By Marika Sboros
The Health Professions Council of SA (HPCSA) has a few problems in its prosecution of scientist Prof Tim Noakes. One is research showing that these diets deprive infants and children of much-needed fats and other vital nutrients during their most formative years. Another is the effects of low-fat diets on heart health. It isn’t what the experts want you to believe it is.
US investigative journalist Nina Teicholz presented this and other explosive evidence during her testimony as an expert witness for Noakes. That was at the HPCSA’s fourth session of the hearing against him in Cape Town on October 25, 2016.
In the first of a three-part series on her evidence, here’s what she had to say:
Why was her evidence so explosive? Well for starters, the HPCSA has charged him with unprofessional conduct for giving “unconventional advice to a breastfeeding mother on a social network (Twitter)”.That was for a single tweet saying that good first foods for babies are LCHF (low-carb, high-fat). In other words, he suggested meat, dairy and vegetables.
Teicholz showed that Noakes’ tweeted opinion was actually evidence-based. Experts could consider his views unconventional in that they conflict with South Africa’s low-fat, high-carb dietary guidelines these days. However, they wouldn’t have considered his views unconventional as recently as 1965, as Teicholz demonstrated.
Teicholz and UK researcher Dr Zoë Harcombe presented other evidence that was problematic for the HPCSA. Both showed that the available evidence did not support the guidelines at the time the US launched them. They said that the evidence still does not support the guidelines. In other words, the guidelines are not evidence-based.
HPCSA advocate Ajay Bhoopchand tried to critique her evidence on the grounds of relevance. He suggested that Teicholz’s evidence was irrelevant because her focus was the US dietary guidelines. He said that SA’s dietary guidelines followed the World Health Organisation, not just the US.
Teicholz dispatched that argument quickly. She showed how closely the SA’s dietary guidelines mirror the US guidelines. She left Bhoopchand stunned into uncharacteristic silence. He declined any further cross-examination. Even Pretoria advocate Joan Adams, chair of the HPCSA Professional Conduct Committee, declared herself “stunned”. That was probably given Bhoopchand’s lengthy cross-examination of Harcombe the day before.
Critics sometimes dismiss Teicholz as “just a journalist”. Bhoopchand wisely didn’t go there. Teicholz has studied science and politics at Yale and Stanford Universities (her undergraduate degree is from Stanford, in American studies).She also has a master’s in philosophy from Oxford University in the UK. She says that her education in political science serves her as well as her courses in science.
“Unfortunately, the story of nutrition policy over the past 50 years is just as much about politics as science, perhaps even more so,” she told me.
In her testimony, Teicholz drew heavily from The Big Fat Surprise. It’s a seminal, unique work she published in 2014. It is the fruits of 10 years’ research into what one wouldn’t ordinarily think of as a murky world: nutrition science.
Unusually for a lay author, two top medical journals have reviewed her book. The American Journal of Clinical Nutrition (AJCN), a premier journal in the US, says of The Big Fat Surprise: “Every nutritional science professional and all scientists should read (this book) as an example of how limited science can become federal policy.” The AJCN describes her book as a “historical treatise on scientific belief versus evidence”.
In The BMJ, former editor Dr Richard Smith is similarly expansive. In a three-page review, Smith says that the book “shook” him. He also says that Teicholz has done “a remarkable job in analysing the weak science, strong personalities and vested interests in political expediency”.
The Economist named The Big Fat Surprise the Number 1 science book of 2014 and called it a “nutrition thriller”. Teicholz joked that that’s “probably an oxymoron”.
Still, it is a fascinating, forensic journey into the world nutrition science. It reveals the policy, personalities, politics and influence of industry in the construction, implementation and maintenance of official dietary guidelines. It is often not a pretty picture.
In the book, Teicholz analyses the last 50 years of nutrition policy in the US. This is particularly as it relates to dietary fat and cholesterol. She looks at the current influential US dietary guidelines the government introduced in 1980. In the ensuing years, most countries, including the UK and South Africa, have followed the US model.
In her evidence, Teicholz looked at the science to support the guidelines’ low-fat, high-carb recommendations when the US first introduced them. She showed that top scientists knew there was evidence to the contrary but ignored or suppressed it for decades.
The consequences for public health have been nothing short of tragic. Teicholz told the hearing that the US guidelines have been a major contributor to the pandemics of obesity, diabetes and heart disease. Interestingly, the US Dietary Guidelines Advisory Committee now warns that low-fat diets actually cause atherogenic dyslipidaemia. In other words, low-fat raises the risk of heart disease. Few other than Teicholz have picked that up.
Just as shocking, she said that official dietary advice deprived infants and children of vital dietary fats needed to absorb vitamins and other nutrients during their most formative years.
The sub-text of her evidence throughout was that the same applies to South Africa’s dietary guidelines.
