Teicholz on how low-fat diets can kill you


By Marika Sboros

Nina Teicholz

At the heart of the trial of scientist Prof Tim Noakes is the diet-heart hypothesis that saturated fat causes heart disease. US investigative journalist Nina Teicholz focused on the hypothesis in her testimony in Noakes’ favour at the fourth session of the Health Professions Council of SA (HPCSA) hearing in Cape Town on October 25.

Teicholz showed how the creator of that hypothesis ignored evidence showing that sugar and other carbohydrates are more likely causes of heart disease. Here, in the final of  two-part series on her evidence, she shows why low-fat diets can be lethal. Teicholz also looks at the role of sugar in the rise of chronic diseases.

The HPCSA has charged Noakes with unprofessional conduct for giving unconventional advice to a breastfeeding mother on a social network (Twitter). That was for a single tweet n February, 2014. Noakes tweeted that good first foods for infant weaning are low-carb, high-fat (LCHF). In other words, he was suggesting meat, fish, chicken, eggs, full-fat dairy and vegetables.

Nina TeicholzTeicholz is author of The Big Fat Surprise. It’s a groundbreaking book that experts internationally acknowledge as changing the face of nutrition science. She based her evidence in chief at the hearing on the 10 years of research it took to write the book.

She told the hearing how US physiologist  Ancel Benjamin Keys  came up with the diet-heart hypothesis in the 1950s.

To support it, he needed research. Keys embarked on the Seven Countries Study. Though fatally flawed, it was an “extremely influential”, study that is still well-cited.

‘Big Bang’ of modern nutrition science

“If you read 10,000 nutrition papers, as I’ve done, they all telescope back to Keys’ Seven Countries Study,” Teicholz said It became the  “Big Bang of modern nutrition studies”.

Study results showed exactly what Keys hoped they would: that men who ate lots of saturated fats had higher rates of cardiovascular death.  That was because Keys “cherry-picked” the countries that he included in the study, Teicholz said.

He avoided countries, such as Switzerland, Germany and France, where he knew that people ate lots of saturated fat yet had low rates of heart disease, Teicholz said. These countries “would have ruined his findings on saturated fats”. 

Teicholz asked Keys’ right-hand man, Henry Blackburn, why Keys avoided those countries.  Blackburn said Keys had “just a personal aversion to being in those countries”.

She presented other problems with the Seven Countries Study, which she has documented in detail in The Big Fat Surprise. These include data “inconsistencies” that Keys could not resolve.

An emblematic error

Dr Ancel Keys on the cover of Time magazine, 1961
Dr Ancel Keys on the cover of Time magazine, 1961

One error was “emblematic”. The men Keys studied on the island of Crete became the foundation for the Mediterranean diet as we know it today, she said. Those men seemed to eat very little saturated fat and yet had very low rates of heart disease.

As well, of the three study periods that Keys spent collecting data on Crete, one fell during the month of Lent. That was when the islanders would have religiously avoided all meat, dairy, eggs and even fish.

“The Greek orthodox fast is a strict one,” Teicholz said. Thus, Keys must have undercounted the amount of saturated fat the Cretans ate. Keys knew of this problem but dismissed it without explanation.

One of Keys’ fellow project leaders, Alessandro Menotti, headed up the Italian part of the Seven Countries Study. Much later, in 1999, Menotti went back to re-analyse the dietary data. He found that the food that best correlated with heart disease was not saturated fats, but “sweets”, Teicholz said.

She asked Menotti how that finding escaped Keys. He told her that the Seven Countries Study leaders “did not know how to treat (sugar). We reported the facts and had some difficulty explanation our findings.”

Sweet poison for hearts

Keys clearly knew that the hypothesis that sugar causes heart disease competed with his own, she said. He also knew that only one could be right. Keys did what he always did when dealing with inconvenient hypotheses: he went on the attack.

He suggested that financial reasons motivated all those who promoted the idea that sugar caused heart disease. Or, he said, they were “just plain wrong”.

Prof John Yudkin
Prof John Yudkin

One of the most prominent proponents of the sugar hypothesis in the 1970s  was John Yudkin, a professor at Imperial College, London. Yudkin is author of Pure, White and Deadly – How Sugar Is Killing Us And What We Can Do To Stop It. 

Keys imperiously dismissed Yudkin’s theory as “a mountain of nonsense”.

