Don’t take dietary advice from non-experts

A column entitled “The Questionable Link Between Saturated Fat and Heart Disease” appeared in the Wall Street Journal recently. To spare you any guessing about where this is headed, I’ll tell you right away: The column itself was pretty darn questionable.

The article starts off very dubiously when the author, Nina Teicholz, tells us that a now somewhat infamous study published in the Annals of Internal Medicine concluded, that “saturated fat does not cause heart disease.” I have read the paper in its entirety, and could not recall any such assertion. So I actually ran a search function on the text of the article, and that statement simply does not appear. So file this one, folks, in the “don’t believe everything you read” drawer.

The plot then quickly thickens, and goes on to curdle, for we learn at the end of the Wall Street Journal piece that Ms. Teicholz has a book due out, entitled The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet. So whatever else the recent Annals paper is or isn’t, it was clearly a nice marketing opportunity for Ms. Teicholz and her publisher.

The recent Annals paper did not show that saturated fat is harmless, and it certainly didn’t show that it is beneficial. It did not even suggest the latter. Is lack of harm really the new standard in healthful eating? I didn’t get that memo. I thought we might actually be interested in food that was genuinely good for us. In any event, if you want to know what the study actually did show, I lay that out in detail, here.

Second, neither the Annals paper nor any other recent research on the topic suggests there is health benefit derived from adding butter, meat, or cheese to our diets. The weight of evidence is very much to the contrary. I know, because I reviewed it recently at the request of a peer-reviewed journal.

Third, Ancel Keys was not wrong – he was exploited by the collusion of Big Food, and our prevailing gullibility. Keys compared diets natively rich in plant foods and diets natively rich in meat, butter and cheese — and recommendations resulted from the differences in health he observed. He never suggested that we should start eating Snackwell cookies — but that is how our culture interpreted advice to eat less fat. Of course health doesn’t improve when you replace one way of eating fairly badly with another way of eating at least as badly. If you don’t get healthy by replacing Coca-Cola with Pepsi, it doesn’t prove that Coca-Cola was good for us all along, does it? That seems to be our tendency — and so we simply reap exactly what we sow.

Fourth, and finally, Ms. Teicholz seems inclined to play the iconoclast card. It’s getting old, frankly, but it generally does work to sell books. So she may well wind up rolling her eyes at this column on the way to cash her royalty checks. I guess that’s up to all of you.

But no, folks — more meat, butter and cheese will not promote your health. Neither will nonsense — no matter where it’s published.

I know that those of you inclined to believe Ms. Teicholz, either because you truly believe bacon cheeseburgers are good for you or because you just with they were, are rolling your eyes at me now. Some of you will likely go further, and post dissenting comments. I welcome those.

But then, inevitably, in a world where diets are embraced with religious zeal and we can’t seem to manage a separation of church and plate, there’s a group that let’s disagreement veer off into disparagement, turning differing opinions into excuses for ad hominem attacks.

Anticipating that, I think it’s important to note that whatever my character, the fact is: I am trained to do what I do. That matters in just the same way that it matters whether or not the captain has been trained to fly the plane. It doesn’t make you a good person or a bad person. It just means you have training and expertise in a particular area.

I am a trained clinical researcher who conducts and publishes studies, and analyzes the work of others routinely for the peer-reviewed literature. I actually teach and study nutrition, and have written textbooks on the subject that have had to run the gauntlet of diverse expert peers.

And — I don’t have a diet to sell. In fact, I am on record as asserting that no single diet is best – and that an optimal diet can be low fat or high, include or exclude meat, be lower or higher in protein, and so on. The theme of healthful eating is well established — the specific winner of the never-ending my-diet-can-beat-your-diet beauty pageant is not.

I think that stuff matters, folks — whatever my character. Let’s focus on content.

Letting non-experts take over our kitchens produces a slower crash than letting them take over the cockpit. But we crash just the same. The result of endless squabbling about such issues as salt, sugar, carbs, or fat while ignoring the well-established fundamentals of feeding Homo sapiens well is a calamitously unnecessary loss of years from life and life from years over a span of decades. It’s a slow motion crash, but it’s a crash just the same.

So, yes — it matters that a journalist with a diet book to sell you was the one to tell us in Wall Street Journal what a recent study about fatty acid intake meant. Maybe she read the study, and maybe she didn’t. But either way, she has no formal training in nutritional epidemiology. And did I mention she has a diet book to sell you?

That’s the lesser issue. Here’s the greater one: remember Atkins?

He proposed more meat, butter and cheese in the 1970s. Yes, the 1970s — go ahead and look it up. You will note that his book that went into the stratosphere a little over a decade ago (much aided by another journalist with good intentions, but dubious conclusions, and a book to sell you, Gary Taubes) was entitled “Dr. Atkins’ New Diet Revolution.” What was it “new” in comparison to? The same diet first published in the 1970s.

So we might ask the question: if Atkins had the truth for us in the 1970s, why did we need a diet revolution in the 1990s? And if that revolution in the 1990s, which reached tens of millions in the early 2000s was really the answer — then why are we reacting to the same dietary déjà vu all over again in the Wall Street Journalas if it were some kind of epiphany?

