The following is a review of Nina Techolz’s book ‘The Big Fat Surprise—Why Butter, Meat and Cheese Belong in a Healthy Diet’.

Based on my own experiences in the 1970s with near-traditional Australian hunter gatherers, I know they ate mainly meat and they prised saturated fats as well as the blood, kidneys, marrow, brain, liver, tongue and the fat. This is what my family also ate in the 1950s as part of the traditional Australian diet. Prior to World War II, heart attacks were so rare that Australian doctors could practice through their entire careers with seeing only a handful of cases. Australians prior to the 1960s ate far more meat than they do now, however today cardiovascular disease is the leading cause of death in Australia. (Take a look at: Michaels, L, 1966, The Etiology of Coronary Artery Disease: An Historical Approach; Brit. Heart Journal, 28, p258).
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Most Australians today would believe that our forefathers in 19th century Australia predominantly ate grains and vegetables with a small amount of meat when they could get it. This was not so. Meat was the predominant food that produced the healthy, strapping, long-lived Australian bushmen and bushwomen of yesteryear. How did we go from a meat-eating, butter-using, lard-cooking society to the fat-fearful, heart attack prone, overweight and constantly dieting people of today? The blame for that can be laid directly at the doorstep of one man: Ancel Benjamen Keys. This story is wonderfully documented by Nina Techolz.
Ancel Keys was a pathologist from the University of Minnesota, who came up with a ‘diet-heart hypothesis’ proposing that fats in our foods raised cholesterol and directly caused heart disease. Through his aggressive and forceful personality he single-handedly drove the movement that has led us to the diets most of us eat today. He has led millions of people around the world into an eating lifestyle which promotes poor mental and physical health, and he did it because he let his monstrous ego override whatever modicum of scientific integrity he had.

