An Interview With The Big Fat Surprise Author Nina Teicholz

Tricia Ward, Nina Teicholz

Disclosures

February 09, 2015

theheart.org | Medscape Cardiology: In terms of nutrition policy, there are calls to move away from being overly focused on macronutrients (carbs, fats, protein) and to instead focus on dietary patterns and real food.[6]

Ms Teicholz: I used that language in the book because that's the language of nutrition science for the past 50 years. Every single study that you read by the nutrition scientists is about polyunsaturated fat, monounsaturated fats, and saturated fats. Your eyes glaze over with those terms. But who goes into the dining room and says, "Mom, can I have 30% saturated fat and 10% carbohydrates for dinner?" Nobody. You say, "Can I have spaghetti and meatballs?" While it doesn't make sense to talk in those terms, it's very hard to do good science that will tell you anything about what leads to disease by just looking at overall dietary patterns.

A common argument is: What about the Japanese? They didn't get heart disease, and they mainly ate vegetables. It may be the diet that saved them from heart disease. But by the way, they had much higher rates of stroke and cerebral hemorrhage than Westerners.[7] How do you know what that's due to? You don't know if it's the vegetables that seem to be protective, or if it's the absence of sugar. That's another hypothesis. You have to test individual items in order to say anything conclusive. It's also true that the Mediterranean diet was based on observations about post-war Crete islanders. They attributed it to a relative lack of meat, but it's not even clear that those data were collected in any way that is convincing. Was it the total absence of sugar from their diet? A dietary pattern is just not helpful from a scientific point of view.

theheart.org | Medscape Cardiology: Speaking of the Mediterranean diet, it is the dietary pattern that is among the most recommended for prevention of cardiovascular disease, but you're critical of some of those data as well.

Ms Teicholz: The Mediterranean diet looks better than the low-fat diet. In all of the clinical trials on the Mediterranean diet, it's been tested against the low-fat diet. The low-fat diet is a failed diet. The largest-ever clinical trial in the history of nutrition science was on the low-fat diet. It was the Women's Health Initiative, and it showed in 50,000 women that it was completely ineffective for fighting obesity, diabetes, and heart disease.[8] That was also confirmed in smaller clinical trials. The low-fat diet doesn't work.

If you compared any higher-fat diet with the low-fat diet, it looks better. The Mediterranean diet is just the main diet that has been compared with the low-fat diet, and so that's why we talk about the Mediterranean diet. A higher-fat German diet or a higher-fat Chilean diet or a higher-fat Finnish diet would probably also look better than the low-fat diet. In fact, in the one experiment[9] where they compared the Mediterranean diet with the low-fat diet and also compared it with a much higher-fat, low-carb diet (a little bit like an Atkins diet), the Atkins diet did better than the Mediterranean diet. That was a 2-year trial, so it was one of the longer and better controlled studies out there. [Editor's note: In the DIRECT study, compared with a low-fat diet, reductions in total cholesterol/high-density lipoprotein cholesterol ratio were greatest in the low-carb group, and reductions in low-density lipoprotein cholesterol were highest with the Mediterranean diet. The Mediterranean diet also appeared to improve fasting plasma glucose levels in the 36 subjects with diabetes. No statistically significant differences were observed between the low-carb and Mediterranean diets.]

My point is that scientists got obsessed with the Mediterranean diet in large part because it's a great place to go for scientific conferences. Everybody loved meeting in Italy, Spain, and Greece. There are extremely long-lived people in other parts of the world. The one common factor is that they have a higher-fat diet compared with our failed low-fat diet.

theheart.org | Medscape Cardiology: You're suggesting that part of the attraction of the Mediterranean diet was all of the conferences held in a sunny climate.

Ms Teicholz: I got a lot of great quotes from people who went on those trips. There was a constant series of junkets with chefs, scientists, food writers, and food journalists at fantastic, sun-kissed spots all over the Mediterranean, and people just loved it. They were also quite inventive conferences, in that instead of just convening scientists, they also brought together chefs and talked about food and the history of food. It was this rich, multisensory experience. There's no question that the reason everybody got interested in that diet was partly the allure of the Mediterranean junket. There are long-lived people in the Siberian Steppe, but nobody wants to go to food conferences in Siberia.

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