And while the Seven Countries Study was large and seemingly persuasive, it was still only observational.  A basic principle of science is that observational studies can only show association but not causation, Teicholz said.

For causation, clinical trials are needed, preferably randomised controlled clinical trials that are “absolutely gold standard”.

Teicholz showed how governments around the world undertook randomised control clinical trials (RCTS) on the diet-heart hypothesis throughout the 1960s and 1970s. They used foods high in vegetable oils, such as margarine and soy-filled milk.

Trying, failing to prove heart hypothesis

Teicholz did not go into those in detail since a previous expert witness for Noakes, British obesity researcher Dr Zoë Harcombe, reviewed much of those studies in her evidence. Teicholz referred briefly to research that included the Finnish Mental Health study that lasted for 12 years. She also included studies that the US National Institutes of Health (NIH) funded. Among these are the LA Veterans Study, the Minnesota Coronary Survey, and the MrFit Trial.

The NIH alone spent billions of dollars on studies, trying – and failing – to prove Keys’ hypothesis, Teicholz said. These trials were “remarkably special” as they were highly controlled, in-patient environments where researchers served all meals to participants.

Additionally, almost all these studies had “hard endpoints.” This meant they had “indisputable outcomes”, such as death, which “cannot be contested”.  The diagnosis of a heart attack was another end point but “a little more disputable”, Teicholz said.

Pure, White and DeadlyMany studies today use far less reliable “intermediary endpoints”. These include lipid markers such as LDL-C (low-density lipoprotein cholesterol) and HDL-C (high-density lipoprotein cholesterol).

There is “quite a lot of dispute” over those, she said, in terms of which best predicts heart-attack risk.

Altogether, the trials on the diet-heart hypothesis included more than 75 000 subjects, mostly men but some women. They showed that restricting saturated fats reduced total cholesterol.

However, there was no impact on the ultimate outcome – whether or not people died of a heart attack.

Fat and cholesterol

In recent years, researchers globally have looked at this data. There are now more than a dozen published meta-analyses and systematic reviews, Teicholz said. Nearly all have concluded that saturated fat and dietary cholesterol did not cause death from heart disease.

The research has consistently shown that low-fat diets lower HDL-C (so-called “good cholesterol”). That means, in effect, that they actually increased the risk of heart disease, she said.

Some official bodies are taking notice, Teicholz said. For example, The  Canadian Heart and  Stroke Foundation (CHSF), that is the equivalent of the AHA in the US and the Heart and Stroke Foundation of South Africa. It has re-evaluated the data. In 2015, the CHSF lifted the cap (as a percentage of calories) on saturated fats.

Although few people are aware of it, the US Dietary Guidelines for Americans also no longer recommends a low-fat diet. That’s precisely because of compelling evidence that it causes heart disease, Teicholz said. But it’s also because clinical trials on more than 52,000 people show a low-fat diet to be “ineffective in fighting any other kind of chronic disease”.

Teicholz presented disturbing evidence to show that by 1981, nearly 12 sizeable studies on humans found a link between lowering cholesterol and cancer. That was principally for colon cancer. Other research linked vegetable oil diets with an increased risk of lung cancer.

Teicholz cited Noakes’ analysis of the US Women’s Health Initiative  (WHI) study on nearly 49 000 women over seven years. He found that women with the least insulin resistance at the start of the trial had a greater risk of developing type 2 diabetes if they were eating the low-fat diet compared to the control diet.

Effects of low-fat diets on blood sugar

The low-fat diet also worsened glucose control in women with diagnosed diabetes.

Both these markers imply that the low-fat diet increased the risk for diabetes, compared to the control group eating a higher-fat diet, she said. WHI authors concluded that health professionals should exercise caution in advising women with diabetes to reduce dietary fat “unless accompanied by additional recommendations to guide carbohydrate intake”.

In other words, the advice was that “women should be careful about eating so many carbs because a low-fat diet was, by definition, a high-carb diet”.

Teicholz told the hearing that it’s therefore fair to say that many RCTs on the diet-heart hypothesis “found no evidence of benefit and some evidence of harm”.

The diet-heart hypothesis has been “the most tested hypothesis in the history of nutrition and disease”, she said. “And the results were null.”

