stunning hypocrisy on display here throughout the book as Teicholz self-righteously impugns other scientists for allegedly cherry-picking data or ignoring evidence that didn't fit the narrative WHILE AT THE VERY SAME TIME cherry-picking and ignoring contrary evidence.
I'll leave you with one last thing that I found kind of amusing. On page 288 Teicholz discusses Dr. Atkins and 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)." I decided to check her bibliography and download the Vogue issue in question via ProQuest. She cites it as "Take It Off, Keep It Off Super Diet . . . Devised with the Guidance of Dr. Robert Atkins," Vogue 155, no. 10 (1970): 84--85." I looked on pages 84-85 and it wasn't there. Strange, right? Where did she come up with that citation? As it turns out (as of this writing, at least) it is cited that way on Dr. Robert Atkins's Wikipedia page: [...]It turns out that the actual Vogue article is located in the same issue, but different page numbers. My guess is that Teicholz simply copy-pasted the Wikipedia reference and never even saw the original magazine issue.
In conclusion, I would not recommend purchasing this book. All the (bad) information that in this book is the exact same (bad) information you can find on any low-carb blog or another book like GCBC.
P.S. Teicholz's fatty acid structure found on page 25 is wrong on several levels, but I'm sure anyone that has taken Organic Chemistry 101 already knew that.
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