By Marika Sboros
Apart from jumping the gun on a “guilty” verdict, the Health Professions Council of SA (HPCSA) has another big problem in its prosecution of scientist Prof Tim Noakes: all the evidence showing that low-fat diets increase the risk of heart disease.
If that were not bad enough, these diets also deprive infants and children of much-needed fats and other vital nutrients during their most formative years.
US investigative journalist Nina Teicholz presented this and other explosive evidence during her testimony as an expert witness for Noakes at the HPCSA’s fourth session of the hearing against him in Cape Town on October 25, 2016. In the first of a two-part series, here’s what she had to say.
Why was her evidence such a body blow to the case against Noakes? Well, the HPCSA has charged him with unprofessional conduct. That was for giving “unconventional advice to a breastfeeding mother on a social network (tweet) sic”. In that tweet, he said good first foods for babies are LCHF (low-carb, high-fat). In other words, he suggested meat, dairy and vegetables.
Teicholz showed that Noakes’ views on LCHF are very much evidence-based. Experts could consider his views unconventional in that they conflict with South Africa’s low-fat, high-carb dietary guidelines. However, they wouldn’t have considered his views unconventional in the least as recently as 1965, as Teicholz demonstrated. That was before the introduction of low-fat guidelines around the world.
Additionally problematic for the HPCSA is that Teicholz and another expert witness for Noakes, British obesity researcher Dr Zoë Harcombe, gave evidence to show the guidelines are based on shaky science.
In other words, they are, for the most part, not evidence-based. That’s if you look at all the available evidence, not just the bits that suit a particular viewpoint.
HPCSA advocate Ajay Bhoopchand did try his best to critique Teicholz’s testimony. He suggested her evidence, which focused on the US dietary guidelines, wasn’t relevant in South Africa. He said SA’s dietary guidelines followed the World Health Organisation, not just the US.
Teicholz despatched that argument quickly . She showed how closely the SA’s dietary guidelines mirror the US guidelines.
So compelling was her evidence, that Teicholz left Bhoopchand stunned into uncharacteristic silence. He said he had no further questions. Chair of the HPCSA Professional Conduct Committee Pretoria advocate Joan Adams declared herself “stunned” at that. That was probably given Bhoopchand’s lengthy cross-examination of Harcombe the day before.
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Critics like to dismiss Teicholz as “just a journalist”. Yet her meticulous, investigative journalism has been seismic. It has shaken the very foundation of the nutrition world. Bhoopchand wisely didn’t go there.
Teicholz studied both science and politics at Yale and Stanford Universities (her undergraduate degree is from Stanford, in American studies). In addition, she has a master’s in philosophy from Oxford University in the UK. She likes to say 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 her ground-breaking book: The Big Fat Surprise. It’s a seminal, unique work she published in 2014. It is the fruit 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. One is the American Journal of Clinical Nutrition (AJCN), a premier journal in the US.
It 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 its praise. In the course of a three-page review, Smith says the book “shook” him. He says 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 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 has analysed the last 50 years of nutrition policy in the US, particularly as it relates to dietary fat and cholesterol. She looks at the current and massively influential US dietary guidelines the government introduced in 1980. In the ensuing years, most countries, including the UK and South Africa, followed the US model – and still do.
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 that data 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. She said the US Dietary Guidelines Advisory Committee now warns low-fat diets cause atherogenic dyslipidaemia. In other words, it raises the risk of heart disease. Few other than Teicholz have picked that up.
Just as shocking, she said official dietary advice deprived infants and children of vital dietary fats needed to absorb vitamins and other nutrients during their most formative years.
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The sub-text of her evidence throughout was that the same applies to South Africa’s dietary guidelines.
Teicholz told the hearing how her nutrition journey began: with an investigation into trans fats for Gourmet, a food magazine, in 2004. 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 journalistic approach to research.
— Marika Sboros (@MarikaSboros) October 28, 2016
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 were trying 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 said, like she was “investigating the mob”. The analogy is not inappropriate.
She 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 have been her arguments that in 2015, the Canadian Senate invited Teicholz to give an hour of testimony to its committee charged with looking at the country’s dietary guidelines. The Senate Committee recently announced that the guidelines would be completely overhauled.
Teicholz is similarly credited with helping to convince the US Congress that it needed a formal peer review of that country’s dietary guidelines. That review 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. That was 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 would raise 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 like Keys on the knuckles, warning 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 to avoid heart disease.
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”. From there it spread around the world.
In effect, the AMA 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. The AMA advised people to decrease animal foods in general and to switch to plant-based foods as a way of avoiding saturated fat and cholesterol.
This made little logical sense, 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, that 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” that was a hardened form of vegetable oil. It 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 landed on the cover Time Magazine in 1961 and became “the most important nutrition scientist of the 20th century”.