Click here to read: NOAKES: CASE AGAINST HIM FALLING APART?
Teicholz told the hearing how her nutrition journey began: with an investigation into trans fats for Gourmet, a food magazine, in 2004. Consequently, this assignment introduced her to the “world of fat”.
“Fat is what we obsess most about in nutrition,” Teicholz said, “how much fat to eat, what fat, good fat, bad fat, low-fat, non-fat.”
Her research into transfat quickly threw up an intriguing possibility: That everything we thought we knew about dietary fat was “completely wrong”; that US nutrition policy had probably gone “completely upside down and backwards as to what we should be eating”.
Teicholz is not given to sweeping statements. She is thoroughly grounded in the scientific method. One of the many strengths of her book is her dogged, critical, independent approach to research. She did not rely on summary statements or review papers. Instead, she went back to all the original papers, sometimes back to the original data. In the many cases where scientists tried to hide their data – some of it published in foreign language publications – she hunted those down too and got someone to translate them professionally.
She interviewed hundreds of scientists, most of them top in the field in the US and internationally. Some interview subjects said in hushed tones that they “couldn’t talk about fat”. They slammed the phone down. Teicholz found that unsettling. She felt at times as if she were “investigating the mob”. The analogy is not inappropriate.
Teicholz attended conferences and interviewed hundreds of industry executives to find out industry’s role in this story. It soon became clear, she told the hearing, that the vilification of saturated fat simply did not stand up to close scientific scrutiny.
So rigorous are her arguments that in 2015, the Canadian Senate invited Teicholz to testify for an hour at its committee charged with looking at the country’s dietary guidelines. The Senate Committee recently announced that the health authorities would completely overhaul the guidelines. That process has begun.
Teicholz has also helped to convince the US Congress that it needed a formal peer review of that country’s dietary guidelines. That review too has recently begun.
But just how did so many of people across the globe come to believe that saturated fat and cholesterol cause heart disease?
Like any idea, it was born in “a moment in time”, Teicholz told the hearing. It began in the 1950s in the US when there was “rising panic over the increase in heart disease that had come from seemingly out of nowhere in the early 1900s”.
Competing explanations fingered vitamin deficiency, auto exhaust, or an increasingly stressful lifestyle as causes of heart disease.
One man believed otherwise – University of Minnesota pathologist Ancel Benjamin Keys. Keys believed saturated fats were the cause. He believed that saturated fat and dietary cholesterol raises blood cholesterol, clog arteries, and cause a heart attack.
He called his belief the diet-heart hypothesis. It became a pillar of US dietary guidelines. It still lies at the heart of dietary guidelines across the globe today.
Teicholz described Keys as “a unique personality”. He had a “kind of indomitable will,” she said. He would “argue people to death”. Keys had an “unwavering faith in his own beliefs.”
Teicholz, in her characteristically measured style, said it was “fair to say” Keys was always “more interested in being right than in being a good scientist”. Others have described him as a ruthless, arrogant bully.
In the 1960s in the US, the only group telling people how to eat and what lifestyle habits to have to avoid a heart attack was the American Heart Association (AHA). Before 1961, Teicholz told how members of the AHA even rapped diet-heart supporters such as Keys on the knuckles. It warned against “uncompromising stands based on evidence that does not stand up under critical examination”.
Keys quickly turned that around. He and close colleague Jeremiah Stamler got themselves appointed onto to the AHA’s nutrition committee. Within a year, through sheer force of personality, Keys had implanted his diet-heart hypothesis into the AHA.
In 1961, the AHA began advising men not to eat saturated fat and dietary cholesterol. This was the very first official advice anywhere in the world telling people to avoid saturated fat and cholesterol to prevent heart attacks, Teicholz said. “This was where it was all born,” she said. From there, it spread globally.
In effect, the AHA told people to stop eating meat, full-fat dairy and eggs. It told them to switch to margarine instead of butter and to use vegetable oils instead of ancient fats such as lard or tallow. It advised people to decrease animal foods in general and to switch to plant-based foods.
This wasn’t logical in terms of the trends in fat consumption at the time. Teicholz showed how consumption of animal fat was already dropping in the US. At the same time, consumption of polyunsaturated vegetable oils “perfectly paralleled” the rise in heart disease rates.
She described the rise of polyunsaturated vegetable oils, such as soybean, corn oil, sunflower. She said these did not exist as foodstuffs until 1911. That was when industry introduced the first vegetable oil food product. Consumers in the US knew it as “Crisco”, a hardened form of vegetable oil that was meant to replace lard.
Research going back to the 1950s documents a litany of serious adverse health effects of these oils. Yet Keys’ beliefs prevailed. He featured on the cover of Time in 1961 and became “the most important nutrition scientist of the 20th century”.