She presented the competing carbohydrate-insulin hypothesis of obesity. Evidence to support it includes;

  • More than 74 randomised controlled trials, virtually all on Western populations
  • At least 32 trials of low-carb diets have lasted six months or longer
  • Three lasted two years (the gold standard) to see any adverse side effects.

These trials have established that low-carb diets are safe, she said. They have also established efficacy for fighting obesity, diabetes, and heart disease (improves nearly all CVD risk factors).

Interestingly, Bhoopchand cross-examined Teicholz on her evidence only briefly. The chair of the HPCSA’s committee, Pretoria advocate Joan Adams, declared herself “stunned” and the brevity of his cross-examination.



  1. I can tell them exactly why modern carbs are driving disease.

    Food is like a code. The elements within a food provide that code and the body can then interpret it. So when you eat an orange, as a complete food the body knows what to do with the elements within it. However, food products made with processed flour and sugar are denatured – missing some or even most of the elements that would tell the body what to do with it. That either leaves parts of the food structure stuck in limbo floating around the body getting into mischief, or it means that the body then has to call on its own nutritional resources to try to fill in the blanks.

    It doesn’t take a rocket scientist to realise that it wouldn’t take long in that scenario for the body to go into nutritional debt and start to degenerate. If the food we eat robs more from the body than it effectively gives, we are in trouble.

    Not only is wheat now a highly-hybridised grain containing a lot of ‘foreign’ and complex proteins that are not present in original strains (which had 14 chromosome as opposed to the current 42 – and we know what just ONE extra human chromosome or TWO can do to the human body!), but the nutritional powerhouse, the wheatgerm, is removed to prolong shelf life. So people are getting a huge blast of weird carbs and proteins with virtually none of the nutritional ‘code’ to aid in the digestion of at least some of it. Every time humans ‘improve’ on our food, they create yet another tier of complexity and difficulty. It is assumed the human body can deal with whatever is thrown at it, but everything has its limitations…..

    Sugar is another ‘food’ stripped of its nutrient code at source. Even in the wholefood realm, plant foods grown in poor, depleted soils are missing aspects of their nutritional code.

    Pseudo-food may look, smell and taste like food, but they are a hologram. They do not contain the nutritional richness or power of whole, unmeddled-with, REAL food, grown or raised in nutrient and mineral-rich soil and pasture. Plant foods grown in naturally (not chemically) fertilised nutrient-rich soils, animals raised on mineral and nutrient-rich pasture, eggs generated by chickens allowed to forage and not fed by nasty commercial fish meal (ever noticed how most eggs, even so-called ‘free-range’ taste of fish these days….?),

    The stronger and more nourishing the soil and water, the healthier the plant. The stronger and more nourishing the food, the healthier the human……..

  2. There was another man talking about the dangers of sugar in the early 1970s. Published in 1974 was “The
    Saccharine Disease: Conditions caused by the Taking of Refined Carbohydrates, such as Sugar and White Flour” By T. L. Cleave, M.R.C.P. (Lond.) (M.R.C.P. is Membership of the Royal College of Physicians).

    If you search for the title on Google, a website “journey to forever” appears to have the entire book online.

    • Michael, I thought I remembered Nina Teicholz mentioning T.L. Cleave in ‘The Big Fat Surprise’, but I can’t find the reference. Cleave was certainly one of a number of westerners who noticed the good health of traditional societies before the arrival of sugar and flour. Unfortunately, Ancel Keys unpleasant and unscientific attacks on anyone who didn’t share his opinion eventually closed down the debate. He was humilated at a conference where people laughed at his idea and left bitterly determined to prove himself right. That was far more important than the science and his reputation has now been destroyed as a result. The truth will out.

      The whole book is online and I’ve attched a link.


      • Concerning obesity, T.L. Cleave said, “Obesity stems from the appetite being deceived by the unnatural concentration present in white flour and in sugar, so that a person eats too much.”

        Well, I think he was spot on there. It was only 42 years ago.

        • You make such good points, Stephen. I will ask the “nutrition thriller” author herself what she knows of Cleave. Sounds like a man so ahead of his time.

          • Looking at the book some, he’s not really so much low-carb as anti-processed foods, particularly white flour and sugar.

            I see he’s also written the following book: “Fat Consumption and Coronary Disease (1957), Bristol: Wright.”

            It’s interesting we’ve heard so much about Yudkin but not so much about Cleave.

