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Nina Teicholz

1a479e8cf51ae59288822bdedd01bd7c?s=47 DoctorAkil
March 31, 2021

Nina Teicholz

Why We Came to Believe That Fat (and Saturated Fat) Are Bad for Health – and What the Science Now Says



March 31, 2021


  1. Myths and Misconceptions in Nutrition On Fat, Saturated Fat &

    Meat Presentation to: By Nina Teicholz
 Investigative science journalist Author, The Big Fat Surprise Executive Director, The Nutrition Coalition
  2. “A gripping narrative” that should be read by researchers, clinicians

    and healthcare providers.” —The Lancet “Impressive . . This book shook me. . . Teicholz has done a remarkable job” —The BMJ “A page-turner…a nutrition thriller,” The Economist “A Best Book of the Year”— Wall Street Journal , Mother Jones, Forbes, Times of London, BBC Food, The Economist The Big Fat Surprise (Simon & Schuster)
  3. © Nina Teicholz ` Disclosures • I receive (modest) royalties

    for my book • None of my work has ever been funded by the meat industry— or any industry.
  4. © Nina Teicholz Biases • I avoided saturated fat, all

    fats, and red meat for 25+ years • I’m from Berkeley, CA • I got into this subject because I researched the subject of dietary fat, not meat.
  5. © Nina Teicholz We need to explain this: % prevalence

 in adults ages 20-74 years Data from NHANES and NHES surveys
  6. Tell me I’m not killing myself on keto!

  7. © Nina Teicholz How it All Started RATE OF HEART

    DISEASE PER 100,000 PEOPLE 1900 1955 Rate of heart disease per 100,000 people
  8. © Nina Teicholz What causes heart disease? •Vitamin deficiency •Type

    A Personality •Auto Exhaust Source: Mann, George V., “Diet and Coronary Heart Disease.” Archives of Internal Medicine 104 (1959): 921–929, 922.
  9. © Nina Teicholz Ancel Keys’ 
 “Diet-heart hypothesis” Saturated Fat/

    Dietary cholesterol Raised cholesterol (in the blood) Heart Attack
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  11. Ancel Keys was “Mr. Cholesterol” The most influential nutrition scientist

    of the 20th century
  12. 1961: The American Heart Association First advice anywhere in the

    world to limit saturated fats and cholesterol in order to prevent heart disease
  13. What Was the Evidence?

  14. None
  15. © Nina Teicholz Studying the islanders on Crete….
 who were

  16. © Nina Teicholz ….during Lent “The Greek Orthodox fast is

    a strict one and means abstaining from all foods of animal origin, including fish, cheese, eggs and butter” —Contemporary Observer
  17. © Nina Teicholz Nutrition scientists knew this was weak evidence….


  18. Inevitability of False Positives

  19. © Nina Teicholz Inevitability of False Positives

  20. Trying to prove the diet-heart hypothesis with randomized controlled clinical

    trials (the “gold standard”) • There were actually a large number of government-funded, randomized, controlled clinical trials…..on hard endpoints • • On altogether at least 67,000 men and women, in experiments lasting 1 to 12 years • Most in in-patient settings; therefore highly controlled. • RESULTS: No Effect of saturated fats on cardiovascular mortality or total mortality. No Effect on myocardial infarction, stroke, total coronary heart disease (CHD) events, major CHD events. Source: Astrup et al, JACC State-of -the-Art Review, Journal of the American College of Cardiology (2020),
  21. The diet-heart hypothesis is the most tested hypothesis in the

    history of nutrition and disease
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  24. Why is this not known?

  25. The Politics of Nutrition Science

  26. Selection Bias: the Minnesota Coronary Survey Conclusion: “For the entire

    study population, no differences between the treatment and control groups were observed for cardiovascular events, cardiovascular deaths, or total mortality." The BMJ 2015: The more the men 
 lowered their cholesterol, 
 the more likely they were 
 to die from cardiovascular death. Ivan Frantz
  27. Selection bias, continued Results: On average, supportive reviews underutilised the

    available RCTs to a greater degree than other reviews. Amongst the supportive group, citation bias was common—23 (82%) reviews cited only the one RCT that was supportive.
  28. Re-emergence of this trial data 2007 2014 Conclusions: A meta-analysis

    of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. 2010 Conclusions: “Although substitution of dietary polyunsaturated fat for saturated fat has been shown to lower CVD risk, there are few epidemiologic or clinical trial data to support a benefit of replacing saturated fat with carbohydrate.”
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  30. “REVIEW OF REVIEWS” Conclusion: Diets that replace saturated fat with

    polyunsaturated fat do not convincingly reduce cardiovascular events or mortality…[We] must consider that the diet-heart hypothesis is invalid or requires modification.
  31. “There is no robust evidence that current population-wide arbitrary upper

    limits on saturated fat consumption in the United States will prevent CVD or reduce mortality.”
  32. Review papers that found an effect of saturated fats on

    heart disease focused on LDL-C
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  34. What about LDL-cholesterol? Ron Krauss, MD Also true that lowering