We are flying in circles. If we had reduced our intake of meat, butter and cheese by eating more vegetables, nuts, fruits and legumes — we might be living in a Blue Zone by now. But we didn’t and we aren’t. We just started eating more starch and sugar. As we all know, America runs on Dunkin’ — tell them what they’ve won, Johnny!

So now, we can add back meat, butter and cheese (the consequences to the planet be damned, apparently) — and then what? We’ll be back where we were when we first recognized we weren’t where we wanted to be. After all, if our meaty, cheesy, buttery diets had been making us lean, healthy and happy in the first place — why ever would we have changed them?

So it’s “more meat” for the myopic, who can’t see far enough back to realize we’ve been there, done that — and it didn’t work out so well for us last time. It’s “more cheese” for the chumps who don’t recognize that the next great diet is one we’ve tried before. In fact, the title of the book by the Wall Street Journal columnist is almost shockingly like the title of Taubes’ piece in the New York Times Magazine from 12 years ago. In 12 years, our progress is nicely captured by going from a “big fat lie” to a “big fat surprise.” We fly in circles, and our kids pay the price.

It would be bad enough, frankly, if we fixated on genuinely new dietary theories while ignoring the latent potential of what we do truly know to prevent as much as 80 percent of all chronic disease. But what’s even worse is that after a delay of roughly a decade, we reliably forget the follies of our recent history, and fall in love again with some dietary has-been.

Or in other words, when it comes to our seemingly insatiable appetite for dietary nonsense, the one true expert is Weird Al Yankovic who presciently said: “Eat it! Eat it! If it gets cold, reheat it … ” I don’t know anything about Weird Al’s character, but the man can sure cook up a song!

Bon appétit, everybody.

David L. Katz is the founding director, Yale-Griffin Prevention Research Center. He is the author of Disease-Proof: The Remarkable Truth About What Makes Us Well.

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  • ninguem

    I’ve always liked a line from Susan Powter (remember her?) surely a non-expert, definitely flamboyant, she said this decades ago.

    It was something along the lines of “don’t eat anything where you can’t recognize where it came from”.

    If it’s torpedo-shaped, though maybe with head and fins cut off, it’s a fish. Eat it.

    If it’s a breaded square, maybe it’s a fish, maybe a rat, give it a pass.

    The less processed, the better.

    • rbthe4th2

      I go by make it a habit, eat like a rabbit and don’t eat anything that has a commercial.

  • http://frugalnurse.com/ Frugal Nurse

    I always enjoy reading your post and columns, Dr. Katz. I remember one post especially when you encapsulated a healthy diet into one sentence: “Food, not too much, mostly plants.” I tell that to everyone.

    • Lisa

      The quote is from Michael Pollan’s book, “In Defense of Food: An Eater’s Manifesto.” The actual quote is “Eat Food. Not too much. Mostly plants.”

      • http://frugalnurse.com/ Frugal Nurse

        Well, whoever said it, I still like it!

        • Lisa

          Pollan’s book is well worth reading if you are interested in diet related matters.

          • LeoHolmMD

            Indeed. Far from “expert”, he did something few are doing these days: investigative journalism. His work almost reaches the point of “read no further”.

          • SonoIo

            really great point. the expert thing is nonsense – insight comes from the most unlikely sources.

  • Arby

    Well, I know grains and dairy make me ill. I can gain 3-6 pounds in a couple of days after I eat some and have a crushing fatigue that goes along with it. Yes, inflammation or edema or both, not fat. I do find that broccoli and kale make me feel better.

    Pretty much all I can eat is meat/fish, some fruits and most vegetables. I don’t need to listen to anyone except my own body to know this.

    • JR

      Have you been tested for Celiac? Most people freshly diagnosed with Celiac can’t tolerate milk. Gaining five pounds and crushing fatigue after eating grains is pretty common for people with celiac. And many other grains are cross-contaminated with wheat as they are processed together in the same facility.

      Instead of going gluten free, I actually recommend trying to eat wheat for every day and seeing if it makes you sick. I did that for three weeks, and I was strongly debating if I should wake someone up to take me to the emergency room or not. I was convinced I couldn’t have it and was trying to prove I didn’t… I’m a bit stubborn.

      • Arby

        Thanks, and yes I have, but it was too late. I had already been off of gluten for about a month before my PCP suggested one and we both agreed that it would be futile. My endocrinologist however went ahead and ordered one months later along with some other tests. It was negative.

        I read they are finding that intolerance to gluten is as big an issue and it doesn’t show on blood tests, so I figure I’m doomed regardless. And, I did do a challenge once, because I was in denial. I really did not want to give up a lot of foods. It made me miserable.

        Now, i supplement with gelatin. It is harmless, and still a viable food, so it is not like it’s a woo remedy. We’ll see how I do with it.

  • SonoIo

    Nina Teicholz’s book is not a diet book – it is essentially a dissertation on the history of the Anti-fat crusade. To characterize it as a diet book is absurd in the extreme. It’s also not clear why this person feels he needs to come after it with such vigor – after having posted essentially this same thing on his lInked in page. I’m baffled.