The Story

In a 1952 presentation at Mt Sinai in New York (later published in a paper that received enormous attention), Keys formally introduced his diet-heart hypothesis that fat in the diet increased blood cholesterol which resulted in heart disease. A graph he presented showed a close correlation between fat intake and death rates from heart disease in six countries. It was a perfect yet simple upward curve, suggesting that if you reduced fat intake to zero your risk of heart disease would almost disappear
This almost naive connect-the-dots presentation in 1952 was the con that built our mistrust of fat today. All the illnesses that have subsequently been linked to eating fat—heart disease, obesity, cancer, diabetes and others—originates from the implantation of this idea into the scientific establishment by Ancel Keys and his obsessiveness in promoting this at a political level rather than for scientific inquiry. Today when you choose cereals for breakfast, lean chicken breast and salad for lunch and pasta for dinner, this eating style can be traced back to Ancel Keys.
In the 1950s, Keys travelled broadly to promote his ‘fat-causes-heart-disease’ hypothesis and used the six-countries chart as the persuader. However, he ran into scientific opposition by Jacob Yerushalmy, founder of the Biostatistics Department at Berkeley. He considered that Keys had massaged his data, omitting some and including only that which supported a correlation between fat consumption and heart disease. If all the data was used, he suspected that it would only show a scatter of dots not the clean curve that was presented. Yerushalmy published a strong rebuttal of Keys’ work (Yerushalmy and Hilleboe 1957, ‘Fat in the Diet and Mortality from Heart Disease’: A Methodologic Note, NY, State, J. Med.)
For her book, Nina Teicholz interviewed Henry Blackburn, a long-time associate of Keys who was present when Keys first read the rebuttal. Blackburn described Key’s response: “I’ll show those guys’ … and he went off and designed the Seven Countries Study, not to undertake better science to retest his hypothesis, but to prove his point”—and rise above anyone who would challenge him. Instead of following the scientific method and attempting to refute his diet-heart hypothesis, he made it his mission to search for any evidence that confirmed his personal ideas, while ignoring or belittling any conflicting evidence.
Keys’ formidable powers of persuasion along with his political academic credentials assisted over time to get his ‘diet-heart hypothesis’ accepted by the establishment. Anyone who dared to disagree was attacked with great vitriol in the pages of any journal in which an opposing argument to his ideas appeared.
Through his political affiliations, Keys ran roughshod over his detractors. In 1961 he graced the cover of Time magazine, and got the American Heart Association (AHA) and the National Institutes of Health (NIH) to accept his hypothesis on the evils of fat. With these two establishments, Keys had the money and the political influence to strongly promote his anti-fat bias to both doctors and the public.
With the diet-heart establishment promoting the bias, Americans and then the rest of the world, cut their fat intake and changed from eating the traditional animal fats to eating plant-derived polyunsaturated fats.
This initially posed a problem for the food industry because saturated animal fats have cooking properties that are difficult to reproduce when using polyunsaturated plant fats. So the food industry switched over en masse to using trans fats to emulate the cooking properties, and the public was led by these scientific organisations to believe that these new trans fats were health foods.
Through concentrated political pressure, Keys was eventually able to persuade the United States government to accept the ‘diet-heart hypothesis’ and intervene in the health of all its citizens by recommending a diet in which saturated fat was reduced to 10 per cent of all calories and the recommended dose of carbohydrates was increased to 55-60 per cent. This was a major change from the high meat/fat/dairy diets of previous generations with their very, very low rates of heart attack.
With the government now promoting for its citizens a high carbohydrate-based diet, recommending polyunsaturated oils over saturated fats, the large food companies that sold these products began to make huge profits on their fast foods such as biscuits, breads, cookies and crackers. The political orientation to healthy eating suited the corporate food manufacturers just perfectly.
While most doctors blindly accepted and promoted this new establishment dogma, paediatricians were having doubts. Children didn’t get heart disease, so why should they have to reduce their fat intake, drink skimmed milk, and increase their carbohydrate loading? Eventually the paediatricians were won over and they began to change the first solid foods introduced to infants from that of meats with fat chewed by their mother to rice, then followed by cereals, fruits and carbohydrate-based fast-foods such as crackers.
Nina Teicholz describes a study undertaken by British researchers to test the low-fat healthy diet hypothesis on infants. This involved putting Gambian children after weaning, on a low-polyunsaturated fat diet. These infants were compared to English infants on a traditional diet of whole milk and meat. Both groups received the same number of calories. By the age of three, however, the Gambian infants weighed 75 per cent less than they should have, according to traditional standard growth charts, while the Cambridge infants were growing normally and weighed 8 pounds more on average at this age. (Nina Teicholz notes that while rice porridge, the first solid food fed to Gambian infants, contained 5 per cent energy as fat, the processed rice cereals that American parents have been feeding their babies contains zero grams of fat). From this it could be considered that if children are raised on low-fat diets, they could be heading for health problems later in life.
During the years Keys had been promoting his ‘diet-heart hypothesis’, he had been spending a good deal of time in Italy, in a house he built overlooking the sea south of Naples. With this Mediterranean influence, he focused on various diets of the cultures around the Mediterranean that supported his ideas. By combining a number of the low-fat meals, Keys laid the foundation for what was to become known as the Mediterranean Diet. In 1975, Keys reissued a low-fat cookbook he had previously published and renamed it: ‘Eat Well and Stay Well the Mediterranean Way’. This was basically a repackaging of his low-fat diet with a Mediterranean slant. The dogma was taken up by other scientists from Italy and Greece who used Keys’ bogus data to promote their cultural predisposition to eating with olive oil.
They were funded by the olive oil industry, and their association essentially evolved into a campaign to seduce scores of foreign scientists and food writers into attending ‘medical conferences’ on the Mediterranean coast, drinking free wine and eating free food. The food journalists could experience tasty olive oil drenched foods to compare with the less tasty low-fat, high carbohydrate foods back home. As the Mediterranean Diet gathered momentum in America and other countries, a handful of researchers focused on researching this highly recommend diet. They soon found that there was not one diet but a diversity—there was no single Mediterranean Diet, so each research group basically created its own idea of the Mediterranean Diet and studied this. Today in a vein similar to the many ‘join-the-club-diets’ there is vast variation in the understanding of what constitutes a Mediterranean diet.
Over the last 50 years because of this change to a high-carbohydrate diet over a fat-protein dominated diet, most Western countries are in the midst of obesity, diabetes, and heart illness epidemics. The big food companies have grown bigger and more politically powerful. By funding and grooming food scientists these giant industries have been able to keep the detrimental effects of plant-derived trans fats from becoming public knowledge. The public thought they were eating polyunsaturated fats because, from the day hydrogenated oils were introduced in the form of Crisco in 1911 right up until the year 2005 (nearly a century later), not one major scientific conference had been devoted to the benefits or hazards of trans fats. Today the real hazards of trans fats are more broadly known to the public, thankfully because of the internet, and all in a short 10 years of exposure.
While more people are reading labels, most still believe that saturated fats are bad. Most also now understand that trans fats are also bad for health. So to keep their profits intact, the big food industries cannot profitably advertise that their foods have either saturated fats or trans fats. So the race has been on for many years now to find other plant oils that can replace these two types, and it is a bit scary where our big-business commercial foods are leading us. It’s a big step into the unknown for our health because there is no easy way the effects of new toxic plant oils on population health except by looking at the results of changes to health over another generation.
The dietary guidance by the establishment has followed Keys’ view for 50 years now, and despite half-a-billion dollars having been spent trying to prove his hypothesis, the evidence of its health benefits has never been produced. Meanwhile, rates of obesity, cancer and diabetes are rising and heart disease remains a leading cause of death. It’s worth wondering if the establishment’s working hypothesis will ever be changed now. And if alternative ideas are to be considered, nutrition science must, like any science, provide an open, civil and unbiased climate for genuine debate and inquiry, and enter a post‑Keysian era for the health of us and our children.
Either Nina Teicholz will be burned at the stake, or she will be applauded as a heroine for health. She can allow us to return to the high-fat diets of our ancestors and eat our way to better heart health with a clearer conscience for doing the ‘right’ thing for our bodies. I recommend reading her book— it demonstrates a common sense understanding of foods and dieting.