    LDL-C via diet does not have the same effect as lowering with drugs
  35. Fiona Godlee, Editor-in-Chief of The BMJ “The point about saturated

    fat is: the evidence is now looking pretty good, but the guidance hasn’t shifted… there doesn’t seem to have been an enormous ‘mea culpa’ from the scientific community that we got it so wrong. That does surprise me.” 
 Swiss Re/BMJ conference, June, 2018
  36. So Butter is Indeed Back!

  37. None
  38. Lard Butter

  39. The original, natural fats Tallow Suet

  40. Oils used as lubricants for machinery in industrial revolution

  41. © Nina Teicholz Vegetable Oils enter the food supply-1911

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  44. Chemistry of Fatty Acids

  45. © Nina Teicholz Chapter 9, “Toxic Oils” The effect of

    vegetable oils on oxidation and inflammation.
  46. What Are Some of the Benefits of Saturated Fats? •

    Do not oxidize and cause inflammation. STABLE fats. •Increase HDL “good” cholesterol—and are only food known to do so. •Saturated fats are present in nutrient-dense foods, often with nutrients in their most bio-available form. • Associated with a decreased risk of stroke.
  47. “We’re all afraid of saturated fat, but saturated fat actually

    appears good for you.” Dr. Salim Yusuf Chair, Cardiovascular Disease at McMaster University Medical School Past President, World Heart Federation
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  49. Selection Bias…has been lasting • These early trials “have never

    been systematically reviewed by any of the dietary guideline committees.” • [G]uideline committees have never gone back to systematically review these early trials but instead relied on other government reports. Source: Teicholz, N, BMJ 2015
  50. 2 slices cheddar 8 oz steak 6 oz mackerel

  51. © Nina Teicholz •Dropped by the American Heart Association in

    2013 • “Insufficient evidence” •Dropped by the US Dietary Guidelines for Americans in 2015 • “no appreciable relationship between consumption of dietary cholesterol and serum cholesterol” Cholesterol caps are gone Source: Report by the 2015 Dietary Guidelines Advisory Committee, USDA-HHS, .2015. Source: https://doi.org/10.1161/01.cir.0000437740.48606.d1Circulation. 2014;129:S76–S99
  52. Foods with Cholesterol

  53. © Nina Teicholz The “low-fat” diet is also gone

  54. Trials on the Low-Fat Diet Women’s Health Initiative
 Multi-center, NIH-funded

    trial, on nearly 49,000 women, for 8 years, on average:
 Conclusions: the low-fat diet did not help fight obesity, cardiovascular disease or any type of cancer. (This trial looked at hard endpoints). 
 Howard BV, Van Horn L, Hsia J, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA 2006;295:655–66. “Boeing trials”
 On a 1,230 men and women, tested on the USDA diet. 
 Conclusions: No benefit for weight loss, blood sugar control (diabetes), and mixed outcomes for heart disease (LDL-C dropped, but so did HDL-C and triglycerides went up)
 Knopp, R.H., et al., Journal of the American Medical Association 278, no. 18 (1997): 1509-15; Walden, C. et al, Arteriosclerosis, Thrombosis, and Vascular Biology 20, no. 6 (June 2000): 1580–1587.
  55. © Nina Teicholz Low-fat Diet is Over “…there is no

    conventional message to recommend low-fat diets.” Alice Lichtenstein, Vice-chair, 2015 Dietary Guidelines Advisory Committee “Strong and consistent evidence from RCTs and prospective cohort studies shows that reducing total fat (replacing total fat with carbohydrates) does not lower CVD risk. This implies that total fat restriction may not be evidence based.” 
 Frank Hu, Committee Member
 -2015 Dietary Guidelines Advisory Committee public meeting, September 15, 2015, Day 1, starting at minute 273:45) “…dietary advice should put the emphasis on optimizing types of dietary fat and not reducing total fat” (Italics added) 
 -Dietary Guidelines Advisory Committee Report, Part D, Ch 6, p. 13, lines 460-461
  56. Source: 2015 Report by the USDA Dietary Guidelines Advisory Committee,