            Wikipedia says: “Dr. Cleave was a 2009 inductee into the Orthomolecular Medicine Hall of Fame.” It appears as if he was no quite so vilified as Yudkin. I’ll be interested to see what the “nutrition thriller” author has to say.

          • Not surprised at Cleave’s focus. Will look into his book on fat consumption. Thanks for raising it. There was fascinating debate in the hearing about just what LCHF means. There are general principles, but it’s a spectrum. The HPCSA legal team and its expert witnesses seemed to have great difficulty with the idea that ketogenic diets are not dangerous by definition. Just couldn’t get their heads around the idea of nutritional ketosis. Or that while a ketogenic diet IS low-carb and high-fat by definition, not all low-carb, high-fat diets are ketogenic. And that as the brilliant “nutrition thriller” author herself said: “Science is not settled” – no matter what some nutrition scientists, doctors and dietitians want us to believe.

          • Thank you, Marika. I’ve found the reference to Cleave. It’s in chapter ten of The Big Fat Surprise.

            “The British Royal Navy’s Surgeon Captain Thomas L. Cleave had seen the same phenomenon in so many remote areas to which he travelled in the early 1900s that he called all chronic diseases the ‘saccharine diseases’, because so many of these ailments arrived in concert with the introduction of refined carbohydrates – principally sugar and white flour.” (Page 300 of my paperback version)

            Clearly many others noticed the same thing at different times and in different places. For those interested, chapters one and ten of Nina Teicholz’s book describe the background very nicely. All this knowledge and common sense from around the world was simply tossed aside.

          • Thanks for that Stephen. And now that you mention it, I remember reading it in Nina’s book. The scale of suppression and ignoring of evidence that contradicts conventional “wisdom” really is astonishing. Criminal, really.

          • “The HPCSA legal team and its expert witnesses seemed to have great difficulty with the idea that ketogenic diets are not dangerous by definition. Just couldn’t get their heads around the idea of nutritional ketosis. Or that while a ketogenic diet IS low-carb and high-fat by definition, not all low-carb, high-fat diets are ketogenic. ”

            The ignorance of medical professionals (to say nothing about most nutritionists!) about basic physiology and what hormones do is just astounding. No wonder they believe the calories in/calories out nonsense.

          • Indeed. And it’s not just medical doctors but dietitians and dietitian academics involved in this case who seem to suffer the same level of ignorance. That’s very worrying for their patients.

  3. What a pity that the gentlemanly John Yudkin was overwhelmed by the more powerful and ruthless Ancel Keys. The result has been a health calamity. Although long dead, Yudkin is being gradually recognised as the man who was right and who could have saved us from the disaster of the low-fat diet and all the obesity and diabetes that followed in its wake.

    The defenders who the current stupid orthodoxy should hang thiwer heads in shame. Instead, they persecute and attempt to silence Tim Noakes, Gary Fettke and Jennifer Elliot. The ADSA and other ‘compromised’ and backward organisations are trying to hold a tide back that will eventually drown them. No one will be running to help this discredited bunch of sponsor defenders. They’re paid to help the public and do the opposite. Is their a more discredited ‘profession’ in the world than dietitians? Snake oil salesmen are more trusted. I exclude from criticism the few valiant nutritionists around the world who reject the current nonsense and fight to give good advice to people.

    Another excellent report. Thank goodness for Nina Teicholz’s work. And Zoe Harcombe and Caryn Zinn. And Tim Noakes legal team.

    • Couldn’t agree with you more! Having read ‘Pure White and Deadly’ as well as other books in a similar vein (for example Gary Taubes ‘The Case Against Sugar’, it is immediately apparent that something else is going on here. Taube’s other book ‘Good Calories/Bad Calories’ is an indictment of whole populations being admonished to follow what amounted to a nutritional experiment with ‘evidence’ that can be viewed with hindsight (and thorough examination) to be both erroneous and flawed.
      It was criminal that the American Dietary Guidelines should be molded by politicians, notably Senator George McGovern in 1977. This advice (it was stated) would improve health and reduce the incidence of heart attacks/heart disease. In the years since its implementation other countries adopted the guidelines and as a result we have seen burgeoning obesity epidemic rates and diabetes and no improvement in heart disease.
      It is equally disgraceful that ‘big food’ (and ‘big sugar’) continue to dictate food policy (whatever the politicians say). Until we begin to look at the evidence all around with hard science and without prejudice, the epidemic will continue to grow.

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