Reconsideration of Saturated Fat and Cholesterol: Separating Fact from Fiction

by Nina Teicholz

“This book should be read by every nutrition professional…

All scientists should read it.”

–American journal of Clinical Nutrition

“A Best Book of 2014”

–The Economist

“Top 10 Nonfiction of 2014”—The Wall Street Journal 

“Most Memorable Healthcare Book of 2014”

–Forbes

“A Best Book of 2014”

–Mother Jones, Times of London, BBC Food, Kirkus

Reviews, Library Journal

“Impressive . . This book shook me. . . Teicholz

has done a remarkable job”

British Medical Journal 

What I’ll talk about today:

1.

What I discovered about America’s  nutrition policy gone wrong

2.   Why this is (sadly) relevant to dairy

How it All Started RATE OF HEART DISEASE PER 100,000 PEOPLE

19001955

Ancel Keys’ Diet-Heart Hypothesis

1961:

First advice world-wide to limit saturated fats and cholesterol

Animal fats vs. Vegetable fats 20th

century

What is natural? Which is a “whole food?”

Ancel

Keys was “Mr. Cholesterol”

The most influential  nutrition scientist of the 

20th

century 

The Seven Countries Study

Six Countries Study 

Keys A. Journal of Mount Sinai Hospital 1953; 20:118-139

Trying to prove Ancel Keys’ hypothesis

• Randomized, Controlled Clinical Trials (gold standard of evidence)

•75,655

men and women, in experiments lasting 1 to 12 years. 

•Conclusion: None

of these showed that saturated fats had an effect 

on cardiovascular mortality.

L.A. Veterans Trial—risk of cancer

Politics of Science

Conclusion: “For the entire study 

population, no differences between the 

treatment and control groups were 

observed for cardiovascular events, 

cardiovascular deaths, or total 

mortality." 

Selection bias, continued: Minnesota Coronary Heart Study

Government got involved: 1977 US Dietary Goals

Senator George McGovern

Rate of Obesity in US

Is it all our fault?

• Americans eat too much junk

• Americans exercise too little

On Exercise…

• “…physical activity is generally insufficient by itself

to bring about 

clinically significant weight loss…a dietary intervention is usually 

needed”• Physical Activity Guidelines Advisory Committee Report, 2008 

• “sedentary behavior cannot be shown to lead to obesity.”• Report by the 2015 Dietary Guidelines Advisory Committee 

• Conclusion: You can’t exercise your way out of a bad diet

Maybe it’s not our fault after all…

Maybe its’

the fault of the Food  Guide itself…

What does the science now say?

#1: Saturated Fats Do Not Cause Heart Attacks

Now 14 meta‐analyses and systematic reviews looking at:link between saturated fats and heart disease. 

Taken together, these conclude that:

• Saturated fats are NOT ASSOCIATED WITH

heart disease

• Saturated fats have NO EFFECT ON cardiovascular mortality

#2: Eating Cholesterol does not Worsen Blood Cholesterol

Ancel Keys’ Diet-Heart Hypothesis

Low‐fat diet doesn’t work

• Tested in NIH‐funded, randomized controlled clinical trials 

(gold standard)

• On 

>65,000 men and women

• Conclusions: Low‐fat diet cannot be shown to fight obesity, diabetes, 

heart disease, or cancer of any kind.

#3: Fat Does Not Cause Cancer

• World Cancer Report 2007: • No association between fat of any kind 

and cancer.

#4 Fat Does Not Make you Fat

Swedish Government Report 2014

Major macronutrient shift in US 1965‐2011

Source: Cohen et. al., Nutrition, 2015 (Article in press)

How Carbohydrates Make you FAT

Path to Diabetes (consistent exposure to insulin over time)

So let’s back out of the low‐fat diet…

• Reducing carbohydrates down to 40% or less is a good 

recommendation for the healthy population (This is what we ate in 

1965)

• For people with metabolic conditions (obesity, diabetes, heart 

disease), further carbohydrate restriction is a good idea

• >50

clinical trials (gold standard) showing benefits of low‐carbohydrate 

diet for weight loss, controlling blood glucose (diabetes) and improving most 

heart disease risk factors. 

• Including 3 trials of 2 years duration (considered adequate to reveal any 

adverse effects)

• Key thing is that it works without calorie reduction. Without HUNGER

• “LCHF”

low‐carb, high‐fat• Ketogenic• Paleo (low‐carb but no dairy)• “Banting”

in South Africa

Used to be called Atkins…

Now goes by other names…

Also hitting the mainstream…

“I Ate Butter and my Pants Fell Off”

What About Dairy?

Nutrition science rallying behind dairy fats…

And Keys hypothesis on dietary cholesterol and 

saturated fat collapsing…

However, in the Dietary Guidelines…

Dairy Healthy intake: Healthy eating patterns include fat-free and low-fat (1%) dairy, including milk, yogurt, cheese, or fortified soy beverages (commonly known as “soymilk”). Soy beverages fortified with calcium, vitamin A, and vitamin D, are included as part of the dairy group because they are similar to milk based on nutrient composition and in their use in meals. Other products sold as “milks” but made from plants (e.g., almond, rice, coconut, and hemp “milks”) may contain calcium and be consumed as a source of calcium, but they are not included as part of the dairy group because their overall nutritional content is not similar to dairy milk and fortified soy beverages (soymilk). The recommended amounts of dairy in the Healthy U.S.-Style Pattern are based on age rather than calorie level and are 2 cup-equivalents per day for children ages 2 to 3 years, 2½ cup-equivalents per day for children ages 4 to 8 years, and 3 cup-equivalents per day for adolescents ages 9 to 18 years and for adults.!

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