    Table D1.33
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  58. © Nina Teicholz

  59. © Nina Teicholz

  60. © Nina Teicholz

  61. © Nina Teicholz "relatively lower consumption of red and processed

  62. © Nina Teicholz …a review on this topic turns up

    a surprising fact: a systematic review on health and red meat has not been done. Although several analyses look at “animal protein products,” these reviews include eggs, fish, and dairy and therefore do not isolate the health effects of red meat, or meat of any kind.37 Teicholz, BMJ, 2015
  63. © Nina Teicholz T2 diabetes

  64. © Nina Teicholz and Heart Disease..

  65. © Nina Teicholz And death….

  66. 1961: The American Heart Association First advice anywhere in the

    world to limit saturated fats and cholesterol in order to prevent heart disease
  67. © Nina Teicholz

  68. © Nina Teicholz Limitations of this data • An association

    in epidemiology can be considered as “cause and effect” if it meets certain criteria (according to the Bradford Hill criteria). • Most importantly: strength of the association
  69. © Nina Teicholz What is a “strong association?” • The

    one great success story of epidemiology: Smoking and lung cancer • Heavy smokers had a 15-30 times greater risk of dying of lung cancer vs. “never smokers.”
  70. © Nina Teicholz •For the WHO-IARC decision…. •1.17 “relative risk”

    for fresh meat and cancer •1.18 “relative risk” for processed meat and cancer Bouvard, Loomis,Guyton et al., Carcinogenicity of consumption of red and processed meat, Lancet Oncology, Oct 2015
  71. © Nina Teicholz Where are the Rigorous Data on Meat?

  72. © Nina Teicholz GRADE reviews of Red Meat The Grading

    of Recommendations, Assessment, Development and Evaluation (GRADE)
  73. © Nina Teicholz

  74. © Nina Teicholz

  75. © Nina Teicholz

  76. © Nina Teicholz

  77. © Nina Teicholz Red meat and heart disease

  78. © Nina Teicholz Red meat and heart disease

  79. © Nina Teicholz Conclusions: There is no strong evidence that

    red or processed meats cause ill-health OR that avoiding these meats will improve health
  80. © Nina Teicholz Why is red meat good for health?

    • Contains: • B vitamins (including B12), iron, and zinc, selenium • Iron • “Heme iron from lean meats is highly bioavailable, hence, an excellent source” • “the highest source of iron from natural foods are clearly organ meats.” 
 (2015 Dietary Guidelines Advisory Committee Report). • Note: beef contains > 2x the amount of iron per serving vs. lean white meat
  81. © Nina Teicholz Shortfalls of nutrients in the US •

    Iron. • 20% of women, ages 12-19, “underconsumed” • 16% of women, ages 20 to 49, “underconsumed” • pregnant women, “A public health concern” • B12 • women of reproductive age, “Nutrient of concern” • adolescent girls, “underconsumed” • Older adults “underconsumed” • Protein: Underconsumed by older adults and adolescent girls Source: 2020 Dietary Guidelines Advisory Committee report
  82. Lack of Vitamin B12 •Babies who don’t receive enough B-12

    in the womb run the risk of developing dangerous defects. •Expectant mothers with B-12 deficiency are up to five times more likely to have a child with a potentially disabling or fatal birth defect, many of which involve the brain or spinal cord. •Children also need B-12 for their brains to develop and their nervous systems to grow. Kids short on B-12 can face problems with digestion and growth. •Such deficiencies have even been linked to neurological and behavioral disorders • Source: NIH, https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
  83. Protein: Consider the Source

  84. • “just two spoonfuls of meat a day given to

    children on a vegetarian diet could produce a dramatic and permanent improvement in their physical and mental development” • “Even when they were adolescents these children who were fed as vegans when they were young still had delayed development or permanently impaired development”
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  89. © Nina Teicholz @bigfatsurprise Nina Teicholz author page on Facebook

    www.ninateicholz.com www.nutritioncoalition.us Teicholz@gmail.com Nina Teicholz Investigative science journalist Author Executive Director, The Nutrition Coalition Thank you!! Please ask questions!