    The fact that the medical community does NOT have the answers to the obesity epidemic is clear. The fact that this person tells us that he is a medical expert in this area therefore holds no water. This person also has a lot of “correspondents” that found this WSJ article and he felt the need to diss it after getting off his horse, he wrote, and on his way to get one of his kids at the airport. But he felt the need to bash a book he has not read – he didn’t know anything about it.

    Frankly, it’s odd and unsettling. We all now have access to the literature and we can all add to the conversation. As a nurse, I don’t think it is a good thing to resort to “trust me I’m a doctor” – when doctors have let us down so much in the past.

    We are in the middle of an obesity epidemic – and I, for one, would like to hear from anyone who’s looked deeply into the literature.

    And since this person has “correspondents” – which is clear from his linked in posts that he has people who follow him and post comments in his favor – not clear if they are paid – but I suspect that this post will get blasted.

    The whole thing is very troubling indeed.

    • LeoHolmMD

      Agree. Doctors and other experts blew it. Micro-nutritionism has led us astray at every opportunity. Farmers had it right all along. Too bad we have a culture trying to destroy them.

  • http://www.myheartsisters.org/ Carolyn Thomas

    The Annals paper’s own authors write, in their conclusion: “Current evidence does
    not clearly support cardiovascular guidelines that encourage high
    consumption of polyunsaturated fatty acids and low consumption of total
    saturated fats.”

    That sounds pretty definitive to me. They are not saying bacon cheeseburgers are good for us, but the study does appear to dispute what I and all other heart attack survivors are routinely warned by our doctors: that eating less saturated fats and more polyunsaturated fatty acids will improve our cardiovascular health. The study authors – and Ms. Teicholz – tell us that evidence simply does not support that claim.

    Taking nutritional advice from doctors, as some commenters here have already astutely pointed out, is fraught with unfortunate results. Take eggs, for example. During the 70s, when cholesterol studies first identified the culprit, heart patients were told by physicians: NO MORE EGGS! Ever! Fast-forward a few more years, and doctors began advising: Well, okay, maybe one egg per week is allowable. Another decade or two later, docs tried this one: three eggs will likely not make you keel over from another cardiac event. And today, my cardiologist confidently advises me that eating an egg a day is perfectly fine.

    Why do I suspect that the researchers of the 70s were similarly vexed by emerging data that challenged their early egg warnings?

    • querywoman

      Yup! Fads come and go. Research Ellen Swallow Richards who “mothered” the American school lunch program and also Home Economics classes.
      She wanted immigrants to fry, not boil foods.

  • SonoIo

    reasonable argument. I do sort of believe that – yet the truth is I put patients on both diets and both work. The proof has been in the doing of it. More than one path to health – the A to Z trial showed that, among others.

  • querywoman

    Do you consider medical doctors nutritional experts? I don’t. I’m not sure I really consider anybody a nutritional expert.

  • querywoman

    What’s a natural diet? Our ancestors usually clubbed an animal to death and then ate it. Fruits and vegetables were available, in some parts of the world, in season.
    Then people learned to store grain.
    The medical profession, when in control, serves people the cheapest food it can find: wheat!
    In a hospital or a nursing home, almost every meal will be heavy in wheat. It’s easy to store, easier to store than potatoes, which take up more space. Rice takes a little longer to cook.

    My friend did a brief stay in a nursing home, and one night they got hot dogs for supper!

  • Dorothygreen

    I thought the study as reported in the Times was rather clear. Especially, when the authors discussed what was found when looking at fatty acids in the blood. One Omega 6 – arachodonic acid, Omega 3 and two saturated fats – stearic and palmitic where significantly associated with lower risk.

    I feel you are over reacting when you think people reading this article will start eating unlimited amounts of saturated fats. I do agree though that the NYT author overdid it. The picture of a double cheeseburger, maybe a piece of lettuce and tomato with bun was ridiculous. I will be sure NOT to read her book. I talked about this article to some seniors and showed this picture and then another without the bun and topped with 5 times the vegetables. They understood.

    Dr Katz and the author of the NYTimes article or anyone who wants optimal health, I encourage you to read The Wahls Protocol. Dr Wahls developed this protocol based on enormous research for optimal nutrition. Most of us do not have the reason, or the discipline, for this diet at its most optimal level. But, just to get to the first level can make huge differences in the prevention and reversal of most chronic diseases. It is the highest recommendation of any with regard to vegetable and full color fruit consumption – 9 cups, It is high fat (high whole food fat – coconut, organ meats, wild fish and grass fed red meat), just what would give a Keys follower stress. Stress that is known to increase blood sugar and hence, risk of atherosclerosis. The total lipid level she recommends to strive for is > 200, HDL > 60, triglycerides <100.

    She was deteriorating fast, drugs did not help. Her diet worked. She reversed severe degenerative multiple sclerosis. She was out of her reclining wheelchair and walking with one cane in 3 months. In a year she was doing 18 miles on her bicycle. Clinical studies continue. There are reports outside the studies of those who have success with reversing obesity and other chronic diseases.